Montrose Parent Group

FREQUENTLY ASKED QUESTIONS ABOUT PHYSICAL THERAPY, OCCUPATIONAL
THERAPY, AND ADAPTED PHYSICAL EDUCATION SERVICES
1. What is adapted physical education?
Adapted physical education is a diversified program of developmental or remedial
activities designed to enhance the gross motor abilities of students who have substantial
medical, orthopedic, and/or neurological conditions. Activities are
generally adapted to meet the specific needs of the student and to allow them to participate as
much as possible in the curriculum based on the student’s IEP.
2. If a student is receiving APE services, does it need to be included on the IEP as a Primary
Service?
APE should be included as minutes on the IEP service plan if the student needs such
intervention to be successful in regular physical education. This should be determined by
appropriate assessment.
3. If a student moves to another district that does not provide APE, what is the process to
remove APE from the IEP or is it now the responsibility of the general education PE teacher
to document goals and objectives?
If the district does not provide APE services and it is designated on a student’s IEP, the district
should have a plan to meet the goals and objectives addressed in the IEP as related to motor
skill development. These services could be met by a regular PE teacher with consultation and
collaboration by OT/PT or others with a knowledge base in this area. The regular PE teacher is
always responsible for meeting the standards and benchmarks of the program. The IEP goals
and objectives in APE support the standards and benchmarks of the regular PE program.
4. Do you need someone certified in adapted physical education to provide adapted physical
education services in Colorado?
No. The State of Colorado does not license the Adapted Physical Educator. Current
requirements are an undergraduate degree in physical education and a strongly recommended
12 semester hrs in adapted physical education.
5. How do you refer a student for occupational therapy, physical therapy, or adapted physical
education services?
Any child who is having difficulty in the OT/PT/APE area(s) may be referred through a child
study conference. The parent, teacher or other person may make this contact through the
student’s teacher or other school personnel. Many of the referral policies differ from district to
district.
6. When do you involve the therapist in the referral/assessment process?
Therapists should work within their districts to establish clear referral guidelines. The number
of filters through which a referral goes prior to reaching an OT/PT/APE service provider
depends on the number of staff available to respond to the requests. Some districts involve
OT/PT/APE staff at the level of the Initial Child Study. Other districts wait until resource
teachers have identified significant needs in motor skills before involving OT/PT/APE. All
districts need to involve the OT/PT/APE specialist prior to the initial IEP meeting, for a student
with motor-based needs.
7. Can a child receive occupational or physical therapy services under a 504 plan, without
receiving special education?
Yes. A child can receive occupational or physical therapy under Section 504 without receiving
special education.
A 504 plan is not intended to be an alternate route toward receiving OT or PT services in the
absence of an IEP. Some districts provide direct OT or PT services to students on 504 plans
and other districts provide consultative services. Please refer to your districts 504 coordinator
for comprehensive information.
8. If the therapist and other school staff in the IEP meeting feel that discontinuing
occupational therapy or physical therapy services is appropriate, but the parents disagree,
who makes the final decision?
Parents are equal participants in the IEP meeting. School staff must consider parents’
recommendations/concerns. The objective of the staffing team is to write an IEP that provides
the child with a free, appropriate public education (FAPE). If the parents disagree with the
IEP, they have the right to initiate a due process hearing.
A parent will often feel most comfortable with a gradual cessation of therapeutic intervention,
for example, going from a direct to a consultative model, or from a consultative model to a
monitoring model. It is wise to inform a parent in advance of the IEP of the possibility of
cessation of physical therapy or occupational therapy services. Allow the parent to ask
questions or give them time to formulate questions regarding concerns with discontinuation of
services, prior to entering the frequently intimidating environment of the IEP meeting.
9. Can a physical therapist perform occupational therapy services or can an occupational
therapist perform physical therapy services?
The immediate answer to this question is “no”. Only an occupational therapist or a supervised
occupational therapy assistant (certified) can perform occupational therapy. Similarly only a
physical therapist or a supervised physical therapy assistant can perform physical therapy.
When determining student need, however, the emphasis should be on the skill set the student
needs to master, or the area of function for which accommodations must be made. The
emphasis should not be on the service provider; the emphasis should be on the area of student
need.
Many districts utilize a Primary Therapist Model. In this model, either a physical or
occupational therapist is the primary therapist serving a specific school. This model does not
suggest that a physical therapist is doing occupational therapy or that an occupational therapist
is engaging in physical therapy. The Primary Therapist Model heralds the value of transdisciplinary
and collaborative practices.
There are many advantages to student, family, and staff when using a Primary Therapist Model.
Like all models of intervention, the value of this model is upheld when implemented with
fidelity.
