In today’s episode we’re talking about some routes you can take to get Occupational Therapy Services, and more importantly what you should look for in an OT/how you can make the most of your time working with them.
As usual, a couple of caveats/things to keep in mind before we start the episode. First, I’ll be specifically referencing therapy in an outpatient/private pediatric clinic. There are OTs that work in schools, in hospitals, and even home therapists. I’m not talking about those. My entire career and frame of reference has always been in a private clinic, so that’s what I can speak to.
The other thing to keep in mind is that I’m located in California. Different states and countries may have different routes, regulations, requirements and may even refer to some things differently than I do, so if some things don’t sound familiar, sorry about that!
Getting into an OT clinic
I’m going to keep this part brief because I have a LOT of great tips I want to share for when you’re actually in therapy, and also because this part of the process can seriously look so different based on so many different factors, and I can’t possibly cover all of them here.
BUT… here’s my spiel (which, by the way, has actually changed over the years). I used to always say “go straight to your pediatrician and tell them what you’re saying, and they’ll direct you from there). Now… I say things a little differently.
You still absolutely want to clue in your pediatrician and talk to them about your child’s sensory behaviors, but you don’t need to depend on them to guide you or refer you to a clinic. Sure, you may need their input for a certain code or something if you plan to seek reimbursement from insurance, but you can get this a different way.
So what I usually recommend, is to go directly to the OT clinic you want to be seen at. Start with a google search, or even through a local facebook mom group and search for local private pediatric OT clinics in your area. Get a list of as many that you can find within driving distance, and just start cold calling.
You can start by saying “My child is 5 years old… he has challenges with XYZ and I think he could benefit from OT. Do you accept my insurance?”
Usually, the receptionist/director can tell you exactly how to get a certain code or sign off from your MD and you can retroactively get it that way. If you’re not even seeking insurance reimbursement, even better- you can just go ahead and ask them to make your evaluation appointment.
If your child has sensory challenges, be very clear with them that you want the evaluation to assess their sensory processing abilities, not JUST their fine motor or gross motor skills.
What to look for in an Occupational Therapist
I always get asked what people should look for in an OT or if they should ask for a certain background or education.
What you should know is that OTs get our license and pass our boards based on a general graduate program, there is no specialization that we get from grad school. We get education and course curriculums covering every diagnosis and age throughout life.
We take a test, we get our license and we go through a few internships then apply to work in any field. Then we do have to keep up with professional development courses where we usually find our niche field and take a lot of courses to further our development in one specific area, like sensory integration.
If you have a brand new OT straight out of graduate school, they probably don’t have any specialized courses under their belt, yet…. But try to give them a chance! I once was that student, and…. I don’t want to brag… but I was a great OT, even out of grad school, and if families didn’t take a chance on me, I wouldn’t be where I am now.
This is also the time you’d want to ask them about what their wait list looks like in the event you do end up seeking treatment with this facility.
What to do if you get told no services are needed
Sometimes, our kids just know how to “turn it on” just enough to “pass the test” AKA not qualify for services. Now, this looks different of course with different clinics and whether or not you’re going through insurance, but speaking from my experience, at a private clinic where families paid out of pocket, there were a lot of times when I did not recommend services based on several factors.
First of all, I NEVER dismissed a family just because their child’s scores were average or weren’t below a certain number. I always took into consideration what the family mentions, teachers mentions, etc and would make the best call that way. Also, it was never a one way conversation.
I would never say, “Sorry your child doesn’t seem to need OT, Bye.” It was very much a transparent discussion, where I said something like “Look, I know you’re here because you mention your child has been having meltdowns at home and has a hard time with xyz.
I didn’t see it in the clinic when I assessed him, and your sensory questionnaires came back within normal limits. However, I do recognize that kids can behave differently in new environments. Here’s what I saw….” then we’d talk there.
At the end of those conversations, I always gave them at least 1 resource to go home with (either a book, a podcast episode, or another referral to another professional, or some strategies to try) OR I would sometimes offer them to try a few sessions with me to work on those same skills that they wanted help with.
Sometimes within those first few sessions, the child may display behaviors I never saw before, so I end up keeping them on the caseload. Other times, it really does seem like the child doesn’t need skilled OT services, so I’d discharge them.
Common complaints from parents
1. “I don’t think my child is making any progress in OT.”
A common complaint that comes up from parents is that they feel like their child isn’t making progress at all, or isn’t making progress fast enough. This is kind of a tricky one because, there really is no rulebook that says a child must be able to improve this skill within 1 month. A lot of goals are written this way (with a time line) to add structure, but mostly it’s for insurance.
If you have expectations of progress in your child that you’re not seeing, this is definitely something to have a conversation with the therapist about. But keep in mind, your child may be making progress in different ways that aren’t as obvious. They may not be meeting the exact goals that you had hoped for yet, but they are moving in the right direction. Sometimes the therapist can bring this up to you and explain in ways that make it more clear. Definitely worth a conversation.
