Fill - Free fillable The Occupational Profile as a Guide to PDF form

CE-1

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE-1

ARTICLE CODE CEA0419 | APRIL 2019

The Occupational Profile as a Guide to

Clinical Reasoning in Early Intervention:

A Detective’s Tale

Rondalyn Whitney, PhD, OTR/L, FAOTA

Director of Faculty Development and Scholarship

West Virginia University’s School of Medicine

Department of Human Performance, Morgantown, WV

This CE Article was developed in collaboration with AOTA’s Children & Youth

Special Interest Section.

ABSTRACT

According to the Occupational Therapy Practice Framework: Domain

and Process, 3

Edition (Framework; American Occupational

Therapy Association [AOTA], 2014), all initial client evaluations

must include an occupational profile and a subsequent analysis of

occupational performance. It is through the process of completing

the profile that the therapist begins to learn about the client’s back-

ground, priorities, and desired therapeutic outcomes. Completion

of the profile also begins dialogue regarding the possible effect of

factors, patterns, skills, and context and environment on the client’s

ability to fully participate in activities of daily life.

One can think of the occupational profile as a systematic way

to organize the therapist’s clinical reasoning. When presented

with a client with complex needs, having a methodology to guide

evaluation and develop an informed intervention is critical for

effective outcomes. Take the case of a child with complex medical

concerns who lives in an underserved, rural environment: Having

a tool to guide one’s reasoning process becomes essential for iden-

tifying and resolving the unique barriers limiting occupational

engagement.

LEARNING OBJECTIVES

After reading this article, you should be able to:

1. Recognize how using the AOTA Occupational Profile Template

guides clinical reasoning

2. Identify key decision points using clinical reasoning to assess

and develop a plan of care for a child with a complex medical

disorder

3. Describe the distinct value of occupational therapy in early

intervention using terminology from the Framework

4. Recognize the process of using inductive and deductive rea-

soning as part of the clinical reasoning process during early

intervention cases

INTRODUCTION TO THE OCCUPATIONAL PROFILE

The occupational profile helps create a summary portrait of a

client viewed as an occupational being, organizes the evaluation

around the activities the client wants to do but has difficulty with

or cannot do, and frames the process of inductive reasoning. The

occupational profile is an essential tool to improve the quality of

occupational therapy services and demonstrate the profession’s

distinct value to other health care providers, reviewers, and

payers.

The American Occupational Therapy Association (AOTA;

2017) has developed an Occupational Profile Template to assist

occupational therapy practitioners with this process regardless of

their practice setting. Interventions developed by occupational

therapists (OTs) must always be based in theory and focused

on meeting the unique occupational needs of the client and, if

applicable, their family, rather than on a condition. Completed

occupational profiles can be incorporated into an electronic

medical record.

The purpose of this continuing education article is to demon-

strate how the occupational profile can be used in early interven-

tion. The case example is based on a real client and the profile

developed for that family. As such, some of the specifics may not

generalize to all children. Still, the process of using the Occu-

pational Profile Template to articulate and describe the distinct

value of occupational therapy during early intervention is offered

as a contribution to the larger scholarly discussion within the

profession.

The evaluation data is obtained from the client’s perspective

or, in the case of a child, through observation and interview with

the family and caregivers. These formal and informal conver-

Earn .1 AOTA CEU

(one contact hour and

1.25 NBCOT PDU).

See page CE-8 for details.

CE -2 ARTICLE CODE CEA0419 | APRIL 2019

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE Article, exam, and certificate

are also available ONLINE.

call toll-free 877-404-AOTA (2682).

sations are examples of strategic interviews that lead to an

individualized, routines-based, client-centered approach to

intervention. The Occupational Profile Template provides an

outline of occupational concerns that should be addressed when

completing the occupational profile for an individual (AOTA,

n.d., 2017).

Occupational therapy practitioners are mystery solvers and

problem solvers. When conceptualizing the approach to inter-

vention, therapists must start with an evaluation of the client to

better understand what they can and cannot do, and what inter-

vention would enable functional participation. You might say

occupational therapy practitioners are “lifestyle detectives,” who

search for clues, test hypotheses, interpret findings, determine

conclusions, and disseminate discoveries. Occupational therapy

practitioners solve mysteries by profiling or creating portraits

of clients, examining clues within contexts, and synthesizing all

the collected data points that are then summarized and provided

to the client in the form of a plan (Whitney & Luebben, 2014).

The art and science of the evaluation process guides the thera-

pist to develop functional goals that meet the needs and values

of the client (Reynolds et al., 2017), but as with all great sleuths,

a formula for inductive and deductive thinking is essential.

