Occupational Therapy

Related services are required to assist a child with a disability to benefit from special education, and includes speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, early identification and assessment of disabilities in children, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services for diagnostic or evaluation purposes. Related services also include school health services and school nurse services, social work services in schools, and parent counseling and training (IDEA, 2024). “Occupational Therapy is a related service to specially designed instruction. As a related service OT supports education for all students in all environments and school activities is the primary focus. Occupational therapy focuses on engagement in meaningful, important occupations that support access, learning, and participation in school.” (Clark, Rioux & Chandler, 2019) 

Occupational therapy practitioners refer to both occupational therapists and occupational therapy assisstants. The OT is responsible for all aspects of OT service delivery and is accountable for the safety and effectiveness of the OT service delivery process. Occupational therapy assistants deliver occupational therapy services under the supervision of and in partnership with an OT (AOTA, 2021 Telehealth and Occupational Therapy in Schools).  

Occupational therapy practitioners who work in educational environments are related service providers (United States Department of Education, 2017a) who support students to gain access to, participate in, and benefit from their educational programs. Therapists work collaboratively with school personnel and parents/guardians of students with disabilities to evaluate and plan students’ educational programs and to provide intervention to meet students’ individual educational needs. Therapists may work directly in preschools, schools, worksites, community settings, children’s homes, and provide therapy through telehealth methods. (Guidelines for Practice of OT and PT in Educational Settings, 2023) 

This act regulates the practice and licensure of occupational therapy practitioners. Regulations identify minimum standards of practice for occupational therapists, supervision of occupational therapy assistants, supervision of applicants with temporary licenses, and delegation of duties to occupational therapy aides and other unlicensed personnel. The Pennsylvania State Board of Occupational Therapy Education and Licensure website provides links to relevant laws and regulations (Commonwealth of Pennsylvania, 1982a). 

To ensure adherence to legislation and regulatory requirements in providing occupational therapy services, practitioners in schools have a responsibility to:  

• Make recommendations for services in accordance with federal, state, and local policies and procedures related to school practice, in both general and special education 
• Apply information for state occupational therapy practice acts and rule to service delivery in schools 
• Understand state regulations for Medicaid cost recovery and other payment sources and adhere to professional codes of ethics and billing requirements.  

Guidelines for ensuring consistency with professional practice are as follows:  

• OT practitioners must demonstrate professional role performance and conduct aligned with AOTA official documents, state occupational therapy regulations, and best available evidence 
• OT practitioners conduct evaluations aligned with current evidence and best practices across the home, preschool, school, and community environments or from the day care, education, or transition team 
• During the evaluation, OT practitioners must identify the child’s performance in his or her occupations, the affordances and barriers to successful engagement, and expectations for the child’s development and participation and synthesize information to develop a working hypothesis. 
• In collaboration with the team, OT practitioners identify priorities and concerns of parents and school staff to develop goals for the school-age child.  
• OT practitioners must determine service recommendations based on individual need, as indicated by the OT evaluation and data shared during the team process.  
• Occupational therapists develop an OT intervention plan and share that plan with occupational therapy assistants that provides a framework for implementing the IEP.  
• OT practitioners demonstrate service delivery aligned with current evidence and best practices, provide intervention in the least restrictive environment to enhance the child’s benefit from education; provide assistance to teachers to enhance the participation of children in school activities and routines, including the provision of strategies for improving performance in these activities; use assistive technologies, universal design for learning principles, and environmental modification.  
• OT practitioners document progress toward annual goals in accordance with organizational and professional requirements and measure outcomes.  
• OT practitioners determine the need for ongoing or discontinuation of services or for referral to other professionals. (AOTA, 2021 Telehealth and Occupational Therapy in Schools). 

American Occupational Therapy Association (AOTA) 

Pennsylvania Occupational Therapy Association (POTA) 

National Board of Certification for Occupational Therapists (NBCOT) 

“Students with low incidence disabilities have complex and varied needs that include medical conditions or physical limitations that affect movement, vision, communication, or hearing.  The key principles of IDEA (2004) specific to service provision hold true for students with low incidence disabilities. These students should be educated in the context of general education. However, many of these students will require a network of services and supports to be able to participate in the least restrictive environment as well as careful planning to prepare them for life after school. The educational team, including the family, determines what a student needs to access and participate in their educational program, with the expectation that every student can and does learn. OT services start with a comprehensive evaluation that identifies a student’s strengths and needs for school performance and participation. Given occupational therapy practitioners skills in activity analysis, they can bring vital knowledge to the team to promote increased opportunities for student engagement and participation across contexts and environments. When working with this population, services on behalf of the student and program support may require more time from school OT practitioners. Effective use of services on behalf of the child in addition to direct services with the student is more likely to result in the student having an increased ability to access and participate across all educational environments. The occupation of the student is a primary focus when working with this population in schools. The occupational therapy practitioner can support access and participation in academics in a variety of ways. For example, there is a growing evidence base for OT services that support literacy development through interventions that support the use of adaptive equipment, assistive technology, or both; positioning; and the development of fine motor, executive functioning, processing, and visual-perceptual skills. The OT may also support the teaching of math by adapting math manipulatives so the student can easily access them. When working with this population, data-based decision making should be used as part of systematic instruction throughout the intervention process to ensure that the students are meeting their goals. The OT should record data that not only document strengths and needs but also enable evaluation of the student’s participation and performance in the curriculum and across school environments.  (Frolek Clark et al., 2019) 

American Journal of Occupational Therapy 

OT Practice Magazine 

AOTA (2021) Teleheath and occupational therapy in schools.  

Frolek Clark, G., Hollenbeck, J. (2019). Best practices in school occupational therapy interventions to support participation. In G. Frolek Clark, J. E. Rioux, B. E. Chandler (Eds.), Best practices for occupational therapy in schools, (2nd ed.) (pp. 341-348). AOTA. 

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