Posted in Eleanor Cawley, M.S., OTR/L

So Why Should Occupational Therapists Bother to Write Rubrics?

Mostly, therapists read my posts on social media and then move on. Some comment positively and others, not at all. But then there are those times when there  is that one person who challenges you. I must say, that one person tends to get my fight on! I feel that I have to prove my work all over again. But I really love the debate. To those of you who feel that rubrics are not necessary, that’s okay. However, I feel they are.
Rubrics have been around for a very long time. During my research for my book, “Using Rubrics to Monitor Outcomes in Occupational Therapy“I found that rubrics actually began not in the educational field but in the medical field, decades ago. I feel that rubrics were lost in the shuffle in part due to the changes in the provider/client relationship, moving from power over to power with and ultimately to power through our clients. Now that we are searching for ways to become more ‘client-centered’ as a profession, I feel that transparent, understandable documentation is the key.

It has always been our premise, as occupational therapists, to have our clients engaged in purposeful activity. With the increasing intrusion of third-party payment systems into what we do with our clients and the struggle to become ‘client-centered’ having a method of recording progress becomes increasingly important. Yes, of course, we need to get paid for our work but we also have an obligation to our clients, any one receiving our services.

We all have those people, who question what we do.  I am sure that each and every one of us has had this experience.  Sometimes we can explain what is going on, through statements based on clinical knowledge, but then there are other times that we need real data.  Some challengers will accept the “+” or “-” system of data collection [“+” yes the client was able to perform the task or “-” no the client was not able to perform the task]  while

 

My Book Cover2
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others want more information.

So rubrics offer us a method of documenting some of our thought processing with regard to critical thinking, clinical reasoning and judgment. Sharing rubrics with clients and caregivers provides them with a tool to engage them in the treatment process in a way that is greater than just sharing goals.  By encouraging clients to monitor their own progress they become more vested, more engaged and more accountable to themselves and to us, their service providers, ultimately leading to greater gains.

Rubrics may be initially time-consuming to learn and to write, just like any other skill, the experienced therapist will soon be developing rubrics a lightening speed and have at their disposal a wealth of data and documentation supporting our services.  In my humble opinion, if a therapist chooses to use or not to use rubrics, it is okay, it’s their decision.  I choose to use rubrics, engage my clients in progress monitoring, and have data specifically highlighting the client’s progress.  In my opinion, how can I expect my clients to make the best progress if I do not share my expectations with them. I feel that I empower my clients through the use of rubrics, because I want to, not because I have to.

 

 

Posted in Eleanor Cawley, M.S., OTR/L

Revisiting The Student Interview

The Student Interview CoverAI have worked with middle and high school students most often.  At this age, a student’s frustrations increase proportionally to the workload.  They are aware of what works and what does not work for them.  When frustrations run so high and parents begin to panic, it is at this time other professionals, advocate and lawyers, become involved.

The Student Interview was developed because of a number of school-based cases that I had been involved in were quite intense.  Every small detail of the case was explored in depth.  I felt that it was imperative that the student have a voice and that I had a document that asked all the right questions. While it is very sad to see the state of the educational system, as it is right now, I feel that the educational system is in transition.  There are always ups and downs when experiencing a transition.

Over the last few years, I have used this interview with many students.  Since this is a form to complete, it is good experience for a student in the transition process.  There is a variety of questions, relevant to the student’s educational, vocational and self-care needs.  Some questions require a yes or no response, while others are open-ended and call for more detail.  The Student Interview serves its intended purpose quite nicely. Since using The Student Interview, I have not had that “uh oh” moment when something comes up that I should be aware of.  At least nothing that I have not at least asked and have a response to.

I really love a student’s surprise when he or she is asked to complete the satisfaction survey.  This is often the very first time a student is asked for his or her opinion on services.  I, now, provide each student with this interview.  I find it an invaluable tool not only as written documentation but also as a basis for a deeper conversation regarding a student’s skills, and their perceptions of themselves.

 

Posted in Occupational Therapy

-Using Rubrics to Measure Patient Progress in All Practice Areas

Taken from the handout "Putting on Socks with One Hand" from Ohio State's Wexner Medical Center
Taken from the handout “Putting on Socks with One Hand” from Ohio State’s Wexner Medical Center

The following example of using a rubric in a rehab setting was developed from the handout “Putting on Socks with One Hand” available on Ohio State’s Wexner Medical Center site.   The rubric contained in this post was developed from this handout so that the directions that are provided to the patient match the expectations of the therapist as set forth in the assessment rubric.  If you have read my book, “Using Rubrics to Monitor Outcomes in Occupational Therapy”,  you would know:

 “Various dictionaries define a rubric as a set of rules.  In this case, rules that are used to make a judgment regarding a student’s level of performance.  Rubrics identify the standard of performance.  It is a way of communicating what is expected, describing a level of performance and the associated quality.”

So now we can see how the handout becomes a rubric and how a rubric is more clear and more transparent as a method of documenting patient progress than any other.

The rubric contains not only the steps to follow [listed as criteria] but also contains descriptors [as a graded judgment of attainment].  In this example, level of attainment or goal progress is assessed through the number of trials [red].  This method of documenting goal progress can be monitored and judged by any other therapist working with the patient when the primary therapist is not present.  The criteria is measurable and can be measured.  This meets the IDEA criteria.  By outlining the rules for judgement, consistency between raters [therapists] is possible.  Does each therapist [measuring progress] find the same areas of deficit?  More than likely, yes.  The potential for inconsistency can come from the therapeutic activities conducted prior to the task.  For example, did the primary therapist apply heat, but the covering therapist did not?  Did the primary therapist perform stretching exercises differently than the covering therapist?  While there are many variables between therapists, a consensus in deficit areas should be judged to be similar.  Please keep in mind that the rubric contained in this post is an assessment rubric [a standard based on the handout provided to the patient].  Once the patient’s deficits or limitations have been identified, the rubric will need to be modified to meet the individual needs of the patient.  Initially, developing a rubric can be time consuming.  However, once you have developed your rubric and saved it to use again, it can easily be modified for each individual patient.

