Making Minutes Meaningful as School-Based OT Practitioners

How do you, as a school-based occupational therapist (OT), determine recommendations for service time to ensure meaningful progress? 

Do you have a go-to recommendation, almost like a prescription? 

Does your district tend to put 30 minutes weekly or twice-weekly on every IEP that is found in need of OT services?

In the clinic setting, it’s not unusual for OT to work with a child for an hour at a time, maybe even multiple times in a week. But school isn’t a clinic. Schools follow an educational model, not a medical model. 

The way many people think about minutes is often at odds with what truly supports student success in schools. 

OT Minutes Are Just Part of the Picture

It’s important to meet minutes – it’s legally mandated, after all! But, what if we change our approach when it comes to determining the minutes needed? 

If minutes drive outcomes, then we should see students with the most minutes making the most progress, but that’s not the case.

In AOTA’s book Collaborating for Student Success: A Guide for School-Based Occupational Therapy (Hanft & Shepherd, 2016), there is much evidence for using a collaborative approach, which sometimes but not always includes direct “hands-on” service time.  This book outlines several studies in which students receiving consultative support made significant progress. As the title of the book suggests, collaboration is key for student success. 

It’s vital to consider the educational need and the realistic context in which that need occurs. Collaborating in the classroom, addressing purposeful goals and tasks, enhances student success and progress toward IEP goals. 

Emphasizing Participation over OT Minutes

Meaningful participation is what we seek.  

Some of the most common arguments I hear against bringing OT services into the classroom are 1) it is hard to meet the minutes, and 2) it is hard to come in at times that feel relevant. 

This might be because of reasons like this:

• The class is only doing 10 minutes of writing at a time, but your service time is for 30 minutes. 
• Your goal is related to writing A-Z, but the class is never writing the entire alphabet, so data collection is too hard. 
• It takes the class a while to get started on tasks, and you feel like your time is wasted if not directly spent supporting a fine motor activity. 

As you collaboratively write goals and recommend services, you must consider the student’s real-life environment and expectations. OT practitioners are skilled at evaluating the person, environment, and occupation, but sometimes we remove the student from their environment so much that we lose sight of the full picture.

Rethinking Service Delivery

Keep in mind that the I in IEP stands for individualized. There are plenty of districts that look for a blanket approach, and I get it. It can make planning, scheduling, and caseload management much easier if everyone is on consult or if everyone receives 30 minutes of direct every week.  But is that what’s best for the student and their individualized plan?

As professionals, we are ethically bound to make recommendations as we see fit using our clinical judgment and best practice guidelines. Unfortunately, that often means pushing back against the “easy” route. 

Making the Shift 

As you collaborate with your team and identify a student’s areas of need, carefully consider the entire context. What does that need look like in the actual school routines, classroom setting, and daily schedule? Is that need impacting multiple aspects of the day? 

How will you use your unique skills in activity analysis to develop interventions, accommodations, and strategies that support the student’s participation and growth as it relates to their IEP? 

It may feel strange at first to make recommendations that are, well, individualized! Don’t be afraid to share your clinical reasoning and continue to educate your team on how OT can best support the identified needs.

Would It Be School-Based OT If It Were Easy? 

Unfortunately, in the school system, we face barriers that may complicate this process. This includes:

• IEP software systems
• Administrator push-back
• Teacher or parent/caregiver disagreements

Although several factors make it challenging to fully embrace the shift from focusing on minutes to participation, it is vital that, as a profession, we accept the challenge and seek best practice, holding fast to the OT Code of Ethics and Standards of Practice for Occupational Therapy. 

Aligning school-based OT service with best practice, using a collaborative and integrated approach, will yield positive results. Partnering with your school team and focusing on addressing relevant school-based needs benefits your students, strengthens the team, and leaves a lasting impact.  

REFERENCES
American Occupational Therapy Association. (2020). Occupational therapy code of ethics. American Journal of Occupational Therapy, 74(Supplement 3), 7413410005p1–7413410005p13. https://doi.org/10.5014/ajot.2020.74S3006

American Occupational Therapy Association. (2021). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 75(Supplement 3), 7513410030. https://doi.org/10.5014/ajot.2021.75S3004

Hanft, B., & Shepherd, J. (Eds.). (2016). Collaborating for student success: A guide for school-based occupational therapy (2nd ed.). AOTA Press.