GUIDELINES AND SERVICES FOR OCCUPATIONAL THERAPY AND PHYSICAL THERAPY

GUIDELINES AND SERVICES FOR OCCUPATIONAL THERAPY AND PHYSICAL THERAPY Linda Paule, Coordinator San Bernardino City Unified School District Dr. Patty Imbiorski, Director Special Education

TABLE OF CONTENTS PAGE INTRODUCTION 4 DESCRIPTION OF OCCUPATIONAL THERAPY SERVICES 6 SERVICE DELIVERY 8 OT REFERRALS 10 OT REFERRAL FLOWCHART 11 ROLES AND RESPONSIBILITIES OF OT IN SCHOOL SETTING 12 DISTRICT OT STAFF 13 REFERRAL FORMS 14 DESCRIPTION OF PHYSICAL THERAPY SERVICES 26 AREAS OF EXPERTISE FOR SCHOOL PHYSICAL THERAPISTS 27 CLIME PROGRAM 29 USES FOR CLIME 30 WHAT ARE MOTOR SKILLS? 32 ABOUT EDUCLIME 33 CALIFORNIA CHILDREN SERVICES 35 RESOURCES AND REFERENCES 36

INTRODUCTION State and Federal laws and regulations mandate Occupational Therapy and Physical Therapy services. The Individuals with Disabilities Education Act (IDEA) defines the services required. Students eligible for Special Education services can receive Occupational Therapy, a Designated Instruction Service (DIS) that addresses the following areas: (i) (ii) (iii) improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation; improving ability to perform tasks for independent functioning when functions are impaired or lost; and preventing, through early intervention, initial or further impairment or loss of function (34 C.F.R. 300.16[b][5]). Physical Therapy is defined as services provided by a qualified physical therapist (34 C.F.R. 300.16[b][7]). Physical Therapy can be provided by a physical therapist employed directly by the school district or through a contracted agency. In additional to occupational and physical therapy services provided to students through the school district, California Children Services also provides occupational and physical therapy services when those services are deemed to be medically necessary. This handbook will provide you with information on the types of services, who provides those services and where they are offered. 4

DESCRIPTION OF OCCUPATIONAL THERAPY SERVICES The Occupational Therapist can provide both direct services and consultation in a variety of areas that affect the educational development of the child. Some examples of areas of expertise and as well as the expected outcome are highlighted below: Postural stability, which includes muscle tone, muscle strength and endurance. The goal is to help the student maintain functional body positions during daily school activities. Sensory registration and processing which includes perception and discrimination of touch and texture and visual spatial relationships. The goal is to assist the student with attention to tasks and transitioning between various tasks. Motor planning which includes sequencing movements. The goal is to help the student learn new motor acts and perform physical tasks at the appropriate level. Fine motor, which includes strength, coordination, prehension grip and shoulder/wrist stability. The goal is to assist the student with manipulating objects and using a variety of writing tools. Assistive devices including environmental modifications and adapted materials to assist the student in compensating for lack of skills. Social skills including the ability to make eye contact and sustain communication with others. The goal is to assist the student in being successful in the classroom and giving the student the ability to ask for help and contribute to class and playground activities without resorting to aggression and other negative behaviors to gain attention. Many areas of expertise can be addressed by additional Special Education Personnel. Areas where overlap can occur are in the areas of communication skills, academic and readiness skills, vocational skills, community-based instruction and functional mobility. Based on eligibility, the Individualized Education Program (IEP) team would decide who could provide the most appropriate service and in which setting. Once an assessment has been completed and the IEP team has met to determine eligibility, if the team determines that the student qualifies for and is in need of Occupational Therapy there are a variety of ways in which services can be delivered. The preferred model is the collaborative model. The Occupational Therapist will collaborate with the parents, school staff and other relevent staff members sharing information, techniques and therapy strategies that will benefit the child throughout the school day. Staff development and inservice training may be offered to individual members or, in some cases, to a whole staff. After any staff development or inservice training the Occupational Therapist will provide ongoing support to any staff providing strategies to the child during the school day. Past inservices have included Handwriting Without Tears which is a systematic program teaching printing and cursive handwriting skills. 6

Direct services may also be recommended for some issues such as sensory integration. These services can be provided in the classroom, on a pull-out basis or at the Therapy Clinic housed at Harmon School. The services may also be provided by the Occupational Therapist or by the Certified Occupational Therapy Assistant, under the supervision of the Occupational Therapist. The Occupational Therapist may also recommend equipment and devices to help the student become more successful in the classroom. Examples of equipment used include Move N Sit cushions, slant boards, adaptive scissors and pencil grippers. In some cases, the OT Department may have sample items to borrow until school sites can acquire their own equipment. 7

