Editor's note: This text-based course is a transcript of the webinar, Early Intervention and School Assessment, presented by Lauren Arnone, OTD, OTR/L.
*Please also use the handout with this text course to supplement the material.
Learning Outcomes
- After this course, participants will be able to analyze key components of comprehensive occupational therapy assessments for children and youth under Early Intervention (EI), the Committee on Preschool Special Education (CPSE), and the Committee on Special Education (CSE), including best practices for utilizing standardized and non-standardized evaluations.
- After this course, participants will be able to differentiate essential strategies for effectively interpreting and communicating assessment results to caregivers and interprofessional team members.
- After this course, participants will be able to differentiate between various assessment tools and methods to develop individualized, evidence-based treatment plans for children and youth receiving OT services.
Introduction/Agenda
Today’s course focuses on assessment in early intervention and school-based occupational therapy. We only have an hour together, and that’s certainly not enough time to cover such a broad topic. However, we’ll begin by exploring some of the key components of an occupational therapy evaluation. I’ll walk you through how we go about selecting appropriate assessments, how we interpret those assessments, and how we communicate our findings clearly and effectively. From there, we’ll look at how to use those results to inform evidence-based, occupation-centered treatment planning for our clients.
We will take it back to the foundation—the evaluation process. Evaluation and assessment are the first critical steps in the OT process. If you’re a recent graduate, this is likely very fresh in your mind. You probably spent a lot of time in school studying the components and significance of this phase.
I’m referencing here from the Occupational Therapy Practice Framework, Fourth Edition (OTPF-4). For those who have practiced for many years, it’s easy to lose sight of these foundational principles. The daily rhythm of treating clients, completing evaluations, discharges, and beginning again can pull us away from these core concepts. But it’s so valuable to revisit the OTPF and reconnect with the framework that guides our profession.
Review: The OT Process
As occupational therapy practitioners, we follow a process that, hopefully, you remember from your training. It’s made up of three essential parts: evaluation, intervention, and outcomes. During the evaluation phase, our focus is on understanding what the client wants. We need to identify what the client can do and has done and recognize both the supports and the barriers that impact their health, well-being, and participation.
But as we all know, this isn’t a neat, step-by-step process. It doesn’t happen in a straight line where we evaluate, intervene, measure outcomes, and discharge. It’s much more dynamic and cyclical. We’re constantly evaluating, delivering interventions, and reassessing outcomes—whether those outcomes come from standardized assessments or are measured against the goals we’ve set with our clients.
We’re always asking ourselves: Based on what we’re seeing, what’s the next step? Do we need to reevaluate? Is it time to adjust the interventions? Sometimes, we find that our clients are making great progress, and everything is on track, so no major changes are needed. Other times, our clients may have achieved their goals and are ready to move forward to the next stage of their journey.
This continual loop—evaluating, intervening, reassessing, and planning the next step—is the heart of our work. It’s a fluid, responsive process that ensures we stay aligned with our clients’ evolving needs and goals.
OT Assessments in EI & Schools
When we are looking at early intervention, we're talking about children from birth through age 2 years and 11 months—our littlest ones. At this stage, we typically assess present levels of motor skills, functional cognition, social-emotional development, and performance across all areas of occupation. Early intervention focuses primarily on the family’s concerns, priorities, and available resources. After all, we can’t ask a baby what they want to work on. They can’t tell us that at this age, so we rely heavily on the family to guide the direction of our intervention and assessment process.
When it comes to school-based assessment, we generally refer to children ages three through twenty-one. Preschool typically includes children ages three to five, and then school-age services continue from five through twenty-one. Children eligible for special education services can receive them until they reach the age of twenty-one.
In assessing school-aged children, we continue to look at similar domains—motor skills, functional cognition, social-emotional skills, and developmental performance. However, the key difference is that these areas must be evaluated in the context of the child’s academic participation and performance. Our focus is on school-related occupations. Unlike other settings, such as home health, where the focus might be more on ADLs or community integration, in school-based therapy, our assessments and interventions are directly tied to how the child engages with the academic environment and accesses the curriculum.
