OTS 202: Why Every School-Based OT Needs an Occupational Profile
- 8 hours ago
- 43 min read
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Welcome to the show notes for Episode 202 of the OT Schoolhouse Podcast.
Are you still relying on the Peabody or BOT as your go-to assessment? You're not alone, but you might be missing something critical. In this episode, we dive deep into occupation-based assessment with Dr. Alysha Skuthan and Dr. Erin Gaby, who recently published groundbreaking research on the occupational profile in school-based practice.
This conversation is for every school-based OT who has ever wondered: What actually makes an assessment occupation-based? Why does the occupational profile matter? And how can I fit it into my already overwhelming workload?
The research reveals surprising findings from their research showing that 35% of school-based OTs don't complete occupational profiles, despite it being a formal requirement in the Occupational Therapy Practice Framework.
You'll hear practical strategies for collecting occupational profiles, honest talk about barriers like time constraints and parent communication, and compelling reasons why using occupational language in your reports matters for advocacy. Plus, they discuss occupation-based alternatives to common standardized tests and share their favorite tools like the School Function Assessment.
Listen to learn how shifting to occupation-based practice can transform not just your assessments, but your entire intervention approach.
Learning Objectives
— Learners will identify the key characteristics that distinguish occupation-based assessments from skill-based assessments
— Learners will recognize why the occupational profile is an important component of every SBOT evaluation
— Learners will identify the importance of using occupational language in evaluation reports for professional advocacy
Guest Bio
Alysha Skuthan, PhD, OTR/L, CWHS is the capstone advisor and an adjunct assistant professor in the Post-Professional Occupational Therapy Program at Shenandoah University where she facilitates doctoral research and academic writing. As a pediatric occupational therapist of 11 years, she prioritizes occupational engagement through occupation-based practice and family centered care. She is well published with over 18 peer reviewed publications, more than 40 poster presentations, and an AJOT Authors & Issues Webinar: Session 39. She graduated from Nova Southeastern University and the University of Florida.
Erin Gaby, ppOTD, OTR/L, BCP earned her entry-level Master of Science in Occupational Therapy from Milligan College in 2006. Since 2007, she has worked within the Greene County TN Public School System, where she has spent the past 19 years supporting students and school communities through occupational therapy services. In 2023, Erin obtained board certification in pediatrics through American Occupational Therapy Association. She further advanced her education by completing her post-professional Doctorate in Occupational Therapy from Shenandoah University in 2025.
Quotes
"At school, the number one goal is just them getting the nutrition that they need."
— Alisha Grogan
"School is one of the things that always comes up for parents. Often kids will not eat at school, even if a parent is sending their preferred items."
— Alisha Grogan
"I don't know that I agree that it's a school-based therapist's job to improve the variety of foods that they're eating, but it is their job to help them have a successful meal, lunch, snack time with what they are eating."
— Alisha Grogan
"It's nice to hear you say some of this because we all want to support the kids as best as we can... but if we don't have the tools at our disposal, we maybe don't have the training... it gets tricky."
— Jayson Davies
Resources
Episode Transcript
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Jayson Davies
Are you skipping the occupational profile during your evaluations because maybe they take too long? If so, you are not alone. We're going to talk about that research in just a moment. However, you might be missing one of the key pieces to your evaluation that AOTA actually requires. Welcome to the OT School House podcast, where we dive deep into school-based occupational therapy practice. I'm your host, Jayson Davies, an OT practitioner with over a decade in school-based OT experience. Today, I'm joined by two incredible OT practitioners, Dr. Alysha Skuthan, a faculty member at Shenandoah University and a leading researcher in occupation-based assessments, as well as Erin Gaby, a school-based OT practitioner with 19 years of experience, who recently completed her post-professional doctorate, which, of course, we'll be discussing right now. Together, Erin and Alicia published research revealing that over a third of us school-based OTs aren't completing occupational profiles during our evaluations, and that is despite it being a formal requirement within the occupational therapy practice framework that document we call the OTPF. In this conversation, we are going to break down what actually makes an assessment occupation-based, why the occupational profile matters more than you might think, and practical strategies for fitting it into your already overwhelming workload. So, if you've ever wondered if conducting an occupational profile is really necessary, or how to conduct it in an efficient manner, or maybe even how to incorporate it in your real report that you have to write for that IEP. Today's episode is for you, and if you already know all that, well, stay tuned anyways, because we're going to talk about how this occupational profile can actually guide which assessment tools you use later in your evaluation. Let's dive in with Erin and Alysha.
Amazing Narrator
Hello, and welcome to the OT School House Podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now, to get the conversation started, here is your host, Jayson Davies. Class is officially in session.
Jayson Davies
Erin and Alysha, welcome to the OT School House podcast. I hope you are having a fantastic afternoon, and I want to start off with just a really fun question, and you know what, Alysha, we'll start with you. What was the first assessment tool you ever remember using in your school-based OT practice?
Alysha Skuthan
Oh my gosh, I was ill prepared. Jayson, no, I'm just gotcha. I think, right? I think, honestly, probably the first tool I ever remember in schools was the PD, or no, yeah, I think it was the PD.
Jayson Davies
the PD.
Alysha Skuthan
Yep.
Jayson Davies
all right. And you know, we're going to start talking about some occupation-based assessments here in a moment, and maybe that one will come back up. But I also want to throw it over to Erin really quickly. And for you, the same question, what was the first school-based OT assessment tool that you recall using?
Erin Gaby
I would say it was probably either the Peabody or the Berry Visual Motor Integration, that's probably what I was shown first when I first started. So.
Jayson Davies
that's very common, right? Especially the Peabody, that's a common one. So now I want to throw it to whoever wants to respond first to this one. Is that an occupation-based assessment tool?
Erin Gaby
No.
Jayson Davies
Perfect. That should be the answer. I think that's the answer for most of us. I think a lot of people would have responded with the Peabody as well. The PD might be out there, the bot, whether it's the two, the three, whatever iteration that was out there when they came in the SPM sensor profile, right, those are very common assessment tools that we get to know in our first few days as a school-based occupational therapist. But today we are here to talk about occupation-based assessments, and let's dive in. And I really want to start with you, Alicia. What does it even mean to be an occupation-based assessment, like we throw this term or word, we also say don't use jargon, and this is obviously a jargon-filled word. What does it mean?
