Using the Occupational Therapy Practice Framework to Guide the Evaluation Process and Make Assessment Choices in School Practice - AOTA
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Continuing Education Article
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-8 for details.
Earn .1 AOTA CEU
(one contact hour and
1.25 NBCOT PDU).
See page CE-8 for details.
Using the Occupational Therapy Practice
Framework to Guide the Evaluation Process and
Make Assessment Choices in School Practice
Patricia Laverdure, OTD, OTR/L, BCP evaluation processes and the choice of assessment measures
Assistant Professor of Occupational Therapy and tools in school practice
Virginia Commonwealth University 2. Apply the Framework to guide clinical decision making for
client-centered and occupation-focused evaluation
Pamela Stephenson, OTD, MS, OTR/L 3. Examine informal, formal, and standardized assessment
Assistant Professor of Doctor of Occupational Therapy program measures and tools that address client factors, occupa-
Mary Baldwin University tional engagement, performance patterns, and contexts and
environments
MaKenzie McDonald, OTDS 4. Appraise and select assessment measures and tools that best
Occupational Therapy Student support educational and clinical relevance, data-based deci-
Virginia Commonwealth University sion making, and evidence-based practices in school-based
evaluation
This CE Article was developed in collaboration with AOTA’s Children &
Youth Special Interest Section. EVALUATION IN SCHOOL PRACTICE
Practice Guidance for the Evaluation Process
ABSTRACT Since the passage of educational legislation entitling free and
Federal legislation, contemporary teaching and learning practices, appropriate public education opportunities for all children,
professional guidance, and scientific evidence influence the ways school occupational therapy has evolved from a practice
in which occupational therapists design and implement evalu- resembling traditional clinic-based services to one that is
ation in school settings. Evaluation is a key role of occupational strongly grounded in supporting student participation in activ-
therapy practitioners in school settings, and one of the central ities that occur naturally in the school setting (Handley-More
purposes of evaluation is to determine whether a student has a et al., 2013). The shift in approach, while gradual, was guided
disability; whether that disability adversely affects the student’s by federal legislation, contemporary teaching and learning
participation, performance, and progress in the general education practices, professional guidance, and scientific evidence, all
curriculum; and whether the student requires specially designed of which continue to affect the roles of occupational therapy
instruction to access and make progress in their educational practitioners and the ways in which they practice in school
program (Jackson, 2007). settings.
The domain of occupational therapy as defined in the Occupa- Evaluation is a key role of the occupational therapy practi-
tional Therapy Practice Framework: Domain and Process (3rd. ed.; tioner in school settings and one that is guided by federal and
Framework; American Occupational Therapy Association, 2014) state statutory regulation (American Occupational Therapy
provides an effective tool to guide the evaluation process and Association [AOTA], 2018). One of the central purposes of
make assessment choices for school-based practitioners. evaluation in schools is to determine whether a student has a
disability; whether that disability adversely affects the student’s
LEARNING OBJECTIVES participation, performance, and progress in the general education
After reading this article, you should be able to: curriculum; and whether the student requires specially designed
1. Recognize the influence of legislative requirements, pro- instruction to access and make progress in their educational
fessional guidance, and scientific evidence on the design of program (Jackson, 2007).
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Guided by the Individuals with Disabilities Education Act by a top-down approach that emphasizes participation in activ-
(IDEA; 2004), teams endeavor to determine students’ educa- ities that occur within natural contexts. Employing a top-down
tional and functional strengths and needs and to identify the approach is consistent with contemporary occupational therapy
services and supports required to be successful in school. The practice guidance that considers the occupations of the student
reauthorization of IDEA in 2004 acknowledged the importance and subsequently identifies the supports and barriers necessary
of identifying students’ strengths as well as their educational for participation in those occupations (Goldstein et al., 2004).
needs through a robust and collaborative evaluation process of A top-down approach that focuses on activities, participa-
data collection, synthesis, and analysis. tion, and the influence of contextual factors is also consistent
It is important to note that educational and occupational ther- with the International Classification of Functioning, Disability,
apy practice terminology refers to evaluation as the process of gath- and Health: Children & Youth Version (ICF-CY; World Health
ering data, while assessment refers to the specific tests and measures Organization, 2007). The ICF-CY provides a shared perspective
that may be used as part of that process (Jackson, 2007). Addition- and language that can be helpful in school practice to facilitate
ally, each state defines within its practice act the specific roles and opportunities to work across professions and contexts (Cramm
responsibilities that occupational therapists (OTs) and occupational et al., 2012). It helps practitioners consider function in terms of
therapy assistants have in the evaluation and assessment process. the individual’s characteristics and attributes, as well as the tasks
To assist teams in determining students’ educational needs, the and environments in which they typically engage. It emphasizes
evaluation process must elicit relevant functional, developmental, ability to participate in activities typically expected with a given
and academic information (IDEA, 2004). Federal education leg- age and context.
