Occupational Therapy in Schools

Occupational therapy in schools looks a lot different than it has in the past. With social distancing requirements, sanitizing needs, and changes to school schedules, therapists are looking for ways to meet the needs of their students. This year, school-based OT looks different than any other year, and occupational therapy activities will reflect those changes. Here, you will find strategies that school-based OT practitioners can use in the classroom as part of push-in services, in small groups, or in an individual, pull-out model.

Group Occupational Therapy

Many OTs need to move from a push-in model to pulling each one of their students out of the classroom for therapy intervention. Other therapists will focus on pushing into the classroom for a small group activity with a couple of students who are in the same classroom.

Regardless of the model, occupational therapy activities will need to have social distancing practice in place and thoughtful use of supplies. Looking for group occupational therapy activities that can be completed with a small group?

Some recommendations for group OT can include:

Arranging the occupational therapy room so that students are well-spaced out. Using painters tape to create marked stations for each student can be used for social distancing, but also to help kids work on personal space, body awareness, and spatial awareness. Students can carry this skills over to functional tasks such as standing in lines in the hallway or getting on/off the school bus, or in the community.

Sensory coping strategies in the classroom can be adjusted to address social distancing requirements while meeting the child’s needs. Think about Simon Says, wall push-ups, I Spy games, etc. These therapy Simon Says commands can target many different skills through play.

Brain breaks can be used on an individual basis, in small groups, or in the whole classroom.

Mindfulness activities can be implemented in therapy sessions or in small groups.

Pushing into the classroom to work with a small group might be something that some therapists have to do per school recommendations and wishes. When pushing in to the classroom, precautions can be taken to try a group activity without close interaction like “I Spy” or “What’s missing?” visual perception games. Add handwriting to these group activities to work on specific skills, too.

There are points for both push-in service and pull out model of school occupational therapy during a pandemic. For example, pushing into the classroom or using a consultation model can mean less equipment that needs to be sanitized between sessions.

School Occupational Therapy Suggestions

These suggestions can be used by school-based OT professionals in pull-out sessions or in push-in therapy in the classroom.

Plan ahead. Use this interactive school-based OT planner to plan out activities based on themes and come up with a plan for each week. This can help with accessing materials and using what student’s have in their desks to work on certain skills. (See below for how to use what the student has in their desk.)

Organize the OT space so that items can not be accessed by students. Keeping items out of reach of students will allow for less sanitation time between sessions.

Pull out items that will only be used during that session and place each used item into a designated bin or “sanitize zone”. These items can be sanitized after each session and allowed to dry after the use of sanitizer.

Washing hands before/after each session. When children come into the occupational therapy space as a small group, or when a small group is seen in push-in services, therapists can have each child wash and dry their hands or use hand sanitizer both before and after each session. Make it part of functional goals, if it is something that can be used to meet the goals of the child. Hand-washing offers opportunities to work on eye-hand coordination, fine motor skills, tactile sensory experience, attention, organization, motor planning, and more…all part of a functional activity of daily living. Add in the clean-up portion (throwing away paper towels) and you’ve got aspects of IADL work as well.

Allow time for washing hands/sanitizing. we know that as therapists, we have a FULL schedule. Some OT professionals juggle 60+ students and many different school districts. But, allowing time for sanitizing and hygiene is a must. It’s not going to be easy, but like everything else, we are going to be forced to slow down and take that necessary time. Try to add that cleaning/sanitizing time right into sessions. The student can do their last activity while the therapist sanitizes materials.

Incorporate outdoor recess as a therapy session. So many goal areas can be addressed through play and social interaction in outdoor recess. While this “down time” might look different than it has in years past, games and small group activities can be incorporated into occupational therapy sessions, in a “push-in” model that occurs outdoors. Here are sensory diet activities for outdoor recess.

Outdoor occupational therapy sessions. Sensory processing activities on the playground is an excellent way to work on sensory needs and regulation. What’s more, is that the outdoors offer the perfect environment to work on so many OT goal areas. Take students to the playground for sensory and motor work. Use a blacktop surface for fine motor and core strength activities. Use a shading lawn area to work on various coping strategies. Here are sensory diet activities for the playground.

Use teletherapy slide decks- Even though OT professionals may be in the schools (or virtual depending on the district and state), there are many free teletherapy resources like OT slide decks available that can be used in person, too. Try these teletherapy activities, specifically this alphabet slide deck that teaches letters with a handwriting, letter formation, and gross motor brain break activity.

These occupational therapy teletherapy activities can be helpful for remote learning, hybrid models, or even in the classroom.

School-Based OT Kits

With social distance needs and the sheer inability to sanitize materials all day long, using an inexpensive kit for each student can be accomplished. Here, you will find suggestions on how to create a kit for each student. Small occupational therapy kits can be created at a low cost. Here are some OT kits that we’ve covered:

Fine Motor Kit

Craft kit for occupational therapy

Themed occupational therapy kits

DIY handwriting fine motor kit

A small kit for each student may be necessary. I tried to come up with a list of LOW cost materials and ones that can be spread across a caseload. For example, a $1 deck of cards can be split up among man students as they each get 5-6 cards. A pack of pipe cleaners or a pack of straws can be distributed among many students, especially if the pipe cleaners are cut into smaller sizes.

These kits can be organized into a plastic zip-lock baggie for each student. Write the child’s name on the bag and make sanitizing the outside of the bag part of the child’s session. Kids can participate in this aspect, too…an essential self-care ADL of hygiene!

