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Title: Personnel issues in school-based occupational therapy : supply and demand, preparation, and certification and licensure
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Table of Contents
    Front Cover
        Page 1
    Preface
        Page 2
    Table of Contents
        Page 3
    Abstract
        Page 4
    Main
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
    Reference
        Page 26
        Page 27
        Page 28
    Appendix
        Page 29
        Page 30
        Page 31
        Page 32
Full Text






Personnel Issues in School-Based Occupational
Therapy: Supply and Demand, Preparation,
Certification and Licensure
Prepared for the Center on Personnel Studies in Special Education



by
Yvonne Swinth
University of Pudget Sound

Barbara Chandler
James Madison University

Barbara Hanft
Hanft Consulting Inc., Silver Spring MD

Leslie Jackson
American Occupational Therapy Association

Jayne Shepherd
Virginia Commonwealth University


May 2003
(COPSSE Document No. IB-1)


Center on Personnel Studies in Special Education


UNIVERSITY OF FLORIDA


http://www.copsse.org









CENTER ON PERSONNEL STUDIES IN SPECIAL EDUCATION


UNIVERSITY OF FLORIDA

JOHNS HOPKINS UNIVERSITY

VANDERBILT UNIVERSITY

UNIVERSITY OF COLORADO BOULDER

INSTRUCTIONAL RESEARCH GROUP, LONG BEACH, CA

COPSSE research is focused on the preparation of special education professionals and its
impact on beginning teacher quality and student outcomes. Our research is intended to inform
scholars and policymakers about advantages and disadvantages of preparation alternatives and
the effective use of public funds in addressing personnel shortages.

In addition to our authors and reviewers, many individuals and organizations have contributed
substantially to our efforts, including Drs. Erling Boe of the University of Pennsylvania and
Elaine Carlson of WESTAT. We also have benefited greatly from collaboration with the National
Clearinghouse for the Professions in Special Education, the Policymakers Partnership, and their
parent organizations, the Council for Exceptional Children and the National Association of State
Directors of Special Education.


The Center on Personnel Studies in Special Education, H325Q000002, is a cooperative
agreement between the University of Florida and the Office of Special Education Programs of
the U. S. Department of Education. The contents of this document do not necessarily reflect the
views or policies of the Department of Education, nor does mention of other organizations imply
endorsement by them.
Recommended citation:
Swinth, Y., Chandler, B., Hanft, B., Jackson, L., & Shepherd, J. (2003). Personnel issues in
school-based occupational therapy: Supply and demand, preparation,certification
and licensure. (COPSSE Document No. IB-1). Gainesville, FL: University of
Florida, Center on Personnel Studies in Special Education.

Additional Copies may be obtained from:
COPSSE Project
P.O. Box 117050
University of Florida
Gainesville, FL 32611
IDEAS 352-392-0701
thatVork 352-392-2655 (Fax)
U. S. Office of Special
Education Programs There are no copyright restrictions on this document; however
please credit the source and support of the federal funds when
copying all or part of this document.









CONTENTS

Abstract 4

Introduction and Overview of Occupational Therapy (OT) Services 5

Unique Role of OT in the Schools. 8

Supply and Demand 11

Preparation and Education of OTs 15

Certification and Licensure 18

Summary 23

REFERENCES 26

APPENDIXES

Appendix A. Definitions of the Nine Most Commonly Used Pediatric Practice
Models .29

Appendix B. Jurisdictions Regulating OT Assistants (OTAs) 30

Appendix C. Projects Supporting the Continuing Competencies of School-Based
Practitioners 31

Appendix D. Specialty Certifications/Training Available to OTs Working in
Educational Settings 32

TABLES

Table 1. Comparison of OT in Four Settings 6
Table 2. School-Related Occupations Addressed during OT Assessment and
Intervention 9
Table 3. AOTA Members (OT/OTA) by Ethnic Origin 11
Table 4. Possible Recruitment and Retention Strategies for OT Practitioners 14
Table 5. Definitions of Types of Regulation for OT 19
Table 6. Jurisdictions Regulating OTs 20
Table 7. Competencies for OTs in School-Based Practice 21

FIGURES


Figure 1. Flow Chart of Preparation To Become an OT









ABSTRACT

State and local district personnel have long expressed concern about Occupational Therapists
(OTs) shortages and OT preservice preparation for work in schools and early childhood
programs. This paper explores the existing OT literature on supply and demand of school
practitioners, their professional preparation, and how they are certified and licensed. Findings
suggest that there may be a shortage of OTs within the next 5 years; some content specific to
school settings is usually included in preservice preparation; and most school-based OT
practitioners have a state certification or license but it may not be specific to educational settings.










INTRODUCTION AND OVERVIEW OF
OCCUPATIONAL THERAPY (OT) SERVICES

The Individuals with Disabilities Education Act (IDEA, 1997) requires schools and early
intervention programs to utilize appropriately qualified personnel to provide special education,
related services, and intervention services. These services are designed to help meet the
educational and developmental needs of eligible children with disabilities. IDEA, via its
Comprehensive System of Personnel Development (CSPD) and State Improvement Grant (SIG)
provisions, also requires states to ensure that they have an adequate supply of qualified providers
who can offer special education, related services, and early intervention services.

Over the past years, concerns have been voiced about the preservice preparation of occupational
therapy (OT) practitioners to work in schools and early childhood programs. States and local
districts have long complained of shortages of occupational therapists (OTs) in these settings. In
addition, the Twenty-Second Annual Report to Congress on the Implementation of the IDEA
(2000) highlighted the need for additional full-time therapy positions. This paper will explore
OT personnel issues with particular emphasis on OTs' role under IDEA.

OT developed in the early 1900s and flourished as a profession during World War I. At that
time, OTs worked to assist wounded soldiers and returning veterans to gain independence in
their daily self-care, social, and work activities. Within 20 years, the profession had expanded in
response to social and economic trends to provide services to a variety of adult populations,
children, and the elderly.

Today, OTs address the occupational performance needs (the ability to participate in life
activities) of individuals of all ages. For a majority of practitioners, the focus of work has been
with individuals with disabilities. Offering preventative services, however, and working with
non-disabled individuals who are experiencing occupational performance (participation)
problems, are growing areas of practice. Occupations are the "ordinary and familiar things that
people do every day" (American Occupational Therapy Association [AOTA], 1995, p. 1015) that
bring purpose and meaning to their lives in home, school, work, community, and leisure settings.
Thus, OT practitioners focus on restoring and promoting performance and participation in daily
life occupations relevant to an individual's (a) developmental and chronological age; (b) role as
student, family member, and worker; and (c) his or her social participation within the physical,
social, and cultural context. The focus of OT in a particular setting is guided by the setting,
reimbursement mandates, and client (student) needs.

Table 1 illustrates how OT services differ across the four settings in which OTs typically
provide their services.








