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The
school-based occupational therapist can play an important role in the
instructional support/pre-referral/early intervening process. The purpose of
this process is to provide students with the supports necessary to meet their
needs within the general education setting prior to initiating the IEP/SPED
process.
In many cases, this level of support may be sufficient to meet the
student’s needs, and a referral for evaluation through special education may
not be necessary. Therapists possess skills, using the OT Practice Frameworks,
to analyze performance in areas of occupation client (child) factors, activity
demands, and context. This analysis enables the therapist to make
recommendations for strategies to address the student’s educational needs. The
occupational therapist’s ability to consider the interrelationship of all these
factors on the child’s educational performance can bring a unique perspective
to this process.
Example:
Reported
Problem - difficulty remaining upright in seat and difficulty focusing on whole
class directions
The
OT may provide the teacher with general information about the different types
of movement and the potential effect on the student’s behavior and/or
recommend:
~movement
activities prior to seated work
~a
trial w/ a seat cushion
~adjusting
the desk/chair height
~changing
the location of the desk
~providing
directions one at a time
~providing
a written or pictorial list of steps in a task for the student to check off
The
chart below demonstrates how the analysis of issues in any of the domains of
occupational therapy practice might lead to a specific strategy to support the
student need. It is this analysis that helps to determine the strategy
recommended.
Instructional Support Strategies - Example: Working
Cooperatively with Peers
|
Occupation |
Domain |
Concern |
Strategy |
|
Turn taking during small
group activity |
Child Factor |
Impulsivity and short
attention span limits ability to wait turn, results in ‘off task’ and/or disruptive
behaviors |
-Have an adult provide
tactile cue to shoulder as a reminder of need to attend and to wait.
-Set up reward system for
successful turn taking
-Provide a tangible
marker to indicate turn to speak. For example the student can speak when the
picture is passed to his or her hands. |
|
Activity Demands |
Task requires lengthy
turn for each student |
-Adapt/modify task so
that turns are shorter
-Give student a job to do
related to the activity, such as recording the responses of others or keeping
score so that he or she is engaged throughout the activity
-Provide another activity
or fidget object while waiting for next turn |
|
Context (Environment) |
Distracted by other
groups nearby and by books and other materials within easy reach of group
activity area |
-Position location of
small group in least ‘busy’ area of classroom, away from other students and
material |
|
Sharing Materials |
Child Factor |
Takes materials from
peers without asking and hoards materials, refuses to share with peers |
-Start with allowing the
student to have own materials or begin by sharing with only one other student
-Teach, post and review
rule of sharing individually and as a class
-Set up chart/reward
system for appropriate sharing
-Model how to share,
including use of words |
|
Activity Demands |
Limited number of
materials requires greater amount of sharing and disrupts the productivity of
independent work time for student and others in class |
-Provide own set of
materials for certain independent work tasks
-Use timer for use of materials
before passing
-Begin with smaller
groups or pairs so that the student can practice structured turn taking
-Explain clear rules for
sharing at the beginning of each activity through the use of social stories |
|
Context (Environment) |
Student is in desk
cluster farthest from teacher desk making monitoring of sharing more
difficult |
-Reposition student in
desk cluster close to teacher desk/area of instruction
-Have fewer peers in the
student’s desk cluster so that turn taking is more manageable |
|
Respecting Personal Space
of others |
Child Factor |
Unaware of personal
boundary guidelines, tends to get in peers’ space |
-Teach appropriate
personal space – use strategy such as ‘arms length’ or practice with and then
visualize hula hoops around each person
-Provide each student
with own space such as the use of mats during meeting time |
|
Activity Demands |
1. Activities require
movement of limbs and bodies to music resulting in unintentional and
unexpected physical contact with peers
2. Classroom routine
involves an open concept so that students are free to use all spaces for
learning activities. It is not clear to the student where to be. |
-Select movement to music
activities with controlled/structured movements rather than generalized or
random movements.
-Determine personal space
boundaries prior to each activity with tangible markers such as tape or a
mat specific to that activity
. -Designate spaces
within the room that that can be used for specific activities. For example, have separate desks available
for all students who cannot work on unstructured table space. |
|
Context (Environment) |
Students seated randomly
on carpet for circle time |
-Provide carpet squares
or other boundaries at circle time
-Perform some activities
seated in chairs rather than on rug |
Instructional Support
Strategies - Example: Managing Clothing & Personal Belongings: Completing
classroom routine
|
Occupation |
Domain |
Concern |
Strategy |
|
Completing AM routine
upon arrival to classroom |
Child Factor |
Limited balance and fine
motor skills interfere with removing outer clothing and putting personal
belongings away |
-Instruct classroom staff
to assist in those aspects of specific tasks that the student is unable to
perform (ex. hooking zipper, putting on mittens)
-Place a chair in the
coat area to allow the student to sit when removing outer clothing |
|
Activity Demands |
Multiple factors
interfere with completion of routine such as:
insufficient time, given
motor control factors, and
too many students in the
area to allow enough room to negotiate |
-Allow student to begin
first or have staff assist with the process.
-Reduce number of
students in coat room at one time by using a staggered schedule |
|
Context (Environment) |
Coat room is a small
area, hooks are located on two levels and student’s hook is in the middle on
the top level, just barely within reach |
-Change location of hook
to lower level at the end of the row of hooks for easier access and to allow
the student to use the wall for support when putting belongings away |
Instructional Support Strategies - Example: Illegible Handwriting
|
Occupation |
Domain |
Concern |
Strategy |
|
Sitting
at Desk |
Child Factor |
Postural Control |
Seat Cushion |
|
Activity Demands |
Sitting too long at one
time |
Shorten writing sessions,
provide breaks |
|
Context (Environment) |
Desk/Chair Size |
Appropriate size
desk/chair |
|
Letter Formation |
Child Factor |
1. Pencil Grasp
2. Poor letter formation
habits developed |
Pencil Grip
Practice correct
letter formation at home |
|
Activity Demands |
Materials: Pencil, Paper |
Alter materials: size and
type of writing implement, line size and type of paper |
|
Context (Environment) |
Distracted by peers |
Change seating location
for writing |
|
Writing Sentences |
Child Factor |
Spelling |
Provide word list |
|
Activity Demands |
Organizational demands of
assignment |
Provide template/graphic
organizer |
|
Context (Environment) |
Unable to see board |
Preferential seating near
board |
This pre-referral process of providing instructional
support may include a screening, done by the occupational therapist, to determine
the next steps necessary to address the student’s educational needs. A
screening is a process of gathering information for the purpose of determining
the need for formal evaluation. What constitutes a screening may be defined by
state licensure law. A screening typically may include observation in various
settings (classroom, gym, cafeteria, playground, during transitions, or other
locations), and interviews with teachers, parents, and/or other adults involved
in the student’s educational program. It
also may include checklists and record review. The pre-referral process may
result in recommendations for accommodations or strategies (instructional
supports), or in a referral for a formal evaluation.
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Special Education Process 
