As a school-based OT, you likely care a lot about being great at your job. You probably also want to be as effective as possible for your students. And while there are a lot of things that you can start doing to improve, there are also things that you can actually cut from your practice today that are just as impactful.
Working for Free
Call it working off the clock, taking work home, working way past contract hours, etc. Whatever the case is for your situation, stop doing work in the schools that you aren’t being compensated for.
Look, I get it. We all love our students and want the best for them. We are often handed workloads that aren’t doable in less than 40 hours. Taking work home, working on holiday breaks, or just staying at school super late to get it all done is a culture that is super common in the school system. And a LOT of teachers and other staff do it.
And yet, none of this makes it okay.
We cannot keep pretending that is a good relationship to have with a job. And we can’t make new school-based OTs feel bad when they reject this schedule because they want to have an actual work-life balance.
If you’re working off the clock, it’s really hard to quit cold turkey. But what you can do right now is take a stand and make yourself a promise that you will stop normalizing this paradigm.
Hand-Over-Hand
At this point, I have completely removed hand-over-hand from my practice and I suggest you do the same. The most important reason to stop doing this immediately is that it violates an individual’s bodily autonomy. By moving someone else’s body without permission, you are teaching them that they do not have a right to their own body. They learn that other adults can do as they please to their body. Kids and adults with disabilities are already a vulnerable population when it comes to sexual assault, and this kind of teaching can put them in an even riskier position.
If that alone doesn’t convince you, it should also be stated that hand-over-hand isn’t even really that effective at teaching new skills. It often instead teaches students to be dependent on adults. I’ve worked with many older autistic students who literally wouldn’t even attempt tasks without grabbing for an adult’s hands to guide them. Is this really teaching students the independence that we so highly value as OTs?
If you’re wondering what to do instead, try modeling, visual cues, verbal cues, and tactile cues. And above all else, make sure you’re asking students to do tasks that are meaningful and interesting to them.
If you must continue using hand-over-hand, make sure you have explicit consent from your student, even if they are non-speaking and this may be difficult to obtain. We can always try another therapy activity that day – but we can’t necessarily undo the damage that hand-over-hand can cause.
For another take on this practice, check out this article from Learn Play Thrive.
Tracing Letters
As OTs, we know a lot about fine motor skills and handwriting development. So you may not be surprised to learn that tracing is not a natural developmental skill that must take place before writing letters independently. In fact, it can even be harmful to learning efficient letter formation. Tracing just isn’t the same action as making a fluid stroke to write a letter, and doing it without modeling can lead to some interesting formation patterns, to say the least.
Still, you’ll find tons of worksheets and other activities at the PreK and K level that encourage this task. While you can’t control a student’s whole school day, you can remove these activities from your sessions and encourage the teachers you work with to focus on other activities. Need ideas to practice literacy for early writers? Try modeling, highlighted letters, a structured handwriting curriculum, and consistent opportunities to practice. And for your older students with high support needs, it’s worth taking a look at what fine motor/written expression tasks actually match the student’s cognitive level, as well as digital tools, name stamps, and other accommodations.
P.S. Not all tracing activities need to be thrown out. Tracing things like abstract shapes or lines and dot-to-dot pictures can be great ways to build pencil control without learning harmful handwriting habits that are hard to change.
Buying Stuff With Their Own Money
Do you want to know one of my biggest pet peeves on peds OT social media? Target dollar spot hauls. Amazon Prime day deals. Even thrifty Goodwill finds!
As cute and tempting as these things are, it drives me nuts to see school-based OTs spending their own money on therapy items.
And for those of you who are ready to hear it, I want you to know why this practice ends up being harmful for your students.
It’s rooted in good intentions, right? School districts are often strapped for cash, but you want your students to have the best experience possible. So you hit up the Target dollar spot to buy treatment materials, fun games, or incentives.
No biggie – it’s 5 bucks here, 20 bucks there. You’ll “write it off” on your taxes later. And you can justify it because you’re enriching the therapy experience for your students, right?
Maybe in the short-term. But in the long-term, this is not a sustainable practice. There will come a time when you can’t keep funding therapy out of your own pocket. Maybe it’s because you need something specialized that they don’t sell at Dollar Tree. Maybe it’s because it’s something SUPER expensive. Maybe it’s just that your partner lost their job and you no longer have the discretionary income you used to.
No matter the scenario, something will happen that will require you to go to your district for funding. And do you know what your admin will think?
It’s not going to be the warm and fuzzy, “Aww, our OT never asks for anything – let’s just give it to her.”
Their thought process is going to be a lot more along the lines of, “We have never had to increase the budget in this area before. Why now? And is what they’re asking for justified and truly necessary?”
Remember: you are providing a service that is legally required and educationally necessary. That means that as hard as it might be to budget, your school district needs to give you the materials you need to do your job effectively.
Assessing And Treating Only Fine Motor Skills
When considering what falls into our domain in the schools, we should first look at the Individuals with Disabilities Education Act (IDEA), the federal law that governs special education and the main source of how OT functions in the school system.
IDEA defines OT as:
“Occupational therapy—
(i) Means services provided by a qualified occupational therapist;
(ii) Includes—
(A) Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;
(B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and
(C) Preventing, through early intervention, initial or further impairment or loss of function.”
Further, IDEA goes on to state that certain things related to OT must be included in an IEP:
“(4) A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child—
(i) To advance appropriately toward attaining the annual goals;
(ii) To be involved in and make progress in the general education curriculum in accordance with paragraph (a)(1) of this section, and to participate in extracurricular and other nonacademic activities;
(iii) To be educated and participate with other children with disabilities and nondisabled children in the activities described in this section;”
As you can see above, nowhere in the IDEA definition of OT does it refer to motor skills at all. So why have school-based OTs been pigeonholed into being fine motor therapists? The reasons probably have a lot to do with historical practice, lack of support/funding, and trying to adapt the medical model of OT to schools. What’s important to note is that both IDEA and AOTA (and likely your state laws too) support you utilizing your full scope of practice as an OT as long as it is related to the student’s education. That means we should be assessing and addressing way more than just fine and visual-motor skills.
Curious about what’s in our scope of practice in the schools? This article may help.
If you’re looking to set yourself up for success in your school-based OT job, removing some of these harmful practices will help. Of course, this is often easier said than done. Consider picking one or two of these items to focus on at a time. And once you’re ready to become as effective of a therapist as you can be, come join us in The Dynamic School OT Course. You’ll find actionable steps on what you actually SHOULD be doing in your school-based practice.
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