As school-based occupational therapy practitioners, we support students in ways that extend beyond the therapy room. Consultations are a particularly powerful tool, serving either as a standalone service or a complement to direct therapy by improving skill carryover into the classroom.
Research (see references below) shows that consultations between OTPs and school staff enhance intervention implementation and improve students’ participation in academic and social settings. When staff integrate OT strategies into daily routines, students experience greater gains in areas like sensory regulation, fine motor skills, and executive functioning.
However, consultations come with challenges. Time constraints, unclear expectations, and resistance to change can limit their effectiveness. So, how do we navigate these barriers, establish trust with staff, and ensure consultations make an impact?
In this article, we’ll explore:
When consults as a service are most beneficial
How consultations can be used effectively as a standalone service and alongside direct therapy.
Strategies for implementing consults,
And a few common myths about using consults in school-based OT.
When Are OT Consultations Most Beneficial?
Consultations can be highly beneficial when used with fidelity, but they are not always the best fit for every situation. I have found that consults work best when:
IEP goal(s) requires consistent implementation across the student’s natural environments, such as the classroom, playground, or cafeteria. This is true for more goals than you would expect - especially handwriting and typing.
The OTP and school staff have good communication skills. You don't need to be in the classroom every week or even every month, but you and the staff must find a method of communication that works for both of you (more on this in a moment).
All team members are focused on problem-solving. If all team members are open to both listening to one another and sharing possible solutions, consultations work very well!
While the IEP may state that the OT(A) is providing the consult, we must remember that consultation requires a two-way knowledge transfer. The teacher's ideas and solutions are just as important as our own. We must not forget that as we consider and recommend ideas.
Two Approaches to School-based OT Consultations
1. Standalone Consultations
Standalone consultations are effective when the student’s needs can be met through classroom or school staff-directed services. These consultations typically focus on helping the staff embed strategies into the classroom or other environments.
Examples:
Fine Motor Skills: Coaching a teacher on using an adaptive tool like a slant board, pencil grip, or squeeze scissors so that they can then help the student on a daily basis.
Social Participation: Providing ideas to a teacher to promote structured play or group activities that promote peer interactions and turn-taking skills.
2. Consultations as a Support to Direct Services
I also like to utilize consultations to enhance the effectiveness of my direct therapy treatments. In this approach, consultations complement therapy sessions, ensuring that the skills taught in therapy are reinforced and adapted to real-world contexts.
Examples:
Reinforcing Therapy Techniques: Sharing the student's preference for holding a pencil with staff. This allows for the teacher to A) know that you looked at, and "approved" of the student's grasp, and B) helps the teacher to know when to (or when not to) intervene in the classroom.
Supporting Self-Regulation: When we find something that helps a student regulate in an OT session, sharing that with the teacher is a consultation. You and the teacher might discuss how something used in a one-on-one setting can used in the classroom.
Strategies for Implementing Consultations
Effective consultations don’t happen by accident—they require intentionality, clear communication, and a genuine partnership between the OT practitioner and school staff. By focusing on these key strategies, you can ensure your consultations are impactful and lead to meaningful progress for students.
1. Build Strong Relationships with Staff
Take the time to build rapport with teachers, aides, and other team members by showing genuine interest in their observations and concerns. Spend time in the classroom or with the student’s team to understand the dynamics and context of the student’s environment.
When staff feel valued and respected, they are more likely to implement your recommendations and share valuable insights about the student’s performance.
2. Establish Clear Expectations
Begin by outlining the purpose of the consultation and how it ties to the student’s IEP goals. Also, determine with the staff member(s) how and when consultations will occur soon after the IEP to prevent uncertainty.
The most challenging part of consultations is getting started. Establishing what the consultations will look like and when they will occur removes a significant barrier to getting started.
3. Tailor Communication Methods
In-person consultations are great, but they are challenging to organize within the time constraints of a school day. While in-person meetings allow for real-time problem-solving and relationship-building, alternative methods can keep the process moving when time is limited.
Digital tools like email or forms can help you gather observations and provide feedback. Asynchronous video tools, like Loom.com, can allow you to demonstrate a strategy tailored specifically for the student.
Regardless of the method, make sure communication is personalized to the student’s needs and stays aligned with privacy laws like HIPAA and FERPA.
4. Provide Hands-On Modeling and Coaching
Teachers appreciate hands-on modeling.
So, when possible, demonstrate interventions in real-time, whether it’s teaching a teacher how to help the student use a slant board for handwriting or guiding an aide in supporting the student during sensory breaks.
