Occupational Therapy services for the special needs child in the school setting is considered a related service provided to enhance the student's ability to adapt, function in the educational setting, and support educational goals. School based therapists focus on removing barriers from these students' ability to learn, and increase their independence within their school and academic environment. Occupational Therapists are concerned with the child's ability to participate in their "occupations" in life, or their activities of daily living such as access throughout the school environment, self help skills, play, social skills, academics, recess, lunch, fine and gross motor performance, visual processing skills, sensory processing, positioning, transitions, functional communication, adaptations, and more.
Does your child/student receive School Occupational Therapy Services? What model of treatment does the child receive? Do they get Direct Service or "Pull Out" services once or twice a week? Do they receive monitoring, consultative services, or collaboration and communication services? What do these services look like to your child/student and their Occupational Environment, and are these services enhancing or supporting the special needs and child's educational goals? Is each delivery of service being performed to its greatest effectiveness and being applied appropriately?
The Direct Model: In this service delivery model, children are seen either individually or in a small group once or several times a week. These students are either seen directly within the classroom (probably pulled to the side) or removed from the classroom setting and seen within the occupational therapy room. This was built around a clinical model of routine and appointments. This does not necessarily promote the generalization of skill to the classroom or other setting within the school day.
Monitoring: A treatment plan is set up by the therapist and implemented by a predetermined other. The student is reassessed at determined intervals and the program is adjusted periodically.
Consultation: Occupational therapy consultation is usually requested to address a specific problem or to make recommendations or changes. This information is used to have an ongoing impact within the student's educational and home environments.
Recently more attention has been given to Collaboration and Communication Services. It is our belief that Occupational Therapists have realized the need to move away from a primarily direct one-on-one or pull out service delivery. This allows focus on the classroom and each environment the child accesses within their day even expanding outside of school. This model brings together a team approach turning from the one OT as the "expert model". Within this model the team jointly develops goals and objectives, collaborates within the classrooms, jointly monitors interventions, and jointly reviews student progress. This helps the OT better utilize interventions toward academic goals throughout the school context. Occupational Therapists should extend themselves and include not only the academic teachers, but also the families, aides, lunch room employees, physical education, school psychologist, music, nurses, school administration, playground monitors, etc. Occupational Therapists can offer programming suggestions, provide adaptive equipment suggestions, provide demonstration, knowledge, modeling suggested interventions and programs, modify materials, modify the environment, alter work demands, share information, and work within the environment of the classroom or activity, rather than pulling out, as often as possible.
There are many difficulties the Occupational Therapist has when delivering services. Some include: ever growing caseloads, structure of delivery, and the time to organize frequent meetings with the team. This needs time and support. It is noted that the system may need adjustment and change for the Occupational Therapist to provide the best model of treatment to the special needs students they are supporting. Occupational Therapists need to continue educating administration and its educators and seek out training to improve consultative services. It is important for the recommendation of services to clearly demonstrate what the child needs. Vary the frequency of service - not every child needs the same. Base everything on an individual criterion. It is a must to look at the need for increased indirect services for training, meetings, modifications, etc. Specifically look to increase classroom-based services.
We cannot stress enough the importance of carryover of any interventions, sensory diet, etc to home and often this critical component is neglected. Occupational Therapists need to continue to be creative and, when involved in a team approach, be patient, embrace the environment, move away from being the sole expert to collaborating - do not assume you are the only expert, listen well, spend more time in the classroom, continue to teach what your role is in the school, share goals, communicate effectively, respect all members of the team including the student, and learn from everyone.
When I interviewed a member of the lunch personnel, I was so impressed how she simply could change a child's day by learning what the child liked and disliked, what sensory issues they had and how the environment could be adapted for the child. It is simple, she said, through observation and collaboration she could easily help provide simple environmental adaptations and even more so, avoid putting food on the tray that will negatively affect the child, maybe even causing a complete meltdown. This seems so simple however it can impact a child's day so profoundly. My hat is off to this woman and her team.
As a long time School Pediatric Occupational Therapist with Sensory Integration Certification, I felt very committed to this subject. Even in the earlier days I often found myself gravitating toward the less conventional proactive consultative model and felt this superior for most instances when compared to the pull out model. I love working with the special needs child within the classroom setting and found this to be the most successful model as the teacher and I consulted constantly and were together to learn, make adaptations etc. This was in turn extended to the families so they could put forth what they learned into the home and community environment. I would like to thank all of the wonderful, committed professionals I have worked with over the years who made a collaborative model of treatment quite successful.
Further reading on the effectiveness of Occupational Therapists in School and the model of Collaboration:
Susan Donohoe OTR SI and SIPT Certified Owner, KozieCare LLC, Kozie Clothes www.kozieclothes.com