How Occupational Therapy is Delivered in School

Your child has just qualified for school-based Occupational Therapy services. Depending on the recommendation of the therapist, services may be integrated into the classroom, delivered outside the classroom, consultative or a combination of methods. Depending on the IEP format at your school district, consultation and direct service minutes may be differentiated in the service grid, or it may be narrated in the OT’s report. If you don't see it on the report anywhere, you can also ask directly. If there is an agreed on strategy that you and the IEP team agree on and it is not stated on the IEP document, you may request for it to be added. Sometimes, it is not specified to leave flexibility for the therapist and team, so that it can be changed as needed without amending the IEP. If in doubt, always ask your team questions.
Integrated Therapy

Also known as a “push-in” model is the usual preferred mode of service delivery in an educational environment. It allows the student to participate in the classroom activities with therapy support. This guarantees that the focus of therapy has relevance to the student’s expected performance in the classroom. By working directly in the classroom, the use of therapeutic techniques and adaptation is more likely to occur. The classroom staff can benefit how to implement these techniques and adaptations by observing and working with the therapist. This method also allows for co-teaching or team teaching where the therapist and the classroom teacher jointly design and implement learning experiences. Many students in the classroom can also benefit from a multidisciplinary approach. Integrated therapy is common for Special Education classroom as well as primary grades.

Working with classroom aides and behaviorists

Therapists may plan an individual program that involves specific activities to be carried out with the help of another person, this includes a teaching assistant, one-on-one student aide, etc. The therapist can provide training to the person who will implement the program and this may include modeling and coaching as the child participates in the activity. Continuous monitoring and contact is necessary to supervise the delivery of the program and to update with changes as needed. This method is common when implementing the use of assistive technology (word processing devices, adapted writing tools, etc).

Outside the classroom

This is also known as a “pull-out” method of delivery. In this method, the therapist takes the student out of their classroom to work on individual skills that are far below the level of the other students in the classroom. This is also appropriate when the therapeutic activities cannot be completed in a typical classroom, such as when using large sensory equipment. A pull-out model of service is also appropriate when therapeutic interventions are distracting for the other students or when it interferes with the teacher teaching. It has been cautioned that pull-out models of service are less effective when compared with the integrated approach (McWilliam, 1995).


Strengthening - Build with magnets, Clothespins and tongs, Hide and find small items in resistive medium such as Theraputty
Visual Motor/Eye hand coordination - Cutting, multi-step crafts, drawing, Lite Brite, Make a necklace, Toy hammer with nails, lacing
Manipulation/Fine motor - Coins in slot, use of tweezers and tongs, placing stickers on paper
Posture - adjust seat and table height, recommend standing, use of therapy ball
Sensory - Use of school-based items such as playground aparatus, schools walls for push ups, calisthenics (jumping jacks, animal walks) to recieved increased sensory input to help regulate sensory systems


All treatments require a degree of consultation with the staff including teachers, assistants, administration and other specialists. The team of people working with the student will problem-solve together, each contributing from their own expertise.

Consultative services include monitoring and updating strategies that are already in place such as:

  • use of pencil grips
  • use of sensory equiptment
  • modifying sensory diets
  • input on adaptations to the environment
  • seat and desk positioning
  • desk position in the classroom
  • brightness level
  • input on any new concerns related to occupational therapy that occur throughout the school year.
Professional Time

Outside of working directly with students and staff members, therapists also require invest time to better serve students in the school. This includes review of previous reports and IEPs, making and acquiring materials, preparing items for therapeutic use in the classroom setting and for individual use, and researching specific treatment methods for individual students.


Terms Defined: In OT
Terms Defined: In the IEP
Guide to OT Assessments