Many times, an OT is part of an early intervention team, helping to establish eligibility through assessments utilizing standardized tests approved by the state.

“The OT will serve on the Individual Family Service Plan, especially if the child [showed] a need for OT due to delay or diagnosis in an area that affects function in oral motor, fine motor, as well as activities of daily living. For 0- to 3-year-old[s], that would include things like cooperating with and participating in bathing, dressing, brushing their teeth, combing their hair, and feeding,” explains Sheree York, PT, MS, PCS, director of the PT/OT department and EI program at Children’s Health System in Birmingham, Ala.

“The role of an OT is helping identify eligibility and the needs of the child in several areas, typically oral motor, fine motor, and activities of daily living. Then the OT provides intervention to support the family,” she notes.

Ideally, occupational therapists, physical therapists, and speech therapists work together in early intervention programs to effectively meet the needs of the child and family.

Addressing Needs

Children with autism, Down syndrome, cerebral palsy, ADHD, as well as premature infants are often in need of OT services. Some conditions, such as cerebral palsy, may not be diagnosed until after 1 to 2 years of age; however, a child may be in an early intervention program before the formal diagnosis. In other cases, children have developmental delays with no known cause.

For some children, the school setting provides an opportunity to receive OT. “Our program is an inclusive preschool [ages 3 to 5], with children who are in Head Start or Pre-K Counts … all in the same classroom. The therapists support the children throughout the school day during the classroom daily routine. Therapy in this type of setting looks natural. We blend therapy into whatever the child is doing and provide support as needed. There is no ‘pull-out’ therapy at our centers. In our 0 to 3 program, therapy is provided in the home and the community,” explains Siobhan Ideishi, an OT at KenCrest Services, the largest early intervention and preschool special needs service provider in the city of Philadelphia.

The length of time that an OT sees a child varies. Each state differs on how much therapy is authorized per child per week.

“In the state of Florida, most children are only authorized for one to two times per week. However, therapists may recommend above the given amount based on the child’s needs,” says Michele Lederhandler, MS, OTR/L, of Dimension Therapy in Davie, Fla.

Ideishi agrees that the frequency of OT depends on the child. “Children are typically seen by therapists for one half hour a week. A child [with more need] may receive services for an hour a week. If we engage the children in community group activities, they are getting repeated opportunities to practice the skills they need to,” she says.

A Family Affair

OTs often use strategies to increase family involvement and caregiver training for children. “For example, the therapist encourages parents/caregivers to observe therapy sessions and be proactive in their child's development. Other strategies include parent meetings; home program information/handouts; and communication via e-mail, telephone, and journal,” Lederhandler explains.

In the preschool setting, Ideishi says there are many opportunities for parental involvement.

“Parents are encouraged to volunteer in the classroom and join activities at the center, whether it is a morning exercise program or [accompanying] their child on a community outing. Parents are also provided with information regarding child development and activities to do with their child, which can enhance their child’s development,” she says.

“Children are continuously assessed during treatment sessions to determine progress within their areas of concern. The child's plan of care/goals are updated as needed until they are functioning at an age-appropriate level,” Lederhandler notes.

According to York, in many cases with the team therapy approach, the OT and team have specific goals as part of a plan, and the OT or team is required to re-evaluate every six to 12 months. “However, if the OT is seeing them more often, he or she is getting a feel if the plan is on track or if the goals need to be revised,” she says.

OTs often look to see how the family is coping. “At a time when the child is doing great, the OT may still need to be touching base with the family to see how they are doing,” York says.

“There is a point that if the child is not making progress and the family feels competent with the situation, the OT can step back. Therapy is not necessarily increased based only on progress because some of the diagnoses have pretty poor prognoses. The key is matching the needs of the child and family that you can affect, not going forever in the old traditional way,” she says.