PENNSYLVANIA PHYSICAL THERAPY ASSOCIATION
GUIDELINES FOR THE PRACTICE OF
PHYSICAL THERAPY
IN EDUCATIONAL SETTINGS
April 2009
This document was written by a task force of the Pennsylvania Physical Therapy
Association (PPTA) Pediatric Special Interest Group (SIG). We acknowledge the support
of the Pediatric SIG and the PPTA. We also acknowledge the contributions of the
members of the task force for the 2006 revision of these guidelines: Glen Birmingham,
PT, MS, PCS; Pat Butler, PT; Karen Fox, PT, DPT; Rita Geddes, PT, MEd, DPT; Paula
Rhodes Glasser, DPT, PCS; Lori Glumac, PT, DSc, PCS—co-chair; Ronnee Greenstein,
PT, MS, PCS—co-chair; Cynthia G. McMillen, PT, MS, PCS; and Marianne Zenyuch,
MSPT.
Please note that these are guidelines only and are not to be taken as the official policies of
the PPTA.
Task force members for the 2009 revision:
Glen Birmingham, PT, MS, PCS (Austill’s Rehabilitation Services, Inc.)
Kathy Coultes, PT, MSPT, PCS (Mercy-Fitzgerald Hospital, Coordinator of Mercy Kids
4 Fitness Program)
Rita Geddes, PT, MEd, DPT (Bucks County Intermediate Unit #22)
Lori Glumac, PT, DSc, PCS (Capital Area Intermediate Unit #15)
Ronnee Greenstein, PT, MS, PCS (Lincoln Intermediate Unit #12)
Sean Powers, SPT (Neumann College)
TABLE OF CONTENTS
I. Introduction .....................................................................................................................1
Purpose of Guidelines ....................................................................................................1
Physical Therapy in Educational Environments ............................................................1
Legislation......................................................................................................................1
Federal Legislation...................................................................................................1
Individuals with Disabilities Education Act (IDEA 1997) ..........................1
Individuals with Disabilities Education Improvement Act (IDEA 2004) ...1
Technology Related Assistance for Individuals with Disabilities Act
(Tech Act) ....................................................................................................2
Americans with Disabilities Act (ADA) ......................................................2
Rehabilitation Act, Section 504 ...................................................................2
Pennsylvania Legislation .........................................................................................2
Title 22 Chapter 14 Special Education ........................................................2
Title 22 Chapter 15 Protected Handicapped Students ................................ 3
Physical Therapy Practice Act .....................................................................3
State Entities ..................................................................................................................4
Pennsylvania Department of Education (PDE) .....................................................4
The Pennsylvania Training and Technical Assistance Network
(PaTTAN) ....................................................................................................4
Local Entities .................................................................................................................4
Intermediate Units (IUs) ........................................................................................4
Local Educational Agencies (LEAs) .....................................................................4
II. Definitions in Educational Environments .......................................................................5
Least Restrictive Environment (LRE) ...........................................................................5
Gaskin Settlement ..................................................................................................5
Location of Services ..............................................................................................5
Instructional Support Team (IST) ..................................................................................5
Multidisciplinary Evaluation (MDE) .............................................................................6
Evaluation Report (ER)..................................................................................................7
Reevaluation Report (RR)..............................................................................................7
Individualized Education Program (IEP) .......................................................................7
Goals and Objectives .....................................................................................................8
Related Services .............................................................................................................9
Supports for School Personnel (SSP) ............................................................................9
Specially Designed Instruction (SDI) ............................................................................9
Transition Services.......................................................................................................10
Extended School Year (ESY) ......................................................................................10
Response to Intervention (RTI) ...................................................................................11
504 Plan / 504 Service Agreement...............................................................................12
i
Confidentiality--Family Educational Rights and Privacy Act (FERPA) .....................12
Progress Monitoring.....................................................................................................12
School-Based ACCESS Program (SBAP) ...................................................................13
Child Abuse Reporting Requirements .........................................................................13
Brain STEPS ................................................................................................................13
Preparing for the APTA Vision 2020 ..........................................................................14
III. Qualifications and Competencies for Physical Therapists in Educational
Environments ...............................................................................................................15
Qualifications for Physical Therapists in Educational Settings ...................................15
Possible Supplemental Qualifications..........................................................................15
Competencies for Physical Therapists in Educational Settings ...................................15
Optional Professional Memberships ............................................................................17
IV. Service Delivery ..........................................................................................................18
Role of the Physical Therapist .....................................................................................18
Role of the Physical Therapist Assistant .....................................................................18
Participation in Screening as Part of Child Find ..........................................................19
Participation in MDE Process ......................................................................................19
Participation in IEP Development ...............................................................................19
Participation in 504 Plan Development .......................................................................20
Providing Skilled Intervention .....................................................................................20
Progress Monitoring.....................................................................................................20
Prevention and Wellness ..............................................................................................22
Transportation ..............................................................................................................23
Referral Requirements .................................................................................................23
Episodic Nature of Physical Therapy Services ............................................................24
Adding, Revising, and Discontinuing Physical Therapy Services ..............................24
V. Utilizing the APTA Guide to Physical Therapist Practice, 2nd Edition, in
Educational Settings.....................................................................................................26
Disablement Models .....................................................................................................26
Evidence-based Medicine .............................................................................................26
Finding Current Best Evidence .....................................................................................26
Examination ..................................................................................................................27
Evaluation .....................................................................................................................30
Diagnosis.......................................................................................................................30
Prognosis .......................................................................................................................31
Intervention ...................................................................................................................31
Coordination, Communication, and Documentation ..........................................31
Patient/Client-related Instruction ........................................................................32
Procedural or Direct Interventions ......................................................................32
Re-examination/ Re-assessment ...................................................................................33
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VI. Administration of Educationally-based Physical Therapy Services ............................34
Supervision ..................................................................................................................34
Work Load, Case Loads, and Assignments .................................................................34
Professional Evaluation ...............................................................................................35
Pre-service and In-service Education...........................................................................35
Mentoring .....................................................................................................................36
Clinical Instruction of PT/PTA Students in Educational Settings ...............................36
Costs and Budgeting ....................................................................................................37
References / Resources ......................................................................................................38
Websites .............................................................................................................................40
Appendix A: Application of the APTA Guide to Physical Therapist Practice,
2nd Edition, to Educational Settings ...................................................................................42
Appendix B: Components of an IEP Goal .........................................................................44
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I. INTRODUCTION
Purpose of Guidelines
The purpose of this document is to provide physical therapists in Pennsylvania with
information and guidelines relative to providing physical therapy services in educational
settings for students age 3 to 21 years.
Physical Therapy in Educational Environments
Physical therapists work in schools, worksites, preschool programs, and children’s homes to
support students to benefit from their educational programs, have access to their education,
and participate in their education. Therapists work collaboratively with school personnel and
parents of children with disabilities to evaluate and plan children’s educational programs and
provide intervention to meet children’s individual educational needs.
Legislation
Federal Legislation
Individuals with Disabilities Education Act (IDEA 1997)
The Individuals with Disabilities Education Act (IDEA 1997) mandates a free and
appropriate public education (FAPE) for all children regardless of their disability or
the severity of the disability. Part B of the Act addresses the education of children
age 3 to 21 years who have a disability that hinders their education and their ability
to access or benefit from their education. The IDEA Amendments of 1997
significantly improved the educational opportunities for students with disabilities
by focusing on teaching and learning, and establishing high expectations for
students with disabilities to achieve real educational results. IDEA strengthens the
role of parents in educational planning and decision making on behalf of their
children. It also focuses the students' educational planning process on promoting
meaningful access to the general education curriculum. (reference:
www.pattan.k12.pa.us )
Individuals with Disabilities Education Improvement Act (IDEA 2004)
In December 2004, IDEA 1997 was reauthorized as the Individuals with
Disabilities Education Improvement Act of 2004 (IDEA 2004). IDEA 2004
continues to ensure that all children with disabilities have a free appropriate public
education and that the rights of such children and their parents are protected. It also
aligns with the No Child Left Behind (NCLB) Act. Some of the changes made in
IDEA 2004 focus on improving educational outcomes for students with disabilities
rather than the special education process. Other changes emphasize the need to
reduce paperwork and expand opportunities to reduce disagreements between
schools and parents. (reference: www.pattan.k12.pa.us )
1
The final regulations needed to implement changes made to IDEA 1997, as
amended by IDEA 2004, took effect October 13, 2006. These regulations can be
accessed at:
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/20
06/pdf/06-6656.pdf
Technology Related Assistance for Individuals with Disabilities Act (Tech Act)
The Tech Act authorizes the state to create a statewide system of technological
assistance for people with disabilities. States can receive discretionary grants to
assist them in developing and implementing consumer-responsible, comprehensive
statewide programs of technology-related assistance for individuals of all ages who
have disabilities.
Americans with Disabilities Act (ADA)
The Americans with Disabilities Act requires that people with disabilities have
equal opportunity compared to people without disabilities for employment, state
and local government services, public accommodations, commercial facilities, and
transportation. It also includes the establishment of TDD/telephone relay services.
Rehabilitation Act, Section 504
Section 504 of the Rehabilitation Act of 1973 is a federal law that protects
qualified individuals from discrimination based on a disability. The
nondiscrimination requirements of the law apply to employers and organizations
that receive financial assistance from any Federal department or agency, including
the U.S. Department of Health and Human Services (DHHS). The organizations
and employers include public educational agencies as well as many hospitals,
nursing homes, mental health centers, and human service programs.
Pennsylvania Legislation
Title 22 Chapter 14 Special Education
This state legislation:



establishes the special education regulations in Pennsylvania for school
districts
provides regulatory guidance to ensure compliance with federal laws and
IDEA 2004 and its regulations
ensures that all students with disabilities have available to them a free
appropriate public education that is designed to enable the students to
participate fully and independently in the community, including preparation
for employment or higher education
2

ensures that the rights of students with disabilities and their parents are
protected. (reference: www.pattan.k12.pa.us)
Title 22 Chapter 15 Protected Handicapped Students
This state legislation:






addresses school districts’ responsibility to comply with the requirements of
Section 504 and its implementing regulations at 34 CFR Part 104 relating to
nondiscrimination on the basis of handicap in programs and activities
receiving or benefiting from federal financial assistance
implements the statutory and regulatory requirements of Section 504--Section
504 and its accompanying regulations protect qualified handicapped students
who have physical, mental, or health impairments from discrimination
because of those impairments
requires public educational agencies to ensure that these students have equal
opportunity to participate in school programs and extracurricular activities to
the maximum extent appropriate to the ability of the protected handicapped
student in question
requires school districts to provide these students with the aids, services, and
accommodations that are designed to meet the educational needs of protected
handicapped students as adequately as the needs of non-handicapped students
are met
states that aids, services, and accommodations may include, but are not
limited to, special transportation, modified equipment, adjustments in the
student’s roster, and the administration of needed medication
uses the term “protected handicapped students” for students identified and
protected by Section 504. (reference:
www.pacode.com/secure/data/022/chapter15/chap15toc.html)
Physical Therapy Practice Act
This act regulates the practice of physical therapy, licensure of physical therapists,
registration of physical therapist assistants, and use of supportive personnel. The
Physical Therapy Practice Act also sets standards for physical therapist
application for a certificate of authorization to practice physical therapy under this
act without physician referral for up to 30 days. This is termed “direct access.”
Regulations regarding direct access in Pennsylvania received legislative approval
in 2004. (reference: www.ppta.org/site/1/docs/ptact.pdf)
3
State Entities
Pennsylvania Department of Education (PDE)
The Pennsylvania Department of Education assists the General Assembly, the
Governor, the Secretary of Education, and Pennsylvania educators in providing
for the maintenance and support of a thorough and efficient system of education.
The Pennsylvania Training and Technical Assistance Network (PaTTAN)
PaTTAN is an initiative of the Pennsylvania Department of Education, Bureau of
Special Education. PaTTAN supports the Department of Education by:

