Think of a child who struggles in your classes. Now think of the myriad things they may be struggling with at any given time. It may well be the lesson content itself, but perhaps it is the chair they have to sit on, the non-stop hum of the light above them or even just the act of holding a pen for an extended period of time. All of these are issues that an occupational therapist (OT) can help with.

For a long time, the common perception was that OTs were only called into schools to offer specialist fixes for complex needs. But that notion is shifting. The role of the OT is rapidly changing in education, moving away from traditional clinical settings and directly into schools and classrooms.

This greater integration is being accelerated by programmes like Partnerships for Inclusion of Neurodiversity in Schools, a national initiative launched in 2024 that brings specialist health and education professionals into mainstream primary schools to help shape whole-school special educational needs and disabilities (SEND) provision.

Occupational therapists in schools

This represents a shift from the traditional “refer, assess, treat” model that saw OTs based in health services, explains Dr Sally Payne, an OT and professional adviser for the Royal College of Occupational Therapists. Instead, she says, there’s a growing recognition that such a model simply “isn’t sustainable” in light of increased demand. And so OTs and schools are increasingly working together to ensure a proactive, preventative approach, which is all about “helping young people take part in the everyday routines and activities that are important to them, that support their development, health and wellbeing”.

It’s an incredibly broad brief, Payne acknowledges, covering everything from the basics of self-care, such as getting dressed and using the toilet, to being able to demonstrate learning on paper and enjoying the playground at breaktime. But being on the ground in schools is markedly different from “sitting in a clinic, waiting for families to turn up so we can do our standardised assessments”, she continues.

“There is a place for that and times when we need to do that, but actually where we can have the most impact is in children’s natural context. That’s where we see the difference that we’re making. And it’s brilliant that we’re able to do more of that now than we have before.”

But what does this shift in how OTs work mean for schools? And how can teachers and leaders make the most of their support?

Katy Dickson, a principal therapist at multidisciplinary organisation Words First, explains that schools first need to recognise that the impact of OT input comes from its foundational nature. She notes the rise in the use of speech and language therapists in schools in response to what has been termed a “speech and language crisis”, but underscores how the work of OTs is distinct.

“When you’re coming in as a speech and language therapist, there’s loads you can do,” she says. “But speech and language works in a slightly higher centre, whereas if there are processing issues or there’s a sticking point further down in the neurological building blocks, you’re not going to get as far with your speech and language therapy. OT comes in at that root, primitive reflex, sensory needs level. And if you can settle reflexes and work on that very foundational sensory layer, you’re going to improve the outcomes further up the chain.”

What that looks like in practice is often imaginative problem-solving, she continues, particularly when it comes to working with the stretched budgets of the state system (she highlights that it’s a common misconception that OTs only work in independent schools or specialist provision, which is not the case).

“We can get really creative,” Dickson says. “We’re very good at finding a solution that isn’t going to be costly, but will give the impact that we need. If a school can’t afford specialist pencil grips, we’ll teach them how to put rubber bands around a normal pencil.”

Her colleague Amy Wright, a team lead at Words First, agrees. “I’ve got so many resources in the boot of my car,” she says. “We can be working with specialist equipment, but we can often work it out for next to nothing. For example, in early years they have to learn to put their coats on independently, to go in and out. Sometimes children’s zippers are so tiny, it can be very hard for some children around those fine motor skills. So you can buy actual zip extensions or you can just put a little bit of ribbon or something on it to make it longer.”

And for teachers, Payne says, simply raising awareness can be transformative. “When you open their eyes to it, they go, ’Gosh, look at my classroom. Why does everybody have to use the same pencil and the same pair of scissors?’ If we make those small changes, that can have a real impact on learning. Sharing our knowledge about child development, about physical health and mental health, can really help change the way that staff present activities and support the children.”

She also highlights the ways that wisdom from OT services is being disseminated through “brilliant websites with universal information” about, for example, what a good grip looks like for writing, from the National Handwriting Association. “That means you can try it out, you don’t have to wait to see an OT,” Payne says. There are also regular webinars, and many OT services now offer telephone advice lines.

“You can phone up and say, ‘I’m not sure about John, he’s really struggling in the morning,’ and then we would have a conversation. What does he do before he comes into the class? Is he coming straight off the school bus he’s been on for 45 minutes right into the classroom? Is there something we could be doing to invigorate him and get him ready for learning? You can have those conversations quickly, and that might be enough. Or it might be that you do need to make that individual referral into an OT service, and that could be done by parents, teachers, school leaders or whoever.”

Training teachers

But OTs are increasingly also being called on for wider work in schools, offering universal strategies, Dickson explains. This will often be around ensuring a trauma-informed approach, because “that is across so many schools now, and we’re seeing an increase in children who will come with trauma in their system”, she says.

“We’re thinking about the impact of that in terms of being able to learn; if we’re in a state of survival, we don’t have access to the frontal cortex, we can’t learn. So how do we create safety at school and that sense of wellbeing?”

That universal approach can also mean undertaking in-depth audits of schools, exploring and advising on policies and procedures as well as environmental elements (seating, room noise and light glare) and proposed plans for sensory rooms and other spaces, Dickson explains.

At the more targeted level, Payne adds, OTs will now often be training teachers and teaching assistants to be able to lead interventions themselves. If a school undertakes training in, for example, fundamental movement skills, that means the children who need that support are “benefiting from therapeutic approaches and strategies for the 30 hours that they’re at school, not just once a week when they might be seeing an OT directly”.

Dickson gives the example of recent training for a cohort of schools around how to manage children who are chronically tired in the classroom. School staff are also increasingly requesting training in relation to sensory needs and regulation.

But does that mean more work for teachers and teaching assistants in already exhausting schedules? It’s often quite the opposite, Wright says, because finding the right intervention can have a remarkable effect on a child’s experience in school, and make them less reliant on adult assistance.

So, for schools looking for this kind of support, what’s the best way to access it? There are a number of different approaches to working with an OT, Dickson says, from ad hoc days for assessments and recommendations to short contracts, training programmes for staff or a contract for regular weekly support.

These support services can be accessed through NHS referrals, or, increasingly, by private commission. Schools can conduct their own search to find local services based on need. Alternatively, they can find a suitable team through their local authority or the RCOT’s “find an occupational therapist” service.

Whichever route a school takes, the hope is that OTs are now better placed to help schools build both confidence and capacity to meet the increasingly diverse needs of their students.

Ultimately, Payne says, through cultivating a better understanding of children’s functional challenges and prompting early intervention, OTs can help to improve the overall inclusivity of the school environment, necessitating less input further down the line.

“If we can see more children early, we won’t have that high demand because we’ll have met those needs [already],” she says.

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