The SENCO's Guide to OT Referral: When to Refer and What to Expect
The SENCO's Guide to OT Referral: When to Refer and What to Expect
When a child is struggling with handwriting, struggling to dress for PE, or crashing through the classroom, it is easy to default to an Educational Psychology (EP) referral. But Occupational Therapy (OT) is often the …
For schoolsPublished 28 April 202614 min read· Written by the Sensphere OT team
When a child is struggling with handwriting, struggling to dress for PE, or crashing through the classroom, it is easy to default to an Educational Psychology (EP) referral. But Occupational Therapy (OT) is often the intervention that changes practice. This guide sets out when paediatric OT is indicated, how to commission it, and how to use OT evidence in your SEND processes. It assumes you know the SEND Code of Practice and how to build a case for statutory assessment.
What Paediatric OT Covers in a School Context
Occupational Therapy in school focuses on functional performance across the child's daily occupations, learning, self-care, participation, and play. The school OT works with the occupations that matter in the educational setting: handwriting, fine and gross motor tasks in PE and practical subjects, independent self-care (changing for PE, managing lunch, toileting), sensory processing as it affects participation and learning, attention and regulation to stay engaged in group settings, and daily living skills relevant to the school day.
In the school context, OT addresses the person-environment-occupation fit. If a child cannot manage to change for PE within the time available, an OT might work on speed and independence of dressing, suggest environmental modifications (a quieter changing area, peer buddy), or help you understand if sensory processing is a barrier (discomfort with the changing room temperature or texture of uniform). The goal is always functional independence and participation in school life.
What OT does not cover is important to be clear about. Speech and Language Therapy (SALT) addresses communication and swallowing. Educational Psychology addresses cognitive and learning profile, behaviour support, and psychometric assessment. Child and Adolescent Mental Health Services (CAMHS) addresses emotional wellbeing and mental health conditions. When a child presents with overlapping difficulties, multi-disciplinary assessment is often the strongest approach. A child with Developmental Coordination Disorder (DCD) and Developmental Language Disorder (DLD) will benefit from both OT and SALT working together. A child with autism and sensory processing difficulties who also has reading difficulty might need OT, EP assessment, and possibly SALT, all three provide different and complementary evidence of need.
Does this match a pupil you're currently supporting? If you'd like to discuss a referral or talk through the process, book a free 15-minute call, we work directly with SENCOs and school teams.
Classroom Indicators That Suggest OT Referral
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The most reliable indicator of OT need is a discrepancy between what the child can do intellectually and what they can do physically or sensorily within school tasks. Watch for these specific patterns.
Handwriting that is significantly below peers despite targeted intervention is a red flag. The child might have legible output in short bursts but fatigue quickly, or the writing might be slow and labour-intensive, limiting their ability to get ideas down in other subjects. Some children avoid written tasks actively, they choose not to contribute in literacy, or they produce minimal output in timed tasks. If handwriting intervention (letter formation practice, kinaesthetic approaches) has not shifted the picture, OT assessment is indicated to rule out fine motor difficulty, pencil grip dysfunction, or postural weakness.
PE and gross motor learning that lags noticeably behind peers can point to DCD. The child might struggle with ball skills, balance, or learning new movement sequences. They may be unable to ride a bike, skip, or throw with accuracy by an age when peers can. They often appear clumsy or "accident-prone", knocking things over, tripping, or bumping into peers. If the child has intellectual ability in line with peers but motor learning is slow, OT assessment clarifies whether DCD is present and what classroom provision should be in place.
Fine motor tasks affecting scissors, craft, construction, model-making, or practical subjects offer additional indicators. The child might hold scissors ineffectively, be unable to thread beads or build with small blocks, or avoid these tasks. In secondary settings, resistant or poor quality work in Food Technology or Design and Technology might point to unidentified fine motor difficulty.
Self-care independence lower than age-expected is significant in a school context. A child who takes an abnormally long time to change for PE, still struggling with buttons, sleeves, or socks while peers are ready, warrants OT input. Similarly, if a child is not managing lunch independently by mid-primary (opening containers, managing cutlery, clearing their space), or if toileting independence is delayed, OT assessment helps distinguish between motor difficulty, executive function difficulty, and sensory factors.
Sensory behaviours that affect learning are common and often missed. A child who covers their ears in assembly, is distressed in the lunch hall, refuses certain clothing textures (wearing PE kit over uniform, for example), crashes and bangs into furniture, or mouths objects beyond age-expected levels might have sensory processing needs. OT assessment identifies whether the child is sensory-seeking, sensory-avoiding, or has sensory discrimination difficulty, and what school adjustments will help them access learning.
Postural control during seated work is another indicator. If the child cannot maintain upright posture for handwriting, slumps or leans heavily on the table, or shows early fatigue even in short writing tasks, there may be core strength or postural control difficulty that OT can address.
