PT Referral and Evaluation Process
What Should I Do If I Think My Child Needs Physical Therapy (PT) in School?
Express concerns: You are your child’s voice
Talk to someone and ask questions if you suspect or have concerns that your child has postural, movement or physical challenges limiting their education. You should talk to and notify the teacher, administration or local education agency (LEA).
Ask yourself:
- Is the quality of my child’s function/movement impairing him/her to access their education?
- Without physical therapy services, is my child able to learn and participate during their school day to their fullest educational potential?
- Would my child’s physical therapy involve more than just medical care? (your child’s PT needs must be educationally related)
- Does my child have the potential to use PT to improve their access to the school and achieve academic/educational goals?
- Does your child’s needs require the specific skills of a Physical Therapist to meet academic/educational goals?
Referral and Screening
- Ask your school district their process of getting a physical therapy (PT) referral.
- A referral must be made to have an assessment by a physical therapist (PT).
- You can request a referral for physical therapy! Let the educational team and PT know your concerns.
- The LEA and educational support team can also make a physical therapy referral.
- IDEA (Individuals with Disabilities Education Act) requires that a child be assessed in all areas related to the suspected disability.
- IDEA site: https://sites.ed.gov/idea/idea-files/guide-positive-proactive-approaches-to-supporting-children-with-disabilities/
Examples include but not limited to: motor function, classroom skills, playground and sports participation, self-help skills, social participation, mobility, social-emotional learning, assistive technology needs, sensory regulation, and prevocational and transitions needs (IDEA, 2004)
Screening: Every school district in Pennsylvania (Commonwealth of Pennsylvania, 2023i) may follow different steps to determine eligibility for school-based physical therapy but is required to:
- Identify and provide initial screening for students prior to referral for special education evaluation
- Identify students who may need special education services and programs
Once requested, the physical therapist can be involved in the screening process to see if your child has motor and/or functional difficulties that limit participation at school and recommend PT services at school. Any student who meets the criteria for 1 or more of the 13 Disability Categories listed under IDEA may be eligible for school-based PT.
Categories of Disability Under IDEA, https://www.parentcenterhub.org/wp-content/uploads/repo_items/gr3.pdf
If the screening determines that your child will benefit from PT services at school, the PT will be part of the evaluation team.
The Multi-Disciplinary Evaluation (MDE) Process
- Written parent/guardian permission is required to evaluate/re-evaluate your child
- Team assessment and decision making that includes you so please provide any input in all areas related to the disability.
- An Evaluation Report (ER) is written by the educational team, which includes the physical therapy assessment.
- Evaluations must occur, and the report be presented to the parents within 60 calendar days of receiving parental consent (Commonwealth of Pennsylvania, 2023i)
The Individualized Education Program (IEP) Process
Once your child qualifies for physical therapy based on the evaluation and you agree to the Evaluation Report (ER), an IEP meeting will be set up.
The IEP team can include, but not limited to: parent(s)/guardian(s), regular education teacher, special education teacher, local education agency (LEA) representative, paraprofessionals, related service providers (Physical Therapist, Occupational Therapist, Speech-Language Pathologist, school health services, school psychology, school social work, behavioral health services, assistive technology, audiology, transportation or other services necessary for students to succeed at school) and whenever appropriate, the student.
- The IEP Team discusses the evaluation results (your child’s strengths and needs) with your feedback and input.
- Ask questions and express your concerns as the team develops goals for your child based on their present levels of performance.
- After the physical therapy goals/objectives are written and agreed, the team then decides:
- How often your child will receive services (frequency) – daily, weekly, monthly, quarterly
- Length of time per each PT session (usually 20-30 minutes/sessions)
- How services will be delivered: individual or group sessions
- Type of service: Direct Service (face to face contact with your child)
- Indirect Service (therapist providing instruction to other staff members or to you/family)
- Virtually
- Where sessions will be held (location)
- Student’s need for Extended School Year (ESY) services (criteria varies per school)
- Transition services are included in the IEP at age 14
You may be asked for consent for the physical therapist/school to contact your child’s pediatrician in order to get a prescription/referral for PT services, as required by Pennsylvania state law.
The IEP is:
- a legal document
- written as a guide for the child’s free appropriate public education (FAPE)
- provided in the student’s least restrictive environment (LRE)
Monitor Progress
It is important for you and the physical therapist to communicate regularly on how your child is doing. If they are making progress, or if not, what can we do as a team to change interventions and/or strategies?
