Friday, August 12, 2011

"OT Eligibility" and "OT Goals"

School is starting soon (if it hasn't already in some areas) and some therapists have asked a familiar question I've heard many times at my workshops or in conversations with other school-based OTs and OTAs:
When providing school-based services, does the child must first 'qualify' for occupational therapy and does an occupational therapist have to have specific O.T. IEP goals or can the OT work off the teacher’s goals?
Before we can answer this question, we must keep in mind that there is a hierarchy in the process for a child receiving special education services; in short, this hierarchy includes the following components:
  1. Child is having difficulties meeting general education curriculum expectations.
  2. Child is referred for special education assessment; this assessment may also include an occupational therapy evaluation as part of a comprehensive picture of the child's abilities and difficulties.
  3. Child qualifies for special education services under one of the 13 categories noted by IDEA.
  4. An Individualized Education Plan (IEP) is developed; this plan includes many elements, one of which is the goals and objectives.  (In many school districts, personnel and therapists sometimes call the goals and objectives as the "IEP" but remember that the IEP is a larger document/plan and that the goals/objectives are just one component of it.)  At this point, an OT may suggest draft goals/objectives based on her assessment and as part of the IEP team but these are not 'OT goals and objectives' - they are part of the larger plan for the child.
  5. Once the goals and objectives have been determined and agreed to by all members of the IEP team (including the parents, administrations, teachers, therapists, etc.), then placement is determined.  Placement includes who will help the child meet his/her goals/objectives and where those services will take place.  It is ONLY during the placement stage of the IEP, will it be determined if expertise of related services personnel are needed to assist the student in meeting his/her goals and objectives.  At this point, the OT may recommend direct or consult services and must note which goals/objectives will be addressed by these services.  
I’ve illustrated this further in this adapted excerpt from a chapter I wrote in:  Preschool and school-based therapy.  In A. Wagenfeld & J. Kaldenberg (Eds.) (2005), Pediatric Theory and Practice for the Occupational Therapy Assistant.  Thorofare, NJ: SLACK Incorporated.

THE STRUCTURE OF IDEA ’97 and IDEA ’04 PART B:
The pyramid below illustrates the basic components of IDEA ’97 and IDEA ‘04 Part B as well as the sequence and context of service delivery.  Note that all services for children with disabilities begin with evaluation at the base of the pyramid.  The next level is eligibility followed by the development of the Individualized Education Plan (IEP) and then placement.  Each component of the process will be discussed below.
EVALUATION-DRIVEN SERVICES:
Eligibility for ALL special education and related services is based on evaluation.  (NICHCY, 1998, 2010).  Occupational and physical therapy may serve two roles in this evaluation process; first, in a diagnostic role in which assessment results contribute to the overall picture of a child’s abilities and differences in his educational setting and second, for placement decisions concerning related service provision.  Note that there is no assessment for occupational therapy (or any other related services) eligibility.  There is only assessment to determine if a child needs special education AND related services to make educational progress and if a child meets the eligibility for special education services, they also have access to related services if the expertise of related service professionals is needed for the child to make educational progress.

When therapists evaluate in a diagnostic role, their input is part of a comprehensive assessment.  This assessment includes an evaluation of the student’s cognitive, psychosocial and sensory motor performance areas.  Many school psychologists and diagnosticians will administer a battery of tests designed to cover all three elements with emphasis either on cognition, psychosocial skills or sensory motor skills dependent upon the suspected disability or the child’s difficulties in meeting his/her educational and curriculum expectations.  However, additional in-depth information on the student’s educational performance may be requested from professionals with additional expertise in a certain area.  For example, for a child suspected of having autism and whose parent or teacher reports significant sensory issues, an occupational therapist with additional expertise in sensory processing testing may be involved.  For a student who has difficulties with walking within the classroom or around the campus, it would be very appropriate to ask for a physical therapist to evaluate the child as well.  An evaluation for a student with moderate mental retardation who is having difficulties with self-help skills may also require additional assessment by the occupational therapist.  In all three examples, the related services personnel contribute to the child’s overall evaluation.

Once the initial assessment has been completed, a meeting is called to determine eligibility under the 13 categories for special education (these categories include: Autism, Blindness, Deafness, Emotional Disturbance, Hearing Impairment, Mental Retardation, Multiple Disabilities, Orthopedic Impairment, Other Health Impaired, Specific Learning Disability, Speech or Language Impairment, Traumatic Brain Injury, or Visual Impairment.

DEVELOPING THE IEP AND PLACEMENT:
Once eligibility is determined, an IEP is developed.  An IEP or individual education plan is a written plan based on assessment results that is developed, reviewed, and revised in a team meeting; this team must always include the parents, teacher(s) and an administrator, and may also include other personnel such as other instructional services (ie: Speech Therapy, Special Education) or related services (ie: Speech Therapy, Occupational Therapy, Physical Therapy, Psychology, etc.).  An IEP includes, among other things:
  • parental concerns
  • a statement of the specific communication needs of the child with vision deficits, hearing deficits, or of limited English proficiency
  • results of the evaluation or reevaluation
  • strengths and competencies of the student
  • a statement of the present levels of educational performance of the student
  • annual goals, including benchmarks or short-term objectives as well as the method to measure goals and objectives.
At this point, all members of the team will draft goals and objectives and an occupational or physical therapist may suggest draft goals/objectives based on the assessment results for the team to consider.  Although an OT or PT may suggest these goals/objectives and they may be agreed to by the committee, these goals/objectives are part of the student’s comprehensive educational program and are not just considered the “OT’s goals” or the “PT’s objectives”.

Once the draft goals/objectives have been agreed to, placement is determined.  “The appropriate placement for a particular child with a disability cannot be determined until after decisions have been made about the child's needs and the services that the public agency will provide to meet those needs. These decisions must be made at the IEP meeting, and it would not be permissible first to place the child and then develop the IEP. Therefore, the IEP must be developed before placement.” (NICHCY, 1999, p. 15)  Placement includes:
  • the special education and related services and supplementary aids and services to be provided to or on behalf of the student (including modifications)
  • anticipated frequency of general, special and related services
  • location of services to be provided (ie: where the child will receive these services)
  • the projected date for initiation and anticipated duration of services
  • the extent to which the student will be able to participate in general educational programs
  • consideration of behavior issues
  • transition needs 
Special Note: Occupational and physical therapists may also evaluate after the child has qualified for special education services.  In this instance, the IEP team may agree to request additional assessment and then meet again to review those results.  At this meeting the related services provider may also suggest additional goals and objectives for the IEP committee to consider and make recommendations for related services to assist in implementing the goals and objectives during the placement stage of the IEP. 

2 comments:

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  2. Thank you! That is a nice, comprehensive description of the process. I am constantly running into people in all positions in schools (including some OTs) who are really not clear on how this works. I guess it is pretty dry. :)

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