School Systems SIS Frequently Asked Questions (FAQs)

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1 School Systems SIS Frequently Asked Questions (FAQs) The following FAQs were developed using effective practice standards, American Occupational Therapy Association (AOTA) documents, and the No Child Left Behind Act (NCLB) and the Individuals with Disabilities Education Act (IDEA). For additional information or clarification on NCLB and IDEA, the reader should refer to the U.S. Department of Education s website at What is occupational therapy (OT)? Occupational therapy is concerned with an individual s ability to do and participate in desired daily life activities, or "occupations." Engagement in occupation to support participation in context is the focus and targeted end objective of occupational therapy intervention. Engagement in occupation is seen as naturally supporting and leading to participation in context (AOTA, 2002). In school settings, occupational therapists and occupational therapy assistants support student learning and behavior by focusing on participation in academic, nonacademic, extracurricular, and vocational activities and routines, including the use of adaptive or assistive technology, as well as activities of daily living, such as life skills, needed for school success and transition. How can students receive occupational therapy in the schools? Under IDEA, eligible students with disabilities may receive occupational therapy as a related service if the student needs it to benefit from special education. Parents and teachers may request that a student be evaluated to determine his or her need for special education and related services. An occupational therapist can be part of the evaluation team. If the team (which includes the parents) determines that the student is eligible for special education, then all related services are considered. If the team decides occupational therapy is necessary for the student to benefit from his or her education program, then occupational therapy is included on his or her individualized education program (IEP). IDEA allows services to be provided directly to a student, on behalf of a student, or as a program support for teachers and other adults working with the student. In addition to the IDEA, some students with disabilities receive occupational therapy services to access public education programs, services, and activities under Section 504 of the Rehabilitation Act of 1973 (as amended). Under Section 504, occupational therapy can be provided alone or in combination with other educational services and may be provided directly to students or as program supports to teachers working with the student. Each state and local school agency has its own guidelines for determining student eligibility under Section 504. Under IDEA 2004, occupational therapists also may assist in the identification and provision of appropriate early intervening services (EIS), response-tointervention (RtI) strategies, and other problem-solving approaches used to support student learning and behavior. These proactive, preventative, approaches are designed to minimize the occurrence of behavior and learning

2 problems for students with and without disabilities and to reduce the need for more intensive services later (AOTA, 2004). Decisions regarding the use of occupational therapy expertise in these preventative approaches will be made by building-level student support or resource teams What are the role and function of occupational therapy under Part B and Part C of IDEA? Under Part B (which includes preschool), occupational therapy is a related service that is provided to help a student benefit from special education (or specially designed instruction). As a related service, occupational therapy supports the child s "occupation" of learning and his or her ability to participate in educational activities and in the environment. However, services are provided only if the student needs them to meet his or her annual goals as identified in the IEP. IDEA also encourages and supports schools efforts to identify and intervene earlier for those children who demonstrate early learning and behavioral problems, before they need to be referred for special education. Occupational therapy can be an important component of these EI services and of other school-wide activities. In Part C (EI services for infants and toddlers), occupational therapy is a primary EI service that can be provided alone or in combination with other early intervention services. What is a related service? IDEA defines related services as "transportation, and such developmental, corrective, and other supportive services (including occupational therapy ) as may be required to assist a child with a disability to benefit from special education" (Section 602(26)). Each state may include additional services not specifically mentioned in the law or regulations. To individualize a student s program, the IEP team may determine that additional services and supports not explicitly listed in the law or regulations may be needed for a particular student. This determination is made through the collaborative team process that reviews evaluation results, student strengths and needs, the student s annual goals, and available supports and services. The expertise of occupational therapists and occupational therapy assistants lies in their knowledge of occupation and how engaging in occupations can be used to affect human performance and the effects of disease and disability (AOTA, 2002). At school, occupational therapists and occupational therapy assistants focus on assisting students to engage in meaningful and purposeful daily school "occupations" so that the students can be successful in the educational setting. According to IDEA, this includes participation in the same academic, nonacademic, and extracurricular activities occurring before, during, or after school that are available to students without a disability. The schoolrelated outcomes of a student s areas of occupation activities of daily living, education, work, play, leisure, and social participation are described in Table 1 below.

