What's My Role Here, Anyway? Understanding the Scope of OT in Schools

Maybe, like me, you were drawn to the field of occupational therapy (OT) because the scope is so broad.  When you chat with OT practitioners (OTPs) in five different settings, you'll get 5 very different reports of what a day in their life looks like. 

Having a broad scope can make it challenging to define our role if we don’t have a good grasp on the unique factors impacting a particular setting.  I’ve found this to be especially true in schools.  

Defining the Scope of OT 

Let’s remind ourselves what the definition of occupational therapy is.  According to the Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020), occupational therapy is defined as the “therapeutic use of everyday life occupations with persons, groups, or populations (i.e., clients) for the purpose of enhancing or enabling participation".  Seems like that would cover quite a lot, doesn't it?

Review the Practice Framework further, and you will certainly find great detail about the vastness of “everyday life occupations” within our scope of practice.  

An Educational Model

For some students, occupational therapy plays a vital role in facilitating a student’s ability to access and participate in their school routines and academic curriculum.  

In schools, OTPs may be involved in school-wide initiatives and programs to support student well-being.  Much of our work, however, falls under the umbrella of Special Education and must abide by federal legislation and state policy in this area. 

In the school setting, we are obligated to consider if a student’s needs are educationally relevant and if specialized intervention from an OTP is needed to support access and engagement in the student’s special education curriculum. 

It’s a lot to consider when what we’d love to do is help every child we see. 

So, What’s our Scope in Schools?

To determine the need for occupational therapy at school, a thorough evaluation and collaboration with the school team must occur. (Hopefully your school has a solid referral process in place, but more on this another time!)  

Throughout your evaluation, you look at routines and activities expected of the student throughout their school day.  You’ll be looking at areas such as their fine motor skills, sensory needs, and ability to functionally navigate their school environment. 

OTPs also have an eye for executive functioning challenges, emotional regulation concerns, and need for assistive technology.  

Our scope is wide, yet limited, at the same time.  There is so much we can address, but we must be attentive to the needs within the school context.   

Determining the Need for School-based OT

Let’s say that during the evaluation you see some sensory differences.  Maybe the student runs their hand against the wall as they walk, they fidget at their desk, or you notice they don’t like to wear a jacket.  

You might see that a child has social difficulties.  They struggle to take turns and are quick to blurt out answers.  You notice the student is impulsive and will quickly grab things they want.  

When determining the need for OT services, it is important to refer back to educational relevancy and consider if the areas you observed are negatively impacting the student’s ability to benefit from their educational placement.  

You Aren’t Alone! 

It is vital that OTPs consider the school team as a whole.  Although social skills, sensory needs, fine motor and so much more fall within our scope, we are not the only ones on the school team able to address these areas.  

Consider your unique role and what you would bring to the table that’s different from other team members - it may or may not be necessary! 

Feel like you need more support in this area?  Check out my Facebook group here: School-Based OT Mentorship.

Looking for more individualized support? Contact me at [email protected] for information about upcoming mentorship groups!

Written by: Jennifer Huff, OTR

REFERENCE:
American Occupational Therapy Association (2020). Occupational Therapy Practice Framework: Domain and Process (Fourth Edition). American Journal of Occupational Therapy, Vol. 74(Supplement_2), 7412410010p1–7412410010p87. doi: https://doi.org/10.5014/ajot.2020.74S2001.