Tea Time with School-Based OT @SarahBeeOT

Hi friends! Pinkys up because we are having tea-time with Sarah @SarahBeeOT. She is sharing about her experiences as an occupational therapist working in the school system, so if you have ever been curious about the who, what, when, where, whys of school-based OT you'll be sure to enjoy this interview!

Q: What practice setting are you sharing about today?

A: School-based OT working with students in grades K-3

Q: What is your educational background? What degree(s) and/or specialties do you hold?

A: For undergrad, I earned a Bachelor’s Degree in Health Sciences. My graduate degree is Master of Occupational Therapy (MOT). My professional credentials are MOT, OTR/L. I will say that my educational career track was a bit atypical since I was admitted into my OT graduate program under the Jumpstart option. This meant that my first semester of MOT coursework counted both towards my Master’s and Bachelor’s Degree. This “double-dipping” saved me a little bit of time and money.

Q: How long have you worked in this practice setting?

A: The 2020-2021 school year will be my 3rd year practicing as a school-based occupational therapist.

Q: Please describe a typical day in your practice setting? (e.g. what time do you arrive/take break(s)/leave work?

A: My contract hours are from 7:45am to 3:15pm. I’m required to be at school during this time, but I usually arrive early or stay late to prep, write evaluations/progress notes, or to attend IEP meetings. I’m allowed 30 minutes for lunch each day which I can schedule at my leisure.

Q: Do you formally clock in and clock out, if so, how is on the computer or via sheet, etc.?

A: Just the honor system- no formal clocking in/out.

Q: Who provides you with your schedule? Do you typically stay on this schedule or does it fluctuate depending on patients’ availability?

A: Ah, scheduling! One of my favorite parts of the job (said no one ever). I create my own schedule at the start of each school year but it often changes on a weekly basis. Scheduling can get tricky since we are not allowed to pull students from specials (art/gym/library/music), lunch, or recess to provide therapy. We also have to schedule around any other services the student receives (special education instruction, speech, PT, social work, etc.). I have to be flexible and willing to change things up as the school year progresses! When appropriate I will do co-treatment sessions (with other disciplines) or push-in sessions (providing therapy within the student’s natural learning environment). These types of sessions can sometimes help with avoiding scheduling conflicts.

Q: How many patients do you typically see? How long do you work with them for?

A: Most of my students are seen in 30-minute increments and it’s typical for me to have up to 9 sessions per day. An exception to this would be Wednesdays, which are early dismissal days. My Wednesday afternoons are dedicated to staff meetings and catching up on paperwork.

Q: What type of diagnoses do your patients typically have? Can you please provide 1-2 activities you would do in a standard treatment session with one of these patients?

A: The range of diagnoses can vary, but some common ones include Autism, ADD/ADHD, Down Syndrome, Fragile X, and Cerebral Palsy. In the school-based setting my role is to help students access their educational program. This can include working on anything from ADLs to handwriting and everything in between. My sessions vary significantly depending on the student’s functional goals, but they all typically consist of three main components: (1) activities to address underlying skills (i.e. strength, visual perception, fine motor control, bilateral coordination, sensory processing, motor planning); (2) targeted practice of the specific skill (i.e. dressing, handwriting, cutting); (3) free choice activity determined by student. For a kindergarten student with a goal of improving written communication skills, their session might start with a warm-up activity using theraputty, followed by building letters with multi-sensory materials, and then finishing with letter formation practice using pencil and paper.

Q: Do you have meetings to attend throughout the day? If so, how long and who attends these meetings with you?

A: Meetings are a big part of school-based OT! In this setting there are several types of meetings I am responsible for attending each week. There’s a variety of Individualized Education Program (IEP) meetings, Special Education staff meetings, school-wide staff meetings, OTR/COTA supervision meetings, and meetings with the other therapists in the district. At my school in particular, we typically schedule IEP meetings before/after school, while the other meetings are scheduled during my work day.

Q: What type of documentation do you complete? (i.e. how long does it take, how frequent are your notes due, etc.)

A: We currently just use paper documentation for treatment session notes. For each student I print out a chart that lists their goals and objectives. This chart is kept in the student’s “working folder” along with any work samples I decide to keep. After each session, I write a quick note to summarize significant data or observations relevant to the student’s progress towards their goals. These notes only take me a few minutes per student and are completed by the end of each day. Additionally, I have to complete IEP documentation for each student annually (summarizing strengths/needs, present levels of functional performance, developing new goals, etc.) and write progress notes at the end of each trimester. These are both completed using an electronic documentation system and can take several hours to complete.

Q: What does a typical evaluation look like? How long does it take? What assessment tools do you use?

