Clare Gladwin Regional Education District

OT/PT Guidelines April 2013

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VISION

Clare-Gladwin RESD is the place known for offering exemplary education services.

MISSION

To provide cooperative assistance, creative leadership, and specialized expertise to

local school districts to enhance and expand educational opportunities for all.

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Table of Contents

Purpose --------------------------------------------------------------------------------------------

Philosophy ----------------------------------------------------------------------------------------

State and Federal Regulations --------------------------------------------------------------

Qualifications for OT, PT, COTA, PTA ------------------------------------------------------

Definitions for Occupational and Physical Therapy -----------------------------------

Specific Roles for OT, PT, COTA, PTA -----------------------------------------------------

OT/PT pre-referral and referral process --------------------------------------------------

Evaluation process -----------------------------------------------------------------------------

IEP/IFSP Eligibility ------------------------------------------------------------------------------

Exit Criteria --------------------------------------------------------------------------------------

Scope of practice for OT/PT -----------------------------------------------------------------

Nonpublic and home school ----------------------------------------------------------------

Assistive technology ---------------------------------------------------------------------------

Acknowledgements ----------------------------------------------------------------------------

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Purpose

The purpose of this handbook is to define the practice of school-based Occupational Therapy (OT) and Physical Therapy (PT) services in order to support the educational goals of students with disabilities in Clare and Gladwin counties. It has been determined that guidelines will help outline delivery of OT/PT services to eligible students and provide a flexible, consistent, and unified approach for Clare and Gladwin County’s public schools.

These guidelines are written for providers of occupational and physical therapy services, special education administrators, building administrators, and all school personnel responsible for service plan delivery within Clare and Gladwin Counties. In addition, it may also benefit parents, teachers, and other professionals. This handbook is written as a source of information and suggestions for implementing occupational and physical therapy services. The intent is to supplement, not replace, the Individuals with Disabilities Education Improvement Act of 2004, the Michigan Revised Administrative Rules for Special Education, and local school board policies.

PHILOSOPHY

Occupational and Physical Therapy staff at Clare Gladwin Regional Education School District (RESD) provides premier special education-related and early intervention services that support students in their education process. Therapy staff can be vital members of an educational team. This document supports collaborative teaming and integrated work. No single Individual Education Program (IEP) Team member provides services in isolation from other service providers. The IEP Team’s goal is to ensure that the student benefits from his/her educational experiences.

Occupational and Physical Therapy staffs are concerned with aspects of development that enhance educational performance to include functional motor, fine motor, visual perceptual, visual motor coordination, and sensory processing. Therapy staff implements treatment to improve, develop, maintain, restore, or adapt when the ability to function in the learning environment is adversely impaired.

A student must exhibit a physical or developmental disability which may interfere with the student’s ability to benefit from education before qualifying for OT and/or PT services. The student’s school-based therapy needs should directly relate to support his or her academic program, as the therapies facilitate maximum independent functioning within the educational environment.

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Federal & State Regulations/Guidelines

To be eligible as a “student with a disability”, IDEA 2004 section 602 and the results of the evaluation indicate that the student meets the specified criteria for an impairment in 1 or more areas of impairment identified in the Act (such as autistic spectrum disorder, speech and language, physically impaired, etc.) and as a result of the identified impairment, the student needs special education and related services.

The Individuals with Disabilities Education Improvement Act (IDEA) of 2004 defines Occupational Therapy as a related service:

§300.34(c) (6) Occupational therapy means: (i) Services provided by qualified occupational therapists; and (ii) Includes-

(A) Improving developing or restoring functions impaired or lost through illness, injury, or deprivation;

(B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and

(C) Preventing through early intervention, initial or further impairment or loss of function.

The Michigan Revised Rules for Special Education of 2002 R 340-1701b(d) “Occupational therapy” means therapy provided by therapist who has been registered by the American occupation therapy association or an occupational therapy assistant who has been certified by the American Occupational Therapy Association and who provides therapy under the supervision of a registered occupational therapist. The Individuals with Disabilities Education Improvement Act (IDEA) of 2004 defines Physical Therapy: §300.34(c) (9) Physical therapy means services provided by a qualified physical therapist. The Michigan Revised Rules for Special Education of 2002 R340-170b(f) “Physical therapy” means therapy prescribed by a physician and provided by a therapist who is licensed by the state of Michigan under 1978 PA 368, MCK333.1101 et sq. or a physical therapy assistant who provides therapy under the supervision of a physical therapist. Federal Definition The federal definition of occupational therapy services within the context of special education. 34 CFR 300.34 (a) (6) “Occupational Therapy” includes: i) Means services provided by a qualified occupational therapist; and (ii) Includes-- (A) Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;

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(B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and (C) Preventing, through early intervention, initial or further impairment or loss of function. Physical Therapy Definition The federal definition of Physical therapy services within the context of special education. R340.1701 b (f) Physical Therapy means therapy prescribed by a physician and provided by a therapist who is licensed by the state of Michigan under 1978 PA 368, MCL 333.1101 et seq. or a physical therapy assistant who provides therapy under the supervision of a licensed physical therapist. 34 CFR 300.34 (a) (9) “Physical Therapy” Physical therapy means services provided by a qualified physical therapist. The Federal Register (August 2006) contains regulations implementing changes necessitated by the reauthorization for IDEA (2004). The evaluation of children with disabilities is addressed in 300.122. It states that they must be evaluated in accordance with 300.300 through 300.311 of subpart D of part II. These sections include legal requirements for parent consent ( 300.300), evaluation procedures ( 300.305), additional requirements for evaluations and reevaluations ( 300.305), and the determination of eligibility ( 300.306). Michigan Revised Administrative Rules for Special Education (2009) also addresses these requirements in Rules 340.1710, 340.1721 and 340.1745.