A great deal of what occupational therapy practitioners

learn is associated with specific conditions, but people often

have complex patterns of dysfunction. The mystery facing

occupational therapy practitioners is: What is the problem that

needs to be overcome, and what are the barriers this person is

experiencing that block them from what they want to accom-

plish? Once the OT identifies the problem of the case, they must

isolate what they know and what they need to know; suggest

a strategy and a theoretical approach; and after implementing

the strategy, again evaluate to determine whether the client

perceives their problem has been solved.

Fans of mysteries may recognize this process as a profile used

by detectives, and many of the most popular TV dramas today

take viewers through the journey of expert FBI profilers who

gather data from a crime scene and use that data to profile the

unknown subject, who will, oftentimes, be found through the

use of this articulated profile. FBI profilers use environmental

and contextual clues for recording and analyzing the psychologi-

cal and behavioral characteristics of a person to build a pic-

ture—a portrayal of the unknown subject involved in the crime.

The profiler uses this picture to narrow down the potential per-

petrator and to solve “who done it.” OTs are mystery solvers who

also use a systematic evaluation, the occupational profile, to

record and analyze a client’s mental and physical characteristics,

assess and predict capabilities, and deduce the best intervention

to optimize functional outcomes.

As with a detective, gathering client information follows a

systematic approach to critically evaluate and clinically portray

the function and dysfunction of the individual. OTs use both

inductive and deductive reasoning to understand and resolve

barriers of occupational engagement. When combined, these

two forms of reasoning result in clinical reasoning within the

profession.

For example, inductive reasoning would be used when con-

sidering how a specific child behavior can help move the family

to understand and form more generalized conclusions about the

behavior, whereas deductive reasoning might be used to take a

larger theoretical construct—say the use of Ayres’ Sensory Inte-

gration (ASI) theory to support a specific conclusion (Schaaf et

al., 2018; Whitney, 2018).

Each detective has their tools. One of my favorite mystery

writers uses cooking to help her organize, categorize, and syn-

thesize her reasoning when solving murders (so many murders!)

in her small town (Davidson, 1992). OTs have our own tools to

shape our reasoning on the best ways to help each client.

THE FIVE STEPS OF CLINICAL REASONING

Clinical reasoning follows a five-step process of decision making:

1. Appraise the evidence, including the data provided in a refer-

ral and through strategic interviews.

2. Develop a clinical hypothesis to organize and guide

assessment.

3. Use the data collected.

4. Problem solve to evaluate the clinical hypothesis.

5. Test the clinical hypothesis (Cronin, 2018).

The Occupational Profile Template organizes clinical reason-

ing, beginning with the purpose of the referral and prompting

the therapist to consider areas of occupational competence

(function) and challenge (dysfunction) as part of the client

report. Ideally, as the therapist works to gather data about func-

tion and dysfunction and notes the influence of the environ-

ment and context, a clinical hypothesis begins to emerge from

the well-organized data collected. The profile leads the therapist

to create client-centered goals specifically directed toward

resolving areas of occupational dysfunction documented in the

profile. The final step of intervention is to return to the client’s

goals to assess whether they have been met.

The template organizes and serves to frame the client as an

occupational being, one with occupational potential and capaci-

ties. A client report is developed to document the client’s reasons

for seeking services, occupational strengths, values, history,

and performance patterns (routines, roles, habits, and rituals).

These constructs are operationalized in the Occupational Therapy

Practice Framework: Domain and Process (3

ed.; AOTA, 2014).

Occupational engagement is profiled by evaluating the client’s

environment and context, specifically what supports or impedes

occupational engagement in the physical, social, cultural, per-

sonal, temporal, and virtual contexts. Data from the profile guide

the generation of client goals and priorities, as well as outcomes

targeted for intervention, intervention type, and approach.

Bandura (1986) postulated that people learn by observing,

imitating, and modeling others. The social context, the expecta-

tions and relationships with others in the environment, and the

cultural context, including expectations of society and routines

within the family, create the cultural context that, in turn, influ-

ences client identity and activity patterns. Together, these create

a profile or portrait of a client as an occupational being.

