RECOMMENDED PRACTICES

FOR

OCCUPATIONAL AND

PHYSICAL THERAPY SERVICES IN

ILLINOIS SCHOOLS










2003

ILLINOIS STATE BOARD OF EDUCATION

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TABLE OF CONTENTS












Page

Purpose................................................................................................................. 1

Section I Overview of Occupational Therapy and Physical Therapy
as a Related Service .........................................................................
2

Introduction ..........................................................................................................
2
Statute Review......................................................................................................
2
Differences between IDEA and Section 504.........................................................
9
Description of Occupational Therapy and Physical Therapy Service Providers ... 10
Educational Relevance ......................................................................................... 13
Distinction between School-Based Therapy and Non-School-Based Therapy..... 15

Section II Determination of the Need for Therapy .......................................... 16

Introduction ........................................................................................................... 16
Identification of Students with Disabilities ............................................................. 16
Request for Assistance under Section 504........................................................... 19
Referral, Assessment and Eligibility for Occupational Therapy
and/or Physical Therapy ..................................................................................... 20

Section III Provision of Occupational Therapy and Physical Therapy in the
Education Setting ............................................................................ 29

Introduction ........................................................................................................... 29
Implementation of Occupational and/or Physical Therapy.................................... 29
Documentation...................................................................................................... 33

Section IV Administrative Considerations ...................................................... 37

Introduction ........................................................................................................... 37
Employment, Retention and Recruitment ............................................................. 37
Space, Equipment and Materials for Service Delivery.......................................... 38
Workload Determination ....................................................................................... 39
Supervision and Management of Therapy Personnel........................................... 40
Continuing Education............................................................................................ 41
Third Party Billing.................................................................................................. 41


References............................................................................................................ 42

Appendix ............................................................................................................... 45

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The Purpose of this Document

The purpose of this document is to present administrators, occupational and/or physical therapy
personnel, educators, other professionals, and parents, with information regarding the provision
of occupational and/or physical therapy in educational environments. This document is
intended to serve as guidance so that each Local Educational Agency (LEA) employing
therapists can establish or update their own procedures for providing these support services to
students who must receive occupational and/or physical therapy.

Information provided herein is based upon standards of practice defined by the Illinois
Occupational Therapy Practice Act, 225 ILCS 75/1 et seq., the Illinois Physical Therapy
Practice Act, 225 ILCS 90/1 et seq., 23 Illinois Administrative Code Part 226, the American
Occupational Therapy Association (AOTA), and the American Physical Therapy Association
(APTA).

Inherent in this document are the following assumptions:

• Students with disabilities must be served in the least restrictive environment possible.
• The educational curriculum and educational needs of the student define the educational
relevance of an activity.
• The educational environment is the location where a student’s curriculum is implemented.
• While motor functioning may be assessed by professionals trained in various disciplines
(e.g., occupational therapists, physical therapists, psychologists, early childhood teachers
and physical education teachers), occupational therapists and physical therapists assess
motor functioning and adaptive abilities from their unique perspectives as described in this
document.
• Even though occupational therapy and physical therapy sometimes overlap, they are
separate disciplines with separate entry-level educational experiences and separate
licensure laws.
• Occupational therapy and physical therapy must both be available to students in the
educational environment as needed. Equal availability of either service is assumed. (Iowa,
1996)

Administrators responsible for supervision of occupational therapy (OT) and physical therapy
(PT) departments and therapists should have access to and be knowledgeable of the most
current resources, particularly those listed below:

FEDERAL
Americans with Disabilities Act of 1990, 42 U.S.C. 12101 et seq., 28 C.F.R. Part 35 (Title
II, Department of Justice), 29 C.F.R. Parts 1630, 1602 (Title I, EEOC).
Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq., 34 C.F.R. Part 300.
Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794, 34 C.F.R.
Part 104.

STATE

Illinois Occupational Therapy Practice Act, 225 ILCS 75/1 et seq.

Illinois Physical Therapy Practice Act, 225 ILCS 90/1 et seq.

