The world of school-based occupational therapy is unique and different than any other setting. We are medical professionals in a world of education. You could say that we are “the odd man out”. As occupational therapists, we are educated to support a medical model. However, when we cross over to school-based therapy, our framework and foundation must shift to an education model. Because of this, I feel like school-based OTs spend an insane amount of time educating parents, faculty, and staff about our role in the school system.
Since we are initially trained in the medical model, if a therapist is just starting in the school system as a brand new graduate, or if an OT practitioner is transitioning into the schools after 20 years in inpatient rehab, the simple idea of starting in a school-based model can be daunting and terrifying all at the same time. So, when Jayson prompted the community to share a tip for new practitioners on Instagram, there were almost a hundred helpful comments from experienced school-based OT practitioners. Clearly, therapists are more than willing to give advice, especially related to areas and situations where they wish someone would have told them how to (you can fill in the blank).
As we dove into the comments more, several themes surfaced and we wanted to take some time to share and expand on these words of wisdom.
Tip #1: Build relationships with everyone on campus
“Make sure your admin know who you are” @Theaccommodationstation (Alexandra)
“Make friends with the custodian! You never know when you’ll need to borrow tools/hardware or have them rig something up for you!” @Theeverydayot (Sarah)
“In addition to making friends with the building secretaries and janitor, befriend the gym teacher…Also, don’t forget to provide support to the ‘specials’ teachers (art, gym, music, and computer). These teachers a lot of time get little support and aren’t quite sure how to meet students’ needs. Art and gym are often great classes to push in to for OTs.” - @Raejean84 (Raejean)
Each school you walk into is a family. Each member has its role and place, and no one wants to be left out. In all the years I have been in the schools, I cannot count the number of times I have borrowed the janitor’s hammer to “fix-up” a student’s locker to increase accessibility, or the number of adapted scissors (usually the loop scissors) I have given to art teachers for our students in special education classrooms to use while in their classroom. These are all things that can help build relationships within each of your campuses. No one is too great or too small to be involved. When you ask for that hammer, be genuine while you ask how their day is going. Take a second to see what the cafeteria monitor’s favorite TV show is. When you take the time to build these relationships across the entire campus, you can bet that they are going to reciprocate that relationship and take an interest in you.
Tip #2: Take time to build rapport
“Always start with building rapport with your clients, you’ll be able to more effectively meet your goals once your students have a solid trust in you and your relationship!” - @Kidscopinglab (Dr. Meryl & Shae)
The phrase “It takes a village to raise a child” can definitely apply here. Taking some time to build rapport with each of those individuals can help bring the entire team together. It can be simple things, like asking about their day, or offering to check supplies of adapted paper so they never run out. It could mean taking some time to sit in on the IEP meeting they told you about last minute, or adapting and integrating parent strategies into the classroom setting. Once you take this time to build rapport with the team, it becomes easier for them to help you as well if you get into a difficult situation.
Tip #3: Do not be afraid to ask questions
“Ask questions! Ask where the bathroom/gym/nurse’s office is rather than wandering around until you find it…Ask for help, Ask what people mean by acronyms- you get smarter and better at your job when you ask clarifying questions than when you pretend to know what people are talking about” @Michellemarie5 (Michelle)
This is where the previous rapport building and building relationships can come in handy. If you have taken the time to build rapport and relationships on your campuses, they are going to be more likely to help you. It can be embarrassing to ask simple questions about the location of the bathroom or where room 204 is. If you take time to build relationships, the teachers and staff are going to be more than willing to help you. They know you care.
Tip #4: Reach out for training and in turn, train others
“Take advantage of all the mentorship you can get. Watch and learn” @Tarradp (Tarra)
“Do a lot of training. Train those teachers, push in, and present, present, present. You have too many kids to see all alone so instill help in the staff. Collaborate constantly.” - @Kidsviewtherapy (Theresa)
“Collaborate and create alliances with your case carriers and specialized academic instruction teachers, They will be your eyes and ears for your students everyday even if you physically can’t be on the school campus.” @Mamawells329 (Christine)
“Push in to the classroom, let the teachers see you working with the students. It will help create rapport with the teachers and buy-in for interventions you want to implement. Also makes sure what you might be working on in a pull out session transfer into their everyday environment” @Ashmenzies (Ashley)
Take a second to think back to your entry-level OT curriculum. What was one of the tools your professors or instructors would use to help teach concepts? Teaching others! Once you have received some training or some correction, take the time to turn around and apply it. This could be through training a teacher on a strategy you are using with a student or discussing a new strategy with a coworker or colleague. This can also help you build collaborative teams and alliances within your different campuses. If you have access to other OTs, maybe see if they can come and observe you or sit with you through your first IEP meeting. They can help you point out things about yourself that you may not pick up on. It could be little things like “your posture appeared very closed and uninviting” to “when you are talking with the parent, a different way to phrase that would be…”. Do not look at it as a colleague trying to pick apart everything little thing you do, but as an opportunity to grow and learn as a therapist.
