This study aimed to explore the day to day practices of school-based OTs in the USA. practice. The researchers surveyed 500 school-based occupational therapy practitioners across the United States to get a comprehensive picture of their roles, responsibilities, service delivery models, intervention approaches, and how they provide feedback to families. What makes this research particularly valuable is that they looked across all three settings: elementary, middle, and high school, which helps us see how the role shifts as students age.

Methods

• Online survey
• Data collection from January to March 2024 
• 500 responses available for analysis.
• Quantitative data analysed using descriptive statistics and correlations,
• Open-ended responses were analysed using content analysis with two independent coders

Results

Service Delivery Models

• Therapists used a mix of direct 1:1 intervention in therapy rooms. 
• The frequency of use of these approaches changes as students move from early primary school through to secondary, with therapists reporting they use consultation more in middle school and high school. 
• Therapists were also providing staff training, interventions in open areas (e.g. hallways), group interventions and other formats. 

Feedback 

• Between 86% and 91% of practitioners across all settings reported using scheduled progress reports or IEP meetings to provide feedback. 
• Only about 7-8% use scheduled phone calls, and even fewer provide weekly email summaries or quarterly parent conferences. 

Interventions Used

The intervention categories were specified on the questionnaire, and the OTs were asked to identify how frequently they used them. When reporting the results, the researchers defined regular use as weekly or daily use.

In elementary schools, the first years of primary school to age 10, over 90% of OT reported using fine motor (98.6%) and handwriting (95.8%) weekly or daily, with self-regulation or executive function interventions coming in a close second at 85%. Less than half address mental health needs (49.1%) and literacy needs (41.9%).

In middle school, which covers the later stages of primary school and in some countries the start of high school to age 13, the pattern shifts. Fine motor is still most common at 69.5%, followed by self-regulation or executive functions, assistive technology, handwriting, and life skills. Mental health, literacy and pre-vocational skills interventions are underutilised, with less than 40% of therapists addressing these areas.

High school, which in the USA is from the age of 14, shows the biggest shift in focus. Life skills top the list at 56.5%, along with self-regulation (55%) and prevocational skills (54.3%). Handwriting drops to less than 30%, this makes sense developmentally. But literacy participation is barely addressed at all, with only 17.6% providing these interventions regularly.

Time use

• Half of their time working with students and half on administrative tasks 
• 25% of their time on paperwork 
• 15% in IEP meetings
• Smaller percentages of time were spent looking up evidence and or resources for their students, doing staff training or attending staff meetings, supervising other therapists or students, developing resources and engaging in leadership activities

Practical Takeaways

Overall this research provides a clear snapshot of how OTs in USA schools are delivering services and using their time. I think the descriptions of time use are really helpful to show that we do need the 50% administration time alongside the time we spend working directly with children. There is also a clear recommendation that schools need to be providing OTs with adequate space and resources, which is helpful for those of us who are often working in corridors.

I have found some of the comments in the discussion section interesting, particularly linked to mental health and literacy interventions and types of service provision. I think sometimes OTs on the ground in schools are trapped between a rock and hard place with regards to statutory documentation. For me, some of this change needs to occur at a policy level and within mandated documents like IEPs and EHCPs and be a focus of leadership to support OTs on the ground to make these changes. 

In terms of literacy and mental health interventions, I think this opens up an interesting debate on the OT role, which was not considered in the article. The authors identified that we need to be translating our handwriting interventions into literacy, which makes sense. However, if literacy is defined as including reading and grammar and spelling, these are not areas that I feel as an OT I have much expertise and I know that many of the teachers and psychologists I work with are much better placed to provide literacy interventions. So whilst there is some evidence that OTs can do these. 

Ultimately, perhaps the key question isn’t whether OTs can address literacy and mental health, but whether we should be leading these interventions if other professionals may have more relevant expertise and consistent presence. This research could be used to initiate a team discussion about strategically matching professional expertise and availability to student needs in order to maximise outcomes.