islation mandates that teams use various procedures that include The Framework guides therapists in skilled observation by
multiple informants (e.g., student, teacher, caregivers, instruc- clearly identifying the domain of occupational therapy practice
tional and administrative staff), multiple contexts (e.g., class- and outlining the occupational therapy process of evaluation,
rooms, cafeterias, playgrounds), and multiple modes (informal intervention, and outcome measurement (AOTA, 2014). School
and formal approaches, strategies, tests, measures) to evaluate occupational therapy evaluation not only considers areas of
students who are suspected of having a disability. However, the occupation, such as ADLs, education, play and work, rest and
federal law does not specify particular methodologies, tests, and/ sleep, and social participation, but also the student’s perfor-
or measures that must be used (IDEA, 2004) (this may vary by mance skills and patterns and how these affect participation in
state and local educational authority [SEA and LEA]). the educational context. Through analysis of the student’s occu-
Instead, the law emphasizes the need to design an indi- pational performance, occupational therapists are well poised
vidualized and comprehensive evaluation process that fully to highlight the student’s strengths as well as their needs, and
illuminates the effects of the suspected disability on access, inform the team’s understanding of the supports and barriers
participation, and progress in grade-level educational opportu- that influence participation in school occupations.
nities. This process enables team members to make predictions Taking a structured approach to skilled observations of
about the supports and barriers necessary to achieve success in occupational performance allows practitioners to collect and
postsecondary educational, vocational, and independent living organize their data; identify the adaptations and instructional
occupations (IDEA, 2004). methodologies most likely to enhance participation and prog-
From an occupational therapy perspective, this approach ress; reduce the effect of bias in evaluation and assessment; and
empowers occupational therapy practitioners to use their profes- articulate the distinct value of occupational therapy (Frolek
sional reasoning skills to select the most appropriate combination Clark & Handley-More, 2017).
of methodologies (e.g., informal/formal observation, interview,
assessments, tests, measures) for each individual student being Authentic Evaluation Practices
evaluated to effectively identify the influences on student partici- Occupational therapists rely on clinical decision making models
pation, health and well-being, and future life outcomes. to design an occupation-centered, collaborative, and evi-
In addition to federal and state educational legislative man- dence-based evaluation in school settings. Accurate evaluation
dates, the Occupational Therapy Practice Framework: Domain and data is critical for developing a student’s individualized educa-
Process (3rd ed.; Framework; American Occupational Therapy tional program. Normative standardized scores alone provide
Association [AOTA], 2014) guides the evaluation process in little guidance in planning a student’s educational program and
school practice. Historically, a bottom-up evaluation approach may not be relevant. In fact, even when an assessment score
that primarily considers skills deficits through the lens of a is obtained, it is imperative that occupational therapy practi-
medical model has been common in school settings. This tioners and those with whom they work understand assessment
impairment-based approach to evaluation addresses primarily the scores in relation to the student’s school performance.
problems of body structure and function thought to underlie the Formal and informal observation strategies across contexts and
functional limitations of the disability. environments in schools provide authentic opportunities to capture
However, to meet federal requirements, practice standards, not only capacity, or what the student can do under the controlled
and the increasingly robust body of evidence on evaluation and conditions of an assessment, but also performance in the natural
intervention planning, the deficits-based model has been replaced settings of daily life. Observing functional skills and performance
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components across contexts in the school setting provides critical and funders (Persch et al., 2013), and in settings where there
data on what students are capable of doing, how they do it, and may be role blurring and overlap with other professions. In
what they use to facilitate their performance and overcome chal- school practice, the occupational profile helps occupational
lenges and barriers. An evaluation conducted in a student’s natural therapy practitioners articulate not only the student’s voice and
context can be designed to intentionally and flexibly address the the distinct value of the profession, but also practitioners’ com-
questions of the team and collaboratively capture the data that will mitment to client-centered practice. The profile also captures
be most meaningful for decision making (Laverdure, 2018). the student’s perspective without making judgments.
