School Nurses Dr Rachel W Alachnowicz PT Graduated from The College of William and Mary in 1996 with a BS in Chemistry Masters of Science from the Medical College of Virginia in 1999 Doctorate of Physical Therapy from Virginia Commonwealth University in 2006 ID: 717139
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Slide1
The Role of Physical and Occupational Therapists in the School Setting Working Collaboratively with School NursesSlide2
Dr. Rachel W. Alachnowicz, PT
Graduated from The College of William and Mary in 1996 with a BS in Chemistry
Masters of Science from the Medical College of Virginia in 1999
Doctorate of Physical Therapy from Virginia Commonwealth University in 2006Why I became a Physical TherapistBeen a school system physical therapist for the past 16 years for a large school system in Virginia. Slide3
Linda Carson, O.T.R.Received a Bachelor’s
of Science in
Occupational
Therapy from Virginia Commonwealth University in 1994. Is currently working on a Doctorate in Occupational Therapy through Rocky Mountain University of Health Professions.
Have been
working for the past 12 years in a large school
system in Virginia as an occupational therapist.Slide4
ObjectivesAt the conclusion of this session participants should be able to:
1. Explain
the difference between the medical model and the educational model for purposes of therapy in the school
setting.2. Give three reasons why an interdisciplinary approach to patient care is beneficial.3. Discuss the ways school nurses can work collaboratively with school physical therapist and occupational therapist to insure each medically fragile student is following the plan set by the physician. Slide5
Educational Model vs. Medical ModelOccupational and physical therapy as an educational support
services
can be quite different from
therapy in a hospital or clinic. School-based therapists focus on assisting students to acquire the functional abilities necessary to access educational materials and adapt to their educational environment. We may help students with daily activities related to educational participation, adapt the performance context, teach alternative methods, or facilitate the use of assistive devices. Occupational and physical therapists in schools work with other educational professionals, members of the community and families to help all students engage in their educational activities. This collaboration is also the foundation for promoting the participation of students with disabilities in the general educational environment. Slide6
Educational Model vs. Medical Model
O.T. & P.T.Slide7
Educational Model vs. Medical ModelThere are primarily four ways a child can receive occupational and physical
therapy once a need
has been
identified.a hospital or an outpatient clinic; served by medical modeloutpatient clinic; served by medical model
home-based
services; served by medical
modelschool-based services; served by educational model only when physical therapy is required to meet educational
needs
The factors determining need for intervention may be very different in these
two models
. This can sometimes be very confusing.Slide8
Educational Model vs. Medical ModelIn the medical model:• Referral is initiated by the physician based on a particular diagnosis or
observed delay
in one or more areas of development
• The parent is then referred to a hospital or clinic for an evaluation and/or treatment by the appropriate professional.• Need for service is primarily based on testing and clinical observations. The assessment would take all settings into consideration.• Children with mild, moderate and severe deficits may qualify for services.
• Therapy can address movement quality as well as function.
• The parent is responsible for obtaining the needed services as well as payment
for those services.• Health insurance may frequently assist with payment, but not always.Slide9
Educational Model vs. Medical ModelIn the educational model:•
Occupational and physical
therapy is provided by schools as service only when it is related
to special educational needs.• Related services are possible only when they are “required to assist a child with a disability to benefit from special education".• Need for service is primarily based on testing, classroom observations and input from the student’s IEP team. However, the child is only assessed for
needs associated
with his or her educational program.
• The school district must establish whether the service is needed for the child to benefit from his or her education. There are many "related services" that might benefit
a child with a disability, just as there are many services that might
benefit a
child without a disability.Slide10
Educational Model vs. Medical ModelIn the education model (Continued):
In
general, students with significant need qualify for as these services in order
to benefit from their special education.• Related services, like occupational and physical therapy, are only provided when the student's educational program would become less than appropriate without the service.• A child who does not perform to what may be his/her full potential but
does function
adequately, would not qualify for school based services.
• Related services are provided only when they support an educational need. They are not provided when there is a transportation problem or other obstacle in getting outpatient or home based
occupational and physical
therapy.Slide11
EDUCATIONAL MODEL
MEDICAL MODEL
Who Decides?
Educational team, including parents, student (if appropriate), educators,
administrators and school based therapists determine the student’s educational needs
and what support is required by related services.
