Occupational Therapy Considerations for Occupational Therapy Services In order to receive Occupational Therapy (OT) as a related service, the student must have an educationally disabling condition under IDEA. When referring students for an occupational therapy assessment, the following must be carefully and routinely considered: 1. Prime Age: Therapy is more effective for children from birth through age of eight to ten years. 2. Acute Trauma: Therapy may be advisable for older children following an acute trauma which leads to a long- term disability. 3. Previous Therapy: Alternative programs should be considered for children who have received previous therapy. 4. Priorities: Education students should have their support services carefully prioritized for the maximum utilization of time spent in school. Occupational Therapy, which is an Individualized Educational Program (IEP) related service option, becomes part of a child's IEP when the IEP Team determines that these services are educationally necessary in order for the student to benefit from special education. In addition, the IEP team must determine that the identified needs are so severe that they cannot be met by general education teacher, special education teacher, or other related service providers, such as adaptive physical education teacher. Public schools are not required to provide a related service to a student with disabilities simply because the student will benefit from the service. The IEP Team must determine that a related service is warranted only if it is educationally necessary for the student to benefit from the special education instruction. When the team has explored the strategies, activities and resources available within the instructional environment (Classroom Teacher, SDC, RSP, APE Teachers, etc.), and has determined that the student is not likely to benefit from this program's opportunities without additional professional services from an Occupational Therapist, then a referral to consider OT Services should be made. The objective of occupational therapy is to have a child participate and function as independently as possible in the in the classroom setting. Once a child has been found to be eligible for special education, a listing of all his needs which cannot be met by the regular education program must be made. These become the child's special education needs, which cannot be met by the regular and/or special education teacher(s). This results in raising the possibility of the need for OT involvement (consult/monitor/ or direct service). Methods of OT Service Delivery Related services, as specified in the individualized education program, shall be available when the instruction and services are necessary for the pupil to benefit educationally from his or her instructional program. Instruction and services shall be provided by the regular class teacher, the special class teacher, or the resource specialist if the teacher or specialist is competent to provide such instruction and services and if the provision of such instruction and services by the teacher or specialist is feasible. If not, the appropriate designated Instruction and services specialist shall provide such instruction and services. Designated Instruction and services shall meet standards adopted by the board. (Education Code Section 56363) Direct Therapy employs 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. Occupational therapy personnel have frequent and consistent contact at least once a week; are responsible for planning, implementing and revising the occupational therapy program; and share responsibility for the IEP with other team members. Children can receive direct therapy individually or in small groups. Monitoring employs collaborative teaming to teach and directly supervise other professionals or paraprofessional 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" of the student 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. Consultation is a service in which the occupational therapist's expertise is used to help the education system achieve its goals and objectives. Case consultation focuses on the development of the most effective educational environment for children with special needs. Educationally Necessary vs. Medically Necessary Therapy Therapy conducted in the school is not the same as therapy conducted in the clinic. Therapy differs in these two settings in terms of its intent, the role of the therapist, and the type of support available to the therapist. Medically necessary therapy is usually undertaken as an adjunct to medical treatment for acute and chronic conditions to ameliorate an underlying disability. The goal of medically necessary therapy is to improve global functioning through the use of a variety of modalities. Educationally necessary therapy is provided in the school to help the child access educational services and benefit from his educational program. In the school, educational goals hold a primary position, while occupational therapy goals are undertaken to support the educational goals. The school therapist delivers a wide range of services. These services cover individual therapy, as well as therapy within small groups, and consultation with school staff, and with the child's family. Thus, the school therapist is expected to share his/her knowledge and skills with others by demonstrating and monitoring activities that are educationally appropriate. The principle role of school-based OT therapists is to assist students in benefiting from their educational program. A general guideline is that therapy must contribute to the development, improvement or maintenance of the student's functional level within the educational environment. If a student needs occupational therapy and/or physical therapy to address problems, but the problems do not prevent him or her from benefiting from the educational program, school-based therapy should not be provided. MEDICALLY NECESSARY THERAPY EDUCATIONALLY NECESSARY THERAPY • Therapy goals are primary • Educational progress are primary • Intervention is directed toward alleviation of a • Intervention is directed toward facilitating specific medical problem educational progress • Services tend to be delivered individually in a • Services are collaborative; Much time must clinic or hospital setting be given to communicating with other service providers • Focus is on functional skills and adaptations that • Focus is based on developmental milestones and promote the attainment of educational components of movement; objectives The focus is on functional outcomes • More responsibilities are delegated • Few responsibilities are delegated except to to parents and other educational parents professionals • The therapist works in the school setting • Clients generally come to the clinics to see the therapist The determination of when occupational therapy and physical therapy are educationally relevant is a complex issue. Several issues must be considered when determining the appropriate level of school-based and non-school- based therapy. An IEP team is the only body that determines special education services for a child. Any relevant input from a medical practitioner would be considered by an IEP team along with other health information but there is no educational requirement or authority to fill a physician's prescription for OT. School-based therapy involves "teaming", in which recommendations and decisions are made based on input from all team members in order to determine a student's total educational plan Non-school-based therapists make unilateral recommendations based on their individual findings to determine their individual therapy plan. Program Completion of OT Services 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 has accomplished IEP goals. 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. 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. 6. Deficits are not interfering with child's ability to function adequately within the school environment. 7. Formal reassessment indicates the child no longer requires the previous level of service and IEP team concurs. 8. The child has learned appropriate strategies to compensate for deficits. 9.Strategies can be effectively implemented by current educational team and do not require the training and expertise of an OT. 10. Equipment and environmental modifications are in place and are effective. Note: Sensory Integration Therapy Sensory integrated therapy is not a related service under IDEA 2004; but, rather, a technique or instructional method which may be used in providing special education or related services. The decision to use, or not use, sensory integration therapy as a method should be made by the person responsible for the service or instruction specified in the IEP, based on the professional judgment of the service provider and the needs of the child. This decision should be made only after the child is identified through assessment as an individual with exceptional needs. The local school district is under no obligation to include sensory integration therapy in the IEP since it is a method, not a related service. After the IEP team has identified the child as an individual with exceptional needs and included, for example, therapy in the IEP, the therapist may decide to use whatever method(s) is most effective for carrying out the goals and objectives for that child.
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