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What occupational therapy actually does
Occupational therapy in a school context is rarely about a single difficulty. The therapist looks at the child as a whole and at the demands of the school day, then targets the specific skills that block participation. For a six year old, this may be a handwriting grip and the ability to sit still on a carpet. For a twelve year old, it may be note taking speed, the management of equipment between lessons, or self regulation strategies for an overloaded sensory environment. For a sixteen year old, OT often turns into executive function coaching, supporting the planning and time management that A Level or IB Diploma study requires.
The therapist's value to the school is the translation. A clinical recommendation becomes a classroom adaptation: a slope board on the desk, a wobble cushion on the chair, a different pen, a movement break before maths, a quiet corner for the end of lunch. Teachers and SENCos can implement these adaptations once they understand them; the OT is the bridge between the diagnosis and the lesson plan. For wider context, our SEN support at international schools piece covers the broader inclusion landscape.
The three school OT models
International schools sit in one of three OT models. The first is the in house model. The school employs a paediatric OT directly, usually part time, and sessions sit inside the school day with the cost included in fees. This is the strongest model and is most common at well funded British, American and IB campuses in Tier 1 cities.
The second is the embedded clinic model. The school does not employ an OT directly but partners with a clinic which provides a therapist on site for one or two days a week. Sessions are billed separately to the family, sometimes through the clinic's insurance arrangements, sometimes privately. This model is common in Singapore, Hong Kong and the larger Dubai schools.
The third is the referral model. The school identifies the need and refers the family to external providers, who then deliver therapy outside school hours. The school accommodates by sharing reports and implementing recommended adaptations, but the logistics, scheduling and cost sit with the family. Most smaller international schools and many European campuses sit in this model.
Need a school with strong OT support?
Send the specifics of your child's profile and your destination city to the Get Help form. We will return a shortlist of schools with verified in house or embedded OT, an indication of fee structures, and a steer on which campuses can take a new referral this academic year. There is no charge for this service.
The questions to ask in admissions
Generic questions get marketing answers. Specific questions get specific answers.
Which OT model does the school operate? A confident school answers in one sentence with the model and the named therapist or clinic. A weaker school says "we have OT support available" without further detail.
If OT sits during the school day, which lesson does my child miss, and how often? Schools that have thought this through rotate the missed lesson; schools that have not pull from the same subject every week, which creates a learning gap of its own.
What recent OT recommendations has the school implemented for similar children, and how were they reviewed? Strong schools cite specific examples; weaker schools refer in generalities. For the broader question set, our questions to ask before choosing a school piece complements the items above.
How does the OT integrate with the classroom teacher and the SENCo? Look for evidence of a written handover after each session, joint planning meetings, and named contact points. The best signal is that the form tutor knows what the OT is working on without needing to look it up.
Working with external OTs
If the school operates a referral model, choose the external OT before you sign the school offer wherever possible. Continuity matters more than the prestige of the clinic; a child does best with the same therapist for at least one full academic year, with quarterly reviews. Look for therapists with paediatric specialisation and experience of the curriculum your child is sitting; British and IB curricula put different demands on handwriting and note taking than the American system.
Insist on a written communication channel between the OT and the school. The single most preventable failure point we see is an external OT and a SENCo who do not know each other. A monthly email summary, copied to the family, costs little and avoids large problems. Read our piece on IEP and 504 international school equivalents for the documentation that helps anchor that communication across systems.
Cost and insurance
Expect to pay GBP 90 to 160 per session in London, Singapore, Hong Kong and Dubai, with sessions usually 45 to 60 minutes. Geneva and Zurich sit at the upper end of this range, occasionally higher. Most major paediatric OTs see children once a week during term time; some clinical recommendations are intensive and require two sessions per week for a defined block.
Insurance coverage is uneven. Comprehensive corporate medical schemes often cover paediatric OT in full or with a co payment, but routine outpatient OT can fall outside many family plans. Read the policy schedule carefully, and ask the OT clinic for their documentation requirements before you commit. The strongest clinics handle insurance billing in house; smaller practices ask the family to manage reimbursement.
Transitions and continuity of care
International families move. The most disruptive aspect of an OT plan is the transition between cities; the clinical recommendations transfer but the relationship does not. Plan the handover deliberately. Ask the current OT for a written summary of the past twelve months and the goals for the next six. Identify the new city's OT before the move and book an initial appointment for week two of the new term, not week ten when the gap is already painful. Our relocate hub includes the wider transition framework that this slots into.
FAQ
Some do. Larger British and IB schools in Tier 1 cities often employ a part time OT or contract one through a clinic. Smaller campuses tend to refer to external providers and host the sessions in school. Always ask how the OT is funded and whether sessions sit inside or outside the timetable.
Expect GBP 90 to 160 per session in London, Singapore, Hong Kong and Dubai. Insurance frequently covers part of the cost if the family is on a comprehensive corporate medical scheme. Waitlists for the strongest paediatric OTs run three to eight weeks at the start of an academic year.
It depends on the school's policy. Strong inclusion programmes treat OT as part of the school day, sometimes pulling a child out of one lesson per week. Other schools require OT to happen after school or on weekends, which adds time pressure on the family.