Medical team determines
focus, frequency and
duration of therapy.
Insurance coverage may be
determining factor.
What?
Therapy focuses on adaptation and intervention to allow the student to participate, access their special education and school environment.
Therapy addresses medical
conditions; works to get full
potential realized.
Where?
On school grounds, bus, halls, playground, classroom, lunchroom, …
In the clinic, hospital or
home.
How
The student’s educational needs are met individually. Services may include direct
one on one treatments, staff training, program development, collaboration with staff, integrated therapy, inclusive therapy (with peers) or by consultation for the student’s daily program.
Direct one on one treatment
to accomplish set goals.Slide12
EDUCATIONAL MODEL
MEDICAL MODEL
ELIGIBILITY
Educational need as
determined by the IEP team.
Medical need as determined by medical professionals.
COST
No cost to student or family.
Fee for service payment by family, insurance or
governmental assistance.
DOCUMENTATION
Related to IEP with accessible,
readable language guided by
the setting and best practice.
Dictated by insurance
requirements and guidelines of the setting. Emphasis on medical terminologySlide13
EDUCATIONAL MODEL
MEDICAL MODEL
THERAPY EXAMPLES:
Gait training
To improve efficiency, speed to safely move between classes.
To improve heel strike or
attain normal gait pattern,
not required for daily
function.
Range of motion
Positioning program to
address range of motion daily during class activities. Goal to
attain what range is needed for
daily living.
Program to gain full
physiological joint range,
beyond what is required for daily living.
Changes in physical status
Adapting equipment, schedule
or environment to provide
access to special
education/meet IEP goals.
Rehabilitate for strength,
range of motion to attain
full potential post surgery.Slide14
EDUCATIONAL MODEL
MEDICAL
MODEL
THERAPY EXAMPLES:
Oral Motor
Skills and
Feeding
To improve responsiveness
to sensory input such as food texture and temperature. To work on motor performance such as chewing, lip closure, swallowing and self-feeding.
Program
to develop a feeding schedule, amounts, methods of intake in addition to sensory responsiveness and improving oral motor performance.
Visual Motor Activities
Interventions that
involve movement activities and also collaboration with others to modify the environment or the student’s routines.
Programs that involve
improving eye movement and muscle control/ postural control
Fine Motor Skills
To improve efficiency, speed to be able to cut with scissors, write letters within the lines, and put puzzle pieces together.
Program to gain full
physiological muscle strength and normal movement for what is required for daily living.Slide15
Educational Model vs. Medical ModelSome children will receive services through both models.
For
some children
the frequency or intensity of occupational and physical therapy they receive at school through the educational model will not meet all of the child's needs for OT and PT. There may be goals that are
not addressed by
school-based
therapy and would require home or community based services from the medical model. In each setting, the child should be
assessed individually
to determine the best way to meet his or her needs.Slide16Slide17
Historical Perspective Of OT & PT in the School SettingOccupational and physical
therapy and the
therapist’s
role in educational settings have evolved along with educational reforms. Traditional school-based therapy often isolated students with disabilities from their peers. Therapists identified “problems” among students and treated them in a special therapy room. The need for more appropriate education of students, including those with disabilities, spurred legislative changes in the mid 1970s. Professional research in physical therapy suggests that a collaborative service model works best. Slide18
Occupational and Physical Therapy As An Educational Support Service Historical Continuum
Formerly
Focus on Disabilities and Problems
Pullout Isolated Service
Families Given Information, Little Involvement
Students’ Segregated from other Students
Therapy-specific Student Goals
Therapist Provides Service Independently
Standardized Tests Used
Clinic-Based Assistance
Currently
Focus on Student Learning Outcomes and Abilities
Support to Student from all School Personnel
Families Team with School Personnel as Partners
Students Included with other Students
Curriculum-based Educational Student Goals
Many Types of School Personnel Involved
Also Observe and Assess Student Level of Functioning
School- and Community-Based Assistance Slide19
“Ten Principles of Good Interdisciplinary Team Work”
Background:
Interdisciplinary
team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes.Method: This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work.
Results:
Ten
characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles
.
Conclusions:
Purposed competency
statements that an effective interdisciplinary team functioning at a high level should demonstrate.
