ESE:Occupational and Physical Therapy Manual

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Contents

Introduction

In order to improve physical and occupational therapy programs in Pasco County, the committee developed this manual to assist all staff in the provision of quality services. We felt it was important to provide information regarding general considerations for development and evaluation of our programs for exceptional students. This manual is to serve as a vehicle for planning, communication and coordination among the exceptional student teachers, therapists, school principals and other educational staff.

Purpose

The District School Board of Pasco County provides Physical and Occupational Therapy services to Exceptional Student Education students in accordance with the Individuals with Disabilities Education Act (IDEA). This manual provides a guideline for provision of educationally relevant therapy services. Under IDEA, Occupational and Physical Therapy are related services provided in the educational setting. The purpose of school-based or educationally relevant therapy provided in the educational setting is to enable the student to benefit from their special education and to assist the primary program in helping the student achieve his/her individualized education plan (T/IEP) goals.

Definition of Services

Occupational Therapy Program

Occupational Therapy is the use of purposeful activity or interventions designed to achieve functional outcomes that promote health, and prevent injury or disability, and which develop, improve, sustain, or restore to a functional level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, physical disability or other disorder or condition. It includes assessment by means of evaluation and observation through the administration and interpretation of standardized or non-standardized tests and measurements.

Occupational therapy services include but are not limited to:

  • The assessment and provision of treatment in consultation with the individual, family, or other appropriate persons;
  • Interventions directed toward developing, improving, sustaining, or restoring daily living skills, including self-care skills and activities that involve interactions with others and the environment, work readiness or work performance, play skills or leisure capacities, or enhancing educational performance skills;
  • Developing, improving, sustaining, or restoring sensorimotor, oral-motor, perceptual, or neuromuscular functioning; or emotional, motivational, cognitive, or psychosocial components of performance; and
  • Education of the student, family, or other appropriate persons in carrying out appropriate interventions.

These services may encompass assessment of need and the design, development, adaptation, application, or training in the use of assistive technology devices; the design, fabrication, or application or rehabilitative technology such as selected orthotic devices; training in the use of orthotic or prosthetic devices; the application of physical agent modalities as an adjunct to or in preparation for purposeful activity; the application of ergonomic principles; the adaptation of environments and processes to enhance functional performance; or the promotion of health and wellness (AJOT, 1995, 49, p. 1072-1073).

Physical Therapy Program

Physical Therapy is a dynamic profession with an established theoretical and scientific base and widespread applications in the restoration, maintenance and promotion of physical function.

Physical Therapists services include but are not limited to:

  • Provide services to students who have impairments, functional limitations, disabilities, or changes in physical function and health status resulting from injury, disease, or other causes;
  • Interact and practice in collaboration with a variety of professionals.
  • Identify risk factors and behaviors that may impede functioning;
  • Provide prevention and promote health, wellness, and fitness;
  • Consult, educate, engage in critical inquiry, and administrative activities; and
  • Direct and supervise the physical therapy service, including support personnel.

As clinicians, physical therapists engage in an examination process that includes taking the student history, conducting a systems review, and performing tests and measures to identify potential and existing problems. To establish treatment, diagnoses, prognoses, and plans of care, physical therapists perform evaluations, synthesizing the examination data and determining whether the problems to be addressed are within the scope of physical therapist practice. Based on their judgments about diagnoses and prognoses and based on student goals, physical therapists provide interventions (the interactions and procedures used in managing and instructing patients/clients), conduct reexaminations, modify interventions as necessary to achieve anticipated goals and expected outcomes, and develop and implement discharge plans (APTA, Guide to Physical Therapist Practice, 2001, pp. S13, S31-S32).

Roles & Responsibilities of the Occupational Therapist

Occupational therapy roles may include screening, peer review, evaluation, treatment, program planning and consultation as well as administration and education, and related professional responsibilities. The roles are

I. Evaluating students to specify the need for occupational therapy services to assist the primary program.

  • A. Conducting an individualized, detailed and documented assessment of a student known or suspected to have a handicapping condition, which includes utilizing evaluation tools and skills to assess such areas as:
  • 1. Self Care (Feeding, Clothing Management, Hygiene);
  • 2. Learning Environment (Assistive Technology, Positioning, Access to Classroom Supplies); and
  • C. Fine Motor (Utilizing Educational Materials, Motor Planning, Visual Perception)
  • B. Reporting/recording results of the evaluation process.
  • C. Identifying pertinent goals and recommendations for program management and level of therapy needs to enhance student's performance abilities

II. Planning the program

  • A. Establishing collaborative goals and benchmarks with ESE teachers and specific remediation techniques for each exceptional student receiving occupational therapy services
  • B. Participating on the educational team by attending school staffings/meetings regarding students and programs
  • C. Prepare/present/coordinate occupational therapy programs with teacher/staff for classroom implementation


III. Participating in educational program planning for individual students to coordinate occupational therapy goals and program plans with total educational programs

  • A. Prepare/present/coordinate immediate and long-range goals or occupational therapy programs as a part of the Individualized Educational Plan
  • B. Discuss/adapt/coordinate occupational therapy programs with student/family/staff
  • C. Determine need for and recommend appropriate adaptive equipment and devices needed by a student to enhance performance abilities
  • D. Participate in school staffings/meetings regarding students and programs
  • E. Prepare/present/coordinate educational home programs with the student/family
  • F. Prepare/present/coordinate occupational therapy programs with teacher/staff for classroom implementations
  • G. Develop current records/files/charts regarding occupational therapy programs, goals, and student's progress to meet school requirements


IV. Implementing appropriate intervention programs to facilitate functioning and enhance a student's ability to learn and develop.


A. Facilitating student's participation in purposeful activities to enhance acquisition of

  • 1. Self care;
  • 2. Fine/gross motor skills;
  • 3. Sensory processing;
  • 4. Visual-motor skills;
  • 5. Improved neuromuscular functioning;
  • 6. Functional skills in the learning environment;
  • 7. Prevocational/vocational activities/skills;
  • 8. Play/leisure activities; and/or
  • 9. Assistive technology.
  • B. Adapting the environment to
  • 1. Assure proper positioning to enhance functions desired;
  • 2. Enable the child to access the environment through the use of assistive technology/adaptive equipment;
  • 3. Facilitate desired performance response and enhance developmental skills.
  • C. Monitoring/modifying/discussing performance response with the IEP team
  • D. Instructing student/family/staff in use of adaptive equipment and devices
  • E. Designing/constructing/recommending adaptive equipment/devices/techniques when appropriate


  • V. Managing/supervising school based occupational therapy programs


  • A. Acting as an advocate for student's program need;
  • B. Informing and referring student/family for appropriate community services;
  • C. Planning/managing the budget, and ordering supplies/equipment;
  • D. Maintaining environment, materials and equipment, inventory, and educational resources;
  • E. Attending and participating in conferences and committee meetings related to pediatrics and occupational therapy in the school setting;
  • F. Supervising therapy assistants for implementation of occupational therapy practice;
  • G. Determining space needs/requirements in conjunction with school-based administrators;
  • H. Developing and implementing program for different levels of service: student, school, and district;
  • I. Assists supervisor in recruitment and orientation of new staff; and
  • J. Supervising supportive personnel and student affiliates; and
  • K. Other therapy related duties as assigned by supervisor.


VI. Consulting with school personnel and parents regarding services provided by occupational therapy


  • A. Discussing in formal conferences, the benchmarks, goals and descriptions of a school-based occupational therapy program;*B. Coordinating occupational therapy programs with the T/IEP team;*C. Provide/recommend materials, equipment, assistive devices, techniques to enable the child to reach his/her T/IEP goals.*D. Determining need for and receiving consultation from other staff members or outside resources when needed to provide appropriate services for the individual.


VII. Sustaining current professional responsibilities


  • A. Apprising self of legal responsibilities, professional ethics, standards of practice, school policies, rules and regulations*B. Maintaining current licensure as required by state and national regulations*C. Updating job descriptions according to state and national laws, rules, regulations and delivery patterns*D. Maintain confidentiality


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Roles & Responsibilities of the Occupational Therapy Assistant

The role of the occupational therapy assistant is to provide individual and small group treatment and to assist the registered occupational therapist in program planning, evaluation, administration and education of other school personnel. The roles are

I. Assisting in student evaluation

  • A. Gather information for the registered occupational therapist including review of records, student observation, or gathering input from T/IEP team
  • B. Assist the registered occupational therapist in administering tests
  • C. Assist the registered occupational therapist in screening


II. Participating in educational program planning*A. Assist by providing input for goals and benchmarks for student's individualized treatment plans; and

  • B. Assess, assemble, record, and maintain appropriate data regarding student's treatment and progress.


III. Implementing appropriate intervention programs to facilitate a student's development and functioning in the educational environment

  • A. Facilitating an student's participation with purposeful activities to enhance acquisition of
  • 1. Self care;
  • 2. Fine/gross motor skills;
  • 3. Sensory processing;
  • 4. Visual-motor skills;
  • 5. Improved neuromuscular functioning;
  • 6. Functional skills in the learning environment;
  • 7. Prevocational/vocational activities/skills;
  • 8. Play/leisure activities; and/or
  • 9. Assistive technology.
  • B. Assisting in designing/constructing/recommending adaptive equipment/devices/techniques when appropriate;
  • C. Assessing proper positioning to enhance functions desired


IV. Assisting in managing school based occupational therapy program*A. Documentation and record keeping;

  • B. Offering suggestions and assisting in ordering and maintenance of equipment, supplies, and educational resources;
  • C. Attending conferences/seminars and committee meetings related to school program;
  • D. Other therapy related duties as assigned by registered therapist or supervisor.


