FREQUENTLY ASKED QUESTIONS ABOUT PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND ADAPTED PHYSICAL EDUCATION SERVICES

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1 FREQUENTLY ASKED QUESTIONS ABOUT PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND ADAPTED PHYSICAL EDUCATION SERVICES 1. What is adapted physical education? Adapted physical education is a diversified program of developmental or remedial activities designed to enhance the gross motor abilities of students who have substantial medical, orthopedic, and/or neurological conditions. Activities are generally adapted to meet the specific needs of the student and to allow them to participate as much as possible in the curriculum based on the student s IEP. 2. Do you need someone certified in adapted physical education to provide adapted physical education services in Colorado? No. The State of Colorado does not license the Adapted Physical Educator. Current requirements are an undergraduate degree in physical education and a strongly recommended 12 semester hrs in adapted physical education. 3. How do you refer a student for occupational therapy, physical therapy, or adapted physical education services? Any child who is having difficulty in the OT/PT/APE area(s) may be referred through a child study conference. The parent, teacher or other person may make this contact through the student s teacher or other school personnel. Many of the referral policies differ from district to district. Please consult with your district for specific information. 4. When do you involve the therapist in the referral/assessment process? Therapists should work within their districts to establish clear referral guidelines. The number of filters through which a referral goes prior to reaching an OT/PT/APE service provider depends on the number of staff available to respond to the requests. Some districts involve OT/PT/APE staff at the level of the Initial Child Study. Other districts wait until resource teachers have identified significant needs in related skills before involving OT/PT/APE. All districts need to involve the OT/PT/APE specialist prior to the initial IEP meeting, for a student with OT/PT/APE related needs. 5. Can a child receive direct occupational or physical therapy under a 504 plan, without receiving special education? Yes. A child can receive occupational or physical therapy under Section 504 without receiving special education. Schools receive no state or federal reimbursement for services they provide under Section 504.

2 These cases are determined on an individual basis by your districts 504 coordinator. Section 504 of the Rehabilitation Act of 1973 is a civil rights law. In order to be protected under Section 504 a student must be determined through an evaluation process to: 1). Have a physical or mental impairment that substantially limits one or more major life activities. 2). Have a record of such an impairment or, 3). Be regarded as having such an impairment. 6. If the therapist and other school staff in the IEP meeting feel that discontinuing occupational therapy or physical therapy services is appropriate, but the parents disagree, who makes the final decision? Parents are equal participants in the IEP meeting. School staff must consider parents recommendations/concerns. The objective of the staffing team is to write an IEP that provides the child with a free, appropriate public education (FAPE). If the parents disagree with the IEP, they have the right to initiate a due process hearing. A parent will often feel most comfortable with a gradual cessation of therapeutic intervention, for example, going from a direct to a consultative model, or from a consultative model to a monitoring model. It is wise to inform a parent in advance of the IEP of the possibility of cessation of physical therapy or occupational therapy services. Allow the parent to ask questions or give them time to formulate questions regarding concerns with discontinuation of services prior to entering the frequently intimidating environment of the IEP meeting. 7. Can a physical therapist perform occupational therapy services or can an occupational therapist perform physical therapy services? The immediate answer to this question is no. Only an occupational therapist or a supervised occupational therapy assistant (certified) can perform occupational therapy. Similarly only a physical therapist or a supervised physical therapy assistant can perform physical therapy. In many districts, particularly rural districts, hiring a qualified occupational therapist or physical therapist can be challenging. If the district does not have, for example, an occupational therapist and are attempting to hire one, the physical therapist may be used, in the interim, only if that PT has expressed the ability to do so; meaning that the PT feels sufficiently confident with his/her skills to temporarily take on the responsibilities of the OT, until a qualified OT is hired. This still would not be considered occupational therapy service provision. Rather, a child would be receiving services from a physical therapist instead of receiving no services at all. In this situation notify the parents in writing and obtain signed consent by the parents of this change in service provision. Continue to actively pursue specialized staff to meet the needs as outlined in the IEP s. In addition, create an addendum page to the IEP clearly outlining the situation. If OT is indicated on the service providers page it must be

