of California

1
of California
Brown Bag Lunch Series A statewide training
series on health and policy topics affecting
children and youth with special health care
needs. This series is geared towards diverse
stakeholders including families, youth,
professionals, parent-to-parent staff and
advocates.
The voice of families the vision of quality
health care the future for children and youth
with special health care needs
2
Family Voices of California is locally based,
nationally connected A statewide collaborative
of locally-based parent run centers working to
ensure quality health care for children and youth
with special health care needs. As the State
Affiliate of National Family Voices, we are
Californias federally funded Family-to-Family-He
alth-Information-Center providing statewide
support to families of CYSHCN. For more info,
visit www.familyvoicesofca.org
3
  Family Voices of California  (FVCA) strives to
present families and professionals with a wide
range of views and options in its materials and
trainings.   The materials and trainings are not
necessarily comprehensive, are not meant to be
exhaustive, nor are they an endorsement of the
author and/or presenter.   If you would like to
offer feedback or if you know of additional
resources, speakers and/or materials that may be
helpful, please do contact us at
www.familyvoicesofca.org
4
Access them anytime.

• To see one of our archived webinars, or join an
  upcoming one, visit our website.
• All PowerPoints materials posted online
  following the webinar.
• www.familyvoicesofca.org
• Margaret Mary Finn
• mfinn_at_familyvoicesofca.org

5
Educationally Related Occupational and Physical
Therapy Services
California Childrens Services

• Family Voices of California Webinar
• October 3, 2012
• Carol Cohen, Parent Health Liaison, FRN Alameda
• Pat Louie, Assistant Chief Therapist, CCS Alameda

6
How can my child qualify for Occupational or
Physical Therapy

• The question to ask is NOT Does the student
  qualify for OT or PT in school?...but rather
  Is an occupational therapists or physical
  therapists skills and expertise a necessary
  component of the students educational program
  in order for him/her to achieve his/her IEP
  goals?

7
Related Services

• In order to receive any related service including
  physical and/or occupational therapy in the
  school setting a child must be found eligible for
  Special Education in any of the 14 categories
• When a child is found eligible for Special
  Education services, the IEP team will determine
  what additional services a child will need.
  Related services should enable a child to
• Make meaningful progress towards meeting their
  annual goals
• Be educated in the least restrictive environment
• Make progress in the general education
  curriculum

8
Rules of the IEP Process
Educational Benefit
Placement
Goals
Assessment and Eligibility determination
9
Assessments

• Establish a childs need and must be as complete
  and accurate as possible.
• Should be completed in all areas of a childs
  suspected disability.
• Documentation of all the childs needs is
  absolutely essential.

10
Goals

• Goals establish reasonable expectations of how
  much your child will progress. Think in terms of
  where you want your child to be at the end of the
  year.
• If goals are set too low, services can be set
  very low.
• If goals are set too high, a child may not have
  success
• If goals are reasonable, yet a child is NOT
  making adequate progress, you have a reason to
  request additional services be put in place

11
Placement

• Description of all services and supports that are
  needed as well as WHERE a child will receive
  these services. Placement should include
  everything that is necessary for a child to have
  a reasonable chance of achieving his or her IEP
  goals

12
How are OT and PT defined by IDEA?

• Occupational Therapy services must be provided by
  a qualified occupational therapist and include
• Improving, developing or restoring functions
  impaired or lost through illness, injury or
  deprivation
• Improving ability to perform tasks for
  independent functioning when functions are
  impaired or lost
• Preventing through early intervention initial or
  further impairment or loss of function
• Physical Therapy means services provided by a
  qualified physical therapist
• Note this is all that IDEA says about
  educational PT

13
What is Educationally Related OT?

• According to the American Occupational Therapy
  Association (AOTA), OT is concerned with a
  persons ability to participate in daily life
  activities or occupations. In the school
  setting, an OT
• Uses their expertise to help children to be
  prepared for and perform learning and school
  related activities and to fulfill their role as
  students.
• Supports academic and non-academic outcomes,
  including social skills, math, reading, writing,
  recess, sports participation, self-help skills,
  and prevocational/vocational participation for
  children and students with disabilities, 3-22
  years of age.
• Is skilled in facilitating access to curricular
  and extra-curricular activities for all students.
  
