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Referral - Granite School District

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Referral - Granite School District Powered By Docstoc
					                                 Student Intervention Profile - Occupational Therapy                                      SIP-OT Eval
                                              Independent School Skills                                                          06/11
                                                                                                                   GSD - Salt Lake City
Student Information: Please attach a copy of the school/student ID card
Student:                                   Student ID:                              DOB:                               Date:
School:                                                        Teacher:                                                        Grade:
Kindergarten:         AM Class          PM Class         Preschool (circle days attending):   M   T W Th             AM Class           PM Class
Parent Name:                                       Address:                                                          Phone:

Safety Issues
           ● If there is an immediate safety concern, please contact the OT Department at 385-646-4548.
                  Please be able to describe your concern and continue with this form
           ● If safety is not an immediate concern or there is no concern for safety, please continue with this form.

   Medical Diagnosis
          Student has a diagnosis of:                                                                       (attach medical information)
          Student has no known diagnosis
   Applicable Testing - Please list scores below or include a copy of scores on evaluations completed on the student
   Cognitive testing results - Choose from below or add others
          Measure(s)                                                 Date                                            Score
          Woodcock-Johnson
          WISC
          Stanford-Benet
          Batelle
          Other
   Perceptual testing (VMI, MVPT)
              Measure(s)                                             Date                                            Standard Score



Problem Analysis (in area of specific concern)
   Area of Concern: You will need to have data on each area checked
              Self Care           School Fine Motor Skills                Life Skills         Sensory Processing
   Special Education or 504 Information
   List the goal(s) from the current IEP or need(s)/accommodation(s) from current 504 plan that the student is having difficulty meeting
   pertaining to this referral.




   What issues might be interfering with the child achieving this/these goal(s)?




Comments:




Interventions
    ● Choose two pre-referral interventions for each area of concern (see Teacher Tools & Pre-Referral Suggestions)
    ● Attach samples of work, if appropriate
   Date Plan Developed:
   Plan Developed by (list all):




                                                                                                                          Page 1 of 15
                                   Student Intervention Profile - Occupational Therapy                                          SIP-OT Eval
                                                Independent School Skills                                                              06/11
                                                                                                                         GSD - Salt Lake City
Self-Care:       This includes dressing for toileting or outdoor clothing, feeding, and school hygiene (washing & toileting)
    Intervention #1:                                                       Start Date:                              End Date:
    Goal of Intervention:
    Group Size:            1:1            Small Group: How many                               Large Group: How many
    Frequency:             Daily              times a week                 Other (please specify)
    Duration:              15 min         20 min              30 min            Other (please specify)
    Interventionist:       Reg Ed         Spec Ed             Para              Counselor
    Attendance (# of days present / # of session):                     %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe              1             2         3              4             5             6             7            8            9               10
    Date
    Data
    Assessment Tool:
    Intervention #2:                                                       Start Date:                              End Date:
    Goal of Intervention:
    Group Size:            1:1            Small Group: How many                               Large Group: How many
    Frequency:             Daily              times a week                 Other (please specify)
    Duration:              15 min         20 min              30 min            Other (please specify)
    Interventionist:       Reg Ed         Spec Ed             Para              Counselor
    Attendance (# of days present / # of session):                     %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe              1             2         3              4             5             6             7            8            9               10
    Date
    Data
    Assessment Tool:
Please place comments on the back of this page (if needed)
Results of First Intervention (Action)                                          Results of Second Intervention (Action)
Date of Meeting:                                                                Date of Meeting:
        Adequate progress - continue intervention and/or revise                          Adequate progress - No OT evaluation request is
        goal                                                                             indicated at this time
        Criteria achieved - continue intervention and change goal                        Criteria achieved - No OT evaluation request indicated at
        criteria OR exit intervention                                                    this time
        Unable to determine due to attendance issues - continue                          Unable to determine due to attendance issues - continue
        intervention #1                                                                  Intervention #2
        Intervention unsuccessful - revise and continue with                             Intervention unsuccessful - refer for OT evaluation
        intervention #2



