In 45 of 50 states, occupational therapists are not eligible to pursue formal administrative positions in public school systems (e.g., director of transition services, special education director) on the basis of state-level legislation and credentialing. Most state boards of education, however, recognize other related service providers (e.g., speech-language pathologists, social workers) as credentialed educators. Most states require education credentials to pursue further administrative credentials and, thus, administrative positions. Occupational therapists and other stakeholders lack awareness of this issue. In this column, I summarize the issue; identify occupational therapists’ qualifications for eligibility to pursue these positions; and provide solutions, primarily at the state level, to effect change so occupational therapists can be recognized as equals to their related service provider peers and use their unique skill set to influence public school communities as administrators.
Twenty percent to 25% of all occupational therapists work in a school setting and perform various tasks as they support classroom teachers, collaborate with other related service providers, and work with administrative leaders in special education meetings (American Occupational Therapy Association [AOTA], 2017a; Davies, 2021; Occupational Therapy Association of California, 2016). Although some school-based occupational therapists acquire leadership positions within their district (e.g., occupational therapy supervisor, lead occupational therapist), and all school-based occupational therapists’ roles and responsibilities both require leadership qualities and categorize them as leaders to other staff members, occupational therapists in 45 of 50 states do not meet state qualifications to pursue formal administrative leadership roles (e.g., director of transition services, special education director, principal, superintendent) in public school systems of the United States with an occupational therapy degree alone (AOTA, 2007, 2017b; Lastres et al., 2021; Occupational Therapy Association of California, 2016; Polichino & Hollenbeck, 2017; Sauvigne-Kirsch, 2017).
Related service providers, such as school social workers, counselors, psychologists, nurses, and speech pathologists, have the option, in most states, to earn the education credentials needed to pursue administrative credentials and, thus, administrative positions. In contrast, occupational therapists who work alongside these providers and are grouped among them in federal legislation (e.g., the Individuals With Disabilities Act of 1990 [IDEA; Pub. L. 101-476] and the Every Student Succeeds Act [ESSA; Pub. L. 114-95]) are not included in state-level legislation as professionals eligible to obtain education credentialing that opens the door to formal administrative leadership positions (AOTA, 2017a; Davies, 2021; Illinois State Board of Education, n.d.-a, n.d.-b; Lastres et al., 2021; Michels et al., 2022; Occupational Therapy Association of California, 2016).
Some states (e.g., Washington, New Jersey, and Colorado, with gray areas of eligibility in Massachusetts and Wisconsin) have incorporated occupational therapists as credentialed providers in schools (Illinois State Board of Education, n.d.-b; Lastres et al., 2021). State departments of education (SDEs) issue education credentials to related service providers, but most SDEs do not acknowledge occupational therapists as meeting state qualifications and do not group them in the same category as other providers (Davies, 2021; Lastres et al., 2021; Michels et al., 2022). Education credentials are the prerequisite that allows other related service providers to pursue the administrative credentials needed to fill administrative leadership positions, in conjunction with experience working in the school setting; occupational therapists may have the same amount of experience in school settings as a social worker, speech-language pathologist, and so on, but they remain ineligible, under SDEs, to pursue education credentials, administrative credentials, and administrative positions, despite their number of years of experience in schools, level of degree held, or additional leadership degrees pursued. Some occupational therapists, however, have additional experience in other professions (e.g., a degree in education with experience teaching), and SDEs have allotted them education credentials. In most states, this is one of the only ways occupational therapists can rise to administrative roles in school systems and use their education and unique skill set to effect change.
Related service providers recognized by most SDEs must meet specific requirements to receive an education credential. Today’s occupational therapists meet the requirements of a master’s degree or higher, completion of a preparatory program in the field of specialization, and an internship or equivalent experience (Illinois State Board of Education, n.d.-b; Illinois State Board of Education, Center for Educator Effectiveness, 2015; Lastres et al., 2021; Sauvigne-Kirsch, 2017). However, additional requirements pertaining to the culmination of coursework and exams that address methods of teaching are not available for occupational therapists to pursue in most states because an occupational therapy degree is not an acceptable prerequisite or a recognized “field of specialization” compared with other provider degrees.
Many occupational therapists, as well as related service provider peers and administrators, are unaware of occupational therapists’ ineligibility (Lastres et al., 2021). Some occupational therapists and other stakeholders who are aware may not support occupational therapy’s inclusion or state-level legislation for occupational therapy eligibility. However, occupational therapists have the skill set and leadership abilities to pursue administrative leadership roles, if they so choose, alongside eligible school support personnel (AOTA, 2007, 2017b; Lastres et al., 2021; Sauvigne-Kirsch, 2017; Polichino & Hollenbeck, 2017). That said, occupational therapy education alone does not prepare educationally credentialed occupational therapists to be effective educational administrators. Like any other professionals interested in administrative roles, to be qualified and prepared, occupational therapists would need to pursue additional coursework, an administrative license, and an internship or apprenticeship for an introductory experience and practice with the responsibilities of administrative positions.
