2014-15 Dev of School Based OT and PT Best Practice Professional Development Unit

1. Terri Sadecki, PT OT/PT Department 2014-15Dev of School Based OT and PT Best PracticeProfessional Development Unit

2. During the course of this PDU, what three instructional strategies did I implement? What strategy worked best? During this PDU I have learned several strategies that have been determined to be best practices for our OT/ PT department • How to define PT educational model versus medical model: There are times during the school year that teachers and parents ask me what this difference is and why doesn’t their student/child qualify for PT in schools. With the research based material and information shared during this PDU, I now have forms that explain this difference. As a school-based PT, I also have more knowledge with the differences. • Data Collection: Each therapist is required to write a therapy note after every therapy session and this should contain data on the skills the therapist is working on with the student. In the past, my note would include objective information regarding the therapy session and how student responded. After this PDU, I am also addressing the overall goal and explaining how my session activities were relevant to goal and objectives. I also include data information for the activities, such as # of trials successful or improved. • Research based practices and evaluations: Prior to this PDU, I had been using techniques and evaluations I was familiar with through my education, training by other therapists and further continuing education with my students. After this PDU, I learned what techniques/evaluations have evidence based research behind them and learned how to reference these research based articles on the web.

3. How did I apply the PDU strategies in my classroom/practice? (examples) Who did I collaborate with during the PDU? Discuss the ways you collaborated while implementing the PDU strategies. • I was able to apply this strategy of better understanding the PT educational versus medical model easily during my practice working with students, parents and teachers. I was asked this difference several times during the school year and after this PDU, was able to educate them better by having handouts, along with better knowledge and understanding myself. For example, I was able to answer their questions and feel confident of their understanding. I also collaborated with peers during this PDU with research on the information monthly. We also collaborated by putting up our research on OneNote to share. • I was able to apply the strategy of data collection more easily after I had attended this PDU and searched for research based articles and narrative accounts on the web. Also, we collaborated as a group on all of our research findings to allow an expansive guide for all OT/PT therapists to use. This collaboration allowed me to document my therapy sessions with more objectivity and data collection related to overall goal and objectives. For example, this practice allowed me to measure the student progress with more precision and accuracy, along with using progress monitoring. • With research based practices and evaluations, it was easy to apply to my PT practice with students on my caseload. During this PDU, we had each researched evidence based PT practices and assessments that were documented through medical research sites, such as APTA (America PT Association). We collaborated with each other through OneNote, which allowed us to a larger knowledge base. I was able to continue PT therapy sessions using these, such as strengthening protocol with students diagnosed with CP.

4. What did I learn to do differently as a result of the PDU and strategy implementation in my classroom or practice? This PDU helped me to change my therapy practice with students on my caseload having gross motor concerns: • Assisted me with better defining the PT educational versus medical model to parents, teachers and staff when asked why the student/child didn’t qualify for PT services. • Assisted me to determine which students would BEST benefit from OT services, PT services and a combination of both services. Each student is evaluated individually and this PDU helped us define the roles of PT and OT’s better within DPS. • Assisted me with better understanding progress monitoring and data collection, along with how as a PT I can better utilize them to demonstrate progress with my students. • Assisted me with better knowledge of evidence based practices and assessments at my disposal through research on the web. • Also, assisted me with learning how to access this research online using medical search websites.

5. Why is this PDU action research process important to my students learning and to my growth as a professional? There are several reasons why this PDU research process is important to my student’s learning and my own professional growth: • Allows me to better understand my role as a PT in the educational setting • Allows me to better understand which students PT would most benefit working with and how the OT/PT roles can be defined better for students’ benefit, using the CDE’s recent publication • Allows me to better understand progress monitoring and data collection methods which allow me to calculate student progress more precisely when address their goals and objectives • Allows me to create more functional goals and objectives that relate more specifically to each student, along with their gross motor and functional mobility concerns. • Allows me to utilize more research based therapy strategies and assessments that have been proven to facilitate progress during their research • Allows me to understand how to find more research base studies and locate them online, that are relevant to my therapy strategies with students on my current caseload. • Allows me to have access to this wealth of knowledge the PDU participants have gathered and can utilize on our OneNote site.

