Occupational Therapy Assistant Job Description

In a school district, an Occupational Therapy Assistant is the person who makes the occupational therapy part of a student's IEP happen week after week. The occupational therapist evaluates, writes the plan and sets the goals. The assistant, working under that therapist's supervision, runs the sessions, adjusts activities on the fly, and records what the student can do now that they could not do in September. The focus is educational: can this second grader write legibly enough to complete classwork, can this middle schooler open a locker and get to class on time, can this kindergartner stay regulated through a fire drill.

A 2019 chapter on assistants in schools, published by AOTA, describes the range of the work. Under the occupational therapist's supervision, assistants can provide services at many levels, including direct and group instruction at the building level, consultation with teachers and staff at the building and district levels, and attendance at meetings. Its sample job description has the assistant collaborating with the therapist to develop intervention plans and interventions in the student's school context and routine, so the therapy fits the classroom instead of competing with it.

A typical day mixes four kinds of work:

• Direct service. Pull-out sessions in a therapy room for grasp, visual-motor skills, keyboarding or self-care, and small groups that practice the same skills with peers.
• Push-in support. Sitting beside a student during writing time or in the cafeteria, prompting the strategy the plan calls for, and watching what breaks down in the real setting.
• Consultation. Showing a teacher how to set up a slant board, giving a paraprofessional a simple prompt sequence for zipping a coat, or helping a family pick a pencil grip to try at home.
• Documentation. Treatment notes, progress data on IEP goals, and attendance logs, written in whatever IEP or records system the district uses.

The supervising relationship is the spine of the job. A good assistant notices when a student's performance has stalled, when a new diagnosis or medication seems to have changed things, or when the classroom demands have moved past the current goals, and brings that to the therapist with data rather than impressions. The therapist decides what to change; the assistant makes the change work in the room.

The setting shapes the pace. Sessions are fitted around class periods, assemblies, testing windows and the bus schedule, and an assistant may split the week between two or more buildings. The physical side is real: floor work with young children, helping students with transfers or positioning, and carrying bins of materials from school to school. BLS notes that occupational therapy assistants may work with children who have developmental disabilities, and a school caseload can run from a student who needs help with handwriting alone to a student with significant physical or developmental disabilities who needs support with eating, toileting and mobility.

What it is not: the assistant does not set a student's eligibility for services, does not write the initial evaluation, and does not change the plan of care on their own. The value of the role is consistent, skilled delivery of a plan someone else designed, close enough to the student to see what works.

Education. The usual entry path is an associate's degree from an accredited occupational therapy assistant program, and BLS notes that assistants usually need a state-issued license. Programs are accredited by the Accreditation Council for Occupational Therapy Education (ACOTE), and accreditation is not optional: BLS notes that licensure requires completing an accredited program, fieldwork and passing an exam. Associate's programs generally run 2 years of full-time study, with coursework in subjects such as anatomy, psychology and kinesiology, plus the activity analysis that underpins every session.

Fieldwork. Under the 2023 ACOTE Standard C.1.12, OTA students complete Level II fieldwork for a minimum of 16 weeks full-time, in placements that reflect more than one practice area, or in a maximum of three different settings. Anyone aiming at schools should plan placements with that rule in mind. Where a placement site has no occupational therapy services of its own, the 2023 standards require a minimum of 8 hours of direct supervision each week. As a rough guide, a school-bound student should try to get at least one placement with children, ideally in a district or an outpatient pediatric clinic, so that the IEP process is familiar before the first job.

Certification and licensure. After graduating, candidates take the National Board for Certification in Occupational Therapy (NBCOT) exam to earn the Certified Occupational Therapy Assistant (COTA) credential. The state license comes from the state's occupational therapy regulatory board, and AOTA's 2019 chapter on assistants in schools lists a passing grade on the entry-level exam approved by the state board and fulfillment of state licensure requirements among the qualifications. Check the state board's rules before applying, since licensure details vary by state.

Skills that carry the job.

• Activity analysis on the fly. Breaking a task like buttoning or copying from the board into steps, then grading it up or down within a single session.
• Data discipline. Taking the same measurement the same way every session, so a progress report reflects the student and not the observer.
• Plain explanation. Teachers and families need one clear strategy, not a lecture on sensory processing.
• Scheduling and travel. Building a weekly schedule across buildings that respects class time and leaves room for supervision meetings.
• Physical stamina. Floor work, lifting materials, and helping students move safely.

