Coming to the school setting, I didn’t fully understand the educational model.  Navigating caseloads, schedules, and meetings across roughly half a dozen schools, I hit the ground running! 

As you can imagine, coming from a clinic, I felt comfortable pulling students out of the classroom for our OT sessions. The teachers were happy to send students out, and the students were glad to leave. 

Things seemed to be going well, but I quickly saw that there was a disconnect I could not ignore.

Realizing the Classroom Need

Too often, I’d walk into a classroom and see my student sitting at their desk but not doing their work – they were disengaged, struggling, or simply not participating in the classroom task. Sometimes they appeared attentive, but upon approaching them I’d see doodles on a paper rather than work on the assignment. 

In most cases, this wasn’t due to poor effort or attention from their teacher. I began collaborating with teachers and classroom staff to seek their perspectives. Some themes quickly emerged, such as: 

• The student was in and out of the class all day, and transitions didn’t always occur at natural times.
  
  
• The teacher wanted to give instructions to catch the returning student up, but sometimes it felt like they were too deep into it or the student had missed too much.
  
  
•  The student was too far behind grade level to be able to do what the class was doing.
  
  
• The teacher had felt they tried everything, but couldn’t figure out how to help the student. 

 I began to ask myself what I could do. 

My ultimate goal as a school-based occupational therapist is for students to be able to access and participate in their school experience. Doesn’t it make sense that to do that, we should spend time in the very spaces in which our students are struggling to participate?

Why Integrated Occupational Therapy Services Matter

Traditional pull-out sessions have their place, but the literature supports collaborative, integrated school-based occupational therapy services as best practice. There are several reasons, but here are just a few: 

• Least Restrictive Environment - Legally, students must be educated alongside their non-disabled peers to the maximum extent appropriate.
  
  
• Generalization - When we teach skills during real-time activities and tasks, we ensure the strategies are relevant and applicable to the context. 
  
  
• Focus on Educational Needs - We operate under an educational rather than a medical model. To effectively understand educational needs, it’s vital to understand what is required of our students across school environments.
  
  
• Empowers Classroom Staff - Increased opportunity for regular communication contributes to better coordination of efforts, ability to effectively embed strategies directly into classroom routines, and gather real-time feedback to make adjustments as needed so that staff are equipped to meet student needs daily. 

Change is Hard

If you or your district have a history of providing pull-out services for occupational therapy, the transition can be difficult.  

Don’t be afraid to start small. Seek ongoing collaboration and communication. Advocate for your role as a school-based practitioner. Gently educate your team on best practices for school-based occupational therapy. 

The change won’t happen overnight, but it will be profound. 

Championing Student Success

Embracing an integrated approach requires a mindset shift from a traditional medical model. It is invigorating to see our students participate and succeed in their meaningful school spaces. 

Your skills as an occupational therapist uniquely equip you to see the classroom and school spaces in ways that other team members may not. You identify barriers and supports to help your student engage in what they need to do, want to do, and are expected to do in their educational environment. 

The Power of Just Right Support

As occupational therapy practitioners, we often speak of the “just right challenge”. We see how activities need to be adapted and graded in order to push our students to grow while allowing them to be successfully engaged.

The more time we spend with our students in their natural school spaces, the more that we’re able to empower them, and the staff working with them, to have the just right support in place to engage in their educational programming. 

What it’s All About

Recently I walked into a classroom to work with a student who I just started working with. I quickly saw that he did not have the tools to be successful in the activity as it was given. 

I was able to break down the task, provide some adjustments, and assess the need for additional tools that might be helpful in the classroom space. 

In the 20 minutes that I was there, the student was able to complete the task, keeping up with his peers. He eagerly raised his hand and contributed to the group discussion, proudly sharing his work. 

Afterward, I was able to follow up with relevant school staff to help them understand what tools were needed, and how to better support the student in those types of activities in the future. 

Moments like that remind me why this is what we do.  Supporting a student to go from being unfocused, disorganized, timid, and uncertain to confident and proud to share their work as a successful participant  – that’s what it’s all about. 

What’s Your Next Step?

Have you tried integrating OT services into the classroom or other school spaces? Does it all feel a bit overwhelming? Remember, it’s okay to start small! Focus on how you can bring OT to your students, rather than bringing your students to OT. 

If you’ve been wanting to move toward a more integrated approach but aren’t sure where to start, I’d love to invite you to check out my course From Isolation to Integration: Effective OT in the Natural School Environment.


Not only does this course provide 6.75 hours of on-demand video content, but you’ll also have access to a private community space to collaborate with others walking through the course – I’ll be there too to offer support, problem-solve, and work with you to determine strategies to help you apply what you learn along the way. 

You can get all the details here: From Isolation to Integration: Effective OT in the Natural School Environment

Don’t forget, you can always follow along with me in my Facebook group! 

Want some more quick tips on providing integrated services? Check out my earlier blog post here: https://www.jenniferhuffllc.com/blog/integrated-therapy-services-pushing-into-the-classroom