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What Does 'School-based Therapy' Mean?

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Occupational therapy within schools is, by law, a related support service. It has to relate to academics and support the mission of mastering the required curriculum.

But what exactly does that mean? Where are the boundaries of our profession and where are the constraints that govern what is "school-based occupational therapy"?

For a child, everything is relative to school: processing sound, sequencing instructions, socializing, eating, prioritizing, being time aware, tolerating frustration, problem-solving, personal goal setting, and meeting teacher expectations are just a few of the daily activities that support learning.

For a child with a sensory-processing issue, you might have to add deciphering and categorizing visual and auditory stimuli. This can be a frustrating and fearful challenge for the child with SPD. Creating safe havens for reasoning out these issues is the real role of the school-based OT.

Teaching the child how to modify a task may be more important than teaching the specific concept. Take, for example, Jack, a bright 13-year-old middle-school student who, in addition to having fine-motor issues that make his handwriting almost impossible to read, becomes easily overwhelmed by long-term assignments. He just does not know where to begin-so he puts it off until the last minute, rushes through it, and then interprets the poor grade as a self-fulfilling prophecy of his "obvious inadequacies."

Therapy had to meet the IEP goals of improving handwriting and the ability to fill out assignments in class within a given time limit. The challenge was how to get Jack there so that the solution would be long-term and life affirming.

Fear of failure and task styles appeared to be holding Jack back more than his fine-motor and organizational/time issues. OT began with teaching Jack unfamiliar games that he would then have to teach to a friend who would come to OT as a "guest." At first he was very nervous about learning the games but, slowly, learning how to "read the rules" became easier. Going step by step through the game first by himself, then with the OT and then with a friend was easily translated into how to approach those dreaded long-term assignments.

The OT asked teachers to send at least one worksheet in advance of the classroom presentation; however, this was met by some teachers with resistance, who thought it would give Jack an unfair advantage. It became the OT's job to convince the teachers it was a way of helping Jack to become more independent over time with tasks that currently appeared to be too challenging.

As performances in class slowly increased, Jack's self-esteem increased and compliance from the teachers did as well.

Learning to chunk the tasks into doable parts helped Jack keep from becoming overwhelmed so easily and let him feel that he was getting the job done bit by bit. This was huge for Jack and became a study style he carried with him into high school.

Once he felt he could do the assignments and understood what was expected of him, the mechanics and writing and organization were more easily addressed.

The mandate of the IEP was to teach legible handwriting and note taking and to decrease time on task so Jack could complete assignments within allotted times (without extensions). His immediate need was to learn how to approach tasks with confidence so that he could feel competent.

It is the role of the OT to make these professional judgments within the context of the mandated goals. Seeing every child as an individual, addressing their particular needs and creating the environment for them to achieve success is life affirming. And that is the global goal of all OT treatment throughout the life span.

Be brave enough to acknowledge the "box," see outside it and reconstruct it for the benefit of the child. This will not only help the child, but will also make the teacher a partner in the therapy process.

What does school-based therapy mean? It means caring for the child while simultaneously being curriculum conscious and therapeutically creative.

Susan N. Schriber Orloff, OTR/L, is the author of Learning RE-Enabled (a National Education Association featured book), and the Handwriting on the Wall Program. She is the CEO/executive director of Children's Special Services, LLC, in Atlanta. Reach her at www.childrens-services.com or susanorloff@childrens-services.com.


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