School-Based Occupational Therapy

Welcome to Part three of the school based occupational therapy

case study involving Jessica.

Part three isn't look at the O.

T process within the school system from start to finish

or no look at evaluation, intervention, planning, discharge within the

school system as well as challenges that came up in

this case.

A lot of different components go into making an evaluation.

There's gonna be a variety of assessments.

Specific documentation as well is forming an I P.

Part to really look at assessments.

For Jessica, you went over standardized assessments, informal interviews and

observations. So let's briefly review what we learned.

As for standardized assessments, we decided that the Dash three,

the S F A in the universal School function tool,

where the best assessments to give us a good idea

of her abilities as well as her areas of concern.

And then we had informal interviews as well.

We interviewed her parents, caregivers, teachers Perez and Jessica herself.

The parents and the caregivers are really important to interview

because they know the student the best they were gonna

have their own areas of concern as well is golden

with the students to work on.

And then you also want to introduce yourself and explain

what you do, so you gain their trust.

Next, the teachers and Perez you really, really, really need

to gain their trust because they're going to be the

ones implementing therapy ideas such as modifications and adaptations.

They're gonna help Jessica access release restrictive environment and then

talking to dress herself is super important because she has

her own wants and needs an autonomy.

And she's has a say in her therapy as much

as she can.

And last but not least, we have observations always really

important to observe a student in their natural environment.

It just in case that they may act differently or

do things differently than you would see in the therapy

room. Do you want to see them in their classrooms?

Whether that be their general education classroom, P e music

art, see them in the cafeteria as well as recess.

It's going to give you a better idea of their

motor skills, social skills, emotional skills, things like that.

Yeah, now, the next we have documentation evaluation documentation is

really gonna bury by this school that you're working at

here at ABC Middle School.

We have a form on Google Drive that we fill

out for documentation and then I gets filed away.

I'm not gonna go into every specific component of documentation

just for the sake of time.

But just know that most all evaluation documents have to

have information about the student assessments and the information you

got from the assessments, referral information and then recommendations and

whether you think there appears appropriate or not.

And if it is appropriate, what the recommended degree would

be like, how much therapy that the student would need

and the next we have i E.

P's, I eat peas or individualized education plan, and every

student within the school system that receives special education will

have an I.

P. This ensures that all team members are working on

the same goals to ensure that the students making progress

and able to access their education the way that they

need again.

I'm not gonna go into every little detail for the

I P, but just know that with Jessica, she has

her general education teacher, her resource room teacher ot PT

speech and in division therapist.

All of these different team members are gonna have their

own areas of concern on the I P that they

want to be working towards.

And they also have to list ways that they're going

to help intervene with these areas of concern, whether that's

an accommodation modification or even a specific goal.

Nice. Let's look at intervention planning for Jessica So interventions

or how we're addressing those areas of concern that were

listed on her i e.

P. Protea specific.

We decided that dress cut needs to work on fine

motor skills, self care skills, communication and accessibility, safety navigating

her environment.

And then we also believe that we need to educate

other team members to make sure we're on the same

page. And there's a lot of different components that went

into us deciding on what interventions were appropriate for her.

And let's look at how we decide on those first.

We need to decide on an intervention approach, and this

is what really drives your plan.

You should be familiar with these four different intervention approaches.

We decided that modify and adapt is inappropriate approach for

Jessica because she needs to modify a lot of the

fine motor, gross motor and communication skills that she needs

to access her education preventing maintains also an important approach

to keep in mind because with her spasticity in her

upper extremities, we want to make sure that she means

taints that range of motion so she can still access

her environment and prevent it from getting worse.

Next, we have evaluation results and everything that we got

from those assessments and observations and different interviews are gonna

hope determine what interventions we want to use with Jessica.

So from the standardized assessments, we learned that Jessica has

age appropriate academic skills.

She's very brilliant, and she's just not able to verbally

communicate that, like other students are.

She's able to say yes and no on her iPod.

Um, she does require assistance with nearly all of the

tasks that she has just do to her limited range

of motion and strength and communication skills.

And then we also realize that her I gay system

shows some promise.

But it is a little bit more tedious than her

iPad just because with her third nerve palsy, it affects

one of her eyes working normally like the other one,

so her eye gay system has to be recalibrated every

time that she uses it.

I've been looking at the results we got from the

observation and informal interviews.

