Information Update Bulletin 97.07

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October 1997

TO:District Administrators, CESA Administrators, CHCEB Administrators, Directors of Special Education and Pupil Services, Building Principals, University and Technical College Faculty, Parents, and Other Interested Parties
FROM:Juanita S. Pawlisch, Ph.D., Assistant Superintendent
Division for Learning Support: Equity and Advocacy
SUBJECT:Systems Change Involving Occupational Therapy and Physical Therapy

For the past decade many Wisconsin school districts have struggled to fill occupational and physical therapy positions to serve children with disabilities. The Wisconsin Educator Supply and Demand Project has consistently reported a moderate to critical shortage of therapists in schools. In 1995, the Supply and Demand Project conducted a special survey of administrators of special education. Based on a survey return rate of 93 per cent, the data showed that 18 percent of school occupational therapist (OT) positions and 29 percent of school physical therapist (PT) positions took over six months to fill. In addition, 31 percent of OT positions and 61 percent of PT vacancies attracted only one applicant. A nationwide shortage of occupational and physical therapy personnel in all employment settings compounded the related services dilemma faced by Wisconsin schools. To complicate the dilemma, therapy personnel were typically educated and experienced in a medical model that was often inappropriate to educational service delivery in the least restrictive environment.

A number of efforts were made to address the issues. In 1993, chapters PI 3 and PI 11.24 of the Wisconsin Administrative Code were revised to create opportunities for occupational therapy assistants (OTA) and physical therapist assistants (PTA) to work in schools. The revision enlarged the pool of therapy personnel available to schools. A multi-CESA project disseminated Guidelines for OT and PT Assistants in a School Setting to help schools benefit fully from the revision. In 1996, the Department disseminated Occupational Therapy and Physical Therapy: A Resource and Planning Guide to all district administrators, directors of special education, and school OTs, PTs, OTAs and PTAs in the state. This was an effort to provide consistent information on school therapy to personnel from diverse backgrounds. In 1996, twenty accredited or developing programs educated future OTs, PTs, OTAs or PTAs in Wisconsin, an increase from twelve programs in 1992. National surveys began to predict that supply would meet demand by 2005. Still, many exceptional education programs could not find therapists who were available and prepared to work in schools.

Earlier this year the Department conducted four focus groups around the state. The focus groups consisted of school-based therapists, therapy assistants, directors of special education, and faculty from professional and technical college therapy programs in Wisconsin. The participants addressed the question, "what are the issues in the shortage of OT and PT personnel in schools?" The collective response to that question formed the basis for an action planning group to identify problem statements, goals, and strategies for a systems change in school OT and PT. The mission of this systems change is to ensure an ample number of physical therapy and occupational therapy personnel with competencies in school based practice, who will collaboratively provide services that enhance the educational programs of children with disabilities. The long-term goals include:

  • recruitment. School districts will be able to recruit occupational and physical therapists and assistants within a two month time period and will have more than one qualified applicant. Objectives within this goal are to (1) increase therapists' and therapy assistants' awareness of school based therapy as a career, (2) develop a centralized job information exchange between districts and therapists, and (3) increase administrative support for school based therapists and therapy assistants.
  • retention. Given activities that support job satisfaction and performance, the retention of school based OTs, PTs, OTAs and PTAs will increase. Objectives within this goal are to (1) orient existing school administrators and staff to school based occupational and physical therapy and unique retention strategies for therapy staff, (2) develop a statewide support network for school based OT and PT staff, (3) collect, generate, and disseminate guidelines and contract language that reflect competitive salary and fringe benefit packages for therapists and assistants in school based practice, and (4) ensure that information on the roles and responsibilities of therapists and assistants in school based practice is presented in all higher education institutions training therapists, assistants and teachers.
  • service delivery. IEPs and accommodation plans will be developed, implemented and evaluated in a collaborative system. Objectives within this goal are to (1) increase the knowledge and understanding of the roles and functions of therapists in schools for all stakeholders, (2) increase skills in collaboration for all persons who have a vested interest in a child's education, and (3) reexamine caseloads of therapists and assistants.

A systems change in the availability and delivery of OT and PT involves a wide array of stakeholders. The responsibility for achieving the goals of this mission lies not only with therapists and the Department, but with higher education, unions, school boards, and school administrators. Involvement of directors of special education and pupil services will be crucial for creating marketing strategies, supportive work environments, staff inservice training and compensation packages that make schools an attractive employment option. This is evident in the major factors identified by the focus groups as driving the unavailability of enough therapy personnel with school-based competencies:

  • Insufficient entry level training in school based practice.
  • School salaries and benefits that are not competitive in the therapy market, accompanied by a high cost to schools.
  • Lack of understanding of the roles of therapy personnel in schools among school administrators, third party payers, therapists, parents and the general public.
  • Inferior working conditions for therapy personnel in schools.
  • Excessive caseloads and conflicting job duties.

Systems change involves continuous change over several years. The State Superintendent has committed discretionary grant funds to CESA 1 to pilot a local project that promotes recruitment and retention of therapy personnel, investigation of therapy assessments linked to educational outcomes, OT and PT participation in team collaboration, and involvement of parents. CESA 1 is collaborating with the Department and other stakeholders to lay the groundwork for a statewide systems change by:

  • scheduling four regional workshops in the coming school year to teach school therapists to administer the School Function Assessment, a new outcome oriented evaluation tool;
  • networking with higher education about curriculum and fieldwork revisions that better prepare student therapists and assistants for teamwork in an educational model;
  • developing a statewide advisory committee representative of stakeholders;
  • participating with other discretionary grant recipients to align OT and PT related grants with goals of the system change; and
  • incorporating beneficial strategies from the pilot project into a summer institute for therapists and others who can facilitate statewide training.

Information on the OT and PT systems change project will continue to be disseminated through leadership conferences, professional meetings, and mailings. Questions regarding this bulletin should be directed to the Exceptional Education Team, Division for Learning Support: Equity and Advocacy, 125 South Webster Street, P.O. Box 7841, Madison, Wisconsin 53707-7841, (608) 266-1781 or TDD (608) 267-2427.