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Question and Answers – Taking Care of Business Column – out on May 24, 2010 OT Advance
Q. There are definitely students within my district that struggle with fine motor skill development. Unfortunately, it is the only area of impairment and the district is very strict about meeting requirements for a 504 plan. I would love to have an opportunity to provide intervention for this type of child, but feel that legally I didn’t have the grounds to do so.
A. For starters, I just want to review the difference between an IEP and entitlements under 504. Terri Mauro, author of 50 Ways to Support Your Child’s Special Education offers a good succinct differentiation. A 504 plan falls under the Civil Rights laws. “504″ refers to Section 504 of the Rehabilitation Act and the American with Disabilities Act, which specifies that no one with a disability can be excluded from participating in federally funded programs or activities, including elementary, secondary or postsecondary schooling. It is designed to attempt to remove barriers and allow students with disabilities to participate freely in education. Like the ADA, it seeks to level the playing field so that those students can safely pursue the same opportunities as everyone else. A 504 plan spells out the modifications and accommodations that will be needed for these students to have an opportunity perform at the same level as their peers. This could include things like a wheelchair ramps, blood sugar monitoring, an extra set of textbooks, a peanut free lunch environment, home instruction, or a tape recorder or keyboard for taking notes.
An IEP falls under the Individuals with Disabilities Education Act, and is much more concerned with actually providing educational services. Students eligible for an Individualized Education Plan, represent a small subset of all students with disabilities. They generally require more than a level playing field, and usually significant remediation and assistance. Only certain classifications of disability are eligible for an IEP, and students who do not meet those classifications but still require some assistance to be able to participate fully in school may be candidates for a 504 plan.
It is entirely possible that students with grasp, fine motor and handwriting issues may not be eligible for federally funded OT services through 504 or an IEP, but as we all know, it does not mean that services are not indicated. There are school districts who opt to hire therapists directly through a “miscellaneous” budget line, a grant, money raised by the PTA specifically for handwriting groups or privately, by parents. Unless a therapist is in a school district under a contract that forbids this, an OT can certainly pursue this opportunity. This should still be regarded as providing occupational therapy services, and in states that require it, an OT should still get an MD prescription, and have malpractice insurance in place prior to beginning services.
Q. As an OT trying to build a private practice, I want to encourage potential patients to contact me to ask questions, and am considering an “Ask the Therapist” link for patients to use on my website. Is this okay to do?
A. Great question. I always encourage therapists to make their websites active and not passive, to build in ways to instantly interact with patients, and set the tone of the relationship. Having an “Ask the Therapist” link, or just offering your email address as a place to send questions, is one way to get the ball rolling. It also eliminates at least one round of “phone tag”. However, how you answer any question posed to you via emails very important.
From a risk management viewpoint, vulnerability for malpractice exists with every interaction a therapist has with a patient, and an email exchange is considered a legitimate interaction. So the answer you offer a potential patient has to be carefully tailored to the question, and should remain reasonably general in nature. You can certainly offer information about treatment you might suggest, what you have offered similar type patients etc., but you certainly would not want to give specific treatment recommendations or exercises for a patient to try on their own. The prudent answer in most cases is to suggest that the patient come in for an evaluation or first contact their doctor depending on state regulations. The following list of additional risks associated with electronic communications for health professionals were compiled by MD Anderson Hospital, and are worth mentioning.
Emails:
- can be copied, circulated, forwarded, and stored in paper and electronic files.
- can be accidentally or intentionally immediately broadcast worldwide and received by many unintended recipients.
-are easier to falsify than handwritten or signed documents.
-backup copies of email, may exist even after the originator or recipient has deleted his or her own copy.
-employers and online services have a right to archive and inspect e-mails transmitted through their systems.
-emails are discoverable and can be used as evidence in court.
-emails can be misinterpreted.
- emails may not be answered in the time frame expected by the sender.
SAVE THE DATE: LEGAL FORUM FOR PRIVATE PRACTITIONERS – Sep15 2010, NYC 6-9 PM: for details and to register, visit www.nytherapyguide.com.
Iris Kimberg MS PT, OTR, has worked in the non-clinical aspect of therapy for the past 27 years. She is the founder of NY Therapy Guide (www.nytherapyguide.com), a site dedicated to the growth, viability and success of therapists in private practice. Iris offers workshops, workbooks and private consultations on business topics related to private practice. She teaches Marketing and Entrepreneurship in the DPT Program at Columbia University, and writes the Taking Care of Business Column for Merion Publications. Iris can be reached at infonytherapy@aol.com.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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