Occupation-Based Vs. Skills-Based Assessments
I want to pause here and make a distinction I’ll revisit as we move through the rest of this presentation: the difference between occupation-based and skills-based assessments. As occupational therapists, our work is inherently centered around occupation. Our assessments and interventions revolve around meaningful engagement in everyday activities that matter to our clients. We come from a holistic perspective, aiming to address the whole person through a top-down approach.
Some of you who are newer to the field may remember the distinction between top-down and bottom-up approaches from your academic training. With a top-down approach, we look at the occupation—what the individual wants or needs to do—and use that as our anchor. We're not narrowly focused on isolated skills unless those skills impact the person’s ability to perform a meaningful occupation. It’s not that strength or visual perceptual abilities aren’t important, but in occupational therapy, they hold value only when they help us understand occupational performance.
Too often, we rely heavily on skills-based assessments—measuring range of motion, strength, and visual motor integration—without always bringing it back to occupation. One of my goals for this session is to encourage a renewed focus on occupation. Let’s bring our attention back to the core of our practice and consider how we can use both occupation-based and skills-based assessments thoughtfully and intentionally.
Just because someone presents with decreased strength or difficulties in sensory processing doesn’t necessarily mean they will experience limitations in function or independence within a meaningful occupation. That’s why evaluating both sides of the equation is essential. We must assess occupational performance and examine the underlying skills and client factors that may support or interfere with it.
If we’re not accurately assessing a client’s performance within real occupations, can we truly develop and pursue client-centered, occupation-based goals? I invite you to reflect on that question as we continue.
Occupation-based assessments follow a top-down approach and focus on a client’s—or caregiver’s—ability to complete specific, meaningful tasks. We’re looking at how independently someone can perform the activities that matter most to them. In contrast, a skills-based assessment reflects more of a bottom-up approach. Without context or meaning, these tools measure client factors, body functions, and performance skills.
For example, many of you are likely familiar with the Peabody. It’s a well-known skills-based assessment. We evaluate visual motor skills when we ask a child to complete a block design task. Still, we must ask ourselves whether that skill directly translates to meaningful occupations in that child’s life.
That said, skills-based assessments are incredibly useful. They often help us understand why we see difficulties in occupation-based tasks. For example, an occupation-based assessment might reveal that a child struggles with handwriting. A skills-based tool could help us determine whether this difficulty stems from decreased strength or poor ocular motor control. When used together, these two types of assessments offer a fuller, more nuanced understanding. However, we must never forget to prioritize the occupation as the heart of our evaluation process.
Skills-Based Assessments
- Alberta Infant Motor Scale (AIMS)
- Batelle Developmental Inventory
- Beery–Buktenica Developmental Test of Visual–Motor Integration
- Bruininks–Oseretsky Test of Motor Proficiency (BOT)
- Developmental Test of Visual Perception (DTVP)
- Peabody Developmental Motor Scales (PDMS)
- Sensory Profile
- Sensory Processing Measure
- Developmental Assessment for Individuals With Severe Disabilities
- Motor-Free Visual Perception Test (MVPT)
These are some examples of skills-based assessments you may use in practice. And just to be clear—they’re not inherently bad. They’re reasonably necessary. We need skills-based and occupation-based assessments to understand our client comprehensively. The challenge arises when we use these assessments in isolation and then try to conclude occupational performance. It’s not always a straightforward connection.
Take the Beery VMI, for example. It might indicate that a child has decreased visual motor integration. While we might assume that would naturally translate into challenges with handwriting, the evidence doesn’t always support that assumption. So while tools like these provide valuable insight into underlying skills, they shouldn’t be viewed as the entire foundation of our evaluation process.
On the other hand, occupation-based assessments are tools that keep our focus where it belongs—on occupation. These assessments help us evaluate whether a child can participate in a meaningful task and to what extent they can do so independently. They give us direct information about performance in context. We can see not just if there’s a deficit in a skill, but whether that deficit impacts the child’s ability to engage in daily occupations that are important to them or their caregivers.
Skills-based assessments can tell us much about why a child might struggle. However, occupation-based assessments show us whether that struggle affects their functional participation. And that distinction is critical in delivering client-centered, meaningful therapy.
