of California
Brown Bag Lunch Series
A statewide training series on health and policy
topics affecting children and youth with special
health care needs. This series is geared towards
diverse stakeholders including families, youth,
professionals, parent-to-parent staff and advocates.
The voice of families
the vision of quality health care
the future for children and youth with special health care needs
Family Voices of California is locally based,
nationally connected
A statewide collaborative of locally-based
parent run centers working to ensure quality
health care for children and youth with
special health care needs. As the State
Affiliate of National Family Voices, we are
California’s federally funded “Family-toFamily-Health-Information-Center” providing
statewide support to families of CYSHCN. For
more info, visit www.familyvoicesofca.org
Family Voices of California (FVCA) strives to present
families and professionals with a wide range of views
and options in its materials and trainings.
The materials and trainings are not necessarily
comprehensive, are not meant to be exhaustive, nor
are they an endorsement of the author and/or
presenter.
If you would like to offer feedback or if you know of
additional resources, speakers and/or materials that
may be helpful, please do contact us at
www.familyvoicesofca.org
Access them anytime.
To see one of our archived webinars, or join an
upcoming one, visit our website.
All PowerPoints & materials posted online
following the webinar.
www.familyvoicesofca.org
Margaret Mary Finn
mfinn@familyvoicesofca.org
California Children’s Services
Educationally Related Occupational
and Physical Therapy Services
Family Voices of California Webinar
October 3, 2012
Carol Cohen, Parent Health Liaison, FRN Alameda
Pat Louie, Assistant Chief Therapist, CCS Alameda
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How can my child qualify for
Occupational or Physical Therapy
The question to ask is NOT
“Does the student qualify
for OT or PT in
school?”...but rather… “Is
an occupational therapist’s
or physical therapist’s skills
and expertise a necessary
component of the
student’s educational
program in order for
him/her to achieve his/her
IEP goals?”
5
Related Services
• In order to receive any related service including physical
and/or occupational therapy in the school setting a child
must be found eligible for Special Education in any of the
14 categories
• When a child is found eligible for Special Education
services, the IEP team will determine what additional
services a child will need. Related services should enable a
child to:
– Make meaningful progress towards meeting their annual goals
– Be educated in the least restrictive environment
– Make progress in the general education curriculum
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Rules of the IEP Process
Educational Benefit
Placement
Goals
Assessment and
Eligibility determination
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Assessments
• Establish a child’s need and
must be as complete and
accurate as possible.
• Should be completed in all
areas of a child’s suspected
disability.
• Documentation of all the
child’s needs is absolutely
essential.
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Goals
Goals establish reasonable expectations of how
much your child will progress. Think in terms of
where you want your child to be at the end of the
year.
• If goals are set too low, services can be set very low.
• If goals are set too high, a child may not have success
• If goals are reasonable, yet a child is NOT making
adequate progress, you have a reason to request
additional services be put in place
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Placement
• Description of all services and supports that
are needed as well as WHERE a child will
receive these services. Placement should
include everything that is necessary for a child
to have a reasonable chance of achieving his
or her IEP goals
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How are OT and PT defined by IDEA?
Occupational Therapy services must be provided by
a qualified occupational therapist and include:
• Improving, developing or restoring functions impaired or lost
through illness, injury or deprivation
• Improving ability to perform tasks for independent functioning
when functions are impaired or lost
• Preventing through early intervention initial or further
impairment or loss of function
Physical Therapy means services provided by a
qualified physical therapist
Note: this is all that IDEA says about educational PT
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What is Educationally Related OT?
According to the American Occupational Therapy Association (AOTA), OT is
concerned with a person’s ability to participate in daily life activities or
“occupations.” In the school setting, an OT:
• Uses their expertise to help children to be prepared for and perform
learning and school related activities and to fulfill their role as
students.
• Supports academic and non-academic outcomes, including social
skills, math, reading, writing, recess, sports participation, self-help
skills, and prevocational/vocational participation for children and
students with disabilities, 3-22 years of age.
• Is skilled in facilitating access to curricular and extra-curricular
activities for all students.
