Picture this.
A first-grade teacher just showed you a handwritten note from a concerned parent requesting an initial special education evaluation for their child.
The note details the child’s difficulties in school—trouble with focusing, struggles with handwriting, and frequent fidgeting during class. And at the end of the note, in clear handwriting, the parent has specifically requested, “Please make sure OT, PT, and SLP are included in the evaluation.”
You pause. There are certainly areas of concern, but should OT be a part of the initial evaluation process?
While the parent’s request is understandable, you’re also aware that some of these concerns might be addressed through other services or strategies without involving an OT assessment just yet. Do you agree to assess right away, or do you wait for the psycho-educational evaluation to provide more clarity?
As school-based OTs, this scenario is a common one, and making the right decision isn’t always straightforward.
In this article, we’ll explore:
When an OT eval should be implemented during the initial special education evaluation request
When you may want to wait for the psycho-educational evaluation
And three ways to respond to a parent’s request for an OT evaluation (during the initial special education request)
By examining various situations, we can ensure that our evaluations are purposeful, timely, and aligned with the student’s specific needs.
Understanding the Initial Evaluation Process
When a student is referred for special education services, the first step is typically a comprehensive psycho-educational evaluation. This evaluation is conducted by a school psychologist (often with the support of a special education teacher) and typically assesses cognitive, academic, and emotional functioning to determine if the student meets one or more of the 13 qualifying criteria for special education services.
From a district’s perspective, waiting until the psycho-educational evaluation is completed before conducting additional assessments, like OT, may seem logical. It allows the team to determine if direct instructional services, such as resource programs (RSP) or specialized academic instruction (SAI), can address the student’s needs first. By waiting, the district may hope to achieve one or both of the following:
Avoid unnecessary evaluations that could lead to services the student may not need
Preventing therapists' caseloads from ballooning and, ultimately, saving the district money.
However, as OTs, we know there are times when waiting isn’t in the best interest of the student. Some concerns are simply not best assessed in a psycho-educational evaluation— they are concerns that fall squarely within our scope of practice.
When an Occupational Therapy Evaluation Should Be Considered Immediately
In my perspective, there are a few areas where an Occupational Therapy Evaluation should be part of the initial evaluation. These are situations where waiting for the psycho-educational evaluation may delay critical services the student needs.
Here are some of those situations:
1. Sensory Concerns Impacting Education Access
When sensory processing challenges are present, they typically won’t be captured in a standard psycho-educational evaluation. Even worse, the sensory-related concerns may be misidentified as strictly behavioral concerns, which could have service-related implications for years to come.
Students with sensory concerns might struggle with attention, behavior, and participation in the classroom. These difficulties often have a significant impact on their ability to access their education. If sensory issues are reported by parents or teachers, it makes sense to assess OT from the start, rather than waiting.
2. Fine Motor Skill Deficits Impacting Education Access
Fine motor difficulties, such as challenges with handwriting, using scissors, or manipulating classroom tools, are areas we are uniquely qualified to address. If these concerns are noted early on, conducting an OT evaluation as part of the initial referral can help get the student the support they need right away. Even in younger students where handwriting might not have been formally taught, if fine motor delays are evident, addressing them sooner rather than later can prevent future frustration.
3. Activities of Daily Living (ADLs) Impacting Education Access
ADLs, including self-care skills like donning/doffing a sweater, toileting, and feeding, are often overlooked in the typical special education evaluation process. If there are significant concerns in this area, we can provide crucial support that other services may not address. Even if services are not warranted after the OT evaluation, any consultation and accommodations we provide could go a long way in supporting both the student and the school staff.
When to Wait for the psycho-educational Evaluation
While there are clear cases for immediate OT involvement, there are also times when waiting for the psycho-educational evaluation might make more sense. Here are a few scenarios where it may be best to hold off on an initial OT evaluation:
1. No Clear OT-Related Concerns
If the primary concerns are academic or speech-related, and there is no indication that the student is struggling with fine motor skills, sensory processing, or other OT-specific areas, it’s reasonable to wait. In these cases, the psycho-educational evaluation will often uncover the main areas of concern, and OT may not need to be involved unless something specific arises later.
2. Concerns That Can Be Addressed by Teachers
For younger students, difficulties like handwriting or scissor use can sometimes be supported effectively through classroom instruction. If a student hasn’t yet received formal handwriting instruction or hasn’t had the opportunity to practice fine motor tasks in school, it may be best to wait until these foundational skills are taught before assessing OT. Similarly, if a student is still adapting to school routines, they may not need OT support at the initial referral stage.
