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The School OT Guide to IEPs, 504s & Classroom Support
Starting your first school-based OT job can feel overwhelming. Between IEP meetings, evaluations, accommodations, and the endless acronyms, it can be hard to know where to start.
In this episode, Rachel and Amanda chat and break down the basics of school-based occupational therapy. Amanda shares what she wishes every new school-based OT knew before walking into their first IEP meeting, explains the differences between IEPs, 504 plans, and MTSS, and offers practical tips for collaborating with teachers, administrators, and the rest of the educational team.
They also discuss how school-based OT differs from clinic-based practice, why goals need to be educationally relevant, what consultative services actually look like, and how to feel more confident advocating for students while working as part of a multidisciplinary team.
Whether you're a new graduate, transitioning into the schools, or just curious about how school-based OT works, this episode is packed with practical advice to help you feel more prepared.
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The School OT Guide To IEPs, 504s & Classroom Support
Starting a school-based occupational therapy role can feel overwhelming. You may know how to evaluate a student, identify areas of need, and choose meaningful interventions, but what happens when you walk into your first IEP meeting?
Suddenly, you are sitting alongside teachers, administrators, special education staff, caregivers, and other service providers. Everyone brings a different perspective, and they are looking to you to explain how occupational therapy can help the student participate more successfully at school.
Let’s break down some of the most common terms and responsibilities school-based occupational therapists and occupational therapy assistants encounter. From IEPs and 504 Plans to classroom accommodations and service delivery models, this guide will help you better understand your role on the school team.
What Makes School-Based Occupational Therapy Different?
School-based occupational therapy looks different from therapy provided in a clinic or early intervention setting. In a clinic, a child is coming specifically for therapy. In a school, the student is there to learn, participate in classroom routines, interact with peers, eat lunch, attend recess, navigate the school environment, and get on and off the bus.
This means school-based OT must focus on educational access and participation. A challenge may be important from an occupational therapy perspective, but the school team also needs to understand how it affects the student’s ability to function within the educational environment.
For example, instead of focusing only on whether a student can tolerate a particular sensory activity, the OT may explain how regulation affects the student’s ability to:
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Attend during instruction.
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Transition between activities.
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Use classroom tools.
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Complete written work.
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Participate with peers.
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Become more independent during the school day.
This educational focus does not make sensory processing, motor skills, or regulation less important. It means the therapist must clearly connect those underlying skills to school participation.
The School Team Approach
School-based OTs do not work in isolation. They collaborate with classroom teachers, special education teachers, speech-language pathologists, physical therapists, administrators, caregivers, and other members of the student’s educational team.
Each person sees the student through a different lens. The OT brings valuable knowledge about sensory processing, regulation, fine motor skills, visual-motor skills, posture, handwriting, self-care, and functional participation.
At the same time, the therapist must consider the teacher’s curriculum, the demands of the classroom, and the student’s overall educational priorities.
A helpful question to ask is:
What does this student need the most support with in the classroom, and how can occupational therapy help the student become more independent?
The goal is not to keep a student in OT indefinitely. The goal is to provide effective support, help strategies carry over into daily routines, and build independence whenever possible.
Understanding Common School Support Plans
IEPs, 504 Plans, MTSS, and behavior intervention plans are related to student support, but they are not interchangeable. Here is a simple overview of each.
What Is an IEP?
An Individualized Education Program, or IEP, is a comprehensive special education plan designed around an individual student’s educational needs. The document outlines information such as:
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The student’s strengths and areas of need.
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Present levels of academic and functional performance.
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Measurable goals.
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Accommodations and modifications.
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Special education and related services.
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Service frequency and duration.
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Transportation or other supports, when applicable.
Each team member contributes relevant information so that someone reading the document can understand the student’s needs and how the school will support them. The IEP team meets at least annually to review the plan and update goals.
Parents and caregivers may also request a team meeting if they have concerns or want to discuss the student’s supports and services. Any changes to the plan are addressed through the IEP team process.
What Is a 504 Plan?
A 504 Plan outlines reasonable accommodations that help a student access learning within the general education environment. These accommodations may include supports such as:
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Preferential seating.