• Trains parents, staff members, and caregivers in educating students
with diverse learning needs
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The School Occupational Therapist works with:
• Students to improve their performance in a variety of learning
•
•
•
•
environments (e.g., playgrounds, classrooms, cafeterias,
bathrooms)
Parents to help them support their children’s learning and
participation in school
Educators and other school support staff to plan and develop
activities and environments that include all students
Para-educators to support child success and promote child safety
within the school environment (e.g., physical and behavioral
assistance needs)
Administrators to provide training for student, staff and parents, as
well as to recommend equipment for schools and ways to modify
existing classrooms, buildings and curriculum
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What is Educationally Related PT?
•
•
•
According to the American Physical Therapy Association
(APTA), physical therapy services support the educational
team and help the student perform successfully in school.
Physical therapy addresses the ability to move parts of the
body, assume and maintain postures, and organize
movement and functional gross motor skills.
The PT works with students to build strength and
endurance for functional mobility (e.g., climbing stairs,
opening doors, mobility in and about the school, carrying
materials, accessing the playground, participating in field
trips and work experiences).
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OT and PT are Designated Instructional
Services (DIS) under IDEA
• DIS shall be available when the instruction and services are
necessary for the child to benefit educationally from his or her
instructional program.
• To receive any DIS a child must be identified as having a
disability under IDEA.
• California Ed Code, Section 56031 defines DIS as special
education. In California, therefore, a child who has been
determined eligible for special education may have an IEP that
contains DIS as the only special education service provided, if an
assessment demonstrates such therapy is needed.
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PT and OT under Section 504
A child who has a disability as defined under Section 504, but who
does not meet eligibility criteria for an educationally disabling
condition under IDEA may still be eligible to receive federally
defined related services pursuant to a 504 plan
An OT or PT may be involved in providing accommodations to the
educational environment and/or curriculum. Such accommodations
may include:
•
•
•
•
•
Accessibility to classrooms, schools, rest rooms and transportation
Provision of simple adaptive devices such as pencil grips, specialized
tools and lap trays
Adaptations for written communication
Positioning or meeting specialized health care needs
modifications of assignments and curriculum
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Indicators for Educationally Related
Occupational Therapy Referral
•
•
•
•
•
•
•
•
Difficulty in learning new motor tasks
Poor organization and sequencing of tasks
Poor hand use (including writing and tool use)
Difficulty in accomplishing tasks without the use of adaptive
equipment, environmental modifications or assistive technology
Unusual or limited play patterns
Deficits in adaptive self-help or feeding skills in the educational
setting
Poor attention to tasks
Notable overreaction or underreaction to textures, touch or
movement
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Indicators for Educationally Related
Physical Therapy Referral
•
•
•
•
•
•
•
Delayed Gross Motor skills
Difficulty in learning new motor tasks
Unusual walking or movement patterns
Difficulty in moving or moving unsafely in the school environment
Difficulty in maintaining an appropriate sitting posture
Poor balance or falling frequently
Difficulty in accomplishing tasks without the use of adaptive
equipment, environmental modifications or assistive technology
• Postural or orthopedic abnormalities
• Reduced endurance or fatigue
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Requesting an Evaluation
• A parent should request in writing that they would like
their child evaluated for Occupational and/or Physical
therapy. In the letter, request “prior written notice if the
district plans on denying the request.”
• A district may not require an Adaptive Physical Education
(APE) assessment or services before referring for an
assessment by an OT or PT. A child does not need “to fail”
in APE before an evaluation is offered. They are different
services.
• A district cannot require that the child be first evaluated by
California Children’s Services prior to a district evaluation.
• Only a Licensed OT or PT can assess a child for services, or
determine educational need.
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Levels of Service
• Direct services (either group or individual)
• Consultation to staff and/or parent
• In some cases services may be provided by a special
education teacher (especially if they are OI
credentialed) or by the adapted physical education
(APE) specialist if it determined the child does not
require the expertise of a physical or occupational
therapist to to receive educational benefit
• On the IEP, therapy services should be specified for
type (individual or group), level, duration and
frequency, not “as needed.”
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Adapted Physical Education
• Credentialed APE specialists
have training in basic body
mechanics, kinesiology and
other medically oriented
subjects that assist in
teaching the basic concepts
of movement, speed, force,
rhythm, complex motor
skills and sequences, play
and leisure skills, and social
and group interaction skills.
