Therapy ServicesTherapy ServicesOverview of the OT’s/PT’s Role in the Overview of the OT’s/PT’s Role in the

Schools from Beginning to End Schools from Beginning to End (Referrals to Dismissal of Services).(Referrals to Dismissal of Services).

Presented by Barbara Jungbluth-Jermyn PT, ATP M.J. Care Physical Therapist

Information CoveredInformation Covered Prior to an IEPPrior to an IEP Assessment and ToolsAssessment and Tools Report and Goal WritingReport and Goal Writing Delivery of Services Delivery of Services

“Treatment”“Treatment” Discontinuing ServicesDiscontinuing Services

Prior to an IEP…Prior to an IEP…

An OT/PT may be asked to:An OT/PT may be asked to:– observe a student

– present to staff about commonly raised issues

– participate in a Student Support Team (SSP) meeting

– talk to a teacher and provide ideas for the classroom

Assessment and Tools…Assessment and Tools…

ObservationsObservations

– A request for observation usually comes from one of two sources:

informal (SSP meeting or parent request)

formal (part of the evaluation domain sheet and will be followed by an IEP eligibility determination meeting)

“Informal” “Formal”Parent Consent:

usually a form or letter that has been approved by the district

filled out on a section on the multidisciplinary evaluation form

Documentation:

short/informal but should always include recommendations

-OT/PT Screening report-IEP eligibility summary on formal paperwork (usually given to the psychologist or case manager)

Question being asked…

Are there any OT/PT related concerns and if “yes” what could the teacher and parents do to help?

How involved are the concerns being observed and does further OT/PT evaluation need to be completed?

ObservationsObservations

How do you complete an How do you complete an observation?observation?– Collect information– Observe in classroom environment– Review handwriting samples– Complete an assessment that is

generally not part of an evaluation

ObservationsObservations

Considerations Deficit: Inadequacy or insufficiency Disorder: Illness; a medical condition involving a

disturbance to the usual functioning of the mind or body; a derangement or abnormality of function.

TBI Down Syndrome MS Amputation CNS anomaly, i.e., aneurism, hemisphere-ectomy;

Agenesis of the corpus callosum Delay: Slower than expected; a significant lag in

comparison to norms. Progress in a sequential but drawn out pattern

Making decisions about intervention Making decisions about intervention and service deliveryand service delivery

Assessment and Tools…Assessment and Tools…

Evaluations:Evaluations:

– An OT/PT should only complete an evaluation if a student already qualifies for special education…

– OR has consulted with the evaluating psychologist and the team feels there is a strong possibility that the student will qualify for special education.

Assessment in the Educational Assessment in the Educational Setting:Setting:

– Functional Skills in the School Setting

– Foundation Components for Motor Skills

– Visual Perceptual or Visual Motor Skills

– Sensory Processing

EvaluationsEvaluations::To determine how to best conduct the evaluation;Consider the parent/teacher concerns the student’s environment and the needs of the student; their overall level of function. (cognition and motor)

Gathering data for AssessmentGathering data for Assessment (Dunn; Best Practice Occupational Therapy)(Dunn; Best Practice Occupational Therapy)

Records reviewRecords review Norm-referenced measuresNorm-referenced measures Criterion referenced measuresCriterion referenced measures Informal measuresInformal measures Skilled observationSkilled observation Monitoring engagementMonitoring engagement Attending to environmental featuresAttending to environmental features

– Defining behaviors in observable and neutral termsDefining behaviors in observable and neutral terms InterviewsInterviews Ecological measuresEcological measures Activity analysisActivity analysis

EvaluationsEvaluations::

Functional Evaluations:Functional Evaluations:

Grades K-6

Compares a student’s abilities to those of their peers in their current classroom (not criterion based by age groups)

Can be used to:– compare progress over several years– compare functional abilities between program placements– assist in identifying goal areas for IEP– document progress and effects of interventions– prioritize areas of need for program planning

Can be completed by the entire educational team, including SLP, PT, classroom teacher, educational assistants, etc.

Excellent tool for facilitating collaborative development of IEP goals

School Functional AssessmentSchool Functional Assessment(SFA)(SFA)

Functional Evaluations:Functional Evaluations:

By: Helena Hemmingsson,Sneafridur Egilson,Oshrat Hoffman,Gary Kielhofner

Based from the Model of Human Occupation (MOHO) and gathers information looking at the student’s view of how satisfied they are with their abilities and accommodations/modifications in school.