What Families Can Do At Home?
One of the most important components of school-based physical therapy is supportive parents/guardians/families at home.
Things you can do at home to ensure your child has a successful outcome during school-based PT:
- Communicate often with your child’s therapist/IEP team to see how thing are going during therapy sessions.
- Don’t be afraid or hesitant to ask questions. (call, text, email, notes, attend session, video/record, keep notes/data)
- Learn exercises that you can work on at home to support your child’s therapy at school.
- Practice techniques regularly at home so that they may carry into the school environment.
- Inform the physical therapist of any worries you have about your child's ability to function both at home and in the classroom.
- Work closely with your child’s teacher, PT and IEP coordinator to ensure your child is progressing as expected with school-based PT.
Is School-Based physical therapy free?
Yes, if your child qualifies for school-based PT, the services are provided at no cost to you. Special education programs for schools are paid for by taxpayer dollars from the federal and state levels.
What are some signs that indicate a student may benefit from skilled Physical Therapy Services in the Educational Environment?
Some activities may include but not limited to:
- negotiating the school - walking patterns, stair climbing, opening/closing doors, up/down ramps, wheelchair skills, etc.
- sensory processing - dislikes touching different objects, craves movement, fearful of movement, poor body awareness, etc
- gross motor skills (large motor skills) - jumping, skipping, hopping, running, etc.
- posture - does not sit properly, slumps on desk frequently, backpack/bookbag safety, etc.
- self care skills - transferring on/off toilet, getting backpack on/off, etc.
- balance skills - falls frequently, stumbles when walking, etc.
- coordination skills - difficulties throwing, catching and kicking, bicycling, etc.
- transition skills - on/off school bus, walking in classroom line, going from sitting to standing, walking between different surfaces, etc
- navigating in the community - field trips, work/vocational sites, parking lot, shopping, escalators, etc
- safety drills – exiting building
- participating in class activities - gym, recess, playground equipment, etc
- environmental/safety awareness - hallways, stairwells, cafeteria, bathrooms, auditorium, outside, gymnasium, etc
- training – staff, family, administration, etc
- limitations in – range of motion, strength (upper body, core, legs), tone, head control, body control, etc
- health – monitoring obesity, injury prevention, endurance training, cognitive/mental/emotional, etc
What activities can be worked on during a physical therapy session?
Listed here are some, but not all, examples of what may occur during a physical therapy session.
- strengthening exercises for the body
- stretching exercises
- instruction and practice of functional skills such as stair climbing, carrying books or backpack, open/close doors, etc.
- walking activities in the classroom, hallway, cafeteria, gym class, etc.
- assessment/modification equipment such as classroom desks and chairs, bathroom modifications, positioning
- equipment, etc.
- activities to improve the large motor skills necessary for physical education or recess
- coordination activities
- activities to improve sensory processing such as obstacle courses, swinging, jumping, etc.
- instruction and practice of wheelchair use
- activities to improve balance
- instruction to other staff and family that works with the student
- assessment/acquiring/training in assistive devices, adaptive equipment
Where Can My Child Receive School-Based Physical Therapy Services?
- Your child will receive physical therapy services in their natural environment that is least restrictive.
- Listed here are some, but not all, examples:
- classrooms, therapy room, hallways, stairwells, cafeteria, gym, bathroom, auditorium, playground, community (field trip locations), work sites, buses/vans, vocational/transitional sites
- Ask and keep a list of how you can contact the school, teacher, IEP team member, physical therapist, etc
- Always know that a Physical Therapist, along with other IEP team members, are responsible for working with you and your child to remove barriers to education that a disability may cause.
Section 504 of the Rehabilitation Act of 1973
A federal law that protects qualified individuals from discrimination based on a disability.
In the school setting, a student meets the criteria for services under a Section 504 Service Agreement if the student has a physical or mental impairment that substantially limits one or more major life activities.
If the Multi-Disciplinary Team determines the student does meet the criteria under Section 504 of the Rehabilitation Act of 1973, a written Section 504 Service Agreement documenting services, modifications and accommodations is required.
The overall outcome of school-based physical therapist services under a Section 504 Service Agreement is to facilitate successful participation for the student, in both learning and functional aspects, throughout the school day.
Sites for Parent Resources
https://www.pattan.net/Parent-Information/Pennsylvania-Supports