Occupational & Physical Therapy Guidelines for Service Provision within the Schools

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1 1 Occupational & Physical Therapy Guidelines for Service Provision within the Schools 2012

2 2 Introduction* Purpose The purpose of this document is to provide guidance regarding school-based Occupational Therapy (OT) and Physical Therapy (PT) services that support the educational goals of students with disabilities within Montcalm Area Intermediate School District (MAISD). These guidelines have been developed to facilitate the appropriate referral and delivery of OT and PT services to eligible students; educate and support other school personnel in carrying out the student s plan within a collaborative educational model; and provide a consistent, and unified approach to treatment of students within MAISD. These guidelines are written for providers of Occupational and Physical Therapy services, special education administrators, building administrators, special education teachers, general education teachers, and all school personnel responsible for service plan delivery. In addition, this document may also benefit parents, physicians, and other professionals working with those students who receive school-based OT and/or PT services. *Components of these guidelines were based, in part, upon documents created by Genesee Intermediate School District, Wexford-Missaukee Intermediate School District, Kent Intermediate School District, Maryland State Department of Education, and Missouri Department of Education. Philosophy Registered Occupational Therapists (OTR), Certified Occupational Therapy Assistants (COTA), Physical Therapists (PT) and Physical Therapist Assistants (PTA) provide related services that assist students with disabilities in making progress toward academic and functional achievement within the general education curriculum. OT and PT services can be provided in any setting along the special education continuum of special education programs and services and/or the natural setting. Occupational and Physical Therapists address the psychomotor aspects of development and academic performance. Therapy services focus primarily on the inter-relationships of the nerves, muscles and sensory systems to improve independent functioning within the educational environment and/or natural setting. Therapists provide interventions to improve, develop, maintain, restore or adapt

3 3 when a student s disability adversely impacts his or her ability to progress in the general education curriculum or to meet developmental milestones. Definitions Occupational Therapy is defined by the Michigan Revised Administrative Rules for Special Education (2009) and by P.L (Individuals with Disabilities Education Act) as follows: R b (d) of the Revised Michigan rules states: Occupational Therapy means therapy provided by a therapist who has been registered by the American Occupational Therapy Association or an Occupational Therapy Assistant who has been certified by the American Occupational Therapist Association and who provides therapy under the supervision of a registered Occupational Therapist. Individuals with Disabilities Education Act (IDEA) expands the Michigan definition: S Related Services (c) (6) Occupational Therapy: i. Means services provided by a qualified Occupational Therapist; ii. And includes A. Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation; B. Improving ability to perform tasks for independence if functions are impaired or lost; and C. Preventing, through early intervention, initial or further impairment or loss of function. Physical Therapy is defined by the Michigan Revised Administrative Rules for Special Education (2009) as follows: R b(g) of the Revised Michigan rules states: Physical Therapy means therapy prescribed by a physician and provided by a therapist who is licensed by the state of Michigan under 1978 PA368, MCL et seq. or a Physical Therapy Assistant

4 4 who provides therapy under the supervision of a licensed Physical Therapist. Individuals with Disabilities Education Act (IDEA) expands the Michigan definition: S (c) (9) Physical Therapy: i. Means services provided by a qualified Physical Therapist. Pre-referral Process Pre-referrals The pre-referral process for OT and/or PT services is intended to ensure that a variety of intervention strategies and activities are exhausted before a formal referral is made. These strategies and activities often result from school-wide procedures such as Response to Intervention, Student Assistance Teams, or Instructional Consultation Teams. During the pre-referral process, school based teams establish protocols for collecting data, which is culminated with a data collection review by the team. Response to Intervention Response to Intervention (RTI) is an approach to delivering services to all students that includes the coordinated efforts of a variety of school personnel, including general education teachers, special education teachers, administrators, and related service providers. Suggested OT/PT Activities During the RTI Process Therapeutic activities prior to a special education referral may include, but are not limited to: 1. Provide the teacher with suggestions for positioning students for fine motor/gross motor activities. 2. Create a handout for teachers that contain strategies to use with various fine/gross motor or sensory regulation problems. 3. Provide suggestions for alternate handwriting activities to enhance writing skills.

