The team determines the level of service provision based upon the student’s unique learning needs. The occupational therapist selects the intervention approach. When considering services within the least restrictive environment (LRE) the team attempts to keep the student in the general educational environment with their non-disabled peers to the maximum extent possible. The IEP, therefore, does not design a curriculum, rather, the IEP designs the services that the student needs to enable them to make progress in the general curriculum, and to help them participate in school.  [A Parent's Guide to Special Education, A joint publication of the Federation for Children with Special Needs and The Massachusetts Department of Education (undated).

Teams may find it necessary to identify accommodations, modifications, or services to meet specific learning needs of student’s with disabilities so that they are able to access the general education curriculum.

Occupational therapy intervention is recommended as a related service to special education when the team determines that the student requires OT to access the curriculum, participate, and make effective progress in their educational program. The purpose of the OT intervention is to support the student within the general education environment whenever possible. This means that services should take place within the classroom, playground, cafeteria, gym, hallway, or other school context whenever appropriate. When services occur outside of the general education setting, the team must explain the reason for removing the student in the IEP (non-participation justification). 

Occupational therapy intervention may be provided in a variety of ways. LRE must be considered when determining the type of intervention(s) for each individual student. The following descriptions are presented in order of least to most restrictive. Services can include any combination to best meet the student’s educational needs. When providing direct services, the occupational therapist must also engage in ongoing communication with teachers and other team members so that effective strategies can be incorporated into activities throughout the school day and progress can be monitored within the educational environment.

Accommodation– an accommodation is a support or service that is provided to help a student to fully access the general education curriculum or subject matter and demonstrate what he or she knows. An accommodation does not change the content of what is being taught (Nolet, V. & McLaughlin, M.J., 2000). Accommodations may include strategies or assistive technology. Some examples of strategies include adapting the environment (i.e. appropriate desk/chair size, preferential seating), adapting the materials (i.e. highlighting the left hand margin of the paper, securing the writing paper to the desk), adapting the mode of instruction (ex. break down instructions and/assignments into smaller steps, provide written copies of lecture notes) or provision of a sensory diet. Assistive technology may range from low-tech such as a pencil grip to high-tech such as specialized software.

Modification– a modification is a change to the general education curriculum or other material being taught. The teaching strategies are modified so the material is presented differently and/or the expectations of what the student will master are changed. (Nolet, V. & McLaughlin, M.J., 2000).  Examples of modifications that OT may recommend include reducing the amount of written work required or having the child tear paper rather than cut with scissors.

Consultation - Consultation, as defined in the IEP process, involves the OT service provider working with other school staff to assist the student in achieving his or her educational goals. When the OT service provider is listed on the IEP service delivery grid as responsible for addressing a particular goal, then the OT service provider is accountable for attainment of that goal.  The act of consulting involves collaboration among team members who jointly determine an agreed upon method for achieving student goals. Examples of consultation include:

Scheduled discussion between the teacher and the OT service provider to mutually decide the best way to integrate therapeutic interventions in the classroom and modify the environment.

 

The OT service provider and other team members share information about the student's specific problems and ways they can be addressed in the educational setting.

 

The OT service provider and parents work together to develop a method to support the students’ school participation, such as homework completion.

 

The OT service provider works with the paraprofessional to model and instruct in how to work with the student.

 

The OT service provider works with the teacher, paraprofessional, and other team members on how to position the student for a variety of educational activities.

 

The OT service provider and teacher discuss how the curriculum could be modified to accommodate the student's special needs and they create lesson plans together.

 

The OT service provider consults with outside agencies such as a physician, a developmental optometrist, an outside behavioral consultant, or another service provider.

 Direct Services - the occupational therapist or occupational therapy assistant has direct contact with the student. 

In-class/Context - Services need to be provided in the least restrictive environment. Therefore, children with disabilities should receive services within their regular education classroom with their non-disabled peers to the extent possible.

Service delivery can take place in any regular education context, such as in the cafeteria, gym, playground, bathroom, classroom, art class, music room, or other locations.

Examples of in-class direct intervention include working with a student on writing/computer skills during written language class time, developing self-feeding skills during lunch or snack time, and developing or facilitating social/play skills at recess.

Out of Class - Services may be provided outside of the regular education setting when it is determined that this is necessary in order for the student to make effective progress in his/her educational program.

Depending on the severity, issues such as distractibility, low self-esteem, the need for privacy, or the need for specialized equipment, are examples of when services outside of the regular education setting may be considered. Services should not be provided outside of the regular education setting due to scheduling constraints, ease in student grouping, teacher’s request, or because therapy space is available.

Service delivery outside of the regular education setting should be considered time limited. The need for services outside of the classroom as the least restrictive environment must be an ongoing consideration.
 

Once the team has determined the level of service provision, the OT service provider uses clinical reasoning to determine the appropriate theoretical approaches and methods for achieving the IEP goals. These decisions regarding methodology of OT intervention are based upon available evidence, including research, student progress towards goals, available resources, and other considerations. 

Federation for Children with Special Needs and the Massachusetts Department fo Education (Undated). A parent’s guide to special education. http://www.fcsn.org/parentguide/pguide1.html

(Nolet, V. & McLaughlin, M.J., 2000). Accessing the general curriculum:  Including students with disabilities in standards-based reform,, Thousand OaksCA: Corwin Press, Inc.