educational setting. Furthermore, when a therapist is in a school setting, he/she must write goals which are “educationally relevant.” Therapists in the schools have different roles than those in outpatient clinics. It’s our job to assist students to function in their regular and special education classroom.
There are times in a school setting when the therapist is “consulting” or providing helpful suggestions based on observations and data. The purpose of the consultative model is to identify and collaborate with school staff/resources to provide suggestions and ways to modify the environment/situation for optimal success. The suggestions are meant for improved functional skills in the classroom, during transition times, with center times (for younger students), for planning/organizing, with grip on pencil or scissors, or for visual-perceptual work. The therapist is working with the people who teach the student, the aide or other staff, but not directly with the student when doing consultation. Additionally, when a therapist is working on goals for carry-over, he must ensure the staff working with the student is well-trained.
Another model for providing therapy is by direct service. When a therapist is performing direct services, he/she is working with the student to learn new skills and this usually takes place in the therapy room or quiet area of the classroom. The therapist is using hands-on techniques and focuses solely on the student’s needs and goals. For example, when working on pencil grip, the therapist may be using putty with small objects placed inside to increase hand strength. Next, they practice using the appropriate pre-writing strokes of forming lines. This is not taking place with the other students in the classroom since the student needs to focus and receive the therapist’s individual attention. However, a therapist may have other students in a small group with their targeted student. This is often the case when a speech-language pathologist is working on social skills training.
Some districts use integrated service models. This means that therapists are working hands-on with the student among her peers in her natural environment. The individual student is receiving services to improve functional/ academic skills and achieve goals in the targeted area of weakness. Here’s an example: the OT may be working on cutting with the student while she’s at center time with her peers.
It is important to note whether a therapist is performing consultative or direct services, because she must always take data on the student’s progress to provide necessary information for IEP goal monitoring. Additionally, law mandates that IEPs be reviewed annually and/or at least every three years. The student must receive services in the least restrictive environment. It can be confusing for caregivers to know what may qualify for school therapy services, so please consult your individual therapist or your district or state regulations. They can usually be found on the district’s website, but it’s your right to know these regulations, so ask for a copy.
What Are Some Signs My Student May Need Therapy?
There are many strategies wonderful teachers use with all students or those who may show signs of struggle that are not part of an individualized education plan. They are called “pre-referral interventions.” Schools have been using different approaches to use research-based instruction. Response to Intervention (RTI) is a multi-tiered approach divided into three support levels and the intensity increases with each level. Visit the site: www.rtinetwork.org for information. The site is extremely helpful and explains RTI in clear terms.
Other pre-referral interventions may be done. They may include something such as posting a visual schedule of the school day on the board or copying tests onto only one side of the paper. Often times, after a parent/teacher meeting, the team may agree that some minor changes in school or at homework time will work well. When common strategies have been tried and failed, it may be time for some extra help from a therapist. Please document the things that worked well for your student; did not work well; behaviors the student had when you tried the strategy; or questions you have.
Look for the following signs in different areas where a student may benefit from skilled therapy intervention.
• has more difficulty than other children with self-care activities such as: tying shoes, getting jackets on/off, toileting, set-up or clean-up of lunch;
• avoids or refuses to complete center craft activities;
• exhibits behaviors that are not age appropriate when doing independent work (tantrums, making loud noises with mouth, getting up frequently to sharpen pencil during the time allotted);
• does not initiate speech or social interactions with other students;
• cannot re-tell a story or provide details after reading a passage;
• has difficulty navigating stairs, gym class, and hallways;
• cannot transfer from place to place without falling;
• avoids learning new skills and skills in the classroom;
• has difficulty walking in line or being close to children;
• does not participate in recess and gym activities;
• has difficulty organizing desk and homework materials;
• demonstrates increased difficulty copying work from the board;
• forgets assignments or seems disorganized;
• difficulty with handwriting, using a pen/pencil, forming letters and numbers, forming cursive letters;
• has trouble with the use of tools such as scissors, hole punchers, staplers;
• demonstrates frequent tantrums when tasks are difficult;
• places objects in mouth frequently such as clothing, classroom items, toys;
• has difficulty with following commands or classroom routines;
• does not know left from right;
• avoids getting messy with items such as glue and paint;
• difficulty sitting still and seems in “constant motion”;
• has trouble making friends;
• seems to get lost easily in the school building or when transitioning between activities;
• difficulty playing independently at recess or reckless/impulsive behavior;
• difficulty maintaining upright posture in her chair or during circle time;
• has visual-spatial trouble.
The list above is not exhaustive, but is meant to show examples of what difficulties a student may have. Remember that there are many variations in the time each child acquires skills. For example, if a child has a condition affecting his development, there may be a discrepancy between his actual age and his functional age levels. For example, it is important to note if a particular child is performing academic work well beyond his age expectations, but needs extra help to make friends or remember classroom routines.
Difficulty with activities of daily living (ADLs) are often an indicator of the need for additional therapy. Things such as re-dressing after toileting, blowing nose, opening/closing containers, using toilet, washing hands, opening/closing doors, putting on/taking off jacket, managing backpack, walking, navigating stairs