Table 1. Comparison of OT in Four Settings

Component Educational Medical Industrial Community
(e.g., 0-3; psychosocial)
Client Student with special needs; Individual of any age Injured workers on- Individuals with needs in the
parents; caregivers; teachers, with disability, the-job; employers broad array of social services:
aides and other school personnel developmental delay, interested in developmental skills, commu-
or chronic illness; prevention programs nity living, housing, income
family members; support, vocational preparation,
caregivers; transportation, and shelters;
medical personnel family members, caregivers.
Service Site Public and private schools; Hospitals, public and Work sites across Child and adult day care; club-
community preschool; vocational private clinics, home broad array of houses; transitional living pro-
training sites health agencies, skilled industrial settings; grams (group homes); out-
nursing homes medical site for patient mental health services;
injured worker recreation programs (e.g.,
YMCA, camps) wellness clinics
Focus of Student performance/ Performance of Performance of job- Performance of activities of
Assessment/ participation in education, activities of daily living related skills specific daily living appropriate to
Intervention activities of daily living, work, appropriate to home, to worker's home, school, work, or
play and social occu-pations school, and/or work responsibilities community living
relevant to school life or responsibilities and position
transition to work or community
living
Outcomes of Improved student learning, Ability to care for self Return to work Independent functioning in all
Intervention behavior, and progress in the independently or with and/or improved areas self care and community
general curriculum & school adapted devices to work performance/ daily living without need of
environment; role competence; engage in home, participation support or decreased levels of
adaptation for transition to work, school and/or work support
community, and/or post- occupations
secondary education.
Payment for State and local public education Medicare, Medicaid, Workman's comp.; Medicaid, charitable, and
OT Services funds; Individuals with Disabilities private insurance, employer training private funding, governmental
Education Act; Medicaid; Rehab CHAMPUS (military), funds; state voca- support.
Act (504) VA, individual pay tional rehabilitation







AOTA was founded in 1917. OT practitioners include OTs and OTAs. Currently, there are
approximately 50,000 members of the Association (including both OTs and OTAs). According
to the U. S. Bureau of Labor Statistics (USBLS) 2002-2003 Occupational Outlook Handbook
(2001a, 2001b, 2001c), there were over 78,000 OTs and 25,000 OTAs in the U. S. Most OT
practitioners are certified through the National Board for Certification in Occupational Therapy
(NBCOT). Board-certified practitioners are designated Occupational Therapist Registered (OTR
for OTs) or Certified Occupational Therapy Assistant (COTA for OTAs). All OTs and OTAs
must pass a national certification exam and are initially certified through NBCOT. Depending on
the preference of the therapist and state licensure/certification requirements, some therapists and
therapy assistants may choose not to maintain their NBCOT certification. If this is the case, they
drop the R or the C from their title. OTs have at least a bachelors degree, and OTAs have at least
a 2-year associates degree. A majority of therapists are female and Caucasian.








UNIQUE ROLE OF OT IN THE SCHOOLS

OT practitioners work with children and youth who have physical, behavioral/psychosocial, and
cognitive delays or diagnosed disabilities from birth to age 21, as well as with their family
members. They may also provide services to other professionals (e.g., medical staff, educational
staff, support staff) who work with these children, families, and systems (e.g., school district,
departments of education). Services are provided in a variety of settings, including schools, early
intervention programs, hospitals and rehabilitation centers, private clinics, homes,
community/institutional mental health programs, and juvenile correction facilities.
The majority of OT practitioners who work with children provide their services in public school
and early intervention programs under Parts B and C of the IDEA. IDEA Part B identifies OT as
a related service for eligible children ages 3-21 years who require assistance to benefit from
special education. Under Part C, OT is a primary service for eligible infants and toddlers from
birth through age 2, and their families. In early intervention, OT services enhance young
children's development and functional performance (ability to participate) in daily settings and
support family members and other key adults in their parenting and childcare responsibilities.
Although this paper focuses on OT services under IDEA Part B, many of the core issues
regarding preparation, supply/demand, and certification/licensure of OT practitioners are similar
for Part C programs. See Case-Smith (1998), Hanft & Anzalone (2001), Hanft, Burke, &
Swenson-Miller (1996), Humphry & Link (1990), and Schultz-Krohn & Cara (2000) for
discussions of the role and preparation of OTs in early intervention programs.
The public school is identified by almost 25% of AOTA members as their primary work setting
(AOTA, 2001a). This percentage underscores the need for school-based practice to be an integral
part of OT professional preparation (Swinth, 2002). In an educational setting, OT practitioners
focus on helping students engage in meaningful and purposeful daily school occupations-the
activities that make a student successful and engaged in school life. The school-related outcomes
of the primary occupational areas (i.e., activities of daily living, education, work, play/leisure,
and social participation) are described in Table 2.








Table 2. School-Related Occupations Addressed during OT Assessment and
Intervention


Occupational Area


Activities of Daily Living
(Basic and Instrumental)


Educational Outcome


Cares for basic self needs in school (e.g., eating,
toileting, managing shoes and coats); uses
transportation system and communication devices to
interact with others; develops health management
routines and when appropriate, home management
skills for independent living (e.g., cleaning, shopping,
meal preparation, budgeting, safety and emergency
responses)


Education Achieves in a learning environment including academic
(e.g., math, reading), nonacademic (e.g., lunch, recess),
prevocational and vocational activities (e.g., career and
technical education)
Work Develops interests, habits, and skills necessary for
engaging in work or volunteer activities for transition to
community life upon graduation from school
Play/Leisure Identifies and engages in age-appropriate toys, games,
and leisure experiences; participates in art, music,
sports, and after-school activities
Social Participation Develops appropriate social relationships (and
behavioral strategies) at school with peers, teachers,
and other educational personnel within classroom,
extracurricular activities, and preparation for work
activities.
(AOTA, 2002)


OT practitioners assess three interrelated elements that affect participation in goal-directed
activities or occupations in school: individual functions, performance skills/patterns, and
contextual/activity demands. Each student has unique physical structures; sensory, neurological,
emotional, and mental functions; and challenges that affect successful school-related
performance in education, self-care, play, and social participation (AOTA, 2002; Hanft, 1999a,
1999b). Performance skills (i.e., motor, process, and communication/interaction) are the
observable goal-directed actions with a purpose in daily life. Both the context (e.g., the physical,
cultural, and social environment) (Orr & Schade, 1997) and specific activity demands (e.g.,
child's body functions and structures, performance skills, properties of an object, and use of
space and timing) affect how well a student performs a given task or role. To illustrate:

A 4-year old girl with congenital deformities in her forearms limiting motions of her
hands (physical functions and structure) is taught to use adapted scissors and heavy
construction paper (activity demands) to complete her much-loved art projects and
classroom lessons (performance skills).







An 8-year old boy with an attention deficit disorder who has difficulty completing
assignments and following directions due to perceptual and sensory motor problems
(neurological functions and structure) can benefit from reorganization of his work
space (physical and social context) and additional time (activity demands) to
complete assignments (performance skills).

