functional goals--HELP (Full Version)

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mnpt -> functional goals--HELP (June 18, 2003 5:02:00 PM)

I have a question on functional goals. I am battling with Medical assistance to get authorization to continue seeing an 8 year old with very poor coordination and gross motor skills. I am ripping my hair out. Our OT also has battled them. They do not feel that an 8 year old being able to tie his shoes is a functional goal or need. From a PT perspective, they call my goals "test scores" and not goals. For example, he has a very hard time with skipping, hopping etc and also ball handling. He has a hard time catching ball, kicking ball and so on. Gym class is torture for him as the kids pick on him heavily. SO we work alot on throwing a ball at targets, catching balls so that he can participate with his peers. My goals consist of things like, being able to catch a ball thrown to him overhead from a distance of 10', with the goal being that he is able to catch the ball 5/10 tries with 2 hands. He used to run from a thrown ball or hide from it with his hands over his head, and he has progressed to trying to catch it etc, so he has made progress. What am I missing??????



ikePT -> Re: functional goals--HELP (June 19, 2003 4:18:00 AM)

Try stating the child's deficits in more "grown up" functional terms and emphasize how his limitations may impact future needs to seek medical care. MA (and insurance companies in general) are not interested in his inability to interact with his peers. Is his balance and coordination deficits significant enough to impact his safety at home, school, or in the community? Can he negotiate stairs, uneven terrain, playground equiment. Does he fall or trip or have accidents frequently? If so you can point out that he is at risk for serious injury. Has his inability to participate in PE or other physical activity put him at risk for weight gain/obesity, diabetes, etc. I know these things may seem like a stretch but my experience with procurring wheelchairs and other equipment for kids has taught me that insurance companies are not interested in a child being able to move about his environment as much as they are interested in preventing secondary complications from improper positioning (orthopedic deformity, contractures, respiratory compromise, etc.) When I write a letter of medical necessity I go "heavy" on the secondary comlications and "light" on what you and I would consider the functional implications. Good Luck! Oh...and one more thing....doesn't this child qualify for school-based PT?

[This message has been edited by ikePT (edited June 19, 2003).]

[This message has been edited by ikePT (edited June 19, 2003).]



ikePT -> Re: functional goals--HELP (June 19, 2003 4:18:00 AM)

Try stating the child's deficits in more "grown up" functional terms and emphasize how his limitations may impact future needs to seek medical care. MA (and insurance companies in general) are not interested in his inability to interact with his peers. Is his balance and coordination deficits significant enough to impact his safety at home, school, or in the community? Can he negotiate stairs, uneven terrain, playground equiment. Does he fall or trip or have accidents frequently? If so you can point out that he is at risk for serious injury. Has his inability to participate in PE or other physical activity put him at risk for weight gain/obesity, diabetes, etc. I know these things may seem like a stretch but my experience with procurring wheelchairs and other equipment for kids has taught me that insurance companies are not interested in a child being able to move about his environment as much as they are interested in preventing secondary complications from improper positioning (orthopedic deformity, contractures, respiratory compromise, etc.) When I write a letter of medical necessity I go "heavy" on the secondary comlications and "light" on what you and I would consider the functional implications. Good Luck! Oh...and one more thing....doesn't this child qualify for school-based PT?

[This message has been edited by ikePT (edited June 19, 2003).]

[This message has been edited by ikePT (edited June 19, 2003).]



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