Hi everyone,

I'm a school based OT in the schools in south Louisiana.  We mainly use a combination of direct/consult services, but I'd have to say I provide mostly consultative services.  I struggle with this because sometimes I feel I should be doing more direct services.  I work full time and have approximately 80 children on my case load.  I'm also on the assistive technology team.  My frequencies are mainly 1 x month consult, but I do have several 2 x month.  I usually try to check with the children/teachers more often than this, but it is not always possible.  

I was just curious what other school based case loads look like and do you provide more direct services versus consult? 

Also, what are your average caseloads?   

I firmly believe that both consult and direct services are extremely beneficial.  I personally don't think that we should be providing direct services without letting the teachers know exactly what is going on.  I did my fieldwork in the schools in Hattiesburg back in 1999 and we did all direct services back then... we would pull the child do our little thirty minute session then drop them back off.  The teacher often had no clue what we were doing with the child.  The consult method is really awesome when you have the right dynamic and repoire with the teacher/paraeducators.  I was just curious about what you all thought.  I struggle with the consult model because I feel like I'm sometimes not doing enough... especially when the teachers expect direct services even though you are a consultant.  Thanks so much for your insight.  I've been a school based therapist for 4 years and I am constantly learning new ideas.  Always striving to be a better therapist.

I also work in the schools.  We primarily use a consultative model too.  I found the book The Consulting Therapist to be very helpful with my transition into the school. 

We have 6 OTRs and 1 COTA.  Our caseloads range from 45-75 students with numbers constantly growing.  Many students on our caseloads are only seen 30 min/month allowing 1-2 quick visits to the classroom.  I try to collaborate with my special education teachers weekly.  That is the goal, not the reality.  Meetings, evaluations and various other committments require me to change my schedule daily.

 While I can see the benefit to direct service, I struggle with pulling a child from class. I feel like they need to be in the class to learn and it takes them so much more effort to catch up when class time is lost. 

I use my own model for treatment... I treat the school first (what does the prinicpal and counselor need, is the curriculum meeting the schools needs, is the cafeteria a sensory nightmare), the teacher next (how can she better meet the needs of all of her students, what exercises can she work into her day that helps my student and the entire class, can I support her by providing website resources or school resources) then I treat the child (what does this child need, how can that fit into his/her day, do the parents want info/exercises/to be involved) 

I'd love to hear how others are working in the schools. I've been in schools for 3 years (an OT for 10).   

Micknab,

Your consult model really encourages me as that is pretty much how we work too.   I do truly believe that we are helping our students with the consult model, it just may be baby steps sometimes is all.  I also completely agree that you should avoid pulling the child from class.  Our kiddos are not going to generalize many tasks if done in isolation.   They are often already academically behind anyway so pulling them to miss more academics is really not the best plan.  Your model for treatment is very much like mine, I really like how you stated it though.. the school first, then teacher, and the child, with everything in the best interest of the child.  I was just curious because I often talk to other therapists at continuing education [therapists from other parishes (counties in Louisiana) and even out of state] and it seems that there are still a lot of therapists who do a lot of direct therapy.  

We have a wonderful group of therapists, 4 OTR's (2 full time and 2 part-time).  The two full time therapists have about 80 students each, the two part-time therapists 40-45.  Our caseloads are constantly growing too.

Thanks for the tip about The Consulting Therapist, I'm going to get it as soon as possible.