OT in the Schools (Week 8) Flashcards
What makes school-base OT unique?
- practice in schools is influenced by educational model
- models of service delivery
- composition of teams
- extent of consultation and collaboration
- prevalence of group interventions
- integration within the public school system
- Opportunity to define OTs role (good time to advocate for OT!)
What are unique skills you need for entry-level competency in the schools?
- interpersonal skills
- well-informed of coursework and educational continuum
- Assistive tech
- Knowledge of UE functioning
- Knowledge of developmental milestones
- Grade level milestones
1975 Education of All Handicapped Children Act (EHA)
- Federal legislation mandating inclusion of children with disabilities into public ed.
- over 1 million children allowed access to FAPE in the LRE
- OTs included as “related service” in special education process
FAPE
Free and Appropriate Public Education
- Every child deserve a free education that is appropriate for their needs
LRE
Least Restrictive Environment
- Education should be provided in the least restrictive environment; an environment that allows the child to be successful (general ed; some general ed and some special ed; some below average classes, etc)
1986 EHA Amendments
- Preschool and EI added to legislation and service provision
- Head Start, EI, IFSP
1990 Individuals with Disabilities Education Act (IDEA)
- Rename of original EHA
1991 IDEA Amendments
- Expanded related services to include AT services and transition support
- Transportation support as well– riding on the bus; making accessible
1995 IDEA
- School Mental Health Centers established
1997 IDEA Amendments
- Placed emphasis on delivery of related services in the general education classroom.
- Encouraged related services to relate directly to child’s general education.
- Requires students with disabilities to participate in state and district assessments.
2001 No Child Left Behind (NCLB)
- Primarily an general education law.
- Emphasizes student learning outcomes.
- Every child receives same education– based on standardized tests
2004 IDEA Improvement Act
- Preventative services through early intervening.
- Focus on preparing students for further education, employment and independent living – postsecondary success.
What occupations are engaged in at school?
ADL, IADL, Rest and Sleep, Education, Work, Play, Leisure, Social Participation
How is a child identified for Special Ed. evals?
- Child find
- Any adult may refer (parent, teacher, etc
- And OT will be asked to access the child if the special education team feels it is needed
Child find
- system that locates, identifies, and evaluates all children with disabilities (doctor referals if you know someone from treatment)
Types of Special education programs
- IEP (individual plan)
- 504 Plan (individual plan)
- Early intervening services (EIS; Group or individual plans)
- Response to intervention (RtI; Group or individual plans; looks at kids who would benefit from services to prevent needing services later in life)
IEP
- ex: OT, resource/special ed teacher, SLP; goals; tx plan; acommodations; resources
504 Plan
- less formal than IEP
- when kids don’t meet criteria for IEP
- Ex: need a seperate room for testing, feeder at lunch, access to playground with w/c; typically no treatment
Special education process for IEP
- SpEd referral
- Use the eval the school uses for comprehensive eval (OT, SLP, psych, SpEd)
- then determine eligibility based on scores
- write our (OT) section of the IEP
- meeting with everyone on the IEP to determine eligible or not eligible
OT Role in Special Edu. Process
- IDEA mandates that school personnel evaluate all areas of suspected disability
- Eval must be completed within 60 days of parental consent
- Relevant academic, functional and development data is gathered (assessments and/or skilled obs)
- Top-down or occupation based assessment is considered best practice
- Use of assessment tool is not required
Eligibility for Special Edu. (disability within these disability categories)
Mental retardation Hearing impairment Speech/language impairment Visual impairment Serious emotional disturbance Orthopedic impairment Autism Traumatic brain injury Another health impairment Specific learning disability Deaf-blindness Multiple disability IF age 3-9 years, has a significant developmental delay as determined by appropriate diagnostic testing for physical, cognitive, communication, social/emotional or adaptive development. OR child needs SpEd services
Eligibility for OT as related services
- Once made eligible for special education, the team determines eligibility for OT.
- Evaluation results, student education program and annual goals are all considered in
determining necessity for OT. - Children deemed ineligible for OT services under IEP may qualify based on 504.
OT Role in Documentation
- Student education plan and goals are written collaboratively as a team.
- OT support must be educationally relevant to student academic participation and progress.