             Signature                             Position                                   Signature                                Position
Documentation needed for referral for OT evaluation: Check off each item listed below before sending it to your Occupational Therapist. If the
form is sent without the following information, it will be returned for completion. PLEASE NOTE: Please attach all additional information.
Send COPIES only, the originals should be kept at the school.
            Signed "Prior Notice and Consent for Evaluation/Re-                               Scores from appropriate testing tools
            Evaluation" with "Motor" and "Psychomotor" boxes checked
            Pre-referral Interventions completed and documented with                          Applicable medical information (Please attach any other
            work samples, if appropriate                                                      information not covered)




                                                                                                                                      Page 2 of 15
                                    Student Intervention Profile - Occupational Therapy                                                SIP-OT Eval
                                                 Independent School Skills                                                                    06/11
                                                                                                                                GSD - Salt Lake City
School Fine Motor Skills:                   This includes play skills, grasp/holding pencil and/or crayons functionally, pre-writing activities (coloring, cutting,
gluing accurately), handwriting, letter formation, reversals, letter size, alignment, and spacing.

    Intervention #1:                                                             Start Date:                              End Date:
    Goal of Intervention:
    Group Size:             1:1                Small Group: How many                                Large Group: How many
    Frequency:              Daily                  times a week                  Other (please specify)
    Duration:               15 min             20 min               30 min            Other (please specify)
    Interventionist:        Reg Ed             Spec Ed              Para              Counselor
    Attendance (# of days present / # of session):                           %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe               1              2             3              4             5             6             7             8             9              10
    Date
    Data
    Assessment Tool:
    Intervention #2:                                                             Start Date:                              End Date:
    Goal of Intervention:
    Group Size:             1:1                Small Group: How many                                Large Group: How many
    Frequency:              Daily                  times a week                  Other (please specify)
    Duration:               15 min             20 min               30 min            Other (please specify)
    Interventionist:        Reg Ed             Spec Ed              Para              Counselor
    Attendance (# of days present / # of session):                           %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe               1              2             3              4             5             6             7             8             9              10
    Date
    Data
    Assessment Tool:
Please place comments on the back of this page (if needed)
Results of First Intervention (Action)                                                Results of Second Intervention (Action)
Date of Meeting:                                                                      Date of Meeting:
         Adequate progress - continue intervention and/or revise                               Adequate progress - No OT evaluation request is
         goal                                                                                  indicated at this time
         Criteria achieved - continue intervention and change goal                             Criteria achieved - No OT evaluation request indicated at
         criteria OR exit intervention                                                         this time
         Unable to determine due to attendance issues - continue                               Unable to determine due to attendance issues - continue
         intervention #1                                                                       Intervention #2
         Intervention unsuccessful - revise and continue with                                  Intervention unsuccessful - refer for OT evaluation
         intervention #2



               Signature                                 Position                                   Signature                                 Position
Documentation needed for referral for OT evaluation: Check off each item listed below before sending it to your Occupational Therapist. If the
form is sent without the following information, it will be returned for completion. PLEASE NOTE: Please attach all additional information.
Send COPIES only, the originals should be kept at the school.
              Signed "Prior Notice and Consent for Evaluation/Re-                                   Scores from appropriate testing tools
              Evaluation" with "Motor" and "Psychomotor" boxes checked
              Pre-referral Interventions completed and documented with                              Applicable medical information (Please attach any other
              work samples, if appropriate                                                          information not covered)




                                                                                                                                            Page 3 of 15
                                   Student Intervention Profile - Occupational Therapy                                             SIP-OT Eval
                                                Independent School Skills                                                                 06/11
                                                                                                                            GSD - Salt Lake City
Life Skills:     This includes skills related to the bathroom (faucets & towels), drinking fountains, backpacks, desk/materials, lockers lunchroom,
computers in school, and endurance & fatigue.

