Occupational Therapy in Pediatrics PDF

OT1029: OCCUPATIONAL THERAPY IN PEDIATRICS EDUCATION Professor: Diane Allison I. Lotho, OTRP, CIA Date: Oct. 9, 2024 There are two important measures that should be implemented by TABLE...

OT1029: OCCUPATIONAL THERAPY IN PEDIATRICS EDUCATION Professor: Diane Allison I. Lotho, OTRP, CIA Date: Oct. 9, 2024 There are two important measures that should be implemented by TABLE OF CONTENTS everyone who is under the regulation of the state I Educational Participation 1. ‘Requires that states provide free appropriate education A Role of OTs (FAPE) in the least restrictive environment (LRE) for B Education for Everyone students with disabilities attending public schools’. C Occupational Roles of a Student 2. Provision of individuality designed special education and D Occupational Therapy in Schools related services to children 3 to 21 years of age. II OT Process in School-Based Practice It’s telling us that the children with disabilities should be identified III Transitions from the general public, and these children with disabilities should IV Tips be provided with free, appropriate education in a least restrictive environment. When it comes to related services, these are services that the According to Plato, when you enjoy academic participation, child would need that is not directly related to education but can performance in academic settings, and also fulfilling any roles that support participation in the classrooms. are related to your academic participation, you are to protect it. When children, with or without disabilities are able to access OTHER LAWS something that’s enjoyable even in the form of education, which is somehow structured, are to own it and protect it. And when you Section 504 of the Rehabilitation Act and the Americans with do, it will have a very huge impact on the way you decide on your Disabilities Act (ADA) future roles and career after you get your formal education. ○ For people who cannot be accommodated or are not part of the scope of IDEA or EHA No Child Left Behind EDUCATIONAL PARTICIPATION The UNESCO Salamanca Statement on Principles, Policy and Education is important in honing one’s future Practice in Special Needs Education Education, formally speaking, helps a child in transitioning into an The Cali Commitment to Equity and Inclusion adult United Nations Sustainable Development Goals (UN SDG) Education prepares us for adulthood and all its complexity, Kathmandu Statement of Action, Putrajaya +2: Advancing demands, and all the future roles and responsibilities that come andMonitoring SDG 4.2 with it. UNESCO Right from the Start: build inclusive society through When you get educated, your knowledge is enhanced, your skills inclusive early childhood education are honed, and you develop attitudes and values that are critical to fulfilling adult responsibilities, which will lead you to different Table 1. Evolution of EHA from 1975 to 2009 (Case-Smith) transitions in life. YEAR IMPORTANT LEGISLATIONS & DEVELOPMENTS ROLE OF OCCUPATIONAL THERAPISTS INFLUENCING OT’S ROLE IN SCHOOLS OTs help children find meaning and purpose in their academic participation. We focus not only on preparing them for adulthood, 1975 Education of All Handicapped Children Act (EHA) but also on ensuring they enjoy and find meaning in their performance skills from an early age. Whether they face delays, 1986 EHA Amendments (add preschool and early lack accommodations, or struggle with performance skills, we're intervention) here to help them achieve those to thrive and engage meaningfully in school. 1990 Individuals with Disabilities Education Act (IDEA) THE EVOLUTION OF THE SCHOOL-BASED 1991 IDEA Amendments (added assistive technology & OCCUPATIONAL THERAPIST transition) *Western context 1995 Center for School Mental Health Analysis & Action ENACTMENT OF THE EDUCATION OF ALL HANDICAPPED (University of Maryland) ACT (EHA) OF 1975 Center for School Mental Health in Schools (UCLA) The government would want to enact laws, policies, and provide regulations and monitoring to the access of proper education, 1997 IDEA Amendments (Emphasizes access to general education that is equal and appropriate and even free for those education; mandates FBAs and BIPs; includes students who do not have the means to study and children who have with disabilities in district wide assessment) disabilities Eventually, because of changes in terminologies and also in 2001 No Child Left Behind (NCLB) - Emphasizes inclusive education, the evolution continued to progress and there accountability, achievement, & effective teaching are changes in names, ideas, and concepts that surround all enactment. The entire enactment has also made huge impact on 2004 Individuals with Disabilities Improvement Act (IDEA how school-based occupational therapists are needed in the 2004) - Aligned with NCLB; increased emphasis on moment accountability and outcomes) This is the way of the government to provide opportunities