Occupational therapy for teenagers can look a lot different than OT interventions for preschoolers. High school occupational therapy is a niched component of school-based OT, but one that needs it’s own set of resources and tools. High school occupational therapy providers will find this blog post as a helpful resource.
Middle school occupational therapy and high school occupational therapy sessions focus more on transitional stages as children age into teenagers and beyond.
Occupational Therapy for Teenagers
In the younger grades, school occupational therapy practitioners go into the school setting armed with playdough, scissors, pencils, crayons, glue, fidgets, and a few games/puzzles.
What about the middle school occupational therapy population…and those years following in the high school OT interventions? These teenagers are not motivated by crayons, Candyland, letter formation exercises, or cut and paste activities. Nor should they be. Unless your middle school caseload is in a self contained classroom functioning at a preschool level, these games and activities are not appropriate or practical. This post will explore the tricky transition from elementary to middle school occupational therapy.
Starting in late elementary school, many therapists transition their caseload from a direct to indirect, or consultative therapy model at this time, especially if they have been working with a particular student for several years.
Reasons OT for teenagers moves to consultation
When a student remains on the OT caseload into the middle school setting, therapy typically does transition to consultation. Why? There are several valid reasons for doing so. There are many reasons why transitioning from direct services to a consultation model is appropriate for teenagers (in middle school and high school). The primary reasons for transitioning to a consultative model are:
- Teenagers are self conscious and do not care for a therapist coming into their general education classroom to sit by them, observe, or ask questions. A consultative model allows the student to take ownership over their therapy recommendations.
- Middle school schedules are busy. It can be difficult to ensure carryover of occupational therapy goals when there are many different teachers on the student’s schedule. Therapists make suggestions but then the recommendations may not be carried over to each class. Additionally, pulling a student for individual therapy weekly means they are missing valuable learning time.
- Handwriting habits are set and unlikely to change at this age. Pencil grasp development and letter formation skills are often formed by the age of eight, making adjustments in middle school difficult. The same is true for Visual perceptual skills.
- Students do not want adaptations that make them stand out from their peers. They will resist noise cancellation headphones, a scribe for written notes, alternative seating, weighted items, or noticeable fidgets.
- Executive function – many middle schools already incorporate these skills into their program through schedules, planners, online classrooms, and reminders.
- Students in the middle school and high school settings are most likely using technology, virtual classrooms, and email to do much of their school work by this point.
- Students have often been receiving services since early elementary school. Changes are less likely to happen at this stage, if they have not already.
Direct interventions Occupational Therapy for teenagers
High school occupational therapy is not a one size fits all model.
There are several reasons to keep a student on a direct therapy service model during the high school years. It’s important to realize that moving from direct services to consultation should not occur simply because the student ages out of the elementary buildings.
Teenagers receiving occupational therapy services may continue on with the direct therapy model for several reasons:
- Self contained students work at a different pace than their mainstreamed counterparts. They may continue to need more intervention.
- Lower level learners will need to be transitioning to a life skills or self help model, if they have not already. This means new objectives and goals to address. Some of these areas to address include: life skills cooking tasks, starting at the beginning with cursive name writing, changing clothing for gym or swimming at school, perineal care to address menstruation needs, or other skills.
- Teenagers are a different breed of people. There are new social expectations, hormonal changes, levels of independence, and increased demands for self help skills or self-regulation skills.
- It may take time to educate families and caregivers about this change in service model, and expectations. Automatically moving everyone to an indirect model, or discharging them, may be too abrupt for anxious parents or overwhelmed teachers
The Role of the occupational therapist with teenagers
The teenage years bring many changes that impact functioning abilities that impact the education in middle school or high school.
Seruya and Ellen write about the Role of the Middle School Occupational Therapist. They highlight several important factors or strategies to intervention
- Involve your learner in decision making about goals and objectives. These will be more meaningful and motivating to your students.
- Transition away from typical handwriting goals to more functional goals
- Teach typing and word processing using a typing program
- Address motor skills use of calculators, rulers, graph paper, etc.
