Pediatric Occupational Therapy Services can be provided across a continuum of settings and a variety of different ages including toddlers, children, and young adults. It is important to note that in all of these settings the activities and sessions will be play driven which optimizes motivation to complete functional tasks. Even though the child may just be sitting playing with a toy, in the larger picture that one toy may be targeting a plethora of other motor skills to assist with development. Pediatric Occupational Therapists can work in many different settings, and assist children in becoming as independent as possible within their daily routines.
School Based Services:
A child may qualify for school based related services as soon as they age out of Early Intervention, which would be three years of age. A child may be referred to the Child Study Team, where they may be evaluated by a team of professionals to see if they are eligible for special education. If they are eligible, then the IEP (Individualized Education Plan) process would begin to determine what services may be needed, as well as, to support the child within their least restrictive environment. In the school setting, related services may include Occupational Therapy, Physical Therapy and Speech Therapy. In terms of Occupational Therapy, the mandate and duration of sessions would all be determined based on standardized assessments and clinical observation. A child would receive services through an IEP or a 504 Plan.
School settings for related services follow an educational model, whereas an outpatient clinic may follow a medical model of the therapy. School Based Occupational Therapists look at a child’s skills to see where the educational impact is. Therapy services are provided to assist students to become independent and participate throughout the school day. Some areas that are targeted during the school day may include fine motor skills, visual motor skills, self-help, such as unpacking and packing their belongings, classroom organization, attention to task,handwriting skills, and/or prevocational skills. A school setting may allow for job training, and transition programs for ages 18 to 21. The school setting allows for additional collaboration between the therapists, teachers, and child study team for greater carryover of skills and to meet the needs of the child within their school day.
Outpatient Clinic Based:
Outpatient Therapy is usually in a clinic or a sensory gym. This setting typically follows a medical model of therapy. Following a medical model, therapists may work on additional skill sets that may not be addressed through school based services, whereas in the school, it always relates back to the specific educational impact. A medical model looks at the child’s skill to help them become successful in their daily life at home and within the community.
Outpatient Therapy is sometimes covered by insurance or can also be self-pay. Outpatient Clinics may also have additional equipment and tools that a school based room may not have, such as large sensory gyms including swings, mats, and climbing equipment. Outpatient Occupational Therapy services may also include fine motor and visual motor skills.They may also work on gross motor skills, overall muscle strengthening, sensory integration, and feeding therapy. Clinics focus on a child’s skill within all environments; therefore, can target a wide variety of tasks with specific one on one time with the therapist. It is important to note that outpatient services may be provided after the child's school day or on weekends. It is also important to consider that a child may behave differently after the school day if they are exhausted from a full day of school with little break before more therapy after school.
Early Intervention:
Early Intervention is available for infants up to three years of age. Many parents do not know that their child may be eligible for Early Intervention services. Early Intervention is to help assist babies and toddlers develop basic skills and hit their developmental milestones. A child may receive Early Intervention if they are delayed in their milestones or have a developmental disability. Some skills that may be addressed through Early Intervention may include walking, crawling, talking, playing, eating and sensory processing. Therapists will often use the toys that the child specifically has in their own home during the sessions to target their skills. A big part of Early Intervention is Caregiver and Parent Education. Early Intervention is done in the home setting where it is most natural for the child. It also allows the parents to be involved in the process so they can continue to reinforce skills when the therapist is not there.
Home Based Therapy:
Home based Occupational Therapy services may be provided to children who are unable to return or attend school based on their conditions or diagnosis. It allows for the child to receive their services that are necessary within their home environment. Treatment planning can be tailored to their needs within their home, and how a child can be independent within their own natural environment. Home based services may also be provided for children with more severe diagnoses such as those who are immoble. A therapy session for them may include parent education and assisting the family with learning passive range of motion for preventive care, such as contractures and bed sores. Similar to Early Intervention, there is a big emphasison on Family Education, and having the family and caregivers a part of the process. A parent can also hire a pediatric OT to come to their home for additional support even if the child does not qualify for services elsewhere or may not have the resources to drive them to a clinic.
Acute Care:
Acute care is another setting where Occupational Therapists often work especially with babies, children and young adults. Acute Care Occupational Therapists may see the children right after they have had surgery or may be battling a chronic diagnosis. Children may be referred for Occupational Therapy services in the hospital for a variety of reasons which may even include potential for developmental delays based on prolonged hospital visits. Skills addressed may include strengthening, mobility, and activities of daily living performance.
By Andrea Doumar, Pediatric OT @ot_room
Andrea Doumar is a Pediatric Occupational Therapist, who graduated from Seton Hall University for both her undergraduate and graduate degrees. She has always been passionate about working with children and helping them reach their full potential. She is very creative and loves sharing all of her craft and activity ideas. When she is not being an OT, you can find her at the beach, traveling, or DIYing.
