03-03-04 - AOTA Statement on NCLB
Statement for the Record
Committee on Education and the Workforce Hearing on No Child Left Behind: Improving Results for Children With Disabilities
March 3, 2004
Contact: Leslie Jackson
301-652-6611 x2023
The American Occupational Therapy Association (AOTA) submits this statement for the record of the March 3, 2004, hearing. We appreciate the opportunity to provide this information regarding the relationship of occupational therapy services to improving results for children with disabilities under the No Child Left Behind Act (NCLB). It is important for Congress to monitor how well the law meets its objective of holding states and schools accountable for improving educational outcomes for all students, including those with disabilities. The topic of this hearing is critical to the development of a better, clearer picture of how America's public schools should educate students with special needs.
Children's education and learning continues to receive a great deal of attention from teachers, administrators, parents, and policy makers across the country. Of concern to everyone is how to best educate all students to high standards and how to appropriately measure student progress, particularly for students with disabilities and those with limited English proficiency. Embedded in NCLB is recognition of the link between improved student outcomes and well=trained and qualified personnel. The law also requires school personnel to use effective instructional practices and other supports to help children learn. These and other issues have also been raised in the pending reauthorization of the Individuals With Disabilities Education Act (IDEA). NCLB and IDEA are expected to work in concert to help schools meet the learning and behavioral needs of children with disabilities. Occupational therapy services can play an important role in this effort.
Occupational Therapy Services Under IDEA and NCLB
Occupational therapy is concerned about an individual's ability to do everyday activities, or occupations, so that they can participate in school, at home, at work, and in the community. Occupational therapy practitioners use purposeful activities to help children bridge the gap between their capacity to learn and full, successful participation in education, work, play, and leisure activities.
Occupational therapists look at the individual's strengths and needs with respect to daily life performance in school, home and community life, focusing on the relationship between the child and their performance abilities, the demands of the activity, and the physical and social contexts within which the activity is performed. In addition to the physical aspects, each individual's occupational performance is viewed through a psychological-social-emotional lens. This perspective helps the occupational therapist to understand what is important and meaningful to the child as well as how their roles, experiences, strengths, and patterns of coping affect performance in learning and other activities.
Occupational therapy for the school-aged child is intended to help them succeed in school. Intervention strategies may focus on information-processing, academic skill development, social interactions, and ability to function in the school environment. For adolescents, occupational therapy focuses on preparation for work=life choices, improvement of social and work skills, and learning how to create or alter the environment to maximize productivity.
How Occupational Therapy Helps Support NCLB and IDEA
Occupational therapy intervention for children and youth is planned in consultation with parents and families, teachers, and other professionals, and is directed toward achieving desired outcomes. Children are being challenged by increasingly higher standards of educational performance and achievement. They may feel pressure from parents, peers, and others to behave in certain ways or to conform to certain expectations that may be in conflict with one another. Depending on the student's age, the presence of any learning difficulties may have debilitating effects on his or her sense of accomplishment or social competence. Difficulties with completing class assignments or in getting along with others may lead to frustration and self-isolation. Occupational therapy intervention for these students can address these stresses by identifying these psychosocial problems.
In addressing learning problems, occupational therapists identify the underlying performance skills, including motor, process, communication, and interaction skills that impede the student's ability to participate in learning and other school-related activities. Intervention strategies and service models are designed to support desired educational outcomes, and may be provided individually or in small groups. The therapist also works with classroom teachers and the student's family to determine how to modify the home or classroom settings, routines, and schedules to provide structured learning opportunities and experiences that support the student's emerging skills. Occupational therapists also help students participate in lunch activities in the cafeteria and to identify organizational strategies so they can attend to instruction in the classroom.
Occupational therapy can have a significant supportive role in testing under NCLB. The occupational therapists' expertise in helping students meet school activity and task demands can help teachers and individualized education program (IEP) Teams to identify appropriate accommodations needed in the classroom or learning environment to support the student's skill level. This includes identification of and training in the use of assistive technology or other aids that will help the student complete his assignments, as well as to participate in state and district assessments. These accommodations might include simple keyboarding devices such as the Alpha Smart; low-tech solutions such as built-up pencil grips, notebook paper with raised lines, and elevated writing surfaces to assist with handwriting; and carrels to limit students' peripheral=vision distractibility.
