OTSH 83: Evaluations vs. Screenings

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Welcome to the show notes for Episode 83 of the OT School House Podcast.

In this episode, Jayson shares the difference between screenings and evaluations. Using AOTA documents, IDEA references, and court cases, we will discuss when it is and is not appropriate to use screenings in a school-based setting. We will also briefly discuss how to ensure that your using a top-down approach when completing evaluations.

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Episode Transcript

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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's your host, Jayson Davies. Class is officially in session.

Jayson Davies

Hey there and welcome to Episode 83 of the OT School House podcast. Thank you so much for being here. For anyone who has never listened to an episode of the OT School House podcast, maybe you just saw something on Facebook about evaluations and screenings, and you hit play. I just want to thank you so much for being here and also introduce myself. My name is Jayson Davies, and I am an Occupational Therapist in Southern California. I'm the host of this podcast, the OT School House podcast, and I've been practicing as a school-based OT for about nine years now. And well in this episode, I am just super excited to get into the three keys to school-based occupational therapy screenings and evaluations.

That's what we are going to talk about today. How screenings are similar, how they are different from evaluations, and also when to use a screening versus an evaluation. So we're going to talk about what IDEA says we're going to talk a little bit about what AOTA says about screenings and evaluations. And then we're going to kind of bring it all together and talk about when to use which one and how they can impact your practice as an occupational therapist working in the schools. All right. So real quickly, usually, this is the moment in the podcast where I get to introduce our guests. But I'm going to take this opportunity since it's just me and you today to share a little bit about myself. I am a school-based occupational therapist as I mentioned in Southern California. And I do have experience as both a contracted occupational therapist and in-house or district employee occupational therapist. In fact, recently, I also had an opportunity to work as an online contracted therapist for a teletherapy company, which was very interesting, I must say, personally, my preference is to work within a school district. I just feel like you have a better connection with all the people involved. The kids, the teachers, the administrators, people up above you, the speech therapist, the other occupational therapist in the district, I just really appreciate that setting.

I'm also the creator and owner of otschoolhouse.com and School House education LLC, which is kind of the overarching company that runs OT School House. So at OT School House, we provide professional development opportunities through this podcast their conferences, through recorded CEU or professional development opportunities. And you can learn all about that at otschoolhouse.com and by listening to this podcast, really, this is really a place for school-based OTs to come to learn to be heard, I really like to interact with you. And with every single person that listens to this podcast. If you've ever sent me an email, if you've ever sent me a direct message on Instagram or Facebook, you know that I get back to you. It may be a week or two. But I will get back to you. It's something that I just believe in that we all need to communicate and get in touch. So feel free to hop on Instagram, if you're not driving, and send me a quick message saying “hello, let me know you're listening to Episode 83”. And just that, you're enjoying this, that you appreciate this, and that you want to learn more, you can even drop a message in there and say, Hey, Jayson, I'm really trying to do this at work. I'd really love a podcast about whatever that is that you're working on, I will definitely try to get something in here for you.

So if you're here today, listening to this podcast, you saw the title, maybe you just listened to every podcast no matter what the title is. But this particular title, maybe you saw it and it said evaluations and screenings. Well, you're probably just like me, your school-based OT practitioner who wants to do right by the children and the students you serve. And by that I mean, you want to know when should I do an evaluation? Or when should I do a screening? What's the difference between the two? You're right on, you're in the right place. You might also be wondering, you know, how can I make my life as a school-based occupational therapist easier? I've heard of people using screenings. I've heard of people using the evaluations. But sometimes it seems like a screening can be an evaluation or an evaluation is a screening. How does that make my life easier if I screen? Or how does it make my life more difficult if I screen? Well, we're going to talk about that in a little bit.

Okay. So, today, we have three overarching key points that we're going to go over. And those three, I'm going to lay them out right here so you know what to expect are, why screening is not an evaluation, how to use screenings as a means to reduce unnecessary evaluations and actually help more students. So how you can help more students even though you're actually going to be evaluating fewer students. And also how to how to produce effective evaluations to support individual students, we're going to go over that just a little bit as well. So we're gonna start with what I think most of you are very familiar with. And that's OT evaluation, not everyone's screens. But I think everyone does occupational therapy evaluations in the schools. I'd like to share with you a direct quote from the Individuals with Disabilities Education Act, also known as IDEA. And well, this is talking about evaluation. So listen really quickly, each public agency must conduct a full and individual initial evaluation in accordance with other parts of IDEA before the initial provision of special education and related services to a child with a disability under this part. So basically, it's saying that we must conduct an evaluation, not screening and evaluation before the initial provision of special education and related services are provided.

As an occupational therapist, we are a related service provider under IDEA. And so in order to provide a student with services, under an IEP as a related service, we must have an evaluation. If we are going to provide that service to the student, whether it be an individual or even a small group service, or even consultation on behalf of that specific student, we need to have an evaluation. The fourth and most recent edition of the occupational therapy practice framework published in Asia by AOTA, notes that the evaluation process is focused on finding out what the client wants and needs to do, determining what the client can do or has done, and identifying supports and barriers to health, well being and participation. Participation is the key word there because as school-based OTs, we are really focused on the student's ability to participate and access their curriculum. Within the Individuals with Disabilities Education Act, they don't break down different evaluations like what an OT evaluation should look like, versus a speech evaluation, versus a psychoeducational evaluation. But they do list out in Section 300.304, that we must use a variety of assessment tools and strategies to gather relevant functional, developmental and academic information about the child, including information provided by the parent, that is a key one information provided by the parent, I recently went through a due process. And well, I'm not gonna lie with you, I'm not perfect, I omitted getting parent information. I might have called the parent and left a voicemail, but I never actually got the information that I should have gotten.