Alysha Skuthan
Right? Great question. So, I think it's so it can be so muddled, but yet it should be so clear, because we are occupational therapists, right now. I try to explain to my husband, who's not an OT, and he goes, yeah, occupation, you use occupy, I go, yeah, can you elaborate, you got it after all these years, he goes, maybe, right, so it's just it's one of those terms that can be so nuanced, but when we think more about occupation based, I think the key is to prioritize occupation as the focal point in what we do, right, so that is what gives us our skill that's our special sauce, because nobody else is an occupational therapist, but us, right? So that's why it's intended to be infused in what we do. So, how can we incorporate occupation at the core through the lens when we do assessments, when we do our treatments, and when we do interventions? So, occupation-based practice is really at the forefront. Prioritizing occupations instead of more of the rote skill type practice, which might be, oh, stack these blocks, oh, write your name, oh, do this. It's looking more holistically that top-down approach for what are the occupational challenges that the child might be experiencing when we're in schools, and how can I best facilitate that type of progression versus only writing a name, only doing a button, only you know, looking more specific at the skills, occupations more holistic, looking top down at overall, what are they able to do, are they able to engage in their everyday routines in school, what does that look like, what are those overall occupation-based implications?
Jayson Davies
Gotcha, and okay, you kind of answered this already, but I'm gonna, I'm gonna go a little bit further. I'm gonna press if a school-based occupational therapist, your practitioner, right, is listening. Like, I just want to be able, in 10 seconds, to recognize if this assessment tool that I use 300 times a year is occupation-based, is there a quick question that they can ask themselves?
Alysha Skuthan
I think, yeah, I think it's what goals do you create, right? So, I think it's, and when we have something like Aaron mentioned, the Peabody, right, it can be very specific, like I'm making a goal for them to build VMI, I'm making a goal specifically to improve fine motor, whatever that might mean, right, versus I have an assessment like the SFA, where it's looking holistically at their performance within schools. My goals are going to be more related to their participation, they're going to be related to more of their academic performance, they're going to be related to larger scale contexts, which are the occupations that we want to dive into when we're doing these more specific assessments. I'm not saying there's not a place, but it's not occupation based in the same way I think that we're trying to do occupation based practice when we push in in the classroom, when we're in that academic setting, it lends itself to occupation, but yet sometimes those assessment tools that are so rote, we've done them so many times, fall into that skill based assessment, and we miss out on the overall occupation.
Jayson Davies
Man, I wish we could all talk about occupation the way that you do. That would be fantastic.
Alysha Skuthan
Thanks. I'm a little obsessed, so it's a problem, but I'm willing to admit I have a problem.
Jayson Davies
It all starts with understanding that part, right?
Alysha Skuthan
Right.
Jayson Davies
Okay. Now you have been completing this work for some time, and we're going to dive into Aaron's work, specifically about the occupational profile in just a moment, but this is to a degree a piece of your larger project where you are really trying to support OT practitioners to be occupation-based, not just in assessments, but in general, and I just want to hear from you, like, a where that started, and kind of be where it is now.
Alysha Skuthan
Yeah, great question. I appreciate that you're calling me old. I'll take it. It's okay, but I have to first give to it's fine. It's fine. Dr. Wendy Stav, she's phenomenal, fantastic. She was my mentor back when I was getting my PhD, and she opened up my eyes to I identified occupation was not happening with what I was seeing in pediatric practice, but she helped paint the picture of, oh my gosh, it's actually lack of occupation-based practice, and that was my light bulb moment of a, I am sick and tired of doing the Peabody, I am not going to do it again, these goals, if I see one more goal for stacking blocks from a level two field work student who comes in, or from an assessment I'm given when I collect a patient from somebody else. Right, we all share them. It was just.. I was done. I was tired of seeing it. I'm like, what? What makes me skilled, right? If there's.. if somebody else can come in, a developmental specialist, and say, okay, these are the results if I was doing EI of this limitation developmentally here. What makes me unique as an occupational therapist. So it just was a lot of reflection, and I go, "Oh, wow, you know, I think I missed out when I was first practicing on this concept of occupation, because I was so focused on getting that insurance check mark, getting my billing taken care of, that I didn't take a step back and reflect on, am I actually doing occupational therapy or am I doing skill-based supports that don't require this OT lens that we grow and we acquire during our time in clinic, clinical practice, and back in schools. So, it led me to my dissertation, and that came in several publications, and I've been grateful to continue working on that. But my one of my biggest studies came out in age ot 24 no, 24 I don't know what year it was, 2021 I think it was 2021 maybe, maybe 22 My son was born like it's a model, but it came out in a jot, and I really dove into, okay, what are OTs out there using, especially pediatric wise? Am I right? Is it really the Peabody? Is it really the bot, or am I? Is it something where there are other assessments I'm not familiar with, because I'm still growing. We're all learning every day as OTs, right? So I wanted to take a big scale approach and quantitatively explore what's out there. Do people know what occupation-based assessments are, and if so, why not? What does that look like? So then I did a qual study where I dove more specific. Into what that implicates for practice when they do pick occupation-based assessment tools, and then it's just spiral from there. So it's just a continuation of how else can I look at this occupation-based assessment component and highlight, okay, there is a problem, but what can we do to kind of fix that problem and help us as a profession use occupation intentionally, beginning at that assessment piece.
Jayson Davies
Okay, I've gotta, I've gotta ask this follow-up, because I can, I can hear people screaming at me. You mentioned, like, what are the outcomes of using an occupation-based assessment? I believe you would, where you would go forward from that is the actual intervention itself. Before you mentioned that, I was going to ask, like, what is the problem with non-occupation-based assessments, like, you know, the Peabody BD and the Bot Three, but let's go with the more, I think, positive kind of the direction you were going, and why is, how does it help us down the road?
