School Based PT – Policies and Procedures


Sarah posts:

DEAR ERI COMMUNITY:
I am looking for PT eligibility/discharge criteria for school based PT. My district is working on beefing up their policies and procedures and I would like to know what is typical in other districts. 

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17 Responses to School Based PT – Policies and Procedures

  1. Kathryn Biel says:

    One of the clarifying statements that I use (which I got from the School-Based Therapists Conference a few years ago) is that, “School-based therapy is not intended to meet all of the therapeutic needs of a student; rather it is intended to ensure that a child can have physical access to his or her education.” Keeping that statement in mind, I use test scores to support eligibility. However, I often do not use test scores to support discharge, as the students are still often significantly delayed as compared to their typical peers (not to say that I never use test scores for discharge). For those children that are not appropriate for standardized testing, I look at the following criteria: how does the student enter/exit the building? how is the student able to exit in case of emergency? can the student make it from one building location to another? does the student have the requisite strength to manage books and materials? does the student have sufficient core and postural strength to sit up, attend and write? can the student stand up from the floor without assistance?

    Sometimes, the child is able to do these things independently. Sometimes, the child needs adult assistance, and will always need assistance due to physical and/or cognitive limitations, and no amount of PT will change that.

    Also, I look at progress versus plateau in my more involved students, and use this for justification. Especially with Medcaid now reimbursing the school districts, we have to justify EDUCATIONALLY relevant services that are not maintenance therapy. If I cannot justify that, then I look to provide services in a non-direct, consult mode rather than direct services.

    Hope this helps!

    • I agree completely with the above statement. Some school districts allow a clinic based approach to these children and it is very costly to the system, and in my opinion is NOT why we are asked to contract with the schools in the first place. The comments about educationally relevant intervention in comments above is spot on and the attitude of “you can get all your therapies at the school now” is one that needs to be discouraged. School based PT’s have a purpose and an important one, but clinically based intervention is not one. It doesn’t mean you are lazy, just fulfilling the job you are hired for. Good luck!

    • Lori says:

      I contatced the Peds. section of the APTA and they sent me their rules and regs for school based therapy. It was very helpful.

  2. D James says:

    http://www.pediatricapta.org/special-interest-groups/school-based-therapy/index.cfm
    You can find state guidelines here that may include the information you are looking for.

    California’s Guidelines include:
    The team may consider the following conditions when determining that a child no longer needs OT or PT or either one to benefit from the education program when the:
    • Child’s needs are being addressed by OT or PT no longer negatively affect his/her educational performance in the general education or special education program, is functional within the educational environment, and therapy services are no longer indicated.
    • Child no longer requires OT or PT as a related service in order to benefit from his or her special education program.
    • Child consistently demonstrates behaviors that inhibit progress in OT or PT, such as lack of cooperation, motivation, or chronic absenteeism. In those circumstances, the IEP team should consider the initial eligibility decisions since the behaviors may reflect social maladjustment, environmental, cultural, or economic factors rather than an actual disability. The IEP team may also explore alternative services or strategies to remedy the interfering behaviors or conditions.
    • Child’s needs are better served by an alternative program and/or service, as determined by the IEP team.
    • Therapy is contraindicated because of the change in medical or physical status.
    • When the student’s anticipated goals and expected outcomes related to OT or
    PT intervention have been met for a particular episode of care.
    • When based upon the therapist’s judgment it is determined that the student will
    no longer benefit from therapy.

  3. Nancy Martin says:

    Students receive PT in school in order to work on motor skills that are necessary to function in school (basically sit, stand, transitions, walk,up and down stairs, manage doors). I do not use standardized testing at all for eligibility or for dismissal. I use the SFA (School Function Assessment) for students who have mild to moderate physical disabilities, and I use the TopDown Motor Milestone Test of the MOVE Curriculum (Mobility Opportunities Via Education) for students with severe physical disabilities. If a student is able to access all areas of the school and campus, and can independently sit, stand, transition, and walk to scheduled classes, then they are dismissed from PT.

  4. Michelle Turner says:

    Entrance Criteria (any one of these):
    The student is elgible for special education services due to the disability.
    An assessment was done and he/she has scores that are significantly below the mean.
    ****PT goals and objectives are educationally relevant. I would like to emphasize educationally relevant because school based therapy services is often confused with medically based therapy services.

    Exit Criteria (any one of these):
    The student has reached/accomplished his goals as age, grade level, or cognitively appropriate.
    The student has received services for 3 or more years and has not made any progress for more than 6 months.
    The students rate of progress in therapy continues to be steady despite a decrease in therapy services.
    The students needs can be met by other educational professionals using a consultative model or by making accommodations.
    A parent and/or team requests PT services to be discontinued.
    Therapy is contraindicated due to a change in medical or physical status.
    -I would like to add that outpatient clinics offer equipment that some school districts do not have access to or funding for and therefore providing direct services may not be in the best interest of the child.

  5. Denise DesJardins says:

    Using the “teacher” either classroom or physical education provider is important in backing up discharge from direct services. If they are not having difficulties accessing/interacting with their environments then what are school based PT goals. If there is no goal then there can’t be need for services. I agree using standardized testing for students with low cognitive skills may not give a realistic picture of true skill level.

