TABLE OF CONTENTS Introduction 3 General Definitions of Occupational and Physical Therapy 3 Roles of School-Based Occupational and Physical Therapists 4 Response to Intervention (RtI) 5 Eligibility for School-based Occupational and/or Physical Therapy 7 Definition of a Student with a Disability 7 School-based Occupational Therapy 8 School-based Physical Therapy 10 The Pre-Referral Process 12 Occupational and Physical Therapy School-based Evaluations 12 The IEP & Designing a Therapy Intervention Plan 14 Practicing the Concept of Least Restrictive Environment 17 Determining the Service Delivery Method 17 What Is the Difference Between Workload and Caseload? 20 Dismissal from Occupational and/or Physical Therapy Services 21 Appendix A Child Study (CS) Occupational Therapy Screen Request Process 22 Appendix B Occupational Therapy RtI Screen 23 Appendix C Occupational & Physical Therapy Pre-Referral Request 25 Appendix D Early Childhood Occupational & Physical Therapy Screening Request 26 2
INTRODUCTION The purpose of this document is to guide the provision of school-based occupational therapy (OT) and physical therapy (PT) services that support the educational goals of students with disabilities. The intent is to articulate the procedures and actions of the Michigan Administrative Rules for Special Education (MARSE; September 2013) and the Individuals with Disabilities Education Act (IDEA 2004). IDEA mandates a free and appropriate public education in the least restrictive environment for students who are eligible to receive special education services. OT and PT are considered related services under IDEA and may be implemented in a variety of ways within the school system to best meet a student s individual academic and functional needs. These guidelines have been written to facilitate the appropriate referral and delivery of OT and PT services to eligible students between the ages of 3 and 26; to educate and support other school personnel in carrying out the students plan within a trans-disciplinary model; and to provide a flexible, consistent, and unified approach for treatment of students within the Newaygo County Regional Educational Service Agency. These guidelines are written as a source of information for those who are responsible for service planning and delivery of school-based OT and PT; which may include OT s, PT s, special education teachers, general education teachers, administrators and parents. GENERAL DEFINITIONS OF OCCUPATIONAL AND PHYSICAL THERAPY Occupational Therapy Occupational therapists are professionals who require a Bachelor s degree (pre 2007 graduate) and a Master s degree (post 2007) from an accredited university. Occupational therapists are certified to practice by passing a national board exam and fulfilling the requirements of the State of Michigan to obtain licensure. Occupational therapy is defined by the American Occupational Therapy Association (AOTA) as the therapeutic use of occupations, including everyday life activities with individuals, groups, populations, or organizations to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings. Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical and mental health, well-being, and quality of life. 3
Physical Therapy Physical therapists are professionals who have graduated from an accredited physical therapist education program and have passed a national examination approved by the American Physical Therapy Association. Physical therapists must be licensed in the state in which they practice. Many physical therapists have additional qualifications, such as advanced practice post-professional degrees and certification as clinical specialists through the American Board of Physical Therapy Specialties (ABPTS). Therapy Specialties As defined by the Michigan Public Health Code [333.17801(d)], (The) Practice of Physical Therapy means the evaluation of, education of, consultation with or treatment of an individual by the employment of effective properties of physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting or alleviating a physical or mental disability. Physical therapy includes treatment planning, performance of tests and measurements, interpretation of referrals, initiation of referrals, instruction, consultative services, and supervision of personnel. Physical measures include massage, mobilization, heat, cold, air, light, water, electricity and sound. Practice of physical therapy does not include the identification of underlying medical problems or etiologies, establishment of medical diagnoses, or the prescribing of treatment. In Michigan, a prescription by a physician is required for physical therapy, and is effective for 90 days unless otherwise noted. At NC RESA, a PT prescription is typically written to be effective for one year. Physical therapists work in a variety of settings. The rest of this document will focus on the practice of school-based occupational and physical therapy. ROLES OF SCHOOL-BASED OCCUPATIONAL AND PHYSICAL THERAPISTS According to the NC RESA job description for Occupational and Physical Therapists (last amendment January 2013) the general function of an Occupational Therapist and Physical Therapist shall be the responsibility of providing diagnostic and/or therapy services to students who are suspected of being disabled and/or are disabled. Essential duties shall include, but are not limited to: Evaluate students Prepare MET and evaluation reports Participate in MET and IEPT meetings Write appropriate goals and objectives Provide therapy to students 4
