Occupational Therapy & Physical Therapy Services

Assessment - Refers to the process of determining the need, nature, frequency and duration of treatment; deciding the needed coordination with others involved, and documenting these activities.

Evaluation - Refers to the process of determining the need, nature, frequency and duration of treatment; deciding the needed coordination with others involved; and documenting these activities.  The evaluation addresses the varying degrees of developmental delay, neurological deficits, and/or neuromuscular disorders:

• Sensory-motor skills such as sensory awareness, sensory processing, and perceptual skills
• Neuromuscular functioning such as range of motion, muscle tone, and endurance as related to daily living skills, school/work activities, play and leisure skills, and vocational skills
• Motor skills, especially fine motor coordination/dexterity, visual-motor integration, and oral-motor control
• Cognitive components such as arousal, attention span, sequencing, problem-solving, and generalization of learning
• Psychosocial/psychological components such as interest, self-concept, social conduct, self-expression, time management, and self-control
  • When appropriate, standardized tests should be used.  Standardized tests are those whose scores are based on accompanying normative data, which may reflect age ranges, sex, ethnic groups, geographic regions, and socio-economic status.  If standardized tests are not available or appropriate, the results shall be expressed in a descriptive report.

Individual Treatment - Includes the provision of intervention activities, procedures, and environmental modifications necessary to implement the goals and objectives of the IEP and the occupational therapy intervention plan.

Direct Therapy - In direct therapy, the occupational therapist has frequent contact with the student to help the student effectively meet demands (self-care, physical, and social, emotional, academic) within current and anticipated educational environments.

Monitoring - (Reimbursable as a treatment service for the time of the therapist only.)  - In monitoring, the occupational therapist develops the intervention plan to enhance IEP goals but instructs others (teachers, aides, paraprofessionals, and volunteers, parents) to carry out the procedures.  The selection of monitoring interventions should be based on consideration of both the health and safety of the student, and the appropriate procedural precautions.

Case Consultation - Reimbursable as a treatment service for the time of the therapist only and must pertain specifically and completely to an individual student.)  - The purpose is to develop the most effective educational environment for the child with special needs.  This service is frequently provided when a child shifts from a self-contained special education classroom to a regular classroom with resource room help.  Case consultation might be used to alter the style of presenting materials, to develop remediation materials for the child to use in the classroom or to adjust the demands for specific required tasks.

Occupational therapy evaluation
Occupational therapy:  Individual treatment - one therapist to one student
Occupational therapy:  Group treatment - one therapist to five or fewer students

Treatment Plan Requirements  - An assessment and treatment plan are required annually.  The treatment plan must be based on an evaluation by an occupational therapist.  Further, the treatment plan must indicate goals/objectives and level of service (type and frequency of service). 

A progress note is required approximately every six months or at a reasonable interval to document the student's progress and the continuing need for service. Quarterly progress reporting in IEP Plus is acceptable when dated and signed by the provider.

Indicate where the student is in relation to the treatment plan goals. Quarterly progress reporting in IEP Plus is acceptable when dated and signed-up by the provider.

Indicate if the treatment plan requires changes in the goals and/or objectives and Indicate if the type or frequency of the treatment requires modification.

Authorized Personnel  - Occupational therapy services, when provided by the State of Delaware, licensed occupational therapist or a certified occupational therapist associate (COTA) under the supervision of a State of Delaware licensed occupational therapist.

Occupational Therapists should send the local cost recovery specialist a list of the Certified Occupational Therapy Assistants they are supervising at the beginning of each school year.

• Full assessment(s) in the appropriate discipline area(s) with pertinent documentation such as tests, evaluations, and diagnosis (updated at least every 3 years), and an annual reassessment documented in a written format including narrative information summarizing the child's status and the continuing need for treatment.
• A treatment plan  (IEP) prepared by the respective therapist(s) that describes the goals/objectives and level of service(s) (i.e., type and frequency of service) needed. The treatment plan is required annually and must be signed by the Occupational Therapist.
• A progress note is required approximately every six months or at a reasonable interval to document the student's progress and the continuing need for service. Quarterly progress reporting in IEP Plus is acceptable when dated and signed by the provider. A progress note should:
  • Indicate where the student is in relation to the treatment plan goals
  • Indicate if the treatment plan requires changes in the goals and/or objectives and
  • Indicate if the type or frequency of the treatment requires modification.
• Each occurrence of the student's service, including the date (three-point), type, length, and scope of professional services provided.
• Any significant contacts made in relation to the student.
• All records must contain the full signature of the professional providing the services and/or supervision. 

Assessment - Refers to the process of determining the need, nature, frequency, and duration of treatment; deciding the needed coordination with others involved, and documenting these activities.

