GUIDELINES FOR OCCUPATIONAL THERAPY SERVICES

The purpose of this document is to clarify eligibility guidelines for occupational therapy services in the Chappaqua Central School District. Occupational therapy is provided to facilitate a student's ability to adapt to and function in an educational program. An occupational therapy program may be designed to assist in developing underlying skills that support academic learning or to help in the acquisition of specific skills. The presence of a disability does not necessarily indicate a need for occupational therapy. For example, if a child shows limited upper extremity strength or range of motion, occupational therapy is educationally relevant only if that lack of strength or range impacts upon functional skills, e.g., independent transfers, ability to manipulate classroom tools and/or independent toileting.

Occupational therapists address the daily occupations of school life. Occupational therapy may include interventions to improve gross and fine motor skills, to organize and use materials appropriately, to interact with peers, to attend to and focus on instructions or directions, to learn daily living skills and, when necessary, to use assistive technology or compensatory strategies. As a related service, occupational therapy must be educationally relevant and necessary. The American Occupational Therapy Association identifies performance areas that can be addressed by occupational therapists (work, leisure and self-care) and the performance components that contribute to capacity to develop skills in these areas. The following are examples of students who may require occupational therapy services:

	Those students who have difficulty modulating their responses to environmental stimuli and are unable to attend to classroom lessons, stay in their seats, or tolerate close physical proximity to their peers.
	Students who, because of poorly developed body schema have trouble organizing their bodies when learning new motor tasks, and developing spatial concepts.
	Students who have problems with fine motor coordination who cannot effectively write, cut and construct.

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Eligibility

Students who may require occupational therapy service include:

Children whose classroom performance is significantly below the functional level of his/her classroom peers. These functional activities may include nonacademic aspects of a school program, including manipulating books and tools for writing or moving about the classroom and school.
Children whose scores on standardized tests of performance components (gross motor coordination, dexterity, visual-motor integration, sensory processing) or performance areas (activities of daily living, educational activities such as handwriting) fall 1.5 standard deviations below the mean.
Previous attempts to alleviate the problem have not been successful.
Potential for change in student's problem through intervention appears likely.
Unique experience of therapist is required to meet student's identified needs.

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Referral Procedure

1. Child Study Team (CST). A teacher or related staff member may refer to the Child Study Team if the presenting problem has an educational impact. The CST will then determine if an occupational therapy evaluation will be recommended. The occupational therapist will conduct an evaluation and recommend services as necessary.

2. Committee on Special Education (CSE). The CSE is responsible for determining a child's eligibility for special education and related services. The CSE can refer a child for an occupational therapy evaluation. Services recommended by the CSE are mandated by law.

3. Section 504. This law provides for accommodations and/or modifications to meet the needs of disabled students as adequately as those of non-disabled students. Students may be eligible for Section 504 protections when a disability substantially limits a major life activity in school and mandated adaptations are needed to prevent discrimination. Referrals are made through the 504 committee.

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Continuum of Services

Service provision options

	Direct therapy refers to those intervention activities that are individually designed and are carried out by the therapist and one child, or the therapist and a small group of children.
	Monitoring refers to the following: the therapist carries out an assessment to identify the strengths and needs of the child. The therapist designs an intervention plan to be carried out by another staff member and remains responsible for the outcome of the plan, e.g., a child may have a self-feeding program that is established by the occupational therapist and carried out by the classroom aide on a daily basis.
	Consultation differs from direct therapy and monitoring in that the therapist is using his or her expertise to enable another person to address issues and outcomes identified by that person. This model is most appropriate when there is little or no need for direct interaction between the student and therapist in order to address goals.

2. Service intensity

Services are most often provided 2 times per week for 30-minute sessions. Frequency is determined by such factors as: number of performance components contributing to the dysfunction, severity of the problem, rate of progress, and impact of removal from classroom on academic performance. Students are seen either individually or in small groups depending on the value of peer interaction in achieving specific goals and/or the necessity for individual attention/physical interaction with the therapist.

Service intensity is likely to be greater in early education. At that time, treatment addresses not only specific performance areas but also the neurodevelopmental foundations that contribute to holistic growth. Students in intermediate grades are more likely to receive services of less intensity, and goals address acquisition of specific skills such as vocational or graphomotor skills. Brief and intermittent intervention may also be provided to problem-solve accomplishing a particular task.

3. Mode of delivery

	Integrated services are provided in the classroom or in the context in which the targeted skill naturally occurs.
	Pullout service is provided when integrated services would be disruptive to other members of the class, or when foundation skills need to be developed before the target task can be successfully addressed.

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Discontinuation of Services

The following are indicators that therapy is no longer indicated:

	The student has met educationally relevant therapy goals and can participate independently in the areas of concern.
	Adaptations or accommodations have been provided to facilitate independence.
	The problem has ceased to be educationally relevant.
	Teacher/parents have learned and can carry out appropriate techniques to assist the student.
	The student progress has plateaued/potential for further change is unlikely.