Alysha Skuthan
I think it changes our perspective, right, so when we pick the skill-based assessments again, there's a time and place. If a kiddo comes in and they're having really specific visual motor integration, great, pop out the beery, fine tune, facilitate, but yet when we get those specific skills, what is our overall goal here? We want to make sure we have the translation and the application to the occupation, because that's our job, right? We can practice and say, okay, yes, this kiddo can now do a puzzle. Great. So, what, right? So, for me, and when I, you know, did some of these studies and things, when therapists intentionally use occupation-based assessments, it was very common that they said their perspective shifted, so occupation remained the focus, and depending on their setting, when it was school-based, it was that collaboration with the teacher and really intentionally integrating into the classroom and that child's routine, right? So that way the occupational focus could be embedded into the appropriate contextual facet, whatever that would be for that particular child. And when I talked to outpatient clinicians, I saw that the therapist who did and were intentional about it really focused on the caregivers, right, rather than them being the OT end all be all. You got to come see me, I'm going to give you the supports. It was a how can I shift my perspective through parent coaching and modeling through this occupation lens? Because that kiddo is with that parent way more than I'm with them. So how can I facilitate the occupational engagement when I'm not here? Right, it's just it's just that mindset shift. So interventions tend to look more occupation-based versus a here's a worksheet, right? Try this grip, try this whatever specific tool that would be more skill in nature, and instead can be okay. The occupation, the problem is that this child can't sustain attention in the classroom. It's not that they can't write right, they have that component, but how can I tie in handwriting within this overall occupation to promote the attention, to promote the participation in the classroom, which is the occupation that we're looking at there.
Jayson Davies
Absolutely, and part of being an occupation-based practitioner is using an occupational profile. Cue the segue over to Erin. This is perfect, because I, I use an occupational profile. One of the things that at the OT schoolhouse we did years ago is we actually kind of adapted a OTs version of an occupational profile kind of to fit the school needs, because it's a very different environment, and we needed something, you know, specific to our environment. That said, I never thought about it really as an assessment piece, like for me it was just kind of this knowledge background, right, like getting to understand. So, Aaron, I want to kind of jump over to you here and kind of say, or ask, what was your hypothesis, and why address the occupation profile when it is very well established in the OTPF? It's something that I think we all learn about in OT school, so why was it necessary to kind of dive into it further?
Erin Gaby
So I've been an occupational therapist in a school setting for 19 years, and so I've seen a lot of OT evaluations like come across my desk, and I started noticing that I was not seeing that section that said occupational profile, and I remember one specifically that I got from another therapist that was actually it was working in our district but not on staff, and there was like two sentences at the start of the report, and then it just jumped right into like a visual motor test, and I kept thinking, I just really want to know, like, what does this student like, like, what's their favorite toy, or what's their favorite thing to do, and I wasn't seeing any of that, and so it just made me really want to explore, is it just these that I. Seeing, or is this going on in other places as well? Like, is it just me, or is it a practice issue?
Jayson Davies
Yeah, absolutely. To follow up on that, right, you brought up some questions that are in our occupational profile, like, you know, what does the kid enjoy, where what are their routines, you know, what client, what type of environment does their classroom look like? I know that's part of the occupation profile as well, but I'm going to be honest, I think when we're asking these questions to a teacher or a parent as a school-based therapist, what is your kid's favorite toys? What are their TV shows? What do they enjoy? What do they not enjoy? I sometimes wonder, like, are they like wondering why are we even asking these questions, so like I guess for us, as though as a profession, like why is that so important before we dive into the VMI or a different tool,
Erin Gaby
right? It's, I mean, I feel like a lot of it's about intrinsic motivation, like I really need to develop a rapport with that student. If we want to have, you know, a therapeutic benefit, we have to have that rapport, and so it starts, I feel like, with finding out, you know, what do they like, what's important to them, what works well for them, because we can use that, you know, to our, to help us, you know, like help that student.
Alysha Skuthan
I think it's definitely like you said, Erin, participation over compliance. I know that's a buzzword that kind of pops up lately, but yes, totally agree.
Jayson Davies
Yeah, yeah. For me, one of the reasons that I key in on occupational profiles so early on in my assessments is because I feel like it can guide me through the rest of my evaluation process, not only the rapport that we're able to build with not even just the student, the teacher, and the parent through the occupational profile, but also feel like it guides me because if I don't understand the real concerns from all the different parties, then how am I supposed to know where to go with my actual evaluation? Does that resonate with either of you?
Erin Gaby
Yes, absolutely. I mean, I feel like in the school setting, especially like when you're working with children in general, it's not just that child that you're working with, I mean, there's parents, there's teachers, there's classroom assistants, there's other therapists, I mean, it's, it's a huge team, and so it's so important to get, you know, all that perspective for sure.
Jayson Davies
Great. All right. Well, we take a very quick break. When we come back, we're going to dive back in with Aaron to discuss the components of an occupational profile, and also why some of us use it, but don't say we're using it. So, stay tuned. All right, we're back. Erin, you mentioned a few different components of it. We talked, you know, about rapport, participation. What are some of the key components to an occupation, occupational profile, especially when we're using it inside of the school-based realm. What do we want to collect?
Erin Gaby
I think we start with kind of the things that people traditionally think about, where you're trying to find out, is there, you know, medical history or their, you know, family history, you know, experiences that they've had, have they already had special education services before, any school therapies already previously, you know, or outpatient therapies. But then it goes, you know, we expand that and start looking more at the environment, like what are some supports that that child already has in place that could help them, and then also, what are some of those barriers or things that they don't have in place right now? Just like one example might be even like insurance or family supports in place, you know, what is their family life like? You know, is the parent working, you know, things like that. I mean, all those things that I think we, as OTs, consider, and we look at those details, even though others may see, like, you know, they may not understand why we're looking at those specific details, but then finding out, you know, what is that occupation of concern in the school setting, asking the teachers, you know, asking the student when you can, and asking the family, you know, what are your concerns? So.
Jayson Davies
Yeah, no, I think that's true. I always like to get as many people as I can to tell me both whatever the concerns might be, as well as, you know, what they view as the student's strengths, and so that way the more information that we have, it's data, the more data we have to then continue on with either the rest of our evaluation, eventually our actual recommendation synopsis, and then our intervention. So it absolutely does help you mentioned a report once upon a time, right, having two sentences. About the student in the ideal world, what does an occupational profile look like on an evaluation from your perspective?
