How much training did you get on filling out an IEP? If you’re like most school-based OTs, this was probably a minimal part of your onboarding, if it was addressed at all! And unfortunately, even when training is provided, it’s often done by administrators who don’t fully understand the OT scope of practice in the school system. As a travel school-based OT, I’ve reviewed hundreds of IEPs from a variety of states and districts, and there’s one particular mistake I see all the time, and that’s the present levels.
Present Levels for OT
So, this section of the IEP goes by different names in different states and districts, such as the PLP, PLOP, or PLF. But no matter what you call it, the function is the same: it’s the part of the IEP that reports what a student can currently do, from both an academic and functional standpoint.
This is quite possibly the most important part of the IEP, because it’s really what drives the rest of it – goals, services, accommodations, etc. Having an accurate and up-to-date Present Levels section is key to having an effective IEP.
And writing a good Present Levels section requires contributions from the entire team. That means the general education teacher(s), special education teacher, and any related services providers like speech and OT.
The part where this gets tricky is figuring out which provider contributes to each section. This section is different than the special education evaluation section where you get a dedicated space to report on OT concerns. Instead, Present Levels are divided up into categories like Academic, Vocational, and Fine Motor.
Now, I say this with love, and it’s probably not your fault, but if you’re reporting on every area you address with a student in the fine motor box on Present Levels, this is not best practice.
Fine Motor Present Levels
Now, perhaps you have a student where you really are only working on fine motor skills with them. In that case, then yes, totally appropriate. But as school-based OTs, we typically do so much more. So if you’re working on things like gross motor skills, sensory processing, executive function, ADLs, etc. – this shouldn’t all be crammed into the fine motor box.
Now you may be wondering, why does this matter? Isn’t it nitpicky to care about what section it’s in, as long as all the info is there?
Imagine talking to a teacher in real life who asks you, “How is [student] doing with fine motor skills?” and in one breathless reply, you say “Well, they’re able to maintain stability while sitting on a classroom chair. They can navigate the school environment appropriately, including opening doors or going upstairs. They do seem to be bothered by excessive loud noise, and a good accommodation for that is noise-canceling headphones in the cafeteria. They do sometimes need directions repeated for them in class, and they require prompting to get started on most tasks.”
That teacher would probably say something like “That’s great, but I was more wondering about how they were doing with copying short sentences and cutting with scissors.”
It comes off as confusing and disorganized, right? It reads the same way in a written document. And if that IEP were to ever be looked at with legal scrutiny, say, by an attorney or an advocate, it would probably be critiqued pretty heavily. Having these present levels mixed up makes it trickier to make sure that goals and services are being written to address all of the areas that the student needs help with.
The Literal and Metaphorical Fine Motor Box
Beyond just being a confusing way to write a document, there are more implications for putting all OT data into this section. Not everything we do in the schools is based on fine motor skills, and the more we put ourselves into that box – literally – the more our coworkers and teams think that’s all we do. A big part of my role as a school-based OT has been educating my teams that we do way more than motor skills, and we can’t really blame them for thinking this when this is the only area we write in on the IEP.
Plus, once we start taking responsibility for that box as the “OT box,” we reinforce the idea that any time a student has fine motor deficits, they require school-based OT, which is definitely not the case. Your IEP teams need to get used to OTs contributing to multiple Present Levels sections on the IEP, and those teams need to get used to filling in the fine motor box in some cases.
Barriers To Implementation
So, I find that most OTs who put everything in the fine motor box aren’t actually doing it because they think all they address is fine motor skills. They do it because that’s how they’ve seen other IEPs being written, or an admin has even instructed them to fill it out this way so that all the OT data can be in one concise place.
But what is important to remember is that the fine motor box isn’t a mini OT eval. Federally, you are not required to complete an annual OT eval on students. Instead, you should be reporting progress on their previous goals as well as discussing what their current levels of functional performance are. But sometimes, it takes advocacy and education on your part to help your admin or supervisor understand this.
What To Do Instead
So, if you’ve been doing this, don’t beat yourself up! You didn’t know any better. But now that you do, it’s your duty to start making those small, systematic changes. Which means that you should start filling out the Present Levels boxes that actually go with the things you’re addressing. These boxes look different in every state and even district to district, but generically, you may also want to consider filling out boxes titled things like “Gross Motor Skills” “Adaptive/Life Skills” “Social-Emotional” or even “Other.” You may need to fill out multiple boxes, and that’s okay. You may even fill out a box that another provider will comment in as well, and that’s also okay.
If this sounds like a big change for you, you may want to give your admin or case managers a heads up beforehand so they can know what to expect. Sometimes, you may get pushback. If that’s the case for you, a good compromise may be attaching a mini “progress note,” so to speak, to the IEP. This is not a federal requirement beyond what you already have to do to report progress on goals, but if your admin wants a paragraph that updates the team on just OT, this can be a good way to transition. You can simply type this up in a Google Doc and then attach it to the IEP – that way the Present Levels can remain organized and accurate. Again, this is not a legal requirement and technically all of this information should be captured somewhere on the IEP between Present Levels, Goals, Services, and Accommodations, so I wouldn’t recommend creating more work for yourself unless this is what you have to do to transition.
This process may take time and education for other staff, but this is such a worthwhile change that can have a bigger impact than you’d expect. All of these small changes lead to bigger conversations that help occupational therapy be respected, utilized, and understood in the school system. If you have any questions about how to make this shift, I would love to have you join me in my Facebook group where I offer support to other school-based OTs looking to have a more effective and impactful practice.
Looking to make even bigger changes? My course, The Dynamic School OT, is the perfect fit for OTs who want to be known as more than the fine motor therapist or handwriting teacher. It takes an in-depth look at tricky situations like this one, as well as evaluation, appropriate interventions, IEP meetings, and much more. Click here to learn more!