Includes areas such as Writing, Reading, Speaking, Remembering things, Doing Homework, Taking Exams, Doing Sport Activities, Social Break Activities, Going on Field Trips, and Interaction with Staff.

More information can be found at www.moho.uic.edu/assess/ssi.html.

The School Setting Interview (SSI) Version 3.0, 2005The School Setting Interview (SSI) Version 3.0, 2005

Fine Motor, Gross Motor and Fine Motor, Gross Motor and Visual Motor Evaluations:Visual Motor Evaluations:

Birth-5 years of age; Reporting results; Standard Score vs. Age Equivalency Score

6 subtests: Reflexes, Stationary, Locomotion, Object Manipulation, Grasping, and Visual-Motor Integration

Physical Therapist commonly completes the gross motor subtests.

Peabody Developmental Motor Peabody Developmental Motor Scales - Second Edition Scales - Second Edition

(PDMS-2)(PDMS-2)M. Rhonda Folio and Rebecca R. Fewell (2000 Edition)

Fine Motor, Gross Motor and Fine Motor, Gross Motor and Visual Motor Evaluations:Visual Motor Evaluations:

By Robert H. Bruininks & Brett D. Bruininks

Ages 4-21 years

Physical Therapist commonly completes the gross motor subtests.

8 subtests: Fine Motor Precision, Fine Motor Integration, Manual Dexterity, Bilateral Coordination, Balance, Running Speed and Agility, Upper-Limb Coordination, and Strength

Bruininks-Oseretsky Test of Bruininks-Oseretsky Test of Motor Proficiency, Second Motor Proficiency, Second

Edition (BOT-2)Edition (BOT-2)

Fine Motor, Gross Motor and Fine Motor, Gross Motor and Visual Motor Evaluations:Visual Motor Evaluations:

Ages 4.5 to 14 years

Physical Therapist commonly completes the gross motor subtests.

Even though it is discontinued, most school districts have the BOTMP available and may not have purchased the new edition.

Administration of both editions is very similar, however scoring and some individual items have changed.

Bruininks Oseretsky Test Of Bruininks Oseretsky Test Of Motor ProficiencyMotor Proficiency(BOTMP) -1978(BOTMP) -1978

Fine Motor, Gross Motor and Fine Motor, Gross Motor and Visual Motor Evaluations:Visual Motor Evaluations:

Part of the (MDS) McCarron-Dial Evaluation System used for vocational training and evaluation

Birth-5 years of age

Both gross and fine motor items need to be administered

Great evaluation for students with visual impairments, neurological disorders, and complex cases.

More information can be found at www.mccarrondial.com

McCarron Assessment of Neuromuscular McCarron Assessment of Neuromuscular DevelopmentDevelopment (MAND)(MAND)

Fine Motor and Visual Motor Fine Motor and Visual Motor Evaluations:Evaluations:

Be Careful! You may come across older editions in the schools as well as Short forms and Long forms. All are administered the same but scoring criteria has changed.

Ages 2-8 years

Sometimes used by psychologists

Best as a screening tool and when using both the Motor and Visual Perceptual Subtests.

The Beery-Buktenica The Beery-Buktenica Developmental Test of Visual-Developmental Test of Visual-

Motor Integration, Motor Integration, (5th Edition) (5th Edition)

(VMI)(VMI)

Handwriting Evaluations:Handwriting Evaluations: By Denise DeCoste, Ed.D., OTR Published by Don

Johnston

Guide for assessing the components of writing (not standardized)

Four Components with Handwriting or Keyboarding:

– Alphabet writing– Copying a sentence– Writing a dictated sentence– “Free writing” of student’s own ideas.

Skills that can be objectively analyzed are:– Speed of writing and how it changes with

different tasks or pencil vs. keyboarding– Accuracy of letter formation (legibility) as

tasks change– If the student’s difficulties are due to fine

motor skills, letter formation, copying, – spelling, or idea generation (indicating OT

vs. Educational support needed)

Assistive Technology Assistive Technology Assessment:Assessment:

Developing a Written Developing a Written Productivity ProfileProductivity Profile

(WPP)(WPP)

Handwriting Evaluations:Handwriting Evaluations:

By Susan J. Amundsen, M.S., OTR/L

Evaluates manuscript and cursive by students grade 1-6

Normative data is obtained for letter and word legibility

Scores are presented in percentages

Evaluation items are similar to those needed in the classroom

Evaluation Tool of Evaluation Tool of Children's Children's

Handwriting Handwriting

(ETCH)(ETCH)

Visual Perceptual Evaluations:Visual Perceptual Evaluations:

By D. Hammill, N. Pearson, and J. Voress

Ages 4-10 years

Separates subtests into Motor Reduced Visual Perception and Visual Perception.

