Occupational Therapist (OT) in the schools

[Babbs]

I started to post this under a different thread, then realized that it was not fair to "jump the fence" on that one. So I started a new thread in order to vent a little about one of my favorite subjects.

The difference between qualifying for an IEP and Occupational Therapist (OT) being a related service so therefore should be offered...

Per IDEA 204, "Occupational therapy means services provided by an occupational therapist including improving, developing, or restoring functions impaired or lost through illness, injury or deprivation, improving ability to perform tasks for independent functioning if functions are impaired or lost, and preventing, through early intervention, initial or further impairment or loss of function." Also per IDEA 2004, a "related service means ... other supportive services (including...occupational therapy...) as may be required to assist a child with a disability to benefit from special education..."

There is a huge difference between qualifying for an IEP and whether or not a student needs Occupational Therapist (OT) in order to benefit from FAPE. Yes Occupational Therapist (OT) is a related service. Yes, Occupational Therapist (OT) can be provided in the schools. But as is pointed out often on these boards - IEPs are individual education plans. Just because a child gets Occupational Therapist (OT) in the community does not mean the child automatically needs Occupational Therapist (OT) in the schools to benefit from his/her educational environment. An evaluation by an Occupational Therapist (OT) looks not only for a fine, gross, or sensory motor delay, but also that there is significant impact on the child's performance in his/her educational environment and that the student requires Occupational Therapist (OT) services in order to have the essential skills to benefit from his or her educational environment.

There is nothing in the law stating that Occupational Therapist (OT) in the schools provides full remediation. Especially now with such emphasis on passing standardized tests, related services looks hard at when a student is pulled out from his/her LRE to participate in therapy. If the student has the essential skills to participate in his educational environment, a related service Occupational Therapist (OT) is not going to pull that student out of academics in order to remediate a motor skill.

Many times I have seen a standardized motor assessment score used to justify providing a child with Occupational Therapist (OT) as a related service in the schools. However, a motor delay or dysfunction does not automatically qualify a student for services. I prefer, instead, an assessment called the School Functional Assessment or SFA. It is the most comprehensive functional assessment I have seen out there - it was developed by Occupational Therapist (OT)'s and is a criterion referenced test. This means the student is rated compared with peers, but if used yearly can be used to rate progress for himself. This test I use often when a child has a significant motor delay or medical diagnosis but teachers or staff can't seem to quantify how the delay may be impacting the child's function in the school setting. It looks at all educational environments (including playground, PE, transportation etc), at how much assistance or adaptations are required for a student to perform, and breaks down tasks into physical and cognitive tasks and covers just about any non-academic activity a child performs during a school day.

 

[Sheila]

I have some pet peeves myself. One is school districts’ narrow interpretation of their responsibilities. It’s been fodder for many attorneys as evidenced by the multiple thousands of Due Process Hearings and lawsuits that have been filed over the years throughout the US.

For those who aren’t aware, FAPE is the right of every child in the United States. It is incorporated into and the foundation upon which IDEA is based.

Jemma1028’s signature reflects that her difficult child has ADHD and Sensory Integration Disorder (SID). There are some authorities who contend that fine and gross motor skill problems are almost always inherent with-ADHD. Sensory Integration Disorder (SID) is not an uncommon co-existing condition either. School district professionals know this, yet time and time we see parents post about Occupational Therapist (OT) not being provided and it’s a crucial service in my opinion.

I don’t recall seeing anything in the regs to the effect that a related service must have “significant impact on the child's performance in his/her educational environment and that the student requires XYZ services in order to have the essential skills to benefit from his or her educational environment” prior to “qualifying” for a related service. This sounds to be school district policy. Can you post the federal rule, reg or statute?

To my knowledge there’s not a 2nd qualifying requirement under IDEA – an individual qualifies for special education and related services or s/he doesn’t. Section 300.34(a) and section 602(26) of the Act state that, “related services include other supportive services that are required to assist a child with a disability to benefit from special education."

Pet peeve #3, sds that do not comply with Section 300.304(c)(6) which “requires that the evaluation of a child with a disability be sufficiently comprehensive to identify all the child’s special education and related services needs, whether or not commonly linked to the disability category in which the child has been classified.” As I mentioned before, Occupational Therapist (OT) services are denied time after time – matters not that fine/gross motor skills and or Sensory Integration Disorder (SID) impacts learning, social skills development, etc.

