Occupational/Physical Therapy
How does a child receive OT/PT services
There are primarily four ways a child can receive occupational and/or physical therapy once a need has been identified.
- a hospital or an outpatient clinic; served by the medical model
- outpatient clinic; served by the medical model
- home-based services; served by the medical model
- school-based services; served by the educational model only when occupational and/ or physical therapy is required to meet educational needs
The factors determining the need for intervention may be very different in these two models.
This can sometimes be very confusing.
In the educational model:
- Occupational/Physical therapy is provided by schools as service only when it is related to educational needs.
- Related services are possible only when they are “required to assist a student with a developmental delay or disability to benefit from special education”.
- Need for service is primarily based on testing, classroom observations and input from the student’s IEP team. However, the child is only assessed for needs associated with his or her educational program.
- The school district must establish whether the service is needed for the child to benefit from his or her education.
- In general, students with significant needs qualify for as these services in order to benefit from their special education.
- Related services, like occupational/physical therapy, are only provided when the student's educational program would become less than appropriate without the service.
- A child who does not perform to what may be his/her full potential but does function adequately, would not qualify for school based services.
- Related services are provided only when they support an educational need. They are not provided when there is a transportation problem or other obstacle in getting outpatient or home based occupational/ physical therapy.
In the medical model:
- Referral is initiated by the physician based on a particular diagnosis or observed delay in one or more areas of development.
- The parent is then referred to a hospital or clinic for an evaluation and/or treatment by the appropriate professional.
- Need for service is primarily based on testing and clinical observations. The assessment would take all settings into consideration.
- Children with mild, moderate and severe deficits may qualify for services.
- Therapy can address movement quality as well as function.
- The parent is responsible for obtaining the needed services as well as payment for those services.
- Health insurance may frequently assist with payment, but not always.
Some children will receive services through both models. For some children the frequency or intensity of occupational/physical therapy they receive at school through the educational model will not meet all of the child's needs for occupational/physical therapy. There may be goals that are not addressed by school based therapy and would require home or community based services from the medical model. In each setting, the child should be assessed individually to determine the best way to meet his or her needs.
DETERMINATION OF SERVICES
EDUCATIONAL MODEL
WHO DECIDES?
Educational team, including parents, student (if appropriate), educators, administrators and school-based therapists determine the student’s educational needs and what support is required by related services.
WHAT?
Therapy focuses on adaptation and intervention to allow the student to participate, access their special education and school environment.
WHERE?
On school grounds, bus, halls, playground, classroom, lunchroom, etc.
HOW?
The student’s educational needs are met individually. Services may include direct one on one treatments, staff training, program development, collaboration with staff, integrated therapy, inclusive therapy (with peers) or by consultation for the student’s daily program.
ELIGIBILITY
Educational need as determined by the IEP team based on testing eligibility.
COST
No cost to student or family.
DOCUMENTATION
Related to IEP with accessible, readable language guided by the setting and best practice.
Therapy Examples
Provided by therapist reinforced by trained staff.
Gait Training
To improve efficiency, speed to safely move between classes on campus and to interact safely with peers.
Range of Motion
Positioning program to address range of motion daily during class activities. Goal to attain what range is needed for daily living.
Changes in Physical Status
Adapting equipment, schedule or environment to provide access to special education/meet IEP goals.
Difficult Writing
Strengthening, positioning, repetitive motions due to fine motor, visual motor or other impairments.
ADLS*: Feeding, dressing, toileting, grooming
Lunch Room Assessment, equipment training/issued transfers, safety.
*Assisted Daily Living Skills
MEDICAL MODEL
WHO DECIDES?
Medical team determines focus, frequency and duration of therapy. Insurance coverage may be determining factor.
WHAT?
Therapy addresses medical conditions; works to get full potential realized.
WHERE?
In the clinic, hospital, or home.
HOW?
Direct one on one treatment to accomplish set goals.
ELIGIBILITY
Medical need as determined by medical professionals.
COST
Fee for service payment by family, insurance or governmental assistance.
DOCUMENTATION
Dictated by insurance requirements and guidelines of the setting. Emphasis on medical terminology.
Therapy Examples
Provided by therapist or assistant. Must be doctor prescribed.
Gait Training
To improve heel strike or attain normal gait pattern, not required for daily function.
Range of Motion
Program to gain full physiological joint range, beyond what is required for daily living.
Changes in Physical Status
Rehabilitate for strength, range of motion to attain full potential post surgery.
Difficult Writing
Rehabilitate and Cognitive Tasks in home and community.
ADLS*: Feeding, dressing, toileting, grooming
In home therapy swallowing difficulties, swallowing studies, equipment issued.
*Assisted Daily Living Skills