What are some of the most common related services used in schools?
Page 6: Occupational Therapy Services
A primary goal of occupational therapy (OT) is to support a student’s participation in school-related routines and activities, such as zippering a coat, completing a classroom assignment, or playing during recess. Occupational therapy practitioners identify the student’s strengths, as well as his or her challenges, during all educational activities, whether they take place in the lunchroom, classroom, or playground. They are experts in looking at the student holistically and assessing his or her activity performance in terms of its components: cognitive, sensory, motor, perceptual, and social-emotional. They are skilled in analyzing and modifying activities and environments so that they are conducive to learning and social participation. Students who receive OT services are those who might be facing difficulties with:
- Completing classroom assignments
- Organizing classroom materials and workspaces
- Manipulating objects or materials (e.g., scissors, paintbrush, pencil)
- Turning pages in a book
Performing self-help skills (e.g., putting coats on or taking them off, changing for gym class, pulling pants up or down for toileting)- Feeding themselves (e.g., holding a spoon, chewing food, avoiding foods for sensory reasons)
- Attending to tasks or following directions (e.g., in cases in which the student is easily distracted by things in the environment)
- Taking notes in class or writing legibly
- Tolerating sensory input (e.g., the student might have aversion to some textures, tastes, or sounds)
- Carrying out tasks that involve visual-perceptual skills (e.g., tracking text when reading so as not to skip words or lines, visually identifying important information in text or on worksheets)
- Participating socially (e.g., developing peer relationships, turn-taking abilities)
- Transitioning from one environment to another (e.g., high school to post-secondary job or college)
Qualified Providers:
To be qualified, an occupational therapist or an occupational therapy assistant (OTA), who work under the supervision of an OT, he or she must have a college degree that ranges from an associate’s degree for an OTA to a master’s or doctorate degree for an OT. To be qualified to provide services, both OTs and OTAs must pass a national certification exam.
Roles: OTs and OTAs are experts in analyzing and modifying tasks and environments (e.g., classroom, playground, lunchroom) so that students with disabilities can learn and actively participate during the school day. By providing accommodations or by making adjustments to or redesigning the activity, OTs help students’ access curricular and extracurricular activities.
National Professional Organizations: The American Occupation Therapy Association, Inc. https://www.aota.org/.
Heather Grinage, a school-based practitioner, provides occupational therapy services to a young student with low muscle tone who is having difficulty participating in the self-care activities that are necessary for her school success.
Watch the video below to see how OT is provided for this young student in the lunchroom (time: 1:33).
Transcript: Heather Grinage Provides Occupational Therapy Services
Ms. Heather: We have been working on opening up different packages and containers so that Catelyn can be more successful at lunchtime. And sometimes she relies on her peers to help her out, which is okay, but we want her to learn to do it by herself. Okay, okay. Oh, you’re going to do that one first?
Catelyn: Yes.
Ms. Heather: Oh, good job. Awesome. Pull hard. Good work, Catelyn. Let’s work on your chocolate-chip granola bar. Okay, Ms. Heather’s going to help you, okay? Remember, we’re going to do two pinches. Pinch it here. Ready? Let me help you with your fingers. You ready? I’m going to kind of start it for you, and we’re going to pull, pull, pull, pull, pull, pull, pull. Oh, did we get it? And, look right here, we’re going to pull it on the side again. Pull, pull, pull. Okay, and look. I think you can stick a finger in. You see where there’s a little hole there? Good job, Catelyn. You’re doing great. Keep it up. Use those pincher fingers. Great. Oh, you did a good job. Oh, wow, you did such a good job. Tell her what a great job she did. Good work, all right.
Listen as Heather Grinage furthers describes how she collaborates with teachers to provide assistance with adapted equipment for the young student in the video above (time: 2:12).
Transcript: Providing Assistance with Adapted Equipment
Teacher: A lot of times, we’ll put in some adaptive equipment into the classroom, and that might be something that’s altered a little bit to make the job of writing, cutting, being a student in the classroom easier. So Catelyn has a couple of things. She has a pencil that has a very thick lead. We saw when she was doing some activities that she was a little shaky and that she has weakness. The lead in this pencil is very thick so it gives her a wider base of support for writing and it allows her to have smoother lines while writing so her writing’s more legible. We’ve also worked on grasp skills with her, and I’ve put little stickers on her pencils to help cue her to hold the pencil correctly. Okay. So we’ve placed stickers on her pencil so that she knows where to position her fingers and thumb correctly. Otherwise, a lot of times, Catelyn might hold the pencil like this. Because of the weakness, she’s using more fingers and a larger motor movement, and these stickers help her to position her thumb and finger in a functional position for writing. All right. The other piece of adaptive equipment that Catelyn has that we weren’t using earlier, because we wanted to make sure we had a clear shot of everything, is a slanted surface. The reason for this slanted surface is to get her hand and her wrist in a more functional position for writing. When she holds her wrist in this position, it blocks small finger and thumb movements, so the slanted surface helps get her wrist and fingers in a more functional position for writing. It also helps her visually because of the arc or the slant of her paper versus when she’s looking up at the teacher and then looking down. She doesn’t have to move her head at a larger angle while using the slanted surface. So this helps her out quite a bit. It’s also helped because she doesn’t always use her left hand as a stabilizer. So if she gets tired or fatigued, she can always clip her paper on at the top.
