Occupational advantage

The benefits of early intervention occupational therapy in school
Rachel Gillespie looks at how in-house occupational therapy is making a big difference to the lives of children and their teachers at a school in Singapore.
What OTs do in schools

Do you have students that struggle to hold a pencil or pay attention in class? That’s where we come in useful. Having a team of in-house Occupational Therapists (OTs) in a school setting is a relatively new concept, albeit an important one. The role of the OT is to assist people in developing independence in their daily occupations. A child’s occupation is working (and playing!) in school, so therefore it makes sense that they are supported within this environment. After all, children spend over 50% of their waking hours at school.

A new model of inclusion

I am very fortunate to work in a forward-thinking school, which is paving the way across Asia for this model of inclusion. At Stamford American International School Singapore, we have a large Support Department of almost 70 staff, including 5 OTs and 5 Speech and Language Therapists. On top of this, we have in-house school psychologists, behavior specialists, academic support teachers, counselors, a team of nurses and an early interventionist on our team. And yes – we are a mainstream school!

 “My kids just can’t sit still – help!”.

This call for help is all too familiar and I’m sure many teachers can relate. OTs, along with the wider Student Support Department, are key contributors in the education team and are there to collaborate with teachers to promote student success. Not only do we work directly with students on a one-to-one or small-group basis, we also carry out training with teachers and parents to educate them as to how they can better support their child using a range of strategies. As an OT team, we analyse the activities and school environment to reduce barriers that are limiting the child’s participation.

Let’s consider two common scenarios:

  1. “Her handwriting is so large and all over the page, it’s impossible to read even though she is trying her best.”
  2. “He’s always on the go, wandering around the room or falling off his chair. I can see he wants to learn but just can’t seem to manage his body!”

Sound familiar?

Handwriting intervention

In the case of the handwriting issue, an OT would initially assess the student to determine the cause behind their ‘messy’ handwriting. There could be due to a variety of possibilities, such as poor spatial awareness, visual-motor difficulties or lack of fine motor control. Solutions to support this child can range from providing adapted paper to use in class, to having the OT work on the child’s underlying body-spatial awareness and visual-motor skills. In a wider context, we can suggest differentiating/modifying the curriculum & assessment materials to support the child in achieving success. In some cases, an OT may also provide assistive technology or the child can choose to type rather than write if they are identified as having specific writing delays (i.e. dysgraphia).

A child on the move

For the student in example 2, we would look at the layout of the classroom environment, seating considerations and consider any distractions that may be a factor (think hanging art displays, multiple posters around the walls, the location of the student’s desk, a noisy road outside). We could try a straightforward solution such as a ‘move-n-sit’ air cushion, or have the child work at a standing desk. For other students, we need to look more in-depth at their underlying sensory processing skills. In these situations, the OT works closely with parents (as they know their child best) and would carry out multiple assessments and observations around the school environment, while all the time collaborating with the teacher.

Supporting teachers

OTs are often asked “How can I better support all of my students, not only those with additional needs?”

Empowering teachers is at the forefront of our work. As a student support team, we are readily available to provide on-going training throughout the year to equip school-wide staff with the skills they need to support all students, including those without disabilities. The team works alongside teachers to differentiate lesson plans, and we are active participants in developing the curriculum to enable every student to achieve their full potential. A student support team is vital in supporting students with academic, emotional, physical or developmental challenges.

The wider OT profession

At this point, you may be confused. OTs work with the elderly, right? Spending their day fitting grab rails and prescribing wheelchairs? This is also true! Our profession stretches into many areas. I started out as an OT working in a hospital setting, doing exactly as mentioned above, fitting grab rails and prescribing wheelchairs. Our training is extremely broad and ranges from areas such as hand therapy, mental health, neuro-rehab, home modifications and pediatrics. In the hospital setting, we work within a multi-disciplinary team alongside the doctors, nurses, physios, speech therapists, social workers etc.

Applying OT theory to a school setting

Despite the change of setting from hospital to pediatrics and school-based therapy, I am still working within a multi-disciplinary team. I have just switched out the medical team for our teaching teams. Our overall goal always remains the same: to help our clients (students) become as functional and independent as possible in their daily occupations. This begins with identifying what the client needs and wants to do, what barriers are in place and what support is needed to participate in those activities. In the medical setting, we may work on teaching a client how to dress themselves after a stroke. Comparatively, in a school setting our goal is more likely to be along the lines of supporting a student to successfully engage in gross motor tasks in a PE class (catching a ball), or learning the social skills needed to play and interact with their friends.

The value of early intervention

Our work in schools may seem like a rose-tinted ideal.  However, I believe that every child should have access to an in-school support team. As educators it is our responsibility to ensure that our students are equipped with the skills needed to succeed in their lives. I also have no doubt:  early intervention from an Occupational Therapist in school works.



After starting her career as an Occupational Therapist in a healthcare setting, Rachel Gillespie moved to pediatric occupational therapy before her appointment as an in-house Occupational Therapist at the Stamford American International School in Singapore, where she works at their Early Years Village centre. 




All images kindly provided by Stamford American International School