Executive function difficulty where sensory or motor factors appear to contribute warrants multi-disciplinary referral. A child might appear disorganised and impulsive, losing belongings, forgetting instructions, but if you also notice they move slowly, tire easily, or are sensorily avoidant, OT input alongside EP assessment gives a fuller picture. It is important to distinguish between ADHD-presentation difficulty and motor/sensory-driven difficulty, as the intervention pathway differs.
Referral Routes
In England, there are several routes to OT assessment. Understanding each is essential because they involve different timescales, consent pathways, and cost implications.
NHS OT referral through the child's GP or school health service (health visitor or school nurse in some areas) goes through your Integrated Care Board (ICB) and local NHS trust. GP referral is the most reliable route but is also variable by region. Some ICBs commission OT through paediatric disability services, others through community health teams, and some have long waiting lists (18+ months is not unusual). Parental consent is required before any referral is made to NHS services. In practice, you flag the concern with parents, recommend they see their GP, and provide parents with specific points to raise (handwriting difficulty, PE struggles, fine motor delay). The school can write supporting information if asked.
Direct school commission of private OT is increasingly used where budget allows and NHS waiting times are problematic. Schools can commission a private OT assessment directly, with parental knowledge and consent. Alternatively, you can signpost parents to self-fund private assessment if school budget does not stretch to it. SENsphere accepts direct referrals from schools, no GP letter is required, and offers assessment and reporting at several levels. An initial assessment with a written summary costs from £450; a full assessment with detailed report is from £650 to £695. If the assessment is being commissioned specifically as evidence for an EHCP application, a formal evidence report pathway is available from £850. For families unable to afford private assessment, this remains a barrier, but some schools build OT assessment into their annual SEND budget.
EHCP-linked referral is used when you are building a case for statutory assessment. You can request in writing that the local authority (LA) commissions an OT assessment as part of the EHC needs assessment under Section 323 of the Children and Families Act 2014.¹ The LA must consider your request and either commission the assessment or provide written reasons why not. Set out the functional concerns clearly, attach school evidence, and explain why NHS waiting times make this necessary. Many LAs will commission OT assessment if you make a explicit, evidence-based request.
What to Provide When Making a Referral
A strong referral gives the OT concrete, functional information rather than a diagnostic label. Avoid "child struggles in school" or "poor at PE." Instead, write: "Cannot maintain legible handwriting for more than five minutes; after that, letters reduce in size and clarity deteriorates significantly, limiting his ability to record learning in other subjects."
Include existing documentation: your SEN support plan targets and progress data, any previous EP reports or paediatrician assessments, and any speech and language therapy or other professional input already in place. This context helps the OT prioritise what to assess and whether multi-disciplinary working is needed.
School-specific observations are valuable. Describe what the child can and cannot do in PE (does he manage ball skills, balance, new movement sequences?), handwriting tasks (speed, legibility, fatigue, effort), lunchtime (opening containers, managing cutlery, independence), transitions (does sensory overload affect ability to move between spaces?), and group participation (does he cover his ears in assembly, avoid certain spaces, show sensory-seeking behaviour?). The more contextual and specific, the better the OT can prioritise assessment.
Provide school contact details and name the staff member the OT should liaise with during assessment. Include information about the child's timetable (school observation windows if you are requesting in-school assessment) and any upcoming pressures, SATs, annual review deadlines, school placement decisions, that might affect the assessment timeline.
Have a pupil you'd like to discuss? Sensphere works directly with schools and SENCOs, from focused school observations to full EHCP assessment reports. Book a free call or view school services.
What to Expect from the OT Process
Timeline. Private OT assessment at SENsphere typically moves from referral to report within 4 to 6 weeks. The written report itself is usually completed within 10 to 15 working days of assessment completion. NHS OT, if available, is typically slower, waiting lists of 6 to 12 months are common. Plan accordingly when evidence is linked to a deadline (EHCP application, annual review, tribunal).
School observation. Whether the OT observes in school depends on the assessment package commissioned. Some packages include school observation; others do not. If observation is important to your assessment question (for example, you want to understand how the child manages PE or lunchtime), confirm this at referral and discuss what observation windows are available. School observation requires school consent and a confirmed date, and it is usually brief (one to two sessions).
Feedback to school. The written report goes to the commissioning party (parent or school, depending on who referred). The OT will offer a brief verbal debrief with you if arranged in advance, this is useful for clarifying recommendations and planning how to embed them into your provision. Make this explicit in your referral if you want this conversation.