V. Sustain current professional responsibilities

  • A. Apprising self of legal responsibilities, professional ethics, standards of practice, school policies, rules and regulations
  • B. Maintaining current licensure as required by state and national regulations
  • C. Maintaining confidentiality


___________________________________________________________________________

Roles & Responsibilities of the Physical Therapist

Physical therapy roles may include screening, peer review, evaluation, treatment, program planning and consultation as well as administration and education, and related professional responsibilities.

The roles are:

I. Evaluating students to specify the need for physical therapy services to assist the primary program.

  • A. Conducting an individualized, detailed and documented assessment of a student known or suspected to have a handicapping condition, which includes utilizing evaluation tools and skills to assess such areas as:
  • 1. Postural reflex maturation;
  • 2. Sensory and motor development;
  • 3.Joint range of motion;
  • 4.Muscular development;
  • 5. Activities of daily living;
  • 6. Postural and gait deviations;
  • 7. Adaptive equipment needs;
  • 8. Orthotic/prosthetic needs;
  • 9. Wheelchair modification/recommendation;
  • 10. Assistive technology;
  • 11. Bus transportation needs; and
  • 12. Functional motor skills.
  • B. Reporting/recording results of the evaluation process.
  • C. Identifying pertinent goals and recommendations for program management and level of therapy needs to enhance student's performance abilities.


II. Planning the program

  • A. Establishing goals and objectives and specific remediation techniques for each exceptional student receiving physical therapy services.
  • B. Participating on the educational team by attending school staffings/meetings regarding students and programs.
  • C. Prepare/present/coordinate physical therapy programs with teacher/staff for classroom implementation.


III. Treating students


  • A. Managing the disability based upon results of the evaluation may include


  • 1. Positioning;
  • 2. Neurodevelopmental and neuromuscular facilitation to enhance motor skills;
  • 3. Sensorimotor integration;
  • 4. Gait training;
  • 5. Pulmonary exercises;
  • 6. Post-operative exercises;
  • 7. Monitoring of prosthetic, orthotic, and adaptive appliances;
  • 8. Management of skin care;
  • 9. Cardiovascular fitness;
  • 10. Joint mobility/stability procedures;
  • 11. Postural control activities;
  • 12. Functional mobility activities;
  • 13. Gross motor development stimulation;
  • 14. Motor learning development;
  • 15. Strengthening programs;
  • 16. Wheelchair assessment/maintenance;
  • 17. Assistive technology; and
  • 18. Bus transportation.
  • B. Designing/recommending adaptive equipment and devices when appropriate.


IV. Consulting with professionals, instructional assistants, and parents in relation to special education programming.

  • A. General consultative services including::*1. Identifying and recommending the elimination of architectural barriers; and
  • 2. Advising on special equipment consideration
  • B. Interpretation, including
  • 1. Advising on the special education needs of the student at the T/IEP staffing;
  • 2. Explaining physical abilities and disabilities;
  • 3. Explaining the rationale for physical therapy intervention; and
  • 4. Serving as liaison between the school and medical community
  • C. Prevention, including
  • 1. Advising on safety considerations for staff and students;
  • 2. Recommending ways to prevent contractures, deformity, fractures, etc.; and
  • 3. Instructing in appropriate lifting and transporting techniques for staff.


V. Administering the functions necessary for the development and implementation of physical therapy services, such as:

  • A. Planning and managing a budget;
  • B. Developing current records/files/charts regarding physical therapy programs, goals, and student progress to meet school requirements;
  • C. Supervising physical therapist assistants for implementation of physical therapy program;
  • D. Initiating and terminating services;
  • E. Determining space requirements in conjunction with school-based administrators;
  • F. Supervising supportive personnel and student affiliates;
  • G. Ordering and maintaining equipment;
  • H. Assisting supervisor in recruitment and orientation of new staff;
  • I. Developing and implementing programs for different levels of service: student, school, and district; and
  • J. Other therapy related duties as assigned by supervisor.


VI. Educating professionals and instructional assistants within the educational environment such as*A. Teaching special skills necessary for proper handling and positioning of students;*B. Demonstrating the use of adaptive and assistive devices; and

  • C. Demonstrating the use of and care of orthotic and prosthetic devices.


VII. Sustaining current professional responsibilities:

  • A. Apprising self of legal responsibilities, professional ethics, standards of practice, school policies, rules and regulations;
  • B. Maintaining current licensure as required by state regulations;
  • C. Updating job description according to state laws, rules, regulations, and delivery patterns; and
  • D. Maintaining confidentiality.


___________________________________________________________________________

Roles & Responsibilities of the Physical Therapy Assistant

The role of the physical therapy assistant is to provide individual and small group treatment and to assist the registered physical therapist in program planning, evaluation, administration and education of other school personnel. The roles are

I. Assisting in student evaluation

  • A. Gather information for the registered physical therapist including review of records, student observation, or gathering input from T/IEP team;
  • B. Assist the registered physical therapist in administering tests; and
  • C. Assist the registered physical therapist in screening.


II. Treating students

  • A. Under the direction of a registered physical therapist the physical therapist assistant may provide
  • 1. Positioning;
  • 2. Neurodevelopmental and neuromuscular facilitation to enhance motor skills;
  • 3. Sensorimotor integration;
  • 4. Gait training;
  • 5. Pulmonary exercises;
  • 6. Post-operative exercises;
  • 7. Monitoring of prosthetic, orthotic, and adaptive appliances;
  • 8. Management of skin care;
  • 9. Cardiovascular fitness;
  • 10. Joint mobility/stability procedures;
  • 11. Postural control activities;
  • 12. Functional mobility activities;
  • 13. Gross motor development stimulation;
  • 14. Motor learning development;
  • 15. Strengthening programs;
  • 16. Wheelchair assessment/maintenance;
  • 17. Assistive technology; and
  • 18. Bus transportation.
  • B. Assist in adaptive equipment and devices when appropriate.


III. Program planning

  • A. Assess progress on current objectives and keep the registered physical therapist informed
  • B. Keep data on students they are treating when appropriate
  • C. Assist in development of goals and objectives for student's individualized treatment programs


IV. Administration

  • A. Documentation and record keeping
  • B. Assemble and maintain current records/charts/files regarding physical therapy program goals and student's progress
  • C. Assist in ordering and maintaining supplies and equipment
  • D. Other therapy related duties as assigned by registered therapist or supervisor


V. Education

  • A. Assist in providing trainings to teachers, bus personnel, and instructional assistants
  • B. Demonstrate the use of adaptive and assistive devices
  • C. Demonstrate the use of and care of orthotic and prosthetic devices
  • D. Teach special skills necessary for proper handling and positioning of children


VI. Sustain current professional responsibilities

  • A. Apprise self of legal responsibilities, professional ethics, standards of practice, school policies, rules and regulations
  • B. Maintain current licensure as required by state regulations
  • C. Maintain confidentiality




Roles & Responsibilities of the Parents

I. Sign "Parent Consent for Formal Individual Evaluation MIS 425" which will enable school personnel to begin the evaluation process

II. Obtain the initial medical evaluation of the child and the appropriate physician's prescription for therapy (physical and/or occupational therapy)

III. Participate in the following

  • A. Post evaluation notification;
  • B. Staffings;
  • C. IEP conferences;
  • D. Team meetings; and
  • E. Parent-teacher-therapist conferences

If the parent is unable to attend the above, he/she may provide input through phone calls and/or written notes

IV. Follow through on recommended therapeutic home programs

V. Inform teachers and therapists of changes concerning the child at home (i.e., medication, seizures) VI. Contact therapists/teachers regarding clinic appointments so that progress reports may accompany the child

VII. Express any concerns about the child and request help


___________________________________________________________________________

Roles & Responsibilities of the Teacher

I. Communicate with the therapist regarding the student’s current functional status


II. Follow through on all recommended therapeutic programs, including data tracking sheets, when needed

III. Monitor instructional assistants in implementation of educational and therapeutic programs.

IV. Coordinate with all T/IEP team members when conducting T/IEP revisions and meetings, including reevaluation team meetings.

V. When considering a change in PT/OT services, send home MIS#762 (Invitation to Staffing or Educational Plan Conference) after insuring therapist can attend meeting.

VI. Conduct T/IEP team meeting.

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Standards of Practice

Criteria for School Based Services

Procedures for Provision of Services

Response to Intervention

Sensory Processing Disorders

Standard I: Professional Standing

  • 1. A therapist and assistant shall maintain current license, registration, or certification as required by law.
  • 2. A therapist and assistant shall practice and manage programs in accordance with applicable federal and state laws and regulations.
  • 3. A therapist and assistant shall be familiar with and abide by their respective Code of Ethics from APTA and AOTA.
  • 4. A therapist and assistant shall maintain and update professional knowledge skills and abilities through appropriate continuing education or in service training or higher education. The nature and minimum amount of continuing education must be consistent with state law and regulation.
  • 5. An assistant must receive supervision from a registered therapist as defined by official documents. The nature and amount of supervision must be provided in accordance with state law and regulation.
  • 6. A therapist and assistant shall provide direct and indirect services in accordance with standards and policies.
  • 7. A therapist and assistant shall maintain current knowledge of the legislative, political, social and cultural issues that affect the profession.

Standard II: Referral

  • 1. A therapist shall accept referrals in compliance with appropriate laws and district procedures.
  • 2. A therapist may accept referrals for assessment or assessment with intervention in performance areas, performance components or performance context when individuals have or appear to have dysfunctions or potential for dysfunction.
  • 3. A therapist, responding to requests for service, may accept cases within the parameters of the law and district procedures.
  • 4. A therapist shall assume responsibility for determining the appropriateness of the scope, frequency, and duration of services within the parameters of the law and district procedures.
  • 5. A therapist and/or assistant shall refer individuals to other appropriate resources when the therapist determines that the knowledge and expertise of other professionals are indicated.
  • 6. A therapist and/or assistant shall educate current and potential referral sources about the process of initiating referrals.

