School-based practice is the largest practice area for occupational therapists in the United States. Provision of occupational therapy services in the public schools is unique from practice in other settings in that it is guided primarily by federal and state laws and regulations that are specific to the educational setting.

History of the role of OT in the school setting

Occupational therapy has not always been provided by the public schools. The inclusion of OT and other related services came about as a result of congress passing legislation that supported the education of all children including those with disabilities. Congress first passed the Education for All Handicapped Children Act (EHA) in 1975. Prior to 1975 many children with disabilities were excluded from public education. Public schools were not obligated to educate children with disabilities and these children were often placed in special segregated schools or government-run institutions or remained home, receiving no education at all.

Revisions and amendments to EHA (1986, 1990, 1997, & 2004) have continued to refine the statute, and the most recent amendment is titled the Individuals with Disabilities Education Improvement Act of 2004 (IDEA04).Other changes in federal legislation, including the No Child Left Behind Act (NCLB), have also influenced the provision of special education and related services, including occupational therapy, to children (ages 3-21) with disabilities in public education settings.

Current Role of OT in the Public Schools

Occupational therapists working in the public schools work differently than OTs in any other setting. Our role in the public schools is defined by special education law (Individuals with Disabilities Education Act, IDEA). Occupational therapists are in the public schools in order to enable a Free and Appropriate Public Education (FAPE). Our mandated purpose is to support school participation (engagement in occupation) in the Least Restrictive Environment (LRE).

Occupational therapy is a related service under IDEA in the public schools. As a related service, OT is provided for eligible students when necessary for the student to benefit from special education.

IDEA-04 defines related services as developmental, corrective, and other supportive services that are required to assist a student with a disability to benefit from special education. The following is a list of services that are included but not limited in the definition of related services:

Speech-language pathology

Occupational & Physical therapy

Orientation & Mobility

Psychological

Counseling

Social Work

Transportation [Section 300.24(a)].

 

In order to receive occupational therapy services, a student must be found eligible for special education (see also Special Education Process for a more detailed description) or under Section 504 of the Rehabilitation Act (see Section 504). Eligible students must have an eligible disability as defined under federal or state regulations, and this disability must be limiting the student’s ability to make effective progress.

OT Service Provision

Least Restrictive Environment (LRE) is a mandate that requires education be provided to the maximum extent possible with other students who do not have disabilities.

OT services in the schools are delivered in the manner that is least disruptive to the student’s educational experience.

When determining OT services we consider LRE first

Copyright 2007 Jan Hollenbeck 

School based occupational therapy is often provided via consultation or in-class services addressing what will most efficiently facilitate functional performance within the school environment. Despite the presence of a disability, the focus of intervention is not on remediation but rather, it is on enabling a student to make effective school progress in the least restrictive environment.