“There is no defined or correct method to adequately and equitably meet the need s of all students in an unprecedented event such as the current COVID 19 pandemic response. LEAs need to be flexible and consider employing a variety of delivery options as they make reasonable efforts to provide services to students with disabilities." (from TEA, https://tea.texas.gov/sites/default/files/covid19_special_education_qa_updated_march_20.pdf)
School districts will each determine how to best provide education to all students during this confusing and rapidly changing climate. There is probably no option that does not come with advantages and disadvantages. Districts must consider access to instruction, equality, efficiency, competence with technology and more; many will want to follow the guidance of their attorney. It has been made clear that as soon as districts begin to provide instruction to students, all the mandates from the Individuals with Disabilities Education Act (IDEA) are in effect, including timelines for initial evaluations and implementation of Individual Education Programs (IEPs). As related service providers, school-based occupational therapists and physical therapists need to work closely with district leaders to determine how to assist the district to meet its obligations. In many districts, this will be your Special Ed Director or Coordinator.
As you more forward, here are some things you'll want to consider:
As many school districts are scrambling to problem-solve how to deliver educationally-relevant related services to students, there has been much discussion around the use of telehealth services. There are many things OTs and PTs should consider when planning to use telehealth as a service delivery model. Therapists must be informed on what their state licensure rules say, as well as ethical considerations, FERPA compliance, access, reimbursement, and logistics. Here is what Texas OT and PT Rules require, along with some helpful resources.
OT RULES (December 2019)
(39) Telehealth--A mode of service delivery for the provision of occupational therapy services delivered by an occupational therapy practitioner to a client at a different physical location using telecommunications or information technology. Telehealth refers only to the practice of occupational therapy by occupational therapy practitioners who are licensed by this Board with clients who are located in Texas at the time of the provision of occupational therapy services. Also may be known as other terms including but not limited to telepractice, telecare, telerehabilitation, and e-health services.
(3) The occupational therapist is responsible for determining whether any aspect of the evaluation may be conducted via telehealth or must be conducted in person.
(4) The occupational therapist must have contact with the client during the evaluation via telehealth using synchronous audiovisual technology or in person. Other Texas Board of Occupational Therapy Examiners December 2019 37 telecommunications or information technology may be used to aid in the evaluation but may not be the primary means of contact or communication.
(f) Plan of Care.
(7) Except where otherwise restricted by rule, the occupational therapy practitioner is responsible for determining whether any aspect of the intervention session may be conducted via telehealth or must be conducted in person. (8) The occupational therapy practitioners must have contact with the client during the intervention session via telehealth using synchronous audiovisual technology or in person. Other telecommunications or information technology may be used to aid in the intervention session but may not be the primary means of contact or communication.
(9) Devices that are in sustained skin contact with the client (including but not limited to wheelchair positioning devices, splints, hot/cold packs, or therapeutic tape) require the on-site and attending presence of the occupational therapy practitioner for any initial applications. The occupational therapy practitioner is responsible for determining the need to be on-site and attending for subsequent applications or modifications.
(10) Except where otherwise restricted by rule, the supervising occupational therapist may only delegate to an occupational therapy assistant or temporary licensee tasks that they both agree are within the competency level of that occupational therapy assistant or temporary licensee.
PT RULES (March 2020)
§322.5. Telehealth (a) When used in the rules of the Texas Board of Physical Therapy Examiners, telehealth is the use of telecommunications or information technology to provide physical therapy services to a patient who is physically located at a site in Texas other than the site where the physical therapist or physical therapist assistant is located, whether or not in Texas. (b) Physical therapy telehealth services must be provided by a physical therapist or physical therapist assistant under the supervision of the physical therapist who possesses a current: (1) unrestricted Texas license; or (2) Compact Privilege to practice in Texas. (c)The provision of physical therapy services via telehealth requires synchronous audiovisual or audio interaction between the physical therapist or physical therapist assistant and the patient/client, which may be accompanied by the use of asynchronous store and forward technology. (d) Standard of Care. A physical therapist or physical therapist assistant that provides telehealth services: (1) is subject to the same standard of care that would apply to the provision of the same physical therapy service in an in-person setting; and (2) the physical therapist is responsible for determining whether an evaluation or intervention may be conducted via telehealth or must be conducted in an in-person setting. (e) Informed Consent. A physical therapist that provides telehealth services must obtain and maintain the informed consent of the patient, or of another individual authorized to make health care treatment decisions for the patient, prior to the provision of telehealth services. (f) Confidentiality. A physical therapist or physical therapist assistant that provides telehealth services must ensure that the privacy and confidentiality of the patient's medical information is maintained during and following the provision of telehealth services, including compliance with HIPAA regulations and other federal and state law. (g) The failure of a physical therapist or physical therapist assistant to comply with this section shall constitute detrimental practice and could subject the licensee to disciplinary action by the Board. (h) Telehealth is a mode for providing one-on-one physical therapy services to a patient/client and is not a means for supervision of physical therapy aides.
