Essential Components to any School-Based Occupational Therapy Assessment.

Let’s face it. Writing school-based OT Assessment Reports in today’s public education climate can be hard, hard, hard….

I was personally inspired to take a more proactive approach to report writing after a parent went through one of my assessments with a red pen. Talk about getting my butt handed to me.

I was not only blind-sided, I was immediately thrown into a defensive and anxious state of mind. I felt my professional opinion was being hijacked by my anxiousness. If you have ever had this happen, having a report that is clear, concise, and well written can be your saving grace.

Assessing any student in “all areas of suspected need” can be daunting and confusing. Prioritizing and interpreting those findings can take us down a rabbit hole of possibilities.

In this post I’m going to review my personal process that I have improved upon since experiencing this tuff meeting. I want all of us (Teachers, OTs, and all other providers) to go into IEP meetings confident and with reports that serve the student.

May we all be able to review our report findings with confidence and make recommendations to the IEP team that can be clearly implemented with fidelity.

So, you've received that referral, gotten signed permission from the parent and that 60 day timeline is ticking down....what do you do first?

1. First thing is first

Start at the beginning. Getting a strong Developmental History/Background for the student is essential to understanding the student’s suspected areas of need. I have often found IEP teams and parents requesting OT, PT, or other services are not entirely certain of why it is they are requesting the assessment. Getting a comprehensive background can help you build the student’s occupational profile. I include the following in this part of my assessment:

A) Student Interview- what are the student’s interests? Do they enjoy school? Why or why not? What are the student’s favorite classes? Why? What are their least favorite? Do they have friends?

B) Priorities from the perspective of both the parents and the classroom teacher(s), also any other service providers

C) Review both previous educational and medical assessments if available, including psycho-educational, occupational therapy, speech therapy, etc​.

D) Educational background (grades, time in special education, behaviors, attendance, etc.

E) Developmental History and medical diagnosis.

2. Identify why the student referred for occupational therapy assessment?

Find out what has been tried with the student as part of Response to Intervention (if anything has been tried?). In our district, I have instructed teachers and personnel to invite me to IEP meetings whenever there is a concern related to occupational therapy (i.e. low VMI scores, poor handwriting, possible behavior related to sensory processing difficulty etc.). This way I can hear first hand what the problems are. If I am unable to attend, I ask that they thoroughly fill out a referral form. At the IEP, you may be able to suggest strategies for the teacher to try and begin collecting data on at this point. This step and the first step should be conducted as soon as possible in the assessment process if possible.

3. Collaborate!

If you’re lucky enough (as I am) to have an amazing Special Education team and department, I have found collaborating with the school psychologists and any other service providers prior to writing the report can be a huge benefit to present accurate and relevant findings to the IEP team!

I think back to a middle school student who was demonstrating difficulty with behavior and self-regulation during writing/reading tasks. Speaking with the school psychologist and speech therapist proved invaluable as the student had both auditory and visual processing deficits. Therefore, using tools to help access in these areas would prove to be more beneficial than say a chew tool! Remember we are looking at the whole child not just the defecits.

4. Observe!

Observe the student in their natural learning environments! I feel student observation is probably the most valuable part of your assessment. Observing in multiple settings during times which the student is performing in areas of strengths, as well as those times in areas of weakness. How do they do with transitions and unforeseen changes in their schedule? This all can be looked at through observation.

What are your observations of the main classroom environment? What could the teacher easily implement in this environment for the student? (a correctly sized chair?) Observations can tell us what could potentially be barriers to implementation of strategies for this student. How often have you become frustrated with the lack of follow through and carry over? Did you observe the natural setting to see if what you were recommending was able to be implemented with fidelity? These are important things to ask yourself and these will come up in the IEP. So best be prepared now!

5. Assess the student

Assess the student in “all suspected areas of disability” related to occupational therapy services. Do not leave any stone unturned and follow the rabbit hole should you find one. Be thorough! I utilize both functional skills observations as well as standardized assessments. Neither one by itself is sufficient in justification of service level recommendation and both provide valuable information that can inform your assessment.

Remember occupational therapy is a wonderfully gray field. It was built on the “art and science” of occupation. Embrace that concept when you look at your assessment. It’s both the challenge and the grace of our profession. Then look to the guidelines of your state. Be sure you can adequately defend your reasoning behind your recommendation.

6. Make it School-based!

Be prepared to explain medically based services versus educational based occupational therapy services. (Have a pre-planned speech that sites state guidelines and of course the main difference being access to education!)

7. Speaking of state guidelines, add them into your report.

They will be the most objective means of determining the need for occupational therapy services or in some cases not needing OT services. Site them in your interpretation of findings. Remember you are needing to have the student access education in the Least Restrictive Environment. The purpose of school is EDUCATION not occupational therapy. If your state guidelines are like mine there is a great deal up for interpretation. I focus on function and access to academics.

8. Remediation Plan

Develop an evidence-based treatment plan or remediation plan based on your assessment report and findings. This should reflect the needs and strengths of the student which you will likely also list in the IEP. Your goal in your plan should be clear and concise (Check out our post on writing S.M.A.R.T. IEP goals). Because our IEP writing software does not allow it; I write my short term objectives on my remediation plan. I may also list treatment strategies and collaboration/consultation plans. This is also where you will develop your progress monitoring strategy for your proposed IEP goal.

9. Evidence-based!

Look up and maintain relevant research to support your treatment/remediation strategy. You may find articles on self-regulation/handwriting/visual motor skills to prove valuable in supporting your recommendations. It could be useful to create and keep a binder of relevant research articles in your office and update it often. Evidence –based practices in schools is required by law this is any easy way to ensure you are doing so and have easy references for meetings.

10. Plan for discharge!

I have found that exiting students from occupational therapy services is DIFFICULT! Often parents and/or the IEP team do not want to let go of the services they perceive as benefiting their child. OT services are not meant to remain on an IEP indefinitely. Creating a remediation plan with clear objectives is going to lead to a recommendation of exiting the student from service once they no longer need the support. The IEP team determines the need for occupational therapy services and is a team decision and that decision is based on our evaluation, treatment, and progress reporting. I also exit a student with an assessment but its good to have those conversations up front even if discharge does not happen for 3-6 years.

Hopefully we can work together to get our students thoroughly and accurately assessed. I know that this list may seem overwhelming; however in a world of due process and standards I think its best to take the time to complete a thorough OT assessment. It will save you trouble in the long run and give a great foundation for treatment and progress monitoring!

Let us know in the comments and on Facebook what your doing to assess your students! Whats on your OT evaluation checklist? Have you had a meeting where you've had your cage rattled? How did you handle it?

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Abby