Being brand new to school-based occupational therapy can be overwhelming. This setting can be so rewarding, but it’s also markedly different than any other OT position. Yes, even if you have experience in pediatrics! While experience comes with time, there are also some things new school OTs can do right now to set themselves up for success.
Familiarize yourself with the laws, rules, and regulations
This is easily the biggest difference between school-based practice and other settings. And it’s likely that your pediatrics class in OT school didn’t have time to go over all of the different laws and regulations that can affect school-based practice. Luckily, this information is available freely online. Honestly, this task alone can feel intimidating to begin, but it’s so important to do so that you can fully serve your students as well as protect your license. Commit to reading 1-2 pages a day of the relevant portions of the following documents:
- Individuals with Disabilities Education Act (IDEA)
- Section 504 of the Rehabilitation Act
- Americans with Disabilities Act
- Your state OT regulations/practice act
- Your state education regulations
- Your district’s special education policies and procedures
Many states may also have a guide specifically for school-based OT, which can be a lifesaver!
Set up systems for time management

Schools in America are chronically underfunded, and one way this shows up is intense workloads for school-based OTs. While you shouldn’t be expected to carry a truly unmanageable caseload, there are some timesaving strategies that you can employ. One way I do this is blocking off my schedule for all of my specific tasks such as treatments, evaluation, documentation, responding to emails, and LUNCH. Reserving space in your schedule for ALLLL of the tasks you end up doing helps prevent more treatment time from being added where it simply won’t fit in. Other ways I save time involve keeping completely digital documentation, attempting to only be in one building per day, and using Google Forms to track consults with teachers. If you’re doing all of this, and you find yourself still struggling to come up for air? Talk to your admin. It’s likely that more staffing is needed. And no matter what you do, never work off the clock or more than your contracted hours.
Ensure there is a referral process in place
If you’re joining a team of established school OTs, you might find that there already is a referral process and that it’s working well. If so, score! But as a travel OT who has worked in many districts with inconsistent staffing, I find that this isn’t always the case. Setting up a referral process can help you ensure the students that are referred to you for assessment are appropriate and will likely be recommended for services. I can’t tell you how many students I’ve assessed that didn’t go through a referral process who had no need for school-based OT. And the sad part is, for most of these students I could have told you that after spending 30 minutes with them! For this reason, I try to heavily recommend that students are screened instead of heading straight to OT assessment. This will allow me to observe the student in their natural environment and watch for any difficulties that have been reported. I also like this option because it allows me to start giving strategies to teachers right away – whereas the assessment process can take several months before the reports are reviewed and recommendations are implemented. Before you implement this step, check with your district to ensure that they are on board with a screening process. Most will be, but some are hesitant to do so due to fear of litigation.
Start building relationships with school staff and parents
Gosh, this is a big one. You could say that developing rapport with caregivers is important in any setting, but this is truly the key to being effective in the schools. Since you’re only spending a bit of time with your students, most of your skill lies in training teachers, paraprofessionals, and parents on the strategies you’d like students to use every day. But it’s incredibly challenging to get that carryover with caregivers when they don’t really know you. So spend time right from the start being friendly and getting to know people. One of my favorite tricks for this is sitting in the staffroom for lunch – this is also a great way to get teachers comfortable with your referral process.
One last thing – don’t assume that the only people you should give the time of day are teachers. Custodial staff, office managers, and admin assistants are typically awesome people who can really help you out in a jam.
Exercise your advocacy skills

Advocacy doesn’t stop when you leave OT school! Unfortunately, or maybe fortunately depending on how you look at it, there are still lots of opportunities to advocate in the school setting. You may need to advocate for your students and getting them the equipment they need to be successful. You may need to advocate for yourself and making sure your workload isn’t impossible. You may need to advocate for OT in general to make sure your school teams know that we are more than fine motor therapists! It’s definitely a setting where you may find yourself becoming a squeaky wheel.
I hope these tips were helpful! Though learning the ropes of this setting was challenging at first, I truly love practicing in the schools now. And I imagine that with time, you will too! If you have any questions, I would love to have you join me in my Facebook group where I share videos and resources all about school OT.
Looking to take your learning even further? My course, The Dynamic School OT, is the perfect primer for therapists new to the school system. We’ll take an in-depth look at all of the topics discussed here, as well as evaluation, RtI, appropriate interventions, and how to manage difficult situations. Click here to learn more!
Put in place a time several times a week to work with all kindergartners. Then you can see who needs to be referred.
Yes! Great tip!