A 15-year-old adolescent with mental retardation and extreme sensitivity to sounds
and touch (mental, emotional, sensory functions, and structure) that limits her speech
and social interactions (performance skills) may benefit from slow and rhythmical
exercise periods (activity demands) just before play and meals (social and cultural
context) to learn sign language to communicate with peers and family.

Incorporating the dimensions of educational relevance into assessment and intervention is a
critical yet complex aspect of school-based practice. OT practitioners analyze what a student
does to participate successfully in a school setting by assessing the combined influence of
individual characteristics, performance skills, performance patterns (i.e., routines, habits, and
roles), the educational context, and specific activity demands. OT intervention is directed toward
helping a student achieve the educational goals and objectives agreed upon by the entire team,
including family members (Giangreco, 1995). Therapists must assess the student's functions in
the school environment and describe how their intervention will improve
performance/participation in academic and nonacademic parts of the educational program (Hanft
& Place, 1996).

When OT services can support a student's ability to benefit from the educational program, OTs
choose a practice model or frame of reference to study the factors that are supporting or
interfering with the student's performance/participation in an educational setting. The nine most
commonly used pediatric practice models (see Appendix 1 for definitions) applicable to
educational settings are: developmental, sensory integration, neuro-developmental,
biomechanical, motor control, coping, occupational adaptation, behavioral, and cognitive (Dunn,
2000; Kramer & Hinojosa, 1999). The therapist must also choose an approach (e.g., to
establish/restore, adapt/modify, maintain, prevent, create, or promote) to specify how
intervention will promote functional performance (ability to participate) in school activities
(AOTA, 1999). An example of the establish/restore approach is guiding movement and postural
adjustments on playground equipment during recess for a child who is very unsteady and unsure
about the orientation of his or her body in space. A modify/adapt approach is analyzing the
environment to find a quiet spot with little traffic for a child who overreacts to sensory input.

Intervention by an OT may include working with children individually, co-leading small groups
in the classroom, consulting with a teacher about a specific student, providing inservice for
groups of educational personnel and/or family members, and serving on a curriculum or other
systems-level committee. Service delivery needs to be considered within the total school
environment (or home and community environments for Part C and transition). Rather than
choosing one model of service delivery, recommended practice emphasizes choosing from and
moving among a continuum of service models throughout the course of intervention as student
performance/participation improves (Case-Smith & Cable, 1996; Hanft & Place, 1996; AOTA,
1995).








SUPPLY AND DEMAND


Employment Characteristics

According to AOTA (2001b), the median age for OTs and OTAs in the U. S. is 39 and 40 years,
respectively. Approximately 69% of therapists work full time (30 hours or more), and 25% work
in two settings. Among those working in two settings, 10.5% work in schools. Three out of ten
therapists change jobs every 2 years. It is projected that the characteristics of the job of an OT
practitioner (e.g., workload, physical demands) may impact retention. Additionally, 18.2% of
the respondents are considering leaving the OT profession: 42.8% of these desire to work in a
different field; 15.2% plan to stop work temporarily, 11% plan to retire or stop working
permanently, and the rest were not accounted for. Within AOTA, about 94% of the OTs are
women and 6% men. The percentage of male OTAs is steadily decreasing from 8.2% in 1990 to
6.6% in 1997 and 4.1% in 2000. AOTA members are predominantly white (90%); the
distribution across ethnicities is shown in Table 3. The ratio of male therapists to female
therapists and the diversity percentages may be similar for OT personnel working in schools, but
there are no specific data available.


Table 3. AOTA Members (OT/OTA) by Ethnic Origin

Ethnic Origin OT OTA

No Information Available 5,072 1,024
African American 488 123
American Indian 41 7
Asian 1,052 55
Asian American 74 9
Hispanic/Latino/Latina 454 71
Multiracial 40 7
Other 228 23
White 21,409 2,652
Total 28,858 3,971
(AOTA, 2001b)



Projected Growth

According to the USDOE (2001), by 2010 the OT profession will experience a faster growth
than average for all occupations. Although OT employment growth was stunted in the late 1990s,
in certain practice settings due to imposed federal reimbursement limits for therapy services,
employment opportunities are projected to increase by 21%-35% for OTs and OTAs. Job
openings due to the growth of the profession (accounting for net replacements) are projected to
reach 46,000 by 2010. Three main population trends influence the outlook for employment:
increased number of middle-aged and elderly Americans, increased life expectancy, and the
expansion of the school-aged population and the population of students with disabilities who
require extended services (USBLS, 2001a).
1 1







AOTA recently reported the results of the 2000 Member Compensation Survey (2001a). About
25% of the 2,417 respondents (a 53.7% return) worked in schools, the largest primary work
setting. This represents a 7% growth in school-based practice since 1997. Approximately 68.8%
of the respondents work full time (30 hours or more per week), and 25% of respondents work in
two settings. Over 10% work part-time in schools, and 6.4% work in early intervention as a
secondary job (AOTA, 2001b).

Factors Influencing Supply and Demand

Shortages of school OT practitioners have been reported to Congress for many decades. In the
2000-2001 accounting, 12,915 OTs were employed in public schools of whom 12,727 were fully
certified (Ideadata.org, 2003). An additional 6,395 OTs were employed to serve infants and
toddlers with disabilities (Ideadata.org, 2003). Many contextual factors affect the supply of and
demand for OTs. As in special education in general, it is difficult to predict the exact shortages
and demands due to the ever-changing environment and the multiple ways data are collected on
state and national surveys (Boyer, 2000; Federal Resource Center for Special Education, 1999,
2000, 2001). Three critical factors may affect future supply and demand of OTs: trends in the
health care environment, trends in the educational environment, and trends in institutions of
higher education (IHE).

After the passage of the Balanced Budget Amendment of 1997, demand for OTs in medical
settings dropped. This increased the pool of OTs available for schools; school OTs increased
dramatically from 9,561 in 1998-1999 to 12,915 in 2000-2001; and the percentage fully certified
increased from 97% in 1998-1999 to 98.5% in 2000-2001. These employment trends are not
likely to prove enduring, however, and other changes are on the horizon. With Baby Boomers
aging, employment opportunities for OTs in medical and nursing facilities are likely to grow.
Furthermore, because OT training programs have had declining enrollments since 1997, fewer
new practitioners will enter the OT job market. In 2007, when master's degrees will be required
for entry to the profession, bachelors-level programs will be outmoded, and the supply of new
practitioners will be diminished further.

Salaries

According to the 2000 AOTA Compensation Survey, average income for full-time and part-time
OTs remained the same since 1997, while OTAs' average full-time income decreased slightly
and part-time income increased by 18.5% (AOTA, 2001b). Although incomes for OTs and OTAs
increased 33 to 41% during the 1990s, most of that growth occurred in the first 7 years of the
decade. There is concern that salary stagnation may lead to dissatisfaction in earning power and
the profession. According to AOTA (2001a), the overall median full time annual salary for OTs
in school settings was $42,000 (a median hourly salary of $23.08). USBLS (2001b) estimated
the median annual salary for therapists in elementary and secondary schools to be $45,320.
According to AOTA (2001a), OTAs who work in schools make a median annual salary of
$28,000 (a median hourly salary of $14.90). USBLS (2001c) estimated the median annual salary
for OTAs in general (not school-based specifically) at $34,340. Because of questions about the
economy and reimbursement procedures, future salary levels are unknown (Salsberg &
Martiniano, 2002).







