Mar 23
Guidance for School-Based Therapists Amid COVID-19

“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:

  • How is your school district planning to deliver instruction to students?
  • How is your school district planning to individualize instruction to students wit
  • h an IEP?
  • How can you gain access to instruction being provided to students you are serving?
  • How can you contact teachers to collaborate and provide support?
  • If instruction is being provided through an online platform, can you schedule to participate in order to provide needed support?
  • If your district is asking you to provide services through telehealth, are you versed in your discipline's licensure rules related to telehealth?
  • What technology support will you need to provide services?
  • How will you communicate with parents who do not speak English?


Mar 19
Preliminary Guidance: Telehealth for School-Based OT and PT

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)

§362.1. Definitions.

(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.

(e) Evaluation.

(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://pediatricapta.org/news/#n1168

https://www.aota.org/Practice/Manage/telehealth/coronavirus.aspx

https://www.aota.org/Practice/Manage/telehealth.aspx

https://www.ptot.texas.gov/idl/C63E31BF-6000-2402-6758-EC11F1479F47 (Chapter 322.5)

https://www.ptot.texas.gov/idl/D4241942-233A-C3A1-8353-137E9423412E

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)​

ADVICE

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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Apr 17
April is National Occupational Therapy Month!
Nov 10
To Consult or Not to Consult: That is the Question.

Direct vs Indirect services.jpg

 ​To Consult or Not to Consult: That is the Question.

Direct versus indirect services. Which should I do?

 by Janine Calmes, PT, MS

 
TxSpot has received many questions about direct services versus consultation services. First, it may be helpful to understand that neither the state of Texas nor the Individuals with Disabilities Act (IDEA) use the term, “consultation.”
IDEA regulations state that a student’s IEP must contain a statement of “special education and related services and supplementary aids and services…to be provided to the child, on behalf of the child, and…(through) program modifications and supports” (IDEA Regulations, Part B, Section 300.230, italics added).
The Texas Education Agency (TEA) uses the terms, “direct” and “indirect” to describe services. The TEA describes these two terms as follows:
Direct services usually refer to hands-on, face-to-face interactions between the related services professional and the student. These interactions can take place in a variety of settings, such as the classroom, gym, health office, resource room, counseling office, or playground. Typically, the related service professional analyzes student responses and uses specific techniques to develop or improve particular skills.
Indirect services may involve teaching, consulting with, and/or directly supervising other personnel (including paraprofessionals and parents) so that they can carry out therapeutically-appropriate activities. …. (For example), a physical therapist may serve as a consultant to a teacher and provide expertise to solve problems regarding a student's access to instruction.
Although the TEA defined direct and indirect services in their 2009 FAQ, the terms were not meant to be mutually exclusive since they describe methodologies that may both be needed to best meet the student’s ongoing needs. Defining and limiting the methodologic approach can result in unnecessary inflexibility that is unresponsive to student needs.
Instead of defining the treatment approach as either direct or indirect, the evidence supports a blended approach, sometimes called an integrated service model. This model stresses the importance of working in context: interventions are applied in the environment and to the task or activity where the student’s needs occur. Integrated services include both direct and indirect services embedded into the natural environment where the participation or performance issue occurs.
 Unfortunately, some IEP management software is designed using a drop-down menu that requires a forced choice of direct OR indirect. If so, there is sometimes a “work around” that will allow designation of a blended approach.
Further complicating the matter is Medicaid reimbursement for services. Medicaid only reimburses for direct service, that is, for service when the student is directly involved. For example, time spent consulting or training staff or developing or modifying the adaptive equipment is billable ONLY when the student actively takes part in the activity.
There are times when the therapist may be pressured to provide only direct services. However, IDEA indicates that the treatment approach is to be determined by the IEP committee based on individual student needs. It should not be influenced by software limitations, the student location (e.g. - school vs. homebound) or reimbursement rules (Medicaid). It must be recognized that both direct and indirect services are important in contributing to successful student outcomes and should be included as part of integrated IEP service time. 
Some school districts support the concept of “classroom support” in which generalized support or consultation is offered to the teacher and other classroom personnel to provide non-individualized strategies that apply to any student in the class. An example would be an occupational therapist who describes the strategy of using a short pencil or broken crayon to help students develop a tripod grasp for handwriting. This is a general strategy that would be applicable to any or all students in the class.  This type of generalized support does not need to be included as part of IEP service time.
So, to the question, “Direct versus indirect services: Which should I do?” the answer is…Both!
 

 


Oct 13
Happy National Physical Therapy Month!

gold-fireworks-animated-gif.gif
 
from Harris County Department of Education - School-based Therapy Services  
 
 Thank you, PTs and PTAs, for all you do to help make students' lives better!
 
Check out helpful links below:
 
 
 
 
 
 
 
  


Aug 22
Social Narratives and Social Stories - Are They Effective?