23 Illinois Administrative Code Part 226



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PUBLICATIONS
American Journal of Occupational Therapy (AJOT)
OT Practice
Ethics in Physical Therapy
Guide to PT Practice
Pediatric Physical Therapy
PT Magazine

OTHER
American Occupational Therapy Association Guidelines for Occupational Therapy in the
Schools
American Physical Therapy Association Guidelines for Physical Therapy in the Schools

Illinois Guidelines for Physical Therapy Practice in Educational Environments (Illinois


Physical Therapy Association, 1994)

Illinois Physical Therapy Association for Illinois Learning Standards and Alternate
Performance
Indicators


































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Section I

OVERVIEW OF OCCUPATIONAL THERAPY AND
PHYSICAL THERAPY AS A RELATED SERVICE

INTRODUCTION

Section I provides a chronological perspective of the laws and policy which created an
atmosphere and, ultimately, a mandate for providing occupational therapy and physical therapy
services in educational environments.

This section also defines the training, certification and licensure requirements for occupational
therapists, certified occupational therapy assistants, physical therapists and physical therapy
assistants.

Finally, this section looks at the educational relevance of occupational therapy and physical
therapy. Common educational purposes for students to receive these therapies are listed. A
distinction is made between therapies that are the responsibility of the educational system and
those that are the role of non-educational-based clinical therapy.

LEGAL OVERVIEW

Prior to 1969, students in Illinois with disabilities or health impairments primarily received both
their educational and therapeutic services in residential settings or community and private
agencies. In 1969, Illinois enacted the first law that mandated services for students, essentially
beginning formal special education services for children ages 3-21. Since that time, state and
federal legislation have continued to affect the services for children with disabilities in
educational settings.


1965 ─ Illinois House Bill 1407, approved July 21, 1965 (Enrolled Law 35 403)

(currently at 105 ILCS 5/14-1.01 et seq.)

The State of Illinois passed this first statute providing for special education in 1965 requiring that
all school districts provide special education for children with disabilities residing in their district
after July 1, 1969.

1970 ─ The Elementary and Secondary Education Amendments of 1970 (ESEA)

(P.L. 91-230)

(currently at 20 U.S.C. 1400 et seq.)

The ESEA consolidated into one act a number of previously separate federal grant acts relating
to children with disabilities.

1973 ─ Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112)

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(currently at 29 U.S.C.§ 794 )

Section 504 initiated a national commitment to end discrimination on the basis of a person of
any age having a disability. This law established a mandate to bring persons with disabilities
into the mainstream of American life and established a White House Conference on
Handicapped Individuals for the purpose of developing a plan of action to solve the problems of
individuals with disabilities. The authority of Section 504 extends to any program or activity
receiving federal financial assistance.

1975 ─ The Education of All Handicapped Children Act (EHA) (P.L. 94-142)

(currently the Individual with Disabilities Education Act (IDEA) at 20 U.S.C. 1400 et
seq.)

The EHA offered federal financial assistance to states to provide special education services in
educational settings. The federal requirements were similar to the services already in place in
Illinois under Illinois House Bill 1407. However, the federal requirements added a complaint and
due process procedure providing procedural protection for students receiving special education
and related services. As a condition of federal financial assistance, this law initiated the
requirement that states provide a free appropriate public education (FAPE) for children ages 5
through 18 in the least restrictive environment (LRE) no later than September 1, 1978 and that
all states seeking federal financial assistance serve student populations ages 3 through 5 and
18 through 21 no later than September 1, 1980. The law also provided incentive money to
states for early childhood programming (ages 3-5 years).

The EHA was the first law that made reference to occupational and physical therapy as "related
services." The term “related services” is defined in the EHA (now IDEA) as

“transportation, and such developmental, corrective, and other supportive services
(including speech pathology and audiology, psychological services, physical and
occupational therapy [emphasis added], recreation, and medical and counseling services,
except that such medical services shall be for diagnostic and evaluation purposes only)
as may be required to assist a handicapped child to benefit from special education, and
includes the early identification and assessment of handicapped conditions in children.”

1978 ─ State Board Policy on Special Education

In February 1978, the Illinois State Board of Education adopted a policy on special education
addressing both the state and federal intent up to that period. The policy states:

The State Board of Education endorses the basic tenets of Public Law 94-142, the
Education for All Handicapped Children Act of 1975, and states the components of that
endorsement to be as follows:

1.
A free, appropriate public education for every handicapped child in Illinois ages 3-18
by September 1978, ages 3-21 by September 1980.

2.
A right-to-education policy for all children; education provided at no cost to parents
when placed by the state education agency or local education agency.