Occupation-Based Assessments
- Assessment of Motor and Process Skills (AMPS)
- Miller Function and Participation Scales (M-FUN)
- Pediatric Evaluation of Disability Inventory (PEDI)
- Canadian Occupational Performance Measure (COPM)
- Minnesota Handwriting Assessment
- Print Tool
- School Functional Assessment (SFA)
- Test of Handwriting Skills
- Test of Playfulness
- Roll Evaluation of Activities of Life
- Weekly Calendar Planning Activity
These are some examples of occupation-based assessments, and hopefully, you're already incorporating some of them into your practice. If not, this list is a great place to start. It's certainly not exhaustive—many more options are available—but it serves as a solid foundation.
As conversations with your employer arise around the quality and effectiveness of evaluations, or when you’re asked whether your current tools are still meeting your needs, this can be an ideal time to reassess your assessment toolkit. You might find that specific tools are being phased out or new versions are being released. When deciding whether to adopt an updated version, exploring additional occupation-based assessments that could bring more value to your practice might also be a good opportunity.
Adding a broader range of occupation-based measures can strengthen your evaluations and support more meaningful, client-centered intervention planning. It’s worth exploring these tools and considering how they align with your setting and the populations you serve.
Components of an OT Eval
- Occupational Profile
- Analysis of Occupational Performance
- Synthesis of the Evaluation Process
So, what are the components of an occupational therapy evaluation? We begin with the occupational profile, then move into the analysis of occupational performance, and finally arrive at the synthesis of the evaluation process—our interpretation. I’m going to walk through each of these steps with you.
As students, we’re taught that the occupational profile is foundational and critical to the evaluation process. However, once we step into real-world practice, especially in fast-paced environments like schools or early intervention programs, time becomes a serious constraint. Often, we feel like we barely have enough time to complete a single assessment, let alone gather a full, detailed profile. We may find ourselves asking a few quick questions to the parents or teacher, and then moving straight into testing. However, taking the time to develop a comprehensive occupational profile can make a tremendous difference. In a school-based or early intervention setting, this means clearly understanding the child’s routines, strengths, challenges, interests, and the priorities of the family and team members involved.
Next comes the analysis of occupational performance. Here, we use our assessment tools—both occupation-based and skills-based—to evaluate how the client is functioning in their daily activities. We gather data, observe performance, and identify areas where support may be needed.
The final step is the synthesis of the evaluation. This is where we interpret the collected data, combine it with what we’ve learned through the occupational profile, and make sense of what it all means. This synthesis is what allows us to move forward with clarity. It guides our clinical reasoning and shapes our evidence-based interventions to support our clients’ growth, participation, and success.
Occupational Profile
The occupational profile is probably a review for many of us, but we tend to lose sight of it as we go into practice. That’s why revisiting these foundational elements can be so valuable. The occupational profile summarizes the client’s history and experiences, daily living patterns, interests, values, needs, and the relevant contexts that shape their everyday life. It is essential to a truly client-centered and holistic evaluation, even for our youngest clients.
Even infants and toddlers benefit from this process, though they can’t always communicate their needs and interests directly. Sometimes, a three-year-old may surprise us with how clearly they can express what’s meaningful to them, but other times, even older children may not be able to articulate those thoughts. In those cases, the caregivers become vital informants in the evaluation. Their perspective helps us understand what truly matters in the child’s life.
When developing the occupational profile, involving the client, caregiver, and other relevant team members is essential. For example, a middle school teacher may approach you with concerns about a student’s handwriting—perhaps it's difficult to read and impacts classroom participation. However, that perspective must be considered if the student and their caregiver are not concerned and prefer exploring typing. Including all stakeholders helps ensure our recommendations are relevant and collaborative.
Now, I want to pause and say that I don’t work for AOTA or receive anything for saying this, but I genuinely believe in the value of membership. If you’re not already a member, I highly recommend joining. You gain access to many valuable resources, including their occupational profile template. It’s a practical tool that outlines what information should be gathered and helps guide your conversations during evaluation.
The occupational profile should include the reason for referral or why OT services are being sought. What are the child’s or family’s concerns related to occupational engagement? In early intervention, this takes on a family-centered lens—what’s concerning or challenging for the family as they support their child’s development? A baby can’t tell you they want to eat a wider variety of foods, but if a caregiver notices feeding challenges and that’s a concern for them, then it becomes a priority for us.
