Multi-tiered advocacy for occupational therapy in schools

Occupational therapy can transform students’ ability to thrive in schools. Yet practitioners often report that the profession is misunderstood, narrowly applied, or constrained by systemic barriers. Practitioner frustration and student limitations stem from these challenges, commonly cited as

• limited understanding of occupational therapy’s scope;
• referrals reduced to handwriting, fine motor, or sensory processing;
• misconceptions that services only apply under the Individuals with Disabilities Education Act IDEA of 2004 (IDEA);
• heavy caseloads that limit program development; and
• lack of leadership pathways.

Insights from Rachel Kostelz’s capstone experience with AOTA’s Federal Lobbyist, Abe Saffer, underscore the need for advocacy to promote the value of occupational therapy in schools.

Everyday Advocacy

Advocacy starts in daily practice, where every interaction shapes how occupational therapy is understood and valued.

Understanding Policy

Understanding the policies guiding our work empowers practitioners to advocate effectively. Without this knowledge, others may interpret policies in ways that narrow our scope.

IDEA identifies occupational therapy as a related service to help students with disabilities access and benefit from their education. According to the U.S. Department of Education ([DOE], 2006), occupational therapy includes

• improving, developing, or restoring impaired functions;
• enhancing the ability to perform tasks for independent functioning; and
• preventing further impairment through early intervention.

In schools, function refers to a student’s ability to participate in meaningful roles, interact with peers, and engage in learning experiences, not isolated skills (Laverdure & Seruya, 2024). The word preventing highlights the importance of proactive support that removes barriers before they disrupt learning, allowing practitioners to advocate for early interventions that benefit all students.

The Every Student Succeeds Act of 2015 builds on IDEA by recognizing occupational therapy practitioners as Specialized Instructional Support Personnel. Such recognition reinforces our role as partners in broader efforts to emphasize prevention, mental wellness, and barrier reduction. This designation also equips practitioners to advocate for inclusive programming, influence initiatives, and highlight their contributions to student engagement and achievement.

Reflection: Do I fully understand the laws and policies that guide my work?

Participation-Focused Language

Participation-focused language highlights how occupational therapy supports student access, engagement, and inclusion by shifting attention from isolated skills to what students can do–learning, interacting, and joining activities (Frolek Clark & Polichino, 2021). This approach is key in multi-tiered systems of support, where practitioners contribute at individual, group, classroom, and school-wide levels (Lynch et al., 2023). Aligning our language with education’s mission demonstrates how expertise in development, health, and occupation translates into strategies that drive student success.

Participation-focused language begins with everyday word choices in reports, meetings, and conversations. For example, saying a student has handwriting difficulties narrows our role to a single skill, while focusing on written expression emphasizes participation in meaningful occupations. Similarly, reframing sensory needs in terms of social-emotional learning and inclusive environments highlights how our services support student engagement and the conditions that enable it. The language we use shapes expectations, fosters belonging, and expands opportunities for all learners to participate fully.

Reflection: Do my words frame student engagement and what makes engagement possible?

Occupation-Centered Practice

Occupational therapy adds distinct value in schools by supporting students’ participation in meaningful routines and activities (Cahill & Beisbier, 2020). Sustaining this occupation-centered focus requires attention to personal, contextual, and occupational relevance (Jewell et al., 2022). Building on these essentials, the Occupation-Centered Intervention Assessment (OCIA) (Jewell et al., 2022), provides a reflective structure for analyzing and guiding interventions. Its effectiveness relies on occupation-based evaluations that capture authentic participation in school routines, ensuring interventions support meaningful engagement rather than isolated skills. For example, written communication services might consider:

• Evaluation: Combine occupation-based assessments with performance analysis during classroom writing and review of writing samples across a school day.
• Professional Reflection: Consider whether interventions preserve personal, contextual, and occupational relevance.
  • Personal: Ensure that writing supports a classroom project the student values.
  • Contextual: Embed strategies into classroom routines, like journal writing or project-based tasks.
  • Occupational: Maintain a focus on writing as functional communication rather than just mechanics.
• Intervention Planning: Prioritize support for written communication across classroom activities using tools, accommodations, or co-teaching to help students produce work and meet academic expectations.
• Collaboration: Partner with teachers, support staff, and families to embed strategies into routines, using shared language to show how adaptations, task modifications, and scaffolding support meaningful participation. Active collaboration helps shape classroom practices and school-wide approaches that foster inclusion and engagement in written communication.
• Advocacy: Promote system-wide practices, programs, and policies that support engagement for all students in written communication and literacy.