CE-3

ARTICLE CODE CEA0419 | APRIL 2019

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE-3

ARTICLE CODE CEA0419 | APRIL 2019

In the case of pediatric practice, children live within the

context of their families and participate in the routines of that

family within the sociocultural environment (Primeau, 1998;

Schaaf et al., 2011). In the area of West Virginia where this

article’s case example takes place, the social ecology is char-

acterized by family networks, traditional gender roles, and a

complex fatalism (a belief that all events are predetermined

and inevitable, and personal power is impotent in terms of

changing one’s fate; Rural and Appalachian Youth and Fam-

ilies Consortium, 1996). The Appalachia Regional Commis-

sion defines Appalachia as being made up of sections of 12

states spanning New York to Mississippi. West Virginia is the

only state in which all of its counties are part of Appalachia.

In the case example presented in this article, contextual clues

are essential to closing the case of occupational dysfunction

(West Virginia Early Childhood Transition Steering Commit-

tee, 2008).

CASE EXAMPLE: ROSE

Rose was a 3-year-old girl with complex medical needs who lived

in rural Appalachia. The occupational profile was completed

for Rose as part of a larger, multidisciplinary team assessment

provided as part of a summer camp program specifically for

children with complex medical disorders. The cost for partici-

pants is covered through a grant from the U.S. Department of

Education. Families initially meet with multidisciplinary team

members, who conduct an evaluation and plan treatment.

Throughout the week the families move between various labs,

each of which provides specialized services.

The Occupational Therapy Template provided an under-

standing of Rose’s perspective and background and helped

identify priorities and desired targeted outcomes that the family

believed would lead to Rose’s engagement in occupations and

support her participation in family routines (AOTA, 2017).

Client Report

Articulate the reason the client is seeking service: What are

the concerns related to engagement in occupations? Why is

the client seeking service, and what are the client’s current

concerns relative to engaging in occupations and in daily

life activities? (This may include the client’s general health

status.)

• Rose presented with autism, cortical visual impairment, and

hypotonia. Rose was referred for an occupational therapy

evaluation as part of a comprehensive, interdisciplinary team

evaluation to determine appropriate interventions.

• Rose’s parents were not sure she could hear, and they

expressed additional concerns about her vision. Sometimes

she seemed to hear, sometimes she seemed to see, and other

times she was unresponsive to auditory or visual input. The

family was seeking services to improve functional mobility

and communication and to learn strategies to reduce Rose’s

frequent meltdowns during family routines.

Effect on Occupation

Rose’s mother described her as “fully dependent” on the family,

with the mother as the primary care provider of Rose and her

6-year-old brother. The father worked at a grocery store and, as

the family only had one car, the mother had limited access to

community resources for assistance in caregiving. The mother

was an artist and musician who hoped to return to work once

the children were in school.

What are the occupations in which the client is successful (i.e.,

function) or areas that are not at the expected level of function

(i.e., dysfunction)? In what occupations does the client feel suc-

cessful, and what barriers affect their success?

Rose was described by her parents as a “very picky eater.”

She was still nursing and used nursing as a primary coping

strategy when she felt overwhelmed or stressed. Her mother

stated this limited her own ability to pursue her interests

away from Rose.

Communication with Rose was primarily through simple

gestures, with some basic signs used for words such as father,

more, all done, music, fish (for Goldfish crackers), and sing. For

instance, Rose placed two hands on her head to request a favor-

ite song. Many of these communication strategies were idiosyn-

cratic and understood only by the family.

Volitional movement was limited: the family carried Rose

everywhere, using a front-pouch baby carrier. Her mother and

father took turns carrying her.

Rose could crawl short distances and walk about five steps

with help (the mother or father would hold her hand). After

five steps or so, Rose would typically sit on the floor and then

crawl to her mom to nurse. Attempts to place her in mobility

devices such as strollers or grocery carts were unsuccessful—

Rose would thrash to get out, cry, and otherwise appear very

distressed.

All self-care tasks were dependent, and the sleep schedule

was erratic given Rose was still in diapers and not yet able to

control her bowels or bladder.

The family had several routines that engaged Rose in play

and social interaction, including singing, simple signing, and

playing with a toy drum. Rose enjoyed it when her dad swung

her between his legs and up above his head. Overall, Rose had

a limited range of play schemes. She was able to retrieve 10/10

mini M&Ms from a busy patterned blanket. However, she

retrieved 0/10 non-candy items from a solid background.

Rose’s performance with novel tasks improved when they

were presented in quiet environments. She was intolerant of the

sound and vibration from rolling wheels. She was provided pink

high-top tennis shoes that lit up, and a walker. With these mod-

ifications, she was willing to stand and demonstrated bilateral

reciprocal movement in the lower extremity (walking about 10

steps). Combining noise-cancelling headphones with a stroller

improved her tolerance.

