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!

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.
 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!


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




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
·         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-
·         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. 

Aug 11
What is Happening with Sunset Review for OT and PT Licensing?

Jean Polichino, OTR, MS, FAOTA
Senior Director, School-based Therapy Services, Harris County Dept. of Education

new1.pngIt has been a very busy year for those responsible for regulating the practice of occupational therapy (OT) and physical therapy (PT) in our state. The agency that supports the licensing of practitioners from both disciplines, the Executive Council for Occupational Therapy and Physical Therapy Examiners (ECPTOTE, is undergoing the process of Sunset Review by the Texas Sunset Advisory Commission. Every state agency must undergo this process periodically, justifying its existence to commission members who are tasked with identifying and eliminating waste, duplication and inefficiency. The ECPTOTE review was in preparation for the 2017 legislative session, as the Commission must make recommendations to the legislature and governor whether there remains a compelling reason for Texas taxpayers to continue to benefit from licensing OTs and PTs, and if so, whether there are cost-saving measures the state could take in administering the licensing process.

The news regarding ECPTOTE is very good! The Sunset Staff Report issued in April found that licensing of OT and PT practitioners remains an important consumer protection function for the state of Texas. In their report, they identified the following issues that are the focus of their recommendations:
§  The requirement for facility registration, while providing a revenue source for the state, is unnecessary.
§  The PT and OT statutes unnecessarily impede therapists from working across state lines.
§  The PT board’s “process for turning its continuing competence approval program over to the Texas Physical therapy Association is an inappropriate delegation of its governmental duties.”
§  The OT and PT boards should be conducting fingerprint-based criminal background checks of licensure applicants and licensees.
§  The state should continue licensing by the OT and PT boards under the administration of the ECPTOTE until 2029.
Although there were initial thoughts the OT and PT boards might be transferred to a much larger umbrella agency supporting many other boards, they determined that ECPTOTE is efficient and effective in protecting Texas consumers and administering the licensing process for licensees. Transferring the boards would be a costly disruption.
The Texas Sunset Advisory Commission held a public hearing on June 23, 2016 to discuss the report’s recommendations and hear testimony from the public. Subsequently, the commission will make recommendations to the legislature when they convene in January of 2017. For more information about how the Sunset process works and to read the full report, go to https://www.sunset.texas.gov/   

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Jul 21
So You Have Decided to Become a School-Based Therapist!

Melinda McGouldrick, OTR, MOT
Manager, School-Based Therapy Services, Harris County Dept. of EducationWondering woman 2.jpg

For whatever reason, you have decided it’s the right time to change from being a therapist in the hospital, clinic, or skilled nursing facility. You are experienced in your current world, you know the language, you speak in familiar acronyms, and the processes and equipment are familiar and routine. Yes, you educate.  You give home programs, you are involved in discharge planning, and you educate caregivers.

You are ready for change . . . you are making the leap . . . you like working with kids . . .it sure would be nice to be on your own children’s school schedules . . . .It takes a while, but you land a new job in the schools. Wow! 
You know there will be new learning and you are ready. Just know that the change is bigger and there are more differences than you had anticipated.  This is not a bad thing…just under appreciated until you live it. 
You have become comfortable knowing that ROM is range of motion, H&P is history and physical, etc. etc. and you can even read it when a physician scribbles it on his notes. Be prepared, because you will find that the acronyms in the education world are completely different. In the resource section of this website there is a 7 page list of Frequently Used Acronyms and Terms for School-based Practice in Texas.  The only familiar term that you will notice is TBI for traumatic brain injury.  It is a different and rich language. (Frequently used Acronyms and Terms for School-based Practice in TX; TxSpot Resources Page)
Other resources on this website describe the difference between school-based practice and the medical model/clinical focus.  (Comparison of School-Based to Clinic-Based Therapy; FAQ: Clarify school-based v. medical model; School Based vs. Clinical Based Therapy- Region 10 website) The services therapists provide in the school setting are vital components of a therapy world that is serving the 3-21 year olds in our state…we are helping to prepare for their future and in doing so our own futures.  This is not to say you will not continue to consider self-care, mobility, positioning, and the underlying fine and gross motor skills.  Your identity as a therapist who values the facilitation of independence and helping people will continue to be nurtured.  But, as a therapist, it is a mind shift to support.  You will look at the role of others on the team and regard the environment through a different set of lenses.  Among other things you will be supporting literacy and assistive technology, and “UDL” (Universal Design for Learning).  Your goals will no longer be therapy-specific goals, but will be in support of the student’s educational goals within a team plan.  You are now a member of a group whose mission is to help a student be able to receive a free and appropriate education and to participate in his or her educational environment. 
At the most basic level of operations, you have always organized yourself and your personal schedule in regard to work hours.  Now you will think in terms of days.  If you worked full time you had vacation and sick time or PTO or EIB.  In the schools when you are enjoying that winter or spring break or that long summer break with your children, those days are not counted in your “contract” days.  Don’t get me wrong; it is fabulous to not be dealing with hospital holiday scheduling stress.  You will still get personal leave days, but they are counted differently and depend on the school or district in which you work.
Just remember when you are feeling overwhelmed with all the effort and learning and energy that you put into this change…it is all worth it!
I’ve made the switch and you can, too. You’re going to love it! 

1 - 10Next

​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.