School-Based Occupational Therapy Activities & Interventions

Occupational therapyContrary to popular belief, occupational therapy is not just handwriting and scissor skill work.

Occupational therapy has evolved and expanded its role in children’s education. Occupational therapists (OTs) may work with students with physical limitations as well as children with developmental delays and learning disorders.

To provide comprehensive intervention, OTs may also work with students with speech or language problems, hearing or visual impairments, and behavior or emotional difficulties.

In the United States, approximately 20% of OT practitioners work in school settings (Clark, Rioux, & Chandler, 2019). This figure shows the extreme importance of occupational therapy within the school setting.

In this article, we will provide interventions and therapy activities for school-based occupational therapists. Tools that will ease your vitally important work are included as well.

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4 Effective Interventions to Use With Students

A seasoned school-based OT will explain that building trust and rapport with students, meeting the students where they are, and collaborating with families (Cahill & Beisbier, 2020) are critical before beginning any intervention.

Once those steps are established, here are several interventions to try.

Fine motor skills

Fine Motor Olympics was created by an OT for OTs. This structured program has been proven to address students’ difficulties with fine motor skills. This intervention provides a guide to hand function and an in-service training program. Additionally, a quick screening and record form are also included to identify needs and track student performance.

Visual perceptual skills

OTs can address visual perceptual skills by using word searches, crossword puzzles, mazes, origami, and tangrams. The Purple Alphabet created a video demonstrating cheap and easy activities to practice visual perceptual skills. Some of the activities included in this video are tasks using ten frames, tangrams, and mirror drawing.


For students with sensory processing disorders, sensory defensiveness, or autism, brushing may be an effective technique. Benson, Beeman, Smitsky, and Provident (2011) found that brushing is just as effective as the deep pressure proprioceptive technique in encouraging the development, participation, and occupational performance of a child with sensory needs.

The brushing technique utilizes a particular therapy brush, such as the Therabrush, and training is highly recommended for this technique.

Attention to task

Flexible seating is an effective method for improving students’ attention to tasks while providing the opportunity for movement (Anderson & Hartley, 2018). When the OT provides various seating options such as stools, exercise balls, soft cushions, couches, or stand-up desks, students can choose which seating option is best for them.

OTs could collaborate with the general education teacher to implement this strategy in the classroom.

It is recommended that treatment should ideally begin with a gross motor activity (sensory), then transition to a fine motor task, and end with working on the goal. According to a national survey by the American Occupational Therapy Association (Barnes, Beck, Vogel, Grice, & Murphy, 2003), sensory integration was the most commonly reported occupational therapy intervention in the United States.

Therefore, it is essential to pair these activities with sensory input opportunities to enhance their effectiveness.

Top 3 Resources & Activities for School-Based OTs

Activities for OTsHandwriting Without TearsⓇ by Learning Without Tears has a new 2021 edition that offers a digital approach to teaching pencil grip, letter formation, and literacy skills.

This award-winning program is research proven and helps students to develop the skills needed for both print and cursive writing.

This product features a digital student edition, teacher’s manual, music, and fun animations that can also be displayed for student activities on an interactive whiteboard.

For students who are typically developing, not so typically developing, verbal, and nonverbal, the Alert Program may be beneficial. Used in over 85 countries worldwide, the Alert Program uses the engine analogy to help teach self-regulation and includes learning materials such as books, games, and songs to help students who may be in a high-alert, low-alert, or optimum-alert state.

Because of our digital age, is an excellent resource where students learn and practice typing skills. Students begin with a placement test, and from there, the program places that student at the appropriate level with lessons that teach correct finger positioning. The lessons and games are free; however, an ad-free version is also available with exclusive features.

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Writing Progress Notes: 3 Examples

Note-taking format is usually a personal preference and an aspect directed by the school district. Frequency, however, may vary and is also dictated by the school district.

Note taking on daily activities and the student’s response to the activity may occur daily, weekly, monthly, or quarterly. Sometimes OTs may utilize software where a drop-down menu provides responses or comments concerning the exercise. Regardless, notes help the provider to determine the progress toward the student’s goals.

You will need to check with your local education organization to determine the exact method and frequency of progress notes required and what is in alignment with the special education law.

SOAP notes

SOAP notes constitute an older note-taking method and cover all areas of documentation, including the:

  • Subjective
  • Objective
  • Assessment
  • Plan

Below is an example given by a practicing OT:

S: Mom says, “She can write her name.”

O: The student wrote 5/6 letters of her name, legibly, with a visual model.

A: Student was able to write all 6 letters of her name today, legibly, with verbal cues only.

P: Student is approaching a goal. Will try a magnet letter board or handwriting without letter wooden pieces next week to facilitate memorization of letters.

Teacher templates

Teachers Pay Teachers offers a variety of note templates to use.

  • Daily Therapy Treatment Notes is an excellent resource for recalling details in the moment, tallying data, and planning your next OT session. This document allows you to print forms or add individual student information and goals on an editable PowerPoint file.
  • Occupational Therapy progress notes is a free resource that allows the user to check off specific criteria and write short anecdotal notes. This document also includes a sample of a completed notes page.

