Embedding Intervention

It has been 37 years since occupational therapists starting practicing in the schools under the Individuals with Disabilities Education Act (IDEA). Prior to that, OTs worked in specialized schools or institutions providing services to students and other young people with disabilities. These services were often provided from a medical, habilitative or rehabilitative perspective. Unfortunately, many of us carried that model of service provision into the schools. Over the years, though, we have learned better.

We learned our services are to support the student in the educational environment to foster participation and accomplishment in the schools. We learned to work in ways that spread our intervention efforts beyond a dose/response in each treatment session. We learned to provide services to support the student as a student.

We also learned we are a part of an Individualized Education Program (IEP) team. We learned to work closely with teachers, as they spend the most time with each student and are the primary implementers of the IEP. We learned to work with the teachers and the student in the classroom to better support the student for better outcomes, both socially and educationally.

So why do many of us still take a student out of the classroom and work with that student in isolation? Some services are provided in the classroom, but are still done in isolation-in the back of the room, with the student and therapist doing something different than what the teacher and other students are doing. Direct, indirect, push in and pull out are all approaches that have long outlived whatever usefulness they may have had at one time.

IDEA regulations use the phrase "special education and related services to be provided to the child, or on behalf of the child" [34 CFR 300.320] [20 U.S.C. 1414(d)(1)(A)(i)]. Our primary role in the schools is as a related-service provider. We are "related" to the educational program. Thus, our efforts should be to that end.

The law also requires these services be provided within the context of the general education program; any location other than that must be justified as necessary for the child's benefit. Therefore, we should be working in the classroom with the teacher to embed what we recommend in the daily routine of the classroom.

When we work like this we are returning to the roots of our profession, in which a therapeutic milieu was developed so that all activities and tasks and the environment itself were designed to support development and growth. Are there environmental modifications which would make the classroom more efficient or a more effective learning environment for the student? Does the teacher understand which educational goals and objectives on the IEP you are supporting? Can you articulate to the teacher how your recommendations/interventions relate to and support the IEP goals? Are you supporting the teacher in carrying out the IEP?

There is no better way to provide services "to the child, or on behalf of the child" than to collaborate with the teacher in the classroom and embed intervention into the classroom routine. Good collaboration takes time, effort, understanding and patience. Working with the teacher to help the student achieve his educational goals and participate in the daily routines of school is well worth doing.

Barbara Chandler, PhD, OTR/L, FAOTA, has 32 years of experience as a practitioner, manager, advocate and educator. She is the chair of AOTA's Early Intervention and School System Special Interest Section and is an associate professor of pediatrics and research in the OT department at Winston-Salem State University, Winston-Salem, NC. She can be reached at

Classroom Clinic Archives

It sounds like supporting the child in the classroom and giving modifications. How about teaching the missing foundational skills and skill building? The classroom is not always conducive to this intervention. I would hope that we are working on skill development to move the child forward. You can't expect the student to be able to use a pencil and write neatly and keep up if the have weak muscles, etc. I feel that individualize intervention and some in classroom sessions where you demonstrate the strategies for carryover to teachers is a better balance.

wilma saavedra,  COTAMarch 12, 2014

This is a great article, and one which should receive a lot of publicity! Indeed, "there is no better way to provide (OT) services "to the child, or on behalf of the child" than to collaborate with the teacher inthe classroom and embed intervention intor the classroom routine"! However it takes a lot of patience and education to get there. Many teachers have so many students and such little help in the classroom that they become quite irritated at the prospect of an OT working with a student within the classroom and involving the teacher. All they want to do is get on with their lesson plan, and have the student removed from the classroom to be "fixed" by the service provider and returned. I think they are overwhelmed with the overcrowded classrooms. It takes a lot of work, but as the months go by, teachers usually become less irritated and more tolerant when they begin to see the benefits of classroom intervention.

Mercy ,  OT,  School-basedOctober 17, 2012


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