We also want to identify the child's strengths and barriers. What’s getting in the way of participation? And just as important, what are they doing well? We have to build on their strengths and highlight what they are capable of.
We consider values and interests. What matters to this child or this family? If handwriting isn’t something they value, it’s going to be hard to make progress in that area. I’ve rarely seen older elementary or middle school students make significant gains in handwriting unless they are personally invested in that goal. If it’s not meaningful to them, progress will be limited.
It’s also important to understand routines and roles. This is especially critical in early intervention, where challenges in occupational performance can significantly impact a family’s daily routines. And finally, we must identify the child’s and family’s goals and priorities for therapy. When working with older children, we need to be mindful of whether the goals we are targeting are truly aligned with their interests and values. If not, we have to ask ourselves whether pulling them from class for therapy is the most effective or respectful use of their time.
Gathering this information through a well-developed occupational profile helps us ground our evaluation in what truly matters to the child and family. It sets the stage for meaningful, collaborative, and effective therapy.
Analysis of Occupational Performance
The next phase after completing the occupational profile is analyzing occupational performance. We often consider this the “meat and potatoes” of the evaluation process. In this phase, we use various assessment tools to examine how the child is functioning, not just in terms of their client factors or performance skills, but most importantly, their ability to engage in meaningful occupations identified during the occupational profile.
This part of the process should be rooted in the models of practice and frames of reference that guide our clinical reasoning. Those of you who are newer to the profession may still have these frameworks fresh in your mind, but for all of us, it’s important to revisit them regularly. They serve as the roadmap for our assessments and interventions. For example, if you’re working with a child with sensory processing challenges, drawing from a sensory integration frame of reference will help determine appropriate assessment tools and point you toward effective, evidence-based intervention strategies.
A critical component of this phase is clinical observation. We should always make the time to observe the child in their natural environment. Early intervention often means observing them at home or in daycare. In a school-based setting, it means spending time in the classroom, in specials, or less structured spaces like the cafeteria. A child may appear to function well during a calm classroom activity. Still, their struggles may become more apparent in a noisy, overstimulating lunchroom while trying to carry a tray and find a seat. These real-life moments reveal how a child manages their occupations, and our observations in these contexts are invaluable.
These observations also help us decide which assessment tools to use. We begin by evaluating occupational performance using occupation-based assessments. If a teacher reports that a student is struggling with handwriting, it’s essential to use a standardized handwriting assessment that is evidence-based and occupation-centered. Once we’ve confirmed a performance issue, we can use skills-based assessments to investigate why the difficulty exists. For instance, if the child struggles with copying from the board, a tool like the Beery VMI, the BOT, or an ocular motor screening might help us uncover contributing visual-motor or perceptual challenges.
This layered approach allows us to understand the full picture. We begin with occupation—assessing whether the child is participating successfully and independently—and then look more closely at the underlying skills. The goal is not simply documenting improvements in isolated abilities like strength or visual tracking. We want to know whether those improvements translate into greater functional independence in the occupations that matter most. That’s the outcome we are aiming for: meaningful, real-world participation.
Choosing & Using Evidence-Based Assessment Tools
So, how do we know which assessment tools to use? I touched on this earlier, but it's worth looking closer. The decision should be rooted in the information gathered from the occupational profile, your clinical observations, and the frame of reference you use to guide your evaluation. And don’t forget about the Occupational Therapy Practice Framework—the OTPF-4—which was released in 2020. It remains one of our most essential resources for defining the scope of what we do.
Choosing the correct assessments can feel overwhelming, especially if you’re newer to practice. You might receive a referral for a child in early intervention, preschool, or a school-based setting, and the teacher shares a long list of concerns—maybe handwriting is barely legible, attention is fleeting, transitions are a struggle. It can feel like there’s too much to sort through. That’s where it helps to ground yourself in the OTPF. Skimming through the list of occupations can help you re-center and identify which areas are most relevant to the child’s challenges and strengths. From there, you can begin to determine what needs further assessment.
Occupation-based assessments should be prioritized, especially those supported by strong psychometric properties—valid and reliable tools. Each evaluation must include at least one occupation-based assessment. These tools will help you make meaningful, functionally relevant conclusions about the child’s participation.
