Wednesday, April 22, 2015

A Day in the Life | School-based OT, Part 3

Today, I'd like to welcome my OT social media idol, Cheryl of OT Notes! If you enjoy reading blogs like mine, then you have Cheryl to thank! As one of the original OT bloggers (in fact, I remember when her blog was the only OT blog I read), Cheryl was a big inspiration to me when I was thinking about starting my own blog, and she continues to inspire me today. I'm so honored to have Cheryl here to share a "typical" day as a school-based therapist.

I work as an occupational therapist in the school system, and literally no day and no week are the same! My days can even be wildly different than that of my coworkers, just by the nature of our caseloads.The educational model is different from the medical model in how and why services are provided. OTs in the school system provide direct services and consultation to help students access their Free and Appropriate Public Education. These services are mandated through the Individuals with Disabilities Education Act for students who go through the IEP process, and through Section 504 of the Americans with Disabilities Act for students who do not qualify for special education. You can check out AOTA’s fact sheet on OT in the school system for more details.

My school district employs about 5 full time OTs and 3 COTAs to cover about 45 schools across our county serving about 20,000 students. I have what I consider a fairly large number of schools and students, but the majority of my students are on consultative services, and I do have assistance from the COTAs at some of my schools to help cover direct services. I do my best to keep my schedule similar from week to week. I’m usually at the same school every Monday, for instance. However, if there are meetings, evaluations, or other reasons that services are missed, the schedule will get reworked. I also try to not make multiple trips per week to my farthest away schools, and instead try to sneak in time to see those students if I have to be out at the site for a meeting.

I have a preference for front-loading my day and my week so I have time for paperwork and catch up as the week goes on. The beginning of the year is absolutely CRAZY trying to find all of my kids and find the best time in their schedule to provide their OT. I try avoid all encore/special classes (art/music/PE/band/library), lunch, recess, core classes, scheduled transition times, and other interventions (speech and sped pullouts). I can’t always do it, but I try!

Monday: I head to a local elementary school. This is a Title I school which serves a lower-income population than some of the other city schools. There are two classrooms for students with autism or developmental delays. I absolutely love the staff here and they are really committed to a lot of positive projects to build their school and community. They also treat me well- I have a mailbox, case managers are quick to inform me when there is a change, teachers frequently fill out screening forms when they have a concern, and everyone is friendly.

8:00 - I meet my COTA buddy in the parking lot and we lug in a variety of tools and activities. We get set up in the case manager office/intervention area. We communicate before the day about which IEP goals we will address in which way. There are a couple of slots of individual kids where the other practitioner will type notes to catch up, screen new students, or observe consult students. We try to plan this out at the beginning of the day. We are trying to do a once monthly push in session to the autism classroom, and we work on ideas for this also.
8:30 - we see a pair of preschoolers with IEPs for speech impairment. They are getting OT as an early intervening service (EIS, also known as Response to Intervention) to address fine motor concerns.
9:00 - we see a kindergarten student working on basic skill acquisition as part of his IEP. Sometimes we will pull a peer from a first grade class for EIS at this time as well.
9:30 - The case manager runs a reading intervention group and we write some notes.
10:30 - The COTA sees a life skills student who is working on basic prewriting and self-help skills. This is also the time we will do a once monthly push in group in the autism classroom. Most recently, we did a Dr. Seuss theme where we made puppets and oobleck. We used the oobleck to trace letters and shapes, and the puppets to promote social interaction.
11:00 - We see a pair of second graders who have made great progress. Both have attention difficulties and one has an orthopedic impairment. These kids always make us smile, so we end the morning on a high note.
11:30 - we take a lunch either with the case managers in their room or in the staff lounge with the first and second grade teachers. Occasionally someone will ask a question about a kid but usually it’s pretty relaxed.
12:00 - after lunch, we move our materials to another room so that we can continue to have a space and not interrupt other services. This is better for seeing individual students with autism who need additional structure of the smaller room.
12:30 - I see a student with autism with a lot of supports in place. We use a visual schedule, tangible rewards, and multisensory activities to try to get his best participation. The COTA and sometimes the speech therapist will join me for sessions on occasion to help facilitate the readiness skills we are addressing.
1:00 - I’ve just started seeing an older student who was referred for EIS. We are working on perceptual skills and improving handwriting spacing and sizing.
1:30 - The COTA sees another student from the autism classroom. She has made great strides in readiness skills since the beginning of the year and responds really well to the COTA’s ebullient personality.
2:00 - We finish with our final pairing of IEP students. Both have an orthopedic impairment and so we have a more intense focus on hand skills- opening containers, completing multi-step activities, and becoming speedier with classroom tasks.
2:30 - I spend this time catching up on documentation for the day. I fill in the times or absences on my lesson plan sheets for each student. I write notes for the individual sessions. If I have time or pressing deadlines, I may work on upcoming IEPs or writing reports.
3:30 - done for the day! I pack up my car and go get my son from daycare. Unlike jobs I’ve had before, I don’t ever worry about email or notes at home.

About Cheryl:
I got my Master in Occupational Therapy degree from West Virginia University in 2007 and have been writing the OTNotes blog since 2008. I have literally worked with clients across the lifespan- Day 1 to 100+ years and love the flexibility of OT. I’m loving the speed and stability of a full time school system job in Maryland. I have presented at 2 state conferences and twice at AOTA conferences on online and social media tools related to OT as well as other topics. I will be hosting #otalk2us this fall on school system issues.

IMG_8382-8.jpgConnect with Cheryl:
Blog: OT Notes
Twitter: @otnotes
OT Connections:

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