INFORMATION ON TELEHEALTH
https://www.ptot.texas.gov/idl/C63E31BF-6000-2402-6758-EC11F1479F47 (Chapter 322.5)
STUDENT PRIVACY AND ONLINE SERVICES
Respecting Student Privacy while using online educational services
VIDEO CONFERENCING PLATFORMS
https://zoom.us/ (free to create account and time limit on free use waived currently)
The following are some words of wisdom from Laurie Ray, School-based Physical Therapy Special Interest Group of the Academy of Pediatric Physical Therapy:
"While (these)* resources are provided for your information, EVERYONE must comply with their LEA, district, state and federal regulation, policy and directive! Please do not begin any practice without consideration of legal and ethical principles AND approval from your administration and supervisors! This is not a time to problem-solve on your own…lone rangers, dismount! Work within your school district/LEA and administrative structures to ensure compliant, thoughtful, reasoned action or inaction.
Each student, IEP, situation and intervention must be thoughtfully considered with applied clinical reasoning, there is no single 'answer' to all."
Best regards and be well,
Laurie Ray, PT, MPT, PhD
*("These" resources does not refer to those listed in this article, but the thoughts apply.)
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OTs and OTAs – Thank you
for all you do to make students’ lives better!!
out helpful (and some fun) links below:
Therapy in School Settings
School-Based OT Fact Sheets
Tip Sheets - Children and Youth
and Youth - Evidence-Based Practice Resources
Competency Assessment Platform
in the 21st Century (Why handwriting belongs in the
Successful Participaton at School -
TxSpot March Resource of the
Online Resources for
Keyboarding Practice (including games)
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To Consult or Not
to Consult: That is the Question.
by Janine Calmes, PT, MS
In 2016, the American Occupational
Therapy Association (AOTA) published Occupational Therapy Practice Guidelines
for Individuals with Autism Spectrum Disorders (AOTA 2016). It is part of a
series of practice guidelines published by AOTA. This book covers the state of
evidence on a multitude of interventions an occupational therapy practitioner
might use and is a “must read” for those who interact with persons on the
spectrum. To give just a taste of the valuable information in this book, I
summarize below the evidence on social narratives/Social Stories.
Manager, School-Based Therapy Services, HCDE
Jean Polichino, OTR, MS, FAOTA
Director, School Based Therapy Services, HCDE
It's About Time!
What is a Therapist’s Obligation for Making Up Missed
As with many things in special education,
the answer to the question, “Do we have to make up missed therapy sessions?” is,
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Preliminary Telehealth Guidelines
Happy National Occupational Therapy
Check out our useful links.
Discusses provision of direct
services versus consultative (indirect) services compared to integrated
Happy National Physical Therapy
Month! Enjoy some helpful links.
Summarizes evidence for use of Social
Stories for persons with ASD as given in the book, Occupational Therapy Practice Guidelines for Individuals with
Autism Spectrum Disorders (AOTA 2016).
How do we go about developing and
How to determine if missed visits
must be made up.
Ideas to help establish yourself as
part of the team.
Tips to get organized at the start
of the school year.
Update on the Sunset Review process
for the Texas OT and PT Licensing Board.
What to expect; Some differences
between school-based therapy and clinic-based therapy.
Wrapping up your school year: Making
sure your documentation is complete for the next year or the next
Evaluation tools for Adapted
PTs and OTs and Adapted Physical
Education in Texas
Points to consider when a parent
brings an advocate or lawyer to an ARD meeting.
Explains the focus on literacy in
Handwriting referrals to school
OTs related to STAAR and STAAR-A tests.
When is it time to dismiss a student
from therapy services?
The academic benefits of physical
Transitioning from caseload to
Screening for sleep deprivation.
Questioning the "why" behind lack of
motivation at school.
When to use standardized assessment