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The Individuals with Disabilities Education Act, also known as IDEA, is a law ensuring services to children, and students with disabilities throughout the nation. IDEA regulates how states and public schools provide intervention and special education to more than six and a half million infants, toddlers, children and youth with disabilities (Building the Legacy, 2012). IDEA, however, also requires children with disabilities to receive related services. Related services are extra services that assist children with disabilities to gain independence. This is done by providing extra help and support in needed areas, such as speaking, walking, or moving. Children and youth, ages three to twenty one, receive special education and related services under IDEA, Part B. Under Part B, IDEA mandates all children with disabilities have available to them, a free appropriate public education, which is also known as FAPE. IDEA also requires, and emphasizes, special education and related services that are designed to meet every students unique needs. These services are to prepare students eventually for employment, and independent living (Building the Legacy, 2012). Students who qualify for related services under IDEA, are required by law to receive them.
There any many types of related services that a student may receive within their free public education. These services include, but are not exclusive to: psychological services, physical and occupational therapy, speech pathology and audiology, recreation, and medical services. The umbrella term also includes school health services, transportation, social work services, and parent counseling and training. The related services that will be provided to a child, are determined by a child's individualized education, or IEP, team and or multi-factored evaluation. However, once established, these related services become a part of the student's IEP team gaining an important role in the student's future. Focusing on the educational school setting, physical therapy, occupational therapy, and speech and language pathology are three of the most common related services one may encounter that serve children and youth with disabilities.
Physical therapists, occupational therapists, and speech and language pathologists working in the schools, provide intervention for students who are eligible for special education and related services under IDEA (Reeder, Arnold, Jefferies, McEwin 2011). There are students who are not eligible for special education, yet still have a disability. These services can be provided to those students who do not meet eligibility for special education, but only if they still have a disability. This is required, by law, under Section 504 of the Rehabilitation Act of 1973 (Reeder, Arnold, Jefferies, McEwin 2011).
Physical therapists, occupational therapists and speech and language pathologists are critical, and key aspects of students with disabilities daily lives. These services provide important and crucial interventions to students that will assist in the ultimate going of gaining independence as an individual. In order to understand these three related service categories in education, an individual must have an idea of their function. This can be accomplished by providing a working definition, and with examples, as well as information regarding what each related service does for children in schools.
Since the passage of PL 94-142 in 1975, a foundational law which provided students with disabilities a free and appropriate education, physical therapy, also known as PT, has been considered a related service in the public schools (Brown, Majority 2010). IDEA emphasizes the role of the physical therapist to be servicing students while allowing them to reach their maximum level of independence within the education setting. In general, physical therapists can help people of all ages improve their movement, as well as manage discomfort. According to the Bureau of Labor and Statistics, to become a physical therapist in the school setting, one must typically acquire a masters degree, and some times a doctoral degree in physical therapy is necessary. Also according to the United States Bureau of Labor and Statistics, physical therapists have an average salary of $76,310 per year (Physical Therapists: Occupational Outlook Handbook, 2012). However, if working in the school setting, physical therapists usually make the same salary as a teacher. All states do require physical therapists to be licensed regardless of where they work.
In a public school setting, physical therapy services are provided to all students with disabilities. It is a common misconception that all students with physical disabilities receive physical therapy; this statement is false. Just because a student has a physical disability does not mean that student will receive physical therapy services. The job of the physical therapist in the public schools, is to allow a particular student to navigate within their educational setting by improving gross motor functions. Some examples of gross, meaning large, motor skills are walking, running, and ascending and descending stairs. Ultimately, it is a physical therapist's responsibility to open up opportunities to utilize gross mobility skills, within the context of the school day (Damiano, 2006). For example, just because a student has cerebral palsy and uses a walker, does mean not that particular student receives physical therapy services. The student may require services, however, if they are functioning within their educational setting, the student is not required to receive physical therapy services.
The physical therapy services a student receives must have an educational impact that will allow the student to access their free and appropriate education. With that being said, within the school setting, there are many ways for a physical therapist to assist a student to access their free and appropriate education. Their job is not black and white. There are multiple ways and models for physical therapists to deliver services to help students. Some of the more common services delivery modes that physical therapists provide in schools are direct, adaptive/assistive equipment, and consultation (Brown, Majority 2010).
Direct service involves a physical therapist providing therapy in a face-to-face setting(Brown, Majority 2010). Direct service, or hands on physical therapy, may take place in a therapy room, a separate room other than the classroom or the classroom itself (Brown, Majority 2010). The direct service model is provided, and used by a physical therapist mostly in a one on one scenario. This means there is only one physical therapist and one student who are working at the same time. This is done to give sufficient attention to improve functional and gross motor skill that are needed to gain access to a student's educational environment. An example of a functional gross motor skill under the direct service model may be a physical therapist modeling and assisting a student one on one on how to navigate a hallway, or use the handrails within a bathroom.