- Address organization of locker and homework planner.
- Provide adaptations if your learner is not able to complete work in an effective manner. A scribe to write notes for them, word processing versus written documentation, lessen the workload if writing is too labor intensive, preferential seating to improve attention.
- Address any lingering or new sensory concerns. Provide adaptation for these with preferential seating, alternative seating, gum or fidgets for self regulation, ear plugs to reduce incoming sounds, and organizational tools. Specifically, brain breaks for high school can be a great resource for self-regulation, anxiety, attention, and emotional needs.
- Address important life skills – learners need to know their emergency contact information, effectively groom themselves, take care of feminine hygiene issues, advocate for themselves, and follow a schedule.
- Some interventions may require private therapy to be more appropriate such as meal preparation, laundry, ordering from a menu, shopping, budgeting, or filling out an application. These would be appropriate goals for students in a self contained classroom.
how to improve handwriting for teenagers
There are times when therapists are called to continue to address handwriting in their middle school population. Intervention needs to be functional, beyond basic letter formation. Functional handwriting can mean learning to write the letters in a name in print or cursive, filling in forms, and essential handwriting life skills.
Handwriting help for middle schoolers
One handwriting goal for middle schoolers, or even handwriting in high school may address the letter formation or number formation to write identifying information such as name, address, phone number.
For example, a handwriting goal for teenagers may be:
“This student will be able to independently write identifying information (name, address, phone number) without a model with 80% legibility.”
Another handwriting goal might be:
“The student will be able to write or access information to fill out a form independently.”
The OT Toolbox has a great post about filling out forms. (Coming soon)
Transition to middle school and high school occupational therapy
What can you do to help this transition to middle school occupational therapy and high school occupational therapy?
- Educate – teachers, parents, and other caregivers may not understand the role of the occupational therapist in middle school. It may be time for a little education on the services provided and the therapeutic model.
- Empathy – reducing therapy minutes may feel like the student is not going to improve, or they are being given up on. It is tough for parents to imagine their learner may never write a sentence, read independently, or live alone. This is the time to gently begin this conversation.
- Collaborate – work with educators and families to determine what are appropriate functional goals and needs in the classroom, and how they can be addressed. This blog on collaboration between OT and educators can assist.
- Continue Direct Intervention– There may be a need for direct therapy intervention. Keep your students motivated with relevant and important treatment activities.
- Address life skills. The OT Toolbox has a series of life skills posts including cooking, laundry, filling out forms, and social stories.
Working with teenagers in occupational therapy can be challenging. A few final tips for the OT working in middle schools or high schools:
- Remember teenagers are suddenly big and somewhat awkward.
- Keep goals and objectives focused on relevant and functional skills.
- Educate staff and caregivers about the role of the OT in schools.
- Provide resources, and make adaptations to the educational environment to help students better access their curriculum.
- Try not to be in the hallways when they are transitioning between classes!
HIGH SCHOOL OCCUPATIONAL THERAPY
School based occupational therapy is drastically different from private or outpatient therapy. Private therapy follows a medical model with hands on treatment, learning objectives, and goals relating to anything impeding function. The educational model focuses solely on education related goals. It aims to adapt and modify curriculum, so students are able to access their education. Because of these different treatment models, High School Occupational Therapy is going to look different at school than at a clinic. This post will delve into both types of therapy models as learners are being prepared for life after high school.
HIGH SCHOOL OCCUPATIONAL THERAPY CLINIC MODEL
In a clinic or outpatient therapy model, learners work on their “occupation”. Occupation is defined as daily activities that are goal oriented. It is what you do. Each person’s occupation looks different. It might be in the role of parent, child, grandparent, worker, student, housekeeper, engineer, or bricklayer. Occupation is typically referred to as a job, and in essence being a child is a job. What are the daily activities involved in being independent as a child? This is the core of occupational therapy.
What is the role of a high school student?
In occupational therapy, one of the key components impacting functional performance is the environment. For the high school occupational therapy client, this is something that must be considered.