Maintain a schedule of service and student progress Consult with staff and parents Establish and maintain agency contacts Complete timely submission of claims to Medicaid for eligible students on caseload Act as a resource, if needed, to employees, students and the general public visiting the NC RESA Possess knowledge of NC RESA s organization, mission, and philosophy Perform other duties deemed appropriate by the Executive Director of Intervention & Prevention Services In addition, best practice for school-based occupational and physical therapists includes working in collaboration with teachers, other related service providers, other school staff, and parents/guardians. Other responsibilities may include: Participation in Response to Intervention (RtI) Observations in classroom or other school environment Consultation with teachers to offer classroom-based strategies Attending meetings that support student programming Activities that support students in the natural environment or general education curriculum Staff training and professional development Providing assistance in environmental modifications, and adaptive equipment or devices Recommending appropriate positioning (PT) so students can access instruction Linking parents/guardians to appropriate community-based resources Designing home exercise programs and related activities for carryover Supporting school compliance and data tracking Transition from school to post-school activities RESPONSE TO INTERVENTION (RTI) The National Association of State Directors of Special Education defines Response to Intervention as the practice of (1) providing high quality instruction/intervention matched to student need and (2) using learning rate over time and level of performance to (3) make important educational decisions. Through the Response to Intervention (RtI) process, OTs and PTs participate in team-based problem solving for students in general education programs. IDEA, 5
2004{614(a)(1)(E) supports therapists involvement in the RtI process stating The screening of a student by a teacher or specialist to determine important instructional strategies for curriculum implementation shall not be considered to be an evaluation for eligibility for special education and related services. The goals of Response to Intervention measures are to: Close the achievement gap Remediate learning problems (not simply to label disabilities) Support and intervene early (not test and place for special education) Response to Intervention (RtI) uses a multi-tier model of early intervening and service delivery to support student success. Tier 1 (Basic Instructional Curriculum)--Available to all students OTs and/or PTs may provide classroom consultation regarding environmental accommodations such as seating and positioning adjustments, movement programs, suggesting a variety of writing utensils such as pencils/paper and universal screening for fine motor, gross motor and sensory motor risks. Tier 2 (Basic Instruction and Supplemental Intervention) Individualized OTs and/or PTs may work closely with the teacher/staff to develop classroom interventions for a particular student to be successful in their educational program. The NC RESA Fine Motor Intervention Manual is utilized and staff is directed to specific interventions in the manual that correlate with areas found to be at risk during the universal screening. Examples may include a specific pencil grip, weighted pencils or sleeves, slant boards, ball chairs or sensory strategies. Therapists monitor student s success with the recommended interventions and continue to provide support through the first grade. Tier 3 (Intensive Intervention/Child Study) Individualized OTs and/or PTs may work with staff and student on intensive and individualized instruction such as developing/monitoring sensory diets and/or use of visual supports along with digging deeper diagnostic testing in the areas of sensory processing, fine motor, visual motor and visual perception. Other responsibilities of the therapist include: Completing documentation of universal screens and recommendations Reviewing findings/recommendations with the teacher and staff 6
Training staff in the purpose, use and precautions of recommended equipment/strategies/programs Providing information to teachers and staff in the RtI fine motor screen process and the therapists role in the process Collecting data and submitting it to the Instructional Management Team (IMT) for progress monitoring Attending IMT meetings when needed to review student data Attending Child Study meetings regarding Tier 2 and 3 students Perform follow up screenings for Tier 2 and 3 students and document student progress Evaluating the Result of Response to Intervention The teacher or academic intervention specialist collects post-intervention data for comparison to baseline data. The results may be interpreted as follows: Goal Met Teacher and/or appropriate school personnel continue the intervention strategies. Further involvement of the therapist may be unnecessary at this time. Goal Not Met If the student has been making progress utilizing the strategies implemented, the