a knowledgeable consumer: types of tests, theory selection, and
service delivery models
have many areas of expertise and tend to specialize in specific
age ranges and settings. All therapists share a common knowledge
base but add to it by experience and advanced education. A pediatric
therapist works with children and is usually employed in Early Intervention
(EI), a hospital, a rehabilitation center, a school, or a private
clinic or practice. Your state occupational therapy association
should be able to provide you with a list of therapists in your
area. Don't be afraid to inquire about experience, credentials,
and advanced training.
Even among pediatric
therapists, you may find different frames of reference for practice.
For example, many therapists use Sensory Integration, an OT theory
developed by Dr. A. Jean Ayres. Others may emphasize neurodevelopmental
therapy, first developed by Dr. Karel Bobath and his wife, Berta,
a physiotherapist in England. Some therapists emphasize the Model
of Human Occupation or other mental health models. Theories are
the tools that underlie intervention: in reality therapists often
combine several theories when providing intervention. You should
try to match your concerns for your child with the training and
expertise of the therapist.
The assessment process may include three
levels of testing:
- Screening to determine the probable need for service;
use of less formal tools such as checklists, histories, etc. are
acceptable at this level.
- Identification (diagnosis) of specific problems
(e.g., Dysfunction in Sensory Integration, motor delay, visual-perceptual
dysfunction, etc.). This should be done through use of standardized
tests. Standardized means that certain procedures have been followed
in test development to ensure uniformity in administration, scoring,
and interpretation. For the purpose of identification, the child's
performance or behavior is compared to that of a normative group;
it is then determined that the results (scores) are equal to the
normative sample, above those of the sample, or below. Identification
depends upon how "like" the child's performance is to
the comparison group. Common tests used by OTs for this process
Evaluation (measurement) of the current level
of concerns or behaviors; it provides a benchmark for gauging
change or progress (hopefully the results of intervention). Standardized
measures as well as "clinical observations" that are more
qualitative and discretionary may be used. An observation of the
child in the natural environment (e.g., home or school) may be done.
Often the standardized measures use important performance criterions
(tasks or skills such as mobility, independent sitting, use of scissors)
or outcomes rather than group comparisons (comparing the child's
general abilities to those of a matched typical group). This is
because the concern is whether or not the child is improving functional
or developmental tasks (outcomes), not which group he or she belongs
in (identification). Some standardized tests have both norm-referenced
and criterion-referenced qualities (e.g., PDMS-2). The School Function
Assessment (SFA) (Coster, Deeney, Haltiwanger, & Haley, 1998)
is an example of such a measure designed specifically to measure
change in performance and behavior in early school grades.
- Peabody Developmental Motor Scales 2nd Ed.
(PDMS-2) (Folio & Fewell, 2000);
- Bruininks-Oseretsky Test of Motor Proficiency (BOTP)
- Mullen Scales of Early Learning (MSL) (Mullen,
- Movement Assessment Battery for Children (Movement
ABC) (Henderson & Sugden, 1992);
- Sensory Integration Praxis Tests (SIPT) (Ayres,
- Developmental Test of Visual Perception 2nd Ed.
(DTVP-2) (Hammill, Pearson, & Voress, 1993);
Service Delivery Models
After the evaluation is completed,
the team (family, professionals, interested parties) discusses
how the OT can BEST meet the needs of the child. Most people are
acquainted with the traditional "direct-service" medical
model, but as you will see, there are several ways to provide
meaningful intervention. The models are not mutually exclusive
and may be combined.
Direct: practitioner directly treats
the client or a small group of clients.
Monitor: practitioner has treated, but no
longer treats the client directly; practitioner oversees (i.e.,
suggests, interprets) tasks and activities performed or observed
by someone else (e.g., the home educator or a teacher).
Consultant: Consultant: practitioner
had not and does not treat the specific client directly but oversees
tasks and activities performed or observed by someone else (e.g.,
the home educator or a teacher); practitioner may provide general
information or recommendations about conditions, diagnoses, etc.
Transdisciplinary: model developed
in early intervention; a single discipline practitioner (e.g.,
the occupational therapist) serves as the primary service provider
with input from other disciplines as needed; goals and strategies
are developed across the disciplines.
Inclusion: the practitioner performs
treatment within an ecologically valid or natural environment.
For a child in school, this is the classroom; for the child in
day care, this is the day care center; for the child at home,
this is the home.
Case Manager: the practitioner coordinates
services; analyzes fiscal benefits; advocates for essential services;
advises client, family, or caregiver; monitors use of resources.