What is School-Based OT?

What is School-Based Occupational Therapy?

According to federal IDEA guidelines, occupational therapy in the school setting is considered a related service. Related services are defined as transportation and such developmental, corrective, and other supportive services.

The legal intention of school-based occupational therapy as a related service is not to address every deficit area identified by the evaluating team.
Under the law, related services are only required to the extent that such services are necessary to enable the child to benefit from special education programming.

Related services, as with any other service in an Individualized Educational Program, are determined on an individual basis by the student’s IEP team.

For direct OT services to be necessary, the team must agree there are issues that negate the student’s performance, and must agree that the issues require the unique skills of an OT and cannot be effectively addressed by other means or personnel.

But What do School-Based OT's Do?

Occupational therapists have unique training that supports the educational team in their determining if a student's has deficits in sensory-motor, cognitive or psychosocial development, and if those deficits negate their ability to participate and progress in a general education setting.

In the school setting, occupational therapists apply a Person-Task-Environment approach to support student participation and progress. OT's collaborate with instructional staff, school-based physical therapists, and school-based speech-language pathologists for task and environmental modifications.

Person: OT's engage the child in therapeutic activities and exercises that promote age-appropriate skill development. Examples of skill areas include gross and fine motor coordination, visual-motor integration, and sensory regulation. These skills are necessary to navigate the school setting, use school tools, complete self-care tasks and utilize school-based technology.
Task: OT's use activity analysis to break down the steps of a particular task in which a student may be having difficulty. They provide strategies to the educational team for adapting tasks in order to maximize student performance. Some examples include:
- Adaptive Writing Aids: slant boards, adapted pencil grippers, adapted paper, use of speech to text, use of word prediction.
- Postural Supports: alternative positioning and seating equipment including feeder seats, sidelyers, adapted toileting equipment, corner chairs, bolster seats and standers.
- Sensory Supports: sensory diets, weighted vests, bear hug vests, tactile input, sit n'move cushions.
- Behavioral Supports: consult on development of visual schedules, positive reinforcement, Applied Behavior Analysis techniques.
- Adaptive Equipment for Self-Care: velcro shoes/elastic laces/lock laces, magnetic clothing fasteners.
- Mobility Supports: manual wheelchairs, power wheelchairs.
- Assistive Technology: specialized computer hardware and software, and iPad/tablet applications to support access to curriculum.
Environment: OT's analyze the setting or context in which the person performs the task and provide strategies that promote success. Environmental modifications may be required. For example, changes may need to be made to a bathroom to make it wheelchair accessible for a student, desks and chairs may have to be fitted to promote proper sitting posture, sensory elements of a classroom may need to be changed such as lighting or floor covering to help with sensory regulation, and a child may require a visual schedule to promote compliance.

These three elements, Person-Task-Environment, are typically addressed simultaneously by the occupational therapist.

How does a student become eligible to receive OT services in schools?

I will try to provide a short explanation to a very complex procedure.

A student is identified as having trouble in school. They are not keeping up with the level of instruction as their same-age, same-grade peers.
Interventions to help the student are not successful and a disability is suspected as to why the student is not performing as their peers.
An evaluation is requested. Under IDEA, a individualized and thorough evaluation of the child's educational needs must be completed in order to determine if the student has a disability and if specially designed educational services (including related services) are needed. A parent, doctor, teacher or other educational team member can request an evaluation. The occupational therapist may be part of the evaluation team if there are concerns with performance components of sensory motor, cognitive and psychosocial development that may affect the learning process (AOTA, 1999a).
The data obtained through the evaluation, known in Ohio as the Multi-Factored Evaluation (MFE), is used to determine if the student has a disability. Common "categories" of educational disability in the state of Ohio include: Autism, Specific Learning Disability, Multiple Disabilities, and Emotional Disturbance.
The data obtained through the MFE is also used to determine is specially designed instruction is needed. This means that the student is not progressing in the general education curriculum and needs the material presented in a modified way.
The MFE identifies specific "needs" for the education of the student. Those "needs" then drive the development and the goals for the student in their Individualized Education Program (IEP).
It may be determined that the unique training and skills of an occupational therapist are required to support one or more of the goals on the IEP.
The occupational therapist provides appropriate degree and intensity of services to meet the goals. Service delivery options include Direct, Monitoring and Consultation.
- Direct Services: This method is most recognized. This is when therapeutic interventions are provided individually to the student or in a small group directly by the occupational therapist. The interventions can take place in the classroom, designated therapy area, or any other customary are of the school (e.g. playground, cafeteria).
- Monitoring: This delivery method involves the occupational therapist establishing and overseeing specific programs and intervention strategies; but the interventions themselves are carried out by another educational team member.
- Consultation: This method involves the collaboration and sharing of information with educational team members and parents to problem solve issues and implement strategies to support educational performance.