Standard III: Screening

  • 1. A therapist, in accord with state and federal guidelines and district procedures, shall conduct screenings to determine whether intervention or further assessment is necessary and to identify dysfunctions in performance areas.
  • 2. A therapist shall screen independently or as a member of an interdisciplinary team. An assistant may contribute to the screening process under the supervision of a therapist.
  • 3. A therapist shall select screening methods that are appropriate to the individual's age and development level; gender; education; cultural background; and socioeconomic, medical, and functional status. Screening methods may include, but not limited to, interviews, structured observations and record reviews.
  • 4. A therapist shall communicate screening results and recommendations to appropriate individuals.

Standard IV: Assessment

  • 1. A therapist shall assess individual performance areas, performance components, and performance context.
  • 2. A therapist shall follow accepted protocols when functional and standardized tests are used.
  • 3. A therapist shall analyze and summarize collected evaluation data to indicate the student’s current functional status.
  • 4. A therapist shall document assessment results, methods, environment, and personnel needed to accomplish the intervention goals.
  • 5. A therapist shall complete and document results of assessments within the time frames established by our practice settings, government agencies, accreditation programs, and third-party payers.

Standard V: Intervention Plan

  • 1. A therapist shall develop and document an intervention plan based on analysis of the assessment data and input from the T/IEP team. An assistant may contribute to the intervention plan under the supervision of a therapist.
  • 2. The intervention plan shall be stated in goals that are clear, measurable, observable, functional and appropriate to the individual's needs, teacher/classroom needs, personal goals, and expected outcome after intervention.
  • 3. The intervention plan shall be consistent with established principles and concepts of theory and practice. The intervention planning process shall include:
  • A. Formulating a list of strengths and weaknesses
  • B. Estimating rehabilitation potential
  • C. Identifying measurable annual goals and benchmarks in conjunction with the T/IEP team
  • D. Collaborating with the individual, family members, other caregivers, professionals, and community resources
  • E. Selecting the media, methods, environment and personnel needed to accomplish the intervention goals
  • F. Determining the frequency and duration of services.
  • G. Identifying a plan for reevaluation
  • 4. A therapist shall prepare and document the intervention plan within the time frames and according to the standards established by district procedures, government agencies, the accreditation programs, and third-party payers. The assistant may contribute to the formation of the intervention plan under the supervision of the registered therapist.


Standard VI: Intervention

  • 1. A therapist or an assistant shall implement a program according to the developed intervention plan. The plan shall be appropriate to the individual's age and developmental level, gender, education, health status, functional ability, interest and personal goals, and educational setting. The assistant shall implement the intervention under the supervision of the registered therapist.
  • 2. A therapist or an assistant shall implement the intervention plan through the use of specified purposeful activities or therapeutic methods to enhance performance and achieve stated goals.
  • 3. A therapist or an assistant shall be knowledgeable about relevant research in the practice area. The therapist shall interpret research findings as appropriate for application in the intervention process
  • 4. A therapist or an assistant shall educate the student, student's family or legal guardian, non-certified personnel, and other educational team members, as appropriate, in activities that support the established intervention plan. Either the therapist or the assistant shall communicate the advantages/disadvantages of the intervention.
  • 5. A therapist or an assistant shall maintain current information on community resources relevant to the practice area.
  • 6. As specified in District procedures, a therapist shall periodically reassess and document the individual’s levels of functioning and changes in levels of functioning in the performance areas, performance components, and performance context. An assistant may contribute to the reassessment process under the supervision of a registered therapist.
  • 7. A therapist shall formulate and implement program modifications consistent with changes in the individual's response to the intervention. An assistant may contribute to program modifications under the supervision of the registered therapist.
  • 8. A therapist or an assistant shall the document the services provided, including the frequency and duration of the services within the time frames and according to the standards established by District procedures, government agencies, accreditation programs, and third-party payers.
  • 9. A therapist shall systematically assess the review process of student care to determine the success or appropriateness of interventions. An assistant may contribute to the process in collaboration with the registered therapist.

Standard VII: Transition Services

  • 1. A therapist or an assistant shall participate, when appropriate, in preparing an individualized transition plan based on the student's needs and shall assist in the fulfillment of life roles through activities in such a plan.
  • 2. A therapist or an assistant shall facilitate the transition process in cooperation with the student and the multi-disciplinary team or other community support systems, when appropriate. The therapist may initiate referrals to appropriate community agencies to provide needed services.

Standard VIII: Discontinuation

  • 1. A therapist shall discontinue service, when appropriate, according to District procedures.
  • 2. A therapist shall document current functional status related to performance in their educational environment. An assistant may contribute to the process under the supervision of the registered therapist.
  • 3. A therapist and an assistant shall allow sufficient time for the coordination and effective implementation of the discharge plan.

Standard IX: Management

  • 1. A therapist or an assistant, under the supervision of a registered therapist, shall provide the management necessary for efficient organization and provision of therapy services.
  • 2. A therapist or an assistant, under the supervision of a registered therapist, may perform the following management functions:
  • 3. Education of members of other related professions and physicians about therapy
  • 4. Design and periodic review of all aspects of the therapy program to determine its effectiveness, efficiency, and future directions.
  • 5. Incorporation of a fair and equitable system of admission and discharge for therapy services.
  • 6. Participation in cross-disciplinary activities to ensure that the total needs of the individual are met.
  • 7. Provision of support and for clinical research or collaborative research when such projects have the approval of the appropriate governing bodies, and the results of which are deemed potentially beneficial to students of therapy services now or in the future.


___________________________________________________________________________

Program Coordination

I. Interdisciplinary Communication

  • A. A therapist or assistant, if delegated, will attend meetings, as needed, to address student's therapy needs in the educational environment. All service providers on the T/IEP need to be apprised of any team meeting and must be invited to attend. Any T/IEP team member can initiate a meeting regarding a child's needs, but the teacher with whom the student spends the majority of time will be responsible for coordinating team meetings, which includes specifying dates and inviting persons concerned.
  • B. In-service can be provided for teachers, parents, instructional assistants and other school personnel by the therapist regarding appropriate strategies to use with students.
  • C. While therapy is a related service, the therapy staff is available to assist with program coordination/support relative to the student's or the program's needs. These services may exceed the direct treatment of a child (e.g. adapting a classroom to best fit student's needs, recommending modifications to school environments such as electric door openers, becoming involved in other district functions such as transportation or community involvement (FDLRS, advocates), etc.)


II. Case Review for Occupational and Physical Therapy

Case Review meetings will take place at least monthly during the school year and may occur more frequently when needed such as just prior to FTE periods. All therapists are responsible to attend and participate in Case Review Meetings. Therapists must have permission from the Supervisor to miss any meeting if necessary.

During Case review meetings, all initial evaluations for consideration of PT or OT will be brought before the group to discuss recommendations, need of educationally based therapy and service model of delivery. (NOTE: A therapist may choose to certify a private therapy evaluation to qualify a student for therapy and that evaluation does NOT need to come before case review.) This includes:

  • A. Incoming out of state students as they need a Florida based therapy evaluation for eligibility.
  • B. All evaluations performed by a District therapist for initial eligibility.
  • C. Any unusual evaluations that a therapist may want additional input from their peers.


Other topics for discussion during Case Review meetings might include:

  • A. Standards of Practice in the school system
  • B. Current changes in IDEA, FAPE, NCLB that may impact the practice of Physical and Occupational Therapy
  • C. To discuss any current concerns that impact all PT’s or OT’s.

Prior to the discussion:

  • A. The evaluation should be completed on the District evaluation form.
  • B. The therapist should have the Case Review form ready to be completed at the meeting.
  • C. The evaluation needs to include data from a District approved Assessment/Evaluation tool.
  • D. Applicable work samples should be included in the presentation.


After the group has reviewed any new evaluations, the Case Review form must be completed by the evaluating therapist, copied and filed in the students working PT (OT) file. A copy must also be filed in the District Office Case Review binder found in the Supervisor of Related Services office. Additionally, the therapist is responsible for completing the Tracking form for OT/PT Screens/Referrals and turning it in at the Case Review meeting monthly regardless of whether new evaluations by that therapist are being presented that month.


III. Parent Involvement

Parents must be involved in the development and implementation of T/IEP goals and objectives per IDEA guidelines. The therapist may have resources available for parents, (e.g. reference materials, home exercise programs, etc). It is important to maintain open communication with parent and document parent contacts appropriately.


IV. Plan of Care

  • A. Therapist prepares the Plan of Care Form for each student contact in therapy and may receive input from the assistant in this process. The plan of care is prepared on an annual basis per IEP dates of service and IEP revisions.
  • B. The Plan of Care requires the signature of a licensed therapist.
  • C. The original Plan of Care will be filed in the orange, OT/PT cumulative folder. An additional copy is filed in the OT/PT progress file and kept each year until dismissal from therapy or graduation. All records will then be kept for 5 years after dismissal or graduation.

V. Daily Services Documentation

  • A. Therapist and/or assistant completes Daily Services Form on Docusystem for each student contact in therapy as needed to record any pertinent information regarding students therapy program, including but not limited to direct treatment, consultation, and monitoring. If other personnel are present or participate in the treatment, this might also be documented in the note.
  • B. Supervising therapist signatures are electronically filed within Docusystem. Supervising therapist is required to review all assistant’s notes within a 2 week time frame.
  • C. All notes are to be completed in a timely manner, i.e. the day service is provided.
  • D. All notes must be completed in Docusystem electronically.
  • E. Copies may be released to parent/legal guardians/third parties as requested in a timely manner with appropriate fees charged as needed.


