Traditional OT school systems practice has been characterized by frequent referrals for handwriting, fine motor and sensory processing concerns (Casillas 2010a, 2010b). However, school-based occupational therapy practitioners are not prohibited from taking on a larger role in this practice arena. The expansion of school OT will require the development of a cadre of leaders who are well informed and armed with the skills to navigate this sometimes complex terrain that is comprised of rules, regulations, and loopholes.

Occupational therapists (OTs) believe that a student‘s learning and participation at school is achieved through his or her engagement in meaningful occupations. As occupations are defined as the multidimensional and complex ―everyday activities (AOTA, 2008, p. 628) that provide structure to life, children engage in numerous occupations that can be divided into several distinct ―areas of occupations (p. 630), such as school, work, activities of daily living, and social participation (AOTA, 2008). Some examples of occupations that students engage in during elementary school, for example, include completing school assignments, socializing with peers, developing work and study habits, organizing personal spaces (e.g., lockers and spaces to complete homework), and participating in extracurricular activities (Polichino, Frolek Clark, Swinth, & Muhlenhaupt, 2007).

Occupational therapists appreciate that learning occurs when a child has the benefit of a supportive environment and his or her skills match the challenges associated with the educational task (Royeen & Marsh, 1998; Swinth, Spencer, & Jackson, 2007).

Services provided by occupational therapists in schools are designed to help children with, and at-risk, for disabilities gain authentic access to the curriculum, the general education environment, and the community (AOTA, 2004; Polochino et al., 2007; Swinth et al., 2007). Occupational therapists address the educational needs and promote the participation of students by providing services focused on increasing performance skills (i.e., motor, process, and communication and social interaction skills), performance patterns (i.e., habits, roles and routines) and personal factors (e.g., strength, sensory processing and dexterity) (AOTA, 2008). In addition, occupational therapists intervene to make adjustments to aspects of the learning environment and to make recommendations for instructional strategies, as well as associated tools and materials (AOTA, 2004, 2008).

Occupational therapy is designated as a related service under the Individuals with Disabilities Improvement Act (IDEA, 2004). According to IDEA, related services are, developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education [§300.34]. The roles of occupational therapists prior to IDEA 2004 had been limited to screening and evaluating students that receive, or are being considered to receive, special education; providing direct services to students who were found eligible for occupational therapy services and special education; and consulting with general and special education teachers, as well as other personnel, to support students receiving special education (Dunn, 2000). The 2004 IDEA legislation also allows for occupational therapists to act as potential providers of early intervening services for students in general education who do not receive special education or related services (OSER, 2007).

Despite the inclusion of occupational therapy in the federal legislation, some administrators, teachers, and other related services providers are unaware of the scope of occupational therapy.

It is our job to educate these important stakeholders on the full scope of our role and to inform them of our roots in mental health.

According to Bazyk (2011), occupational therapy practitioners can use a three-tiered model of providing proactive and responsive school-based mental health services. This framework allows the OT to provide prevention/promotion services to the entire student body, as well as more intensive services to children who are identified as being at-risk for mental health concerns AND those with diagnoses mental health conditions.