APE can augment OT or PT
services
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Orthopedically Impaired Credential
It is recommended that children with severe orthopedic
impairments have a teacher with an OI credential as
their case manager. OI teachers have expertise in
collaborating with medical professionals and in
adapting equipment. They are trained in augmentative
communication and assistive technology. They are also
able to provide APE, positioning and seating
adjustments, and sensory integration activities.
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California Children’s Services (CCS)
• CCS provides medically necessary PT and OT through the Medical
Therapy Program (MTP). Therapy must be prescribed by a CCS
approved physician. Active therapy services and prescriptions are
reviewed every 6 months.
• Eligibility for CCS services is limited to children ages 0-21 with
specific neuromuscular, musculoskeletal or muscular diseases such
as cerebral palsy or muscular dystrophy. Please visit the CMS
website for more information.
http://www.dhcs.ca.gov/services/ccs/Pages/MTP.aspx
• Children under three years of age may be served, if they are at risk
and show signs that they may have an eligible condition, but don’t
yet have a clear diagnosis. A medically eligible condition must be
diagnosed by age three in order to continue to receive services.
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California Children’s Services (CCS)
• The IEP team determines
where to record CCS
therapy services.
• Frequency and duration of
CCS services should be
recorded on a child’s IEP
• For more information on
recording CCS therapy on
the IEP, see this publication:
www.disabilityrightsca.org/
pubs/512401.pdf
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Can a child receive therapy from CCS
and the school district concurrently?
• School district therapy must be educationally
necessary and CCS therapy must be medically
necessary, so it is possible to receive services
from both.
• School therapy services can not duplicate or
conflict with the CCS therapy plan. Goals and
objectives from the CCS and school district
therapists must be different.
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For example:
• If a CCS Occupational Therapist is working on selffeeding and dressing, and the school district OT is
working on keyboarding and handwriting skills needed
to complete school work, this is not a duplication.
• If the CCS Physical Therapist is working on balancing on
one leg and lifting the opposite foot to step over a
threshold, and a school district PT is working on
balancing on one leg and lifting the other to kick a ball,
this is a duplication of services as both therapists are
working on the same muscle groups and movements.
• Please visit the CMS website site earlier to view CCS
Numbered Letter 11-1600.
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Other options for therapy
Request a physical or occupational therapy
evaluation referral from your child’s pediatrician. If
your child is not eligible for CCS, but still has a
medical need for therapy your insurance may agree
to provide this service. If denied the evaluation or
recommended therapy, you may need to file for an
independent medical review through Department
of Managed Care or Department of Insurance,
depending on your medical coverage.
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Medi-Cal
• For children with Medi-Cal,
therapy services may be
covered through EPSDT
(Early Periodic Screening,
Diagnosis and Treatment).
• EPSDT provides medically
necessary and ameliorative
supplementary medical
services
• Visit this site for more
information:
www.dhcs.ca.gov/services/
Pages/EPSDT.aspx
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Beyond Therapy
There are many opportunities for
children to develop physical skills
outside of a medical or educational
setting.
Your child can participate in a special
needs programs like E-Soccer,
Challenger Little League, or
wheelchair basketball. Also look for
inclusive programs offered by local
recreation departments or at private
gymnastics, swimming, yoga or
martial arts programs.
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• Fine motor skills can be
worked on in arts or
music programs. Many
programs are open to all
children if requested, and
offer your child a chance
to gain appropriate social
skills with typically
developing children.
Don’t be afraid to ask if
your child can be
included.
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Therapy doesn’t just
happen with a therapist.
If your child is receiving
therapy, continue
activities at home by
requesting a home
therapy program.
Many exercises can be
completed with low cost
items or things you
might already own.
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Sources and Resources
• Guidelines for Occupational Therapy and Physical
Therapy in California Public Schools CDE, 1996
• A Composite of Laws, www.cde.ca.gov
• Special Education Rights and Responsibilities, CASE
and DRC www.disabilityrightsca.org
• Family Resource Network Alameda, Recreation list
available by download at www.frnoakland.org
• Get help with insurance from Office of the Patient
Advocate (916) 324-6407 www.opa.ca.gov
• Medi-Cal Managed Care Ombudsman (888) 4528609
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