The last thing that we use in the classroom setting is a wiggle cushion. Sometimes, when Catelyn is sitting at her desk or trying to attend to the teacher, she almost goes down into a shutdown state where she daydreams, looks off, and isn’t attentive. And so this allows her to sit on a cushion and have a little bit of wiggle movement and helps to her for her be a little more alert and attentive while she’s doing classroom work.
the OT's Corner
Listen as Sandra Schefkind describes school-based occupational therapy.
Sandra Schefkind, MS, OTR/L
Pediatric Coordinator,
American Occupational Therapy Association (AOTA)
Bethesda, MD
Providing services in the least-restrictive environment (time: 1:59)
Transcript: Sandra Schefkind, MS, OTR/L – Supporting students’ participation academically and socially
Occupational therapy practitioners help individuals to participate in their daily routines or their daily activities. Occupational therapy helps children to be able to participate in all of their school environments, whether it’s on the playground, in the lunchroom, in the classroom, or on the school bus. Practitioners try to support student achievement in terms of their academics, but also their social participation. This includes reading and writing, but it also includes student behavior and mental health that impacts their learning. So we want students to be able to access and progress through the curriculum. For example, occupational therapists can support students when they’re completing their classroom assignments, by addressing their assistive technology needs, or supporting their ability to attend and follow directions, and also helping them transition to the next grade level.
Occupational therapy practitioners would also support students during nonacademic activities, too. That would include social participation and positive behaviors that are necessary for school success. Examples of this would be self-advocacy skills, coping with stress, developing and keeping friendships during playground time. Occupational therapy practitioners might also be involved in school-wide initiatives such as early literacy and bullying prevention. We want to help make a good fit between the student, the environment where he’s participating, and the activity that he’s being asked to perform. Occupational therapy practitioners analyze performance of students in terms of their components, in terms of the activities sensory, motor, perceptual, cognitive, emotional, functional communication, and the social skills that are necessary for someone to participate and to be able to engage in their life routines. We’ll also look at their environment. Is the environment conducive and accommodating to the student in order for him to participate? Are there barriers that need to be reduced? We look at the student by assessing their strengths, needs, desires, interests, and their future goals.
Transcript: Sandra Schefkind, MS, OTR/L – Providing services in the least-restrictive environment
We are trying to provide services in the least-restrictive environment to the extent possible. Whenever possible, we are providing service within the classroom to see genuine, naturally occurring activities and events to see how the child engages or participates during the school day. For example, how is this child completing a classroom task when they’re dealing with the challenges of outside noises through the window? How well does this child participate during recess time on the playground or when they’re being asked to transition back into the classroom? Is this child organized with his locker and his school materials? Is he ready to learn? How independent is this child when he’s zippering his coat or navigating the hallway? Is his attention or his behavior impacting his social participation or his learning? When we observe the student in the classroom, our clinical observations help to identify this child’s strengths and his challenges.
The occupational therapy practitioner would also be offering valuable information to support the teacher. We want to help the teacher to be able to do their job. The therapist might recommend some classroom modifications to reduce the barriers and to increase the student’s ability to engage in his school activities. For example, the therapist could conduct an in-service to all the educators for some handwriting strategies that could benefit all the students. Or the therapist might recommend some alerting or calming strategies that might impact the classroom behavior of all the students. Some of these strategies are referred to as UDL, or Universal Design for Learning, because that’s referring to the design of the school materials or the methods that will promote the learning of all the students.