Recruitment and Retention


A variety of strategies have been used to recruit OT practitioners to work in the public schools
and to retain them. States like Washington and Virginia have had specific programs through
their departments of education, although Washington's was discontinued in the fall of 2002 due
to budget cuts and the end of Virginia's CSPD/SIG grant. Table 4 provides examples of
educational strategies, incentives, and follow-up supports that have been mentioned in the
literature. Although recruitment activities (e.g., educational stipends in return for years of
service, continuing education support for school-based therapists, development of recruitment
materials for high school students, and support for recruitment at job fairs around the country)
are mentioned in the literature, no research that evaluated the success or effectiveness of these
activities could be identified.









Table 4. Possible Recruitment and Retention Strategies for OT Practitioners
Educational Strategies Incentives Everyday Supports

Partnerships with IHE and state DOE to Increased starting salaries: Professional mentorship local or long
allocate funds for educating therapists: Sign-on bonuses distance; formal or informal; within and
Tuition support Pay-back scholarships or loan- outside the OT profession:
Stipends for living forgiveness programs Family mentorship programs
Textbook financial support Community-based discounts (e.g., help Follow-up support: (e.g., telephone calls, email
with banking set up, moving expenses, contacts, buddy systems, consultation, or field visits)
Collaborative service learning in the community recreation membership etc)
Awareness and use of existing state resources
Mentorship prior to leaving the IHE Stipends for critical needs areas
Distance education/online courses with flexible scheduling Monies for additional traininghelp OT personnel
(e.g., a portion of a course, a course, or a sequence of be part of the team.
specialized courses) Free workshops and materials Interdisciplinary learning and service
Exposure to field through field trips, fieldwork experiences Salary pay incentives for Peer reviews
Interdisciplinary training additional training or coursework Journal clubs
Specialized training in school-based practice Specialized training (e.g., Yearly retreats or state conferences on
Provide professional development that assistive technology, state school-based practice
specifically links OT and educational conference, or different treatment Lending library
environments approaches)
environments appr ) Local special interest club
Provide professional development with all Co-research or program
stakeholders (e.g., educators and therapists development with IHEs Local support group
together) Encourage personal growth Online "chats" to share questions and
Transition to school practice training for information
therapists in other practice settings
Market the profession at job fairs, career
development, volunteer experiences
(Compiled from: Hanft & Anzalone, 2001; Peters & Shepherd, 1999; Salsberg, 2001; U. S. Dept. of Health & Human Services, 1999,2000,2001)









PREPARATION AND EDUCATION OF OTS

There are multiple entry routes into the OT profession. For most of the 20th century, the
baccalaureate degree was the entry-level degree. In the late 1960s and early 1970s, entry-level
masters degree programs were developed to offer professional preparation for individuals with
bachelors degrees in other fields. Such programs offered either a Master's of Occupational
Therapy (MOT) or a Master's of Science degree. By the mid-1980s, professional masters
programs were open to students without bachelor degrees who had completed 2 to 3 years of
undergraduate education. The ratio of masters entry level to bachelors entry-level programs
equalized in the mid-1990s. By January 2007, AOTA will require the masters degree as the
entry-level degree for all OTs.

Many universities also offer post-professional masters programs, which OTs with bachelors
degrees often seek; the status of these programs after 2007 is unknown. Finally, a few
universities now offer the Doctorate of Occupational Therapy-clinical degrees with different
curricula for individuals with/without an entry-level OT degree. Increasingly, some OTs,
particularly those who want to teach or complete research, have earned a doctoral degree (Ph.D.
or Ed.D.) in another field. Common fields include educational psychology, special education,
and anthropology.

All preservice educational programs for OTs or OTAs must meet Standards for Accreditation
established by the American Council on Occupational Therapy Education (ACOTE, 1999). Only
graduates of programs accredited by ACOTE may take the NBCOT professional examination,
the basis for entry into the profession in all states.

ACOTE Accreditation Standards indicate all the content that must be included in accredited OT
educational programs, allowing flexibility to reflect the mission and philosophy of individual
programs. An extensive review process that includes OTs and consumers is used to develop the
standards. Once the new Standards have been adopted, ongoing Standards review becomes the
responsibility of the ACOTE Standards and Ethics Committee, a standing committee of ACOTE.
This Committee is responsible for review of the feedback obtained through the Standards
Evaluation Forms and other evaluation instruments. Five years after new accreditation standards
are adopted, ACOTE will appoint members to serve on the ACOTE Educational Standards
Review Committee. Over a 4-year period, this Committee conducts a complete evaluation and
revision of the Standards.

All OT programs are evaluated every 5, 7, or 10 years, depending on whether it is an initial
accreditation or re-accreditation and the performance during the last review. The Standards
define what all entry-level practitioners must know to be able to work in any service setting. The
purpose of OT entry-level education is to provide students with a foundation for working in any
setting rather than to teach specific expertise in any given setting (e.g., schools). It has been
reported that it is not uncommon for OTs working in the schools to get an advanced degree (in
OT or a field related to school-based therapy) to support expertise development, but no empirical
data could be found to support this report. One Standard specifically mentions the educational
environment, and most OT educational programs include content related to school practice in
courses) related to pediatrics. OT programs can add additional course content not included in
the Standards. Some programs have received federal grants to add content related to educational
practice settings. Thus, a few programs have specific courses related to school and early
S15







intervention (Amundson, 1995; Brandenburg-Shasby & Trickery, 2001; Chandler, 1994, 2002;
Powell, 1994).

One study addressing preparation of OTs for school-based practice was found in the literature
(Brandenburg-Shasby & Trickery, 2001). This study included therapists with 1959-1999
graduations. Less than 50% of 1990-1999 graduates had completed any fieldwork in a school
setting as part of their preparation. They reported an average of 81 hours of pediatric content, and
19% reported that their curriculum had a separate school-based course. The authors concluded
that their results "suggest that a large percentage of entry-level therapists are accepting positions
in school-based practice with minimal to no time spent addressing this practice area in their
preservice education" (p. 1).

The Standards, which have little content specific to school-based practice, provide a knowledge
base that is a foundation for practice in educational settings. The Standards require course work
in anatomy, neurology, and lifespan human development with particular emphasis on
occupational development at each stage of life. Content on disease, disability (including
developmental disability), injury, aging, and environmental causes of dysfunction is included.
The OT process-that parallels determining eligibility and identifying need for specially
designed instruction in the schools-is a major component of the preservice curriculum. Course
work on the major approaches to intervention, such as assistive technology, addresses all age
levels and a variety of occupational dysfunctions. Systems of service provision (e.g., working as
a team, transitioning between settings, community linkages, and advocacy) and funding of
services are included. Finally, the Standards emphasize clinical reasoning and problem solving in
most OT curricula. Based on the Standards, entry-level OTs should have a strong foundational
knowledge that supports practice in school-based settings. The Standards also bring a needed
perspective to student performance/participation in the schools.