Amy Collins​​, OTR, MOT    Practice Guidelines for ASD - AOTA.png
 

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.  

The term social narratives describes a group of interventions in which a short story is developed to address a specific social behavior or social situation, such as how to sit on the school bus or how to behave in a public bathroom. They often address situations described by Brenda Smith-Myles as part of the “hidden curriculum,” those norms, expectations, values, and beliefs that are implicitly, not explicitly taught. The name, Social Stories, is a trademarked term referring to social narratives that meet ten specific criteria (Gray, 2000). The AOTA Practice Guidelines discuss six Level 1 studies on Social Stories in its review.
Half of the studies found an increase in positive social behaviors or decrease in challenging behaviors. One study concluded that Social Stories with music were more effective. One study did not adhere to the guidelines for Social Stories development. The remaining studies had mixed results. These AOTA guidelines conclude that Social Stories should be used to improve social skills with careful monitoring of outcome effectiveness.
For more information on using social narratives and Social Stories, check out these websites.
For an online summary of OT practice guidelines for individuals with ASD, check out:
American Occupational Therapy Association. (2016). Occupational therapy practice guidelines for individuals with autism spectrum disorder. AOTA Press. Bethesda. https://myaota.aota.org/shop_aota/prodview.aspx?type=d&pid=298560661&sku=900385
 


Feb 08
Developing and Maintaining Competence as a School-Based Therapist

​Amy Collins, OTR, MOT                                                                                                                                                            Manager, School-Based Therapy Services, HCDEcompetence 4.jpg

Competence as a school-based occupational therapist or physical therapist is a challenge that requires one to be familiar with the laws and regulations that govern school practice, knowledge of current evidence, and understanding of best practices, all of which evolve over time (Laverdure, 2014).  But how can we go about developing and maintaining that competency? Faucher (2011), states that expert practice involves self-assessment, the attainment of new knowledge, and the application of that knowledge.
Self-assessment requires us to step back from the daily hustle and objectively reflect on areas where we have developed competency, and areas where we still need to grow. Once self-assessment has occurred, practitioners can develop a plan to address those areas. Professional development plans (PDP) spell out how new knowledge will be gained, and how it will be applied in practice. PDPs typically include measurable goals, action steps, and specify how the new knowledge will be applied in practice. They usually include timelines for completion and some means of accountability. AOTA is continually developing tools to help occupational therapy practitioners self-reflect and self-assess, including the AOTA Board Specialty Certification in School Systems and the Professional Development Tool (AOTA, 2003). The Academy of Pediatric Physical Therapy (APPT), a section of the American Physical Therapy Association, publishes the quarterly journal, Pediatric Physical Therapy. The journal includes articles of interest to school-based physical therapists. The APPT’s School-Based Physical Therapy Special Interest Group offers on-line resources as well as an annual conference available to members and non-members alike.
Common ways practitioners acquire new knowledge are through professional development such as workshops, professional literature, and learning from other competent practitioners. A work place that promotes continuous learning is critical to a practitioner’s efforts. Work environments that have systems and processes in place make it possible for practitioners to acquire and apply new knowledge. One way that work environments can support continuous learning is by setting aside time for practitioners to meet with other practitioners, both within their discipline and between disciplines in order to model, mentor, share, and discuss new information. Other ways are by supporting attendance at professional development offerings and monitoring continuing competence as part of the performance evaluation process.
While TxSpot is an excellent resource for credible information related to school-based practice, membership-only resources are not available through TxSpot. There is no substitute for membership in your professional organization, which offers a wealth of tools and information conducive for continuing education.
References
 Laverdure, P. (2014). Considerations for the developmental of expert-practice in school-based occupational therapy. Journal of Occupational Therapy, Schools, & Early Intervention, 7, 225-234. 
Faucher, C. (2011). Development of professional expertise in optometry. Journal of the American Optometric Association, 82, 218-223.  


Oct 27
It’s About Time! | School-based Therapy

Jean Polichino, OTR, MS, FAOTA   

Senior Director, School Based Therapy Services, HCDE 

 It's About Time!

 OR

What is a Therapist’s Obligation for Making Up Missed Therapy Sessions?   Alarm clocks 2.jpg

 

As with many things in special education, the answer to the question, “Do we have to make up missed therapy sessions?” is, “It depends.”  

