Homebound is an instructional setting determined by a student’s Admission, Review, and Dismissal (ARD) Committee. For students aged six and older, specific eligibility criteria must be met for a student to receive instruction in this setting. Students aged three through five may be placed in the homebound instructional setting if deemed appropriate by their ARD Committee. The student’s Individualized Education Program (IEP) will document homebound as the instructional setting and outline other necessary components identified by the ARD Committee to ensure the student receives a Free and Appropriate Public Education (FAPE).

When determining a student’s need for occupational therapy (OT) or physical therapy (PT) in a homebound setting, it is essential to apply the same individualized considerations as in any other instructional setting. A one-size-fits-all approach should be avoided. Individual student needs vary, and it is inappropriate to assume that homebound services will always or never be provided, or that students will consistently receive a predetermined number of visits, or a specific fraction of their service time compared to their school-based placement. Therapy services in the homebound setting must address functional and academic needs that directly impact the student’s ability to access and benefit from their educational program as outlined in the IEP.

Best Practices for Determining OT and PT Needs in Homebound Settings

An integrated service model that employs an interdisciplinary team approach is recommended. Several factors should be considered when evaluating the need for OT or PT in a homebound setting:

1. Curriculum Demands
   • What goals and objectives will be addressed by the homebound teacher and other providers?
2. Learning Environment
   • What aspects of the environment where learning will occur might support or hinder participation?
   • For example, what seating and positioning options are available to optimize engagement? Are adapted instructional materials needed to assist the student with participating in learning activities? Are additional mobility supports needed to ensure the student can safely navigate their home environment for learning activities?
3. Staff Knowledge and Support
   • Do school staff require guidance to meet the student’s physical needs and promote participation in learning activities?
   • For instance, do they understand how to position the student optimally for learning?
4. Existing Supports and Services
   • What supports are currently in place, and what additional strategies may facilitate or hinder the student’s participation?
   • What other accommodations, modifications, assistive technology, or instructional and related services are being provided to address the student’s needs?

Therapists should assess whether there are unmet needs that necessitate OT or PT services. Recommendations must be based on the student’s current needs within the homebound setting. Comprehensive information gathering and collaboration with the student’s team are critical to identify specific needs and the supports already in place. The ARD Committee must determine whether OT or PT services are required to support the student’s progress toward mastering IEP goals and how such services might assist.

Collaboration and Coordination

Since homebound services typically occur in the family’s home, coordinating with homebound teachers or other providers when scheduling therapy visits is essential. This ensures that OT or PT services remain educationally relevant and collaborative.

Conclusion

• Students placed in a homebound setting remain eligible for special education services and are entitled to receive all the supports and services necessary to benefit from their educational program.
• The process and factors considered when determining a student’s need for occupational therapy (OT) or physical therapy (PT) in a homebound setting are the same as in any other instructional setting.
• Service delivery in a homebound setting may require adjustments in frequency, duration, and methods of progress monitoring.
• Therapists should remain flexible and collaborate with the ARD Committee to adapt services to the unique demands of the home environment while maintaining alignment with the IEP.

 

 

Collaborative goals are Individualized Education Program (IEP) goals developed by an interdisciplinary team. Collaboration is a core component of the Individuals with Disabilities Education Act (IDEA). Collaboratively developed goals can result in improved outcomes, shared ownership, and increased teamwork in selecting and implementing strategies to support students’ mastery of their IEP goals. Further, there is no wording in the IDEA or Texas law that requires service providers to write their own discipline-specific goals. According to the “Joint Statement on Interprofessional Collaborative Goals in School-Based Practice, “IEP goals are individualized to the student and do not belong to any specific discipline.”  (AOTA, APTA, ASHA, 2002, p. 3).

OTs and PTs often collaborate and co-implement IEP goals with classroom teachers, helping to support both academic and functional goals. However, they can collaborate with any instructional or related services providers the student may need, including homebound teachers, teachers of students with visual impairments, speech-language pathologists, music therapists, orientation and mobility specialists, adaptive PE teachers, and more.  