The Standards require internship or practicum experiences at two levels. Referred to as field-
work in the Standards and in the profession, these supervised experiences teach the student to
apply didactic information in an actual setting with clients. Level I Fieldwork experiences occur
in a variety of ways while students are engaged in course work, often once a week or one week
per semester, often in public schools (Chandler, 1995). The experiences are tied to the course
work of that semester, either as part of the course or as a separate course that complements other
courses. Faculty, practicing OTs, and other professionals may serve Level I Fieldwork
supervisors. During Level I Fieldwork experiences, client contact is carefully monitored with
observation and self-reflection of observations as predominant Level I experiences.

Level II Fieldwork, which moves the student into an entry-level practice role in several different
practice settings, consists of a minimum of 24 weeks (6 months) of full-time work under the
supervision of an OT. Practice settings for fieldwork are not specifically delineated in the
Standards. Many OT educational programs have used a traditional Level II Fieldwork model of
placing students in one setting with clients with physical disabilities and in another setting with
clients with psychosocial diagnoses. More recently, programs have started to use a medical
model/social model dichotomy for determining fieldwork sites. Others have used an
institutional/community dichotomy. In the past, some IHEs were hesitant to use schools as a
primary Level II Fieldwork site, but this restriction is rapidly disappearing. Pediatric sites,
including schools and early intervention settings, are now clearly used as core Level I and Level
II Fieldwork placements (Amundson, 1994; AOTA, 1993; Swinth, 2002). For example, a student
may observe and participate in a preschool special education class once a week for a semester as

1 /_








Level I Fieldwork and complete a three-month Level II Fieldwork experience in a public school
under the supervision of an OT (who may be providing services in multiple schools).

Despite the current interest in school-based practice, there is no agreement within the field that
this is an entry-level position. Although some practitioners (Swinth, 2002) view school-based
practice as an advanced or specialized practice area, the reality is that many OT practitioners
enter school-based practice as their first position after graduation. Figure 1 summarizes the
process of becoming an OT.


Figure 1. Flow Chart of Preparation To Become an OT


Completion of two or more years of undergraduate prerequisite course work
(By 2007 this will be an undergraduate degree)

Acceptance to an accredited program in OT

Successful completion of didactic course work and Level I Fieldwork

Successful completion of six months of Level II Fieldwork

Graduation from an accredited program in OT

Passage of the National Board for Certification in Occupational
Therapy Registration Examination

Application for practice within a specific state

Granting of license (or state-specified credential) to practice in that state









CERTIFICATION AND LICENSURE

Graduates from an accredited OT educational program are eligible to take the NBCOT
registration examination. OTs who pass this exam may use the OTR credentials. Certification by
NBCOT, a private organization, and state regulation of practice both exist to protect the
consumer of OT services. Generally, state regulation requires that practitioners be initially
certified by NBCOT to qualify for a license, but only two states require therapists to renew
NBCOT certification to maintain state licensure. Only state regulation of practice carries the
force of law. NBCOT, which owns the R that some OTs use and C for OTAs, can revoke
certification (i.e., use of the R or C). In addition, NBCOT can impose other sanctions for
unprofessional acts, which may eventually lead to the loss of a state permission to practice. OT
practice is regulated in all 50 states, the District of Columbia, Guam, and Puerto Rico. Each state
or jurisdiction details the specific requirements that OTs and OTAs must fulfill before they can
practice OT. States vary in the type of regulation provided (e.g., licensure, mandatory state
certification or registration, voluntary state certification or registration, title control or trademark)
and who is covered by the regulation-OTs only; OTs and OTAs; or OTs, OTAs, and OT aides).
See Table 5 for a definition of the types of regulations for OT practitioners.

States also vary in the provision of temporary or provisional credentials in OT. Table 6 lists
jurisdictions' OT regulations. Although most jurisdictions (48) regulate OTAs, three states
(Virginia, Hawaii, Colorado) do not. New York certifies OTAs through the New York
Department of Education (see Appendix 2). The state regulation and its credential (license,
trademark, certification, registration) grants the OT practitioner permission to practice in that
jurisdiction. After the OT student passes the NBCOT certification examination and meets all
requirements for a state credential, he or she can use the appropriate title as granted by the
credentialing agency. States authorize OTs to use one of these credentials, including OTR/L, OT,
and OT/L. Similarly, states may authorize OTAs to use OTA, OTA/L, or other similar
designations.

States' OT practice acts are consistent with AOTA's Standards of Practice (AOTA, 1998) and
define the legal scope of practice for OT practitioners within that state. These laws set
professional parameters and address topics (e.g., scope of practice, continuing competence,
supervision, unprofessional conduct, and licensure requirements). States differ in scope of
practice and other details; thus, OT practitioners must be familiar with their state requirements.
Responsibility for oversight and enforcement of the OT practice act rests with the appropriate
state regulatory agency in each state. These agencies, which are known by different names (e.g.,
Department of Professional Regulation, Board of Medicine, the Department of Consumer
Affairs), may have responsibility for other professions in addition to OT.

Renewal

Most states require OT practitioners to renew state credentials periodically. Each state defines
the criteria an OT practitioner must meet for renewal. One common requirement is the need to
document continuing education or professional development in the relevant area of practice.
Appendix 3 lists the continuing education and professional development activities that have
been available to school-based OTs over the past 15 years.