6. PDU Data AnalysisReflecting on the data you have collected, how did this experience impact instruction, progress monitoring, student performance, and your own practice? This experience has impacted my therapy strategies, progress monitoring, student performance and how I qualify/exit students for PT related services. • My therapeutic strategies have changed to more research based strategies, along with emphasizing more functional mobility within the students’ learning environment (not just classroom). Example- having a student who uses a wheelchair for longer mobility distances use his walker for more functional tasks, such as walking to lunch and sitting on bench with peers rather than in wheelchair at end of the table. • My progress monitoring and data collection techniques have changed the most dramatically, along with my daily therapy notes. These changes have allowed my to demonstrate better progress with my students, along with allowing my notes to include data collection, assessment on progress, changes I would like to see and plans for future therapy sessions. • Using research based techniques and assessments has been seen as a positive thing for my students performance. These techniques have been researched to show changes and improvements which will allow my students to really benefit from my treatment changes. • My qualifying/ exit criteria has changed to align better with the PT educational model and roles of PT within DPS. This can only benefit the students’ attending DPS and receiving PT services with an IEP.

7. How will I apply my new learning in the future to further my practice? What are my next steps? Applying my new learning to further my PT practice within DPS is similar to my Data Analysis since I have been making changes with my practice throughout his while PDU. • I will continue to research online evidence based research that includes therapy strategies and techniques I have been using or new techniques I want to try. There are several medical data bases online that allow me access to thousands of research studies. • I will continue to refine my skills of progress monitoring and data collection that apply to my overall PT goal and objectives. This will allow me to better measure my students progress at whatever level that may be. • I will also continue to work on writing my goals and objectives to facilitate improved functional mobility by following the PT educational model and role of PT (in reference to CDE’s publication) • My future strategies with PT students will include shifting therapy to address PE common core standards and supporting students more in their regular education setting.

8. PDU Artifact #1 This artifact is based on the document I share with teachers, parents and staff explaining differences of school-based PT and medical based PT. It helps me explain the differences and why a student may or may not qualify for school-based PT. I am showing only part of this form due to space . If you want to see more, please feel free to contact me. http://blog.easystand.com/2011/04/clinic-based-versus-school-based-physical-therapy-and-occupational-therapy/ Website used in this PDU for resource. • A child with motor impairment may benefit from skilled Physical Therapy intervention. The way the need for services is determined and how the services are delivered vary based on whether services are delivered in a medical or educational setting. • Who Qualifies?In the medical or clinical setting a child receives therapeutic intervention based on some combination of physician recommendation, medical diagnosis that tends to have an accompanying motor impairment, and a therapist’s identification of deficits or delays via evaluation. Some insurance companies require a child to score well below what could be considered an average range of motor ability to be eligible for ongoing medical based therapy. • In the school setting, Physical Therapy is a “related services”, deemed necessary when they are required to assist a child with a disability to benefit from special education. It is only appropriate to provide PT to children who qualify for special education services. In order to receive services in a school setting, a child must have unique needs that the team agrees can only be addressed with the particular knowledge and skill the PT provider can contribute. These needs are agreed upon by the family and educational team and are reflected in the goals and adaptations on the child’sIndividual Education Plan (IEP). • How Is Service Provided?A child is treated in a clinic in an individual or small group session with the therapist. Intervention can be focused on the areas of need identified in the evaluation. Time is set aside periodically to discuss progress with parents or caregivers and make recommendations for home activities to build upon the gains made in therapy. • School-based PT service must relate directly to the child’s ability to participate in special education and access a free and appropriate public education. The therapist may see the child directly to focus on a skill in an area with fewer distractions. The therapist may see the child as the child participates in the routine activities of the school day. Examples are working on gait and balance skills 1-1 in hallway, working on motor skills in physical education, or working on mobility when all the children are moving from one location to another. The therapist’s role may be direct or consultative. This may include teaching classroom staff about sensory strategies, transfers, body mechanics, positioning, or use of adaptive equipment to maximize a student’s success.