Erin Gaby
I guess just going based on like how I've done my own is it's just the very first thing that I start with on my evaluation template, it's it's the very first page and I just go through, I usually start, you know, with the background information that I have, and then, you know, having that section on what are that child's strengths, and then a section of what are the challenges currently, and really that section is very key, because you're finding out right there in that moment what is the occupation of concern, and that you said it kind of guides you for the whole rest of the evaluation process.
Jayson Davies
Yeah, Alysha, what about you? Is there anything in particular that you really like to use in your evaluations?
Alysha Skuthan
I mean, I think it's intentional. I feel like the occupational profile can be conceptualized with intentional questions, right? Just kind of really looking in the moment, seeing the response of the child again, if applicable, right? If the kiddo can participate, and then diving into the additional personnel, but tailoring what I ask, so I can create that comprehensive perspective. But I always want to know what the kid likes, right? I always want to prioritize that on there, what they don't like, because if I come in with a bluey worksheet and it's going to be a mass hysteria panic meltdown, let me avoid that, right? Like, let's use our questions, so we can create a beneficial session for the children and for the whole team, right? And I know I mentioned before briefly, but I think the occupational profile allows me to facilitate participation with the kid that active engagement, which is so essential in therapy, by looking at the environment, knowing the parents' background, knowing the kiddos' background, right, more specifically outside of just the OT assessment results, right, or whatever assessments we end up selecting in that in that timeline, in that process. So, I think for me, the like session section is most important to paint that whole perspective, so if Erin's out of town, I can take over her, you know, caseload for the week, and I'm able to jump in where she left off.
Jayson Davies
Yeah, awesome. Thank you. Now, Erin, diving a little bit deeper into your, your actual work, Alicia, your work as well, you guys are co-authors on this work, you had some interesting findings: a) not everyone's using an occupational profile, and b) as I kind of hinted earlier, some people are using an occupational profile to a degree, but not calling it that. Let's start with the first part of that, and let's break that down. Why do you cited 65% of participants are completing an occupation or profile? I just kind of like, okay, well, that means reverse math, right? Did the math the opposite way. 35% of us are not conducting an occupation or profile. Let's first start with maybe the why. Did you glean any as to any reasons as to why it might not be being used?
Alysha Skuthan
I think, based on, you know, the results and things, why people don't use it, there were several factors that were listed, right, when we looked at all the themes from the responses that we gathered from participants, and one of the factors that I found most interesting was that the therapists themselves were a factor, right? One therapy, one participant, she said, you know, verbatim, I've never heard the term occupational profile before. Today, I graduated OT school in 1988 and I go, 'Whoa, okay. Like, as I'm reading, I'm going, 'Okay, like, I appreciate the honesty, and I'm so glad that people were reflective in that moment, right? That maybe it's something that they might not remember it from OT school, or maybe you know things have shifted obviously in the past. What would that be, x number of years, right? So I think that the therapist themselves can sometimes be barriers, because we're not required to take a CEU on the occupational profile to be practicing, right? We have to maintain up-to-date and evidence, but again, that's an opportunity for our profession to say, well, what does that need to be, so we can create that consistency, time constraints, workload, like my caseload is too busy, I don't have time to add this occupational profile to an already busy, we all know what IEP season looks like, right? We get it, right, but that was a common barrier listed, sometimes they would say lack of space or access to caregivers to parents to kind of get that again, that holistic perspective to support that profile. Right, I mean, I remember where I well write the note home to parent, you hope you get a response right. Obviously, we can use email communication, other methods, but I distinctly remember towards the beginning of my career I would send home a note and then never hear. I'm like, that's great, great communication, right? So I understand, right?
Jayson Davies
I want to ask you on that. I want to ask you on that really quickly, because that happens a lot, right? We send home a flyer in the backpack, or a question on the backpack, we hope we get it back. We send home an email, hope we get it back. Sometimes the email just initially, or it just comes back, like this email does not exist, it happens, or. We just can't get in touch with the parent. Do you allude to that in your report? If something like that happens.
Alysha Skuthan
Do we, Erin, talk? I know we mentioned that as something that the therapist indicated that they don't do, but I think it wasn't really the results of our study where it gleaned on what to do next. I think that'd be a little bit outside of the scope of just the study results, but as far as if you're asking, you know, clinically or my perspective on it, I feel like it's our job to get to know the family outside of only IEP season, so creating that intentional involvement, whatever that might mean, right? And Erin, feel free to jump in with what you think that might look like as well, of course.
Erin Gaby
Just when you were mentioned to you about the do you include that like in the report, I don't, I had read a school psychology report, actually just today, where she had noted, she said I, you know, reached out to the parents or by phone and received no answer, and she had actually typed that into the school psychology report, so.
Jayson Davies
Yeah, I've seen that too, and I think it was after I saw it in a school psych report that I was like, should I be doing this, and you know, I'm not saying it's in regular practice of mine that I put that into the report, but we all have cases where we know that something might go to trial and might be reviewed by others, and I go back and forth as to whether or not that helps hurt or does nothing for our evaluation, like it's kind of like throwing someone under a bus, but at the same time, if you don't put it in, then you get back to the whole if it's not documented, it never happened type of thing, and so if it's not documented that you tried to reach out to the parent, then it's not, yeah, so sorry to throw you both on the spot there, but like I think it's just something, it's one of those things that comes up, and we each have to kind of figure out what we're going to do in that case.
Alysha Skuthan
Agreed, and I think you're fine, throws on the spot, we don't mind, but maybe Erin. Hey, no, I'm kidding, but we're good. I think it's important we have to document it right. If we don't have that opportunity, then who else can we lean on here? Right, who else in the scope of the child's everyday participation in school can we then ask to facilitate what this occupational profile needs to include? But I think if we don't document it, then that can cause us to be in an ideal situation as we progress into, you know, our trajectory within the care for that child.
Erin Gaby
It kind of gets to circle back around, it could kind of just contributes to that occupational profile, because you're thinking, oh, okay, so maybe this child, you know, doesn't have maybe the same parent support in place, and that's being very judgey. I don't, I'm not trying to judge, just it's just something like a thought that might be something that you.
Jayson Davies
Makes you wonder.
Erin Gaby
Yeah.