VI. Environmental Adaptations and Equipment

  • A. Therapists are involved in maintaining inventory of capital equipment as needed or requested. Equipment that is not being used at one school may be loaned to another school to maximize effective use of all equipment. When equipment is transferred from one site to another, the therapist is responsible for completing appropriate paperwork to move the item to another site. Therapists need to survey equipment that is available before ordering new equipment. Prior to ordering large pieces of equipment for use in the classroom, the therapist will consult with the teacher and supervisor.
  • B. Therapist is responsible for ordering, selecting and/or providing information on equipment and supplies needed to meet the child's T/IEP goals.
  • C. Facilities are designed to meet specifications for handicapped students. Therapists, teachers, and administrators provide input regarding new facilities.
  • D. Physical Therapists are responsible to inspect and tag any manual wheelchair, power wheelchair or scooter for transportation purposes on school busses before transportation can be initiated. The therapist will indicate the proper bus tie-down points for each chair, and will date and tag the chair with the red inspection tag to indicate that it is safe for transport and the necessary components for transport are present and in current working order. Refer to memo ESE-07/08-MM-005 for additional details.


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General Forms for ESE with Descriptions

  • 1. Monthly In-County Mileage Report (MIS # 108) – (now completed electronically, printed and turned in to supervisor) Used to report monthly in-county mileage for reimbursement.
  • 2. Property Acquisition/Disposition Report MIS 212 Used to delineate where property/equipment is moved from one site to another.
  • 3. Student Accident Report MIS 406 Used to report any accidents involving student observed by therapist/assistant.
  • 4. Consent for Evaluation MIS 425 This form is sent to parents/guardians by the in-school staffing chairperson or student's teacher to obtain permission for initial evaluation.
  • 5. In-School Staffing Report MIS 433 This form is used by the in-school staffing chairperson to document minutes of the in-school staffing for each student discussed.
  • 6. Consent for Reevaluation MIS 444 This form is sent to parents/guardians to obtain consent for their child to be formally reevaluated. This would be used when the team recommends a therapy evaluation.
  • 7. ESE Students with Disabilities Safeguards Review MIS 710 This form is read to parents at all T/IEP meetings.
  • 8. Report of Parent Contact MIS 713 This is a sample of a form used at the school level to document all contacts with parents.
  • 9. Formal Reevaluation Report MIS 718 Used to document a records review prior to the reevaluation, the results of the reevaluation and a follow-up parent contact to discuss the results.
  • 10. Physical/Occupational Therapy Prescription MIS 732
  • 11. Notice and Consent for ESE Services MIS 755 This form is used to notify parents of the results of an ESE Eligibility Staffing and program placement decision when the committee determines that the student is eligible for the ESE program. It must be reviewed and signed by parents indicating approval for placement prior to serving a student in the ESE program.
  • 12. Parent Invitation to Staffing and Individual Educational Plan Conference MIS 762 This form must be used to invite parents to any T/IEP team meeting.
  • 13. ESE Summary of Procedural Safeguards MIS 774 Given to parents at all initial ESE staffings.
  • 14. Staffing Checklist: Occupational/Physical Therapy Program MIS 777 This form lists all data required to staff a student for the Occupational/Physical Therapy program, including the date the data was generated, the type of instrument used (when applicable), and the person responsible for generating or completing the data. The form also serves the purpose of providing parents with a list of documents used to determine program eligibility.
  • 15. Permission for Release of Records and/or Information from Records MIS 791 Used to obtain parent consent for information to/from outside agencies.
  • 16. Pasco County Exceptional Student Education Staffing MIS 795 This form is used at the ESE program eligibility, dismissal and reassignment staffing to document results of the staffing and to record persons in attendance at the staffing.
  • 17. Informed Notice of Change to the Provision of ESE Service MIS 797 This form must be used by related services when adding a child, discontinuing services, or when changes in the level of service delivery or amount of services are implemented.
  • 18. T/IEP Team meeting Recommendations Regarding Reevaluation MIS 809 Used to determine what reevaluations or evaluations are being recommended or not recommended to enhance student's performance.
  • 19. Informed Notice of Denial MIS 821 Used to notify parent of denial to initiate a formal evaluation, a component requested on the T/IEP or a change in the educational setting.
  • 20. Informed Notice: Evaluation (s) NOT Required MIS 824 Used to notify parent that evaluation previously consented to is no longer necessary.


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Physical/Occupational Therapy Program Forms with Procedures

PROCEDURES RELATED TO PROGRAM FORMS

  • A. Introduction to Forms
  • 1. These forms do not have an MIS number in the upper right hand corner.
  • 2. Purpose of form (s) is to inform or collect program data and are not copied for school records.
  • 3. Revisions of these forms can be made by any member of the OT/PT staff. Upon approval of the entire team, the revised form can be given updated in the resource manual when completed.
  • B. Initial Contacts and Screens:
  • C. Evaluation
  • D. Case Review
  • E. Child is staffed on caseload for services
  • G. Treatment specific areas - Sensory
  • H. Treatment specific areas - Equipment
  • I. Other Forms/inservices/documents

___________________________________________________________________________

Therapy Specific Policies

ABSENCES

Absences from work for any reason should be reported to the immediate supervisor in advance, if possible. If you are sick, have an emergency or need to be out for any reason, you are required to phone in and/or email prior to 8:00 AM Student Support Programs and Services direct line (813) 794-2600. Please follow-up with an email to: immediate supervisor, OSSPS secretary for supervisor, Andrea Jackson, the designated covering therapist , and your scheduled schools for that day.

See Pasco District School Board Policies for Instructional/Non-Instructional personnel for details on Leave of Absences.

ABSENCE WITHOUT LEAVE

Any employee who is willfully absent from duty without leave shall forfeit compensation for the time of such absence and shall be subject to termination.

An employee who is absent without leave on a temporary basis, shall not be subject to loss of pay and/or subject to reprimand or dismissal if said absence is beyond the individual's control and the employee is unable to notify the immediate supervisor and said employee is eligible for paid leave during his/her absence. Upon request by the immediate supervisor, reasonable documentation, if the situation permits, and/or explanation will be furnished by the employee at the earliest possible time.

ADVANCED STUDY AND EDUCATION SERVICE LEAVE

Upon request, the School Board may grant an employee leave of absence without pay for advanced study or educational experience for a period not to exceed one year when such study or experience is directly related to the employee's subject field. Such leave may include requests for acquiring experience in and knowledge of an individual's field of study as an employee in industrial or private employment if the employer certifies to the district that the experience is in the employee's field. Normally, this leave will be granted only after two or more continuous years of service in the district.

CHILD REARING LEAVE

A leave of absence without pay for a period of up to one year shall be granted for child rearing. Said leave for a period of up to one year shall be granted for child rearing. Said leave shall be granted in connection with childbirth, adoption, or death of the other parent. Requests for such leave shall be made in writing to the office of the superintendent at least 30 days, when possible, prior to the commencement of the leave.

An employee who takes a leave for this purpose shall be guaranteed the right to return to the position held prior to going on leave provided that the leave does not exceed 12 weeks.

CIVIC PARTICIPATION LEAVE

Upon request, an employee shall be granted civic participation leave without pay. Such leave includes, but is not limited to, election or appointment to a constitutional office in a federal, state, county, or municipal government or subdivision thereof. The employee shall notify the Board in writing of his/her intention of accepting such office or assignment and shall keep the Board informed of his/her status at annual intervals thereafter. Such leave shall be renewed yearly, upon application, for a period equal to the term of office to which said employee has been elected or appointed.

EXTENDED PERSONAL LEAVE

Upon request, an employee with two or more continuous years of service in the district shall be granted a leave of absence without pay for up to one year for reasons other than child rearing, military service, advanced study and education service, civic participation, or health provided that the primary purpose shall not be to engage in gainful employment. The reason for such request shall be stated in the application for leave.

HEALTH LEAVE

Upon request, an employee shall be granted a leave of absence without pay for up to one year for reasons of poor health as certified by a licensed medical physician. Such leave shall not be granted more than once in any five-year period.

ILLNESS-IN-LINE OF DUTY LEAVE

An employee shall be entitled to illness-in-line-of-duty leave not to exceed ten days during any work year because of personal injury received in the discharge of duty or because of illness from any contagious or infectious disease contracted in his/her work. In case of sickness or injury occurring under said circumstances, the School Board may grant additional leave. No leave granted under this provision shall be charged to accrued sick leave.

JURY DUTY

An employee absent from duty because he/she has been selected for jury duty, subpoenaed, or asked to appear as a witness in cases not involving personal litigation for matters not related to his/her employment, shall be paid his/her regular salary by the Board. Such time shall not be deducted from sick leave accumulation. The employee shall not be required to sign over to the School Board any money received for such service.

MILITARY LEAVE

An employee drafted for military service or called to active duty with reserve components shall be granted a leave of absence without pay except as provided in Florida Statute 115.07. A copy of the military orders shall be attached. Effective July 1, 1987, the "annual period" referred to in Section 115.07, Florida Statutes, shall be from July 1 through June 30.

PERSONAL LEAVE

An employee shall be allowed up to six days of personal leave at full compensation during each year of his/her employment. Such leave will not be cumulative and shall be deducted from accrued sick leave when used. Such leave shall not be used for recreational purposes, and the employee may be required to give the reason for requesting leave to the immediate supervisor. Said reasons may include family problems, household emergencies, legal business, transportation problems, or other stated reasons.