3 understood that a PT temporarily providing therapeutic intervention still does not qualify as occupational therapy. The primary issue is meeting the student s needs. The secondary issue is recognizing that OT and PT are not synonymous disciplines. A school district may not use their OT s and PT s as indistinguishable professions. They are distinct disciplines governed by separate standards of practice, ethics, professional guidelines, as well as registration, licensing, and certification requirements. 8. What if a school district does not have the specified OT/PT/APE provider listed on the IEP? If the IEP committee determines that the student requires a specific service to meet the student s educational needs and to ensure that the student receives an appropriate education then the district must find a way to provide the service. This can be done through a number of ways: Consultation to district personnel from a local/private service provider Find others, whom the school district and the parents mutually agree upon, who have specific training in the area of need (see question #7) Shared cost of provision of private services with an understanding of what the educational goals are and what the clinical goals are and the amount of time to be delivered to the student, etc Contracted services from a home health agency, hospital, clinic Program considerations the specific program may already offer similar components which would meet the student s needs 9. Can OT or PT services be designated as motor services on the IEP. No. Occupational and physical therapy are distinct disciplines. They should not be grouped together under the heading of motor on the related services page. The IEP should clearly indicate which service is needed to support access and benefit from special education. The specific discipline, or both, should be included on the IEP. based upon objective data and staffing team input. 10. Can a therapist delegate procedures like brushing or range of motion to teachers or other school staff? Occupational and physical therapists should not delegate direct therapy procedures that require the skills, knowledge, experience, training, and judgment of a therapist, COTA or PTA to teachers or other school staff. There are some school activities in which the roles and responsibilities of therapists and teachers coincide. For example, sitting in the classroom, writing, eating, and moving through the school are part of the child s school day. Both therapists and educators may have a role in helping the child increase his or her participation in these school activities. Therapists

4 provide indirect service by collaborating with school staff to adapt materials, provide and train in use of adaptive equipment or assistive technology, or integrate a skill learned during therapy into the classroom. (Occupational Therapy and Physical Therapy: A Resource and Planning Guide, 1996 Wisconsin Department of Public Instruction, p. 107) A therapist can delegate a specific procedure, but it is the therapist responsibility to oversee the program, collect data on effectiveness, and determine any changes in the frequency or duration of that method of intervention. Districts may have individual guidelines determining whether specific activities such as range of motion can be delegated. Check with your Director of Special Education. IDEA does allow for paraprofessionals with appropriate training and supervision to assist in the provision of: early intervention, special education, and related services. For more information regarding appropriate use of paraprofessionals: Does the therapist decide if the child needs therapy? The therapist makes the recommendation, but the staffing team makes the decision. 12. How often must an occupational therapist or physical therapist conduct an evaluation of a student? The therapist must conduct an evaluation for the initial staffing and for the triennial staffing (three year re-evaluation). It is good practice to perform an evaluation prior to discontinuation of services to obtain an objective assessment of current level of functioning. 13. Does a physical therapist or occupational therapist need a physician s referral to provide physical or occupational therapy in the schools? No. School based physical and occupational therapists do not need a physician s prescription to provide services. 14. If a student has a physician prescription for physical or occupational therapy is the school obligated to provide these services? No. The school s staffing team, which includes the parents, decides whether a student needs physical or occupational therapy in order to benefit from special education services. The role of the school OT and PT is towards academic and curricular access. School therapists either adapt the environment or teach a specific skill to generate academic or environmental access. It is not the role of the school based therapist to refine or maximize specific skills. It is the role of the school OT and/or PT to facilitate development of skills sufficient for environmental, self-help, or curricular access within the educational environment.

