pull-out vs. home services?

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Registered: 03-31-2003
pull-out vs. home services?
8
Wed, 11-02-2005 - 10:35am

Sylvia just had a PT eval this morning, and the evaluator said that, without even scoring her officially, she could tell me that Sylvia absolutely qualifies for PT. I think PT will be a very good thing for her, but I'm just concerned as to how all this is going to fit into her day.

Currently she attends preschool M-F, 8:45-11:15am. She gets speech 3x30 and OT 2x30, so basically every day she's pulled out of class for 1/2 hour for some kind of therapy. She's in a self-contained class (12:1:1) so she gets lots of support in the classroom as well -- but more than that, she absolutely LOVES school, LOVES her teacher, LOVES being in the class.

I don't know yet how much PT they're going to recommend that she have, but I guess what I'm concerned about is her getting pulled out of class so much that she misses much of the school day. I know that all of her services are extremely important, but I also think it's extremely important for her to have the daily interaction with her teacher and peers, and I'd hate for that to be sacrified. She especially adores circle time and music time, and I know she'd be so disappointed if she regularly missed that. It is a special ed class, and I think that pretty much all the kids are pulled out for therapy to a greater or lesser extent, so I'm sure they know how to handle it, but I'm just worried... She does *so* well at school -- it just makes her so happy to be there -- and for a kid who's always been really anxious in social situations, that's a huge thing. I want to keep the momentum going in that area as well as get her all the services she needs, but I'm not sure how that will work.

The other option is to contract for therapy outside of school. Since it's PT I don't know that we'd be able to get home services -- probably we'd have to take her to another site. But that's a tricky option, too -- first of all because I do have a 2 year old son who would have to be dragged along to all the PT sessions if they were in the afternoon. Then, too, while Sylvia doesn't nap anymore, she desperately needs a long stretch of quiet time after lunch. She's exhausted -- both physically and emotionally -- when she comes home from school each day, and after lunch she runs up to her room for quiet time. I read her a story and she hangs out in her room literally for 90 minutes, reading books, playing quiet games, etc. And her brother still NEEDS his nap, so any services would have to take place at 3:30pm or later -- and of course, the later in the afternoon we get, the more tired and cranky Sylvia gets. I also worry about "overbooking" her -- it is a great effort for her to hold it together when she's around other people, and I worry that PT in the afternoon on top of school all morning would really overwhelm and overburden her.

As you can see, I'm TOTALLY overthinking this!!! But I was curious how you all handled the various therapies your kids receive. How much time is reasonable to be pulled away from class, in a 2.5-hour day? Do you feel, in general, that it's better to receive services at school? Like I said, I don't even know if receiving services outside of school is an option for us -- but I wanted to have lots of information on hand before I went into the meeting with the CPSE (which probably won't take place until after Thanksgiving).

Thanks, and sorry for the long and rambling post...

Jennifer :)

iVillage Member
Registered: 03-26-2003
Wed, 11-02-2005 - 12:13pm

relax! we have it easy here in rochester.

yes, PT can be done at your home. the advantage of having it at school is the motor room equipment is there. what are the main PT concerns? how does she do with her other pull out services?

I really like the PT at EIECC. Matt gets services there. i now work for an agency in the area that provides services for birth through 5 and we have PT's. i think it's nice having a balance of services at home and school. most agree that ~20-25 hours of services total a week is ideal, but it's what your comfortable with. i can give you some names if you email me off board.

also, PT is usually only 1x60 in most cases, maybe 2x60. so it might not interrupt home life too much.

valerie

~Valerie
iVillage Member
Registered: 06-25-2003
Wed, 11-02-2005 - 12:38pm

Jennifer
Another one from NYS, I see. Well, CPSE won't provide services at home. (I've tried), so you would be springing for therapy privately, and most insurance only covers so many sessions per year. Private PT is pricey.

Is your CPSE chair approachable? Mine was, and I would bring these issues up before the meetings and we would think of solutions together. I know many would advise you not to show your hand, but an open and honest approach worked well for me.

I can think of some suggestions to make the day workable for her:

Change some of the speech and/or OT sessions to push-in, rather than pull-out, and add the PT sessions as pull out (You can't really push PT in)

Extend the school day 2 or 3 times (whatever the recommendation) each week to have PT sessions before or after class

HTH and good luck,

-Paula

-Paula

visit my blog at www.onesickmother.com
iVillage Member
Registered: 03-26-2003
Wed, 11-02-2005 - 5:08pm

actually, we do get home services in monroe county, ny.

my son gets...