Understanding the student’s developmental, medical, Strategies for developing an occupational profile will vary
educational, and occupational history; the curriculum, class depending on the age, preferences, and communication and
expectations, and instruction provided; and the contextual and cognitive skills of each student. For young students, drawing
environmental effects on performance and participation can may be a helpful strategy—there is evidence that children
guide the methods of data collection used in the evaluation provide more detail when asked to draw their information in
process (Laverdure, 2018). addition to verbalizing it (Gross et al., 2009). Alternatively, ask-
Data are gathered through: ing children to take photographs of the things that are strengths
• Intentional and objectively conducted skilled observation and challenges for them can be effective (Mahoney et al., 2015),
that is aligned with the purpose of the evaluation and whereas using a semi-structured interview format can elicit
designed specifically around what is to be observed meaningful information from older students.
• Interviewing inventories that specifically engage key stake- School occupational practitioners can use a combination of
holders (e.g., student, caregivers, teachers, teaching staff, ser- strategies to establish the occupational profile, convey the stu-
vice providers) in the observation and data collection process dent’s voice in a meaningful way, and build a strong foundation
• Observational rating scales (e.g., matrices and rubrics, work for collaborative practice. Using appreciative inquiry with stu-
samples) designed to capture the salient differences in per- dents (Morris & Hollenbeck, 2016; Stephenson et al., 2017) and
formance and participation collaborative conversations with teachers (Orentlicher et al.,
• Curriculum-based assessments co-administered by occupa- 2014) can support the collection of data to develop the student’s
tional therapists and teaching staff occupational profile (see Table 1).
• Occupation-based assessment methodologies
Choosing and Using Assessment Measures
Developing the Occupational Profile Although not required in many SEAs and LEAs, or by federal
Developing an occupational profile is an essential element law, occupational therapy practitioners may supplement the
across all occupational therapy practice settings (AOTA, occupation-based evaluation process with formalized and/or
2014). In school practice, it offers practitioners opportunities standardized assessments, tools, and measures (assessments).
to elicit the voice of students to guide further evaluation, goal Practitioners may combine the use of assessments intentionally
setting, and intervention planning. The occupational profile is when necessary to validate and discriminate difference versus
a thorough inventory of the individual’s preferences, patterns, disorder, and to provide discriminative, descriptive, predic-
strengths, and interests, as well as a description of the supports tive, and evaluative information to the school team. To reduce
and barriers that affect occupational performance and partic- assessment bias, it is important that the occupational therapist
ipation (AOTA, 2017). The occupational profile assists practi- understand the type of data that the assessment will reveal, and
tioners to articulate the distinct value of occupational therapy, that the assessment is appropriate to age, condition, and setting
particularly in a climate of increased scrutiny from regulators (Laverdure, 2018). The type of information that the assessment
Table 1: Building a School-Based Occupational Profile (adapted from AOTA, 2017)
Elements of the Occupational Profile Eliciting Data from Students Eliciting Data from Teachers
Occupational History and Experiences “Tell me what it’s like for you at school” “How is this “In what activities does the student do well in your
year different from last year?” class?” “What factors contribute to how they perform in
your class compared with last year?”
Interests and Values “What do you like to do at school?” “What sort of “What is their favorite part of the school day?”
things are important to you?”
Strengths and Needs “What are you really good at?” “What is hard for you “In what areas does the student do well academically?”
at school?” “What do you think would help you (with “When is the student able to work successfully?” “What
this) at school?” strategies are used to support success?”
Supports and Barriers What or who helps you do well at school?” “What or “What helps them be the best that they can be?” “How
who makes it hard for you to do well at school?” does instructional help or hinder learning, occupational
engagement, and performance in the classroom?”
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will provide and how the information can be used to inform Collecting and analyzing explicit outcome data requires assess-
decision making can often be found in the assessment manual. ment tools that are designed to be used as outcome measures and
Discriminative assessments are designed to distinguish are highly responsive to change. Evaluative assessments tend to
between individuals who have a particular characteristic and capture student occupational engagement and performance skills
those who do not (e.g., developmental impairment). They are and patterns. Examples of commonly used evaluative assessments
most often normative referenced, yield normative standard include the Canadian Occupational Performance Measure (Law
scores, and are commonly used by occupational therapists to et al., 1990), Pediatric Evaluation of Disability Inventory (Haley et
identify and document functional deficits and support eligibility al., 1992), and School Function Assessment (Costeret al., 1998).
determination. The use of discriminative assessments requires
knowledge of the derivation of standard scores from raw scores; Using the Framework to Organize Assessments
identification and comparison of standard deviations, confidence Choosing the right assessment to enhance the occupation-based
intervals, standard error of measurement, percentile equivalents, evaluation for the right student and condition can be daunting.