Rose’s vision and hearing were tested as within normal lim-

its, with behaviors (avoidance) affecting functional use.

CE-4 ARTICLE CODE CEA0419 | APRIL 2019

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE Article, exam, and certificate

are also available ONLINE.

call toll-free 877-404-AOTA (2682).

What are the client’s values and interests (i.e., personal interests

and values)?

Rose had a small musical toy drum that played a song she

enjoyed, and she would dance (seated) when the music was

played. When challenged to perform a novel task, Rose crawled

into her mother’s lap to nurse. Rose appeared to be easily

engaged by music.

What is the client’s occupational history (i.e., life experiences)?

The mother stayed at home to care for the two children (Rose

and her 6-year-old brother) and stated she missed her own work

as a musician. She reported feeling “trapped” at times as well as

feeling guilty for these feelings.

The mother was limited in her ability to participate in her

son’s community and school activities due to her responsibilities

with Rose and lack of independent transportation.

The dad was the sole financial supporter of the family, work-

ing at the local grocery store as a checker, a position that did not

provide health care benefits.

Rose’s parents were very concerned about Rose’s ability to

learn (e.g., could she see or hear, what were her developmental

delays, why was she so avoidant of noise from the stroller or

grocery cart?).

What are the daily routines in the family and habits within

those routines (i.e., performance patterns—routines, roles,

habits, and rituals)?

• Rose could imitate simple, familiar gestures. She was overly

avoidant of novelty and got overwhelmed quickly.

• Her parents reported that Rose loved M&Ms. Her mother

carried a container of mini M&Ms to motivate Rose to

behave in certain ways.

• Rose could manipulate familiar items, such as a small favor-

ite toy drum that played music. Her performance improved

when she was in a quiet area with minimal distractions.

• Rose was able to demonstrate understanding the expectation

to point to picture cards and select icons for preferred activi-

ties (e.g., swing, M&M, Goldfish).

• Rose was unable to isolate her index finger for pointing. Her

mother was shown how to provide facilitated guidance (sup-

porting Rose’s arm to reduce gravity), which compensated

for limited shoulder strength/mobility and improved Rose’s

ability to isolate her right index finger and point to provided

visual prompts (90% accuracy). Rose signed “more” to con-

tinue with this task for several trials, clapped, and seemed

pleased with her success.

• In the motor lab, the therapists tested an adapted bike. With

her feet strapped to the pedals, Rose’s parents pushed Rose

down the hall while she held onto the handles and her feet

moved with the pedals. Rose appeared to enjoy the move-

ment provided as her legs moved with the bike, guided by her

parents.

• Next, Rose was fitted with pink high-top tennis shoes that lit

up and made a squeak sound when she stepped. Her weight

was supported by her parents, who held her by the hands as

she walked. Rose seemed very pleased with these shoes, step-

ping to create the sound and light. Once seated, Rose raised

her leg to show first her mother then her father her shoes.

When asked to try the communication devices, Rose cried

and crawled to her mother to nurse. Testing was discontin-

ued and resumed the following day. The testing room and

situation were modified—the lights were dimmed, the music

of the communication devices was turned off, and Rose was

provided the opportunity to swing in a spandex hammock

before participating in the testing. Reducing sensory input

and making environmental modifications resulted in clear,

consistent, and observable increase of purposeful perfor-

mance: Rose was able to follow cues to touch the device

with 80% accuracy and to persist with the task for 8 minutes

before asking to swing. Her performance improved when in a

quiet area with minimal distractions.

What aspects of the client’s environments or contexts do they

see as supports and barriers to occupational engagement?

Physical (e.g., buildings, furniture, pets)

• Rose was fearful of being moved in a stroller or other device

with wheels (she appeared to be fearful of the noise or

vibration). She was extremely avoidant (her parents used the

word “terrorized”) of the sound and movement of a grocery

cart if they attempted to put her in one to complete their

shopping.

• Avoiding movement limited the family’s ability to participate

in many activities outside the home.

Social (e.g., spouse, friends, caregivers)

• Rose had a supportive family who had been receiving ser-

vices through the Birth to Three program. Her mother felt

isolated at home as Rose’s primary care provider for most of

the day and with limited interaction with friends and family.

• Rose used immature strategies to get her needs met, such as

crying and using avoidant behaviors when challenged by a

task. There were few children in the area and none within

walking distance.

Cultural (e.g., customs, beliefs)

• The family and community network was strong—the

extended family provided financial and respite support.