SABBATICAL LEAVE

After seven years of satisfactory service in the Pasco County public school system, a sabbatical leave of absence may be granted to an employee for the purpose of completing a doctorate. The following conditions will prevail:

  • 1. No more than one employee at a time shall be placed on sabbatical leave during any school year.
  • 2. To be eligible, an employee must be enrolled in a program approved by the Florida Department of Education and have completed enough of the required work to be eligible to complete the course work toward the degree during the sabbatical period. If the degree is not conferred within two years after the last day of the sabbatical leave, the employee shall reimburse the Board within two years for the full amount of the leave plus eight percent interest. This condition may be waived by the superintendent due to extraordinary circumstances.
  • 3. Employees on sabbatical leave will be paid 55 percent of the salary that would have been drawn during the time of the leave. In the event that more than one applicant meets the criteria explained above, the superintendent shall select the employee to receive the sabbatical based on strong leadership potential and long-term career commitment.
  • 4. Sabbatical leave may be allowed if satisfactory arrangements can be made for smooth operation of the school system.
  • 5. Any employee granted a sabbatical leave with remuneration shall file with the superintendent a schedule of courses to be taken and shall complete all such courses by meeting graduate degree standards or shall reimburse the Board for the full amount of the remuneration paid to him/her for the period of the leave plus eight percent interest. Changes in said schedule of courses may be made upon mutual consent of the superintendent and the employee.
  • 6. Any employee granted sabbatical leave with remuneration is required to serve at least three years in the county after termination of the leave. In the event such employee should accept other employment instead of servicing Pasco for the full three years as specified above, he/she would have to reimburse the Board as follows:
  • a. Zero years of return service - the full amount of the sabbatical
  • b. One year of return service - two-thirds of the amount of the sabbatical
  • c. Two years of return service - one third of the amount of the sabbatical
  • 7. All monies owed would be due within two years of the date of termination. Eight percent would be charged on the unpaid balance on the yearly anniversary of the termination date.
  • 8. In addition to compensation from the district, the employee may accept scholarships, stipends, fellowships and graduate assistantships as long as these funds added to district compensation do not exceed the salary regularly scheduled for this employee.
  • 9. Application for the sabbatical leave should be made prior to the time of the reappointment of personnel for the following year in order to allow time to arrange for adequate replacements.

SICK LEAVE

  • 1. Each employee employed on a full-time basis shall be credited with four days of sick leave at the end of the first month of employment during each year of employment and shall earn one day of sick leave for each month of employment thereafter; such leave shall be credited as earned. Sick leave shall not be used prior to the time it is earned.
  • 2. The number of sick leave days credited during any one year shall be equal to one day for each month of employment.
  • 3. An employee who has accrued sick leave outside the district, but in the State of Florida shall be credited on a day-for-day basis with all accrued leave. Said leave shall be credited in the same manner as sick leave earned within the district.
  • 4. Sick leave shall be cumulative from year to year. There shall be no limit placed on the number of days an employee may accrue.
  • 5. Sick leave days accumulated by an employee prior to an approved leave of absence shall be credited to the employee upon return.
  • 6. The District School Board of Pasco County will provide meritorious attendance incentive pay to employees at normal retirement (retirement under any established retirement plan with full or reduced benefits as provided by law or mandatory retirement due to attainment of the age 70) or to the employee's beneficiaries if service is terminated by death. Meritorious attendance incentive pay shall be determined as follows:
  • a. During the first three years of service in a Florida school district, the daily rate of pay multiplied by 35 percent times the number of days of accumulated sick leave credited with the District School Board of Pasco County.
  • b. During the next three years of service in a Florida school district, the daily rate of pay multiplied by 40 percent times the number of days of accumulated sick leave credited with the District School Board of Pasco County.
  • c. During the next three years of service in a Florida school district, the daily rate of pay multiplied by 45 percent times the number of days of accumulated sick leave credited with the District School Board of Pasco County.
  • d. During and after the tenth year of service in a Florida school district, the daily rate of pay multiplied by 50 percent times the number of days of accumulated sick leave credited with the District School Board of Pasco County.
  • e. During and after the fifteenth year of service in the Pasco school district, the daily rate of pay multiplied by 75 percent times the number of days of accumulated sick leave credited with the District School Board of Pasco County.
  • f. During and after the twentieth year of service in the Pasco school district, the daily rate of pay multiplied by the number of days (100 percent) of accumulated sick leave credited with the District School Board of Pasco County.
  • 7. If employment is terminated for any reason other than retirement or death, employees shall receive one-half the percentage of all accumulated sick leave as stipulated in the schedule in item 6 above. This language shall not apply to employees who choose to transfer their accumulated sick leave to another Florida school district.
  • 8. Sick leave days may be used either for personal illness or emergencies as defined below:
  • a. Personal illness of the employee.
  • b. Death or illness in the immediate family. Immediate family shall mean husband, wife, child, father, mother, brother, sister or other close relative or member of his/her household.
  • c.Extended illness and/or disability related to pregnancy if leave request is accompanied by a physician's statement of disability.
  • 9. Sick leave will be deducted in one hour, half-day or full-day units.

SICK LEAVE BANK, GENERAL

  • 1. Establishment The General Sick Leave Bank shall be established upon adoption of this policy by the District School Board of Pasco County.
  • 2. Purpose The purpose of the sick leave bank is to provide income protection to participating employees suffering catastrophic personal illness or injury not otherwise compensated by the Board or Workers' Compensation.
  • 3. Membership Eligibility All employees holding sick leave-earning positions who are not members of either the instructional or noninstructional bargaining units shall be eligible to participate in this bank after one year of employment in the district and accumulating at least ten days of unused sick leave. To become a member, eligible employees shall contribute one day of sick leave to the bank. Enrollment shall be open from the first workday in September through the last workday in September in each year.
  • 4. Benefits Members of this bank may receive up to 100 paid sick leave bank days in a year (October 1 through September 30) subject to the following conditions:
  • a. The need must arise from the member's own personal catastrophic illness or injury.
  • b. All accumulated personal sick leave must have been exhausted.
  • c. Five consecutive days of absence must follow immediately after exhausting personal sick leave.
  • d. A certificate must be completed by a physician describing the illness or injury.
  • e. The member must submit the application to his/her supervisor who will investigate the request and submit his/her findings, his/her recommendation(s), and the member's application and physician's certificate to the chairman of the General Sick Leave Bank Committee.
  • 5. Conditions
  • a. In the event a member has a preexisting condition on the date of enrollment and had not been a member of one of the other district sick leave banks in the year immediately preceding his/her enrollment in this bank, there shall be 90-day waiting period before eligibility based upon disability due to that particular illness.
  • b. If a member draws 25 or more days from the bank in a given year and either returns to work or further withdrawal of days from the bank is refused, his/her membership shall be suspended for the remainder of the year. Membership may be reinstated in the following year by meeting initial membership requirements.
  • 6. Depletion The bank shall be deemed depleted when the balance reaches 1200 hours. Participating members shall contribute one additional day each time the bank is depleted, but not more than once each year. Upon bank depletion, each member shall be required to either contribute one additional day or withdraw from membership. If a member elects to withdraw from membership or does not have one day of sick leave to contribute, he/she shall be removed from membership and invited to reapply the following year. In each instance, initial membership requirements must be met.
  • 7. Administration A General Sick Leave Bank Committee shall be established and shall administer the bank according to these and other applicable existing laws, policies and procedures. The composition of the committee shall be as follows:
  • a. The assistant superintendent for human resources development or his/her designee.
  • b. The supervisor of student services responsible for school nurses.
  • c. Five members elected at large from among the members of the bank.
  • 8. The committee shall function as follows:
  • a. The assistant superintendent for human resources development or his/her designee shall be chairman. The chairman shall conduct meetings, initiate and receive all correspondence, and generally administer the business of the committee.
  • b. A vice chairman shall be appointed by the chairman and shall conduct meetings at the request of the chairman in his/her absence.
  • c. A recording secretary shall be appointed by the chairman to record minutes of meetings.
  • d. A quorum shall consist of three members plus the presiding officer.
  • e. The chairman shall have no voting power except as a tie-breaker.
  • f. Specific guidelines, rules and definitions may be developed by the committee.
  • g. The primary purpose of the committee shall be to consider and approve or disapprove applications for sick leave bank use. The committee shall define "catastrophic" for the purpose of administering the bank. The committee shall also investigate alleged abuses and, on findings of wrongdoing, the employee shall repay all wages and benefits expended by the district.
  • h. An annual report on the status of the bank shall be given to all members.
  • i. The superintendent shall be provided with a monthly report on the status of the bank.

BUDGET

Each registered therapist is responsible for managing and overseeing the allocated funds for their specific discipline's caseload.

Important Facts

  • 1. If one piece of equipment or the cumulative order for a company is $1000-$2999, three telephone quotes are required and must be submitted with the purchase order.
  • 2. If one piece of equipment or the cumulative order for a company is $3000+, three written quotes are required or a bid process may be required. Check with the Purchasing Agent in the purchasing department prior to submitting such purchase orders to determine the correct procedure.
  • 3. Sole source items - those items that can only be obtained from one company. When a sole source item costs $1000+, obtain a written letter from the manufacturer on company letterhead stating that the item is sole source. This must accompany the purchase order.

Procedures

  • 1. Each therapist is to submit ESE merchandise request forms to the bookkeeper at the school where funds for OT/PT have been allocated and who will then type purchase orders. Before any item is submitted, therapists are responsible to determine if that item is available elsewhere in the district.
  • 2. If all allocated funds will not be needed, inform the ESE supervisor prior to mid-February so funds can be redistributed.
  • 3. Generally, plan to process all orders by the middle of March but the final date is set by the bookkeeper.
  • 4. Process orders throughout the year as waiting until January may result in a loss of funds.
  • 5. Each therapist is responsible for his/her own budget. The Budget Spreadsheet will be completed and maintained each year by the therapist.
  • 6. District Instructional Media Center (DIMC) supplies are charged against the therapists' budget. Therapists and assistants are responsible for obtaining the amount at the time of service to include when tracking funds.
  • 7. Each ESE Merchandise Request form should only include items from a single fund source (e.g. 510 materials/supplies). Each therapist is responsible for obtaining the correct fund source. Should an item need to be purchased that is not allocated as a fund source, check with the ESE bookkeeper to make sure existing funds can be transferred to the new fund source.

