1. Occupational and Physical Therapy Referral Procedures

2. Fine Motor Red Flags 3 Year old Self Care Unbutton large buttons
unsnap
Use a spoon and fork
Uses a napkin
Doff clothes
Donn pull over shirt/elastic pants
Visual Motor
Draw a circle and cross
Trace a horizontal line
Draw a picture meaningful to them
Grasp
Pincer grasp
Open web space when grasping manipulatives
Static tripod grasp
Bilateral Coordination
Cut/snip with scissors
Visual Perceptual
Complete at least 4 piece puzzle
Builds 8-10 block tower
Copy simple 3 and 4 block designs
Sensory Processing
Follow simple 2-3 step tasks
Directional terms: bottom/ top, over/ under, behind/ in front

3. Fine Motor Red Flags 4 year old Self Care Zip a zipper
Buttons large buttons
Holds fork in fingers, not fist
Knife for spreading
Donn and doff clothing with independence
Visual Motor/Perceptual
Copies a cross, square
Imitate 5-6 block pattern
Complete 8-12 piece puzzle
Bilateral coordination
Cuts line, circle and emerging square with scissors
Sensory processing
Directional terms: up/down, forwards/backwards, low/high, above/below
Follows multiple step directions

4. Fine Motor Red Flags 5 year old Self Care
Dress independently with occasional assistance for fasteners
Grasp
Emerging dynamic tripod grasp
Show hand preference
Visual motor/perceptual
Copies a square
Identify and print letters of first name
Colors between vertical lines
Draw triangle and rectangle
Bilateral Coordination
Cuts a circle
Sensory processing
Directional terms: right/left

5. Fine Motor Red Flags 6 year Visual Motor/perceptual
Writes upper and lower case letters from model
Matches and sorts a variety of objects
Bilateral coordination
Cuts variety of simple shapes

6. Gross Motor Red Flags 2 ½ year old Jumps forward 24 inches
Jumps down inches, both feet
Kicks ball with good force 6 feet
Catches ball 5 feet away with arms and hands extended
3 year old
Ascends/ Descends steps, no support, alternating feet
Throws ball 10 feet
3 ½ year old
Runs with good form and fair speed
Stands on one foot 3-5 seconds
4-5 year old
Hops on one foot
Catches ball with hands /arms bent
Skips
Hits target with ball 12 feet away6
6 years old
Jumping jacks
Dribbles a ball
Able to follow 3 step obstacle course
Stands on one foot with eyes closed

7. OT/PT REFERRAL PROCESS
The IEP Team conducts a Reevaluation Plan Meeting to discuss a referral for Occupational Therapy or Physical Therapy.
The parent must be invited to this meeting using Enrich notification letters. Psychologist and SLP (if applicable) must be consulted and included in this Re- evaluation process. The Re-eval date will change because the re-evaluation plan looks at all areas.
Complete the reevaluation plan and indicate that an OT and/or PT evaluation(s) will be conducted by checking further testing needed for fine motor and/or sensory sections (OT) or gross motor (PT).

8. OT/PT REFERRAL CONTINUED
Parent signs the Enrich Consent to Re-Evaluate (include letter of permission to Evaluate)
Teacher completes OT and/or PT referral form (which can be found on the district 7 website within the departments: special education)and has parent sign cover page at meeting.
IEP team should request a prescription for “OT evaluation and treatment” or “PT evaluation and treatment”
OT: OT can complete an evaluation WITHOUT a prescription IF school/parent is unable to obtain. Please sent a note with referral packet if unable to obtain the OT prescription.
PT: A physical therapy prescription is required for a student to be evaluated.
Submit the referral packet, (including a copy of the OT prescription if available) to the Director of Special Services for signature.

9. Processing Requests
The Director of Special Services will submit the referral packet to the OT/PT assigned to their district
The OT/PT will contact the school/special education teacher to schedule the evaluation.
OT/PT will complete evaluation
OT/PT will notify Case Manager when evaluation is complete. Case Manager will send home appropriate meeting notifications and schedule evaluation results meeting.

10. OT/PT Evaluation Follow-up
After the OT/PT evaluation, the Multidisciplinary Team (including the OT/PT) reviews the results and completes the Evaluation review meeting.
If the IEP team agrees that the student would benefit from OT/PT as a related service, the OT/PT information will be added to the current IEP and the updated IEP will be reviewed at the meeting.
If the team does not decide that OT/PT is needed as a related services, the Multidisciplinary team reviews the areas of weakness and makes recommendations for classroom interventions/accommodations as needed.

15. OT/PT Screen Requests Please email or contact the OT/PT Department
For OT contact:
Melissa Hendricks
Or Ann Marie Moore
For PT contact:
Aimee Sarver
Or Susan Smith
Phone (864) (and ask for therapy department)
An OT/PT screen my be requested for:
1- A student who has an IEP or a 504 that you would like to determine if he/she would benefit from OT services
2- A student that does not have services, but you would like OT/PT recommendations for the classroom teacher to incorporate
Students who do not have an IEP or 504 are not eligible for an OT/PT evaluation or direct services.

16. OT Staff Chapman Houston Mary H Wright EP Todd Pine Street Cleveland
Melissa Hendricks, OTR/L
Sara Lane, COTA/L
Houston
Johanna Abadia-Gonzalez, OTR/L
Mary H Wright
Ann Marie Moore, OTR/L
Holley Tankersley, COTA/L
EP Todd
Pine Street
Cleveland
Park Hills ELC
Freddie Davis, COTA/L
Jesse Boyd

17. PT Staff Chapman Shannon Roberts, PTA Houston Jennifer Jacobs, PTA
Mary H Wright
Aimee Sarver, PT
EP Todd
Susan Smith, PT
Pine Street
Cleveland
Park Hills ELC
Jesse Boyd