Using occupational therapy recommendations in your classroom

The process of receiving support from an occupational therapists

When to make a referral

Occupational therapists can support children with a large variety of skills.  If you’re not sure what an occupational therapist is, you can learn more here in this article – What is a children’s occupational therapist? Common things a therapist might help with in the classroom include handwriting, poor independence with self care skills like dressing, dyspraxia and sensory processing differences.  Students who is struggle to pay attention because they can’t stay seated in their seat, or are so clumsy that they can’t hold their pencil correctly are the ones that OTs can help.  Student who’s motor skills are delayed and behind their peers could be referred.  Or, students with sensory processing needs the classroom could also receive support.

Making a referral

The process of making a referral to a therapist varies depending on location.  Even within the same country, for example the UK, the process is different in different areas.  You will need to research where the service is and what their process for referral is.  Often, school can refer.  Usually, parents and GPs can also make the referral.

Some departments request that you have tried their package of recommendations before you make the referral.  If this is the case, they will request that you demonstrate evidence of using recommended strategies when you submit the referral. The school SENCO will usually have a good understanding of the local process.

Some parents will choose to see a private therapist.  This typically costs upwards of £450 for an in person assessment, so it is not an option that is open to many families.  Some clinics offer a screen at a lower cost and the fees vary depending the location and experience of the therapist.  If families do want to proceed privately in the UK they can check the private practice register to locate a local therapist.

Equipment is a different process

In the UK, equipment like seating or wheelchairs is typically provided by a different department (Social Services rather than NHS).  So, in some cases there may be two different therapists involved.

What happens once a referral is made to the occupational therapist

This depends whether the referral has been sent privately or publicly.  It will also vary hugely depending on the area the child lives in.

Private assessments

If the family has gone down the private route, they will typically have an appointment within 3 months.  However it will again depend on the location, as there is a high demand even for private therapists.  This typically results in a report which will outline the students strengths and challenges.  There may be an attached programme of support ideas.  Or, the recommendations will be included within the report.  Often, additional therapy sessions are recommended.  Again, the parent will need to pay for these and sessions usually start from £75.

Public assessments and support

Within the UK this varies widely again depending on location.  In some areas, the therapist will come into school and hold trouble shooting meetings with the SENCO or teacher.  Other areas will provide assessments in clinic.  Sometimes, there is a specific therapist attached to specific schools, in other areas there is not.  Often there is a waiting list.  Historically, NHS benchmarking data indicates the average of an 85 day wait to see a community occupational therapist.  However, if school has been required to gather evidence of using universal strategies prior to referral in reality this wait is much longer.  Parents also routinely report waiting for six months to a year.

Typically, following assessment a summary of recommendations is provided.  Sometimes, the student will receive one to one support and in some areas the run groups.  Often, the student’s programme will be provided for school staff to run and it will be updated termly or annually.  Unfortunately, in many cases, there will be no review and the child will be discharged.

After the child has been seen by the occupational therapist

Often an OT assessment for the classroom will result in a report or plan.  This should include recommendations.  It’s important that you understand the information in the report.  If it is unclear, don’t be afraid to ask the therapist to explain the information to you.  Sometimes, the information might not be relevant for your own classroom so it’s OK to ask for different ideas or clarification.

Suggestions made by the occupational therapist should help the student to engage in their learning.  If they are causing more disruption than helping then please feed this back to the therapist.  If you’re not sure what they are for, or how to use them correctly, please ask.  In addition, if the student has made progress and their plan needs updating let the therapist know.  By doing this the student will make quicker progress as they will be being reviewed as required.

Allocate the time and make someone responsible

There is so much to fit into a school day.  Typically, the only way to successfully run an OT programme is to schedule it in.  Firstly, a staff member must be made responsible for running it.  Secondly, time needs to be allocated during the school day for the programme.

If the child has an EHCP in the England, there may also be specific recommendations for input the education department must legally provide.  The school is typically responsible for ensuring this support is provided.  It may include allocation of teaching assistant time to support the student.  It could also include suggestions for things like sensory breaks.  Sometimes, there are specific activities to be included during the day.

Consider where you can double up

For example, can you work on gross motor skills in PE?  Some recommendations within OT programmes include activities using therapy balls or larger equipment, or they include throwing and catching tasks.  These are much harder to complete in a classroom setting.  A suggestion for these activities is to schedule them to your PE warm-up or to create a lunch time motor skills club.  The aim is to integrate them into lessons and activities that are already happening rather than putting them into the ‘another thing to do’ basket.  If they can be added to the weekly routine, then it is much more likely they will happen, and happen with ease!

Still not sure what an OT is?

I explore what an occupational therapist is, including the history of the word occupation and how occupational therapists can support children at school in this SENDcast episode.

Don’t be afraid to use behaviour management

Just because a therapist has made a recommendation, it doesn’t mean the classroom rules don’t apply.  If a student is not using a recommended piece of equipment or a strategy appropriately, you are still allowed to set behaviour expectations.  The earlier you can set these the better.  It may be that the equipment needs to be removed for a short time, in order for the student to understand they need to use it correctly.

Add finger warm-ups or handwriting practise before your handwriting lesson

This is another whole class idea and it only needs to take five minutes.  However, if the OT has suggested additional pencil activities or worksheets, or, if they provided fine motor skill activities, a great time to do these is straight before your handwriting session.  This helps for two reasons.  Firstly, it provides a warm-up for the children’s fingers which in some cases can help to prepare them to hold their pencil.  Secondly, worksheets develop pencil control can help to reinforce the skills needed to write letters and words on the line.  Again, you only need five minutes but a little bit of regular practise will likely have a bigger impact over time than sporadic or no practise.

If you need ideas for handwriting in particular, the National Handwriting Association has some useful resources.  GriffinOT’s Write Rules programme is a fantastic whole school approach to teaching handwriting correctly from day one.  It’s a complete scheme of work.  If you’re looking for specific ideas to help a child with their pencil grasp our programme, ‘Supporting Pencil Grasp Development,’ could be helpful.  As an extra resource, if you’re confused by the large number of pencil grips that are available then I would recommend looking at our pencil grip review page.

Including sensory strategies

Sensory strategies are frequently recommended by occupational therapists to support attention and engagement in the classroom.  These are designed to help to organise the student’s arousal level in the classroom so they can attend.  They could include things like wobble cushions or fidget toys.  Or, it may be that there is a sensory diet or sensory circuit included in the occupational therapy report.  We explore the use of sensory strategies further in this post.  I explore using sensory strategies in the classroom further in this post Sensory Strategies and Supports for the Classroom.

In summary – occupational therapy in the classroom

I know it’s not always easy to include the recommendations outside professionals provide into the classroom.  In my experience, if the recommendations can be embedded into the daily timetable they are more likely to be done.  I hope that you have found at least one of the suggestions helpful!