OT Corner: Occupational Therapy in the Schools: The Assessment Process
By Amy Wagenfeld, Ph.D, OTR/L
Originally printed in June, 2005

I am going to wrap up our series on kindergarten readiness, EI, and 
preschool OT issues with a chat about school-aged OT services.  That said, 
this month I would like to talk about OT in the schools - beginning with 
what is essentially kindergarten… the big league!

Like school-based preschool OT services, primary, middle, and high school 
OT services falls under the umbrella of IDEA, and are child, rather than 
family-centered. Maybe I should review and clarify this, as when I talk 
about child-centered I am referring to the fact that an IEP is written 
for the child (with hopefully some input from parents). The difference 
lies in the fact that services provided by a school-based OT are for children, 
not families, which IS the case for early intervention. Hopefully, this 
clears up any confusion I may have inadvertently caused.

Like preschool services, school (aged) therapy is included in an IEP, and is 
reviewed on an annual basis. Re-evaluation also occurs every three years, 
again, like preschool services. The service models are also the same, and 
include monitoring, consultation, and or direct services. Since I talked 
about these models before, I won’t repeat myself.

Let’s jump right into assessment, and then talk about actual treatment. A 
school aged OT evaluation is more often than not based on initial observation 
of functional skills; specifically, how is the child doing in the school 
environment, despite any limitations? Natural observations are really 
important as they give the observer a very accurate picture of what is 
going on in the child’s life Sometimes a child may be able to do a specific 
task in a very quiet space, yet when faced with the typical environment of a 
busy classroom, may not be so successful. In essence, the cliché, “a picture 
is worth a thousand words,” does apply in this situation. Another important 
tool that occupational therapists use are standardized assessments, and for 
children, there are many which assess things such as gross and fine-motor 
skills, visual perceptual skills (not necessarily what we see, but how we 
understand what we see), sensory skills, handwriting skills, and self-care 
skills, to name just a few.  Depending on what has been determined by the 
referring party to be at issue, the OT selects the assessments tools that 
best seem to address what needs to be evaluated. *A note about all, or at 
least most pediatric OT assessments— children tend to enjoy them and find 
them fun, as the evaluations are really work in disguise, AKA, play.

Many school related OT referrals have to do with handwriting issues, 
ranging from illegibility to concerns about pencil grip.  Determining if 
and what amount of OT is recommended is a process that involves the whole 
team, and parents are very much a part of the decision making process. I 
am going to talk more about handwriting in an upcoming column, but will 
lead into it with a discussion about prewriting next month. But, before 
we tackle handwriting I may take a breather from these heavy topics and 
write a more "OT Lite" column for next month.  Take care and be well!