• The rural, low socioeconomic setting had limited access to

resources (no public transportation, educational resources

were limited). The mother was hesitant to express her own

needs as she didn’t want to complain or sound like she wasn’t

grateful for Rose.

Personal (e.g., age, gender, supplemental educational services, edu-

cation)

• Rose was a 3-year-old child in rural Appalachia. She had an

older brother (age 6) and lived with her mother, father, and

brother in a small (1,000-square-foot) home.

CE-5

ARTICLE CODE CEA0419 | APRIL 2019

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE-5

ARTICLE CODE CEA0419 | APRIL 2019

• The family income was less than $20,000 per year, with

health care provided through Birth to Three and Medicaid.

Temporal (e.g., stage of life, time, year)

• Rose was in the pre-operational period of cognitive develop-

ment. She did not attend pre-school or day care—there were

no programs in the area that her parents believed could meet

Rose’s needs at that time.

Virtual (e.g., chat, email, remote monitoring)

• The family had one cell phone that they shared. They had

limited access to the Internet (they could use the comput-

ers at the library). There were three radio channels in their

community, and they did not have access to cable channels

on television.

• No broadband was available in the rural community, limiting

access to communication and services.

Client Goals: Client’s Priorities and Desired Targeted Outcomes

Rose’s parents wanted her to be able to communicate with oth-

ers outside the family as well as improve her ability to express

her needs to them. They were concerned about functional

mobility and hoped to find a way to make a stroller or similar

device acceptable to their daughter. They expressed a desire to

find strategies that would help Rose develop a greater range of

frustration tolerance.

Approaches included:

Reduce impairment: Improve functional mobility by address-

ing sensory motor development. Reduce sensory-adverse barri-

ers to participation and exploration.

Compensatory strategies: Provide opportunity for exploratory

play on stomach and other planes to facilitate performance.

Assistive technology: Provide assistive technology to promote

communication and mobility.

Adapt environment/occupation: Construct environments that

entice play and engagement using sensory exploration, follow-

ing Rose’s lead.

Provide assistance/caregiver training: Provide training for par-

ents in safe movement/input for Rose. Promote understanding

of expected developmental milestones and setting up senso-

ry-friendly learning experience using routines-based activities

(i.e., stirring batter while making weekly pancakes).

Profiling Rose: Solving the Case

Theory helps move the steps of clinical reasoning from the-

ory to intervention. ASI theory was identified as the primary

theoretical approach to guide intervention with Rose. ASI

is a developmental theory that assumes children acquire

sensory-based motor function in predicable order (Ayres,

1979). In Ayres’ theory, SI is an individual’s ability to respond

adaptively to sensation over a broad range of intensity and

duration. When sensory input is “integrated,” the individ-

ual can use sensory information to support optimal arousal,

attention, and activity levels to meet the demands of the

environment in a fluid, flexible manner or respond in an

adaptive way. When sensation is perceived and processed in a

disordered way, responses to that sensation are disordered as

well (Whitney, 2018).

The function–dysfunction continuum within this theory

characterizes function as the ability to regulate daily responses

to sensory events and dysfunction as nonadaptive responses to

sensory situations. OTs assess the function within each sensory

system as well as the person’s ability to integrate multiple sen-

sory information for functional use (Kramer & Hinojosa, 2010;

Schaaf & Mailloux, 2015).

The postulate regarding change guides intervention to

support the child in achieving an optimal level of arousal

by facilitating the child’s development of self-regulation;

improving sensory processing; and providing opportunities to

integrate sensory, motor, affective, communicative, and high-

er-level skills through developmentally appropriate play-based

learning opportunities. Behavioral modification is identified

as a secondary approach. This theory postulates that behavior

is a response that is strengthened when a reinforcement is

provided. Reinforcements can be positive or negative (Skin-

ner, 1976). The postulates for change addressed by these two

theories are then used to frame the intervention—that is, to

organize the theoretical material and translate that informa-

tion into practice.

The occupational profile provides a document that allows

the next therapist or reader to deconstruct the clinical reason-

ing of the original interventionist. The five steps of clinical

reasoning can be identified through the occupational profile

created for Rose. Step one of clinical reasoning is to assess the

evidence. For the OT, part of the detective work was aimed

at differentiating Rose’s patterns of performance—were her

habits because of underlying dysfunction, learned behavior,

or immature sensory processing and integration? The occupa-

tional profile helped guide the clinical reasoning to generate a

clinical hypothesis.

For example, Rose’s parents provided information about

their child that the therapist combined with information

in the reports from the early intervention team. Additional

data was gathered through observation and testing (step 1).

