Occupational Therapy

Occupational Therapy
What Does an Occupational Therapist Do?

Occupational therapists help children with the “job” of being a student. Through remediation, accommodations, and adaptations, they help teachers make sure that students’ skills are a match with the demands of the classroom and school, to ensure that all students can participate with their classmates and benefit from their education. OT’s assess and address motor skills, sensory needs, and visual perception. They also help the team with assistive technology needs, and may help staff use sensory strategies to help with behavior or social skills.

Occupational Therapy in Schools
  • Services provided by a licensed OTR (Registered OT) or a COTA (Certified Occupational
  • Therapy Assistant) under the supervision of an OTR
  • Focus is on a person’s ability to participate in daily life activities and roles, or “occupations”
    Child’s occupation? Student
Definition

According to the Virginia Regulations governing Special Education Programs for children with Disabilities

“Occupational therapy” means services provided by a qualified occupational therapist or services provided under the direction or supervision of a qualified occupational therapist and includes:(Regulations Governing the Licensure of Occupational Therapists (18VAC85-80-10 et seq.); 34 CFR 300.34(c)(6))

  1. Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;
  2. Improving ability to perform tasks for independent functioning if functions are impaired or lost; and
  3. Preventing, through early intervention, initial or further impairment or loss of function.

OT’s Role In School

  • Part of the special education team
  • Helps to identify barriers to participation in and benefit from educational setting
  • Helps to make a better “match” between the student’s skills and the demands of the school setting
  • May use consultation to staff & family and/or direct work with the student

OT is a “Support Service” In Schools

  • This means that OT is added on to an IEP or 504 to support the primary service providers:
    • Special educators
    • Speech & Language Therapists
  • SO… Students must first be found eligible for special education services before schools are required to consider providing direct OT services.

Process To Determine Need For OT Services

  • Often, a request for assessment is made by the special education team.
    • This can be part of initial or triennial evaluation, if it is strongly suspected that OT will be needed.
    • It may be a result of discussion around developing an IEP.
  • Following assessment by an OTR, the educational team will meet to consider the results of the assessment and determine whether it is necessary to add OT services to the student’s plan.

What Are The Criteria For OT Services?

  • IEP or 504 Team decision, given the guidance of an OT (after observation &/or assessment)
  • Services must be driven by the IEP/504 goals
    • There should not be “OT goals,” but educationally-related goals that the OT is helping to work towards

Medical vs Educational Model For OT:

Differences Between Medically-Based and School-Based Occupational Therapy

Many people are familiar with Occupational Therapy (OT) through a medical setting. They may have a family member who received therapy after an injury or as part of rehabilitation in a clinic or hospital in their community. Parents may receive a referral for Occupational Therapy for their child from their pediatrician. However, there are some differences in OT delivery within the school setting from the medical or health-related setting. Following is an explanation of the role of OTs in schools and how this differs from OT in a health setting.

OTs who work with students in public schools are employed by the schools. Their services are mandated by the Individuals with Disabilities Educational Act (IDEA) or by Section 504 of the Americans with Disabilities Act (ADA). The scope of these services are guided by these laws.

Scope Of Services In Schools vs. Medical Settings

The difference between medically-based and school-based OT is the scope of the focus of services. A clinic or hospital-based therapist will evaluate, recommend services, treat and monitor progress for any impairments that can be measured. For example, a clinic-based pediatric Occupational Therapist may work with a student who has some fine motor weaknesses that make playing the guitar frustrating, if that is a meaningful activity for that child. They may address sensory processing difficulties that make bath-time upsetting and frustrating for the family.

Within the school setting, however, OTs address disabilities, skill deficits, and/or injuries that directly impact that student’s ability to participate in and benefit from school-related tasks and roles. In the above examples, the students may qualify for Special Educational services due to learning differences, but may still not qualify for school-based OT. They do not need to be able to play guitar or soccer or tolerate a bath to be able to benefit from their educational setting. The skill deficits would need to be such that their educational performance or participation is significantly impacted.