  6. Joy Waters says:

    In Georgia we are using the Considerations for Educationally Relevant Therapy(CERT)tool at everay IEP meeting to evaluate the continued need for PT (and OT) in the school environment. It helps us to consider several factors for beginning, continuing, or discontinuing PT/OT. You can access it by going to the website http://www.gadoe.org then at top right in the “Search this site” box type in physical therapy. Then click on Occupational and Physical therapy. On the right under the heading “Technical Assistance” you will see the link to the Considerations tool and some instruction on how to use it.
    This has really helped us to get some consistency from student to student and made our decisions more objective. It is not an evaluation tool but it does help as we consider several contributing factors. Hope this helps.

  7. Janet says:

    We use a functional Eval that was developed by examining what a child can do and can’t do in the school setting. When the need for testing arises the HELP is used as a guideline and the Test of Gross Motor Development is used.
    Discharge I agree with the above statements, check with the teacher and PE teacher and make sure what you are providing is educationally relevant.

  8. Rhona Melberg says:

    The criteria for both services and discharge for school based therapy is similar. To qualify for school services the disability has to impact the child’s ability to access his education. There are many state guidelines for PT & OT school practices that you can find online which go into detail for these criteria. After doing this for over 20 years I am still changing how I assess students. Although I do use some standardized testing, I have recently begun doing a much more functional participation based eval. By determining if the student is having difficulty in the school environment I then will decide what might be the cause of the difficulty and determine what further testing may be required. Unlike the clinic, having a disability does not necessarily qualify someone for PT. The eval is not to determine a disability, but if the disability impacts the student’s access to the school curriculum and/or environment. Even once a child is found to have difficulty, the next step is usually to determine what types of accommodations may be used rather than necessarily recommending direct service. Discharge usually occurs once the disability no longer impacts the student’s ability to access his curriculum or the accommodations are in place, even though he may still benefit from clinical therapy outside of school. In my district I cannot discharge a student who is receiving direct services without a written eval. This means getting a written consent for an eval and then having an IEP meeting to discuss the results and recommendations. Even if the parent agrees to discharge at the meeting, the child is required by law to continue receiving services until the IEP is actually signed. And if the parent rejects my findings it can drag on for a long time. It is one of the most frustrating parts of school PT for me. Hope this helps you somewhat.

  9. Nina Meyer says:

    I’m really happy to read all of the other posts- so great to see what’s happening in different districts/ states. I am on an Evaluation Team for a Nassau County (NY) Agency, and I also work in a center-based program, and as was mentioned, most of the time, the criteria for qualifying and being discharged from PT are very similar. The Nassau County school districts only accept a standardized test, such as the PDMS-2 (Peabody- for up to 6 years), the AIMS (for children up to 18 months), and the BOT and GMFM for slightly older kids, for example. They was to see a z score of at least a -1.50 in 2 areas- ie PT and OT, or -2.00 in 1 area, say if they are only getting a PT eval. There are plenty of times that a child will get a -1.60 in more than 1 area, and the district still only approved 1x 30 min. For NYC, you don’t always need to use a standardized test, depends on the district, and in those cases I will often use an SFA when I can, as I truly feel it’s the most school-relevant and reflective of school function. When the district doesn’t require standardized testing, you need a 25% in at least 2 domains, or 33% delay in 1 domain. This also holds true for when you’re retesting at the end of the year…if the district people are in a good mood and the scores are borderline, they may cut from 2 to 1x 30 min, otherwise they may cut services altogether. Once a child is already in the system, I think the therapist’s opinion carries a lot more weight. When you meet a child for an hour eval, it’s not so easy to be so persuasive, even though your gut tells you that the child definitely needs PT. If you are in a school district that can be persuaded to take into account standardized testing, checklists, and therapist opinion, I truly believe that is best. The tests out there do not always properly tease out a child’s weaknesses, and you can get a false sense that they are higher functioning than they truly are. For the reasons mentioned about regarding parents, I also find it much harder to discharge a child, especially one who has been receiving therapies for years. We need to be advocates for our profession and remind parents and other professions who may refer for PT in school, that “school based” and “medical-model” based PT are greatly different.

  10. Kristen Suvick says:

    I am a school related PT working with kids in cyber school setting. I worked in the school setting following college for several years and then took another several years off while raising my 3 children. Going back to work in this new setting is challenging in many ways. First of all I am the only PT employed by this center and lack a professional peer group. I happened upon this website looking for suggestions for goal writing with children that are not in the traditional school setting but are young (5-8) and would have difficulties in a traditional school setting. For example, the children don’t have access in their current educational environment to heavy doors, stairwells, playground equipment, etc., but I feel as if they should be prepared in the event that they do attend a traditional school in the future. I am also curious about writing goals for children with autism who lack motivation to participate in many gross motor activities such as ball skills. Is it appropriate to work in these areas? Consistent performance of skills is difficult with behavior issues therefore traditional goal writing methods I previously used are complicated. Many of my clients have autism and this is new compared to the large percentage of children with cerebral palsy that I commonly treated in the past. Any related information or suggestions you could share or links to IEP goal writing for the autistic population would be helpful. I am really excited to have found this website!!!

    • Kelly Ball says:

      This is a great question, and I would love answers from other therapists on this one. I wonder if the administrators of the site might consider making this a separate blog post?

    • Kristen Suvick says:

      Please help! I am also trying to figure out how to justify working on stairs etc that don’t exist in the cyber school setting. Does not having stairs at home mean that they don’t need to work on stairs because it is not in their educational setting?

  11. I used to use that as a criteria …but when fitness and wellness goals were included int the NJ core curriculum goals , I felt I had to get creative and work on one foot balance activities and “make steps” from therapy play structures.

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