A: A typical evaluation includes use of standardized assessment tools in combination with supplemental clinical observations and learning environment observations. Some commonly used assessments include the BOT-2, Beery-VMI, M-FUN, Brigance IED III, SPM, and DTVP-3. It usually takes me at least 2 sessions to administer any standardized tests, however this can extend longer depending on the student’s functional abilities. For the learning environment observations, I will observe the student for approximately 30 minutes to get an idea of their functioning within their natural environment (versus in the OT room). The location and timing of the observation varies based on the functional concerns. Some examples include observations during writing, art, transitions to/from recess, and mealtimes.

Q: What is a ball-park range of what an OT can expect to earn in your practice area (please also include approximate geographical location - rural South Carolina, suburb in Connecticut, etc.) Please also include if this rate is for per diem, with benefits, per visit, etc.

A: In general, the school-based setting pays much less than medical settings like acute rehab or skilled nursing facilities. The salary for school-based OTs also varies significantly depending on geographical location and type of employment (contractor or district employee). It could be anywhere from $40k to $80k+ depending on location and benefits. In rural states like mine (Maine) the pay is much lower than somewhere like New York, New Jersey, or California. I currently hold a salaried position as a district employee and am on the same contract as our teachers. My salary is based on my degree level and years of experience, and my contract includes medical/dental/vision benefits. While I can’t disclose my actual salary, I will say that regardless of pay, my benefits, schedule, and overall quality of life are 100% worth it.

Q: How did you get your “foot in the door” to work in this setting?

A: You know, it all really worked out by chance. My transition from the pediatric outpatient setting to school-based OT started by covering a maternity leave. This was a great way to get an introduction to the setting. I then went on to cover the same school’s Extended School Year (ESY) program that summer, and later was hired on for a full-time position. If you’re looking to get into school-based OT, I definitely recommend job shadowing at different schools in your area. This will help you build professional relationships and gain an understanding of how different districts operate.

Q: What is your favorite part of this practice setting? Can you provide a favorite memory of a patient/client that you know OT positively impacted their life?

A: One of the best things about my setting is getting to work collaboratively with other professionals in order to help our students learn and grow. Also, it’s just super fun being back in elementary school again! It’s so difficult to pinpoint a single memory, but I will say that one of my favorite things about my job is whenever a student overcomes a personal obstacle during therapy. Getting to share those moments of pride and excitement with them when they accomplish a goal is really the best thing ever. It validates the importance of the work we do as occupational therapists and shows that I am facilitating meaningful change in my students’ lives each day.

Q: What is the biggest mistake you’ve made in this setting? How did you correct this mistake (if possible) or what did you learn from it?

A: I’ve yet to make what I’d consider a “big” mistake in this setting, although I know it is bound to come someday (we’re all human after all). I have run into issues with IEP documentation at times, though. There was one instance where I realized a significant error in my documentation after an IEP had already been reviewed, submitted and sent home to the student’s family. This required me to contact the student’s case manager to re-open the IEP so it could be revised. The case manager then had to complete additional paperwork and contact the parents regarding the changes made. Even though it wasn’t a huge deal to amend the IEP, I felt embarrassed about my oversight and felt guilty that it resulted in more work for the case manager. I’ve since learned to triple-check my documentation before submitting and to give myself grace when mistakes happen. Also, checklists for IEP documentation have since been a real life-saver.

Q: How do you personally prioritize self-care and prevent/manage experiencing burnout?

A: I am one of those people who can’t seem to take their own advice on this one! I understand the importance of work-life balance, I really do. But I also find myself taking the stress of work home with me on a daily basis and battling the “Sunday Scaries” every weekend (both of which contribute to burnout). The biggest things for me have been talking it out with coworkers and family, indulging in my favorite Netflix shows (The Office and Grey’s Anatomy on repeat), hiking, and flotation therapy. It’s still a work in progress but I’m making an effort to get better at it. If you have any tried-and-true methods for preventing burnout, please let me in on your secrets!

Q: If you could go back in time, what advice would you give yourself (or to a new grad) who wants to enter this practice setting as an OT

A: Review IDEA, take some school-based continuing ed courses, connect with school-based OTs on social media, seek mentorship, and job shadow at schools in your area if possible. When interviewing, be sure to ask lots of questions that will give you insight into the district’s values and what the school’s community is like. And most importantly, when in doubt go with your gut. You know more than you think you do.


Sarah is a pediatric occupational therapist currently practicing in the school-based setting. She loves sharing her OT activity ideas on Instagram and creating fun and engaging therapy resources for fellow OT practitioners. When she’s not thrifting OT supplies at Goodwill and Target, you’ll probably find her hiking through the mountains of New England or on her couch binge-watching The Office. You can connect with her on Instagram at @SarahBeeOT for tips, tricks, activity inspiration and more as she navigates the chaos of the upcoming school year!

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