Coaching builds confidence and ensures staff understand how to integrate strategies into the student’s daily routine. Over time, gradually shift the responsibility to the staff as they become more comfortable, providing support as needed.
5. Monitor Progress and Adjust Strategies
Use data collected from classroom observations, staff feedback, or student work samples to assess whether the intervention is effective.
Remember, an IEP is a living and fluid document. If something is not working, there are many pieces that we can adjust to make better progress, including reconsidering services.
6. Respect Staff Time and Workload
Say it with me: Teachers need more support, not more tasks.
Introduce strategies that are easy to integrate into their routines and avoid overwhelming them with complex or time-intensive recommendations.
Schedule consultations or check-ins at convenient times, such as during prep periods or after school.
Looking for personalized support with consults?
Join the OT Schoolhouse Collaborative & attend our live Q+A sessions!
Inside the Collaborative, we host live Q&A Zoom sessions to support one another every month. These calls allow you to receive immediate feedback from me (Jayson) and other school-based OT practitioners who want to help you.
Join the OT Schoolhouse Collaborative today to attend our next Collaboration Hour!
Myths About school-based OT Consults
Misconceptions about consultations often limit their use. Let’s debunk a few common myths:
Myth 1: “You must have an OT goal for a consult service.”
OTs don’t need a specific goal to provide consultation services. Many practitioners support teacher-created goals by offering expertise that enhances the student’s educational experience. This is commonly known as "tagging on" to a goal
Myth 2: “High school students should only get consult services.”
Automatically limiting high school students to consults without considering direct services could violate IDEA’s requirement for tailored interventions. In the same way, defaulting to providing only direct services to Kindergarteners could reduce a student's access to the LRE.
Myth 3: “I can’t see a student for both direct services and consult services.”
Direct and consultation services can be combined. This approach is well-supported by research and enhances the carryover of skills. It's also one of my preferred service models and has greatly impacted my practice.
Myth 4: “Consults are only for sensory.”
As noted before, consultations are versatile and can address a variety of skills, including fine motor development, executive functioning, social participation, and more.
Myth 5: " The OT/teacher is ALWAYS responsible for collecting data."
I've seen this go both ways. Some say it is always the teacher's responsibility to collect data on goals, while others note that the OT must take the data. This is why clear expectations are key to success. Only you and your team can decide who will take data on individual goals.
The Wrap Up
Consultations are a powerful and flexible tool in school-based OT practice. They enable us to support students in meaningful and individualized ways while maintaining their access to the Least Restrictive Environment.
Whether used as a standalone service or to complement direct therapy, consultations empower staff to implement strategies that align with IEP goals and foster student progress in their natural environments.
As you finish this article, be sure to have a look at the resources below. You might want to save them for another time when you need to prove the validity of school-based OT consultations.
👋 Jayson
Ps. Thank you to everyone who responded to my weekly newsletter asking about this topic. There were many of you, so I hope this helps.
References
Gjellstad, M. (2023). Impact on Teacher Ratings & Perceptions of Efficacy of a 3:1 Model of OT Service Delivery. The American Journal of Occupational Therapy. https://doi.org/10.5014/ajot.2023.77s2-po150.
Langbecker, D., Caffery, L., Taylor, M., Theodoros, D., & Smith, A. (2019). Impact of school-based allied health therapy via telehealth on children’s speech and language, class participation and educational outcomes. Journal of Telemedicine and Telecare, 25, 559 - 565. https://doi.org/10.1177/1357633X19875848.
Trương, V., & Hodgetts, S. (2017). An exploration of teacher perceptions toward occupational therapy and occupational therapy practices: A scoping review. Journal of Occupational Therapy, Schools, & Early Intervention, 10, 121 - 136. https://doi.org/10.1080/19411243.2017.1304840.
Villeneuve, M. (2009). A critical examination of school-based occupational therapy collaborative consultation. Canadian Journal of Occupational Therapy, 76, 206 - 218. https://doi.org/10.1177/000841740907600s05.
Villeneuve, M., & Hutchinson, N. L. (2012). Enabling outcomes for students with developmental disabilities through collaborative consultation. The Qualitative Report, 17(Art. 97), 1-29. http://www.nova.edu/ssss/QR/QR17/villeneuve.pdf
Wilson, A., & Harris, S. (2018). Collaborative Occupational Therapy: Teachers' Impressions of the Partnering for Change (P4C) Model. Physical & Occupational Therapy In Pediatrics, 38, 130 - 142. https://doi.org/10.1080/01942638.2017.1297988.