The most important part of occupational therapy assessment

This morning my OCC 471 class is taking their final examination as I write this entry.  The class content was focused on occupational therapy assessment in pediatric settings and I am aware that the students are nervous as I sit at the front of the room.  I wish that I had a way to make them feel better.

This blog is generally about my practice and not about my teaching - even though there are many logical points of intersection.  The whole point of teaching is to prepare people FOR practice and I know that all these students spent the weekend trying to answer the same question, "How will I know when I know enough??"

As I was walking toward the college this morning I watched birds flying around the bell tower of Ball Hall.  My immediate thoughts were related to wondering why birds choose the highest spot on campus to congregate.  I figured that there were probably a few possibilities:

  • the like the view of the lake
  • the perch has geographic proximity to nesting
  • their leader went there and others followed
  • high altitude perching is a survival behavior because predators can't get that high
There are probably some reasons that I can't think of.

I am not really sure why the birds were up there, so I decided that maybe they just had lofty aspirations - and I just didn't have enough wisdom to understand their motive.

It is a safe position to take, and it actually leaves open the oppportunity to respect the behavior.  I think that is important.

I mention all this because I wanted to write such a question on the examination but it was hard to put into a multiple choice format.  So while these students learned all about early intervention and school therapy and standardized vs. non-standardized assessments I hope they also learned a little about respecting things where they were - especially when they don't have the wisdom  yet to fully understand a situation.

We run face-first into this as a practice issue every day.  My first encounter with the concept was in a decidedly non-pediatric context.  I was consulting to a nursing home and I was very inexperienced - I often wodered if I knew enough to do a proper job.  Thankfully the COTA was highly competent but more importantly the residents themselves were also highly competent even though they were the ones 'receiving services.'

Of course this pre-dated the current models that drive nursing home reimbursement but at that time occupational therapy served an important maintenance function for those residents.  Many of them had long term and chronic disability but each day the residents made sure that they got to the OT room to do their "work."  Some chose to do craftwork, some participated in cooking groups, some wrote letters (for themselves and others) and some even put pegs into pegboards.  At that time my instincts bristled against that activity choice and I wanted to change their tasks to something that I perceived as being more occupationally and developmentally appropriate.  However, those residents took the initiative to make a sign and they placed it on the door to the OT room.  The sign read something like

Let no one call another man's work insignificant.

That is a really powerful statement, even though my 21 year old mind couldn't really comprehend it at the time.  That was over 25 years ago, and in these intervening years I have taken a deep dive into the source philosophy of Martin Luther regarding Faith and the meaning of Work - and perhaps I am now beginning to understand the aspirations of those residents a little.

They were very wise people.

Anyway this is a recurrent theme when you are gifted with a professional license to provide care.  I believe that we need to be cognizant of the power differentials between caregivers and 'patients' and how we develop understandings of their 'conditions' - like when we do our occupational therapy evaluations!  We also need to be mindful of  how we dispense advice through our interventions.  I think that we might be lucky if we happen to have any wisdom - and even if we do have it then we have to be sure that we don't wield it stupidly.

So do my students know enough???  Do they know if their assessments will lead them to the best interventions???  I just hope that when they see birds flying around bell towers that they will empty their minds of prejudice.  I hope that they will be willing to wait for the wisdom to come to them if they look deeply enough and wait patiently enough for the understanding.

If that happens, I will have served my purpose to them.


OK so I just realized that I partially told some of this story (about that nursing home) in a blog post three years ago. The bad news is that I am repeating myself. The good news is that my message is consistent and I REALIZED I partially told the story before. LOL!! Someone please let me know when I stop realizing that I am repeating myself. That will be my signal that it is time to hang up the keyboard. :D

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