Reflection: Am I ensuring my practice stays occupation-centered?

Strategic Advocacy

Advocacy grows when practitioners influence programs, partnerships, and service models across school communities.

Service Models

Service structures shape both perceptions of our role and our ability to meet student and school needs (American Occupational Therapy Association [AOTA], 2025). Many schools still use caseload models, basing staffing on student numbers and limiting proactive, system-level work.

Workload models recognize the full scope of occupational therapy, including direct services and indirect proactive, preventative work such as training, observations, environmental modifications, team participation, data collection, and systems-level initiatives (AOTA, 2025). Such services extend beyond individualized education programs (IEPs), advancing equity, building educator capacity, and fostering inclusive learning environments.

Workload-based staffing positions occupational therapy as essential to student success across all tiers of support. This model supports collaboration, Universal Design for Learning leadership, and early barrier reduction, reinforcing occupational therapy’s value at individual and systemic levels.

Reflection: How am I influencing decisions to align staffing with student needs and outcomes?

Responding to Societal Shifts

IDEA’s 50th anniversary in 2025 marked a pivotal moment for occupational therapy advocacy. Before its enactment, students with disabilities were excluded or segregated (Sandoval Gomez & McKee, 2020). Today, access is not enough; students deserve meaningful participation and belonging. Occupational therapy, with its focus on function, environments, and participation, is well positioned to advocate for inclusive practices.

An Ohio district’s prevention-and-wellness initiative, led by occupational therapy practitioners (Pfirman et al., 2023), implemented an MTSS mental health model with universal Tier 1, 2, and 3 supports. Intervention hours spent were increased fivefold; students remained in school 85% of the time during behavior escalations, and 80% of screened students received timely care. This demonstrates how program-level advocacy expands access, participation, and student success.

When a district launched an initiative to create “think spaces” in classrooms, an occupational therapist saw an opportunity (Thomas, 2025). She advocated for joining the initiative, highlighting how to strengthen student engagement in designing and using the spaces. This ensured the spaces were meaningful opportunities to learn, not just places to go. By leading the co-creation process, setting up stations so students could trial self-awareness and regulation techniques, and integrating reflection into daily routines, she aligned the initiative with district goals and student needs. This strategic advocacy elevated occupational therapy’s visibility, strengthened staff collaboration, and embedded practices that fostered emotional literacy, community, and purpose.

Reflection: How am I partnering with the school community to influence programs and elevate occupational therapy’s impact?

Systems Advocacy

Systems-level advocacy maximizes impact, empowering practitioners to influence policy, anticipate change, and keep participation and equity central.

The Big Picture

The educational landscape is constantly evolving. State priorities shift with leadership changes, while federal guidance responds to emerging societal needs. Federal funds make up only 8% of school revenue, leaving most resources at the state and local levels (Saffer, 2025a). As funding tightens nationwide, schools may face difficult choices, yet this also creates opportunities for practitioners to elevate the value of their work. Staying alert to policy changes and aligning services with key priorities positions practitioners as essential voices in shaping education.

Continuous engagement means monitoring the educational environment, including:

• District mission statements, strategic plans, and performance reports (DOE, 2024)
• State and federal policy updates, bills, and budgets (National Center for Education Statistics, 2024; DOE, 2025)
• Societal trends in mental health, school safety, and inclusion
• National and state occupational therapy associations for early insights and advocacy support.

Reflection: How am I staying informed about changes in education, funding, and policy priorities?

At the Policy Table

Occupational therapy must have a unified voice in policy discussions. Practitioners can offer solutions grounded in expertise and aligned with system goals; advocacy is most powerful when coordinated through state and national associations. Engaging collectively at school, district, state, and federal levels helps shape policies on tiered supports, school mental health, and equity, ensuring inclusive learning environments for all students.

For example, when a state passed legislation to create a committee tasked with developing workload recommendations, an occupational therapist proactively asked to participate in the early planning process. This led to an invitation to join a focus group and to invite other practitioners to contribute (J. Rioux, personal communication, August 14, 2025). An active role in the state occupational therapy association and government affairs involvement enabled her to respond quickly and engage effectively. Early engagement ensures occupational therapy perspectives are included from the start.

Across the country, practitioners influence policy by partnering with Departments of Education to develop practice guidelines, ensure Medicaid compliance, and represent the profession. Associations such as the Occupational Therapy Association of California, lead legislative efforts (AB 1009) to recognize occupational therapy leadership in schools. Practitioners also hold elected positions from local councils to state legislatures and Congress, bringing occupational therapy expertise to policy decisions across education, health, and community systems. State and national organizations, including AOTA, support practitioners by tracking policies, providing resources, and connecting networks, while communities of practice offer spaces to share strategies, discuss policy, and build professional support.

