In 2022, the Individuals with Disabilities Education Act provided assistance for about 7.2 million students between the ages of 3 and 21. That represents roughly 15% of the entire student population. I believe, and the evidence shows, that for these students, occupational therapy can be a crucial source of help — a way of conferring skills and adaptations that allow them to achieve their goals both in and out of school and at any age.
We have a problem, though. The role of occupational therapists in education is often misunderstood or overlooked. Training gaps and lack of professional support contribute to an expected shortage of these therapists in schools, one that stands to deprive 15% of our students of resources they need to express their true selves and animate their full potential.
When I worry about this problem (which I do perhaps too often), I’m not thinking in abstractions. I’m not picturing figures in tables or agonizing over the sanctity of Section 504 of the Rehabilitation Act (although those things would also align with my worrying). I’m thinking about the human stories at the heart of the abstractions. I’m remembering, for example, a girl with muscular dystrophy who, when I met her, was struggling to believe in herself and who, with a few tweaks to her school routine, was able to graduate early and start writing for Teen Vogue at 15, and who will soon appear on Disney+. True story!
How many extraordinary people might be held back if we don’t find a way to increase the presence of OTs in schools? That’s what I worry about.
Occupational therapy vs. physical therapy
Occupational therapy is a collection of treatments centered on the activities (or “occupations”) that are meaningful to the individual being treated. Occupational therapists address physical, mental and emotional conditions through functional activity. Physical therapists, on the other hand, focus on strengthening the body, restoring range of motion and lessening pain or disability through manual treatments and motor exercises.
The beauty of this holistic discipline is in the wide range of conditions it can address. OT can help anyone dealing with physical, sensory or cognitive deficits, from children having trouble regulating emotions to adults physically weakened by eating disorders to seniors struggling with visual awareness.
OT in the classroom
For students with disabilities, occupational therapy aims to minimize the disruption to learning that a disability may cause. The OT’s job is to analyze the learning environment, prioritize areas of need, develop intervention plans, help students approach their challenges with a solution mindset and help them enlarge their agency and build self-confidence.
This could mean finding creative ways to help a student with motor skills disorders learn to write. It could mean helping a student with sensory processing challenges stay engaged socially to overcome the sense of exclusion that they may face. It could mean adjusting a curriculum or content delivery method to suit student needs. It could mean helping students with activities of daily living, such as eating or self-care. No two intervention plans are identical, because no two students are.
Current best practice in school-based OT, and special education in general, is to promote the least restrictive learning environment possible. If we can keep a student in their classroom and bring an OT to assist them while their teacher leads a lesson, great. If it makes more sense to pull them out of class and go through interventions with fewer distractions around them, great. No matter the approach, we want to show students that their disabilities do not set them apart from their peers in any ultimate way and do not prevent them from making valuable contributions to their school communities.
How can we help with schools’ shortage of OTs?
All the benefits of OT in schools depend on having access to OTs. The looming shortage of OTs in education isn’t going away on its own — it has coalesced from several factors over time and will almost certainly require time and concentration to solve. A vicious cycle has emerged, in which some districts are forced to rely on too few OTs to support too many students, causing those therapists to feel overworked and isolated, causing them to leave the school setting, causing the pressure on their remaining colleagues to increase.
The problem is complex and widespread. But there are things we can do about it.
One of the main drivers of the shortage is the mismatch between what is commonly taught in OT degree programs and what is required of OTs in an education workplace. Most OT programs teach a medical model, which prepares therapists for work in clinical settings but does not translate easily to a classroom. This imposes a burden of learning on OTs working in school settings that can lead to burnout, especially early in their careers, or discourage them from seeking school positions in the first place.
OT graduate programs tailored to education settings, like those pioneered at the University of St. Augustine for Health Sciences, where I teach now, can ease that burden. Through hands-on experience and pedagogical training, we can help school OTs feel prepared on day one for the role they will fill.
This creates a virtuous cycle: Each therapist prepared in this way is more likely to stay in education, acting as a peer or mentor for those who come after them, bolstering the specialty’s support network, reducing the workload, making it more likely that new OTs will stay in education and acting as peers or mentors for those who come after them.
Incorporating OT in schools and securing the pipeline of skilled therapists to do the job is a matter of human rights. Students with disabilities, like all other students, deserve a high-quality education and the opportunity to realize their full potential. Because the OT shortage has such profound implications for a large portion of the student population — and, consequently, for society at large — and because there are solutions available to us right now, I believe we have a duty to work to reverse the trend we’re seeing and put more well-prepared, well-supported OTs in education.
Our future selves will thank us.
Catherine Daniel spent 13 years serving as an occupational therapist in the Central Texas region public school system and has a Master of Occupational Therapy from Western New Mexico University. She joined the University of St. Augustine for Health Sciences in 2021 and now works at the Austin, Texas, campus as an instructor of OT programs.
Opinions expressed by SmartBrief contributors are their own.
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