IDEA 2004 stipulates that a related service must be provided if needed to assist the child to be involved and progress in general ed curriculum, to advance appropriately toward attaining the annual goals, and/or to participate in extracurricular and other nonacademic activities with other children with and without disabilities. However, the question that IEP teams must answer, as so beautifully expressed by Mary Muhlenhaupt, OTR, is not "Does Johnny need OT or PT at school?," but rather, "Does an OT’s or PTs knowledge and expertise provide a needed component of Johnny’s program that will achieve identified outcomes?”

TEA Guidance/FAQ

Q: How is a student’s need for related services determined?
A: Each student's need for related services, like the need for special education, is determined by the student’s ARD committee as part of the individualized education program (IEP) process.

Q: How often should a student receive a related service?
A: ARD committees determine the frequency, location, and duration of related services based on a student’s individual needs.

Determining IEP OT/PT Needs and Services (and Intervention Plans)
Sequence of IEP Development:
  1. Team members report finding/review existing data
  2. Team identifies student strengths and prioritizes needs
  3. Team writes prioritized goals that student can reasonably achieve within annual IEP timeframe
  4. Team determines least restrictive environment for plan implementation
  5. Team determines services and supports student will need to benefit and make progress in program

NYC School-Based Occupational and Physical Therapy: Practice Guide (2011)

See Chapters III: Occupational and Physical Therapy Assessment Process
Establishing IEP goals
Determining Need for Services
Chapter IV: Designing a Therapy Intervention Plan
Determining Intervention Focus Area
Determining Service Delivery Method
Determining IEP Recommendation
Considerations for Therapy Services at Various Grade Levels

Note: This document has really nice visual supports/graphic organizers/flow charts/tables to help clarify the decision making processes!!

Vermont's OT & PT Decision Making Guidelines for IEP Services

Santa Clara County SELPAs- Delivery Model For School Based Occupational Therapy Services 2012

Considerations in Determining Amount and Frequency of Therapy:

The decision on the amount, duration, and frequency of services should take into account the following factors:
  • Take into consideration the interrelationships among the various disciplines serving a particular student.
  • Determine the student’s potential to benefit from occupational therapy services
  • Decide if this is a critical period of skill acquisition or regression related to development or disability.
  • Consider who the client is -- the student, educational staff, and parents/caregivers.
  • Determine if any part of the program can be performed by others in addition to the occupational therapist.
  • Consider the amount of training that needs to be provided by the occupational therapist to others that are carrying out the program.
  • Consider the degree the problem interferes with function in the educational setting.
  • Is the child having difficulty meeting high priority demands in educational environments of activities of daily living, assuming the student role, social participation, play, leisure or vocational pursuits?
  • Do the discrepancies between the child's performance and the demands of the activities or environment interfere with the child's ability to benefit from special education; or do the discrepancies interfere with the child having equal opportunity to gain access to, benefit from, or participate in the educational program or services?
  • Is intervention, collaboration with teachers, or mobilization of resources by the occupational therapist an effective and efficient way to improve the child's ability to function in the environment?
  • Does the child's current educational placement include efforts to address the effects of the disability?
  • Will the effects of the disability influence, interfere with, or prevent the child's educational progress, safety, or ability to function in the anticipated school environment, particularly if the child is first entering school or is changing environments?

Determining Services and Goals for Speech Only

Q: I have a question about OT supporting speech only students in the schools. How is OT related to the SI disablitiy. What would this look like written as a collaborative objective between Speech and OT?
Answer From Ask TxSpot: 10.3.14
"During a not-too-distant period in our state’s history, it was the perception/belief of educators in some settings that young children with “speech only” disabilities were entitled to speech therapy services but did not require access to the full scope of special education and related services. We now know this perception/belief is incorrect.

