Expanding the Role of School-Based Occupational Therapy THROUGH HIGH SCHOOL TRANSITION SERVICES

Transcription

1 Expanding the Role of School-Based Occupational Therapy THROUGH HIGH SCHOOL TRANSITION SERVICES

2 Graduate of Colorado State University School-based therapist since 1998 Lead Therapist since 2006 Fieldwork and Employment Experience: Outpatient Mental Health Rehab Hospital Skilled Nursing Became involved in HS Transition in 2008 Working to make OT an integral part of High School Transition. Linda Q. Rudd, OTR/L Lead Therapist, Peoria Unified School District, AZ

3 Audience Experience How many years in school-based practice? Primary age/population served? Intervention focus? Why are students referred? What skills do you address? What is the average age that students are discharged? How are students discharged and why? Upon discharge from occupational therapy, are the student s disabilities remediated?

4 Audience Experience Do you currently address development of skills related to employment? related to adult living? for post-secondary (after high school) training and education? Are you qualified to support these occupational areas?

5 The AZ OT Pilot Beginning... IDEA Partnership (OSEP) The Beginning Community of Practice in Support of Transition American Occupational Therapy Association Sandra Schefkind, Pediatric Coordinator Arizona Department of Education William McQueary, ESS Transition Services Peoria Unified School District Dawn Ratke, Director of Special Education Research Eastern Kentucky University - Research Karen Summers, MS, OTR/L Peoria Unified School District Occupational Therapists Linda Rudd, OTR/L

6 Arizona OT Pilot - Supports IDEA Partnership Community of Practice on Transition Arizona Department of Education Transition Coordinator American Occupational Therapy Association Peoria Unified School District Occupational Therapists Eastern Kentucky University Researchers

7 Transition Services Mandated by Federal Law IDEA Goal of Transition Services Improve post-school outcomes for students with Disabilities Defined as: A coordinated set of activities for a student with a disability that is designed to facilitate movement from high school to post-school activities, including employment (competitive or supported), education (vocational, training or college), community participation, and independent living. Monitored by OSEP Indicator 13 Included in IEP no later than age 16

8 IEP Transition Components (by age 16) INDICATOR 13 - IEP REQUIRMENTS q Measurable postsecondary goals (MPG) q Updated annually q Based upon age appropriate transition assessments q Coordinated set of activities q Course of study q Annual IEP goals q Student invitation q Outside agency invitation, with prior consent 8

9 Assessment Transition Services Process Formal and Informal (Standardized and Situational) Interests, Preferences and Strengths Measurable Postsecondary Goals After high school I will.... Employment, Education or Training, Adult Living Supported by Assessment data Transition Activities Action Plan To increase Self-Awareness and Self-Determination To Develop skills and knowledge Course of Study High School Courses

10 Occupational Therapy Services - Process Practice of OT Practice of Transition Assessment Client values, interests, roles, routines Performance & Process Skills Treatment Goals Interventions Personalized Meaningful Related to Treatment Goals Education Family, patient, community education and training Assessment Student interests, preferences, strengths Aptitudes & strengths Postsecondary goals Transition Activities Individualized Related to MPGs Course of Study High school classes related to MPG

11 Where there is a will.... There is a way....

12 Student Example MARK 18 y.o. with spastic diplegia cerebral palsy Gregarious, infectious smile and attitude, great speaking voice, outgoing and social; academic strengths in Reading, Writing and Listening/ Speaking Gait disturbance, poor spatial and orientation skills, difficulty with Math Overly optimistic and seemed to have limited insight to disability Multidisciplinary Re-evaluation was requested by parents prior to graduation. Occupational Therapy Ansell Casey Above average skill in Employment related skills Below average skill in Adult Living Skills Recommendations Referral to OT for Driving Evaluation Summarized FAPE accommodations Ergonomic assessment at future job site

13 Student Example SARA S/P Cerebellar medulloblastoma resection age 9 ATAXIA Good student, organized, persistent, understood her learning style, good in Math Difficulty with gross and fine motor control, decreased disability awareness, not socially engaged, decreased selfadvocacy Sophomore Employment MPG: Cake Decorator Course of Study Life Facts Class Transition Assessment Functional Capacity Evaluation OT/PT in class Junior Employment MPG: Accountant Course of Study Transition Classes Senior Education MPG: Community College Transition Assessments Functional Mobility Evaluation OT/PT Assistive Technology Evaluation Transition Activities Site Visit to Disability Center at CC Adult Living MPG: in Apartment Activities ADL Considerations Catalog Review

14 Student Example MARTIN Educational Dx of Emotional Disability. High verbal skills, physically strong and active, liked to ride BMX bikes Multidisciplinary reevaluation Freshmen Year Occupational Therapy Quick Neurological Screen Test Adolescent Sensory Profile Used to explain Learning Preferences Poor Executive Skills: poor attention and concentration Unable to interpret social cues Very emotionally reactive Persecution Complex Ataxic tremor all motor Employment MPG: Work in Bike Shop Transition Assessments Adolescent Sensory Profile Age-Appropriate Fine Motor Skills Functional Capacity Job Site

15 Changes in OT Practice PUSD Increased OT service days at the High School Training in Transition and IEP Documentation Participation in Annual IEPs at the High School Embedded Services In Transition HS In all special education classrooms And general education settings including Special Areas, playground, cafeteria, etc. Push towards collaborative goal writing Not discipline specific goals Identification of Age Appropriate Assessments