    Intervention #1:                                                          Start Date:                              End Date:
    Goal of Intervention:
    Group Size:            1:1              Small Group: How many                                Large Group: How many
    Frequency:             Daily                times a week                  Other (please specify)
    Duration:              15 min           20 min               30 min            Other (please specify)
    Interventionist:       Reg Ed           Spec Ed              Para              Counselor
    Attendance (# of days present / # of session):                        %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe              1             2            3              4             5             6             7            8            9               10
    Date
    Data
    Assessment Tool:
    Intervention #2:                                                          Start Date:                              End Date:
    Goal of Intervention:
    Group Size:            1:1              Small Group: How many                                Large Group: How many
    Frequency:             Daily                times a week                  Other (please specify)
    Duration:              15 min           20 min               30 min            Other (please specify)
    Interventionist:       Reg Ed           Spec Ed              Para              Counselor
    Attendance (# of days present / # of session):                        %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe              1             2            3              4             5             6             7            8            9               10
    Date
    Data
    Assessment Tool:
Please place comments on the back of this page (if needed)
Results of First Intervention (Action)                                             Results of Second Intervention (Action)
Date of Meeting:                                                                   Date of Meeting:
        Adequate progress - continue intervention and/or revise                             Adequate progress - No OT evaluation request is
        goal                                                                                indicated at this time
        Criteria achieved - continue intervention and change goal                           Criteria achieved - No OT evaluation request indicated at
        criteria OR exit intervention                                                       this time
        Unable to determine due to attendance issues - continue                             Unable to determine due to attendance issues - continue
        intervention #1                                                                     Intervention #2
        Intervention unsuccessful - revise and continue with                                Intervention unsuccessful - refer for OT evaluation
        intervention #2



              Signature                               Position                                   Signature                                Position
Documentation needed for referral for OT evaluation: Check off each item listed below before sending it to your Occupational Therapist. If the
form is sent without the following information, it will be returned for completion. PLEASE NOTE: Please attach all additional information.
Send COPIES only, the originals should be kept at the school.
             Signed "Prior Notice and Consent for Evaluation/Re-                                 Scores from appropriate testing tools
             Evaluation" with "Motor" and "Psychomotor" boxes checked
             Pre-referral Interventions completed and documented with                            Applicable medical information (Please attach any other
             work samples, if appropriate                                                        information not covered)




                                                                                                                                         Page 4 of 15
                                    Student Intervention Profile - Occupational Therapy                                             SIP-OT Eval
                                                 Independent School Skills                                                                 06/11
                                                                                                                             GSD - Salt Lake City
Sensory Processing:                  This includes over responsiveness, under responsiveness, touch (tactile)/personal space, oral/mouthing, auditory, and
transitions.

    Intervention #1:                                                           Start Date:                              End Date:
    Goal of Intervention:
    Group Size:             1:1               Small Group: How many                               Large Group: How many
    Frequency:              Daily                 times a week                 Other (please specify)
    Duration:               15 min            20 min              30 min            Other (please specify)
    Interventionist:        Reg Ed            Spec Ed             Para              Counselor
    Attendance (# of days present / # of session):                         %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe               1             2            3              4             5             6             7            8            9               10
    Date
    Data
    Assessment Tool:
    Intervention #2:                                                           Start Date:                              End Date:
    Goal of Intervention:
    Group Size:             1:1               Small Group: How many                               Large Group: How many
    Frequency:              Daily                 times a week                 Other (please specify)
    Duration:               15 min            20 min              30 min            Other (please specify)
    Interventionist:        Reg Ed            Spec Ed             Para              Counselor
    Attendance (# of days present / # of session):                         %
    Intervention Progress Data (record below or attach computerized printout): Collect daily for 10 consecutive days
    Probe               1             2            3              4             5             6             7            8            9               10
    Date
    Data
    Assessment Tool:
Please place comments on the back of this page (if needed)
Results of First Intervention (Action)                                              Results of Second Intervention (Action)
Date of Meeting:                                                                    Date of Meeting:
         Adequate progress - continue intervention and/or revise                             Adequate progress - No OT evaluation request is
         goal                                                                                indicated at this time
         Criteria achieved - continue intervention and change goal                           Criteria achieved - No OT evaluation request indicated at
         criteria OR exit intervention                                                       this time
         Unable to determine due to attendance issues - continue                             Unable to determine due to attendance issues - continue
         intervention #1                                                                     Intervention #2
         Intervention unsuccessful - revise and continue with                                Intervention unsuccessful - refer for OT evaluation
         intervention #2



