OTPF in Action: Crafting Your Occupational Therapy Evaluation Framework

 In this episode of Animals and Aquatics, Gina delves into the intricacies of utilizing the Occupational Therapy Practice Framework (OTPF) in the evaluation process. She highlights the significance of understanding the OTPF's components and discusses its applicability in various occupational therapy niches, including nature-based therapy, hippotherapy, and aquatics. Gina provides valuable insights and practical examples to guide listeners through crafting comprehensive evaluations using the OTPF framework. Whether you're a seasoned occupational therapist or a student, this episode offers valuable strategies for optimizing your evaluation processes and enhancing client outcomes. 

Transcript

Microphone (3- Logitech USB Headset) & Integrated Camera 0:01

Hey, welcome back to animals and aquatics in April for occupational therapy month. This month. Remember we are taking a deep dive into the occupational therapy practice framework. Now if you've downloaded your copy and you're ready to follow along. Let's get started.

Microphone (3- Logitech USB Headset) & Integrated Camera-1 0:30

Hi, welcome to animals and aquatics. Gina your cohost. And this month we are taking a deep dive into the occupational therapy practice framework and how you can use it in unique niches, such as hippotherapy, aquatics, animal assisted therapy and nature based therapy. And today, specifically, I want to focus on using the OTPF in the evaluation process. In fact, we found it invaluable in creating occupational therapy. Evaluation framework. And I'd like to take you through that a little bit today. And as I've mentioned, if you have your OTPF and want to follow along, this may help it make sense to you. You can find free downloads online. And just pull up the PDF to look through it. Now the nice thing about the OTPF and I talked to my students in the occupational therapy assistant program a lot about the OTPF because. I feel like if you sit down with this document for enough time, It really is like its own occupational therapy education. It talks a lot about what our scope of practice really is. And I think it's a great resource document. I also think that it really can help to guide our process and a lot of the textbooks that we use reference OTPF and now we're working on OTPF for. And they go through the occupational therapy process using OTPF the other thing I really like about it. Is, it fits really well with the WHOs international classification of disability and function model. And I think when we're talking to our colleagues internationally, it really is a good starting place where we have some things in common and some common language to work from. And when you're working in a unique niche, the last thing we need getting in between us and other occupational therapy practitioners is language or the way that we're wording our terminology. So some of the key aspects that the OTPF looks at are of course occupations. So our ADL's, IADL's, health management. Rest and sleep. Education work, play. Leisure and social participation. We also look at contexts such as environmental factors and personal factors. We can take time to work with performance patterns, such as habits, routines, roles, and rituals. And then we break it down into performance skills. So this is where I like to focus. Most of my occupational therapy evaluation. This is looking at motor skills, process skills and social interaction skills. And we can wrap it up when we're completing our evaluation with client factors, such as values, beliefs, spirituality. And body functions and structures. So with the OTPF, when we want to look at the OT process. So that's how he provides services. It's really well outlined in the OTPF. And the evaluation starts with the occupational profile. And there's a good example of an occupational profile on AOTA. But it starts with why is the client seeking services and how is this related to how they're engaging in occupations in daily life? So that's always a good place to start and it really puts occupation at the front and center. Then we talk about what is the client doing successfully and what barriers are impacting their success in what they want to be able to do. Then we can look at occupational history, values, interests, and contacts. Before we get to those performance patterns. So when we get to the performance patterns, that's where I really like to take that deep dive. And the second part of this is the analysis of occupational performance. And this is where I really want to take those performance skills and look at them really carefully. So I'm going to go through some of those, but I do want to finish up looking at what the OT process. So this is the whole process first. So we're talking about the evaluation and again, the evaluation is composed of the occupational profile. The analysis of occupational performance and then the synthesis of the evaluation process. So this is looking at their values and priorities. This is interpreting any data that we've collected. So for me, that's often the data that I've collected from a sensory profile or the PEDI. So that's a pediatric evaluation of disability inventory, or maybe it's the BRIEF executive function scales. So I'm going to interpret that data then developing and refining my hypothesis about the client's occupational performance. Both the strengths and the deficits. And we'd like to work from a strengths based approach. So we like to highlight what those strengths are and then explain how we're going to incorporate those into our plan of care. Then we might look at any support systems that might be impacting the success of the client and our interventions in this process. And coming up with the goals. So we create our goals, obviously in collaboration with the clients. And usually that's done in an interview format. Although when we do want to be a bit more formal about it, we'll use the COPM. So that's the Canadian occupational performance measure. And then as part of the evaluation, we're already selecting outcome measures that are going to determine progress towards our goals. And we'll look at whether we need to. Repeat the re-evaluation process or move on to discharge. In our intervention phase. The intervention plan. So what exactly are we going to include? What are the timeframes that we expect this to be? What is our approach? Are we looking at promoting wellness? Establishing or restoring particular skills, maintaining where the client is at. Modifying or prevention. And then what's our service delivery method. So when, where, and what