Z-scores, T-scores, standard nine, and percent in stanine in a nor- For some, assessment choice is limited by availability. For oth-
mal distribution; and analysis of test results for planning for goal ers, it is limited by exposure or practice. To meet the regulations
setting and effective instruction and intervention. set by IDEA (2004) and SEA and LEA requirements, assessment
Discriminative assessment data enables the therapist to iden- tools must be chosen with the same intentionality given to the
tify deviations from the norm, discuss the effects of those devi- informal and formal authentic observational processes and
ations on performance and participation, and consider effective occupational profile development previously described. Using
instruction and intervention to remediate and/or accommodate. the Framework as a guide can be instrumental in identifying the
Descriptive assessments most often address client factors. assessment tool that will reveal the data required for effective
Examples of commonly used discriminative assessments include decision making and educational planning.
the Bruininks-Oseretsky Test of Motor Proficiency (Bruininks & The domain of occupational therapy is defined in the Frame-
Bruininks, 2005) and the Peabody Developmental Motor Scales work as the “profession’s purview and the areas in which its
(Folio & Fewell, 2000). members have an established body of knowledge and expertise”
Descriptive assessments highlight the differences among (AOTA, 2014, p. S3), and “occupational therapists are skilled in
individuals within similar groups. They allow practitioners evaluating all aspects of the domain, their interrelationships,
to compare the individual they are testing with others with and the client within his or her contexts and environments” (p.
similar characteristics. Determining the characteristics of the S4). Drawing from the domain to guide assessment selection
descriptive sample is important to make valid comparisons, to leads to effective and efficient data collection.
establish an occupational profile of strengths and needs, and to Validation; discriminating between difference and disor-
guide decision making. Examples of commonly used descriptive der; and collecting discriminative, descriptive, predictive, and
assessments include the Gross Motor Functional Classifications evaluative information are categorized using the occupational
System (GMFCS) (Palisano et al., 1997) and the Manual Classi- therapy domain in four main areas (see also Table 2 on p. 5):
fication System (MACS) (Eliasson et al., 2006), which are often • Assessing Occupation: Assessments that measure engage-
used with children and youth with cerebral palsy. ment in meaningful activity and occupation
Predictive assessment data supports the occupational thera- • Assessing Performance Skills and Patterns: Assessments that
pist’s ability to predict the likely outcomes of children and youth measure participation
based on their patterns of strengths and needs. The predictive • Assessing Client Factors: Measures that assess body function,
qualities of many assessments may be combined with evidence structure, and personal factors
related to functional status, disease/disability progression, and • Assessing Context and Environment: Measures that assess
rate of progress to further support the prediction of developmen- the influence of environment
tal, educational, and functional outcomes. Predictive assessments Although assessments may be categorized into more
generally have strong test-retest reliability and predictive validity than one area of the occupational therapy practice domain,
and may be used as outcome measures. Examples of commonly a thoughtful approach to the choice of assessment is
used predictive assessments include the Classifications Systems recommended.
(GMFCS and MACS) for children with cerebral palsy described The following examples may illuminate this concept.
above and the Movement Assessment Battery for Children for Example 1: A 3 year old named Sam had just been found
children born prematurely (Griffiths et al., 2107). eligible for special education services and had begun attending
Finally, evaluative assessments measure change over time. the preschool program located within his local elementary
With the stringent federal and state legal requirements for school. The teacher noticed that Sam had difficulty regulating
accountable practice and the shift from compliance to compliance his activity level and that his inability to sit still for circle and
plus results (U.S. Department of Education, 2016), evaluation centers limited his ability to participate effectively and learn in
data is “instrumental in supporting the implementation of effec- the school context. A referral to occupational therapy services
tive interventions, overcoming instructional barriers, and facili- was made, and with parental permission the occupational thera-
tating data-based decision making” (Stephenson et al., 2017, p. 2). pist began the evaluation process.