5 5 4. Provide techniques and strategies to modify classroom environment to facilitate sensory regulation. 5. Provide suggestions for adaptation of activity (e.g. using a different size ball in physical education class or different scissors for cutting) to promote success in learning. Referral Process After pre-referral activities are exhausted, referrals for OT and/or PT services may originate from the following sources: Student Assistance Teams After presenting the child to the team, members of the student assistance teams may directly contact an individual occupational or physical therapist to review specific student concerns. Therapists will ask that all relevant staff complete a screening form. Parent Request If a parent requests an evaluation for OT and/or PT services, staff will follow and complete the Review of Existing Evaluation Data (REED) process, as mandated by special education law. Upon the completion of the REED, it will be determined whether additional data is needed to determine the need for OT and/or PT services. Physician Request A physician s prescription must be considered by a student s IEP team. The IEP team will determine if the prescription warrants an educational need for a school-based evaluation by an OT and/or PT. The intent of school-based therapy can be different from clinical-based therapy. There may be medical concerns or issues that indicate medical based therapy, but that does not automatically indicate a school based need for therapy. Evaluation Process Evaluations are completed when additional information is required by a Review of Existing Evaluation Data (REED) to determine a student s academic strengths and needs.

6 6 Evaluations may include the following: 1. Review of initial classroom intervention strategies. 2. Review and analysis of academic and medical records. 3. Review of current IEP, if applicable. 4. Interviews with parents, teachers, and relevant school staff. 5. Observations in a variety of settings. 6. Administration of evaluation tools, such as checklists and rating scales. 7. Administration of standardized assessments. 8. Review and analysis of prior IEP team evaluations. Upon completion of an evaluation, a written report including a summary a findings and recommendations for service will be completed and reviewed at and IEP team meeting. Eligibility Criteria for Service Determination of services is established through the referral, evaluation, and an IEP process. OT and/or PT services may be provided to students who: 1a. For infants and toddlers to age 3: display delays that interfere with developmental milestones and 2 standard deviations below the mean on a standardized test. 1b. For school-aged children: display delays or deficits that interfere with progress toward the general education curriculum for school-aged children and 2 standard deviations below the mean on a standardized test. 2. Have documented neuropsychological or motor deficits that interfere with academic progress or developmental milestones. 3. Have a need for environmental adaptation to allow for increased independence in a school or community setting. Specific eligibility assessment criteria can include the following: 1. Potential for improvement

7 7 2. Health and safety 3. Severity of disability 4. Modifications to the environment and/or equipment needs 5. Therapy needs related to academic or developmental progress 6. Maintenance of maximum level of function for students with degenerative conditions. Specific Eligibility Requirements Criteria for eligibility for OT services in the school setting both A and B must be met: A. The student is classified and eligible for special educational services under at least one of the disability areas outlined in the Michigan Administrative Rules for Special Education. There must be documented evidence that occupational therapy is required to assist the student to access and benefit from the general educational curriculum. B. The student demonstrates a motor impairment in one of the following categories: Developmental, Motor Function, or Sensorimotor. Criteria for eligibility for PT services in the school setting A, B, & C must be met: A. The student is classified and eligible for special educational services under at least one of the disability areas outlined in the Michigan Administrative Rules for Special Education. There must be documented evidence that physical therapy is required to assist the student to benefit from general education curriculum. B. The student demonstrates a gross motor impairment in either Developmental or Motor Function category. C. An annual physician s prescription is required. Prescriptions must be renewed yearly for continued service. This is a legal requirement for delivery of PT services within the school setting.

8 8 Service Delivery Specific Roles of Occupational Therapy Staff Occupational therapy staff evaluates, consult, monitor and/or treat students in the following areas: Educational Training The goal is to build capacity in the educational setting with ongoing training to empower families, teachers, and other school staff to meet the educational needs of all students through use of Occupational Therapy strategies. Foundational /Developmental Skills Include (but may not be limited to): sensory processing, perceptual motor/visual motor, and reflex development/integration. Accommodations in the Educational Setting Assessment and implementation of strategies which accommodate the learning needs as well as the physical environment, such as in classrooms, hallways, restrooms, lockers, playgrounds, and cafeterias. Components of Movement Development of head and trunk control for fine motor and bilateral skills, motor planning, and coordination of body parts for purposeful and skilled movement as appropriate to the learning environment. Assistive Technology Occupational Therapists work with a team to assist in the educational setting to adapt and/or make recommendations for low tech as well as high tech equipment for the purpose of educational benefit. Self-Care Skills Include (but may not be limited to): feeding, dressing hygiene, toileting, oral-motor, and regulatory skills to participate in activities as appropriate to educational goals and objectives. Adaptation of Equipment Design, construction, and equipment for functional use (i.e. writing, dressing, feeding; recommendations for positioning, wheelchairs, hand splints, upper extremity braces, transportation, and seating devices as appropriate to the learning environment.