offering professional development (with a focus on special education) that
builds the capacity of local educational agencies to meet students' needs
 developing training courses, offering technical assistance, and providing
resources to build the skills of intermediate unit and school personnel in order
to improve student achievement
 providing services to support Early Intervention, student assessment, tutoring
and other partnership efforts, all designed to help students succeed.
(reference: www.pattan.k12.pa.us/default.aspx)
PaTTAN has three regional offices located in King of Prussia, Harrisburg, and
Pittsburgh.
Local Entities
Intermediate Units (IUs)
Intermediate Units were established in 1971 by the Pennsylvania General
Assembly. Pennsylvania’s 29 Intermediate Units operate as regional educational
service agencies that provide programs and services to Pennsylvania’s 501 public
school districts and over 2,400 non-public and private schools. They also serve as
liaison agencies between the school districts and the Pennsylvania Department of
Education.
Local Education Agencies (LEAs)
An LEA is a local entity that operates schools, including primary and secondary
public and private schools. Examples include but are not limited to local school
districts, intermediate units, and charter schools.
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II. DEFINITIONS IN EDUCATIONAL ENVIRONMENTS
Least Restrictive Environment
According to IDEA, students shall be educated in classes following the least restrictive
environment requirements, commonly known as LRE. These requirements state that, to
the maximum extent appropriate, children with disabilities must be educated with
children who do not have disabilities. Basic Education Circulars of Pennsylvania Code
states: “The presumption of IDEA is that IEP teams begin placement discussions with a
consideration of the regular education classroom and the supplementary aids and services
that are needed to enable a student with a disability to benefit from educational services”.
The law also states that special classes, separate schools, or other removal of children
with disabilities from the regular educational environment may occur only if the nature or
severity of the child's disability is such that education in regular classes with the use of
supplementary aids and services cannot be achieved satisfactorily. (reference: 22 PA
Code 14.145)
Gaskin Settlement Agreement
This agreement addresses inclusive educational practices for Pennsylvania
students with disabilities by:



articulating the establishment of an advisory group to the Department of
Education
mandating training, technical assistance, monitoring, and compliance
regulations
requiring local schools and school districts to offer a full continuum of support
services allowing children with disabilities to be educated in regular
classrooms. (reference:
www.pattan.k12.pa.us/regsforms/CourtOrdersGaskin.aspx)
Location of Services
Individualized Education Program (IEP) teams determine what programs and
services are appropriate for students and the location where services are to be
provided. Special education services are portable and may be provided in a wide
variety of locations. 22 Pa Code 14.141 gives the definition of itinerant, resource,
part-time and full-time classes; however, the determination of the level of services
outlined under 22 Pa Code 14.141 is not limited to special education classrooms
alone. Special education services can be delivered in locations that include
regular education classrooms, community-based settings, and vocational settings.
Instructional Support Team (IST)
School districts establish ISTs in elementary schools, K-6, to provide instructional
support to students experiencing academic or behavioral difficulties in the classroom
5
setting. The IST may determine that a referral for a multidisciplinary evaluation is
appropriate. Children under kindergarten age and over sixth grade age are referred
directly for a multidisciplinary evaluation.(reference: Commonwealth of Pennsylvania
State Board of Education, Title 22, Special Education Programs and Services, Part I:
Chapter 14, 14.24, July 1, 1990)
Multidisciplinary Evaluation (MDE)
A parent, local educational agency (LEA), or instructional support team may initiate a
multidisciplinary evaluation for a student. For children transitioning from Part C Infant /
Toddler services, the reason for referral should include determining if the child is eligible
for Part B Preschool Early Intervention / Preschool special education services. To be
eligible for special education services, a child must have a disability and need specially
designed instruction. The evaluation process shall "use a variety of assessment tools and
strategies to gather relevant functional and developmental and academic information,
including information provided by the parent that may assist in determining whether the
child is a child with a disability and the content of the child’s individualized education
program, including information related to enabling the child to be involved in and
progress in the general education curriculum, or for preschool children, to participate in
appropriate activities." [reference: IDEA 2004, Section 614(b)(2)(A) (i) and IDEA 2004,
Section 614 (b)(2)(A)(ii)] IDEA 2004 also stipulates that “each local educational agency
shall ensure that the child is assessed in all areas of suspected disability” [reference:
(IDEA 2004 Section 614 (b)(3)(B)] and “assessments, tools, and strategies that provide
relevant information that directly assists persons in determining the educational needs of
the child are provided." [reference: IDEA 2004 Section 614 (b)(3)(C)] A physical therapy
evaluation may be requested as part of a child's evaluation. IDEA 2004 requires that a
child be assessed in all areas related to the suspected disability. This may include motor
function.
Reevaluation includes a review of existing evaluation data and classroom-based
observations and assessments. Following this review, the IEP team decides if additional
evaluations or assessments are needed. The IEP team determines if the child continues to
be eligible for and require specially designed instruction. In Pennsylvania, school-age
students with mental retardation as an exceptionality must have a reevaluation every two
years. School-age students with exceptionalities other than mental retardation must have
a reevaluation every 3 years. The parent and the local educational agency may agree that
a reevaluation is unnecessary. [reference: IDEA 2004, Section 614, (a) (2) (B) (i) (ii)].
For pre-school students, a reevaluation report needs to be issued every two years unless
the Mutually Agreed Upon Written Arrangement (MAWA) Early Intervention program
possesses a signed parental Permission/Agreement that a re-evaluation is not necessary at
this time. If determined to be necessary, reevaluations may be more frequent than
mandated by law.
6
Evaluation Report (ER)
The results of the multidisciplinary evaluation are reported in an Evaluation Report by
the multidisciplinary team. Part B of IDEA 2004 says that the Evaluation Report must be
issued no later than 60 calendar days from receipt of parental permission (reference: 22
PA Code 14.123 (b); 34 CRF 300.301 (c )). For school age students, the 60 calendar
days stop the day after the end of spring semester and re-start the day before fall semester
begins. (reference: 22 PA Code 14.131 (b)). The physical therapist is responsible for
submitting information for the evaluation report for students supported by physical
therapy or evaluated by a physical therapist. Each school district or Intermediate Unit has
a designated procedure for evaluation reports which may include use of online programs.
There is no requirement for a meeting at any point in the evaluation or reevaluation
process.
Reevaluation Report (RR)
The results of a reevaluation are reported in a Reevaluation Report. The regulations for
issuing the report within 60 calendar days for students also apply to Reevaluation
Reports. For school age students, the 60 calendar days stop the day after the end of spring
semester and restart on the day before fall semester begins. (reference: 22 PA Code
14.123 (b)
Individualized Education Program (IEP)
The Individualized Education Program team writes the student’s IEP to address specially
designed instruction and educational goals based on the student’s strengths and needs.
The IEP must be based upon and responsive to the ER or current present levels. The IEP
team includes the parent(s) of the child with a disability, regular education teacher,
special education teacher, related service providers, local education agency (LEA)
representative, and whenever appropriate the student. The IEP team considers the
academic, developmental, and functional needs of the child with a disability. The IEP is a
written document and guide for the child’s free appropriate public education in the least
restrictive environment. Individual districts may utilize a variety of computer or webbased documentation systems to aid in IEP development and documentation. Physical
therapist should familiarize themselves with LEA documentation systems and policies.
According to IDEA 2004, the IEP must include:




a statement of the child’s present levels of academic achievement and functional
performance;
how the child’s disability affects the child’s involvement and progress in the
general education curriculum;
how the disability affects the child’s participation in appropriate activities (for
preschool children);
a statement of measurable, annual, academic, and functional goals designed to
meet the child’s educational needs that result from the child’s disability and
7