What the report contains. The most useful reports for SENCO practice include specific, quantified recommendations for school. They describe what the child can and cannot do, explain why (fine motor difficulty, poor postural control, sensory processing differences), and set out what school provision should be in place, targets for the SEN support plan, environmental adjustments, equipment, and staff training. If an EHCP application is planned, the OT should use language that maps to Section B (special educational needs) and Section F (special educational provision). Ask explicitly for EHCP-ready language if that is your pathway.
Using OT Evidence in SEN Processes
SEN support plans. OT recommendations must translate into measurable, time-bound targets. Do not write "improve handwriting." Instead, write: "By [date], [child] will produce legible handwriting for a sustained 10-minute task using the pencil grip and postural strategies recommended by his occupational therapist." Include what school will do (adult modelling, specific feedback, use of sloped writing board) and what success looks like (consistent grip, maintained posture, clear letter formation).
EHCP applications. OT evidence informs Section B (the child's special educational needs), Section C (health and care needs), Section F (special educational provision), and Section H (outcomes). The report must explicitly link functional difficulties to educational impact, not just "poor handwriting" but "poor handwriting limits his ability to record learning across the curriculum, affecting progress in literacy and other subjects despite adequate phonological and comprehension skills." Provision in Section F must be specific and quantifiable. If the report recommends a sloped writing board and pencil grip intervention, the EHCP must specify these rather than vague provision like "specialist teaching support." Challenge unclear provision wording from the local authority from the outset.
Annual reviews. OT reports older than 18 to 24 months may be challenged by the local authority as out of date, particularly if the child is in the EHCP system. Plan for updated OT evidence every two years if provision is linked to specific OT recommendations. This is especially important if the child has DCD or persistent fine motor difficulty, as evidence needs to be current.
JCQ access arrangements. Extra time for exams or use of a word processor requires functional evidence. Joint Council for Qualifications (JCQ) regulations require that access arrangements be "substantial and long-standing."² OT evidence describing the functional impact, for example, "produces significantly less written output than peers in timed tasks; handwriting deteriorates markedly under time pressure; uses pencil with high pressure and excessive grip tension, limiting speed", supports the case. Importantly, JCQ also requires that assessment was completed by a suitably qualified professional. Make sure the OT's qualifications are clear in the report and that the OT is registered with the Health and Care Professions Council (HCPC). Coordinate this evidence with the Educational Psychologist, as JCQ requires EP sign-off for most access arrangements.
SEND tribunal. If school OT evidence and parent-commissioned independent OT evidence diverge at tribunal, the quality and specificity of the report matters. OT reports must reflect the OT's professional duty to the child, not to the school or parent commissioning the report, but to the child's best interests. Reports that are vague or appear to minimise or exaggerate difficulty are vulnerable at tribunal. Commission OT assessment from qualified, HCPC-registered practitioners who understand the tribunal context and can articulate their reasoning clearly.
Whole-School Approaches and Staff Training
OT input need not be limited to individual assessment. Many OT practitioners offer whole-school consultation and training on sensory processing, Developmental Coordination Disorder, and task adaptation applicable across the school.
Sensory circuits are an example of whole-school intervention. A brief (10 to 15 minute) morning sequence of alerting, organising, and calming movement, typically delivered before learning begins, can reduce sensory-driven behaviour and improve readiness for learning across the cohort. The OT designs the circuit; teaching assistants run it daily. Emerging UK evidence suggests benefit for children with sensory processing difficulty and those with ADHD-type presentation, though the research base is still developing.
Universal Design for Learning (UDL) principles reflect OT thinking about task adaptation and sensory environment. Designing learning experiences that offer multiple means of engagement, representation, and expression from the outset reduces the need for individualised adjustments. An OT might consult with your school on seating, lighting, noise levels, writing tools, access to movement breaks, and task structure, changes that benefit learners with motor or sensory difficulty but also benefit all pupils. This preventative approach reduces the number of children who need individual assessment.
References
1.Children and Families Act 2014. HM Government.
2.Special Educational Needs and Disability Regulations 2014. HM Government.
3.SEND Code of Practice: 0 to 25 years (2015). Department for Education and Department of Health.
4.Equality Act 2010. HM Government.
5.Royal College of Occupational Therapists (2017). Occupational Therapy for Children and Young People in Educational Settings. RCOT.
6.Royal College of Occupational Therapists (2019). Professional Standards for Occupational Therapy Practice, Conduct and Ethics. RCOT.
7.Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2007). Movement Assessment Battery for Children-2. Pearson Assessment.
8.Blank, R., Barnett, A. L., Cairney, J., Green, D., Kirby, A., Polatajko, H., & Vinçon, S. (2019). International clinical practice recommendations on the definition, identification and intervention for developmental coordination disorder. Developmental Medicine and Child Neurology, 61(3), 242–285.
9.Joint Council for Qualifications (2024). Access Arrangements and Reasonable Adjustments. JCQ.
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