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For many years I gave workshops around the country training therapists who were newly employed in a school-based setting. One of the keys to this transition from a medical to an educational model involves the concept of seeing the child in his/her natural environment. As therapists trained in the medical profession, we are often used to seeing clients in a hospital or clinic treatment room, and setting goals and objectives for each discipline (PT, OT and/or Speech). Originally, as a new therapist to the school system, I practiced this similar model - pulling  students out of class and seeing them for OT specific goals. In this pull-out model, my "treatment room" was often a storage closet, the stage in the cafeteria or the library. As my experience in the educational model grew, along with changes/reauthorization to IDEA (the Individuals with Disabilities Education Act) the concept of moving from a medical pull-out model to an inclusive educational model became a more practical, efficient and rewarding way of working with students that required therapy services. Now best practice tells us that school-based therapy may look more like the following:

  • In the classroom to assist with fine-motor skills like cutting and handwriting
  • In the hallways during transitions to help with mobility/gait such as keeping pace in line with peers or using a walker or crutches
  • In the cafeteria to help with self-feeding skills or social skills to help build peer relationships
  • In physical education to assist with adapting the curriculum and gross-motor skills to match the skill level of the child
  • On community based outings in social/public settings such as a child using an augmentative communication device to order from a fast food menu
  • In secondary on-the-job training sites to make recommendations and adaptations such as using non-skid matting to help stabilize a work area for the student that wraps utensils/napkins for a restaurant 

Providing therapy services in these types of natural environments ensures better carryover of the skill, promotes better collaboration between teachers/therapists, supports transdisciplinary goals and empowers both the teachers and the students in becoming more successful.

How do you practice therapy services in your school? Tell us your suggestions!

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Comment by Anna Harper on December 2, 2011 at 5:03pm

I work in home health only now but I try to make a point to contact the school PT to make sure we can collaborate with the best way to integrate our goals into all the places that the child is spending time!  working as a team always benefits the child even if it takes a little extra time :) 

Comment by Diane Andrew on December 1, 2011 at 5:42pm

Sometimes OT can be part of school wide assemblies, helping students stay calm, doing compressions, or brushing to keep students part of the big, often disorganized, noisy occasions. 

Comment by Cecilia Cruse on December 1, 2011 at 5:13pm

Thanks for your comments as well!

Comment by Martianne Stanger on December 1, 2011 at 3:04pm

I understand, thanks.


Comment by Cecilia Cruse on December 1, 2011 at 1:02pm

Your thought process is on track. We do sometimes work with small groups  for isolation of skills then try to generalize them so that the students can be successfull at all times...not just when the therapist is present.  My main point is to get therapists to change from doing therapy in separate environments that may be too restrictive and so not in compliance with  LRE (or Least Restrictive Environment as outlined by IDEA). If they  instead practice integrating and sharing their knowledge and skills in this more inclusive model it is more practical for the teachers and students.

Comment by Martianne Stanger on December 1, 2011 at 11:56am

Not exactly the same, but we have an at-home behavior mod specialist.  It's all well and good that she comes here, but we realized recently it might be more effective for her to accompany us to places where issues happen - the grocery store, the playground, therapy sessions, etc.  So, she may do that.  My take is that practicing some sills and behaviors in isolation at first but then having a specialist, parent or educator put help put them into play and tweak them in "real" use is best.


As a former private, public and charter school teacher, I cannot see how exclusive in-classroom help would work, but maybe it's b/c I have never seen a model of it.  I do think that a brief one-on-one or small group focused session followed by natural environment sessions would be great.

Comment by Cecilia Cruse on December 1, 2011 at 11:05am

Yes absolutely! There is a much better carry over effect with this model and I found the students made better progress and the teachers felt more empowered and had more resources to think outside the box for solutions. Everybody wins!

Comment by Mary Franzen Costello on December 1, 2011 at 10:57am

Another benefit I see to Natural Environment is what others learn by observing. In our school, OT is there 1 time a month. The teachers and paras are the ones who have to help teach the skills mentioned above, and that can't happen if the child is alone with the OT.

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