A quick note on Delaying Referrals as a Means to Manage Caseloads.
Lately, it’s becoming more common for districts to delay OT evaluation requests—regardless of the concerns—until after a student has undergone a psycho-educational evaluation. While I understand the financial pressures and the need to manage service provider caseloads, this type of blanket policy seems to undermine the spirit of the Individuals with Disabilities Education Act. The purpose of IDEA is to ensure that every student’s needs are met on an individualized basis.
While I fully agree that not every student referred for special education requires an evaluation from every related service provider. However, implementing a policy that delays or prevents related service evaluations, regardless of the specific concerns raised, goes too far. The core of IDEA is individualization—the decision to include any service provider in the evaluation process should be made based on the student’s unique needs, not because of a broad, one-size-fits-all policy.
Let’s be clear: managing staff caseloads should never be the primary reason to avoid evaluating a student. While it’s important to ensure we are not conducting unnecessary evaluations, decisions should always be driven by what’s in the best interest of the student. If a student’s needs do not clearly fall within the OT scope, it may indeed be appropriate to wait. But that determination should be made by the team on a case by case basis, rather than through an inflexible district policy aimed at controlling caseloads.
Responding to a Parent’s Request
It’s no secret—parents often request a full evaluation from all service providers, including OT, even when their concerns don’t align with our scope of practice.
When you receive such a request, it’s crucial to approach the conversation with empathy and understanding. Remember, most parents aren’t familiar with the intricacies of IDEA or the evaluation process—especially if this is their first time navigating special education. Their understanding may be based on a few hours of online research or even a quick chat with AI. Our role is not only to assess but also to guide parents through the process with clear, compassionate communication.
So, how do you address a parent’s request for an OT evaluation that doesn’t seem warranted?
The best starting point is simple: pick up the phone. A personal call can go a long way in building rapport and clarifying misunderstandings.
Take time to listen and understand the parent’s concerns. Often, they may not fully grasp what an OT evaluation involves or may assume it covers areas outside of our scope. By directly addressing their concerns, you can clarify whether an OT evaluation is likely to provide useful information. And if you feel the eval is warranted, this conversation can serve as your parent interview to learn more about the child.
However, if after understanding their concerns, you believe an OT evaluation isn’t necessary at this stage, explain how waiting for the psycho-educational evaluation could provide valuable insights that could help guide the need for OT services later. If the parent is receptive and agrees, it’s a good idea to ask them to send a follow-up email confirming that they’re withdrawing their request for an OT evaluation. This ensures there’s a written record of their decision.
And if the parent remains firm in their request for an OT evaluation, you have a few options:
Conduct the evaluation, even if OT services may not be warranted. This allows you to gather data and make an informed recommendation.
Collaborate with the school psychologist to include a brief OT assessment section as part of their broader evaluation. This provides a middle ground, addressing the parent’s concerns without requiring a full OT evaluation.
Discuss with your administrator or special education department the possibility of issuing a Prior Written Notice (PWN). This would formally communicate the district’s decision not to conduct an OT evaluation based on the lack of OT-related concerns.
Personally, I try to avoid issuing PWNs, especially for initial evaluation requests. Refusing to assess a student can put both you and the district in a difficult position. It not only frustrates the parent, but it can also create potential legal challenges down the line. If, at a later date, the student is found to require OT services, the parent could argue that the evaluation and services were unjustly denied from the start. #MakeupServices
This is why I tend to err on the side of conducting the evaluation. I would rather gather the necessary data and conclude that OT services are not needed than make the decision not to evaluate at all, only to later discover that the student did require OT support. Having the data in hand allows you to make a more informed decision—and protects both you and the district should the need for OT services arise in the future.
Conclusions
At the end of the day, deciding whether to assess a student as part of the initial special education referral process should always be a case-by-case decision. Some students will clearly benefit from an OT evaluation right away, while for others, it makes sense to wait until the psycho-educational evaluation provides more information.
Collaboration with the IEP team and open communication with site administrators is key to making these decisions, as is clear communication with parents. When we advocate for a thoughtful, individualized approach, we ensure that our evaluations are purposeful and lead to meaningful, timely services for the students who need them.
My hope is that your district is not putting in place blanket policies that prevent evaluations. But if they are, I hope that you take small steps toward explaining such policies can be detrimental to the students who need services the most.
And if you do decide to evaluate the student, here is how I would go about doing that.