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

Cost Effective School-Based Assistive Technology Programs

By now, almost every school district has an Assistive Technology Program. Many students have access to graphic organizer, text to speech and word prediction software within their classrooms or at least in a computer lab. But, that is a BIG BUT, does the district have to provide computers for home use?  Not in my opinion!

School districts are switching over to Google and Google Apps for students to use while at school.  This allows the student to have a school-based e-mail with access to Google Drive.  Documents created in school with Google Apps can then be opened and worked on at home.

Companies, licensing assistive technology software to districts, provide a number of options for sharing this programming for the students to use at home.  This may come in the form of a web based version or an actual disc or thumb drive that a parent can use to load the software onto their home computer.

If students can access work from school at home and then have the assistive technology software available on their home computers, there is no reason for students to have a device to carry back and forth from home to school.

It is my belief that students should have two e-mail addresses to access between home and school.  One, of course, should be their g-mail account through Google and the other should be an Outlook account through  One might think that a g-mail account would suffice.  It might if the student has no executive function issues and is very well organized. However, that Microsoft Office Suite that we know and have grown to love, has the best digital notebook program EVER!  Yes I mean, EVER!  Microsoft OneNote comes with every version of the Microsoft Office Suite.  If you have the Microsoft Office Suite, you have OneNote. School districts have had this programming forever and never knew it!

If you create an Outlook account, you have OneNote!  There is a modified version within your Outlook account, along with Word, PowerPoint and Excel. What is not to like?  Then the absolute best thing is to download the the free OneNote App.  Yes, that’s right, I said free!  With this app, a student can have access to his or her notes anywhere there is an internet connection!

The absolute best case scenario is to have the Microsoft Office Suite on your home computer.  Create your notebooks at home and store them within your Outlook account.  When you create your notebook, choose the web option as the location to store your notebook.  Under web location, log in with your Outlook log on and password.  You will use the same log on and password to open your notebook within the app on your iPad or Android device.

Setting up your notebooks from your home computer through the Microsoft Office Suite provides many more options, with my favorite option being the template feature.  This saves oodles of time.  Just add the template to your notebooks from your home computer and their will magically appear on your other devices. You can scan handouts and homework assignments into the notebook at home or photograph them with your tablet or phone when in school or in the community.  The best part about this program is IT IS AN AUTOSAVE PROGRAM!  If you forget to save something, no big deal, once you put it in a notebook, it is there until you take it out.

Microsoft OneNote is a life saver.

  • Parents never again will have to run to school with a forgotten assignment, as long as, the student put the assignment in their OneNote Notebook.
  • Is it time for a notebook review by your teacher?  Share the notebook with your teacher!
  • Left your notes in school and you have a test tomorrow?  Access your notes anywhere there is an internet connection.
  • Organize your OneNote Notebooks just like you would your paper notebooks or binders.  You can easily add tabs for sections and add new pages to each section.

I like my OneNote notebooks better than Evernote. There are organizational features in OneNote that Evernote cannot match. OneNote is easy to use. Open your notebook to where you need to add a new assignment then either use a scanner (if your at home) or take a photo of the assignment. It will go right to the place that you have open. Nothing could be easier.

So going back to the original topic of cost effective assistive technology, with the availability of a number of free options that work across platforms (PC or Mac), there is really no reason to provide each student with a device to take home. Students are entitled to a free and appropriate education but not necessarily a free computer.  If assistive technology is needed, then absolutely provide it. Send home the software but not a device.

Of course we all worry about where our tax dollars are being spent and in my opinion, sending home devices with students can be a huge waste of our tax dollars. There is an easy solution and we should take advantage of it. Yes, there are homes without internet or even a computer. Recently, many local libraries have begun distributing free wireless devices for internet access to families in need. Netbooks are a reasonable option, for those students requiring assistive technology, and who are without computers in the home. The netbook can be left at home and returned to the district at the end of the school year.  While there may be some normal wear and tear on the netbooks, there should not be damaged from transporting the devices repeatedly to and from school.

In my opinion, internet should be free and accessible to everyone.  If you need something faster than what is a free connection, then go ahead and pay for the faster service.