The function–dysfunction continuum was created—what

one might expect from a child of this age given the resources

available in the environment and the contextual influences.

The evidence was organized in the client report section of

the profile and a hypothesis was generated (step 2). The OT

began to form a hypothesis—a profile of the client in this

case.

When observing Rose’s response to visual stimuli, and

using the assumptions outlined in behavioral theory (reward-

ing participation with M&Ms or songs; step 3), the OT

hypothesized that Rose’s willingness to respond to tasks

when rewarded did not support engagement in the presented

activities (step 4). The detective needed a different hypothe-

sis (step 5).

Understanding Rose’s poor frustration tolerance as a

response to feeling overwhelmed by sensations in the environ-

CE-6 ARTICLE CODE CEA0419 | APRIL 2019

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE Article, exam, and certificate

are also available ONLINE.

call toll-free 877-404-AOTA (2682).

ment provided the family with a new way of supporting Rose’s

engagement in daily routines.

The profile culminates in articulating client-centered goals

to resolve areas of occupational dysfunction and will allow for

assessing when the client’s goals have been meet. For an FBI

profiler, this would be the moment when the characteristics

of the suspect are released to the public, generating leads that

lead to offender’s capture—case closed. For the OT, this is the

point for intervention to be offered, response to intervention

observed, and data from that observation used to plan future

intervention strategies.

In the case of Rose, intervention strategies following

ASI theory guided the OT to provide sensory intervention

to prepare Rose to be able to meet sensory challenges and

to improve her occupational engagement. By the end of the

week, Rose was able to demonstrate understanding the expec-

tation to point to picture cards and select icons for preferred

activities (e.g., getting to swing, receiving M&Ms or Goldfish),

when provided with a quiet, less distracting environment.

After the OT reduced the sensory input from the communica-

tion device provided to Rose by the speech pathologist, Rose

completed the camp able to use the device without having a

tantrum. Follow up from the early interventionist will con-

tinue to build on this foundation.

The final steps of clinical reasoning direct the therapist to

return to the clinical hypothesis to assess whether the hypoth-

esis was correct. This is accomplished in part by assessing the

outcome of intervention. In this case, we return to Rose and her

family.

Rose was very pleased with her shoes, stepping to create

the sound and light. When seated, she raised her leg to show

her mother or father her shoes. Rose benefited from swing-

ing and other sensory strategies that provided movement

within safe play routines. As her comfort with movement

increased, and with the incentive of the sound and light,

Rose become more tolerant of the mobility devices provided

and with fine motor activities. Her family demonstrated this

new ability to incorporate frequent rest breaks and activities

to promote sensory modulation and to compensate for Rose’s

poor endurance (sensory motor dysfunction). Finger isola-

tion and hand function improved when Rose was provided

with assistance to compensate for limited shoulder strength

and mobility.

Her parents were relieved that Rose was able to hear and

respond to direction when she was afforded a supportive

environment, and they expressed their excitement to build on

this new skill. They were optimistic that Rose might be able to

attend pre-school and benefit from participating in the local day

care environment.

CLINICAL IMPLICATIONS

The occupational profile enabled the OT to prioritize care in

collaboration with the family and detect barriers to occupational

engagement. The clinical reasoning steps guided the systematic

profiling of this case. Outlining the approach to intervention

frames the process the therapist will use to gather observa-

tional data during intervention. Using the occupational profile

supported the OT to highlight the distinct value on the team.

Having the parents describe their experience of raising a child

with development delay, and understanding their perception

of how intervention would promote adaptation to their family

routines, helped inform the quality of care within the larger,

multidisciplinary team.

Once a detective solves a mystery, they have to share

their findings in a way that allows others to follow the line of

reasoning that connects the disparate clues and resolves the

mystery. Documenting occupational therapy services is equally

important. Long after the services are provided, documenta-

tion remains as evidence of the occupational therapy services a

client received. Occupational therapy practitioners share their

distinct contribution to clients through their documentation.

The Occupational Profile Template can be inserted directly into

the treatment record which allows another therapist to follow

along with the documented clinical reasoning skills outlined in

the profile and learn from the documented therapeutic process

of the practitioners who wrote the documents. Documentation

can be well written or poorly developed and uninformative.

Practitioners are wise to note: Both writing styles have equal

longevity.

CONCLUSION

The occupational routines of a family raising a child with

complex medical disorders in rural Appalachia benefited

from the clinical reasoning approach afforded and framed by

the Occupational Therapy Profile Template. Intervention is

first guided by the theoretical approach, with assumptions

stipulated that align with and follow the evidence provided

through the theory. Data are gathered and analyzed using the

assumptions and expectations proposed or postulated by the

theory.

