1. OT/PT Frequently Asked Questions
… and other concerns
Dr. John D. Barge, State School Superintendent

2. Dr. John D. Barge, State School Superintendent
The Educational Model
In the educational model, most therapies are considered a related service
child is assessed for needs regarding his/her educational program.
The IEP Team must establish whether the service is needed for the child to benefit from his or her education.
Provision of Free Appropriate Public Education (FAPE)
The legal duty to provide a related service arises only when, without the service, the child’s educational program would become less than appropriate.
Dr. John D. Barge, State School Superintendent

3. Sample Differences in Intervention Strategies for Service Delivery
Educational Model
Gait training to decrease time required for students to walk a certain distance (e.g., classroom to bus)
Program directed at maintaining or improving functional joint motion skills needed during the school day such as putting on a coat or reaching for items in a locker.
Medical Model
Crutch training for acute temporary sports injury.
Program directed at promoting full joint range of motion in excess of basic requirements for performance of routine activity or skill.
Dr. John D. Barge, State School Superintendent

4. Sample Differences in Intervention Strategies for Service Delivery
Educational Model
Fabrication of splints to enable the student to perform educational task such as writing, eating, using a keyboard, or stabilization of work material.
Seating on the bus and at school. Therapist may modify seating or positioning.
Medical Model
Fabrication of splints to restore range of motion.
Seating outside the school setting. (e.g. shower chair at home)
Dr. John D. Barge, State School Superintendent

5. More Sample Differences
Educational Model
Adaptive equipment required post injury to provide access to educational environment to meet IEP goals.
Development of hand skills sufficient for functional writing, keyboarding, cutting, buttoning, etc.
Medical Model
Muscle strengthening, range of motion, or whirlpool post surgery to restore function.
Treatment to maximize finger dexterity, rate, and speed.
Dr. John D. Barge, State School Superintendent

6. Dr. John D. Barge, State School Superintendent
How We Work
Therapy is a related service to special education and is provided only if the child needs therapy to function in the educational setting
In the school, the need for therapy is determined by the IEP Team and should be related to the IEP.
Parents are a part of this team and should share in the determination of the amount, frequency and duration of therapy.
Physicians can provide information about the educational impact.
Dr. John D. Barge, State School Superintendent

7. How We Work
Therapy may be provided individually or in small groups by a therapist or therapist assistant.
Intervention may or may not be provided directly with the child.
Collaborating with educational staff to modify the child’s environment and daily school activities is always a part of school therapy.
Therapy takes place where the child receives education.
Appropriate intervention may be provided in classrooms, hallways, gyms, playgrounds, lunchrooms, bathrooms, or in a separate therapy room.
Brad Bryant, State Superintendent of Schools
“We will lead the nation in improving student achievement.”

8. Dr. John D. Barge, State School Superintendent
How We Work
The decision to discontinue therapy is made by the IEP Team.
when the student no longer is eligible for special education,
when other members of the IEP Team can provide necessary interventions,
or when the child can perform school tasks without therapeutic intervention.
There may still be a need for community-based services.
Dr. John D. Barge, State School Superintendent

9. How is the Need for Therapy Determined
It is the responsibility of the IEP team, based on the evaluation evidence presented by the occupational or physical therapist, to determine whether or not the student requires occupational or physical therapy to receive a FAPE.
The need starts with the educational goals and objectives.
Dr. John D. Barge, State School Superintendent

10. How is the Need for Therapy Determined
School-based occupational and physical therapist provide services when they are determined to be necessary for the child to benefit from his or her specially designed instruction to make progress in the general education curriculum, as well as , meet their developmental and functional needs.
Occupational and physical therapy in a school setting are not based on a medical model and therapists do not provide services when there is not an educational need for the service.
Brad Bryant, State Superintendent of Schools
“We will lead the nation in improving student achievement.”

