Your First 90 Days as a School-Based OT (Checklist Included)
- Feb 26
- 8 min read
Updated: Mar 2
No matter the university you attended or the experience you have in other OT settings, starting as a school-based OT is equal parts exciting and overwhelming.
The caseloads are high, the calendar is packed with IEP meetings before you've even met your students, and no one has handed you a manual on where to start.
The good news? You don't need to have it all figured out on day one.
Here's a week-by-week roadmap for your first 90 days to help you get from overwhelmed to a point where you actually have an idea what is coming next.
Get your FREE 90-Day Checklist!
Before we dive in, I put together a free companion checklist that walks you through every step in this guide, organized by week. It's printable, it fits in your binder, and it's yours to keep.
Enter your name and email below and I'll send it straight to your inbox.
*School districts sometimes block our emails, so we suggest using your personal email to ensure you get your checklist.
Week 1: Orient Yourself
Get to Know the People Who Will Support You
Before you worry about therapy schedules or IEP goals, invest time in building relationships. Your effectiveness as a school-based OT will depend far more on your connections with people than on your clinical skills alone.
Make it a priority to introduce yourself to:
Other OTPs: If your district has other OTPs, be sure to connect with them. Try shadowing or meeting up with another OTP for lunch once a month to get the support you need.
The speech-language pathologist (SLP): When there isn't an OT to ask for help, SLPs can be your next best option for IEP and goal writing support. Later on, they also make great collaboration partners.
The school psychologist: A key partner in evaluations and eligibility decisions. They tend to have a good sense of the referral processes and district policies. They test a lot of kids and may be able to help you understand standardized assessment data.
School secretaries: They run the building (no joke). Be kind, be grateful, and never underestimate them. When you need a quiet room, copies of your report, or help finding a kid, the secretary will be your go-to contact.
The custodians: They will help you solve problems you didn't know you had. The custodial staff has helped me with everything from finding a chair for a kinder kid to building a Southpaw Swing rig in the OT room.
Organize Your Caseload
You can't serve students if you don't know they exist. Set up a spreadsheet before your first week is over and populate it with the following for every student on your caseload:
Student name and grade
Classroom teacher
Case carrier (If different from the teacher)
Service frequency, minutes, and type (direct, consultative, or both)
Date of last evaluation
Annual IEP date
Triennial re-evaluation date
This spreadsheet becomes the dashboard that guides your week-to-week operations. It may not be glamorous (unless spreadsheets are your jam), but it might be the single most important organizational tool you build.
Quick note: To complete this step, you will need access to your district's IEP and student management systems. Don't be afraid to reach out to the IT department if you don't have access to these systems in the first few days.
Get Ahead of Upcoming IEPs
Scan your spreadsheet immediately for students with IEPs that are past due or due in the next 4 to 6 weeks. Get in touch with the case carrier to see if an IEP has been scheduled, and block time on your calendar now to meet with those students to review their goals before the meeting.
The thing you want to avoid at all costs: walking into an IEP and telling a parent, "I haven't had a chance to see your child yet." Unless it is genuinely your very first week on the job, this erodes trust quickly. IEPs don't wait for your timeline, so flag them on day one.
IEPs are such a big deal that I have heard of new school-based OTPs being asked to attend an IEP even before their official start date. So, yeah, you want to be prepared for them.
Weeks 2–3: Get Moving
Set Up a Schedule. It Doesn't Need to be Perfect.
New practitioners often delay starting services until they can build the "perfect schedule".
But let me share a secret with you. There is no such thing as a perfect schedule!
Build a schedule, start seeing students, and adjust accordingly as conflicts arise. You can (and will) regularly revise your schedule as you add students, dismiss students, and make changes to students' service minutes.
A schedule that starts imperfect and gets refined beats a perfect schedule that never gets off the ground. Movement is progress.
Pro tip: Using a Google Doc or Sheet to keep your schedule makes it easy to share with teachers who want to know exactly when you see their students. Some teachers care, others don't.
Build Your Goal-Tracking System
Keeping track of student goals and progress doesn't need to be complicated, but it does need to be consistent. One approach that has helped me is using a physical binder for each school site (or every one to three schools, depending on caseload size).
Organize each binder by the days and times you see students. When you finish with one student, flip the page, and the next student's goals and data sheets are right there. No hunting, no guessing. And if a student is absent, you just flip to the next student.
Your daily progress notes and data tracking can live in the same binder.
Prefer digital? A Google Doc or folder system organized by school and session time works just as well. What matters is that your system reduces friction so you can focus on the student in front of you, not on finding paperwork.