Some items to include in individual kits include:

• Play dough mini-tubs- Here are fine motor activities using play dough.
• Pony beads- Here are fine motor activities using beads.
• Piece of bubble wrap- A big sheet of bubble wrap can be cut into small sections and added to a toolkit. Use it for fine motor work, opening the thumb web-space, or a sensory fidget. You can even use bubble wrap in a visual perception exercise.
• Pipe cleaners- These are great fidget tools! Here is just one way that pipe cleaners can be used for precision and dexterity.
• Mini-erasers- Stack them, sort them, and use mini erasers in visual perceptual activities.
• Coins- Manipulating coins is a fine motor workout.
• Stickers- These 10 reasons why kids need to play with stickers explains it all.
• DIY tongs- Use craft sticks to make DIY tongs.
• Craft sticks- A handful of craft sticks can be used for fine motor work or visual perceptual activities. Here are pick-up sticks activities that can be modified with craft sticks.
• Sheet protector
• Craft pom poms- Use craft pom poms for fine motor work.
• Straws
• Playing cards- Grab a deck of cards and add a handful to each OT kit. Use playing cards in fine motor work and other activities.
• Clothes pins- Here are fine motor activities using clothes pins.

School Occupational Therapy Activities

Use the items students have in their desks. This year, they will be using more individual items that come from home and are separated from other students, so use those materials. Some items and occupational therapy activities include:

Markers- Use regular markers in occupational therapy activities like the ones we have listed.

Scissors- Students will likely have their own set of scissors in their desk. Work through this scissor crash course to work on precision and dexterity.

Colored Pencils- If students have colored pencils, use them to work on handwriting, visual motor skills, and fine motor work. Here are colored pencil activities.

Pencil box- If students have a pencil box to hold their materials, use that pencil box in OT activities!

Crayons- Crayons are always on the back-to-school list. There is a reason why crayons are so effective in building skills…Use those power tools in school occupational therapy sessions. Here is just one way to work on distal finger control with crayons. And, kids will love this 3 crayon challenge!

Ruler- If kids have a personal ruler in their desk, use that to work on bilateral coordination, eye-hand coordination, fine motor skills, pencil control. Here is one way to use a ruler to help with cursive writing.

Small pencil sharpener- This is a school supply item that is often times on the back to school supply list. But this year, it will be even more important for students to have their own pencil sharpener. Why not use it to work on arch strength, bilateral coordination, pinch and hand grasp, and endurance? Using a small pencil is effective in tripod grasp and hand strength, but kids can sharpen those pencils and work on skills, too.

Books- Books and workbooks can be used for proprioceptive input and heavy work.

Folders and papers- Kids can work on organization and executive functioning skills with the materials they have in their desks. Folders, papers, and all of the “stuff” can get overwhelming fast, especially for the child struggling with impulse control, focus, attention, and other executive functioning skills. Work on those areas with strategies.

Getting kids RE-ACCLIMATED

Kids have been out of the school setting since around March. That is three months longer than the typical summer break. We all know that kids experience the “summer slide” on a typical year. This year will be different in the way that kids re-enter the school setting.

Some children may have been completely isolated over the course of the last months. They’ve seen a drastic change in social settings, shopping in stores, and cancellation of activities or sports. Heading back into a group setting (even if it is smaller in the way of less children in the classrooms or more space between settings) may throw some kids off.

Kiddos that previously had difficulty with coping in the classroom, attention or behavior concerns, meltdowns, trouble listening or focusing on their lessons…they may struggle even more than before.

Even students that weren’t previously on caseload may struggle. Teachers may have questions for you or more children to “take a look at” as the entire school population re-acclimates back into the classroom setting.

AOTA has suggestions for working with clients in the midst of COVID-19. In the case of increased stress or anxiety in kids, therapists can work with families, teachers, and students to adjust so that the student can perform functional tasks that impact their education. This might look like addressing coping needs, emotional regulation, or self-awareness.

In other cases, it might look like recommendations for a routine or wellness. This wellness wheel can be helpful in addressing the balance of kids at home and at school.

As therapists, maybe we can offer movement-based activities or brain breaks that can be done as a whole group. Perhaps a consult with a teacher on one student leads to a deep breathing session for the whole class.

Educating parents, teachers, administrators, and even the students themselves on the connection between movement, coping tools, behavior, and cognitive processes will become more necessary.

Try some of these mindfulness and coping tools that can be used in school occupational therapy sessions or consultation:

Brain breaks can be used on an individual basis, in small groups, or in the whole classroom.

Mindfulness activities can be implemented in therapy sessions or in small groups.

This easy coping strategy requires no materials or items, making it sanitizing-friendly.

These anxiety and sensory coping strategies can be helpful with re-acclimation to the classroom and learning.

Working on social emotional skills can be helpful in identifying emotions as a result of reentering the classroom…and help kids come up with coping tools.

Final note on school based OT

This year is going to be a doozy! Occupational therapists, however are just the professionals to adapt to whatever changes come our way. Remember to take time for self-care as a therapist and address the stress and burnout with coping strategies and balance. Rest. Use these tips for occupational therapists to stay organized yourself. You’ve got this!

Free OT Slide Decks:

Here is a free Space Theme Therapy Slide Deck.

Here is a free Strait Line Letters Slide Deck.

Here is a free “Scribble theme” Handwriting Slide Deck.

Teach Letters with a free interactive Letter Formation Slide Deck.

Try this free interactive letter writing/brain break slide deck.