Settings Flashcards
Early Intervention Setting Basics
- Ends at age 3 (goes into school system)
- Purpose: to head off issues before child grows/develops
- Largely about coaching families of children/incorporating interventions into daily life
- For children with: 1) developmental delay, 2) diagnosed disability that might cause delay, and 3) at the state’s discretion who are deemed at risk of delay
- Services may be offered in NICU, pediatric outpatient center, hospital or clinic; supported through private/other funding
Early Intervention Services under IDEA Part C
• Age 0-3
• At risk of delay, or having disabilities
• Offered in home, daycare, early head start, or community settings
• IDEA Part C offers grants to states for these services, under state’s lead agency
• Includes: family training, special instruction, OT, service coordination, assessments, assistive tech
• Provided by qualified personnel, in natural environments
• Services must address:
1) Physical development
2) Cognitive development
3) Communication development
4) Social/emotional development
5) Adaptive development
OT under IDEA Part C
• Designated as PRIMARY SERVICE under Part C in 2004; specifically listed in statute
• OTPs may be SERVICE COORDINATOR as well as SERVICE PROVIDER
• Part of team to build family’s capacity to care for child/promote development in natural environments where they live, work and play
***OTP can provide: Direct Service, Service Coordination, Consultation, or Education/Training
OT Process in Early Intervention
1) Evaluation (screenings, assesments, interview, collab with family /team)
2) Intervention (collab with family/team, develop IFSP, use evidence-based practice)
3) Outcomes (promote function, meet family/child’s goals and needs)
Individualized Family Service Plan (IFSP)
Plan of care for child under early intervention (when entering school at age 3). Emphasis:
• Team approach
• Family/child centered
• Natural environments (home, preschool, etc.)
• Multidisciplinary
• Collaborators review every 6 months
• Emphasize goals of child
Early Intervention: Play Time
- Increases social skills
- Advances motor coordination
- Develops problem-solving abilities
Early Intervention: Meal Time
- Promotes independence in self-feeding
- Improves ability to eat a variety of foods/textures
- Creates family-friendly schedules
Early Intervention: Bath Time
- Addresses positioning needs
- Ensures safety during ADLs
- Promotes sensory-rich experiences
Early Intervention: Social
- Manages emotions
- Develops self-advocacy skills
- Strengthens family bonds
Settings for OT in Early Intervention
- DAYCARE (peer interaction, coaching daycare providers, promote play skills)
- HOME (establish healthy sleep schedule, design safe play areas, support family caretaking)
- COMMUNITY (promote safe transport., increase ease in transitions, facilitate participation in activities)
School Based Practice for OT
- Ages 3-22
- Work with teachers, aides, speech path., PT, principal, parent/caregiver
- FRONT OFFICE SECRETARY is your link to all!
- Only instance of OT where the family is not #1; agenda must work with TEACHERS
Principles of IDEA
- Free and appropriate public education
- Least restrictive environment
- Appropriate evaluation
- Individualized Education Program (IEP)
- Parent and student participation in decision making
- Procedural safeguards
OT and IDEA
- OT is related service that may be required to enable student to benefit from spec ed.
- Services designed to enhance student’s abilities to participate in educational process
- OT improves developing or restoring functions impaired/lost
- OT improves ability to perform tasks for indep functioning
- OT offers prevention thru early intervention, initial, or further impaired/lost function
Least Restrictive Environment (LRE)
Most appropriate education with non-disabled peers/regular classroom.
• May require classroom modification(s)
• Can still include time in 1:1 with OT, PT, SLP
INCLUSION: either full or part day integration as much as possible into general population
School Based Evaluation
• Multi-factored Evaluation (MFE): multidisciplinary team conducts eval to determine if child warrants special ed services
• Can be initiated by parents or school team; sometimes physician
• Can include observations, standardized tests, parent/teacher questionnaires
• Federal law mandates reeval every 3 years
• Initial questions may be:
- What are child’s present levels of performance?
- What are child’s educational needs?
- Does child need special ed/related services?
- What additions/mods are needed to meet annual goals in IEP and participate in general curriculum?