Pre-made logbook

OTs may also choose to use a logbook such as the Counselor Log Book, which can be found on Amazon. This resource includes a designated space for the client’s name, date, start and end time, next session date, purpose of the meeting, discussion, observation/consultation notes, actions, and occupational therapist and signature.


An OT may also choose to use specific software to keep notes, such as the following:

  • Quenza encompasses all therapy elements in one easy-to-use system. Quenza provides intake forms, homework exercises, and questionnaires, and OTs can evaluate students with feedback forms. Using each of these components and easily converting the results into manageable notes would produce comprehensive records.
  • Double Time Docs includes a system that generates a fully written report after the therapist answers multiple-choice, fill-in, and short-answer questions about the sessions.
  • Noteable prides itself in providing a platform where users spend less time entering data and more time extracting valuable insights. This software offers client-centric caseload management, customizable report design, intelligent billing automation, and business intelligence that is also ideal for applied behavior analysis service providers.
  • TheraOffice offers an efficient and customizable documentation system where users merely have to take one to two minutes of daily notes.

Checklists, Forms, & Assessments for Your Sessions

Assessments for Occupational TherapyDocumentation in occupational therapy is paramount.

Sladyk (1997) remarked that although documentation is the most dreaded part of occupational therapy, it is the most crucial skill to have as an OT.

The book Best Practices for Documenting Occupational Therapy Services in Schools is an excellent resource to expose yourself to all the various methods of documentation.


This School-Age Checklist for Occupational Therapy is an excellent tool to use when first evaluating students for OT services.

The Occupational Therapy Quarterly Progress Report from is an easy-to-fill-in checklist, ideal for documenting the progress toward goals.


The AOTA Occupational Profile Template is a great resource to help OTs onboard students who are new to occupational therapy.

The Teachers Pay Teachers website has several forms that would be beneficial for school-based OTs, including the Occupational Therapy Documentation Form Data Sheet. This simple form can be used to document daily OT interventions.

Also available for a nominal fee are the Occupational Therapy Guided Consultation / Data forms. These forms include a short form/general form and a preschool, elementary, and middle school consultation form that are effective for collaborating with general education teachers for monthly collaborations or evaluations.


According to a survey done by Rodger (1994), OTs commonly use the following tools for initial and ongoing assessment:

Additionally, the Sensory Processing Measure (Parham, Clark, Watling, & Schaaf, 2019) is also used to determine student needs.

The type of measurement will often be mandated by the school district in which the OT works; however, many of these commonly known evaluations can be found at Therapro, Pearson, or by clicking on the links above.

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6 Helpful Software Options to Upgrade Your Work

There are countless software programs available for your OT practice. To determine which may be right for you and your students, here are a few to get you started.

Documentation and scheduling


Quenza is a user-friendly online resource that provides a tool to push out activities and pathways to clients. These tools are stored in an online library and promote client engagement.

The responses to these activities allow the practitioner to track and manage the client’s results. The Quenza app also allows for direct and safe client–practitioner communication.

Additionally, this website contains a blog with cutting-edge and research verified strategies. Not only is this resource beneficial for occupational therapists, but it would be helpful for therapists, healthcare professionals, coaches, counselors, mental health practitioners, and social workers.

The Quenza app is in continuous innovation. The app developers have planned to add a multilingual client app, groups and group chat functions, advanced linear scales, the ability for clients and practitioners to share files, scheduling and billing features, and videoconferencing.


10to8 is highly rated by Google, G2 Crowd, Capterra, and Finances Online. This online appointment scheduling software offers various subscription plans, including a free option. 10to8 boasts bank-rate security, data encryption, Data Protection Act compliance, European data hosting, and 99.99% server uptime reliability.

Power Diary

Power Diary, which is also highly rated, helps practitioners and clients create and manage appointments, disperse appointment reminders, manage payments, and make use of form templates.

This software also includes telehealth videoconferencing capabilities and a space for practitioners to organize their notes. Power Diary is used and supported by over 26,700 health practitioners and offers a free 14-day trial.

Student software

Like other interventions, technology has proven effective; however, it should be gauged to match students’ diagnosis, age, and specified outcomes as directed by the evidence (Cahill & Beisbier, 2020).


Skywriter is a free app where users can practice writing lines, shapes, and letters in the “sky” using an airplane. This app is available on Google Play and the Apple App Store, and your students will love it!

Paint Sparkles Draw

Paint Sparkles Draw is an interactive app in which students can draw using multiple colors and sparkles, while music accompanies the drawing. It has been rated the number 1 coloring app according to the Apple App Store and is also free.

Chrome extensions

Various tools, add-ons, and extensions are offered to Chrome users to assist students with fine motor needs, including voice typing. Of particular note is the Read and Write tool, which is free for teachers. Many of these resources can be found on the OTs with Apps & Technology website.

Our 3 Favorite Books on the Topic

Books are invaluable items, filled with riches to learn even more. Here are three books we recommend for anyone involved with Occupational Therapy.

