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Physical Therapy & Occupational Therapy: Scope of School Services
Physical and occupational therapists work in both school environments and medical environments. As related service providers in schools, therapists are limited in the range of services they can provide due to the requirements in the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act (Section 504).
IDEA defines related services as "Transportation and such developmental, corrective and other supportive services as are required to assist a child with a disability to benefit from special education (300.16). "
Occupational and Physical Therapy Services under IDEA Part B (Ages 3-21)
For children from three years of age to twenty-one who require special education, occupational and physical therapy services must be related to goals in the special education program and described in the IEP or IFSP. As a rule, the activities of school occupational and physical therapists fall into four categories for children from three to twenty one.
Limitations of School Occupational and Physical Therapy Services
- School therapists evaluate the sensory motor functioning of students with disabilities and assist in determining service needs.
Evaluations of sensory motor functioning are often completed by school occupational and physical therapists when the child has an orthopedic impairment or a significant deficit in motor skills that may affect educational performance. Motor development may also be evaluated by other educational personnel when there is no question of need for OT or PT therapy services.
- School therapists address access to education for students with disabilities.
Both IDEA and Section 504 of the Rehabilitation Act of 1973 require that school programs provide the same level of access for students with disabilities that is provided to non-disabled students in all services provided by the school. Examples of OT and PT activities in this realm might include recommendations for building modifications, modification of equipment such as playground and positioning equipment and computers and modification of curricular tasks to account for physical limitations.
- School therapists address safety of students and school staff.
Therapists assure the safety of students and care givers in several ways. They monitor student's motor skills to make sure that they are not participating in activities which are dangerous. They monitor equipment used by the student including walkers, school chairs and feeding utensils to make sure that the student's use does not pose a danger. School therapists may also check regularly for the possible development of medical problems such as contractures or muscle weakness and act as a liaison between the school program and the child's medical provider. Finally, therapists train school staff in proper lifting, safe feeding and physical management skills that address the safety of both the student and the school staff.
- School therapists help teach motor skills associated with success in school.
For many children with orthopedic or neurological impairments, the educational team may determine that some of the goals on the IEP/IFSP should address the learning of new motor skills associated with school or developmental performance. Occupational and physical therapists may help plan, implement and monitor instructional programs addressing the development or refinement of fine motor, gross motor or visual motor skills, postural adaptations and ability to complete school work.
School based OT and PT services for children from age 3 to 21 are defined by law as "related services" and thus must support the specially designed instruction listed on the IFSP or IEP. Motor delay confirmed by evaluation results does not automatically indicate a need for school therapy. There must also be an impact on the child's performance or access. School therapy must deal primarily with the impact the disability has on student function in the educational process. If the functional problem can be treated by itself, or if there is no appreciable effect on function, additional treatment of the cause of the disability would usually be considered medical intervention rather than being within the scope of educationally based therapy services.
Occupational and Physical Therapy Services under Section 504
Some students with disabilities may not be in need of specially designed instructional programs (special education) but may still need the services of an occupational or physical therapist in order to benefit from their regular educational program. For these students, the OT or PT may work with the school to 1) evaluate the motor needs of the child 2) help assure access and 3) help assure safety as described above.
OT and PT Services In Early Intervention Programs Under IDEA Part H (Ages Birth-2)
Part H of IDEA, which defines the responsibilities of early intervention (El) programs for children from birth to three, requires that occupational and physical therapy services be related to the child's development. Because the focus is on developmental milestones rather than specially designed instruction in school, the line between OT and PT services which are provided by Early Intervention programs and those which are provided by medical providers is less clear than it is under part B. More intensive OT and PT service may be needed by children from birth to three than is needed for children age three and above. The rationale is that a higher level of service at a young age could reduce the level of disability as the child matures. Some general statements can be made which may help the EFSP team determine the type and level of OT and PT services provided to an individual child through the early intervention program.
- One clear distinction between Early Intervention OT and PIT services and medical therapy is that El programs only provide OT and PT services which are deemed necessary by the IFSP team and are listed on the IFSP. Early Intervention programs are required to provide adequate OT and PT services, but are (not required to provide the entire spectrum of therapy options. Sometimes the IFSP team agrees on a certain level of service and the family or medical provider would like to see additional treatment. When this happens, both the medical and El therapists may work with a child.
- EI occupational and physical therapists treat quality of movement issues if they are affecting function or have the potential to affect function as the child grows. Many children may develop motor skills which allow them to function effectively but may still show some difference in motor functioning from nondisabled children. When the child's motor skills are functional and do not pose a future risk of deformity or loss of function, occupational and physical therapy services are usually not provided by the El Program.
- In Oregon, children with disabilities from birth to three years of age, are entitled to receive services designed to meet the developmental, needs of the child but are not entitled to a free and appropriate public education (FAPE). Early intervention programs may seek outside services such as occupational and physical therapy on behalf of the child with disabilities.
While the above guidelines may assist in determining the nature and amount of occupational and physical therapy services provided to children and youth through educational programs, it should be emphasized that both IDEA and section 504 require that the unique needs of each child be considered when identifying the OT and PT services to be provided. Occupational and physical therapists in educational programs must act as members of the educational team in determining need for OT and PT services. School districts are advised that distinguishing between an educational and a medical PT or OT service or treatment can be problematic in some instances. School districts need to carefully consider the issues and obtain professional legal advice when necessary.