Occupational Therapy & Physical Therapy in Illinois Schools

Occupational Therapy The therapeutic use of purposeful and meaningful occupations or goal-directed activities to evaluate and provide interventions for individuals and populations who have a disease or disorder, …

Occupational Therapy … an impairment, an activity limitation, or a participation restriction that interferes with their ability to function independently in their daily life roles and to promote health and wellness. American Occupational Therapy Association (AOTA)

Physical Therapy The evaluation or treatment of a person by physical measures, such as therapeutic exercise, positioning and physical touch, for the purpose of preventing, correcting, or alleviating disability, or promoting physical fitness and well-being. American Physical Therapy Association (APTA)

Educational Relevance Occupational therapy (OT) and physical therapy (PT) are included as “related services” of special education under federal and state laws. Individuals with Disabilities Education Act (IDEA), 2004.

Educational Relevance For a related service to be included on the individual educational plan (IEP), the IEP team must determine that the student requires that service to benefit from special education.

Educational Relevance When determining the need for OT or PT services, the IEP team must first consider the student’s annual IEP goals and objectives, and the supports needed to attain those goals.

Educational Relevance The IEP team then determines if the expertise of a therapist is necessary for the student to attain annual IEP goals. How are these decisions made?

Assessment Data to determine educational need for OT or PT may be obtained through a variety of assessment methods, including: Records review Observation of student in typical school environments and activities

Assessment Assessment of environmental barriers and supports Review of student work samples Interviews with student, teacher(s), parent(s), community providers

Assessment Completion of standardized assessment of relevant skills, as needed Non-standardized functional performance assessments

Team members gather data about the student’s overall functional ability within the school environment. Focus is on what is expected of the student in the natural educational environment, in comparison with grade-level peers.

Student performance related to: Student Factors Student performance related to: Personal Care Mobility Gross Motor Fine Motor Visual Motor Sensory Processing

Environmental Factors Learning environment - student needs related to: seating & positioning in classroom, cafeteria, specials, bus architectural barriers (stairs, curbs, doors) access to storage areas, cafeteria, playground, bathroom

Environmental Factors Consider what supports are currently available to address student’s needs Consider need for training of staff and/or parents to carry out an intervention program

Occupational Therapy Areas of Focus: Activities of Daily Living Educational and Vocational Activities Play or Leisure Activities

Physical Therapy Areas of Focus: Mobility and Movement Posture/Positioning Safety in Accessing Environments

Entrance Criteria Based on the student’s function in relevant performance areas, all of the following criteria should be considered to determine if the student’s need requires the expertise of OT or PT:

Entrance Criteria There is a significant limitation in at least one performance area. The problem adversely affects the student’s ability to benefit from his/her educational program.

Entrance Criteria The unique expertise of a therapist is required to meet the student’s identified needs or to assist the team in providing the educational program. The potential for student improvement over time through intervention appears likely (change is unrelated to maturity).

Educational Relevance Decisions regarding OT and PT are directly tied to the student’s overall educational program and goals. All team members support the attainment of educational goals. Illinois State Board of Education (2003)

Educational Relevance Therapy and other related services become a means or method to attain educational goals and objectives/benchmarks, rather than the focus of separate therapy goals or objectives/benchmarks. Illinois State Board of Education (2003)

eliminate barriers that hinder access to educational environments Educational Relevance OT and PT can support & assist with problem-solving to: eliminate barriers that hinder access to educational environments assist with modifications and accommodations to support students in their education program. This can happen through consultation with other team members.

Educational Relevance A general guideline is that therapy must contribute to the development, improvement or maintenance of the student’s functional level within the educational environment.

After a student’s outcomes (annual IEP goals) have been identified, the team therapist and other members of the IEP team determine the following: 1. The methods and strategies of intervention anticipated, given the type of skills to be learned or environmental modifications needed.

2. The level of expertise required to implement the methods and strategies. Now the decision is made regarding need for OT and/or PT, followed by decisions regarding type, amount, frequency of supports and services.

Teams must always consider the requirement for providing education in the least restrictive environment for a student to be successful. Direct intervention from therapists should be considered only after consultation support has been attempted and data suggests it is unsuccessful.

Exit Criteria (school-based therapy is not a life-sentence!) Based on the student outcomes after intervention occurs, each of the following criteria should be considered to determine if the student no longer requires therapy:

Exit Criteria The expected therapy outcomes have been met and no additional outcomes are appropriate. The potential for further significant change as a result of therapy intervention appears unlikely, based on previous attempts.

Exit Criteria The identified limitation(s) no longer require(s) the unique expertise of the therapist. The educational team can carry out the program without the intervention of OT/PT. The problem ceases to be educationally relevant.

Exit Criteria Therapy is contraindicated due to change in medical or physical status, and psychological and/or social complications.

References American Occupational Therapy Association. (2006). Occupational therapy in educational settings under the Individuals with Disabilities Education Act. Bethesda, MD: Author American Physical Therapy Association. (2009). Providing physical therapy in schools under IDEA 2004. Alexandria, VA: Section on Pediatrics, American Physical Therapy Association. 23 Illinois Administrative Code Part 226 (special education).

References Illinois Occupational Therapy Practice Act, 225 ILCS 75/1 Illinois Physical Therapy Practice Act, 225 ILCS 90/1 Illinois State Board of Education. (2003). Recommended Practices for Occupational and Physical Therapy Services in Illinois Schools. Springfield, IL: Author. Individuals with Disabilities Education Improvement Act of 2004. Pub. L. 108-446, 20 U.S.C. § 1400 et.seq. Retrieved from http://idea.ed.gov