School Based Therapy Frequently Asked Questions

1. Who may provide OT and/or PT?
Only a licensed OT including licensed OTAs under the supervision of an OT, may provide therapy. Other educational professionals and paraprofessionals, such as instructional assistants may, at the discretion of an OT or PT, carry on the recommended activities following training by the OT or PT. Consultation and monitoring by an OT or PT is necessary under all circumstances. For additional information, see Guidelines for Occupational Therapy and Physical Therapy in California Public Schools (2012), appendix 5.1.

2. When is a referral for an OT assessment appropriate?
A referral for OT is appropriate when a child is not able to participate in the educational curriculum at the expected level of ability, when modifications and accommodations have not been effective, and when the areas of concern are in the domain of OT practice. For additional information, see appendix 7.4, “Sample OT and PT Referral Form.”

3. Does an assessment to determine the need for OT need to be completed by a licensed OT?
Yes. No other service provider possesses the same licensing, qualifications, educational background, or training. Note: A PT may conduct an assessment in accordance with the referral without a specific medical diagnosis. Although a referral for PT can come from any source, a PT cannot perform treatment intervention without a diagnosis from a physician or other duly licensed practitioner. For additional information, see Chapter 5.

4. May a district require an adapted physical education (APE) teacher to do an assessment before an OT or PT evaluation is considered?
No. A District may not require an APE assessment or APE services before considering an assessment by an OT or PT.

5. If it has been determined by a physician or an outside agency that a child may benefit from OT, is the LEA responsible for providing these services?
No. However, an IFSP/IEP meeting should be held to review the outside report and determine if additional supports and/or services are necessary for the child to benefit from his/her educational program. Whenever OT services are considered, those professionals with the qualifications should attend the IFSP/IEP meeting. An IFSP/IEP team in the LEA must determine whether a child requires occupational therapy or physical therapy in order to benefit from the instructional program. The LEA is not responsible for OT and/or PT unless it can be demonstrated that the child has an educationally related need that only OT or PT (or both) can address.

6. Do OT assessments determine that the child meets eligibility as an individual with exceptional needs?
No. The need for OT and/or PT alone does not make a child (based on the eligibility criteria) qualified to be considered an individual with exceptional needs. The IEP team determines eligibility for special education on the basis of assessments in all areas of a suspected of disability (5 CCR § 3030).

7. When does a child receive OT as a related service?
The IEP team determines that OT services are included as a related service when assessment results show an educational need that only OT can address. A child’s diagnosis or disability alone does not indicate a need for therapy. However, the team considers the potential impact of the disability on the child’s education.

8. How are the amount and mode of therapy service provision determined in an IFSP/IEP?
If the child is determined eligible as an individual with exceptional needs, goals are developed. The IFSP/IEP team determines which team member(s) has the expertise to achieve desired outcomes. If it is determined that OT is appropriate to meet the identified goal, the OT, based on professional frameworks, determines the methodology, intensity, and frequency of therapy required for the child to meet the identified IFSP/IEP goal(s). OT or PT or both services may include direct services (individual or small group) and/or a consultation to the IEP team.

9. Are there any regulations prohibiting a school district from providing OT services to a child without special education eligibility?
No. There are no federal mandates prohibiting the provision of OT services to a child without special education eligibility.  Each LEA makes a determination to provide OT based on the child’s needs. OT can be provided as a related service under IDEA 2004. However, some school districts provide OT as an accommodation under Section 504 of the Rehabilitation Act of 1973 and then develop a 504 Plan.

10. What does IDEA 2004 require regarding the least restrictive environment as it relates to the provision of OT and PT services in public schools?
IDEA 2004, Part B, requires “that to the maximum extent appropriate, children with disabilities…are educated with children who are not disabled” (34 CFR § 300.114(A)(2)(i)). There is a requirement to educate special needs children with children who are not disabled to the maximum extent possible. The “least restrictive environment” clause in the law was aimed at preventing a school from segregating
students with disabilities from the general student body. The IDEA explicitly states that mainstreaming is not appropriate “when the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily” (20 USC § 1412(5)(B)). The goal and intent of OT and PT as related services is to support a child’s ability to participate and be successful in the least restrictive environment. Services are provided in a setting that best meets this

11. What is the intent and meaning of the term “natural environment” in IDEA 2004 Part C?
“To the maximum extent appropriate, early intervention services are provided in natural environments, including the home, and community settings in which children without disabilities participate (34 CFR § 303.12(b)).” The IFSP must contain “A statement of the natural environments in which early intervention services will appropriately be provided, including a justification of the extent, if any, to which the services will not be provided in a natural environment;” (20 USC § 1436(d)(5)). By definition, natural environments mean settings that are natural or normal for the child's age peers who have no disabilities” (34 CFR § 303.18). This includes a variety of settings, including but not limited to, homes, community parks, and recreation family program settings, community toddler preschool and early intervention programs, baby gyms, and playgrounds.

