-       SPED: services to meet the needs of a child w disabilities

-       No cost to the child or family

-       Implemented in schools, homes, hospitals, institutions, or other settings

-       Provided as part of FAPE: Free Appropriate Public Edu

-       In the least restrictive environment

-       OT is considered a related service under IDEA

-       Therapy in school based practices are intended to minimize obstacles to edu in the setting

-       # of therapists in school settings (OT & PT) = 27,240 (2009-2010)

o   Bureau of labor statistics 2016: 130,400 OT jobs w 10% working in schools (still most current stat)

-       Employment factors

  -       Must be in place before services can begin

-       Members (7):

1. Parents

2.  reg edu teacher

3. special edu teacher

4. representative of local edu agency

5.  individual who can interpret instructional implications of eval results

6. discretion of parent or agency/other individuals who have knowledge regarding the child & related services

7. When appropriate, the child

-       Doc identifies the student’s edu needs & how they will be addressed

-       Team member collaboration & comm is essential

o   Process=indirect service

o   Additional team members

o   Requirements of an IEP:

1. Child’s present level of edu performance, how disability affects participation

2.  Measurable annual goals

3. Statement of special edu/related services

4. Statement of the extent to which child will not participate w children w/o disabilities in the reg classroom

5.  Statement of any modifications

6.  Projected date for initiating services

7.  Statement on how student progress towards measurable goals & how will be assessed

-    OT should be involved in the creation of an IEP

-       How therapy is provided varies greatly by school

o   May be one on one in private env

o   More recent move towards interventions within the classroom, consulting w educators

o   Model of services is directly by the IEP, national, state, and local policies, and individual school setting

-       Ways of entering the SPED system

o   Identified w disabilities btwn the ages of 2-5

>  Provided in preschool covered by IDEA

o   Often pediatrician refers child or Child Find

>  Each state must have comprehensive system of Child Find in order to identify, locate, and eval children w disabilities residing in each state who are in need of special edu & related services

o   May have been identified & receiving EI through IDEA part C

o   Come lateral on educational careers

-       Once referred they can qualify under a variety of disabilities

-       Provided under IDEA part C, for children birth-3

-       If child is determined to have a disability, both child & fam qualify for services & an IFSP is put into place w the participation of the fam

-       OT/PTs may be sole providers or work with other EI providers

o   Interventions often focus on delay of dev milestones, minimizing or preventing future impairments, addressing functional skills/motor skills & AT

-       Models of providing care

o   Work in transdisciplinary teams where members collaborate to provide the most effective service

o   Primary service provider where a team member is the primary contact & provide and is coached by other discipline members of the team to meet all goals

-       Therapists need to have a good understanding of policies

o   Need to be able to comm with stakeholders

-       Changing school based env

o   ^ push for interventions in classrooms & less pulling out

o   Use inclusion & collaborative models

o   Work w children in natural env & collaborate w teachers

o   More time spent observing groups of students for early intervening services

-       Be aware of the impact of MH on children

o   Social emotional health has been proven to impact learning

o   May still be considered an emerging area of practice

-       450 million ppl worldwide are treated for some form of MI (mental illness)

-       In US, 26.2% adults will be dx with a MI

o   9.8 million or 1 in 25 experience severe/persistent MI (2018)

-       NIH: 1 in 5 children (21.4%) age 13-18 have/will have a mental illness

o   5-9% have severe emotional disturbances

-       Currently on DSM V

o   d/o vary by individual, culture, env, & severity

Mental Health Policy:

1770- 1800

-       1775: individuals were admitted to first psychiatric hospital in Philadelphia as a safe, calm retreat

- Mid 18^th century: concern for care & moral treatment & mental hygiene mvmts influenced mental health policy & practice

MH policy:

1940s

-       In 1940s: concerns about MH of returning WWII soldiers

-       The National Mental Health Act 1946

-       1948: first community MH center established, more practitioners began working in the comm-based settings

MH policy:

1960s

-       1960s: services focused on managing symptoms, remaining stable, & remaining out of hospital

-       1961: the Joint Commission on MH & MI recommended comm-based services to support the transition after hospital stays

-       Community Mental Health Act of 1963

o   Community Mental Health Centers (CMHC) established to provide inpatient/outpatient services as well as consultation & edu, day tx, crisis services

MH policy:

1970-1980

-       1970s: chronic mental illness were not being support by the national health system

-       1977: The President’s Commission on MH was created

o   Creation of MH systems Act of 1980, purpose to improve MH services by:

>  Prioritizing MH services for most vulnerable

>  Restructuring guidelines to give states more control

>  Requiring planning for implementation programs

>  Improving links btwn MH & general health

>  Improving advocacy

MH policy:

1900s

-       Movement 1: start of 1990s evidence based mvmt influenced policy about quality effectiveness of care

-       1992: the federal gov created the Substance Abuse and MH Services Administration (SAMHSA)

-       Movement 2: recovery movement

o   Recovery is a journey of healing & transformation enabling a person w a MH prob to live a meaningful life in a comm of his/her choise while striving to achieve his/her full potential

