All can indicate occupational therapy needs within the school setting (Case-Smith, 2002).
A student may not have the fine motor skills or hand strength to complete a writing task, and may fail the assignment. A student may focus so much on writing and copying the notes that they cannot attend to the content of the lesson.
A student may outright refuse to complete an assignment or act out in an attempt to escape or avoid the embarrassment of being unable to perform in the classroom, resulting in noncompliance and misbehavior.
This is when a school-based occupational therapist (OT) can create a turnaround in the classroom, and in this article, we review this therapy with some practical examples.
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What Is School-Based Occupational Therapy?
Occupational therapy does its best to match a child’s ability to the demands presented in school.
OT intervention is critical for students with the difficulties mentioned above, mainly because “schools have the responsibility to contribute to the health and development of children in their care and because children have no choice but to spend a certain period of time each day at school” (Bundy et al., 2008, p. 523).
The role of OTs in a school setting is to equalize a student’s abilities to the tasks required; however, the role of the OT has expanded to much more than fine motor skills such as handwriting and scissor skill work.
OTs may work with students with physical limitations, developmental delays, learning disorders, speech or language concerns, hearing or visual impairments, or behavior or emotional difficulties. OTs may work with students on self-regulation skills, attention to task, or sensory challenges.
An OT is part of a child’s education team. For example, if a child qualifies for an individualized education plan under the Individuals with Disabilities Education Act, they may be eligible for occupational therapy services.
Sometimes, a certified occupational therapy assistant may support the OT and students by providing interventions prescribed by the OT.
School-Based OTs: A Job Description
The overall responsibility of a school-based OT is to furnish support and provide interventions for students to engage in school activities and achieve independence within the school setting (Campbell, 2019).
OTs first begin by assessing a student’s fine and gross motor skills, visual perception, attention to task, and sensory processing. OTs may use common assessments, such as (Parham, Clark, Watling, & Schaaf, 2019; Rodger, 1994):
- Motor-Free Visual Perception Test
- Bruininks Oseretsky Test of Motor Proficiency (BOT-2)
- Visual-Motor Integration Test
- Ayres’s Clinical Observations
- Revised Gesell Developmental Schedules
- Sensory Processing Measure
Questionnaires, standardized assessments, and interviews are also used to determine if a student is eligible for OT services (Campbell, 2019).
If a student demonstrates a need for occupational therapy, the OT will collaborate with the student’s team to recommend a plan and create goals. OTs deliver services within the school setting, including pull-out or push-in services.
Pull-out services require the OT to remove the student from the general education setting for one-on-one or small group instruction. In contrast, push-in services involve the OT’s inclusion within the general education setting, where they deliver real-time feedback and accommodations and assist other students within the classroom.
Ongoing data collection is essential, as this determines students’ progress toward goals and intervention success. Documentation in occupational therapy is the most critical skill, although it is often the most dreaded OT task (Sladyk, 1997).
The average caseload for an OT is approximately 44 students (Spencer, Turkett, Vaughan, & Koenig, 2006); therefore, it would be beneficial for an OT to be organized and efficient.
Patience is another helpful virtue for this profession.
Additionally, OTs need to collaborate with school staff members, parents, and students; therefore, good written and verbal communication skills would be required.
An undergraduate degree is needed to become a school-based OT; OTs may eventually want to pursue a master’s degree to remain marketable and up to date with the latest interventions. Some areas require specific state certifications or licenses to practice occupational therapy.
School-based OTs may work in traditional brick-and-mortar school buildings or from a teletherapy setting for rural or difficult-to-staff school districts. Having students at various schools within a district or even multiple districts within a local education agency is typical.
6 Practical Examples of OT Goals
With the help of the school team and considering the needs stated in the initial assessments, OTs suggest precise goals that students should master to improve their functioning within the school setting. The OT and student address these goals during each session and track the progress made.
OT goals should be SMART+R, meaning they are specific, measurable, attainable, result oriented, timely, and include a reward. For help writing SMART+R goals, you can use our Setting SMART+R Goals worksheet.
There are countless formats to follow. Fusion is an excellent resource for various goal formats and additional examples. Here are some specific examples of OT goals in practice.
Fine motor skills
Samantha is a kindergartener who has demonstrated difficulty with the fine motor skill of cutting. She struggles to hold the scissors correctly.
Therefore, this goal is appropriate to help improve her ability to use scissors to cut simple shapes:
- Samantha will cut simple shapes, such as squares and rectangles, out of paper with smooth edges in three of five trials with limited help and 50% verbal cues to promote hand–eye coordination.
