Craven County Schools’ Occupational Therapy Plan of Care and Contact Notes
Confidential
Student:
School:
OT frequency/length:
DOB:
IEP Dates:
Location of OT services:
PLAN OF CARE
STUDENT PARTICIPATION FACTORS TO BE TREATED INCLUDE: (mark all that apply)
Personal Care (feeding, toileting, dressing, hygiene, managing personal belongings, personal organization, mobility)
Student role/Interaction Skills (following classroom/specials/school/bus/cafeteria protocols & routines, safety awareness, respecting the
space/time/materials of others, requesting help, making needs/wishes known, social awareness, building/maintaining relationships)
Learning academics/Process skills (following demonstrations, copying models, carrying out verbal directions, attending to instruction, using
classroom tools, managing materials, completing assignments)
Play (turn-taking, imaginative play, sharing materials, exploring new play ideas/opportunities)
Community Integration/Work (fieldtrips, school-related vocational training)
Graphic communication (handwriting, keyboarding, drawing, coloring, art)
COMMON CORE/ESSENTIAL STANDARDS TO BE ADDRESSED:
SUBJECT AREA
STANDARD
Math-Traditional
STUDENT PERFROMANCE COMPONENTS TO BE TREATED INCLUDE:
Mental Functions:
cognition
attention
self esteem
level of arousal
motivation
impulse control
Sensory Functions and Pain:
seeing/related functions
smell
hearing functions
proprioceptive functions
Neuromuscular and Movement Related Functions:
ROM
joint stability
endurance
reflexes
integration
crossing midline
fine and gross motor control
radial-ulnar separation
in-hand manipulation skills
(mark all that apply)
memory
sleep
perception
coping and behavioral regulation
sequencing complex movements
thought (recognition, categorization,
generalization)
vestibular
touch functions
taste
pain
temperature and pressure
strength
eye-hand coordination
ocular control
bilateral
tone
grading and control of movements
maturity of grasp
POSSIBLE INTERVENTION ACTIVITIES:
GOALS, FREQUENCY, DURATION, LOCATION – found in IEP
SKILLED INTERVENTION APPROACHES: (check all that apply)
Create/Promote (e.g., health promotion)
Modify/Adapt (e.g., environmental modification)
Establish/Restore (e.g., skill acquisition or remediation)
Prevent (e.g., early intervening support; avoiding secondary
complications)
SKILLED INTERVENTION TYPES: (check all that apply)
ONE-ON-ONE INTERACTION
GROUP
WHOLE CLASS
PROGRAM/ROUTINE DEVELOPMENT
CONSULTATION WITH TEAM MEMBERS (e.g., problem solving)
EDUCATION OF TEAM MEMBERS (e.g., training)
ENVIRONMENTAL ADAPTATION (e.g., assistive technology)
Craven County Schools’ Occupational Therapy Plan of Care and Contact Notes
Confidential
Student:
School:
OT frequency/length:
DOB:
IEP Dates:
Location of OT services:
SKILLED INTERVENTIONS: (mark all that apply)
Occupation-based interventions (training embedded in actual activity e.g., personal care, using classroom tools)
Activities of daily living
Classroom/playground/hallway based activities
Task analysis and modification
Purposeful activities (individual activities/components of activity that develop skills)
Developmental approach
Therapeutic activities to improve functional performance
Organizational compensatory strategies
Multimodality approach
Social Skill training
Joint attention training
Preparatory methods:
Therapeutic exercise
Range of motion exercises
Neuromuscular reeducation of balance, movement and posture
Fine motor exercises
Eye hand coordination activities/visual motor integration techniques
Activities to improve motor memory
Functional integrative approach
Sensory activities
Sensory integration techniques
Spatial perceptual activities
Visual perceptual training
Visual perception exercises/activities
Visual memory activities
Splinting/orthotics
Assistive technology services
Treatment of oral function/oral motor techniques
DISCHARGE PLAN:
The IEP team will consider data for the student to be exited or Plan of Care will be modified in accordance with student’s needs based on one or
more of the following events:
1) Goals are achieved
2) OT is no longer required for the student to benefit from special education program
3) Parent request
4) Child has achieved maximum expected level of function at this time
TEAM DISCUSSION ON SUGGESTIONS FOR PARENT and TEACHERS:
REFERRAL (e.g. community programs/resources, other disciplines):
This plan was created by:
on:
(date)
Definitions of “Skilled Intervention” Terms:
Therapeutic exercise:

Range of motion exercises: Exercises which maintain or increase passive or active range of motion in a joint (such as the shoulder) to
facilitate function and protect the integrity of the soft tissue around that joint.