Reevaluations In general, as part of any reevaluation, IDEA 2004 §300.533 states that the IEP Team and other qualified professionals as appropriate shall-

(1) Review existing evaluation data (REED) on the child, including- (i) Evaluations and information provided by the parents of the child; (ii) Current classroom-based assessments and observations; and (iii) Observations by teachers and related services providers; and

(2) On the basis of that review, and input from the child’s parents, identify what additional data, if any, are needed to determine-

(i) Whether the child continues to have a disability; (ii) The present levels of performance and educational needs of the child; (iii) Whether the child continues to need special education and related

services; and (iv) Whether any additions or modifications to the special education and

related services are needed to enable the child to meet the measureable annual goals set out in the IEP of the child and to participate, as appropriate, in the general curriculum.

Furthermore, if the IEP team, and other qualified professionals are appropriate, determines that no additional data are needed to determine whether the child continues to be a child with a disability, the school district shall-

(1) Notify the child’s parents-

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(i) Of the determination and the reasons for it; and (ii) Of the right of the parents to request an assessment to determine

whether the child continues to be a child with a disability; and (2) Not be required to conduct the assessment unless requested to do so by the child’s

parents.

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Qualifications

Occupational Therapist, Registered (OTR)

• As of January 7, 2007- all entry level program- a Master’s degree is required • If an occupational therapist was certified prior to January 78, 2007 they are

“grandfathered in” • Successful completion of a national occupational therapist registration exam • Every three years renewal with National Board for Certification in Occupational therapy

(NBCOT) • State of Michigan Licensure • Physician’s prescription is not necessary for assessment or treatment in an education

setting. However, a physician’s prescription is required for Medicaid billing

Certified Occupational therapist Assistant (COTA)

• Associates degree from an approved and accredited occupational therapy assistant program (certification) must be renewed every two years

• Works under the supervision of a registered Occupational Therapist • Every three years renewal with National Board for Citification in Occupational Therapy

(NBCOT) • State of Michigan Licensure

Physical Therapist (PT)

• All physical therapists require a Bachelor’s through Doctorate in PT • Successful completion of national physical therapy licensure examination- • State of Michigan Licensure • Physician’s prescription is necessary to begin treatment in the educational setting

Physical Therapist Assistant (PTA)

• Associate’s degree from an approved and accredited physical therapy assistant program • Works under the supervision of a Physical Therapist • State of Michigan Licensure

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Definitions for Occupational and Physical Therapy

The emphasis of school based services provided by Occupational Therapy (OT)/Physical Therapy (PT) has shifted over the years from a medical approach to an educational approach. The functional skills a student needs to perform in the educational setting are dependent on a variety of factors; including the student’s diagnosis, present level of function (performance), educational program, and overall developmental, cognitive and academic abilities. Some OT/PT skill deficits many not directly impact educational progress and may not constitute educational need. In order to receive OT/PT services at school, the impairment must be linked to the student’s inability to access the curriculum and to achieve educational goals and objectives on the IEP. Also, the students’ needs must be met in the least restrictive environment.

Occupational Therapy in the school environment focuses visual perceptual/motor integration skills, fine motor skills, self-help skills, functional life skills, sensory processing skills (including sensory modulation and sensory motor skills) and assistive technology. Students are evaluated using assessment tool which are appropriate to their chorological age and/or functional level, and which are the most inclusive of racial, cultural and socioeconomic differences. Evaluations are completed with, but not limited to a combination of standardized assessments, clinical observation, and checklists.

Physical therapy as an educational support service can be quite different from physical therapy in a clinic or hospital. School-based therapists focus on removing barriers from students’ ability to learn, helping students develop skills which increase their independence in the school environment, and educating school personnel about the different considerations required for students with disabilities. Everything the therapist does with students in the school must be educationally relevant. Therapists examine and intervene to improve students’ functional abilities in school classrooms, hallways and other areas that may be part of their educational program (i.e., community facilities and vocational settings). The therapist works with teachers to help students acquire functional abilities necessary to access educational materials and move about the school. To help students function better in classrooms, the lunchroom, or restrooms, therapists may work with them or with school personnel on adapting or modifying their equipment/materials. Other assistance includes helping students participate in activities outside of the school through mobility on field trips, sports events, on playgrounds and within the community.

The physical therapy services include the following; a evaluating students with disabilities by performing and interpreting tests and measurements and/or clinical observations of neurophysiological, musculoskeletal, cardiovascular, respiratory, and sensorimotor functions. B) planning and implementing treatment strategies for students based on evaluation findings. C)

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improving, maintaining and slowing the rate of regression of the motor functions of a student to enable him/her to function in his educational environment. D) Administering and supervising therapeutic management of students with disabilities, recommending equipment, and providing training to parents and educational personnel.

The practice of physical therapy does not include identifying underlying medical problems or etiologies, establishing medical diagnosis or prescribing medical treatment.

