Occupational Therapy Service Delivery

Occupational Therapy Service Delivery Academy School District #20

Mission Statement:

The occupational therapists in Academy School District #20

 Assess students’ abilities to function within the educational environment in the following areas:

o Sensory and motor readiness for learning

o Self-help and independent living skills

 Design, implement and/or support programming needed to maximize students’ abilities to function within the educational setting in the domains listed above.

 Serve the continuum from preschool to high school, with an emphasis on early intervention, providing the most direct services during the preschool and early elementary school years.

Differences between PT and OT service delivery models :

The PTs in District 20 most often use a model of collaborative consultation, with emphasis on training classroom staff to carry out motor programming on a daily basis using the MOVE curriculum. The OTs feel that a variety of service delivery models are appropriate for occupational therapy, since we primarily serve a different population of students than those served by physical therapy.

The PTs work primarily with SSN students, who have significant classroom support from teachers and paraprofessionals. The skills on which they concentrate (sitting, standing, walking or moving around in the environment, etc.) are usually mastered by the time a student is at a developmental age of 24 months. Once students achieve that level of gross motor functioning, their motor skills are generally considered to be "functional for the educational setting", and further refinement of gross motor skills is addressed by regular and/or adaptive PE.

The foundational skills which the OTs address (manipulative, visual-motor and self-help skills, as well as sensory processing abilities) are usually acquired from 0 to 8 years of age, requiring more cognitive processing and a longer period of maturation than the development of foundational gross motor skills. Therefore, students who have exceeded the developmental level of 24 months may be considered functional for the educational setting for gross motor skills, but still have a lot of developmental growth to achieve before they can be independent in the basic sensory, manipulative, visual-motor, and self-help skills required in the academic environment.

The OTs spend about 70% of their time meeting IEP requirements for preschool and resource students, and 30% of their time supporting SSN classrooms. Therefore, 70% of our time is spent serving children who do not have classroom paras assigned to them on a regular basis. The resource students that we serve often need more 1:1 assistance with skill development

1 than can typically be provided by a classroom teacher or resource teacher/para. With the state's emphasis on reading, writing, and mathematical achievement, resource staff has a minimal amount of time to assist with the development of basic foundational sensory and motor skills.

The next few pages describe the various service delivery models that the OTs use according to the ages and needs of students, as well as their classroom settings and performance expectations.

Preschool

The preschool service delivery model was originally limited to collaborative consultation with preschool teachers. In recent years, we have found that it is more effective to use a variety of service delivery models for students who are delayed in the development of their fine motor and visual-motor skills or who have difficulties with sensory processing.

Even though manipulative, drawing, and cutting activities are provided in the preschool classroom on a regular basis, students with impacted sensory and/or motor systems need more individualized and repetitive instruction than is typically provided in the small group activities. For instance, these students often need hands-on assistance and multiple visual and/or verbal cues to participate successfully in the provided activities. When the ratio of adult to student is 1 adult to 3 or 4 students, this kind of assistance is difficult to provide on the regular, intensive basis that is needed to develop adequate skills.

With the gradual increase in the severity of delays in development of the students coming into the district preschool programs in recent years, and the addition of typical peers who also need attention, classroom teachers and paras have less time available to do the 1:1 skills training that is required to develop the basic fine motor/visual-motor abilities (drawing and cutting) to prepare their students for kindergarten.

Early intervention literature supports our approach of using a combination of service delivery strategies, including:

• Observation of the student within the classroom

• Ongoing assessment of skills

• Collaborative consultation with teachers and family to provide suggestions to carry over skill development in daily routines (such as the development of a "sensory diet" that can be implemented and carried out by classroom staff and/or families on a daily basis)

• Direct intervention for skill development (ideally, doing this in the classroom setting is recommended; however, in very crowded and noisy classrooms it may be more beneficial to work with the child in a less distracting environment). This direct intervention can be provided by the therapist or her/his assigned OT paraprofessional.

Elementary Resource: Grades K-3

I. How students qualify for O.T. services

 When a teacher is concerned about a student’s deficits in functioning in the classroom, a student study conference is required as the first step for intervention. One outcome of

2 a student study conference is that a referral is made for a special education evaluation, but other types of intervention may be tried first.

 If a student is experiencing problems that are insufficient to warrant an immediate referral for special education testing, the teacher and parents may be provided with a list of home program activities to help improve skills, or with specific suggestions regarding accommodations such as pencil grips, type of paper, slant board, etc. Depending on the area of difficulty, written suggestions for sensory activities that can be used with all of the students in a classroom might be provided. If the student does not demonstrate improvement after a specified time period (response to intervention), and OT is contacted again, then additional steps can be taken. Again, one possibility is a referral for a special education evaluation if the student’s problems are having a significant impact on her/his ability to benefit from education.

 If fine motor skills are the ONLY area of concern, the family may be encouraged to pursue private occupational therapy, since ongoing direct or consultative OT cannot be provided in isolation in the school setting due to its definition in federal legislation as a related service. The exception to this might be in the case of a student on a 504 plan who can receive OT consultation without receiving services from any other special education professionals.

 If a student is experiencing very obvious and impacting deficits that are interfering with educational achievement, an immediate referral for a special education evaluation, including an occupational therapy assessment, may be made at the student study conference.

 In order to receive direct or consultative OT services on an ongoing basis a student must qualify for special education services under one of the disability categories defined by the state, and the special education team must feel that a student’s difficulties with fine motor, visual-motor, and/or self-care skills are having a significant impact on his/her ability to benefit from education.

