Pediatric Occupational Therapy Settings: Early Intervention and Schools

Major Legislation

Individuals with Disabilities Education Act (IDEA)

U.S. federal law

Originally passed under a different name in 1975

Requires free, appropriate, public education (FAPE) for all children regardless of their disability

Updated multiple times

Part B: Serves children ages 3-22

Part C: Serves children birth until 3rd birthday

Early intervention services for children 0-3 added in 1986

Each state/school district may have different implementation guidelines; all must follow the law

IDEA Evaluation

•Determine eligibility for program

•Often involves formal assessment tools (required in EI)

•Annual for Early Intervention

•Every 3 years for Schools

IDEA Assessment

Ongoing with every session

Formal determination of progress (report beyond session note); may involve formal assessment tools

Prior to goal review/revision

Every 6 months in EI

Annual for schools

Major legislation: Individuals with Disabilities Education Act Part C

Age 0-3

Major terminology

Child Find

Individualized Family Service Plan (IFSP)

Family centered services

Natural environment

IDEA Part C 

Federal grant program, Each state implements differently

Services to support families and young children age 0-3 with developmental delays and/or at risk for developmental issues

Natural settings

Main developmental areas: physical, cognitive, communication, social or emotional, and adaptive development

Purpose of early intervention:

lessen the effects of disability or delay

reduce educational costs by minimizing the need for special education

minimize the likelihood of institutionalization, and maximize independent living

enhance the capacity of families to meet their child's needs

Major Outcomes of EI

Building positive social-emotional skills and relationships

Acquiring and using knowledge and skills

Taking appropriate action to meet their needs

1. , which includes how children interact and play with other children and adults, how they show their feelings, and how they follow social rules.

2. , which includes how children understand basic concepts, learn new things, solve problems, and use words or other ways to communicate.

3. , which includes how children become more independent by learning to move on their own, feed themselves, ask for assistance, begin to get dressed, and take care of basic needs.

Child Find

Every state must have screening procedures to identify children with developmental delays

Child and Family Connections (CFC) [located throughout IL]

Service Coordinator sets up evaluation services

EI Evaluation vs. Assessment

•Evaluation: Formal and informal testing to determine initial eligibility for EI services

•30% delay is most common method of eligibility determination

•Being an EI Evaluator requires additional certification in Illinois

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•Assessment: Formal and/or informal testing to determine progress and continued needs

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•Illinois has list of “approved” published assessment tools

Developmental Areas Evaluated (by team)

•Global

•Cognitive

•Motor (fine motor and gross motor)

•Adaptive

•Communication (receptive and expressive--articulation is subcategory)

•Social emotional

•Hearing

Vision

*bolded is what OTs contribute to

adaptive behaviors or skills

Skills needed to do everyday tasks

Functional skills

Occupational performance

Child Eligibility for EI Services (Illinois)

•Child has a medial diagnosis typically resulting in a developmental delay, such as spina bifida, cerebral palsy, or Down Syndrome.

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•Child has a current developmental delay of 30% or more in at least one area of development.

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•Other risk factors suggest a developmental delay may occur if services are not provided.

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•Eligibility re-determined annually (less stringent criteria for continued eligibility)

Referral for OT Services

IFSP team determines family-centered goals and services/supports needed to meet the goals

Should be linked to family activities and measurable

OT is a primary service that can be recommended to address goals

16 different EI services in IL

Service coordinator submits authorization for needed services to agency/individual family selects

What service (OT)

Service delivery info: setting, billing, intensity/frequency, method and type of treatment (i.e., individual direct, IFSP preparation, assessment)

Start and end dates for authorization

OT intervention

•Natural environments

•Focus on building relationship with family

•Need to learn about this family’s routines

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•Materials for therapy—

Use what the family has

•Can significantly vary

•Access (and help family access)

community resources

transition:

•Preparing for:

•discharge from EI services

•potential entry into early childhood special education services

Schools

Major legislation: Individuals with Disabilities Education Act Part B

Major terminology

Free, appropriate public education (FAPE)