Categories of Disability under IDEA (1997)
- Intellectual Disability
- Hearing Impaired (HI)
- Speech Language Impaired (SLI)
- Vision Impaired (VI)
- Emotional Disturbance (ED)
- Orthopedic Impairments (OI)
- Autism
- Traumatic Brain Injury (TBI)
- Other Health Impaired (OHI)
- Specific Learning Disabilities (SLD)
What OT Evaluates in School Setting
- Level of Participation (in school activities)
- Assessment of Performance in: motor, sensory responsiveness, perceptual processing, psychosocial/cog abilities, school environment
- Teacher expectations and curriculum standards
Components of an IEP
- Present levels of performance
- Goals
- Special ed and related services
- Explanation of non-participation
- Participation assessments
- Dates, frequency, location, duration of services
- Transition services
- Measuring/reporting of student progress
IEP Team
Collaboration between: • Individuals familiar with child • Regular education teacher • Special education teacher • Local educ agency representative (LEA) • Individual to interpret eval results • Parents • Any other individuals who parents/LEA feel have knowledge/expertise about child including related services (OT)
IEP Goals
- Reflect a holistic picture of child and understanding of what is required to function in school and knowledge of curriculum
- Establish overall goals to maintain student’s health/vitality
- Enhance student’s participation in this and future inclusive environments
- Increase student’s social integration
- Refer to essential functional skills that have frequent/multiple apps across environments and activities
Service Delivery of OT in Schools
- Direct Service: integrated or pull-out
- Monitoring: development of program to be carried out by others
- Consultation: primary method of service, or supplemental to direct service; cooperative partnership with other professional or parent to engage in reciprocal problem solving
OT in Preschool
- OT supports child to successfully participate in roles/requirements of that setting
- Process: Referral > Screening > Evaluation
- Areas: play, self-help and classroom maintenance, and pre-academic skills
Main Intervention Strategies for OT in Schools
- Change the task
- Change the environment/context
- Change the child’s skills/abilities
OT Service Delivery Models in Schools
- Collaborative teams
- Consultation
- Group intervention sessions
- Individualized treatment
- Partnering with families
School Settings where Services are Mandated
- Public Schools
- Charter Schools
- Preschools
- Early Start
- Home Based Charter Schools
OTA’s Role in Schools
- Demonstrate service competency in areas delegated by OT
- Assist with data collection
- Score tests
- Develop/administer intervention plans
- Consult/collaborate with educational staff
- Develop goals in collab with OT
- Develop schedules
- Train staff/parents to implement programs and strategies in class and/or home
- and MORE!
Occupational Therapist’s (NOT OTA) Role in Schools
- Evals, interpretation of assessments
- IEP meetings
- All of OTA role/responsibilities
- Development of goals
- Supervision of OTA
- Reviewing/co-signing OTA notes
- Collab with other team members
- Working with parents
Tips for Providing OT Interventions at School
- Make use of any space given to you
- Use class/school equipment, but provide materials necessary
- Be aware of class schedules, teacher/child’s needs
- Be aware of child’s self-perceptions
- Small groups make interventions less intrusive
- Be flexible and think on your feet
- Grade activities to match/challenge skills
- Email may be best way to collaborate
- Get teacher feedback
- Pull out service can occur on playgrounds, closets, hallways, etc.
- Create continuum betw tx sessions and classroom by communicating with teachers/parents
Public Law 94-142 (1975) – Education of Handicapped Act (EHA)
- Free and appropriate public education (FAPE) - students 5 to 21
- Least restrictive environment (LRE)/inclusion
- Due process for parents (impartial mediator resolves differences with school if needed)
- Individualized Education Program (IEP)
Services Available to Special Education Students:
- Transportation
- PT/OT
- Assistive technology
- Psychological services
- School health services
- Social work services
- Parent counseling/training
- Speech Therapy (ST)*Also/only standalone service for other students
Rehabilitation Act 1973 (Section 504)
Any school receiving federal aid cannot discriminate against persons who have disabilities.
• Student with disability not eligible for special ed but requires reasonable accommodations in regular education may be eligible for services through 504.