Screening - The process of surveying an individual in order to identify previously undetected problems and reviewing written or verbal information concerning a handicapped child in order to determine the need for school physical therapy services. 

Screening may include:  

• Review of written information
• Direct observation by a physical therapist, other professionals, and parents
• Discussion of information, history and current concerns between the physical therapist and parents and/or other professionals on the multidisciplinary team

Evaluation - Refers to the process of obtaining and interpreting data necessary for service delivery.  The nature of evaluation will be determined by the student's handicapping condition and how it impacts the educational program. 

The physical therapist should be a member of the multidisciplinary team and the IEP team, where appropriate, in order to:

• Provide the participants at the multidisciplinary team meeting with the physical therapy evaluation and information necessary to determine eligibility for physical therapy services.  
• Determine the student's physical therapy needs and/or related services; to recommend goals and objectives, procedures, materials, environments and any other considerations necessary for meeting those needs

Categories of Physical Therapy Evaluation Services may include, but not be limited to:

• Standardized tests
• Non-Standardized tests, such as:
  • Adaptive devices and equipment utilization
  • Functional motor skills
  • Classroom positioning
  • Gait analysis
  • Analysis of postural control and/or deviations
  • Manual muscle testing
  • Developmental testing
  • Mobility skills
  • Environmental accessibility
  • Postural responses (reflexes & automatic reactions)

Treatment  - The type and level of treatment services are a direct outcome of the ongoing reassessment of therapy services.  Service options include:

• Direct Service
  • Normalization of the postural tome in preparation for function using neurophysiological techniques
  • Positioning and body mechanics in classroom programming
  • Therapeutic exercise (strength, endurance, coordination)
  • Modalities - hot packs, cold packs, whirlpool, electrical stimulation, biofeedback, infrared
  • Range of motion (ROM) exercise
  • Development, maintenance, training for adaptive equipment and devices
  • Functional mobility (wheelchair, automobile, bike, tricycle, access to public transportation)
  • Stimulation of cardiovascular and respiratory function
  • Functional motor skills
  • Self-management training
  • Postural control, symmetry, and stability
  • Disability awareness training
  • Gait training

Case Consultation - (Reimbursement as a treatment service for the time of the therapist only and must pertain specifically and completely to an individual student.).  The role of consultation is child-specific monitoring, supervising, teaching and training professionals, paraprofessionals, parents and student in the educational environment, home and/or community environment.  This may include:

• Providing general information about a specific student's handicapping condition.
• Developmental/Maintenance/Demonstrating use and care of adaptive/assistive devices for a specific student,
• Teaching special skills necessary for proper handling, lifting and positioning for a specific student.
• Recommendations for enhancing a specific student's performance in education environments.

Billable Physical Therapy Service Procedures - The following services are included in the Physical therapy services category and should be used to document service provision for the purpose of reimbursement.

• Physical therapy assessment
• Individual Treatment - One therapist to one student
• Group Treatment: - One therapist to five or fewer students

• An assessment and treatment plan is required annually.  The treatment plan must be based on an evaluation by a physical therapist.  Further, the treatment plan must indicate goals/objectives and level of service (type and frequency of service). Notice of referral for physical therapy by a licensed physician is required to be updated annually.
• A progress note is required approximately every six months or at a reasonable interval to document the student's progress and the continuing need for service. Quarterly progress reporting in IEP Plus is acceptable when dated and signed by the provider. 
• Indicate where the student is in relation to the treatment plan goals
• Indicate if the treatment plan requires changes in the goals and/or objectives and
• Indicate if the type or frequency of the treatment requires modification.

Authorized Personnel  - Physical therapy services, when provided by the State of Delaware, licensed physical therapist or a licensed physical therapy assistant (PTA ) under the supervision of a State of Delaware licensed physical therapist.

• Full assessment(s) in the appropriate discipline area(s) with pertinent documentation such as tests, evaluations, and diagnosis (updated at least every 3 years), and an annual reassessment documented in a written format including narrative information summarizing the child's status and the continuing need for treatment.
• A treatment plan IEP) prepared by the respective therapist(s) that describes the goals/objectives and level of service(s) (i.e., type and frequency of service) needed. The treatment plan is required annually and must be signed by the provider.
• A progress note is required approximately every six months or at a reasonable interval to document the student's progress and the continuing need for service. Quarterly progress reporting in IEP Plus is acceptable when dated and signed by the provider. A progress note should:
  • Indicate where the student is in relation to the treatment plan goals
  • Indicate if the treatment plan requires changes in the goals and/or objectives and
  • Indicate if the type or frequency of the treatment requires modification.
  • Each occurrence of the student's service, including the date (three-point), type, length, and scope of professional services provided.
  • Any significant contacts made in relation to the student.
  • All records must contain the full signature of the professional providing the services and/or supervision.