-       1996: first Federal MH Parity Act

-       Supreme court decision in 1999: further supported comm-based services

o   Olmstead v L. C.: under the ADA unjustifiable institutionalization of person w a disability who, with proper support, can live in the comm is discrimination

MH policy:

2000s

-       2003: New Freedom Commission on MH (NFCMH) Committee release final report: Achieving the Promise: Transforming MH Care in America

o   SAMHSA

o   Detailed the status of, made recommendations for the changes in, and highlighted the fragmented nature of both federal & state MH sys

o   Committee set forth goals of a transformed MH system in order for those w severe & persistent MI to live, work, learn & participate fully in their communities

o   One aspect of change addressed the inequality of insurance plans & their coverage of MH

-       2008: the Emergency Stabilization Act: MH parity act and addiction equity act

o   Ensures fair & equal coverage of MH & substance abuse d/o but previous plans do not have to cover

-       Mid 2000s wellness mvmt concerned about high morbidity & mortality of those w a MI

o   Need to address whole health of the person, promote well-being & implement effective services

o   Utilized for persons in crisis, acute symptoms, danger to themselves or others

o   Inpatient unit goal: provide safe & structured env to manage issues of inability to care for self, danger to self & others and/or deterioration in condition

o   Originally for those in need of the most intensive MH care

o   Maybe unable to live in comm due to safety concerns or committed by the court

o   LTG: provide stabilization w reintegration into comm

-   Provides structured program for those...

1) ready for d/c from inpatient but still req high level of support

2) high risk of re-hospitalization

-   Person attends individualized program for day, evenings, weekends – remain in the community, return to work

o   For those struggling in the early stages of crisis

o   Immediate, short term, individualized treatment to minimize the crisis & deter hospitalization

o   Overnight residential care 24/7

o   Comprehensive services to severely mental ill and children, fam, and adults suffering from stress

o   Core services: outpatient services, 24 hours emergency care, day tx/partial hospitalization, screening for long term psych

o   To be eligible for Medicare must treat at least 40% who are not eligible for Medicare benefits

o   Comprehensive, intensive, individual, coordinated, structured services

o   Goal is to address social, edu, and leisure needs of participants by promotion of daily routines & a sense of belonging

o   Open @ least 5 days/wk, some evening & weekends outings

o   Provide services during the day to provide structure to ^ quality of life & health status of those 65+

o   Similar to day rehab programs but they also provide support & structure to meet vocational needs

o   Original clubhouse is the Fountain House in NYC 1948

o   Individuals are members w a focus on work, work order day, members & staff work side by side

o   Typically open 8 hours/day, 5 day/wk, and evenings & weekends

o   Transitional & supported employment

o   Comprehensive, flexible, comm-based treatment support 24/7/365

o   Multidisciplinary team

o   Participants are dx w severe, persistent MI, hx of diff being safe, diff with ADLs & IADLs

o   Case management, initial & ongoing assessment, psych services, employment, housing, fam support & edu

o   Effective for those w a hx of multiple hospitalizations & co-occurring substance abuse

o   Consumer run services/peer support programs

o   Consumers provide services & structure for other consumers

o   Drop in centers, meet social & leisure needs

o   May be referred out of need more intensive support

-       Unique needs, both fam & child need support

-       Coordinated networks of community based services of both public & private services

-       Client-centered, fam-centered, culturally appropriate so children may reach their full potential @ home, school, comm

-       Outcome: increase behavioral & emotional strength and a reduction in MH probs

-       OT begin in 1917 within the field of MH

-       Began working w individuals to engage in interests & normal activities to reduce symptoms of MI

-       By 1950s, OT were working in psychiatric facilities & comm programs

-       Today: frequently new roles are always emerging

o   Adult day service programs

o   Day rehab programs

o   Clubhouse programs

o   P/ACT programs

o   Employment programs

o   Psychiatric hospitals/units

o   Comm mental health centeres

o   Outpatient psychiatric clinics

o   Group homes

o   Home health agencies

-       OTs help individuals dev the skils & necessary support for independence productive living

-       Role of OT: may be direct care, consultation, case mgmt., edu, or administration

-       Areas of coping skills, emotional reg, stress mgmt., relapse & MH recovery

-       Identify/implement health habits, rituals & routines to support wellness

-       Support creation of wellness recovery action plan (WRAP)

-       Provide info to ^ knowledge & use of comm-based resources

-       Provide info on monitoring physical health concerns & strategize to control, recognize & respond to acute changes

-       Professions in MH must be aware of psychiatric dx, symptoms, & tx and how they impact services

-       As those w MI continue to have other health issues there is a continued need to address both physical & MH

-       May advocate & implement health & wellness programs such as Hearts & Mind (SAMHSA’s Wellness Initiative 10x10 campaign transformed into this

o   SAMHSA Wellness initiative: Goal to prevent 1 million heart attacks over 5 years (began in 2011)

o   Hearts & Minds: See link in canvas module