Posted in Eleanor Cawley

Pushing the Birds out of the Nest

Leaving the nest copyThese opinions are my own based on my personal school-based experiences and recent postings from other therapists on social media 

When is it time to discharge?

This is always one of the biggest questions when it comes down to CSE Meetings and whether or not to recommend services for students next year. Of course, in a school-based setting, the big ‘money makers’ are handwriting and now keyboarding. Before making that decision, I think that it is important to look at the student’s level of function in a particular environment. I feel that when we report progress a rubric is very important but so is the environment or context in which the skill is performed. When I look at either handwriting or keyboarding I look at the following:

  1. Can the student perform the task automatically with my assistance in a therapy room?
  2. Can the student perform the task automatically in the therapy room without my assistance?
  3. Can the student perform the task automatically in a classroom with my assistance?
  4. Can the student perform the task automatically in a classroom without my assistance?

This is an important factor that is left out of documentation on goal progress. Anyone that knows about me, knows that I love to use rubrics. I love documentation to be clear and concise, understood without my being there to explain. So I often base my documentation on the level of self-sufficiency-does the student have the power to perform the task over a wide range of activities and settings. In other words, is the handwriting or keyboarding at the level of being automatic? The DeCoste Writing Protocol is an evidence-based tool with some very good research supporting its development. Based on this research, both handwriting and keyboarding should be at the level of automaticity. If these skills are not automatic, then the focus in on the motor components of the task and therefore the student cannot meet the cognitive demands of the writing task. Basically, we will not know what the student has absorbed because he or she cannot get it on paper.

I remember hearing somewhere that in order to do your best on a test, you should take the test in the same location that the teaching or learning took place. Could that mean that a student may hand write better if he or she is in the room where they actually learned the skill? It is certainly an interesting point and possibly one for a good research study. Our goal is to have the student generalize the skills to all handwriting or keyboarding tasks-to become proficient. The Written Language Production Standards provides us with what is expected of a student with regard to handwriting and keyboarding at a particular grade level. Does your student meet those standards? Do you think that your student is capable of meeting those standards? Why or why not? Is the student capable of meeting those standards in a variety of settings without your support? Why or why not? I feel that I am not doing my job well, if I can’t answer these questions, my student is not performing as expected within the classroom and I have not offered alternatives.

There is also something else to consider and that is the student’s expectations and preferences. Is this student so overwhelmed with handwriting or keyboarding that they have just given up? I use The Student Interview to explore the student’s preferences and understanding of their own skills, i.e., what the student thinks they can do to what the parent thinks they can to and compare that to what I and the teacher see them do. The level of anxiety and frustration that a student experiences with not being able to express themselves on paper should be considered.

So while I would always like to think that OT RULES and I have all the answers, I don’t. What I do know is this, keep the student involved with determining goal progress, assess the skill across settings and keep the student in mind when determining where to go next, if anywhere. If you think that you can discharge a student when they can type 10 words a minute and they are in the 4th grade or above, think again. That student is not ready to handle the keyboard in the classroom.

Posted in Assistive Technology, Eleanor Cawley, M.S., OTR/L, Occupational Therapy

How Important is the Content of a Referral When Evaluating for Occupational Therapy?

When conducting an evaluation, in my case either an occupational therapy or assistive technology evaluation, is the quality of the referral important?  In my opinion, absolutely!

Occupational therapy [and assistive technology] cover a huge array of skills in an infinite number of areas.  When conducting a school-based evaluation, it is prudent to know what the student’s difficulties are.  For example, if a student is unable to take notes, I would explore a variety of skills in detail [visual tracking, handwriting, orientation to sound, etc.].  I would need to know that the student is having difficulty in this area and this is an area that the school would like to address.  I would also need to know what the student thinks:  Is writing notes the problem or is something else.  Students need to provide feedback during an evaluation.  Their feedback provides insight to strengths and limitations that professionals might not see.

If I were evaluating a senior citizen, I would need to know what current and future living situations are being discussed and what the expectations of the patient and possibly the family might be.  For example, does the patient and or the family expect that this patient will cook or shop independently?  Although I would surely conduct a global assessment of this patient’s skills, I would definitely expand and focus on the skills that the patient is expected to be able to do.  In the case of cooking and shopping, my evaluation would focus on handling utensils, navigating the kitchen, energy conservation and safety, including fall prevention, both in the kitchen and out in the community, the patient’s ability to follow written and verbal directions, generating a shopping list, etc.

The referral asks the questions that the patient and his or her family need answers to.  Having a referral focuses the evaluation on the client, the student, the patient.  It shows the person being evaluated that his or her needs are important and valued.  This helps develop a rapport with the client that can support the therapeutic process so that the client has a vested interest in participating in therapy.

So, in addition to the diagnosis, the client needs to learn what an occupational therapist does and what he or she can assist with prior to the evaluation.  My next blog will cover “Just What Does and Occupational Therapist do?”