Things You Might Observe OT's Doing

Medically-Based School-Based

OT’s may:

  • Guide exercises and activities to strengthen sensori-motor skills for daily skills in any area of life activities
  • Work with patients post-injury to help regain functional daily skills (such as self-care and work skills)
  • In sensory integration clinics, apply SI theory to try to change clients’ sensory processing systems for better sensory-motor outcomes
  • Make splints, manage wounds, procure and adjust orthoses, etc.
  • Use heat and cold, ultrasound, and other medical modalities
  • In mental health settings, lead activity and social-emotional groups, often using therapeutic activities

OT’s may:

  • Use activities and find strategies or modifications to strengthen and/or work around sensori-motor skill weaknesses as they impact school skills
  • Identify and address areas of need in students with learning differences
  • Help other school staff identify and use strategies as needed so that students with sensory processing needs can participate in the educational setting
  • Consult to classroom staff to advise on safe and appropriate use of medically-provided splints, orthoses, or similar devices
  • Advise teachers on how to best teach students visual-motor skills (handwriting, cut-and-paste activities, etc.)
  • Help identify and teach use of assistive technology devices, from enlarged handles to electronic interfaces
  • May help address social skills needs

Frequently Asked Questions

Q: Why do OTs work in schools?

OTs who work with students in public schools are employed by the schools. Their services are mandated by the Individuals with Disabilities Educational Act (IDEA), and by Section 504 of the Americans with Disabilities Act (ADA). The scope of these services are guided by these laws.

Q: How can my child receive OT services?

Anyone can access OT services within their community. There are procedures that must be followed to have these services covered by health insurance, and PT is stipulated in Virginia to be “upon medical referral and direction,” so that a referral by a physician is requested. But there is no official “qualification” process to access medically-based OT. This access usually begins with an evaluation to determine whether services are recommended to work on related needs and goals.

By contrast, Occupational Therapy within the school setting is part of a child’s Special Education programming, through an Individualized Educational Plan (IEP) or a 504. In order to receive direct OT or PT, a student must first qualify for Special Education services through the Eligibility Process. This means that a student must have a learning or other disability that interferes with his or her participation and/or progress in the school setting. OT services never “stand alone” on an IEP. They are “Support Services,” meaning that they are included in an IEP if they needed to support the primary Special Education services (such as Speech Therapy or services from an Exceptional Education teacher).

If he or she does is not found eligible under IDEA, a student may qualify for a 504 if he or she has any disability, long-term illness, or various disorder that “substantially” reduces or lessens his or her ability to access learning in the educational setting. If a student is not found to qualify for either an IEP or a 504, the school is not required to provide OT services. In fact, the school cannot provide those services without written permission from parents.

Q: Why won’t the school therapist do what my clinic-based therapist does?

A second difference between medically-based and school-based OT is the scope of the focus of services. A clinic or hospital-based therapist may evaluate, recommend services, treat and monitor progress for any impairments that can be measured. For example, a clinic-based pediatric Occupational Therapist may work with a student who has some fine motor weaknesses that make playing the guitar frustrating, if that is a meaningful activity for that child. They may address sensory processing difficulties that make bath-time upsetting and frustrating for the family.

Within the school setting, however, OTs address disabilities, skill deficits, and/or injuries that directly impact that student’s ability to participate in and benefit from school-related tasks and roles. In the above examples, even if the students may qualify for Special Educational services due to learning differences, they may still not qualify for school-based OT . They do not need to be able to play guitar or soccer or tolerate a bath to be able to benefit from their educational setting. The skill deficits would need to be such that their educational performance or participation in school activities is significantly impacted.

Q: But my doctor wrote a prescription for the school to provide OT.

Doctors will sometimes write a recommendation or even a prescription for OT services through the public schools for a particular student. A private professional who evaluated the child may make recommendations of services or accommodations that they feel may be helpful in the school setting. The educational team (which includes the parent) for that student does need to consider that request, but it remains up to the team to determine whether the student requires those services within the actual serving school setting. Information specific to that student and how he or she is performing within his or her classroom and other school setting should guide this decision.

Q: Might an OT work with my student even though she doesn’t qualify for special education?

Some school districts do choose to utilize the expertise of their OTs beyond IDEA/IEP and 504 requirements. This is sometimes used as part of a Response to Intervention (RtI) model, a tiered approach, or a collaborative model. A school district may have staff OTs demonstrate to teachers how different teaching methods for visual-motor tasks may benefit students who learn differently, for example. They may utilize both OTs and PTs in designing physical plants, emergency planning, curriculum design, and supply lists. OTs may even work directly with whole classrooms of students to demonstrate helpful techniques for classroom staff or to help conduct regular screenings. This level of inclusion of Therapists within the Regular Education environment may benefit students who do not qualify for direct therapy services.