11. Dr. John D. Barge, State School Superintendent
Who Makes the Referral?
Teachers, parents and other school personnel may initiate the referral for an evaluation through the IEP process.
An occupational or physical therapist evaluation may be conducted as part of the initial, comprehensive evaluation to determine whether or not the child is a child with a disability and if special education is required.
After a child is placed in special education, the need for an occupational or physical therapy evaluation is determined by the IEP team.
Dr. John D. Barge, State School Superintendent

12. Role of School-based OTs and PTs
The role and responsibility of the occupational or physical therapist, as a related service provider and as a member of the IEP team, is to assist students with disabilities to benefit from their specially designed educational programs.
The school-based occupational or physical therapist supports the student’s ability to gain access to the general education curriculum in accordance with their IEP and to function across all educational settings.
Dr. John D. Barge, State School Superintendent

13. Prescription vs IEP Decision
The written medical prescription should be considered by the IEP team in making its determination as to whether or not occupational or physical therapy is required based on educational impact.
The IEP team will review available data and may request additional assessments as needed.
The school must provide prior written notice if they refuse to conduct the evaluation and the parent may use dispute resolution procedure
Dr. John D. Barge, State School Superintendent

14. Therapist Disagrees with IEP Team
The provision of occupational and physical therapy services is determined by the IEP team based on the needs of the student and the educational goals that have been developed.
the therapist is a contributing member.
No one member of the team unilaterally requires or denies any aspect of the recommended services for the child, this includes discontinuing service and/or frequency of services.
Dr. John D. Barge, State School Superintendent

15. Parent Disagrees with IEP Team
The on-going need for OT and PT for students with disabilities is determined by the IEP team.
This decision should be based on the evaluations used and the student’s IEP goals.
Should the team decide that occupational or physical therapy is not needed for the student to successfully meet the goals on the IEP, they should make every effort to help the parent to understand the difference between the educational and medical model of therapy.
Dr. John D. Barge, State School Superintendent

16. Parent Disagrees with IEP Team
It is not a requirement that all members should agree with the determination, but that their input be a part of the decision-making process.
If the process is followed and justification for the decision is based on the results of the comprehensive evaluation, the decision should be sound.
Dr. John D. Barge, State School Superintendent

17. Self-Help Skills: (toileting, dressing and feeding)
The IEP team develops the goals and objectives based on the student’s needs and abilities.
Therefore
Therapist should support the goals of the team as they all work on the them.
should not work on this skill in isolation
Dr. John D. Barge, State School Superintendent

18. Sensory Integration Therapy
Sensory Integration therapy is an acceptable practice in occupational therapy.
This therapy is typically recommended for students with Autism Spectrum Disorder and others with specific developmental delays who exhibit sensory issues.
As with any other related service, decisions concerning the programs used and delivery model are left to the IEP team.
Dr. John D. Barge, State School Superintendent

19. Dr. John D. Barge, State School Superintendent
Handwriting Skills
The decision as to whether or not handwriting instruction is provided by an occupational therapist is made by the student’s IEP team.
In many instances, general and special education teachers work on improving handwriting skills.
Dr. John D. Barge, State School Superintendent

20. Handwriting Skills
OT can support HW for eligible students by assisting teachers with information on appropriate positioning, posture, etc
The OT should not work on this skill in isolation; the team would work on it.
Brad Bryant, State Superintendent of Schools
“We will lead the nation in improving student achievement.”

21. Therapy Progress Reports
The requirement for reporting progress for the goals that OT and PT are supporting is the same as the requirement for reporting progress on all IEP goals and objectives.
Progress on IEP goals should be reported to the parents at least as often as parents of nondisabled students are notified about progress.
Parents should be informed of how they will receive these reports of progress toward annual goals.
Therapists contribute to the progress reporting and may or may not provide additional data as needed.
Dr. John D. Barge, State School Superintendent

22. Therapy on Consultative Basis
Students are required to receive at least one segment per month of direct services from the occupational or physical therapist to be counted as receiving services through a consultative model.
FTE
A segment refers to one sixth of the school day and may be split up within a month to multiple segments (contacts) or provided all at once.
Dr. John D. Barge, State School Superintendent

23. Questions? Brad Bryant, State Superintendent of Schools
“We will lead the nation in improving student achievement.”