• Must have condition that “substantially limits one or more major life activities” such as learning.
Americans with Disabilities Act (ADA 1990)
Prohibits discrimination in employment, transportation, accessibility, and telecommunications
• Protects persons with disabilities
Public Law 99-457
Part C addition to EHA (1975)/renamed IDEA (1990)
• For birth to age 3
• Includes indentification and referral, evaluation, determination of eligibility, development of individual family service plan (IFSP), and transition plans.
No Child Left Behind Act (NCLB), 2001
Supports use of scientifically based practices
• “Adequate Yearly Progress” report (single accountability standards)
• OTs must consider research when selecting intervention/instruction practices
• Collaborate/consult with team to prioritize child’s needs
Rights of Parents and Children
- Notification of all proposed actions in writing
- Parental consent to evaluate/reevaluate
- Notification and right to attend all IEP mtgs
- Right to independent evaluation
- Right to appeal school decisions
- Informed of rights in writing
Transition Plan (Schools)
- Includes steps taken to support students and families as changes occur
- Educating families/students about resources available and their rights
- When student turns 14, transition services focus on vocational education
Tips for Working with Parents
- Listen
- Use plain language
- Put parents at ease in meetings
- Highlight child’s strengths
- Speak to them before meeting
- Be clear about what has been done
- List main problems (not all of them)
- Ask parents for suggestions/advice
- Provide suggestions
- Follow up with parents
Tips for Working with Teachers
- Respect teacher’s style, rules, classroom
- Spend time in the classroom
- Ask the teacher’s opinion
- Prioritize strategies
- Provide short written strategies
- Respect teacher’s time
- Communicate in short emails/writing
- Help determine child-teacher fit
- Present self as resource
- Use OT resources to help teachers
- Provide solutions
- Use plain language
Discontinuing Services in School Setting
- Often difficult due to rapport built
- Ease out by decreasing frequency
- Discharge or decrease in frequency decided with IEP team
- May continue on a consultative basis
Transition Services
- Entering a variety of adult roles/activities
- Transition Team: interdisciplinary and interagency team responsible for IEP and transition services
- Student is most crucial member of team!
OT Contributions to Transition
- Help student access, participate in, benefit from OT’s specialized educ and transition services
- Understand educ performance and participation demands
- Positive future-oriented and student-centered
- OT services can occur at multiple levels to help child transition
Policies (Laws) for Transition Services
- IDEA of 2004
- Section 504 of Rehabilitation Act
- ADA
- Ticket to Work, and Work Incentive Improvement Act
Evidence-Based Practice in Transition Services
- Collaborative interdisciplinary and interagency teamwork
- Ecologic approaches
- Self-determination, self-regulation, social competence training
- Recommended practice: paid work experience during high school
Aspects of Transition
OPPORTUNITIES
• Employment, Postsecondary School, or Living
NEEDS • Financial/Income • Friendship/socialization • Transportation • Health/Medical • Legal and Advocacy
Ecological Approach in Transition
- Specify environments
- Prioritize performance environment
- Identify activities
- Divide responsibility
- Conduct assessments
- Record evaluation findings
- Share findings
Active Involvement of Student in Transition
- Take part in planning/decision-making
- Self-determination
- Become positive agents of change in own lives
- Actively pursue their own goals
- Direct support and preparation in process
- Professionals must relinquish control
- Collaborate to implement strategies
- Social competency
Social Competency in Transition
- Self-regulation
- School environment that recognizes/addresses bullying
- Explicit training/programming to address work skills needed for success
- Social skills training
- Job-related social skills training
Transition: Paid Work During High School
- Evidence supports this
- Supported employment
- On-the-job training
- Job carving (creating duties to match child)
- Customized employment (negotiate job to match child)
Community Systems
- Any facility outside of traditional medical model that provides health-related services or programs.