In the IEP development process, providers must determine how, when, and by whom data collection will occur and who will be responsible for reporting progress to parents via the progress report. Generally, multiple providers will collect their own data and share it with the provider responsible for progress reporting.  

Here are a few resources for more information:  

Joint Statement on Interprofessional Collaborative Goals in School-Based Practice (from AOTA, APTA, ASHA)

Fact Sheet: Developing Collaborative IEP Goals (from APTA)

Fact Sheet: Occupational Therapy's Role with School Settings

Fact Sheet: Providing Physical Therapy under IDEA Part B - An Overview of School-based Physical Therapy

 

Related services such as occupational therapy (OT) and physical therapy (PT) are supportive services provided to students with disabilities to assist them in benefiting from special education. But how does one determine what is appropriate in terms of the time, frequency, and duration of services needed to provide support to a student?

 

TxSpot often receives questions as to whether tools or guidelines exist that can help determine the amount of therapy a student will need at school.  While several tools have been developed, including the “Determination of Relevant Therapy Tool,” the “Considerations for Educationally Relevant Therapy,” and the “Occupational Therapy and Physical Therapy Service Needs Checklist, A Guide to Service Delivery for Ages 3-21,” more research is needed to determine whether these tools have validity. There are so many variables to consider that it is difficult for a tool to address them all. But what these tools do have in common is a focus on determining what services are educationally relevant, in other words, what is needed for students to make adequate progress toward their goals and objectives and benefit from their special education program.

 

Research does support an integrated model of service delivery. This means services provided to the child and on behalf of the child (direct and indirect) that are embedded in natural environments during daily routines. This approach emphasizes the importance of 1) working in collaboration with the educational team, and 2) applying interventions at the time and place the participation or performance concern occurs. An integrated approach doesn’t assume the barrier to success is in the child with the disability but rather acknowledges that the issue is often the fit between the student and his environment.

 

With all of this in mind, what should therapists consider when formulating recommendations about the time, frequency, and duration of services? The therapist must gather data regarding not only student factors such as physical abilities, sensory processing, and self-help skills, but also contextual factors that impact a student’s performance or participation. These can include the supports that are currently in place, how adequately these supports are helping the student to succeed and the skillset of the teacher. It is likely that a first-year teacher who does not have experience working with students with autism will likely need more support from OT than a veteran teacher. The inexperienced teacher may need support to learn how to implement common sensory strategies in the classroom, set up a structured environment, utilize visual schedules, etc. The school environment must also be considered and includes the physical, time-based, and sensory aspects of all areas of the campus, such as the classroom, hallways, bathrooms, cafeteria, playground, gym, and more.

 

Factors such as the amount of structure in the classroom or noise level in the cafeteria to the spacing and layout of classroom desks and tables can all impact how successful a student may be. All these factors must be considered when determining how much support may be needed from your service in order for the student to make adequate progress and benefit from his education. Consideration should be given to time that may be needed to adapt a student’s environment, activities and tasks, support accommodations including assistive technology, and more.

 

The student’s evaluation is one source of data and is a critical tool to help therapists in developing educationally relevant recommendations. A school-based evaluation must address concerns that prompted the request for the evaluation, but should also address the student's participation and performance across all domains within the scope of OT or PT. The evaluator must consider the student’s Individualized Education Program (IEP), including Present Levels of Academic Achievement and Functional Performance (PLAAFP), goals and objectives, and other supports and services currently in place to address the student’s needs. If a student was evaluated in a previous school year, the therapist will want to consider additional data when formulating recommendations. Sources include information from the student’s IEP such as progress on goals and objectives and the student’s present levels of academic achievement and functional performance, as well as progress notes and reports and data collected by both the therapist and teacher.

 

In consideration of the above information, therapists must think about not only any time needed to work directly with a student but also time to collaborate and communicate with and provide training/education to others on the student’s educational team. Thought must also be given to the time needed to order, create, or adapt equipment or other assistive technology. Finally, time must be allotted to collecting and analyzing data on student progress and the effectiveness of interventions.