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Table 2: Using the Framework Domain to Categorize and Choose Effective and Efficient Assessments
Assessing Occupation: Assessments That Measure Engagement in Meaningful Activity
Time to Format/Type of Format and
Measure Purpose Constructs Age Administer Administration Scores
Canadian Occupa- Identify occupa- Measures clients’ Any age, with or 15–30 minutes Semi-structured Standardized scores,
tional Performance tional performance perceived occupa- without disabilities interview by therapist norm-referenced
Measure problems, define tional performance in
priorities, and guide three areas: self-care,
goal setting productivity, and
leisure
Miller Function and Assess a child’s per- Measures mild to 2.6–7.11 years 20–30 minutes per Workbook/task Standard scores,
Participation Scales formance related to moderate delays in subset, 45–60 min. format, administered percentile ranks,
school participation, visual, fine, and gross for entire assessment by therapist age equivalents, and
with a focus on motor motor skills progress scores
skill performance
Pediatric Evaluation Comprehensive Evaluates capability 6 months–7.5 years, 45–60 minutes for Questionnaire format, Standard and scaled
of Disability Inventory assessment of and performance of physical or combined administration and administered by performance scores
functional skill devel- functional activities in physical and cogni- scoring parent report, profes-
opment and level of the domains of self- tive disabilities sional judgement, or
independent perfor- care, mobility, and combination
mance of functional social function
activities in a child’s
environment
Assessing Performance Skills and Patterns: Assessments That Measure Participation
Time to Format/Type of Format and
Measure Purpose Constructs Age Administer Administration Scores
Children’s Assess- Examines partici- Five dimensions of Children with and 30–45 minutes Questionnaire, Mean intensity and
ment of Participation pation in everyday participation including without disabilities, self-report, or subjective enjoyment
and Enjoyment activities outside of diversity of activity, 6–21 year interview
school classes frequency, enjoyment,
and context
Child Occupational Captures children and How competent does 8–13 years (must 25 minutes Self-report, struc- Importance rating
Self-Assessment youths’ perception a child feel engaging have self-reflection tured interview scale, priorities for
regarding sense of in and completing and planning skills change
occupational compe- activities?
tence and importance
of everyday activities
Goal-Oriented As- Assesses functional Measures 7 tasks 7–17 years, with or 45–60 minutes Series of seven Standard scores, with
sessment of Lifeskills motor skills required requiring fine or gross without disabilities occupation-based option to document
for daily living skills motor skills: utensils, activities progress over time
locks, paper box, note-
book, carry tray, ball
play, manage clothing
Participation and En- Assess participation Home, school, and 5–17 years, with or 25–40 minutes Parent report ques- Rating scale of partic-
vironment Measure— in the home, at community without disabilities. tionnaire ipation frequency,
Children and Youth school, and in the involvement and
community as well as desire for change,
environmental factors and environmental
of participation support
Preferences for Activ- Recreational, active Measures activity 6–21 years, with or 15–20 minutes Self-report or Preferences for
ities of Children physical, social, skill preference without disabilities interview involvement in mean-
based, and self-im- ingful activities
provement
School Function Assessment of func- Participation, task 5–12 years 60–90 minutes. Judgment based Raw scores, criterion
Assessment tional capabilities and supports, activity questionnaire, inter- scores 0–100 for full
performance of func- performance view, or observation grade functioning
tional activities that
support participation in
academic and related
social aspects of an
education program
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The occupational therapist observed Sam’s performance and routines as well as his interest and skill in playing on the play-
participation during circle and centers. She interviewed Sam’s ground equipment and with the construction materials.
caregivers, teachers, and the teaching staff. She noted the ease Given Sam’s sensitivity to loud sounds in the environment
with which he managed his arrival, dismissal, and snack time and his tendency to shout and make loud noises himself, the
Table 2 continued
Assessing Client Factors: Measures That Assess Body Function, Structure, and Personal Factors
Constructs Time to Format/
Measure Purpose Age Scores
Evaluated Administer Administrations
Bruininks-Oseretsky Comprehensive Fine motor precision, 4–21 years, and 11 Complete form, Series of motor tasks Age-based standard
Test of Motor Profi- assessment of gross fine motor integra- months 45–60 minutes that require a skilled scores, percentile
ciency and fine motor skills tion, manual dexterity, professional to guide ranks, age equiva-
bilateral coordination, *short form is avail- child through as- lents, and descriptive
balance, running able, 15–20 minutes sessment and score categoriest
speed and agility, up- during performance
per limb coordination,
and strength
Developmental Identify difficulties in Visual motor 2–99 years, and 11 10–15 minutes Child completes a se- Standard scores,
Test of Visual Motor visual motor integra- integration, visual months ries of tasks in a test percentiles, age
Integration tion. Supplemental perception, and motor booklet. Professional equivalents
versions assess coordination guides child with
visual perception and scripted instructions
motor coordination and manually scores
resultst
Developmental Test of Identify the presence Measures 7 tasks 4–12 years 30 minutes Child completes a Composite scores for
Visual Perception and degree of visual requiring fine or gross series of tasks in a motor reduced visual
perception and visu- motor skills: utensils, test booklet. Skilled perception, visual
al-motor difficulties in locks, paper box, professional guides motor integration,
children notebook, carry tray, child with instructions and general visual
ball play, manage and manually scores perception
clothing results.
