Who can receive Occupational and Physical Therapy Services
in the Educational Setting?
Educational Relevance
School-based therapy is integrated into the school’s educational program as a means to enhance functioning and attain educational objectives. Occupational therapists and physical therapists can provide support to the total educational system. They can assist with problem solving to eliminate barriers that hinder access to educational environments and assist with modifications and accommodations to support students in their regular education program. The school system also provides the therapy specified on the Section 504 plan or, as deemed necessary by the team, for achievement of a student’s identified educational goals and objectives/ benchmarks.
When occupational therapy and physical therapy are provided as educational services, decisions regarding what type of therapy is provided, how it is provided and who is to provide it are directly tied to the student’s overall educational program. All team members support the attainment of these educational goals. Thus, therapy and other related services become a means or method to attain educational goals and objectives/benchmarks, rather than the focus of separate therapy goals or objectives/benchmarks. School-based therapy is not intended to meet all the therapy needs of a student but is intended to meet needs of the student to promote success in the educational environment.
Through the ADA and Section 504, occupational therapy and physical therapy are provided to assist a student to access their general education program. Occupational therapy and physical therapy, in the educational setting, have traditionally been classified as “related services”. This therapy is provided to enhance the student’s ability to adapt to and function in educational settings. As members of multidisciplinary teams, occupational therapists and physical therapists also assist in determining appropriate programs for those students with disabilities. All therapy within the educational setting must have a relationship to educational performance while directly impacting the student’s ability to benefit from their educational experiences.
Occupational therapists and physical therapists in schools need to identify the educational significance of therapy provided to students. Educationally-related therapy needs remain broad and allow for varying interpretations at local levels dependent on individual student needs. The most common educational purposes for students to receive occupational therapy and/or physical therapy services within the school environment include:
1. Enhancing school mobility and participation in educational activities by increasing strength, accuracy and speed.
2. Ensuring easier total care by maintaining flexibility.
3. Improving manipulative skills for self-care and paper/pencil tasks through reach, grasp and dexterity.
4. Enhancing comfort, participation and attending by maintaining functional postures.
5. Increasing functional use of hands and visual regard by providing stable positions.
6. Ensuring independence in feeding and oral motor skills for safety and nourishment.
7. Maintaining functional movement by prevention of contractures and deformities.
8. Facilitating safety in the school environment by decreasing the possibility of injury to student’s self or others as he/she moves or performs skills/tasks.
9. Improving success for small muscle school tasks by increasing coordination of eye-hand movements.
10. Facilitating access to and mobility within school by assessing and changing the environment.
11. Increasing functional use of extremities through adapted equipment.
12. Enhancing ability to learn through sensorimotor activities that address motor planning, attending and behavior issues.
13. Arranging preparation for vocational needs.
14. Promoting competency and safety of educational staff in body mechanics, handling techniques, motor skills and classroom adaptations.
15. Facilitating student’s independence through access to assistive technology.
Differences between school-based and non-school based services
The determination of when occupational therapy and physical therapy are educationally relevant is a complex issue. Several issues must be considered when determining the appropriate level of school-based and non-school-based therapy.
1. School-based therapy is a part of a student’s total educational program. Therapy provided within the school setting has a different orientation than therapy provided in non-school settings. School-based therapists identify needs of the student and assist in providing strategies on how best to capitalize on abilities as well as minimizing the impact of the disabilities in the educational environment. Non-school-based therapists typically evaluate performance based only on a student’s disabilities. The school-based therapist also evaluates a student to determine abilities as well as disabilities. The school-based therapist then determines the adverse effect these disabilities have on the student’s performance in the educational and/or community-based instructional settings. Input is gathered from teachers, parents, students and other educational staff as to how these problems may influence performance areas within the educational environment.
2. School-based therapy involves “teaming”, in which recommendations and decisions are made based on input from all team members in order to determine a student’s total educational plan Non-school-based therapists make unilateral recommendations based on their individual findings to determine their individual therapy plan.
3. The principal role of school-based therapists is to assist students in benefiting from their educational program. A general guideline is that therapy must contribute to the development, improvement or maintenance of the student’s functional level within the educational environment. If a student needs occupational therapy and/or physical therapy to address problems, but the problems do not prevent him or her from benefiting from the educational program, school-based therapy should not be provided. Most non-school-based therapists do not have these criteria superimposed on their recommendations for intervention (Royeen, 1992).
Key Considerations for the delivery of OT and PT services in the public school setting
(Virginia handbook)
1. Services are provided to enable the student to benefit from his or her special education program and facilitate access to the general curriculum.
-Strategies should be integrated into the classroom and school environment to support learning of curriculum content
-Interventions should support skills that are needed for graduation
2. Services are provided in the student’s daily educational routine
-Skills are taught across all educational settings
-Therapeutic activities occur throughout the school day and often are implemented by instructional staff in collaboration with the therapist.
-Skills must be taught in naturally occurring environments
-Skills must be generalized across different school settings, not isolated solely with the therapist in a separate area
3. Services are provided through a team approach
-Team members share information, strategies, and techniques to assure continuity of services.
-Educational strategies and interventions are developed and implemented jointly by the IEP team members including the student when appropriate
-Regular team meetings provide the communication of information and outcomes that guide the plan of activities and instruction that occurs throughout the day in the classroom, home and community.
4. Services are provided through the use of a variety of delivery models
-Service delivery models include monitoring, consulting and working
directly with the student.
-Effective therapy services generally include a combination of models to meet the unique needs of each student.
-Effective therapy services include the following:
-Training parents and school staff in activities and accommodations to be implemented throughout the student’s day
-Observing and critically analyzing student performance and responses that prevent the student from benefiting from his or her educational program
-Identifying, selecting, and adapting special materials and equipment
-Collaborating and coordinating with teacher and families for needed changes in instruction and in the learning environment.
-Consulting with students, parents and school staff.
5. A student’s need for OT and/or PT services may vary over time
-Student therapy needs differ in intensity and in focus during the students’ school years.
-These fluctuations are reflected in IEP, IFSP, or 504 plans and should be fluid and flexible, based on the immediate educational needs at any time during the student’s course of study.
*Considerations for services may be especially necessary during periods of transition between schools or into community activities, and when significant changes to educational and career transitions occur.