Neuromuscular reeducation of balance, movement and posture: The use of exercises, equipment, or manipulation-based therapeutic
modality, to strengthen the communication between muscles and nerves, intended to help a patient recuperate functional activity, after
trauma, cardiovascular accident or inactivity. The individual receiving treatment is encouraged to feel the correct position of joints and to
perceive the direction of movement of the body extremities.

Fine motor exercises: Exercises which develop dexterity and strength in the hands.

Eye hand coordination activities: Activities which necessitate the information received through the eyes to direct (and maintain)
attention, control, guide and direct the hands, in order to execute the task.

Visual motor integration techniques: Techniques designed to assist an individual to integrate a visual target with an accurate hand
movement.

Activities to improve motor memory: Activities which result in movement patterns becoming automatic to increase independence and
efficiency in functional motor skills.

Functional integrative approach: Integrates neurologic and orthopedic science (motor control, NDT, range of motion, strength training) to
facilitate a functional outcome.
Craven County Schools’ Occupational Therapy Plan of Care and Contact Notes
Confidential
Student:
School:
OT frequency/length:
DOB:
IEP Dates:
Location of OT services:
Visual Perceptual Training:

Visual perception exercises/activities: Exercises/Activities which assist the individual to accurately perceive and interpret what the
eyes see. These activities require the individual take information in through the eyes, interpret it, and organize it for use. Activities
may address depth perception, directionality, form constancy, position in space, spatial awareness (distance between person and
objects), visual figure-ground, vertical/horizontal/diagonal perception and plane integration.

Visual recognition memory activities: Activities which facilitate the individual’s ability to actively hold visual information in the mind
needed to do a complex task such as reading, reasoning, comprehending, writing and learning. The cognitive processes involved
include the executive and attention control of short term memory.

Visual sequencing activities: Activities which help an individual overcome, or compensate for, their difficulty seeing and copying
objects in a sequential order.
Sensory Activities:

Sensory integration techniques: A neurological approach to assist an individual to organize and respond to sensory information
more effectively, adapt to environmental demands, and/or maintain an efficient level of arousal or attention.

Spatial perceptual activities: Activities to increase an individual’s awareness of their body schema and directionality in space (body
image and where it is in relation to the objects around them).
Purposeful activities:

Developmental approach: Teaching/facilitating the developmental progression of a motor skill in order to ultimately achieve success
at a more difficult motor task.

Therapeutic activities to improve functional performance: Utilizes research-based activities/programs/techniques (such as
Handwriting without Tears, task analysis, visual cues) to facilitate a functional outcome.

Therapeutic listening exercises: Activities which assist the individual to accurately perceive and interpret what the ears hear. These
activities require the individual take information in through the ears, interpret it, and organize it for use

Organizational compensatory strategies: Teaching/implementing organizational strategies to assist the individual to become
functionally independent at a task/role.

Multimodality approach: Using alternative media/modalities to teach a task to an individual who has different/unique learning
styles.

Social Skill training: A form of behavior therapy (the premise of which is that maladjusted behavior can be modified by learning new,
more appropriate behaviors to replace them) to help people who have difficulty relating to other people by teaching them the
verbal and non verbal behaviors involved in social interactions.

Joint attention training: A technique whereby joint attention behaviors are taught to individuals with autism using a behavior
modification procedure, to facilitate more appropriate functional social/play skills in that individual.
Occupation based interventions:

Activity of daily living: Teaching new skills or adapting the task/environment to facilitating functional independence in routine
activities that people do everyday (eating, bathing, dressing, toileting, transferring, hygiene).

Classroom based activity: Teaching new skills or adapting the task/environment to facilitate functional independence in a classroom
activity that peers are doing (writing, drawing, coloring, cutting, gluing, group work, projects, playing, etc).

Task analysis and modification: The analysis and modification of a multi-step or complex task to break it down into more achievable
steps, so as to facilitate functional independence.
Assistive technology services: Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive
technology device. Assistive technology device means any item, piece of equipment, or product system, whether acquired commercially off the
shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability.
Craven County Schools’ Occupational Therapy Plan of Care and Contact Notes
Confidential
Student:
School:
OT frequency/length:
Date:
Session:
of
for this IEP year.
Today we worked on these benchmarks/objectives:
(copy and paste here, insert checkmark boxes)
Skilled Interventions:
DOB:
IEP Dates:
Location of OT services:
Service Delivery (Time/Contact):
Setting(s):
Student response/data to therapist intervention:
Domain(s) Addressed:
Methods/Approach:
Strategies/tools used:
Comment/Plan:
Treating Therapist: