Originally Issued September 8, 2020

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Introduction 

Occupational therapists (OTs) have remained resourceful and resilient throughout this pandemic. Practicing within the school setting is evolving as the environments continue to change. Occupational therapists should continue to work with their employers, parents and guardians, school boards, and individual schools to determine the most appropriate process for service provision for the students.

As a reminder, orders, directives, and guidance from the Ministry of Health and Chief Medical Officer of Health (CMOH) overrule the information in this document. The information provided here is also not intended to take the place of legal advice. The College has received questions from occupational therapists requesting clarification about expectations.

Questions and our answers are listed below:


1. Do I have to complete a self-screener each day as an occupational therapist working in schools?

Yes. All staff/occupational therapists and students must complete a self-screener every day before attending school. For more information please see: COVID-19: Health, safety and operational guidance for schools (2021-2022).


Contingency Plans

We recommend that occupational therapists proactively create a contingency plan in case they test positive for COVID-19 and are required to remain in isolation at home. An occupational therapist may wish to clarify with their organization about work arrangements during isolation, how students/families will be notified during this time, etc. If an occupational therapist is providing private service, a plan should be in place to notify their remaining clients about service being temporarily suspended, or if there is another occupational therapist that can provide coverage until you are cleared to return. The same applies if an occupational therapist’s child/family member is placed under quarantine by public health.


2. Is the self-screener completed before school by the student/guardian sufficient to start occupational therapy services?

Yes, you can rely on the student or guardian’s completion of the self-screen, and it is strongly recommended that confirmation of this negative self-screen be documented prior to withdrawing a student from the class for occupational therapy services.  

If entry to the school requires mandatory completion and a negative result of the daily COVID-19 School and Child Care Screening, additional screening at the time of assessment is not required. However, as part of the required Point of Care Risk Assessment (PCRA), the occupational therapist should confirm that the health status of the student has not changed since arrival to school, through physical observation, asking the student how they are feeling and consulting with school personnel. Physical distancing, wearing the required PPE, considering collateral information, and using clinical judgement are also essential tools in providing safe services.     


Point of Care Risk Assessment

When providing in-person service to a student, occupational therapists are reminded to complete a Point of Care Risk Assessment (PCRA) as referenced in the Operational Requirements for Health Sector Restart which  require assessment of the task, the student, and the environment. 

The results of this PCRA will help an occupational therapist to determine if and how the service should proceed. For example, if an occupational therapist has decided to do an in-person mobility assessment that will involve student repositioning, there may be additional personal protective equipment (PPE) needs to consider prior to the visit, for example, surgical/procedure mask, gloves and eye protection (goggles or a face shield), hand hygiene before and after contact with the patient and the patient environment, and after the removal of PPE.

3. What if a child becomes sick during the session?

Please review the COVID-19: Health, safety and operational guidance for schools (2021-2022) document, which describes the processes to follow if an individual, including students, staff, contractors, visitors, parents, guardians, becomes ill while at school, including during any before and after school care affiliated with the school. 

Please refer to the Government of Ontario: COVID-19 Guidance: School Case, Contact, and Outbreak Management.

4. What personal protective equipment (PPE) is required??

Occupational therapists must follow the protocols and recommendations for PPE from Public Health and the Ministry of Health and any additional organizational/school requirements. At minimum occupational therapists must wear a surgical/procedural mask for the full duration of their working day, including throughout all interactions.

5. What additional infection prevention and control (IPAC) procedures should be in place when working in schools?

Please refer to the Public Health Ontario’s Checklist, COVID-19 Preparedness and Prevention in Elementary and Secondary (K-12) Schools and The Standards for Infection Prevention and Control.

Disinfecting Equipment

Public Health Ontario has advised that spaces, toys, and equipment frequently and regularly used items should be cleaned thoroughly. Please refer to Public Health Ontario’s Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd Edition. Occupational therapists can also contact the manufacturer to determine the most appropriate infection prevention, and control for cleaning equipment or devices to avoid damage. In addition, occupational therapists can seek out and review organizational guidance pertaining to requirements for disinfecting equipment.


6. Consent Considerations

The process for obtaining consent remains the same for occupational therapists who will be providing services in person in schools, or remotely. Occupational therapists are expected to obtain informed consent from the student or their guardian to ensure there is an opportunity to address any questions. Consent discussions should include such things as the nature of the service, any modifications to service, withdrawal options, and alternatives. Occupational therapists working in schools should include any COVID19 related requirements and procedures in the consent process, for example:

  • How and when to contact parents/guardian by phone, or email, if required
  • Who may be involved in the occupational therapy services and the participant’s role
  • Risks, benefits, and any limitation of participating in remote or in person service
  • Information about privacy and security features of virtual services

As a reminder, student/guardian consent can be given verbally. Obtaining written consent is not a College requirement but may be a requirement of the practice setting or organization.

Consent must be documented in the clinical record as outlined in the Standards for Consent.


7. Documentation

Considerations for documenting COVID-19 related information:

  • confirmation of the daily screening process if available
  • results of the PCRA 
  • any modifications to the occupational therapy assessment or interventions

The Standards for Record Keeping describe expectations for documentation.


8. What about virtual services for children that are staying home?

Occupational therapists can refer to the Virtual Services resource for recommended practice when providing service virtually. The Information and Privacy Commissioner of Ontario also has a helpful resource: Privacy and security considerations for virtual health care visits.

Additional questions?  Please reach out to our Practice Resource Service where our occupational therapy Practice Consultants are available to answer your questions by email: practice@coto.org or phone 1.800.890.6570 or 416.214.1177 ext. 240.