Listen to Episode 45 of the OT School House Podcast for even more tips!
Tip #5: Find your own organization strategy so you can be flexible
“1. Using electronic documentation as much as possible and find some sort of way to keep track of IEP dates. 2. Try to avoid bouncing back and forth between schools.” - @Yoursch00lot (Amanda)
“I recommend making yourself a checklist of all the things that need to be completed before/after IEPs (data collection, teacher consult, scoring goals, drafting goals, documentation, etc.).” - @Sarahbeeot (Sarah)
“Before IEP meetings observe the child in class, talk to the teacher, and call the parents." - @Wootherapy (Meghan)
“Be kind to yourself. Figure out a schedule that allows you to spend the most time with your kiddos and supporting staff.” - @Mornings.with.an.ot.mom (Danielle)
“Be flexible! Write everything in pencil because it will change. Also, give yourself some grace to make mistakes and take long on things. The first year is DIFFICULT and so you need that year to learn the rhythm and routine of the school year.” - @hopemccarroll (Hope)
Everyone is going to have their own way to keep organized. Jayson, for instance, keeps items electronically. He even offers you resources for free to help with organization when you subscribe to the OTschoolhouse.com email list. I, however, do not keep up with items well if I keep them online or electronically. I have forms that I keep in one binder and have dividers for each campus. I have had systems in the past where I had a binder or folder for each campus. I think you need to figure out a system that works best for you that is going to help you stay organized. Also, I keep a paper planner and write out a schedule every single week. I take it as an opportunity to cluster treatment sessions on the same campus and look at moving sessions if I have an IEP meeting or additional staff meeting on the campus a different day of the week. I do this knowing that my schedule will change during the week, but I can easily keep track of the sessions I need to move and reschedule when changes come. And that is not an “if changes come” but “when they come”.
Tip #6: Document everything
“If it’s not documented, It never happened!” -Elisa Wern
Documentation is everything. Documentation is not just for treatment sessions but, it is also for everyday tasks and conversations as well. If an incident happens, document it. A consultation with a teacher or conversation with the parent, document it. If you attended an IEP meeting or staffing, document it. You really should do this for a number of reasons: First, It becomes part of the child’s running record and chart. Even IEP meetings can help document recommendations made about service time so another therapist could look at it and see the progression over time. Second, this can also really show the time it takes to be part of a child’s case. Districts are always looking for documentation related to how you spend your time during the day. This is a great way to document that. It is hard to quantify a conversation with a parent or how long consultation meetings with teachers actually take. This is a way to keep track of that. And finally, if you are ever questioned about how you spend your time, you are able to pull your own documentation records and see exactly what you did because you documented it.
Tip #7: Advocate for yourself
“Advocate for the children but most importantly YOURSELF.” @OTwithKenzie (Kenzie)
“Change takes time. You will see many things you are not ok with. Focus on the things you can change.” - @mornings.with.an.ot.mom (Danielle)
In the school system, advocating as an occupational therapist could look many different ways. Maybe it is advocating for additional OT staff or for help on a campus or two because you are behind on treatment sessions or piled with evaluations. You may also choose to advocate for additional programming on a campus because of a trend you are seeing related to the mental health and anxiety in the children on that campus. You may also advocate for additional training and help on a particular case. Do not be afraid to be honest with yourself and others about your needs. Many of the educational service centers and AOTA have tons of resources, but you may not always know how to access those. It never hurts to ask!
Although you may feel alone in this endeavor of school-based therapy, know that you have access to a plethora of other school-based therapists virtually that you can also rely on for additional advice. There are many Facebook groups, podcasts (such as the OT School House Podcast), blogs, and Instagram accounts (including all the people who are quoted in this article) that can all be used as resources to build your own therapy community. Do not be afraid to put yourself out there and to build that community!
Have a great first year!
Hope McCarroll has been an occupational therapist since 2011. Her primary area of focus has been school-based occupational therapy services. She recently made the leap to academia and is currently core faculty at University of St. Augustine for Health Sciences. Hope continues to practice as a pediatric occupational therapist while teaching occupational therapy students.