approach will be used. We might look at what the discharge plans are going to be, and we can make any recommendations or referrals to other professionals. Then we begin to carry out our interventions, right? That's the part we think of most, and this could be one-on-one sessions. This could be group interventions. This could be virtual. Although when we're incorporating animals in, or we're doing nature based sessions, these are very experiencial and face-to-face, but we can do them in a one-on-one format. We can do them in group format. We can be included including psychosocial education components to it. Right? So there's a number of different ways that we might be doing our intervention implementation. And through this, we're also monitoring the client's response through ongoing observation evaluation and re-evaluation as needed. The last part that's actually part of the intervention phase is the intervention review. We're re-evaluating the plan, how it's implemented. How it's working to achieve our goals and outcomes. Modifying the plan as needed. And if you're working with occupational therapy assistance, this is something that we're doing on an ongoing basis as part of our supervision model. Now when we get to the end, that's our outcomes. And we've already determined some of our outcomes in the evaluation section, but we want to make sure that they're valid, reliable and very importantly sensitive to change. And so sometimes we're seeing change. The family is seeing change, but if we haven't selected the right outcome measures, we may not actually see a difference. And it's really important to know which assessments. Our pre-post measures and can be used for outcomes. And which ones are just used to gather data. So that's really important when you're looking at outcome measures. With our outcome measures. We're looking at how that's impacting goal achievement and also how that's being transferred to daily living skills or occupational performance. So that's how OTPF lays out the occupational therapy process. And the first part of that process, is the evaluation and I get a lot of questions about the evaluation when you are in a non-traditional setting. And the nice thing about it is it doesn't really matter what setting you're in. You're going to be using a lot of the same types of evaluation tools. But I will also add a caveat to that. In that there are some specific things that we do need to know that are unique to our setting. So that might be something like an life-threatening allergy to insects, right? If we're in a nature based setting, we really need to focus on that. If there are any fears or trauma related to being in the outdoors or open spaces. Sensory processing challenges around. Eh, any component that we might experience in a nature based setting. Right. We want to know those things ahead of time. And so as part of our evaluation process, it's important that we're considering any precautions, any Contra indications. And putting that all together. Now. If this is something that you're thinking about and struggling with. They're using the occupational therapy practice framework the OTPF is a great way to get started because it really is pretty structured. You can take the OTPF and the different categories, make some check boxes. And make your questions from. The components that it gives you in the occupational profile or download the AOTA. And get started. If you're really struggling more with the niche specific areas, then that might be something that we're covering in Business Barn Raising. When we get started in June, that might be really helpful for you. So when we start to look at the occupational performance, this is where I said, I really liked to go ahead and break it down to those process skills, because I think the OTPF really does a nice job of breaking down process skills into something that is not only easy to understand, but it's also easy to explain to others. And when we're in a unique setting, again, we don't want things that are going to impair our communication with other professionals, right? We want to be using kind of standardized language. So that way, anybody in a traditional outpatient clinic or a hospital based setting, I can really understand what it is that we're working on. And I think this is really important when we are working in niche settings. The performance skills that we're looking at include the motor skills, the process skills and the social participation skills. So we're going to I'm going to give you some examples in how I'm using those in my evaluations, just so you can get an idea. And again, if you've downloaded the PDF and you can follow along or you can see how I might be working through with one of those. In motor skills, we have a couple sub categories, including positioning the body obtaining and holding objects. Moving self and objects, sustaining performance. So something like endures. So the definition for endures is persist and complete the task without demonstrating physical fatigue, pausing to rest or stopping to catch the breath. Now, if you've been in a nature based setting, this will immediately jump out at you. And there's examples of effective occupational performance and ineffective performance of this skill, but we can think about it of a child who's able to get out to our outdoor classroom without fatiguing, pausing to rest or stopping to catch their breath. If we know that they need to stop multiple times, then maybe they're having trouble with this category of endures in sustaining performance. Another area we can think about is the moving self and others and a moving self and others, right? Coordinates uses two or more parts of the body together to manipulate and hold task objects without evidence of fumbling or task objects, slipping from their grasp. If we're incorporating any of our nature based materials, we can look and see how well the client is able to coordinate their body. And those tasks, objects sticks come to mind, right? Because kids are always picking up sticks and rocks in our nature based session. So we can look at that. Coordination moves, lifts, walks, transports, calibrates flows. Those are all in the motor skills category. Now when we move from motor skills, we can move into the performance skill of process skills. Let me just give you the definition. Process skills are a group of performance skills that represent small observable actions related to selecting, interacting with and using tangible task objects. Carrying out individual actions and steps and preventing problems of occupational performance from occurring or reoccurring in the context