Many times parents ask if they really need a full evaluation. Evaluations are expensive and time consuming. They may have one from the school or their child had been in therapy before. They just want to get down to the therapy, to get to the fix.
Over the years I’ve come to value this important step in the therapeutic process more and more. In the schools we formally re-evaluate every three years and there are years I can’t wait for that re-eval year to come up again. Even though I work with a student weekly, the process of formal evaluation brings me so much information I can’t get in weekly sessions. I often go back and re-read evaluations after months of working with an individual. It keeps me centered on the presenting problems, allows me to see where growth is taking place and areas to focus on next. That’s why it’s important to do a thorough evaluation in the beginning.
So what makes an evaluation valuable?
Let’s look at the components of the evaluation. There are the formal assessments, the clinical observations of behavior and movement, the interpretation or analysis of all that information and finally the recommendations and treatment plan that comes out of it. Formal assessments are the standardized tests and rating scales which allow us to compare skill performance to same age typically functioning peers. Some of the assessments help to narrow down exactly what pieces aren’t working as well, and where a child’s strengths lay. Scores can be compared over time to demonstrate growth. The limitations of standardized tests are that they demonstrate what a child can do, but they do not indicate how a child does it. What does it take to get that result? How is the child moving, holding themselves, reacting behaviorally? That’s where clinical observations play an important role. Observations give the depth and background that help inform who the child is. Clinical observations are sometimes formal, specific activities/actions that are done to see how a child carries out the action. Other times they are the informal observations regarding how a child reacts. All of this observational information is important in describing the individual, what’s working and what’s not working. The standardized tests will give us numbers, the observations will give us context.
Both the formal assessments and the observations produce information. It’s then my turn to look at all the information and ask Why? Why is this individual not functioning at optimal? What pieces are holding this child or person back? What pieces can we use to build on to strengthen skills and perceptions? My education and training as an occupational therapist allows me to analyze the information in relation to the roles that person holds such as family member, student, team mate, worker, musician, community member etc. How is this person and their family affected by the deficits that were identified?
That leads right into the last and most important part of an evaluation – the recommendations and treatment plan. Now that we know all of this, what do we do about it? I always start with education – what does this family need to know that will make the therapy process successful? Do they need information about how the body processes information? Do they need to know how to adapt activities or the home to increases success and decrease stress? Will they understand the importance of the home activities and be able to implement them? Do they need a referral to other professionals that can also help? This is the starting place – the learning phase. Which is just as important as the actual therapy. When the education base is in place, the therapy has maximum benefit.
Finally there is the plan. What are we going to focus on right now and set as goals? Hopefully by this point the parents have shared their goals and desired outcomes, which are incorporated into the treatment plan. The goals are broken down into achievable and measurable objectives. Different methods are identified to achieve those goals. And most therapists agree that a key to making progress on those goals are the incorporation of a home program, which is outlined here as well. It’s the blueprint or working document for coming therapy.
Here is where a full evaluation becomes so valuable – once those objectives are met, we go back o the evaluation and decide have we met the goals or are there other goals to work on. A good evaluation will outline the next phase of treatment. A long the way we re-evaluate using the same tools to help measure progress. The value of the evaluation is that it provides the frame for progress to take place. Because in the end we all want progress for a better outcome.