12-25-06
Is That Really OTs Domain? Providing Mental Health Services in the Schools
Susan M. Cahill
Summary
Practical ways to enhance the scope of your services.
"Will school districts really support OT intervention for students with social–emotional issues?" I hear this question time and again from frustrated colleagues, and my answer is, "yes, but..." As an occupational therapist and a special education administrator, I have sat on both sides of "educational relevance." I know what it feels like to be asked the typical questions that school-based occupational therapy practitioners face on a daily basis, such as:
- Will that cushion really make him pay attention better?
- How hard will it be for the teacher to follow through with this recommendation?
- OT is just like PT, but for the hands, right?
- Why does a third grader need to know how to apply for a job?
- You work on other skills besides handwriting?
A new question has made its way onto my list, with regard to providing services to students with social–emotional issues: "Is that really OT's domain?" Unfortunately, I am not just hearing this question from administrators, teachers, and social workers. I am hearing it from occupational therapists and occupational therapy assistants. I truly believe that occupational therapists know the answer to this question, but somehow we have accepted the limited roles that we have been given in this practice setting. One of the reasons I became a school administrator was to work from the inside and change perceptions of how occupational therapy is viewed in school systems. Any occupational therapist who has tried to convince a teacher that she really can do more than teach handwriting knows that changing school culture is not easy, and that it takes a great deal of finesse.
The time for action is now. State and federal regulations are mandating that schools support the psychosocial development of students. Occupational therapy practitioners working in school systems must seek support from other members on the individualized education program (IEP) team. We have to be strategic and thoughtful in our approach and become truly invested in the process. We must feel confident in defining our scope of practice, educate the individuals we serve and work with, become full-fledged members of the educational team, and provide quality occupational therapy services to students with social–emotional needs.
Scope of Practice
From my perspective, the first step is to become familiar with occupational therapy's scope of practice. We have to know what we are sanctioned to do. Some good places to start are the Occupational Therapy Practice Framework: Domain and Process1 and the Children With Behavioral and Psychosocial Needs: Occupational Therapy Practice Guidelines.2 Many state boards of education also publish guidelines for practitioners working in the schools, which may be found on the Internet or through state occupational therapy associations. All of these documents solidify our position as competent professionals capable of providing services to students with social–emotional needs.
Most school practitioners work as part of an occupational therapy department that is under a larger umbrella of a school district or special education cooperative. So if questions still remain about occupational therapy's role in working with students who have social–emotional needs, get together with other occupational therapy practitioners and brainstorm. Discuss concrete ways in which occupational therapy intervention could support a student's behavioral, social, and emotional needs. Generate some phrases that you might use to educate staff members on your role, and practice using them. Another suggestion is to develop a department-wide position statement that outlines your collective views on providing such services. Seek support for your statement at a school board meeting and then disseminate it to school administrators and other key players.
Educate
Besides disseminating a position statement, we can do much more to educate school- and district-level administrators, as well as IEP team members on what occupational therapy is, and at the same time support their understanding and acceptance of our role in facilitating the participation and academic achievement of students with social–emotional needs. Teachers and related service providers are busy, and it is often challenging to find time to schedule a 30-minute meeting or an in-service. However, it is even more difficult to explain the breadth of our expertise to a teacher as she is eating lunch and grading papers in the faculty lounge. In this respect, I believe that we must become good detectives and even better salespeople.
It is worthwhile to find out which individuals in your school are progressive thinkers and which are wary of change. Most practitioners who have worked in a building for a semester have a fairly good sense of this already. After you have identified the progressive thinkers, choose one with whom you have a relationship and begin a dialogue at a time that is convenient for that person. Start by learning his or her definition of occupational therapy. Listen carefully, and then with the same enthusiasm that you would use to teach a student something new, share your definition. Be supportive and answer the individual's questions with kindness and openness. Accept the challenging issues that are raised and reframe them to support your position. Talk about what it looks like when a student has social–emotional needs, and then share what occupational therapy intervention for this student might look like.
Time must also be spent obtaining support from people who might feel professionally threatened by your direct involvement with students for whom they typically provide services. Social workers, guidance counselors, and school psychologists provide counseling services to students with social–emotional needs. These providers need to fully understand how occupational therapy is different from the services they are providing. By showing respect for their expertise and being clear about ours, we can gain their endorsement. This approach will also alleviate any concerns your special education supervisor may have about duplicating services. Additionally, it will demonstrate your desire to provide child-centered services within the context of a multidisciplinary team.
Become a Full-Fledged Member of the Educational Team
Embrace your identity as an educator. The minute you signed a contract to work in the school system, you made an underlying commitment to become "one of them." An educator understands the legislation governing special education, the evidence-based instructional methods that are effective in teaching students, the curriculum, and the local learning standards. If you are unfamiliar with any of these concepts and are working in a school setting, you need to do your homework. Having a working knowledge of these critical constructs will demonstrate commitment to the educational process and a deeper understanding of what is at stake for every student you service. Other team members will notice your investment and appreciate that you have assimilated to the school culture.
Often, teachers and administrators question the investment of itinerant therapists coming to their buildings. From their perspective, being a team member means more than providing consultation; it means being visible and available. Attending school assemblies, eating lunch in the faculty lounge, and getting to school a few minutes early are just some ways to send the message that you want to be part of a larger team. Providing your contact numbers and e-mail address will also demonstrate your willingness to provide support when challenging situations present themselves throughout the year.