If you would like a copy of this assessment rubric, please follow my blog and send your e-mail address to eleanorot@gmail.com

One Hand Sock Data Sheet

Posted in Assistive Technology

-Using OneNote to take Notes in Secondary Schools and College

Another of my favorite therapy areas is teaching students how to take notes.  Taking notes is not easy.  Students must be able to respond to auditory cues with a pen/pencil or a keyboard.  Some students feel the need to take down every word, while others can take down the highlights.  Since I am an occupational therapist, my job is to teach students how to respond to environmental cues with movement.  So I would like to talk about taking notes in my favorite note-taking program, OneNote.

There are a number of reasons to set up note – taking templates or forms in OneNote.  For example, this T-Chart can be used for a number of different classes and discussions within a class.  Prompts that may indicate that a T-Chart should be used are:  Compare/Contrast; Conversely; Vocabulary Words/Definitions; Pros/Cons, etc.  This note-taking template can also be used for pre-algebra/algebra or anywhere where there is a rule and a sample.  The Cornell style of note-taking also uses a asymmetrical T-Chart for cues and notes.

Simple T-Chart created from a table and saved as a template
Simple T-Chart created from a table and saved as a template

Much of the job is already done for the student.  The page is already formatted for the student.  I find that formatting is often part of the delay and disorganization in taking notes.  If you click on the date, a little calendar appears and the date can be easily changed (calendar will indicate the correct date).  The same can be done for the time. Rows can easily be added to the table by clicking on the appropriate icon in the ribbon at the top of the screen or by right-click and then click on Table.  The color of the page and print can also be changed to address any visual concerns.

The real trick is learning the verbal prompts so that the appropriate form can be identified and opened.  The great part of this system is that this is an auto-save program!  If the student closes the program before saving, the work will still be there.  Another factor to consider is keyboarding speed and accuracy.  Figure out if the student can take dictation on the keyboard accurately before recommending this method to any student.

Posted in Eleanor Cawley, M.S., OTR/L, New Beginings, Occupational Therapy

Should Middle and High School Students Participate in the Evaluation and Annual Review Process?

Should Students Have a Voice?

Absolutely!  Most students at the middle and high school level are looking for a sense of independence.  Students of this age are often at a point where they want to know why they should continue therapy, and if they continue, why they can’t decide what they need to work on.  In a school setting, the goals need to relate to a student’s educational and/or vocational needs.  There is so much more information that a therapist needs to know to determine a student’s perception of his or her abilities and further determines whether or not a student really needs to continue.  Standardized test scores, although important, are only a snap shot of the student’s abilities at the time the student participated in the assessment.  It is not a clear and thorough picture of the student’s ability to function in a classroom.

I have often found that a student will provide more information if the questions are presented in a written format, particularly with sensitive areas, like activities of daily living, presented in checklist format.  Students will review the document, quickly at first, check an answer [which the therapist or teacher can expand on later] and then move on.  The written format provides a canvas, if you will, to create a dialogue with the student.  For example, let’s say that the student checks off that he or she can make a sandwich, ask the student how he or she makes that sandwich and you will get a better idea if he or she really is capable of making that sandwich.

I have developed a written interview, which I began using with some of my students over the last few years.  I was able to better assess a student’s abilities and perceptions of being able to care for him or herself and support classroom skills.  It prevents that ‘oh no’ moment when something is revealed in a CSE meeting that you should know but don’t surfaces.  When interviewing a student verbally, many of those items are glossed over and the interview proceeds.  A written document is a bit impersonal and the student may just answer more truthfully and feel more comfortable in doing so.

Let’s go back to that sandwich; a student checks off that he is able to make a sandwich.  Later, when reviewing the interview with the student, you ask, “How do you make that sandwich?”  The student lists all the items that he needs for the sandwich but is unable to describe how to actually make that sandwich.  This may indicate that a student has a form of dyspraxia or apraxia that has been addressed in other areas through years of therapy, but not yet in the area of self-care.  In very basic terms dyspraxia (problems with) or apraxia (unable to) refer to sequencing the steps to perform a skill.

This is enlightening and indicates other areas need to be explored.  When evaluating a student, all methods of gathering information should be used.  Standardized and non-standardized testing is important but so is the interview of the student and the teacher and authentic assessments, such as a rubric, to provide a balanced assessment of the student’s abilities.

A school-based assessment includes a reason for the referral [the problems that the student is having in the classroom], and his or her motivation for educational activities.  In my opinion, motivation can be broken down in to at least two components:  skill and desire.  If a student has limited or no skill in a particular area, there will be no desire to engage in the activity.

Motivation becomes a particularly important factor in the middle and high school years.  In order to encourage participation in therapy, students need to participate in and feel part of the evaluation process.  For one reason or another, a student may become disillusioned with therapy.  Comments may be made by peers, making the student uncomfortable with being pulled out of class.  Pushing into the class may not be an option either and may further target the student for comments and potential bullying.  At this point, if the student is so resistant to the therapeutic environment, consults may be the only option other than discharge.

Bibliography

Cawley, M.S., OTR/L, E. (2013). Using Rubrics to Monitor Outcomes in Occupational Therapy. Huntington Station: Eleanor Cawley, M.S., OTR/L.