The Pre-referral Process for school-based OTs - World of OT
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The Pre-referral Process for school-based OTs


Are you tired of getting excessive referrals? Want to be a resource to teachers but don’t know how to? Or find yourself swamped with referrals from team members that eats away time from things that you want to and need to be doing?

Let’s explore the pre-referral process and how it can help you!


What is the pre-referral process? 

A pre-referral process is a series of steps collaboratively put in place in response to concerns from a team member related to a student’s access and participation in the educational setting. It is everything that happens before and may potentially lead to a formal referral for evaluation and services. The pre-referral process can be a productive and time-saving method to address concerns and accommodate the student’s needs before they are referred for a special education evaluation or services.


Here’s the essence of what a pre-referral process could encompass:

  • Screening–  A pre-referral screening form is completed by an IEP team member who has concerns related to a student’s functioning, an observation by the school therapist after getting permission from the parents, followed by suggestions for best next steps. These suggestions could include strategies for teachers to incorporate, or putting in place accommodations or task/ environmental modifications or even recommending a comprehensive evaluation, so as to best meet the individual needs of the student in the least restrictive environment.


  • Incorporating a RtI / MTSS or similar tiered approach where the school therapist supports the students needs within the general education setting by either providing in-services/ trainings to the educators or small group support  for teachers/students, before moving on to 1:1 support incorporated by the Student Success Team (SST). This approach provides services early to struggling learners and enables them to succeed in school. It requires collaboration between all school personnel and involves evidence-based instructional methods as well as decision-making based on data and monitoring of the student’s progress. The RTI model has been shown to increase student performance and decrease the number of referrals to special education.


However, like many other things in school based practice – the pre-referral process is one of those “it depends” situations. The procedures required may differ from one district to another. Also, each department(OT/PT/SLP etc.) within the special education department may have their own pre-referral process.

It may include just a simple screening or a full blown robust RtI approach, or most likely something in between! While your district may or may not already have a pre-referral process in place – there are always ways to tweak it or make it more air-tight! Hopefully that helps clarify what a pre-referral process is and what it could look like. 


Why having a pre-referral process in place is important:

      • Team Clarity – There are so many benefits of implementing a collaborative pre-referral process – and the most obvious one is that all team members are on the same page. There is on what to do and what to expect when a concern related to a student’s school participation arises.


      • Efficiency – This process also helps streamline things for you as the school therapist as it does for others, while also enabling the therapist to be able to provide services beyond their caseload without having to work around the clock.


      • Appropriate Referrals – It also helps minimize excessive, premature or inappropriate referrals for services which will save you valuable time. This allows you to spend the most time focusing on the goals for the student while still being able to provide support for the team and school in general.


      • Empowerment for Teachers and the Whole Team! – And can you believe that you can actually make a groundbreaking difference on how things are done, all while empowering the teachers, who will take with them all that they learn through the process- these tips and tricks will touch many more students’ lives in their role as an educator!


      • Gathering Crucial Information for Next Steps – The implementation of a pre-referral process also gives an opportunity to better understand the team’s concerns, students educational goals, strengths, interests and needs as they relate to school functioning. This significant information is crucial to determining next steps.



Doesn’t implementing a pre-referral process – no matter how simple or grandiose – now seem like a no brainer ?

What does your current pre-referral process look like and what are you hoping to add to it? What’s your next step?

I’d love to hear in the comments below!


P.S. If you are a new school-based OT hoping to start the school year with confidence rather than overwhelm and you’d like access to comprehensive information pertaining to school-based OT, tried and tested templates, efficient workload management systems along with several other resources to help you hit the ground running, I’d love for you to check out the online self paced course Nuts and Bolts to Becoming a Successful School Based OT’ and it’s pre-approved for AOTA CEU’s too!



This blog post was originally written by the author for Pediastaff

Ushma Sampat
[email protected]
  • Alison Mazurak
    Posted at 17:32h, 06 August Reply

    Is a screening for one student in a class or the whole classroom?

    • ushma
      Posted at 16:41h, 07 August Reply

      The screening would typically be for a student that someone on the IEP team has concerns about. Hope that helps clarify things!

  • Deb Bermudes
    Posted at 13:03h, 07 August Reply

    Our school has an SST process in place….in some cases I am asked to ‘take a peek’ at students and give suggestions, or to actually provide some limited ‘intervention (though I believe it’s important to get parent permission for this)- – – we do not have a formalized RTI/MTSS process in place for OT specifically – as there is for reading intervention for example…..
    team members can be collaborative though tend toward ‘service specific thinking’. which can be limiting…

    • ushma
      Posted at 16:46h, 07 August Reply

      Yes! Parent permission for anything that is not happening at the whole class level is so important!

      Thank you so much for sharing what your schools pre-referral process looks like!

      Given that there is a RTI process in place for reading, do you think you might be able to adapt and implement one for OT too?

  • Christina Raquedan
    Posted at 09:23h, 04 September Reply

    I don’t get referrals until they qualify for Special Ed services.

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