- Schools, camps, homeless shelters, faith-based centers, clinics, mental health orgs, foster care centers, sensory clinics
- Service delivery models: direct, individual, group, coaching, mentoring, education
- Community is part of person’s natural environment
- Area with geographic and political boundaries
- Where members have identity and sense of belonging
Community-BASED Practice vs. Community-BUILT Practice
Community-BASED:
• Skilled services provided by practitioner using interactive model
• Focus on deficits
• Initiated by medical model (referral from health care providers)
Community-BUILT:
• Skilled services provided by practitioner using collaborative/interactive approach
• Focus on wellness and health promotion from a public health perspective
• Referrals from variety of community sources
Health in Community Setting
Complete physical, emotional and social well-being. OT must understand community in which child functions to support optimal health.
Intentional Relationship Model
Therapeutic modes of interacting; part of the therapeutic relationship/trust/rapport between client and therapist. • Advocating • Collaborating • Empathizing • Encouraging • Instructing • Problem solving
Healthy People 2020
Provides framework for prevention of illness and premature death.
• Goals to: increase healthy years of life for all; achieve health equity and end health disparities; create healthy social/physical environments; promote health behavior and quality of life.
Community Mental Health Center Act (1963)
Community-based services rather than institutionalization. (See: Ikuigu’s Model)
Ikuigu’s Model for Designing Community Mental Health Programs
1) Educating about OT
2) Establishing referral system
3) Identifying/administrating appropriate assessments/evals
4) Integrating key persons into therapeutic process
5) Implementing individualized interventions
6) Supporting community reintegration
Challenges to Practices in Community Systems
- Funding
- Ability to maintain communication among service providers
- Cultural competence
Team Members in Medical Systems
Children, families, specialists, generalists, nurses, OT, PT, etc.
Continuum of Care in Pediatric Medical Settings
(Most critical to least): • Neonatal Intensive Care Unit (NICU) • Pediatric Intensive Care Unit (PICU) • Subacute Care • Home-Based Care • Residential or Long-Term Care
(Also: Pediatric Rehab and Hospital OT Clinics)
Models of Medical Care
1) PRIMARY: Preventative; visits to primary care physician (PCP)
2) SECONDARY: When child becomes ill and requires medical intervention; when referred to specialist
3) TERTIARY: Hospitalization
4) QUARTERNARY: Less common extension of tertiary; severe trauma, burns, transplants
Neonatal Intensive Care Unit (NICU)
• Necessitated by complicated births
• Neonate who is physiologically unstable (unable to maintain temp, heart rate, breath rate)
• Neonatologist is medical team leader
• Symptoms:
- Cyanosis (blue from lack of oxygen)
- Bradycardia (less than 110 beats/min)
- Low Birth Weight (less than 2500 G)
- Very Low Birth Weight (less than 1500 G)
- Extremely Low Birth Weight (less than 750 G)
- Others: Respiratory difficulties, surgeries, injuries
Pediatric Intensive Care Unit (PICU)
- Also called a Step-Down Nursery
- Address acute symptoms (after heart surgery, brain surgery, significant illness, etc.)
- Wean patients off external medical supports
- Sensorimotor stimulation given as tolerated
- Pediatric intensivist (AKA pediatric critical care medicine specialist) is medical team leader
- OT encounters children with wide range of diagnoses/ages
Medical/Surgical/General Care Units
- Children who require 24-hour medical attn
- Diagnoses include: trauma, drowning, falls, sports-related injuries, flu, cardiac conditions
- OT documents medical status/progress during rounds to other professions
- Frequency/duration varies from 2-5x per week for 30-60 minutes.