               Signature                               Position                                   Signature                                Position
Documentation needed for referral for OT evaluation: Check off each item listed below before sending it to your Occupational Therapist. If the
form is sent without the following information, it will be returned for completion. PLEASE NOTE: Please attach all additional information.
Send COPIES only, the originals should be kept at the school.
               Signed "Prior Notice and Consent for Evaluation/Re-                                Scores from appropriate testing tools
               Evaluation" with "Motor" and "Psychomotor" boxes checked
               Pre-referral Interventions completed and documented with                           Applicable medical information (Please attach any other
               work samples, if appropriate                                                       information not covered)




                                                                                                                                          Page 5 of 15
                            Granite School District - OT Department
               Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Self Care Domain: participating in or completing the actual skill
Dressing for toileting or outdoor clothing
              Practicing with larger fasteners
              Adapting fasteners: a paper clip or key chain for a zipper pull, use Velcro or elastic as appropriate
              Teach only one part of the task at a time, adding parts as they gain skill
              Schedule time in the day (everyday/multiple times a day) to practice the ask i.e.: coat - in the
              morning, recess and going home; clothing fasteners - during a manipulatives center, toileting, free play
              activity, make a work shirt, art shirt or lunch shirt to put on and take off
              Color code arm and sleeve. i.e. blue string in arm hole matches blue string around (or blue dot on)
              corresponding hand
              Color code buttons to buttonholes
              Provide hand-over-hand assistance and gradually reduce the assistance to complete the task
              Use belt loops on pants to help pull pants up on both right and left sides
              If the child has one-sided weakness, have them put the weaker side in first when dressing take
              the stronger out first when undressing
Feeding
              If they cannot carry their tray, have a peer or adult carry it for them
              Provide set-up if the student cannot open containers or cut food into bite-sized pieces
              Allow choices for fussy eaters, play with foods - building, painting or making pictures with foods
              Change the textures of foods very slowly by adding cookie crumbs, cereal crumbs, etc
              Try different utensils for foods, cups or straws for drinking
              Pre-cut food into bite-sized pieces
              If student stuffs their mouths, give them small portions, a little at a time
              Try a visual timer if student is too slow or distracted to eat
              Verbal or picture cue to swallow
              Make it fun - count how many chews, earn stickers for so many bites, crunch soft/loud
              Provide supervision and encouragement while eating
School Hygiene
         Washing
              Have students wash hands/face frequently during the day to practice the skill
              Have a mirror mounted by the sink and check after eating if face needs to be washed
              Have fun dollar store wash cloths for each student to use
              Provide picture cues for task
              Use fun ideas for same motions: rub sanitizer in hands, lotion face or hands, body paints on face
              or hands then wash, before eating, after eating, wash off lip balm
              Break down task into individual parts, learn one then add the next etc. i.e. turn faucets on, put
              soap in hands and rub together, rinse soap, water off, dry hands. You can also reverse this process and
              start with the end and add the previous ones (called backward chaining)
          Toileting
              Schedule toileting breaks throughout the day
              Provide picture cues for task
              Provide assistance and gradually reduce the amount of help needed
              Practice skills in a fun way or reward for trying or success. i.e. boys: aim for Cheerios; girls: a
              drop of blue food coloring will turn green
              Use a small toilet ring over an adult size if student is scared sitting on the toilet
              If child is afraid of the noise the toilet makes when flushing, use earmuffs or headphones to
              decrease the noise level, you can also practice putting a square of tissue in the toilet and have them
              watch and flush. This can help desensitize the "fear" of the noise or action.
                              Granite School District - OT Department
                 Occupational Therapy Teacher Tools and Pre-Referral Suggestions