team may continue the intervention, re-evaluating the result every 4-6 weeks. If the student has not been making progress, the team may develop other intervention strategies. The team may refer the student for a pre-referral screening for special education services. ELIGIBILITY FOR SCHOOL-BASED OCCUPATIONAL AND/OR PHYSICAL THERAPY A student must be eligible for special education to be considered for OT and/or PT services in the schools according to MARSE (Michigan Administrative Rules for Special Education) and IDEA (Individuals with Disabilities Education Act federal regulations). Eligibility for special education does not mean automatic eligibility for related services, including OT and/or PT. Final determination of eligibility is made by a multi-disciplinary education team. Definition of a Student with a Disability Per MARSE: Michigan Administrative Rules for Special Education (September 2013) 7
R 340.1702 Student with a disability defined. Rule 2. Student with a disability means a person who has been evaluated according to the individuals with disabilities education act and these rules, and is determined by an individualized education program team, an individualized family service plan team, or an administrative law judge to have 1 or more of the impairments specified in this part that necessitates special education or related services, or both, who is not more than 25 years of age as of September 1 of the school year of enrollment, and who has not graduated from high school. A student who reaches the age of 26 years after September 1 is a student with a disability and entitled to continue a special education program or service until the end of that school year. Occupational and physical therapy services in the educational setting differ from those in rehabilitation or other medical settings both in scope and intent. In the school setting, OT and PT are part of a broad program based on student s achievement and functional performance congruent with the educational curricula. The provision of therapy and outcome is based on the impact the disability has on educational performance rather than on the disability itself. OT and PT services in the school are solely to support the educational process. A student may manifest a disability that does not significantly interfere with educational performance and then OT/PT services would not be warranted. Occasionally, a student may require medically based therapy services outside the scope of the Individualized Education Program (IEP) goals, and the family can pursue community resources to meet medical-rehabilitation needs. School-based OT/PT is designed to enhance the student's ability to fully access and be successful in the learning environment. For occupational therapy this may include, but is not limited to, working on handwriting or fine motor skills so the child can complete written assignments, helping the child organize himself or herself in the environment (including work space in and around the desk), working with the teacher to modify the classroom and/or adapt learning materials to facilitate successful participation. For physical therapy this may include, but is not limited to, assisting students with mobility equipment in the classroom, lunch room or playground. Best practice indicates that interventions are most effective when provided where performance naturally occurs. School-based Occupational Therapy Occupational therapy is a health profession in which therapists and therapy assistants help individuals to do and engage in the specific activities that make up daily life. For children and youth in schools, occupational therapy works to ensure that a student can participate in the full breadth of school activities from paying attention in class; concentrating on the task at hand; holding a pencil, musical instrument, or book in the easiest way; or just behaving appropriately in class. 8
Occupational therapists and occupational therapy assistants help students perform particular tasks necessary for participation or learning. The whole purpose of school-based occupational therapy is to help kids succeed, says pediatric occupational therapist Leslie Jackson. Occupational therapy practitioners don t just focus on the specific problem that a child s disability may present; rather, they look at the whole child and tackle individual tasks, helping students find ways to do the things they need and want to do. Usually, occupational therapy is provided to students with disabilities. But occupational therapy can be made available to other children who are having specific problems in school. Occupational therapy practitioners also work to provide consultation to teachers about how classroom design affects attention, why particular children behave inappropriately at certain times, and where best to seat a child based on his or her learning style or other needs. Occupational therapy may be recommended for an individual student for reasons that might be affecting his or learning or behavior, such as motor skills, cognitive processing, visual or perceptual problems, mental health concerns, difficulties staying on task, disorganization, or inappropriate sensory responses. A common manifestation of difficulties in school involves handwriting, in many cases because this is a key occupation that students must master to