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Extra time.
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Movement breaks.
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Modified classroom materials.
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Access to sensory tools.
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Environmental adjustments.
A 504 Plan is different from an IEP and does not automatically mean a student receives special education instruction. Depending on the student’s individual needs and the school’s procedures, occupational therapy may sometimes be included as a support under a 504 Plan.
What Is MTSS?
MTSS stands for Multi-Tiered System of Supports. It is a framework schools use to provide increasing levels of academic, behavioral, or functional support based on student need.
Although implementation can vary among districts, MTSS is often described in three tiers:
Tier 1: Universal Support
Tier 1 includes strategies and supports available to all students. These may be built into the classroom and used proactively to help the entire group participate and learn.
Tier 2: Targeted Support
Tier 2 provides more focused intervention, often in a small-group setting, for students who are beginning to fall behind or need additional help. Teachers and other team members gather data, monitor progress, and adjust strategies based on how the students respond.
Tier 3: Intensive Support
Tier 3 involves more individualized or intensive intervention when previous supports have not been enough. The student may receive longer, more frequent, or one-on-one support while the team continues gathering data and evaluating needs.
MTSS can help the team meet students where they are and provide support within general education. When a student continues to demonstrate significant educational needs, the team may consider whether a formal evaluation for special education or other services is appropriate.
What Is a Behavior Intervention Plan?
A Behavior Intervention Plan, often called a BIP, is used when behavior significantly interferes with a student’s education or affects the safety and learning of the student or others. Not every student with an IEP has a BIP.
When one is needed, the team works together to identify the behavior of concern and develop specific, consistent strategies to support the student. The focus should be on understanding the student’s needs and helping the team respond in a supportive and effective way.
The OT & COTA’s Role In The IEP Process
In the school setting, occupational therapy is typically considered a related service. The OT is not usually the student’s case manager or the person leading the IEP meeting; instead, the therapist contributes assessment findings, recommendations, goals, accommodations, and information about the student’s functional performance.
The OT may also support a goal led by another team member. For example, a special education teacher may be working on a written-expression goal while the OT addresses the fine motor, visual-motor, positioning, or tool-use skills that help the student complete written work.
COTAs provide services under the supervision of an OT and contribute valuable treatment observations and progress information according to state rules, district procedures, and the established supervision plan. The strongest school-based OT services are collaborative.
Strategies should not exist only in the therapy space. They should help the student function during real classroom routines.
Classroom Supports That Can Help Many Students
Not every helpful classroom strategy requires an IEP, specialized equipment, or an individual therapy session. Many supports can be introduced universally and made available to any student who benefits from them.
Use a Slant Board
A slant board brings the work surface closer to the student and may help promote:
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A more upright posture.
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Improved wrist positioning.
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More efficient pencil grasp.
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Easier visual attention to the page.
This can be especially helpful for younger students who are developing handwriting skills, though older students may benefit as well.
Build Movement Into the Day
Movement breaks do not need to be complicated. Students can crawl or skip during an appropriate transition, participate in a brief whole-class movement activity, or take a walk to get a drink of water.
The best movement strategy is one that is realistic for the classroom and helps students return to learning.
Offer Different Scissor Options
Keeping left-handed and loop scissors available can make cutting activities more accessible. Loop scissors allow the student to squeeze the handles together while the scissors reopen more easily.
They can support children who are still learning the hand movements required to open and close traditional scissors. The long-term goal may be progression toward standard scissors, but an adapted option can help the student participate more independently right now.
Provide Flexible Working Positions
Students do not always need to sit upright at a desk to learn. Depending on the activity and classroom expectations, consider allowing students to:
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Work while lying on their stomach.
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Sit on the floor.
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Use an alternative seat.
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Turn a classroom chair around and face the back for added support.
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Work under or beside a small table.
Providing appropriate options can help students find a position that supports attention, comfort, and participation.
Make Sensory Tools Universally Available
Fidgets, flexible seating, and other sensory tools can initially feel new and exciting to the whole class. Once that novelty wears off, students who do not need them often stop choosing them, while those who genuinely benefit may continue using them.