Occupational therapy leaders and educators, occupational therapists, occupational therapy students, school administrators, and state education policymakers must be aware of occupational therapy’s ineligibility to weigh the option of occupational therapists becoming equals among related service providers in school settings and contenders for roles in school administration. Increased awareness of this issue can promote the advocacy among occupational therapy professionals that is required for change.
Administrative Leadership Opportunities Are Important
Because 20% to 25% of occupational therapists work in schools, it is essential to explore the potential for occupational therapists to pursue formal leadership roles to expand occupational therapy’s impact on education and address reported rates of burnout and high turnover among school-based occupational therapists. There is low sustainability in school-based occupational therapy positions because of low salary ceilings (Davies, 2021; Sauvigne-Kirsch, 2017). Pursuing administrative leadership positions would incentivize occupational therapists practicing in schools who are seeking upward mobility to maintain their jobs with the opportunity to pursue administrative leadership positions. Beyond the exclusion limiting school-based occupational therapists’ pay and career advancement, this keeps them from using their ability to develop programming to benefit staff, students, and the community (Davies, 2021; Lastres et al., 2021; Michels et al., 2022). Limitations on leadership capacities put occupational therapists who pursue school-based positions at a loss for opportunities to apply this specific occupational therapy skill set.
In addition, because other service providers are eligible for these positions, occupational therapists’ ineligibility offers them less of a seat at the table and less equitable involvement among professional peers (Lastres et al., 2021; Polichino & Hollenbeck, 2017). Occupational therapy’s exclusion from education credentialing hinders school-based therapists from being seen as equals among related-service provider peers and perpetuates the lack of knowledge of and awareness surrounding occupational therapy’s expansive role, scope, and value in the school setting (Davies, 2021; Lastres et al., 2021; Michels et al., 2022). This affects a practicing occupational therapist’s experience in their career. Although not every occupational therapist seeks to pursue administrative positions, having an occupational therapist in an administrative position would allow for proper recognition and support of occupational therapy’s overall role and value in schools. The role and scope of school providers can align with the evidence-based practice of their advancing profession when individuals in the profession have the opportunity to use their voice at the administrative level.
Occupational Therapists Are Fit to Stand Alongside Professional Peers
At the federal level, through ESSA and IDEA, occupational therapists are grouped alongside educationally credentialed support personnel as Specialized Instructional Support Personnel (Davies, 2021; Lastres et al., 2021; Michels et al., 2022). They are considered education providers who work with teachers and on education goals. State levels need to recognize this grouping. State-level legislation limits occupational therapy’s eligibility, although some states have incorporated the profession among credentialed providers in public schools (Davies, 2021).
This incorporation makes sense because school leadership is within occupational therapy’s scope of practice. Occupational therapists are trained to work in systems at various levels, with experience guiding pathways to leadership. Those working in schools have relevant experience working with general and special education students, collaborating within interprofessional teams, and understanding teacher workloads and challenges (Polichino & Hollenbeck, 2017). Their occupational therapy education provides a knowledge base of human growth and development, students and performance, creative approaches to problem-solving, contexts of service delivery, and management (AOTA, 2007, 2017b; Lastres et al., 2021; Polichino & Hollenbeck, 2017; Sauvigne-Kirsch, 2017; Schefkind, 2017). All occupational therapists, especially those who have earned a doctorate, hold state licensure and receive preparation for leadership. All of this prepares occupational therapists with school-based experience to pursue formal administrative roles.
Occupational therapists’ recognition as educationally credentialed providers at the state levels aligns with the profession’s goals and is something the profession’s association supports. Advancement into formal leadership roles supports AOTA’s Centennial Vision and Vision 2025; holding leadership positions will allow occupational therapy’s influence in schools to be robust and widely recognized (AOTA, 2007, 2017b; Michels et al., 2022; Sauvigne-Kirsch, 2017). AOTA has demonstrated initial steps of awareness and advocacy for the issue through their infographic Path to Leadership for the School-Based Practitioner (AOTA, n.d.) and a letter to state superintendents of education and state directors of special education with suggested actions supporting a change in eligibility for occupational therapists (AOTA, 2017a; Schefkind, 2017). Although support exists, awareness is still lacking in the profession, and considerable barriers to change remain.
Barriers to and Concerns About Change
Many state-level barriers include legislation, budgeting, and a limited number of therapists in state advocacy groups (Sauvigne-Kirsch, 2017). Legislation regarding occupational therapists’ eligibility for education credentialing, and thus the capability to pursue the administrative credentialing necessary for administrative leadership roles in the public school system, differs from state to state. Each SDE has specific legislation detailing eligibility requirements for education credentialing. Legislation in states that recognize occupational therapists as eligible providers for education credentialing should be considered and reviewed to make the necessary changes in legislation in the 45 states where occupational therapists seek eligibility for credentialing. Because this issue lies in the hands of each state and cannot solely be addressed at a national level, state organizations must collaborate with AOTA to make change on a case-by-case basis.