School Fine Motor Skills Domain
Play Skills:
               Cue the child to use both hands together, one to stabilize and one to do the task
               Set up a daily table time for students to play with a variety of toys and activities that are at the
               students developmental level requiring the use of both hands: opening and closing containers, taking out
               and putting objects in containers, stacking sorting, making patterns, using glue, tearing, nuts and bolts,
               lacing cards, sticker fun, scooping or spooning, clothes pins, eye droppers, pouring, etc.
               Play interactive games one-to-one with student to get them to attend and interact: games like
               patty cake, pushing over blocks, popping bubbles, jumping while holding your hands, touch body part
               (head, shoulders, knees and toes song), singing songs, peek-a-boo, etc.
Grasp/Holding Pencil and/or Crayons Functionally:
               Use broken pieces of crayon or small pieces of pencil (1-2 inches) to encourage using their fingers
               for grasping
               Use an easel or vertical surface to assist with a good functional grasp on writing tools
               Wind a rubber band around the tool where the fingers need to be
               Try a commercially available pencil grip
               Have student hold a small item in ring and little finger while writing or cutting; this helps to facilitate
               a more functional grasp.
               Verbally remind the student to hold with their fingers
               When holding a writing tool, rest it in the web space rather than it standing up
               Schedule a daily fine motor center with small manipulatives to sort, glue, and construct.
               Activities that incorporate punching holes in paper, using tongs, light brights, peg boards, lacing and
               beading, etc. (Use of thumb, index and middle finger activities)
Pre-writing Activities: Always position paper tilted with right corner up for right-handed students and the left corner up
for left-handed students. Their non-dominant hand should always stabilize the paper.
               Provide direct instruction; small group or one-to-one
               Incorporate finger warm ups i.e. open/close hands, touch finger tips to thumb
               Schedule time to practice the skills
               Practice making the lines for shapes i.e. vertical, horizontal, plus, circle, square, diagonal, triangle

               by tracking, connecting dots, placing stickers along line, gluing small items or string along the line. Use
               finger painting or a variety of writing tools, the more fun the faster they learn.
               Practice making the pre-letter lines - up, down, across, around, and diagonal
               Use a variety of tools; fat, skinny, smelly, contrasting colors
           Coloring
               Bold the outline lines to help coloring in the lines, use a raised or glue line on the line as a border
               to stay in the lines.
               Cue to slow down
               Do only one part of the picture "in the lines" and gradually expand how much needs to be done in
               the lines
               Put textures under their paper when coloring: i.e. embossed wallpaper samples, cross stitch
               plastic mat, course sand paper, art foam sheet or a tablet, etc. This makes coloring more fun and can
               increase the time they spend coloring and attention to task.
           Cutting
               Cue child to hold the scissors and paper "thumbs up", put a sticker on the thumb nail so they
               can see it when they cut.
               Use a picture cue on the desk of the proper grasp of scissors
               Use thicker paper (easier to cut), laminate paper, cardstock, construction paper, grocery bags,
                             Granite School District - OT Department
                Occupational Therapy Teacher Tools and Pre-Referral Suggestions

School Fine Motor Skills Domain
              index cards, cut licorice, play dough snakes, straws or outline borders with string, glue, make the thick
              with a bold/highlighter marker, or punch holes along the line and have students cut hole to
              hole
              Cues to slow down and watch what they are doing
              Follow the developmental sequence for cutting: cut 1" line, 2 snips on straight line, across paper
              on the line, gentle curves, sharper curves, corners, zigzags, then simple shapes
              Give them a little "road" line from the edge of the paper to the shape to help them start cutting
              Use commercially available spring opening scissors to assist with opening
              To slow down cutting, use a small string and tie the inside loops of the scissors together loosely
              to prevent the scissors from opening up all the way.
           Gluing Accurately
              Use glue sticks rather than liquid glue initially
              Place glue on the paper rather than the object being glued
              Use colored glue to see where to place the object
              Practice glue dots
              Trace using glitter glue
              Place colored dots or stickers where the student needs to use the glue or place the object
Handwriting
              Whole classroom handwriting instruction
              Small group instruction
              Direct instruction
              Increased daily practice time; increase time for them to do their work neatly
              Practice writing letters/words with eyes closed, this helps with visual memory of the letters and
              spelling.
              Decrease writing/copying while working on legibility
              Always position paper tilted with right corner up for right-handed students and the left corner up for
              left-handed students. Their non-dominant hand should always stabilize the paper.
              Change the width of the writing paper, some do better with wider or narrower lines
              To line up math problems try graph paper, theme paper turned sideways or highlight small areas to
              mark the place for the answer(s) to go in or to place numbers in when borrowing or carrying over.
              Contract for neatness, earning points for neat work
              Try a mechanical pencil if they press too hard. Practice hard and soft pressure with clapping,
              stomping, etc. to understand the words better
              If they write too light or have shaky lines, try a dull pencil, marker, or a pad of paper under their paper
              Sloppy writing? Cue to slow down and attend to detail
              Place a sticky note or highlighted mark by the problems on a worksheet the student needs to do,
              the sticky note can be moved to each problem or each line as the student advances on the sheet. You
              can also fold the paper so only part is visible at a time.
              Provide a desk copy instead of copying from the board and/or move desk closer to the board to
              make copying easier
              Keep the board clean by erasing irrelevant information
              Be aware of glare off the white boards
Letter Formations:
             Direct instruction on letter formations with worksheets tracing, copying and independent
             production with supervision for correct formations
              Provide a letter line/strip on their desk as a visual cue
              Use a variety of media like clay, chalk, wiki sticks, puzzle pieces of the letters
                             Granite School District - OT Department
                Occupational Therapy Teacher Tools and Pre-Referral Suggestions

