Experts at Hand: When is an occupational therapist also a SEND expert?

By Jacqui Brett, LLB (Law), BSc (OT), PG Cert Prof Dev (OT), PG Cert (SI), MRCOT, HCPC

Contents

The Government’s new Experts at Hand programme sounds like exactly what families have been waiting for: specialist help in schools, earlier, before children hit crisis point. But there’s a hard truth we can’t gloss over: we don’t just lack the numbers to deliver this vision;

we lack the depth of expertise it actually requires. Thousands of children are already stuck on waiting lists, therapy vacancies remain unfilled, and demand keeps rising. A qualified professional is not automatically a specialist, and children will often require more than generic advice or entry‑level interventions. If Experts at Hand is going to work, it must deliver what its name promises: access to experts, not simply professionals with the right job title.

Jacqui Brett is a registered highly specialist occupational therapist, neurodevelopmental diagnostician & sensory integration practitioner. She writes here for SNJ about her concerns

Guest post by Jacqui Brett, LLB (Law), BSc (OT), PG Cert Prof Dev (OT), PG Cert (SI), MRCOT, HCPC

The Government’s new Experts at Hand programme has been broadly, but cautiously, welcomed across the SEND sector. The vision is compelling: bringing specialist expertise into mainstream schools earlier, reducing unnecessary escalation and helping schools meet needs before children reach crisis point.

As a specialist occupational therapist working with autistic children, young people with ADHD, dyspraxia, dyslexia, and sensory differences, I support that vision. But do we have the staffing capacity to meet the challenge? And when we promise schools “Experts at Hand”, do we actually mean experts? Or do we simply mean professionals who happen to hold the right qualifications?

The right idea

The occupational therapy profession has long argued that support should be needs-led rather than diagnosis-led. In her recent article Breaking Down the Schools White Paper and What Comes Next, Dr Sally Payne described the reforms as “a direction we strongly welcome” and highlighted the importance of “early support, inclusive environments and joined-up services”.

The Royal College’s of Occupational Therapists (RCOT) submission to the Independent Government Review on Mental Health, ADHD and Autism reinforced this position. It stated that support should be based on “functional needs” rather than diagnostic status. It highlights that diagnosis too often becomes “the gatekeeper for support”. We know that environmental adaptation, sensory-informed practice and participation-focused intervention can significantly improve outcomes long before a diagnostic label arrives.

But I must stress that a diagnosis is still important. I see this daily in my role as a neurodevelopmental diagnostician; the right label provides self-understanding, increases self-compassion and underpins self-advocacy. It provides legal protections, contextual understanding and a lens to view your differences. We cannot lose sight of the why: why is this tricky, why is this happening? Because blurred vision problems could be caused by a scratched cornea, high blood sugar or a brain tumour, and the intervention needs to match the difficulty.

Are the specialists at hand sufficiently to match the need?

The challenges here are numerous. In June 2025, over 1.7 million pupils in England were identified as having SEND. The number of pupils with Education, Health and Care Plans (EHCPs) has more than doubled over the last decade, which shows our understanding has increased. We are catching up, research is evolving, girls and marginalised groups are less likely to be missed, and we are recognising a wider range of difficulties. But I’m left wondering if we somehow have a secret stockpile of therapists simply waiting in the wings to take up these roles?

In this RCOT workforce strategy document, 67% of OT’s saw demand for services increase over the past year, with “complexity of needs” the most common driver.

The charity Sense noted “Ambition must be matched by delivery” and there is currently “no clear workforce plan to recruit and train the additional professionals needed to make these reforms successful”. As of April 2025, there were 47,332 registered OT’s, but demand for services is estimated to have risen by 67 %, vacancies remain unfilled, and around 8% of OT’s are expected to leave the profession.

Figures show that in 2024, 19,070 children and young people were waiting to see an occupational therapist in the community. The current delays in accessing occupational therapy for children and young people attending mainstream schools have been linked to emotional distress, reduced participation in learning activities, delayed development of essential skills such as handwriting and self-care and increased pressure on teachers and other school staff. There is also a higher overall absence rate for children with Special Educational Needs and Disabilities (SEND) in England. In autumn 2025/26, this was 12.87% for pupils with an EHCP and 9.25% for pupils receiving SEN support, compared with 5.39% for pupils with no identified SEND.

Expertise matters

There is the assumption that all occupational therapy input is equal. It isn’t. The Government’s Experts at Hand guidance describes occupational therapists as professionals who provide “functional assessment and analysis”, “environmental adaptation and inclusion”, “early identification and preventative support” and support for sensory processing needs. That sounds like a straightforward checklist, but in reality, those skills require highly developed clinical reasoning.

Understanding why an autistic child is unable to remain in a classroom is not simply about observing behaviour. We come back to the why: Is it sensory overload? Interoceptive processing difficulties? Executive functioning challenges associated with ADHD? Motor planning difficulties linked to dyspraxia? Anxiety? Autistic burnout? A combination of all of the above? We know neurodivergence is often complex, co-occurring, and spans across physical and mental health. So these are not questions that can be answered through a short training course or a newly acquired qualification.