Lack of awareness of this issue is one of the most notable barriers. However, the school-based occupational therapists who are aware may not be interested in inclusion in eligibility among other related service providers for fear of changes in roles and responsibilities. Many occupational therapists have questions and concerns regarding licensure, role delineation, professional identity maintenance, union status, medical reimbursement, insurance, salary, and retirements and benefits (Lastres et al., 2021; Sauvigne-Kirsch, 2017). In addition, some stakeholders do not support occupational therapy’s inclusion, noting various concerns (e.g., licensure/credentialing costs for occupational therapists; lack of eligible programs available to candidates, influencing the supply of school-based therapists; reduction in the eligible pool of school-based occupational therapist candidates; California Commission on Education, Commission on Teaching Credentialing, 2022).
Occupational therapists must address these concerns to effectively advocate for the desired change. The benefits of this change’s impact on school-based occupational therapists, school communities, and the occupational therapy profession outweigh the concerns noted. Occupational therapists concerned about inclusion in credentialing need to look past unknowns that would affect them personally, in their specific school and career, and consider the bigger picture of benefits for the field of occupational therapy at large.
Benefits for Occupational Therapists, Schools, and Students
In this column, I have shown how occupational therapists would benefit from obtaining eligibility and pursuing administrative positions. This option would offer opportunities for increased recognition and a better seat at the table for practicing school-based therapists, with increased pay and an ability to develop programming to benefit staff, students, and the community for occupational therapists who choose to pursue administrative positions (Davies, 2021; Lastres et al., 2021; Michels et al., 2022; Polichino & Hollenbeck, 2017).
The benefits, however, accrue not only to occupational therapists but also to the students and schools. First, including occupational therapists as service providers eligible for administrative positions increases the pool of individuals interested in administrative roles, thus addressing administrative shortages (Davies, 2021; Polichino & Hollenbeck, 2017). In addition, eligibility would make school jobs more attractive to occupational therapists, leading to their increased recruitment and retention in schools (Polichino & Hollenbeck, 2017). Students could rely on consistent providers. Schools would see the outcomes of this benefit, and many others, over time.
When considering the next steps of advocacy efforts, it may be helpful to consider Bronfenbrenner’s (1977) ecological systems theory, displayed in Figure 1, to plan systematic advocacy efforts that engage school-based occupational therapists in professional advocacy strategies (Dawnette et al., 2015). Change can start at the microsystem and move through the macrosystem. Potential actionable items at each level include the following (Davies, 2021; Polichino & Hollenbeck, 2017; Sauvigne-Kirsch, 2017; Schefkind, 2017):
▪ Microsystem and Mesosystem
∘ Using occupational therapy’s mission and goals with data and evidence-based practice to justify occupational therapy’s role in addressing system-wide issues to stakeholders
∘ Analyzing similarities between occupational therapy credentials and training and that of other related-service providers who hold education credentials to strengthen the argument that occupational therapists, with further administrative education, are just as qualified to pursue administrative positions
∘ Providing state education associations with a better understanding of occupational therapy’s scope of practice and value
∘ Presenting the problem to degree programs to incorporate coursework that focuses on school systems, classroom management, and curriculum, to enhance readiness for SDE credentialing
∘ Encouraging occupational therapy doctoral programs and students to pursue capstone opportunities with a specialization in advocacy within schools
∘ Participating in state-level professional organizations to request action from the representative assembly
∘ Advocating, through state legislation, the opening of opportunities for formal training and credentialing for leadership roles while encouraging other stakeholders to support the cause
∘ Seeking opportunities to invite school administrators to occupational therapy conferences or meetings to increase awareness and bidirectional communication
∘ Collaborating with occupational therapy associations to create advocacy plans to convey norms in school-based practice and aim for a shift, using data to support norm shifts
Overall, state associations need to collaborate to aim for a shift in the known norms of school-based occupational therapy to include administrative leadership. Various states are at different points in advocacy efforts for recognizing occupational therapy’s qualifications for administrative opportunities; some have made giant strides, and some have made none. To understand how best to play a role in advocacy efforts, occupational therapists advocating for the cause must familiarize themselves with the stage of advocacy in which their state lies.
States that have advocated and incorporated occupational therapists as credentialed providers in schools show us the possibility of occupational therapy’s eligibility, and occupational therapists must present a united front as professionals regarding the opportunities and roles available to them (Davies, 2021; Polichino & Hollenbeck, 2017). Occupational therapists need to be the ones to lead the charge for the causes pertaining to the profession. Other providers, once informed, may support occupational therapy’s cause, but it will be occupational therapists who get a say in whether change occurs.