enable the child to be involved in and make progress in the general education
curriculum; and
a description of how the child’s progress toward meeting the annual goals will be
measured and when periodic reports on progress the child is making toward
meeting the annual goals will be provided”. [IDEA Section 614
(d)(1)(A)(i)(I)(aa)(bb)(II)(aa)(bb)(III)]
The IEP must also include specially designed instruction and necessary related services
including the frequency, location, and duration of related services. Transition services are
included in the IEP when appropriate.
Physical therapists may contribute information to an IEP in various sections (e.g., present
levels of functional performance, how the student's disability affects involvement and
progress in the general education curriculum). Additionally, physical therapists may
make recommendations for goal development (including appropriate measurement and
reporting methods), service delivery, and specially designed instruction.
Goals and Objectives
Individualized Education Programs include academic and functional goals. Short term
objectives are required for school age children with disabilities who take alternate
assessments aligned to alternate achievement standards. IEP goals should:
1. address needs identified in the ER, RR, or IEP;
2. match the intensity of need in the Present Levels of Educational Performance
(including family priorities for their child’s development for pre-school children);
3. address both the present and future needs of the student;
4. be discipline-free;
5. be chronologically age-appropriate;
6. be functional;
7. serve a relevant purpose in the student’s education;
8. support participation in appropriate activities;
9. be meaningful to the student and the student’s family;
10. include activities that the student can perform frequently;
11. be understandable to team members;
12. provide a clear focus for instruction;
13. be measurable to provide a framework for ongoing progress monitoring; and
14. be expected to be achievable in a program year based on the child’s present level
of performance.
NOTE: All IEP goals are student goals (not classroom goals, physical therapy goals,
etc.) and are discipline-free. Goals are not be labeled with a specific discipline such as
physical therapy. The team decides which goals are most important for the student to
accomplish, without regard to the discipline usually associated with them. Identifying
goals as physical therapy goals will lead to physical therapy as an isolated service rather
8
than a related service that directly assists a student to benefit from his or her educational
program.
Related Services
A student may require a variety of services, commonly called related services, in order to
benefit from or access his/her special education program. These services, along with
location, frequency, and duration are listed in the IEP. Related services are defined in
IDEA 2004 as “transportation, and such developmental, corrective, and other supportive
services (including speech-language pathology and audiology services, interpreting
services, psychological services, physical and occupational therapy, recreation, including
therapeutic recreation, social work services, school nurse services designed to enable a
child with a disability to receive a free appropriate public education as described in the
individualized education program of the child, counseling services, including
rehabilitation counseling, orientation and mobility services, and medical services, except
that such medical services shall be for diagnostic and evaluation purposes only) as may
be required to assist a child with a disability to benefit from special education, and
includes the early identification and assessment of disabling conditions in children.”
[IDEA 2004 602 (26)(A)].
Supports for School Personnel
Supports for school personnel are the supports provided for the child to school personnel
who will be assisting in implementation of any part of the IEP. School personnel may
include special education teachers, aides, related service providers, bus drivers, childcare
provider staff, etc. Any assistance, materials, training, equipment, or information that is
needed in order to provide FAPE and implement specially designed instruction would be
listed in this section. This section of the IEP includes consultation and collaboration with
specified personnel (e.g., physical therapist) to support a child’s IEP. It also includes
training or materials for personnel in order to enable the child to be involved in
appropriate activities, participate with non-disabled children, and to progress toward
annual goals. Location, frequency, and duration of each support for school personnel
must be specified in the IEP.
Specially Designed Instruction (SDI)
Specially designed instruction is the essence of special education and is based on the
identified educational needs that result from the child’s disability. The purpose of SDI is
to ensure that the child is able to attain goals and to be involved and progress in
appropriate activities in the LRE. The SDI section of the IEP may identify materials,
techniques, modifications, assessments, and activities as well as the anticipated location
and frequency. In relation to physical therapy, SDI may include specific adapted
equipment, materials accommodations, strategies, procedures, and other adaptations to
support the student’s IEP.
9
Transition Services
Many educationally related transitions, or changes in status, occur for children with
disabilities and their families. The three major transitions include: 1) transition from Part
C (early intervention) to Part B at age three years; 2) transition from preschool to schoolage services; and 3) transition from school to post-school activities.
If a pre-school child is within one year of transition to a program for school-age students,
the IEP must contain goals that address the transition process such as:
1.
2.
3.
4.
preparing the child for competence in the next environment;
supporting the child and parent in making a smooth transition;
preparing the receiving agency/staff; and
supporting communication between receiving and sending staff as needed.
IDEA 2004 states that beginning no later than age 16 years, and PA law states that
beginning no later than age 14 years, desired post-school outcomes are identified on a
student’s IEP. These include post-secondary education and training outcomes,
employment outcomes, and independent living outcomes, if appropriate. The IEP team
must state in the IEP how each transition activity/service needed to assist the student in
reaching goals will be provided. The IEP team must also indicate if an IEP goal will be
written to support transition to post-school outcomes.
Extended School Year (ESY)
Extended school year services are special education and related services that are provided
for a student with a disability beyond the normal school year in accordance with the
student’s IEP. Most school districts have specific ESY policies, but schools cannot
establish general rules for deciding eligibility for ESY. A student’s need for ESY is
determined on an individual basis by the IEP team. Considerations include:
 significant or substantial loss of skills or regression during breaks from school along
with failure to recoup skills within a reasonable time after returning to school
 the nature and extent of the student’s disability
 the student’s rate of progress
 student’s need for interaction with peers without disabilities
 degree of regression in the past
 availability of alternative resources
 parent’s ability to provide educational structure at home
 emerging skills
 predictive data based on the opinion of professionals.
The annual deadline for determining ESY eligibility for school-age children with severe
disability is February 28. The Notice of Recommended Educational Placement must be
issued to the parent no later than March 31 for children with severe impairments. All
10
students with disabilities, including preschool students, can be considered eligible for
ESY programs (reference: 22 PA Code 14.132).
NOTE: ESY services cannot be provided for the sole purpose of maximizing a student’s
educational opportunities. ESY is not designed as a period of learning new skills but
instead for the student to retain skills. ESY services must be provided only if necessary
for the provision of FAPE to the child as determined on an individual basis in accordance
with Secs. 300.320-300.324.
References: Arnold, S. Extended school year services. In: Providing Physical Therapy
Services under Parts B & C of the Individuals with Disabilities Education Act (IDEA).
McEwen, IR, ed. Alexandria: Section on Pediatrics, American Physical Therapy
Association; 2009., p. 127-129; and 34 CFR Parts 300 (2006).
Response to Intervention (RTI)
Response to Intervention is an early intervening strategy to enable early identification
and intervention for students at academic or behavioral risk prior to student failure. RTI
is an assessment and intervention process to systematically monitor student progress and
make data based decisions about the need for and provision of: 1) instructional
modifications; 2) research based interventions; and 3) increasingly intensified services in
order to address the needs of a struggling student. Fundamental principles of RTI include:
school wide screening for critical skills, high quality instruction, frequent assessment, a
team approach, and data based decision making.
RTI is a departure from deficit based assessments due to focus on:
 possible interventions rather than what is “wrong” with the student
 addressing the needs of all students, not just those with educational labels
 the responsibility of all educators for all students
 positive outcomes for all students
 multi-tiered service delivery models with differentiated instruction to meet individual
needs
A school based physical therapist may participate in a team working to meet a student’s
needs prior to establishing eligibility for special education. School based PTs and PTAs
may be called on to provide expertise in modifying classrooms, suggest learning
strategies, or give input in other areas in which they could assist with problem solving for
a student. The goal is to do what is required for that student to succeed with their
curriculum with the fewest restrictions possible.
(Reference: Laurie Ray, Physical Therapy Consultant for NC Dept. of Public Instruction.
RTI description written 1-12-09 for the APTA, Section on Pediatrics, School-based SIG)
11
504 Plan / 504 Service Agreement
The main criterion for eligibility for a 504 Plan, also referred to as a 504 Service
Agreement, is a physical or mental impairment that substantially limits one or more
major life activities. Major life activities means functions such as caring for one’s self,
performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and
working. [reference: Section 504, Section 104.3(j)(2)(ii)] The purpose of 504 Plans is to
protect students with disabilities from discrimination for reasons related to their
disability. School age students that require physical therapy to accommodate for their
functional limitations or provide access to their educational environment, but do not
require special education services (specially designed instruction), may receive physical
therapy services under Section 504 of the Rehabilitation Act of 1973. The educational
team writes the needed aids, accommodations, and services into a 504 Plan for the
student rather than an IEP.
Confidentiality--Family Educational Rights and Privacy Act (FERPA)
The Family Educational Rights and Privacy Act (FERPA) (reference: 20 U.S.C. § 1232g;
34 CFR Part 99) is a Federal law that protects the privacy of student education records.
The law applies to all schools that receive funds under an applicable program of the U.S.
Department of Education. FERPA gives parents certain rights with respect to their
children's education records. These rights transfer to the student when he or she reaches
the age of 18 or attends a school beyond the high school level. Students to whom the
rights have been transferred are termed "eligible students."





Parents or eligible students have the right to inspect and review the student's
education records maintained by the school.
Parents or eligible students have the right to request that a school correct records
which they believe to be inaccurate or misleading.
Schools must have written permission from the parent or eligible student in order
to release any information from a student's education record.
Schools may disclose, without consent, "directory" information such as a student's
name, address, telephone number, date and place of birth, honors and awards, and
dates of attendance. However, schools must tell parents and eligible students
about directory information and allow parents and eligible students a reasonable
amount of time to request that the school not disclose directory information about
them.
Schools must notify parents and eligible students annually of their rights under
FERPA.
Progress Monitoring (see pages 19-21 for additional information)
Progress monitoring is a scientifically-based practice used by educational professionals
(including physical therapists) to assess students' performance and evaluate the
effectiveness of instruction and intervention. Monitoring student progress through data
collection and analysis is an effective way to determine if physical therapy services are
12
meeting the needs of the student and whether the therapist should change intervention
and/or strategies. “Progress monitoring involves:

Collecting and analyzing data to determine student progress toward specific goals

Making intervention decisions based on review and analysis of student data.”
(reference: www.pattan.k12.pa.us/teachlead/ProgressMonitoring.aspx)
School-Based ACCESS Program (SBAP)
The School-Based ACCESS Program is a cooperative effort of the Pennsylvania
Department of Education (PDE), the State Department of Public Welfare, the federal
Centers for Medicare and Medicaid Services, and PDE’s contractor, Leader Services
(reference: www.leaderservices.com). The SBAP provides Local Educational Agencies
(LEAs) partial reimbursement for health related services that are provided as part of an
Individualized Education Program to Medicaid eligible special education students.
School districts and Intermediate Units choose whether or not to participate in the SBAP,
and participating school districts and Intermediate Units manage the process for
reimbursement. The student’s parents must give permission for the student to be included
in the program. Physical therapy is a covered service under the SBAP. For each student
who is Medicaid eligible and for whom parent permission has been obtained to
participate in the SBAP, physical therapists and physical therapist assistants document
monthly on Professional Services Logs for services provided.
Child Abuse Reporting Requirements
Under 23 Pa.C.S. § 6311 and PA Code § 40.202, physical therapists and physical
therapist assistants who have reasonable cause to suspect that a child coming before them
is a victim of child abuse, are required to report or cause a report to be made through their
employer to the Department of Public Welfare. Reports of suspected child abuse should
be made immediately by telephone to ChildLine (800) 932-0313. Within 48 hours,
written reports should be made on forms prescribed by the Department of Public Welfare.
Under 23 Pa. C.S. § 6318 and PA Code § 40.205, physical therapists and physical
therapist assistants who participate in good faith in the making of a report, will have
immunity from civil and criminal liability. Physical therapists and physical therapist
assistants who willfully fail to comply with the reporting requirements in § 40.202, are
subject to disciplinary actions and criminal penalties.
Brain STEPS
The Brain STEPS Child & Adolescent Brain Injury School Re-Entry Program has
consulting teams available to families and schools throughout Pennsylvania. Teams are
extensively trained in the educational needs of students returning to school following
brain injury. Teams work with local school staff to develop educational programs,
academic interventions, strategy implementation, and monitoring of students who have
sustained brain injury. Many regions in Pennsylvania have fully functioning multidisciplinary Brain STEPS teams, and it is expected that all 29 Pennsylvania Intermediate
13
Units will have teams by 2010. Brain STEPS team composition varies, but teams must
include a minimum of five members from the IU region (physical therapists, occupational
therapists, speech therapists, school psychologists, consultants, teachers, school nurses),
at least one parent of a child with brain injury, and one or two medical rehabilitation
professionals from the community.
The Brain STEPS Child & Adolescent Brain Injury School Re-Entry Program is funded
by a grant from the PA Department of Health. It is implemented by the Brain Injury
Association of PA in partnership with the PA Department of Education. Brain STEPS
teams help with:









