For those OTs and OTAs headed back to school-based practice in the next few weeks, it is so exciting to reconnect with young students and learn some new faces. What might also be crossing your mind is starting new habits to help on those days where your carefully planned schedule all falls about as suddenly there’s an IEP meeting to prepare for, a teacher who needs to talk, a student who was absent during their regular session, documentation waiting to be finished, and an unexpected school event all ready to throw off the rest of your afternoon. Whew!
Whether you are new to school-based practice or have been working in schools for years, managing everything that comes with the role can be challenging.
And sometimes, the strategies that make the biggest difference aren't the ones you learned in school. They are the practical systems, shortcuts, and approaches you pick up from experience and from other OTs and OTAs.
In this blog, we’ll explore practical school-based OT strategies for managing your schedule, caseload, and time while keeping participation and collaboration at the center of your practice.
Here's what we'll cover in this article:- Takeaway 1: Keeping school-based OT connected to meaningful student participation
- Takeaway 2: Understanding why your caseload number doesn't tell the whole story
- Takeaway 3: Practical ideas for scheduling, collaboration, and managing your work day.
Let's start with something that can easily get lost when the school year gets busy: what school-based occupational therapy is really there to support.
Sometimes it can be easy to focus on a single skill for a student, but school-based occupational therapy is about much more than addressing an isolated skill.
If we dive back into our foundational documents such as the Occupational Therapy Practice Framework (OTPF-4), school-based OT practice can help students with so many valued occupations. Depending on the student and context, school-based OT may support areas such as education, ADLs, play, social participation, health management, work readiness, and more.
Think about what that can look like during an ordinary school day.
A student might need support putting on winter clothing before recess. Another may have difficulty participating in cooperative games with classmates. An older student might be developing work-readiness skills or learning an IADL such as laundry as part of preparing for greater independence.
This broader perspective matters because it changes the question from:
"What skill should I work on?"
to:
"What does this student need to participate more successfully in their school environment?"
That distinction can influence where intervention happens, who is involved, and which strategies make sense. Research backs up this focus as well. Cahill and Beisbier (2020) support occupation-based interventions for improving participation and performance in children and youth, particularly when intervention occurs in natural contexts and connects with meaningful goals.
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In practice, that can mean looking beyond isolated exercises and considering opportunities to:
- Work within natural school routines.
- Use activity- and occupation-based interventions.
- Modify environments or tasks to support participation.
- Match strategies to the individual student, goal, and setting.
- Collaborate with the people who are already part of the student's day.
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Of course, knowing what school-based practice can look like is one thing.
Finding the time to actually do it is another.
If your schedule sometimes feels like a puzzle where the pieces keep changing shape, you are not alone.
School-based OT practitioners may be balancing a long list of competing demands: direct services, evaluations, documentation, I
That is why looking only at caseload size can miss a significant part of the picture.
Caseload vs. workload
This is an important distinction that is being discussed more and more in school-based practice:
Caseload is the number of students served.
Workload includes the work required to support those students including direct services, documentation, evaluations, meetings, consultation, collaboration, MTSS, advocacy, scheduling, and other responsibilities. (Seruya & Garfinkel, 2020)
On paper, a caseload will show how many students the OT practitioner is serving, but what it doesn’t capture is other factors such as the OT practitioner might be traveling between buildings, have frequent meetings they are expected to attend, be navigating complex student needs, and be consulting with teachers frequently.
That's why asking "How many students are on your caseload?" doesn't necessarily tell us whether the workload is manageable.
In a recent survey by Edick et al. (2023), over 75% of surveyed OT practitioners wanted to use a workload approach. At the same time, they identified barriers including administrative support, high caseloads, time, and knowing how to transition to a workload model.
This is also where advocacy becomes important.
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If the work happening outside treatment sessions remains invisible, it can be difficult for others to understand the full scope of the OT or OTA's responsibilities.
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But even when the larger system can't change overnight, there are practical strategies that may help make the day-to-day workload more manageable.