Gross Motor Function Evaluates changes in Examples of motor 5 months–16 years 45–60 minutes Observation plus 4-point scoring
Measure (GMFM) gross motor function skills evaluated in- score sheet system
in children with cere- clude rolling, walking,
bral palsy (GMFM-66). jumping
GMFM-88 evaluates
gross motor function
in children with Down
syndrome
Manual Ability Classi- Classifies how Classifies what Children with n/a, score made in Observations of child Numerical classifi-
fication System children with cerebral children do with both cerebral palsy, 4–18 accordance with and interview of cation based on a
palsy use their hands hands together years observation and parents, teachers, or 5-item scale based
when handling objects interviews child used to deter- on manual ability
in daily activities mine a child’s ability
Peabody Develop- Assesses motor skill Six domains: Birth–5 yearss 45–60 minutes. Child participates Standard scores,
mental Motor Scales development grasping, visual- in series of tasks percentiles for total
motor integration, administered by motor, fine motor, and
reflexes, stationary, evaluator gross motor quotients
locomotion, object
manipulation
Sensory Profile Identifies how Caregiver and teacher Birth–14 years, and 5–20 minutes Standardized ques- Each form produces
sensory processing reports on child’s 11 months. tionnaire completed a sensory system
may affect a child’s response to sensory by caregiver or score, behavior score,
participation at events throughout *Five versions teacher and sensory pattern
home, school, and the day using the available depending score. The school
community appropriate form on the child’s age companion version
and setting produces a school
factor score
Sensory Processing Provides a complete Scores praxis and 2–5 years preschool 15–20 minutes per Parent or teacher Norm-referenced
Measure picture of children’s social participation as version, 5–12 years form completes a rating standard scores with
sensory processing well as visual, auditory, standard version scale descriptions and
difficulties at school tactile, propriocep- clinical information
and at home tive, and vestibular provided
functioning
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Table 2 continued
Assessing Context and Environment: Measures That Assess the Influence of Environment
Constructs Time to
Measure Purpose Age Who Scores
Evaluated Administer
Pediatric Volitional Play-based assess- Motivational 2–7 years, with or 10–30 minutes Observational Scored on a con-
Questionnaire ment of a child’s mo- strengths, weakness- without disabilities assessment tool tinuum of volitional
tivational strengths es, environmental development
and weaknesses in support, hindrances,
various settings and activities of
interest
School Setting Investigates student How do environmen- 10 years and older, 40 minutes Patient-reported out- 4-step rating scale
Interview environment fit for tal factors influence physical disabilities or comes based on 16 indicating need
students with physi- student’s activity and motor dysfunction interview questions for environmental
cal disabilities participation? adjustment
occupational therapist suspected sensitivity issues that may influence performance, participation, roles, and satisfaction.
be affecting his attention and regulation. She completed the Collecting assessment data across the domains of occupational
occupational profile and chose an assessment to measure client therapy ensures that the occupational therapy practitioner cap-
factors (Sensory Processing Measure) to validate her suspicions tures all relevant data so the team can make informed decisions
and inform her intervention planning. based on the student’s developmental, learning, and functional
The therapist’s choice of assessment to validate the data priorities. Data are discriminative, descriptive, predictive, and
collected from formal observation and interview and to discrim- evaluative, and they provide valuable information that enables
inate between difference and disorder enabled her to efficiently the team to consider current and future roles and occupations in
and effectively plan interventions with the classroom teacher to educational, community, work, and postsecondary settings.
address Sam’s attention and regulation and design approaches
his caregivers could carry over at home. REFERENCES
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pendently. The occupational therapist, who had been seeing
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chose to administer an assessment tool aimed at eliminating Assessment (SFA). San Antonio, TX: Therapy Skill Builders.
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task and environmental modification. Explicitly identifying the Therapy in Pediatrics, 32, 388–403.
areas of need and using the Framework to choose assessments
Eliasson, A. C. C., Krumlinde-Sundholm, L., & Rosblad, B. (2006). The Manual
to collect discriminative, descriptive, predictive, and evaluative Ability Classification System (MACS) for children with cerebral palsy: Scale
information enabled the occupational therapist to design effec- development and evidence of validity and reliability. Developmental Medicine
tive accommodations and modifications to support Johnny’s and Child Neurology, 48, 549–554.
needs in the classroom. Folio, R., & Fewell, R. (2000). Peabody Developmental Motor Scales. Austin,
TX: Pro-ed.
Frolek Clark, F., & Handley-More, D. (2017). Best practices for documenting occu-
Summary pational therapy services in schools. Bethesda, MD: AOTA Press
When data are collected systematically in natural and least
Goldstein, D. N., Cohn, E., & Coster, W. (2004). Enhancing participation for
restrictive environments, and the domains defined within the children with disabilities: Application of the ICF enablement framework
Framework are used to guide the evaluation process, the analysis to pediatric physical therapist practice. Pediatric Physical Therapy, 16,
of occupational performance effectively describes the student 144–120.
and his/her patterns of daily living, interests, and needs. The Griffiths, A., Morgan, P., Anderson, P., Doyle, L., Lee, K., & Spittle, A. (2017).