School Fine Motor Skills Domain
               Change the tone of your voice for direction of the letters. i.e. voice goes up when stroke goes up etc.
               Trace highlighted letters
Reversals:
               "b" is like "B" without the top circle. Magic "c" letters - c, d, g,o,q,s - start as a magic "c"; "p"
               and "b" start with a line; "z" starts like the letter "e" so it is easy (ez) to remember starting direction
Letter size:
               Teach letters in groups talls, smalls, and grounders (dip below the line)
               Use color-coded paper. i.e. Blue for sky (talls), green for grass (smalls) and brown for ground
               (grounders)
               Use a highlighted writing line
Alignment: (letters on the writing line)
              Teach student to "bump" the top and bottom lines. No floaters or sinkers
               Bold or highlight the writing lines
Spacing:
               Use graph paper to visualize a blank space
               Use a penny, sticker, dot, small candy for spaces. Gradually fad cue.
               Make a green line for the margin to help student begin writing at the margin (green line), then fade
               the cue.
                              GraniteSchool District - OT Department
                 Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Functional Life Skills Domain - Accessibility of the space and tools needed to
                                                  accomplish the task

Bathroom:
               Provide supervision/assistance, if needed
               Add extra time to practice task
               Practice lock on bathroom stall
               Have school adjust location of toilet paper roll dispenser, if needed
               Let child use a more private, accessible, or closer bathroom
               Use a foot stool if feet dangle when sitting on the toilet
            Faucets
               Lever arms on faucets if student cannot use grasp faucets
               If student cannot reach, approach the sink from side
               Use a secure foot stool to assist with reach
            Towels
               If student cannot reach towel dispenser, school can change location/type of dispenser or use a
               hand towel or disposable towel brought with the student to use
               Use a secure foot stool to assist with reach
Drinking Fountain:
             Provide a water bottle or a cup with or without a straw for student use
               Use a secure foot stool to assist with reach
Backpack:
               Provide a zipper pull on the zipper
Desk/Materials:
             Make sure the desk fits the student - sitting with feet on the floor, arms resting on the desk
             surface (a little above elbow height)
               Raise or lower the desk to an appropriate height or find a lower or taller chair
               Help the student organize their desk
               Have the whole class spend a half hour a week organizing/cleaning their desks
               Velcro a pencil to the top of the desk
               Have a set of books in the classroom for the student
               Provide two sets of book for home and school
               Provide an accessible space for materials in each classroom
               Rearrange the classroom for accessibility
               Visual classroom schedule for the whole class
               Individual word or picture schedule
               Provide color-coded folders, dividers or notebooks for organization of class papers
               Provide a place for completed work or work to be turned in
Locker:
               Provide a key rather than a combination lock
               Provide a locker with a shelf and hook the student can reach
               Allow a place in the classroom the student can store their coat, backpack and/or books
               Provide a locker close to the first or last class
Lunchroom:
               Practice carrying a lunch tray with solid objects on it and gradually add some that can spill
               (like rice, beans, etc.)
               Practice opening containers needed for lunch time
                            GraniteSchool District - OT Department
               Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Functional Life Skills Domain - Accessibility of the space and tools needed to
                                               accomplish the task

