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

-Can I Save and use Rubrics in MicroSoft OneNote?

As an occupational therapist, working as an independent contractor, I have been asked quite frequently, what programming do I use for notes. Well, I use Microsoft OneNote.  I love the versatility of this program and the auto-save feature.  If I need run to my next appointment, I never have to worry if I have saved the notes that I have just written.  Notes are always legible and you can make templates for note forms that you use regularly.

One thing that I really like about OneNote is that I can create my assessment rubrics [you know that I am a big fan of rubrics] and save each one as a template.

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Screen Capture of a rubric in OneNote

Do you see those little green boxes?  Just one click [if on a computer] or tap [if on a tablet] and OneNote will check the box for you. Once you set up your rubrics and save them as templates [you must save templates only once], they will be available to you forever. You then have accurate and transparent data collection for each session.  I recommend using one page per session.  You can also make templates in Excel to graph your data.

I recommend making a notebook for each individual patient.  Templates are available across all notebooks that you create [another cool feature].  When you discharge the patient, import the Excel file into OneNote and you will have complete and accurate data of the patient’s progress [with a graphic] over the course of your treatment.  You will have to enter the data separately into the Excel file but it is faster and more accurate.

My book, Using Rubrics to Monitor Outcomes in Occupational Therapy, explains how to develop and modify a rubric and the importance of accountability and transparency in our documentation.  Adapting to the new regulations can only support and teach others about what we do so that we do not get swallowed up by professions waiting to do so.  While this may be initially time consuming, once you have your assessment rubrics in place, documentation will be easy.  Remember, you can e-mail a page using a HIPPA Compliant e-mail system [like hushmail.com] or print it for your records.

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 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.