That said, you also have to consider the child’s abilities and tolerance for testing. If a child has significant cognitive or language delays, using an assessment that relies heavily on verbal instructions might not be appropriate. You want the tool to match the child’s capacity so that you're getting accurate data, not a false impression of their abilities, because the assessment format didn’t align with how they process information.
In outpatient settings, the family’s resources and availability must also be considered. If you’re selecting a tool that requires several sessions, ask yourself if the family can realistically attend that many appointments. Even in school-based practice, it is worth considering whether an assessment is efficient and appropriate given the setting and time constraints.
Sometimes, you’re limited by what’s available. Your school or clinic may only have a small number of tools on hand. While some free assessment tools can be downloaded and used appropriately, there may also be a need to advocate for expanding your toolbox, especially when new, updated versions of assessments are released. That can be a good time to reflect on whether your current tools still serve your clients well or whether it’s time to introduce something new.
It’s also essential to ensure you're trained to administer any tool you plan to use. Some assessments, like the Sensory Integration and Praxis Tests (SIPT), require specific certification. For those that don’t, it's still best practice to familiarize yourself with the tool—review the manual thoroughly, and practice administering it with a peer or friend before using it with a child.
Ultimately, your goal is to select assessments that allow you to connect your findings directly to meaningful engagement in occupation. The results of your evaluation should guide you toward interventions that support real-world function and participation, not just improvements in isolated skills. That alignment is what makes our work truly impactful.
Resources for Choosing & Using E-B Assessment Tools
Several helpful resources are available regarding selecting and using evidence-based assessment tools. And once again, I’ll reiterate that I don’t work for AOTA and receive no compensation for mentioning them, but I believe strongly in the value of their resources. Of course, there are many tools from various sources, but AOTA offers a couple of beneficial ones worth highlighting.
One such resource is their pediatric evaluation checklist. This tool walks you through the process we’ve been discussing, starting with the occupational profile and guiding you through a checklist of various assessment types. It includes occupation-based tools, client factor assessments, and more skills-based options. It’s a practical way to organize your evaluation process and ensure you cover everything clinically relevant.
AOTA also offers a quality toolkit, which includes curated lists of evidence-based assessment tools across multiple practice areas. Within the Pediatrics section of the toolkit, you’ll find a list of assessments supported by current evidence. It’s a great starting point if you’re exploring new tools or determining what fits your setting best.
That said, no matter what resource you’re using, you must do your homework, especially if considering purchasing or adopting a new assessment tool. Just because a fieldwork educator or supervisor recommended a particular tool at one point doesn’t mean it still represents best practice. Take some time to review the latest literature. You can use AJOT if you have access through AOTA, or explore other open-access journals to find recent studies.
For instance, a recent article in AJOT looked at the minimally clinically significant difference for the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI). The article highlighted a weak correlation between VMI test scores and functional occupational performance. This doesn’t mean we should stop using the Beery VMI altogether. It’s still a valid tool, but we must be cautious about how heavily we rely on it, especially when trying to justify the need for services or monitor long-term progress.
If you notice that a child appears to be doing better in the classroom but their VMI scores remain unchanged—or the reverse, where the scores improve but functional performance doesn’t—it’s worth examining more closely. These situations should prompt you to step back and ask whether the assessment captures what’s truly meaningful for the child’s occupational participation.
This is why including at least one occupation-based assessment in your evaluation battery is so critical. These tools help you connect your clinical findings to actual functional performance. They allow you to measure the impact of your interventions in authentic, meaningful contexts and ensure that your goals and treatment plans remain truly client-centered.
Synthesis of Evaluation Results
Once we’ve completed the occupational profile, administered an occupation-based measure, selected and conducted appropriate skills-based assessments, and observed the child in at least one setting—ideally more—the question becomes: What do we do with all of this information? This is often where things can start to feel overwhelming, especially for newer therapists. You’ve gathered a stack of data, but now you’re faced with interpreting it and figuring out how it all fits together.
The key is to step back and systematically move through the process. Start by reviewing what the occupation-based assessment tells you. Is the child experiencing difficulty participating in a specific occupation? Are they demonstrating independence, or are there clear areas of need? This sets the foundation for everything else.
