How to decide when and how to provide OT or PT?

In making a decision to provide either occupational or physical therapy within the school environment, IEP teams must ask the following questions:

• •   What does the child need to learn?
• •   Which strategies facilitate this learning?
• •   Does the child require the expertise of an OT or PT to achieve the educational outcome through the implementation of these strategies?
• •   How should intervention be provided (i.e., direct or consultative model)?

Many times, physicians and other service providers who have worked with the child make specific recommendations for therapy. These recommendations need to be considered, but decisions must be made in the context of the child's educational needs. Therefore, the IEP may not always reflect the amount of services recommended if some of these are not related to the child's educational needs.

Using information available in the diagnostic summary, IEP teams need to decide what services and level of services are needed. Many routine classroom activities directed by teachers and paraprofessionals help develop a young child's fine and gross motor skills (cutting with scissors, playing games with balls or bean bags, drawing, etc.). Sometimes these routine activities, without the aid of an OT or PT, may be sufficient to meet the child's needs. In some cases, the team may determine that an OT or PT may need to provide consultation so that a teacher or paraprofessional can more effectively implement strategies to improve the child's motor skills that relate to the educational needs.

In other cases, the team may determine that a child's needs are such that he/she really needs direct therapy from an OT or a PT in order to implement the IEP goals and objectives because of the level of expertise required. If direct OT or PT is shown as the service on the IEP, it needs to be provided by that professional. Also, the code of ethics for each of these professions needs to be followed in terms of roles and levels of supervision. In any case, it is very important that the IEP clearly indicates how services will be provided, (consultation, group, individual) so that the parents and all members of the team know who will be doing what. This can be summarized in a narrative fashion or by specifically listing these types of related services.

Sourced from

Dunn, W., Brown, C., & Duigan, A. (1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 48(7).

Hanks, B., & Place, P. (1996). The consulting therapist: A guide for occupational and physical therapists in schools. San Antonio, TX: Therapy Skill Builders.

Virginia Department of Education. (1991). Handbook for Physical and occupational therapists working in school settings.