succeed in school. A teacher might notice that a student cannot write legibly or has serious problems in other motor tasks. The occupational therapy practitioner can work with the teacher to evaluate the child to identify the underlying problems that may be contributing to handwriting difficulty. The occupational therapy practitioner looks at the child s skills and other problems (including behavior), in addition to his or her visual, sensory, and physical capabilities. They also take into account the school, home, and classroom environments to find ways to improve the handwriting or to identify ways the child can compensate, such as using a computer. Accessing school-based occupational therapy is fairly straightforward, but it is the school team who makes the decision of whether or not a student requires occupational therapy. Not every student needs occupational therapy, even if the student has a disability. Those who do may have problems that the teacher can address after consulting with an occupational therapy practitioner and modifying their teaching technique or the environment for the entire class. The education team could recommend one-on-one services. Usually these services are integrated as much as possible into the child s routine to promote better integration of skills. 9
Students with disabilities have been able to receive occupational therapy at school since the 1975 passage of the Individuals with Disabilities Education Act (IDEA), which served as the original impetus for school-based occupational therapy. The law stipulates that students with disabilities must have access to the occupational therapy if they need it to benefit from special education. In 2001, Congress passed the No Child Left Behind (NCLB) Act which requires schools to improve the academic achievement of all students, including those with disabilities. In 2004, the reauthorization of IDEA extended the availability of occupational therapy services to all students, not just those with disabilities, in order to fully participate in school. The determination of need for occupational therapy (OT) services and the intensity of that service is dependent upon identified need in one or more of the following domains: Personal independence, including self-care and community integration (i.e., activities of daily living and school/play/leisure activities) Adaptive behavior (including activities of daily living and play) Fine motor and neuro-motor development including the qualitative aspects of performance Sensory processing (including visual and tactile perception) Sensory-integration (including the ability to use sensory information for functional goals) Perceptual motor (including visual motor integration and sensory-motor coordination) Attention and self-regulation (including sensory modulation, the ability to selectively focus and shift attention, inconsistency of performance or effort especially if associated with motor incoordination, presence of sensory-based stereotypes, or periods of exacerbated behavior) Psychosocial development (including relationships with peers and adults) School-based Physical Therapy Physical therapy is a related service provided under Part B of IDEA. IDEA defines related services as a support services that may be provided to assist a child with a disability to benefit from special education. This definition is important to differentiate physical therapy services that are necessary to help a child within the context of his/her educational programming versus the more medical and rehabilitative therapy that does not relate directly to a student s learning and performance in school. Therefore, it is noted that some children may qualify for physical therapy in a medical setting, but if their disability is not interfering with school function, they do not require school-based physical therapy services. 10
Sue Effgen, et al. (2007) reported competencies for physical therapists working in schools. Physical therapists working in school settings should seek competence in the following areas: Content Area 1: The context of therapy practice in schools Content Area 2: Wellness and prevention in schools Content Area 3: Team collaboration Content Area 4: Examination and evaluation in schools Content Area 5: Planning Content Area 6: Intervention Content Area 7: Documentation Content Area 8: Administrative issues in schools Content Area 9: Research School-based physical therapists provide intervention in the following areas related to a student s ability to access the educational environment: Mobility o Including access to various areas of the school environment by walking or using assistive devices including walkers, wheelchairs, crutches, etc. and including endurance and activity tolerance. Transfers o Including training of students and staff in lifting techniques, transfer techniques and use of lifts. Physical Environments o Including accessing and maneuvering in all school environments, including classrooms, hallways, gym, cafeteria, playground, bathroom, locker, and bus, etc. Adaptive Equipment o Including seating, standing and other positioning equipment or recommendations to facilitate functional posture for school activities. This may also include recommendations, training, and maintenance of orthotics and prosthetics as appropriate. Gross Motor Developmental Skills o Including large motor activities which require balance, coordination and strength. 11
