Question #1:  Are you a OT/COTA or a PT/PTA?
Question #2: How do you provide the majority of your service? Direct (one on one or in a group) or indirect (consultation with teachers, staff and parents)?

For OT/COTA’s:

  • 88% of respondents provide primarily direct therapy
  • 12% of respondents provide primarily indirect therapy

For PT/PTA’s:

  • 100% of respondents provide primarily direct therapy


  • 95% of respondents provide primarily direct therapy
  • 5% of respondents provide primarily indirect therapy
Commentary:  I found these results very interesting.  Although this is by no means a research survey is does give some clues about school based practice.  There is not an extensive amount of research on direct versus indirect school based therapy but what is available seems to indicate that both methods of delivery are acceptable.  Dreiling and Bundy (2003) compared preschoolers who received occupational therapy via a direct method or a consultative method.  Both groups made progress and either delivery method was effective.  Palisano (1989) compared students with learning disabilities who received direct or consult OT and PT.  Again, each method of delivery was equally effective with the consult group making greater gains on the Bruininks.

When caseloads get tight or students are on waiting lists perhaps therapists could evaluate whether a consultative model would be suitable for some students.

Dreiling DS, Bundy AC. (2003).  Comparison of Consultative Model and direct-indirect intervention with preschoolers.  The American Journal of Occupational Therapy, Sep-Oct; 57(5): 566-9.
Palisano, RJ (1989).  Comparison of two methods of service delivery for students with learning disabilities.  Physical and occupational Therapy in Pediatrics. 9(3): 79-100.

Want to post a response to commentary?  e-mail response and we will review it and post responses.
Response from Chris on 3/23/07:  If you read Giangreco’s research on related services provided in the school district, as well as what IDEA dictates, “best practice” is providing educationally relevant PT services in the least restrictive environment possible (implying not a pull out)…supporting the IEP goals that are written in a discipline free format and offering an integrated type of PT service:  collaborative, ranging from consult to monitoring to direct services if needed.  This is how I try to practice in a school district, grades K-12, although I admit to it not always being easy….and is seemingly threatening to other therapists who choose not to practice in this manner.  Also latest research…shows “more” services is not better.  Interesting survey results.