12.5 hours/week at school with 2x30 speech, 2x30 ot, and 1x30 Pt there.

home we get 3x60 seit, 3x60 speech, and 3x60 OT plus 1x60 psych consult per week.

but it's not like that up in syracuse.

valerie

~Valerie
iVillage Member
Registered: 03-26-2003
Wed, 11-02-2005 - 9:14pm

Ok, I am not a new yorker and I don't know your situation, but...would it be possible for them to do her therapy right after school and for you to pick her up a bit late? I asked for this when my daughter was in K so she wouldn't miss academic time and as long as I did the transporting they were totally cool with it. So instead of picking her up at the regular pick up time I picked her up a 1/2 hour late on those days. It just happened to work with the schedule of those at the school. But it is at least worth a try.

If not the other option is to ask for full day preschool adn she only be pulled out during one half of it so she has the other half completly in the class.

Renee

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Registered: 03-31-2003
Thu, 11-03-2005 - 10:23am

Thanks SO much for all your replies. It's nice to know that we do have some options here... I'd like to go into the meeting from a position of knowing everything that's available. I do think it might be a good idea to try to call the chair of the CPSE before the meeting; I've had good interactions with her in the past, and I think I'll have better luck if I don't spring my concerns on her during the meeting itself.

I actually have a parent-teacher conference scheduled with Sylvia's teacher for Monday, so I think the first thing I'll do is talk to her teacher about all this, find out what she thinks Sylvia might be able to handle, etc. Then, once I get the report back from the eval, I'll call the CPSE chair.

I guess so much of this depends on how much PT they recommend she have. If it's 1x60, for example, doing it during school probably wouldn't be so bad. Anything more than that, though, and I think I'd want to look into other options. I don't believe her preschool does full-day, and I'm not sure that's the best option at this point anyway -- it's been a HUGE adjustment for her to just go M-F all morning, and I don't know that she's ready for full-day. But I'd certainly consider at-home services, or even taking her to another location (or perhaps back to the school) one or two afternoons a week for PT...

Jennifer

iVillage Member
Registered: 10-13-2004
Thu, 11-03-2005 - 11:36pm

When my son was in preschool, I made sure that he had the absolute MINIMUM therapy that we could get by on. Generally, I would do a bit of speech and then give it a break. Then I'd do some OT and give it a break. I worried that he'll be overwhelmed with therapies and it would have adverse effects on him. It was quite a mish-mash way of doing things, but it worked well for us. And he had time to just be a kid - which to me is the most important thing.

So, if I were you, I'd be cutting back on one of the existing services and slotting the PT in the newly made gap.

Dress Up Games, Doll Makers and Cartoon Dolls @ The Doll Palace
iVillage Member
Registered: 10-03-2004
Fri, 11-04-2005 - 5:41am

And we did the opposite with many therapies, but then every child is different. Malcolm had lots and lots of therapies, but that hasn't stopped him from just being a kid. We also scheduled many hours of playdates. He has had lots of help, but now at 8 he is able to play for hours and hours with his friends, is way ahead of grade level academically, is learning more and more about interacting with the world. And now he doesn't do as many therapies as he does activites he enjoys, Tae Kwondo, horseback riding, swimming, chess club.

You know your daughter best and whether more therapy would be too much for her. We found that our son was thirsty for learning and working on areas he had difficulty with, and that all the therapies really helped him become more of himself.

yours,

Sara
ilovemalcolm

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Registered: 03-31-2003
Fri, 11-04-2005 - 1:27pm

You know, I actually thought of bringing this up during the IEP meeting... Sylvia tends to be very intense when she's learning, and focusing for extended periods of time really exhausts her. That's what I'm really worried about: that she'll be overwhelmed if we schedule too much therapy for her. But then again, I'd hate to deprive her of something that will be good for her... It seems like a balancing act.

I guess these are all good things to bring up when I meet with her teacher on Monday. I believe her ST and OT will also be at the conference, so it will be a good opportunity for me to figure out how she's doing with all her therapies, in class, etc., and how much more everyone thinks she'll be able to handle.

Jennifer