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Managing the logistics of school-based practice can sometimes feel just as challenging as providing the occupational therapy services themselves. While there is no perfect system, having a few tried-and-true strategies can make the workload feel much more manageable.
1. Managing Your Schedule: Start with a master scheduleBefore filling in treatment times, create a master schedule that includes the bigger pieces of your school day. Consider classroom schedules, lunch, specials, meetings, travel between schools, and other times when students may or may not be available. Then begin adding direct services around those responsibilities. Using a schedule template can also help make it easier to see your week as a whole and make adjustments when things inevitably change.
2. Managing Your Caseload: Keep one system for tracking your students and upcoming responsibilitiesBefore filling in treatment times, create a master schedule that includes the bigger pieces of your school day. Consider classroom schedules, lunch, specials, meetings, travel between schools, and other times when students may or may not be available. Then begin adding direct services around those responsibilities. Using a schedule template can also help make it easier to see your week as a whole and make adjustments when things inevitably change.
3. Managing Your Time: Orient yourself at the beginning of the week and again each dayBefore filling in treatment times, create a master schedule that includes the bigger pieces of your school day. Consider classroom schedules, lunch, specials, meetings, travel between schools, and other times when students may or may not be available. Then begin adding direct services around those responsibilities. Using a schedule template can also help make it easier to see your week as a whole and make adjustments when things inevitably change.
The goal is not to have the perfect schedule, caseload system, or workday. The goal is to have systems in place that make it easier to adjust when school-based practice does not go according to plan because it rarely does!
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There is no single perfect way to organize a school-based OT caseload, build a schedule, or manage every responsibility that comes with the role. What works for one practitioner may not work for another. An OT serving one elementary school may need a completely different system than an OT traveling between several buildings or an OT/OTA team sharing responsibilities across a district.
The goal is not to create a perfect schedule.
It is to develop systems that help you spend less time figuring out how to manage the work so you can spend more time doing the work that matters: supporting student participation, collaboration with school teams, and providing meaningful occupational therapy services.
Sometimes the best strategies cannot be found in a textbook. They come from other OT practitioners who have tried something, adjusted it, and figured out what actually works in the middle of a real school day.
Sometimes the best strategies cannot be found in a textbook. They come from other OT practitioners who have tried something, adjusted it, and figured out what actually works in the middle of a real school day.
Sometimes the best strategies cannot be found in a textbook. They come from other OT practitioners who have tried something, adjusted it, and figured out what actually works in the middle of a real school day.
School-based occupational therapy is a unique practice setting that requires us to balance student needs with schedules, meetings, documentation, collaboration, and all of the other responsibilities that happen behind the scenes. While those logistical pieces can sometimes feel overwhelming, developing systems that work for you can make a big difference in how your approach your day.
You do not have to figure it all out at once or reinvent the wheel. Some of the most helpful strategies are the ones we learn from experience, from problem-solving through our own challenges, and from other OT practitioners who have already found practical ways to make school-based practice more manageable.
In Tried & True: Strategies for School-Based Occupational Therapy Practitioners, we’ll take a deeper look at practical strategies for building and managing your schedule, organizing your caseload, managing your time, and navigating the everyday realities of school-based practice. My hope is that you leave with a few ideas you can adapt to your own setting and most importantly, strategies that help you spend less time managing the logistics and more time focusing on what we enjoy the most: supporting students’ participation and success at school.
References
Cahill, S. M., & Beisbier, S. (2020). Occupational therapy practice guidelines for children and youth ages 5–21 years. American Journal of Occupational Therapy, 74(4), 987-1035.
https://doi.org/10.5014/ajot.2020.744001Edick, J., O’Brien, S., & Hardman, L. (2023). The value of collaboration with occupational therapists in school settings: Elementary teacher perspectives. Journal of Occupational Therapy, Schools, & Early Intervention, 16(3), 313-329.
https://doi.org/10.1080/19411243.2022.2054488Seruya, F. M., & Garfinkel, M. (2020). Caseload and workload: Current trends in school-based practice across the United States. American Journal of Occupational Therapy, 74(5), 1138-1146.
https://doi.org/10.5014/ajot.2020.039818 
