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Continuing
Education (CE)
Q:
What do I need to have for an audit? Licensure vs. Certification Q: Do I have to renew my certification? A: No. However some national companies or hospitals state that their employees will be licensed and certified. If you work for one of these companies you will need to maintain your certification. For more information about certification contact NBCOT at 301/990-7979 or www.nbcot.org Those who decide not to renew can use the OT or OTA designation, as written in Chapter 369. Q: If I do not renew my certification what are the consequences? A: You cannot sign yourself as OTR or COTA. Those designations are trademarked by NBCOT. If you do not renew you can continue to use your Texas license as OT or OTA. Q: Can I practice after I pass the NBCOT exam and am certified? A: Not in Texas. You must have a license to practice occupational therapy in Texas in your hand and on the wall of your employer. topics Referrals Q: Can I accept a referral from a nurse practitioner? A: Yes. The professional association modified the OT Practice Act, TOTA in 1999 so that occupational therapists can take referrals from anyone who in their practice act may write script. That includes but is not limited to physicians, chiropractors, dentists, physicians' assistants, nurse practitioners, psychiatrists, podiatrists. This change went into effect in 1999. It will be written into the OT Practice Act when the legislature finished with the re-codification. topics Supervision Q: What kind of supervision do I need to give someone with a temporary license? A: Please read the OT Rules in §373.2, Supervision of a Temporary Licensee. Q: Do I have to send in my Supervision Log A: The current renewal forms ask that all therapists sign that they have completed their required continuing education and properly given or received the required supervision. The Supervision Log is still maintained as a record of supervision, and if audited for it must be able to produce it or substantiate your supervision some way. But the Supervision Log does not need to be mailed to the board with the renewal. topics Practice Questions Q:
Please explain about OT services and ECI.
DS is a separate and distinct service. If appropriate, the licensed professional on the team may provide his or her own related professional service at the needed frequency and intensity, or refer to another appropriate medical provider whenever indicated through the IFSP process. A physical therapist may provide consultation and supports to a DS provider or deliver physical therapy directly, or both, depending on what the interdisciplinary team deems appropriate for a child. Depending on need, a child may receive both DS and PT and/or OT. DS does not replace physical or occupational therapy. For AOTAs explanation please click here for PDF document. Q:
What is the difference between my role as an OTR in an Early Childhood Intervention (ECI) setting and my role providing Developmental Services (DS)?
Children receive DS services as a result of the IFSP. Once the child's outcomes are developed by the team, which includes the parent(s), the team decides who would be the most appropriate person to assist the family with the outcome/strategies. Besides the Early Intervention Specialist (EIS) anyone of the seven professionals could provide DS services and, as an example, in some ECI programs an occupational therapist may provide 30 minutes of occupational therapy and 30 minutes of DS services. The DS services may be a more generalized fine motor session that would not necessitate an occupational therapist to provide. The EIS has an overview of general early development and training in working with families in the natural environment. Q:
Do I need a referral for school practice?
Examples of medical conditions that would require a referral would be for a student with cancer, rheumatoid arthritis, muscular dystrophy (might not be needed during times of stability, but would be needed during times where the student is clearly degenerating and functional or medical status is changing), or when a CP child has a rhizotomy or gets a baclifen pump. The flu or another virus is not cause for a medical referral, but significant change in medical status or functional condition would be. At some facilities they get a medical referral on an annual basis, the but Rules do not specify a frequency. Q: We recently had an ARD (Admission, Review & Dismissal) on a child where the parent disagreed with both the OT time and goals. The student’s former IEP (Individualized Education Program) is expired but the parent wishes for us to continue services. We have revised the IEP, which still does not satisfy the parent though she still wants us to continue with services. How do we proceed?
In order for occupational therapy or any other related services to be provided, Texas Rules require a written Plan of Care based on a current occupational therapy evaluation. In the case of school practice under IDEA, the Plan of Care is the IEP, specifically the relevant goals and objectives being supported by occupational therapy (collaborative goals and objectives are fine, as long as it is clear in the written document what OT is supporting). So, in answer to your question, there must be an IEP in place in order for OT to be provided. When confusion arises in cases of disagreement, school-based OTs and OTAs should look to the district special education administration for guidance regarding which IEP to follow. If there is no IEP, an ARD meeting must be held to decide which goals and objectives OT will address before any services are provided. Q: If a student qualifies for Special Education services as a student with Speech Impairment ONLY (goals address language and articulation issues), can OT be a related service for the child for fine motor issues in the classroom setting?A: The issue is confusing in our state because Texas has classified speech as an instructional service in our Education Code, rather than as a related service, as it appears in IDEA. On page 9 of the 2004 TEA document, Provision of Related Services, TEA is explicit regarding the action school districts must take regarding related services: “District information reflects that all disability categories are considered for related services.” Along with all official TEA documents, Provision of Related Services can be accessed at: http://www.tea.state.tx.us/special.ed/ Finding a way to support speech goals may be difficult (what is OT “relating” to?). The OT should work with the ARD committee to determine if there is an education need for occupational therapy, and if so, to develop goals that support the student’s special education program. Q: Can an Occupational Therapist write the Restorative Nursing Program for a patient?
A: The OT cannot run the restorative nursing program; but can make a recommendation for the patient to participate in the restorative nursing program and/or any specific recommendations for the patient as part of the discharge from skilled services.
Q: Can the Occupational Therapy Practioner sign off for an Activities Director?
A: No. The Activities Director is not providing occupational therapy services. Unless the Activities Director is working with a client, under the direct, on-site supervision of the OTR, and unless that client’s activity is part of a prescribed OT plan of care, the OTR should not sign off on the Activities Director’s services.