Jayson Davies
Yeah, and maybe you follow up again, or you try, and I mean it's hard. Not every occupational therapy practitioner can can go to, like, back to school night and track parents down, or anything like that, but you know it's nice if we can be visible, and at least, like, it's nice to be able to put a face with a with a name and a parental face with a child face, and like, these two go together, and yeah, that's hard when you have 100 kids, I get it, teachers have 30, and it's hard for them, but you know we try, we try our best. So, all right.
Alysha Skuthan
as we can.
Jayson Davies
What were your initial reactions when you heard that 65% use an occupational profile, obviously alluding to 35% don't? I don't know which one of you was actually the first to see that data point,
Alysha Skuthan
that would be Erin.
Jayson Davies
Yeah, do you remember that moment?
Erin Gaby
Well, it's like we, where we use the Google form, it automatically made these cute little pie charts, the data charts. So I was a little, I'm kind of a nerd, but I was a little obsessed with, like, I would go in and check and see every time somebody was surveyed, I could say, oh, you know, you would see the pie chart shifting.
Jayson Davies
Yeah, yeah, I do the same.
Erin Gaby
Though. Yeah, but it's.. it's one of those things. Sadly, in some ways, I wasn't surprised. If that makes sense, I guess, just based on what I had seen on the reports I had reviewed before of OT evaluations, so I wasn't super surprised, but also it did is a little disheartening, I guess. Maybe.
Jayson Davies
Yeah.
Erin Gaby
To see that.
Jayson Davies
Yeah.
Alysha Skuthan
I thought it was going to be lower, to be honest.
Jayson Davies
Oh, really?
Alysha Skuthan
I did, yeah, because I think there's not the intentionality with integrating that particular phrasing on the assessment, so it might just be the perspective of, okay, you know, actually I might be doing components of the occupational profile, which likely does happen, right? And that's a limitation we talked about, was we weren't there, you know, explaining or there in moment, it was a survey, right, and so I think that there might be some. Participants potentially out there who are doing components of the profile, but it's just not through the lens of a comprehensive occupational profile. So, I was expecting it to be lower, just because I know the language isn't always available. As Aaron said, it's not something I see often.
Jayson Davies
Gotcha, gotcha. And, as we kind of alluded to earlier, some people use an occupation profile, but maybe don't call it that. Before we dive into the details of that, were those people included in the 65% who do, or the 35% who don't? I know it's been a little while since you looked at the numbers, but how would that, would that go?
Erin Gaby
I think the way we worked with the question was, it was just that, do you, com, you know, do you complete an occupational profile as a part of your evaluation? So it wasn't just, we didn't specifically ask, do you complete components of it, we just kind of asked in general, but then in the qualitative data people, some of the participant comments specifically would state, oh, well, I use components of it, but just not formally. You said.
Jayson Davies
Gotcha. Okay, that makes sense. So then let's talk about, did anyone share with you what they called it, instead of an occupational profile If they put it on their evaluation?
Erin Gaby
I think some of it fell under what you would consider like a background section, like background slash history section. Some people commented that they did that instead.
Jayson Davies
Okay, no, I think that's fair. I mean, like, for a long time I did have it, was just background that was the evaluation wording that you know was passed on to me from the OT practitioners before, and even if I had created, I probably would have thought to do the same thing, because we're not trying to use jargon, potentially. However, as occupational therapists, occupation is very key to what we do, and so I also see the value of being forward with it and making this our occupational profile and putting it as you kind of alluded to Aaron, like right there, front page occupational profile, boom, here it is, trying to try to figure out how to phrase this, but I guess, where do you both fall, and I'll let you both answer this one, like where do you fall on kind of the reason, or the reason not to call it occupational profile in our actual evaluation report. I don't know. I'll let you, whoever wants to speak up first.
Alysha Skuthan
Well, rock, paper, scissors. No, I'm kidding. Do you want to go ahead? Me, okay? I think it needs to be there, right? I mean, we are occupation, obviously. I'm very biased with my perspective on the importance of occupation, but.
Jayson Davies
Not at all.
Alysha Skuthan
If we, if we don't, not at all, right? Ha ha. But if it's not on there, then we don't have the opportunity to educate and to further reinforce the nuances and the beautiful thing that makes our profession what it is, right? So I think if there's a concern for therapists out there that it might be jargony. Okay, add a sentence that defines what it is, right? Give it - I'm not saying the whole OTPF definition, but give little components and say this is the background information to facilitate, or to, you know, allow us to do our therapy sessions, whatever we want to do to simplify, remove the medical air quote jargon, right? I include it, I think it should be there.
Jayson Davies
Yeah, and Erin, you, you already talked about, you put it on your first page. Do you call it occupational profile?
Erin Gaby
I do. In one of the references that we used in our publication talked about the importance, like, if with occupation-centered practice, is that you use that occupational language, and not only your words, your verbal words, but in your written language as well. And so I thought this is perfect example. Your OT evaluation report is that written language, and it's just two words, but it's so impactful, and I don't know why we're so hesitant, I guess, to use that language, because if we aren't using it, then no one else is, and if I could go on and on, this is kind of.. I could get on.
Jayson Davies
Advocacy here.
Erin Gaby
You know? If sometimes I think we, as OTs, are our own worst enemies, because if we're not advocating for our profession, nobody else is going to know. I mean, if other OTs don't know, then we can't expect, like, our teachers and parents and other school team members to understand that.
Jayson Davies
Yeah, I completely agree with that. I, there have been times, and I always talk about having in a while, but I often talk about using the IEP as a platform to advocate, like we get our 10 minutes of fame at the table in the IEP, and like everybody has to shut up and listen to us, and you know that is a great opportunity to say, hey, here's. My report. Here's my template. Yes, the first two words you see on their occupational therapy, right into that, you see occupational profile. Let me tell you what an occupational profile is. And here is, here's what I have learned about your student through, you know, all the important people in his or her life, and I think that is a great way to to advocate for our profession, while not being like overly like it's not like blunt in your face. Like, let me share with you what occupation means. Like, it's a nice little way to do it. So, yeah, I agree. I'm on board with that. All right. The occupation, though, DPF, the Occupational Therapy Practice Framework Number Four: list out three steps, basically, for an evaluation has to include three steps. In my opinion, it should be more. I go in depth in that in other places, but three steps: occupation or profile, basically an assessment of the skills of the client, and then a recommendations, essentially like a summary recap and recommendations synthesis is actually the word I believe they use. Number one is occupational profile. Does that mean that it is required in our evaluations?