Occupational therapists and physical therapist can function as a part multidisciplinary evaluation team for students suspected of being in need of special education. Evaluative input by the occupational therapist/physical therapist can include clarifying the reason for referral, observations in various school environments, interviews, testing, progress monitoring, and record review. Determination of therapy services is the decision of the Individualized Educational Planning Team (IEPT). Consideration of the following questions may assist the IEPT in determination of therapy provisions:

1. What are the student’s educational needs for which the occupational therapist /physical therapist can provide unique skills and perspective?

2. How do the needs of the student impact educational performance?

3. How will the OT or PT services improve performance that will contribute to achievement of the student’s educational goals aligned with curriculum?

4. What can the OT or PT provide that is different from the other team members?

NP

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Occupational therapy or physical therapy services in the educational setting differ from those in rehabilitation and other medical settings both in scope and in intent. In the school setting, occupational therapy and physical therapy is part of a broad program based on students’ achievement and functional performance congruent with the educational curricula. The provision of therapy and outcome is based on the impact the disability has on the educational performance rather than on the disability itself. Occupational therapy and physical therapy services in the schools are solely to support the educational process. A student may manifest a disability that does not significantly interfere with educational performance and then school-based occupational therapy or physical therapy services would not be warranted. Occasionally, a student may require medical based therapy services outside the scope of the IEP goals, and the family can pursue community resources to meet medical-rehabilitation needs.

School-based therapy is different from clinical-based therapy in terms of its intent, roles of the therapist, and the types of support available.

School Therapy Clinical Therapy Intent IEP Driven Prescription driven Educational goals are primary Therapy goals are primary To reduce the effects of acute and chronic

conditions so the child can benefit from their education program.

To treat acute and chronic conditions

Characteristics Services are collaborative with time given to communicating with other service providers, parents, and teachers.

Services tend to be discipline-based

Focus is on functional skills and adaptions that promote attainment of educational objectives.

Focus is on developmental milestones, components of movement, and performance

The therapist goes to the students in the educational setting and provides a variety of services on educational need; including individual, small group therapy, and consulting with teachers who work with the student.

Clients come to the clinic to receive one-on-one therapy from the therapist.

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Specific Roles of Therapy Staff

Therapists’ caseload is uniquely individual. Variables will influence a therapist caseload may include but are not limited to service delivery model, travel time, severity of student disability, supervisory responsibilities and individual program needs. Consideration of caseload is a cooperative effort between the therapist, teaching staff, and administration. Flexible scheduling can be used to allow for a combination of delivery models (direct service, monitoring, and consultative) and to respond to the varying needs as a student enters, progresses, or exits the program.

The therapist’s workload refers to the accumulation of all of the responsibilities of an OT/PT. These activities include but are not limited to service delivery, information school teams. Families, and administrators of the student’s individual needs, addressing the student’s needs, evaluations, report writing, supervising COTA’s/PTS’s, consulting with parents and teachers, IEPT meetings, child studies, Medicaid billing, and travel. The OT/PT workload activities are outlined in the graphic organizer below.

Specific Roles of Occupational Therapy Staff

Occupational therapy staff evaluates, consult, monitor and/or treat students in the following areas:

Fine motor skills: Assess a student’s ability to use classroom tools and materials effectively and teach adapted measures when needed.

Visual Perceptual/motor integration skills: Assessment of a student’s ability to process Visual information. Visual perception plays an important role in spelling, mathematics, and reading. The goal is to teach or remediate visual perceptual deficits which may lead to difficulties in learning, recognizing, and remembering letters and words, learning basic mathematical concepts of size, magnitude, and position, confusing likeness and minor differences, mistaking words with similar beginnings, distinguishing the main idea from insignificant details, and poor handwriting.

Educational Training- The goal is to build capacity in the educational setting with ongoing educational training to empower families, teaches, and other school staff to meet the educational needs of all students.

Sensory Processing Skills- Include (but may not be limited to): sensory integration, perceptual motor, reflex development/integration, oral motor, self-regulatory, and readiness abilities as foundations for sensory processing skills as appropriate to the learning environment.

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Accommodations in the Educational Setting- Assessment and implementation of strategies which accommodate the learning needs as well as the physical environment, such as in classrooms, hallways, restrooms, lockers, playgrounds, and cafeterias.

Components of Movement- Development of head and trunk control for fine motor and bilateral skills, motor planning, and coordination of body parts for purposeful and skilled movement as appropriate to the learning environment.

Assistive Technology- OTs work with a team to assist in the educational setting to adapt and/or make recommendations for low tech as well as high tech equipment for the purpose of educational benefit.

Self-Care Skills- Include (but may not be limited to): feeding, dressing, hygiene, toileting, oral-motor, communication, and regulatory skills to participate in activities as appropriate to educational goals and objectives.

Adaption of Equipment- Design, construction, and modification of splints and equipment for functional use (i.e. writing, dressing, feeding), and training in use of upper extremity prostheses; recommendations for positioning, wheelchairs, hand splints, upper extremity braces, transportation, and seating devises as appropriate to the learning environment.

Pre-Vocational/Vocational Skills-: Manual dexterity, strength, endurance, physical capabilities, adaptive methods, and equipment as appropriate to the learning environment.

*Note: The practice of Occupational Therapy does not include identifying and underlying medical problems or etiologies, establishing medical diagnosis, or prescribing medical treatment.