Normalize the tools, teach students how to use them appropriately, and provide choice rather than forcing a particular strategy. A support is only useful when it helps the student participate more successfully.
Build Relationships Before Adding More to a Teacher’s Plate
Teachers already carry a tremendous amount of responsibility. A long list of complicated OT recommendations can quickly become overwhelming; even when every suggestion is well-intended.
If you are new to a school, begin by asking:
How can I best support you and your classroom?
Build trust, learn the classroom routines, and observe where challenges consistently occur. Then offer one manageable idea at a time.
For example, if the class regularly struggles to regulate in the afternoon, offer to lead a five-minute movement break and demonstrate what it can look like. Showing a practical strategy within the actual classroom routine is often more helpful than simply handing the teacher another list.
Strong relationships also make it easier to check whether recommended tools are still available and being used. A slant board, pencil grip, name stamp, adapted paper, or pair of loop scissors cannot help if it has been misplaced or is not accessible when the student needs it.
Push-In, Pull-Out, and Consultative OT Services
School-based occupational therapy may be delivered through different models depending on the student’s needs and the IEP.
Push-In Services
With push-in services, the therapist supports the student within the classroom or another natural school activity.
This model allows the OT or COTA to see the real task, environment, and expectations. It can also make it easier to support carryover because the therapist, student, and teacher practice strategies where the student actually needs them.
Push-in support should be coordinated carefully so that it does not unnecessarily disrupt instruction. Joining during writing, art, centers, or a classroom craft may provide a natural opportunity to address cutting, grasp, positioning, or participation.
Pull-Out Services
With pull-out services, the student leaves the classroom to work directly with the therapist in another space.
This can provide a quieter or more controlled environment for targeted skill development. However, communication with the teacher remains essential. The classroom team needs to know what tools and strategies are being used so those supports can carry over beyond the therapy session.
Both push-in and pull-out sessions are forms of direct service. The IEP specifies how frequently and for how long the student will receive those services.
Consultative Services
Consultative occupational therapy is an indirect service model. Rather than working directly with the student on a regular schedule, the therapist may:
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Observe the student in the classroom.
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Check in with the teacher.
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Review whether accommodations are effective.
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Replenish or adjust adapted materials.
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Problem-solve new participation challenges.
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Offer recommendations to the educational team.
Consultation may occur monthly, quarterly, or according to the student’s plan and local procedures. Even when a consult is brief, documentation matters.
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Record the date.
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What was discussed or observed
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How the student is responding.
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What the team plans to try next.
Practical Takeaways For School-Based OTs & COTAs
As you navigate school-based practice, keep these ideas in mind:
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Connect OT to education. Clearly explain how sensory, motor, or regulation needs affect classroom access and participation.
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Collaborate with the whole team. Ask teachers what is most challenging and work toward shared priorities.
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Focus on independence. Use therapy to help the student participate with less adult support over time.
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Recommend realistic strategies. Begin with simple ideas that fit naturally into the classroom routine.
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Follow up consistently. Check whether tools are accessible, accommodations are being used, and strategies are actually helping.
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Use the student’s natural environment. When appropriate, practice skills in the classroom where the student needs them most.
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Document communication. Keep a clear record of observations, teacher feedback, recommendations, and next steps.
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Know your local procedures. Laws and broad frameworks guide school services, but documentation, billing, supervision, and service delivery practices can vary by state and district.
Final Thoughts
Your first IEP meeting or your first year in a school may feel intimidating. You do not need to know everything on day one.
What matters is that you understand your role, connect your recommendations to meaningful school participation, communicate clearly, and approach the educational team as a collaborative partner. Whether you are helping a student regulate, hold a pencil, use scissors, type, transition, or participate more independently, your work matters.
Progress may not always be obvious from one day to the next, but thoughtful school-based occupational therapy can make a lasting difference in a student’s educational experience.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science & art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views & opinions on how to address common sensory challenges, health related difficulties & what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.
Keep in mind that we may receive commissions when you click our links & make purchases. However, this does not impact our reviews & comparisons. We try our best to keep things fair & balanced, in order to help you make the best choice for you.
This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.
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