School-Based OT with Allison

Next in the “Students in the Field” series, we have Allison (of Allison The OT Student) sharing her experience in the schools! She completed this fieldwork both through tele-therapy and in-person in the schools and the amount of flexibility you need to accomplish something like that as a student is out of this world – you’re amazing Allison!

Now let’s get into it!

Hi! My name is Allison and I am currently a 3rd year OTD student in Boston. I finished both of my Level II Fieldwork placements and am currently working on my Advanced Doctoral Experience (ADE). The ADE is a doctoral capstone project, and mine involves a research project, clinical practice, and advocacy initiatives. I graduate in May! YAY!

 I have always envisioned myself working with children, adolescents, or young adults with intellectual and developmental disabilities (IDDs). After my Level II Fieldwork experiences in outpatient pediatrics and school-based practice, I can definitely say that I still want to work with this population. I’m not sure exactly where I’ll end up, but this summer I will be taking the NBCOT exam and applying to jobs. Hopefully, I will find a job where I can work with individuals with IDD, have a mentor, and maintain occupational balance as a new practitioner! 

What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?

Today I am going to be sharing my experience in school-based practice, where I worked in an elementary, middle, and high school. In the school system, a student qualifies to receive OT services if OT is necessary for the student to meet educationally relevant goals. In my experience, the school system is very data-driven. So, students who are referred by a teacher, parent, or other for an OT evaluation will qualify for OT if results on standardized assessments are below comparable norms and the OT practitioner determines that these results prevent the student from participating fully in the curriculum. 

What is OT’s role in this setting?

In the school system, OT’s role is to support students in accessing the curriculum. Any goal that an OT works on in the school setting must be educationally relevant, support the student’s access to the curriculum, and be supported by data. Something that I found interesting was the way that OTs complete documentation in the school setting. Rather than writing daily treatment notes, OTs track data in a way that works for them (e.g. excel sheets, goal attainment scaling, rubrics). OTs then use that data to inform progress reports that are written a few times per year and sent home to parents. 

Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?

I did feel prepared going into this setting, mostly due to the School-Based Practice in OT elective that I took in my second spring semester. If you are interested in the school setting and your program offers a school-based elective, I highly recommend taking it! I learned about general pediatric conditions, evaluations, and interventions in the pediatric course that is part of the general OT curriculum, but the school-based elective provided a more in-depth education on applicable laws, the difference between an IEP and a 504 Plan, models of service delivery, and intervention techniques. I found this additional information to be very helpful not only in my school-based fieldwork placement but also in my outpatient pediatric placement. 

I also prepared by reviewing common pediatric conditions, assessments, and interventions. I recommend reaching out to your Clinical Instructor (CI) before you start and asking for any resources that they recommend, as well as what standardized assessments and intervention techniques they use most often. 

What resources were the most helpful during your time there?

During my time in school-based practice, my CI shared lots of resources that she uses on a daily basis. Some resources that I found particularly helpful are:

– Double Time Docs: This is a program that helps you write evaluations in half the time! In a fast-paced setting where you have a large caseload and only so many hours in the day, this was super helpful. This is definitely a program that I will look into purchasing when I am an OT practitioner. 

– Q-global™ from Pearson: Another evaluation tool that I found really helpful! This program allows you to enter raw data from standardized assessments and calculates the results for you. 

– ACE (Autism Curriculum Encyclopedia©) from The New England Center for Children©: This was a very helpful program for data collection, tracking, and program modification if you are working with students with autism. The school system that I was in was very data-driven, so this program was useful. This was purchased by the school district for certain students. 

– Boom Cards: I did my Level II Fieldwork project on Boom Cards at this site. For remote students, Boom Cards can be helpful for working on various life skills using virtual flashcards that you can create. 

– TeachTown®: Another helpful tool for remote students using videos and errorless learning.

– Handwriting Without Tears® or Wilson Fundations®: My school district used Fundations®, but my CI and I used some HWT terminology. Learning more about these programs was really helpful!

– TypingClub: A free digital keyboarding curriculum!

– Pinterest: Always helpful for OT treatment ideas!

– Youtube: Great for music, activities, and videos for students who earn breaks as part of their behavior plan.

– GoNoodle®: Tons of free exercise/GM activities for students and teachers!

How did you stay organized and manage your time?

During this fieldwork placement, I used my laptop along with two organizational tools provided by and shared with my CI: a program binder and a daily planner. Since the school system that I was at used Google Docs/Gmail/Google Calendar, I used features such as Google Tasks and Google Keep to stay organized on tasks that I had to complete. For intervention planning, I used resources from the program binder that my CI already had as well as a daily planner. At the end of each day, I would plan for that day the following week. For example, if I saw a handful of students on Tuesday, after seeing them I would plan their sessions for the following Tuesday in the daily planner. The program binder was a quick reference for students’ goals and materials used to work on their goals. 

What was your schedule like?

My schedule was M-F from 7:30am to approximately 2:30pm. Some days I left later (3:00-3:30pm), and some days I worked on evaluations once I got home. But generally, I did not do work for fieldwork once I got home. Here is a more in-depth look at my schedule on a typical day:

7:30-8:00am: Arrive, get settled, review treatment sessions for the day and prepare materials as needed.