             Practice cutting foods, if needed, using play dough
             Provide using serving utensils with rice, beans, etc.
             Provide assistance for opening containers and cutting foods with a peer or adult in the lunchroom
Computers in the school:
            Provide a computer at an appropriate height
             Turn mouse pad over and tape down for additional resistance
             Slow mouse speed
             Enlarge font
Endurance and fatigue:
            Give rest breaks throughout the day
             Break tasks into smaller work periods
             Pair with a peer for some work
             Allow extra time to complete tasks
             Reduce tasks to the most important parts
             Avoid too many "up" and "down" stairs and halls. Try to group classes during the day, if possible
             Provide extra time to navigate halls between classes. Leave class early or last to avoid crowded
             and/or noisy halls
             Look at schedule and try to conserve their energy, when possible, to be used for the most
             important tasks.
             Use a slanted surface to read books and write
                             Granite School District - OT Department
                Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Sensory Processing Domain
              Post a visual schedule for the class and/or student
              Review rules and schedule often throughout the day, especially any changes
              Reduce the noise level in the room!
              Small groups remain more organized and on-task
              Minimize waiting
              Review what to do before doing it
              Use a signal for control; lights off, bell noise, etc.
              Use consistent behavior strategies for attention, initiation of work, completion of work, etc.
Over Responsiveness: too active, poor attention to a specific task (attends to everything but the one thing needed
           TRY calming and organization input:
              Provide behavior strategies for attending to work and completion of work
              Set clear expectations
              Minimize waiting
              Have a visual schedule for the class
              H
              Have a visual schedule for the student
              Break down learning into smaller units of time
              Decrease lighting - try use of natural light rather than fluorescents
              Minimize visual clutter in the classroom
              Have quiet zones or times in class to reduce auditory distractions
              Create a "calm corner" in the classroom
              Provide quiet activities
              Avoid crowded or noisy hallways
              Allow movement breaks throughout the day
              Minimize desk clutter
              Specialized seating away from distraction: door, windows, sink, water fountain, or certain peers
              Try sitting on a pillow, egg crate foam, cushion or ball
              Have student turn their chair around and sit straddling the chair with their chest leaning on the
              back of the chair
              Use a desk with the chair attached
              Use a block or stool under feet, if feet do not touch the ground
              Use a slanted board for papers and/or reading. A 3" - 4" binder will work
              Allow alternative positions for work like standing, laying on the floor or kneeling
              Give movement breaks to pass out paper, get supplies, take a letter to the office
              Use yoga moves or other physical movements throughout the day
              Heavy work activities like scrubbing desks, moving chairs help with calming
              Placing heavy objects on lap or try having a student wear a weighted backpack
              Walking breaks or running/skipping breaks in the gym or outside
              Be first or last in lines
              Sit in an area with a little extra personal space
              Place a taped/Velcro square around desk area as a boundary to stay inside of
              Use a mat on the floor to mark their spot to stay on
              Marks/tape on floor to mark where to stand when lining up or use the wall as some students
              may feel more organized leaning on the wall
              Use music that has a definite beat to it, soft, slow and rhythmical
              Try calming scents, vanilla, lavender, chamomile
                              Granite School District - OT Department
                 Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Sensory Processing Domain
               Use headphones or ear muffs to decrease auditory distractions
               Use different colors of paper or writing tools to capture attention
               Use a variety of writing tools
               Place papers over sandpaper or other embossed papers for coloring or writing activities to
               increase attention
               Bold lines to draw attention to them
               Use a timer
               Use standing for some activities rather than sitting
               Incorporate edibles during seated activities to increase attention - crunchy, chewy or foods to
               suck on (FYI: sucking is good for near vision activities)
               Try quiet fidgets or stress balls to help with attention and keep hands to self
Under Responsiveness: doesn't seem to attend to anything, sleepy, slumps in desk, appears not to hear you.
           TRY organizing and alerting input
             Provide behavior strategies for attending to work and completion of work
               Set clear expectations
               Minimize waiting
               Alternate sitting and standing
               Try small group instruction
               Use yoga moves or other exercise movements throughout the day
               Stomp, jump, clap, or do an animal walk to the next activity
               March or stomp on bubble wrap or bubbles