10. What if a school district does not have the specified OT/PT/APE provider listed on the IEP?
If the IEP committee determines that the student requires a specific service to meet the
student’s educational needs and to ensure that the student receives an appropriate education
then the district must find a way to provide the service. This can be done through a number of
ways:
• Consultation to district personnel from a local/private service provider
• Find others, whom the school district and the parents mutually agree upon, who have
specific training in the area of need (see question #7)
• Shared cost of provision of private services with an understanding of what the
educational goals are and what the clinical goals are and the amount of time to be
delivered to the student, etc…
• Contracted services from a home health agency, hospital, clinic
• Program considerations – the specific program may already offer similar components
which would meet the student’s needs
11. Can OT or PT services be designated as “motor” services on the IEP?
Yes, “motor” services can be listed on the IEP. In cases where “motor” services are
documented or “OT/PT” services are documented, it is important to provide a statement
explaining the model of service delivery being used to meet the student’s needs.
12. Can a therapist delegate procedures like brushing or range of motion to teachers or other
school staff?
“Occupational and physical therapists should not delegate direct therapy procedures that
require the skills, knowledge, experience, training, and judgment of a therapist, COTA or PTA
to teachers or other school staff. There are some school activities in which the roles and
responsibilities of therapists and teachers coincide. For example, sitting in the classroom,
writing, eating, and moving through the school are part of the child’s school day. Both
therapists and educators may have a role in helping the child increase his or her participation in
these school activities. Therapists provide indirect service by collaborating with school staff to
adapt materials, provide and train in use of adaptive equipment or assistive technology, or
integrate a skill learned during therapy into the classroom.” (Occupational Therapy and
Physical Therapy: A Resource and Planning Guide, 1996 Wisconsin Department of Public
Instruction, p. 107)
A therapist can delegate procedure such as brushing but it is the therapist responsibility to
oversee the brushing program, collect data on effectiveness, and determine any changes in the
frequency or duration of that method of intervention. A therapist can delegate range of motion
but may choose to do so through the use of therapeutic positioning to achieve the range or
stretch. Due to the greater risk of injury with improper “ranging” a therapist may choose to
delegate on a case by case basis. Districts may have individual guidelines determining whether
specific activities such as range of motion can be delegated. Check with your Director of
Special Education.
IDEA does allow for paraprofessionals with appropriate training and supervision to assist in the
provision of: early intervention, special education, and related services. For more information
regarding appropriate use of paraprofessionals:
https://www.ideapractices.org/resources/files/para_report.pdf.
13. Does the therapist decide if the child needs therapy?
The therapist makes the recommendation, but the staffing team makes the decision.
14. How often must an occupational therapist or physical therapist conduct an evaluation of a
student?
The therapist must conduct an evaluation for the initial staffing and for the triennial staffing
(three year re-evaluation). It is good practice to perform an evaluation prior to discontinuation
of services to obtain an objective assessment of current level of functioning.
15. Does a physical therapist or occupational therapist need a physician’s referral to provide
physical or occupational therapy in the schools?
No. School based physical and occupational therapists do not need a physician’s prescription
to provide services.
16. If a student has a physician prescription for physical or occupational therapy is the school
obligated to provide these services?
No. The school’s staffing team, which includes the parents, decides whether a student needs
physical or occupational therapy in order to benefit from special education services. The role
of the school OT and PT is towards academic and curricular access. School therapists either
adapt the environment or teach a specific skill to generate academic or environmental access. It
is not the role of the school based therapist to refine motor skills. It is the role of the school OT
and/or PT to facilitate development of skills sufficient for environmental, self-help, or
curricular access within the educational environment.
17. What are the qualifications of school-based therapists?
Both Physical and Occupational Therapist graduate from approved graduate and
undergraduate programs. They then must qualify under the State of Colorado’s licensure act
for educators as special service providers. Physical Therapists must also qualify for a State of
Colorado Physical Therapy license. Occupational Therapists must qualify for National
Certification. Adapted Physical Educators must maintain their teaching license.
18. What is the difference between special education and 504?
Special education is a program designed by an IEP committee. Students meet the state and
federal guidelines to qualify for special educational disabilities which are, as determined
through assessment, interfering with that student’s ability to receive reasonable benefit from a
regular education program. There is federal funding attached to IDEA (Individuals with
Disabilities Education Act) to support these students obtaining specialized services.
Public Law Section 504 of the Rehabilitation Act is a Civil Rights Act enacted in 1973 to
ensure that all students are treated fairly and that no one is denied access to a free and
appropriate education. Section 504 is designed to eliminate discrimination on the basis of
handicap in any program or activity receiving federal financial assistance. No person with a
disabling condition shall be excluded from federally funded programs or activities solely by the
reason of his or her disability, including accessibility to programs available to all persons. It is
the responsibility of regular education to provide services required by Section 504. Support
may be given to the regular education staff from the special education staff.
Students who do not meet the criteria for an educational disability may meet the criteria for
services under Section 504. There is no federal funding to districts attached to Section 504.
Additional information on Section 504 can be found at www.cde.state.co.us.
Access the special education option.
19. If a student recently had surgery, does he/she automatically qualify for special education
services?
No. The student must qualify for special education by meeting the criteria set forth in the state
rules. If the student does not qualify with educational disability he/she may be considered for
services under Section 504.
20. Are private occupational and/or physical therapists allowed to practice their services in the
school?