9 9 Pre-Vocational / Vocational Skills Manual dexterity, strength, endurance, physical capabilities, adaptive methods, and equipment as appropriate to the learning environment. *Note: The practice of Occupational Therapy does not include identifying underlying medical problems or etiologies, establishing medical diagnoses, or prescribing medical treatment. Direct Service-direct service to students may include: Feeding/Oral Motor Training Fine Motor Skills Therapeutic Exercise Prevocational Skills Sensorimotor Skills Visual Motor Skills Visual Perceptual Functional Performance Daily Living Skills Assistive Technology Supports Consultation - The goal is to facilitate learning with ongoing training to assist students, families, teachers, and other school staff to meet the educational needs of all students. Assessment and implementation of strategies can accommodate the learning needs as well as the physical environment, such as in classrooms, hallways, restrooms, lockers, playgrounds, and cafeterias. Specific Roles of Physical Therapy Staff Physical therapists assess, treat and/or make recommendations to improve or maintain a student s level of functioning by addressing the following areas: Educational Training The goal is to build capacity in the educational setting with ongoing educational training to empower families, teachers, and other school staff

10 10 to meet the educational needs of all students. Staff training in safe transfer and lifting techniques to prevent injury to both students and staff to and from chairs, wheelchairs, floors, toilets, cars, buses, and beds. Functional Mobility Weight bearing and balance activities are designed to maximize mobility. Gait training in use of braces, orthotics, and lower extremity prosthesis may include assistive devices (such as crutches, walkers, and canes) to negotiate all surfaces including stairs and ramps. Training in wheelchair use for independent mobility is also provided as appropriate to the learning environment. Environmental Adaptations in the Educational Setting Recommendation and design of equipment which adapts the instructional environment (i.e. entrances, restrooms, classrooms, transportation) to minimize obstacles which may prevent student participation. Posture Assessment of deformities of the muscular-skeletal system (i.e. scoliosis, leg length discrepancy) and postural asymmetry. Provision of exercise programs to improve posture when appropriate. Components of Movement Development of head and trunk control for general stability and coordination, gross motor skills, balance and equilibrium reactions, reflex development and integration of basic senses. Exercises and activities designed to increase muscular strength and endurance, reduce abnormal muscle tone, maximize desired joint motion, and prevent deformity from interfering with normal movement patterns in neck, trunk, and extremities. Adaptive Equipment Needs Recommendation, design, constructions, and/or modification of equipment such as positioning devices, wheelchairs, adaptive seating, mobility aids, braces, orthotics, and other specialized needs. Community Mobility Assist classroom teacher in developing goals and programs for student mobility in the community as appropriate to the learning environment. *Note: The practice of physical therapy does not include identifying underlying medical problems or etiologies, establishing medical diagnosis or prescribing medical treatment. Direct Service- direct service to students may include: Strength Training

11 11 Balance Activities Gait Training Mobility Training Motor Planning Activities Posture Positioning Activities Pulmonary Enhancement Therapeutic Exercise Physically Accessing Environment Consultation - The goal is to facilitate learning with ongoing training to assist students, families, teachers, and other school staff to meet the educational needs of all students. Assessment and implementation of strategies can accommodate the learning needs as well as the physical environment, such as in classrooms, hallways, restrooms, lockers, playgrounds, and cafeterias. Termination of Services Termination of services may be determined only at an IEP meeting. Occupational Therapy and/or Physical Therapy support services may be terminated when a student meets one or more of the following: The student has accomplished the goals of the IEP and further goals are not needed. The student no longer demonstrates progress or change; however, periodic evaluation is recommended to determine the need for future intervention. Special and/or general education teachers are able to provide maintenance of function without therapists consultation. The student is no longer eligible for services under an IEP. The problem ceases to be educationally relevant.

12 12 Parent/guardian written request for termination of services. In the case of Physical Therapy, prescriptions are no longer provided by a medical doctor. A written report must be completed at the termination of service and termination of services must be documented in the IEP. A review of existing evaluation data (REED) process must be completed prior to the IEP team s termination of special education services and/or eligibility. The service provider must provide a report to the IEP team stating that OT and/or PT services are no longer needed. Therapy Caseload and Workload A therapist s caseload is uniquely individual. Variables which will influence a therapist s caseload may include, but are not limited to: service delivery model, travel time, severity of student disability, supervisory responsibilities, and individual program needs. Consideration of caseload is a cooperative effort between the therapist, teaching staff, and administration. Flexible scheduling is used to allow for a combination of delivery models (direct service and consultative) and to respond to the varying needs as students enter, progress, or exit the therapy. All OT/PT staff use a 3-and-1 model. Generally, students receiving direct service will be seen by an OT and/or PT during the first three weeks of each month. Indirect/consultative services are generally provided in the last week of each month. Direct services, however, may be provided in the last week of each month depending on scheduling and workloads. The therapist s workload refers to the accumulation of all responsibilities. These activities include, but are not limited to, service delivery, informing school teams, families, and administrators of the student s individual needs, addressing the student s needs, evaluations, report writing, consulting with IEP team members, attending IEP team meetings, Medicaid billing, and travel.

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