Examples: supporting students who have challenges with:
Attention (time: 2:34)
Transition needs (time: 2:10)
Sensory issue (time: 2:22)
Transcript: Sandra Schefkind, MS, OTR/L – Attention
The occupational therapist is trying to promote the participation of this child throughout the school day, so the question is how are these attention issues impacting his participation? The occupational therapy practitioner might be offering strategies to try to calm the child, or try to help him to attend and to focus. The therapist might be modifying the environment or an activity so the child can be more successful. For example, the therapist might recommend a different placement of the desk or a cushion for the child to sit on that might give him a little more sensory and motor input as he performs his schoolwork. Another possibility would be trying to infuse more physical activity throughout the school day. Perhaps this child needs more breaks during some academically challenging times within the classroom so he has some opportunities to change his focus and kind of “get his wiggles out” so he can better attend to classroom instruction. Breaking down a task into its key components and offering classroom instruction in parts or with simple directions might help this child complete his assignments more successfully. An occupational therapist might be able to help to break down these tasks. The occupational therapy practitioner is an expert in assessing any school day activity and suggesting ways that work best for this child.
For example, can he complete his assignment best from copying from the board, listening to the directions, or perhaps using adaptive paper and pencil to complete a task? The therapist is really an expert in breaking down the tasks into the parts the child’s being asked to do. We can ask the child to just do part of an activity that the teacher’s asking him to complete. Would that help him be more successful? The occupational therapy practitioner may help to identify a different learning style for this child with attention issues that might be better suited to him specifically. For example, the child might actually be more successful in completing a worksheet if he’s standing rather than sitting at a desk. The occupational therapy practitioner is trying not to just help this individual student with attention issues but really supporting all the staff to understand how we can make this classroom more conducive to learning and to make things more conducive for this particular child to be able to complete his learning.
Transcript: Sandra Schefkind, MS, OTR/L – Transition needs
The occupational therapy practitioner can support this student as his transition needs are being addressed. How can we build on this student’s skills, interests, and his strengths and move him towards community integration, towards post-secondary career or education? We want this child with a disability to express his interests and his goals. This is the concept of self-determination. How realistic are the student’s future goals and how can the occupational therapy practitioner offer opportunities within the school day so he can build his skills so that he’s more ready to enter the work place in the future? For example, can the occupational therapy practitioner help a middle school student or high school student build a work portfolio? Could this child volunteer in the school library to practice his work or job skills like punctuality and dependability? What are this child’s leisure interests and how can these be promoted? Does he have the social skills necessary to make and keep a friend so that this child is better integrated into the community? We’re interested in helping this child develop the needed living skills so he can participate socially and academically currently, but also for the future. The occupational therapy practitioners can also partner with outside agencies to see if this child can get an internship or volunteer job and even go to the sites to assess if the work place is accessible and if the tasks are well suited to his abilities. Occupational therapy practitioners have great expertise in activity analysis and environmental modification, so they could look specifically at the internship tasks and recommend modifications so the child can be as successful as possible in meeting the activity’s demands. Occupational therapy practitioners want to try to help the student be more readied, be more prepared, and be more successful for his future work, future education, and his social participation.
Transcript: Sandra Schefkind, MS, OTR/L – Sensory issue
The occupational therapy practitioner has expertise in assessing the sensory components that are all around us, whether it’s sounds, smells, textures, movements. This is what we typically receive and filter and accommodate all day, every day. But the student with a sensory challenge might find certain smells or textures irritating, and this might lead to inattention or oppositional behavior. So, first, an assessment, such as a sensory profile or sensory…conducting a sensory processing measure could be conducted. Then the occupational therapy practitioner might develop a “sensory diet” for an individual student so he can receive the optimal sensory input for his school performance and try to actually reduce his sensitivities and promote his school participation. A simple example would be that of a child who’s really averse to glue. Let’s say he goes to art class, and the teacher’s asking him to participate in an art activity, and he’s literally gagging when he’s being asked to squeeze the glue bottle, and he becomes oppositional. He doesn’t want to participate in the activity. And the teacher might be misinterpreting this disengagement or this oppositional behavior, thinking that he’s just noncompliant, when he truly just is so uncomfortable with the texture of the glue that he’s not able to participate in this art activity. A simple suggestion that the occupational therapist might offer would be just to use a glue stick so the child doesn’t have to manipulate the glue, and that might solve the problem. And then the child would be able to complete the art activity and feel successful. This child really just needs some simple accommodations and some strategies to help him participate more fully. But then the therapist would also try to slowly introduce different classroom textures and provide a “sensory diet,” individualized to this child, to accommodate and remediate some of this hypersensitivity that he’s showing to sensory information. And then the therapist would also collaborate with the teachers to try to address the sensory needs throughout the school day, because there could be other challenges. If the student’s having difficulty with the glue, he might have challenges during other school activities, such as textures, food textures at lunchtime, or even, for example, during science instruction when there would be a sand experiment. He may have difficulty with that texture.