and Support EIS and Rtl access for education to be given to everyone, whether what your race, age, needs, the government wants that there is equal access and opportunities for all 2009 NCLB - Anticipated reauthorization Eventually, the EHA has changed its name into Individuals with Disabilities Education Act (IDEA, 2004) ADAJAR, AMPARO, BERINA CARLOS, CO, CUDAL, DATA, DOMDOM, FELIX, MAIGTING, MONTON, SANTOS, TORRES, VELARDE I 3OT 1  Other Occupational Performance Areas (critical for EP) EDUCATION FOR EVERYONE ○ Play ○ Leisure PRINCIPLES OF THE INDIVIDUALS WITH DISABILITIES ○ Social Participation EDUCATION ACT (FORMERLY EHA) ○ ADLs 1. Free Appropriate Public Education (FAPE) ○ Work Every eligible child is entitled to an appropriate education that is free to families (supported by public funds) OCCUPATIONAL THERAPY IN SCHOOLS Those who have children with disabilities and are also IDEA definition (2004) scarce in terms of finances and resources are entitled to ○ “Improving, developing, or restoring functions impaired or appropriate education which is given by the state because lost through illness, injury or deprivation”; there is support from public funds ○ “Improving ability to perform tasks for independent 2. Least Restrictive Environment (LRE) functioning when functions are impaired or lost,” and Children with disabilities are most appropriately educated ○ Preventing, through early intervention, initial or further with their nondisabled peers. impairment or loss of function” Special classes, separate schooling, or other removal of ○ To carry out roles, it is important for OTs to know the children with disabilities from the regular educational domains and processes so that in multidisciplinary environment is to occur only when the nature or severity meetings, we know when to speak up and the boundaries. of the disability of a child is such that education in regular Important to respect other collaborators. classes with the use of supplementary aids and services ○ Ex. Even though we know a lot on a certain area, it may cannot be achieved satisfactorily not be the scope of our practice We are to mix CWDs with other students who are non-disabled. We want them to be able to maximize each other’s potentials in a least restrictive way. OCCUPATIONAL THERAPY SERVICES 3. Appropriate Evaluation Promote self-help All children with disabilities must be appropriately ○ Important to train cx in basic ADLs (eating, bathing, assessed for purposes of eligibility determination, dressing, grooming) before going to school for them to be educational programming, and individual performance able to participate in complex tasks such as education monitoring Positioning Eligibility for placement in a LRE, for placement for special ○ Cx who as physical limitations and challenges in classes, for an Individualized Education Program(IEP), positioning towards their school materials/tables/chairs and also receipt of supplemental services, aids, assistive must be provided AD prescriptions/recommendations or techs and devices. changes in their seating arrangement 4. Individualized Education Program Sensory-motor processing A document that includes an annual plan is developed, ○ Cx with challenges in sensory processing or modulating written, and (as appropriate) revised for each child with input may be provided SI intervention by the OT disabilities. Fine motor performance An IEP is a multidisciplinary document. Is used as a guide ○ FMS enhancement in handwriting, cutting, etc. to make sure that the child receives education that is Psychosocial function individualized and tailored fit to his/her needs/disabilities. ○ Participate in social experiences with sound social 5. Parent and Student Participation in Decision Making emotional skills, social skills, and social thinking Parents and families must have meaningful opportunities Life skills training to participate in the education of their children at school and at home. OCCUPATIONAL THERAPY PROCESS IN 6. Procedural Safeguards SCHOOL-BASED PRACTICE Safeguards are in place to ensure that the rights of Referral children with disabilities and their parents are protected, Evaluation and that students with disabilities and their parents are Individualized Education Plan provided with the information they need to make Occupational Therapy Services decisions. In addition, procedures and mechanisms must Annual Review and Reevaluation be in place to resolve disagreements between parents and school officials REFERRAL Not every client will be well-informed, especially those with less access to knowledge, education, and resources that Referral of a child suspected as having a disability may be made can help them sound decisions by any source, including parents, teachers, and other individuals They are provided with what they need to make decisions OT evaluation may be requested at the time of referral that are evidence-based, decisions that are protected by ○ Ex. If the person to report is knowledgeable