5 15. What is the difference between a medical model of intervention and an educational model of intervention for occupational therapy and physical therapy services? Medical Model: (a.k.a. Clinical model) medically related services are generally performed to change the child s physical status. Treatment objectives are generally chosen along a predetermined developmental sequence or physical change sequence/rehabilitation sequence, regardless of the amount of time required to achieve the goal. Educational Model: All services, including techniques chosen, are designed to meet the student s educational goals as determined at the IEP meeting by the IEP committee. At times adaptations or modifications and/or monitoring or consultation may be the only intervention (s) necessary. These interventions may improve the student s ability to function at school without changing the child s physical/developmental status. Improved function is of primary importance to allow the student to better perform in the classroom. The techniques and/or modifications chosen by the individual occupational and/or physical therapist may reflect this and are determined by that individual, not dictated by an outside agency. The therapist s professional judgment, training, and experience play a role in this determination. An educational setting is, ideally, not a rehabilitation setting and should not serve to replace a rehabilitation setting unless rehabilitation has been determined to be a prioritized need on the student s IEP as determined by the IEP committee. (This may be true in some instances such as a student returning to school following spinal cord injury or traumatic brain injury, while he/she is still in a critical recovery period and/or when the students are a young child who is still making developmental gains). If a child is fully included in a classroom, treatment interventions are chosen to fit socially into the classroom setting. In this model, many individuals (classroom teachers, aides, others) may provide therapeutic input to the student throughout the day and across the educational environment. This would be delivered under the direction and following instruction from the educationally-based physical and/or occupational therapist. 16. What qualifications do educationally based therapist have? Both Physical and Occupational Therapist graduate from approved graduate and undergraduate programs. They then must qualify under the State of Colorado s licensure act for educators as special service providers. Physical Therapists must also qualify for a State of Colorado Physical Therapy license. Occupational Therapists must qualify for National Certification. Adapted Physical Educators must maintain their teaching license.

6 17. What is the difference between special education and 504? Special education is a program designed by an IEP committee. Students meet the state and federal guidelines to qualify for special educational disabilities which are, as determined through assessment, interfering with that student s ability to receive reasonable benefit from a regular education program. There is federal funding attached to IDEA (Individuals with Disabilities Education Act) to support these students obtaining specialized services. Public Law Section 504 of the Rehabilitation Act is a Civil Rights Act enacted in 1973 to ensure that all students are treated fairly and that no one is denied access to a free and appropriate education. Section 504 is designed to eliminate discrimination on the basis of disability in any program or activity receiving federal financial assistance. No person with a disabling condition shall be excluded from federally funded programs or activities solely by the reason of his or her disability, including accessibility to programs available to all persons. It is the responsibility of regular education to provide services required by Section 504. Support may be given to the regular education staff from the special education staff. Students who do not meet the criteria for an educational disability may meet the criteria for services under Section 504. There is no federal funding to districts attached to Section 504. Additional information on Section 504 can be found at Search under Section If a student recently had surgery, does he/she automatically qualify for special education services? No. The student must qualify for special education by meeting the criteria set forth in the state rules. If the student does not qualify with educational disability he/she may be considered for services under Section Are private occupational and/or physical therapists allowed to practice their services in the school? Individual school districts must follow their own policies. In practice, some school districts allow private service providers into their buildings as a favor to the parents. This arrangement can vary from being arranged informally with the school and staff involved to a formal agreement addressing such concerns as (but not limited to): Use of equipment Liability Use of space Safety Whether educational recommendations by private service providers will by followed by school staff