3 Table 1 School-Related Occupations Addressed During Occupational Therapy Assessment and Intervention Occupational Area* Activities of daily living (basic and instrumental) Education Work Play/leisure Social participation Educational Outcome Cares for basic self-needs in school (e.g., eating, toileting, managing shoes and coats); uses transportation system; if needed, uses communication devices to interact with others Achieves in a learning environment including academic (e.g., math, reading), nonacademic (e.g., lunch, recess), prevocational, and vocational activities Develops interests and skills necessary for engaging in work or volunteer activities for transition to community life upon graduation from school Interacts with age-appropriate toys and objects; identifies and engages in appropriate games and leisure experiences; participates in art, music, sports, and after-school activities Develops appropriate school relationships with peers, teachers, and other educational personnel within classroom, extracurricular, and preparation for work activities; engages in appropriate behavior that does not interfere with learning and social relationships *Occupational Therapy Practice Framework: Domain and Process, AOTA, Swinth, Y., Chandler, B., Hanft, B., Jackson, L., & Shepherd, J. (2003). Personnel issues in school-based occupational therapy: Supply and demand, preparation, certification and licensure. (COPSSE Document No. IB-1). Gainesville: University of Florida, Center on Personnel Studies in Special Education. Available online from Is special equipment needed to provide occupational therapy services? Not necessarily. Occupational therapists and occupational therapy assistants working in educational settings use a wide array of service models, materials, strategies, and accommodations to support a student s participation and progress in school. Occupational therapists may offer simple strategy application through collaborative consultation with teachers, help design an

4 environment that supports improved processing for learning and performance, use existing school materials and equipment to facilitate greater access to learning, or introduce a low-tech or high-tech device that allows the student participation in the learning activity. The individual needs of the student drive this selection and application. Who decides the frequency, intensity, location, and service delivery model used for occupational therapy services? Does a doctor s prescription or order determine the need for, frequency, or intensity of these services? Under IDEA, IEP teams are responsible for reviewing the results of the evaluation, establishing student goals and outcomes, and identifying the specific services and supports, including amount, frequency, duration, and location, needed to help students accomplish their individualized goals. IDEA mandates a team decision-making process. The team needs to avoid overlap and duplication of services and plan a program that preserves the student s right to a free appropriate public education in the least restrictive environment, within a context that is "only as special as necessary." Depending on the occupational therapy practice act in a given state, a doctor s prescription may or may not be required for any occupational therapy service. Be sure to check with your state s regulatory agency if you need clarification regarding the rules and instances in which this referral is required. However, even in states where occupational therapists need a physician referral, this requirement does not relieve the IEP team of their mandated responsibility to review evaluation results, determine student goals and outcomes, and identify the services that are needed to help the student achieve those goals. The physician referral does not supersede the IEP team s responsibility for decision making regarding the content of the student s IEP. Are related service personnel required to provide specialized therapies (e.g., sensory integration, auditory training) for a student? A distinction needs to be made between occupational therapy as a related service and the specific intervention approaches that may be utilized by a particular discipline. Sensory integration, for example, is not a related service, but it is one of many theory and intervention approaches that may guide an occupational therapist s or physical therapist s assessment selection and recommendations for a particular student. While IEP teams may discuss specific intervention methodologies, IDEA and case law leaves the decision about specific intervention approaches to the professional. The professional uses a multitude of factors for decision-making, including assessment results, desired outcome, data from interventions previously tried, etc. What is a reasonable caseload for school-based occupational therapists or occupational therapy assistants? IDEA is silent regarding caseloads. However, certain states and local education agencies do have rules that define minimum and maximum caseload sizes. Check with your state s occupational therapy regulatory board, state education agency, or school district to see if this is the case where you work.

5 It is difficult to define a therapist s workload by the number of students for whom they can provide services. An occupational therapist should work with his or her administrator to determine the total number of service hours he or she can provide within a week s time. The actual number of students that may be seen within this amount of service time varies, according to a variety of factors. These factors include the specific service levels that are listed in students IEPs, the amount of travel between schools, the number of evaluations the therapist is expected to complete, time needed for supervision of occupational therapy assistants or for assistants to receive supervision, administrative duties such as equipment management, and others. Further, changes in NCLB and IDEA make time for activities including collaborative teamwork and data collection and analysis critical. Watch the AOTA Web site for more resources on this topic. What type of documentation is required for occupational therapy under IDEA? Most school districts develop some type of policy and procedures related to documentation. Beyond the initial evaluation or reevaluation, the IEP, and ongoing reporting on student progress, IDEA is relatively silent on documentation, although other types of paperwork are required under the law. The occupational therapist s role in completing any of these documentation or paperwork requirements will vary depending on the state or school district or both. AOTA documents are clear that occupational therapists and occupational therapy assistants under the supervision of an occupational therapist should document their services. The Standards of Practice for Occupational Therapy (AOTA, 2005), the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and the Guidelines for Documentation of Occupational Therapy (AOTA, 2004) mandate the development of an occupational therapy specific intervention plan and the collection of data documenting therapy outcomes. State regulatory boards also may have specific documentation requirements that must be followed by all therapists working within that state. Can occupational therapy be a related service to a student who is eligible for special education in speech only? All students identified as having a disability under IDEA have access to related services if the IEP team decides there is an educational need. Related services are designed to help students benefit from their specially designed instruction (special education). Occupational therapy may be provided for a student whose specially designed instruction is provided by the speech language pathologist if occupational therapy is needed to help the student benefit from the specially designed instruction of speech language. Who decides when occupational therapy services are needed or when they are no longer needed? IDEA identifies the IEP team (which includes the parents) as having the responsibility for determining when occupational therapy services are or are not needed. Decisions about the need for occupational therapy should be based on the results of the student s initial evaluation or re-evaluation, the