with the OT laws, and decisions that are sound as it came from domain and process, OT may enter the process various professionals that are experts in their field Parents and students are the main experts in this process, EVALUATION hence we need their input in such a way that they are not Procedures used in accordance with laws and policies to misinformed or miseducated determine whether a child has a disability; ○ Depends on the context of where you are (Ex.laws and OCCUPATIONAL ROLES OF A STUDENT policies in US determine how evaluations are conducted) Student The nature and extent of special education and related services is Friend also determined in this stage Teamplayer ○ Lets us know if the child who is suspected of having a disability need special education and related services Evaluation strategies: interview and review of documents OCCUPATIONAL THERAPY DOMAIN IN SCHOOL-BASED ○ Interview and communication skills are important. If you’re PRACTICE able to ask logical questions, then you will get the Occupation of education necessary information. ○ Academic - different subjects ○ Documents can be card review, records review, or ○ Non-academic - going to the toilet, freeplay at the anything critical to understand the picture of a child playground during lunch break comprehensively ○ Extracurricular - clubs, after school sports, tutorials Consideration of contextual factors ○ Prevocational and Vocational - prepares children for ○ Physical, social, cultural, sensory, and virtual environment transitions or choice of careers; long term possibilities ADAJAR, AMPARO, BERINA, CARLOS, CO, CUDAL, DATA, DOMDOM, FELIX, MAIGTING, MONTON, SANTOS, TORRES, VELARDE I 3OT 2  COLLABORATIVE ENVIRONMENTAL DESIGN AND THE SCHOOL FUNCTION ASSESSMENT ADVOCACY Top-down strategy to initiate the evaluation process Children as collaborators ○ To understand how a child performs; their wants + needs ○ OTs and other health professionals are in a prime position Comprehensive assessment of function for students in K to to advocate for children’s roles (with or without disabilities) Grade 6 in consultation process Measure the student’s performance in functional tasks that ○ If you think the child is fit enough for the evaluation support participation in academic and social aspects of process to speak out, collaborate, and design the elementary school intervention plan and IEP— make sure to advocate for the ○ Note strengths and areas of improvement child to be an active participant in the whole process Facilitate collaborative programming during IEP development Children’s playground and provide a means of documenting progress ○ Four key considerations for playground safety: age or developmentally appropriateness, equipment and equipment placement, supervision and maintenance ○ Playground environments can be categorized as defined and creative ○ Can support the whole well-being of the child in terms of learning, whether academically, non academically, physically, mentally, or social ROLE OF OT Helps make environment (e.g. playgrounds) accessible to all children ○ Ex. recommendation on a proper playground placed in school and how it should facilitate the learning of children based on its design, safety, and availability Helps provide a safe play environment ○ Not just creativity that enhances a child’s learning Helps enhancing inclusion of children with special needs in different play environments ○ Sensory environment assessment so children who are limited and restricted will have necessary accommodations for them to join and play TOP-DOWN VS BOTTOM-UP APPROACHES Assists children in social play activities in the environment Occupational Performance Areas Provide environmental modifications and adaptations as needed ○ Top-Down: Evaluate participation in occupation first Occupational participation before the nitty gritty (CONT. EVALUATION) look into the performance skills and patterns Development of Occupational Profile ○ Bottom-Up: Evaluate component functioning first ○ To get the whole picture of the child and support Performance skills and patterns all affect intervention planning and recommendations later on occupational performance Participation and performance skills, education, context and specific educational or activity demands Evaluation of school environment ○ To see how it supports or hinder child’s performance Documentation (IE, daily notes, IEP, etc.) Eligibility ○ Whether the child needs your help or other professional’s help; for individualized educational plan Types of Assessment Tools ○ Developmental - whether or not the child has delays compared to the expected milestones and performance skills the child should present across areas and settings ○ Functional - child’s function of child in terms of wholeness of performance ○ Child-reported HRQL - child’s QOL and well-being as a participant in the important settings they are in ○ Complement evaluation with an assessment tool comprehensive enough to support documentation