Specific Roles of Physical Therapy Staff

Physical therapists assess, treat and/or make recommendations to improve or maintain a student’s level of functioning by addressing the following area:

Educational Training- The goal is to build capacity in the educational setting with ongoing educational training to empower families, teachers, and other school staff to meet the educational needs of all students. Staff training in safe transfer/lifting techniques to prevent injury to both students and staff while transferring students to and from chairs, wheelchairs, floors, toilets, cars, buses, and beds.

Musculo-Skeletal Development/Posture- Assessment of deformities of the musculo-skeletal system (such as scoliosis or leg length discrepancy) and postural asymmetry. Provision of exercise programs to improve posture when appropriate to support functional performance in the educational setting. Exercises and activities are designed to increase muscular strength and endurance, reduce abnormal muscle tome, maximize desired joint motion, and prevent deformity in order to facilitate participation in the educational setting.

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Functional Mobility- Weight bearing and balance activities are designed to maximize mobility. Gait training in uses of braces, orthotics, and lower extremity prostheses may include assistive devices (such as crutches, walkers, and canes) to negotiate all surfaces including stairs, ramps, and playgrounds. Training in wheelchair use for independent mobility is also provided as appropriate to the learning environment.

Components of Movement- Development of head and trunk control for general stability and coordination, gross motor skills, balance and equilibrium reactions, reflex development, and integration of basic senses to support functional performance in the educational setting.

Adaptive Equipment Needs- Recommendations on design, construction, and/or modification of equipment such as positioning devices, wheelchairs, adaptive seating, mobility aids, braces, orthotics, and other specialized needs to support functional performance in the educational setting.

Environmental Adaptions- Recommendations on design of equipment which adapts the instructional environment (such as entrances, restrooms, classrooms, and /or transportation) to minimize the obstacles which may prevent student participation. Assist classroom teacher in developing goals and programs for student mobility in the community as appropriate to the learning environment.

*Note: The practice of physical therapy does not include identifying underlying medical problems or etiologies, establishing medical diagnosis, or prescribing medical treatment.

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Services Provided by The Therapist Versus the Assistant

OT Eligibility evaluations

Write letters of medical necessity for equipment

Attend IEP/METs to identify progress & services

Responsible for all service delivery for students eligible for OT services

Conduct equipment & othotic evals. Collect, analyze, & interpret student

data Develop sensory diets

Program development Oversee COTAs

OT/COTA Provide services

(direct/consultative Select therapeutic stategies

Collaborate on student performance

Provide in-service & training (for parents, parapros/teachers)

sensory motor groups in early childhood programs

Documnetaion of student performance

Assistvie technology

COTA Provide therapeutic services

under general supervision of the OT

Collects & provides data to the supervsion OT

Selects & implments activites in accordance with the IEP

PT Eligibilty Evaluations

Write letters of medical necessity for equipment Conduct equipment & orthotic evalautions

Consult students pre-k-12 Establish care plans for

students Oversee PTA's

PTA Manufcature items

needed for students Provide majority of direct

services for CGRESD classrooms

Whole group activites for CGRESD classrooms

Summer motor enrichment activities

PT/PTA Equipment repair &

adaptation Telephone contacts with

parents/vendors Attend team meetings

Tranfer traingin for staff Moto groups for early childhood programs

Prescriptions Atten IEP/METS to

indentify progress and plan for programs and

services Home programs

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Referral Process

Initiations or referrals may result from many different entities, but are not limited to the following:

Pre-Referral: the pre-referral process for occupational therapy and/or physical therapy follows the same procedures as for other special education services. It is recommended pre-referral and intervention strategies should be tried for an appropriate period of time. Response to Intervention (RTI) is the practice of (a) providing high quality instruction/intervention matched to student needs and (b) using learning rate over time and level of performance to make important educational decisions (National Association of State Directors of Special Education (NASDSE, 2005). This could include activities for the student in the school setting and/or a screening by a therapist.

Best practice recommends that OT/PT be part of the Child Study Process. A teacher/parent may request a child study team meeting to discuss a child and the concerns related to progress in the curriculum.

Parent request for referral:

If the parent requests an evaluation, the special education legal requirement should be followed. The school provides the parent notices of intent to complete an evaluation, or refusal to evaluate. Written parental consent is needed prior to conducting an evaluation.

Physician’s request for referral:

A physician’s prescription is treated as a recommendation to be considered by the student’s IEP or MET team. The IEP/MET team reviews the prescription and any relevant date to determine the education need that may or may not be associated with the request, and determine if an evaluation will be completed. Although the need for related services and/ or an evaluation is determined by the education team and not the doctor, information from the doctor must be considered by the IEP/MET team. If written parent permission has been given through a release of records, OT’s, PT’s and other professionals may communicate with the doctor about the decisions of the evaluation and/or the IEP.

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Evaluation Process

OT and PT evaluations are requested when additional information is required. The evaluations are conducted by appropriate qualified therapists and should be comprehensive and objective. Parental consent is required prior to initiation of the initial evaluation and the evaluation review. The nature of the evaluation and the selection of evaluation tools are determined by a student’s suspected disability and how it affects the educational program.

• Evaluations may include one or more of the following: • Review of pertinent medical and educational records • Review of the current IEP (if applicable) • Interviews with the student, parent/guardian, teacher • Observations in a variety of school environments • Evaluations of activity demands that impact educational performance • Administration of informal evaluation tools, such as self-care, functional and behavioral

checklists • Administration of standardized assessments • Assessment of the student’s neurological, musculoskeletal, cardiopulmonary, and

integumentary systems as they relate to the educational setting • Analysis of the evaluation findings for IEP team consideration

A written report must be completed at the end of each evaluation. Educators and parents find it helpful to have OT and PT reports written in layperson terms. Medical terms should be explained by definition and by application to the educational setting.