Individual school districts must follow their own policies. In practice, some school districts
allow private service providers into their buildings as a favor to the parents. This arrangement
can vary from being arranged informally with the school and staff involved to a formal
agreement addressing such concerns as (but not limited to):
• Use of equipment
• Liability
• Use of space
• Safety
• Whether educational recommendations by private service providers will by
followed by school staff
• The time of day the student can be removed from the classroom to be seen by
private service providers
• The forum the private service provider should use if it is felt there should be
changes in the student’s educational programming
• A forum for the educators to address concerns, if they arise, that are presented to
them from the private service provider due to difference in philosophy
• Standards of conduct for the private service provider to adhere to
21. Are private physical or occupational therapists allowed to “dictate” the therapy the student
receives at school?
No. It is up to the IEP team to identify the student’s educational needs, write and implement
the educationally-based goals and objectives. It is, however, the parents’ right to request that
the school staff consider additional assessment information and to invite whomever they choose
to the IEP meeting.
22. If a school district is offering physical education to its regular education students, then what
is its obligation to the special education student?
If a school district is providing physical education to its regular education students it must
provide an opportunity for its special education students to participate in physical education or
adapted physical education.
23. What if daily therapy has been request by the parent, private provider, or other individual
and the therapist is in conflict with this recommendation?
The standard for school-based therapy interventions are the words “appropriate”
and “reasonable benefit”. The IEP team should decide the amount of therapy the student needs
in order to gain reasonable benefit from his/her education. In addition, the IEP team may
decide that it is appropriate for the therapist to train other staff to carry out the required
intervention. Optimally, student objectives and therapeutic activities are embedded within the
student’s daily schedule, thereby increasing frequency of engagement in therapeutic tasks to
increase functional outcomes.
24. Is extended school year (ESY) provided in the OT/PT/APE areas?
It may be. This is a determination of the IEP committee. Every child with an IEP has the right
to have ESY explored as part of their IEP meeting. Extended school year services are provided
for those students who demonstrate a regression in skill level over breaks (summer break,
winter break, spring break). Skills which have been mastered are lost during the course of a
break and recouping these skills takes a greater span of time than the span of the break.
Documentation of skill levels pre and post break are required.
25. Can a district use the following criterion: if the child’s gross or fine motor level is
commensurate with cognitive ability, then there is no need for therapy?
No. The fact that the child’s delay in motor skill development is commensurate with the
child’s developmental levels in other areas is not an appropriate standard by which to determine
a child’s need for occupational therapy or physical therapy.
26. Can occupational or physical therapy be the only service provided on an IEP?
For preschool children who qualify for preschool under the “preschooler with a disability”
classification, occupational and physical therapy services can be stand-alone services, if the
district of attendance allows for stand-alone OT or PT services in preschool. For students in
grades K – 12 physical and/or occupational therapy services cannot be the only service on an
IEP. Occupational and physical therapy services are related services to special education and a
student is eligible to receive these services if they need them in order to benefit from their
special education programming.
OT and/or PT services can be stand-alone services under Section 504 of the Rehabilitation Act.
27. My child received therapy in another district, why doesn’t he/she receive therapy in the new
district?
In the absence of quantifiable eligibility criteria, individual districts have varied interpretations
of the criteria for eligibility. Colorado uses the Needs Model to determine a student’s need for
specific services, so long as a student is duly assessed and his/her needs are considered by the
IEP committee. The district must indicate what services it is providing and how it is proposing
to meet the student’s needs. In some instances consultation from a PT, OT, or APE may assist
others in providing educationally based services to a student.
In accordance with the Colorado rules and/or district guidelines, if a student enters a district
with an existing IEP, the district has an option to provide services immediately in accordance
with the IEP or refer the student for a complete assessment and IEP meeting.
28. If a child is enrolled in a private school, can he or she still receive occupational or physical
therapy as a related service?
Yes. A student who is enrolled in a private school by his or her parents may receive
occupational or physical therapy as a related service if that student meets the requirements of
special education and requires OT or PT in order to benefit from special education.
29. How do therapists write educationally relevant or functional goals and objectives?
Within the educational model of therapeutic intervention occupational therapy and physical
therapy goals should be written with educationally- relevant function as the objective. Goals
should not be written solely based on test performance or a developmental milestone. Rather,
the emphasis should be on function for that student within his/her educational environment.
30. Do therapists have to take the PLACE test?
Occupational and Physical Therapists do not have to take the PLACE test. Adapted Physical
Educators are still required to take this test as part of their licensure.
31. I have an active CDE license indicating licensure for K-12 population. Since I routinely
treat children from birth to 21 years how do I amend my CDE license to indicate 0-21 years
instead of K-12?
To change the grade level from K-12 to Birth-21 for School Occupational Therapist and School
Physical Therapist the applicant would need to contact the University where they completed
their program. The college would be able to tell the applicant what additional coursework they
would need to take, if any, to change the grade level designation. The applicant would need to
provide a cover letter, an Institutional Recommendation, and transcripts, if applicable, from the
University where they completed their program.
You can obtain the Institutional Recommendation form from the Colorado Initial License
application. This application can be found on the CDE website (www.cde.state.co.us) or call
CDE (303) 866-6628 ext. 0.