INDIVIDUALIZED EDUCATION PROGRAM ○ Choose an assessment tool that is readily available, Program documented by a multidisciplinary team knowledgeable to administer, and critical in developing Who are the members of the IEP Team? intervention plan ○ Child’s parents What is the difference between evaluation and assessment? ○ 1 regular education teacher of the child ○ Evaluation - refers to the process of gathering and ○ 1 special education teacher of the child interpreting information about the student’s strengths and ○ 1 special education provider (when appropriate) educational needs; strengths and needs of child ○ A representative of the public agency ○ Assessment - refer to the tests or measures used to ○ An individual who can interpret the instructional obtain data about specific areas of function; specific area implications of the evaluation report of function ○ Other individuals (as appropriate) ○ Would be great if you complement them to each other ○ Child with disability (when appropriate) especially if available and would strengthen ○ Multidisciplinary — important to know your domain so you documentation in determining the needs of the child won’t overlap with other collaborators and are able to provide role expectation to the development of program ○ Children can be invited to the development of the IEP program if they have the readiness, especially in age and cognitive ability, to participate in the discussion. ADAJAR, AMPARO, BERINA, CARLOS, CO, CUDAL, DATA, DOMDOM, FELIX, MAIGTING, MONTON, SANTOS, TORRES, VELARDE I 3OT 3  Steps in the development of IEP: ○ For those with necessary behavioral or socioemotional ○ Vision of child’s needs needs will be helped right away by the teacher who is ○ Measurable goals familiar with all the needs of the students in the classroom Allow family to set goals with the team ○ Easier for the teacher to provide additional support and ○ Special Education and related services carry out because they are part of that classroom from How is this recommended in terms of frequency, end to end. intensity, and necessary accommodations and supplementary services that the child needs OT SERVICES ○ Statement of accommodations ○ Placement in LRE Scientifically-based Instructional Practices ○ Transition Plan ○ The services and recommendations we provide are based from evidences/resources/reference of the highest quality ○ Ensure that recommendations provided are right on the COMPONENTS OF AN IEP GOAL current trends, at par with the needs of the child, follow the parameters of school practices, and make sure that it Components Description Example something that the parents can understand and carry out in their own conveniences Who Performer of the task Student Integrated Service Delivery ○ OT is critical in programs that a child receives to help What Specific school task Will be able to transfer to make their school participation more holistic and participate in circle time ○ Provide everything in the least restrictive environment to foster the child’s participation Condition How the task will be done Independently Consultation ○ Always provide in a way that is open to collaborate with the parent, child, and other professionals and service Criteria for How success will be For 30 minutes for 5 Success determined consecutive days providers (teachers, doctors, etc.) Intervention Strategies When Consulting ○ Reframe the teacher’s perspective By When When goal will be met Annual goal Provide education if they have concepts/ideas that may be too rigid or do not see outside the domain Who Will Person responsible for Teacher Measure measuring success and process because they aren’t informed yet. ○ Improve the student’s skills Provide necessary interventions so the child can Annual Goal: The student will be able to transfer to and participate in circle time independently for 30 mins. participate fully in the classroom ○ Adapt the task ○ Adapt the environment Short-term Goals: 1. The student will be able to transfer independently from sitting on chair to ○ Adapt the routine the mat for circle time for five consecutive days, in 3 months. 2. The student will be able to take turns with peers to participate in circle DETERMINING OT FOCUS AREA time activity for 5 consecutive days, in 9 months. Student Annual goals are good for 1 school year ○ Remediation or restoration of skills and encouraging ○ Cannot be attained without the STGs behaviors that can support participation ○ E.g. Improving fine motor manipulation skills to enhance SPECIAL EDUCATION PROGRAM PLACEMENTS mealtime tool usage Task Inclusion ○ Modifying the physical and cognitive demands of an ○ Full inclusion activity Child is in general education and is not restricted ○ E.g. Simplifying directions or breaking down instructions to perform in any ax/task that is presented in the into easy-to-follow steps general classroom Environment Some students may need necessary ○ Modifying or adapting the environment supplementary services and aids which are