Q:
I have had a director of Special
Education ask me about OTs refusing to do sensory integration therapy in
the schools. There are more and more demands for SI therapy in the schools,
many times by parents, and the director wanted to know what position she
should take with her OT. What do you suggest?
A: Sensory Integration/Sensory Processing is one of the theoretical frames of reference in occupational therapy. ALL occupational therapists working in schools should have a working knowledge of Ayres' original work in this area and also of the current work by Winnie Dunn, Lucy Jane Miller and others that is contributing to the evolution of thought regarding this framework (as with any profession, keeping up with the literature is critical to practice competency). Through observation of the student in context, and, through use of assessment tools such as the Sensory Profile School Companion and Sensory Processing Measure for Home and School, any occupational therapist should be able to detect atypical sensory processing as part of the OT evaluation, and be able to document whether or not it is contributing to learning and participation difficulties. If a student is identified as having atypical sensory processing that is interfering with his learning and participation, any occupational therapist should be able to provide strategies to the IEP team that can be incorporated into his daily routines at school (including features of a sensory diet, using auditory or visual cues and/or social stories to prepare the student for transitions, consulting with the teachers to ensure sensory motor opportunities are included in his recess time and PE program, etc.). Under both IDEA 2004, and the No Child Left Behind Act of 2001, providers (teachers & related services personnel) must ensure their practices are evidence-based. The OT should stay abreast of the evidence for all interventions, including sensory-based interventions. At present (2008), there is research occurring to determine whether a "sensory processing disorder" exists separate from diagnoses of anxiety disorder, ADHD or Autism (see http://www.spdnetwork.org/research/index.html), and research comparing aspects of sensory processing to temperament (http://classes.kumc.edu/sah/resources/sensory_processing/summary_research/conceptual_articles.htm). The IEP team (called the ARD Committee in Texas) has the ultimate responsibility for developing the IEP. The OT presents his or her data from assessment to add to the data others have contributed to the Full and Individual Evaluation (FIE). From all the data collected for the FIE, the IEP team decides 1) what the student's goals and objectives should be for the upcoming year, and 2) what supports and services are needed to help the student succeed. IDEA 2004 stipulates that a related service must be provided if needed to assist the child to be involved and progress in general ed curriculum, to advance appropriately toward attaining the annual goals, and/or to participate in extracurricular and other nonacademic activities with other children with and without disabilities. However, the question that IEP teams must answer, as so beautifully expressed by Mary Muhlenhaupt, OTR, is not "Does Johnny need OT at school?," but rather, "Does an OT’s knowledge and expertise provide a needed component of Johnny’s program that will achieve identified outcomes?” If the answer is yes, the OT needs to determine theoretical framework(s) for intervention planning (SI/SP, Motor Learning, Psychosocial, etc.) that offer the greatest opportunity for support in context. This information would not be stipulated in the IEP, as trials of several approaches may be necessary before determining the appropriate approach(es) for an individual student. Data collection on student response to intervention and progress monitoring on IEP goals should be a routine part of all occupational therapy service in schools. The Occupational Therapy Practice Framework: Domain and Process (2002), available at AOTA, should guide all OT practice, including school practice. Selected References A Guide to the Individualized Education Program. (2000, July). Jessup, MD: (Available at [http://www.ed.gov/offices/OSERS] http://www.ed.gov/offices/OSERS). Bundy, A. & Murray,E. (2002). Sensory Integration: Theory and Practice (2nd Edition). Philadelphia: F.A. Davis. Developing Educationally Relevant IEPs: A Technical Assistance Document for Speech-Language Pathologists. (2000, September). Reston, VA: The Council for Exceptional Children. Dunn, W., The Sensations of Everyday Life: Empirical, Theoretical, and Pragmatic Considerations (the 2001 Eleanor Clarke Slagle Lecture. The American Journal of Occupational Therapy. 55 (6). 608-620. Dunn, W., Myles, B.S., & Orr, S. (2002). Sensory Processing Issues Associated with Asperger Syndrome: A Preliminary Investigation. The American Journal of Occupational Therapy. 56 (1). 97–102. Dunn, W. (1999). Sensory Profile. San Antonio, TX: Psychological Corporation. Foss, A., Swinth, Y., McGruder, J., & Tomlin, G., (2003, July). Sensory Modulation Dysfunction and the Wilbarger Protocol: An Evidence Review. OT Practice. CE 1-7. Miller, L. J. (2003, February). Empirical Evidence Related to Therapies for Sensory Processing Impairments. NASP (National Association of School Psychologists) Communique, www.nasponline.org/publications/cq312si.html. Miller, L. J. (2008, April 12). Physiological Measurement of Sensory Modulation Disorders. Presentation at AOTA Conference. Long Beach, CA. Muhlenhaupt, M. (1998, December). Does Johnny Need OT in School? OT Practice. 26-28. Muhlenhaupt, M. (2000, December). OT Services Under IDEA 97. OT Practice. 10–13. Mulligan, S. (2003, March). Examination of the evidence for occupational therapy using a sensory integration framework with children: Part one. Sensory Integration Special Interest Section Quarterly, 26, 1-4. Mulligan, S. (2003, June). Examination of the evidence for occupational therapy using a sensory integration framework with children: Part two. Sensory Integration Special Interest Section Quarterly, 26, 1-5. ) Swinth, Y., & Mailloux, Z. (January 28, 2002). Addressing Sensory Processing in the Schools. OT Practice. 8 – 13. Vargas, S. & Gregory Camilli (1999). A Meta-Analysis of Research on Sensory Integration Treatment. The American Journal of Occupational Therapy. 53 (2). 189 – 198. Written by: Jean Polichino, MS, OTR, FAOTA; Director, Therapy Services Division, Harris County Department of Education.
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