l0










Table 5. Definitions of Types of Regulation for OT

Type of Regulation Description Requirements for Practice* Oversight Agency

Licensure/Practice Act Provides highest level of public protection by prohibiting Mandates entry-level State Health Department delegates authority to
unlicensed individuals from practicing OT or referring to competence. an occupational therapy board or advisory
themselves as OTs/OTAs. Licensure laws reserve a certain board, consisting of occupational therapy
scope of practice for those who are issued a license, practitioners, consumers and/or other health
professionals
Mandatory Certification* Protects the public by prohibiting non-certified individuals from Mandates entry-level Government agency maintains registry of
[Certification as granted by referring to themselves as occupational competency. individuals who successfully complete eligibility
the OT regulatory board or therapists/occupational therapy assistants. Unlike licensure, requirements.
advisory board/council. To individuals under certain circumstances can practice if they do
be distinguished from not refer to their services as occupational therapy.
certification granted to Certification laws may provide for definition of occupational
individuals passing the therapy.
National Board for
Certification in Occupational
Therapy (NBCOT) exam.]
Protects the public by prohibiting non-registered individuals Competency standards may Government agency maintains registry of
from referring to themselves as occupational be required by the individuals who successfully complete eligibility
therapists/occupational therapy assistants, although they can government agency requirements.
practice if they do not refer to their services as occupational maintaining the register.
therapy. Registration laws may provide for definition of
occupational therapy.
Mandatory Registration* Voluntary certification or registration does not protect either There are usually no state Other than the state's constitutional authority to
the title or the practice. The state does not have the legal requirements for practice. govern health, safety and welfare, there are
authority to prohibit a non-certified or non-registered person However, the practitioner's usually no express requirements for the
from practicing occupational therapy unless that person has professional association governance of the profession.
violated certain standards of care. may advise on entry-level
competency. Practitioners
are subject to the entry-level
competency requirements
for reimbursement by third-
party insurers, private
insurers, and Medicare.
Voluntary Certification or Prohibits individuals who have not met specific education and Mandates entry-level Government agency maintains registry of
Registration entry-level examination requirements from referring to competency. individuals who successfully complete
themselves as occupational therapists/occupational therapy eligibility requirements.
assistants, although they can practice under certain
circumstances, if they do not refer to their services as
_____occupational therapy.
* The terms registration and certification are often used interchangeably. Therefore, it is important to understand the provisions and protections of each type of
regulation, rather than assuming certain provisions are automatically included. (AOTA State Policy Department, 8/99)









Table 6. Jurisdictions Regulating OTs
Year States Year States
1990 Alabama 1984 North Carolina
1987 Alaska\ 1983 North Dakota
1989 Arizona 1976 Ohio
1977 Arkansas 1984 Oklahoma
2000 California 1977 Oregon
1978 Connecticut 1982 Pennsylvania
1985 Delaware 1968 Puerto Rico
1978 District of Columbia 1984 Rhode Island
1975 Florida 1977 South Carolina
1976 Georgia 1986 South Dakota
1998 Guam 1983 Tennessee
1987 Idaho 1983 Texas
1983 Illinois 1977 Utah
1980 Iowa 1998 Virginia
1986 Kentucky 1984 Washington
1979 Louisiana 1978 West Virginia
1984 Maine 2000 Wisconsin
1977 Maryland 1991 Wyoming
1983 Massachusetts States with Registration Law:
2000 Minnesota 1998 Hawaii
1988 Mississippi 1986 Kansas
1997 Missouri 1988 Michigan
1985 Montana States with Certification Law:
1984 Nebraska 1989 Indiana
1991 Nevada 1993 Vermont
1977 New Hampshire States with Trademark Law:
1993 New Jersey 1996 Colorado
1983 New Mexico
1975 New York


44 states with
licensure laws
for OTs

47 jurisdictions
with licensure
laws for OTs

3 states with
registration laws
for OTs

2 states with
certification laws
for OTs

1 state with
trademark laws
for OTs

Total: 54
Jurisdictions
regulate OTs
(AOTA State
Affairs Group,
March 2002)


Additional Credentials for Practice in Education or Early Intervention
Settings


Some states have also established additional requirements for OT practitioners to work in
schools or early intervention programs. These varying requirements may include education-
related classes, an education credential, or early intervention certification requirements.
Individual practitioners must obtain the relevant state OT credential before they fulfill any
additional requirements to provide services in schools or early intervention programs.


Competencies


Several states, some authors, and one research study have defined competencies for OTs working
in educational settings (Brandenburg-Shasby & Trickery, 2001; Golubock & Chandler, 1998; M.
Mulenhaupt, personal communication, 2002). Additionally, some organizations, such as The
Association for Persons with Severe Handicaps (TASH), have statements on competencies for
related services providers, including OTs, in the schools (The Association for Persons with
Severe Handicaps [TASH], 1999). There is little variation among these sources, indicating a
common view of school-based competencies for OTs. However, no research establishes: (1) the
relationship of these competencies to actual practice and (2) that a school therapist with these








Table 7. Competencies for OTs in School-Based Practice
1. Knowledge of current laws, regulations, and procedures related to the education of children with special
needs.
2. Knowledge of the educational system and its critical components (mission, organization, codes, funding,
eligibility process).
3. Knowledge of disabling conditions and their effects on sensory, motor, psychosocial, and cognitive
development and function.
4. Knowledge of major theories, treatment procedures, and research relevant to providing occupational
therapy services for children with special needs.
5. Ability to select and administer appropriate assessment instruments and procedures taking into account
age, developmental level, disabling condition, and educational placement.
6. Ability to assess functional performance of students with special needs within the school environment.
7. Ability to engage in consensual decision making as part of the IEP process.
8. Ability to interpret assessment results appropriately and use results to develop an intervention plan
relevant to the educational environment.
9. Ability to plan, implement, and modify intervention strategies using a continuum of intervention
approaches.
10. Ability to communicate effectively (orally and in writing) with education personnel, administrators,
parents, students, and community members.
11. Ability to explain the role of occupational therapy within the school settings to education personnel,
parents, students, and community members.
12. Ability to document assessment and intervention results in the proper manner for a school setting and
relate this information to the educational goals of the student.
13. Ability to schedule, to implement, to evaluate, and to modify service provision to meet the therapeutic as
well as educational needs of a full student load in the school environment.
14. Ability to facilitate transitions among agencies, programs, and professionals in service provision changes
(early intervention to preschool, preschool to elementary, elementary to middle and high, high school to
work and/or adult services or independent living.
15. Ability to supervise occupational therapy assistants and fieldwork students as appropriate.
[Golubock & Chandler, 1998]
Note: These are the over-arching competencies; complete document includes 128 additional
competencies that further delineate the fifteen overarching competencies.

competencies is a competent school therapist. Competencies for school-based OTs are presented
in Table 7.

AOTA and NBCOT also have developed competency programs for OT practitioners, which can
be used by the individual practitioner to evaluate his or her own performance. However, there
has been no research to establish effectiveness of these tools for competency development and
performance.

Specialty Certification

Inherent in OT credentialing is the notion of practitioner competence, both for entry into the
profession and for ongoing/advanced practice. Both NBCOT and AOTA expect OT
practitioners to maintain and update their competence throughout their careers (AOTA, 1998;
NBCOT, 2000). Several options exist for experienced OT practitioners to demonstrate advanced
competency. For OTs, these include advanced training and/or specialty certification in neuro-
developmental treatment, sensory integration, pediatrics, and many other clinical approaches.
Qualified OTAs may be able to participate in the AOTA Advanced Practice program. (In June
2002, a moratorium was placed on the BCP and AOTA Advanced Practice certifications while
data are collected regarding its utility to the practitioner, the consumer, and the profession). The
purpose of these certifications is to improve clinical expertise. They are not specific to school-
based practice (see Appendix 5 for details about different certifications).