6 student s academic, developmental and/or functional needs, and the desired goals or outcomes to be achieved, as identified by the team. Factors that should not be considered in the decision-making process include the specific disability category or condition, staff availability, administrative convenience, or availability of reimbursement. Can an occupational therapy assistant provide occupational therapy services? Yes, an occupational therapy assistant is an occupational therapy practitioner that has been credentialed by completing an accredited occupational therapy assistant program, passing a national exam, and meeting state-specific certification/licensure requirements. Occupational therapy assistants are obliged to adhere to the Occupational Therapy Code of Ethics (AOTA, 2005) and Standards of Practice (AOTA, 2005). In addition, each state regulates the practice of occupational therapy and may have developed specific guidelines to regulate the supervision of OTAs. Also refer to AOTA s Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2004) for more information on OTA roles, responsibilities, and supervision requirements. How are paraprofessionals to be used to provide occupational therapy services? IDEA allows paraprofessionals that are "appropriately trained and supervised, in accordance with State law " to assist in the provision of EI, special education, and related services. NCLB has further clarified the preparation and training of paraprofessionals. Occupational therapy practice is regulated in all 50 states, the District of Columbia, and Puerto Rico. These regulations must be followed relative to the use of paraprofessionals in the delivery of occupational therapy services in a given state. An authoritative resource on the use of paraprofessionals is available at Can occupational therapy services be provided by a physical therapist (PT) or adapted physical educator (APE)? No, only occupational therapists or occupational therapy assistants, under the supervision of an occupational therapist, can provide occupational therapy services. If occupational therapy is listed as a needed service in the IEP, an occupational therapy practitioner must provide the service. APE is defined as special education in IDEA, while OT and PT are related services. While OT, PT, and APE services share a common thread in supporting a student s motor development, related services can not be a substitute for special education. The unique frame of reference for practice, skills, and expertise of each discipline differs and allows for an array of services that can contribute to a student s success. However, these other services do not substitute for the need for occupational therapy intervention. Are parents required to use their personal insurance or Medicaid to pay for therapy services in the schools? State and local education agencies are responsible for assuming the costs of public education, including the cost of special education and related services.

7 Under IDEA, students with disabilities are entitled to a free appropriate public education (FAPE) and are entitled to receive these services at no cost to themselves or their families. However, IDEA also recognizes that schools should not be the sole financier of the all of the services a child with a disability may require. States and local districts are able to utilize all sources of public funding to help pay for services provided under IDEA, including Medicaid. A child s private insurance can only be billed under very limited situations. What if a child may benefit from occupational therapy services but is not eligible under IDEA? If the student is not eligible for occupational therapy services under IDEA, services may still be available through various state or locally designed early intervening and instructional support programs. Occupational therapists often serve on student support or student resource committees or teams designed to examine and provide support for a multitude of learning and behavioral needs. Occupational therapists also may be available, in some school districts, to support student participation in school-wide approaches (e.g., NCLB initiatives). Occupational therapy services may be available for a particular student under Section 504 of the Rehabilitation Act of Each local school district must have a designated 504 official. Check with this individual at your local school district. How can a school district find occupational therapy personnel for their programs? There are several ways to advertise for occupational therapy personnel: Web-Based --Post open positions on AOTA's OTjobLink at --The education employment section of your state s Web site National and Regional --Contact your state occupational therapy association. Inquire about job postings in your area. --Contact state or local universities with occupational therapy programs. Offer to guest lecture, host volunteer hours, or mentor a new graduate. --Become an official fieldwork site for occupational therapy and occupational therapy assistant programs in your area --Advertise in state and local occupational therapy association publications (e.g., newsletters, conference publications, CE brochures) --Advertise in national publications (e.g., OT Practice, Advance for Occupational Therapy Practitioners, AOTA online job bank).