• Trains parents, staff members, and caregivers in
  educating students with diverse learning needs

14

• The School Occupational Therapist works with
• Students to improve their performance in a
  variety of learning environments (e.g.,
  playgrounds, classrooms, cafeterias, bathrooms)
• Parents to help them support their childrens
  learning and participation in school
• Educators and other school support staff to
  plan and develop activities and environments that
  include all students
• Para-educators to support child success and
  promote child safety within the school
  environment (e.g., physical and behavioral
  assistance needs)
• Administrators to provide training for
  student, staff and parents, as well as to
  recommend equipment for schools and ways to
  modify existing classrooms, buildings and
  curriculum

15
What is Educationally Related PT?

• According to the American Physical Therapy
  Association (APTA), physical therapy services
  support the educational team and help the student
  perform successfully in school.
• Physical therapy addresses the ability to move
  parts of the body, assume and maintain postures,
  and organize movement and functional gross motor
  skills.
• The PT works with students to build strength and
  endurance for functional mobility (e.g., climbing
  stairs, opening doors, mobility in and about the
  school, carrying materials, accessing the
  playground, participating in field trips and work
  experiences).

16
OT and PT are Designated Instructional Services
(DIS) under IDEA

• DIS shall be available when the instruction and
  services are necessary for the child to benefit
  educationally from his or her instructional
  program.
• To receive any DIS a child must be identified as
  having a disability under IDEA.
• California Ed Code, Section 56031 defines DIS as
  special education. In California, therefore, a
  child who has been determined eligible for
  special education may have an IEP that contains
  DIS as the only special education service
  provided, if an assessment demonstrates such
  therapy is needed.

17
PT and OT under Section 504

• A child who has a disability as defined under
  Section 504, but who does not meet eligibility
  criteria for an educationally disabling condition
  under IDEA may still be eligible to receive
  federally defined related services pursuant to a
  504 plan
• An OT or PT may be involved in providing
  accommodations to the educational environment
  and/or curriculum. Such accommodations may
  include
• Accessibility to classrooms, schools, rest rooms
  and transportation
• Provision of simple adaptive devices such as
  pencil grips, specialized tools and lap trays
• Adaptations for written communication
• Positioning or meeting specialized health care
  needs
• modifications of assignments and curriculum

18
Indicators for Educationally Related
Occupational Therapy Referral

• Difficulty in learning new motor tasks
• Poor organization and sequencing of tasks
• Poor hand use (including writing and tool use)
• Difficulty in accomplishing tasks without the use
  of adaptive equipment, environmental
  modifications or assistive technology
• Unusual or limited play patterns
• Deficits in adaptive self-help or feeding skills
  in the educational setting
• Poor attention to tasks
• Notable overreaction or underreaction to
  textures, touch or movement

19
Indicators for Educationally Related Physical
Therapy Referral

• Delayed Gross Motor skills
• Difficulty in learning new motor tasks
• Unusual walking or movement patterns
• Difficulty in moving or moving unsafely in the
  school environment
• Difficulty in maintaining an appropriate sitting
  posture
• Poor balance or falling frequently
• Difficulty in accomplishing tasks without the use
  of adaptive equipment, environmental
  modifications or assistive technology
• Postural or orthopedic abnormalities
• Reduced endurance or fatigue

20
Requesting an Evaluation

• A parent should request in writing that they
  would like their child evaluated for Occupational
  and/or Physical therapy. In the letter, request
  prior written notice if the district plans on
  denying the request.
• A district may not require an Adaptive Physical
  Education (APE) assessment or services before
  referring for an assessment by an OT or PT. A
  child does not need to fail in APE before an
  evaluation is offered. They are different
  services.
• A district cannot require that the child be first
  evaluated by California Childrens Services prior
  to a district evaluation.
• Only a Licensed OT or PT can assess a child for
  services, or determine educational need.

21
Levels of Service

• Direct services (either group or individual)
• Consultation to staff and/or parent
• In some cases services may be provided by a
  special education teacher (especially if they are
  OI credentialed) or by the adapted physical
  education (APE) specialist if it determined the
  child does not require the expertise of a
  physical or occupational therapist to to receive
  educational benefit
• On the IEP, therapy services should be specified
  for type (individual or group), level, duration
  and frequency, not as needed.