AOTA has established Standards of Practice through its Representative Assembly of
representatives from each state. These Standards of Practice delineate ethical and practical
procedures and processes for responding to referrals, evaluation, and determination of need for
therapy, treatment intervention, and discharge from services. Designed to be applicable for all
practice settings, the Practice Standards provide a framework for providing OT services. In
addition, the Code of Ethics, which must be taught in all OT educational programs, provides
guidance for decision making through the commitment to core values of beneficence, veracity,
and justice. The language in most state regulatory laws also provides parameters for legal and
ethical practice. Most state regulatory laws vest the decision making about initiation, type, and
discontinuation of OT services with the OT professional. The OT's decision may be different
from the decision of the Individualized Educational Program (IEP) team in the school setting,
placing the OT in an ethical dilemma of being required to provide services to a child who in his
or her judgment does not need the services. Providing unneeded services is a violation of most
state regulatory laws, and this is not an infrequent occurrence for OT practitioners. It has been
reported that conflicts like this cause therapists to leave the school-based setting; however,
empirical data to support this could not be found in the literature.









SUMMARY

OT personnel issues, particularly for practitioners working in educational settings, are complex
and often convoluted. There are data addressing the role and work force issues of OTs, OTAs,
and OT in general. However, data specific to OT in the schools are limited, and there is more
opinion than research in the literature. There appears to be a decrease in published research
regarding school-based practice over the past 8-10 years. Available research addresses
intervention strategies and issues rather than personnel issues. Currently, a 2-year national study
is being conducted to help define issues and trends in school-based OT (Swinth, 2002). This
study is partially funded by AOTA and utilizes both quantitative and qualitative methodologies.
Data collection should be completed by the spring of 2003. These data may help provide
empirical support for some of the current beliefs about personnel issues in educational settings.

Supply and Demand

Given the information reviewed and the limitations of the empirical data, this section
summarizes the critical unanswered questions and research needs related to the OT personnel
issues addressed. National data predict a shortage of OTs within the next 5 years. Data regarding
supply and demand in educational settings are confusing: some sources indicate a shortage and
other sources do not. The critical unanswered questions and research needs are:

1. Are all students who need OT in the schools receiving it?

2. What are the "real" vacancies for OT practitioners in the schools? A national data
collection tool with a standardized means for collecting and analyzing data is needed
to understand the true supply and demand issues in OT.

3. Are there data on the reasons therapists go into school-based practice and why they
stay or leave? (Any student research/graduate projects housed at university programs
that begin to address some of these questions should be accessed and analyzed).

4. What factors support the retention of OTs working in the public schools?
a. Is attrition a problem?
b. Do OTs working in the schools leave the field completely?
c. Is there movement from the schools to other positions?

5. Are there evidence-based, comprehensive recruitment and retention strategies used in
other professions that could be applied to OT?
a. How do these strategies work on local, regional, state, and national levels?
b. Could an interdisciplinary program be used to recruit and later support OT
practitioners?
c. Would building on-line mentorship opportunities help with recruitment and
retention?









6. The number of OT graduates was smaller over the last 2 years because of changes in
health care reform and the economy. How will this impact the viability of institutions
of higher education (IHE) OT programs and the shortage of OTs in the schools?

7. What are effective recruitment and retention strategies for OTs entering the
profession and the schools as a work place?

8. Is recruitment of OT practitioners from culturally and linguistically diverse groups a
problem?

9. What can local education agencies (LEAs) do to support the recruitment and retention
of OTs in educational settings?

Preparation and Education of OTs

OT practitioners receive an education that prepares them to work in any practice setting, but they
may not receive all the information needed to be successful in educational settings as part of their
preservice education. Competencies and continuing education strategies for school-based
therapists are identified in the literature, but many lack a research basis. The critical unanswered
questions and research needs are:

1. What are the general competencies needed for entry-level therapists who desire to
work in school-based settings? Can school-based therapy be considered an entry-
level or an advanced position?

2. What are the practice-setting preferences of students before course work? After
course work?

3. Does a preservice internship (e.g., Fieldwork II) in school-based settings help entry-
level therapists better prepare for working there?

4. Do training partnerships with IHEs and departments of education lead to better
prepared practitioners and better OT services?

5. How are minority students being recruited into the OT field, especially given the
recent change to entry-level masters programs?

6. What type of interdisciplinary training is occurring to help related service and
education students and faculty understand their unique roles within the education
environment?

7. Do faculty at schools that train teachers understand the unique role of OT in the
schools?









8. What kind of inservices or supports (e.g., mentorship, tuition reimbursement) are
available to OT personnel from the state departments of education and the LEAs to
recruit therapists into school-based settings?

9. Do OT services improve student outcomes in the general education curriculum?


Certification and Licensure

Most therapy practitioners have a certification or license to work in their state. However, these
are not specific to educational settings. A few states have specialty certification to work in the
schools, but we found no evidence that these certifications made any difference in job
performance. The critical unanswered questions and research needs are:

1. Do any special certifications support the services OTs provide in the schools?

2. What types of continuing education courses/content best support the role of OTs in
the schools?

3. How do OTs in the schools prefer to receive continuing education?

4. Does specialty certification to work in the schools (e.g., WA state model) result in
better services for children and youth under IDEA? Do OTs and other professionals
value this type of certification? How does it affect vacancies or competency?

5. How do IHEs with OT programs interface with state departments of education to
collaborate on preservice and inservice training?

6. Does continuing education lead to better services in the schools?











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Appendix A. Definitions of the Nine Most Commonly Used Pediatric Practice Models

Practice Model Definition
Developmental Based upon an understanding of normal development that recognizes the sequential nature of
development. Also recognizes that there are basic foundations from which skills develop.

Sensory Integration Used when a student has sensory processing difficulties. This model is based on the understanding that
the organization of sensory information in the brain may help children develop adaptive responses to
successfully meet environmental challenges.
Neurodevelopmental A sensorimotor approach in which techniques are applied to help facilitate normal developmental patterns.
Interventions are designed to help enhance the quality of movement and motor performance within the
environment.
Biomechanical The biomechanical approach is used when a person has neuromuscular or musculoskeletal dysfunction
and cannot maintain appropriate muscle activity or posture. Adaptive equipment is used to help
compensate for the lack of function so that students can perform functional skills as efficiently as possible.
Motor Control This model emphasizes the therapeutic use of functional tasks as well as provision of feedback to the
learner in order to support the development of motor skills needed to participate in daily life activities.

Coping This model is based on a cognitive behavioral model. Through the development and utilization of coping
resources, the student is able to deal with current challenges as well as develop a repertoire of skills
needed to address future challenges.
Occupational Adaptation This model goes back to the roots of occupational therapy and recognizes that the primary role of
occupational therapists in all settings is to enable occupations.

Behavioral This model focuses on the acquisition/learning of specific skills in all areas of development.


Cognitive This model uses cognitive theory in order to support the development of functional skills within the
student's environment.


