The Role of School-Based OT in High School (And What the Research Says)
- Jayson Davies
- 17 hours ago
- 9 min read
By the time students reach high school, occupational therapy services frequently come under scrutiny from our peers, and honestly, even ourselves.
Caseloads look different, pull-out services are questioned, and supporting legible handwriting can no longer be easily justified. All of that can lead OTPs to question our own role in the high school arena.
So, do we still support students when they get to high school?
Of course, we do!
In this article, I want to help you
Define a clear and confident role in high school settings
Use transition planning to guide goals, services, and interventions
Support access to curriculum through collaboration and consultation
Answer your questions about Handwriting and 1-on-1 sessions in high school
And prepare students for life beyond high school
I'll also share four real-world OT programs that are being implemented across the country. You'll find those in the pick boxes.
Why OT Still Matters in High School
By high school, students are expected to manage complex schedules, multiple teachers, increased academic demands, and fewer built-in supports. When a student isn’t ready for that level of independence, participation is usually the first thing to break down.
Research consistently shows that students with disabilities experience poorer post-school outcomes related to employment, postsecondary education, and independent living.
At the same time, research has shown us exactly what will improve these outcomes:
Self-determination,
Work experiences,
Inclusive environments,
Technology use,
And daily living skills (Mazzotti et al., 2021)
Those predictors align directly with what we do as OT practitioners.
This isn’t a coincidence.
It’s confirmation that OT in high school matters, especially when it’s aligned with life beyond graduation.
Cue section on Transition planning...
Transition Planning: The Backbone of High School OT
Transition planning awareness among OT practitioners has come a long way in recent years, but it is still not discussed enough when planning OT services in middle and high school.
Transition planning shouldn’t be a procedural requirement section of the IEP you review as parents are walking out the door. Rather, it should be the focal point of the IEP, driving goals, services, and interventions that extend beyond the here and now.
As a profession, we bring a person-centered perspective to transition planning by focusing on how students might function in real roles beyond the classroom.
Research shows that when transition-focused OT is included in high school, students demonstrate improvements in independence, social participation, community living skills, and self-determination (Pierce et al., 2020; Harvey et al., 2022).
So rather than ignoring transition goals or transition planning altogether, let's use it as an opportunity to step forward with clarity and confidence.
So, say it with me like you actually believe it:
Transition-focused OT helps students to demonstrate improvements in independence, social participation, community living skills, and self-determination.
A REAL OT STORY - 1
Using Direct OT Services to Build Life Skills and Self-Determination
What the OT did:
An OT practitioner provided direct services to a ninth-grade student with Down syndrome as part of her transition plan. Rather than focusing on academics, OT targeted functional life skills, including dressing, meal preparation, decision-making, and basic work-related routines.
How services were delivered:
Over six weeks, the OT provided one-to-one intervention twice a week using task analysis, coaching, and collaboration with the student’s teacher and family. Skills were intentionally practiced across both school and home environments to support carryover.
Why it worked:
The student showed measurable improvements in daily living skills and self-determination, along with increased independence and confidence reported by both school staff and family. This example highlights how short-term, occupation-based OT services can meaningfully support transition readiness when tied directly to life beyond high school.
For more insight into this example, view this research article: Harvey et al., 2022
Join us for this 1-hour CEU course on improving transition outcomes for middle and high school students through occupational therapy.
Learn evidence-based strategies to enhance self-determination, pre-vocational skills, and employment exposure, while engaging parents and teachers effectively.
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Collaboration That Improves Access, Not Just Compliance
High school classrooms move fast. Content is dense, expectations are high, and flexibility can feel limited. This is where OT collaboration becomes especially powerful.
While some students may still need to be pulled out of class for OT to work on isolated skills, we can also support access by collaborating with teachers to adjust task demands, support executive functioning, and offer multiple ways for students to demonstrate learning.
This work that directly supports inclusion and participation often happens quietly through planning emails, classroom observations, and "between the bells" coaching, as I like to call it. (you know, the five minutes in between class periods).
I've often found that a 25-minute observation paired with a 5-minute consultation can support a high school student more effectively than a 30-minute one-on-one session.
We also play a critical role in guiding paraprofessionals.
