Occupational Therapy Licensing Board

Q & A:  Early Education
Is it required for OT's to do the testing (fine motor, sensory processing challenges) if it requires in adding OT services to the IFSP?
While the past practice for many years has been that an Early Intervention "Motor Team" comprised of PTs, SLPs, Special Ed. teachers, Autism Specialists, and/or OTs, conducts the initial evaluations for determining eligibility for services, our practice act states that only the OT can make the determination for adding OT services to the IFSP. If the motor team DOES NOT have an OT on the team, and the team feels that there is the need for OT services, then an OT MUST be consulted and make the determination for OT services, including frequency and level of service. For testing, the OT can decide to go with the standardized results of the motor assessment for determining OT services or may elect to conduct a separation observation and assessment. In either case, the OT must be the one to determine what the OT services will look like for that child.
If a child is evaluated by our agency and is found eligible for services in general, but an OT is not on the evaluation team, does the OT who will be the service provider need to complete an evaluation prior to offering services?
The answer is YES, the evaluation team cannot recommend OT services IF an OT is NOT part of the evaluation. An OT must evaluate the child to make a determination is OT services are needed. However, an evaluation DOES NOT have to involve formal assessment: the OT could choose to do a file review of prior evaluations/assessments given, conduct a brief observation of the child, or request permission to conduct a formal assessment depending on whether or not there is sufficient data available to determine the need for OT services. The type of "evaluation" for OT services is at the discretion of the OT, not the evaluation team or the administrator.
Does this vary if the services are a one-time general consultation vs more direct and continual services?
No, there is no distinction between "types" of services provided - OT services are OT services, and the documentation needs to be there, regardless of if it is a one-time consult or services provided over a period of time. Clarification - the evaluation team (sans the OT) may feel that a one-time consult by the OT is all that is needed. However, BEFORE "OT Consult" is put on the IFSP, the team must confer with the OT that a one-time consult is recommended: the OT must be involved in the determination of services that goes on the IFSP (whether this is a one-time consultation, on-going consultation, or direct services). A team cannot limit the OT to a one-time consultation should the OT determine that the child needs services beyond the one visit.
Can an OTA attend an IEP meeting without the presence of the OT?
It is entirely appropriate for an occupational therapy assistant (OTA) to attend an IEP meeting and present information concerning student progress and IEP goals to be addressed by occupational therapy, based on previous collaboration between the supervising occupational therapist (OT) and the OTA. If, at the IEP meeting, the IEP team requests additions or changes to the goals being addressed by occupational therapy, the supervising OT would need to review those recommendations and agree to any changes; the OTA cannot make that decision along, without additional collaboration between the OT and OTA. If, before the IEP meeting, the OT and OTA discussed and agreed upon potential changes in goals or amount or type of service, the OTA may make the changes during the IEP meeting.
Can an OTA review IFSP Goals and enter it into the IFSP if it is just a review or a present level of progress?
As long as there are no "recommendations" or a change in goals, the OTA can draft the review. Best practice would be for the OTA to write up the review, and then have the OT look at it, and then have both names after the write-up (i.e. "submitted by Sally Smith, OTA and Joan Johnson, OTR").




Dear Occupational Therapy Practitioner:
Thank you for your recent license renewal.  An issue has been brought forth to the Licensing Board, and we would like to address it with all therapists in the state of Oregon.  While this matter is directly related to Early Childhood and School Based OT services, this is a reminder for therapists in all practice settings.  As a licensed occupational therapy practitioner in the state of Oregon, you are required to complete an evaluation prior to treating a patient, per OAR 339-010-0050.  The occupational therapy practitioner is the sole party responsible for completing an OT evaluation.  Documentation is a crucial part of the evaluation process, and you are required to document the evaluation, goals, interventions, and outcomes.  Please share this information as necessary with your treatment teams and continue to uphold the integrity of the occupational therapy profession.  Thank you for your continued work in the profession and pledge to the occupational therapy code of ethics.