Background that helps. Prior work as a paraprofessional, childcare worker, camp counselor or rehab aide is useful background, because it teaches the rhythm of working with children before the clinical training. As a rough guide, new graduates can be hired straight into school roles, though a year in a pediatric clinic first can make the transition into IEP work easier.

CPR. BLS notes that occupational therapy assistants may need certifications in cardiopulmonary resuscitation and basic life support; the American Heart Association offers Basic Life Support courses.

The Occupational Outlook Handbook's 2025-35 projections show occupational therapy assistants growing from 52,200 jobs to 63,400 over the decade, a 21 percent increase. Those figures cover the whole occupation, not schools alone, and BLS does not publish a separate projection for school-based assistants.

Schools are a small slice of where these jobs are. BLS reports that educational services, state, local and private, employed 7 percent of occupational therapy assistants in 2025, and the May 2025 wage survey counted 2,840 occupational therapy assistants in elementary and secondary schools. That industry row also explains the pay picture: the school median of $60,110 sits beside a national median of $72,300 for the occupation across all industries. What the school job offers in return is a school-year rhythm and a caseload of children.

Funding is the variable to watch. School occupational therapy is paid for by districts, with help from federal special education grants and, where a state bills for it, Medicaid. A 2024 GAO report on special education estimated that federal IDEA Part B grants were roughly equivalent to 30 percent of the cost of salaries for special education teachers, audiologists, occupational therapists, physical therapists and speech-language pathologists who worked with students with disabilities in the 2021-22 school year.

Medicaid is the other lever. In 2023, CMS, in consultation with the U.S. Department of Education, issued a guide to Medicaid school-based services in which CMS strongly encourages states to promote the use of schools as a setting for Medicaid-enrolled students to get care, and it names physical and occupational therapy among those services. The guide describes billing options such as roster billing, which lets a state compute a rate representative of multiple services, and in one Colorado example it lists the certified occupational therapy assistant among the job categories eligible to bill direct medical services. For an assistant, the AOTA chapter says it plainly: assistants have to follow through on documentation, including policies related to Medicaid reimbursement.

Contract versus district employment. A school assistant may be a district employee on the district's salary schedule and benefits, or may work for a staffing or therapy company that contracts with districts. BLS does not report pay separately by employment arrangement, so compare the specific offers: salary or hourly rate, paid days, travel reimbursement between buildings, and how supervision time is scheduled.

Where the job can lead. Experienced school assistants can take on more complex caseloads, serve as fieldwork educators for OTA students, or specialize in areas such as assistive technology, feeding or early childhood. The bigger step is becoming an occupational therapist, which means a master's or doctoral program (ACOTE sets a 24-week minimum for their Level II fieldwork) and a separate license. An assistant can also move from schools into pediatric outpatient clinics or early intervention, where the skills transfer directly, or come into schools after starting in clinical work. Before taking a school job, read the state's Medicaid school-based services rules and the district's budget for related services, because both shape the position.

Dear Ms. Alvarez,

I am applying for the Certified Occupational Therapy Assistant position at Lakeside Unified School District. I passed the NBCOT exam last spring, hold a state OTA license, and have spent the past year as a COTA with a pediatric outpatient clinic that contracts with two elementary schools in your county. School-based work is where I want to build my career, and Lakeside's co-teaching model for students with IEPs is the reason I am applying here first.

At the clinic, I carried a caseload of school-age children under the supervision of two occupational therapists. Most of my students had goals for handwriting, self-care or sensory regulation. I learned to make a session fit a 30-minute slot between reading block and lunch, to take the same handwriting sample the same way every week, and to bring the therapist a short data summary instead of a general impression when a student stopped progressing. One third grader went from refusing to write to completing a paragraph independently after we worked out a slant board, a shorter pencil and a two-step self-check she could run on her own.

The part of the work I enjoy most is the classroom. I spent part of each week pushing into a resource room, where I learned that a strategy only matters if the teacher can use it when I am not there. I keep a one-page handout for each student with the two or three supports that work, and teachers tell me they use them.

During my fieldwork I also completed a placement at a middle school, so I am comfortable with IEP meetings, progress reports and a schedule that changes when testing week arrives. I am organized about documentation and on time with notes, and I am ready to travel between buildings.

I would welcome the chance to talk about how I could support your occupational therapy team. Thank you for your time and consideration.

Sincerely, Jordan Reyes, COTA