Helping adults know when to step in and when to step back can make the difference between dependence and independence. Inclusive educational environments are a predictor of post-school success, and OT consultation is one way we actively support them.
Working with an adult rather than the student may not always "feel" like OT, but it is.
A REAL OT STORY - 2
Collaborating With Staff to Build a Community-Based Instruction Program
What the OT did:
An OT practitioner partnered with special education teachers and paraprofessionals to launch a small on-campus coffee cart aligned with student transition goals. Rather than operating the program independently, the OT collaborated with the team to identify student roles, task demands, and support needs.
How collaboration showed up:
The OT coached staff on task analysis, prompt fading, and how to support students without over-supporting them. Together, the team aligned daily routines and expectations with IEP transition goals and shared responsibility for monitoring progress and adjusting supports.
Why it worked:
Because the program was built collaboratively, it was sustainable and transferable beyond OT sessions. Students practiced real work skills across the school day, staff felt confident supporting independence, and the coffee cart eventually expanded into a broader community-based instruction program.
Learn more about this program in Episode 109 of the OT Schoolhouse Podcast!
One-to-One OT and Handwriting in High School: Reframing the Debate
If there are two topics that consistently create debate in high school OT, it’s direct one-to-one services and handwriting.
These questions come up often:
Should we still be pulling students?
Does handwriting even belong in high school OT?
Here’s the reframe: neither one-to-one OT nor handwriting disappears in high school, but both change purpose.
In high school, individual OT sessions must shift away from the repetitive skill practice often seen in lower grades and toward functional problem-solving.
One-to-one time becomes a safe, judgment-free space to teach assistive technology, support self-awareness, and help students figure out which strategies actually work for them in real academic and life contexts.
Likewise, written communication still matters, but the goal may not be legibility or "80% linear placement accuracy". Instead, the focus moves to efficiency, endurance, functionality, and access.
That may look like helping a student learn to use keyboarding, speech-to-text, or even AI to express themselves effectively. It may also mean helping a student to learn how to advocate for those tools.
We must reframe the question from "Can I help an older student with handwriting?" to "How can I help this student express themselves?"
When we do that, many more opportunities for intervention arise. Here's an example:
A REAL OT STORY - 3
Reframing Handwriting Through Access, Participation, and Self-Advocacy
What the OT did:
An OT practitioner recognized that handwriting was limiting a student’s ability to demonstrate what he knew. Instead of continuing handwriting remediation, the OT shifted the focus to access by teaching the student multiple ways to express knowledge, including Google Slides, audio recordings, visuals, and other digital formats.
How services were delivered:
These alternative methods were intentionally practiced during OT sessions and classroom activities, not treated as last-minute accommodations. The OT collaborated with teachers to normalize these formats and ensured they were written into the student’s IEP so expectations remained consistent as he transitioned into high school.
Why it worked:
By removing handwriting as a barrier, the student became more independent and confident in academic and extracurricular settings. He learned how to advocate for the tools that helped him succeed and went on to meaningfully participate in electives and activities such as marching band and unified sports. This example highlights how high school OT reframes handwriting—not as a skill to perfect, but as one of many ways to support participation and self-determination.
This story is featured on the Inclusive Occupations Podcast, Season 4, Episode 2: “Living the Amazing High School Life.”
Looking Beyond High School
One of the most compelling reasons high school OT matters is that the skills we support don’t become irrelevant at graduation. High school is where students begin practicing skills they will need in real life.
Thus, high schools are where these soon-to-be-adults must learn to ask for accommodations, explain what helps them learn, and problem-solve when things don’t go as planned. When OT services intentionally build toward these outcomes, we aren’t just supporting success in school. We’re helping student design and bridge to their adulthood
I think this also makes our role easier to explain. When colleagues ask, “Why OT in high school?” the answer isn’t about age or diagnosis. It’s about readiness for what comes next.
Here's how one OT supports what is to come for his students:
REAL OT STORY - 4
Supporting Real Work Experience Through a School–Community Partnership
What the OT did:
An OT practitioner designed a transition-focused program to help high school students gain realistic work experience before graduation. Rather than limiting instruction to classroom-based work skills, the OT partnered with community businesses to expose students to real job expectations, routines, and environments.
