Pediatric: School-based Setting

primary

80-90%; all children, all settings

secondary

5-10%; targeted groups, some children

tertiary

1-5%; individual children with high intensity

IDEA

defines “OT” as “services provided by a qualified OT” and 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

• IDEA is considered special education, and in this case, a student must receive at least one ‘primary service’ (e.g., special education or SLP); OT is considered a RELATED SERVICE, so a primary service must be provided BEFORE OT can be provided for the student’s IEP

  • before IDEA, children with disabilities were not allowed to attend public schools and were instead placed in institutions

  • under IDEA, all children are entitled to a free and appropriate public education (FAPE) in their least restrictive environment (LRE)

  • also lays the framework for the IEP (i.e., a student’s IEP falls under IDEA; this is an important distinction from 504)

*IDEA= special education vs Section 504= general education

IEP

Section 504

from the Rehabilitation Act from 1973 (a law that protects students with disabilities across different contexts), Section 504 prevents discrimination against individuals with disabilities in education, ensuring that students have equal access to education along with accommodations and modifications if they are needed

• to receive OT services under Section 504, a student must meet the following requirements:

  • the student must be ineligible for special education services under IDEA 2004

  • the student must have a documented physical or mental disability; this usually means a medical diagnosis documented by a physician or other qualified health professional

  • the student’s disability must impair his or her ability to…an evaluation is conducted to determine if the student qualifies for a 504 plan based on these criteria

    • walk, breathe, eat, or sleep

    • communicate, see, hear, or speak

    • read, concentrate, think, or learn

    • stand, bend, lift, or work

• 504 is more general and broad than IDEA; as this is the case, a student may be able to qualify for services under 504 if they do not under IDEA

  • this can be relevant in cases when a student has a disability that may otherwise have been impacted for an IEP

• secondly, Section 504 may provide for accommodations to help access education, but not necessarily receive services that are considered ‘special education’

*Section 504= general education vs IDEA= special education

NCLB

No Child Left Behind Act of 2001 was enacted to address accountability and ensure success for all children receiving public education; this act articulated 4 main concepts in public ed:

1. accountability for results and adequate yearly progress in education with an emphasis on reading and mathematics

2. flexibility for states and communities use of educational funds

3. use of research-proven instructional methods and materials

4. parental information, influence, and choices regarding educational services

NCLB and IDEA work hand-in-hand to improve educational standards for all children; Section 504 is a civil right statue, similar to the American Disabilities Act, that prohibits discrimination on the basis of disability by any recipient of federal funds

IFSP

a written plan for providing early intervention services to an infant or toddler with a disability and his or her family; similar to an IEP, but more focused on the family’s goals rather than on the child’s goals

• the “IEP” for IDEA Pt. C

• includes statements of the decisions and actions of the multidisciplinary team and parents or caregivers at the initial ISFP meeting, as well as at subsequent annual meetings, and periodic reviews of progress

LEA

Local Education Agency

RTI

Response to Intervention: a prevention-oriented approach to linking assessment and instruction that can inform educators’ decisions about how to best teach their student

• a goal of RTI is to minimize the risk for long-term negative learning outcomes by responding quickly and efficiently to documented learning or behavioral problems and ensuring appropriate identification of students with disabilities

IDEA Pt. A vs B vs C vs D

A: outlines general provisions, including the purpose of IDEA and the definitions used throughout the statute

B: (school-aged children, ages 3-21)

• requires that a child must be found eligible for special education under 1 of 13 disabling conditions; these disabilities, defined in regulations, are

  • autism

  • deaf-blind

  • deafness

  • emotional disturbance

  • hearing impairment

  • intellectual disability

  • multiple disabilities

  • orthopedic impairment

  • other health impairment

  • specific learning disability

  • speech or language impairment

  • traumatic brain injury

  • visual impairments, including blindness

C: early intervention for infants and toddlers

*D: Includes national activities to improve the education of all children with disabilities:

• professional development

• personnel preparation

• parent training and information centers

• technical assistance

• dissemination of information

• special education research

*there are no specific obligations related to the provision of OT/PT in pt. D

Assistive Technology and Universal Design

“assistive technology service” is defined as any service that directly assists individuals with a disability in the selection, acquisition, or use of an assistive technology device; assistive technology (AT) services provide children with disabilities with access to participation in school tasks and the LRE

• AT may include

  • instructional strategies

  • low-tech and mid- and high- tech equipment (but differs from educational technology, which supports the teaching of a skill or concept, most commonly in the form of software)

when it comes to AT, OTs have to determine the occupational and educational relevance and physical/motor access; can address…

• positioning of the child

• modifications of materials and equipment

• identification of funding source

• ordering equipment

Processes of an OT in the school setting

1. pre-referral services and supports as part of general education process

2. 504 referral and services as part of general education

3. special education referral and request for assessment

4. ISFP infant and toddler program planning

5. IEP planning

6. transition planning and services

7. intervention planning and implementation of IEP services

8. documentation

OT eval

1. activities of daily living

2. arousal, attention, adaptive behavioral and organizational skills

3. assistive and adaptive technology

4. community integration

5. environmental, home, and work (school/play/job)modifications

6. ergonomics and body mechanics

7. fine motor and gross motor function (motor control and motor learning)

8. habits, routines, and roles

9. leisure skills

10. neuromuscular functions

11. occupational profile, interests, values

12. play

13. praxis

14. rest and sleep

15. self-determination

16. social participation

17. tool use

18. visual motor integration

19. work and prevocational skills