7 The time of day the student can be removed from the classroom to be seen by private service providers The forum the private service provider should use if it is felt there should be changes in the student s educational programming A forum for the educators to address concerns, if they arise, that are presented to them from the private service provider due to difference in philosophy Standards of conduct for the private service provider to adhere to 20. Are private physical or occupational therapists allowed to dictate the therapy the student receives at school? No. It is up to the IEP team to identify the student s educational needs, write and implement the educationally-based goals and objectives. It is, however, the parents right to request that the school staff consider additional assessment information and to invite whomever they choose to the IEP meeting. 21. What if daily therapy has been request by the parent, private provider, or other individual and the therapist is in conflict with this recommendation? The standard for school-based therapy interventions are the words appropriate and reasonable benefit, not maximal benefit. The IEP team should decide the amount of therapy the student needs in order to gain reasonable benefit from his/her education. In addition, the IEP team may decide that it is appropriate for the therapist to train other staff to carry out the required intervention. Optimally, student objectives and therapeutic activities are embedded within the student s daily schedule, thereby increasing frequency of engagement in therapeutic tasks to increase functional outcomes. 22. Is extended school year (ESY) provided in the OT/PT/APE areas? It may be. This is a determination of the IEP committee. Every child with an IEP has the right to have ESY explored as part of their IEP meeting. Extended school year services are provided for those students who demonstrate a regression in skill level over breaks (summer break, winter break, spring break). Skills which have been mastered are lost during the course of a break and recouping these skills takes a greater span of time than the span of the break. Documentation of skill levels pre and post break are required. 23. Can a district use the following criterion: if the child s gross or fine motor level is commensurate with cognitive ability, then there is no need for therapy? No. The fact that the child s delay in skill development is commensurate with the child s developmental levels in other areas is not an appropriate

8 standard by which to determine a child s need for occupational therapy or physical therapy. 24. Can occupational or physical therapy be the only service provided on an IEP? For preschool children who qualify for preschool under the preschooler with a disability classification, occupational and physical therapy services can be stand-alone services. For students in grades K 12 physical and/or occupational therapy services cannot be the only service on an IEP. Occupational and physical therapy services are support (related) services not primary services, therefore either special education or speech language services must be on the IEP in order for OT or PT to support access to special education. OT and/or PT services can be stand-alone services under Section 504 of the Rehabilitation Act. 25. If a child is enrolled in a private school, can he or she still receive occupational or physical therapy as a related service? Yes. A student who is enrolled in a private school by his or her parents may receive occupational or physical therapy as a related service if that student meets the requirements for special education and requires OT or PT in order to benefit from special education. The provision of therapeutic services would occur on the premises of the public school which the student would attend if the student were not going to a private school, unless other arrangements are made and mutually agreed upon by the public school, parents, and private school. OT and or PT would be provided on the public school property with appropriate consultation to the private school staff. 26. How do therapists write educationally relevant or functional goals and objectives? Within the educational model of therapeutic intervention occupational therapy and physical therapy goals should be written with educationallyrelevant function as the objective. Goals should not be written solely based on test performance or a developmental milestone. Rather, the emphasis should be on function for that student within his/her educational environment. For example, a physical therapist may be addressing a stand-pivot transfer for toileting purposes. A PT may be working on walking on different terrains for safe playground access. An occupational therapist may be working on distal finger strengthening to open a milk carton. An OT may be addressing simultaneous, bilateral hand use for scissor skills. Include the function in the goal to make it academically relevant.

9 Occupational therapy goals are frequently embedded within special education academic goals. 27. Do therapists have to take the PLACE test? Occupational and Physical Therapists do not have to take the PLACE test. Adapted Physical Educators are still required to take this test as part of their licensure. 28. I have an active CDE license indicating licensure for K 12 population. Since I routinely treat children from birth to 21 years how do I amend my CDE license to indicate 0-21 years instead of K 12? To change the grade level from K 12 to Birth 21 for School Occupational Therapist and School Physical Therapist the applicant would need to contact the University where they completed their program. The college would be able to tell the applicant what additional coursework they would need to take, if any, to change the grade level designation. The applicant would need to provide a cover letter, an Institutional Recommendation, and transcripts, if applicable, from the University where they completed their program. You can obtain the Institutional Recommendation form from the Colorado Initial License application. This application can be found on the CDE website ( or call CDE (303) ext. 0.

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