- OT will support educational goals but will not have profession-specific goals.
- Not profession specific goals! Everyone needs to be working toward goal
What OT services are appropriate in school?
Once deemed educationally relevant, OT proposes how to provide services in the school.
Direct services
- Direct services are applied directly to the child.
Indirect services
- Indirect services may be programmatic or involve consultation or other methods
not direct to the child– we check in. We are not directly involved; paraprofessional; teacher education
In the school setting, who is the client?
- Child, teachers, and other educational support staff
Services may focus on…
- restoration or adaptation of skills or health promotion and prevention
Handwriting and Literacy
- Supporting handwriting within the context of early literacy experiences improves both writing skills and literacy.
- Functional writing, including both the form of writing and content of writing, takes a lifetime to master.
- Writing and reading skills tend to develop in tandem.
Handwriting eval and intervention should be multifaceted, looking at the following…
- Motor skills
- Processing skills
- Language skills
- Exposure to writing and literacy
- Culture of the classroom
- Contextual influences
- Environmental set-up
- Expectations of the teacher and family
- Availability of alternate methods for written expression
Handwriting intervention should/could be…
- Whole class vs individual intervention
- Consistent with school literacy standards
- Generalizable across contexts
Handwriting intervention should show measurable performance changes via…
- Domains of writing
- Legibility
- Writing speed
- Ergonomic factors
- Ex goals: Johnny will create words on spelling test that is within the top and bottom line; Johnny will write name in 9 minutes; will use stamp to put name on paper
IEP Team
- Required: Child’s parent or guardian, One regular education teacher of the child, One special education teacher of the child, One special education provider
- When appropriate: Public agency representative,. Interpreter/advocate, Related service personnel, The student
OT as a related service on an IEP
- OT may or may not be part of the initial IEP evaluation.
- OT can not provide “stand alone” service for a student with an IEP; the student must have special education needs which necessitates OT support.
Section 504 of Rehab Act and ADA
- Section 504 defines disability as any student with “a physical or mental impairment that substantially limits one or more major life activities”.
- OT can be provided directly to the student or through program supports through the students’ teachers.
- OT may be provided without other special education services.
- OT services typically involve reasonable accommodations to access the learning environment.
- School personnel are required to develop 504s but do not receive federal or state reimbursement for services (That is why you don’t see them often)
- 504 process typically established at the state or local level.
Early Intervening services (EIS
- Schools spend up to 15% of special education funds on academic or behavioral support for students who are struggling or at-risk but do not qualify for special education.
Response to Intervention (RtI)
- Targeted early identification and educational programming to support at-risk students with LD.
- May be curriculum-based, classroom based or individual student based (What does this child need to get ready for school?)
Two-tiered model of education under IDEA 91975-2004)
- SpEd= 15% of students
- General education= 85% of students
Multi-tiered model of Special Edcuation, including IDEA, RtI and PBIS (2004 to present)
- Tier 1: early identification and screening of ~80% of students
- Tier 2: Targeted interventions for at-risk ~15 of students
- Tier 3: Intensive individual interventions ~5% of students
School mental health movement
- System-wide emphasis on training and support for child mental-health. (Push for no bullying)
- Public health model of prevention and early intervention related to emotional health.
- Services delivered school-wide, through targeted groups or to individual students. (Train everyone to identify students who are in need of mental health services)
Advocacy for OT in the schools
- Role of OT may be defined at the district level.
- OT can provide a range of services and programming to address range of needs for school-aged children.
- OT has opportunity for both innovation and traditional service delivery.
- Can be creative in intervention! Ex: bringing yoga into PE
What is the role of OT in the school setting?
- To facilitate successful participation and performance in educationally related occupations; advocating; coaching/education
Is there a role for OT in a general education classroom?
- Assess needs of the whole classroom! What is a good idea for everyone? To reach kids that didn’t get services (sensory groups; classroom with 3-4 behavior problems?! Intervene!)
What predicts long-term success for students with disabilities?
- support
- identification
How is change enacted within the school setting?
- Slowly
- lots of politics
- lots of people
- make change with old teachers
- one huge district with many schools
What is the influence of evidence in shaping school-based OT?
- EBP; better serve clients; better outcomes; good to be able to have lit to support rationale; parents want to know “why”
