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The SPD Companion, Issue #020-- Sensory Integrative OT...What You Need To Know Before Starting
November 01, 2007
Welcome to the 20th edition of The SPD Companion Newsletter.
As I have previously mentioned in the Finding An Occupational Therapist For SPD newsletter (make sure you read that in addition to this one, if you haven't already), you are most likely going to want a SIPT Certified OT to do the actual evaluation. These therapists have additional training on how to administer the only comprehensive, standardized evaluation we have at this point in time to most accurately diagnose Sensory Processing Disorders. That said, there are other tests that can/are used very successfully to diagnose SPD, and there are therapists who are not SIPT certified who can do a wonderful job diagnosing SPD! I want to clear this up a little, as it can be confusing!
The first thing I want to talk about is what it means to be a SIPT Certified OT. To be certified, an Occupational Therapist will take four intensive (and expensive!)courses, each being 5 days long. Upon completion of the Sensory Integration certification courses, they will be able to administer, score, and interpret the SIPT evaluation, as well as provide treatment based on SI theory. SIPT stands for Sensory Integration And Praxis Test. It was created and standardized through the work of A. Jean Ayers, the “founder” of Sensory Integration and Sensory Processing Disorder theories and treatment techniques. It is the most comprehensive evaluation we have to date, however, as I mentioned, there are others that are/can be used. I will discuss The SIPT evluation and these in detail in another article, however, you will find links to most of the additional tests within this article. Also note, there is one limitation of the SIPT... it is only standardized for children ages 4-8. Therefore, if someone does not fall in these age ranges, other assessments will indeed need to be used.
At this point, in the educational system for OT's, there is not extensive training in sensory integration theories and sensory processing diagnosis and treatment at the undergraduate level. Additional graduate courses must be taken and mentoring by an experienced and SIPT certified OT will be critical. There are a few courses that are offered, which you can find information on at: USC's website about Occupational Science And Occupational Therapy . It is more of a specialty that OT's pursue additional training in, after or before, they graduate through seminars, conferences, fieldwork, etc. It is taught some in their schooling and training, but extensive knowledge is usually gained through personal study, additional experience and courses outside of the basic college experience. So, it will be important to find out what additional training and experience your OT has had regarding Sensory Integration theories and practice. At this point, you can become SIPT certified and SI certified if you are an Occupational Therapist, Physical Therapist, or Speech Language Pathologist, if you complete the courses. So, it is possible to be evaluated and treated by other disciplines under this capacity, but is most often done through an OT.
Also, know that an OT who is not SIPT certified, may have extensive training regarding other evaluation tools and specific treatment techniques and programs which can make them as good, or even better, than some SIPT certified OT's. It will be up to you to find out. However, the current standards of best practices call for having SI certification to be considered competent in evaluating and treating individuals with SPD. You can find out more about guidelines for competency in the application of SI theory at: http://www.sinetwork.org/aboutspd/guidelines.html.
So... How DO you decide; how do you know if your therapist is the right one? Before they interview you, interview them! You will be spending a lot of time and money (especially if your insurance doesn't pay for it... ah, that is being worked on too!). It is in your best interest to make sure you get the best treatment your money can buy. Here are some questions you may want to ask/get answers to from a potential Occupational Therapist...
Finding a therapist who can not only answer these questions thoroughly and show that they are trained in many of these areas, and who will get you involved as much as possible will be the best thing for you. Also, make sure your personalities match and they will be able to develop a good working relationship with both you and your child. This is incredibly important!
Just as you will have high expectations for your therapist, you will also have to have high expectations of yourself as you get involved in therapy! It is a two way street for sure! If your child has SPD, you will need to get an “honorary OT degree” (that's what I like to call it, anyway). As a parent, you will need to know what your therapist knows. You will have to do your own research, listen to and learn from the therapy sessions, incorporate a sensory diet into every day life, be willing to learn new programs, make therapy a priority for a few months to a year or more, ask about and understand the basic concepts and theories behind sensory processing on the deepest level you can possibly comprehend. It is intensive and a learning process. One you must be willing to take on... for the sake of your child!