1. Best Practices for Occupational Therapy in Schools – Gloria Florek Clark, Joyce Rioux, and Barbara Chandler

Best Practices for Occupational Therapy in Schools

Best Practices for Occupational Therapy in Schools is an informative text that describes working with various student populations, transition planning, assistive technology, enhancing student participation, and work readiness.

The comprehensive book encompasses OT instruction from preschool to postsecondary transitions and provides resources and templates for documentation of occupational profiles and intervention plans.

Find the book on Amazon.

2. Self-Regulation Interventions and Strategies: Keeping the Body, Mind and Emotions on Task in Children with Autism, ADHD or Sensory Disorders – Teresa Garland

Self-Regulation Interventions and Strategies

This resourceful text is highly rated on Amazon and was also a Silver finalist in the Psychology category at the 2015 IBPA Benjamin Franklin Awards.

It contains over 200 proven interventions to assist students in keeping their mind, body, and emotions regulated and on task.

Find the book on Amazon.


3. Occupational Therapy Activities for Kids: 100 Fun Games and Exercises to Build Skills – Heather Ajzenman

Occupational Therapy Activities for Kids

Although Occupational Therapy Activities for Kids is geared more toward families of students who receive occupational therapy, the activities in this book may also be used in the school setting.

One hundred daily exercises presented in this text are intended for children aged one to six years old, and are designed to address physical, social-emotional, and cognitive abilities.

Find the book on Amazon.’s Useful Resources

Many OTs work with students who struggle with social skills and may want to refer to our Social Skills Training for Kids resource.

The mindfulness activities for kids article would be particularly helpful for students with attention deficit hyperactivity disorder; however, these activities would benefit an entire classroom of students.

How to Engage and Motivate Clients in Therapy is another excellent resource to stimulate difficult-to-motivate clients.

If you find it challenging to determine goals for your student, you can download these Three Goal Achievement Exercises. This guide will help you and your students create actionable goals.

To create SMART goals, our Setting SMART+R Goals worksheet will help you incorporate rewards when setting goals in therapy.

If you’re looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF], scientifically designed to promote human flourishing, meaning, and wellbeing.

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A Take-Home Message

The role of the OT in a school setting is to match a student’s abilities to the tasks required at school. Caramia, Gill, Ohl, and Schelly’s (2020) research of kindergarten, second-, and fourth-grade classrooms in the United States found that only 3.4–18.0% of the day is actually spent on handwriting.

However, OT is so much more than handwriting, and the professionals in this growing field have had to adapt and take on more responsibilities.

In light of the expansion of this role, Seruya and Garfinkel (2020) found that school-based OTs note a disconnect between intent, meaning their service delivery, and current practice trends.

What may be required to create a bridge is a more intentional approach to establishing best practices in the world of school-based occupational therapy. We hope that the resources provided and strategies presented in this article could be instrumental to such an undertaking.

At the very least, we trust that these tools will be a welcome addition to your engagement repertoire. After all, you can never have too many tools when dealing with children in a school setting.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.


  • Ajzenman, H. (2020). Occupational therapy activities for kids: 100 Fun games and exercises to build skills. Rockridge Press.
  • Anderson, P. J., & Hartley, M. L. (2018). Flexible seating: Let’s get the wiggles out. Tennessee Educational Leadership Journal, 46(1), 55–60.
  • Barnes, K. J., Beck, A. J., Vogel, K. A., Grice, K. O., & Murphy, D. (2003). Perceptions regarding school-based occupational therapy for children with emotional disturbances. American Journal of Occupational Therapy, 57(3), 337–341.
  • Benson, J. D., Beeman, E., Smitsky, D., & Provident, I. (2011). The deep pressure and proprioceptive technique (DPPT) versus nonspecific child-guided brushing: A case study. Journal of Occupational Therapy, Schools, & Early Intervention, 4(3–4), 204–214.
  • Cahill, S. M., & Beisbier, S. (2020). Occupational therapy practice guidelines for children and youth ages 5–21 years. American Journal of Occupational Therapy, 74(4).
  • Caramia, S., Gill, A., Ohl, A., & Schelly, D. (2020). Fine motor activities in elementary school children: A replication study. American Journal of Occupational Therapy, 74(2).
  • Clark, G., Rioux, J., & Chandler, B. (2019). Best practices for occupational therapy in schools. AOTA Press.
  • Garland, T. (2014). Self-regulation interventions and strategies: Keeping the body, mind & emotions on task in children with autism, ADHD or sensory disorders. PESI.
  • Parham, L. D., Clark, G. F., Watling, R., & Schaaf, R. (2019). Occupational therapy interventions for children and youth with challenges in sensory integration and sensory processing: A clinic-based practice case example. American Journal of Occupational Therapy, 73(1).
  • Rodger, S. (1994). A survey of assessments used by paediatric occupational therapists. Australian Occupational Therapy Journal, 41(3), 137–142.
  • Seruya, F. M., & Garfinkel, M. (2020). Caseload and workload: Current trends in school-based practice across the United States. American Journal of Occupational Therapy, 74(5).
  • Sladyk, K. (1997). OT student primer: A guide to college success. SLACK.


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