               Give movement breaks to pass out paper, get supplies or take a letter to the office
               Marks or tape on the floor to mark where to stand when lining up or use the wall as some
               students may feel more organized leaning on the wall
               Sit on a cushion or ball, bounce on the ball
               Use a slanted board for papers and/or reading. A 3" - 4" binder will work or a vertical surface
               Use a block or stool under feet, if feet do not touch the ground
               Change up your routine, change is alerting
               Movement is alerting. Use small motor breaks to stretch in any position
               Have cold water to drink
               Have a fan blowing on them
               Use fast-paced music with variation
               Sing songs that have actions for them
               Store books and supplies on the floor and have student bend down to get them
               Use your voice - quiet, loud, silly, high, low - to capture attention
               Use different colors of paper or writing tools to capture attention
               Use a variety of writing tools
               Place papers over sandpaper or other embossed papers for coloring or writing activities to
               increase attention
               Add textures to paint such as salt, sugar, sand, etc.
               Bold lines to draw attention to them
               Use alerting scents - peppermint, spice, pine
               Try chewy, crunchy snacks or citrus
Touch (Tactile)/Personal Space:
              Be first or last in line; cross your arms, interlock hands
               Sit in an area with a little extra personal space
                             Granite School District - OT Department
                Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Sensory Processing Domain
               Place a taped square around desk area as a boundary to stay inside of
               Use a mat on the floor to mark their spot to stay on
               Sit on hands or put hands in pockets
               Use medium pressure and hug or rub arms and hands using your hands, their hands using
               fabric, towel, or lotion
               Use a variety of writing tools
               Place papers over sandpaper or other embossed papers for coloring or writing activities to
               increase attention
               Try quiet fidgets or stress balls to help keep hands to self
               Use sand and water play, hiding things in a bucket of rice or beans, texture play
               Use a Q-tip or cotton ball for finger painting or using messy textures
               Have a wet cloth next to the child so they can wipe off messy things right away
               Allow child to wear gloves when working with messy textures
               Cut labels out of clothing (if parents agree)
               Put socks on inside out (removes the toe seam from bugging them)
               Respect a child that is sensitive to touch
               Avoid crowded or noisy hallways
               Have a small plastic hula hoop or place mat to mark work areas on tables
Oral/Mouthing:
             Incorporate more edibles throughout the day especially prior to when you see the most mouthing,
             this will free the hands to play or work
               Use a chew tube or tubing on pencil
               Provide edibles that are spicy or sour
               To help decrease drooling, you can try terry wrist bands (sold for exercise) and cue the student
               to wipe/pat their mouth. Use a vertical surface for appropriate activities (this decreases the pull of
               gravity). Verbal or picture cues to close mouth and swallow.
Auditory:
               Use more visual than verbal cues
               Give one direction at a time. Gradually add more
               Keep directions short and precise
               Have student repeat direction back to you
               Give demonstration with verbal instructions
               Allow time for responses
               Avoid crowded or noisy hallways
               Pre-warn about loud noises before they occur and keep an adult near them if needed to help them
               feel safe and to guide them to what is going on.
               Make a picture sequence of what to do when the fire alarm goes off. i.e. 1) hold your ears;
               2) stand up; 3) line up at the door; 4) follow class outside to the ________________
               Play recordings of loud noises softly and gradually increase the volume
               Have quiet relaxing music playing during centers or work time
               Incorporate "whisper breaks" for 5-10 minutes throughout the day
               Keep classroom noise level low - use more visual and/or gestural cues
               Use headphones to dampen noise levels, can also use ear muffs
               Allow chewing, preferably with edibles
Transitions:
               Post classroom visual schedule
                     Granite School District - OT Department
        Occupational Therapy Teacher Tools and Pre-Referral Suggestions

Sensory Processing Domain
       Reduce transitions
       Set clear expectation of rules
       Use more visual than verbal cues to cue for transitions
       Pre-warn the class or the student individually before transitioning to another activity; verbally, dim
       lights, bell ring, play music, etc.
       Incorporate physical movements when transitioning. i.e. jump, hop, clap, stomp, or animal walks
       Use fidgets or stress balls to get through the transition
       To transition in and out of the classroom have child deliver something to a specific spot where they
       are going and also the way back. This could be a letter, magnet, object needed appropriate to the task
       coming up
       Use counting or saying the alphabet. i.e. "time for math - let's count to 10 while we go to our desks"

				
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