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Special Needs
Changes undermining children's care
Hi this is my first time posting her, I have been on the nest before for my wedding planning and after all the changes I had to make a new account and cut back on posting now that my husband and I decided to TTC I began lurking again on the bump. I am an occupational therapist and wanted to share with parents a change that is occurring in NYC that is impacting children with special needs, I know many of you may not be from NY but I hope you understand how these changes can impact families and help let the people in charge kow what they are doing is not fair.
I hope this is allowed if not I apologize.
The NYC DOE has decided to take away the parents right to choose a therapist for their child , they have told parents they can no longer continue receiving services from the providers they have used in the past and they waited until a few days before the school year began to let everyone know delaying a lot of children's start of services for this school year. This has affectd both school age and preschool aged children.
A petition has developed and it can be signed online here is the link. We thank anyone who signs and passes this information on.
Sorry to bother you but I will be around more often if anyone has any questions or comments please feel free to ask. I hope to learn from you guys as well to make me a better therapist and future parent.
This discussion has been closed.
Re: Changes undermining children's care
Hi! I'm from NYC and I'm a little confused too. With everything going through the school system, my understanding is that the therapist was whomever the school had on staff - it never even occurred to me that I'd have a choice in the matter. It's kind of like teachers - you don't get to choose. It is what it is.
Can you maybe clarify what's going on a little?
Thanks
This is for therapists who provide services through the state/city. In NYC all children ages 3-5 who are determined to need services are provided these services from the city and you were always permitted to choose from any therapist approved by the city's dept of education, preschools do not employee therapists unless they are mandated by the state to do so and the are only programs that are special education programs, in this case unfortunately you are provided services from whatever therapist is on staff however if you felt your child wasn't getting all of the mandated services or saw a regression you had the option to receive services outside of the program from a choice of therapists approved by the city (kind of like choosing a doctor from a list of approved providers for your specific insurance) Children are not required to go to preschool and most preschools are private and are required to supply therapists.
It also affects children of school age 5 -21 if your child's school does not have a therapist, there is a shortage, or if the parent has received an order to have all services provided outside of school, or if the child attends private school the parents would have an option to choose a therapist from the list of approved providers.
The new changes take all of this away they now say you need t g to one large staffing agency and take whatever therapist they provide you, before now you could go to any agency, for example the place closest to your house and could ask for a therapist specialized in a particular treatment or tour the facilit and see if they have equipment recommended for you child or something that would emphasive and continue what ei was working towards. Now they can not.
Maxandruby - where you are you have no choices when it comes to therapists for ei or preschool?
For auntie, in NYC you are no longer allowed to specific in an IEP this is why we find taking away parents choice is so detrimental, if your son was diagnosed with apraxia and you have tried all kids of techniques and know that prompt therapy is the only thing that has worked they can assign you a therapist with no prompt training and you have no leg to stands on because therapists are being told no specific techniques can be put onto the IEP
I am the first one to agree that sometimes new blood is best but shouldnt it be your choice whether or not you want new blood? If you child has continue to make good steady progress why should your child be taken away from that therapist without notice and moved to someone else when that therapist is still available? Not everyone's an afford to pay out of pocket or has insurance to have the option of going elsewhere.
Every therapist has strengths and weaknesses and if they tell you differently they are not being honest, I know my skill set is much stronger with a particular population then with others with the old system I was able to let parent snow that I have very little experience with this situation and would be willing to educate myself and try my best but I know mrs J has been working with this population and has lots of different techniques, wouldn't you rather see mrs J now therapists aren't even given the option to turn down a case as these staffing agencies won't permit it.
Also for auntie sorry I don't know how to add to my old post
In NYC they only care if the therapists are licensed whether they have training in specific techniques is not of concern to the DOE, they only have to provide mandated services not QUALITY services, they have made this clear so as long as you are licensed you should be able to treat anyone.
Auntie I understand what you are saying that rest of the country runs this way, other states around here it doesn't and in some states it does. But you have pointed out many situation where your son wasn't getting the best services just because the system runs that way by you why wouldn't you want to help other children who could get better treatment?
This system was changed with no notice to parents why shouldn't they fight back for what they always had? What's the worst that could happen they don't change it back at least they took the chance and tried to bring it back, because 20 years ago they tried implementing this system and the parents and therapist fought it and up until this year they had won.
I agree that continuing education can benefit every therapist and in some professions it is a requirement to do but therapist also work, they are not reimbursed to take these courses and courses aren't offered everywhere so you can't be trained in everything you can only do your best with what you have and sometimes that isn't enough. As for a doctorate level I know in the OT field that is what they are working towards however I have been around PTs with a doctorate level education who seem to know less about PT then I do, school can not teach you everything, I don't think it is bad but it is not the answer to the problem, in my opinion continuing education courses are far more beneficial. I looked into my doctorate level work to receive it I don't learn any new treatment techniques or about specific populations, I learn about research and one specific thesis topic I would have to research and implement. But honestly with all the budget cuts in this field students can barely find employment that allows them to pay back current student loans, the income is not changing to accomodate additional schooling, though it shouldn't be it is a factor if more schooling is required the income needs to reflect the expenses - with this new system therapists received a pay cut of 28%, for me this isn't about the money it is about the children though I have worked with a child for a number of years and each year he continues to show great progress, prior to starting with me he had not shown any progress with the same therapist for 2 years he had actually regressed in his skills, this child is non verbal and does not have a communication device it took me almost a year to understand his sounds to know what meant he had to go to the bathroom, he need a drink etc. now because they took the choice away from his mother he will go to a new therapist who will spend a year figuring out what this child's trying to communicate with her instead of continuing to work on the skills we have achieved and working to achieve. I learned that if you don't understand him he will have an accident in his pants, taking away from therapy time, if you can't get him a drink he has issues with his kidneys forcing him to miss sessions, he shows frustration when he is not understood and performs very differently and all of this takes away from the time he should be recieving therapy, this child will now receives services from someone at the same level as me not a DOE employee inside of school, but at his home after school the same exact way I treated him why shouldn't mom get to choose who provides the services? Right now two here weeks from when services should have started they still don't have all services because the staffing agency is still trying to figure out how to schedule, but everyone of his therapists from last year were ready to start the first day.