Education and awareness of brain injury for school professionals
Consultation from local medical & rehabilitation professionals
Hospital to school re-entry planning
IEP and 504 Plan development
Academic interventions
Strategy implementation
Educational programming
Monitoring of students until graduation
Brain Injury trainings for schools and families
(For further information, contact Brenda Eagan-Brown, BIAPA Brain STEPS
Coordinator, at eaganbrown@biapa.org, or 724-944-6542)
Preparing for the APTA Vision 2020
By 2020, it is envisioned that physical therapists who work with children, individuals
with developmental disabilities, and their families will be recognized as practitioners of
choice, to whom families have unrestricted direct access, to provide services to children
to prevent, diagnose, and treat movement dysfunction and enhance fitness and function.
By 2020, it is envisioned that the majority of pediatric physical therapists will earn
doctoral degrees and be recognized as pediatric clinical specialists with support from
physical therapist assistants with advanced proficiency in pediatrics; and that both PTs
and PTAs will utilize evidence to practice with competence and skill.
NOTE: In school-based settings, the term “practitioner of choice” must be understood in
the context of physical therapy as a related (rather than primary) service. Physical
therapists function in a collaborative effort with of the members of the educational team
to support a student’s educational program.
14
III. QUALIFICATIONS AND COMPETENCIES FOR PHYSICAL THERAPISTS IN
EDUCATIONAL SETTINGS
Qualifications for Physical Therapists in Educational Settings
1. Current physical therapist licensure in the state of Pennsylvania
2. Criminal Background Check as required by Section 1-111 of the Pennsylvania School
Code (Act 34) for all applicants for school employment who will have direct contact with
students; applicants are required to submit a Request for Criminal Record Check to the
Pennsylvania State Police
3. Child Abuse History Clearance as required by Sections 6354-6358 of the Public Welfare
Code (Act 151) for all applicants for school employment, both Pennsylvania residents
and non-residents; this request is submitted to the Pennsylvania Department of Public
Welfare, Child Line
4. Current Act 114 Clearance (Federal Fingerprinting). You must obtain an FBI clearance
under the PA Department of Education. No other FBI clearance will be accepted.
Possible Supplemental Qualifications
1. Board Certified Clinical Specialist in Pediatric Physical Therapy (certified through the
American Board of Physical Therapy Specialties)
2. PA Direct Access Certificate of Authorization (allows physical therapists to practice for
30 calendar days without physician referral; the PPTA strongly encourages all physical
therapists who are eligible for a direct access certificate of authorization to obtain one)
Competencies for Physical Therapists Working in Educational Settings
Updated competencies for physical therapists working in schools were published in the
Winter 2007 issue of Pediatric Physical Therapy. (Effgen SK, Chiarello L, Milbourne SA.
Updated competencies for physical therapists working in schools. Pediatric Physical
Therapy. 2007;19:266-274.) Nine content areas with specific competencies were identified
and reflect an expanded role of school-based therapists compared to previous competencies.
The authors concluded that physical therapists who work in educational settings require
specific skills and knowledge to effectively serve children with disabilities, and competencies
can guide professional development. The nine competencies (used with permission of the
author) are:
1. Context of therapy practice in educational settings
a. Knowledge of the structure, global goals, and responsibilities of the public
education system, including special education
b. Knowledge of the federal (e.g., IDEA, Rehabilitation Act of 1973, ADA), state,
and local laws and regulations that affect the delivery of services to student with
disabilities
c. Knowledge of the theoretical and functional orientation of a variety of
professionals serving students within the educational system
15
2.
3.
4.
5.
6.
7.
8.
9.
d. Knowledge to assist students in accessing community organizations, resources,
and activities
Wellness and prevention
a. Implement school-wide screening programs with school nurses, physical
education teachers, and teachers
b. Promote child safety and wellness using knowledge of environmental safety
measures
Team collaboration
a. Form partnerships and work collaboratively with other team members, especially
the teacher, to promote an effective plan of care
b. Function as a consultant
c. Educate school personnel and family to promote the inclusion of the student
within the educational experience
d. Supervise personnel and professional students
e. Serve as an advocate for students, families, and school
Examination and evaluation in schools
a. Identify strengths and needs of students
b. Collaboratively determine examination and evaluation process
c. Determine student’s ability to participate in meaningful school activities by
examining and evaluating
d. Utilize valid, reliable, cost-effective, and nondiscriminatory instruments
Planning—actively participate in the development of the Individualized Education Plan
Intervention
a. Adapt environments to facilitate student access to and participation in student
activities
b. Use various types and methods of service provision for individualized student
interventions
c. Promote skill acquisition, fluency, and generalization to enhance overall
development, learning, and student participation
d. Imbed therapy interventions into the context of student activities and routines
Documentation
a. Produce useful written documentation
b. Collaboratively monitor and modify student’s IEP
c. Evaluate and document the effectiveness of therapy programs
Administrative issues in schools
a. Demonstrate flexibility, priority setting, and effective time management strategies
b. Obtain resources and data necessary to justify establishing a new therapy program
or altering an existing program
c. Serve as a leader
d. Serve as a manager
Research
a. Demonstrate knowledge of current research relating to child development,
medical care, educational practices, and implications for therapy
b. Apply knowledge of research to the selection of therapy intervention strategies,
service delivery systems, and therapeutic procedures
16
c. Partake in program evaluation and clinical research activities with the appropriate
supervision
NOTE: The 2009 version of “Providing Physical Therapy Services Under Parts B & C of
the Individuals with Disabilities Education Act (IDEA)” edited by Irene R. McEwen, PT,
PhD, FAPTA, is now available. It can be purchased from www.pediatricapta.org.
Optional Professional Memberships
1. American Physical Therapy Association (APTA) and Pennsylvania Physical Therapy
Association (PPTA)
a. The APTA and PPTA provide continuing education opportunities, advocate
for legislation that impacts the profession of physical therapy, and provide
vital resources for clinical practice (including access to full text journal
articles).
2. APTA Section on Pediatrics
a. Participation in the SOP Listserve is free to Section members and provides
ongoing web-based discussions about current topics in pediatric practice.
b. The peer-reviewed journal, Pediatric Physical Therapy, provides research
articles for evidence-based practice, Clinical Bottom Lines for research
articles, Critically Appraised Topics, and abstracts of Poster and Platform
Presentations presented at annual Combined Sections Meetings.
3. PPTA Pediatric Special Interest Group (SIG)
a. Membership is free for PPTA members
b. To join, contact Rita Geddes, PT, MEd, DPT at rfgeddespt@aol.com
c. The SIG provides information on education and other issues related to
pediatric physical therapy practice in PA.
4. APTA Section on Pediatrics School-based SIG
a. Membership is free for APTA Section on Pediatrics members
b. The SIG website link is http://www.pediatricapta.org/members/school.cfm
c. Sign up for membership at
http://www.pediatricapta.org/pdfs/SIGSignupsheet.pdf
d. Provides information on issues specific to the practice of physical therapy in
educational settings.
17
IV. SERVICE DELIVERY
Role of the Physical Therapist
Physical therapists function as part of the educational team to screen and evaluate
students regarding eligibility for special education and need for related services. They
work collaboratively with the IEP team to: 1) identify student strengths and prioritize
needs in the educational setting; 2) develop goals and specially designed instruction that
address educational needs for the student’s IEP; 3) implement strategies to enable the
student to meet identified goals and to access their educational program; 4) assist with
progress monitoring; and 5) ) recommend and assist with obtaining adaptive equipment
needed by students in educational settings including equipment needed for transportation.
Physical therapists also act as resources for educational teams for supporting students,
educational staff, and parents during the educational process and transition to adult
independence. (reference: IDEA 2004 P.L. 108-446; 2004) Physical therapists function as
part of the educational team serving students identified as protected handicapped students
under Section 504. Physical therapists may also be asked to participate in primary,
secondary, and tertiary prevention activities at the request of the educational institution
(including but not limited to emergency preparedness planning and training). The
physical therapist may also participate in district, county, and/or statewide committees to
address issues and/or legislation relevant to school based services.
Physical therapists may delegate to physical therapist assistants those activities for which
the physical therapist assistant has received formal education and training. A physical
therapist may not delegate certain functions to physical therapist assistants as outlined in
PA Code § 40.53. Functions which may not be delegated to physical therapist assistants
specific to the educational setting include interpretation of referrals; initial/discharge
evaluations, reevaluations, consults or screenings; determining or modifying treatment
plans or therapeutic techniques, and procedures beyond the skill and knowledge of the
physical therapist assistant. “When care is provided to an individual in a preschool,
primary school, secondary school or other similar educational setting, a licensed physical
therapist shall make an onsite visit and examine the patient at least every four patient
visits or every 30 days, whichever shall occur first.” (HB1199 P.N.4189 (3)(ii) pg 31).
Parents, teachers, and other school personnel may carry out and reinforce functional
activities as directed by the physical therapist in the educational environment in
accordance with section 9.2 of the PA Practice Act for physical therapy. While a physical
therapist may provide input regarding a student’s physical abilities, adaptive physical
education (APE) is an educational service that should be provided by a certified teacher.
Role of the Physical Therapist Assistant
Physical therapist assistants (PTAs) may function as a part of the educational team to
provide educationally based physical therapy services, as specified in the student’s IEP,
under the supervision of a physical therapist in accordance with the Pennsylvania
Physical Therapy Practice Act. Physical therapist assistants may not interpret referrals or
18
tests, perform evaluation procedures, initiate treatment programs, assume responsibility
for planning care or perform activities which require the formal education or training and
the skill and knowledge of a physical therapist. (PA Code § 40.171(b).
Participation in Screening as Part of Child Find
School districts are required to locate and identify children thought to be eligible for
special education. Each school district in Pennsylvania is required to identify and provide
initial screening for students prior to referral for special education evaluation and to
identify students who may need special education services and programs (22 PA Code §
14.122). The physical therapist may be included in this screening process to identify
significant motor difficulties for the student and the potential need for related services.
The physical therapist may also participate in the Instructional Support Team to screen
motor performance and determine if a school-based physical therapy evaluation is
warranted. Screening activities do not change the right of a parent to request an
evaluation at any time. When screening a student without parent permission, best practice
suggests that screenings occur in the natural environment where the performance in
question can be observed without direct interaction with the student.
Participation in Multi-disciplinary Evaluation (MDE) Process
The physical therapist as a member of the educational team follows IDEA standards and
procedures for providing evaluations. The evaluation process includes: 1) written parent
permission to evaluate/reevaluate; 2) team assessment in all areas related to the disability;
and 3) team decision-making. The physical therapist can assist in identifying and
documenting student difficulties in completing motor and functional tasks expected in
school routines to determine if the student has a disability as defined by IDEA and is
eligible for special education and related services. The physical therapist contributes
information to the Evaluation Report and collaborates with the educational team in the
decision making process. For school age students, evaluations must occur and the report
be presented to the parents within 60 calendar days of receiving parental consent
(reference: PA §14.123).
Participation in Individualized Education Program (IEP) Development
The physical therapist as a member of the IEP team follows IDEA 2004 standards and
procedures. The IEP team process includes:
1.
2.
3.
4.
determination of academic levels and functional performance;
identification and prioritization of student strengths and needs;
collaboration to determine annual student goals;
identification of resources and specially designed instruction (SDI) needed for the
student to meet the goals and access and participate in the educational program;
5. team determination of the frequency, duration, location, and specific criteria of
needed services; and
6. addressing transition services when appropriate.
19
The need for physical therapy as a related service, frequency and duration of service, and
criteria of intervention to meet the needs of the student is determined by team consensus.
The physical therapist assists in a collaborative manner with these determinations. Due to
the collaborative nature of the IEP team, physical therapists should attempt to attend IEP
meetings for students who receive physical therapy services. The physical therapist may
be excused if the parent and local education agency agree in writing that attendance is not
necessary. The therapist then must submit in writing to the parent and IEP team input to
the development of the IEP prior to the meeting. (reference: IDEA 2004 P.L. 108-446;
2004)
Participation in 504 Plan Development
The physical therapist may be asked to screen or evaluate a student in the regular
education program to determine if the student meets the criteria of Section 504 of the
Rehabilitation Act of 1973. In the school setting, such a student has a physical
impairment that limits one or more major life activities. Subpart D of the regulations of
Section 504 addresses services that will allow the student with a disability to receive a
free and appropriate education (FAPE) as adequately as a non-disabled student (§
104.33). A written 504 Plan (also called a 504 Service Agreement) documenting services,
modifications, and accommodations is required. Under such a plan, school-based
physical therapy services may be identified as a reasonable accommodation and services
would be provided within the regular education environment. (references: McEwen I.
Providing Physical Therapy Services Under Parts B & C of the Individuals with
Disabilities Act (IDEA). Alexandria, VA: Section on Pediatrics, American Physical
Therapy Association; 2000; Smith T, Patton JR. Section 504 and Public Schools: a
practical guide for determining eligibility, developing accommodation plans, and
documenting compliance. Texas: PRO-ED; 1998)
Providing Skilled Intervention
The terms “school-based” and “educationally-based” physical therapy encompass all
physical therapy services provided in educational settings to assist students to access,
participate in, or benefit from their educational programs. These services may be direct or
consultative in nature. Physical therapists typically provide these services in the natural
environment of the classroom, other areas of the school, and in community setting used to
support the child’s IEP. Physical therapists work with the entire team to integrate and
implement therapeutic activities within these natural environments. (reference: McEwen
I. Providing Physical Therapy Services Under Parts B & C of the Individuals with
Disabilities Act (IDEA). Alexandria, VA: Section on Pediatrics, American Physical
Therapy Association; 2000)
Progress Monitoring
IDEA and PA Chapter 14 mandate that data based information or progress monitoring
drives instruction (therapeutic intervention) thus physical therapists that provide services
in Pennsylvania schools must participate in information collection of student performance
20
relative to goals and objectives in the IEP to determine goal progress and to affect
therapeutic intervention.
The expectation of demonstrating progress of clients/patients and justification for the
effectiveness of intervention has been part of physical therapy over the past few years as
well as included in the educational system. It is important that therapists continually
examine the student’s performance as a means to determine if the therapeutic intervention
is effective. Because therapists use goals/objectives as a measure of the intervention in
school-based therapy, collecting data on the student’s performance relative to the
goals/objective criteria provides a measure to determine intervention effectiveness.
The American Physical Therapy Association emphasizes that physical therapists should
maintain “defensible documentation” and has a list of tips for therapists:






