Occupational Therapy

Four Rivers Special Education Occupational Therapy

Procedures for prescriptions and medical releases for occupational and physical therapy with Four Rivers:

Occupational and physical therapists are licensed by the State of Illinois.  The Physical Therapy Licensure Act (225ILCS 90) requires that therapists work under a physician’s prescription.  Per the Occupational Therapy Licensure Act (225 ILCS 75), a prescription is preferred for a student to receive occupational therapy.  However, at the federal level, a physician's order is required for both occupational and physical therapy services, for Medicaid billing purposes.
Reference to the document, Recommended Practices for Occupational and Physical Therapy Services in Illinois Schools, through the Illinois State Board of Education, serves as guidance for Local Educational Agencies (LEA) to establish or update their own procedures for providing these support services.  "LEAs may establish more restrictive policies regarding procurement of prescriptions." (pg. 21). As stated in the document, the information is based on standards of practice defined by the Illinois Occupational Therapy Act, 23 Illinois Administrative Code Part 226, the American Occupational Therapy Association (AOTA), and the American Physical Therapy Association (APTA).

Based on these laws and recommended practices from the Illinois State Board of Education, Four Rivers’ current policy is to secure an original prescription, to our office, in order to provide occupational and physical therapy, for those who qualify.  To resume any services for occupational and/or physical therapy, that have been stopped because a child is under the care of a physician due to an injury and/or another physically restrictive reason or is recovering from surgery, a medical release is required.  Prescriptions and medical releases can be received at the Four Rivers office, via fax, from the doctor's office, but then needs to be followed by an original prescription/medical release, in compliance with the therapists' practice acts and federal regulations.

School Based Therapy

The determination of when occupational therapy and physical therapy are educationally relevant is a complex issue. Several issues must be considered when determining the appropriate level of school-based therapy.
  1. School-based therapy is a part of a student’s total educational program.  School-based therapists identify needs of the student and assist in providing strategies on how best to capitalize on abilities as well as minimizing the impact of the disabilities in the educational environment. The school-based therapist also evaluates a student to determine abilities as well as disabilities. The school-based therapist then determines the adverse effect these disabilities have on the student’s performance in the educational and/or community-based instructional settings. Input is gathered from teachers, parents, students and other educational staff as to how these problems may influence performance areas within the educational environment.
  2. School-based therapy involves “teaming”, in which recommendations and decisions are made based on input from all team members in order to determine a student’s total educational plan.

  3. The principal role of school-based therapists is to assist students in benefiting from their educational program. A general guideline is that therapy must contribute to the development, improvement or maintenance of the student’s functional level within the educational environment. If a student needs occupational therapy and/or physical therapy to address problems, but the problems do not prevent him or her from benefiting from the educational program, school-based therapy should not be provided.  (Adapted from Recommended Practices for Occupational and Physical Therapy Services in Illinois Schools, ISBE)

Returning to School after a Medical Procedure

Per the Recommended Practices for Occupational and Physical Therapy Services in Illinois Schools (ISBE, 2019), Four Rivers requires a physician’s referral when there is a change in type of intervention or following a student’s medical or surgical procedures. This form allows the school and IEP team to better serve the student based on precautions/restrictions or needs following major medical procedures. This form must be completed, signed and returned, by consulting physician, to Four Rivers OT/PT Department before IEP service minutes can begin again.

Before Referring a Student for OT Services

Here is a list of things that you should try before you refer a student for Occupational Therapy - Trying these things may just be the key to a more successful student without the need for OT related services: 

For Movement/Attention

  • Try a hand fidget

  • Frequent breaks

  • Chew toys, gum, hard candy

  • Movement for the WHOLE class prior to seat work

  • Noise blocking headphones

  • Wiggle cushion for seated activities

  • Work standing

  • Or turn chair around so the student has the back up against the desk

For Poor Writing

  • Slant board

  • Raised-lined paper

  • Wider-lined paper (like Handwriting without tears paper)

  • Graph paper can be used for writing as well as math

  • Popsicle stick, finger, or paper clip to use as a spacer in-between letters/words

  • Graph boxes for math numbers

  • Different size and shape pencils (triangular, small golf pencils)

  • Small crayons or pieces of chalk (so only 3 fingers will fit, bulb top crayons)

  • Starting uppercase letters before lower case in Pre-K is developmentally appropriate

  • Daily practice of letters that are formed the same way (c, o, a, d, g,q; l, t, b)

  • Manipulative letters for spelling tests

  • Verbal answers for tests

  • Study buddy

For Poor Cutting

  • Scissors-spring opening, three-hold Fiskars, loop scissors

  • Modify work to be only straight lines to cut, widen margins

  • Cut from cardstock instead of regular paper

Seating Options

  • Appropriate sized desk-feet rest flat on the floor, lap is flat and elbows rest on desk top when arms are extended 

  • Back cushion (pillows)

  • Wiggle cushion if excessive movement during seated activities

  • Personal space at carpet time (use of carpet squares)

Location In Classroom

  • Move to front of the classroom to see board

  • Study carrel/work space to decrease distractions

  • Move to back of classroom to allow for movement and work standing

Copying Notes

  • Have a copy at their desk

  • Outline to fill in during class instead of copying all notes