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

 

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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

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

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

 

Posted in New Beginings

Civility

Parents, Advocates and Lawyers, Oh My!

I am not sure why the CSE Meeting or the IEP have become such a battle ground for parents and school district administrators but something needs to change.  I have absolutely no doubt that parents, teachers, therapists and administrators have the best interests of the student at heart.  Everyone working with the student wants this child to succeed to the best of his or her ability.  What I don’t really understand is the lack of real communication between parents and school district staff.  

I do not know one teacher or therapist who would not try to incorporate the parents’ requests in a student’s educational plan.  Sometimes, for whatever reason, a second evaluation needs to be done.  Maybe the first one was conducted on a bad day for the student or even the evaluator and/or did not provide enough recommendations.  So the evaluation is performed again by a different evaluator.  It is not an insult to anyone.  It is just done.

I would assume that parents and district staff take notes during conversations and meetings-it helps us to remember what occurred during a meeting.  But we all need to follow the law about what is recommended and how it is recommended.  There is a referral process and a procedure that needs to be followed.  There are activities that can be performed based on the student’s educational placement.  For example: community integration and travel may occur at the alternate assessment level but not at the inclusion or resource room level.  

Activities of daily living that include self-care, should be done within the home unless the school is set up and approved to do this type of training [most, if not all, public schools are not].  As a therapist, I can provide some structure to the activities at home by picture prompts [showering, for example], task analysis and rubrics so that together we can get the job done-school staff and parents working together.  

The most important thing is that we need to listen to the student.  Sometimes the student says, “Enough, no more therapy.”  At that point we need to go into consult mode, reduce the therapy sessions to a very low frequency or discontinue therapy.  We must respect the student!

The most important thing that I hope anyone reading this blog takes away, is that we all need to communicate with each other with the student’s future in mind.  We all need to be able to ask questions and answer them, civilly, without threat of legal ramifications.  Unless the situation has degenerated to a point where no communication is occurring, parents and school staff should be able to address all the student’s needs through effective meeting strategies.  

We should be able to:

1.  Start any meeting in a timely manner [some might be a bit late for whatever reason-participation is the import thing]

2.  Set the ground rules.  This is often done with a parent receiving a handout of rights and responsibilities.  I think that this should go further and an agenda be provided prior to any meeting.

3.  Follow that agenda.  Agenda should be developed with the parent and possibly the student [if old enough and able] to ensure that all their concerns are addressed.  

4.  Monitor time spent.  Respect the time of the parent, the student and professional staff at the meeting.  There is generally another meeting that follows right after.

5.  Encourage participation of all those involved, including the student.  Both parents and staff should enable the student’s participation by either a portfolio or statement to be read.

6.  Approve any new follow-up assessments or actions by both parents and district staff.  Referrals need to provide good information about the reason for referral so that all the questions are answered in the report.

7.  Read a summary of the minutes taken before the meeting adjourns for clarity.  

8.  Minutes should be provided to all parties-all district staff and related service providers involved and parents, after the meeting in a timely manner.

 

The thing that I find that does not occur and should is an agenda.  The agenda provides a structure to the meeting and makes sure that all concerns listed are heard and addressed.  It limits the potential for disagreement during the meeting.  A new meeting can always be scheduled to address any new concerns.  It limits the “Uh Oh!” moments for both the parents and the staff.  

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.