If you’re working in a school-based setting, you may sometimes encounter a situation where the child scores poorly on a skills-based assessment, but their functional participation in the classroom is solid. They keep up with their peers, complete work, and manage routines independently. That kind of functional independence should weigh heavily in your clinical judgment.
On the flip side, you may sit in an IEP meeting with data showing that a child scored in the average range on a standardized assessment like the Beery VMI, yet you see real challenges in their day-to-day classroom performance. The numbers don’t tell the full story; this is precisely where your occupation-based assessments become essential. They allow you to show that, although the child technically scored within the average range, they are still not functionally independent in key classroom tasks. That disconnect between test scores and real-world performance supports your clinical rationale for recommending OT services.
It’s equally important to identify and document the child’s strengths. Sometimes these emerge in standardized testing, but just as often, they become evident through your observations. You might find that a child who struggles with fine motor skills is incredibly social and thrives in peer interactions. That’s a strength worth noting and may suggest that a small group OT intervention would be effective. Conversely, you may observe a child who needs a quiet, focused environment to do their best work—perhaps one-on-one support is most appropriate in that case.
Clinical observation is critical in helping you understand where the challenges lie and where the child shines. These insights help shape not just your evaluation summary but also your approach to goal-setting, intervention planning, and communication with the broader team. This phase of interpretation is where we begin to move from data collection to clinical reasoning—making thoughtful, informed decisions about how to support a child in meaningful, functional, and truly client-centered ways.
Communicating Assessment Results
Once we have our assessment results, we must communicate them. This can be a real challenge, mainly when we’ve gathered much data and are trying to synthesize it into a cohesive, meaningful narrative. We spend time writing detailed findings in our evaluation reports, but we need to ensure that our audience—the families, teachers, administrators, and other team members—can understand and use that information.
In early intervention, the family is at the center of the assessment and intervention process. Everything we do needs to be grounded in a family-centered approach. Our communication must be clear, respectful, and aligned with the family's values and goals. In school-based practice, our audience expands to include parents, educators, administrators, and other service providers. While our clinical colleagues may be comfortable reading data, scores, and OT-specific terminology, most team members may not have the same background. Our role is to make the results meaningful and accessible to everyone involved.
We want to emphasize the occupational impact of the assessment findings. Reporting that a child scored within a certain range on the Peabody or the Beery VMI is fine, but it’s not enough. The real question is: how does this score relate to the child’s ability to function in everyday occupations? We must bridge that gap and translate the data into practical, relevant insights about how the child performs and participates in the real world.
We also need to be sensitive to potential language barriers. If the child’s family speaks a different language—Spanish, for instance—do we have a team member who can help translate the report? Can we use tools like Google Translate to support communication? It's not just about translating words, but also about ensuring our message is culturally and contextually appropriate.
Another layer of consideration is literacy. The average reading level in the United States is around seventh to eighth grade. That can be hard to remember when writing professional documents containing complex information, but ensuring that the family can understand our reports and verbal explanations is crucial. They must leave a meeting feeling informed and empowered, not confused or overwhelmed.
One helpful tool here is AI, including platforms like ChatGPT. You can ask for your report or summary to be rewritten at a more accessible reading level. Even if you're not submitting it that way, using that version when speaking to families can help you present information clearly and without unnecessary jargon.
Ultimately, we aim to deliver meaningful, person-centered recommendations that everyone on the team, including the child’s caregivers, can understand and act on. Clear, compassionate, and effective communication is just as important as the assessments themselves.
Treatment Planning Based on Assessment
After gathering all this valuable information from a thorough, occupation-centered, holistic assessment, treatment planning is the next step. This is where we begin to translate our findings into meaningful, client-centered, and occupation-based goals. But how exactly do we move from assessment to intervention?
One effective place to start is with a clear problem statement. This helps us narrow our focus and determine the key areas that should guide intervention. When working with a child with multiple challenges, it can feel overwhelming to address everything at once. A well-written problem statement allows us to pinpoint the most significant barriers to occupational performance and identify where to begin. It helps clarify which areas of occupation are most affected and which will be most meaningful to target.
In school-based practice, our focus should align with access to the curriculum and school-related occupations. We're examining how challenges affect students' ability to participate in classroom routines, complete academic tasks, and engage with peers. We often concentrate on areas such as dressing, feeding, toileting, and early developmental play skills in early intervention. