OT Corner: A Quick Look at the Preschool Occupational Therapy Assessment Process
By Amy Wagenfeld, Ph.D, OTR/L
Originally printed in May, 2005

A preschool occupational therapy evaluation is geared towards a global assessment 
of a child’s ability to participate to the maximum extent possible in functional 
pre-academic activities.  Every school district has different procedures to 
initiate the evaluation process, so I will leave that for you to research.  
A typical preschool occupational therapy evaluation includes looking at school 
readiness skills such as prewriting (which we will talk about in an upcoming 
column), and other foundational skills to ready a child to participate in 
school.  In addition to the actual ‘school related stuff,’ an OT will also 
look at how a child functions in his or her preschool environment — in the 
lunch room, if appropriate, in the classroom, on the playground, in PE, and/or 
with the music and art teachers (again, if part of the program).

Based on functional and standardized assessments, the OT works with the rest 
of the child study team to develop an Individualized Education Plan (IEP), a 
legal document that clearly lays out the goals and objectives for a particular 
child receiving any type of special services.  The IEP is officially reviewed 
annually, and every three years, a child is reassessed to determine 
eligibility needs.

In terms of occupational therapy services, they may be carried out as one or 
a combination of three treatment models — monitoring, consultation, and direct 
treatment.  Monitoring involves no direct treatment; the OT may work in 
conjunction with the classroom teaching staff to come up with an action plan 
of occupational therapy strategies to be implemented with a child.  The OT meets 
on some predetermined basis with the teacher.  I have put children on a monitor 
status if I am just not sure if occupational therapy is needed at the moment, 
but periodically check in to see how things are going, based on the 
recommendations I have provided to the teacher.

Consultation involves having the OT come up with a specific plan for a child’s 
occupational therapy program that in essence is carried out by the classroom 
teacher.  I want to really talk about this because the classroom teacher is not 
serving as a substitute therapist, but instead mainly helps to facilitate a 
program.  Consultation may involve determining that a child with an awkward 
pencil grip needs a gripper, so the OT will come and provide one, will instruct 
the teacher and child how to use it, and then will check in on some predetermined 
basis to see if the grip is helpful, by checking on whether handwriting improving, 
is the child’s hand feeling better (if there was discomfort in the first place), 
etc.  Consultation is more structured than monitoring, in that the OT and teaching 
staff are meeting regularly to discuss the child’s status.  The OT may also have 
a regular schedule in which to come into the classroom to check on the child.

Direct treatment involves actually working face-to-face with the child on a 
predetermined basis, be it individually or in a small group.  The child may be 
seen once weekly, twice, or even daily, for 15, 30, 45, 60-minutes, all details 
that are determined at the IEP meeting.  Treatment is carried out in an on site 
occupational therapy clinic, or ideally, when possible, in the child’s natural 
environment, which, in school, is the classroom.  Frequently, a child is seen 
for both consultation and direct treatment in some creative combination that best 
benefits the child.  The entire process of beginning therapy may seem kind of 
tangled, but with a great deal of open mindedness, flexibility, and good communication, 
the end result, will hopefully be a positive one.

In next month's column we will move beyond preschool and talk about school based 
occupational therapy.  Until then, enjoy!