3.
Education in the least restrictive environment.


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4. Guarantee of procedural safeguards, confidentiality of records, and
nondiscriminatory (racially or culturally) testing.

5.
Individualized education programs (IEP) for every identified handicapped child.

6.
A comprehensive, articulated, personnel preparation program.

7.
State Education Agency supervision of all educational programs for handicapped
children offered within the State of Illinois.

8.
Rights and guarantees applying to children in private or State agency schools as well
as public schools.

9.
An intensive and continuing search for handicapped children. (Illinois State Board of
Education, 1990, p. 7)

1986 ─ EHA Amendments (P.L. 99-457)

(IDEA, currently at 20 U.S.C. 1400 et seq.)

This first of many reauthorizations of Public Law 94-142 reinforced requirements for the
education of children with disabilities ages 3-21 and expanded the mandate to preschoolers with
disabilities ages 0-3. Occupational therapy and physical therapy were required to be available
for preschoolers for the 1990-91 school year. This federal law also established an early
intervention state grant program for children birth through 2 years of age and their families.
These amendments required, in certain cases in the 0-2 population, occupational therapy and
physical therapy to be considered primary early intervention services provided based solely on
the child's need regardless of what other medical or educational services are provided.

Since occupational therapists and physical therapists were now considered the primary early
intervention therapists, they could now be named case managers on the Individualized Family
Service Plan (IFSP) developed to determine specific child and family goals and services.

1990 ─ Americans with Disabilities Act of 1990 (ADA) (P.L.101-336)

(currently at 42 U.S.C. 12101 et seq.)

The ADA federal law expanded to all facets of society the Rehabilitation Act of 1973 and is
considered the major civil rights act for persons with disabilities.

The purposes of the ADA are:

1. To provide a clear and comprehensive national mandate for the elimination of
discrimination against individuals with disabilities;

2.
To provide clear, strong, consistent, enforceable standards addressing discrimination
against individuals with disabilities;

3.
To ensure that the federal government plays a central role in enforcing the standards
established in this Act on behalf of individuals with disabilities; and


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4.
To invoke the sweep of congressional authority, including the power to enforce the
Fourteenth Amendment and to regulate commerce, in order to address the major
areas of discrimination faced by people with disabilities.

The ADA definition of "a person with a disability" is comprehensive and has several
components. Protection from discrimination is extended through the ADA to individuals
who have a disability. Under the law, "’disability’ means, with respect to an individual -

1. A physical or mental impairment that substantially limits one or more of the major life
activities of such individual ("major life activities" include caring for one's self, performing
manual tasks, walking, seeing, hearing, speaking, breathing, learning and working);
2. A record of such an impairment; or
3. Being regarded as having such an impairment.

29 C.F.R. 1630.2(g)



These three categories are further defined as follows.

1, “Physical or mental impairment means:
(1)
Any physiological disorder, or condition, cosmetic disfigurement, or
anatomical loss affecting one or more of the following body systems:
neurological, musculoskeletal, special sense organs, respiratory
(including speech organs), cardiovascular, reproductive, digestive,
genitor-urinary, hemic and lymphatic, skin, and endocrine: or
(2) Any mental or psychological disorder, such as mental retardation,
organic brain syndrome, emotional or mental illness, and specific
learning disabilities.” 29 C.F.R. 1630.2(h)


2. A record of such an impairment
To qualify under this provision, an individual must "have a history of, or have been classified
as having, a physical or mental impairment that substantially limits one or more major life
activities." 29 C.F.R. 1630.2(k)

This second aspect protects persons who have recovered from a physical or mental illness
against discrimination that is based upon their history of mental health treatment. It also
protects individuals misclassified as having a mental illness.

3. Being “regarded as having such an impairment means:


(1) Has a physical or mental impairment that does not substantially limit major life


activities but is treated by a covered entity as constituting such limitations;


(2) Has a physical or mental impairment that substantially limits major life activities only


as a result of the attitudes of others toward such impairment; or


(3) Has none of the impairments defined …but is treated by a covered entity as having a

substantially limiting impairment.”

29 C.F.R. 1630.2(l)

This category is especially pertinent to individuals who have or have had mental health
treatment, whether or not they are disabled by the illness. The stigma associated with
mental illness often results in attitudinal barriers that hinder a person's ability to work or
enjoy life. Concerns by employers regarding productivity, safety, insurance, liability,

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attendance and acceptance by co-workers and customers have been identified as common
barriers that frequently result in the exclusion of persons who have sought mental health
care from the work force.