Hematology/Oncology Units
- Children with blood-related diseases or cancer
- OT focuses on interventions directed toward ADLs, IADLs, Sleep/Rest, Play/Leisure, and Education
- OTs evaluate client factors such as strength, ROM, endurance, visual perception
- OTs recommend AE, modifications to activities, energy conservation
Speciality Services or Units
- Beds in a unit for particular procedures or a particular speciality (prep for surgery, addressing issues after surgery)
- Palliative Care: comfort care for dying child (and family)
- Child life services before procedures that cause pain, depression, anxiety
Subacute Setting
- Patients more medically stable but not ready to go home for medical/family reasons
- Continue to monitor/treat acute symptoms
- Wean off external medical supports
- Provide developmentally appropriate interventions
- Pediatrician as medical team leader
Acute Rehabilitation Setting
- Specialty services found in children’s hospital or rehab hospital
- Programs directed by PT, OT, SLP, 5-6x/wk for 3 hours per day
- Work on rehab for children who have sustained serious injury/illness
- Maximize independence in meaningful activities
Home Care Setting
- OTs help develop discharge plans to help children return home
- Promote caregiver/child bonding
- Medical services on an outpatient/home-delivered basis
- Communication with caregivers and children
- Community-based supports and resources vary with child’s age
- Continue to facilitate acquisition of developmentally appropriate skills
Outpatient Services Setting
- Varies depending on child need/diagnosis
- Interventions focus on meaningful activities and skill acquisition
- Education for parents/caregivers for activities to complete at home
- In some cases, monitor medical need of children (ie: GI tube in stomach)
- Consult with other professionals (ie: wheelchair)
Long-Term Care Facility/Hospice
- Sometimes in form of residential care
- Provide necessary medical care (oxygen, positioning, ventilator support)
- Provide appropriate therapeutic interventions
- Prevent contractures, encourage interaction, optimize positioning, etc.
Patient and Child Support Groups
- Community supports focused on variety of issues: bullying, grieving, coping, etc.
- May focus on specific condition (SCI, CP, etc.)
- OT may lead group or provide consultation
- Sometimes in form of camps for children with specific diagnoses
Assistive Technology Setting
- Provide devices and services for children with disabilities
- May be at hospitals, schools, or in community
- OT requires specific certification to provide services in this area
Role of OTA in Medical Settings
- Conduct initial screenings
- Collaborate with OTR on eval, intervention planning, and implementation
- Gather/review preadmission info to increase understanding of child’s status
- Collaborate on discharge plan
- NO role in NICU
- Active role in PICU with adequate training/supervision; must know equipment, standards of care (ie: sign-out practices, medical supervision), and medical status signs
- Acute role in Subacute, Home, Long-term care, but MUST be aware of signs of physiologic stress and be trained to respond!
Functional Independence Measure (FIM) for Children
- Standardized assessment
- Gives uniform language for all those working with a child
- Conducted by direct observations or interviews with caregiver
- NOT to be used as only diagnostic tool
Challenges in Medical Setting
- Number of specialists involved
- Medical terminology
- Incorporating preadmission habits, roles and routines into interventions
- Palliative care
- Reimbursement (can be from variety of sources: insurance, private pay, donations)
Characteristics of a Successful Health Care Practitioner
- Compassionate
- Empathetic
- Honest
- Uses proper manners
- Effectively communicates
- Actively listens
- Advocates
- Uses sound clinical reasoning/problem solving
Prescriptive/Directive Role (of OTP)
Instructing clients or providing advice for the client to follow. This is one of the main roles when working directly with a child. (ie: Providing a family with a schedule for child’s splint wearing.)
Consultative Role (of OTP)
This is the OTP’s role when working with the family. Consults with the family on possibility of achieving desired goals for the child and for family. (ie: developing child’s splint-wearing schedule incorporating family’s natural routines.)
• Builds collaboration and trust, key to success with families.
Recent changes in service delivery have expanded OTP roles to now include:
- Assessing family interests, priorities, concerns
- Observing/gathering info about daily routines of children/families in their homes and in classrooms
- Gathering/sharing info w/families about development and intervention strategies
- Implementing therapy in collab with parents, caregivers, and general educators
OT Role in NICU
- Address positioning for function, ROM, and age-related motor/sensory development
- Make recommendations re: environment for high-risk infants
- Promote positive oral experiences for feeding
- Provide ongoing parent education and support related to infant behavior/development
- May address feeding/swallowing concerns or provide support for breastfeeding
- May work with family members to help adjust to new parenting roles
Related Services
Designation given to services such as OT, PT, ST, school health and social work: required services for child in special education program (as stated in EHA).
Role of OTA in the IEP Team
• To report findings and recommendations under direction of the OT
(OT is responsible for completing evaluation—with input from OTA—interpreting the info and presenting the report to the IEP team.)