THE PRE-REFERRAL PROCESS 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 Child Study/Student Intervention Team meetings and Response to Intervention as described above. A student can be referred for an OT/PT special education screen by a teacher, parent or other school personnel. Once the therapist receives the referral, the screen must be completed within 30 school days and returned to the local district Child Study/Student Intervention Team Coordinator and the NC RESA Special Education Supervisor. The results of the screen are reviewed with the child study/student intervention team with any of the following next steps: 1. If the student is eligible for special education and a full evaluation is recommended, the Special Education Supervisor generates a REED: Review of Existing Evaluation Data, for the parent to provide informed written consent for further evaluation. An evaluation will be completed within 30 school days of receipt of the parent s written consent. 2. If the student is not eligible for special education, the child study/student intervention team may recommend and gain parental consent for further diagnostic assessments to help support programming in the school setting. 3. If the therapist does not recommend evaluation, there is no further action required from the therapist. OCCUPATIONAL AND PHYSICAL THERAPY SCHOOL-BASED EVALUATIONS Data Collection To determine student s ability to participate and identify factors that restrict participation, the evaluation must include gathering data related to: Teacher, Student and Parent/Guardian Concerns An interview is used for establishing a collaborative relationship with the teacher, parent/guardian, and student. The interview allows the therapist to understand the following: What are the reasons for seeking therapy services? How is the student performing academically? 12
What are the concerns and expectations about the student s performance in his/her current classroom/school placement? Of the concerns identified, what are the priorities? How important is this activity to the student s success in school? Is the deficiency in this area affecting the student s ability to access his/her education? How would the teacher and parent/guardian describe the way the student performs this activity now? What strategies were tried to address these issues? What are the student s strengths, interests and motivations? The responses to these questions clarify how the student s perceived problems interfere with the student s ability to access and participate in school, and how the student s strengths may be utilized to improve school performance. Relevant Student History The therapist must obtain the student s relevant medical and educational history, for example: Are there any current or past medical/health issues (i.e. conditions/diagnoses, medication, surgeries, allergies, injuries, or related contraindications for therapy) that are important to consider when evaluating and planning intervention? What related service(s) is the student currently receiving? What services were received in the past and how did the student respond? Student s Level of Participation in the School The therapist must determine a student s ability to participate in specific school tasks (e.g. transitioning between classrooms, completing class work). This process may require the use of several evaluation tools, ranging from skilled observation to basic tests and measures, and standardized assessments. Therapist must note whether student is able to complete tasks independently (with or without the use of assistive devices) or the student requires assistance to complete tasks. In addition, the therapist must assess how the student s environment and the cognitive or physical demands of various school tasks affect his/her participation. Can the student s environment and/or the demands of the school tasks be modified to improve student s ability to participate? Are adaptations needed? Generally, if no participation restriction was noted, there is no need to further assess the student s performance of specific school-based activities and the assessment ends here. The therapist documents the findings that the student has no participation restriction. Note that many students with disabilities are able to engage successfully in various school activities without related services of OT or PT. 13
If there were participation restrictions noted, to help explain possible causes, the therapist must describe the student s functional performance in areas where these restrictions were observed. When reporting these findings on the OT or PT evaluation report, the therapist must articulate how these limitations and impairments affect the student s ability to participate in his/her educational program. This will assist the IEP team in deciding whether an occupational or physical therapy service would be appropriate for the student s IEP. Data Interpretation In the course of the OT/PT assessment process, the data collected is analyzed to identify student s strengths and weaknesses and create a preliminary recommendation whether OT/PT service is appropriate. These findings are presented to other members of the IEP team in the form of an occupational or physical therapy evaluation report. The