The goal of occupational therapy is to assist people with a disability to reach their maximum level of function and independence in all aspects of daily life through the use of meaningful activities. For a child with a disability, occupational therapy can influence maturation of skills while facilitating understanding of abilities and needs. Private practice in paediatrics is a growing field of practice in New Zealand (Sloggett, Kim, & Cameron, 2003) perhaps because practitioners are not restricted to service areas or criteria specified by Government organisations. In addition, therapeutic intervention can take place in the child's home, in a clinic, or in a school or preschool environment. Whereas therapists who work for District Health Boards or for the Ministry of Education aim to meet the needs of the child and encourage transference of skills, at times they are limited in what can be achieved by a lack of resources. An outline of both services follows along with an introduction to privately funded therapy.
Provision of occupational therapy services for children
Occupational therapy services are generally available to school aged children through Government funding by the Ministries of Health and Education. Similarly, children who have been involved in an accident may be entitled to occupational therapy services through the Accident Compensation Corporation. For funding to be considered under the Moderate Physical Needs Contract, available through the Ministry of Education, children are required to have physical difficulties which impact on their ability to access, participate and learn within the school environment. (Ministry of Education, 2008). These children must be referred by teachers in consultation with parents and the application must be signed by the school principal. Under this contract, an occupational therapist would assess the child, document observations, sets goals and provide recommendations for environmental or activity modifications. Ongoing weekly therapy services are generally not provided. Schools are required to provide any additional support by way of a teacher aide and this has to be recommended for the child.
In the Auckland region, a needs assessment must be completed prior to the child being referred to the health agencies such as the Child Development Service. The needs assessment can then be carried out if the child has a confirmed diagnosis from a specialist and/or if they meet the Ministry of Health's criteria for eligibility. For children over five years of age who meet the funding criteria occupational therapists working under the Child Development Service usually participate in the assessment process, the provision of equipment, and housing modification.
An alternative to Government funded therapy is privately funded occupational therapy. Private therapy usually offers personalised therapy sessions on a regular basis which can vary between twice weekly, weekly or fortnightly. An occupational therapist in private practice will work with the child to provide ongoing support and skill acquisition, assessment and evaluation through engagement in activities. The therapist frequently acts as an intermediary between family members, and educational personnel, to discuss concerns that arise. A private therapist working closely with a child can provide information and support outside of specifications, to both parents and teachers. Information about therapy provision and strategies can be shared whether they relate to home or school environments. In public services, therapy provision is often restricted by contract requirements, funding criteria and case load expectations. In contrast, privately funded therapy allows more specialised input to health concerns. Additionally, discussion of the child's abilities is not limited to specific environments such as school or home rather occupational concerns and skill acquisition, encompasses all aspects of the child's ability to participate in occupations. …