Reflection: What steps am I taking to influence education policy and ensure occupational therapy is represented?

Membership Matters

AOTA shapes federal policy by uniting occupational therapy practitioners nationwide. Working with state associations, AOTA strengthens advocacy to protect the profession and those we serve. A recent example is the withdrawal of 17 states from a lawsuit seeking to declare Section 504 unconstitutional (Saffer, 2025b), which would have threatened protections for students with disabilities. This outcome resulted from coordinated efforts that mobilized state associations, shared updates, supported messaging through AOTA’s Legislative Action Center, and included AOTA staff office hours to address concerns. Together, these actions demonstrate AOTA’s ongoing ability to drive effective federal advocacy and safeguard the profession’s future.

Reflection: How will I invest in occupational therapy’s future?

Conclusion

Advocacy is central to school occupational therapy. Through daily choices and system-level engagement, we strengthen the profession and open doors for every student. Lasting impact comes when we commit to consistent, informed advocacy.

References

American Occupational Therapy Association. (2025). Policy guidance on workload for occupational therapy staffing in schools [unpublished draft presented to the RA].

Cahill, S. M., & Beisbier, S. (2020). Occupational therapy practice guidelines for children and youth ages 5-21 years. American Journal of Occupational Therapy, 74, 7404397010p1-7404397010p48. https://doi.org/10.5014/ajot.2020.744001

Every Student Succeeds Act of 2015, Pub. L. No. 114-95 § 114 Stat. 1177.

Frolek Clark, G., & Polichino, J. (2021). School occupational therapy: Staying focused on participation and educational performance. Journal of Occupational Therapy, Schools, & Early Intervention, 14(1), 19–26. https://doi.org/10.1080/19411243.2020.1776187

Individuals with Disabilities Education Improvement Act of 2004, 34 CFR § 300 et seq. (2004).

Jewell, V. D., Wienkes, T. L., & Pickens, D. (2022). The Occupation-Centered Intervention Assessment: A reflection tool for occupation-centered practice. AOTA Press.

Laverdure, P., & Seruya, F. M. (2024). Theory in school-based occupational therapy practice: A practical application. Routledge.

Lynch, H., Moore, A., O’Connor, D., & Boyle, B. (2023). Evidence for implementing tiered approaches in school-based occupational therapy in elementary schools: A scoping review. American Journal of Occupational Therapy, 77, 7701205110. https://doi.org/10.5014/ajot.2023.050027

National Center for Education Statistics. (2024). Condition of education. https://nces.ed.gov/programs/coe/

Pfirman, N., Rivera, C., & Saffer, A. (2023). Health Policy Perspectives—Health promotion and wellness for all students: School-based occupational therapy as a preventive approach. American Journal of Occupational Therapy, 77, 7702090010. https://doi.org/10.5014/ajot.2023.050242

Saffer, A. (2025a). The Department of Education in 2025: Challenges and opportunities. OT Practice, 30(8), 6–9.

Saffer, A. (2025b). Victory! Section 504 is safe. https://www.aota.org/advocacy/advocacy-news/2025/section-504-victory

Sandoval Gomez, A., & McKee, A. (2020). When special education and disability studies intertwine: Addressing educational inequities through processes and programming. Frontiers in Education, 5. https://doi.org/10.3389/feduc.2020.587045

Thomas, L. (2025, March 13). Tier 1 think spaces, Boston Public Schools [Presentation at the ESSA Advocacy Network].

U.S. Department of Education. (2006). Assistance to states for the education of children with disabilities and preschool grants for children with disabilities; Final rule (34 C.F.R. Parts 300 and 301). Federal Register, 71, 46540–46845.

U.S. Department of Education. (2025). Initiatives. https://www.ed.gov/about/initiatives

U.S. Department of Education. (2024). Where can I find my “state report card” website? https://www.ed.gov/birth-to-grade-12-education/elementary-and-secondary-education/where-can-i-find-my-state-report-card-website

Rachel Kostelz, OTD, OTR/L, is a School Occupational Therapist and strong advocate for practitioners and clients. She completed her capstone with AOTA’s Federal Lobbyist, gaining hands-on experience and policy insights.

Joyce E Rioux, EdD, OTR/L, SCSS, FAOTA, is a School Occupational Therapist, policy advocate, author, and presenter, leading initiatives that elevate occupational therapy practice in schools.