Most students who receive occupational therapy services in public schools are provided services through an Individualized Education Plan (IEP) according to the rules outlined in the Individuals with Disabilities Education Act (IDEA) of 2004. To receive occupational therapy services under IDEA 2004, a student must qualify for special education services and must receive at least one primary service. Primary services include special education instruction in at least one subject area, special education instruction for emotional or behavioral disorders, or speech and language therapy. Since occupational therapy is always a related service under IDEA 2004, one of these other services must be in place before occupational therapy can be added to the student’s IEP. If a student does not qualify for special education services, that student cannot receive occupational therapy services under IDEA 2004.
Some students who do not qualify for special education services may be able to receive occupational therapy services through the provisions of Section 504 of the Rehabilitation Act of 1973. This provision states that:
“No otherwise qualified individual with a disability in the United States . . . shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance . . .” (504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794).
Since public schools receive federal financial assistance, they are subject to the provisions of this act.
Provision of Occupational Therapy through Section 504
To receive occupational therapy services under Section 504, a student must meet the following requirements:
1. The student must be ineligible for special education services under IDEA 2004.
2. The student must have a documented physical or mental disability. This usually means a medical diagnosis documented by a physician or other qualified health professional.
3. The student’s disability must impair his or her ability to:
a. Walk, breathe, eat or sleep
b. Communicate, see, hear or speak
c. Read, concentrate, think or learn
d. Stand, bend, lift or work
An evaluation is conducted to determine if the student qualifies for a 504 plan based on these criteria.
This chart gives some examples of students who have various conditions or problems and how they would qualify for services in public school, if at all.
|Student’s diagnosis/condition and limitations in school||Qualifies for an IEP under IDEA 2004||Qualifies for a Section 504 Plan under the Rehabilitation Act of 1973||Does not qualify for services in public school|
|A student has bilateral hand tremors and illegible handwriting. His academic work is at grade level. He has a medical diagnosis of Type 1 diabetes.||No||Yes||No|
|A student cannot sit still and pay attention in class. The teacher reports that the student is falling behind in her work. Testing reveals difficulty with reading and visual tracking. The student does not have any medical diagnoses.||Yes||No||No|
|A student has a medical diagnosis of autism. He is functioning above grade level in academic subjects. He uses noise reducing headphones and a baseball cap to filter auditory and visual stimuli.||No||Yes||No|
|A student holds his pencil with an abnormal grasp and displays hand and forearm weakness while writing. He is functioning at grade level in all academic subjects. No medical diagnoses are reported by his mother.||No||No||Yes|
As shown by these examples, a student must have a documented medical condition that is affecting his or her performance in school to receive services through a Section 504 plan. If a documented medical condition is not present, services cannot be provided.
Services that Students Can Receive through a 504 Plan
504 plans are accommodation plans that insure students with disabilities are able to access a free and appropriate public education (FAPE). The focus of a 504 plan is accommodation of the student’s educational environment and adaptations to functional tasks so that the student is able to participate in public school in the least restrictive manner.
Some examples of accommodations that might be provided under a 504 plan are:
-modified educational materials such as audio books or electronic worksheets
-preferential seating in classrooms
-extra time to transition between classrooms at the middle and high school level
-transcribed answers on tests and quizzes
-modified or reduced homework
Just about any accommodation that a school might provide to a student with a disability can be provided through a 504 plan.
The provision of related services to identify, provide, and support the provision of accommodations in public school is also considered an accommodation under Section 504. Occupational therapy is considered a related service in public school, so occupational therapy services can be provided under Section 504.
Here are some important points to remember regarding occupational therapy provided through 504 plans in public schools:
1. The student must be evaluated by occupational therapy and must qualify for occupational therapy services based on that evaluation.
2. The occupational therapy treatment plan must be focused on increasing the student’s ability to function independently in school through adaptations. Individual skills may be addressed if those skills are required to utilize adaptations and accommodations.
3. The student must have a clearly identified and documented disability. This is most often based on a medical diagnosis by a physician or qualified health professional.
4. School districts do not receive additional federal funding for the provision of 504 plans, so the school district will not receive any reimbursement for the provision of occupational therapy services under a 504 plan.
5. If an evaluation shows that a student requires accommodations under a 504 plan, including occupational therapy services, Section 504 requires the school district to provide the needed accommodations even though the district will not be reimbursed for those accommodations.
6. A school district may ask the occupational therapist to limit the amount of service provided to a student through a 504 plan due to the costs the school district incurs. Therapists should remember to provide services at a level that will meet the student’s needs. Therapy provided through a 504 plan is not intended to be ongoing, but also must be sufficient to allow the student to access his or her FAPE