1
Q
AOTA quote
A
“Public schools and early intervention are the most common work setting for occupational therapy practitioners: approximately 24% of occupational therapists and 20% of occupational therapy assistants who are members of AOTA identified public schools and/early intervention as their primary work setting”
- school-based is the best way to reach most kids
2
Q
Critical difference between school-based OT services and medical-based services
A
- school-based services: their problems must impact their participation in school
- OT is a related services to assist a child with an education diagnosis and access their educational curriculum
- OT cannot be the primary service provider
- must be specifically related to school-based occupations
3
Q
OT in the schools can be very powerful
A
- it is where we have access to most children throughout the day
- it is must more than handwriting
- “School-based OT services have evolved from a clinical model (pull out and serve) to a focus on participation and educational performance… OTP’s focus on ensuring children and youth can access and participate in the same settings and routines as their peers rather than “fixing” the person or increasing scores on standardized tests. Under IDEA, services can be provided to the child, family, educational staff, or other colleagues in the natural environment or least restrictive environment”
- scheduling can be tricky at school
- best practice is to go to the natural environment and support them in their natural environment
4
Q
Objectives
A
- review history and law of OT services in the educational system
- describe Individuals with Disabilities Act (IDEA) Provisions
- describe the special education process to qualify for services
- identify occupations addressed over the course of a school day
- consider assessments
- describe aspects of the individualized education plan
- describe Tier I, II, and III interventions across school-based occupations
5
Q
Special education policy
A
- superficially designed instruction that meets unique needs of child with a disability
- it is NOT a specific program or a classroom
A set of services:
- modified classroom instruction
- assisted teaching with a paraprofessional
- assistive technology
- behavioral intervention plans
- adapted physical education
- vocational services
- transitional services
- related services
6
Q
Legislation impacting OT in schools timeline
A
- 1975 = Education of All Handicapped Children (EHA) (allowed all children to go to school)
- 1986 = EHA addition of early intervention and preschool (all federal which means the government is required to pay - IMPORTANT)
- 1990 = Individuals with Disabilities Education Act (IDEA)
- 1991 = IDEA Amendment for assistive technology and transitions
- 1997 = reauthorization of IDEA with focus on inclusion
- 2001 = No Child Left Behind (NCLB)
- 2004 = Individuals with Disabilities Improvement Act
- 2015 = Elementary and Secondary Education Act (ESSA)
7
Q
1975 = Education of All Handicapped Children Act (EHA)
A
- prior to this, more than a million children with disabilities were excluded from public education
- mandated OT as RELATED services for children with disabilities ages 3 to 21 to benefit from special education
8
Q
1986 = EHA Amendments (addition of early intervention)
A
- OT as PRIMARY service for children ages 0 to 2 years old with developmental delay or at risk of developmental delay
9
Q
1990 = Individuals with Disabilities Education Act (IDEA)
A
- name changes to use person first language
- ensures educational program is accessible to individuals with disabilities and may include providing specific accommodations
- reauthorized in 1997 with a focus on inclusion
10
Q
2001 = No Child Left Behind Act (NCLB)
A
- requires public schools to raise achievement of all students
- holds states and local education agencies accountable
- was targeting general education students
11
Q
2004 = IDEA
A
- aligns with NCLB
- increased emphasis on accountability and outcomes
- focus upon a tiered system of intervention
12
Q
2015 = Elementary and Secondary Education Act
A
- replacing No Child Left Behind
- the focus is on states developing and implementing plans for creating school environments that help all students succeed in school
- TIERED LEVEL OF SUPPORT
13
Q
2004 = latest reauthorization of IDEA
A
- students should be prepared for further education, employment, and independent living
- early intervening services (previously referred to as RTI (response to intervention)
- to address children at risk for learning and behavior needs
14
Q
Provisions of IDEA (YOU NEED TO KNOW THESE)
A
- Free Appropriate Public Education (FAPE)
- Least Restrictive Environment (LRE)
- appropriate evaluation
- Individualized Education Plan (IEP)
- parent and student participate in decision making
- procedural safeguards
15
Q
Free Appropriate Public Education (FAPE)
A
- every child has the right to go to school and be educated at no cost (ages 3 to 21)
- free education provided at no cost to parents of a child with a disability
- appropriate education designed to meet individual needs of a child with a disability
- public education must be provided to all children through the use of public funds and in the public school system
- education intent to provide education to all students regardless of severity of disability
16
Q
Least Restrictive Environment (LRE)
A
- based on child’s Individualized Education Plan
- neighborhood school or as close as possible
- with non-disabled children to the maximum extent possible and still appropriate for child
- in regular education environment unless appropriate education cannot be achieved using supplemental aides and services
17
Q
Levels of inclusion
A
- full inclusion = regular classroom with support
- class within a class = class has special education teacher and regular education teacher in the same room
- self-contained classroom = classroom within a school with non-disabled children
- self-contained school = all children have disabilities
18
Q
IDEA requirements for appropriate evaluation
A
- multidisciplinary team conducts evaluation identifying functional problems and goals
- What is the child’s present level of performance?
