I have a query regarding provision of Occupational Therapy in the USA. I want to compare it with provision in the UK. In the UK provision is divided between Health and Education. Education do not have any Occupational Therapist Department as they say "it is not essential to learning". As any mother with an autistic child with sensory differences knows sensory stuff has a huge impact and does make it hard for them to access learning in a school environment. You can be referred to an Occupational Therapist via the Paediatrician but the waiting list is around 18 months and the criteria is such that children with other diagnosis are placed at the top of the waiting list. I see OT input as essential as it also informs other professionals so that they can tailor their programmes accordingly. I am trying to see if the Local Educational Authority are failing to meet the Disability Discrimination Act and would be interested to hear other peoples experiences in the UK and USA.
As I understand it, in the states, OT provided by a child's school is only supposed to support him in his educational setting. This leaves things wide open for interpretation and argument. Many school OT's will not address (directly) sensory issues. They will, instead, help the child to feed himself, hold a crayon, learn to use scissors, stuff like that. If a parent wants a full sensory evaluation done, it is done privately.
Obviously, sensory "issues" will affect the way that a child performs in school, but unless the child's IEP (individualized education plan) includes specific goals to support whatever modifications are decided upon, the school does not need to address them. A school OT will typically encourage "sensory breaks" or recommend a specific kind of chair. She will not develop and carry out a treatment plan to directly address sensory issues. Like I said before, it is up to the parent to find a private OT who would do that.
Is it only schools that have special educational needs children that have OT's?
I am surprised they don't include sensory integration stuff as OT's are the profession that discovered it!!
I find it unbelievable, for example, that a child who has auditory differences and is unable to tune out irrelevant noise in the classroom or is unable to habituate to certain noises and therefore will be unable to hear what the teacher says or follow verbal instructions or may focus their attention on something making a noise (such as the flickering lights) is not seen as a child who needs these sensory differences assessing and supports provided to help them access the curriculum.
Without that assessment and support in place other professionals such as autism teacher, educational psychologist etc may even set up programmes that do not address the root of the problem or may even set up programmes that are painful or distressing to the child.
For example to use ABA on a child that won't keep their clothes on and offer, as a reward, a chocolate biscuit or stickers to go on a reward chart, if the child keeps his clothes on is bound to fail if the root of the problem is tactile problems. If the childs clothing is uncomfortable, painful etc how is a biscuit going to help them keep their clothes on??
I am an educator for children with autism in Pennsylvania, USA. If a child presents with difficulties related to sensory, fine motor, functional living skills, etc. the teacher can request a referral for an evaluation for Occupational Therapy services. A parent can also request such an evaluation. The OT and the rest of the IEP (Individualized Education Plan) team (which includes the parents) then decide if the child is eligible for those services and what they should be (Individual or group OT sessions, how often, etc.). I work with an OT who addresses fine motor skills as well as sensory issues. She writes "Sensory Diets" which are recommendations for school staff to do during the day to help the student with sensory issues. These sensory diets are individualized to the child but may include things that incorporate propriocepitive and vestibular activities just to name a few. The OT sees the students in their classrooms during the school day. I hope that helps.
It depends on the quality of public education in the state (varies widely in the u.s.) and more importantly the quality of the team (also varies widely). But, as I stated before, the OT's job, in a public school setting, is to support the child in his academic setting. What that means is totally up to interpretation. This is just one of the reasons that IEP meetings can get contentious.
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