School-based OTOne of the most confusing aspects of pediatric occupational therapy is the differentiation between school-based (or educational) OT and clinic-based (or medical) OT. Occupational therapists in both environments help children reach a maximum level of independence with everyday life skills. However, the domain of OT in a school environment is more restricted. School-based occupational therapy is a federally mandated service provided to students who could benefit from OT intervention. Usually, a parent or teacher makes the initial referral because of concerns seen in the classroom or while doing class work. Every student, regardless of his or her age, is entitled to a complete evaluation in all areas of suspected disability at the request of an IEP team member (parents, teachers, psychologists, RSP, etc.). Not all students who are referred for OT in school qualify for the service. A child qualifies when his or her deficits significantly affect his or her ability to benefit from the individualized curriculum decided upon by the IEP team. Another important factor influencing the provision of services is the ability of other school staff members to implement the interventions recommended by the OT. For instance, if a classroom aide can adequately provide handwriting instruction using the techniques and materials provided by the OT, then, by law, the OT is not necessarily required to provide direct intervention because it would be a duplication of services. In that situation, a consultative model of intervention would be most appropriate for the OT (rather than pulling the child out of class for the same instruction). It is important to note that decisions regarding the provision of services in a school are not unilaterally made by the OT (or by any one member of the IEP team). This ultimately means that the IEP team, together, has the final say as to whether or not a child receives OT services. The occupational therapist can giver her professional opinion as to the appropriateness of school-based services, but it is the IEP team that must decide if those services will, or will not, be provided. |
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| If the IEP team decides school-based services are educationally necessary, an OT will be designated by the district to provide those services on school grounds and during school hours, unless the child is homebound. The goals addressed by school-based therapists are not OT-specific goals, but are goals that have been deemed appropriate by the entire IEP team. Therapists in compliance with federal special education law do not write their own goals, but support the child’s overall educational goals. When a therapist’s skills are no longer assisting a child in benefiting from a curriculum the child is ready to exit from OT services….and this is a good thing.
Whereas a clinic-based therapist may require a doctor’s prescription and insurance authorization in order to begin evaluating and treating a child, a school-based therapist requires only a referral from the special education team of a given school. These school-based referrals are made when a child cannot benefit from his current special education curriculum without the services of a skilled occupational therapist. A child may have difficulty with handwriting and other fine motor and visual perceptual tasks, or may have sensory integration problems which prevent him from learning at his expected level. Unfortunately, not all school districts are amenable to providing the specialized equipment necessary for proper sensory integration treatment, and they are not required by law to provide this equipment. Sensory integration is considered a single methodology used by occupational therapists at their discretion, and is not specified in a child’s individualized education plan (IEP). Therefore, sensory integration therapy provided in schools is usually of a limited nature. The therapists at these schools can help the child best by consulting with the teachers and staff about strategies that may decrease a child’s sensory issues in all school environments, in addition to possible direct intervention. Fortunately, several districts in California have recognized the need for and effectiveness of having on-campus motor rooms which allow therapists to provide proper sensory integration treatment. OT’s in schools often address handwriting concerns. There are specialized handwriting devices and curriculums that may be suggested by the OT, and the OT can often provide direct instruction/remediation of handwriting deficits through direct intervention with a child. However, as children progress in school, bad handwriting habits become less and less responsive to OT intervention. Therefore the importance of early intervention for any developmental delay cannot be overstated! Some students have difficulties which cannot be adequately addressed by school-based OT. These students may benefit from clinic-based OT as well. Usually when a child receives OT in the school and outside of school the two therapists coordinate services so that separate goals are being addressed. This prevents an unethical duplication of services. For instance, the school-based therapist may work on handwriting mechanics and visual perceptual skills in the classroom while the clinic-based therapist may address the sensory integration and overall strength issues that a child has. Children who receive the most benefit from therapy have opportunities to practice new skills at home as well. Handwriting skills, for instance, are not adequately generalized unless a child practices (using correct letter formation and line usage) daily. The more opportunities a child is given to practice new skills correctly, the faster those skills will become second nature. Therefore, it is vital for school-based therapists, parents, teachers, and clinic-based therapists to communicate openly and to carry over gains made in each environment. For more information about school-based occupational therapy, please feel free to contact Ashley King at Action Potential Therapy Services.
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