Supporting Students with SPD in School
As school therapists, we are often called upon to look at children with sensory-based needs and we often use a sensory integration framework or model in evaluating students and providing intervention. Occupational therapists in the public schools use “SI” quite frequently and in many ways.
School OTs address sensory processing in their evaluations and intervention to educate parents and other team members during a team meeting of a student who is ineligible for special education services; to consult with teachers in order to develop and implement a sensory diet in the classroom; to work with the student in context in order to develop sensory strategies for effective participation, to provide direct intervention with the student when other less restrictive options are determined to be ineffective in supporting school participation.
However, when determining our interventions, it is important to understand that school-based practice is governed by laws and regulations outlining how and when OT services may be provided. Occupational therapists working in the public schools are obligated to work under the mandates of special education law and provide services only when necessary for a student to benefit from their special education program (e.g. so that they can receive an education – the primary responsibility of the public schools).
While these mandates do not dictate the specific method public school OTs use in their intervention, they do provide the framework through which the OT must determine the need and context for their interventions with consideration of special education eligibility & LRE. IEP teams must carefully consider a student’s eligibility and individualized needs when determining when and how to address sensory processing concerns in the school setting in a way that is consistent with the guidelines that govern school practice. Following special education procedure allows the OT to use their expertise and all that they have to offer in the area of sensory processing, while ensuring that they are in compliance with educational laws and other governing guidelines. Remember the purpose of related service providers (including OTs) in the public school setting is to support student participation in order to provide a Free and Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE).
In order to be eligible the student must have an eligible disability in one of the disability categories. Sensory processing disorder (SPD) does not, in and of itself, necessarily meet the criteria for a qualifying disability category. The IEP Team including the occupational therapist (not the OT in isolation) determines eligibility. The identified disability must limit the student’s ability to make effective progress in their educational program. Remember, OT is a related service provided only when necessary for the student to access and participate in his or her educational program, and not necessarily to remediate. Once eligible for special education services, the team may then determine that occupational therapy is necessary as a related service so that the student may succeed in achieving the prioritized goals set forth on the IEP.
When OT intervention is warranted for eligible students under special education law, that intervention must be provided using the least restrictive environment (LRE) mandate and must be considered on a continuum from least to most restrictive based upon student need. See Table: SPD Continuum for a graphic illustration of the service provision continuum.
Table: SPD Continuum
The OT must first consider accommodations and consultation, providing direct pullout services only when other less restrictive options have proven ineffective for facilitating student participation. This means that, while there will surely be students who ‘can benefit from’ direct, clinic-based SI-OT, this level of service does not necessarily or typically fall under the purview of the OT working under the mandates governing public school practice.
Ethically, however, we have a responsibility to these students. The occupational therapist has an ethical responsibility to disclose to the family all areas of identified need, even if the area of need does not fall under the responsibility of the public school. The therapist may make suggestions for referral to adjunct services, including occupational therapy outside of the school setting, for the family to seek privately. These adjunct services would not be covered by the public school if they do not meet a school participation need. Therapists must be confident and clear in their ability to articulate their role within the public schools in order to avoid sticky situations when identifying student needs that fall outside of the purview of their mandated role and services. Public school OTs may find it helpful to collaborate on this issue with their administration as well as with other OTs within their school district so that all are clear and consistent with regards to the manner in which this information is relayed to parents and other team members. The reader is referred to website: www.aota.org for the most complete and up to date information on the Code of Ethics.