Ten principles of good interdisciplinary team
work
Susan
A
Nancarrow
, Andrew Booth, Steven
Ariss
, Tony Smith, Pam
Enderby
, Alison
Roots Hum
Resour
Health. 2013; 11: 19. Published online 2013 May 10.
doi
: 10.1186/1478-4491-11-19Slide20
“Ten Principles of Good Interdisciplinary Team Work” Cont.
Competencies of an interdisciplinary team:
1. Identifies a leader who establishes a clear direction and vision for the team, while listening and providing support and supervision to the team members.
2. Incorporates a set of values that clearly provide direction for the team’s service provision; these values should be visible and consistently portrayed.3. Demonstrates a team culture and interdisciplinary atmosphere of trust where contributions are valued and consensus is fostered.
4. Ensures appropriate processes and infrastructures are in place to uphold the vision of the service (for example, referral criteria, communications infrastructure).
5. Provides quality patient-focused services with documented outcomes; utilizes feedback to improve the quality of care.
6. Utilizes communication strategies that promote intra-team communication, collaborative decision-making and effective
team processes.
7. Provides sufficient team staffing to integrate an appropriate mix of skills, competencies, and personalities to meet the needs of patients and enhance smooth functioning.
8. Facilitates recruitment of staff who demonstrate interdisciplinary competencies including team functioning, collaborative leadership, communication, and sufficient professional knowledge and experience.
9. Promotes role interdependence while respecting individual roles and autonomy.
10. Facilitates personal development through appropriate training, rewards, recognition, and opportunities for career development.
Ten principles of good interdisciplinary team work
Susan A
Nancarrow
, Andrew Booth, Steven
Ariss
, Tony Smith, Pam
Enderby
, Alison Roots Hum
Resour
Health. 2013; 11: 19. Published online 2013 May 10.
doi
: 10.1186/1478-4491-11-19Slide21
Interdisciplinary Approach in the School Setting
Role of the School System
Occupational Therapist:
Conducting activity and environmental analysis and making recommendations to improve the fit for greater access, progress, and participation Reducing barriers that limit student participation within the school environment Providing assistive technology to support student success Supporting the needs of students with significant challenges, such as by helping to determine methods for alternate educational assessment and learning
Helping to identify long-term goals for appropriate post-school outcomes
Helping to plan relevant instructional activities for ongoing implementation in the classroom
Preparing students for successfully transitioning into appropriate post–high school employment, independent living, and/or further education
To
help
students develop
self-advocacy and self-determination skills in order to plan for their future and transition to college, career/employment, and community living; improve their performance in learning environments throughout the school (e.g., playgrounds, classrooms, lunchrooms, bathrooms); and optimize their performance through specific adaptations and accommodations Slide22
Interdisciplinary Approach in the School Setting
Role of the School System Physical Therapist:
• document impairments and their severity;
• document students’ functional performance level at school; • modify students’ positioning, methods of functional performance, and mobility; • modify the environment to compensate for or accommodate existing impairments; • instruct parents, students, and teachers about precautions students with disabilities should take at school;
• advise teachers on how they can incorporate equipment, positioning and exercise to promote students’ educational performance;
• advise parents how (at home) they can use equipment, positioning and exercise to maintain or promote their students’ educational performance; and
• establish lines of communication with physicians and therapists who are treating students in the wider health care arena where students receive health and medical services. Slide23
Interdisciplinary Approach in the School SettingThe Role of School Nurses:
Providing preventive services
Identifying problems in the earliest stages
Overseeing interventions and referrals as a way to foster health and ensure educational successPromote a healthy school environment Encourage students to maintain healthy habits and behaviors when they are not in school
Identifying
both actual and potential health problems, providing case management services, and collaborating with educators, school officials, students, and families to ensure students respond positively to their environment and develop normally.Slide24
Interdisciplinary Approach in the School SettingReasons why we need to collaborate:
Medical Professionals need to stick together.
Two heads are better than one.
Dealing with medically fragile students and parents have a tendency to compartmentalize information.Screenings/ConsultationCommunication between the medical world and the schools. Slide25
Case Examples of Therapist/Nurse CollaborationSlide26
Questions????Slide27
Disclosure
Rachel Alachnowicz, DPT and Linda Carson, OTR
We disclose the absence of personal financial relationships with commercial interests relevant to this educational activity within the past
12 months.