CASELOADS AND ASSIGNMENTS OF SCHOOLS

All caseloads will be reviewed at least on an annual basis to assess the needs of each school. All therapists and assistants are considered to be itinerant and permanent assignment to caseloads will be attempted, but may change year-to-year based on need. As a component of this policy, any school approaching 33 hours or more for therapy will automatically qualify for review and consideration of splitting the caseload between two therapists.

Temporary assignments during the school year may be needed in the event of drastic schedule changes, staff changes or administrative directives. These temporary assignments will be based on the best schedule considering regional staff and caseloads to be reassigned.

COPY MACHINES

Copy machines are for school district use. No personal copying is to be done without prior permission. Some schools charge a nominal fee for personal copies. Copy machines are located in designated places in each school for use. Some copy machines may not be used. Permission must be obtained before using a copy machine.

Some schools require the therapy department to supply copy paper. Other schools do not have this requirement. Extra copy paper is kept in the PT/OT office. There should be a ream of paper in the therapy areas of the schools that require the therapy department to supply paper.

ESCORTING STUDENTS

Students are to be escorted when necessary to and from their classroom. Normally, classroom personnel are responsible for transport to and from therapy. No student is to be left in the therapy room or classroom unattended.

FURNITURE/EQUIPMENT/INVENTORY

Furniture and equipment are the property of the school district and are to be used appropriately. All furniture and equipment should be in good repair. Should furniture/equipment break, this must be reported to the supervisor as soon as possible.

An ongoing inventory of all therapy equipment and materials will be maintained and updated as needed.

INITIAL ORIENTATION MEETINGS

New personnel will receive initial orientation with one of more of the district therapy staff, the supervising therapist for assistants and the ESE Supervisor of OT/PT programs. The supervisor or his/her designee will conduct at least one weekly conference with each new employee for the first four weeks. Orientation will include review of the manual, individual school procedures and observation for one week, if appropriate.

INSERVICE TRAINING

In-service training is available at various times during the school year through the school district. If you want to attend a workshop/seminar/conference offered out of the district, please discuss it with your immediate supervisor before making any commitments.

Upon returning from out-of-county in-services, staff should schedule a time to "share" the information and training received with any other staff members desiring the information.

Any staff member who wishes to receive training in a specific area (i.e., splinting, adaptive equipment, feeding programs) should make that desire known at staff meetings, and in-county training can be scheduled as time allows.

When leaving the county on school business or for an in-service, a Request for Leave or Temporary Duty, must be filled out prior to leaving. On return, a Voucher of Reimbursement of Traveling Expenses, must be submitted with a copy of the leave form to the cost center manager. The form must be filled out according to the Travel Expense Payment Procedure.

LUNCHTIME

Lunches can be bought in the school cafeteria or therapy staff can bring lunch. When traveling between schools at lunchtime, you may stop at a restaurant to eat. No one should exceed the half hour lunch time limit.

MILEAGE/TRANSPORTATION

Each employee is responsible for getting himself/herself to work each day by car. Car pooling is encouraged through mutual agreement with the persons involved. Mileage between schools is reimbursed only to the driver whose car is being used that day. Only one driver will be reimbursed when team members are traveling to the same work sites. Passengers do not earn travel reimbursement. Mileage forms (MIS #108) must be completed and approved by the immediate supervisor at the end of the month before forwarding the form to the district office secretary.

PERSONNEL EVALUATIONS

During the first year of employment, therapists will be evaluated by the ESE supervisor at least once during that year which is congruent with the same method for all returning therapists being evaluated at least once per year using the Registered Physical/Occupational Therapist Assessment.

During the first year of employment, therapy assistants will be evaluated by the ESE supervisor at least once during that year which is congruent with the same method for all returning therapy assistants being evaluated at least once per year using the Physical/Occupational Therapist Assistant Assessment.

PHONE CALLS

All phone calls relating to the therapy program should be made during non-treatment times unless it is an emergency. Personal calls of a non-emergency nature coming in or going out should be taken care of during lunchtime or after work hours. Friends and family should be notified of when calls can be taken. A log of long distance calls made will need to be verified monthly.

PROTOCOL FOR ASSIGNMENT OF SUPERVISION OF COTA AND PTA

  • 1. All cases delegated to an assistant will be evaluated by a Florida licensed therapist and have a plan of care established by the therapist of record. The assistant can have input into the plan of care if suggestions are in agreement with the therapist of record.
  • 2. For students receiving direct, monitoring and consult services by an assistant, the student's progress and treatment program will be directed through frequent reporting, both verbal and written, and frequent direct observations of the care rendered to the student by the therapist. The assistant must document any observations and/or discussions with or by the therapist in their daily treatment notes. The therapist must document any additional notes/discussions that are necessary. The therapist must be available via telecommunication and shall be within the same geographic location as the assistant. In addition to telecommunications efforts, the therapist will meet face to face with any therapy assistants they supervise at a minimum of once monthly. The therapist will also be required to visit every school on their caseload at a minimum of once a month to maintain ongoing communication with school team/administration.
  • 3. Any changes in the Plan of Care and delivery of services must be discussed with and agreed upon by the licensed therapist prior to the initiation of any change.

RECORDS/RECORDS MAINTENANCE

Student Therapy Records

Student OT/PT working folders are kept in a locked file cabinet in the OT/PT office. The working OT/PT file contains a copy of the T/IEP, Plan of Care, and prescriptions, when necessary. Additional information pertinent to the child may also be filed in this file. PT/OT working folders should be maintained in reverse chronological order with all reports and papers fastened if possible. Test booklets need not be fastened.

Cumulative Records

Cumulative records are kept for students at their school. Discussion of this confidential information must be reserved for designated areas and times only. Some schools require personnel to complete a form to review a file. Staff must become familiar with each school's requirements and adhere to them. At a minimum, the OT/PT file of the cumulative record should contain the PT prescription, Plan of Care(s), items on the Staffing Checklist: Occupational/Physical Therapy Program (MIS#777)OT/PT checklists (MIS#777), and copies of any therapy related Informed Notice of Change to the Provision of ESE Service (MIS#797).

Deletion of Records

Records may be deleted 5 years after the student is dismissed from the therapy program, moves away to another county/state, or graduates from school. The following procedures should be followed:


If < 25 Ibs, bind paper and attach blank sheet on top with the following information: ATTENTION BILL AMON, OSA CONFIDENTIAL DESTRUCTION TO WAREHOUSE. Please also add therapy contact information and send to Distribution Services


If > 25 Ibs, --place in box(es) and use MIS form #129 (Interdepartmental Request). Fill out the top portion (To: Distribution Services) and below, on the left column, write how many boxes (units). In the middle column under "Describe Service or Item" enter the following information: ATTENTION BILL AMON, OSA CONFIDENTIAL DESTRUCTION TO WAREHOUSE. Please make a copy for yourself and give the form to the Plant Mgr. at your home school.

RESIGNATION OF STAFF MEMBERS

Each employee upon retirement, resignation, termination, promotion, etc., shall turn over to his/her supervisor or successor all books, papers, documents, records (up to date evaluations and three year evaluations within one month especially in cases where consent was obtained more than 20 working days prior to resignation), Plan of Care and all up to date entries in Docusystem, money, property, and keys of whatever kind which he/she may have acquired, received, or held by virtue of his/her position.

No employee who receives any salary or compensation for his/her services shall be entitled to be paid or compensated for his/her last month of services until the provisions of this section have been fully observed.

Any employee violating the provisions of this policy shall forfeit his/her final compensation and shall be punished according to Florida Statute 775.082.

Each therapist and assistant shall be required to give a minimum of two weeks written notice of resignation.

Authority: 230.22(2), F.S. Law Implemented: 230.23(5), F.S.

SCHEDULING

All therapy schedules are established in cooperation with classroom and other special services schedules. Each employee will have a designated caseload, but this can change from time to time. It is the employee's responsibility to notify others of schedule changes or absences. Schedules are provided to the individual schools, ESE Secretary and the OT/PT Supervisor at the beginning of the year and with any subsequent changes. Treatments must not initiate before the first bell or continue after the last bell of the day at any school.

The therapist and/or assistant MUST sign in and out at each respective school throughout the school day.

STAFF COMPLAINTS AND GRIEVANCES

The School Board encourages the prompt and fair handling of problems before they become real grievances. The grievance procedure shall be followed objectively so that no individual should fear retribution for seeking full satisfaction of the problem.

Definition

A grievance is a claim by an employee(s), student(s), parent(s), or applicant(s) of an alleged infraction or misinterpretation of a provision of a policy or agreement that was adopted by the School Board.

Purpose

To encourage prompt and equitable solutions to problems which might become grievances and to ensure that no person need fear coercion, interference, restraint, discrimination or reprisal for utilizing the procedure.

Stages

Stage 1 - A person who feels aggrieved shall orally and informally confer with the administrator involved.

Stage 2 - If a solution is not reached at Stage 1, the person may file a grievance in writing to the involved administrator who will render a decision in writing within 14 days, excluding holidays. A formal grievance shall be filed as soon as possible but in no event longer than 14 days after the grievant knew or could reasonably have been expected to know of the occurrence or action giving rise to the grievance. The written statement shall include a description of the alleged violation, the date of the alleged violation, a suggested resolution, and the signature of the grievant.

Stage 3 - If the grievance is unresolved at State 2, the grievant may request in writing within ten days, excluding holidays, a review by the administrative assistant to the superintendent who will render a decision in writing within 14 days, excluding holidays.