With the onset of a new technological age, where technology is the norm rather than the exception, we need to be just as careful about our money as we are about educating our students.

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

All About Me- The Student Interview & Patient-Centered Interview

Dr. Anne Zachary recently posted “6 Ways Your Child with Special Needs Can Get the Most out of Occupational Therapy.”  She is so right on to suggest an “All About Me” binder that a parent creates for his or her child.  This binder, as suggested by Dr. Zachary, should include relevant information, service providers, favorite toys, and any other info that the parent feels appropriate.  Dr. Zachary calls this the “Ice Breaker!”  This binder is the beginning of a patient-centered interview.  It is the initial collection of psychosocial data that is so important to improving clinical outcomes.

As parents and clinicians, we are charged with encouraging our children to be assertive and responsible.  As school-based therapists, we evaluate, collect data and make many of our judgments through standardized testing and analysis of work samples.  All of this data that we collect has little to do with the feelings or actual function of our students. In my opinion, we need to go a step further.  Our students need guidance to initiate conversation that will lead to information gathering specifically related to a student’s needs.  “The Student Interview” becomes my “ice breaker.”

I recently read an article, Evidence-Based Patient-Centered Interviewing, by Swiss Lyles, et al.  This article describes the basis for Patient-Centered Interview which includes: The Student Interview CoverA

  1. Gathering personal and psychosocial data
  2. Competency in interviewing skills
  3. Relationship building skills that nurture confidence and human understanding

In essence, being in the moment with the patient, focusing on his or her needs which is the basis for ‘therapeutic use of self.’ As therapists, one of the first terms that we learn is ‘therapeutic use of self.’ This term refers to using yourself as a therapeutic tool in the evaluation and treatment process.  It includes being focused in the moment and on your patient.  As a school-based therapist, this is not often easy to do.  There are so many students, assessments, reports and evaluations to conduct that we can easily fail to concentrate our focus on the student.

Interviewing a student may not always be an easy task.  Providing a student the freedom to discuss whatever they choose may actually be a luxury.  So how do we get to a patient-centered interview?  Since our students are still quite young, we still need to guide them through the interview process.  We must encourage them to discuss their needs but guide them to discuss their needs within the realm of occupational therapy.  As some one who has worked in middle and high schools, my focus has been to meet the student’s needs and discharge.  I have sat in many meetings where someone says, “but he has so many deficits.”  It has often been the result of a committee decision to continue therapy and not my opinion. Often, the student has had no input at all.  It is my belief that I need to train my students to be appropriately assertive and give him or her a voice in the process.  My students are emerging into adulthood.

Research has indicated that when physicians encourage a patient to participate in his or her care by asking questions during appointments showed improvement in blood pressure, blood glucose levels and functional status. It is this giving and receiving of information that shapes how a patient feels about their disease or disability giving them control over how their disability impacts on their lives. This creates a sense of commitment to the treatment process. The “Ice Breaker” becomes a tool to promote familiarity and engagement.  I created “The Student Interview” to have the very same effect with my students.  Using “The Student Interview” allows me to learn about a student’s likes/dislikes, what worked or has not worked, what they feel comfortable with, leisure activities, self-care activities, what they think their abilities are.  It is a guided interview with checklists leading to open-ended questions which my students can use to focus attention on their treatment needs.  In my opinion, The Student Interview not only provides a structure to help a student express their opinions and needs but helps to train them to become assertive and not feel as if they have no control.  Using a patient-centered interview has been shown to increase patient satisfaction and compliance with treatment.

I began using The Student Interview a few years ago.  Yes, I did start to develop this resource out of frustration due to numerous challenges brought by unhappy parents. I know that all they really wanted was to focus on their child’s specific needs. What I saw was an over tested and overwhelmed student becoming increasingly frustrated because no one asked them what was important and what worked for them. They did not know how to respond or how to contribute. They were frightened to raise their voices to be heard. The Student Interview allows a student to do just that.