Occupational Therapy Services for Children and Youth in Education and Early Childhood Programs Regulated by Federal Laws

(1) Definitions: This rule applies to all occupational therapy practitioners who include both occupational therapists and occupational therapy assistants as defined in OAR 339-010-0005. All other rules regarding Occupational Therapy practitioners apply notwithstanding what is found in these rules as they apply to practitioners in the education setting.

(a) “Children and youth” refers to a child or student determined to be eligible for services under IDEA or Section 504. Part B under IDEA describes requirements for the provision of special education services for preschool and school-age children and youth, ages 3 through 21 years. Part C, or the early intervention program, focuses on services for infants and toddlers with disabilities and their families. Section 504 and the Americans With Disabilities Act (ADA 1990) define a person with a disability as “any person who has a physical or mental impairment that substantially limits one or more major life activities…” and require a public school system to provide needed accommodations or services.

(b) “Service plans” document the program of services and supports necessary to meet a child’s developmental or educational needs under the IDEA. These specify the need for occupational therapy services and include: the individualized family services plan (IFSP) for infants, toddlers and preschoolers; the individualized education plan (IEP) or a Section 504 Plan for school-age youth.

(c) “Educational or developmental goals” are developed collaboratively by a multi-disciplinary early intervention or educational team, which includes an occupational therapist as a related service provider, when areas of occupational performance have been identified.

(d) “Natural environment” refers to the most appropriate setting for the child to develop the skills needed for occupational performance.

(e) “Educational environments” refers to home; community; day care; preschool, or the general and special education settings.

(f) “Evaluation” is the process of gathering information to make decisions about a student’s or child’s strengths and educational or developmental needs.

(g) “Assessments” are the specific methods or measures used to gather data for the evaluation.

(2) The Occupational Therapy Process:

(a) Evaluation: The occupational therapist is responsible for the occupational therapy evaluation.

(A) The occupational therapist selects assessment methods that focus on identifying factors that act as supports or barriers to engagement in occupations. The initial occupational therapy evaluation should include analysis of the child’s ability to access the natural or educational environment for learning.

(B) The occupational therapist must participate in decisions about the need for occupational therapy services, development of functional, measurable goals and determining which educational or developmental goals occupational therapy will support.

(C) The occupational therapist determines the types, frequency and duration of interventions, as well as accommodations and modifications of the environment.

(D) Screening to determine the need for an occupational therapy evaluation does not constitute initiation of occupational therapy services.

(b) Intervention: The occupational therapy practitioner may implement occupational therapy services, along a continuum, which may include the following:

(A) Direct intervention is the therapeutic use of occupations and activities with the child present, individually or in groups.

(B) Consultation is collaborative problem solving with parents, teachers, and other professionals involved in a child’s program.

(C) The education process is imparting generalized knowledge and information about occupation and activity and does not address an individual child’s specific education plan.

(c) Outcomes: The occupational therapist should review the intervention on an ongoing basis and dependent on the child’s response, modify as needed.

(3) Delegation of therapeutic activities:

(a) The occupational therapy practitioner may instruct others, such as educational or daycare staff, to carry out a specific activity or technique designed to support the child’s the performance.

(b) The designated person must be able to demonstrate the technique as instructed, recount the restrictions, safety factors and precautions.

(c) The occupational therapy practitioner is responsible for ongoing monitoring of the trained person and modifying the procedures based on outcomes and other changes.

(d) When considering the delegation of techniques the child’s health and safety must be maintained at all times.

(4) Documentation:

(a) The occupational therapy practitioner must document evaluation, goals, interventions and outcomes if they are not included in the service plan.

(b) Documentation should reflect the child’s current status, progress towards goals, response to interventions, and strategies that were promising or ineffective.

(c) The occupational therapist should utilize a method of data collection that allows for concise and accurate recording of intervention and progress.

(d) The occupational therapy practitioner is responsible for the analysis of data collected to verify progress and the documentation of their own activities to accomplish the goals.

(e) School records shall be kept for a minimum of seven years.​