update goals regularly
highlight progress toward goals
clearly indicate improvement
show comparisons from previous dates to current date
focus on function
re-evaluate when clinically indicated
Progress monitoring follows these APTA guidelines. Progress monitoring helps the
physical therapist to develop goals or functional school-related outcomes and criteria for
each student and to determine success of school based intervention. Physical therapists’
anecdotal comments, such as, the student is progressing nicely or the student has made
small improvement or the student has made great improvement, do not state the student’s
actual performance in school related motor tasks and activities. Using data from the
student’s performances, the therapist can explicitly report progress or lack of progress.
Because there is minimal valid research relative to physical therapy intervention, another
important advantage of monitoring the student’s real performance is for support of
intervention. We can use the information to change or modify the intervention to guide
the student to success.
The physical therapist assists the IEP team in progress monitoring of measurable goals
stated in the IEP as determined by school district or intermediate unit policy.
Benefits—Physical therapists use progress monitoring to assist in determining when to
continue intervention and when to make adjustments to better facilitate student learning
and task performance. If the child’s performance is not meeting expectations for schoolrelated tasks and goals, the therapist then changes the intervention to the child in an effort
to determine the type and amount of intervention the child needs to make sufficient
progress toward the goals.
Progress monitoring is helpful to physical therapists, parents, students, and other team
members because it provides current information at regular intervals on the student’s
21
progress of the performance as stated on the goal/short term objective. Progress
monitoring allows:
A. Comparison of the performance of the student to individualized goals
B. Identification of sufficient vs. insufficient progress toward student goals
C. Provision of frequent and immediate feedback to students, families, and service
providers about the necessity for adjustments to intervention related to specific
goals.
Procedures-- Goals and short-term objectives must state clearly defined and measureable
motor performance(s). Therapists monitor progress by collecting data or a probe of the
student’s motor performance regularly during intervention. The frequency of data
collection/progress monitoring is included in the student’s IEP for each goal and
objective. Therapists need to develop a system for maintaining the collected data using
charts, graphs or rubrics. A rubric gives numerical values to important qualitative aspects
of goals/objectives if a goal/objective has qualitative components of performance.
Therapists briefly assess the student’s performance as stated in the goal/objective on the
basis specified in the IEP, e.g., weekly, bi-monthly, monthly. After the data collection
(probe), the therapist enters the information onto a table or graph and then decides
whether to continue intervention in the same way or to change it. A change may be
appropriate if the student’s rate of progress is lower than needed to meet the annual goal.
The therapist may change intervention in various ways. After the change, the therapist
can see from the on-going probe information on the tables/graphs whether the change is
helping the student. If not, then therapist may make additional changes in intervention
and continues to monitor the student’s performance at the pre-determined intervals.
Additional Applications--Progress monitoring graphs make goals and progress clear to
all team members and helps promote effective communication between therapists and
parents. Progress monitoring graphs presented in conferences with teachers and
administrators give specific information about a student’s progress and the success of the
intervention methods used. Therapists can also use progress monitoring graphs in IEP
meetings to present specific information about the child’s current performance so that the
team can develop measurable goals that will lead to meaningful progress for the student.
Prevention and Wellness
The Guide to Physical Therapist Practice suggests that the “integration of prevention and
wellness strategies into physical therapy intervention” is a critical component of practice.
PTs can effectively integrate their professional expertise toward the prevention of future
health issues within the pediatric population in the educational setting. Prevention and
wellness issues addressed by a school-based physical therapist may include (but are not
limited to) screenings and/or education for backpack safety, postural screenings,
flexibility screenings, body mechanics, cardiopulmonary conditioning, obesity prevention
or intervention, physical fitness for students with disabilities, and bicycle safety.
Within the educational setting, physical therapists may collaborate with physical
educators, school health councils, nutrition educators, school nurses, and special
22
educators to promote wellness and fitness. PTs can contribute to the development and
implementation of programs and can provide in-services on safe exercise programs.
As a resource for PTs working in Pennsylvania, the Penn State Hershey Center for
Nutrition & Activity Promotion works on a statewide scale through Pennsylvania
Advocates for Nutrition and Activity (PANA) and other regional organizations. Their
objective is to deliver programs and events that support healthy eating and physical
activity in schools, recreation, healthcare, and the community. The website
www.nrgbalance.org provides further information and links for fitness related
information.
Transportation
Physical Therapists may be asked by the LEA to determine if the transportation of
children with disabilities is in line with current standards or to provide input for
transportation needs of a specific student. ANSI/RESNA WC19 provides guidelines that
have been developed for wheelchair transportation safety. Links to these guidelines can
be found in the ‘websites’ section of this document. See page 40 for additional
information.
Referral Requirements
The Pennsylvania Physical Therapy Practice Act (accessible at:
http://www.ppta.org/site/1/docs/ptact.pdf) regulates the provision of physical therapy in
Pennsylvania. Intervention provided on an IEP or 504 Plan must meet the requirements
for physician referral under the Physical Therapy Practice Act. The Physical Therapy
Practice Act states that a physician, physician assistant, or certified registered nurse
practitioner referral is required to provide physical therapy treatment.
If a physical therapist has met the requirements and maintains a certificate of
authorization to practice physical therapy without a referral, treatment can be provided
for a 30-day interval without referral. If treatment continues beyond 30 days, the therapist
must obtain a valid referral from a physician, physician assistant, or certified registered
nurse practitioner (practicing under a written/collaborative agreement with a physician),
podiatrist, or dentist for continuance of physical therapy treatment within the school
setting. Physical therapists in educational settings use professional judgment to determine
how frequently new physician referrals should be obtained. An IU or school district may
adopt a policy that requires a medical referral for physical therapy intervention.
NOTE: A medical referral for physical therapy is only one piece of input to a child’s IEP
team. Each team member’s input must be considered within the context of the child’s
overall program. A physician or team member cannot make decisions in isolation. “If a
physician’s referral specifies a type or intensity of physical therapy that is inconsistent
with the decisions of the rest of the team, then a team member (usually the physical
therapist or parent) must contact the physician and resolve the differences. The referral
cannot be ignored; but neither can the physician order that the physical therapy be
23
provided.” (McEwen, IR. “Providing Physical Therapy Services under Parts B & C of
the Individuals with Disabilities Education Act (IDEA), Section on Pediatrics, APTA:
2009, p. 15)
Episodic Nature of Physical Therapy Services
Changes in individual student needs may indicate changing physical therapy services
from year to year resulting in episodic intervention. These interventions will allow the
student to meet goals, access their educational environment, and/or transition to the next
educational environment or community living. (reference: IDEA 2004, P.L. 108-446;
2004) Physical therapy as a related service is not automatically indicated based upon a
student’s physical or cognitive diagnosis but is determined by the IEP team based upon
the student’s needs. Consideration is given to the child’s placement and other IEP
supports. Physical therapy services may include a range of services and frequencies
which are clearly stated in the IEP. Students may require direct treatment or intervention
that requires the skills of a physical therapist in order to achieve IEP goals or access their
educational environment. Other students may require physical therapy services provided
as support for school personnel when direct intervention is not indicated. Many students
require physical therapy services provided through a combination of related services and
support for school personnel.
Support for school personnel may address a student’s needs through consultation and
collaboration with the educational team (e.g., through group services such as a fitness
program for a Life Skills Support class or through consultation with physical education
teachers.)
Adding, Revising, or Discontinuing Physical Therapy Services
Educationally-based physical therapy services may be added, revised, or discontinued by
several methods, dependent on the time frame when service changes are necessary. Time
frames include:
1. During a multidisciplinary evaluation, the physical therapist may identify student
needs that will support a recommendation for physical therapy service. With team
consensus, physical therapy services are then included in the IEP.
2. At the time of a reevaluation, the results of the physical therapy evaluation and
progress monitoring may support the addition, revision, or deletion of services that
are on the existing IEP. With team consensus, these changes are included in the new
IEP.
3. When an annual IEP is being developed, the physical therapist identifies the student’s
present levels of performance through evaluation, observation, and/or progress
monitoring. The educational team collaborates to develop goals/objectives and to
recommend service, frequency, and duration, which may be an addition, revision, or
deletion of services on a previous IEP.
24
4. Within the term of an IEP, physical therapy services may be added, revised, or
discontinued at any time. Professional judgment is used when recommending
changes, and judgment is based on ongoing assessment of the child’s progress,
changes in the child’s physical condition or abilities, and/or changes in the child’s
environment. The parent and the education agency can agree not to convene an IEP
Team meeting and may develop a written document to amend or modify the child’s
current IEP. (§ 300.324(4)i.) To add, revise, or delete services, the physical therapist
provides current levels of performance based on evaluation and progress monitoring
and makes the recommendation for a change of service. The changes are made as part
of the written document, included in the IEP section for revisions, and the child’s IEP
team must then be informed of the changes.
IDEA 2004 specifically states the processes for making changes to a child’s IEP within
the term of the IEP. References are as follows:
 “If there is a proposed change, the parent of a child with a disability and the local
educational agency may agree not to convene an IEP meeting for the purposes of
making such changes, and instead may develop a written document to amend or
modify the child’s current IEP.” [IDEA 2004 (d(3)(D)]
 Changes to the IEP may be made by the entire IEP team or by amending the IEP
rather than redrafting the entire IEP. The parents can receive the revised copy of
the IEP with the amendments incorporated if they ask for it. [IDEA 2004
(d)(3)(F)]
 The local educational agency must make sure that the IEP team revises the IEP as
appropriate to address any lack of expected progress toward the annual goals and
in the general education curriculum when appropriate. [IDEA 2004
(d)(4)(A)(ii)(I) & IDEA 2004(d)(4)(A)(ii)(II)]
The IEP form recommended by the Pennsylvania Department of Education for students
in school-age programs (kindergarten and above) has a place on the front of the IEP form
specificly for making revisions to the IEP without convening a meeting. The IEP form
can be found at the following
link: http://www.pattan.net/files/Forms/English/IEP_040106.pdf. The form specifically
states as follows: “The LEA and parent have agreed to make the following changes to the
IEP without convening an IEP meeting, as documented by: Date of Revision(s),
Participants/Roles, and IEP Section(s) Amended”.
25
V. UTILIZING THE APTA GUIDE TO PHYSICAL THERAPIST PRACTICE, 2ND
EDITION, IN EDUCATIONAL SETTINGS
Disablement Models
In June 2008, the APTA House of Delegates endorsed the World Health Organization's
(WHO) International Classification of Functioning, Disability and Heath (ICF). The ICF
model describes human functioning and disability as a dynamic interaction between
various health conditions and environmental and personal factors. It recognizes the
impact of the environment on the person's functioning. By using the ICF model, changes
can be described that occur in the body, the whole person, the child's ability to perform
tasks, his or her social roles, and the environment that forms the context of a child's life.
In practice in educational settings, the ICF offers various domains that may be considered
when evaluating a student and in determining what other influences may be affecting the
child, such as environmental factors. After considering all of these areas, the PT has the
opportunity to target interventions and involve others who may be able to provide
services for the student from a different perspective (such as psychology, occupational
therapy, speech-language pathology, etc) so that all of the student’s needs are met.
NOTE: The current Guide to Physical Therapist Practice, 2nd edition (2001) uses the
Nagi Scheme as its framework of a disablement model to identify how physical therapists
practice and assess outcomes. The upcoming revision of the Guide will use the ICF
model and is also planned to have much more information and applicability for pediatric
practice settings.
Evidenced-based Medicine (EBM)
Evidenced-based medicine (EBM) is the integration of best available relevant research
evidence combined with clinical expertise, experience, and patient values. It is an equal
partnership of family and therapist. Included are the therapist’s clinical knowledge,
experience, and skills and the patient’s values or their unique characteristics, preferences,
and expectations.
The practice of EBM includes converting the need for information into an answerable
question, tracking down the best evidence with which to answer the question, critically
appraising that evidence for its validity and applicability to clinical practice, and
integrating the critical appraisal with clinical expertise and the patient’s unique clinical
picture, situation, and expectations.
Finding Current Best Evidence
Some suggestions for more information and resources:


