Employment and Service Delivery Trends of School-Based Occupational Therapists: A National Survey

Abstract

Direct employment, workload approach, and flexible service delivery are considered best practices for school-based occupational therapy; however, inconsistencies in interpretation and implementation of these practices occur. Employing occupational therapists directly, transitioning to a workload model, and providing clarity using state school-based guidelines support collaborative, contextually based services for all children. This research examined school-based occupational therapy employment practices, service delivery, and work responsibilities to determine alignment with best practices using a researcher-developed web-based survey that included Likert-scale, multiple -choice, and open- ended questions. Participants included 342 occupational therapists and occupational therapy assistants in the United States. Study results indicated that, while many occupational therapy practitioners are employed directly by schools, challenges include managing high caseloads of directly served students outside of natural environments, leaving a gap for at-risk students who may benefit from tiered occupational therapy services. A workload approach allows contextually based services and other responsibilities necessary to adhere to best practice and reimbursement regulations. While positive trends are emerging in school-based occupational therapy, significant barriers remain. Advocacy is needed to support direct employment, MTSS implementation, and workload service delivery models aligning with best practice and federal legislation. Evidence indicates that employment practices affect occupational therapy service delivery supported through federal legislation. School children would benefit from flexible models of occupational therapy across school settings, with collaborative tiered services provided for children with disabilities and those at risk, in their natural environment.

The authors' abstract, as published at the source. Journal of Occupational Therapy Schools & Early Intervention, 2026 · DOI ↗