SERVICE DELIVERY Direct Services Direct services, which include specific therapeutic techniques to remediate or prevent problems that are identified through the assessment process, adversely affect educational performance, and are based on program objectives developed by the multidisciplinary team. Children can receive direct therapy individually or in small groups. Collaboration/Consultation Collaboration/Consultation is a service in which the occupational therapist s expertise is used to help the educational system achieve its goals and objectives. Case consultation focuses on the development of the most effective educational environment for children with special needs. Colleague consultation addresses the needs of other professionals in the educational environment system. Consultation addresses the needs of the system to maximize the use of its occupational therapy personnel and improve the effectiveness of the whole system. Monitoring Monitoring employs collaborative teaming to teach and directly supervise other professionals or paraprofessionals who are involved with the implementation of intervention procedures. The occupational therapist completes an evaluation and develops an intervention program to enhance the achievement of the IEP goals, but teaches someone else in the immediate environment to carry out the procedures with the child. The therapist may not supervise all activities of these persons, but provides information and quality control in his or her areas of expertise. The therapist would continue to have contact on a regular basis (at least once a month) to determine whether adjustments in the intervention procedures are necessary. It is recommended that contact be made on site. Dismissal The IEP team may consider the following conditions when determining that the student no longer needs occupational therapy to benefit from their educational program. 1. The student is functional within the educational environment, and therapy services are no longer indicated. 2. Other educational personnel are able to assist the student in areas of concern previously addressed by OT. 3. Student performance remains unchanged despite multiple efforts by the therapist to remediate the concerns or to assist the student in compensating. 8

4. The student continues to make progress in the areas being addressed by OT consistent with developmental progress in other educational areas despite a decrease in OT services. 5. Therapy is contraindicated because of the change in medical or physical status. (Taken from: Guidelines for Occupational Therapy Services in School Systems, The American Occupational Therapy Association, Inc., 1987.) 9

9

OCCUPATIONAL THERAPY REFERRALS A referral for an Occupational Therapy assessment may be requested for any of the following reasons: o Fine Motor/visual motor deficits o Poor organization and sequencing of tasks o Functional communication; handwriting, computer use o Difficulty in accomplishing tasks without the use of adaptive equipment, environmental modifications, or assistive technology o Unusual or limited play patterns o Deficits in adaptive self-help or feeding skills in the educational setting o Poor attention to task o Notable overreaction or underreaction to textures, touch, or movement o Documented, previous attempts to alleviate problems have not been successful. (Taken from: Guidelines for Occupational Therapy & Physical Therapy in California Public Schools, California Department of Education, 1996.) In order to receive Occupational Therapy, a Designated Instruction Service, the student must have an established handicapping condition under IDEA and be found eligible and in need of Special Education services. 10

OCCUPATIONAL THERAPY REFERRAL FLOWCHART Referral Made by School or Parent Parent Consent Obtained to Complete Screening/ Evaluation Evaluation Conducted to Include: Observation Teacher Interview Parent Interview Review of Records Review of current educational setting and supports Standardized Testing, if required IEP Meeting Determination of Need IEP Team Determines Eligibility for OT Services. IEP team determines intensity, time, frequency and delivery of services. Goals and Objectives written. OT Not Recommended Delivery of Services 11

Roles and Responsibilities for the Occupational Therapist: Participate in the identification, referral, and request for assessment Completes educationally related OT assessment, which could include observation, record review and observation. Standardized assessment may also be used as appropriate. Reviews assessment results of multidisciplinary team to determine needs of student. Develops goals and objectives as appropriate for the IEP team. Develops and implements intervention strategies based on goals and objectives of the IEP team. Documents assessment results as well as recommendations and progress towards mastery of objectives for qualified students. Consults with staff and parents regarding services and IEP objectives. Provides staff development to staff and parents in related areas of suspected disabilities and strategies to assist with mastery of objectives. Roles and Responsibilities for the Certified Occupational Therapy Assistant: Provide direct, collaboration and consultation with teachers and staff regarding individual students. Provide resources to teachers, staff and parents to assist with the implementation of therapy goals. Provide appropriate equipment and directions on use to school sites to use with individual students as determined by the IEP team. Occupation Therapy Areas of Expertise: Sensory Registration and Processing: attention and emotional state as well as student s ability to filter extraneous sounds, sights, smells, and maintain focus on teacher and task. Motor Planning: student s ability to organize educational materials and work surfaces in a timely manner. Fine Motor: student s ability to write legibly as well as use a functional pencil grasp, which includes dexterous finger movements. Environmental Adaptations/Assistive Devices: provides appropriate adaptive equipment and assistive technology to allow the student to access instruction. Postural Stability: Student sits with erect posture. Postural muscle tone is adequate to stabilize the trunk, shoulders, and head so that eyes can focus and hands can control paper and pencil. Social Play/Organization of Behavior: Student participates in a cooperative activity. Able to initiate and sustain conversation with peers and adults and listen to others. 12