If a person is rejected from a job because of the myths, fears and stereotypes associated
with mental illness, and no legitimate job-related reason can be articulated by the employer,
that individual would be covered under this aspect. Furthermore, if an individual is qualified
for the job, it is not necessary that he or she prove that an employer's concerns (e.g., that he
or she will be accepted by others, or that insurance rates will not increase) are invalid.

The law states that the term "qualified individual with a disability" shall not include any
employee or applicant who is currently engaging in the illegal use of drugs 29 C.F.R.
1630.3(a)

1990 ─ EHA Amendments (P.L.101-476)

This law changed the name of the EHA (P.L.94-142) to the Individuals with Disabilities
Education Act (IDEA). The following is an overview of changes and additions:

1.
Identified the use of the term "disabled" to replace "handicapped."

2.
Added autism and traumatic brain injury to the list of disabilities that make a child
eligible for special education.

3. Expanded the definition of instruction to encompass instruction in all settings,
including the work place and training center.

4.
Added rehabilitation counseling and social work as related services.

5. Added transition services to promote movement from school into appropriate
activities and adult services agencies and required the inclusion of a transition plan
in the IEP for a student aged 14½ to 21.

6.
Defined assistive technology device as any equipment used to increase, maintain or
improve the capabilities of individuals with disabilities and outlined what assistive
technology services can include.

7. Defined "underrepresented" as minority, poor and limited-English-proficient
individuals.

8.
Required the U.S. Department of Education to conduct an inquiry into services for
children with Attention Deficit Disorder (ADD).

9.
Identified new priority areas for early education programming for children with severe
disabilities, assistive technology, transition and programs for children with severe
emotional disturbance.

10. Provided grants for training personnel in the use of assistive and instructional
technology, research focusing on improvement of services for infants and toddlers
and organization and dissemination of information on ADD.


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11. Authorized improved access to assistive technology devices.

12. Required each state agency to be responsible for administering the early intervention
program including informing parents of the availability of early intervention services
and the extent to which primary referral services disseminate such information. It
also added that the personnel development system must include training of primary
referral sources about the basic components of the state's early intervention
services.

The changes also offered expanded opportunities for occupational therapists and physical
therapists to provide input in the areas of assistive technology and transition.

1997 ─ IDEA Amendments (P.L. 105-17)

(regulations at 34 C.F.R. Part 300)

The reauthorization of IDEA brought about several changes in the law including the following:

1.
Allowed states to expand the definition of developmental delay to include children
ages three through nine. (Illinois has retained the age range of three through five).

2.
Allowed districts to spend only an amount proportionate to the federal funding per
child on children with disabilities in private placements.

3.
Allowed districts to provide services to children with disabilities on the premise of
private schools as consistent with the law.

4. Allowed paraprofessionals and assistants who are appropriately trained and
supervised to assist in provision of special education and related services.

5.
Required that children with disabilities will be included in general state and district
wide assessments with appropriate accommodations.

6.
Prohibited a child from being determined to be a "child with a disability" based on
lack of instruction in math or reading or limited English proficiency.

7.
Required that the IEP of a child with a disability include a statement of how the
child's disability affects involvement and progress in the general curriculum; or for
preschoolers, how the disability affects participation in appropriate activities.

8.
Required that, beginning at least one year before a child reaches age of majority,
parents and the child with a disability must be informed of rights transferred on
reaching age of majority (age 18 in Illinois).

9.
Required the IEP team to include at least one regular education teacher at the child's
grade level, if the child is or might be participating in regular education classes.

10. Required the IEP team to include a special education teacher.

11. Allowed districts to place a child with a disability in an interim alternative educational
setting for not more than 45 days if:


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Document Outline

• INTRODUCTION
  • LEGAL OVERVIEW
• EDUCATIONAL RELEVANCE
• INTRODUCTION
• IEP Components
• Development of IEP Goals
  • • • • • INTRODUCTION
  • Measuring Student Progress
• Transition Planning
  • • • • • DOCUMENTATION
    • Educational Documentation
    • Components and Guidelines for Therapy Documentation
      • • 6.Administrative Records
          • INTRODUCTION
• EMPLOYMENT, RETENTION AND RECRUITMENT
  • • • • • Recruitment Methods

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