(From Kramer & Hinojosa, 1999)









Appendix B. Jurisdictions Regulating OTAs


Year States
1990 Alabama
1987 Alaska
1989 Arizona
1977 Arkansas
1978 Connecticut
1985 Delaware
1978 District of Columbia
1975 Florida
1976 Georgia
1998 Guam
1987 Idaho
1983 Illinois
1980 Iowa
1986 Kentucky
1979 Louisiana
1984 Maine
1977 Maryland
1983 Massachusetts
2000 Minnesota
1988 Mississippi
1997 Missouri
1985 Montana
1984 Nebraska
1991 Nevada
1977 New Hampshire
1993 New Jersey
1983 New Mexico
1984 North Carolina
1983 North Dakota
1976 Ohio
1984 Oklahoma
1977 Oregon
1982 Pennsylvania
1968 Puerto Rico
1997 Rhode Island
1977 South Carolina
1986 South Dakota
1983 Tennessee
1983 Texas
1977 Utah
1984 Washington
1978 West Virginia
2000 Wisconsin
1991 Wyoming
States with Registration Law
1986 Kansas
1988 Michigan
States with Certification Law
1989 Indiana
1993 Vermont
States with Trademark Law
1977 California
States Which Do Not Regulate OTAs
Colorado
Hawaii
Virginia
New York


41 states license OTAs

43 jurisdictions license OTAs

2 states register OTAs

2 states certify OTAs

1 state has a trademark law for OTAs

Total: 48 Jurisdictions Regulate OTAs

3 states regulate OTs and do not regulate OTAs:
Colorado, Hawaii and Virginia

1 state licenses OTs and does not license OTAs: New York (OTAs are
certified by the New York State Department of Education.)

(AOTA State Policy Department, May 2000)










Appendix C. Projects Supporting the Continuing Competencies of School-Based
Practitioners


Project Description

Occupational Therapy The direct result of a federal grant. TOTEMS trained 200 OTs in five states in its
Educational Management in pilot development and thousands more in its implementation phase. The focus of
Schools (TOTEMS) 1980 TOTEMS was the transfer of clinical practice knowledge into an educational
environment. TOTEMS was also used as a resource by some preservice curricula.
Related Services in the Nine lessons that provide a basic history and overview of school-based practice.
Schools, 1991 (AOTA self- Covers topics such as documentation, meeting student needs, writing functional
study course) goals, consultation, and case management
Classroom Applications for Lessons provide practical suggestions for implementing OT services into school-
School Based Practice, 1992 based settings.
(AOTA self-study course)
Occupational Therapy: Eleven units that provide new strategies to help children succeed in the least
Making a Difference in restrictive environment. Increased emphasis on collaboration, functional outcomes,
School System Practice, systems change, and program evaluation as well as practical therapy techniques.
1998 (AOTA self-study Although these study courses are directed to the practicing individual, they have
course been used in seminars on school-based practice in some preservice and graduate
curriculums.
Guidelines for Occupational A document that focused on the educational system and systems of service
Therapy Services in School provision. Guidelines included chapters on job descriptions, caseload determination,
Systems 1987, Second Ed. performance evaluation forms, basic competencies, prioritization of services etc.
1989 The second edition in 1989 updated the information and added a sampling of
important issues (state regulation of practice, liability, payment for services in the
schools, fieldwork, drivers' education, mentoring) being raised at the time by
educational agencies and school-based practitioners.
Occupational Therapy Updated and expanded information from the Guidelines books. A second edition in
Services for Children and 1999 informed therapists of the changes in the 1997 reauthorization of IDEA.
Youth Under the Individuals
with Disabilities Education
Act, 1998
School Systems Special The largest special interest section in the American Occupational Therapy
Interest Section (SSSIS) Association, the School System SIS publishes a quarterly newsletter and maintains
a listserv with an average of over 50 messages a day. These messages cover a
wide range of topics, but primarily provide clinical information.
Promoting Partnerships This initiative grew out of the awareness of the need to build linkages with
Project (1993-97) permanent entities within the educational community, particularly at the state and
local levels. Teams (OT practitioner, state administrator, university personnel) from
nearly every state in the union were trained in the implementation of IDEA. These
teams then conducted educational activities in their own states.
ASPIIRE project This federally sponsored project brings clinical and systemic information together to
enhance the practice capabilities of those OTs working in the schools. The concept
of state contacts and state teams is utilized in the activities of this project as well.









Appendix D. Specialty Certifications/Training Available to OTs Working in
Educational Settings

Type of Description
Certification/Training



Neurodevelopmental Treatment A specialized therapeutic intervention approach developed by Dr. Karl and Bertha
(NDT) Bobath in the 1940s from their work with children with cerebral palsy optimizes the
function of individuals with neurological impairments. Training is provided by the
Neuro-Developmental Treatment Association (NDTA) and consists of the basic 8-
week course on children with CP (training is also available for therapists working
with adults). Beyond the basic course, therapists may take additional pediatric-
related advanced courses in various topics such as gait, hand function/fine motor
control, and handling and problem solving. (NDTA website 10/19/01,
www.ndta.org)


Sensory Integration (SI) The process of "assimilation, organization, and use of sensory information to allow
an individual to interact effectively with the environment in daily activities at home,
school and in other settings" (AOTA, 1997). It is an OT practice model developed
by OT A. Jean Ayres in the 1950s and 1960s (Dunn, 2000). Dr. Ayres' work also
led to the development and publication of the Southern California Sensory
Integration Tests (SCSIT) in the early 1970s. The SCSIT later evolved into (and
replaced) the Sensory Integration and Praxis Test (SIPT) in the 1980s. It is with
respect to these standardized assessments that the term "SI certification" applies.
SI certification currently refers to individuals who have been trained in and are
competent in the administration and interpretation of the SIPT; the proper term is
"SIPT certification." (AOTA, 1997). (Sensory Integration International website at
www.sensoryint.com; Western Psychological Services website at
www.sipt@wpspublish.com/wpsfl 3b.htm)


AOTA Specialty Certification The AOTA Specialty Certification program allows experienced OTs to have
Program in Pediatrics expertise and specialized knowledge in three specific practice areas, including
pediatrics, validated through an application and examination process. Successful
candidates for this voluntary program are awarded appropriate credential that is
recognized as part of their overall professional credential that indicates they have
met predetermined standards and criteria in the designated area. The designation
for persons successfully completing the pediatric specialty certification program is
BCP, which stands for Board Certified in Pediatrics. (AOTA website at
www.aota.org/nonmembers/area3) Note: As of June 2002, a moratorium has
been placed on this certification while data are collected regarding its utility to the
practitioner, the consumer and the profession.


The AOTA OTA Advanced Recognizes those OTAs who have achieved advanced levels of practice in a
Practice program particular area or field, which includes pediatrics or school system practice. The
successful candidate is awarded the designation AP to indicate they have
completed the program and meet the specific standards and criteria. (AOTA
website at www.aota.org/nonmembers/area3) Note: As of June 2002, a
moratorium has been placed on this certification while data are collected
regarding its utility to the practitioner, the consumer and the profession.


Post-Graduate Certificates Several programs around the nation have advanced degrees or post-graduate
Programs/Advanced Degrees certificates that support therapists who want to work in schools. Often these
Specializing in School-Based programs are grant funded and thus do not have extended tenures at any one
Practice university.




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