School-Based Occupational Therapy
This series focus on the roll of school occupational therapy: what we do, what we address, how we make an impact for students.
My absolute favorite thing about being a school OT is working in the child’s natural learning environment. I transitioned from outpatient pads to school OT and immediately saw how much more of an impact my skills could make in the life of a child. Eliminating the contrived environment of a therapy clinic allows the child to make a connection of the skills and strategies taught directly into their personal learning environment.
Some of the areas that I’ll be diving into for education and activity ideas are:
· Self-care skills
· Play
· Feeding & Eating
· IADLs
· Self-Regulation
· Pre-vocational & Vocational skills
· Functional Hand skills
· Access to Education
It’s important to remember that school OT addresses all levels of functioning and all children’s access to education. This includes a wide range of skills and abilities. What a school OT is ‘allowed’ to address will vary depending on state, school district, and school program.
Self-Care Skills
Self-Care Skills can 100% be addressed in the school setting. There. I said it. I’ve had many other Occupational Therapists try and convince me otherwise.
Some of the self-care skills that school-based occupational therapists address are:
· Toileting and toilet hygiene
· Hand washing
· Clothing fasteners
· UB/LB dressing
· Functional mobility
· Personal hygiene and grooming (wash face, brush hair, deodorant, eye care, menstruation management)
Think about everything a child does during the school day…Use the restroom, wash their hands, put on a jacket, unbutton pants for toileting, retie their shoes, brush or fix their hair after running outside, wipe their face after a meal, put on a smock for art class or science experiments, get food out of their teeth after a snack, drink from a water fountain, blow their nose using a tissue (hopefully).
These are all areas that an OT can address and should assess through adaptations, accommodations, and/or therapeutic learning strategies!
Play
Play is an important part of a child’s school day. Play fosters the best learning environment for new skills. It supports social participation and the development of meaningful relationships. It requires problem solving and social thinking.
Some of the play skills that school-based occupational therapists address are:
· Gym/playground participation
· Leisure/free time play skills
· Peer group participation
· Developing and maintain friendships
· Sequencing novel game play
· Hand eye coordination with ball games
Throughout the school day, a child is participating with peers. Such activities may require multi-step sequencing, praxis, hand eye coordination, endurance, and imagination.
School OTs play (no pun intended) the perfect role in facilitating these skills through individual direct, group, and consultative services in the school environment!
Feeding & Eating
Throughout the school day, students may have 1-2 meals; breakfast and lunch. Then there also may be snack times and special activities like earned pizza parties, ice cream sundaes, or popsicles on a hot day on the playground.
Some of the feeding and eating skills that school-based occupational therapists address are:
· Opening of packages
· Going through the lunch line
· Selecting food choices
· Use or eating utensils
· Drinking from cup or water fountain
· Wiping face after eating
· Cleaning up after spills or after eating
· Cleaning up after spills or after eating
· Sensory considerations for environment
School OTs can support a child’s independence and participation in feed and eating in a multitude of ways… Adapting the environment or set-up in the cafeteria to be less overwhelming visually or auditorily (not a word but you get what I mean). Working on use of feeding utensils. Increasing independence in opening containers, packages, and cartons. Sequencing going through the cafeteria line and selecting all the choices needed (most public schools require choice of main, side, fruit/veggie, and drink).
Working on independence in feeding and eating activities in the school environment can greatly increase a child’s confidence in front of peers and improve their food intake for improved attention and arousal during educational activities!
IADLs
IADLs definitely make their appearance in schools.
Some of the IADL skills that school-based occupational therapists address are:
· AT and device management
· Set-up/Clean-up of educational materials
· Driving and community mobility/access
· Money management
· Meal preparation and clean up
· Safety and emergency awareness
· Shopping
· Employment interests and pursuits
From going to a school store, buying extra snacks at lunch, driving to get lunch on a break (senior privileges), microwaving a hot meal from home, these skills pop up outside of “educational time” but are important for a student to access their school environment.
