When School-based PT Goes Too Far

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Setting the Record Straight

According to federal IDEA guidelines, physical therapy in school is considered a related service. As such, related services are provided to children in special education, primarily to ensure the child is able to participate in learning tasks.

For example, if a child requires assistance due to safety issues related to walking and getting to class, the focus of therapy would be addressing adaptation and performance in the educational setting, and is based on education-related difficulties that impair the ability to function in the school environment.1

These services are to provide a child with equal opportunity that would not exist without therapy service and not merely maximization of a child’s potential. Legal mandates require the school-based therapist to deliver only those services necessary to assist students in benefitting from their educational programs.

Eligibility for therapy must be based on the student’s educational goals and whether the expertise of PT is needed to help the student achieve these goals. To require related services for every child with a disability would be inconsistent with the concept of individualization that has been part of the act since its inception in 1975.

Related services are only required to the extent that such services are necessary to enable the child to benefit from special education. Related services, as with any other service in an IEP, are determined on an individual basis by the child’s IEP team.2

Changing Times

This paragraph is now included with every evaluation I complete in my job as a school-based physical therapist in a large, urban school district in one of the poorest cities on the East Coast. I am currently in my 16th year in this position, and my 28th year as a practicing therapist.

Every year, for the past several years, this paragraph has grown. It used to be a mere two sentences, simply stating that school-based services were not intended to replace clinical services, and that we make every effort to coordinate services, and encourage parents to seek both, when necessary.

Sadly, in my opinion, times have changed. I tend to add more information to that paragraph when I am once again faced with defending my reasoning for not providing direct services to a student.

The primary role of my job in the school is to keep students in the classroom. In terms of mobility and accessibility, I will do my professional best to determine the most efficient and safe way for the student to get from point A to point B. It is not simply my opinion, it is what the law intends.

A large part of IDEA involves the least-restrictive environment (LRE). A student attending their neighborhood school, with no accommodations, no adaptations, and no special education services, is the baseline. It is the starting point. This means that my thinking and recommendations to the team must start at the minimal amount of service I believe a child can have in order to benefit from his education.

Interpreting IDEA’s Guidelines

The problems we’ve been facing in my district in recent years stem from parents who’ve been led to believe that more services means better education. More and more we are sitting in meetings that last several hours, and continue over several days, with “advocates” who are not advocating for the best education for the child, but advocating against the school district.

It’s a certainty that I spend more time during the course of the school year defending my professional opinion regarding the lack of need for direct school-based PT intervention than I do servicing students who actually benefit from my skillset.

A large part of the problem is a lack of understanding, even within our profession. Despite physical therapy education advancing to an entry-level doctorate, very little, if anything, has been added to the curriculum regarding school-based services. Basically, little has been added from a baseline of zero information.

Given that school-based services are federally mandated, and therefore present in some form in every public school, it would seem appropriate to give physical therapy students information on the guidelines.

I’ve had both advocates and colleagues tell me that the law can be interpreted in different ways.

Yet after researching, reading, and studying the laws, guidelines, and practice act for 16 years, I no longer see a large scope for interpretation: “Related services are only required to the extent that such services are necessary to enable the child to benefit from special education.”

We like to joke about the ridiculous levels of service and the goals that cross our desks from students transferring into our district. The top two on my list are one student who received direct school-based PT with a goal of improving his golf swing, closely followed by the eight-year-old autistic child who received direct PT services in school working on successfully climbing an 8-foot ladder while wearing his backpack.

We’ve had varsity basketball players with advocates insisting they needed services to improve visual motor skills, and homebound students with nothing on their IEPs except range-of-motion of their extremities.

Best as a Team Approach

Simply, the role of physical therapy in the school setting comes down to function. If a student cannot access or participate in school activities, he cannot benefit from their education.

It’s not the role of the school-based therapist to meet all therapeutic needs of the child, or to rehabilitate the student. This can be difficult for parents, teachers, advocates, and administrators to understand. This is further hampered by the lack of cohesive understanding among our profession. Over and over again we hear statements such as “the student needs therapy in school because he has cerebral palsy.” Or “the student needs therapy because her motor skills are not normal.”

In much the same way that special education could never be expected to bring an intellectually disabled student’s IQ to “normal,” special education-related services cannot be expected to normalize skills in cases of abnormal neurologic or musculoskeletal systems.

School-based physical therapy service is a valuable part of special education. Much like a therapist is an important team member in the care of a patient in a hospital, therapy works best in schools when it’s incorporated as part of a team approach to provide the most effective educational outcomes.

References

  1. McEwen, I.R. (ed.) Occupational and Physical Therapy in Educational Environments. Routledge, 1995.
  2. Federal Register. Vol. 71, No. 156. Aug. 14, 2006 (Rules and Regulations).
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About Author

Lisa Bogacki, PT, MPH

Lisa is a self-employed subcontractor for Pediatric Therapeutic Services Inc. and the sole physical therapist in the Reading (Pa.) School District.

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