As school-based OT practitioners, we are constantly seeking ways to effectively support our students in the natural environment of the classroom.
Push-in services, where we deliver interventions directly in the classroom, can be a powerful approach. With push-in school-based OT services, we can directly support the students in the environment they need to access.
However, the success of these services hinges on careful planning, clear communication, and a deep understanding of our unique role within the educational team. In this article, we’ll explore when push-in OT services are most effective, how our role differs from that of para-professionals, and some common mistakes to avoid.
What Makes Push-In School-based OT Services Effective?
Push-in OT services can be a powerful way to deliver interventions within the classroom context, allowing students to simultaneously learn and practice skills in their natural learning environment. But push-in services are not a one-size-fits-all solution. Understanding when push-in OT is most effective requires a nuanced approach that considers the individual needs of the student, the classroom dynamics, and the goals of the intervention.
Maximizing Natural Opportunities for Skill Application
How often have you watched a student meet their goal in a pull-out session only to return to class and revert to old habits?
Push-in OT services (as a standalone service or in conjunction with pull-out services) are particularly effective when the goal is to help a student apply skills in real-life situations. For example, students working on social skills, sensory regulation, or fine motor tasks to support classroom independence often benefit from incorporating these skills in the classroom rather than in a separate therapy room.
The natural classroom environment offers opportunities for immediate application and generalization of skills, making interventions more meaningful and functional.
Promoting Inclusion and Reducing Stigma
Another advantage of push-in services is the promotion of inclusion. By providing support within the classroom, OT practitioners can help reduce the stigma that sometimes accompanies pull-out services. Students receive the help they need without being singled out or removed from their peers, fostering a more inclusive environment. This can be particularly important for students who may already feel isolated or different from their classmates.
Sometimes, you may need to single out a student during push-in services. Other times, you can disguise an individual session as a group facilitation by interacting with other students in a limited capacity. There have been push-in sessions where I walk around the entire room supporting all students, but I keep a keen eye on the one student I am there to support.
Facilitating Collaborative Problem Solving
Push-in services also create opportunities for collaborative problem-solving with teachers and other classroom staff. Being present in the classroom allows OTPs to work alongside teachers, providing real-time strategies and modifications. This collaboration not only benefits the student receiving OT services but can also enhance the learning environment for the entire class. When therapists and teachers work together, they can develop more holistic and effective strategies that are integrated seamlessly into the classroom routine.
Examples of Effective Push-In Scenarios
With these principles in mind, let’s explore three scenarios where push-in OT services can be particularly effective:
1. Supporting Sensory Processing During Group Activities
Imagine a student who struggles with sensory processing, particularly in noisy and visually stimulating environments. A push-in OT session during a group activity allows you to observe the student’s reactions and provide immediate, on-the-spot interventions. For instance, you might introduce calming strategies, modify the environment, or offer sensory tools that help the student participate more fully in the activity.
You may even follow up on this session with an email to the teacher on what strategies seem to work and strategies they can try. At the next session, you can take data and test new supports as necessary.
2. Enhancing Fine Motor Skills During Classroom Writing Tasks
Another ideal scenario for push-in services is during classroom writing activities. For students working on fine motor skills, being present in the classroom allows you to observe genuine abilities and provide immediate guidance to the student and staff.
In a pull-out session, you might notice the student's grasp and focus on that, but in the classroom, perhaps you see the student struggle more when asked to copy from the board. With that observation, you can provide further suggestions beyond using a tripod grasp and help the teacher understand why the student is turning in incomplete classwork.
3. Facilitating Social Skills in Group Projects
Push-in OT is also invaluable for students working on social interaction skills. By being in the classroom during centers and group projects, you can facilitate positive social interactions, model appropriate behaviors, and help students navigate the complexities of peer relationships in real time. This hands-on support can significantly enhance a student’s social participation and confidence.
In these scenarios, push-in sessions allow us to observe and address challenges as they arise, making our interventions more relevant and immediately impactful. While some may argue, "That is a paraprofessional's job," your ability to observe and intervene during these situations is unmatched.
The Distinction Between Push-In OT and Paraprofessional Support
I, too, have sat in a classroom and wondered, "How am I providing a service different from that of a paraprofessional?"
Before I get into the specifics, even if a teacher, administrator, or parent cannot pinpoint how you are different from a paraprofessional by observing you for a few minutes, that does not mean you are doing something wrong.
After all, to the untrained eye, the keys on a piano all look alike. However, each creates its own unique note, harmonizing together to create a beautiful melody.
The role of an OT pushing into the classroom and that of a paraprofessional and both roles are integral to many students' success, but they are not interchangeable.
Therapeutic Intent vs. General Support
You bring a specialized skill set to the classroom that is rooted in research and therapeutic intent. OT interventions are designed to address specific areas of need, such as fine motor skills, sensory processing, or social participation. Unlike paraprofessionals, who provide general support and assistance, our role is to identify and implement targeted strategies that are grounded in evidence-based practice.