Once the function–dysfunction continuum is created for the

client report, a clinical hypothesis can be developed, client goals

generated, and the intervention planned. These aspects of the

client are organized and articulated following the template of

the occupational therapy profile. The profile is of critical impor-

tance for early intervention practitioners, who are naturally

attuned to the types of and extent to which occupations, habits,

routines, and rituals are involved in a typically developing child’s

daily life.

The document allows for a comprehensive record that

demonstrates clinical reasoning and problem solving individu-

alized to optimize development for the client. Understanding

the profile of family routines can strengthen the translation of

evidence to practice.

CE-7

ARTICLE CODE CEA0419 | APRIL 2019

CE-7

ARTICLE CODE CEA0419 | APRIL 2019

Continuing Education Article

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

REFERENCES

American Occupational Therapy Association. (n.d.). Improve your documen-

tation with AOTA’s occupational profile template. Retrieved from https://

www.aota.org/Practice/Manage/Reimb/occupational-profile-docu-

ment-value-ot.aspx

American Occupational Therapy Association. (2014). Occupational thera-

py practice framework: Domain and process (3rd ed.). American Journal

of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/

ajot.2014.682006

American Occupational Therapy Association. (2017). AOTA occupational

proﬁle template. American Journal of Occupational Therapy, 71(Suppl. 2),

7112420030p1. https://doi.org/10.5014/ajot.2017.716S12

Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psy-

chological Services.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive

theory. Englewood Cliffs, NJ: Prentice-Hall.

Cronin, A. (2018). Overview of the clinical reasoning process. In A. Cronin & G.

Graebe (Eds.), Clinical reasoning in occupational therapy (pp. 3–20). Bethesda,

MD: AOTA Press.

Davidson, D. M. (1992). Dying for chocolate. New York: Crimeline Books.

Kramer, P., & Hinojosa, J. (2010). Frames of reference for pediatric occupational

therapy (3

ed.). Baltimore: Lippincott Williams and Wilkins.

Primeau, L. A. (1998). Orchestration of work and play within families. Amer-

ican Journal of Occupational Therapy, 52, 188–195. https://doi.org/10.5014/

ajot.52.3.188

Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M, Miller

Kuhaneck, H., Pfeiffer, B., … Bodison, S. C. (2017). Using a multi-

faceted approach to working with children who have differences in

sensory processing and integration. American Journal of Occupational

Therapy, 71, 7102360010p1–7102360010p10. https://doi.org/10.5014/

ajot.2017.019281

Rural and Appalachian Youth and Families Consortium. (1996). Parenting

practices and interventions among marginalized families in Appalachia:

Building on family strengths. Family Relations, 45, 387–396. https://doi.

org/10.2307/585168

Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A.

(2018). Efficacy of occupational therapy using Ayres Sensory Inte-

gration®: A systematic review. American Journal of Occupational

Therapy, 72, 7201190010p1–7201190010p10. https://doi.org/10.5014/

ajot.2018.028431

Schaaf, R. C., & Mailloux, Z. (2015). Clinician’s guide for implementing Ayres Sen-

sory Integration®: Promoting participation for children with autism. Bethesda,

MD: AOTA Press.

Schaaf, R. C., Toth-Cohen, S., Johnson, S., Otten, G., & Benevides, T. W. (2011).

The everyday routines of families of children with autism: Examining the

impact of sensory processing difficulties on the family. Autism, 15, 373–389.

https://doi.org/10.1177/1362361310386505

Skinner, B. F. (1976). About behaviorism. New York: Vintage Books.

West Virginia Early Childhood Transition Steering Committee. (2008). Individu-

alized family service plan (IFSP) and individualized education program (IEP): A

comparison of program components. Retrieved from http://wvearlychildhood.

org/resources/IFSP_and_IEP_Comparison_040108.pdf

Whitney, R. (2018). Sensory integration and sensory processing frames of

reference. In A. Cronin & G. Graebe (Eds.), Clinical reasoning in occupational

therapy (pp. 123–142). Bethesda, MD: AOTA Press.

Whitney, R., & Luebben, A. (2014). Interpretation and documentation. In J.

Hinojosa & P. Kramer (Eds.), Evaluation in occupational therapy: Obtaining and

interpreting data (4th ed.). Bethesda, MD: AOTA Press.