9. PDU Artifact #2 • Physical Therapy Definition • Physical therapy in the school setting is services provided by a physical therapist per IDEA.  School based therapy is built on the principle of preserving, developing and promoting independent motor function.  Physical therapy is not a stand alone service and is intended to help students to benefit from and gain access to specialized instruction in the least restrictive environment.  Physical therapists support the student through interventions, strategies and adaptations that focus on promoting functional mobility, positioning, and safe and efficient participation in daily activities and routines. • (From CDE: Physical therapists work collaboratively with a student’s IEP team to improve student access and participation in school and community settings. Physical therapists provide professional expertise in the areas of self-help skills, foundational gross motor skills, mobility skills (transfers, walking, and equipment use), posture and positioning, and recreational skills for age-appropriate play. Physical therapy interventions promote skill acquisition and environmental adaptation and are commonly embedded within the context of student activities and routines.) • Physical Therapist Role Delineation:  Physical Therapist provide.... • Educational Training • training families caregivers and school staff to meet student's educational needs • staff training in transfers and safe lifting techniques • Musculo-skeletal Development/Posture • Adaptive Equipment Needs • Functional Mobility • Components of Movement and Functional Motor Skills • Environmental Adaptations ** This artifact is what our PDU participants came up with for DPS OT/PT department based on our research from several states, such as NC, Illinoi, Montana and NY. It helps guide our PT services with our students on caseload.

10. PDU Artifact #3 • A large part of this PDU was promoting Evidence Based Practices for PT Best Practices. I did a lot of researching during this PDU and found several articles that have helped to change my treatment strategies with EBP research. Evidence-based practice is an important part of our clinical practice as physical therapists. Use of evidence-based practice is one of the primary goals of the Section on Pediatrics and the American Physical Therapy Association. I have included a sampling of websites, links and articles used to complete this PDU. RESOURES: APTA has several resources to assist members with evidence-based practice. • Hooked on Evidence at www.apta.org/hookedonevidence/index.cfm. This site has reviewed articles by therapists with commentary, although you need to be very specific with the topic of your searches. • Evidence in Practice is a special section of Physical Therapy, APTA’s peer-reviewed journal. This section is both instructive and informative regarding how to translate evidence into practice. There are a few pediatric-related articles within the Evidence in Practice series that can be viewed at www.ptjournal.org • Open Door: APTA’s Portal to Evidence-based Practice at www.apta.org—click on “Research” under the “Areas of Interest” navigation menu on the left hand side of the page; then click on “Open Door.” This is a benefit to members and provides access to a number of relevant journals, many with full-text articles. The research journal collections include ProQuest Health and Medical Complete, ProQuest Nursing Journals, and CINAHL. • Pediatric Physical Therapy (Journal of the Section on Pediatrics of APTA) www.pedpt.com/pt/re/pedpt/home.html provides current full-text articles to members and archived articles (after 2 years) free to non-Section members. LINKS TO RESEARCH ARTICLES: http://guides.lib.unc.edu/ebpt-home/ebpt-whatisebptLink explaining what EBPT is https://pediatricapta.org/includes/fact-sheets/pdfs/Evidence-based%20Practice%20Fact%20Sheet.pdf Fact sheet explaining Evidence Based PT Practice http://ptjournal.apta.org/content/85/11/1182.short Research on Fitness Plan for children w/Disabilities http://www.ncbi.nlm.nih.gov/pubmed/20735200 Review of PT interventions with school-aged children with CP www.cincinnatichildrens.org/WorkArea/DownloadAsset.aspx?id=115748 Article on using Yoga working with children on balance, strength and coordination http://www.cincinnatichildrens.org/WorkArea/DownloadAsset.aspx?id=87997 Best Practice article on PT strengthening individuals with CP who demonstrate muscle weakness

11. Exit Ticket • After completing this PDU and reviewing this final project, I realize that I have learned a lot throughout this whole PDU process. Examples are defining PT services in school based setting, explaining differences of medical versus school-based PT services, entrance/exit criteria for OT/PT school-based services and evidence based practices. • Only criticism I can provided is maybe next year OT and PT should be separate for some subjects.