How work experience was supported:
Students first practiced job-related tasks on campus, such as folding boxes, sorting materials, cleaning, and following multi-step routines. The OT focused on task analysis, executive functioning, endurance, and problem-solving. The following week, students completed the same tasks at an actual community job site—such as a pizza restaurant, grocery store, or supply warehouse—while supported by an interdisciplinary team. After each experience, students reflected on preferences, challenges, and next steps.
Why it worked:
By pairing on-campus preparation with real-world experience, students developed confidence, self-awareness, and realistic expectations about work. They learned what different jobs felt like, how management styles varied, and which environments matched their strengths. This early exposure helped students see employment as achievable and informed more meaningful transition goals and planning.
Learn more about this program in Episode 187 of the OT Schoolhouse Podcast!
Key Recommendations for School-Based OT in High School
If you’re looking for a clear way to anchor your high school OT services, these recommendations pull together the main themes of this article.
Anchor services in life beyond graduation.
Let transition planning guide your goals, services, and intervention choices. Ask how each service supports participation, independence, or self-determination in and beyond high school.
Prioritize participation over remediation.
High school OT is most effective when it removes barriers to meaningful participation. Focus on access, routines, tools, and strategies that allow students to engage in real roles rather than chasing isolated skill deficits.
Use collaboration as a viable service delivery model.
Work alongside teachers, paraprofessionals, and staff to design supports that live in the classroom and on the school day. Coaching adults on how to fade support can be just as impactful as working directly with students.
Use one-to-one intervention strategically.
Direct OT services still matter in high school, especially for assistive technology, self-advocacy, and problem-solving real-life challenges. Keep individual sessions purposeful and connected to functional outcomes.
Treat assistive technology and alternative output as access tools, not shortcuts.
Teaching students how to use and advocate for tools like speech-to-text, digital organizers, or alternative formats builds independence and confidence.
Include real-world experiences whenever possible.
Whether through community-based instruction, on-campus work routines, or extracurricular participation, authentic environments are where skills generalize, and confidence grows.
Final Thoughts
High school OT isn’t about holding on to outdated models or justifying our presence. It’s about showing up with clarity and purpose at a time when students are preparing to step into adult roles.
When we focus on participation, independence, and life beyond school, our role becomes easier to explain and harder to replace.
If you are helping students access learning, take on real responsibilities, and understand themselves as capable young adults, you are doing exactly what high school OT is meant to do.
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Resources & References
Carroll, T. C., & Schwind, D. (2023). Evidence-based predictors of post-school success. American Occupational Therapy Association.
Cahill, S. (2023). Interventions to support transition-age students. American Occupational Therapy Association.
Kari Renahan, Erin Knobl, Annie Jiang, Chitrini Tandon, Wenonah Campbell; School-Based Occupational Therapists’ Roles Supporting Transitions Into and Throughout Kindergarten to Grade 12: A Scoping Review. Am J Occup Ther September/October 2024, Vol. 78(5), 7805205170. doi: https://doi.org/10.5014/ajot.2024.050634
Harvey, L., Zapf, S., & Groger, S. E. (2022). Occupational therapy in secondary transition: A case report. The Open Journal of Occupational Therapy, 10(3).
Mazzotti, V. L., Rowe, D. A., Kwiatek, S., Voggt, A., Chang, W.-H., Fowler, C. H., Poppen, M., Sinclair, J., & Test, D. W. (2020). Secondary Transition Predictors of Postschool Success: An Update to the Research Base. Career Development and Transition for Exceptional Individuals, 44(1), 47-64. https://doi.org/10.1177/2165143420959793 (Original work published 2021)
OT Schoolhouse Podcast, Episode 109. From one coffee cart to an entire community-based instruction program.
OT Schoolhouse Podcast, Episode 187. Realistic strategies to build work skills for high school and transition-aged students.
Pierce, D., Spence, A., Sakemiller, L., & Roberts, C. (2021). School-based Transition Readiness Services for Adolescents with Disabilities. Journal of Occupational Therapy, Schools, & Early Intervention, 14(2), 207–224. https://doi.org/10.1080/19411243.2020.1835601
Rehab Ink Magazine. (2023). The emerging role of occupational therapy in post-secondary institutions