New Grad Pediatric Occupational Therapist: A Job Settings Guide

Here are some pros and cons to the most common settings where pediatric OTs are employed.

Outpatient Clinic Setting

Outpatient pediatric occupational therapists usually work in independent clinics. These clinics can vary based on who owns them (OTs, ABA therapists, SLPs, or even for profit companies) and who the payor source is (Medicaid, insurance, or private pay)

In outpatient clinics the OT sessions are usually play based. Once or twice a week for 30-60 minutes for 6 months to a year or longer.

The caseload can also be very varied. From infants to teenagers. Also can include feeding therapy, to sensory integration and kids with severe motor challenges.

Pro of the outpatient clinic setting

• 1:1 sessions
• fun
• lots of progress
• build relationships with the children and families.

Cons

• cancellations
• hard to explain what you are doing is not just play expectably for new grads
• heavy parent involvement
• understanding insurance reimbursement
• Often evening hours because of school age caseload
• Long evaluation write ups
• Very physical
• specialized knowledge needed such as feeding and sensory integration.

Early Intervention

Early Intervention (EI) is a specialized area of pediatric occupational therapy where therapists work with infants and toddlers, typically aged 0 to 3 years. This setting is crucial for addressing developmental delays early in a child’s life, allowing for significant impact during these formative years.

Since early intervention therapy happens in a child's natural environment, you may see a child in their home, daycare, or anywhere a child and family go. I loved being an early intervention therapist!

But since early intervention is so parent heavy, this is not a setting I usually recommend for new grads. In my state it is required that you have at least a year of experience working with young children, and I think that is wise. At times a new grad can thrive in this environment, however it can be lonely and isolating, making it hard to grow professionally.

Pros

• Flexible Scheduling: Therapists can often negotiate their hours, making it easier to balance personal and professional life.
• Rewarding Experience: Directly observing progress and knowing the impact on the child's early development can be incredibly fulfilling.

Cons

• Travel Demands: Extensive driving between homes is common, and mileage reimbursement varies, which can be a significant drawback.
• Variable Income: Many EI therapists work as 1099 employees or on an hourly basis, leading to fluctuations in income.
• Lack of Benefits: Contract positions may not offer benefits like health insurance, a considerable factor to consider in career planning.
• Cancellations: Last-minute session cancellations by families can disrupt the schedule and affect income.
• Heavy Parent involvement: while this can be great for experienced therapists, I find it is difficult for new grads.
• Independent work: with no or little contact with colleagues it can be hard to have a mentor, support and can be lonely.

School Setting

Working in the school setting as a pediatric occupational therapist places you directly in the educational environment where children spend a significant portion of their day. In this setting, OTs primarily focus on assisting students to access their educational curriculum and participate fully in school activities.

In schools, the therapy follows an educational model rather than a medical one. Many times OTs get pigeon holed into helping children with the skills needed for handwriting and sensory processing for attending in the classroom.

School-based occupational therapists enjoy a schedule that mirrors the teachers', with work during school hours and breaks during school holidays, including summer vacation. This alignment offers an excellent work-life balance, making it an attractive setting for many therapists.

Pros

• Aligned with Teacher Salaries and Calendar: Often, school-based OTs have salary and benefits packages similar to educators, including retirement plans and health insurance.
• Regular Work Hours: Predominantly, there's no need for weekend or evening sessions, allowing for a predictable routine.
• Collaborative Work Culture: Working closely with teachers, special educators, and other school staff fosters a team-based approach to student care.
• Job Security: Many school positions are secure, long-term roles within the public or private educational systems.

Cons for the new grad pediatric occupational therapist

• Educational Constraints: The focus is more on academic-related outcomes than on broad developmental goals, which might limit the scope of practice.
• Large Caseloads: Depending on the school or district, OTs might have large caseloads, which can be challenging to manage.
• Bureaucracy and Documentation: School OTs often face extensive documentation requirements and must navigate educational laws and policies.
• Multiple schools
• Not always a school employee, can be contract and not paid for cancellations (but there are less cancellations in the schools)
• Little parent involement
• Possibility seeing children in groups that are not always appropriate for their goals.

While the salary might be lower compared to some clinical settings, the benefits, job stability, and alignment with the academic calendar often compensate for this. School OTs can make a profound difference in children's lives, helping them overcome barriers to successful learning and participation in school life.

I enjoyed my time as a school based therapist, but I did feel I saw less progress with the children I worked with than in other settings.

Choosing the best pediatric OT setting for you has many factors. One of which is where you were able to be luck enough to complete your fieldwork. I would HIGHLY recommend you try and stick to the same or similar pediatric setting.

As I mentioned early my peds fieldwork was on a child psych unit and having my first job in a specialized special education school was a HUGE learning curve. If you do start in a different setting please seek out mentorship such as my program The Efficient Pediatric OT Roadmap.