We learned that just because of really motivated and social

girl she loves being at school, loves being around her

friends. And you can tell because she makes a lot

of vocalizations.

And whenever she's around her friend, she just seems really

happy. You can tell by observing her.

She has a lot of high tone in her upper

extremities. She does have safety concerns using her power wheelchair

by yourself.

She thinks that's funny to run over people or bump

into them.

She doesn't always navigate around obstacles as efficiently as she

should, and sometimes doesn't ride straight down the hallway and

could bump into the wall.

And then also from her interviews with her parents, We

learned that she's just dependent for all self cares, which

is going to be important to know whenever she's at

school for eight hours a day.

Next we have those III people's that we talked about

and every team member is gonna have their own goals,

other working on based on the areas of concern.

So for O.

T, we made a goal for fine motor and self

care PT is safely navigating the environment in speeches doing

a communication function goal.

That doesn't necessarily mean we only have to work in

our goal, but we have to keep in mind.

That's what we're monitoring and wanting to make progress on.

And then documentation specific to intervention is a little bit

different, depending on the student.

So Jessica is eligible for Medicaid and receives Medicaid benefits.

And Medicaid specifically wants us to document our daily notes

saying exactly what we did with the student relating to

back to the idea people and how the student responded

to it.

For students that aren't on Medicaid, we would give a

little bit more information, such as things that may have

went wrong or different the environment.

Talking to teachers, educating other team members but medications a

little bit.

More specifics.

That's how dress it has.

Notes are written, then progress notes are written every quarter,

so every nine weeks, and we just summarize all the

progress I just cause made within those nine weeks in

that note.

So those four components really helped contribute to how we

planned Jessica's intervention and how we're gonna address those areas

of concern that were determined during evaluation and next we

have discharge.

So discharge in the school based setting is going to

be different than a clank based setting in a clinic

usually just discharged a ninja vigil whenever they have quote

unquote got better or method goals.

And in the school system, it's a little bit different

and a little bit harder.

Just to discharge your student from service is there's a

few different ways to determine if a student is still

eligible for service is on first, being an eye renewal

that's on every 12 months.

So all those team members involved in the IAP during

evaluation are going to reconvene in 12 months.

Um, see if there was progress made towards their goal

if they need to make a new goal, or if

a therapy is still appropriate for that student or not.

And then re evaluations were done every three years here

at ABC Middle School.

It may change based on students at other school districts,

but every three years is how we do it here.

This is when you do a whole new reevaluation with

the student, whether it's assessments, those informal interviews and observations,

just get another picture to see if there's any other

information you're not seeing on your day to day therapy

treatments and then transition planning within the school system begins

around age 14.

This is when we start to take into consideration what

the students gonna do after they graduate from high school,

whether that's gonna be going onto in higher education, entering

the workforce and finding appropriate employment for them, or even

other adult service's that they would need after graduation.

So that wraps up the OT process from start to

finish within the school system.

As you can tell, it's really individualized to the student

and some challenges that arose during this case study.

Um, I kind of broke it down into two different

sections. First, being challenges relating to a student with CP

as well as challenges in the school setting itself.

So challenges working with the student with CP.

Um, it's really difficult when you can tell that a

student is cognitively and mentally there, and they just can't

verbalize or show you exactly what they want or need.

Um, this was both limited by her spasticity as well

as her communication deficits.

So it was difficult, always trying, Teoh see what was

important to Jessica and making sure she has autonomy.

It's really important to make sure she has that I've

had near her so she can answer yes, no questions

and making sure that she's agreeing with everything that you're

doing and just making sure that she's being heard.

So that was the most difficult thing with, um, working

with a student of CP and then challenges within the

school setting.

In general, um, school schedule changes whether there is a

snow day or there's a field trip for the students

sick. You just kind of have to adapt to the

schedule some of his students not there that day or

they have outside activity.

You try to reschedule the best you can and a

different day.

But, I mean, you have a full caseload.

You have students, sometimes at several different schools.

Sometimes you just have to be really flexible with the

schedule of the school.

And then the most challenging thing within the school setting,

I believe, is working towards educational goals.

So we're like in a clinic o T.

What they would be able to make goals based on

range of motion and strength and endurance.

But in the school setting, everything has to really back

to education.

You can still address range of motion and strength, but

you have to make sure that you're addressing it because

it's limiting their access to education.

School-Based Occupational Therapy

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