We agree that there’s nothing in the regs “stating that Occupational Therapist (OT) in the schools provides full remediation.” But the goal of education is to produce productive, functional adults – not throw some type of assistive technology or accommodation at the student in lieu of providing an appropriate related service.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> Especially now with such emphasis on passing standardized tests, related services looks hard at when a student is pulled out from his/her LRE to participate in therapy. If the student has the essential skills to participate in his educational environment, a related service Occupational Therapist (OT) is not going to pull that student out of academics in order to remediate a motor skill.</div></div>

That policy is inconsistent with IDEA and should be the school district’s problem to work out. If the student needs the related service, s/he should not have to suffer the consequence of the service being withheld -- now or on down the road.

I don't agree 100% with your position, but I do respect it. Posting different perspectives is good and educational for our members, in my opinion.

I believe it's Pete Wright that said on his website -- don't take my word for it, check it out, do your own research and interpretations -- words to that effect.

 

[Jemma1028]

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> a related service must have “significant impact on the child's performance in his/her educational environment and that the student requires XYZ services in order to have the essential skills to benefit from his or her educational environment” prior to “qualifying” for a related service.</div></div>

This was exactly what we we told when we had our son evaluated through HISD for Occupational Therapist (OT) services. Basically we were told that he was fine because he could write his name and the alphabet in 3rd grade. I sturggle to get him to write 3 sentences in ten minutes. He cant even write his spelling words without one on one attention from the teacher. Occupational Therapist (OT) at Tx Children's at least is teaching him how to type on a keyboard correctly. They work on his fine and gross motor skills and give me excersises to do at home with him on the keyboard and for his Sensory Integration Disorder (SID). I take him during his lunch/recess time and the only class he misses is social studies in regular ed. She sends makeup work for us to do at home. I just had to help him if the SD wouldn't.

 

[Babbs]

Sheila - you have many valid points. Unfortunately I have to head out to work so I will have to post further on some of them.

First - I am a parent of a child with AD/HD. You stated "There are some authorities who contend that fine and gross motor skill problems are almost always inherent with-ADHD. Sensory Integration Disorder (SID) is not an uncommon co-existing condition either. " My son does not have motor skill delays. This is not only my opinion as a parent, or a professional opinion, but I have had him tested by both Occupational Therapist (OT)'s and PT's. He scores within normal limits on every standardized motor assessment for his age. I've also had him seen for possible sensory processing dysfunction. Again, he shows up as having inattention problems and behavioral problems related to the inattention, but no specific sensory concerns. However, his handwriting is horrible and his 2nd grade teacher has mentioned already she feels he has fine motor problems. Does he?

When given a pencil to draw with he can draw elaborate dinosaurs, fairies, trains, etc. He definitely has the fine motor control to express himself through art. He can manipulate legos, tops, peg boards, etc, which indicates he has good manual dexterity. But he can't write legibly. When it comes to individual letters and numbers he is able to reproduce them upon dictation, from memory, with good formation, legibility, and control. But he reverses his numbers on math worksheets and takes 3 lines to write a 5 word sentence on 2nd grade paper.

Considering the evidence I have from testing as well as personal observation, his handwriting problems is from executive functioning and organizational problems not fine motor concerns. His ability to organize all the components of the writing task, from remembering sentence structure, to spelling, to grammar and punctuation, to the motor memory to form the letters and get them neatly on the page is significantly impaired. However, his teacher feels he has a fine motor delay. What is really going on for him is his disability is adversely impacting his ability to write, not just legibly but coherently and according to state educational standards.

I'm not saying that children with AD/HD can't and won't have fine, gross, or sensory motor delays. However, often it is not the fine motor skills which gets in the way of the writing process. As a school Occupational Therapist (OT) I have evaluated students who have AD/HD as a diagnosis but pass every standardized motor assessment that has been given to them. So do they have fine and gross motor impairments? Or is the problem with executive functioning and organizational skills?

My son's case is one in which I would never press an IEP team for Occupational Therapist (OT) services. The data that I have just doesn't indicate that Occupational Therapist (OT) would be required "to assist [him]... to benefit from special education..." I definitely do and will press for specially designed instruction in the areas of organizational skills, behavior, and accomodations for his problems with memory and executive functioning.

The above, in my opinion, is an example of where a full comprehensive evaluation needs to occur in order to see the full picture for a child's needs. I completely agree that all too often SD's interpret the law narrowly. What bureaucracy doesn't? Personally, if I were in the position of having to pay to provide services and I had an exceedingly limited budget, heck yes I'd interpret the law narrowly. That's why I'm in full agreement that as parents we need to educate ourselves not just about the law, but the interpretations of the law (which do vary state to state depending on the decisions handed down by state judicial courts), And be effective case managers for our children - know what the research is and how our child's disability impacts his or her ability to participate in life.