For APTA members - APTA website: www.apta.org Hooked on evidence
For APTA members- APTA website: www.apta.org Open Door – You can access
full text articles in CINHL and Proquest databases
26



For APTA members of the Pediatric section – You can access full text articles
online of Pediatric Physical Therapy at www.pediatricapta.org
The National Institute of Health’s website – www.pubmed.org has access to
abstracts from many peer-reviewed journals.
Evidence-based Medicine: How to Practice and Teach EBM, 2nd edition, by
David L. Sackett, et al 2000.
Examination
As described in the Guide to Physical Therapist Practice, the examination is a process of
obtaining a history, performing relevant systems review, and selecting and administering
specific tests and measurements. In educational settings, components of the examination
may be performed individually by the physical therapist and other team members and
discussed at a team meeting, or in some settings (e.g., preschool), the examination may
be performed collectively with the entire team present. (reference: Application of the
Guide to Physical Therapist Practice to a Pediatric Case, available at:
www.pediatricapta.org.) Typically, the examination is part of the MDE process in the
educational setting, although examination can also take place for the IEP if new
information is needed.
History - The examination may include the following in the area of history:
1. Review of stated goals and notation of progress toward those goals, if the child has an
active Individualized Family Service Plan (IFSP), IEP, or Service Agreement in
place. This is not pertinent for those individuals who are in the process of being
identified and do not have an IFSP, IEP, or 504 Service Agreement;
2. General demographics;
3. Previous physical therapy history;
4. Growth and development;
5. School environment and educational placement;
6. Functional status and activity level related to function in school. This may include
function at home or in the community as it relates to school;
a. Areas include function, access, and mobility within the varied school
environments and during school functions (e.g., bus transportation; recess;
field trips; fire drills; stairs; classrooms including music, art, library; gym;
cafeteria; and playground;
b. Level of participation in special classes (including physical education, music,
art, library), recess, field trips, and special events;
7. Medications and effects of medications on functional ability;
8. Review of other clinical tests;
9. Current condition;
10. Parent’s concerns/issues/goals/expected outcomes;
11. School personnel’s concerns, goals, and expected outcomes (school personnel may
include but are not limited to regular education teachers, special education teachers,
classroom aides or paraprofessionals, school nurse, physical education teachers,
cafeteria personnel, bus drivers);
27
12. Child’s concerns/issues/goals/expected outcomes;
13. Pertinent medical and surgical history; and
14. General health status.
Systems Review - This is a brief or limited examination to provide additional information
through screening in the following areas:




Cardiopulmonary
Integumentary
Musculoskeletal
Neuromuscular
NOTE: Screening of the gastrointestinal system (e.g., concerns such as reflux,
constipation) is also highly recommended due to the impact of this system on posture and
movement in children.
Developmental domains that may influence a child’s function should also be reviewed.
These include: cognition, language and communication, social/emotional development,
adaptive function, physical development, vision, hearing, and play (reference: Using
APTA’s Guide to Physical Therapist Practice in Pediatric Settings available at
www.pediatricapta.org).
The systems review may identify a need for consultation by or referral to other
educational professionals such as an occupational therapist, behavioral specialist, vision
therapist, and speech therapist, or health professionals outside the education setting such
as an orthopedic specialist or neurologist. In addition, the screening may lead to a
decision not to proceed with further testing until the child is seen by another professional
(e.g., if you suspect there may be an undetected fracture). Systems review can be driven
by the child’s history or appearance; by what family, school personnel or the child
reports; or by the educational setting (e.g., preschool, center-based classroom, regular
school, or approved private school).
Tests and Measures - Therapists should select tests and measures based on the purpose
or reason for the referral. Physical therapists may use a variety tools to assess a student’s
function and participation in school-related tasks and activities. IDEA 2004 states that
evaluation must be based on technically sound instruments and on a variety of measures.
The physical therapist should know the purpose of the test and use it for its intended
purpose to ensure that the test is appropriate to assess the child’s function in school.
NOTE: “The difference between ‘eligibility’ for school-based physical therapy and
‘need’ for school-based physical therapy is important to understand. All students who are
eligible for special education and some students with disabilities who do not receive
special education are eligible for physical therapy. Generally, if a student has a disability,
the student can receive school-based therapy if the student’s educational team decides
that the student needs physical therapy services.” (reference: McEwen, IR (2009) page
28
37) Standardized tests may be used for school age students but are not required for
eligibility for related services.
Physical therapists usually use one of three types of testing measures: discriminative,
evaluative, and predictive



Discriminative measures are used to determine whether or not a child has delays
in a particular area such as gross motor skills. Examples of discriminative tests are
the Peabody Developmental Motor Scales-2nd edition and the Battelle
Developmental Inventory-2nd edition.
Evaluative measures monitor change over time and can be used to measure
change as the result of intervention. Examples of evaluative measures include the
Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory.
Predictive measures help identify children who will have delays or disabilities in
the future.
Standardized measurement tools are norm-referenced and/or criterion-referenced.