8 subtests: Eye-Hand Coordination, Copying, Spatial Relations, Position in Space, Figure-Ground, Visual Closure, Visual-Motor Speed, and Form Constancy

Developmental Test of Visual Perception

(DTVP-2)

Visual Perceptual Evaluations:Visual Perceptual Evaluations:

By C. Reynolds, N. Pearson, and J. Voress

Ages 11-74 years

Sometimes used by psychologists

Separates subtests into Motor Reduced Visual Perception and Visual Perception.

6 subtests: Copying, Figure-Ground, Visual-Motor Search, Visual Closure, Visual-Motor Speed, and Form Constancy

Developmental Test of Visual Perception-Adolescent and

Adult

(DTVP-A)

Visual Perceptual Evaluations:Visual Perceptual Evaluations: By Gardner, M.F.

(LL) for ages 4 to 12 and 11 months (UL) for ages 12 to 17 and 11 months

Sometimes used by psychologists

7 subtests: Visual Discrimination, Visual Memory, Visual Spatial- Relationships, Visual Form-Constancy, Visual Sequential-Memory, Visual Figure-Ground, and Visual Closure

Test of Visual-Perceptual Skills, Test of Visual-Perceptual Skills, Revised –Lower Level and Revised –Lower Level and

Upper LevelUpper Level

(TVPS-R)(TVPS-R)

Sensory Processing Tools:Sensory Processing Tools:Sensory Sensory ProfileProfile

By Winnie Dunn, Ph.D., OTR, FAOTA Variety of products:

– Toddler/Preschool (birth to 3 years)– Caregiver Profile (3-10 years)– Adolescent/Adult (12 to adult)– School Companion (3 to 12)

Gathers critical sensory information related to home and school.

Can be used to compare behaviors between different environments.

Each profile provides summaries within different sensory processing areas appropriate to that age group and environment.

Spanish forms also available

Report and Goal Writing…Report and Goal Writing…

Keep medical jargon out of your Keep medical jargon out of your documentation.documentation.

Write reports and goals so a Write reports and goals so a parent can easily understand parent can easily understand them.them.

Goals need to be measurable and Goals need to be measurable and objective.objective.

Delivery of Services Delivery of Services “Treatment”…“Treatment”…

Levels of service:Levels of service:

– Direct: Refers to “face to face” treatment provided either in the classroom (push-in), out of the classroom (pull-out), or in a group.

Delivery of Services Delivery of Services “Treatment”…“Treatment”…

Levels of service:Levels of service:

– Consult: Is time with staff members. On consult, the OT/PT is “checking in” to make sure a certain issue is going well. If problems arise, the OT/PT is available to problem-solve with the team to come up with a new intervention, modification, or strategy. Goals are usually required, but may vary by district.

Delivery of Services “Treatment”…Delivery of Services “Treatment”…

Levels of service:Levels of service:

– Monitor– Indirect– Direct

Pull out Classroom

Discontinuing Services…Discontinuing Services… It is a good idea to let parents and staff know how It is a good idea to let parents and staff know how

long a student might need OT/PT services when long a student might need OT/PT services when you present their evaluation.you present their evaluation.

– Example: A student in 3rd grade is identified with ADHD and has many sensory related issues.

“First OT /PT will address identifying strategies that help Sam to organize himself internally and calm down.”

“Then the goal will be for Sam to learn when and how to use these strategies independently.”

“At some point, Sam should be able to manage his own sensory needs. When he gets to that point, OT will most likely be faded out. This may happen in a year, or maybe five…it depends on Sam’s level of awareness and responsibility.”

Discontinuing Services…Discontinuing Services…

– Example: A 2nd grade student with CP has been working on handwriting intensely but has made little progress and his writing is very slow and legible only 50% of the time.

“I would suggest working on handwriting for maybe another year at the most, but because Joey has such difficulty, starting keyboarding may be a better option for him.”

“With the assistance of the computer, Joey could do more journaling in his classroom and be more independent.”

“If he is also having difficulty learning how to use the keyboard, there are many option with Assistive Technology that can be explored.”