Occupational therapists (OTs) are regulated health care professionals who work with children in a variety of settings, including schools.
As children grow and develop, they learn to do many things, including taking care of themselves, managing their school work, playing sports or developing a leisure interest/hobby.
Sometimes, children have more problems than is typical for their age with motor skills. This can make everyday activities a challenge to learn and master.
OTs know a lot about the development of gross and fine motor skills. Fine motor skills are important for success with daily tasks such as printing, drawing, cutting with scissors and doing up buttons and zippers.
Gross motor skills are necessary for stable posture, skipping, running, catching balls and riding a bike. When children have difficulties with these daily activities because of a motor problem, it is hard to fully participate in the things they need to do, want to do, or are expected to do at home, at school and in the community.
Occupational therapists can help teachers and parents better understand and help these children succeed with everyday activities.
Children and young people learn, play and socialise in school. Whilst most children find participating in activities (or occupations) such as writing a story, playing in the playground or finding their way around the school manageable, these present challenges for some children and young people.
Occupational therapists are trained to understand the whole person, including physical, mental health, emotional and behavioural needs and their impact on school life. Occupational therapists have the expertise to work in both mainstream and specialist school settings
In partnership with the school staff, child or young person and parents/carers, strategies for enhancing participation will be explored, for example:
Collaborating with teachers and staff by providing relevant training and consultation for whole school or whole class approaches. Occupational therapists can advise on reasonable adjustments, support the school’s handwriting policy development, suggest environmental adaptations to support the canteen routine, or ensure the playground is inclusive.
Working with individuals or groups of children or young people on activities such as improving dressing or writing skills, keeping focused on a task, making friends or planning transitions.
Including individualised services with focused support for a child or young person in the school. An occupational therapist can provide a specialist chair so the child or young person can access table-top activities, working with technology providers to support a child or young person’s access to the curriculum or develop skills to play with peers during break times
School-based occupational therapy practitioners are occupational therapists (OTs) and occupational therapy assistants (OTAs) who use meaningful activities (occupations) to help children and youth participate in what they need and/or want to do in order to promote physical and mental health and well-being.
Occupational therapy addresses the physical, cognitive, psychosocial and sensory components of performance. In schools, occupational therapy practitioners focus on academics, play and leisure, social participation, self-care skills (ADLs or Activities of Daily Living), and transition/work skills. Occupational therapy’s expertise includes activity and environmental analysis and modification with a goal of reducing the barriers to participation.
Practitioners can contribute in an early intervening, multi-tiered approach (i.e., Response to Intervention) within general education. Occupational therapists can assist with periodic screenings/probes (including both data collection and analysis), provide teacher training, model activities to whole classrooms or small groups, and assist with team problem solving.
Evaluation services assist the Individualized Education Program (IEP) team with identifying the presence of a disability and whether there is an educational need for occupational therapy services. Occupational therapy intervention is provided directly “to the child, or on behalf of the child, and [as]...program modifications or supports for school personnel
This may include adapting the environment, modifying curriculum, supporting accommodations, ensuring access and participation in school activities and educational programs, and assisting in preparation for transition post-graduation. Services take place in natural school settings during the routines of the school day, and are most beneficial when
they occur at the location and time that the student is experiencing challenges. Services are designed to support progress on the student’s IEP.
Practitioners can provide training in typical and atypical child development and the impact of physical and mental health on learning and participation at school. Training of school personnel in lifts and transfers can ensure student safety and prevent staff back injuries. Occupational therapy practitioners can contribute to universal design for learning (UDL), support the use of assistive technology, and provide information on positive behavior interventions and supports (PBIS) including bullying prevention.
As members of IEP teams, technical assistance teams, problem-solving teams, and curriculum committees, practitioners bring their unique skills to aid students in accessing learning opportunities. They support student participation in school routines while promoting independence.
Occupational therapy practitioners focus on helping students achieve their academic and behavior outcomes which in turn improve school districts’ ability to meet state and national achievement standards (i.e., Common Core State Standards). Practitioners can help students prepare for future employment and life skills needed for community integration.
Occupational therapy is a profession who uses “occupations,” or the activities that we all value and do every day, to help people live their life to the fullest.
The actual therapy sessions or structures can look very different depending on the client, his or her age, and what occupations or activities they need to do. For children, the focus of occupational therapy is to address any developmental, physical, social, emotional, or mental health needs that may be impacting the child’s ability to fully engage in their home, community, and school environments.
Following this, recommendations are given and support with relevant tools are provided.
Well, first, it’s my belief that if a child has experienced early adversity of any type then an occupational evaluation is warranted.
This is because we know that early adversity is, in itself, a risk factor in regard to the ability to participate effectively in the school, home, and community.
Many sensory-based needs can correlate with trauma that a child has experienced. Bruce Perry’s research and work has demonstrated the neurological needs that many of our children with difficult histories experience.
As far as specific issues and red flags to look for I’d say to assess if your child has difficulty with daily tasks that would be appropriate for their age including the following tasks: tolerating and participating in getting dressed, transitioning from one activity to another, engaging with peers, following directions (as appropriate for their age), sensory needs, and behavior needs. Many children who really need occupational therapy and can improve can be mislabeled as “misbehaving” when they actually have true neurological delays that are guiding their behavior. An occupational therapist can help address the underlying needs that their behavior is communicating.
There are several different models and ways to access occupational therapy. Different models also have different levels of intensity, qualifiers for access, and general foci of therapy.
1) Early Intervention is state provided therapy, which is primarily focused on family training. A child must fall below specific benchmarks to qualify for EI. Your pediatrician can make this referral and early intervention is provided through your Local Education Authority.
2) School-based therapy is state provided therapy, which is focused on meeting the child’s needs as relates to their academic goals. A child must fall below certain benchmarks to qualify for school-based therapy. Additionally, a child must qualify for other special education services to access school-based occupational therapy. Ask your special education coordinator at your public school about an evaluation if you think your child may need special education services. This may vary from schools too schools
3) Outpatient therapy is client and family centered. This means that the goals the therapist addresses will be guided by the child and family’s goals.
A physician, dentist, chiropractor, optometrist, or nurse practitioner and even a parent can make a referral to outpatient occupational therapy.
At the British School of Outdoor Education, where I work you can call and our office will walk you through exactly what steps you need to take to set up an evaluation. In my opinion, outpatient therapy provides the best environment to address underlying needs that many of our children experience.
This will vary depending on the setting (Early Intervention, school, or outpatient) but for outpatient therapy you can expect that your therapist will want to understand the child’s medical and social history as well as what activities, routines, and roles are important in your family.
When you set up an OT evaluation, most OTs will do their best to make you and your child feel comfortable. Many OTs will begin the evaluation with some play activity to build rapport with the child.
It’s very different than a doctor’s office visit! Some testing may be completed to evaluate underlying skills such as coordination or visual perception skills. These tests are typically not tedious in the way that IQ or diagnostic testing often is. The OT will also likely want the parent to complete a sensory profile. During the evaluation, it’s likely that the OT will complete several activities with your child that look a good bit like play. This is because play is the language of children and is usually the best way to assess a child’s social, coordination, and sensory needs.
All occupational therapists working with children should be working with the whole family to equip you to know how to best help your child at home.
Your OT can help you structure your morning and bedtime routines to meet your child’s needs, design activities at home to build connection and attachment, implement sensory regulating strategies, and provide home programs to continue to build skills.