 

Keep in mind that decisions about the time, frequency and duration of OT and PT  services are ultimately made by a student’s ARD Committee. The responsibility of the therapist is to be knowledgeable about each student’s unique and individual needs and to recommend an appropriate time, frequency, and duration to the ARD Committee for consideration that is based on data.

 

Links to Resources:

Related Services for Students with Disabilities - Questions and Answers (texas.gov)    

FactSheet -- DosageConsiderations: Recommending School-Based Physical Therapy UnderIDEA (pediatricapta.org)

Joint Statement on Interprofessional Collaborative Goals in School-Based Practice - AOTA, APTA, ASHA

The answer is yes. In federal and state policy, the IEP team (ARD committee in Texas) is given the legal authority to develop a program of special education and related services for the student with disabilities. This is known as the Individualized Education Program (IEP). From a legal perspective, ARD committee decisions must be based on current data, and certainly should consider the recommendation of the service provider.  

The service provider’s responsibility is to bring a sound recommendation to the ARD committee that is supported by evaluation and other current data. In addition, the service provider needs to actively listen to information provided by others present in the meeting as well as questions or concerns posed to him/her. At times, the provider may hear information that is new and warrants discussion and possibly a change in service recommendations. If this occurs, it is good practice to ensure that the ARD deliberations clearly articulate the change in the therapist’s recommendations and the reasons for the change.

If there are differing opinions regarding therapy services for the student and the service provider does not feel that the available information warrants a change in recommendation, he/she should make sure that the deliberations document the original recommendations.  If after that, the committee decides not to follow the recommendation of the service provider, they can do so. This applies to situations where a different frequency or intensity of services is decided upon, or when the committee changes the focus of the service and the goals the provider is supporting, or even when the service provider is recommending discontinuing services and the committee decides to continue the services.

Even if the service provider does not agree with the decision, the IEP must be implemented as specified. While the professional might not be happy about being overridden by the ARD committee, that has no bearing on the district’s responsibility for implementing the IEP. The only legitimate objection that could be made by the professional is in the instance when the services specified by the ARD committee are contraindicated or would result in harm to the student.  

 

I am sorry to hear that you are having trouble getting others to embrace a more collaborative approach; I can certainly appreciate your challenge. Change is a stressful process for most, and it takes time.

Many OTs and PTs are not educated on how to provide services in the school setting and upon entering school practice, employ their knowledge of clinical practices aimed at remediation of impairment or closing a developmental gap. In order to meet the standard of supporting a student's educational needs, evaluations, interventions and supports need to be provided in natural environments during daily routines.

You may want to approach your administration about providing training—to other therapists, diagnosticians, other service providers, teachers, school leaders, and parents—using professional literature and the evidence. We have a mandate from the Individuals with Disabilities Education Act (IDEA) and the Every Student Succeeds Act (ESSA) for practices based on scientific research. Evidence tells us of the importance of context – both in terms of understanding the facilitators and barriers to learning and participation, and in the provision of strategies to overcome the barriers.

Below are two resources to support your position. Both are applicable to school-based occupational therapy as well as school-based physical therapy.  

Joint Statement on Interprofessional Collaborative Goals in School-Based Practice - 2022 (asha.org)

APTA Fact Sheet  - Developing Collaborative IEP Goals

Also, familiarize yourself with  the International Classification of Function and the World Health Organization model for persons with disabilities;  it emphasizes that disability is the result of the interaction between persons and their environment. Take the time to understand the ICF's model of disability in the “Towards a Common Language for Functioning, Disability and Health" (2002) (currently found on page 9).

Another resource can be found within IDEA and IDEA guidance resources. Individuals with Disabilities Education Act (IDEA) Topic Areas. One of the main principles of IDEA is Least Restrictive Environment (LRE).

Good luck with your endeavors towards best practice. 