2. “It looks like my child’s OT isn’t even really doing much with them, like I could do that at home.” Or, something similar like “All they’re doing is rolling around on the ground and making crafts, this isn’t what I took them to OT for”.
I get it. OT just really looks like a lot of play, and sounds and looks like you could do this too at home, or that your babysitter could do this at home.
But I PROMISE you, every OT whether you see it or not, has a specific set of skills that they’re working on: they’re adjusting the environment, they’re supporting posture, they’re supporting your child with stand by assistance, they’re making clinical observations the entire time, you just can’t see it.
It’s just not as straight forward and explicit as physical therapy.
But you can definitely ask your therapist to explain exactly what they’re working on with the obstacle course and how it links to emotional regulation.
I promise you there is a skill being worked on, it is purposeful and they have a plan.
3. “I have no idea what the OT is doing in their session”.
I work with a lot of 1:1 clients who I consult with virtually who share this with me. When I ask them what they’re doing in OT, the parents usually say “To be honest, I have no idea.”
That’s because not all clinics are set up to be able to have the parents sit in and observe their sessions. So you’re basing it on a quick hand off at the end of the session, when the therapist has 1 or 2 minutes to tell you what they did that day and you’re distracted because your child is pulling your hand. Or, maybe you don’t even get those 1-2 minutes face time with your therapist. There were some clients in the past who I would go weeks or months not talking to (the parent) because they’d have to have someone else drop off and pick up their child at OT.
There’s a lot that could make you feel disconnected from the process.
This is definitely something that you need to set aside time to talk to your OT about. Send them an email, call them, try to schedule something so you can get uninterrupted time with them. You don’t want to be disconnected from them especially if you’re paying privately.
You need to be able to carry over those supports and strategies at home for it to have an impact on your child’s regulation. And to carry it over, you need to understand.
4. “My child doesn’t like going to OT.” or, “After OT, my child is always dysregulated”
Let’s say your child doesn’t like going to OT. I don’t always read that as, there’s something the OT is doing wrong, it’s not always their fault. An OT clinic can be very overstimulating and has a lot of structure even if we try to be as child directed as possible, there’s still structure.
Or, maybe it’s the time of day your child is coming. Maybe after school they’re exhausted and they’d rather just be home playing video games or relaxing, so every time they get pulled to OT, they dislike it.
Sometimes when parents come in they’ll tell me “oh man I just had to pull him out of the car to get here, he’s not happy about coming to OT” and i loved when they told me this because this clued me into things and allowed me to spend more time building rapport with the child and made me question things. I would look more into, is there something I’m doing that’s upsetting them, is there a particular part of our routine that’s hard?
One question that usually brought out the most ah-ha moments was when I questioned the parents (of children older than 5) to find out if their child even knew why they were coming to OT in the first place. Like, does your child KNOW why you’re pulling them away from their afterschool play time to come to this clinic playing with this lady?
A lot of the times, their kids didn’t know.
When parents had the conversation after I helped them, it opened up so much more trust and possibilities for progress.
There was more buy in, especially from older students.
When you have the really little ones crying when they’re in the clinic, it’s probably because they’re just overwhelmed and bombarded by a lot of the sensory inputs. The therapist should be offering accommodations and every task should be at your child’s just right challenge level to avoid some fight or flight, but sometimes it’s inevitable especially in the beginning of just starting OT. There’s a lot of things out of their control in these clinics.
So sometimes after OT, parents will say that their child was so dysregulated. That’s probably because the OT session was bombarding them with a lot of sensory input that isn’t always offered at home or school. This is a good sign that your child is in the right place because they need help with regulation. I would tell the therapist about this, though because they can help you.
When parents told me that their child was going home super dysregulated after our sessions, I would start tailoring the end of my sessions to accommodate this so that I wouldn’t send my clients home more dysregulated than when they got there.
Things you could ask your OT to do that you didn’t know they could do
There are a lot of “a-la-carte” things that parents don’t realize they could ask their therapist to do/work on. This is specific to private clinics not dealing with insurance.
- School observations- you can ask your OT to observe your child in their classroom for an hour to notice how they behave in a classroom setting and the OT can make notes/strategies to share with the teacher to help.
- Create social stories for you/with you- you can find a lot of pre-made templates on places like teachers pay teachers, but sometimes you need a very specific example or scenario to prep your child for. I’ve created social stories for my clients in the past to make sure it was specifically tailored to them.
- Create visual schedules/visual tools- you can ask your therapist to help make a visual schedule or any other sensory visual tools like a feelings chart, etc to help implement these strategies at home. Note that you most likely will have to pay your therapist for their time, but if you have the resources this is a great thing to ask for support with. Not many parents have laminating machines and velcro at home, so having the therapist help you with this is great.