In Michigan each school system shall identify, locate, and evaluate students with suspected disabilities birth through 25 years of age. The provision for services shall be determined at the IEP team meeting, using the input of the physical therapist or occupational therapist and the results and recommendations of the therapy assessment. The continuation of services shall be determined at the annual IEP review using input of the therapist.

The Need for Special Education Services As part of the evaluation requirements, in addition to meeting the eligibility requirement as cited above, the IEP team must determine whether the child needs social education and related services. The IEP team has the responsibility to document whether or not the need for special education service exists. Interventions in general education, which may include special or supplemental materials, modification of instructional techniques, or other support services provided within the general education environment, ma suffice to meet the student’s needs. This could also include accommodations made under Section 504 of the Civil Rights Act, 1973.

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A child may have a medical diagnosis and not qualify for special education. A child will be eligible as a special education student only if their impairment adversely affects his/her educational performance. A child whose impairment does not interfere with his/her day-to-day functioning within the educational setting would not be eligible for special education services. In order for a student to qualify for OT service, they must meet the criteria for eligibility (i.e., ASD, LD, PI, OHI, etc.) as determined by the Michigan Rules for Special Education-OT cannot stand alone on an IEP. The continuum of impairment depends on the level of severity. A student with a mild Impairment would likely require no special education services. A student with a mild to moderate impairment would likely require some adaption or modification in the school setting. A student with a moderate to severe impairment may require a more intensive services and/or program. To preserve the child’s right to Free Appropriate Public Education (FAPE) accommodations may be made under section 504 of the civil rights act of 1973. Not all students with impairments experience learning problems, nor do they require special education and/or related services. Only when the accommodations are beyond what is required under Section 504, should eligibility for special education be considered.

Entrance Criteria:

• The student is eligible for special education services due to the disability specified in his or her IEP or 504 plan

• Preschool to grade 2: A composite score of at least 1 ½ standard deviations below the mean as measured by and appropriate assessment instrument. This may translate as having a delay of 12 months in assessments that yield a developmental age score.

• Grade 3 and up: A composite score of at least 1 ½ standard deviations below the mean as measured by and appropriate assessment instrument. If a developmental age score is yielded, a 24 month delay would indicate the need for services, with a significant discrepancy between the assessed area/s and the student’s progress in other academic areas.

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Evaluation legal definition

The Federal Register (August 2006) contains regulations implementing changes necessitated by the reauthorization for IDEA (2004). The evaluation of children with disabilities is addressed in 300.122. It states that they must be evaluated in accordance with §300.300 through §300.311 of subpart D of part II. These sections include legal requirements for parent consent (§300.300), evaluation procedures (§300.305), additional requirements for evaluations and reevaluations ( 300.305), and the determination of eligibility ( 300.306). Michigan Revised Administrative Rules for Special Education (2009) also addresses these requirements in Rules 340.1710, 340.1721 and 340.1745.

Screening and Observations

General Screening – Screening across general populations for instructional purposes (such as “Kindergarten round-up”) is not an evaluation. Instructional purpose means determining appropriate instructional strategies for curriculum implementation. This type of screening does not require parental permission when the test or other evaluation tool is administered to all students; unless consent is required form all parents.

Consultation and Observation by Special Education Staff- In general, state policy limits pre-referral consultation to direct interaction with general education personnel or student observation. It excludes direct interaction with general education students on being evaluated for special education. Activities conducted outside of these procedures are considered general education, and outside of the scope of special education funded staff.

Individual Screening – Screening includes brief, limited contact with a student by special education staff with the intent to lend support in the general education setting and help a building team decide if an evaluation for special education is appropriate. Written parental consent should be obtained prior to any individualized screening contact with a student. It is important that such individual screening remains limited to a brief probe that does not rise to the level of activities typical of a special education evaluation. If an evaluation is needed, written parent consent must be initiated prior to a special education evaluation.

Early Intervening Services – The intent of these services is to prevent evaluation for special education by implementation of tiered general and special education intervention for children not identified as needing special education but who may be experiencing problems in one or more areas of achievement such as reading.

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Evaluation for Special Education – A concern may lead to the need to evaluate for special education when the Review of Existing Evaluation Data (REED) form is signed by the parent or guardian and is received by the local district administration. The 30-school-day timeline for completion and IEP imposed by the State of Michigan begins when the REED is actually received by the district [R340.1721c(2)]. If the student already qualifies for special education then the completion date is noted on the REED form. If a date for completion is not noted for a reevaluation, it is assumed to be 30 school days form the date the parent’s signature/consent is received by the district.

If the REED is an Initial, then a copy of the Special Education Parent Handbook with Procedural Safeguards must be provided to the parent/guardian. In the case of a student who is already eligible for special education, then a copy of the Procedural Safeguards must be offered to the parent/guardian at every IEP.

School personnel may receive a written statement from a parent or guardian requesting a “evaluation” or “testing”. A written request is not the start of the formal evaluation with a 30-school-day timeline. However, it does start a process that requires a written response. Within ten school days of receiving a written request form either the parent/guardian and/or the team for an evaluation, the parent must be notified using the Initial Written Notice of Evaluation for Special Education sample letter which should be sent home by the special education director of the district (see Appendix H [R340.1721(1)].

