RE: School-based therapists

September 10, 2004

You are experiencing a quirk in the details of service provision. The

mandate in the schools is, essentially, to facilitate students' access to

the school system. But that leaves a lot of room for interpretation, and

there are obviously two directions to go.

First, clinicians, used to the clinical environment, see a clinical problem

and envision a therapeutic solution---one that often results in an IEP that

mimics an outpatient treatment plan, e.g. therapy 3X/week. The other

interpretation (you might call it a school-board interpretation) says that

it cannot possibly be a school system's responsibility to ameliorate the

medical/developmental problems of each student, but rather to make

reasonable attempts to facilitate education given the realities of each

student's situation. The two interpretations lead to very different

educational planning.

In our pediatric school-based services we generally play a consultative

role. Whenever possible, aides and teachers are instructed in techniques and

programs. This is far from illegal, and certainly not resultant of someone

trying to " get away with something. " It merely recognizes that a therapy

professional can act in a consultative fashion, and that there are realities

in the payment system---that is to say, it would be crazy to saddle a school

system with correcting all the myriad issues that students bring to the

classroom.

Your school system does seem to be overreacting (especially in regard to

attendance at IEP meetings), but my guess is that they have long been paying

for a clinical, rather than an educational, model of delivery, and the

financial lid blew off. Other providers utilizing a clinical model in the

schools can expect the same in these days of increasing financial pressures.

By the way, in one of the school districts we serve we are working with the

Special Ed Director to remake the delivery system, concentrating our efforts

on early detection of minor delays (at the kindergarten and first grade

levels) through classroom screening, and then incorporating group programs

(for the entire classroom) which can eventually be taken over by teachers.

The hope is that students will benefit, and in the long run, schools will

save intervention dollars.

Dave Milano, Director of Rehab Services

S+SMH

32-36 Central Ave.

Wellsboro, PA 16901

dmilano@...

" Nobody ever forgets where he buried a hatchet. " Hubbard as Abe

, 1930

School-based therapists

I need help from the group concerning legal provision of therapy in schools.

Our school therapists in Missouri are just being told by the school

administrators that they will no longer be providing much therapy, but will

be used primarily on a consultative basis. They are no longer to attend the

IEP meetings or staffings to plan for the IEP. The teachers will be doing

the therapy goals and also providing the therapy and following the

therapists' instructions. According to everything that I have been able to

locate in the state Practice Acts for OT, PT and Speech, this is not legal,

but the schools seem to think that they can get away with it because the

therapy is for " educational purposes " . The students that are receiving the

therapy are not mildly involved, but very severe, with serious spasticity

and tone issues, among other things. I would appreciate any input that

anyone can give me concerning this. Thanks everyone.

Diane P. Pickel, OTR/L

President

Therapy Associates, LLC

11900 W. 87th St. Parkway, Suite 200

Lenexa, KS 66215

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September 10, 2004

Diane,

This is often a difficult situation. As you know the schools will often

try to do the MINIMUM required by IDEA. Many schools that I have worked

at or been associated with try to do this until a parent slaps a law

suit on them for denying appropriate therapy services.

There are often broad interpretations of IDEA. Get to know it and know

it well. Also, remember that in the school setting, we are part of a

team which is supposed to form IEP goals together and decide whether PT,

OT & SLP are educationally necessary for the student. That team,

according to IDEA, must make the decisions together. If the school is

excluding you from the IEPs or other multi-disciplinary team meetings,

you should at least have your PLEP and goals presented for you by the

teacher. I worked at a school where the admin. Did not want us wasting

our expensive time at the meetings so, they asked us to submit our PLEP

and goals to the teacher beforehand and, generally, the teachers were

very pro-therapy. This worked out well.

In another instance at another school, all therapists were excluded from

the meetings and the goal making. That sped director didn't last long

(she was gone the next year).

As a contracted person, I believe we are responsible for educating the

administrators as well as promoting our profession. Just some thoughts

and ideas that will hopefully make your life easier. Your problems are

shared by many! I hope to see more responses on the listserve.

Chad Yoakam, MS, PT

Chad W. Yoakam, MS, PT

Manager of Rehabilitation Services

Livingston HealthCare Orthopedic and Rehabilitation Institute

School-based therapists

I need help from the group concerning legal provision of therapy in

schools. Our school therapists in Missouri are just being told by the

school administrators that they will no longer be providing much

therapy, but will be used primarily on a consultative basis. They are

no longer to attend the IEP meetings or staffings to plan for the IEP.

The teachers will be doing the therapy goals and also providing the

therapy and following the therapists' instructions. According to

everything that I have been able to locate in the state Practice Acts

for OT, PT and Speech, this is not legal, but the schools seem to think

that they can get away with it because the therapy is for " educational

purposes " . The students that are receiving the therapy are not mildly

involved, but very severe, with serious spasticity and tone issues,

among other things. I would appreciate any input that anyone can give

me concerning this. Thanks everyone.

Diane P. Pickel, OTR/L

President

Therapy Associates, LLC

11900 W. 87th St. Parkway, Suite 200

Lenexa, KS 66215

fax

This e-mail may contain confidential and/or privileged information. If

you are not the intended recipient (or have received this e-mail in

error) please notify the sender immediately, destroy/delete all copies

of this e-mail & any attachments. Any unauthorized

copying/disclosure/distribution of the material in this e-mail is

strictly forbidden.

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association.

Join and participate now!

September 10, 2004

Thanks so much for your input. We have gotten great help from others as well.

The bottom line, I'm sure, is money. Our therapists are working hard at

communicating with the parents at this point. I don't think the parents realize

this is happening, and that their severely handicapped students will not be

getting therapy from a professional therapist. Hopefully, we can change this.

At one school, the administrator is a former SLP, so I know this is not coming

from her.