What will NOT work (and believe me, we have seen this over and over!) will be to blindly pick any OT, just expect the school system to address it on their own, not do any follow through at home, not ask questions about how SPD specifically affects your child, just show up at therapy once a week to get out of the house and read a magazine in the waiting room – thinking therapy is done for the week, blaming the schools for not being a rehab center, etc. I can't stress this enough... you MUST be engaged, doing home programs, and actively learning throughout the process. If you are an adult in therapy, the same rules apply! You have to be ready and committed 100%.
Once you have done the research, made the calls, talked with the therapist/facility, etc. you will have an appointment set up. Make sure to ask them if they accept your insurance, how they will bill the insurance, whether you will have to pay anything up front, and what will be covered. Ask them what codes they use, so you can call your insurance to double check if it will indeed be paid for, or not. Also, ask your insurance company about any copayments, frequency of therapy, total number of sessions they will pay for per month/year, cost per OT session that they will cover, etc. so there are no surprises.
To find out what codes tend to be most acceptable to insurance companies for SPD, please read, Most Commonly Used Diagnostic Codes For SPD Evaluation and Treatment .
The good news here is that Sensory Processing Disorders have now become a medically diagnosable condition in one diagnostic manual, the ICDL. Their specific code listings can be found on the following PDF: http://www.kidfoundation.org/news/diagnosticcodes.pdf. And, when/if it is included in the DSM V, the next goal, (read The SPD Companion Issue # 9: Inclusion of SPD In The DSM V for more on this) it should cure (or significantly impact) the no insurance reimbursement blues. Also, understand the importance of the "official diagnosis" for proper, targeted, and effective treatment, as well as further insurance reimbursement for your child's treatment.
An increasing number of insurance companies are covering OT evaluations for SPD (if an alternative diagnostic code is used), but you should check with your insurance company first. If they don't cover it, you may be expected to pay upwards of $500-$1,000 dollars. I know this can be a huge financial burden, but isn't your child more important than an unexpected car repair? And we all find the money for that, don't we? This evaluation will NEED to be budgeted for, the same way other necessary expenses are. It will truly be money well spent to receive a thorough and proper evaluation and diagnosis!
Whether your insurance will pay, or not, be prepared financially for the possibility of additional costs. Get the evaluation done, but make sure you have budgeted for it! It needs to be a priority budget item, just as other expenses are. If it means giving up dinners out, cable tv, a cell phone, or new clothes for a few months or a year, then do it! Your child needs this as much as he needs any other “medicine” a doctor would prescribe. If your child is your priority, you will find a way to make the budget work... you will! If you need additional advice and resources to help financially, please read
Financial Help For Sensory Therapy And Products
The testing process is quite involved if done properly, as it should be! Testing should involve multiple disciplines (for input at the least, anyways), but can be done by one qualified professional such as an Occupational Therapist. It can be done within an early intervention program, school system, teaching hospital, children's hospital or at a special clinic that diagnoses and treats Sensory Integration / Sensory Processing Disorders. The following components should be included:
Questionnaires And Interviews
A good, thorough, proper diagnosis ALWAYS includes questionnaires and "interviews" for the child, family, teachers, other people and/or professionals who interact with the child. These questionnaires will be the first factor in deciding whether further evaluation is necessary and what tests will be used to evaluate the child. These questionnaires will be based on overall functioning, developmental milestones, and "behavioral" indicators of sensory dysfunction.
Generally speaking, the parents, a teacher, and/or another professional fill the questionnaire out, with or without the child's input. However, a child over 7 (or so) can answer the questions too, if they are able. During testing, the therapist will then ask the child further questions based on the information from these questionnaires. Make sure you fill out the SPD Checklist that is appropriate for the age of your child and take it with you to the evaluation. Choose from the following checklists:
SPD Checklist (for all ages).