The direct service model is often used with younger students whose educational curriculum involves a gross motor component (Brown, Majority 2010). However, as a student continues to move forward within their academic career, the direct service model may interfere with a student's academic schedule. The direct service model in physical therapy is used less in the middle and high school years of a student's career. This is because as a student gets older, the class format is structured so that the student's presence in the classroom is a necessity. As stated previously, the delivery model requires time for one on one attention or physical removal from a classroom. This is a major challenge for a student who is academically focused. It would be difficult to receive the proper academic instruction while transitioning constantly in and out of the classroom.
A second form of delivery model for a physical therapist is assisting a student with adaptive equipment. This is done to accommodate a physical limitation that restricts a student to their educational environment. There are multiple, and many forms of adaptive equipment. An example of adaptive equipment may be something as simple as a pencil grip. However, physical therapists in the public school setting often equipped children with wheelchairs, walkers, gate-trainers, etc. This form of delivery often times requires a lot of one on one attention at first, but, in the end, the student ultimately remains in activities with less interruption. Meaning, once a child is fit with their adaptive equipment, they will be able to function with independence, and stay within their school environment.
The third model for services physical therapists provide is the consultant model. According to Brown and Majority, this model involves the physical therapist working with and supervising school staff to implement educational activities to help meet mobility needs (Brown, Majority 2010). In this model, the physical therapist works with the supervising school staff to make sure the school district is up to date on, and meeting mobility needs for all students. As a consultant, the school physical therapist is required to provide training to the school staff. They are also required to explain to the school staff how to meet each students unique needs (Brown, Majority 2010). It is the physical therapist's responsibility to make sure the student is including any specific therapies into their daily routines and activities.
As stated previously, occupational therapy, also known as OT, is another related service that is required for students with disabilities through IDEA. As an overview, occupational therapy focuses on helping individuals of all ages achieve independence in all areas of their daily lives. According to the United States Bureau of Labor and Statistics, on average, and occupational therapist makes approximately $72,320 per year. Just like a physical therapist, if an occupational therapist works in the school setting, they will have the same salary as a teacher. However, this is only true if the occupational therapist is hired by the school district. If hired by an outside source, the occupational therapist's contact is negotiated. Furthermore, occupational therapy and physical therapy are also similar as they both need at least a masters degree to practice. All states also require occupational therapists to be licensed.
According to the American Occupational Therapy Association, occupational
therapy in the educational setting focuses on student participation in both academic and nonacademic areas. These areas include subjects such as math, reading, writing, and other areas of a student's day such as physical education, recess, sports, vocational, self-help skills, and other activities of daily living (American Occupational Therapy Association, 2006). In the school setting, an occupational therapist's main responsibility is to enhance a student's ability to fully access and be successful in their education environment, just like a physical therapist. However, an occupational therapist's work focuses on fine motor skills. Fine motor skills are the coordination of small muscle movements. Improving fine motor skills help improve daily living.
Some examples of fine motor skills that an occupational therapist might work on with a student are buttoning a shirt, tying ones shoes, and working on grasping materials such as writing or eating utensils. However, there are many other ways for an occupational therapist to assist a student to be able to access their educational environment.
As well as working with students on fine motor skills that will improve their daily living, occupational therapists also provide sensory diets to students. A sensory diet is provided, and implemented to an individual who needs some type of stimulation. This stimulation can be from common materials and objects such as a bike, swing, ball, brush, etc. The main purpose of a sensory diet is to assist an individual in self regulation as they may have behavior issues or trouble focusing due to the lack of sensory input. Many sensory diets are used as calming strategies. Sensory diets also seem to go hand in hand with educational goals, as well. No two sensory diets are alike. It also takes trial and error to find a sensory diet that is right for each child. It is the occupational therapists who figures out, and helps develop the sensory diet as well as the skills and strategies needed for the student to adapt in their educational environment. (site occupational therapy and sensory diets)
Speech and Language Pathologist
The third related service, and probably most common in the public school setting, is a speech and language pathologist. Speech and language pathologists are often commonly known as SLPs. In the school setting, speech and language pathologists work with students in the Pre-K range, all the way until grade twelve. Speech and language pathologists are responsible for the intervention with a student's language and speaking abilities. That is, speech and language pathologists work with students who have some type of difficulty communicating with others.
According to the American Speech-Language and Hearing Association, speech and language pathologists are specifically trained professionals who have earned either a master's or doctoral degree, much like a physical therapist and occupational therapist (A Presentation for Teachers, Administrators, Parents, and the Community, 2012). To be a practicing speech and language pathologist in the schools, one must have the certificate of clinical competence from the American Speech-Language and Hearing Association as well as a state license. Furthermore, to receive a license, a speech and language pathologist must have taken the national competitive examination. According to the United States Bureau of Labor and Statistics, on average, a speech and language pathologist makes approximately $66,920 per year (Speech and Language Pathologists, 2012). Just like a physical therapist or occupational therapist, if a speech and language pathologist works in a school, they will make about the same salary as a teacher.