Provide High Quality Services
Many practitioners will have to familiarize themselves with new methods of evaluation to appropriately provide services to students with social–emotional needs. In the wake of the No Child Left Behind Act3 and the Individuals with Disabilities Education Improvement Act,4 we are compelled to conduct valid assessments that afford us the ability to measure change over time. Operating out of only a developmental or sensory integration frame of reference will limit our effectiveness. Therefore, assessments traditionally used in school systems, and based only on these theories, may restrict us from gaining the information we need to make educationally relevant goals that support behavioral and psychosocial development.
Assessments built on occupational therapy theory and designed for use in pediatric settings are the most valuable tools we can use to facilitate our aim. Assessments such as the Pediatric Volitional Questionnaire,5 Child Occupational Self Assessment,6 and Short Child Occupational Profile7 were developed based on the Model of Human Occupation.8 Such tools provide valuable insight into qualities that are directly related to a child's behavioral and psychosocial development, such as volition, roles, and efficacy. Top-down assessments9 such as the School Function Assessment10 can be used to gain information about a child's level of participation, performance with typical school activities, and need for task supports. After we have a better understanding of the student's needs, we can help the team develop occupationally relevant goals, interventions, and accommodations to support academic achievement and participation.
Conclusion
Fostering understanding and acceptance by IEP team members of our role in providing services to students with social–emotional needs requires dedication, creativity, and time. We must not assume that a shift in the school systems' culture will occur without our directing it. In fact, we should embrace this opportunity to reinvent ourselves as clinicians who support the occupations of children in their roles as students, regardless of disability.
References
1. American Occupational Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609–639.
2. Jackson, L., & Arbesman, M. (2005). Children with behavioral and psychosocial needs: Occupational therapy practice guidelines. Bethesda, MD: American Occupational Therapy Association.
3. No Child Left Behind Act of 2001. Pub. L. 107-110.
4. Individuals with Disabilities Education Improvement Act of 2004. Pub. L. 108-446.
5. Basu, S., Kafkes, A., Geist, R., & Kielhofner, G. (2002). A user's guide to the Pediatric Volitional Questionnaire (PVQ) (Version 2.0). Chicago: Model of Human Occupation Clearinghouse, University of Illinois at Chicago.
6. Keller, J., Kafkes, A., Basu, S., Federico, J., & Kielhofner, G. (2002). The Child Occupational Self Assessment (COSA) (Version 2.0). Chicago: Model of Human Occupation Clearinghouse, University of Illinois at Chicago.
7. Bowyer, P., Ros, M., Schwartz, O., & Kielhofner, G. (2004). A user's guide to the Short Child Occupational Profile (SCOPE) (Version 2.0). Chicago: Model of Human Occupation Clearinghouse, University of Illinois at Chicago.
8. Kielhofner, G. (2002). A model of human occupation: Theory and application (3rd ed.). Baltimore: Lippincott Williams & Wilkins.
9. Coster, W. (1998). Occupation-centered assessment of children. American Journal of Occupational Therapy, 52, 337–344.
10. Coster, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998). School Function Assessment: User's Manual. San Antonio, TX: Therapy Skill Builders.
Susan M. Cahill, MAEA, OTR/L, has been a practicing occupational therapist since 1997. The majority of her career has been spent in pediatrics, specifically working in the school systems. In addition to being an occupational therapist, she is a certified school administrator and a faculty member at the University of Illinois at Chicago.
For More Information
AOTA Evidence Briefs:
Children With Behavioral and Psychosocial Needs
Available from AOTA's Web site at www.aota.org. Click on Research, Evidence-Based Practice Resources, Evidence Briefs Series, then Children With Behavioral and Psychosocial Needs.
Children With Behavioral and Psychosocial Needs: Occupational Therapy Evidence Collection (CD-ROM)
By L. Jackson & M. Arbesman, 2006. Bethesda, MD: American Occupational Therapy Association. ($65 for members, $89 for nonmembers. To order, call toll free 877-404-AOTA or shop online at www.aota.org. Order #2213-MI)
AOTA Self-Paced Clinical Course:
Occupational Therapy: Making a Difference in School System Practice
Edited by J. Case-Smith, 1998. Bethesda, MD: American Occupational Therapy Association. (Earn 3.3 AOTA CEUs/33 NBCOT PDUs/33 contact hours. $363 for members, $463 for nonmembers. To order, call toll free 877-404-AOTA or shop online at www.aota.org. Order #3013-MI)
The New IDEA: An Occupational Therapy Toolkit (CD-ROM)
By L. Jackson, 2006. Bethesda, MD: American Occupational Therapy Association. ($49 for members, $69.50 for nonmembers. To order, call toll free 877-404-AOTA or shop online at www.aota.org. Order #4810-MI)
AOTA AudioInsight Seminar:
The New IDEA RegulationsÑWhat Do They Mean to Your School-Based and EI Practice? (Web-Based Extended Replay)
By the American Occupational Therapy Association, 2006. Bethesda, MD: Author. (Earn .2 AOTA CEUs/2 NBCOT PDUs/2 contact hours. $60 for members, $85 for nonmembers. To order, call toll free 877-404-AOTA or shop online at www.aota.org. Order #PWS10061-MI) Available until January 31, 2007.
Practical Considerations for School-Based Occupational Therapists
By L. Pape & K. Ryba, 2004. Bethesda, MD: American Occupational Therapy Association. ($37 for members, $52 for nonmembers. To order, call toll free 877-404-AOTA or shop online at www.aota.org. Order #1233-MI)
Psychosocial Aspects of Occupational Therapy (2004)
By the American Occupational Therapy Association, 2004. American Journal of Occupational Therapy, 58, 669–672.
Reference Information:
Cahill, S. M. (2006). "Is that really OT's domain?" Providing mental health services in the schools. [Electronic Version]. OT Practice, 11(22), 13–16.
©Copyright 2006. The American Occupational Therapy Association. All rights reserved.