8:00-9:00am: Meetings, consults, work on evaluations or other tasks as applicable.

9:30am-2:00pm: Treatment sessions (either 1 student, 2 students, or groups; typically I saw anywhere from 8-15 students per day for 30 minute sessions each, back to back).

2:00-2:30pm: Ensure data collection was completed for all sessions, clean, wrap-up for the day and prep for the next day/week.

What assessments did you use most?

The assessments that I used the most were the Beery VMI™, DeCoste Writing Protocol, BOT™-2, The Print Tool®, DTVP-3, DTVP-A, Developmental Eye Movement™ Test, and The Sensory Profile™ 2. Evaluations are nerve-wracking at first, but just go for it! My advice is to get comfortable with administering standardized assessments early, because then you can focus on the harder part: analyzing results and writing the evaluation. 

What conditions/diagnoses did you see most often?

The conditions/diagnoses that I saw most often included specific learning disabilities, autism spectrum disorder, Down syndrome, seizures, communication disorders, ADHD, and more. 

What did a typical session look like?

A typical session was 30 minutes long and could be an individual, pair, or group session. The groups were a lot of fun, where we worked on keyboarding skills, ADLs (e.g. feeding, grooming, hygiene, tolerance for ADLs), IADLs/vocational skills (e.g. cleaning, hanging clothes, folding clothes, stocking shelves), and sensorimotor skills (e.g. FM skills, arts and crafts, messy play, GM skills). Here are some examples of the things I worked on with students at each level:

– Elementary School: handwriting, keyboarding, ADLs

-Middle School: keyboarding, push-in classroom support, ADLs/IADLs

– High School: vocational skills, ADLs/IADLs

How did you stay client-centered and occupation-based?

Sometimes when you are working on tasks that feel less client-centered, such as handwriting, this is tricky. However, I did my best to adapt the task to make it more fun and engaging for my students. One example of this was when I was working with a student who loved to read and was motivated by books. To work on handwriting, we would read a story together and then write a sentence about the story. Another way that I remained client-centered was to use motivating activities as a reward at the end of the session. Many students would end their session with a GoNoodle® activity, which was motivating and fun for them. 

I stayed occupation-based by practicing the actual occupations that were written in their goals during OT sessions. For example, instead of having a student play with putty, I would have then actually work on handwriting. Or when students had goals around ADLs/IADLs, we spent the session practicing the actual occupations rather than working on bottom-up skills. 

Did you have to do a project or in-service? Could you share what topic you chose? (if you can)

Yes! As I mentioned earlier, my project was about Boom Cards. Since I did Level II Fieldwork during the fall of 2020 and the school system was operating in a hybrid model (in-person/virtual), some students were fully remote and some were partially remote. My CI wanted to learn how to use Boom Cards in OT sessions, so she suggested that this be my final project at this site. I researched how to use Boom Cards, created some of my own, and developed and recorded a training presentation for the staff at the school system. My CI even told me that school staff still use this video after my fieldwork experience ended! 

What was your favorite part of this fieldwork experience?

I have so many favorite parts of this fieldwork experience. One thing that I really appreciated was that my CI provided me with the opportunity pretty early on to complete evaluations and provide intervention sessions completely on my own. This allowed me to “spread my wings” and feel like a real OT practitioner! I think this was a great way for me to feel more confident in my abilities and feel prepared to move on from the student role to the clinician role. 

Another favorite part of this fieldwork experience were the groups that I led with the sub-separate classrooms. They were so much fun! And, this is the population that I love working with so much. 

Finally, one thing that I loved about both of my fieldwork experiences (and one reason why I love OT in general), were the connections that I formed with my clients. I love seeing my clients make progress, motivating them to participate in therapy, and forming meaningful connections with them.

What was your least favorite part of this fieldwork experience?

I’m not sure if I can truly identify a “least” favorite part of this experience. One thing that I struggled with at the beginning was the transition from outpatient pediatrics to school-based pediatrics. I was used to working on emotional regulation in an outpatient setting, and I wanted to address it with some students in the school setting. However, at the school that I was at, this wasn’t something that the OT regularly worked on. Instead, the school psychologist often addressed these goals. This was hard to wrap my head around at first, but eventually I got used to it. I’m not sure if all schools are like this. 

What is something you learned that you will take with you for the rest of your career?

One quote from my CI that stuck with me throughout this fieldwork experience and beyond is, “It’s a marathon, not a sprint.” I think this is really profound and a helpful way to think of school-based OT. Your students will be working on their goals for an entire calendar year, which is different from outpatient services where insurance may only approve 8-16 sessions. In addition, students may continue to receive OT services for many years, where they will have the opportunity to continue to make progress. Thinking of OT in the schools as a marathon rather than a sprint is definitely something that I will keep with me if I ever practice in schools. 

What advice do you have for a student about to start in this setting?

Be open minded, learn from the interprofessional team, and be organized. There is a lot going on in a school setting, between consults, direct services, meetings, evaluations, and a large caseload. But you can do it! Take any opportunity that your CI offers for you to administer assessments, write up evaluations, and provide services on your own, and accept any feedback. It is a great learning experience, and you will probably be surprised by how much you are capable of. Most importantly, HAVE FUN! 





Blog post about school-based OT: 


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