IEP team utilizes this report together with information gathered by other team members to establish and prioritize goals. The team then determines the educational supports that would best address these goals while keeping the student in the least restrictive environment. These supports may ultimately include or not include OT or PT services. Occupational and physical therapy services are identified as related services under IDEA. Related services are needed only when it is clear that: 1. The student s educational needs are greater than can be addressed by instructional personnel in his/her educational setting; AND 2. The services are necessary to benefit from the student s educational program; AND 3. The absence of these supports would adversely affect educational performance to the point that appropriate learning would not occur. THE IEP & DESIGNING A THERAPY INTERVENTION PLAN Once it has been determined that the student requires OT and/or PT services, the therapist should develop an intervention plan. This should include the following: Step 1: Review Initial Evaluation and IEP Goals to Develop an Intervention Plan. Establishing Goals/Objectives The IEP team collaborates to develop educationally relevant IEP goals. IEP goals must be SMART: Specific, Measurable, Attainable, Relevant/Realistic and Time-based. Goals should be clearly related to the student s functional limitations in specific school tasks. Step 2: Determine Therapy Intervention Focus Area(s) 14
In order to achieve the student s IEP goals, the therapist must determine whether the student recommended for OT/PT services requires intervention focused on any or all of the following: Student Remediation or restoration of skills, and promotion of behaviors that would improve participation Resources intrinsic to the student such as body structures and functions, behavior, motivation, skills Task Compensating a student s skills by modification of the physical or cognitive demands of an activity so that student s performance will improve Resources extrinsic to the student such as materials used or procedures followed to complete tasks Environment Compensating a student s skills by modification and adaptation of the environment Resources extrinsic to the student such as physical barriers The three areas are inter-related and complementary. When designing a plan, the above areas must be considered, but one or two areas may be emphasized over another. 15
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PRACTICING THE CONCEPT OF LEAST RESTRICTIVE ENVIRONMENT IDEA states that to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled. Separation of students from their general education peers via gym/music classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily. When determining intervention focus, service delivery model and IEP mandate, the therapist with other members of the IEP team must first consider the least restrictive environment. Collaborative and consultative service delivery methods require less separation of student from class activities. Keeping frequency and duration to a minimum would ensure that a student is able to maximize his/her interaction with his/her classroom peers. Working with the student within the natural educational setting allows the student to practice skills with their peers; while pulling a student to a therapy room limits the interaction to only the student and an adult (i.e. the therapist). DETERMINING THE SERVICE DELIVERY METHOD The therapist determines which service delivery method(s) will be employed to address the identified intervention focus area(s). It is typical for a therapist to utilize a combination of methods, and to move among the continuum of methods as progress is made towards the achievement of the student s IEP goals. NC RESA OT s and PT s, as part of an education team, provide the most effective therapy intervention services when delivered according to a collaborative model, using a team approach in the design and implementation of the student s Individualized Education Program (IEP) goals. A collaborative, or trans-disciplinary, approach is where there is transference of knowledge across discipline boundaries in order to facilitate the provision of consistent programming for individual students. Written in the student s individualized education program, OT/PT services can be written one of two ways: Direct The therapist develops and provides hands-on intervention that does not occur during actual school activities. The student is removed from the classroom. This method is utilized when emphasis is on acquiring new and specific skills in a controlled environment, or when intervention strategies cannot be safely or easily carried out in the student s class setting. The intervention focuses heavily on the student. The task and environment may also be a focus if modifications are being implemented. 17