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

Using Rubrics to Monitor Outcomes in Occupational Therapy

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My Book Cover2

Using Rubrics to Monitor Outcomes in Occupational Therapy

Every practice setting that an occupational therapist, or any other health care provider, works in is demanding accountability and transparency. School-based practice is not immune, gone are the days of a teacher’s or therapist’s opinion. Reports are now required to be a balanced assessment of a student’s abilities, strengths and weakness including both formative and summative data. Occupational therapists need to know how to meet the demands of today’s data driven environment. As a research emergent profession, we are called upon to take data systematically. In an educational environment, occupational therapists should be aligning their data collectionmethods and documentation style with teachers. By aligning our documentation style and data collection methods, a more cohesive picture of the student emerges. This allows for more concise development of the IEP and goals targeted toward the student’s individual needs. Data collection need not be difficult. With a little preparation and smart organization planning, data collection becomes easy. When annual review time comes around, goal progress is also easy to report. This allows better planning for the coming year by the Committee on Special Education. Students also benefit by using rubrics in an occupational therapy setting. Some students cannot see or understand the “hidden curriculum.” These students need the guidelines for achievement that others may not. In using a rubric, you are defining the rules by which you consider a goal achieved. This can potentially improve goal progress and decrease the student’s anxiety about being pulled out or having a therapist in the classroom. For some students, a rubric provides the light at the end of the tunnel. With systematic data collection through the use of rubrics, occupational therapists have a unique opportunity to review and interpret the data collected from his or her students to create pilot or ex post facto studies. This can potentially lead to further research. Rubrics can be a win-win situation.


Topics Included in this book:

About the Author




Why Should Occupational Therapists Use Rubrics?

Critical Thinking, Clinical Reasoning and Clinical Judgment

Thinking like a Researcher

What is a Rubric?

Advantages and Disadvantages of Using Rubrics for an Assessment

Tips for Rubric Development

How Do Rubrics Relate to the IEP?

Types of Rubrics

Just a Word on Organization

Occupational Therapy Assessment

A Balance between Standardized and Non-Standardized Assessments

A More Complete Picture


Clinical Observations

Components of a Rubric


Scoring/Rating Scales




Individual Skill Rubric

Analytic Rubric

Holistic Rubric

Chapter Five

Why are Other Staff Members Taking Data on my Goals?

Making Goals Measurable

What does Measurable Mean?

Goal Development Chart

Collecting Relevant Data

Formative Data

Summative Data

Data Collection


Case Studies


Task:  Shoe Tying

Plan:  Assessment

Questions & Answers

Results & Follow Up


Task:  Keyboarding

Plan: Assessment

Questions & Answers

Results & Follow Up



Table 1:  Types of Rubrics

Table 2:  This is an example of a Individual skill rubric with benchmarks for a cutting with scissors goal

Table 3:  Sample of Staff Log-In Sheet

Table 4:  Methods of Assessment

Table 5:  Descriptive Terms to Rate Student’s Performance

Table 6:  Sample Holistic Rubric

Table 7:  Sample Measurable Goals  for IEP

Table 8:  Goal Development Chart

Table 9:  Types of Data

Table 10:  Interpreting Data Worksheet

Table 11:  Double Loop Shoe Tying Assessment Rubric

Table 12:  Double Loop Shoe Tying Assessment Data Sheet

Table 13:  Adapted Double Loop Shoe Tying Rubric

Table 14:  Adapted Double Loop Shoe Tying Assessment Rubric Data Collection Sheet

Table 15: One Hand Keyboarding Assessment

Table 16:  Graphic Representation of Data Collected

Table 17: Keyboarding Assessment Rubric

Table 18:  Assessment Rubric: Putting on Socks with One Hand

Table 19:  Data Collection: Putting on Socks with One Hand

Table 20:  Assessment Rubric:  Packaging Utensils

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

The Can of Worms is Open!-Building Blocks Missing

I am, in many ways, so grateful for this past year.  I have gone from a caterpillar to a butterfly, so to speak.  I have been so grateful for having the opportunity to collaborate with occupational therapists from all over the world and learn so much.  I am excited about the possibilities for learning from social media and currently sad to see the state it is in.