Best practice indicates the local district should take an immediate proactive response and contact the person requesting the evaluation. The district representative should determine why the evaluation is sought and the nature of the evaluation. At this time the education making the contact should respond the concerns and explain the process. Depending on the specific situation, the process might range from taking the concerns to the buildings child study team for intervention to immediately preparing the paperwork for the parental signature to start a formal evaluation. Ideally, a face-to-face meeting is best since communication may be better and timelines for notices and evaluation consents or written withdrawals of request can be taken care on at one time.

It is important all parties understand that no student can qualify for special education under IDEA (2004) unless it can be documented that prior to the request for evaluation for special education, research-based intervention s within the general education classroom have been provided and have been unsuccessful [§300.306(b)]. These interventions are usually recommended and monitored as part of a general education building team process, such as instructional consultation.

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All communication and responses should be documented. If the parent decides to withdrawal a written request for an evaluation, that withdrawal must be in writing. When this happens the withdrawal is often contingent upon some other action and possible reconsideration of a request for evaluation later, which should also be in writing. If any parental communication is oral, school personnel should still document the verbal exchange in writing.

General Procedures for Evaluation – A special education evaluation includes the use of a variety of assessment tools and strategies to gather relevant functional, developmental, and academic information about the child, including information provided by the parent. Reevaluations require review of existing evaluation data (REED) form the school and any data that may be provided by the parents; observations by teachers and related service providers; formal testing; and documentation of the need for special education services. An evaluation report must be provided in writing to the IEP Team including parents for determination of eligibility and needed services.

A reevaluation requires a REED form. The REED form documents a review of the information available and any additional information needed to determine if a student continues to have a disability and whether the child continues to need special education services.

Individualized Educational Planning (IEP) Team

The CGRESD, in an on-going effort to improve the delivery of ancillary and related services, has explored a variety of new approaches and related concepts. A number of these concepts have been combined into the collaborative service delivery model. This approach utilizes the following elements:

• Team decision on method of service delivery of support services • Increased emphasis on integrated therapy in the students natural environment • Therapy provided in the context of the demands of the educational setting • Multidisciplinary team approach (team takes ownership of total program not

individual discipline orientation) • Significant emphasis on situational evaluation of the student within the

classroom • Collaborative team development and progress reporting of goals and objectives

(discipline free goals) resulting in a significant reduction on IPE goals and objectives

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• Collaborative team development and implementation of supplementary aids and supports, including accommodations, modifications, and/or resources needed to achieve goals and objectives

The Multidisciplinary Team approach views the student in a holistic manner emphasizing team ownership of a student’s educational program. OT and PT goals, objectives, and services are integrated into, rather than isolated from, a student’s total educational program.

Individualized Family Service Plan (IFSP)

When the child is eligible for Early On services for children ages 0-36 months, an IFSP is developed. The IFSP addresses the child’s developmental needs as well as connecting families with community resources. An IFSP is a written plan that guides everything that will be done while a child and family are involved with Early On. It lists what activities, supports and services are needed by a child and family. The IFSP:

• Spells out what the parent and the team will do • Explains what is needed to support the child’s growth and learning • Is individualized for each family and child

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Special Education Eligibility

Criteria for provision of OT service → both A and B must be met:

A. The student is classified and eligible for special education services under at least one of the disability areas outlined in the Michigan Administrative Rules for Special Education. There must be documentation evidence that occupational therapy is required to assist the student to access and benefit from the general education curriculum or special education curriculum.

B. The student demonstrates functional skill impairment in at least one of the following categories: developmental, motor, visual motor, visual perceptual, sensory processing, self-care/activities of daily living or psychosocial.

Criteria for provision of PT service → both A, B and C must be met:

A. The student is classified and eligible for special education services under at least one of the disability areas outlined in the Michigan Administrative Rules for Special Education. There must be documentation evidence that physical therapy is required to assist the student to access and benefit from the general education curriculum or special education curriculum.

B. The student demonstrates gross motor impairment in either the developmental or motor function category.

C. For physical therapy services, a current physician’s prescription is required, specifying duration. Prescriptions must be renewed for continued services this is a legal requirement for delivery of PT services within the school setting.

Early on Eligibility

Criteria for provision of OT or PT service → both A and B must be met:

A. The child is classified and eligible for Early On services as Part C or Part C/B. There must be documented evidence of an established condition and/or developmental delay in at least one of the following categories: motor, visual motor, visual perceptual, sensory processing, self-care/ADL, or psychosocial.

B. OT and/or PT is necessary to assist the student to access and benefit from their natural environment. (In the case of PT, a doctor’s prescriptions required)

Therapy in the educational environment should be viewed as a continuum of services that encompasses a variety of delivery models and intervention strategies under the auspices of special education. These can vary form one –time classroom suggestions and/or accommodations to ongoing consultation and/or direct services. Services may be delivered

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within the therapy room, within the classroom setting, or in a small or whole groups and may be performed as a co-treatment with another discipline if appropriate. The knowledge and expertise of occupational or physical therapy staff can be utilized to determine and design intervention strategies that can be integrated into a student’s daily routine and may be implemented by classroom staff.