Sensory Integration is a specialist area; one of the greatest misconceptions in education is that sensory support is simple. Too often, sensory processing differences are reduced to sensory circuits, wobble cushions, movement breaks or fidget tools. But sensory integration is a highly specialist area of occupational therapy practice requiring postgraduate training, extensive supervision and advanced clinical reasoning.

The RCOT review identified “sensory assessment and environmental modification” as key preventative interventions and highlighted the importance of sensory-informed approaches across schools and communities. That work cannot be carried out in a cookie cutter fashion. True sensory integration practice involves understanding how sensory processing influences participation, emotional regulation, motor performance, social interaction and learning. Without that expertise, there is a risk that sensory needs become either misunderstood or ignored entirely.

A qualified therapist is not automatically a specialist therapist

This is perhaps the most uncomfortable conversation facing our profession. Newly qualified occupational therapists are talented, motivated and essential to the future workforce. Every specialist was once a newly qualified therapist. But there is a difference between being qualified and being an expert.

The Government guidance itself states that Experts at Hand funding should “primarily support fully qualified professionals” and maintain “a clear emphasis on delivery led by trained professionals”. I would go further, I believe that children with complex neurodevelopmental presentations deserve access to clinicians who possess advanced expertise in autism, ADHD, dyspraxia, dyslexia and sensory skills. That hardworking, chronically overwhelmed families deserve recommendations grounded in specialist assessment rather than generic SEND knowledge. That our underfunded schools deserve advice from practitioners who understand the difference between dysregulation and non-compliance; their teachers can be confident that the expert across the table has the experience to recognise and formulate based on complex presentations. This can’t happen at entry level.

If we get this right

The potential of Experts at Hand is huge. The guidance recognises the value of occupational therapists, and other professionals, their value has been demonstrated through programmes such as Partnerships for Inclusion of Neurodiversity in Schools (PINS), where occupational therapists supported schools through sensory audits, environmental adaptation, regulation strategies and staff training. In early evaluations, this programme demonstrated improvements in school confidence, environmental adaptation and support for neurodivergent pupils when occupational therapists and speech and language therapists worked directly alongside education staff.

That is precisely where occupational therapy can make the greatest difference. Influencing environments where neurodivergent children can genuinely thrive and reducing dependence on services. However, that ambition depends upon one critical factor. Expertise. Autistic, ADHD, Dyspraxic, Dyslexic children and those with sensory differences do not simply need professionals at hand-they need experts at hand.

Consider this, at a time when almost one in five pupils in England is identified as having SEND, the question is no longer whether schools need support. The question is whether the support available reflects the complexity of the needs being presented.

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About the author

Jacqui Brett is a specialist occupational therapist, neurodevelopmental diagnostician & sensory integration practitioner.

She is also neurodivergent and a parent to neurodivergent children. Jacqui works with neurodivergent individuals of all ages.

She is passionate about improving understanding and access to support for sensory processing, mental health and neurodevelopmental conditions.

Useful references

CFE Research & Cordis Bright. (2025, November). Partnerships for Inclusion of Neurodiversity in Schools (PINS): Interim evaluation report. Department for Education.
SNJ article on Experts At Hand: A good idea built on wishful thinking and shaky foundations
SNJ article on Using “Not Quite Experts” at Hand will be the only solution to staff the Government’s big new plan for school support
SNJ’s article featuring PINS
Dhas, B. N., Brown, T., Devers, J., Murrill, R., Devecchi, C., & Sriram, V. (2026). Practice readiness of newly qualified occupational therapists in the United Kingdom: A multi-stakeholder qualitative study. British Journal of Occupational Therapy.
RCOT. (2024). Occupational therapy Workforce Strategy action plan – England. The Royal College of Occupational Therapists.
RCOT. (2026a, January 16). Workforce 2024–25 survey: results now published in BJOT. The Royal College of Occupational Therapists.
RCOT. (2026b). Using sensory integration therapy, sensory-based interventions and sensory approaches with children and young people. In Informed View. Royal College Of Occupational therapists.
RCOT. (2026c, March 4). Breaking down the Schools White Paper and what comes next. The Royal College of Occupational Therapists.
RCOT. (2026d, April 28). Delays accessing occupational therapy support in school are harming children, says Royal College of Occupational Therapists. The Royal College of Occupational Therapists.
RCOT. (2026e, June 5). Experts at Hand delivery guidance published: what it means for occupational therapists. The Royal College of Occupational Therapists.
Registrant snapshot – 1 April 2025. (2025, April 14). The HCPC.
Roberts, J. (2026, May 21). Schools could face more legal disputes, SEND experts warn. Tes Magazine.

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Special Needs Jungle was founded in 2008 as a personal SEN blog by Tania Tirraoro. It is now a multi-author, award-winning site covering special needs, disability, mental health and rare conditions in children & young people birth-25 years.

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