Erin Gaby
Yes.
Alysha Skuthan
Yes. There's literature, it shows yes.
Erin Gaby
And I even look at, I mean, the the OT practice framework. The first edition was released in 2002 and so this is not a new thing now. Granted, before that was the uniform terminology, and you know that was something different. So, if you graduated during that time period, you know, maybe that's one thing, but this is, you know, any graduate has graduated since 2002 should have had that awareness, I guess.
Jayson Davies
Yeah, and a little bit of a follow-up, because the OTPF is not a researched paper, right? Like, it's not like someone went out and did research and then said, okay, you know, an occupational profile has been shown to be, you know, lead to occupation-based services and all that good stuff. So, Alicia, I want to come to you, because I think you're probably the one to have done some research on that. Like, where did the idea of an occupational profile actually come from? Because, yes, it's mentioned in the OTPF, but where did it originate? You, do you have that knowledge.
Alysha Skuthan
No.
Jayson Davies
No?
Alysha Skuthan
I don't. I know it's on OTPF, right? And I know the components that go into it. I know I facilitate it with my students, right? and the client children I work with, but I don't know where that specific phrase originated from. I wish I did.
Jayson Davies
We'll have to look into that. That'll be part two. All right.
Alysha Skuthan
let's do it.
Jayson Davies
If I were to ask you this, what makes occupation-based practice, or what is the research behind occupation-based practice as improving, you know, client outcomes? What would the response to that be?
Alysha Skuthan
So occupation-based practice and client outcomes, I would say that literature base is continuing to grow, and I'm working on it, but I don't think there's anything specific that states, you know, okay, occupation-based practice, you can't prove anything, right, causation, it doesn't have correlation does not prove causation, right, but there is a, there are a lot, there is a lot of information out there on I'm part of this occupation-based forum. This group, we have a whole website, we are saying, yay, occupation, because it's needed, and there's a growing body of literature and evidence in there where we're doing clinical trials, and we've gone in and we've given occupation-based tools, and we say, okay, clinic, now go for it, see how your practice changes, and there are positive outcomes reported by clients, by caregivers, by therapists. There is growing data out there to support the influence of intentionally using occupation-based practice and facilitating positive outcomes, but it's growing. It's not as if occupation is a new concept yet. In the literature, in the research, we still have a lot of work to do.
Jayson Davies
That is a very important, important point, because I was just gonna say, you know, whenever we think about learning about the history of occupational therapy, right, we go back to the wars, right, and talking about how soldiers were coming back and getting occupational therapy, and a lot of it was very arts and crafts, and, and like these, these little occupations that help people to improve, but that was before the age of everything needs to be research-based, and we're in that age now, and so just because something doesn't have research behind it from the 20s, 30s, 4060s all the way up until like now, right, doesn't necessarily mean that it is not an established practice that has shown benefit. It just means that maybe there isn't research behind it.
Alysha Skuthan
I would say not behind, you know, it 100% meaning okay, you. Assessment, then do this intervention, and you get this exact outcome right. And I think there will always be variability in it, because every therapist brings their unique therapeutic use of self to the situation, and every client, in our case, children, students, it's going to be different, right? But I think it's important for all of us to just reflect on, and I'm going to sound.. I guess I don't know, whatever. Have you to think about the theory, to think about the model that we are using to kind of guide what we're doing? Right, are we intending to focus only biomechanically? I see a deficit, I'm going to facilitate a deficit, or can we take something like the dynamic model of occupation-based practice? Right, can we take something where it intentionally allows us to prioritize occupation by saying, okay, this is my framework, I'm coming in as the OT, I'm here to look at your occupations and how can I facilitate your engagement in occupations, that's why I'm here, right, that's that's my job, versus thinking about it, where, okay, I'm only looking more specifically at this particular deficit and how I can facilitate it, right, and there are other models out there too, of course, right, and we can argue how they can influence the occupation-based practice, but I think it comes about intentionally selecting a theory or a model, and that allows us to guide our occupational profile, right, thanks AOT for developing that, it allows us to, you know, take those next steps in that practice trajectory.
Jayson Davies
Yeah, it's so interesting. It's so interesting how things come to be in this world, and you know, like our profession is called occupational therapy for a reason, and there have been debates on that, right, on the name and our choice of name, and how that impacts us one way or the other as a profession, but we have always used occupation as a means, as an end, and it has kind of driven the way that our profession has moved forward. So, yeah, no, I like that, and yeah, it absolutely leads right then to that occupational profile. So, let's come back to your research a little bit here, Alicia. You started to talk about some of the kind of, like, the difficulties of getting an occupational profile together, but I don't know if those came directly from the research or if those were some of the things that you just kind of, you know, have experienced yourself. What did the research, what did that qualitative data that you collected say was difficult for the practitioners to put together an occupational profile?
Alysha Skuthan
Yeah, absolutely. So the specific ones the therapist identified that they were inhibiting factors themselves, right? Maybe it's a lack of knowledge on their part that was one that was indicated from our qual findings, time constraints, workload, physical lack, or access to parents and caregivers, right, which we've talked about already. Obviously, at this point in time, participants did mention the students themselves, right. So, sometimes students might be non-verbal, right, or it might be where there's a limited opportunity to allow them to be an active part in the acquisition of the information for the occupational profile, and then some participants also mentioned how components of the occupational profile, meaning the overall one, not one that you guys have created that's tailored more to school-based practice, or the ATA one that they also have that's directly, you know, linked to occupation, or excuse me, school-based practice, they participants said it would be too lengthy, or it's considered to be, you know, too long to include this whole overarching occupational profile. Lastly, the last, you know, when participants indicated that they didn't use it, they had said it was because they needed more education on what the occupational profile look like in practice, so that was another limitation that was indicated by the qual studies in our, in our findings.
Jayson Davies
Gotcha. Okay, and now let's kind of skip to those people who do use it. What did they report as some of the benefits to using the occupational profile? I know I shared a little bit about how it helps to guide my evaluation a little bit, you talked about, like, the rapport building. Anything else?
Amazing Narrator
you want to say anything, Erin? I feel like I've been talking. I can. I'm happy to keep going.