Examples: *Occupational therapist works with the student in the therapy room for finger/hand strengthening/dexterity and visual perceptual activities for handwriting. *Physical therapist works with student in empty stairwell to practice ascending and descending stairs when not used by others. Another form of direct service is when the therapist develops and provides hands-on intervention that occurs during actual school activities. This intervention is provided alongside classroom peers within the natural environment, and emphasizes integration of skills into actual school activities. The intervention focus is often the student and the task, and occasionally the environment. Examples: *During journal writing, occupational therapist works with the student as student utilizes raised line paper, pencil grip, and slant board. *Physical therapist facilitates the student while negotiating stairs with peers in a crowded stairwell. Consultation The therapist collaborates with classroom/school staff and parent/guardian to develop and monitor intervention that will be carried out by these individuals in the school and at home. The therapist must identify the appropriate individuals who will implement the strategies. This intervention may take the form of specific classroom strategies, task modifications or environmental adaptations. It may also include staff training and provision of additional resources. This intervention ensures carry-over of skills learned under the direct therapy method. Examples: *Occupational therapist suggests using a slant board for all writing tasks. *Physical therapist trains classroom staff in safe stair negotiation. 18
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WHAT IS THE DIFFERENCE BETWEEN WORKLOAD AND CASELOAD? The concept of workload encompasses all of the work activities you perform that benefit students directly and indirectly. Caseload refers only to the number of children seen by occupational therapy as part of the Individual Education Program (IEP). A traditional caseload counting approach does not fully appreciate the complexity of the occupational therapy role in current best-practice scenarios. Direct services built around a clinical model of predictable, routine appointments have limited support in the educational literature and do not necessarily promote the generalization of skills to the classroom or other appropriate settings. A simple caseload also does not recognize the potential occupational therapy contribution to the Individuals with Disabilities Education Act of 2004 s (IDEA s) participation focus or its mandate that services support access to and progress in the general education curriculum or natural environment (American Occupational Therapy Association, 2006). School OT/PT Workload Activities 20
DISMISSAL FROM OCCUPATIONAL AND/OR PHYSICAL THERAPY SERVICES Dismissal, or exit/graduation, from OT/PT occurs when the student no longer needs the service to benefit from special education. The goal of OT/PT services is to maximize a student s potential and participation in the classroom while limiting the amount of time the student is removed from his/her peers. Therefore, once the student achieves his/her educational goals or has otherwise reached the maximum benefit from physical therapy services they must be discontinued. The OT/PT will consider recommendations for continuation or discontinuing services based on the following four questions: Did the student achieve his/her IEP goals that require OT/PT services? Does the student continue to demonstrate an inability to participate in school as needed to meet educational goals? Does the student have functional school goals that require OT/PT? Does the student show potential for improvement with regard to these goals? The student may be considered for graduation from physical therapy services when: The student s goals were met or exceeded, allowing for access and participation in the expected classroom or other school environment. The student demonstrates the ability to integrate and apply newly acquired performance into meaningful and functional everyday school activities. The student assumes roles and responsibilities in instructional, non-academic and or extracurricular activities. The student has plateaued and reached maximum potential. The goals established were not met after due diligence in applying multiple intervention plans over an appropriate period of time. Performance can no longer be improved by an OT/PT through remediation of the student s skills and implementation of all feasible task and environmental modifications. The student s goals are no longer valid given a change in context. Environmental and task expectations for performance have changed and the student s performance is an adequate match for the current demands. Planning for dismissal or graduation from OT/PT services should begin at the student s initial evaluation. When recommending initiation of physical therapy services, the therapist will explain how/why services are needed in order for the child to meet his/her educational goals with the understanding that when the goal are met, the student no longer requires school-based OT/PT services. However, it is important to keep in mind that as the student grows and develops, reasonable outcomes of therapy may change. Following graduation from school-based OT/PT services, the assessment process can be re-initiated if the student demonstrates regression or should a new problem arise. 21
APPENDIX A CHILD STUDY (CS) OCCUPATIONAL THERAPY SCREEN REQUEST PROCESS 22
APPENDIX B OCCUPATIONAL THERAPY RTI SCREEN 23
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APPENDIX C OCCUPATIONAL & PHYSICAL THERAPY PRE-REFERRAL REQUEST 25
APPENDIX D EARLY CHILDHOOD OCCUPATIONAL & PHYSICAL THERAPY SCREENING REQUEST 26