ok as ○ E.g. Rearranging classroom furniture to accommodate a long as the child is able to use them as tools to student using a wheelchair perform with their maximal/full potential inside the general classroom ○ Partial inclusion AREAS OF EXPERTISE OF SCHOOL-BASED OT Some students are placed in the general Classroom responsibilities classroom on a half-day basis for them to ○ Enhance learning to fulfill their roles and academic experience and feel how it is to be part of the requirements general classroom in a LRE where appropriate Functional sensorimotor skills / environmental interactions education is provided ○ Shouldn’t be restrictive; must facilitate necessary Have specialized services and aids or other improvement of skills supplementary services that they attend to during ADLs the other half of the day that they are not in the ○ In preparation for school and as independent as possible classroom Transitioning from school to post-school activities ○ Pull-out ○ So that other areas of performance are also taken into Get services/aids that are not part of the consideration and that they receive intervention as classroom students. Any service that one receives outside of the general classroom in order to support performance ANNUAL REVIEW AND REEVALUATION as a student The goals are set in an annual time frame (after 1 school year) To monitor if we have achieved the outcomes that we’re set Self-contained Classes before the school year has started, then the review of IEP and the ○ Only one educator for multiple subjects review of the full process must be done, including the revaluation, ○ That educator handles just one class with the same group so that we can know if the goals are achieved and identify gaps. of students in a similar classroom; teacher does not leave It will also help us to know the strengths and gaps of the entire the classroom for other classes school year, and as a team, we can help the client to participate in the school better. ADAJAR, AMPARO, BERINA, CARLOS, CO, CUDAL, DATA, DOMDOM, FELIX, MAIGTING, MONTON, SANTOS, TORRES, VELARDE I 3OT 4  TRANSITIONS TRANSITION PLAN A plan where the child is also helped in enhancing necessary skills that are important in the future as the child decides on what path to take in terms of pre-career, career orientation, or any functional tasks that will help the child perform in the community better Beginning at 16 years of age (Case Smith) Age 10 years old (Tolentino) ○ As early as age 10, household chores are one of the critical activities that should be provided for the child to be better at his/her transitions. ○ As early as age 2, there are already age-appropriate household chores. “Transition is a process and not a destination.” ○ Not just a destination, but a process that we need to facilitate and measure, and helps us determine where to start, what we need to do, and where to go next. Important to know where to start with the goal and not on the disability of the child Important to look at the realities and baseline strengths of the child, what needs to happen in a period of time, and what are the actions needed to be taken as a team Important to understand clear definitions of what accessibility and accommodations are, and how inclusive spaces in the workplace can help determine the placement of children who are in the transitory stage. TIPS TIPS IN WORKING WITH PARENTS Parents know their child. ○ Not to refute or judge them, but we help them understand their children better and support their ideas and opinions. Highlight the child’s strengths, not only his weaknesses. ○ Strengths-based approach Prioritize problems. Avoid using medical terms during meetings. ○ Communicate in plainest as possible (layman’s term) Gather information about the child before evaluation. ○ Depends on the follow up the parents request and how much they need. Regular or Periodic? Follow-up with the parents. TIPS IN WORKING WITH TEACHERS Be familiar with the teacher’s style, rules and classroom expectations. Know your role as the OT. Observe in the classroom without making suggestions or judging the teacher. Prioritize strategies for the teacher. Provide short written strategies and follow up as necessary. ○ Follow up is done in a very efficient way Respect the teacher's time. Present yourself to teachers as a resource. ○ So that they can tap on OTs when they have problems in classroom management. TIPS FOR PROVIDING INTERVENTION IN THE CLASSROOM Develop good rapport with the teacher. Collaborate with the teacher. Working in small groups makes the intervention less obvious and intrusive. Keep a regular schedule when observing classes. Observe in the classroom without making suggestions or judging the teacher. Provide intervention as the child participates in the activities. Be flexible. Communicate clearly and properly with the teacher. Ask for and accept feedback. ADAJAR, AMPARO, BERINA, CARLOS, CO, CUDAL, DATA, DOMDOM, FELIX, MAIGTING, MONTON, SANTOS, TORRES, VELARDE I 3OT 5