Special education

Related service

Educationally relevant services

Individualized Education Program (IEP)

Least restrictive environment (LRE)

Response to Intervention (RtI)/Multi-tiered Support System (MTSS)

Additional legislation

Rehabilitation Act of 1973---Section 504 (504 plans)

RtI/MTSS services

Someone identifies need (could be for whole school, group, or specific person)

Short term, limited formal evaluation (problem/strategy-specific data collection if individual)

504 services

Disability that impacts basic life activities (that can include learning/school, mobility, other school-related)

“Disability” defined broadly

Evaluation to determine need for services

Eligibility for Special Education Services (1)

•Referral (from parent, teacher, after RtI services, Child Find)

•Domain meeting (also called pre-diagnostic or pre-IEP)

•Team determines what evaluation data needed and who will assess

•Extended IEP meeting (Multidisciplinary Determination Conference)

•Review assessment findings

•Determine educational needs

•Determine need for special education

Determine Need for Special Education

Medical diagnosis versus Educational category of eligibility

IDEA disability categories

Child/youth with disability (above categories) whose disability adversely affects child’s educational performance

Specially designed instruction (what or how information is taught)

IDEA disability categories

Autism Deafness Specific learning disability

Intellectual disability Deaf-blindness Speech or language impairment

Traumatic brain injury Hearing impairment Emotional disturbance

Orthopedic impairment Visual impairment Other health impairment

Multiple disabilities

Developmental delay

Eligibility for Special Education Services (2)

•Extended IEP meeting (cont)

•Goals, accommodations, modifications needed

•Goals first

•Accommodation: change to help student meet typical expectations

•Modification: change to what student is taught/expected to do

•Determine placement and services

•Least restrictive environment

•Related services

•Parent agrees to initial placement

•Annual IEP meeting

Re-eligibility at least every 3 years

least restrictive environment

•Children with disabilities should be educated with children without disabilities to the “maximum extent that is appropriate”

•Special education services (not a place)

•Removal from general education class (separate classes or schools) only when severity of disability does not allow learning even with supports

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•Accommodations and modifications must include consideration of assistive technology

related services

Occupational therapy is a related service in school

Under IDEA, available only to students who receive special education

Educationally relevant

Potential to provide services with a 504 plan (rarely direct services but possible)

OT services also through RtI/MTSS

Transition to Adult Life

IDEA requires transition plan by age 16 as part of IEP (some discussion must start by age 14)

Must address plan and needs for life after school

After high school graduation or after aging out of system (age 22)

Note about AMPS

OT Eval

Chart Review: School File: Existing IEP information, Most recent vision/hearing screen

Interview teacher, review work samples

Clinical Observation in natural settings

Formal (and informal) assessments

What do I need to find out?

What tools are available and appropriate

Considerations for Formal Testing

•What type of testing environment will I need?

•Will I need to provide the student with a motor/sensory break?

•Will I need an interpreter?

•Will I have to structure the testing procedures?

•Will I need a visual schedule?

•What is the best time to see the student?

•Will this student need an incentive?

During Formal Testing

•Is the test still standardized?

•Did the student await instructions?

•Did I have to redirect the student?

•How was the student's posture?

•What hand did they use?

•How was their grasp?

•Did they need a break?

•Were they able to transition between subtest?

•How is the student’s emotional state?

Scoring and Interpretation

•Score assessment (according to manual)

•Determine type of score(s) to report

•Interpret information

•Where does the student fall compared to peers?

•Are there any gaps in skills?

•Are their skills functional for setting?

•Do the results support the basis of the referral when seen in isolation?

•Is occupational performance issue one that can be addressed with accommodations/modifications?

•Identify the strengths and limitations within the person, environment, and occupation  - how did it impact performance on/during the assessment?

eval report

•Summary is most important

•Everyone will read that part

•No new information

•May include recommendations

•Keep in mind TEAM determines eligibility, goals, and services