OPTIMIZING CARE FOR THE MEDICALLY COMPLEX STUDENT - FROM ASSESSMENT TO INTERVENTION: A SPECIAL INTEREST REPORT

Purpose: Advancements in prenatal, neonatal, and pediatric medicine have increased the number of children entering the educational system with diverse medical complexities. Many of these children utilize physical therapy services to facilitate access to their educational environment. However, existing literature is lacking comprehensive guidance for the school-based physical therapist (SBPT) working with medically complex students. This presentation addresses the gap in literature by proposing a framework for physical therapists in this context.

Description: This presentation illustrates a framework aligning with the practice expectations outlined in the Physical Therapy Description of Specialty Practice for Pediatrics (DSP). The framework consists of three steps: assessment, goal development, and intervention.
Assessment aligns with the DSP section on examination, including history, systems review and tests and measures. With the medically complex student it is paramount to conduct a thorough assessment of the whole child, including insight from as many members of the student’s team as possible to capture different skill areas. It is also essential to include observational assessment within the student’s natural school environment. Criterion-referenced assessments provide insight into the student and their progress, rather than highlighting only impairments.
The second step of the framework is goal development, aligning with the DSP sections of evaluation, diagnosis, and prognosis. In this step the SBPT must interpret examination findings to identify activity limitations and impairments, as well as predicting the capacity for improvement based on current strengths and abilities. Goals should be developed as part of a collaborative process including the student, family, and school team.
The final step aligns with interventions and outcomes in the DSP. Interventions include not only direct individualized services, but team collaboration, push-in services, group sessions, and family consultation. Scheduling to maximize alertness and participation throughout the school day is crucial for students with medical complexity. SBPTs can increase participation by emphasizing fun, meaningful activities for the student based on their interests.

Summary of Use: SBPTs are responsible for the examination, evaluation, goal development, and plans of care for students with barriers to access. The framework first delineates the steps and information required for an inclusive assessment, then continues to utilize the results for development of relevant goals and interventions that will foster success.

Importance to Members: Fostering a proactive, inclusive, and integrative approach to physical therapy management for medically complex students ensures educational access for all. This presentation empowers SBPTs to effectively support students of all medical backgrounds by offering a framework that is easily implemented and has no associated costs. This special interest report outlines essential steps to empower school-based clinicians in guiding medically complex students towards not only educational access, but meaningful educational success.