Stage 4 - If the grievance is unresolved at Stage 3, the grievant may request in writing within ten days, excluding holidays, a review by the superintendent who will render his/her decision in writing within 14 days, excluding holidays.

Stage 5 - If the grievance is unresolved at Stage 4, the grievant may request in writing within ten days, excluding holidays, a review by the School Board, and the School Board will make a final decision on the grievance within 21 days.

Authority: 230.22(2), F.S. Law Implemented: 447.401, F.S.

STAFF INJURY

All injuries or illness in the line of duty should be reported to the district office supervisor as soon as possible. Such injury or illness will be reported to workmen's compensation and the superintendent within 24 hours of such notice.

STAFF LEAVES AND ABSENCES

If an employee is granted a leave without pay, he/she is not guaranteed the right to return to the position held prior to going on leave (except as provided for in child rearing leave). However, when such leave is granted, the employee shall be given serious consideration for other positions that may be available when he/she is ready to return from leave.

Extension of any unpaid leave mentioned in this policy may be granted at the discretion of the School Board upon request of the employee for a period of up to one additional year. When any requested approval of said extension is not granted, the reason shall be stated in writing to the person making such request.

SUBSTANCE ABUSE ON THE WORKSITE

Re: Drug-Free Workplace Act of 1988 (Effective March 18, 1989)

The District School Board of Pasco County recognizes that chemical dependency is an illness which is preceded by the misuse and/or abuse of alcohol and other drugs. It is recognized that the problems associated with substance abuse are becoming increasingly commonplace in our society. It is also generally accepted that alcoholism and other chemical dependencies are a form of illness that can be treated successfully if identified as early as possible, and if appropriate treatment programs are promptly instituted. Treatment centers offering such treatment programs are readily available in our community.

The Director of Instructional Employee Relations can provide further information relative to available treatment and treatment centers.

It is the intent of the District School Board of Pasco County to provide a drug-free environment for students and a drug-free workplace for its employees. It is imperative that one realize that students often model the behavior and develop the values as expressed not only by their teachers but others who are associated with them through the school system. The school board is committed to provide an educational environment in which students are not subjected to such harmful activities. In addition, as a school board employee, your actions are a reflection upon other employees in the system and affects the credibility of the total system within the community.

Please be advised that District School Board Policy (GBCB) states that the manufacture, distribution, dispensation, possession, or use of controlled substance is prohibited on any school board property or at any school sanctioned activity. Any school board employee who is in violation of the above will be subject to termination.

At the time of the occurrence of an infraction, the employee must notify his/her employer (supervisor). In addition, the employ must notify his employer (supervisor) no later than five days after a conviction relating to an offense of any criminal drug statute conviction occurring in the workplace. The supervisor will then report the infraction to the Assistant Superintendent for Human Resources.

All employees engaged in a program receiving monies directly from a federal grant will abide by the terms of this law.

SUPERVISORY MEETINGS

Monthly meetings will be held with appropriate therapy staff and the ESE supervisor of PT/OT programs.

Ongoing informal conferences will be held after the orientation period is completed, to discuss concerns and needs.

TEMPORARY DUTY

Temporary duty not to exceed 30 days per applicant for each occasion may be granted for the purpose of attending conferences, workshops, institutes, school visitations and other meetings related to education. When possible, requests to the Board for such leave shall be made at least five days in advance. The Board may reimburse the employee for expenses incurred; however, if the employee is asked by the superintendent to attend as a representative of the district, expenses shall be reimbursed. When temporary duty is granted, the employee shall not suffer loss of salary and the days shall not be deducted from accumulated sick leave or annual personal leave.

THERAPY PROGRAM DRESS CODE

Therapists are encouraged to wear comfortable clothing such as slacks, skirts, pants, blouse/shirt, and low-heeled closed-toe flat shoes.

If a certain style dress is prohibited/allowed at a given school, the therapist will adhere to that code.

If a therapist will be providing service to more than one site on the same day, (s)he will adhere to the more formal dress code.

TREATMENTS

Treatments are provided in accordance with T/IEP and Plan of Care. Therapists/assistants are expected to adhere to treatment schedules or to document reasons for missed treatments.

UTILIZING NON-TREATMENT

All contracted time should be used for school district business. Personal concerns should be handled after work hours. The OT/PT program has many duties that are ongoing such as filing papers, cleaning therapy labs, organizing items on shelves, making samples and assistive devices, etc., that can be completed if extra time is available during the day. All staff should participate in maintaining the therapy labs in good functioning order.

VACATION

Continuous service shall be construed as employment with one or more Florida State agencies without a break in service.

  • 1. Authorized leaves of absence shall be considered continuous employment.
  • 2. An employee shall not earn vacation time while on an approved leave of absence without pay nor shall the time on said leave be credited toward years of experience.
  • 3. A Florida State agency employee who terminates employment at any time other than the end of his/her work year will be considered as having a break in service unless employed by another Florida State agency within ten days.
  • 4. Consecutive employment in ten or eleven month positions will constitute continuous service.
  • 5. An employee who terminates employment will receive a final payment of all accrued vacation days based on the date of termination.
  • 6. An employee who transfers from a vacation earning position to a non-vacation earning position, must use accrued vacation time within the work year if the transfer is effective at the beginning of a work year or by the end of the next work year if the transfer is effective during a work year. If vacation time is not taken within these time limits, it will be forfeited.
  • 7. No employee shall be permitted to accrue more than 60 days of vacation.

Authority: 230.22(2), F.S. Law Implemented: 228.041(21, F.S.; 231.29, F.S.;231.39, F.S.; 231.40, F.S.; 231.41, F.S.; 231.42, F.S.; 231.43, F.S.; 231.44, F.S.; 231.48, F.S.; 236.02(30), F.S. State Board of Education Rule: 6A-1.76; 6A-1.77; 6A01.79; 6A-1.80; 6A-1.81; 6A-1.82; 6A-1.84

WORK HOURS

Regular School

Normal work hours for the regular school year are 8:00-4:00, Monday through Friday. One half hour is allowed for lunchtime. Variations of this schedule must be approved in advance by the OT/PT ESE Supervisor. Two 15 minutes breaks will be scheduled during the assistant's work day. Breaks will be scheduled so as not to interfere with treatment time.



Glossary

Acronyms

EDUCATIONAL ACRONYMS

AFO - Ankle-Foot Orthosis

APE - Adaptive Physical Education

ATEN - Assistive Technology Educational Network

BEEsS - Bureau of Exceptional Education and Student Services (Florida Department of Education, Knott Building, Tallahassee)

CBI - Community Based Instruction

CPI - Crisis Prevention Intervention

DAFO - Dynamic Ankle Foot Orthosis

DHH - Deaf/Hard of Hearing

DNR - Do Not Resuscitate

DOE - Department of Education, Tallahassee, Florida

EBD - Emotional Behavioral Disabilities

ELL - English Language Learners

ESE - Exceptional Student Education

ESOL - English Speakers of Other Languages

ETR - Evaluation Team Report

FDLRS - Florida Diagnostic and Learning Resources System

FSP - Family Service Plan

HI - Hearing Impaired

InD - Intellectually Disabled

ISS - In-school Staffing Committee

LATS - Local Assistive Technology Specialist

LD - Learning Disabilities

LRE - Least Restrictive Environment

LEA - Local Education Agency

MAT - Metropolitan Achievement Test

MOVE - Mobility Opportunities Via Education

OHI - Other Health Impaired

OI - Orthopedically Impaired

P.L. 94-142 - The Education for All Handicapped Children Act of 1975

SBER - State Board of Education Rule

SBIT - School Based Intervention Team

SLD - Specific Learning Disabilities

TAD - Team Analysis of Data (replacing ETR)

TBI - Traumatic Brain Injury

TBIT - Teacher Based Intervention Team

T/IEP - Individual Educational Plan

VE - Varying Exceptionalities

VI - Visually Impaired. Program area including both blind and partially sighted students

Educational Definitions

EDUCATIONAL DEFINITIONS

AUTISTIC - One who has a disability reflected in severe disorders of communications, behavior, socialization, and academic skills, and whose disability was evident in the early developmental stages of childhood. The autistic child appears to suffer primarily from a pervasive impairment of cognitive and perceptual functioning, the consequences of which are manifested by limited ability to understand, communicate, learn, and participate in social relationships.

BRAIN INJURED - A child who, before, during, or after birth, has received an injury to or suffered from an infection of the brain. As a result of such organic impairment, there are disturbances that prevent or impede the normal learning process.

DEAF-BLIND- One who has a hearing impairment and a visual impairment, the combination of which causes severe communication and other developmental and educational problems that cannot be properly accommodated in special programs solely for the hearing impaired or for the visually impaired student.

DISMISSAL - This is the process whereby a student is removed from participation in a special program. This means a student is no longer eligible for that program.

DISTRICT PROCEDURES - Each district submits its plan (District Procedures) to carry out all state, federal, and local requirements for the education of all exceptional (handicapped and gifted) students within that particular school district. These documents, approved by the School Board, contain for each exceptional student category the (1) definition, (2) criteria for eligibility, (3) procedures for evaluation, (4) procedures for providing an individual education plan, (5) instructional program, and (6) procedures for dismissal and reassignment. The documents may also include other planning guides for areas such as vocational education, support services, and multidistrict programs (230.23(4)(m), Florida Statutes).

EDUCABLE MENTALLY HANDICAPPED (EMH) STUDENT - One who is mildly impaired in intellectual and adaptive behavior and whose development reflects a reduced rate of learning. The measured intelligence of an educable mentally handicapped student generally falls between two (2) and three (3) standard deviations below the mean and the assessed adaptive behavior falls below age and cultural expectations (SBER 6A-6.3011(1)).