8 Local --Attend local association or school-sponsored job fairs. --Offer your site as meeting or conference space for your local state occupational therapy association. --Sponsor CE for occupational therapists working in your area; promote your occupational therapy jobs by using local newspapers, including small community newspapers and any promotional literature. How can a school district retain occupational therapy personnel? --Ask your occupational therapy practitioners for ideas on how to improve their work situation; partner with them to make needed improvements. --Include occupational therapy practitioners in planning, communication, and education sessions for instructional staff about new policies and procedures at the program and building level. --Support continuing education for topics and content that school-based occupational therapy practitioners need to do their jobs well. --Ensure your compensation package is competitive with all practice sites in your community (e.g., other school districts, hospitals, home health, rehabilitation facilities, private practice). Where can I find an example of a performance evaluation for a schoolbased occupational therapist? Many districts have performance evaluations that are used with all staff. The challenge is to ensure that all of the items are relevant to the unique roles of the occupational therapist or occupational therapy assistant. All performance evaluations address skills such as quality, productivity, job knowledge, reliability, attendance, independence, creativity, initiative, adherence to policy, interpersonal relationships, and judgment. You may want to work with your administrator to modify your present forms to fit the unique needs of your job (use your current job description as a guide). The AOTA Professional Development Tool (available to members at can help structure a performance evaluation specific to school-based practice. Where can I go for more information? American Occupational Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, American Occupational Therapy Association. (2003). Applying sensory integration framework in educationally related occupational therapy practice.

9 American Journal of Occupational Therapy, 57, American Occupational Therapy Association. (2004). Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy. American Journal of Occupational Therapy, 58. American Occupational Therapy Association. (2004). Occupational therapy services in early intervention and school-based programs. American Journal of Occupational Therapy, 58. American Occupational Therapy Association. (2005). Occupational therapy code of ethics. American Journal of Occupational Therapy, 59. American Occupational Therapy Association. (2005). Standards of Practice for occupational therapy. American Journal of Occupational Therapy, 59. Dolezal, V., Doolittle, S., Edmiaston, R., Erickson, C., & Merritt, S. (2000, July). Developing individualized education programs for children in inclusive settings: A developmentally appropriate framework. Young Children, pp Giangreco, M. F. (2001). Interactions among program, placement, and services in educational planning for students with disabilities. Mental Retardation, 39, Guidelines for making decisions about IEP services. (2001). Montpelier: Vermont Department of Education. Retrieved from the World Wide Web at Hanft, B. E., & Place, P. A. (1996). The consulting therapist: A guide for OTs and PTs in schools. San Antonio, TX: Therapy Skill Builders. IEP Decision-Making About Special Education and Related Services. ( ). Available online at IDEA Partnerships: Guide to the Use of Paraprofessionals. (2001). Arlington, VA: Council for Exceptional Children. Retrieved from the World Wide Web at Maruyama, E., Chandler, B. E., Clark, G. F., Dick, R. W., Lawlor, M. C., & Jackson, L. L. (1999).Occupational therapy services for children and youth under the Individuals With Disabilities Education Act (2nd ed). Bethesda, MD: American Occupational Therapy Association. McEwen, I., Arnold, S., Jones, M., & Shelden, M. (2000). Providing physical therapy services under Part B and Part C of the Individuals with Disabilities Education Act. Alexandria, VA: American Physical Therapy Association. Muhlenhaupt, M. (2000). OT services under IDEA 97: Decision-making challenges. OT Practice, 5(24), National Dissemination Center for Children with Disabilities. See

10 National Dissemination Center for Children with Disabilities. (2001). News Digest: Related Services. Washington, DC: Author. Retrieved from the World Wide Web at Scott, S. M., McWilliam, R. A., & Mayhew, L. (1999). Integrating therapies into the classroom. Young Exceptional Children, 2(3), Swinth, Y. L., Chandler, B., Hanft, B., Jackson, L., & Shepherd, J. (2003). Personnel issues in school-based occupational therapy: Supply and demand, preparation, and certification and licensure. Center on Personnel Studies in Special Education. Available online from Swinth, Y. L., & Hanft, B. (2002). Moving beyond traditional 1:1 service delivery in school settings: Alternative models. OT Practice, 7(16), 12 14, Swinth, Y. L., & Mailloux, Z. (2002).Addressing sensory processing in the schools. OT Practice, 7(2), Szabo, J. L. (2000). Maddie s story: Inclusion through physical and occupational therapy. Teaching Exceptional Children, 33(2), U.S. Department of Education. (2000). A guide to the individualized education program. Available online from Vocational Rehabilitation Act of 1973, as amended, P.L , 29 USC, Sec Last Update: 4/06 (Back)

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