When a student is identified as having a speech impairment, rules for evaluation and development of the IEP are the same as for any of the other disability category under IDEA and the Texas Special Education Rules and Regulations. If the student is suspected of needing a related service such as occupational therapy an evaluation must be conducted and a decision made by the IEP team as to whether there is an educational need for services.

If the IEP team determines OT services are needed, the IEP team must develop goals/objectives, or add OT to existing goals/objectives, as appropriate. In all cases, best practice is for team collaboration, such that the student’s goals/objectives would be supported by speech, OT and instruction or any combination appropriate to that student.

In cases where the issues are pre-writing or written expression (depending on the student), development of a communication goal/objective(s) can work well, with speech taking the lead on verbal expression and OT taking the lead on written expression components. Otherwise, as with all students in need of special education and related services, goals/objectives must be developed to target desired outcomes for the student for the next 12 months."

Note: Areas of collaboration (based on evaluation) for students who are speech only might include strategies and supports in: motor planning, sequencing (multistep activities- oral or motor) pre-writing, self-regulation/behavior, executive functioning, ...

See also for links to TEA and AOTA documentation on the subject:

Educational Relevance Worksheets (need to change SDI to reflect more updated interventions- need different language)

CERT: Criteria for Educationally Relevant Therapy

How do we answer this question from a parent/advocate? "How did you determine your level of services?"

Whatever data and tools we use to help us consider the appropriate amount of time and services- we benefit from a framework and common language to explain to ARDC...
CERT data helps frame it this way:
"periodic, regular, intensive"
TVI Severity Rating Scale data helps frame it this way:
low need, occasional support and maintence of skills
medium need- needs skills but lower priority generalization and fluency development
high need- priority; complete mastery of introduced skills
intense need- priority, acquisition of new skills

Example of TX District's OT & PT Operating Guidelines
see Determining Needs for Services section:

Houston ISD's Operating Guidelines for OT & PT

Sample Intervention Plan- Follows and Uses updated language from Practice Framework


TEA's Guidance for Documenting Services (see SPED Monitoring info for latest and most specific guidance)
For specific questions on documenting services please contact


§346.1. Educational Settings
(c) The physical therapist may provide general consultation or other physical therapy program services
for school administrators, educators, assistants, parents and others to address district, campus,
classroom or student-centered issues. For the student who is eligible to receive physical therapy as a
related service in accordance with the student's Admission Review and Dismissal Committee reports, the
physical therapist will also provide the consultation and direct types of specific services needed to
implement specially designed goals and objectives included in the student's Individualized Education

Service Delivery Models / Continuum

The article below has a really nice table of the variety, rationale and examples of how to document for a variety of service interventions! The Educational Relevance Worksheet (ERW) info above uses a nice form/process that helps distinguish what interventions/service models the student shows need for. While we will [[#|continue]] to have to work around several constraints in our documentation of service delivery, we nonetheless need to be sure we are providing a continuum of individualized services. Just liked there is not a one- size-fits-all type of instruction/teaching, there is not a one-size-fits-all type of therapy model. Since ARD [[#|software programs]] do limit our documentation, many districts' work around for this is to describe more specifically what interventions will be involved into a blurb in the OT/PT Evaluation, the ARD deliberations, and also post descriptions on OT/PT brochures, program websites, etc.

Scroll down on the HISD OT/PT Operating Guidelines to see their description of Service Delivery Models

Consider showing this article below to your special education director and discussing ideas to change how your district currently thinks about service delivery. BTW- speech language pathologists are also struggling with this same issue.

LRE Implications, Instructional Codes based on Service Delivery Models

There are implicatons for LRE/ instructional coding based on whether our services will be pull-out or push-in and based on whether we're pushing in to gen ed or special ed classes. See Section 4 and highlighted areas in the Student Attendance Accounting Handbook 2014-15 below for addtional information. Note: To my knowledge, this isn't something we are usually asked about or necessarily aware of- typically the electronic software systems fill in this information automatically, but it is something we should be aware of.