Then consider the cognition, sequencing, emotional regulation, inhibition & initiation needed to respond to drills and emergency plans at school.
And for our students with accommodations, AAC devices, PECS books, switches, etc. It’s important those students know how to care, maintain, and protect their AT.
School occupational therapists play a role here. Through individual, group, and consultative services, school OTs have the unique skills to break down these skills, find the barriers, and address the performance areas needed to increased independence in the school environment.
Self-Regulation
Emotional regulation is an important skill to have in the school setting.
Think about the last time you were angry or upset… Could you concentrate? Did you need to take a quick break before getting back to work? Did you vent to a coworker about how you were feeling? Did you go for a walk, turn off the lights, or listen to calming music?
Kids need to learn about all of their options for self-regulation, how they affect their body, and what works for them. They need to be able to identify their emotions and use strategies to help them calm their body and mind before getting back to work or following demands in a lesson.
Many students will need co-regulation strategies, where you or staff are aiding them and providing opportunities for optimal regulation, because they may not be able to identify what works best for them right now.
Some of the self-regulation skills that school-based occupational therapists address are:
· Self-regulation and management programs
· Adaptations to environment
· Access to calming areas and materials
· Initiation and inhibition of work tasks
· Self-advocating for wants and needs
Providing sensory-based strategies, mindfulness programs, interception strategies, and school-wide emotional regulation programs are great ways for students to work on these skills in the school environment.
Occupational therapists can help a school, classroom, and/or student work on these skills to improve a child’s attention, participation, performance, and independence throughout the school day.
Pre-vocational & Vocational Skills
When it comes to IEPs and special education, students are eligible for services up to age 21.
As a student gets older, it’s important to start to look at the transition out of school supports and into the community.
For many, that looks like job training or work placements.
There are so many ‘OT skills’ involved in vocational skills.
As OTs, we’re trained to address work, play, and leisure pursuits and participation.
Some of the pre-vocational and vocational skills that school-based occupational therapists address are:
· Sequencing steps to a task
· Quality management of task
· Organization of materials
· AT and adaptations to work tasks and environments
· Time management
· Problem solving skills
· Job training
School OTs can play a role in trailing new job skills, learning the sequence or steps of a task, attending to tasks with divided or sustained attention, and more.
Access to Education
The MOST important area for School OTs address. After all it is the whole reason we’re in schools!
Access to education can refer to so many things. Actually everything that School OTs work on sits into this category.
Some of the pre-vocational and vocational skills that school-based occupational therapists address are:
· Attention in the classroom
· Organization of materials
· Proper print/size of text in books and handouts
· Planning for assignments and activities
· Adaptations to the learning environment
· Technology and computer use
Other ways School OTs can improve access to education... adapting textbooks and printed materials, breaking down activities into parts with visuals, improving sustained attention, modifying the environment to account for sensory sensitivities and needs, using assistive technology to supplement or modify written curriculum and text, improving organization of work materials/backpack/locker... the list can go on and on.
The purpose of School Occupational Therapy is to promote access to education, learning, and participation in the school setting.
Functional Hand Skills
I saved the stereotypical school-based OT skills for last!
Some of the functional hand skills that school-based occupational therapists address are:
· Manipulation of school materials
· Written and typed expression
· Opening/closing of containers and supplies
· Management of clothing fasteners
· Cutting with scissors
· Use of art materials and equipment
Yes, school occupational therapists are the experts of addressing these skills in the classroom. But these skills are to be first taught in the classroom. Occupational therapy will address any assistance needed outside of the teacher’s instruction and offer adaptations as needed.
Emily is a pediatric occupational therapist providing community and home-based OT services in the Greater Philadelphia area, PA. She is a mentor for School-Based Occupational Therapists, offering one-one-one sessions to grow in confidence and skills. Emily Marie OT LLC strives to empower all to achieve their full potential.