As a pediatric occupational therapist, the most common settings involve working in an outpatient clinic or at a school. Many pediatric OTs explore both of these settings through fieldwork opportunities or by diving into it and beginning to work at one.
I’ve heard many therapists inquire about the differences of both in order to find a good fit when job-hunting, so I’ve outlined them below.
One of the biggest differences between the two is that a child who demonstrates difficulty related to their education (i.e., attending to classroom lessons, reading notes, writing legibly, staying organized, using classroom tools, etc.) can receive OT through the school.
Children who experience difficulty in the community or at home exclusively aren’t usually eligible for school OT but can receive therapy at a clinic instead.
So as an OT working in the school, you would be more likely to address difficulty attending to class or poor handwriting than to address a child who can’t sit down and participate in mealtime with his family at home. With that said, there is also overlap. Many clinics address fine-motor and sensory related goals in addition to the issues interfering with function in the community or home.
The hours an OT works at a school are generally the hours of a school day.
A typical school day is anywhere from 7:30 or 8:30 to about 3pm. Hours at charter schools typically run longer, and private schools may vary. At a clinic, the hours tend to run much later into the evening, as school-aged children are in class all day and parents bring them after school hours.
Shaila Singh, MS, OTR/L, is a registered occupational therapist and the founder of Mindful Movement, an occupational therapy and yoga therapy clinic in Ithaca, NY. In addition to the clinic, she has experience working in private and public schools. Singh states that while the frequency – number of sessions per week- is generally higher in schools, the quality decreases. School sessions are fairly short – generally 30 minutes long in an elementary school.
“That time includes picking up the child, transitioning to the room where therapy is held (walking, taking socks and shoes off, preparing the student for what is to come), and trying to address what goals you can by completing them in a short period of time, while accounting for transition time back to class.”
Clinic sessions usually last longer than sessions that take place a a school.
Singh states that the parents/caregivers are overall more likely to carry out the strategies you recommend in a clinic. “From my personal experience in the clinic setting, most parents personally bring their child to receive services willingly, and because they are paying for the services or even a co-pay, there is more carryover, discussion, and interest.”
Clinic sessions usually last longer than schools, running from 45 to 60 minutes. Clinic therapy often depends on scheduling availability of the therapists and child, how much parents can afford, and whether the clinic can accommodate the child, Singh says.
Singh also discussed how sensory integration, an approach used to elicit an appropriate arousal and response from children who have difficulty processing sensory stimuli, can be incorporated.
“School therapy is done throughout the day, and in most cases the child is able to get sensory input from the teachers or aides in the room, as well as make visits when needed to the sensory gym for additional input.” So despite the lack of direct communication that you get with parents every session in a clinic, there can still be carryover depending on the staff support and available equipment.
It’s important to consider the specific scheduling demands, nature of the goals, and environment when deciding between a school-based or clinic-based therapy job. Some clinics even contract therapists out to schools several times a week, blending the experiences together.