Criterion-referenced measures are used to note a child’s ability to perform the
items on the test (criterion) on successive performances and are appropriate to
measure change over time for the child. Test examples of a criterion-referenced
test are The School Function Assessment and Gross Motor Function Measure.
Norm-referenced measures are used to compare an individual’s performance to
group performance. The Peabody Developmental Motor Scales is an example of a
norm-referenced test.
Tests and measurements should include the following areas:
1. Impairment-level measures (e.g. joint range of motion, strength, and sensation);
2. Skilled observation in the various environments of the school setting;
3. Functional limitation (activity) measures through standardized tests of motor or
functional skills. Current tests and measurements available for use with children
include:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Peabody Developmental Motor Scales-2nd edition (PDMS – 2);
Bruininks-Oseretsky Test of Motor Proficiency (BOTMP);
Gross Motor Function Measure (GMFM);
Pediatric Evaluation of Disability Inventory (PEDI);
School Function Assessment (SFA);
Battelle Developmental Inventory-2nd edition (BDI-2);
Hawaii Early Learning Profile (HELP);
Miller Assessment for Preschoolers (MAP);
Functional Reach Test (FRT);
Timed Up and Down Stairs (TUDS);
Timed One-legged Stance (TOLS);
50 feet walk test;
29
m.
n.
o.
p.
q.
Timed Up and Go (TUG);
Pediatric Balance Scale (PBS);
Fitness/endurance tests [e.g., Borg Rating of Perceived Exertion (RPE)];
Exercise testing; and
Gait analysis: speed, distance, surface.
4. Participation level and quality of life assessment
a. Considerations include social interaction and acceptance, participation with
adaptations and modifications
b. Childhood Health Assessment Questionnaire (CHAQ)
c. Pediatric Asthma Quality-of-life Questionnaire
d. Pediatric Evaluation of Disability Inventory (PEDI)
e. School Function Assessment (SFA)
Evaluation
Evaluation is the process by which the physical therapist makes judgments based on data
gathered during the examination. Considerations during the evaluation in educational
settings include:
1. Child’s progress toward IEP goals;
2. Whether or not clinical findings impact on the child’s function or participation at
school;
3. Clinical judgment of student’s status in relation to needs at school;
4. Priorities of the child, family, and school personnel;
5. Stability of the condition in relation to function and participation at school;
6. Chronicity or severity of the current problem;
7. Developmental expectations in relation to the child’s disability and based on most
recent research evidence;
8. Physical environment of the school (e.g., need to negotiate stairs, distances
between classes, etc.) in relationship to the student’s function; and
9. Strengths and needs of the child in relation to function and participation in the
school setting.
Diagnosis
Diagnosis is a label encompassing a cluster of signs related to impairments of the body
systems. (reference: Using APTA’s Guide to Physical Therapist Practice in Pediatric
Settings available at www.pediatricapta.org.) Practice Patterns described in the APTA
Guide to Physical Therapist Practice are not typically used in educational settings.
Diagnosis in educational settings may be appropriately addressed by the physical
therapist making skilled contributions to identifying the child’s strengths and needs in the
school setting.
30
In addition, diagnosis can include the classification of a child’s status in relation to other
children with the same diagnosis. Examples of common classification systems include:
1. Gross Motor Functional Classification System (GMFCS) – The GMFCS is a fivelevel system to classify severity of motor involvement in children with cerebral palsy
based on of their functional abilities and need for assistive technology and wheeled
mobility (reference: CanChild Centre for Disability research accessible at
www.canchild.ca); and
2. Glasgow Coma Scale or Ranchos Los Amigos Scale – used with persons with brain
injury.
Prognosis (including the Plan of Care)
For physical therapists in educational settings, prognosis is most commonly the
determination of the predicted optimal level of improvement in function that can occur
within the specified time of the IEP, usually one year. Factors such as age, function in
various developmental domains, and chronicity or severity of the current condition may
impact the prognosis. The prognosis is considered to be only a best estimate of what to
expect.
In educational settings, the plan of care is driven by the student’s IEP or 504 Plan.
(reference: Using APTA’s Guide to Physical Therapist Practice in Pediatric Setting,
available at www.pediatricapta.org.) Physical therapists and other members of the
education team use identified student strengths and needs to guide decision making when
writing IEPs and 504 Plans. The needs of students receiving special education services
are addressed in discipline-free IEP goals and through specially designed instruction. The
needs of students receiving 504 plans are addressed through modifications,
accommodations, and services. Physical therapists participate in team decisions regarding
development of IEP goals and objectives, specially designed instruction, and the need for
related services and supports for school personnel (including frequency and duration).
Intervention
Intervention in educational settings is the purposeful and skilled interaction of the
physical therapist with the child and members of the child’s educational team. Physical
therapy intervention supports goals and specially designed instruction identified on a
child’s IEP or assists in making accommodations specified in a 504 plan. Intervention
consists of the following components:
Coordination, Communication, and Documentation
Coordination is the working together of all individuals involved with the education of the
child (e.g., identifying needed modifications and accommodations, sharing strategies with
other team members, coordinating school motor programming, data collection, and
progress monitoring.) This may occur formally at IEP meetings, IST meetings, or other
31
team meetings, or more informally by telephone, email, or personal interaction within the
school environment.
Communication is the exchange of information in any form including verbal, written
formal reports, informal reports, email, report cards, and handouts.
Documentation is any entry into the child’s educational records such as evaluations,
present levels, consultation reports, recommendations, progress notes, flow sheets,
checklists, data collection, progress monitoring, and progress reports.
Patient/Client–related Instruction
In educational settings, patient/client-related instruction involves the reciprocal sharing of
information between the physical therapist and other members of the educational team,
including the child and parents. Instruction may include sharing information on:
1. a child’s condition/disability to assist team members to understand present
abilities;
2. the prognosis of a condition to plan expectations for the future (e.g., planning for
a child with Duchenne muscular dystrophy);
3. specific impairments, especially in relationship to functional limitations (e.g.,
planning adaptations to class activities with the physical education teacher)
4. functional limitations (e.g., discussing accommodations or adaptations that may
be needed so that a child may be successful in school);
5. plan of care in regards to what is needed for the child to be successful in the
school and what supports and support personnel is needed;
6. specific strategies/interventions to incorporate into classroom routine;
7. functional mobility and moving between positions;
8. positioning students for participation in educational activities;
9. back safety and body mechanics for safe lifting;
10. use of adapted equipment;
11. transitions (e.g., pre-school to school age, or elementary school to middle school)
and factors that need to be considered in planning for future needs (e.g., the
addition of stairs in the new environment, longer distances between classes, and
new types of classes such as swimming or vocational classes);
12. prevention of secondary conditions; and
13. need for health, wellness, or fitness activities to be able to tolerate an entire school
day five days per week.
Procedural or Direct Interventions
Physical therapy interventions are selected based on examination data, evaluation,
diagnosis, prognosis, and IEP goals or needed accommodations for a particular child in a
specific educational setting. Interventions may be modified or changed based on the
child’s response and progress toward achieving IEP goals. Interventions may require
direct skill training by the physical therapist and may also involve development and
32
monitoring of a classroom motor program or fitness program carried out within the
educational curriculum by other members of the team (e.g., classroom teacher, physical
education teacher, or support staff).
Re-examination/Re-assessment
In educational settings, re-examination/re-assessment includes: 1) progress monitoring of
IEP goals (typically performed weekly, bimonthly, or monthly) and reported to parents at
specified intervals; and 2) performance of appropriate tests and measurements to
determine present levels of functional performance for the student’s annual IEP and/or
RR.
33
VI. ADMINISTRATION OF EDUCATIONALLY-BASED PHYSICAL THERAPY
SERVICES
Supervision and Management
Physical therapy department structure will vary depending on the number of therapists
employed by a school district or an intermediate unit. Whenever possible, physical
therapists in a school district or intermediate unit should be supervised and managed by a
physical therapist. However, this may not be reasonable or practical when there are few
physical therapists employed. The supervisor for physical therapy may then be an
occupational therapist or a supervisor of another educational discipline.
It is important to have written protocols and policies for physical therapy services in
educational settings. Protocols and policies identify the models of service delivery,
expectations for participation in administrative activities, documentation of procedures,
and professional evaluation processes.
The supervisor of physical therapy services participates in the administrative activities of
the school district or intermediate unit in the following ways:
1. Establishes workload, assigns locations and caseloads;
2. Evaluates the quality of services rendered by physical therapists;
3. Establishes training and in-service for the physical therapists;
4. Develops the model for delivery of services, protocols, and procedures; and
5. Manages the budget for physical therapy including equipment, supplies, protocols,
training, and staffing.
Workload, Caseloads and Assignments
The work load of a therapist includes all of the factors listed below. These factors must be
considered when assigning students and locations. It is the total of these factors that
determines the number of students that can be on a therapist’s caseload. Factors influencing
workload and caseload are:
Types of service provided: Services may include assessment of new referrals or continuing
students, direct physical therapy intervention, and consultative services. The type of service
will impact the time the therapist spends with the child and with other team members.
Frequency and duration of service: The IEP team determines service frequency and duration
based on the students’ needs and educational goals.
34
Geographic location of student: Time spent traveling between schools impacts the number of
students a therapist can have on a caseload.
Team meetings and consultation with educational team members: This time is necessary to
ensure that the physical therapist has the opportunity to collaborate with other team members
for integration of the physical therapy program into the school program.
Administrative time: Time must be included for report writing and documentation, meetings,
in-services, staff development, parent contact, administrative duties, and other
responsibilities.
Professional Evaluation
Physical therapists should have a yearly performance evaluation with their supervisor.
Physical therapists should be evaluated in areas of professional performance only by a
physical therapist. If the supervisor is from another educational discipline, the evaluation
should be directed at administrative areas and interaction in the educational setting but
not professional performance. In this situation, options for evaluation of professional
performance should be explored including peer supervision or contracting for physical
therapy supervision by a physical therapist with experience in educational-based physical
therapy. A physical therapist hired by a school agency should identify at the time of
hiring how professional evaluation will be completed.
Procedures for the professional evaluation of the physical therapist should be developed
within the agency. This procedure should include a written evaluation based on
established criteria. An evaluation tool may be adapted from the existing professional
evaluation for teachers and other professionals; however, it is important to have criteria
for evaluation based on pediatric physical therapy competencies as well as professional
skills in the entire educational process.
Pre-service and In-service Education
Pre-service Education: Pre-service instruction should be provided for a physical
therapist entering service in the educational setting. This instruction should include:
1. Instruction in provision of physical therapy service within the educational setting
including understanding of physical therapy as a related service in the IEP;
2. Introduction to applicable Federal and Pennsylvania education laws and regulations;
3. Review of the requirements for practice in the Physical Therapy Practice Act;
4. Review of local protocols and procedures including referral process, development of
IEPs, documentation procedures, service recommendations, models of intervention,
organizational structure, supervision and evaluation procedures.
35
In-service Education: A physical therapist should be provided with opportunities for
continuing education that will promote professional growth and development. These may
include:
1. Local opportunities for professional exchange with pediatric or school- based
providers;
2. Conferences and professional development programs in physical therapy;
3. APTA continuing education courses in pediatrics including courses sponsored by the
APTA School-based Special Interest Group;
4. Opportunities focusing on special education theory or process, provided at a local
level; and
5. Graduate programs in physical therapy or special education.
Mentoring
A mentoring program for a physical therapist entering the education setting is highly
recommended. The new therapist for at least the first year of employment is paired with a
physical therapist with experience in the educational setting. Protocols for mentoring
programs should be developed to include the expectations of both therapists including
expected interactions, time, and commitment. Mentoring can follow the local procedures
for mentoring of teachers and other professionals with adaptations for experiences unique
to physical therapy.
Clinical Instruction of PT/PTA Students in Educational Settings
Clinical instruction in school-based practice settings follows the same guidelines as in
other practice areas. The relationship between an academic program and a clinical site is
a voluntary partnership. The clinical education team consists of the Academic
Coordinator/Director of Clinical Education (ACCE/DCE), the Center Coordinator for
Clinical Education (CCCE), the Clinical Instructor (CI) and the student. School-based
practice settings considering becoming clinical education sites should have a CCCE for
administration, coordination, management, and supervisory purposes. The CCCE may be
a physical therapist; however, this position may also be filled by a physical therapist
assistant, occupational therapist, speech-language pathologist, or similar professional.
A PT or PTA desiring to be a clinical instructor should demonstrate: 1) clinical
competence; 2) legal and ethical behavior; 3) good interpersonal relationships; and 4)
effective skills in communication, instruction, supervision, and performance evaluation.
Clinical instructors should be prepared to address professional behaviors and attitudes,
safety, interpersonal relationships and communication skills, problem solving processes,
clinical performance skills, and administration/management skills. They should also be
familiar with legal, regulatory, and ADA issues in clinical education.
36
The APTA offers a voluntary Clinical Instructor Education and Credentialing Program.
This program is designed for people interested in or involved with the clinical education
of PT and PTA students. School-based PTs and PTAs with an interest in clinical
education are encouraged attend this program.
Costs and Budgeting:
Budgets should include standard items such as salary, benefits, facilities or rentals, office
supplies, continuing education and in-services, and mileage reimbursement, etc.
Budgetary items unique to physical therapy would include toys and therapeutic materials
for the implementation of treatment, positioning equipment, mobility aids such as
walkers or crutches, splinting and adaptive equipment materials, and specialized test
materials and protocols.
It is the responsibility of the physical therapist and the physical therapy supervisor to
ensure participation and input in the preparation of local education budgets.
37
References / Resources
Barry, M. Evidence-based practice in pediatric physical therapy. Physical Therapy. 2001;
9(11):38-50.
Bundy, A. Assessment and intervention in school-based practice: Answering questions and
minimizing discrepancies. Physical & Occupational Therapy in Pediatrics.
1995;15(2):69-88.
Campbell, SK, Vander Linden, DW, Palisano, RJ. (Eds). Physical Therapy for Children, 3nd
Edition. Philadelphia:W.B.Saunders; 2005.
Campbell, SK. Therapy programs that last a lifetime. Physical & Occupational Therapy in
Pediatrics. 1997; 17(1):1-15.
Damiano, D (Ed). Topics in Physical Therapy – Pediatrics. Alexandria: American Physical
Therapy Association;2001.
David, K.S. Monitoring progress for improved outcomes. Physical & Occupational Therapy in
Pediatrics. 1996; 16(4), 47-76.
Drasgow, E, Yell, ML, Robinson, TR. Developing legally correct and educationally appropriate
IEPs. Remedial and Special Education.2001;22(6):359-373.
Effgen SK. Factors affecting the termination of physical therapy services for children in school
settings. Pediatric Physical Therapy.2000;12:121-126.
Effgen SK. The educational environment. In: Campbell SK, Vander-Linden DW, Palisano RJ,
eds. Physical Therapy for Children, 3rd ed. Philadelphia, Pa: WB Saunders
Co;2006:955- 982.
Effgen SK, Chiarello L, Milbourne SA. Updated competencies for physical therapists working in
schools. Pediatric Physical Therapy. 2007;19:266-274
Effgen SK, Klepper SE. Survey of physical therapy practice in educational settings. Pediatric
Physical Therapy. 1994;6:15-21.
Giangreco MF. Related-services decision making: a foundational component of effective
education for students with disabilities. Physical & Occupational Therapy in Pediatrics.
1995;15:47-67.
Guide to Physical Therapist Practice, 2nd Edition. Alexandria, VA: American Physical Therapy
Association: 2001.
Hanft, BE, Place, PA. The Consulting Therapist. San Antonio:Therapy Skill Builders; 1996.
38
Kaminker, MK, Chiarello, LA, O'Neil, ME, Gildenberg Dichter, C. Decision Making for
Physical Therapy Service Delivery in Schools: A Nationwide Survey of Pediatric
Physical Therapists. Physical Therapy. 2004;84:919-933.
Long, T, Toscano, K. Handbook of Pediatric Physical Therapy, Second Edition.
Baltimore:Lippincott Williams & Wilkins;2002.
McEwen, IR, Shelden, ML. Pediatric therapy in the 1990’s: The demise of the educational versus
medical dichotomy. Physical & Occupational Therapy in Pediatrics. 1995;15(2):33-45.
McEwen, IR (Ed). Providing Physical Therapy Services under Parts B & C of the Individuals
with Disabilities Education Act (IDEA). Alexandria: Section on Pediatrics, American
Physical Therapy Association; 2009.
Missiuna, C., Malloy-Miller, T., Mandich, A. Cognitive, or "Top-Down", Approaches to
Intervention. Distributed by CanChild Centre for Childhood Disability Research;1997.
Muhlenhaupt, M, Miller, H, Sanders, J, Swinth, Y. Implications of the 1997 reauthorization of
IDEA for school-based occupational therapy. School System, Special Interest Section
Quarterly of AOTA. 1998;5(3):1-4.
Rainforth, B, York, J, & Macdonald, C. Collaborative Teams for Students with Severe
Disabilities. Baltimore:Paul H. Brookes; 1992.
Rapport, M.J. Laws that shape therapy services in educational environments. In McEwen IR
(Ed), Physical and Occupational Therapy in Pediatrics. Binghamton:Haworth
Press;1995.
York J, Rainforth B, Giangreco MF. Transdisciplinary teamwork and integrated therapy:
clarifying the misconceptions. Pediatric Physical Therapy.1990;2:73-79.
39
WEBSITES
FEDERAL LAWS & REGULATIONS
FEDERAL LAW SECTION 504
http://www.ed.gov/about/offices/list/ocr/disabilityresources.html
http://www.hhs.gov/ocr/504.html
http://ericec.org/fq/sectn504.html
www.usdoj.gov/crt/ada/cguide.htm#anchor65610.
SECTION 504; IDEA
http://www.ed.gov/policy/speced/leg/edpicks.jhtml?src=ln
FEDERAL – OFFICE OF SPECIAL EDUCATION
AND REHABILITATIVE SERVICES
FEDERAL- IDEA 2004 RESOURCES
http://www.ed.gov/about/offices/list/osers/index.html?src=rt
http://www.ed.gov/policy/speced/guid/idea/idea2004.html
http://www.ed.gov/policy/speced/guid/idea/idea2004.html
UPDATES-IDEA 2004
FEDERAL RESOURCES IDEIA RESOURCES
IDEA PARTNERSHIP
http://www.cec.sped.org/law_res/doc/
-
http://www.ideapartnership.org/whatsnew.cfm
PA LAWS & REGULATIONS
PA DEPARTMENT OF EDUCATION
http://www.pde.state.pa.us/
PA – SPECIAL EDUCATION HOME
http://www.pde.state.pa.us/special_edu/site/default.asp
GASKIN CASE
http://www.pde.state.pa.us/special_edu/cwp/view.asp?a=177&Q=109539
Pennsylvania Training and Technical Assistance
Network (PaTTAN)
http://www.pattan.k12.pa.us/
PA CODE CHAPTER 15 –
PROTECTED HANDICAPPED STUDENTS
http://www.pacode.com/secure/data/022/chapter15/chap15toc.html
APTA RESOURCES-PEDIATRIC SECTION
Downloadable Brochures:
 ABCs of Pediatric PT
 Providing PT in the School Systems under IDEA
 Using APTA's Guide to Physical Therapist Practice in
Pediatric Settings
 Evidence-based practice in Pediatric physical Therapy
 A Pediatric Case Example: Application of the Guide to
Physical Therapist Practice
 Intervention for Youth Who Are in Transition from School to
Adult Life
http://www.pediatricapta.org/members/publications.cfm
40