Erin Gaby
Some of the comments were about how helpful it was to kind of paint a fuller picture of the child, and another comment, which I really liked was that they mentioned how it picks up some of that information that might be missing that you might miss out on if you just use a standardized assessment, like if that's all you did with the child, you might be missing a lot of that child, but then they must, the comments were very positive of the participants that do use it consistently. They found it was very helpful.
Jayson Davies
Yeah, yeah, I think that's why we use it. Yeah, so Aaron, I want to ask you this, as a practicing school-based OT practitioner. What are some things that you've done it to make it easier for you to implement it? I mean, we talked about how difficult it can be to get a hold of parents. We've talked about the time constraints and some of the other constraints that people have experienced. What are some little tiny systems or things that you've done just to make it a little bit easier to get the information and put it into your report.
Erin Gaby
As much as possible, just like communication, just like communication one on one, and if a lot of things kind of all fall back on to just having good basic communication, so for example, if you have a student at school that the team is referring for, you know, like maybe that initial comprehensive assessment, if there are some concerns that they're thinking, "Hey, I might need the occupational therapist, you know, to see this child, you know, including them in that initial meeting when your first meeting to talk with the parent to get that initial consent, like that's an ideal time, if you can be invited to that meeting, you've already got the parent right there. The teachers there, we're all, you know, it's so hard to get everybody together. It feels sometimes like we only meet as a whole team like once a year at the IEP. So if you can get in on that initial meeting, that's a good, I feel like way to start the process.
Jayson Davies
Yeah, yeah, I agree. Are you, and this is for both of you. Are you pro technology or a little bit kind of, may I prefer to call and send a letter home in the backpack?
Erin Gaby
I find email has been pretty helpful, or even just a text, I mean, I know sometimes there's that being a little hesitant about like using your, your personal phone number, but it just seems like this parents are more responsive a lot of times I've found just with a text or an email than they are if you just to call them, but.
Jayson Davies
Yeah, and to be honest, it's really easy to create a Google Voice number and send a text message through a Google Voice number that is that you can delete at any time if things get a little, you know, too needy or personal. Of course, you have to be a little careful with HIPAA and FERPA and all that fun stuff, when you go that route, but yeah, I mean, you kind of have to go with whatever is comfortable for the people that you're trying to get the information from. Anyone use Google Forms or Microsoft Team Forms or anything like that?
Alysha Skuthan
I have, I will, I think sometimes too, when I'm doing, if I have the chance right to interact with the parents, I'll ask them right as part of my initial, hey, like, how do you like to be contacted? How can I best facilitate this with you? Do you want to text? Do you want me to knock on your door at 3am Like, what can be arranged here? I kid, of course, but I think for the parents who, when I've asked me, they want a phone call, I'm like, okay, great. I'm going to craft this time in my day, because I know that that's what they want to help this particular student, but yeah, I have used Microsoft Teams or Zoom, or whatever might work best in that moment.
Jayson Davies
Yeah, yeah, okay. So that's the collection of the information. What about when it's actually putting the information into your report, I know we all have a template. Is there certain pieces that you like to put? I mean, do you just basically list occupational profile and then just narrative, narrative, narrative, narrative? Do you try and break it up? Does that make it easier? What have you found just makes it easier to get the information onto the page?
Erin Gaby
I tend to do narrative format, but that's just my, my preference or my style of writing. But I know one of the participant comments in our study said that they made a chart, and so they just had like this organized chart, which I know on your website, Jayson, you do have that free under your free tools, like the OT profile template, so I really like that. So, even just, you know, a chart, something like that, might be a good way to keep it organized visually. Sometimes that's easier for other team members to, to read.
Jayson Davies
Yeah, yeah, that's your chart. I mean, everybody uses different tools, right, and a chart can can be helpful. Narrative can be just as helpful. I'm not currently practicing, but if I were today, and if I could figure out a way to basically get the raw data, whether it be from a Google form or just, you know, a paper pencil form, or however, or you know, from a conversation on the phone, I think we could even plug that information de-identified into a chat agent, Chat GPT, or Clot, and say, "Hey, here's all this information, can you just organize it for me into a nice clean narrative? These are there's many ways that this can be done to make it less time. Consuming, because we know that's a barrier, and I mean, honestly, that's probably the biggest barrier, aside from getting the information from people, like that's a barrier too, and I think those are kind of the two main points that we're addressing. Do you ever find, Aaron, that you feel like you forget to ask questions of, you know the teacher or the parent, is there a way that you kind of have it set out in your head or somewhere, or do you just look at the ot file, maybe to kind of remember what to ask, you know, the team.
Erin Gaby
Sometimes in the moment it is easy to forget things, but just I'm still old fashioned of pen and paper, too, like I said. If it's at the consent meeting, I've got my pen and paper, and I'm like writing down, like, notes, and you know, asking questions. But I do feel, too, after you've met, at least that one time in person, sometimes you'll.. it's a little easier to have that parent or teacher respond back to you, because you've already kind of started to establish that relationship, so it's not like I'm just a random person you've never met, and I'm calling you to ask you about your child, so.
Jayson Davies
That's important, right? We have to build rapport with the with the parents just as much as we have to build rapport with the student, and yeah, it is so much easier to call someone once you have that face to face, you know, you've shook in their hand, or you've seen them in person, it's a little bit easier to pick up the phone and make the call. I will say, I've never regretted picking up a phone and calling a parent. I have regretted not picking up the phone and calling a parent, especially when you get to that IEP and you just have so much more information versus not having that information, it really does help.
Alysha Skuthan
Absolutely, it saves a lot of potential confusion or surprises, right? During the meeting, which I know we've all been a part of, and they go, 'What? Like, I have no idea. And you're going, 'Well, you know, this is what's been happening. So, if there's any way to proactively facilitate that update or that exchange of information.
Jayson Davies
Absolutely, yeah, yeah. Any other, you know, findings that really came out of your research that we haven't discussed today, that is just really important, and it's really something that a school-based OT practitioner should know about.
Alysha Skuthan
I mean, I think we said it. Please don't be afraid to use the occupational profile, you write as a heading, don't be afraid, don't be afraid. A OTA wants us to write our specific guidelines, they say yes, do it, we can do it. I think that was our biggest finding, is just to support the profession in creating more consistency with that, not only for our students, but also for fellow therapists.