Want to fast-track your way to being a confident school-based OT?
Skip the uneasy feeling of being brand new to the schools & learn how to better support the students you serve with the A-Z School-Based OT Course.
Learn and implement the processes and systems I put in place as school-based OT beyond the first 90 days to make my life easier and support my students more effectively.
Weeks 4–6: Build your School-based OT Momentum
Prioritize Rapport Over Progress
This might feel counterintuitive, but for your first six weeks, worry more about building genuine relationships with your students and their teachers than about driving measurable goal progress.
It is very difficult to make meaningful therapeutic progress with a student you don't know yet. Once rapport is established, students trust you, and teachers see you as a collaborative partner, progress tends to follow naturally.
Show up consistently, be curious about each student, and earn your place in the classroom. That investment pays compounding returns.
Conduct Your First Assessment
At some point in these early weeks, you'll face your first school-based evaluation. If you're not sure where to start, Episode 1 of the OT Schoolhouse Podcast walks you through the process step by step.
Don't let the unfamiliarity paralyze you. A solid evaluation follows a clear process, and you've been trained for this — even if it doesn't feel that way yet.
We also have posts about completing evaluations and various assessment tools in our article archive.
Get Comfortable Not Knowing the Answer
You will be asked questions you don't know the answer to — in IEP meetings, in hallway conversations, even from students. This is not a failure. It is an unavoidable feature of being new to a complex setting.
The professional and perfectly acceptable response to this is:
"That's a great question. Let me look into that and get back to you."
Then follow through. Teams respect this far more than a confident-sounding answer that turns out to be wrong. Lean on your SLP, school psych, and fellow OTPs. Find a mentor if you can.
"Fake it till you make it" is not the correct approach as a new school-based OT.
Weeks 7–12: Find Your Footing
Start Driving Intentional Goal Progress
With relationships established and your systems running, you'll (hopefully) begin to feel confident enough to shift from orientation mode to practice mode. You know your students now. You know the teachers (enough). Start pushing intentionally toward goal progress and use your data tracking system to document it.
Lean Into the PLOP → Goals → Services Framework
If there is one idea that will get you through 90% of your IEP meetings, it's this: the Present Levels of Performance (PLOP) drive the goals, and the goals drive the services.
Services are not justified by a diagnosis, parent/doctor referral, or even a well-intentioned teacher.
They are justified by a documented gap between where the student currently performs and what is required for educational participation, and by goals that aim to close that gap. Understand this deeply, and you'll be able to confidently explain and defend your recommendations to any team.
When in doubt: start with the PLOP. Everything else follows.
Inside the OT Schoolhouse Collaborative, I teach a course on how to determine services. Learn more about it here if you need additional support.
Refine Your Schedule and Systems
By now, you're starting to figure out what's working and what isn't. Adjust your schedule, move some pages around in your binder or digital system, and start building the rhythms that will carry you through the rest of the year.
What NOT to Worry About in your first 90 days...
Just as important as knowing what to do is knowing what to set aside... at least for now.
Advanced CEU courses. Your energy is better spent consolidating what you know and applying it. Focused, short-form courses (like these) will give you far more practical value in year one than a deep dive into a specialty framework you haven't had a chance to use yet.
Hours of therapy planning. Over-detailed session plans don't survive reality. Absences, scheduling conflicts, and the unpredictable energy of real students will constantly reshape your plans.
You will be amazed at what you can create in the moment with just the student, some paper, a few different manipulatives, and some open space. Trust your ability to adapt in the moment.
MTSS. The multi-tiered system of supports is an important framework, but it's a layer of complexity to add after you have a solid foundation in the IEP process. Get that foundation first. MTSS will still be there when you're ready.
You've Got This
The first 90 days of any new position are hard. In a school, they're particularly difficult because real students, real families, and real teams are counting on you.
But every experienced school-based OT you admire walked through the same uncertainty you're in right now.
Follow this roadmap, give yourself grace during the learning curve, and focus on the relationships that will make everything else possible. The clinical expertise you're still building will catch up to your commitment — it always does.
And when you need support, this is what the OT Schoolhouse is here for. We'll be here to support you with articles, the OT Schoolhouse Podcast, and the OT Schoolhouse Collaborative.
Now, go enjoy being a school-based OT practitioner!
Don't Forget your FREE 90-Day Checklist!
I put together a free companion checklist that walks you through every step in this guide, organized by week. It's printable, it fits in your binder, and it's yours to keep.
Enter your name and email below and I'll send it straight to your inbox.
*School districts sometimes block our emails, so we suggest using your personal email to ensure you get your checklist.