Service Delivery Models

Direct:

1. The Therapist works directly with the student to promote motor function directed at enabling the student to participate in and making progress in the general education curriculum.

2. The therapist works directly with the student to improve the student’s independent function in self-care skills, which relate to the student’s educational program.

3. The therapist adapts work and training facilities to increase a student’s ability to perform in prevocational for vocational programs.

Consultation:

Consultation involves providing advice, assistance or training to assist other personnel with a student’s goals. The requesting professional has the responsibility to follow through with the recommendations of the occupational and or physical therapist. The therapist provides no direct services to the student; however, the therapist may train teacher, paraprofessionals and parents in activities and use of adaptive equipment. The therapist recommends constructing or obtaining adapted equipment and methods to enable the student to function more independently within the school environment. The student’s status and these services should be frequently updated and reinforced. Some examples include:

1) Instructing and providing information to teacher, parents, paraprofessionals and other professionals in appropriate activities, handling, positioning and use of adaptive equipment regarding a specific student.

2) Consulting with all professional involved with a child to ensure coordination of procedures across the child’s educational environment.

3) Consulting and providing information to parents on home activities. 4) Consulting and providing information to teachers regarding:

a) IEP development b) Adapting the physical environment c) Selecting educational materials and modifying curricular procedures d) Nature and implication of a student’s medical condition

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Consultation for IEP Goals and Objectives- An IEP Team may determine that a student with and IEP does not need direct OT/PT services, but consultation support for remaining special education providers is appropriate. Consultation is documented in the IEP as a Supplementary Aide and Service on the IEP. When a student has consult services the therapist is NOT obligated to write goals/objectives on the IEP. The OT/PT consultation should be focused on helping special education providers address goals and objective son the IEP. To verify service delivery, the OT/PT should log dates and topics of consultation contact.

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Statements regarding Exit form Occupational/Physical Therapy services in the school setting

Providing services to those who the professional deems do not need their services is a violation of most state regulatory laws.

Planning to Terminate/Exit Services:

It may be appropriate to discontinue occupational/physical therapy when one or more of the following occurs:

• The student has accomplished established intervention goal and objectives. • The student has accomplished/reached age level, grade level, and/or level of cognitive

functioning as assessed. • The student performs at a standard expected of his or her typical peers in a school

environment • The student is no longer making significant progress on established objectives despite

changes in intervention strategies or services-delivery models. • The student continues to make gains but there is no evidence that the therapy

interventions are related to the gains. • The identified priority sills are no longer a concern within the student’s educational

context • The student or parent expresses a desire to discontinue services • The student has achieved a composite score of better than 1 ½ standard deviations

below the mean • The student’s rate of progress in the educational environment in the area/s being

addressed in therapy continues to be steady and commensurate with the student’s overall level of progress in other areas, despite a decrease in therapy services.

• The student’s needs can be met by other educational professionals using either a consultation model or by making accommodations

• The team may request that OT/PT services to be discontinued • Therapy is contraindicated due to a change in medical or physical status.

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SCOPE OF PRACTICE FOR

OCCUPATIONAL THERAPY

Home Programs Teach Families and Staff-design and monitor Home programs

Occupation:

Intervention:

Motor planning

& Movement

Visual Motor Development

Communication & Interaction

Play & Exploration of Environment

Promote self- help skills

Pre-Voc Activities

Educational Adaptations

Assistive Technology

Educate and support students, staff and family

Support or initiate classroom activities to facilitate written expression such as: Fine Motor skills Visual Perceptual skills Visual motor coordination Low and High tech AT Support or initiate classroom activities to facilitate school behavior such as: Strategies to organize work Design monitor sensory programs

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SCOPE OF PRACTICE FOR

PHYSICAL THERAPY

Educate families, staff & day care providers – Design & monitor equipment Write letters of medical necessity – Contact with physicians, orthotists, hospital therapists and equipment vendors

Range of motion of neck, trunk, arms & legs

Running Jumping in place & down from steps

Coordination & bilateral play activities

Gait–use of walker, walking &

on stairs

Core strength/ posture –

Ball exercises, holding & reaching,

equipment, positioning

Balance – sitting,

standing, kneeling,

hands/knees

Extremity strength – ball exercises,

climbing, squat to stand,

sit to stand

Mobility planning – crawling, rolling,

transitions, obstacle course,

stairs, playground

Positioning - promote symmetry for eating,

sleeping & play

Focused Intervention – Individual and group gross motor programs such as: awareness of body in space, motor planning, balance & coordination, walking, running, jumping,

stairs, core strength, turn talking, following directions, indoor & outdoor play Monitor use of adaptive equipment

Bring gross motor skills closer to peers, and prepare for Kindergarten Educate classroom staff for carryover of program and use of equipment

throughout week Educate parents in ways to develop gross motor skills at home and in the

community

More significant disabilities – Train transfers, sitting, functional mobility,

wheelchair mobility, ambulatory skills, independent skill development, and applying

functional skillsthroughout school day including education and recess

Assess school environment (within the building and outside) for accessibility and equipment availability Educate classroom staff and students on exercise

programs, equipment usage, and safety that can be built into the classroom routine

Educate family for carryover of functional skills to home and extracurricular activities to support skill

development

Pre-voc fitness

planning

Environmental Accessibility

Monitor Equipment

Educate / support students, staff, parents and community

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Obligation of Nonpublic and Home School

In Michigan law the term “nonpublic schools” also applies to a registered home school. In Michigan’s Auxiliary Services Act, public districts must provide auxiliary services to nonpublic elementary and secondary schools within its boundaries. All special education related services are included in the Act. A public school must provide the same auxiliary services (and thus all special education related services including OT/PT services) on an equal basis to pupils in the elementary and secondary grades at the nonpublic school. As for any IEP, special education related services must address needs related to students’ achievement and functional performance. But for students in nonpublic schools, public personnel may not directly provide instruction in the areas of core academic curriculum, as defined by Michigan Curriculum, and the associated Michigan Grade Level Content Standards. The core academic contact area remains the responsibility of the nonpublic schools.