Jayson Davies
Perfect.
Erin Gaby
Just sharing the awareness that it is something that we are supposed to be doing. I think that was of our quantitative findings, that was like the biggest, had the largest effect size, was just having did the therapist have that awareness that it was requirement. So this is like another reason, like we're so thankful that you invited us onto this podcast, because it's, it's helping to promote that awareness, and we're really, that's the heart of what you know we need to be doing, so that we're all working towards that more occupation-based practice.
Jayson Davies
I am just happy to find a pair of OTs who will shout it from the rooftop as much as I will that we need to use an occupation profile, so thank you so much for being here. Because I, gosh, man, I think you know what the very first episode of this entire podcast, episode one, was the evaluation process in school-based OT, and I did not go back and listen to it or read the transcript in preparation for this, but I can almost guarantee you within the first 10 minutes we are talking about collecting an occupational profile, because yeah, like it is like I mentioned, it drives my entire rest of my evaluation, right? Like we have to do assessment tools beyond the occupational profile, but if you don't do the occupational profile, you're at risk of using assessment tools that are just wasting your time and not taking you in the right direction, versus if you took the time to do an occupational profile, you would actually know to go looking for the right assessment tools that are actually going to measure what is important for the student's referral reason, concerns, and strengths. So can't stress it enough. Go do it all right. Well, let's bring this back full circle. Here you all shared with me some tools that you used on day one as a school-based OT practitioner. Now, what is one occupation-based assessment tool that you might use today instead of that one that you used ahead of time, so if I recall, PD, which one of you was using the PD? Alysha, right?
Alysha Skuthan
That's what I saw first. Yes, today I love the SFA. I love the SFA yeah.
Jayson Davies
Still asking people if they need to use a floppy disk.
Erin Gaby
I think they are supposed to be updating.
Jayson Davies
I agree.
Alysha Skuthan
They're updating it, they're updating it. But what I love, agreed, agreed, and at least we all know when the floppy disk is, right? Like, let's, let's say no, but I like it because it really, it forces you to look at occupation, right? Yeah, and no matter what, despite the floppy disk, right, there's gonna be a question or two that will allow you to really paint that holistic picture. So that's why I would say the SFA, even though it needs this update.
Jayson Davies
Agreed. All right, so Erin, I believe you said the Peabody, and maybe one other one, is there a tool that you maybe prefer more now, because it's an occupation-based tool.
Erin Gaby
I do have, like, the PD, but we have to have a computer adaptive test version, is what it is now, and so it's, it's very simple to use, but that is a good one to use, and because it's for, you know, it crosses a broad span of ages, so from like our young and kids to older kids too. But I am really looking forward. I would love to see the SFA be updated. I hope that happens. Yeah, it's supposed to be.
Jayson Davies
Yeah.
Alysha Skuthan
It is. It's supposed to be in the PD. Great, great choice.
Jayson Davies
Yep. Yes, so I, yeah, we got to be one of the first ones, I think, to kind of break the news a little bit about the SFA a while back, and I'm excited for it. They're supposed to be, and you know, everything is supposed nothing is set in stone, but supposedly they're going to expand it up to high school as well, and so it might be appropriate beyond sixth grade, or is it eighth grade? I can't remember off the top of my head, so that would be nice. And maybe I'll talk a little bit more about email and social media than a floppy deal, so we shall see. One can hope, one can absolutely hope. All right, I have one more fun question here, and this might surprise you a little bit, but Erin, I have to talk about your dream of an HGTV show that revamps a classroom with consult from an occupational therapist. I love that idea. We need to make it happen.
Erin Gaby
I have not reached out to them yet, but I really truly, in my heart, I'm like, I would love for that to happen. Maybe they'll ask me.
Alysha Skuthan
that is awesome.
Erin Gaby
So, does anyone listening with connections with HTTP, let us know, because we think it's awesome. I personally like, back in the day, gosh, maybe 1215 years ago, this is a little more, a little less inspirational, more satirical. That satirical, is that even the right word? Anyways, we thought about having a, and it kind of exists now, is more of the office version of, like, the special education office, like, like, that'd be good, but that's kind of what they have with the teacher show, right? That Abbott Elementary, not special education necessary, but at least in an education world. So. Good times. All right. Well, we've talked a lot about a lot of things today. We discussed the office, HGTV, and then, of course, the occupation profile and occupation-based assessments. Alicia, Aaron, thank you so much for being here. Really appreciate it. Thank you for the fun conversation, as well as the insightful conversation. Really appreciate having you here.
Erin Gaby
Thank you so much, Jayson. Thank you. It's been great. Thank you.
Jayson Davies
Absolutely, we will see you next time, and keep in touch. Take care. All right, let's give a big thank you to Dr. Alysha Skuthan and Erin Gaby for joining us today and breaking down exactly why the occupational profile matters so much in our school-based OT evaluations. I hope this conversation inspired you to maybe relook at your report and how you're incorporating the occupational profile into all of that that goes into your evaluation, right? It's not just about using the bot two or using the SPM, it's about getting a well-rounded picture of our student and putting that all together. Sometimes that occupational profile can really help you when you're synthesizing your results and deciding what services you actually want to recommend, plus it's also required by AOTA within that OTP F. All right, and if you need additional help with completing your occupational profile, we have got you covered. Head on over to OT schoolhouse.com/episode 202 for all the tools, the articles, the links we reference to in this episode, including that occupational profile that I adapted specifically for school-based OT. Well, be sure to put that link over at OT schoolhouse.com/episode 202 if you want to keep learning about occupation. Based practice assessment tools, and everything else that makes school-based OT both challenging and rewarding. I'd love to see you inside our OT schoolhouse, school-based OT collaborative, that is our online community where you can access professional development courses, get mentorship and resources from myself and others, as well as connect from other school-based OT practitioners from all around the world, head on over to OT schoolhouse.com/collab to learn more and start collaborating. Thanks for listening, and I'll catch you in the next episode. Until then, keep putting occupation at the center of everything you do.
Amazing Narrator
Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed? Right now, head on over to OT School house.com Until next time, class is dismissed.
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