Is occupational therapy (OT) in short supply for NYC students? Current conversations have focused on expected losses of social workers, psychologists, and bilingual supports as schools race toward a fiscal cliff caused by the loss of pandemic stimulus dollars.  Beyond that alarming eventuality, NYC is currently missing the boat for special needs students who  require occupational therapy.

Why is OT a thing?

What exactly is occupational therapy? The Individuals with Disabilities Education Act says that occupational therapy is a type of related service. Occupational therapy can maintain, improve, or restore functions of education-related activities, including neuro-musculoskeletal function; motor function such as fine motor skills like writing; oral motor and visual motor integration such as eye tracking; as well as sensory and perceptual function such as self-regulation and how we process information to produce appropriate behavioral responses. 

New York City public schools are mandated to provide either school-based occupational therapy or be willing to provide authorization to obtain free services with outside contracted NY State-licensed therapists.  What happens when there is a provider shortage?  Usually either caseloads become unmanageable, or students go without service, and sometimes both of these things happen simultaneously. This is the case in New York City.

New York’s needs.

Despite seeing over 2,000 budgeted positions for occupational therapists this year and in the FY25 Preliminary Budget for next year, parents have been told that therapists are not available to support our students because there is a shortage. The shortage appears glaringly real on paper because NYC’s annual special education data report indicates that last year during fiscal year 2023, there were only 83 full-time therapists working in districts 1-32. The number of therapists in district 75 (where needs are even greater) was even smaller at 65.

Despite a budget of more than $165 million last year for full-time therapists this does not meet needs.  In districts 1-32, over 66,000 students had an occupational therapy recommendation.   The data says that on average about 8% of those students did not have any occupational therapy encounters.  When you compare full-time therapists to the numbers of students who had a “full encounter”, the OT to student ratio is a staggering and unbelievable 704 students per therapist.  Although the city’s data is not clear what is meant by “full encounter” if you imagine that each student requires more than one session per week it’s easy to understand that the ratio is impossible to service and reliance on outside providers is obvious.

Use of outside contractors is not clear.

If children do not receive their mandated OT in school and during school hours, parents are left to fend for themselves to find their own independent providers. Although NYC public schools’ claims students can get their OT at no cost from independent providers by using school-issued related service authorizations, there actually is the cost of families having to spend their own time (out of school hours) to find a provider as well as costs for transportation and time to attend OT sessions.  But parents cannot be forced to use outside providers and an IEP mandate is still a mandate.

An attractive job.

The job of an occupational therapist is no easy task. As per New York City public schools, therapists are responsible for evaluating and treating students, maintaining and writing daily progress notes, completing attendance records, and attending IEP meetings. Additional duties sometimes require recommending adaptive equipment, accommodations, or assistive technology. Clearly, it’s a busy job however it’s well paid.  According to the Bureau of Labor Statistics, quick facts about occupational therapists show a median job salary of over $93,000 per year with a master’s degree.  The projected growth rate in this field between 2022 and 2032 is expected to be much faster than average at 12% while average job growth rates for all occupations is much lower at only 3%. A local occupational therapist salary comparison table from ZipRecruiter is below.

Shortage is not a new problem.

Back in 2015, Elizabth Harris wrote in the New York Times there had been a sharp rise in OT cases in NYC classrooms. At that time, “Over the last four years, New York City public schools have seen a 30 percent increase in the number of students referred to occupational therapy, to 42,000 students. The city covers the cost, which at $58 million a year is up from $38 million just five years ago. (That dollar figure does not include therapists in schools fully devoted to special-education students.)”  Additionally, the article stated that “Special education advocates in New York City said there are not enough therapists to meet the demand, and that many students who are recommended for therapy are still waiting to receive it.” 

Almost ten years later NYC students are still in the same boat. This is not student failure this is a systemic failure. Ignoring this need and expecting our children to succeed in the classroom is a recipe for disappointment. Also, there’s plenty of collateral damage to go around.  Not only is the student not able to reach their educational goals, but teachers are also asked to compensate for the missing accommodations and other students may be impacted as well.

Answers and a SEED of hope?

NYC has to start thinking outside the box to meet their mandates.  The only effort to innovate has been creation of the Sensory Education Exploration & Discovery program (SEED).  SEED is currently accessible in fewer than 5% of our schools and is a specialized program which was not designed to even exist in every school.

As per NYC Public Schools, SEED is a sensory movement program conducted by a licensed occupational or physical therapist. The program offers sensory experiences that prepare the body and brain for learning and provides strategies for self-regulation that can be used throughout the school day. The curriculum is designed by occupational therapy experts and includes socio-emotional learning modules that teach self and social awareness, self-management, relationship skills and responsible decision-making which are things that nearly all students can benefit from. Students participate in groups of 4 either afterschool on weekdays or Saturdays for 45 minutes sessions. However, students must meet eligibility criteria of public school enrollment, have an IEP with an OT mandate, and display “intensive” sensory needs.  In August 2022, the SEED Program was identified as a “Champion of Change” by the New York State School Boards Association.

Based on the OT shortages SEED-like programs in all schools could be a way to overcome the gap between mandated needs and service providers. For example, can gross motor activities of a SEED type program for general education students who receive OT be administered by a physical education teacher? Likewise, perhaps the social emotional components can be administered by a counselor or social worker if an OT is not available.  Despite the delivery method, or course the main caveat will be to ensure that IEP mandates are met because currently they are not.