New school-based occupational therapists have a steep learning curve.
To be honest, the experience of being a first-year school-based OT can be very similar to being a first-year teacher. Though you may be an excellent therapist and know how to do a great job when it comes to actually working with the students themselves, there is just so much extra stuff to learn and figure out when you are first starting in the schools.
Wouldn’t it be great if you had someone to point you in the right direction during your first year as a school-based OT?
Photo Credit: Nicole Mays via Flickr CC
Personally, this is my third year working in the schools (and my fourth year as an OT), where I serve a high-income, high-profile school district in California. Last school year I supervised and provided OT services for 7 school sites within the district (PreK-8th), plus 3 additional non-district sites, plus supervised a COTA/L and Level II fieldwork student.
I have learned many helpful tips during this time and want to pass them along to those of you who are becoming new school-based occupational therapists!
To be honest, there are so many tips I could include in a post like this. But because I don’t want to overwhelm you or make you freak out and think you need to know everything about everything (because you don’t), I will do my best to stick to the basics, the most important and helpful things you need to know when you’re first starting out. I could include specific tips and information about topics like assessments, screenings, treatment notes, report-writing, email etiquette, IEPs, etc., but I really think that information is best discussed directly with a supervisor or another therapist who knows the ins and outs of your particular district or contract company. So if, after reading this, you still have questions (and I’m sure you will!) be sure to communicate with the appropriate supervisor or therapist for more specific guidance.
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Ready? Here we go!
Helpful Tips for New School-Based Occupational Therapists
Trust is the most important aspect of your job. Especially when you’re first starting out. It will be extremely difficult to work with students, teachers, aides, therapists, principals and, oh yeah, parents, if you do not first develop trust and rapport with them. Trust is key. It is the foundation upon which the rest of your success and credibility as a school-based occupational therapist is built.
Be nice. Can you believe this is seriously a tip I’m including in this list? This tip obviously doesn’t apply specifically to YOU since you’re the nicest person in the world, right? But it’s true. When I stepped into my current role at the beginning of my school-based career, the number one thing people told me about the previous OT was that she wasn’t nice. She was mean. She was rude. The kids didn’t like her. So do everyone a favor — please be nice and smile!
Do your best to build positive relationships with the aides who work with your students. Though the special education and classroom teachers are the ones officially “in charge” of your students’ educational programs, it is the aides who spend nearly every second of the day with them who are primarily responsible for carrying out your OT recommendations in the classroom and on the playground. This is especially true when it comes to implementing sensory diets for students with intense sensory needs. So say “hi” to them. Smile. Learn their names. Get to know them. Develop rapport. Encourage them. Educate them. Affirm them. They will be an important part of the student’s educational success!
Be friendly with the administrative assistants at each school. They are the gateway to the school, the keeper of much of the information you need. You need to be on good terms with them.
Be friendly and do your best to develop a positive relationship with the principal of each school. Rarely will you need them to intervene in a situation in which you are involved but when they do, YOU WANT THEM ON YOUR SIDE.
Same with your Director of Special Education. You NEED to have their respect and support so that when issues come up (and they will), your director will trust you and back you up. I can’t emphasize this enough!
And same with the teachers and your fellow therapists! We all have tough jobs being in the schools and we all need to support each other. Don’t talk bad about certain teachers or therapists. Don’t make them feel like you’re better than them or you’re too busy for them. If you all share a student on your caseload, then that means you are all on a team together and you need to act like it! I have been in situations where a teacher or therapist has backed me up in an email response to a parent or in an IEP meeting because they know me, trust me, believe in me, and are willing to stand up for my perspective or recommendation. That is awesome. I have had instances where the Director of Special Education, Assistive Technology Specialist, or Special Education Teacher has backed me up in IEP where I was being challenged by a Special Education Attorney. So amazing. A positive relationship with teachers and fellow service providers not only goes a long way, but it is also such a rewarding thing and it actually makes going to work FUN!
Don’t rush into treating students right away. It will never work! More than likely, you will be able to spend your first few days (or even your first week or more) putting together a skeleton of your weekly schedule. If you are a full-time school-based OT and have 40+ students on your caseload, you will have A LOT of teachers to touch base with and many other service providers to schedule around (speech, PT, counseling, etc.). You will not be able to figure it all out the first day! So don’t expect yourself to get it all done in the first day or two and then begin treating right away. Give yourself some time to put the giant puzzle-of-a-schedule together and make it work as best you can.
Speaking of scheduling…spend time putting together your master schedule using a system that makes sense to you. Now that I have been working in school-based OT for a couple years, I have developed a method of organizing my schedule at the beginning of the year that works well for me and keeps me from wanting to pull out my hair. Other therapists have seen how I do it and they have liked it, so I thought it might be helpful to briefly describe my system to you if you are just starting out and are intimidated by the thought of organizing a full caseload of students from day one.
Basically, I print out a blank landscape-oriented Monday-through-Friday schedule that has time slots blocked into 30-minute increments for the entire day. So, for example, the first left-hand column has “Monday” listed at the top and then has several boxes below it in 30-minute increments running from the start to the end of the work day. The second column has “Tuesday”, and so on. Then I take out a pack of sticky note thin strips (such as these, or I just cut a pad of sticky notes into thin strips), go through my list of students, and write each student’s name, school, and number of minutes in their session on a sticky strip. Each sticky strip represents one therapy session. By the time I’m done, I have one sticky strip for every session that needs to be run in a week. This gives me a tangible look at just how many sessions I need to work on scheduling throughout the week, which is especially helpful if you have students who receive more than one OT session per week. Then I start sticking “sessions” onto my blank weekly schedule page. Because I am a very hands-on person, this works way better for me than writing a draft schedule in pencil, erasing, writing sessions into different time slots, erasing again, and so on. If I stick a session into one time slot and then I find that I need to move it, I can simply pick up the sticky strip and place it in the new time slot. Easy peasy!