Evaluation services for special education are also an auxiliary service. Public schools OTs/PTs may therefore be involved in evaluations of students attending local nonpublic schools. If the outcome of an evaluation results in special education eligibility, some likely IEP or Non-Public Services Plan considerations are:

1. A proposed IEP/Non-Public Services Plan for only related services-The parent may decide to retain the student’s enrollment at the nonpublic school, and the related services may be provided by the public district at the nonpublic school or other IEP Team determined site.

2. A proposed IEP/Non-public Service Plan determines the need for special education classroom program- If the student requires specialized instruction beyond related services. The student’s resident public district is obligated to offer special education classroom programs to the student. This requires coordination between districts if the resident district is not where the nonpublic school is located. In such cases, options to meet students’ needs include the following:

a. The parent may decide to enroll the students in their resident public district to access the special education classroom program as well as related services.

b. The parent may decide to retain the student in the nonpublic school with enhanced general education support, and with supportive special education related services provided by the public district serving the nonpublic school

c. If a potential need for a special education classroom program is anticipated during the evaluation, public school staff should be especially prompt in involving the parent and resident district so that all parties are aware of the

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issues about needs and solutions that will be discussed at the IEP Team Meeting.

3. Dual Enrollment- Whether involved in special education or not, any student may simultaneously enroll in both the resident district and a nonpublic school. In dual enrollments, the public school is still restricted from providing instruction in core curriculum as described above.

4. The Auxiliary Act does not apply to preschool children- Since the Auxiliary Services Act does not include preschool, questions about special education services should be directed to the student’s resident district. Consultation, evaluation, and special education programs/services are all the responsibility of the resident district. An IEP Must be completed for eligible preschool-aged children. Once in kindergarten, then a Non-Public Service Plan is to be substituted for the IEP for any students continuing to remain enrolled with the non-public school.

The topic of public services to nonpublic schools is more complicated than presented in this brief summary. For example, issues often involve distinctions among programs/services and accommodations, and core versus non-core curriculum. For further information, contact your district administration or refer to policies in Information on Nonpublic and Home Schools published by the Michigan Department of Education.

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Assistive Technology

Use of school Materials, Written Work, Behavior/Self-Regulation, Personal Management/Self Care

What is Assistive Technology?

Assistive Technology is defined in the federal law for students with disabilities called the Individuals with Disabilities Education Act (IDEA).

“Assistive Technology device” means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized that is used to increase, maintains, or improves the functional capabilities of a child with a disability.

“Assistive Technology service” means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device.

Assistive Technology is provided to support the student’s ability to have access to the general education curriculum in the least restrictive environment possible.

Who provides Assistive Technology?

• Assistive Technology is provided through the student’s school, as determined: • By school-site personnel knowledgeable about motor, vision, hearing, processing

and communication (OT, SLP, PT, Teacher, etc.) • Assistive Technology is incorporated into a student’s IEP as a tool to reach curriculum

goals. Typically documented under ‘Accommodations’ • Assistive Technology equipment is drawn from district, RESD, ISD or MITS (Michigan

Integrated Technology Supports) resources. Resources may include no-low tech items as well as devices with electronic and digital components.

What is the Assistive Technology Decision-Making Process?

1. Identification of the student’s team that will be involved with the AT process 2. Use of the SETT form and process to determine tools. 3. Implement trial of tools, with action plan and process for documentation 4. Review level of success in improving student access to and progress in the curriculum,

including goals and objectives.

The OT Role in Assistive Technology Decision Making;

Occupational Therapist have the background to support students in school performance through recommendation or provision of adaptive devices and environmental

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accommodations. Supporting the IEP team and the students in considering assistive technology and then implementing its use in the school setting is a natural expansion of the OT’s role.

Assistive technology interventions generally involve consideration within the following performance areas:

Use of school materials:

• Mechanics of writing (paper, pencil/pen, grip, keyboard, slant board, etc.) • Computer access (positioning supports, keyboard, mouse, trackball, software, etc.) • Reading (adapted books, book supports, E-books, visual supports, etc.) • Math (adapted calculators, adapted paper, etc.) • Recreation/leisure (adapted art, music or PE materials, etc.) • Positioning/seating in the school environment (adapted chair, arm supports, etc.)

Written Work:

• Writing supports (software, digital writing tools, adapted note takers, etc.) • Math (software, tactile/manipulative tools, etc.)

Behavior/Self-Regulation:

• Positioning (seating options, listening devices, adapted timers, etc.) • Schedules (visual supports, digital supports/reminders, etc.)

Personal Management/Self Care:

• Schedules (print, picture or digital adaptions, software, timers, etc.) • Daily living (adapted social stories, digital supports, adapted seating, etc.) • Communication (adapted ASC, switches, software, etc.)