Predictive value of the Movement Assessment Battery for Children—Second
data inform the team of how the student engages in desired Edition at 4 years, for motor impairment at 8 years in children born preterm.
or required occupations, and they illuminate the factors that Developmental Medicine and Child Neurology, 59, 490–496.
ARTICLE CODE CEA0219 | FEBRUARY 2019 CE-7
CE-7CE Article, exam, and certificate
Continuing Education Article are also available ONLINE.
Register at http://www.aota.org/cea or
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-8 for details. call toll-free 877-404-AOTA (2682).
Final Exam
Gross, J., Hayne, H., & Drury, T. (2009). Drawing facilitates children’s reports
of factual and narrative information: Implications for educational contexts.
Applied Cognitive Psychology, 23, 953–971.
Haley, S. M., Coster, W. J., Ludlow, L. H., Haltiwanger, .J. T., & Andrellos, P. A.
Article Code CEA0219
(1992). Pediatric Evaluation of Disability Inventory: Development, standardiza-
tion, and administration manual. Boston, MA: Trustees of Boston University. Using the Occupational Therapy Practice
Handley-More, D., Wall, E., Orentlicher, M. L., & Hollenbeck, J. (2013). Work-
ing in early intervention and school settings: Current views of best practice. Framework to Guide the Evaluation
Early Intervention & School Special Interest Section Quarterly, 20(2), 1–4.
Individuals with Disabilities Education Improvement Act of 2004. Pub. L. 108-
Process and Make Assessment Choices in
446, 20 U.S.C. §§ 1400–1482. School Practice
Jackson, L. L. (Ed). (2007). Occupational therapy services for children and youth
under IDEA (3rd ed.). Bethesda, MD: AOTA Press. To receive CE credit, exam must be completed by
Laverdure, P. (2018). Collecting participation-focused evaluation data across the February 28, 2021.
school environment. SIS Quarterly Practice Connections, 3(2), 5–7.
Law, M., Baptiste, S., & McColl, M. (1990). The Canadian Occupational Perfor- Learning Level: Beginner
mance Measure: An Outcome Measure for Occupational Therapy. Canadian Target Audience: Occupational Therapists and Occupational Therapy
Journal of Occupational Therapy, 57, 82–87.
Assistants
Mahoney, W. J., Soares, P. D., Yoder, W. L., Lewis, A. T., Hristodoulopoulos, J.,
Osisioma, P., & Ayala-Castellano, E. (2015). Through the eyes of a child: Content Focus: Professional Issues; Occupational Therapy Interventions
Using photography for occupational profiles with young children. OT Prac-
tice, 20(3), 11–13.
Morris, M., & Hollenbeck, J. (2016). Evaluating student participation: Focus on
1. Occupational therapy practice in schools has shifted its focus
strengths in your school-based evaluation. OT Practice, 21(1), CE-1–CE-8. from impairment to supporting student participation in activi-
Orentlicher, M. L., Handley-More, D., Ehrenberg, R., Frenkel, M., & Markowitz, ties that occur naturally in the school setting because of:
L. (2014). Interprofessional collaboration in schools: A review of current evi-
dence. Early Intervention & School Special Interest Section Quarterly, 21(2), 1–3.
A. Federal legislation, contemporary teaching and learning
practices, professional guidance, and scientific evidence
Palisano, R., Rosenbaum P., Walter, S., Russell, D., Wood, E., & Galuppi, B.
(1997). Development and reliability of a system to classify gross motor B. Federal mandates that require standardized measures
function in children with cerebral palsy. Developmental Medicine and Child and assessments
Neurology, 39, 214–223.
C. The Framework, which requires all intervention be occu-
Persch, A. C., Braveman, B. H., & Metzler, C. A. (2013). P4 medicine and
pediatric occupational therapy. American Journal of Occupational Therapy, 67, pation based
383–388. https://doi.org/10.5014/ajot.2013.674002 D. Internal and external evidence
Stephenson, P., Laverdure, P., Seruya, F. M., & Cosbey, J. (2017). Not just for
children: Facilitating behavior change in school-based practice. SIS Quarterly
Practice Connections, 2(4), 2–4. 2. One of the central purposes of evaluation in schools is to
U.S. Department of Education. (2016). RDA: Results Driven Accountability. Retrieved determine:
from https://www2.ed.gov/about/offices/list/osers/osep/rda/index.html A. Functional strengths and needs
World Health Organization. (2007). International classification of functioning,
disability and health—Children & youth version. Geneva, Switzerland: Author.