of performing personally and ecologically relevant daily life task. Of course that's all in OT speak. Right? But we're looking at how the person is able to do it. So some components in here sustaining performance. Now we talked about it from the motor skill side. But now we can also talk about it from the process skill side, and we can look at the one attends. We know a lot of our clients have trouble with attention. So attends means does not look away from task performance, maintaining an ongoing task progression. And we can definitely see that many of our clients have trouble with attends. They look away or they don't continue to progress on a task. So we might be able to check off that box and maybe it's mild, moderate, or severe as far as attends, whether they're able to do that. We can look at a process skill under the applying knowledge section that is chooses. Chooses means selects the necessary and appropriate type and number of objects for the task, including tasks, objects that one chooses or is directed to choose. And when we think about giving directions in a nature-based setting in the evaluation phase, we might say. Pick up a stick that's long enough to use as a walking stick. Are they able to apply? Or understand what that means. So they choose a stick that is long enough. Now there is some context here in that. If they've never been hiking before, they've never heard the term a walking stick. All right. We might have to show them an example here. This is my stick. It's a walking stick. Can you find yourself a walking stick? And if they come back with something that's nine inches long. We know that they're having some trouble with choosing. We could also say, choose a crayon. That would color the pictures that you see around you, if we're providing an activity to do and can they choose the necessary and appropriate crayons or markers that they would need for that. We can look at under organizing and timing. We can look at sequencing, performed steps in an effective or logical order with the absence of randomness. In the ordering or inappropriate repetition of steps. And when we think about a child who is having trouble with sequencing in the nature based environment, sometimes we really do need to do things in a particular order. Especially for, putting something together. Or we need to follow a particular trail. We need the client to be able to sequence them in a logical order. And this is a good thing that we can assess as far as process skills go in that initial evaluation phase. To wrap it up there's a ton more things that go into process skills. But I want to make sure I have time to talk about the social interaction skills. This is amazing when we're working in a group setting, but often even when we're one-on-one, we may have another professional helper. We may have an OT student with us. We may have parents along with us. So there's a number of different times when we're going to have social interactions. Or even if we're in a community setting, we're going to have social interactions. So we have initiating and terminating, so approaches and starts or concludes indigenous engages. And I certainly know some of my clients that have trouble with both of those either approaching and starting. So that would be approaches or initiates interaction with the social partner in a manner that is socially appropriate. So we can see if we're in a park setting. Does the client appropriately initiate with a same age peer. Are they inappropriate and initiating with someone who is not a peer or are they inappropriate and initiating, with somebody at the park who. Doesn't want to interact with them. Or are they just inappropriate in their initiation. Such as running up behind somebody and tapping them on the back. Right. That would not be inappropriate initiation. So we could mark that down. If we saw that or we could set up. Social interaction of greeting someone. So producing social interactions, producing speech, gesticulates or speaks fluently. Right. We can look at those areas. In the nature based setting when we're interacting with other people. Physically supporting a social interactions, such as turning towards or looks pace itself, touches and regulates. We know that a lot of our clients have trouble with regulation. So under regulation does not demonstrate. Relevant, repetitive or impulsive behaviors during social interactions. So we would be looking at that regulation specifically within those social interactions, but we would be looking for anything that was repetitive and that could be repetitive actions or even repeating the same story or component of a story. And any impulsive behaviors in that. So thinking about, Running. On a Rocky Creek bed, right? Because they're running with a peer or they're running so that they can be first. And so that could be definitely an impulsive behavior that might indicate that there were some challenges with regulation. There's shaping content of social interactions, such as questions, replies disclosure, expressing emotion disagreeing, and thanks. Maintaining the flow of social interactions, such as transitions, timing responses, times duration. So that would be an example speaks for a reasonable length of time. Given the complexity of the message takes turns. And if we are running groups, we can see this a lot taking turns, but even between the practitioner and the client, we can set up a situation for turn-taking. So, this is how I look at using the OTPF. Now they do have a specific group category. Performance skills for groups. So if you are running nature-based groups, this again is a great section to look at. It does give you a little bit more information. If you're running groups. When we think about our evaluation, remember we have the occupational profile, the analysis of occupational performance. And we have the synthesis of the information. So any of the data that we've collected, including using the OTPF four in the performance skills, as part of our analysis of occupational performance. That's a great way to structure and then write up your occupational therapy evaluation. This can be used in our unique settings when we're incorporating animals, or if we're an aquatic based setting around the pool. All of these still apply. And I think that it gives us again, a very standardized framework to communicate with others, to show our unique value and to keep the focus on occupational performance. I really hope that this was helpful for you today. I do love talking about the OTB app, so we are not done with it in celebration of April as occupational therapy month. Thanks for listening.