- What are the child’s educational needs?
- Does the child need special education and related services?
- What additions or modifications are needed to meet annual IEP goals and participate in general curriculum?
- must be re-evaluated every 3 years
19
Q
OT evaluation
A
- occupational profile = student’s needs, interests, values, and concerns about performing occupations and daily life activities (you need to be 2 st dev below the mean to qualify for services
- analysis of occupational performance
- student’s strengths, problems and potential problems
- What supports or prevents performance?
- performance skills (motor, process, communication)
- performance patterns (habits, routines, roles)
- contact (physical, cultural, social, environmental)
- activity demands
- client factors (body functions and structures)
20
Q
Categories of disability
A
- school age diagnosis
- given between ages 3 to 5 the general diagnosis of Young Child with a Developmental Disability (YCDD)
- you may have a medical diagnosis but not an educational diagnosis (in order for it to be school-based, it has to interfere with your school success)
Educational diagnoses:
- Specific learning disability
- Autism Spectrum Disorder
- Intellectual disability
- other health impairment
- emotional disturbance
- speech or language impairment
- visual impairment, including blindness
- Deafness
- hearing impairment
- Deaf-blindness
- orthopedic impairment
- Traumatic Brain Injury
- Multiple disabilities
21
Q
Elements of Individualized Education Plan (IEP)
A
- every child gets a new IEP every year (IMPORTANT)
- present level of educational performance
- goals and objectives
- special education and related services
- explanation of non participation
- participation in district-wide assessments
- dates, frequency, location, and duration of services
- transition services addressed beginnings to age 16 (IMPORTANT)
- measuring and reporting student progress
- IT IS A LEGAL DOCUMENT (IMPORTANT)
22
Q
IEP Team
A
- general education teacher
- special education teacher
- related services (school counselors, school nurses, OT practitioners, PTs, school psychologist, and SLPs)
- local education agency representative (LEA) = a person that comes from the student’s home district
- individuals to interpret evaluation results
- parents and students of 14 years of age
- others who parents would like to include such as advocates, psychologist, and lawyer
23
Q
Related services
A
- speech and language
- OT
- PT
- psychological services
- social work
- mobility
- student health
- transportation
- vision services
- Deaf/hearing services
24
Q
Parent and student participate in decision making
A
- parents and families must have meaningful opportunities to participate in the education of their children at school and at home
- family says, “this is what we envision for the child; how can we make that happen?”
25
Procedural safeguards
* empowers the families to have the last say in how and where the child is being educated
- ensure the rights of children with disabilities and their parents are protected
- ensure that students and parents are provided with information they need to make decisions
- procedures in place to resolve disagreements
26
Process of assessments and interventions
- early intervening services (pre-K to 12th grade on Tier 1 and 2)
- referral
- evaluation
- eligibility
- IEP
- services
- annual review/re-evaluation
27
Tier diagram
- Tier 3 = intensive, individualized intervention (5%) = those who qualify for ongoing weekly services (2 st dev below the mean)
- Tier 2 = targeted interventions (15%) = 0.15 handwriting group for kids who have never been to school before or sensory regulation group
- Tier 1 = universal interventions (80%)
28
Early Intervening Services (EIS)
- IDEA (2004) has provisions for special education and related service providers to act as consultants to general education
- 15% of federal funding goes into developing and implementing early intervening services
- provides strategies to general education students prior to care team process
29
Interventions for Tier 1 (Universal)
- staff education of OT related issues
- universal screening of fine motor skills
- school wide adoption of programs related to handwriting, sensory regulation, refreshing recess, and comfortable cafeteria
- selecting of curriculum
- input related to playground spaces and walking paths
30
Role of OT in Early Intervening Services (sometimes referred to as RTI, response to intervention)
- part of pre-referral team (care team)
- screen student if have parent’s consent
- may make general suggestions to teachers outside of care team processes
- small group instruction
- general performance including sensory, fine motor, handwriting, social, behaviors, visual perceptual, and environmental
31
Opportunity to expand OT role
- Tier 1 and 2 intervention give tremendous opportunity for OT to expand role within school-based practice
- emerging roles = school mental health
Examples:
- Every Moment Counts
- Susan Bazyk
- ProMotion of mental health through day
- Development, implementation and evaluation of occupation-based model program (comfortable cafeteria, refreshing recess, and calm moment cards)
32
Care team process
- teachers or parents refer child to care team
- care team discusses concerns
- brainstorm interventions
- utilize interventions with data to support success or lack of success
- reconvene to discuss intervention
- team recommends special education evaluation or not
33
How IEP works at school
- assessment
- plan (IEP)
- intervention (planning for a year)
- discharge
34
Collaborative goal writing
- OT goals, SLP goals, and education goals = collaborative goals
35
Intervention process
- intervention plan is based on student priorities
- objective and measurable goals
- service delivery (direct, indirect, and OT/OTA)
- intervention implementation = where does it happen?