- Meet you in the community somewhere- I’ve worked with so many clients out in the community, like a park, the restaurant, Target, anywhere they needed help and support implementing a specific strategy.
- 1:1 parent consults to touch base on goals/educate- this one is so underutilized. Not all private clinics can accommodate this, but it’s worth the ask. If you have a therapist who has a really tight caseload and has no extra time on their schedule, you can ask to replace one of your child’s therapy sessions with a parent consult. Many parents think this is a waste of their child’s therapy services, but really this can totally help boost progress and bridge the gap between what your child is doing in the clinic and what they’re doing at home. Definitely worth it.
Looking for more guidance on how you can support your child’s sensory needs? Let’s work together. I specialize in helping parents understand how sensory impacts behavior and how you can still use gentle parenting techniques for neurodivergent children.
When to switch therapists
A quick side note for this, as a former therapist who had a super full caseload, it’s not always easy to accommodate a change in schedule or to take on a new client within the same practice. Also if you’re switching clinics altogether there’s always a waitlist to think about so just keep that in mind, but there are times when a therapist isn’t the right fit for your child.
- Gut feeling: if you have that parent’s intuition that something isn’t right or just doesn’t feel like the right fit, switch therapists. There’s no specific proof but you just have that feeling? I as a mom, give you permission to make a switch.
- You (or child) repeatedly asks the therapist not to do a certain method/thing and they keep doing it. Common sense, but sometimes I think parents forget, you really have the ultimate say, especially in a private clinic. Yes, hear out the therapist in their clinical reasoning but if they keep pushing for a certain method or language or whatever, and you don’t like it, find another therapist.
- They’re creating goals or agendas without your input. Initially when I get a kiddo on my caseload, I share our goals with their parents and make sure that these goals are appropriate and what the parents feel like they really want to work on. Sometimes those goals change or new areas of focus come up, at which point again, we have a parent consult/conversation and adjust as needed. If you have a therapist who keeps working on goals that are not a priority for you (and they can’t give you a reasonable explanation as to why), then this is cause to seek a new therapist.
When to take a break from OT
Being in a private OT clinic who works with parents who pay out of pocket, I am not bound by a 12 visit or 24 visit maximum. This means, I have long term clients who are on my caseload for years. When I first evaluated them, did I say “Hey, your kid will be in OT for years!”. No. I say what the truth is, “your child can benefit from OT to help with XYZ and I plan to do that through weekly OT. This is just a fraction of the picture of support, I will give you suggestions to try at home, but I can’t predict how your child will respond to therapy. Evaluating is an ongoing process. Let’s start for (I usually give an amount of time) and then re-evaluate as needed.
But there are times when you as the parent feel that therapy is getting “stale” and there are times when it’s okay and even suggested to take a break from OT. Here’s some of the times I’ve suggested parents take an OT break.
- Progress is plateauing. Now again, this is a very subjective term, especially in a clinic where we don’t take data on every single behavior. When I say progress is plateauing, it usually means that we’ve met some goals and have been working on tackling other goals but haven’t been making much progress in that area. That, in combination with a family feeling burnt out from therapy, child starting to want to do extra curriculars and needing a break is when I might say okay let’s take a break and see how much organic growth your child can have in that area or if they can maybe make some growth on their own by participating in more social activities or things that would replace the time at therapy.
- Feeling overwhelmed (you or your child). If you have multiple children with multiple schedules, sports, activities, or maybe you just have one child but they have multiple therapies and clubs and activities. Or hey, maybe you have one child, with no other activities but you are just so overwhelmed with the driving to and from therapy, implementing homework and maybe it doesn’t feel like it’s helping enough. First thing to do, for all those scenarios is talk about it with your child’s OT. They might be able to talk you through some of it, or give you a modified schedule to go every other week, or have some other solution. But at the very end of the day, if you, the caregiver who is responsible for transporting, feeding and being emotionally available for your child is the one who is feeling overwhelmed, it’s OK to take a break. Same goes for your child, if you have them in multiple therapies and they’re doing a lot of extra curriculars, it’s okay to give the a break from therapy.
- Trying a new therapy. Sometimes I’ll get a child on my caseload and work with them for a few months, sometimes 3 months, sometimes 6 months or even a year. And within that time, we make some progress, it may be slow progress. In that time, new challenges may come up or present themselves, or other parts of the challenge become apparent and in my clinical opinion, another profession may be better suited to help that child. Depending on the family, I sometimes recommend an additional therapy while still being in OT, but sometimes I do say it might make sense to take a break from OT and see what this other therapy can do for you. It’s always a discussion with the family, never one sided. I have to make sure the family feels comfortable with this.