Usually, I sent home a questionnaire at the very minimum or a Google form in this case, to be honest, I can't remember if I sent it out, but I did not get that information back. And that was something that, fortunately for me, and never went to due process. But that would have been something that I would have had to potentially explain in that due process. So be sure that you do get some parent information. It also requires within IDEA that we use more than one tool to determine the need for services. So we can't just use observations, we can't just use that parent information, we need to use multiple tools, that could be an observation in addition to a standardized assessment tool, but you still need to be sure to get that parent information. And then also laid out in Section 300.304 is actually that we just need to be at the goal that is actually laid out in IDEA. I thought that was almost a little silly that it had to be mentioned there. But it is there that we have to be ethical.

While AOTA and the OTPS occupational therapy practice framework don't necessarily mention using a top-down evaluation procedure. I think that's something that we all learned in OT school is kind of starting with that very general top theme that concerns overarching concern, and working our way down. And so that is the evaluation process that I use as well. And what that kind of looks like is starting with that student's occupational profile, getting a good picture of them, their strengths, and their concerns. And then from there branching down to the embedded observations to actually get into the classroom and see or translate almost, if what you were told or what you found out by doing a review of historical records and talking to the parent, if what they told you, you can actually see within the classroom happening from there, going down a little bit further then we can pull out this year. And do some structured observations and our standardized assessments in a controlled environment. You can also within that controlled environment, and actually in the classroom, if you want it to is try some relevant trials, if you have the opportunity, you can say, Hey, we still have a few weeks before the IEP or before that assessments do, let's see what happens if I give that student a pencil grip. Or if I put some Thera band around the chair, or if I try one of those other strategies that can be implemented, right within the classroom, that's okay. And that can go into your evaluation. And maybe at the end of your evaluation, you find that those trials that you completed are actually enough for the student as possible.

After you do all of that the profile, the observations, the assessments, any trials that you want to do, then you have to be sure to include two more things, your interpretations. What does everything that you did actually mean? This is really where some reports, I see fall apart, and I've been guilty of that, too. You know, we can't just summarize our findings, we need to actually interpret our findings. What did it mean that the students scored below average on this assessment, but average on this assessment? How does that impact the student's ability to complete classroom activities, that is all part of the evaluation, and then at the end is when we can summarize that up. And even if your district wants you to provide a very specific or general recommendation, some districts even want you to add goals into your evaluation. Again, that's up to the district, it is not required. So I do actually have a tool and I want to offer this to you, you can head over to otschoolhouse.com/checklist. And you will get the checklist that I use during my evaluations. And this is something that just helps you control or not control, I guess it helps you ensure that you are using that top-down approach. If you go down the list in order, you will be completing a top-down evaluation. So that's going to wrap up our discussion on evaluations. But now I would like to take a moment to talk about screening.

So let's go ahead and jump into that. Now I want to start off this section of the podcast with a very clear statement. screenings are not evaluations. This is another quote that comes from IDEA section 300.302. The screening of a student by a teacher or specialist to determine appropriate instructional strategies for curriculum implementation shall not be considered to be an evaluation for eligibility for special education or, and related services. So it's saying that screening is not appropriate in order to qualify a student for eligibility for special education and or related services. So it's not exactly identifying what screening is here. But it's saying that screening is not enough. It does say that screening is really for determining appropriate instructional strategies for curriculum and implementation and around about way, again, this is section 300.302. If you'd like to listen, or sorry, not listen, look it up for yourself in IDEA.

So this is kind of how I break down evaluations versus screenings, and evaluation is individualized, right, you're going to only look at one student, when you do an evaluation, you're not going to see three students and give them all the bot at the same time. That's not what we do. An evaluation is always individualized. The evaluation also will have implications for an IEP team right? After you complete your evaluation, you're going to go in and you're going to give a report to that IEP team, you're going to let them know what the strengths for the student are, what the weaknesses for the student are. And also you're going to present goals and whether or not you recommend services. It's also 100% required before the provision of related services. And occupational therapy, as it relates to IDEA is a related service. Now there are ways to provide services as an occupational therapist without going through IDEA. And that's where the education or sorry, Every Student Succeeds Act of 2015 comes into play. And that's kind of where we're going to go with the screenings. But for this, if you're going to provide services to a specific student, you're going to need that evaluation.

Now, on the flip side, screenings do not have to be individualized. You can maybe not the bot but you can use some tool and provide that screening to an entire classroom or an entire group of kids. It is not necessarily individualized. Screenings are also used to determine appropriate instructional strategies. Whereas the evaluation is used to determine related services and goals. Screenings are used to determine appropriate instructional strategies. Those instructional strategies could be put in place by yourself alongside the teacher, or you can provide the teacher with recommended instructional strategies. And that teacher can then carry out those strategies, you are not providing an individualized strategy, you're providing strategies for the entire instruction. And finally, you can probably already assume this, but screenings do not result in the provision of related services. So now, if screenings don't lead to services, then why would we screen right?

As an occupational therapist, you were hired by special education to evaluate and treat students and to go to their IEP is to write goals to write progress on the report. That's what you were hired to do, right. But if you can't do screenings, I shouldn't say if you can't do screenings, because everyone can do screenings. But that's what you're hired for. And so what does it mean to make that shift over to screening and why would we want to do that? Well, that brings us to the second part of this podcast, where screenings as a means to reduce unnecessary