Bryan is a second-grader whose handwriting is illegible. He also receives specialized academic instruction for reading because he continues to have difficulty recalling the sounds that letters make.
Bryan is able to copy letters that are on the same writing plane (i.e., a small whiteboard on his desk, but not the large whiteboard at the front of the room). He does his best to copy the letters; however, his letters do not consist of the straight lines required.
Here is an example of a goal for this student:
- Given a model, Bryan will draw straight line capital letters three times in four out of five treatment sessions with no assist and 20% verbal cues for increased graphomotor skills while maintaining a tripod grasp.
Desiree is a sixth-grade student in the life skills class who is nonverbal. The ultimate goal for her will be communicating with her caregivers. To communicate, she will be continuing to practice her speech and will be learning sign language.
The following goal will help Desiree communicate:
- With fading prompts, Desiree will use 10 signs, gestures, or word approximations to request, protest, greet, and answer yes/no questions during therapy sessions for 80% of opportunities in 4/5 consecutive sessions.
During class, particularly circle time, Sharon exhibits difficulty remaining seated and participating with her peers. She may sometimes hit a peer who is making too much noise.
Sensory modulation skills are taught explicitly, and she is on a sensory diet (distracting sights, sounds, smells, etc. are avoided).
Sharon would benefit from the following goal:
- Using sensory strategies, Sharon will show appropriate sensory modulation skills to sit and take part in circle time in the classroom without aggression toward peers in four out of five days of the week as measured by observational data.
While waiting for the teacher in the hallway, Rylan sometimes loses his patience by irritating other students, making inappropriate noises, and running around in the hallway.
Rylan will attend occupational therapy sessions to help increase his stamina for standing in line.
The teacher is encouraged to provide frequent positive reinforcement in the classroom and will be able to provide verbal reminders while the class is waiting in the hallway.
- Rylan will tolerate standing in line without tantrums or other poor behaviors with 50% verbal cues three out of five times as measured by behavioral data.
Caydence is also in a life skills class and her individualized education program team wishes for her to be more independent in her self-care skills.
The team would first like to begin working on the tasks of brushing her hair and washing her face. She is able to grasp the hairbrush appropriately and can manipulate her hands to wash her face effectively with some assistance.
A task chart will be used to remind Caydence to perform these activities daily, with the following goals:
- Given a task chart, Caydence will perform grooming tasks like brushing her hair and washing her face with 85% assistance and 40% verbal cues for increased functional independence in daily life.
Using Art Therapy in Schools
Occupational therapy is widely known as a profession that often uses creativity in its practice (Bathje, 2012).
To gain an understanding of some art-based activities that OTs might use in their practice, review our article on Art Therapy. To be clear, OTs are not art therapists; however, using some of the same strategies could enhance the practice of occupational therapy and attain functional goals.
Several benefits of Art Therapy include promoting personal change, development of identity, and self-awareness (Blomdahl, Gunnarsson, Guregård, & Björklund, 2013).
Further, Blomdahl et al. (2013) indicate that Art Therapy is valuable in a variety of clinical situations, including depression, which was mentioned as one of three major concerns for students.
Many OTs work with students who are on the autism spectrum. Students with an autism spectrum disorder may benefit from Art Therapy in introducing strategies for behavioral patterns, sensory issues, tactile awareness, auditory and olfactory sensitivity, emotional issues, motor skills, communication, social skills, and visual thinking (Alter-Muri, 2017).
Clinical vs school-based occupational therapy – The OT Guide
A Look Into School-Based Cognitive-Behavioral Therapy
Mental health continues to be a substantial area of need for many students, and OTs are on the front line in identifying and providing early intervention for these students.
Many students experience anxiety and depression and have difficulties with social relationships (Chan, Dennis, Kim, & Jankowski, 2017). Cognitive-Behavioral Therapy is an effective intervention that could prevent the effects of anxiety, such as diminished academic functioning, peer problems, and other psychopathology (Chan et al., 2017; Haugland et al., 2020; Stallard et al., 2014).
CBT is an intervention used to challenge and change troublesome thoughts, behaviors, and emotions through a change in cognition, behavior, and emotional regulation.
In using CBT, an OT is practicing in a cognitive-behavioral frame of reference, meaning the therapist considers that thoughts, behaviors, emotion/mood, physiological responses, and the environment are all interrelated aspects of the human experience.
This paradigm is critical because a change in one of these areas could improve or deteriorate in another (Duncan, 2011). CBT techniques may include deep-breathing exercises for anxiety, systematic desensitization for phobias, and graded activity scheduling and diaries for chronic fatigue (Duncan, 2011).
The OT Dude offers several examples to help students identify irrational ideas, demonstrate the illogic, and replace those thoughts with more positive ideas.