DISTRICT STAFF Linda Paule, Coordinator 880-6789 Brenda Lehman, Secretary 880-6788 Minaz Chauthani, OTR 473-4503 Lori Dreisbach, COTA 473-4503 13

PHYSICAL THERAPY As of this publication, the District currently has no students identified that require educationally necessary Physical Therapy. Usually, the need for Physical Therapy is less than with Occupational Therapy. Because of the fewer numbers of students requiring Physical Therapy the District currently contracts with a non-public agency for this service. Should a student enroll in the District with an active IEP requiring PT services, forward the IEP to Linda Paule, Coordinator and services will be contracted for the student. If an IEP team believes that a student is in need of Physical Therapy, the administrator of the IEP team should also contact Linda Paule for an assessment. What follows, in the next section, is general information regarding the areas that Physical Therapy addresses in an academic setting. For additional information, please contact Linda Paule at 880-6789. By law, Physical Therapy services includes: services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaption. These services include: (i) screening, evaluation, and assessment of infants and toddlers to identify movement dysfunction; (ii) obtaining, interpreting, and integrating information appropriate to program planning to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and (iii) providing individual and group services or treatment to prevent, alleviate, or compensate for movement dysfunction and related functional problems (34 C.F.R 303.12[8]). From: Guidelines for Occupational Therapy & Physical Therapy in California Public Schools, California Department of Education, Sacramento, 1996. 26

AREAS OF EXPERTISE FOR SCHOOL PHYSICAL THERAPISTS Physical therapists are health professionals with specific training in kinesiology and the remediation of dysfunction. Included in the physical therapist s education are courses in human anatomy and physiology; physical pathophysiology; joint and whole body kinesiology; gait and posture analysis; human development, especially gross motor development and motor control theories, physical treatment modalities; and cardiopulmonary, orthopedic, and neurological rehabilitation. In public schools physical therapists use techniques that correct, facilitate, or adapt the student s functional performance in motor control and coordination, posture and balance, activities of daily living/functional mobility, accessibility, and the use of assistive devices. * Motor control/sensorimotor coordination: assist student to be able to participate in school activities for the duration of the day and improve speed and accuracy of motor skills. Posture/Balance: assist student to maintain functional positions for educational activities, improve muscle tone, balance and positioning. Activities of daily living: student will manage personal needs with minimal need for assistance; manipulate classroom materials, tools, toys, utensils and assistive devices. Accessibility: accessibility to the same instructional materials and areas as nondisabled peers. Environmental adaptations, assistive devices: student will be provided with options and alternatives to participate in activities and accomplish tasks using appropriate devices or equipment for fine motor tasks. *Taken from: Guidelines for Occupational Therapy and Physical Therapy in California Public Schools, California Department of Education, Sacramento, 1996. 27

CALIFORNIA CHILDREN SERVICES California Children Services provides occupational and physical therapy services to children with qualifying medical diagnoses when therapy services are deemed medically necessary. A child may be referred by the LEA to CCS, which will determine whether (1) the child is medically eligible and requires medically necessary therapy and will forward a copy of the assessment report and proposed therapy plan to the IEP team; or (2) the child has an eligible condition that does not currently require medically necessary therapy and notify the LEA; or (3) the child is medically ineligible and notify the LEA. California Government Code Section 7575 (b) states that: The [Health] Department shall determine whether a California Children Services [CCS] eligible pupil, or a pupil with a private medical referral, needs medically necessary occupational therapy or physical therapy. A medical referral shall be based on a written report from a licensed physician and surgeon who has examined the pupil. The written report shall include the following: (1) The diagnosed neuromuscular, muscoskeletal, or physical disabling condition prompting the referral (2) The referring physician s treatment goals and objectives (3) The basis for determining the recommended treatment goals and objectives, including how these will ameliorate or improve the pupil s diagnosed condition (4) The relationship of the medical disability to the pupil s need for special education and related services (5) Relevant medical records Taken from: Guidelines for Occupational Therapy and Physical Therapy in California Public Schools, California Department of Education, Sacramento, 1996. 35

INTRODUCTION

DESCRIPTION OF OCCUPATIONAL THERAPY SERVICES

DESCRIPTION OF PHYSICAL THERAPY SERVICES

CALIFORNIA CHILDREN SERVICES

REFERRAL FORMS

RESOURCES AND REFERENCES

THE CLIME PROGRAM CLASSROOM LEARNING TO IMPROVE MOTOR EFFICIENCY

ACKNOWLEDGEMENT I would like to thank Minaz Chauthani, OTR as well as Lori Dreisbach, OTA for their assistance in gathering information to be included in this handbook. Linda Paule

August 2002 Linda Paule, Coordinator