The significant factor in determining how to proceed can be found in the reason for the missed session.  If a session is missed because the therapist was ill, a special assembly was held, or because the student’s sessions are scheduled on Mondays when holidays result in school closure, it is the responsibility of the school district to ensure those sessions are made up. The therapist should allow for flexibility within his or her own schedule for make-up visits as the need for them is an inevitable reality in school practice. 
If, on the other hand, the occasional missed visit is due to the student’s absence, there is no legal obligation to make up the visit. Having said that, most school districts will want therapists to make a good faith effort to make up the missed session as it is in the student’s best interest to do so.
On those rare occasions when a student is chronically absent, school attorneys advise convening an ARD/IEP meeting to reconsider the IEP. All services are impacted by chronic absences, so it is likely that goals/objectives would need to be revised and the time, frequency and duration of needed services will need to be adjusted. 
In all cases, therapists should document the missed session and the reason it occurred. In cases of chronic absences, therapists should communicate what is occurring to the special education administration and plan together with campus personnel so that appropriate action is taken

 

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Aug 16
New School Year, New Faces

 

Back-to-School-Pencil-Header.png

 

Denice Tucker, OTR
Manager, School-based Therapy Services, HCDE
 
 Whether you are new to schools or returning to the same district, here are suggestions to help you establish yourself as part of the team. Establishing positive relationships will be rewarded throughout the school year. 
 
·         Always wear your nametag.
 
·         Introduce yourself to the following people:
 
A.     the Principal
B.     the Asst. Principal
C.     the Diagnostician
D.     the ARD chairperson/ Special Ed Coordinator
E.      the School Secretary
F.      the person in charge of the copy machine
G.     the Speech therapist
H.     the Adapted P.E. teacher (if there is one)
I.       the school Nurse
J.       the school Counselor
K.      the teachers who provide instruction to students you will be seeing
L.      the facilities personnel
M.    the cafeteria workers.
 
Note:  Make it your business to remember names.  Write them down and review before entering the school the next time. Also it is wise to get email addresses of those you interact with frequently.
 
·       Sign in and out at every school so anyone who needs you will know you are there (for their benefit and yours).
 
·        Learn the daily routines of your assigned students, and work together with the teacher(s) to determine when IEP goals should be addressed. If there are several issues represented in the goals, collaborate with the student and teachers on how to prioritize. Ask when problems occur and in what contexts, and then plan to be there at that time and in that place. As you work through priorities and issues with the student and the campus team, be ready to change the day and time you come. Although consistency of day and time is nice, meeting student needs is more important – flexibility is crucial
 
·      The IEP is your guide, and all issues in the IEP requiring support from your service must be addressed.
 
·       Keep the teachers, campus and students informed about when you will make your next visit.  This can be handled in a variety of methods depending on the preference of the teacher (e.g. email, text, phone call).
 
·       Make it your business to check the ARD calendar every time you are on the campus (check with the Diagnostician, the tracking teacher, the clerical person – whoever maintains the calendar for scheduled ARDs). This will help ensure you are not caught unprepared for an ARD.
 
·      Make frequent contact with school personnel to nurture and maintain positive working relationships.  Your interest will be returned!
 


Aug 16
Tips for GETTING ORGANIZED at the start of the school year | School-Based Therapy

Are you ready.jpg
Denice Tucker, OTR
Manager, School-Based Therapy Services, HCDE
 
·         Print a map of the district from the district website to locate
           schools.
 
·         Collect your student “soft” folders and find out where they
           are securely stored.
 
·         Review ARD/IEP information (are current copies of goals
          and objectives, accommodations/modifications, and services page in your
          soft folder?). 
            
·         Determine ARDed service (time, frequency, duration) and check to make sure
           service time in your records matches that on the service page in the IEP.
 
·         If you are a PT, check to make sure the medical referrals for your students are up-
           to-date.
 
·         Familiarize yourself with the student’s current IEP.
 
·         Meet principals, office staff, diagnosticians, and ARD chairperson at your schools
           and provide them with your contact information.
 
·         Meet/e-mail teachers and find out their schedules; find out when the student is doing
           the activity the activity that the IEP is addressing; give them your contact information.
 
·         Organize a personal system to manage documentation, such as a notebook with
           student attendance, student attendance, progress notes, and IEP objectives.
 
·         Locate resources and test materials in your district.
 
·         Observe your assigned students in the classroom.
 
·         Think through intervention strategies and decide how to serve students in context by
           embeding strategies; write an intervention plan. If needed, write a plan for your OTA
           or PTA.
 
·         Pick up referrals that pertain to your schools and know the process to proceed.
 
·         Identify district procedures for securing parent consent.
 
·         Ask about the paper flow in your district.
 
·         Determine how and where to obtain needed equipment. 
 


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Comments
  
  

​Preliminary Telehealth Guidelines

  

​Happy National Occupational Therapy Month!

Check out our useful links.


 

  

​Discusses provision of direct services versus consultative (indirect) services compared to integrated service.


  

​​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 maintaining competency?​

  

​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 therapist.


  

​Evaluation tools for Adapted Physical Education


  

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 Texas education.


  

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 exercise.


  

​Transitioning from caseload to workload.


  

​Screening for sleep deprivation.​

  

​Questioning the "why" behind lack of motivation at school.


  

​When to use standardized assessment tools.