The Child Developmental Checklist
Know that it will take MANY pairs of eyes and they should ALL be involved in the "questionnaire", interviewing, and gathering information process. So, any information you can get from anyone who is involved in the child's life in a variety of settings will be very helpful. We all see different things, and children act differently in different settings (especially kids with Sensory Processing Disorders!) based on MANY situational and environmental factors. So a thorough evaluation will include information on a child's "behaviors" in a variety of settings.
Standardized And Non-Standardized Tests
After collecting the historical, developmental, and health information they need, the evaluating therapist(s) will then take the child into a sensory room/testing area (ideally without the parent). Here, the therapist will have the child perform a series of tasks (all based on developmentally appropriate milestones) which can include any or all of the following skills:
The therapist will also present sensory input from all sensory systems; oral, olfactory, auditory, vestibular, proprioceptive, olfactory, and tactile. The therapist(s) will make observations regarding the child's reactions to, and processing of, all sensory input, and performance of developmental tasks during the entire evaluation. A parent can expect to wait 2 hours for the evaluation to be completed.
The deciding factors on which type of evaluations will be done include the following:
1. insurance reimbursement
2. whether the evaluating therapist is SIPT Certified
3. which disciplines are involved in the evaluation
4. what areas of dysfunction are being evaluated and causing concern
5. which assessments the therapist is trained in and has access to
Some of the assessments which may be used include the following:
(I will be writing more on the specifics of each of these tests and what they evaluate in future articles... for now, if you are an OT interested in finding out more about, or purchasing any of them, go to http://www.sensoryprocessingdisorders.com/occupational-therapy-assessments.html)
After the assessment is finished, the following will/should happen...
1. The OT will score and evaluate all findings, deciding which, if any, sensory systems are significantly impacted, and if so, how much, when, and why, etc.
2. A meeting with the parents, and child (if appropriate) or the adult that was evaluated will take place to report all results, concerns, and specifics of testing outcomes, and educate all those present on Sensory Processing Disorder as it relates to their child.
3. The therapist, the team, the child, parents and/or adult will agree on a plan; if the individual will have treatment, how much, how often, what the treatment will entail, any home or school programs, etc.
4. The therapist will then write and agree on goals/treatment with parents, adult, and/or child.
5. Treatment will begin once this is all in place, and not before.
You are entitled to and can expect to additionally receive a copy of the evaluation. Make sure you do get one.
Armed with this knowledge, understanding, and information... you should be ready! But, I can't stress enough how critical your involvement will be! You have to be willing to make some lifestyle changes and change some of your daily activities to make this therapy work. You will be asked to do things at home that require time and effort. In some cases, MAJOR time and effort. But, I know you are willing... you know how much your child is depending on you, don't you? I know you know you can't live like this anymore, and neither can your child. You need additional help, resources, support and a good solid plan. You need therapeutic intervention. You need OT. This is the ONLY way SPD can be treated effectively! Are you ready for the commitment? It may take months, it may take years, but it will decrease in intensity over time, as things get better. The first month or two will be the most intensive. Things may also get worse before they get better. Just a warning. Don't be alarmed... this proves his neurological system is changing. Hang on tight. Reach out for support. And be committed, no matter what.
Communication between you and your therapist will be critical! Make sure you are talking about how things are going at home, school, etc., any changes you are seeing (good or bad), what seems to be working, what doesn't, your successes and struggles. Be clear, be consistent, and communicate often and effectively. Make sure your therapist works WITH you, including you in every step of the process... educating you, helping you understand what is going on... the how, why, when, what, etc. Make sure you truly understand SPD and how it relates to your child's specific issues. This will be important for the rest of his life, and yours! Not sure how to explain SPD to your child? Then, please read,
Issue #7 of the SPD Companion: Explaining SPD To Your Child
I do hope this information has been helpful! Thank you for joining me again this month. Your time, interest and support are appreciated, as always!
Take good care.
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