Developmental Coordination Disorder
Assistive Technology and the Individualized Education
Program
 Promoting Your Child’s Development: Information
Resources for Families of Children with Disabilities
 Using Evidence to Select an AFO for Children with Cerebral
Palsy
Legislative Issues
 Update on IDEA
 New information on IDEA
 IDEA 2004, Ppl 108-446 Impact on Physical Therapy related
Services by Kathy David, PT, MS, PCS
http://www.pediatricapta.org/members/peds-govt-affairs.cfm
TRANSPORTATION
 Ride Safe Brochure (www.travelsafer.org/index.shtml)
 University of Michigan Transportation Research Institute
(www.umtri.umich.edu)
 University of Pittsburgh (www.wheelchairnet.org)
 Society of Automotive Engineers (www.sae.org)
 RESNA Rehabilitation Engineering Society of North
America (www.resna.org)
 ANSI American National Standards Institute
(www.ansi.org)
 ASTM American Standards for Testing & Materials
(www.astm.org)
 National Highway Traffic Safety Administration
(www.nhtsa.dot.gov)
 National Mobility Equipment Dealer's Association
(www.nmeda.org)
 The Association for Driver Rehabilitation Specialists
(www.driver-ed.org)
 International Organization for Standardization
(www.iso.org)
 Rehabilitation Engineering and Research Center on
Wheelchair Transportation Safety (www.rercwts.pitt.edu)
The first consideration for transporting students with special needs should be transferring
to a secured child safety seat or vehicle restraint system, depending on the child’s age and
weight. When the extent of disability precludes this, then a wheelchair tie-down system
should be used. The standard for wheelchair safety is the ANSI/RESNA WC19
guidelines. Wheelchairs that have been crash-tested and comply with WC19 standards are
labeled so and they will have four, crash-tested points to secure tie-down straps and
hooks. If the wheelchair is not compliant with WC19 standards, then tie-down straps and
hooks should be attached to the accessible metal frame. While securing the wheelchair to
the vehicle is important, it is just one part of the puzzle. Through the Wheelchair Tiedown and Occupant Restraint System (WTORS), the child should also be secured with a
crash-tested lap and shoulder belt or child restraint harness. It should be noted that the
postural support belts attached to the wheelchair are not strong enough alone to withstand
the impact of a crash. The WTORS should always be labeled as complying with the
Society of Automotive Engineers (SAE) J2249. It is important to secure the wheelchair
so that it faces forward and then secure the wheelchair optimally with the WTORS to the
vehicle. Also, it is important to read and follow all manufacturer's instructions, regularly
check and replace worn or broken components, keep tie-down tracks free of dirt and
debris, and if the WTORS and wheelchair have been in an accident to check with the
manufacturer to determine if repairs need to be made.
(resource: Ride Safe Brochure and ANSI/RESNA WC19)
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Appendix A
Application of the APTA Guide to Physical Therapist Practice, 2nd Edition,
to Educational Settings
GUIDE TO PHYSICAL THERAPIST
PRACTICE
EDUCATIONALLY-BASED PT
Students with Special Education
EDUCATIONALLY-BASED PT
Students without Special Education
A.
Informed consent
Permission to evaluate
Permission to evaluate
B.
Initial examination & evaluation
Gather information
Gather information
 Background history, intervention, etc.
 Background history, intervention, etc.
 Family information
 Family information
 Teachers and school staff information
 Teachers and school staff information
Systems review
Systems review
 Neuromuscular, musculoskeletal,
cardiovascular/pulmonary, integumentary
Observations
Assessments
Plan of Care
cardiovascular/pulmonary, integumentary
Observations
 Performance in multiple school settings
C.
 Neuromuscular, musculoskeletal,
 Performance in multiple school settings
Assessments
 Ecological
 Ecological
 Standardized
 Standardized
Review of findings from background and family
information, educational information, observations &
assessments with the educational team.
Review with educational team the student’s educational
strengths, needs, and priorities for the student to learn
and participate in his/her education.
Write an evaluation report (ER) or re-evaluation report
(RR) with the educational team.
The physical therapist is part of the IEP team that prepares
Review of findings from background and family
information, educational information, observations &
assessments with the educational team.
Review with student’s educational team the priorities for
the student to participate in his/her education.
Write a 504 Plan with the educational team. The Plan
includes necessary aids, modifications, accommodations,
and services.
If educational team agrees that student needs physical
an educational program that includes goals (and
therapy support for access in the educational
objectives, when needed), specially-designed
environment, then the team includes physical therapy
instruction, related services support and support to
support frequency and duration along with information
42
school personnel appropriate for the student’s
related to environmental access.
educational needs and priorities.
If the IEP team agrees that the student needs physical
therapy support to accomplish educational goals, for
access, or to support the IEP, then frequency and
duration of physical therapy services are decided at the
IEP meeting.
D.
Intervention
Physical therapist provides skilled contact with student
and/or consultation with the educational team.
E.
Reexamination and Reevaluation
Physical therapist provides skilled contact with student
and/or consultation with the educational team.
Progress monitoring
Review of changes.
Goal reviews
Re-assessment of student access to school facilities and
Consultation and collaboration with educational team
activities
Consultation and collaboration with the educational team.
Annual 504 Plan review
F.
Discharge/Discontinuation of
Intervention
When the IEP team agrees that the student no longer
When the educational team agrees that the student no
needs physical therapy services to achieve educational
longer needs physical therapy services to access school
goals and objectives or to function in the educational
facilities and activities, physical therapy is no longer
setting, physical therapy is no longer included on the
included on the student’s 504 Plan.
student’s IEP.
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Appendix B
Components of an IEP Goal
Condition
Student
Activity
Describe when and
where the activity
will take place
Identify the student
by name
Describe the desired
activity and the
level of prompting
or assistance
1. When walking
with his class in the
hallways
Matt
will keep pace with
his peers when
given verbal
prompts
2. When transferring Sarah
between activities in
the classroom
will stand from her
classroom chair
given verbal
prompts
Performance
Criteria
Indicate the
performance level
for achievement and
frequency of data
collection.
in 2 out of 3 trials
across 3 consecutive
data analysis points,
as measured
2x/month.
in at least 1 out of 3
trials across 3
consecutive data
analysis points, as
measured 2x/month.
*IEP goals should be developed to address the areas of need identified in the present educational
levels section of the IEP and they should be achievable within a 12 month period of time.
If a student takes the PASA rather than the PSSA, then benchmarks or objectives must also be
included. The following is an example of benchmarks for Goal #1.
Condition
Student
1a. When walking
in the halls with an
adult
Matt
1b. When walking
with his class in the
hallways
Matt
1c. When walking
with his class in the
hallways
Matt
Activity
Performance
Criteria
will accurately
in at least 2 out of 3
identify slow,
trials across 3
medium, and fast
consecutive data
walking speeds
analysis points, as
measured 2x/month.
will keep pace with in at least 3 out of 3
his peers when
trials across 3
given physical
consecutive data
prompts
analysis points, as
measured 2x/month.
will keep pace with In at least 1 out of 3
his peers when
trials across 3
given a visual model consecutive data
and verbal prompts
analysis points, as
measured 2x/month.
Data will be collected via recorded observations of Matt’s performance of these tasks and
progress will be reported to his parents via quarterly written progress reports.
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A second way to approach writing IEP goals is to consider that each annual IEP goal must
include the following:
1. Who will achieve the goal? (the student’s name)
2. What specific skill or clearly defined, observable behavior will the child actually do? The
terms used should describe what the child will actually do. For example: say; walk in line
with peers; propel wheelchair; stand up from chair; walk up a flight of stairs; climb on and
off of the school bus, etc. Do NOT use terms such as improve; increase; understand;
discover; recognize; etc. because these terms are not directly observable and are only inferred
as a function of the child’s performance.
3. How – in what manner or at what level? (For example, look for words such as independently,
spontaneously, with prompts, with verbal/visual cues, fading prompts, 3 out of 5 times, etc)
4. Where – in what setting and/or under what conditions? (This describes the condition under
which the child will perform the behavior and will likely describe some portion of the child’s
daily routines. For example: in the classroom; in the hallways; in physical education class;
at recess; across all settings; when the child is socializing in a group; on stairs; during
mealtimes; during dressing routines; with one other child; in a group of no more than 3
children; etc.)
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