22
Adapted Physical Education

• Credentialed APE specialists have training in
  basic body mechanics, kinesiology and other
  medically oriented subjects that assist in
  teaching the basic concepts of movement, speed,
  force, rhythm, complex motor skills and
  sequences, play and leisure skills, and social
  and group interaction skills. APE can augment OT
  or PT services

23
Orthopedically Impaired Credential

• It is recommended that children with severe
  orthopedic impairments have a teacher with an OI
  credential as their case manager. OI teachers
  have expertise in collaborating with medical
  professionals and in adapting equipment. They are
  trained in augmentative communication and
  assistive technology. They are also able to
  provide APE, positioning and seating adjustments,
  and sensory integration activities.

24
California Childrens Services (CCS)

• CCS provides medically necessary PT and OT
  through the Medical Therapy Program (MTP).
  Therapy must be prescribed by a CCS approved
  physician. Active therapy services and
  prescriptions are reviewed every 6 months.
• Eligibility for CCS services is limited to
  children ages 0-21 with specific neuromuscular,
  musculoskeletal or muscular diseases such as
  cerebral palsy or muscular dystrophy. Please
  visit the CMS website for more information.
  http//www.dhcs.ca.gov/services/ccs/Pages/MTP.aspx
  
• Children under three years of age may be served,
  if they are at risk and show signs that they may
  have an eligible condition, but dont yet have a
  clear diagnosis. A medically eligible condition
  must be diagnosed by age three in order to
  continue to receive services.

25
California Childrens Services (CCS)

• The IEP team determines where to record CCS
  therapy services.
• Frequency and duration of CCS services should be
  recorded on a childs IEP
• For more information on recording CCS therapy on
  the IEP, see this publication www.disabilityright
  sca.org/pubs/512401.pdf

26
Can a child receive therapy from CCS and the
school district concurrently?

• School district therapy must be educationally
  necessary and CCS therapy must be medically
  necessary, so it is possible to receive services
  from both.
• School therapy services can not duplicate or
  conflict with the CCS therapy plan. Goals and
  objectives from the CCS and school district
  therapists must be different.

27
For example

• If a CCS Occupational Therapist is working on
  self-feeding and dressing, and the school
  district OT is working on keyboarding and
  handwriting skills needed to complete school
  work, this is not a duplication.
• If the CCS Physical Therapist is working on
  balancing on one leg and lifting the opposite
  foot to step over a threshold, and a school
  district PT is working on balancing on one leg
  and lifting the other to kick a ball, this is a
  duplication of services as both therapists are
  working on the same muscle groups and movements.
• Please visit the CMS website site earlier to view
  CCS Numbered Letter 11-1600.

28
Other options for therapy

• Request a physical or occupational therapy
  evaluation referral from your childs
  pediatrician. If your child is not eligible for
  CCS, but still has a medical need for therapy
  your insurance may agree to provide this service.
  If denied the evaluation or recommended therapy,
  you may need to file for an independent medical
  review through Department of Managed Care or
  Department of Insurance, depending on your
  medical coverage.

29
Medi-Cal

• For children with Medi-Cal, therapy services may
  be covered through EPSDT (Early Periodic
  Screening, Diagnosis and Treatment).
• EPSDT provides medically necessary and
  ameliorative supplementary medical services
• Visit this site for more information
  www.dhcs.ca.gov/services/Pages/EPSDT.aspx

30
Beyond Therapy

• There are many opportunities for children to
  develop physical skills outside of a medical or
  educational setting.
• Your child can participate in a special needs
  programs like E-Soccer, Challenger Little League,
  or wheelchair basketball. Also look for inclusive
  programs offered by local recreation departments
  or at private gymnastics, swimming, yoga or
  martial arts programs.

31

• Fine motor skills can be worked on in arts or
  music programs. Many programs are open to all
  children if requested, and offer your child a
  chance to gain appropriate social skills with
  typically developing children. Dont be afraid to
  ask if your child can be included.

32

• Therapy doesnt just happen with a therapist. If
  your child is receiving therapy, continue
  activities at home by requesting a home therapy
  program.
• Many exercises can be completed with low cost
  items or things you might already own.

33
Sources and Resources

• Guidelines for Occupational Therapy and Physical
  Therapy in California Public Schools CDE, 1996
• A Composite of Laws, www.cde.ca.gov
• Special Education Rights and Responsibilities,
  CASE and DRC www.disabilityrightsca.org
• Family Resource Network Alameda, Recreation list
  available by download at www.frnoakland.org
• Get help with insurance from Office of the
  Patient Advocate [phone] www.opa.ca.gov
• Medi-Cal Managed Care Ombudsman [phone]