Another area in which occupational therapy can help improve student results is the area of literacy. Poor or messy handwriting is a major reason for referral to occupational therapy in school settings. Many of these referrals are from general education classrooms and may be related to decreased formal instruction in the mechanics of handwriting.
Reading and handwriting are not simple learning tasks. Both require the coordination of complex cognitive, memory, visual, and motor processes. Difficulties in one or more of these areas can also impact a child's view of the entire learning environment (such as learning to spell, use scissors, or move through the hallways without bumping into another child), not just their ability to read and write. Even after these components are mastered, students do not become "writers" unless they also have the requisite language and cognitive abilities to organize ideas and express them appropriately using the rules of grammar and syntax.
Occupational therapy has unique expertise in the areas that affect reading and writing. Children's visual and writing skills are dependent on having a stable base of postural or physical support from which their eyes and hands can do the work of reading and writing. It is difficult, for example, for a child to participate in a reading activity on the chalkboard when they can not keep their head/trunk up for long periods of time, or if they are easily visually distracted and can not "tune out" a visually "busy" classroom. Children with handwriting and visual-perception difficulties often find a way to not perform or complete reading and written assignments. Occupational therapy is an important service that can help meet the needs of children with reading and writing difficulties.
AOTA believes that occupational therapy is an underutilized service that can meet and address children's learning, social, and behavioral needs. As a result, many children who could benefit from occupational therapy do not receive services. This limited access affects both IDEA-eligible students as well as students in general education. Often this limitation is due to a lack of understanding about how occupational therapy can help or because of perceptions that therapists only address 'motor" issues. Occupational therapy training is comprehensive and covers physical, psychological, social and pedagogical aspects of human occupation. Occupational therapy's understanding of human performance, or "do-ing," can be invaluable in helping parents and school staff to understand the relationship between the physical and psychosocial and how these factors support or impede children's progress.
What Is Occupational Therapy?
Occupational therapy is a vital health and rehabilitation service, designed to help individuals participate in important everyday activities, or occupations. Occupational therapy services address underlying performance skills, including motor, process, communication, and interaction skills to assist in the correction and prevention of conditions that limit an individual from fully participating in life. For children with disabling conditions and other educational needs, occupational therapy can help them to develop needed skills within the context of important learning experiences and to perform necessary daily activities such as feeding or dressing themselves and help them get along with their peers at school. Occupational therapy services can help identify strategies for teachers and families to use to facilitate appropriate reading and writing development.
Occupational therapy practitioners have the unique training to assist individuals to engage in daily life activities throughout the lifespan and across home, school, work, and play environments. Services may be provided during only one period of the child's life or at several different points when the child is having difficulties engaging in his or her daily school occupations, such as when they are faced with more complex demands in the classroom resulting from increased emphasis and reliance on written output. Occupational therapy services may be provided in the family's home, at school, and in the community, such as day care and preschool programs, private clinics, and vocational programs.
Occupational therapy evaluation determines whether an individual would benefit from intervention. The evaluation looks at the individual's strengths and needs with respect to daily life function in school, home, and community life, focusing on the relationship between the client and their performance abilities, the demands of the activity, and the physical and social contexts in which the activity is performed. The findings of the occupational therapy evaluation inform the team of the need for intervention. Occupational therapy practitioners use purposeful activities to help individuals bridge the gap between capacity to learn and full and successful engagement in work, play, and leisure activities.
For example, occupational therapy for infants and young children may include remediation of problem areas, development of compensatory strategies, enhancement of strengths, and creation of environments that provide opportunities for developmentally appropriate play and learning experiences. Services for the school-aged child are intended to help them be successful in school. Intervention strategies may focus on improving the child's information-processing ability, academic skill development such as handwriting, and ability to function in the school environment. For adolescents, the occupational therapy intervention focus is on preparation for occupational choice, improving social and work skills, and learning how to create or alter the environment to maximize their productivity.
Occupational therapy is a health and rehabilitation service covered by private health insurance, Medicare, Medicaid, workers' compensation, vocational programs, behavioral health programs, early intervention programs, and education programs. AOTA represents 30,000 occupational therapists, occupational therapy assistants, and students. We thank you, once again, for the opportunity to submit our comments for the record.
9/1/04