ELIGIBILITY - A student meets all approved criteria and has been determined by a staffing committee, after reviewing all available data, to be in need of special services.

EXCEPTIONAL STUDENT - The term "exceptional student" means any child or youth who has been classified under regulations of the state board as unsuited for enrollment in a regular class of the public schools or who is unable to be adequately educated in the public schools without the provision of special classes, instruction, facilities, or related services or a combination thereof. The term "exceptional students" includes the following: the blind and partially sighted, the physically handicapped and other health impaired, the emotionally handicapped, those with specific learning disabilities, and gifted (228.041(18), Florida Statutes).

FREE APPROPRIATE PUBLIC EDUCATION (FAPE) - This term refers to the guarantee of a free appropriate education at all levels of schooling for all handicapped children who are in need of special education and related services. By related services, the law means "transportation" and developmental, corrective, or supportive services required to assist a child to benefit from special education.

FULL-TIME (F.T.)- A student who spends more than 12 hours in one special program.

F.S.P. - Family Service Plan - Same as IEP but is utilized for children five and under where parents direct staff as to their goals for the child.

F.T.E. - FULL-TIME EQUIVALENT - The way financial support for an ESE program is provided is based upon the number of full time equivalent student (F.T.E.'s) in that program, multiplied by the program's weight factor (weighted F.T.E.'s) and then multiplied by the base student allocation.

GIFTED - There are various definitions of gifted and talented. The federal definition describes those students who are capable of high performance in any of five (5) areas: general intellectual ability, specific academic ability, creative thinking and productivity, leadership, and visual and performing arts. Presently in Florida, the gifted student is defined as one who has superior intellectual development and is capable of high performance (SBER 6A-6.3019). The mental development of a gifted student is two (2) standard deviations or more above the mean.

HANDICAPPED - One who is mentally handicapped, hard of hearing, deaf, speech impaired, visually handicapped, seriously emotionally disturbed, orthopedically impaired or other health impaired, deaf-blind, multihandicapped, or having specific learning disabilities (federal definition).

HEARING IMPAIRED (SBER 6A-6.3013(1)) - (a) Deaf - one who is born with or acquires prelingually a hearing loss so severe unaided that one cannot learn speech and language through normal channels. (b) Hard of Hearing - one who is born with or acquires a hearing loss which may range from mild to severe, unaided, and whose speech and language, though imperfect, are learned through normal channels.

HEARING OFFICER - A competent and impartial person who is trained to conduct due process hearings, and who will arrive at an objective decision based upon the presented evidence or information. NOTE: many Florida school districts request the services of a State APA Hearing Officer.

HOMEBOUND OR HOSPITALIZED - One who has a medically diagnosed physical or mental condition which confines the student to home or hospital and whose activities are restricted for an extended period of time. Infants three years of age or less who are deaf, blind, severely physically handicapped, or trainable mentally retarded may receive home instruction. (SBER 6A-6.3020(1)).

INDIVIDUAL EDUCATIONAL PROGRAM (T/IEP) - A plan that represents the most appropriate educational program for each exceptional child. The law requires that each T/IEP include:

  • 1. Present educational performance level of the child
  • 2. Annual and short-term instructional goals and objectives
  • 3. Specific special education and related services to be provided and the extent to which the child will be able to participate in a regular educational program
  • 4. Projected initiation date and anticipated duration of special education services
  • 5. An evaluation plan and schedule for determining at least on an annual basis the achievement of T/IEP goals.

INTELLECTUALLY DISABLED (InD) - One who is significantly impaired in general intellectual concurrent with deficits in adaptive behavior, which are manifested during the developmental period.

LEA REPRESENTATIVE - This is a representative of the district school system at the T/IEP meeting, other than the student's teacher, who is qualified to provide or supervise the provision of special education.

LEAST RESTRICTIVE ENVIRONMENT (LRE) - Each handicapped child must be educated with non-handicapped children to the maximum extent appropriate for that child. NOTE: the law, at no time, uses the term "mainstream".

MATRIX - Document indicating level of services a student receives used for determining funding.

MEDIATION CONFERENCE - An attempt of a third party to intervene prior to a due process hearing in an attempt to reconcile disagreements before legal action has to be taken.

NOTICE - The act of notifying or informing parents, in writing, regarding meetings, conferences, identification or placement procedures, evaluations, etc.

OTHER HEALTH IMPAIRMENTS - Means limited strength, vitality, or alertness due to chronic or acute health problems, which adversely affect a child's educational performance.

PART-TIME (P.T.)- A student who spends 12 hours or less in one special program.

PHYSICALLY IMPAIRED STUDENT - One who has a physically disabling condition or other health impairment and such condition requires an adaptation to the student's school environment or curriculum (SBER 6A-6.3015(1)).

PLACEMENT - The type of educational setting that is determined appropriate to meet the educational, physical, and emotional needs of the student.

PRESENT LEVEL STATEMENT (PLS) - Summary of child's level of functioning and T/IEP needs.

PROCEDURAL SAFEGUARDS - Commonly referred to as "Due Process" procedures, ensures the rights of exceptional students and their parents.

REASSIGNMENT- The process whereby a student is placed in another program. In this case the student is still eligible for the first program.

REEVALUATION - The process by which a student's psychological, educational and/or physical needs are formally reassessed. Formal reevaluation for most programs occurs at least every three years.

RELATED SERVICE - A supportive service provided to assist a child with a disability to benefit from special education.

SPECIFIC LEARNING DISABILITY (SLD) - A disorder in one (1) or more of the basic psychological processes involved in understanding or in using spoken or written language. Disorders may be manifested in listening, thinking, reading, talking, writing, spelling or arithmetic. Such disorders do not include learning problems that are due primarily to visual, hearing or motor handicaps, to mental retardation, to emotional disturbance or to environmental deprivation.

SPEECH AND LANGUAGE IMPAIRED - One who has disorders of language, fluency or voice which interferes with communication, preacademic or academic learning, vocational training or social adjustment (SBER 6A-6.3012(1)).

STAFFING CHAIRPERSON - The school based professional who organizes in-school staffings and processes and organizes information for ESE staffings.

STAFFING COMMITTEE - A committee, consisting of a minimum of three (3) professional personnel, one (1) of whom shall be the district administrator of exceptional students or designee, that utilizes the process of reviewing diagnostic evaluation, educational or social data to recommend student eligibility for special programs and to recommend the student's educational placement.

SURROGATE PARENT - One who is appointed to act as advocate for the handicapped child when the parent or guardian cannot be located.

VISUALLY IMPAIRED - One who has disorders in the structure of function of the eye that even with the best correction and treatment, interfere with learning (SBER6A-6.3014(1)). * (a) Blind - one who after the best possible ocular correction has no vision or has little potential for using vision and relies on tactual or auditory sense for learning. * (b) Partially blind - one who after the best possible adjustments and ocular correction, uses remaining vision for learning.

Medical Abbreviations

MEDICAL ABBREVIATIONS

B Bilateral

L Left

R Right

2? Secondary

ABR Absolute bed rest

ADL Activities of daily living

Ad.Lib. As desired

AE Above elbow

AFO Ankle foot orthosis

AK Above knee

AMA Against medical advice

Amt Amount

AP Anterior-Posterior

ATNR Asymmetrical tonic neck reflex

BE Below elbow

BID Twice a day

BL Blood

BLE Bilateral Lower extremity

BK Below knee

BP Blood Pressure

BR Bed rest

BUE Bilateral Upper extremity

c With

Ca Cancer

CC Chief complaint

CMS Children’s Medical Services

CNS Central nervous system

COTA Certified Occupational Therapy Assistant

CT CAT scan

DAFO Dynamic ankle foot orthosis

D/C Discontinue

DIP Distal Interphalangeal

DNR - Do Not Resuscitate

DTR Deep tendon reflex

Dx Diagnosis

Ex Exercise

/ or EXT. Extension

FH Family History

<or Flex. Flexion

FM Fine Motor

FWB Full weight bearing

Fx Fracture

GM Gross Motor

HTN or HPT Hypertension

Hx History

I Independent

IP Interphalangeal

Lat Lateral

LE Lower extremities

LLE Left lower extremity

LLQ Left lower quadrant (of abdomen)

LOA Leave of absence

LOB Loss of Balance

LPN Licensed Practical Nurse

LUE Left upper extremity

max Maximal

MC Metacarpal

MCP Metarcarpophalangeal

M.D. Medical Doctor

min Minimal

mod Moderate

Neg Negative

NPO Nothing per oris (by mouth)

NWB Non weight bearing

O2 Oxygen

OBS Observation

OOB Out of bed

OPD Out-patient department

Orth Orthopedic

OT Occupational Therapist or Occupational Therapy

OTR/L Occupational Therapist Registered/Licensed

Ped Pediatric

PH Past history

PMH Previous medical history

PIP Proximal Interphalangeal

POC Plan of Care

PO or Post Op. Post-operative

PRE Progressive resistive exercise

PRN As needed/whenever necessary

PT Physical Therapist or Physical Therapy

PTA Physical Therapy Assistant

PWB Partial Weight Bearing

qd Daily

RLE Right lower extremity

RN Registered Nurse

RO or r/o Rule out

ROM Range of motion

RUE Right upper extremity

Rx Prescription

s Without

SH Social history

SOB Shortness of breath

sp or s/p Status post

Stat At once

STNR Symmetrical tonic neck reflex

Sx Surgery

TID Three times daily

TLR Tonic Labyrinthine Reflex

Tx Treatment

UE Upper extremities

WBAT Weight bearing as tolerated

W/C Wheelchair

WFL Within functional limits

WNL Within normal limits


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Appendix

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Bibliography of Resources

Professional Resources


Response to Intervention Resources