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Occupational therapy (OT) and physical therapy (PT) are related services that are provided under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 20 U.S.C. 1400 et seq.). Related services are provided under the IDEA to assist children with disabilities to benefit from special education. Nationally, there is a critical shortage of qualified personnel to provide related services in schools. Due to budget constraints, public school systems also experience challenges in competing with medical facilities to hire these personnel. Due to this combination of the critical shortage of qualified personnel and budgetary constraints, public school systems often times operate with staffing shortages. Therefore, it is important to develop evidence based practices that facilitate the efficient utilization of both personnel time and talent to provide these services in schools. To contribute to this evidence, the researcher investigated change in how OT and PT service providers utilized time in a large urban school district across four school years. These years are consistent with the years investigated by Goodrich, Hawkins, Burridge, and White (2009), who reported an increase across these years in the number of appropriate as opposed to inappropriate referrals generated for OT and PT services in this school district. In the later three years, three interventions designed to facilitate appropriate referrals were implemented. The interventions included training on using an education based decision making process when generating a referral, a modified referral form to guide campus personnel through using an education based decision making process, and the addition of a classroom based support service to the continuum of services provided by OT and PT services. In the current study, a longitudinal analysis was conducted to measure if a significant change occurred in the proportion of time OT and PT service providers spent in various activities performed as a part of their work responsibilities when the increase in the proportion of appropriate referrals was reported. Therapy personnel increased the time spent in providing campus or classroom based support services and in travel. Time spent in providing screening and evaluation services remained stable across the years. The interventions implemented in this school district across these four years were supported as effective practices to improve the efficient utilization of OT and PT services provided in schools. These personnel were able to increase the proportion of time they were able to spend in providing the campus or classroom based support services, offering a proactive model of support in addition to the reactionary, referral driven, model. The referral process improved because less, more appropriate referrals were generated by campus teams (Goodrich, et al. 2009) the time spent in responding to these referrals remained relatively consistent across these years. This time was spent in responding to more appropriate referrals as opposed to being unnecessarily expended to respond to inappropriate referrals. In addition to these two changes in how these service personnel spent time across these years, the number of children recommended to receive OT and/or PT services as a part of the child’s IEP increased.

Special education, Occupational Therapy, Physical Therapy, Related Services, School Based Practice