II. Service Delivery: A survey of best practices in the literature supports our approach of using a combination of service delivery strategies including

• Observation of the student within the classroom

• Ongoing assessment of skills

• Collaborative consultation with teachers and family to provide suggestions to carry over skill development in daily routines (such as pencil grips, slant boards, specific writing paper, a sensory diet to maintain a calm alert state, etc.) • Please note that collaborative consultation is as time intensive as direct intervention, because the therapist needs to schedule times to consult with the teacher (often done at planning times, before school, after school, or over lunch), and to follow-up with the teacher on a weekly or bi-weekly basis. The time intensiveness necessary for collaborative consultation is supported in the literature by several leaders in our field (see reference section).

• Direct intervention for skill development: This may take several forms including

 Pull out: For specific visual-motor skill development some children work better in a less distracting environment than the classroom.

3  Working with the child in the classroom.

 Collaborative consultation with teachers to provide suggestions to carry over skill development in daily routines in the classroom. This may extend to collaborating with the family as well, developing customized homework assignments to help develop a child’s visual-motor skills, providing suggestions for sensory diets, suggesting home activities, etc.

 A short-term, intensive approach (direct services twice a week for one to three quarters is often found to be more effective than seeing the child once a week over the course of a year or longer).

Resource: Grades 3-12

Since the "window of opportunity" for developing and remediating fine motor skills lies within the first 8 years of life, a more compensatory approach is usually chosen for upper elementary students and secondary students.

 Collaborative consultation with the classroom teacher and/or resource teacher is the most frequent service delivery model, if a decision is made to provide ongoing OT services and they are listed on the IEP.

 Collaborative consultation with teachers to provide suggestions to carry over skill development in daily routines in the classroom. This may extend to collaborating with the family as well, developing customized homework assignments to help develop a child's visual-motor skills, providing suggestions for sensory diets, suggesting home activities, etc.

 Frequently evaluations are administered and recommendations are made for the IEP, but no ongoing services are provided. .

Elementary SSN and CSD

These students often have more supports in place (more individualized paraprofessional time, small group experiences in the SSN or CSD classroom, etc.), so the usual service delivery strategies consist of • Periodic observation of the student in the SSN or CSD classroom (this might be bi-weekly, monthly, or less frequently)

• Ongoing assessment of skills, which would involve team collaboration and input of IEP information

• Collaborative consultation with teachers and family to provide suggestions to carry over skill development in daily routines (such as the suggestions for pencil grips, slant boards, writing paper, a sensory diet to maintain a calm alert state, etc.) This may include training classroom paraprofessionals, who will be carrying out the daily interventions.

• Occasionally, with SSN and CSD students in grades K-3, direct intervention for skill development may be provided, with the intention of keeping track of progress and updating classroom recommendations.

4 • It should be noted that the OT provides general consultation to the SSN or CSD teacher on an as-needed basis for all of her/his students, whether or not OT is specified on the IEP, since many of these children experience significant delays in the areas of fine motor and self-help. Attending team meetings on a monthly or twice-a-month basis is a very critical avenue for providing this more generalized classroom support, as well as for providing specific recommendations.

Middle School and High School SSN:

The emphasis with this population shifts to assisting the classroom staff in the development of self- help and independent living skills, as well as consulting regarding intervention for sensory processing problems.

Service delivery consists of

• Assessment of skills, particularly with transfer students, which would involve team collaboration and input of IEP information.

• As with the elementary SSN programs, the OT also provides general consultation to the SSN teacher on an as-needed basis with all of her/his students. Attending team meetings on a monthly basis is often an effective method of providing more generalized classroom support, as well as providing specific recommendations, depending upon the needs of the classroom and the experience of the SSN teacher. (Less experienced teachers frequently need more time-intensive support.)

• Ongoing training of paraprofessionals who carry out daily living skills instruction and practice, or implement sensory diets, may be a critical part of service delivery for those students are in need of improving their self-help skills to become more independent or having sensory activities built into their day to help them maintain an optimal arousal level for learning.

504 Students :

Students who are on a 504 plan because of a specific disability (spina bifida, cerebral palsy, juvenile rheumatoid arthritis, etc.) are eligible to receive OT services, including

• Initial assessment

• Recommendations for appropriate accommodations and modifications

• Periodic, collaborative consultation with the classroom teacher (which initially could be time- intensive)

Response to Intervention (Rti) :

At Tier 1 (screening) O.T. might provide consultation by giving information to parents, teachers, the school nurse, or other school personnel. Determining whether or not occupational therapy is necessary to address a student’s need is important; the skills of an O.T. might not be needed.

5 At Tier 2 (targeted intervention for a specific problem) O.T. could support the building and teacher by imparting information to enrich the classroom environment to address a performance breakdown at some level. An example of this would be to work with a school to adopt a handwriting curriculum that would benefit all students, or giving a presentation on sensory processing with emphasis on strategies that can be used in a regular education classroom to meet students’ sensory needs.

At Tier 3 (more intensive intervention such as working with a student in a small group with increased intensity; could also be a referral for SPED evaluation at this tier) O.T. could continue to support the building and teacher by providing information, could check work samples left in the O.T. box for 3 weeks to monitor progress and provide input, or could be part of a special education evaluation.

OT SERVICE DELIVERY.DOC Revised 5/07