Some of these strategies include:
- Homework and journals
- Assertiveness training
Additional benefits and strategies of CBT can be found in our Benefits of CBT According to Science article. In addition, we provide several worksheets concerning CBT that may be of use below.
PositivePsychology.com’s Useful Resources
When making use of CBT, OTs can fill out these worksheets to gain a better understanding of the student.
- The ABC Functional Analysis Worksheet details the classic ABC technique to collect information on problematic behavior. An OT can use this worksheet for a student who demonstrates behavior concerns or refusals.
- Our Case Formulation Worksheet guides professionals in the four CBT steps to identify the factors contributing to the problem: predisposing, precipitating, perpetuating, and protective.
- An OT may want to refer to the Graded Exposure Worksheet in addressing fears or tactile aversions. Likewise, an OT may wish to use the Imagery-Based Exposure Worksheet to allow the student to self-evaluate using seven steps.
Social skills are crucial to child development, and many OTs work with students who struggle with social skills. You can refer to our resource on Social Skills Training for Kids to pad your toolkit.
Developed by the founders of PositivePsychology.com, Quenza is a client-tracking program that will give you everything you need to monitor student progress in real time so you can stay on top of your students’ improvements and deliver even better occupational therapy outcomes.
This tool encompasses all therapy elements in one easy-to-use system. OTs can use the intake forms, assign homework exercises, assess with questionnaires, and evaluate with feedback forms. Using each of these components and easily converting the results into manageable notes would produce comprehensive records. Quenza offers a $1 trial.
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A Take-Home Message
Occupational therapists have the enormous task of helping a child fulfill their role as a student. OT-related issues that lead to academic trouble, such as illegible handwriting leading to poor grades, can derail a child’s education and career prospects.
OTs can be the saving grace, from helping students write legible letters to maintaining self-control in sensory-rich situations.
No matter the goal, OTs use various methods, including Cognitive-Behavioral Therapy and Art Therapy, to assist children in achieving their goals, ultimately helping students to become more independent at school and learn to find their place in the world.
We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.
- Alter-Muri, S. B. (2017). Art education and art therapy strategies for autism spectrum disorder students. Art Education, 70(5), 20–25.
- Bathje, M. (2012). Art in occupational therapy: An introduction to occupation and the artist. The Open Journal of Occupational Therapy, 1(1).
- Blomdahl, C., Gunnarsson, A. B., Guregård, S., & Björklund, A. (2013). A realist review of art therapy for clients with depression. The Arts in Psychotherapy, 40(3), 322–330.
- Bundy, A. C., Luckett, T., Naughton, G. A., Tranter, P. J., Wyver, S. R., Ragen, J., & Spies, G. (2008). Playful interaction: Occupational therapy for all children on the school playground. American Journal of Occupational Therapy, 62(5), 522–527.
- Campbell, N. (2019). Interventions used among school-based occupational therapy practitioners to promote student performance (Student research paper, Elizabethtown College). Occupational Therapy: Student Scholarship & Creative Works, 17.
- Case-Smith, J. (2002). Effectiveness of school-based occupational therapy intervention on handwriting. American Journal of Occupational Therapy, 56(1), 17–25.
- Chan, C., Dennis, D., Kim, S. J., & Jankowski, J. (2017). An integrative review of school-based mental health interventions for elementary students: Implications for occupational therapy. Occupational Therapy in Mental Health, 33(1), 81–101.
- Duncan, E. A. S. (2011). The cognitive behavioural frame of reference. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (5th ed.) (pp. 153–164). Churchill Livingstone.
- Haugland, B. S. M., Haaland, Å. T., Baste, V., Bjaastad, J. F., Hoffart, A., Rapee, R. M., … Wergeland, G. J. (2020). Effectiveness of brief and standard school-based cognitive-behavioral interventions for adolescents with anxiety: A randomized noninferiority study. Journal of the American Academy of Child & Adolescent Psychiatry, 59(4), 552–564.
- 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.
- Sladyk, K. (1997). OT student primer: A guide to college success. SLACK.
- Spencer, K. C., Turkett, A., Vaughan, R., & Koenig, S. (2006). School-based practice patterns: A survey of occupational therapists in Colorado. American Journal of Occupational Therapy, 60(1), 81–91.
- Stallard, P., Skryabina, E., Taylor, G., Phillips, R., Daniels, H., Anderson, R., & Simpson, N. (2014). Classroom-based cognitive behaviour therapy (FRIENDS): A cluster randomised controlled trial to Prevent Anxiety in Children through Education in Schools (PACES). The Lancet Psychiatry, 1(3), 185–192.