Unfortunately, IDEA is very quiet on the details for related services. In Wrightslaw Special Education Law 2nd edition, there are only three references to related services and 3 for occupational therapy. Three. The interpretation for the law then is left in the hands of the US department of education, 50 state departments of education, and thousands of LEAs.

Under 300.304(c)
"assessments...to assess specific areas of educational need..." and "the assessment results accurately reflect the child's aptitude or achievement level... rather than reflecting the child's impaired sensory, manual, or speaking skills"...

This is where the interpretation that a child's motor deficit must have educational impact.

 

[Sheila]

If I gave the impression that I believe every ADHDer has fine/motor skill problems or Sensory Integration Disorder (SID), it wasn’t my intent. These disorders commonly co-exist, however, and Occupational Therapist (OT) tends to be neglected by some schools.

I know funding is a problem with all schools, but I’ve never been able to figure out why these kids aren’t identified early and remediated when possible. It seems to me that it would be more cost effective in the long run to get problems addressed early.

Motor skills impact so much more than handwriting, but that seems sds’ primary focus. It’s been a good while since I’ve researched motor skill and sensory issues, but I recall they involves a wide range of learning abilities, sequencing, seamlessly processing and transferring learned skills to new tasks, behavior, ability to participate effectively in sports or other physical activities, self-esteem, and on and on and on. I remember enough about it to know that if I had it all to do over again, I would have hit the Occupational Therapist (OT) hard and early.

It’s interesting about your child’s artistic abilities but poor handwriting ability. My son had trouble writing also, yet his ability to draw was/is amazing. He was been evaluated by 3 OTs – each identified fine and gross motor skill problems, tactile defensiveness and sensory issues. One was the sd Occupational Therapist (OT) (she was very good by the way). Ironically, each Occupational Therapist (OT) recommended therapy. There was catch, however. The sd Occupational Therapist (OT) report “Recommendations” section did not recommend Occupational Therapist (OT) per se – just training the parent to do Occupational Therapist (OT) at home, and in our pre-IEP meeting to go over her evaluation recommended professional therapy. I could tell you some personal war stories….

Anyway, as with Jemma, I pulled difficult child out of school once a week and took him to private therapy. It helped him immensely across all environments.

Another interesting thing about our difficult child, you can usually tell by his handwriting whether he’s had his medication. His handwriting and numbers formations was much clearer when he’d had his medication. It’s not as noticeable since the therapy. He still will not convert to cursive however – he says printing is easier for him.

But back to the topic, raising a difficult child is difficult and time consuming. In a situation like this one, when I see something like “ADHD, Sensory Integration Disorder (SID)” in a signature and read where a parent is expending the effort and/or expense of providing private Occupational Therapist (OT) yet the sd’s position is that the Occupational Therapist (OT) is not warranted, I feel fairly confident the school district is side-stepping their responsibilities.

by the way, Jemma, I think you are doing the right thing if you can afford it. Good job! I believe in your case, the sd has not done their job. But, you can spend your time and money fighting with them on this one issue, or get the therapy done in a timely manner. I'm a big believer in the earlier the intervention, the better.

 

[Sheila]

What is really going on for him is his disability is adversely impacting his ability to write, not just legibly but coherently and according to state educational standards.

The "coherently" is certainly a concern. Has a language-based learning disability been ruled out?

 

[susiestar]

Has anyone checked your son for dysgraphia or dyscalculia? If you are not aware of these (and you may be), they are dyslexia for writing and numbers, respectively.

The wonderful art and terrible handwriting, along with clear problems writing sentences, is a big old red flag for dysgraphia. Many people with dysgraphia are very talented with art. But putting words in your head into words on paper requires different brain activities.

Dsygraphia runs in both mine and husband's families. No one was ever diagnosis'd with it until my difficult child. My husband taught himself to write nicely by "drawing" the letters until they became second nature. He did this all by himself, and it took several years.

Dyscalculia is probably not spelled properly. Oh well. It is dyslexia for numbers. Transposing numbers (58 becomes 85, etc...) is a sign that you might want to look at these.

I know that when my kids were in Montessori one of the things they encouraged was anything that used the dominant hand to strengthen it and develop the passages in the brain that are used for writing. Playdough, chopping things, lots of other things are useful.

Hope these give you some ideas.

Susie