Occupational therapists can bring valuable knowledge about regulation, sensory processing, motor skills, participation and the demands of the school environment. Teachers, however, bring something equally important: an in-depth understanding of their classroom, their students and what is realistically possible within a busy school day.
The most effective occupational therapy in schools happens when these areas of expertise come together.
Good collaboration is not about an occupational therapist arriving with a list of recommendations for a teacher to implement. It is about developing an understanding of the classroom, listening to the people working in it every day and finding practical solutions together.
A child may attend occupational therapy for 45 or 60 minutes, but they may spend more than 30 hours every week in school.
For this reason, some of the greatest opportunities to support a child do not happen in a therapy room. They happen during everyday school experiences such as:
Teachers see these situations repeatedly and often notice patterns that may never appear during an individual occupational therapy session.
When occupational therapists and teachers work collaboratively, intervention can become much more relevant to the child's everyday life.
Before recommending changes, occupational therapists should first understand what is already happening.
A strategy that sounds straightforward in a clinical setting may be difficult to implement in a classroom of 30 children.
For example, recommending that a child complete a movement break every 20 minutes may sound reasonable. But what does that look like when the teacher is delivering a maths lesson, supporting several other children and preparing the class to transition to PE?
Rather than beginning with:
"Here are the sensory strategies this child needs."
A more collaborative approach might be:
"When during the school day do you notice they find things most difficult?"
or:
"What have you already noticed helps?"
These conversations recognise the teacher's knowledge and allow the occupational therapist to understand the environment before attempting to change it.
One of the most important principles of school-based occupational therapy is that recommendations need to work in the real world.
Teachers are already managing:
Adding another long programme of activities is rarely the answer.
Where possible, occupational therapists should look for ways to integrate support into what is already happening.
Instead of creating five additional exercises, could the child receive the same input through:
The best occupational therapy strategies for the classroom are often the ones that become part of normal school life rather than another task for teachers to remember.
Occupational therapists have specialist knowledge, but collaboration becomes difficult when recommendations are presented as instructions rather than possibilities.
Teachers are experts in teaching.
Parents are experts in their child and family.
Children and young people are experts in their own experiences.
Occupational therapists bring another perspective to that team.
Respectful collaboration means recognising that no single person holds the complete picture.
Instead of saying:
"He needs a wobble cushion."
we might explore:
"He seems to look for movement when he is expected to sit for longer periods. Have you noticed that too? Could we trial a few different seating or movement options and see which, if any, actually help?"
This shifts the conversation from prescription to problem-solving.
An important part of neuroaffirmative occupational therapy in schools is considering what we are actually trying to achieve.
Sometimes children are referred because they:
The goal should not automatically be to make the child appear quieter, more compliant or more similar to their peers.
Instead, occupational therapists and teachers can ask:
What is making participation difficult for this child?
A child moving in their chair may still be listening.
A child avoiding handwriting may be experiencing significant motor demands.
A child refusing to enter an assembly may be overwhelmed by noise, unpredictability or the number of people present.
Understanding the reason behind behaviour allows the team to develop supports that respect the child's needs rather than simply trying to remove the behaviour.
Children find it difficult to learn when they are overwhelmed, dysregulated or feeling unsafe.
For this reason, collaboration between occupational therapists and teachers should often begin with regulation and the classroom environment.
Rather than asking only:
"How do we get this child to finish their work?"
we may need to ask:
"What is happening for this child before they reach the point where they can no longer engage?"
Occupational therapists can help teachers consider factors such as:
Importantly, regulation strategies should not simply become another list of activities for a child to complete.
They should help adults understand the conditions under which that particular child is most able to participate.
Classroom observation can be one of the most useful parts of occupational therapy support in schools.
It allows the occupational therapist to see the child within the environment where difficulties are actually occurring.
Observation may show that a difficulty originally described as poor attention is more closely related to:
Without seeing the environment, it can be easy to recommend an individual intervention for what is actually an environmental problem.
Sometimes a relatively small classroom adjustment can have more impact than weeks of isolated therapy.
A useful question for occupational therapists is:
"What would make this easier for you?"
This immediately changes the nature of the conversation.
A teacher may not need another sensory programme.
They might need:
This is where occupational therapy can become particularly valuable.
Rather than creating a separate OT programme, we can help make the classroom itself more accessible.
Where possible, occupational therapists can support teachers to develop inclusive classroom strategies that benefit many students.
Examples might include:
Universal strategies reduce the need to single individual children out and can create classrooms that accommodate a wider range of sensory, motor and learning profiles.
A strategy does not necessarily need to be labelled an "OT strategy" to be effective.
Often, the most successful occupational therapy becomes almost invisible because it has simply become part of good classroom practice.
Occupational therapists entering schools will frequently find that teachers and SNAs have already developed excellent strategies.
They may not use occupational therapy terminology to describe them.
A teacher might say:
"I let him bring the books to the office when I can see he's getting restless."
From an OT perspective, we might recognise the value of movement and heavy work.
But we do not necessarily need to replace the teacher's intuitive strategy with a more complicated clinical one.
Instead, we can explain why it may be helping and explore whether similar opportunities could be used elsewhere in the day.
This validates the teacher's expertise and strengthens their confidence rather than creating dependence on the occupational therapist.
One challenge with multidisciplinary working is that professionals can communicate in ways that are technically accurate but difficult to use.
A lengthy occupational therapy report may contain important information, but a teacher may need something very different on Monday morning.
Useful school communication might include:
What are we noticing?
Why might it be happening?
What are the two or three things we could try?
How will we know whether they are helping?
Recommendations should be clear enough that the people supporting the child understand both what to do and why they are doing it.
When teachers understand the reasoning behind a strategy, they are also much better equipped to adapt it when circumstances change.
Not every occupational therapy recommendation will work.
That is not necessarily a problem.
Children change. Classrooms change. Teachers change. The demands of school change.
A strategy that works during September may be unnecessary by January.
A collaborative approach involves:
This turns occupational therapy into an ongoing process of collaborative problem-solving rather than simply issuing recommendations.
Perhaps the most important perspective is the child's own.
Where developmentally appropriate, children and young people should have opportunities to tell us:
A sensory strategy that adults think is helpful may be embarrassing to a teenager.
A movement break that appears effective may actually feel like a punishment if the child is repeatedly removed from the classroom.
Respectful occupational therapy in education means ensuring supports are not simply designed around children but, wherever possible, designed with them.
Successful collaboration between occupational therapists and teachers is rarely about having the perfect sensory strategy, piece of equipment or intervention programme.
It is about developing a shared understanding of the child.
When therapists, teachers, SNAs, parents and the child themselves understand what supports participation, they can respond more flexibly across different situations.
Occupational therapy can then move beyond occasional therapy sessions and become embedded within the child's everyday environment.
Occupational therapists have valuable skills to bring into schools, but those skills become much more powerful when combined with the expertise of the people already supporting the child.
The question should not be:
"How do we get teachers to implement our occupational therapy recommendations?"
A better question is:
"How can we work alongside teachers to make this child's school day more accessible?"
That shift may seem small, but it changes the relationship completely.
When occupational therapists listen first, respect the realities of the classroom and create practical strategies alongside teachers, collaboration becomes easier.
More importantly, the child benefits from adults who are no longer working in separate systems but are working towards the same goal: helping them feel understood, included and able to participate meaningfully in school.
