Are you curious about what discharge from OT looks like in the school system? In some ways, there is a lot of freedom in service recommendations in the school system. Since you’re not bound by insurance, you can technically serve a student as often for as long of a time as you want. However, school-based OTs must uphold the Least Restrictive Environment (LRE). But knowing when you should discharge students in practice can be a lot more complicated than it appears.
When to Discharge Students from School-Based OT
In a perfect world, occupational therapy intervention should be discontinued as soon as it is no longer necessary for the student to benefit from their educational program. But in reality, special education service recommendations are a team decision, and it can take time to even get that IEP team together in the first place. Then, once you have the team assembled, there can be disagreements over whether the student still requires school-based OT. Even if you believe that your services are no longer necessary, parents, teachers, and other IEP team members may see it differently. What makes it even more challenging is that IDEA doesn’t offer a lot of specific guidance on what discharge from related services should look like. However, there are still some guidelines you can use to steer your judgment when making those individualized decisions.
When Functional Outcomes Are Met
Your student has met their goals. Yay! This is the most ideal discharge scenario. And in most cases, everyone on the IEP team will be happy that the student has progressed. Just be sure that your student’s goals don’t need to be revised and updated. Even if they’ve met their current goals, they may still need you if they’re not yet working at grade level. If your student has the potential to have age-appropriate skills, they may still require school-based OT. But, if you’ve discussed it as a team and there are no more goals where your support is required, discharge away.
When the Student Is Unable to Make Continued Progress toward Functional Outcomes
Now, if that first situation is the perfect discharge scenario, this one is potentially the hardest. At times, you will have students on your caseload that are no longer making therapeutic progress. This is one of the trickiest situations to deal with as a school-based OT. Obviously, we love our students, and don’t want to stop seeing them if there’s potential for them to improve. But our services are different than teachers’: our students do need to make continued progress in order to justify therapy. This distinction is hard to explain to IEP teams at times, and parents can often feel like therapists are “giving up” on their student who still clearly has so many support needs. But ultimately, OT where a student doesn’t make measurable change or progress isn’t skilled therapy at all, and it’s our duty to be honest and upfront about this.
A couple of exceptions to this situation: if you have a student who has a degenerative disease, they may actually regress instead of progress. Therapy can still be valuable and necessary to slow the speed of regression. Another thing to consider is if you have students who have equipment and training needs, you should consider staying on the case through indirect/consultative services in order to make sure the team is able to effectively serve the student.
When the Student Is Accessing and Participating in All Areas of Their Educational Program
Maybe it’s not just OT your student is doing really well with – maybe it’s the entirety of their educational experience. Some of your students may even no longer require special education, and others may simply require a low level of maintenance to keep things humming along. In these cases, it’s usually easier to discharge OT because the whole team tends to be in agreement that the student is doing well, but sometimes parents still may worry about losing services. In these cases, be sure to highlight what your student is doing really well with as well as the need to maintain the LRE.
One rare situation to watch out for: if your student is found to no longer qualify for special education but you believe they still require school-based OT, be sure to discuss this with the team. It may be that they do still require an IEP, or they may need a 504 plan.
When Previous Areas Addressed by OT Can Now Be Managed by Trained School Personnel
Say you have a student you’ve been working on clothing fasteners and other self-care with for a while now. You’ve spent time seeing the student in the natural environment. You’ve collaborated on goals with teachers/the case manager. You’ve trained paraprofessionals on strategies they should be using every day with the student. Your student is making appropriate progress toward goals and your sessions don’t seem as necessary anymore.
If you’ve had a case similar to above, this is a perfect example of a time to discharge from school-based OT. While your student still has needs and goals, other members of the team are able to appropriately address them.
While it can be tempting to continue direct services for a student that still has deficits and is making progress, keep in mind that as a specialist, your service is already restrictive. You are saying that a student MUST have an additional specialist to be able to participate in school. This is much more restrictive than a student who only requires a teacher. And since OT is almost always a related service in the school system, this is something we have to consider.
When thinking about service recommendations, ask yourself, “Does this require the specialized knowledge that only a school-based OT can provide? If the answer is no, it’s time to discharge. Or at the very least, consider if you can now serve this student indirectly through consultative services to help aid in the transition.
When Can School-Based OTs Discharge?
Now that you know the situations that should trigger a discharge situation, you may be wondering when this process can actually take place. Because there are so many laws and processes in the school system, it’s not as simple as unilaterally removing a student from your caseload as soon as you think they’re ready. Instead, you should bring up this conversation at an IEP meeting, sharing the data that has influenced this decision. Whether you bring this up at the student’s next annual meeting or call a special meeting is up to you, but remember your duty to the LRE. If the student really no longer requires school-based OT, it’s best to amend the IEP sooner rather than later.
Do School-Based OTs Need to Do an Evaluation to Discharge?
School-based OTs may also wonder what discharge paperwork looks like. Unfortunately, this is an area that’s also not cut and dry. While some states and districts may require a discharge evaluation, there is no federal law that addresses this. However, in most cases, it’s best to at least do some sort of discharge summary/evaluation, even if you don’t complete any new testing and just report on data from your sessions. If everyone is in agreement, this type of evaluation will usually suffice. But if you think some on the IEP team may not be on the same page yet, it may be worth doing a more detailed discharge evaluation.
One thing to remember: evaluations in the school system always require parental consent. So if you’re doing an evaluation that isn’t part of a student’s typically 3-year re-evaluation cycle, make sure to work with your teams to get that consent paperwork in place.
When to Bring Up Discharge from School-Based OT
One last piece to this discharge business: school-based OT is not necessarily meant to be a “forever service.” Remember that the purpose of your service is to help your student access their education as independently as possible. Ideally, this means that someday they won’t need you. And ideally, you should share this intent with families well before discharge is actually on the table. When you first recommend services for a student, you should have an idea in mind when those services will end – and that idea should be shared with the IEP team. Bringing up discharge when you first add a student to your caseload allows the team to understand the purpose of your service and is a proactive strategy in helping the team accept when a student no longer requires school-based OT.
If you’re unsure about how long a student may require OT, it’s okay. Remember, you’re giving your best estimate, not locking yourself or the student into a specific number of years of service no matter what. Things can always change, and that student may need way more or way less school-based OT than you originally anticipated. The important part is bringing up discharge at the beginning of the process, and giving some criteria for what factors might trigger it.
Looking for more support with questions like this? My course, The Dynamic School OT, is the perfect fit for OTs learning how to effectively practice in the schools. We’ll take an in-depth look at service decisions, evaluation, appropriate interventions, IEP meetings, how to manage difficult situations, and so much more. Click here to learn more!