B. The services and supports required to be successful in
school
C. Whether a student has a disability; and whether that
disability adversely affects the student’s participation,
How to Apply for performance, and progress in the general education
curriculum
Continuing Education Credit D. Eligibility for occupational therapy services
A. To get pricing information and to register to take the exam online for the
article Using the Occupational Therapy Practice Framework to Guide the 3. To assist teams in determining students’ educational needs,
Evaluation Process and Make Assessment Choices in School Practice, go to the evaluation process must include the following three
http://store.aota.org, or call toll-free 800-729-2682. components:
B. Once registered and payment received, you will receive instant email A. Functional, community, and academic skills
confirmation. B. Relevant functional, developmental, and academic
C. Answer the questions to the final exam found on pages CE-8 & CE-9 by information
February 28, 2021. C. Independent living, postsecondary, and work skills
D. On successful completion of the exam (a score of 75% or more), you will D. Math, reading, and writing skills
immediately receive your printable certificate.
CE-8 ARTICLE CODE CEA0219 | FEBRUARY 2019Continuing Education Article
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-8 for details.
4. The Framework and the ICF-CY align because they: 8. Which of the following is true in relation to evaluating students
A. Provide a shared perspective and language that can be under IDEA (2004)?
helpful in school practice to facilitate opportunities to A. All students suspected of having a disability must be
work across professions and contexts evaluated using the same evaluation tools and measures.
B. Consider the occupations of the student and subse- B. Occupational therapy practitioners must use a standard-
quently identify the supports and barriers necessary for ized tool as part of their evaluation.
participation in those occupations C. Various tools and strategies must be used in the evalua-
C. Focus on activities, participation, and the influence of tion process.
contextual factors D. IDEA mandates that only academic information must be
D. Help practitioners consider academics in terms of the collected during the evaluation process.
individual’s characteristics and attributes, as well as the
tasks and environments in which they typically engage 9. Evaluation data can be collected through all but which one of
the following:
5. Observing functional skills and performance components A. Skilled observation
across contexts in the school setting: B. Interview inventories
A. Provides critical data on what students are capable of C. Observational rating scales
doing, how they do it, and what they use to facilitate D. Functional development charts
their performance and overcome challenges and barriers
B. Guides interview questions for caregivers and teaching 10. Which one of the following tools assesses client factors and
staff identifies the presence and degree of visual perception and
C. Provides standardized scores required to qualify for occu- visual-motor difficulties in children?
pational therapy services A. Bruininks-Oseretsky Test of Motor Proficiency
D. Fulfills the IDEA requirement for comprehensive B. Gross Motor Function Measure
evaluation
C. Developmental Test of Visual Perception
D. Developmental Test of Visual Motor Integration
6. Which one of the following is true in relation to occupational
profiles in school-based practice?
11. Occupational therapy practitioners may choose to supplement
A. School-based practitioners do not need to develop occu- the occupation-based evaluation process with formalized and/or
pational profiles with children. standardized assessments, tools, and measures (assessments) to:
B. Children need strong verbal language skills to participate A. Reduce assessment bias
in building an occupational profile.
B. Validate and discriminate between difference and disor-
C. The occupational profile includes consideration of the der and provide discriminative, descriptive, predictive,
child’s interests, values, and preferences. and evaluative information to the school team
D. Occupational profiles should only be used with middle C. Meet the IDEA requirement for standardized evaluations
and high school students.
D. Establish the scores required to meet occupational thera-
py eligibility requirements
7. Which of the following best describes a top-down approach to
evaluation in school-based practice? 12. Which one of the following attributes is consistent with the
A. Occupational therapy practitioners primarily use assess- Pediatric Volitional Questionnaire?
ment tools that identify performance skills deficits and A. Investigates student environment fit for students with
subsequently use this data to plan interventions. physical disabilities
B. Practitioners focus on identifying unique client factors at B. Develops patient-reported outcomes based on 16 inter-
the start of the evaluation process. view questions
C. Practitioners are guided by the federal mandate to use C. Takes only 10 to 30 minutes to complete
various evaluation tools and strategies to identify stu-
D. Has a four-step rating scale indicating need for environ-
dents’ areas of need.
mental adjustment
D. Practitioners first consider the school-based occupations
in which students need to participate and then refine the Now that you have selected your answers, you are
specific evaluation process. only one step away from earning your CE credit.
Click here to earn your CE
ARTICLE CODE CEA0219 | FEBRUARY 2019 CE-9
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