Featured Article

Role of Occupational Therapy in School-Based 

Practice and Mental Health

Jordan Earley, MS, OTR/L & Haven Herndon, MS, OTR/L

02/01/2026

The need for mental health services in public schools is ever-increasing, with 1 in 7 children aged 3–17 diagnosed with a mental or behavioral health condition in the United States in 2019 (Centers for Disease Control and Prevention, 2024). However, 39% of public schools report inadequate access to mental health professionals, limiting their ability to address students’ needs (National Center for Education Statistics, 2022). While psychologists, social workers, and counselors have traditionally led mental health efforts in schools, occupational therapy practitioners (OTPs) bring unique skills that can significantly enhance student support. According to the American Occupational Therapy Association (AOTA) Workforce Data, 24.4% of OTPs work in school-based practice (Seruya & Garfinkel, 2020). As schools face increasing demands to address students’ mental health and support access to education, the role of OTPs becomes crucial in providing holistic interventions (Cahill & Bazyk, 2020).

Despite this need, OTPs are often underutilized and limited to working within Individualized Education Plans (IEPs), where they focus primarily on interventions for physical disabilities, rather than being integrated into broader mental health initiatives (Pfirman, Rivera, & Saffer, 2023).  OTPs have the potential to be involved in Multi-Tiered Systems of Support (MTSS), a public health framework used to provide universal, small-group, and individualized support aimed at promoting mental health and well-being for all students (Garbacz et al., 2023). Expanding OTPs’ roles in tiered mental health interventions could address unmet needs, fostering more inclusive and supportive learning environments.

Occupational therapy encompasses areas such as physical rehabilitation and school-based services; however, its foundational focus remains embedded in mental health. The profession started in the early 20th century, spurred by modernization in mental health practices (Creek & Lougher, 2008). From the early days in mental asylums and hospitals, OTPs used purposeful activities to empower individuals, laying the groundwork for modern approaches to psychosocial and emotional well-being. These activities aim to support an individual’s participation and access to occupations within a given setting, such as at school, home, work, and in the community.

Occupational therapy services are influenced by a wide range of approaches to intervention, which include promoting participation and health, disability prevention, restoration of function, adaptation, and modification of tasks, as well as maintaining function within the school environment (Cahill & Bazyk, 2020). We aim to describe the current role of occupational therapy in school-based practice as well as limitations and ways to enhance the incorporation of occupational therapy into mental health in the school setting.

Current State of OTPs in Schools

In schools, OTPs support students’ access to and involvement in the main occupations of work, play, and social participation. Currently, many OTPs working in school-based practice are implementing interventions related to the restoration of function, adaptation, and modification of tasks; however, they are not necessarily promoting participation, health, or disability prevention.  The role of occupational therapy practitioners varies greatly across elementary school settings and often includes handwriting as a specific area of support (Lynch et al., 2023). While OTPs have expertise in fine and visual motor development and can assist with handwriting, limiting their role to handwriting instruction can overshadow their broader capacity to provide mental health and behavioral support. This narrow focus on handwriting and other traditional school-based occupations can reduce OTPs’ involvement in more comprehensive interventions that support students’ overall well-being and participation in the school environment. Relying on OTPs for handwriting instruction, while important, reinforces a misconception of OTPs as remedial instructors rather than comprehensive health professionals.

School district administrations, along with teachers, often lack a strong understanding of the breadth of OTPs’ extensive skill sets beyond special education services, which leads to their underutilization (Benson et al., 2016; Scannell et al., 2023). Teachers and administration often do not utilize OTPs to address additional developmental, behavioral, or participation-based needs when they arise in the classroom. This lack of understanding of an OTPs’ role is a barrier to supporting students effectively (Pfirman et al., 2023). OTPs report that if teachers and administrators had a better understanding of their role beyond the IEP process, it would enable more effective collaboration to address students’ mental health needs through tiered interventions.

A study completed by Jeremy et al. (2024) found that funding and time are identified as two of the biggest factors that impact OTPs’ ability to educate teachers and staff about their role. The lack of collaborative time, along with limited training on the OT’s role, prevents the development of supportive service plans between teachers and OTPs (Cahill & Bazyk, 2020). The challenge of reduced collaboration time is compounded by staff absences or other last-minute schedule changes such as meetings or unplanned calls for student support (Jeremy et al., 2024). However, collaboration time must be mutually agreed upon and maintained to ensure successful implementation. 

Strategies for Involvement

Current research has identified ways to capitalize on OTPs’ involvement in the school setting. The use of a co-teaching model between a teacher and an OT would allow for support and services to be provided to students who qualify for specialized therapeutic services in addition to at-risk students through a more time-efficient model (Cahill & Bazyk, 2020). Co-teaching would also allow OTPs to incorporate mental health supports and strategies into the general education classroom while simultaneously supporting the general education curriculum and handwriting skill deficits.

Teacher and OTPs’ collaboration is critical to support students within the educational setting (Jeremy et al., 2024). Scannell et al. (2023) found that shared planning time, related to training and student-specific discussions, between teachers and staff members positively impacted student performance in the areas of attention and behavioral health. Classroom management and emotional regulation can be improved through collaboration and teacher training (Hui et al., 2016).  Educating teachers and co-workers regarding the role of occupational therapy through workshops and video or informational training would be an effective way to increase the use of OTPs throughout the school setting (Scannell et al., 2023).

Student behavior and classroom attention are areas that frequently challenge teachers and require additional problem-solving. Student behavior and attention are deeply tied to student success in the classroom and can be provided as tiered support. OTPs directly target these skills through meaningful activities that promote development within their natural context. OTPs can implement approaches to support mental health literacy through engagement in occupations and research-based programs such as Social-Emotional Learning and Positive Behavior Intervention and Support that encourage positive youth development (Cahill & Bazyk, 2020). Interventions include providing real-time strategies to staff and students to support access to the general education setting as well as social experiences and participation in leisure activities throughout the school day. Physical activity is one of the most well-tolerated and beneficial interventions for students with attention-deficit/hyperactivity disorder to help manage psychosocial symptoms within the school environment (Ng et al., 2017). For students with sensory processing difficulties, OTPs can provide regulating strategies to improve engagement in their environment such as sensory-based movement. OTPs have also implemented strategies such as mindfulness and yoga to help students with anxiety and depression function more fully in their academic settings (Weaver & Darragh, 2015).  Figure 1 presents strategies that OTPs can use in the school setting to support students’ mental health, well-being, and educational performance across tiers of support. Overall, OTPs support students’ physical, mental, and sensory-based needs as well as improve student skills, task adaptation, environment, and routine within the natural context of their day (Cahill & Bazyk, 2020).