I work in a district that is implementing a new concept of writing IEPs from the beginning of an academic year to the end of the academic year (as opposed to a 12 month period). While this makes sense if the district's academic IEPs/ goals that are TEKS based, I am having difficulty in understanding this for functional goal areas addressed in Occupational Therapy. If a student has an annual ARD in the middle of the year and has mastered some of his/her IEP objectives, OT would of course draft and propose new OT objectives. The difficulty is that the district wants OT to submit a draft IEP for the following school year. Due to the fact that IEPs should be drafted by the students Present Level of Performance I feel as if one cannot draft an accurate IEP for the following school year. It's as if the district is wants OT to simply "guess" as to what that student's level of performance at the end of the school year to draft an IEP for the following year.

In the situation above, the school district has made a decision regarding procedures, and will expect all instruction personnel and related services providers to comply. I agree that there will be guesswork involved, but in practice that is always the case – there is no way to know in advance the actual degree of progress that can be achieved by a student, or the rate at which a student will progress. Should a student return in the fall with different needs (due to growth/maturity, transfer to a different school, etc.), the OT can collect data to document what has changed. An ARD can then be called to update the PLAAFP and make any needed changes in the IEP. 

Developing and implementing collaborative goals/objectives for students promotes team collaboration and team integration of strategies. Too often, separate goals/objectives lead to a focus on impairment without context, fragmentation in service delivery, and no follow through with strategies. This can lead to requests for more therapy time, increasing costs. Below are a few resources you may find helpful.

Occupational Therapy Association (2016). Fact Sheet: Occupational Therapy in School Settings. Bethesda, MD: AOTA Press.

Dole, R.L., Arvidson, K., Byrne, E., Robbins, J. Schasberger, B. Consensus among experts in pediatric occupational and physical therapy on elements of individualized education programs. Pediatr Phys Ther. 2003 Fall; 15(3): 159-66.

Hanft, B. & Shepherd, J. (2008). Collaborating for Student Success: A Guide for School-Based Occupational Therapy. Bethesda, MD: AOTA Press. pp. 155-156.

Wynarczuk, K.D., Chiarello, L.A., Fisher, K., Effgen, S.K., Robert J. Palisano, R.J., & Gracely, E.J. (2019): Development of student goals in school-based practice: physical therapists’ experiences and perceptions, Disability and Rehabilitation, DOI: 10.1080/09638288.2019.1602673   

Clark, G. F., & Chandler, B. E. (eds.) (2013). Best Practices for Occupational Therapy in Schools. Bethesda, MD: AOTA Press. pp. 57 – 61. 

McEwen, I.R. (ed.) (2009). Providing Physical Therapy Services under Parts B & C of the Individuals With Disabilities Education Act (IDEA), 2^nd Ed. Alexandria, VA: Section on Pediatrics, American Physical Therapy Association.

1) a parent requesting OT Recommendation with services page to be sent home ahead.  We were told not to send this home, but to only send the OT Eval/Report.  The service page is presented at end of ARD with our recommendations.​

2) going out of order of the ARD and asked what our recommendation/plan of care is prior to the IEPs being discussed.

3) told to send home OT notes every 9 weeks to family.  Is this required if parent asks? How can we avoid this?

The Texas Education Agency (TEA) provides guidance on this issue, stating that each IEP must include the frequency, duration, and location of the services to be provided. If a service is to be provided less than daily, the frequency must use a weekly reference, such as 30 minutes every two weeks or two 20 minute sessions per three weeks. There is nothing in TEA’s guidance that requires IEP committees to specify during which of those weeks the services will occur. If a grading period reference is to be used, the IEP must clearly document what that duration is (e.g. grading period = 6 weeks). TEA’s guidance does state that, “What is required is that the IEP includes information about the amount of services that will be provided, so that the level of the agency's commitment of resources will be clear to parents and other IEP Team  members. ...The amount of time to be committed...must be ...clearly stated in the IEP in a manner that is understood by all involved in the development and implementation of the IEP.” (Documenting the Frequency, Location, and Duration of Services.)