Educationally Related
Therapy Services
Understanding the role of
physical and occupational
therapists in the school
environment
Jackie Davis Templin, MS, OTR/L
What are the venues for
educational services?
• 0-3 year old Early intervention,
administered thru County Mental Health,
family and child focused, home or
preschools
• 3-preK, thru Intermediate Units and School
Districts, focus on preparing child for
educational setting
• K-12, school based, focus on access to
education.
WHY REFER A CHILD TO
RELATED SERVICES?
• The Child must have a problem with an
observable, functional skill that is critical to
his ability to function in the school
environment, and to succeed in the
classroom.
• The child’s functional problem must be due to
clinical findings that are responsive to
therapeutic techniques or intervention.
Avenues for provision of OT and PT
services in Schools
• IDEA (IEPs) – student must also need special
education or speech services (speech can be a
primary service)
• Rehab Act of 73 (Service Agreements) –
student must have “a mental or physical
impairment that limits one or more major life
activities”
• OT and PT are not stand alone providers and
cannot serve students who do not qualify for
special education (IEP) or disability related
acommodations(504)
What is an IEP?
• What does it look like?
• Lawfully binding document with school
district, student and parents
• OT’s contribute to Present Educational
levels, Goals (may or may not be therapy
specific), Specially Designed Instruction,
Levels of Service (for related services).
What is a 504 service agreement
• Agreement between school district and
parents to provide accommodation to a
student with a disability that limits a major
life function
• May include provision of therapy services
• May include modifications to school
environment
How are students referred to OT in
Schools
• Screens (brief look at student functional problems in
context of school environment, usually does not involve
testing). May lead to therapists recommendation for full
eval
• OT Evaluations are lengthier, most costly to School
districts, may involve testing and more complete
assessment of function in school setting,
recommendations. Must have signed PTE.
• Re-evals periodically assess child school function in
areas of concern by teachers, related service provider.
Must have signed PTR.
Therapy Services on a Continuum
• Move from direct to consultative role
• Decrease frequency as need decreases
• Work toward carryover of skills in
absence of therapist
• Success when therapy is no longer
needed.
Occupational Therapy
Child Exhibits Problems that Impact Ability to:
•
•
•
•
•
Write and Draw
Manipulative Tools such as Scissors
Attend to Tasks and Organize Work
due to Sensory Processing Problems
Perform Self-care Skills
Occupational Therapy in the
schools does not:
• Cure disabling conditions
• Teach routine keyboarding and
handwriting curriculums
• Maintain range of motion
• Fabricate splints and orthotics
Educationally based therapy
vs.
medically based therapy
•
•
•
•
Therapy is delivered to students following very specific federal laws.
Therapy is a related service in schools, not a academic discipline
Therapy supports the child in his/her ability to access their education
Physician prescription does not qualify a student for school based
services
• Recommendation of outpatient PT and OT does not qualify a
student for school based therapy
• Medical information from family is an important consideration for the
team in making decisions about IEP’s
The Least Restrictive
Environment
•
•
•
•
Integrate
Communicate
Accommodate
Educational Relevance
Where is the therapy room?
Where is the equipment?
School based therapy is done in
the natural environment
How is integrated therapy
delivered?
In the classroom, lunchroom, hallways, PE
class, art class, field trips, etc., wherever it is
relevant to the student goals during:
•
•
•
•
•
Classroom “centers” with students rotating between tasks
During a writing, cutting, assembly, or cooking activities.
On the playground during recess to facilitate recess skills
In Physical education, art or music class
Moving between special classes in the hallway and
on stairs
• Arrival at school to follow classroom routine with
• clothing, backpack, homework, etc.
How and where OT’s work in the
school building?
• Pull individual student out of the classroom to
another area- most restrictive, least preferred
• Push in classroom to work with individual child in
context of a specific academic period
• Group sessions either in classroom or outside
classroom
• Consultation with team, teachers and parents
during or outside of school hours
• RTII- may vary, within general education
context
•
Qualification: Asking the Right
Questions
?
•
? Can another professional working with the child address the problem
•
? Has the child received the service previously and did they progress
•
? Are the child’s therapy goals observable, functional, and measurable and
directly related to the child’s educational goals.
•
? If the child is not progressing, will the child deteriorate without intervention
•
? What is the appropriate combination of direct and consultative services
•
? Are the issues related to the child’s therapy a priority in relation to other
issues
•
? Does the child’s functional deficit reflect a significant delay relative to his or
her peers.
Will the child’s condition respond to therapeutic intervention
Use of Therapy Test Scores
• Functional skills and ability to access
the educational curriculum drive the
decision of need for therapy, test
scores generally do not
• Test scores help to identify underlying
issues and some may help to document
progress
Considerations for Discharge from
therapy
• Student is able to access their educational environment,
with or with out adaptations or modifications
• Interventions for the student do not require therapeutic
expertise
• Student needs can be addressed by school staff
• Provision of therapy is not expected to result in progress
• Student has received therapy for several years, no
progress noted
• Student does not want therapy and/or is uncooperative
• Impact of therapy is minimal compared to
consequences of missing classroom academics (MS and
HS years).
Therapy Services on a Continuum
• Move from direct to consultative role
• Decrease frequency as need decreases
• Work toward carryover of skills in
absence of OT
• Success when OT is no longer needed.
Developmental handwriting
readiness skills
• A growing number of typical kindergarten
and first grade students are exhibiting
problems with underlying hand skills that
impact readiness for handwriting
• OT will be consulting with general
education kindergarten and first grade
teachers to set up developmental exercise
programs to help these students start
handwriting with stronger hand skills.
Educational Impact
Good
Candidate for
Related
Services
Documented need
for Specialist
Stimulability