Hey Reader,

I want to admit up front that I am absolutely guilty of what I am about to discuss…

Using consult services as a “discharge” wait list.

What do I mean by that?

I am talking about the student who is probably ready to exit OT… but I kept them on my caseload because it was easier to add a 4/yr consult to the IEP than to complete an evaluation before their next 3-year re-evaluation due date.

If you've done this too, I totally understand why.

Eval lists build up, and the last thing any of us want to do is add even one more name to that list - even if it would lower our caseload.

Plus, consult services can feel like the cleanest way to “hold” support until you can formally exit the student.

But when consult becomes just a holding pattern, it misses what consult can be. Consult services are not designed to be a holding pattern.

Looking back, I can see how using them that way may have affected my credibility and made teachers less receptive when I later offered consultation as a meaningful service.

Consultative services are a legitimate, high-impact way to deliver OT services, especially when they are structured, intentional, and connected to student participation.

So, let’s talk about how to make that shift and use meaningful consult services to get real results for our students.

Consult services are not the step before discharge

Here is the reframe I think we need:

Consult services are not where students wait until we can remove OT from the IEP.

They are a way to deliver OT through the routines, people, and environments that affect participation every day. AKA - Generalize skills to their real world!

That does not mean every student on consult needs to stay on consult.

If a student no longer needs skilled OT support, we should be able to say that clearly and follow the appropriate process for exiting services.

But if a student does need consultative OT, that service needs a purpose beyond keeping the student on the caseload.

A meaningful consult:

• Should be directly linked to an IEP goal - even if you did not write the goal
• Needs a treatment plan in place to meet the goal
• Is a dialogue between you and the teacher(s), not a monologue
• Is a series of experiments where you and the teacher test what works and what doesn’t.
• Requires data tracking and revisions accordingly.

Three shifts to make your consults meaningful

Check out our upcoming course in the School-Based OT Collaborative on consult services. Then keep reading for my 3 recommended shifts to improve your consult services next school year.

Want to provide more intentional consultation services in your practice? Have you struggled to explain consult services, document their value, or move collaboration beyond occasional teacher check-ins? In this course coming to the School-Based OT Collab on June 18th, you'll learn to provide collaborative and consult services that are purposeful, practical, and grounded in the student’s actual school day. ​Explore Strategies for Successful Collaborative/Consult Services​

Make your consults meaningful

1. Start with the functional outcome

“Consult as needed” is not a plan.

Neither is “check in with the teacher” unless we know what we are checking in about.

Start by naming the school routine and the outcome you are trying to affect:

• Completing written work with greater independence
• Participating in classroom transitions with fewer adult prompts
• Accessing materials or assistive technology during instruction
• Managing lunch, recess, or self-care routines more independently

The clearer the participation outcome, the easier it is to decide whether consultation is appropriate and what it should include.

2. Name what you will actually do

Consult should not leave teachers wondering whether you will ever show up again or what you will do when you are there.

Be up front about what the service you are providing will look like.

That may include:

• Observing the student during the routine you are supporting
• Meeting briefly with the teacher or paraprofessional
• Modeling one strategy in the classroom
• Adjusting an accommodation, task demand, or environmental support
• Reviewing a work sample or simple data point

Teachers are more likely to follow through with suggestions when they know what a consult with you will look like and how it connects to the student in front of them.

The more you include the teacher in the decision-making process, the more likely they are to follow through on the suggestions the two of you come up with.

Teachers don’t need another person telling them what to do. They need someone willing to do it with them.

3. Think of your consults as mini experiments

Think of each consult visit as a small experiment: try one support, watch what happens, and adjust based on what you learn.

A simple consult experiment looks like this:

• Question: “What is getting in the way right now of the student meeting their goal to…?”
• Plan: Choose one strategy/accommodation to trial (and who will do what).
• Try it: Use it during one routine (writing, transitions, centers, lunch, etc.).
• Check: Choose ONE data point to track for success.
• Adjust: Keep it, tweak it, or replace it based on results.

You do not need to give a teacher 18 new strategies to try.

You need one reasonable support, a quick way to know if it helped, and a plan for what comes next.

To-do: Evaluate your consults

Take some time as you wrap up the school year to pick one student you currently support via a consult model and ask:

Do I have a real treatment plan in place for this student or am I just winging it?

If the answer is “I’m just winging it”, use this quick reframe to create a plan:

• Outcome: What participation outcome are we supporting (writing, transitions, lunch, self-care, etc.)?
• Routine + team: Which routine/environment matters most, and who are you collaborating with (teacher, para, family, etc.)?
• Plan: What will you actually do during your next Consult (observe, model, adjust an accommodation, review a work sample, meet briefly, etc.)?
• One data point: What is one simple thing you will track to know if it helped?
• Follow-up decision: Based on what you learn, will you keep/tweak/replace the plan—or is it time to start the exit conversation?

This isn’t about shaming ourselves for the times consult became the de facto discharge waitlist.

It is about making our consult services more purposeful from here forward.

Pro tip for next school year: Add a time block on your calendar for consults. Consults that don’t get put on the calendar don't get the attention they need to succeed.

RESEARCH 🧪

In 1990, Winnie Dunn (Yes, that Winnie Dunn) compared collaborative consultation with direct school-based OT services and found that students in both groups achieved a similar percentage of IEP goals, while teachers in the consultation group perceived greater OT contributions.

It was a small pilot study, but it reminds us that meaningful consultation is neither new nor a lesser form of OT.

More than 35 years later, maybe it is time to revisit this question with updated research.

Reference: Dunn, W. (1990). A Comparison of Service Provision Models in School-Based Occupational Therapy Services: A Pilot Study. The Occupational Therapy Journal of Research, 10(5), 300-320.

LAST WORD 👋​
​I was wrong...

I will be the first to admit that I have not always used consult services the way I should have.

I had a lot of success with consults when I put in the effort.

Sometimes, though, they were a convenient way to keep my eval list from spilling over and saved me time. And that was wrong.

When consults are tied to participation, carried out in real routines, and supported with follow-up, they help OT move beyond a once-a-week session and into the student's actual school day.

That is the type of consultation I want teachers to think of when I recommend it.

And that is the type of consultation our students deserve.

Thanks for having a read. I hope this gives you one useful way to look at the students currently receiving consult services on your caseload.

And if you'd like even more support with designing consults that support your students, remember to check out our upcoming course in The Collab!​

Until next time,

👋 Jayson

Jayson Davies, MA, OTR/L
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