- intervention review = generally goals are reported on quarterly (like a report card)
36
Direct (service delivery in schools)
- direct = working with the kid in front of you
- 1 on 1 instruction
- group = all children with identified need or mix of children with identified need and typically developing children as models
- co-teaching
- embedded OT programs (such as Zones of Regulation and Every Moment Counts)
37
Indirect (service delivery in schools)
- planning time with school personnel
- educational in-services
- participation in school-wide committees
- consultation/coaching with teachers and staff
- reframing the teacher’s perspective
- communication and consultation with parents
38
Integrated service delivery
- inclusion on OT in the child’s natural environment
- is more than “treatment takes place in the classroom”
- pull out services ARE NOT considered best practice = they are only appropriate during the initial stages of learning a task
- provides opportunities to access all the children
39
Strategies for moving to an integrated service model
- administration support to increase direct intervention time
- time allocated for collaborative planning
- commit to collaboration by developing positive relationships
- learn about the classroom culture/setting
- offer interventions that align with the classroom structure
- provide information about OT’s role and scope of practice
- explore teacher’s preferences
40
Strategies for integrating direct services
- co-teaching
- occupational performance coaching
- formal occupational therapy embedded programs
41
Co-teaching
- collaboration to design, plan, implement, and evaluate learning experience
- benefit = expanded instructional options, improved program intensity, and enhanced educational continuity
- cons = collaboration can take time
42
Occupational performance coaching
- emotional support = acknowledge the challenges of serving a child in the natural environment
- information exchange = understand individual perceptions of the problem
- structured process = sequence of steps setting goals, exploring options, planning actions, carrying out plan, and checking performance
43
Formal occupational therapy embedded programs
- handwriting programs (Handwiting Without Tears), Size Matters, Write Stat handwriting Program)
- Zones of Regulation/Alert Program
- Drive Thru menus
- Every Moment Counts (embedded mental health)
44
Informal strategies for integrating services (indirect services)
- modifications the physical environment
- modify the schedule
- modify the activity or task
- modify the instruction (break into small parts, visual schedule, and behavioral schedule)
45
Transition services
- address at 14 years of age
- implement at 16 years of age (must be included in the IEP by age 16)
- functional capabilities = ADLs/IADLs, living arrangements, work, leisure
46
Types of schools
- an OT working in a charter or a private school may have more flexibility in how services are provided
- public
- private
- charter
- vocational
- home-based
- alternative
47
Discontinuing OT services
Reasons to discontinue:
- has accomplished goals
- performs at standard of peers
- no longer making significant progress despite changes to intervention
- continues to make gains, but no evidence that OT is responsible
- identified priority skills are no longer a concern
- student expresses desire to stop
Challenging to discontinue:
- have relationship established
48
Provision of services when ineligible for special education
May qualify under section 504 of Rehabilitation Act of 1973:
- no IEP, develop written plan
- responsibility of general education
- OT to assist with environment adaptations, modifications of equipment, and devices
ADA:
- accessibility requirements, adjustments or modification of equipment and devices as needs
Children 2
flashcards
Decks in class (14)
# Cards
-
Introduction To Child And Adolescent Interventions18
-
School-based OT Services48
-
Assistive Technology (AT)33
-
Autism Interventions23
-
Trauma Informed Approaches In Pediatric OT34
-
Managing Challenging Behavios In Pediatric Practice11
-
Early Intervention19
-
NICU25
-
Neuromotor Conditions38
-
Feeding, Eating, And Swallowing56
-
Snack Buddies: Supporting Snack Time, Nutrition, And Parent Connection19
-
Transitional Services22
-
Infant Feeding13
-
CIMT And Pelvic Floor32