Get organized from the start. In addition to organizing your students’ schedules, you will also need to figure out how you want to organize your stuff — files, forms, treatment notes, binders, therapy supplies, trunk of your car, etc. Every school-based therapist has a different way of organizing him or herself and there is definitely no one right way. So however you like to organize yourself, do it. Do it soon. Do it NOW. Life will be so much easier once you do!
Start gathering basic treatment materials and figure out how you want to transport them if you will be traveling from site to site. Personally, I like to use a rolling box (such as this one) to cart my therapy supplies around. It keeps things organized, fits plenty of supplies, and saves my back. Looking for ideas of what therapy supplies to keep in your therapy box? Take a peek at what I have in my therapy box in THIS POST.
Create buffers in your schedule, especially at the beginning of the year. It will be nearly impossible to do your job effectively as a school-based OT if you schedule everything back-to-back-to-back all day, every day. Yes, there are days or times of day where you just have to bite the bullet and do 6 sessions straight without even a chance to get a drink or go to the bathroom. But don’t let your schedule be like that every day, all day long. You need to create natural breaks in your schedule in case things happen like the following (all of these have happened to me): a teacher grabs you in the hallway and just has a “quick question that will only take 2 seconds” which then turns into a 15 minute conversation; you need to run a session long for some reason; you need to do a consult or observe a student at a different time than usual; you need to grab some coffee or food or gas for your car on your way from one school to another because it’s just been one of those days; you get called into a last minute meeting and need to shuffle things around; someone passes through your room while you’re working on a report and you end up unexpectedly talking for a few minutes; or, of course, you get a student added to your caseload and now you need to have a slot for him or her in your already full schedule. Buffer!
Try to schedule a consistent block of time for assessments and write-ups each week. It’s okay if you don’t use that time block for that specific purpose every week. You can treatment plan, prep materials, work in SEIS, squeeze in consults or make-ups, observe in classrooms or on the playground, make phone calls or write emails to parents, do your billing…there is ALWAYS something to be done. But really try to have a protected block of time so when things get crazy, you will still have time to do your screenings, evaluations, and write-ups without having to stay up past midnight every night to get it all done.
Group kids into pairs in your sessions when you can, as long as it makes sense with their needs and personalities. This can help open up your schedule immensely.
Lead groups when you can, especially if you are in an SDC class and have several students on your caseload (especially if they are on consult). It makes sure you have consistent contact with them and their teacher while also keeping your schedule manageable.
If your district allows it, write OT sessions as an annual number on the IEP rather than a “per week” number. The annual number of sessions will depend on how many weeks are in your school year and how many “off weeks” you need to account for. In my experience, having an annual number of sessions to fulfill makes life easier for everyone involved, as opposed to listing it as “30 min, 1x/week” (or whatever minutes and frequency you are recommending). If you haven’t done this before or are unsure of how to approach this, check with your appropriate supervisor or colleague.
Be flexible. Rarely will things go the way you planned. Sessions, schedules, recommendations, reports, meetings. Even district or company policies. Everything. Things are in a constant state of change. If you want to keep your sanity, don’t fight it. Embrace it and go with the flow.
Don’t be afraid to ask questions. It is totally normal to feel overwhelmed and lost when starting in the schools. Ask the administrative assistant how to get to a particular classroom or how to use the copy machine. Ask the teacher who the particular student is that you are observing or working with (you don’t want to observe or work with the wrong student…but it happens!). Ask the custodian where you can find a manila folder or extra paperclips. Ask a fellow therapist where the bathroom is. There are always lots of questions!
Don’t be afraid to reach out to other school-based occupational therapists if you get stuck! Ask other OTs questions you have about particular kids, cases, or assessments (but make sure you protect confidential information). We’ve all been there. And, chances are, there IS an answer to your question, even if it seems improbable or far-fetched. Better to feel silly asking a question and then get a good answer, than to not ask and then make a mistake that then affects the student’s program or your credibility as an OT. If you have questions and are not sure who to turn to for OT support, email me and I can get you connected.
Don’t be afraid to make a mistake. While you definitely SHOULD ask questions, don’t avoid doing something simply because you are not 100% sure how to proceed. Nobody always has all the answers. Remember, you went to OT school and are now trained in areas such as anatomy, physiology, neuro, human development, therapeutic use of self, task analysis, applying frames of reference and, most importantly, improving individuals’ ability to participate and function in the occupations that are meaningful and important to them! Use your clinical judgment, consult resources, determine the best course of action, and then…go for it!
If you’re not sure what to do, focus on school function. The role of a school-based OT is all about supporting students in their educational areas of need. We support their ability to access their educational curriculum and environment (both physical and social), participate in their educational context, and make educational progress. We don’t diagnose. We don’t need to get too caught up in nitty gritty assessment results. Yes, we need to analyze results when writing up reports. And, yes, percentiles and standard scores are important when interpreting standardized assessment outcomes and supporting program recommendations. But, when it comes down to it, we are looking holistically at educational function, access, participation, and progress, and not solely focusing on standardized assessment scores.
Remember that school-based OT is different than clinic-based or medically-based OT. This is so important to remember, yet so easy to forget. As I just mentioned, school-based occupational therapy is about addressing educational areas of need. Not medical need. Those can be two very different things. It can be tempting to run a school-based session much like a clinic-based session. And maybe for many students this is exactly what they need. But just remember that, at the end of the day, we as school-based OTs are supporting students’ areas of need as it relates to their education.
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Are you a school-based OT? What are some other tips you want new school-based occupational therapists to know?