Example: Modifying a Classroom Activity
Consider a scenario where a student is struggling with a classroom task due to sensory sensitivities. While a paraprofessional might assist the student in completing the task, an OT would assess the situation and modify the activity itself, such as using a colored pencil instead of a crayon or allowing a student to use a non-distracting fidget. Your intervention is not just about task completion but about creating an environment where the student can thrive independently beyond this individual assignment.
Collaboration is Key
It’s also crucial to emphasize the importance of collaboration between OTPs and classroom staff. Our work with paraprofessionals should complement each other rather than overlap. Clear communication and mutual respect ensure that both the therapeutic and supportive needs of the student are met effectively.
Sometimes, that means not pointing out something you might have done differently out of respect for their role. Other times, it might mean asking them if you can sit in with the students so they can "have a break" and watch how you support the students. And sometimes, it means that you will learn something new from paraprofessionals. And that is perfectly okay.
Ready to learn how to support paraprofessionals rather than feel like you are a paraprofessional?
In this 1-hour course, My Bui-Lewis and Danielle Delorenzo share the knowledge and resources you need to expand your ability to train and work with paraprofessionals, helping them to implement and support the carryover of strategies in the classroom.
Access this course and more when you join the OT Schoolhouse Collaborative today!
Common Mistakes to Avoid in Push-In OT Services
Even the most seasoned OT practitioners can make mistakes when delivering push-in services. Here are some pitfalls to watch out for:
1. Poor Timing and Lack of Communication
One of the most common mistakes is showing up at an inappropriate time—such as during a test or a transition period (unless you're working on transitions or test taking, of course). This not only disrupts the classroom but also diminishes the effectiveness of your session. Do your best to coordinate with the teacher to ensure your visit aligns with classroom activities conducive to therapy and the student's goals.
Classroom schedules change from time to time, so don't be surprised if your usual time with a class has something else going on. If you can still work in a session with what is happening in the classroom, great. If not, document what happened and move on. You can ask your department and supervisors later how to move forward when this happens again.
2. Being Unprepared and Unintentional
Another common pitfall is entering the classroom without a clear plan. Push-in sessions should be intentional, with specific goals and strategies in mind. Sure, your plans may change based on what you observe, but you should know what goal you plan to address and an idea of how you plan to address it.
Walking into a classroom unprepared can lead to disjointed sessions that are not aligned with the student’s IEP goals or the teacher’s objectives. It can also make you feel inadequate and unsure of how to document the session.
There have been times that I have stated in my own documentation something to this extent: "Pushed into Johnny's classroom to support alternative seating methods. However, upon entering, Johnny was visibly upset. As a result, the therapist engaged in co-regulation strategies and consulted with the classroom staff on co-regulation strategies they can use breathing and sensory strategies with Johnny in the future." It's okay if plans change, but you should have a plan of some kind for when you enter the classroom.
3. Failing to Build Relationships with Teachers
Effective push-in services rely on strong relationships with teachers. Without mutual respect and understanding, it’s difficult to integrate OT interventions seamlessly into the classroom routine. Take the time to communicate openly with teachers, understand their perspectives, and work collaboratively to support the students.
Rather than giving teachers something extra to do, try taking something off their plate - like printing out adapted paper for them or coaching the class through a breathing exercise so the teacher can watch and learn without the pressure of doing it in front of you.
Teachers are constantly scrutinized by admin, parents, and other teachers. If they feel safe with you, they will likely incorporate what you have to share.
The Wrapup
Push-in OT services can be an incredibly effective way to support students within the natural context of the classroom. We can make the most of this approach by understanding when push-in sessions are most appropriate, clearly distinguishing our role from that of paraprofessionals, and avoiding common mistakes.
As you reflect on your current practices, consider how you might refine your push-in services to better meet the needs of your students and collaborate more effectively with your colleagues.
Remember, our goal is to create an environment where every student can thrive, and push-in services are a powerful tool in achieving that mission.
Resources
Cahill, S., & Beisbier, S. (2020). Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years.. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 74 4, 7404397010p1-7404397010p48 . https://doi.org/10.5014/ajot.2020.744001.
Eddy, L., Wood, M., Shire, K., Bingham, D., Bonnick, E., Creaser, A., Mon-Williams, M., & Hill, L. (2019). A systematic review of randomised and case-controlled trials investigating the effectiveness of school-based motor-skill interventions in 3-12-year-old children.. Child: care, health and development. https://doi.org/10.1111/cch.12712.
López-de-la-Fuente, M., Herrero, P., García-Foncillas, R., & Gómez-Trullén, E. (2021). Contextual, Client-Centred Coaching Following a Workshop: Assistants Capacity Building in Special Education. International Journal of Environmental Research and Public Health, 18. https://doi.org/10.3390/ijerph18126332.
Ready to learn how to support paraprofessionals rather than feel like you are a paraprofessional?
In this 1-hour course, My Bui-Lewis and Danielle Delorenzo share the knowledge and resources you need to expand your ability to train and work with paraprofessionals, helping them to implement and support the carryover of strategies in the classroom.
Access this course and more when you join the OT Schoolhouse Collaborative today!
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