2014-15 Development of School Based Occupational and Physical Therapy Best Practice Guidelines

1. 2014-15Development of School Based Occupational and Physical Therapy Best Practice Guidelines By: Rachel Unick OT/PT

2. During the course of this PDU, what three instructional or treatment strategies did I implement? What strategy worked best? Why? During the course of this PDU, the treatment strategies I implemented involved examining my entrance and exit criteria for Occupational Therapy. Specifically, I examined the testing protocols I was using in order to ensure they were sensitive to test for motor difficulties students may have when writing or participating in the general curriculum. I wanted to make sure that the protocols were not merely picking up ability to generate writing, but were looking at motor components. In addition to examining the test protocols, I used the strategies discussed regarding using test scores and any discrepancies between visual and fine motor skills and handwriting scores, or lack there of, to further drive and explain the decision to qualify or not qualify a student. Last, I used our discussions of determining whether students’ writing difficulty was a matter of motor problems or other issues involved in the cognitive processes of writing. I feel that the last strategy of determining if writing difficulties stemmed from difficulties in the more complex processes of writing worked best because it was easier to explain to parents and teachers when the student had met her motor goals and could copy beautifully, but was having difficulty with spelling and attention while writing. I was able to state what I worked on in the schools and provide proof that she was performing in the average range, enabling me to make the decision that she no longer qualified.

3. How did I apply the PDU strategies or course work in my classroom/practice? (examples) Who did I collaborate with during the PDU? Discuss the ways you collaborated while implementing the PDU course work/topics. I applied the PDU strategies that we discussed regarding discharging students. A strategy that was discussed involved starting the discharge process early by commenting on the student’s progress to teachers and parents and setting the stage by saying they were making so much progress and may not need skilled therapy in the near future. I started showing teachers how well he was able to copy and write. I then spoke with the teacher to make sure she knew what he was capable of and that we needed to work on carry over to the classroom. Once he knew that everyone had higher expectations, his classroom work improved. When the time came to make the qualification decision, I had built up enough work samples and test scores that discharging him was not an issue. During the PDU, I collaborated with several of my colleagues regarding the discharge process, in addition to the teachers at the school.

4. What did I learn to do differently as a result of the PDU and strategy implementation in my classroom or in my practice? • I learned to view the discharge decision as a process that needed to be started some time before any meeting. I had always thought of beginning stage of therapy as a step toward discharge, meaning that you select goals that the student needs in order to be successful and that you think the student can reach within a year. However, I never really thought of discharge as a process in which you have to switch gears and really focus on the student’s functioning without cues and also functioning in the classroom. This changed my view on what supports I needed to set up for students and also helped me to better plan when I knew students were making good progress.

5. Why is this PDU process of designing a best practice guide for OT and PT in the schools important to my therapy students and to my growth as a professional? • Designing a best practice guide for OT and PT in the schools is important to my therapy students because it would give an outline of what OTs and PTs are doing. This will increase continuity among the schools and therapists to ensure that students across different schools are receiving the same treatment. In addition, a best practice guide would help to provide a form to give to teachers and staff at school to support what you do. To often staff may have a skewed view of what OTs and PTs do in the school system, leading to confusion and miscommunication. Also, a best practice guide would help my professional growth by providing a measure that I can rate myself on to see which areas I need to work on in order to provide the best treatment for my students.

6. PDU Data AnalysisReflecting on the data you have collected, how did this experience impact instruction/therapy, progress monitoring, student performance, and your own practice? • This PDU experience impacted my therapy by driving the consistency of my progress monitoring. I started to use the same rubrics each month for progress monitoring. This way, I was able to compare months in order to see which letters or skills needed to be worked on next. For the students, they knew what was coming each month and were able to complete the progress monitoring without much help. This also led to me spending less time grading the rubrics and provided consistent forms for work samples.

7. How will I apply my new learning in the future to further my practice? What are my next steps? • I will continue to examine my entrance and exit criteria. I will be sure to communicate the reasoning behind these decisions to staff and parents. Consistency in this communication will help to develop a level of professional trust with staff and parents. I will continue to try to be consistent with my progress monitoring. For me, I think the next steps are to stay involved in the process of constructing a best practice guide and determining county entrance and exit criteria.

8. PDU Artifact #1 Explanation: This artifact is important because it shows both improvement over the school year and how performance increases when using familiar progress monitoring forms. This child made a lot of growth over the year, although his writing is still somewhat delayed and difficult for him.

9. PDU Artifact #2 Explanation: This is a data sheet I compiled to serve as support for making the decision to discharge a student. This student had been meeting all goals for some time and providing visual documentation at the meeting, along with work samples, helped to provide support for the decision.

10. PDU Artifact #3 • Exit: • Prompts exit decision making process: • Meeting OT IEP goals and objectives • Consistency during OT sessions • Handwriting looks better than mine • Completing tasks in less time than others with no cues • Student aware of needs/deficits/strategies • Student performing on grade level • Lack of deficits in motor areas • Skills carrying over to classroom by observation or teacher/sped report Explanation: This artifact is the discharge process I came up with prior to the group discussion. This pertains to the PDU because it added to the group discussion on aligning our exit criteria. This topic was especially important to me this year because I had several students who were meeting their goals and ready to be discharged, but the process is unclear, making building my case for discharge harder. • Body of evidence: • Standardized test scores • Handwriting: Print Tool/Test of Handwriting Skills • WRAVMA (or other visual motor test) • Peabody • SPM • Speed of handwriting • Work samples •  Progress on OT IEP goals and objectives • Have they met any goals? If not, are goals appropriate? • Are they making steady progress? • Is there anywhere to take them before they meet grade level standards? • Is progress carrying over to the classroom? • Is the student independent in using strategies? • Are they aware of their needs/deficits? • Consistency of performance during sessions • Consultation with special education teacher and SLP • Observations in the classroom and during sessions • Consultation with the teacher re:work in classroom

11. Exit Ticket • Please write • What support(s) do you need to further your professional growth in future PDUs? Increased opportunities for PDUs, both inside and outside of the OT/PT department. Increased opportunities for mentoring. • 2 things that you took away from the PDU this year The importance of teamwork and collaboration both in the OT/PT department and with the staff in the buildings The importance of continuity across the district • 1 piece of constructive criticism A clearer sense of expectations for the course