16 Age Appropriate Assessments Fine Motor tests related to employment Functional Dexterity Test Hand and Tool Test Grooved Peg Board Sensory Preferences Adolescent Sensory Profile Learning Style Inventories and Study Skills SMALSI Discover Your Learning Style Multiple Intelligences

17 Age Appropriate Assessments Self Determination Assessments Ansell Casey* AIRs Self-Determination Assessment* ARC Self-Determination Student Scales MOHO SSI School Setting Interview COSA Child Occupational Self Assessment Perceived Efficacy and Goal Setting System - PEGS Children's Assessment of Participation and Enjoyment and Preferences for Activities for Children CAPE/PAC Personal Preferences Indicator

18 Age Appropriate Assessments Transition Scales Supports Intensity Scale/PEDI Enderle Severson Transition Behavior Scale Assistive Technology For participation in educational setting Adaptive Equipment and Environmental modification for work and independent living. Situational or Functional Assessments Occupational Therapists ability to Task Analysis is one of the greatest skills that can be offered for Career Planning. Functional Capacity Evaluations

19 Changes in OT Practice PUSD Increased knowledge and awareness Adult Services Vocational Rehab (Voc. Rehab, VR) through DES Department of Development Disabilities Adult and Adolescent Community Supports and Programs Postsecondary Training and Education opportunities Disability Centers at Colleges and Universities University programs for students with Intellectual Disabilities and/or Autism Participation in District Transition Committees Secondary Transition Mentoring Project ADE Expanded Service Delivery Models

20 Traditional School-Based OT Services Fine Motor Skills Sensory Motor Skills Visual-motor and Visual Perceptual Skills Handwriting School adaptive skills for young children Assistive Technology Performance Skill Remediation Usually discontinued when skills plateau Limited concern regarding adult readiness Limited frames of reference limited scope of practice

21 New School Based OT Services Decrease Focus on Handwriting Remediation Collaborate with teachers for instruction Increase use of AT Expand Performance Areas of Concern Adaptive Skills including Adult Readiness Social/Emotional/Behavioral or Workplace Skills Physical Development Academic Achievement Transition Planning getting out of the motor box

22 New School Based OT Services Services not limited by performance skill deficiencies Any student with a disability is eligible for OT Services are designed to increase function, not necessarily decrease disability Collaborative goal writing vs. discipline specific, performance skill deficit goals Focus on access and participation, not disability remediation or reduction Services continue throughout educational career in a variety of settings with the end in mind Varied model of service delivery

23 New School Based OT Services Increase role in developing student self-advocacy and self-determination Through assessment and activities Increase focus on Strengths-Based Assessment How does the student learn best? What adaptations and accommodations improve outcomes? How does the student view his/her strengths? What are the students goals/priorities? What educational outcomes are essential for the student to achieve his/her Measurable Postsecondary Goals?

24 New School-Based OT Practice Use of multiple intervention strategies Not limited to biomechanical or sensorimotor Focus on the whole student Use Client-Centered Practices Variety of Frames of Reference and Interventions Cognitive-Behavioral Coping Acquisition Practice Developmental Ecological Human Occupation

25 New School Based OT Services Change view of Occupational Therapy as fixer of students with disabilities to...

26 Occupational Therapy = Student Advocate People with disabilities should be honored, valued, respected not repaired

27 Unique Skills of Occupational Therapy Education Life Sciences, Physical Sciences, Psychology Life-span Practitioners Person-centered planning Clinical Assessment Skills Informal Situational Task Analysis Formal Standardized/Norm Referenced Functional interpretation Environmental Engineers Adult Setting Experience

28 From Pilot to Project Educate Occupational Therapists about Transition and encourage the pursuit of this opportunity to expand their role and increase their value in the public education setting. v Educate local school teams including district and site administration, teachers and transition coordinators about the unique skill set of occupational therapy and facilitate greater OT participation in high school to support students with Transition. v Further define a role for ALL school-based related service providers (OT, PT, SLP, School Psychologists) in Transition. Eventually, expand the IDEA requirements for meeting transition service to involve all school-based related service providers.

29 What you can do from here.... Identify OTs interested in High School services Collaborate with District Transition Coordinator Training regarding Transition Components of IEP Learn about Transition services available through district Attend ALL annual IEPs at High School Consider collaborating with OT Univ. Attend a Transition Conference or Transitioncoalition.org Consider collaborating with Transition Specialist at Department of Education Explore different assessment tools Begin to incorporate Postsecondary planning in every evaluation Re-consider the idea of discharging students

30 American Occupational Therapy Association Occupational Therapy Role in Transitions Role in Arizona Pilot is to: Educate Support. Model. Inform. Coach. AOTA Resources-Developed Transition Tool Kit Frequently Asked Questions: Transitions/41879.aspx Continuing Education CD-ROM: TYPE=D&PID=776&SKU=4828

31 Resources Early Intervention & School SIS Archive AOTA : 2010, 2011, 2012 Occupational Therapy Services for Youth and Children Under IDEA, 3 rd Edition - AOTA Collaboration for Student Success: A guide for School-Based Occupational Therapists - AOTA Out in the Real World, Advance article Real-World-1.aspx National Secondary Transition Technical Assistance Center

32 Contact Information Linda Q. Rudd, OTR/L PUSD #11 William McQueary, ESS, AZ Dept. of Education Sandra Schefkind, Pediatric Coordinator AOTA