I know this is not the opinion you as a therapist want to hear, but as both a teacher and a parent of a SN child, I do not think that parents should choose which therapists they want when getting it through the state. If a parent wants to choose the specific individuals that work with his/her child, then they have the option to hire private therapists. If therapists are unhappy with the state requirements of continuing education and the pay, then they also have the option to turn to the private sector.
I understand you are frustrated, but the government is not required to give parents a choice, but only to provide access to those services.
I had no idea our PT only had an associates degree. It's not that she was a bad PT, but why should the city pay the same rate per hour of therapy for someone with an associates degree versus someone with a Bach or Masters? We now have a PT with a Master's. I have already seen the difference in one visit and I feel a bit more comfortable asking her questions about Nate's gross motor development.
My child has received services in both CT and TX, and we didn't get to choose which therapist we wanted from a list. We got who we got based on who was in the school and available. So far (knock on wood) we have been fortunate to have gotten placed with some amazing therapists and teachers, except for our current OT who sucks - but I'm addressing that now w/ private services. It sounds like the folks in NYC have been enjoying a level service that basically the rest of the country has not.
So while I totally 100% understand why people would be upset, what they have had has been a pretty sweet thing and having that taken away would upset me too. And your example about the student you've gotten to know over the years now thrown in with another therapist who doesn't know him etc, totally blows (and that does, I'm not minimizing that at ALL) - its just what the rest of us have been dealing with all along.
Also - from a business / financial point of view. I have no idea how NYC has been able to scale and manage services using that format until now. And how do they manage who gets "first dibs" over the good therapists? I imagine they have therapists who are in high demand and those we aren't - how do they decide who gets to choose first?
Anyway, good luck with your fight. I'll be intetested to see how it works out.
ETA: And I just read the artciles Auntie posted. Obviously the system needs to be changed, that is a broken system and if I were a taxpayer in NYC I would be outraged that that has gone on for as long as it has. And as a Mom of a SN kid I would be FURIOUS at those providers for defrauding the government in the name of helping kids with disabilites. Making money off of them. That is shameful and there is a special place in hell for people like that.
After posting on this board I am more aware that other parents don't get a right I truly believe they deserve but the few states around us run the same way at the preschool level, at the school age level all children get whoever comes along good or bad unless the parents see a regression in progress and they are allowed to choose an outside provider.
It is sad for me as a provider who dedicates everything I can to each child I service to hear that parents have to accept inadequate services just because the state says so. Honestly it goes against everything this profession fights to achieve, like I said before I am the first to let a parent know if I don't feel the child and I mesh well together for whatever reason I would never keep them on my caseload to make money I would refer them to someone I think would be a better fit, it is only fair for the child to receive the best services they can get.
As for how the system worked before every therapist was screened by the DOE and placed on a provider list and parents were provided this list along with reccomendations for therapists most parents would choose the place closest to them and see if ma therapist fit their child's needs and worked from there and parents found references. Of course some people just choose any random person. As for who choose it was the parent who choose someone else didn't tell them you can have this good therapist or you need to take is bad therapist, better therapists tend to be filled first because they have the reputation to support it and other therapist followed it actually encouraged a better system overall because therapists worked harder rather then just being given cases. And at anytime if you were dissatisfied with your therapist you just went and found a new one.
the new system you as a parent are told your child gets services, your child's information (name, phone number, and availability) is sent to the primary agency a staffing company who puts your information into a computer the computer tells them which therapist is available at the same times you need and now you have a therapist - they don't spend time knowing what your child's goals are, parents concerns, and special accommodations your child needs. And the therapists who ran to these staffing companies for decreased pay are the therapists who would have to wait the longest for kids ( therapist who didn't put the effort into building a positive reputation)
As for the article Auntie posted lie I said above these companies who committ this fraud are the companies who have been given first rights to the children of NYC. These are only a small part of the agencies caught committing fraud and most of the ones who provide these related sevrvices are not included in these articles. 10 companies who have been proven to have committed hundreds of thousands of dollars in fraud prior to this system were awarded "first dibs" on these cases this year, while on a payment plan to pay back money to the DOE. The small business who are reputable follow the rules and strive to hire reputable and professional therapists are being pushed out. Who would you want servicing your children?
Also just to clarify the changes that are bing made haven't cut the costs of these programs, they have cut the rates provided to the therapists but the agencies are recieving larger profits and it has only delayed children recieving services these agencies were ill prepared to be awarded these bids and many children including several special needs schools have no therapists three weeks after school started.
This is what we are fighting against - if parents had the right to choose therapists these kids would be recieving services today, therapists understand budget cuts and most are willing to take a slight decrease in pay but don't find it fair that they are recieving all of the cut while these large agencies are increasing profits.