Why We Feel Like We’re Missing the Mark as School-Based Occupational Therapy Practitioners (and what to do about it!)

Years of school. Fieldwork rotations. The daunting board exam.  

You put in the time, did the work, and received the official stamp of readiness to go forth and be an Occupational Therapist or Occupational Therapy Assistant.  But how prepared were you for your role in school-based practice?

If you’ve found yourself trying to explain your school-based role (while questioning it yourself) – you’re not alone.  

Your OT education gave you tools to work with kids – but working in schools isn’t the same as working with children in a clinic. It’s an educational rather than a medical model.  Most of us were never truly taught how to navigate that shift. 

The School-Based OT Practitioner: Shifting From Clinical Expert to Educational Team Member 

In the school setting, you are NOT the expert with the final say.  

Let that sink in.  Did you ever hear that in your OT coursework?  

We must understand this principle that sets schools apart from other settings. In a clinic, you’re in charge of the plan.  Not so in the school system.

This profound shift requires a mindset adjustment.  As a school-based practitioner, you have a seat at the table as part of a much larger team. 

The team’s goal is for the student to succeed within their learning environment.  OT may be necessary for the student to participate in their educational plan. 

You’re not there to simply:

• Fix a pencil grasp.  
• Run a student through reflex integration exercises in a pull-out environment. 
• Improve standardized testing scores.

Instead, you’re there to:

• Help a struggling student participate in writing in a way that’s functional for their context. 
• Support classroom-based strategies that facilitate participation and growth.
• Enhance functional access to the curriculum and school routine.

Recognizing the Challenge

If occupational therapy professionals struggle with navigating and understanding the nuances of school-based OT practice, you can expect other stakeholders to struggle with this as well.

Maybe you:

• Came from a clinic-based setting
• Didn’t have a school-based fieldwork rotation
• Rely on team members and Facebook groups to develop your perception of what school-based OT should and shouldn’t be

You might be hearing things like: 

• “The last OT did it this way…”
• “But my child’s clinic OT said…”
• “This family will expect OT sessions to look like…” 

 And the list goes on and on. 

Advocating for best practices in schools can feel like an uphill battle – especially when there is disagreement among OT practitioners. The challenges are real, but we begin to shift the narrative when we’re clear on our purpose in the educational setting. 

Embracing our Unique School-Based Role 

Think about some of the settings with occupational therapy – hospitals, outpatient pediatric clinics, home health, schools, and mental health facilities. Even within pediatric practice, OT can look very different. 

Remember, most often the school-based OT provider is operating as a related service, as outlined in a student’s IEP.  It only takes a glance around a classroom to identify many students who might benefit from clinic-based occupational therapy. In schools, we support students who require occupational therapy to access and participate in their school routines and academic curriculum.  We operate under an educational model rather than a medical model. 

You recognize that occupational therapy looks different across settings and specialties. 

You wouldn’t dispute:

• A hand therapist creating splints to provide protection
• A PICU therapist addressing positioning
• A clinic therapist centering treatment on expanding a picky-eater’s food repertoire 
• A home health therapist emphasizing caregiver training to help support their child

Doesn’t it make sense, then, for a school-based therapist to focus on supporting a student’s ability to spend meaningful time in their classroom and educational spaces? 

In any setting, OT can address a lot, but it’s vital you are attentive to the needs within that context and environment. 

Reframing Your Target  

When we lose sight of the unique school-based lens, it’s easy to spiral into second-guessing and imposter syndrome. 

You’ll need to explain your role (probably over and over again). Some team members won’t fully grasp it at first, and others will question it – but that doesn’t mean you’re wrong.

When you truly grasp the distinct purpose and capacity of OT within the educational model, everything shifts.  

You make decisions with greater clarity.

Collaboration becomes more purposeful and efficient.

Student needs are met more effectively.

When you see positive change, it empowers you to keep advocating – gently but persistently – for your role as part of the school team.  

Your voice can help bring clarity, keeping the team focused on access, engagement, and meaningful outcomes for each student. 

When the team understands the real target, we stop missing the mark and start making a greater impact. 

Want More?  

Looking for next steps to help you feel more grounded and confident in your role? You don’t have to figure it out on your own.  Check out these additional resources:

📥FREE Download: Tips for Successful Collaboration with Teachers

Team collaboration is a key aspect of our school-based role. Grab these tips to enhance your collaborative process – this will get you on my mailing list so you don’t miss out on upcoming events and ongoing tips sent straight to your inbox (unsubscribe anytime).

📝Additional blog post: What’s My Role Here, Anyway? Understanding the Scope of OT in Schools
Check out this earlier blog post for more information on our scope in schools. 

👉Own Your Role: Insights & Advocacy for School-Based OT Practitioners

This one-hour, on-demand course is packed with tools and support to help you communicate your role and effectively advocate for best practice. Course enrollment is $20. Refer to your state guidelines to determine if it is accepted as continuing education for your licensure.  

Written by: Jennifer Huff, OTR, MOT