The equivocal value of (some) school-based occupational therapy

Occupational therapy, at its best, is a change-enabling service that helps people accomplish goals that are personally meaningful and relevant to how they occupy their time. For kids in school, this means being able to learn and socialize and develop skills for future citizenship.

Therapists routinely wring their hands over issues of eligibility criteria for said services and balance this out against spoken and unspoken procedural rules that are generally applicable only within their own school systems. The interesting aspect to this is that any given school based OT will then believe that the way THEIR school district operates must represent the way that ALL school districts operate (and for that matter, how they are SUPPOSED to operate). Those of us who have the opportunity to interact with dozens or scores of districts across wide geographic areas have wider exposure to the variety of ways that districts interpret presumably identical criteria and rules.

Twice this year I have thrown in the towel at CSE meetings and told the school-based therapist that I concur with their recommendation to discontinue therapy, even though the children arguably had needs that would make them eligible for services. I also followed up by stating that there is little point in arguing for a service when the service provider wants to discontinue a service. This has generated some puzzled looks from the districts who are generally more accustomed to some measure of protestation.

I'm not sure what is different this year in my approach. I am seeing little value in having a child pulled from a classroom (because that is a typical model) to practice some skill or subset of skills in isolation of every other need that is screaming to be met in the classroom. I see little value in trying to convince another professional of a child's needs. I see little value in trying to contact the OTRs who are supposedly supervising the COTAs who make these discharge recommendations - because by the time anyone finds the OTR the meeting is over. I see little value in continuing to suggest that there be some kind of consistent eligibility criteria - because the conversation just seems to get lost when a therapist is convinced that you can meaningfully track a child's progress through a triennial evaluation process. I just don't see the point in trying to educate people about this any longer - because I just can't do it myself.

So the new reality dictates that until situations change I will sometimes tell parents not to bother with school based OT - because sometimes the service has equivocal value. We are finding that we can accomplish more by working with the parents and teachers directly ourselves - even when we are off site. That is the current unfortunate reality.

Three step solution:

1. updated AOTA direction and guidance on philosophical and practice models for school-based OT services, including clear recommendations for OTR/COTA role delineation, general service eligibility parameters, and evidence-based practice guidelines

2. statewide (e.g. NYSOTA) roundtables and plenaries that review the recommendations and 'stamp' them as approved after additional modifications as needed to address state by state regulatory and procedural differences

3. local/regional study groups that meet to develop plans to implement the recommendations