12. If a child is receiving medically necessary therapy from CCS, may he or she also receive therapy from the LEA?
Yes, a child may receive OT from an outside agency such as CCS and still qualify for OT as a related service through the LEA if therapy is educationally necessary (2 CCR § 60325(e) and (f)).

13. Why does an LEA determine whether therapy is educationally necessary or medically necessary?
The federal regulations do not differentiate between medically necessary and educationally necessary therapy. The law mandates that a referral to the LEA for an assessment of gross and fine motor skills shall be considered by either the LEA or by CCS, depending on the information contained in the referral and the pupil’s documented physical deficit pursuant to Section 7572 of the Government Code. In California, CCS is
obligated to provide therapy under the Interagency Responsibilities for Providing Services to Handicapped Children for children who are determined to be medically in need of therapy services and meet CCS criteria (2 CCR § 60310). Children may have medical and/or educational needs related to OT services. Educational needs are determined at the IFSP or IEP meeting. Medically necessary therapy is determined by CCS, and a determination must be made by the LEA as to whether additional educationally related OT is also necessary. If therapy is needed for the child to benefit from his education, it is the responsibility of the LEA to provide it.

14. How do children with mental health needs obtain services in the public school setting?
Children with mental health needs may obtain services through the early intervening services such as Response to Intervention approaches in general education as well as through the special education process. Referrals for mental health services are made by the school psychologist. There are two eligibility requirements that must be met for children to receive mental health services at school. The child must be eligible for special education, and the child must need mental health services in order to benefit from special education.

15. Is it necessary that each child who has been assessed and determined to need help in gross and fine motor skills development receive occupational therapy, physical therapy, or adapted physical education from a specialist?
No, not every child with gross motor and fine motor needs will require special services. The IFSP or IEP team makes the determination of the appropriate strategies and services based upon the identified needs of the child. In some cases, the general education or special education program can meet the child’s needs. In other cases, children will need direct services or consultation (or both).

16. How do OT goals relate to a child’s future educational outcomes?
OTs and PTs can collaborate with the IEP team to improve a child’s performance and participation at school, help to build confidence and self-determination to go to college, find competitive employment, and live an independent, satisfying life. OTs and PTs support the development of the underlying foundational skills (body functions and structures) that influence learning and behavior. Therapists also scaffold a child’s participation in educational activities to address meaningful and relevant educational outcomes.

17. What is the responsibility of the OT in providing services in an Extended School Year?
Extended School Year (ESY) services are defined as special education and related services that are provided to a child with a disability beyond the normal school year in accordance with the child’s IEP and as a necessary part of a free appropriate public education (34 CFR § 300.309(b)). The determination of whether a child requires an extended school year and OT and/or PT during an extended school year is made on an individual basis.

18. What should a school district do if the child’s parents present recommendations for OT, PT, or AT from an outside evaluator and ask the school district to pay for services or purchase technology, but the rest of the IEP team does not believe the recommended services/devices are needed?
The school district must develop an appropriate educational program for the child and must indicate in the child’s IEP the nature and amount of services required by the child to receive a FAPE (free appropriate public education). The child’s IEP must be developed at the meeting with the parents, school personnel, and others as needed. If the IEP team determines that the child requires OT, PT, or AT, the child’s IEP must include a statement identifying the nature and amount of such services needed by that child (McEwen 2000).

The school district is not required to implement all the recommendations provided by the independent evaluator, but: “If the parent obtains an independent educational evaluation at private expense, the results of the evaluation must be considered by the public agency, if it meets agency criteria, in any decision made with respect to provision of FAPE to the child” (34 CFR § 300.502(c)(1).

If the IEP team can show, on an individual basis, by using IDEA Part B procedures for evaluation, IEP development, and placement, that the child does not require the recommended OT, PT, or AT to receive FAPE, then the district does not have to provide the requested service. However, the IEP team should document that it discussed the independent evaluator’s report and recommendations. The IEP team should also document why the services recommended are not necessary to provide the child with FAPE (McEwen 2000).

Selected References

California Department of Education. Guidelines for OT and PT in California Public Schools (2012).