- Self care – grooming, bathing, dressing, using the bathroom, and eating, and overall life skills.
- Instrumental Activities of Daily Living – laundry, cooking, cleaning, managing money, transportation, school, doctor appointments and medications, shopping, social function, and communication
In the medical model, goals function on the above skills that are limiting the learner’s ability to live independently. That being said, there is a time when certain goals are not appropriate anymore. If your learner has been working on shoe tying for eight years, it might be time to transition to velcro. The learner who is never going to live alone might not need to balance a checking account or go to the grocery store.
HIGH SCHOOL OCCUPATIONAL THERAPY SCHOOL MODEL
School based therapy services need to be educationally related. This is often difficult for educators and their families to understand. While it is true the student may need to learn to cook and do laundry, it is only going to impact their education if it is part of their educational objectives. A student does not need a buttoning goal if they never wear buttons to school. The objective of school based therapy is to adapt and modify the curriculum to meet the needs of the student. It is not to teach laundry, but to determine what the barriers might be to the student learning this skill. High school occupational therapy goals do not specifically teach handwriting, but functional communication. Does the student need a name stamp or an ID bracelet to identify themselves?
Tips about High School Occupational Therapy in the School
- Keep goals educationally relevant
- Goals need to be kept in perspective. If your learner can not write their phone number by 11th grade, they might need an alternative method of sharing this information. Some students might never be able to do fasteners independently and need to look toward pull on or adapted clothing. Tommy Hilfiger makes some stylist (although expensive) adaptive clothing for teens and young adults.
- Talk about transition services. LINK TO TRANSITION ARTICLE What is the student working toward after graduation? What are the ‘must have’ skills in order to be successful?
- Talk with the team about what barriers they are hitting when it comes to helping their learners reach goals
- Consider moving students to an indirect or consultative model. Teachers are usually on top of their programs and know what goals they are working toward. Sometimes they need a piece of adaptive equipment or problem solving when they get stuck. I had a student last month whose goal was rolling cookie dough for the class business. He was having difficulty making consistent size balls. He did not need weeks of OT to help him. He needed a five minute consult and a mini ice cream scoop to make the balls uniform in size. Another student needed a handful of fidgets to keep his hands out of his mouth
- Check out this article on Occupational Therapy for Teenagers
- Advocate and educate about the role of the occupational therapist in schools. This does not mean we sell ourselves short, but rather allocated our time wisely, giving direct services to those with more pressing needs.
High School Occupational Therapy Activities
- Keep goals focused on attainable goals. There will be a limited time left for pediatric therapy, and goal completion
- Communicate with caregivers to determine what goals are relevant. There is little point in working on laundry if the parent states the learner will NEVER do their laundry. Ask the caregivers what is most important to them
- Talk with caregivers about plans post graduation. Many families do not think far ahead and are taken aback when confronted with questions and information. Many agencies have waiting lists that are years long, therefore families need to start planning early
- Gear goals toward whatever life program the learner will be transitioning into. These might be vocational, career oriented, or life skills programs
If you find yourself using a direct therapy model with students, you will need some motivating ideas for them.
- Work on self regulation and emotional regulation
- Address executive function skills such as working memory, organization, impulse control, and attention
- Task boxes – these can teach job readiness skills
- Simulate job applications
- Banking tasks including using a debit card
- Researching their own transition plan
- Developing their own goals toward transition
- Alternative methods of self identification
- Begin and adjust job readiness skills
- Find resources for students and their caregivers for their transition plan
- Navigating the cafeteria, opening containers, and paying for lunch
- Calendar skills to manage their time
- Social skills to address any difficulties in the classroom
As a school based therapist, know your role and don’t be afraid to express it. Take the time to educate others, so you are able to spend your valuable time helping as many learners as possible, in the most effective ways. It is easy to get railroaded by an anxious parent or an advocate, but in the end you are doing what is legally required and most effective for their student.
NOTE*The term, “learner” is used throughout this post for readability and inclusion. This information is relevant for students, patients, clients, preschoolers, kids/children of all ages and stages or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.
Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.