According to The Individuals With Disabilities Education Act, speech and language services are provided for school age children with communication disorders that affect a student's educational performance (A Presentation for Teachers, Administrators, Parents, and the Community, 2012). In the school environment, speech and language pathologists work with children who have communication problems such as language, fluency, articulation, voice and swallowing. These problems can affect success in areas such as classroom activities, social interactions, literacy, and learning. These communication problems can be caused, and associated with a variety of factors. Factors including, but not exclusive to: cleft palate, hearing loss, cerebral palsy, autism, developmental delays, traumatic brain injury, and other learning disabilities.
With this being said, a speech and language pathologist in the schools works with all different types of students with disabilities. This means there are going to need to be different service delivery options because no two children with disabilities are the same. According to Joyce Taylor, three of the most common forms of service delivery options for speech pathologists in schools are the traditional pull-out model, the classroom intervention model, and the transdisciplinary team model (Taylor, 1992).
According to Taylor, the traditional pullout model is the most familiar, and may be used in schools with individuals from birth to twenty-one years of age. With this model, a speech and language pathologist pulls a student from their classroom to work with them in a separate environment, usually a therapy room. The traditional pull-out model implements direct services and interventions to either to the individual student or students in small groups (Taylor, 1992).
The classroom intervention model is the service delivery option where intervention is put in place based on the information that most members of a classroom would benefit from speech and language services. With the classroom teacher, the speech and language pathologist may both provide instruction on an a specific schedule. This model is appropriate for at risk, younger children, who be enrolled in the general education classroom.
The third type of common service delivery model for occupational therapy in the schools, is the transdisciplinary team model. This model is structured for the younger school aged children. The speech and language pathologist serves as a consultant and provides critical information to parents. They also give crucial and early assessment and intervention to students. In this team model, all of the members share assessment and implementation of intervention responsibilities (Taylor, 1992).
It is clear that a speech and language pathologist has many versatile roles in schools. However, a speech and language pathologist's work is not done alone. They collaborate with teachers and other professionals to develop and provide intervention that is unique to each student on their caseload. According to Jane Kerr, speech and language pathologists often advise and work with educational staff to deliver language-learning activities within and outside of the classroom (Kerr, 2010). To gain insight information and knowledge about speech and language pathology in the school environment, I completed an interview on a current practicing speech and language pathologist, Sarah, from Cleveland, Ohio. Sarah currently works in a public school district in a suburban elementary school. It is her second year in the schools with no prior experience in the medical field.
When asked how do you like working in the public school setting as a speech and language pathologist, Sarah answered "I enjoy it very much! I like spending time individually with each student. It does, however, get very busy at times. I love the special education team, and the fast paced environment!" The next question I asked was regarding some of the challenges a public school speech and language pathologist had. Sarah answered the question stating, "My large case load and limited time are the two biggest challenges I face. I only get around thirty minutes [with each student], if that. Also, I'm not able to enter the regular education classroom as much as I would like. A lot of my intervention occurs outside of the classroom." According to the book Speech-Language Pathology Services In The Schools by Joyce Taylor, many speech and language pathologists are responsible for more children than they can legally or ethically provide services for (Taylor, 1992).
As a prospective teacher candidate, I have witnessed this large caseload that a speech and language pathologist acquires in the school setting. I have spent quite a bit of time observing in an extremely rural elementary school, and have worked and observed hand in hand with the speech and language pathologist in that school. On her caseload, she had fifty four students. Seven of the fifty four students were located in the classroom in which I completing my observations. On a good week, the students in the classroom saw the speech pathologists approximately one a week in the classroom. My students accounted for thirteen percent of her caseload, and were only seen once a week if that. According to Taylor, the speech and language pathologist is required to make the decision of who receives what amount of time (Taylor, 1992).
According to Kathy David, the choice to implement any individual model of service delivery needs to be supported by evidence (Brown, Majority 2010). That is, as a physical therapist, occupational therapist and speech and language pathologist, one must use only research based techniques. The require to use only research based techniques is based on ethics. According to the Council for Exceptional Children's Ethical Principles, professional special educators and individuals working with students with special needs are to use evidence, instructional data, research and professional knowledge to inform practice (Council For Exceptional Children, 2010). Regardless if you are working in the schools as a PT, OT, SLP, or even a teacher, The Council for Exceptional Children mandates upholding laws, regulations, and policies that influence practice within the school environment (Council For Exceptional Children, 2010).
In conclusion, it is clear to see that physical therapists, occupational therapists, and speech and language pathologists have huge impacts on students with disabilities lives. However, nationally there is a persistent shortage of physical therapists, occupational therapists and speech language pathologists (Ray, 2010). These three related services are necessary, and critical components to achieve independence for the students who require these services. When looking at these services, however, one must realize that even though they have profound differences, they all potentially work with one another to achieve what is right by the child. If a child is deemed in need of any one, or more of these three services, they will work hand in hand together and with the special education teacher. Furthermore, if a student requires of these related services, the PT, OT and SLP will become a part of that child's IEP team. It will be their responsibility to make decisions for that child that will allow them to ultimately access their free and appropriate education.