Batten Down the Hatches – It's Annual Review Time


Kathryn Biel

It’s that awesome time of year when we bury ourselves in paperwork and don’t resurface until June. You know–annual review time.

Last week, I put my scheduled meetings (so far) into my calendar and wept. Balancing a full caseload while preparing for next year is a bit intimidating. But I know I can do it. Each session has begun the information gleaning process. What are we working on? What are we hoping to accomplish?

A few years ago, at the School-Based Therapy Annual Conference, I gleaned this statement. It gets included in every report I write:

“School-based therapy is not intended to meet all of the therapeutic needs of a student; rather it is intended to ensure safe and efficient access to one’s education.”

That statement works for me in two ways. When a student is scoring below average, but can access his or her education, I can justify reduction of service levels or discharge. Conversely, and perhaps more importantly, when a child is testing in the average range, but functionally is not able to put it all together to access his or her education, I can justify initiation or continuation of service. I am fortunate to work in a difference that, at this time, still supports putting non-classified kids on caseload (we call them Improvement students) through RTI.

At this past November’s School-Based “Therapies in the School” Annual Conference, I was able to glean a few more soon-to-be-often-quoted important points from Susan Cecere’s presentation on “Complex School Based Challenges: Collaborative Goals, Embedded Motor Interventions, Data Collection, and Frequency/Intensity Decisions.”

Susan spoke of taking a top-down approach in which the first item considered is the desired outcome/goal for participation. We all know that this piece is so important that there is a specific section on the IEP asking what the parent’s goals are. This also includes the team’s goal. Understanding a student’s needs IN RELATION to the educational environment will help to determine what the functional, contextual problems are for a student.

Once the functional, educational needs are identified, the the barriers and strengths can be identified. Then, strategies to overcome the barriers can be planned and the specific interventions implemented.

I’ve been writing IEP’s for years. I’ve written some great ones. I’ve probably written some crappy ones as well. It’s easy to get complacent, especially when we’re expected to crank them out for meeting after meeting. However, identifying the functional educational needs in this framework can really help to re-focus attention and make us stop and think about what we are doing.

So, here are my new bullet points for consideration during IEP writing:

  • What activities and routines are problematic?
  • What is the level of participation and the participation restrictions?
  • How are the needs understood IN CONTEXT to establish EDUCATIONAL RELEVANCE?
  • What is it in THAT CLASS that is causing THAT BARRIER? Once that is identified, it is important to identify who is the best provider of the intervention (e.g., a child who has issues with sequencing–while the sequencing impacts motor performance, it is the sequencing and not the motoric aspect that needs intervention)
  • School therapy is not intended to substitute for medical therapy but to work in tandem with it.
  • If a skill or activity CANNOT be observed or measured during a child’s normal school day, then it might NOT be relevant to the child’s educational needs.

Obviously, I will continue to have parents who disagree with this rationale. There will always be the situations where therapy will be provided, regardless of my recommendations. We all have those cases. It goes with the territory.

Once I’ve figured out whom  I will be recommending services for, at what frequency/intensity/duration, and where the services will be performed, then I will need to establish goals. Based upon the information gathered above, the goals will be easy to identify. Susan Cecere also recommended the use of SMART goals in goal writing. SMART goals are:

  • S: Specific
  • M: Measurable
  • A: Attainable
  • R: Relevant
  • T: Time-Bound

Okay, so I’ve got my toolbox ready. I know the framework for critical thinking. I know how I’m going to go about thinking about my goals. Good luck to you all and may the odds be ever in your favor.

~Kathryn Biel, PT, DPT