I was communicating with Katherine [Handwriting with Katherine] and we were discussing my last blog, ‘Does Backpack Safety Awareness go far Enough?’  I really just expressed a lot of my own opinions, but isn’t that one of the privileges of having a blog? In my opinion, one of the major issues, understanding the importance of developing all the blocks before constructing the building.  One of my pet projects, as if you didn’t know, is taking notes.  There is often a recommendation for assistive technology when what is really needed is more building blocks.  As occupational therapists know, good handwriting is built on quite a number of those building blocks; posture, visual perceptual/motor skills, functional pencil grip, enough muscle strength and endurance to maintain the writing task for as long as is needed, integration of primitive reflexes, etc.  All of these skills are building blocks that lead to good handwriting, and there are many more.

I am often amazed at how a student could come to me in the 7th grade with poor handwriting skills but missing vital building blocks.  The response often is to get him to take notes on the computer.  The first thing that comes to my mind is, “Well if he can’t take handwritten notes, what makes you think he can miraculously take notes on a keyboard?”  Posture, visual tracking, listening, responding to prompts, formatting the page, keyboarding, etc are all part of taking notes.   I am thinking of one student in particular, 12 years old, in OT since early intervention, who still did not have legible handwriting.  I observed this student in class and in the therapy room [or should I say therapy closet].  I was shocked beyond belief!  What I saw was the residual Asymmetric Tonic Neck Reflex [ATNR] in all its glory.  Of course, I could report my findings, but not make a recommendation to visit a neurologist [district policy].  Any way, this student exhibited classic signs of a residual ATNR.  He was right handed, but left foot and eye dominant.  He tested positive for an ATNR in quadruped. When hand writing, he sat on his left leg with his left arm flexed with his head tilted tilted slightly downward and turned to the right. Basically, reading with his left eye. Using a thumb wrap pencil grasp, he was able to write, but as he moved away from midline, he had difficulty retaining his grip on the pencil.  His grip was so tight, I could not pull the pencil from his hand without having him topple over.  He was so involved in maintaining control of his body that he failed to learn the listening skills, visual tracking skills, and all the other skills needed for effective note-taking.

Teachers have been complaining for years about his handwriting.  He was able to type with both elbows tight against his body but unable to type and read from copy placed to either side as any slight head turn would trigger the ATNR.  Any visual tracking to left or right of midline triggered the response. Was he aware of what was happening to him? Did anyone teach him different strategies? One of the first things that I did with him was to encourage him to write with the paper placed in landscape rather than portrait.  This way he was always writing at midline.   He was asked to sit further back in the classroom so that he did not have to turn his head to see the board.  He was asked to work this way as we continued to work on integrating the ATNR. Here is a link to Lisa Fass, OTR/L and her videos on using Yoga to integrate the ATNR   [Yoga Poses for Primitive Reflex Integration]. This student has made some progress in improving his handwriting and in integrating the ATNR.


Every baby is born with primitive reflexes which are often integrated in the first few months of life.   I chose this picture of the ATNR because it shows both the upper and lower extremity responses to head turning. As you can see, the arm and the leg on the side to which the head is turned are outstretched.  The opposite arm and leg are bent-a sword fighting position.    Some babies, when pushing down on the foot of bent leg and reaching with the arm on the same side, it can help the baby learn to roll from supine [on his or her back] to prone [on his or her tummy].  Again, this is why tummy time is so important to development.  Lisa’s video of integrating the ATNR is working in prone [tummy time].

Some therapist’s feel that once a child gets past the age of nine and the age of rapid changes in neuroplasticity, no amount of therapy will address integration of primitive reflexes.  So maybe the jury is still out on this one.  What I do know is this:  therapists working is school districts need more than a closet to address many of the needs of their students; good mats and equipment should be provided by the school district; therapists need to be able to spot all the signs for deficits in handwriting; therapists need to be able to make recommendations “from one parent to another” or “personally, I would…”  I am not sure how this went on for so long.  But it did and now this student is stuck in limbo with poor handwriting, just learning about why his handwriting is so poor and what he can do for himself.