Final Exam

Article Code CEA0419

The Occupational Profile as a Guide to

Clinical Reasoning in Early Intervention:

A Detective’s Tale

To receive CE credit, exam must be completed by

April 30, 2021.

Learning Level: Intermediate

Target Audience: Occupational Therapists and Occupational Therapy

Assistants

Content Focus:

rocess of Occupational Therapy: Evaluation

1. There are five steps in clinical reasoning. Which of the following

is the final step?

A. Evaluate whether the client perceives their problem has

been solved.

B. Appraise the evidence.

C. Develop a clinical hypothesis to organize and guide

assessment.

D. Test the clinical hypothesis.

2. After seeing a child rock and hold her ears during circle time,

generalizing that the child may find loud noises overly stimulat-

ing based on Ayres’ Sensory Integration® theory is an example of:

A. Deductive reasoning

B. Inductive reasoning

C. Problem solving

D. Executive function

How to Apply for

Continuing Education Credit

A. To get pricing information and to register to take the exam online for the

article The Occupational Profile as a Guide to Clinical Reasoning in Early

Intervention: A Detective’s Tale, go to http://store.aota.org, or call toll-free

800-729-2682.

B. Once registered and payment received, you will receive instant email

confirmation.

C. Answer the qu

estions to the final exam found on pages CE-7 by

April 30, 2021.

D. On successful completion of the exam (a score of 75% or more), you will

immediately receive your printable certificate.

CE-8 ARTICLE CODE CEA0419 | APRIL 2019

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Continuing Education Article

CE Article, exam, and certificate

are also available ONLINE.

call toll-free 877-404-AOTA (2682).

3. A child withdraws to his mother’s lap and insists on nursing

after being asked to play with a toy that lights up and plays

music. Concluding that the child finds noise or light to be overly

stimulation or frightening is an example of:

A. Deductive reasoning

B. Inductive reasoning

C. Problem solving

D. Executive function

4. Data from which one of the following tools guide the generation

of client goals and priorities as well as outcomes targeted for

intervention, intervention type, and approach?

A. Sensory profile

B. Occupational profile

C. Therapeutic hypothesis

D. Master module

5. Which one of the following was not mentioned in the article as a

contributor to the profile of a child as an occupational being?

A. The social context

B. The expectations of and relationships with others in the

environment

C. The cultural context

D. Temperament

6. The primary purpose of an occupational profile is to:

A. Organize the evaluation around the activities the client

wants to do but has difficulty with or cannot do

B. Document progress for payer

C. Ensure reimbursement

D. Promote the distinct role of occupational therapy in

practice

7. Which of the following is not included in the client report

section of the Occupational Profile Template?

A. Cultural context

B. Occupations in which the client is successful

C. Personal interests

D. Performance patterns

8. Which of the following circumstances would belong in the

context portion of the Occupational Profile Template?

A. The home has five steps leading to the front door.

B. The child is 3 years old.

C. The child cries and uses avoidant behaviors when pre-

sented with a challenge.

D. Social supports and barriers to occupational engagement

9. In a 3-month follow-up with Rose, which one of the following

outcomes would you expect her parents to report to you given

the profile presented for her?

A. Rose was able to respond to verbal prompts without

avoidant behaviors in five out of seven trials.

B. Rose could indicate she wanted more glue for her art

project from her Sunday school teacher.

C. Rose was able to ambulate 20 feet without fatigue.

D. Rose was now able to dress independently.

10. In what way was the virtual context identified in the occupation-

al profile presented?

A. No broadband was available in the rural community,

limiting access to information and communication.

B. The family could not use the Internet for social activity.

C. Rose could use the computer for her homework.

D. The family did not have television.

11. The primary purpose of documentation as identified in the

article is to:

A. Provide evidence of occupational therapy services

received by the client

B. Advocate for the profession

C. Determine frequency and duration of continued services

D. Connect disparate clues for problem solving

12. Which of the following is not true of the Occupational Profile

Template?

A. It can be inserted directly into the treatment record.

B. It allows another therapist to follow along with the docu-

mented clinical reasoning skills outlined in the profile.

C. It helps the next therapist reading the profile learn from

the documented therapeutic process of the previous

therapist.

D. It provides a release in the health record for future

researchers.

Now that you have selected your answers, you are

only one step away from earning your CE credit.

Click here to earn your CE

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

The Occupational Profile as a Guide to

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank The Occupational Profile as a Guide to Form

Related forms

Fillable The Occupational Profile as a Guide to

Fill Online, Printable, Fillable, Blank The Occupational Profile as a Guide to Form

Related forms

First 20 documents completely FREE!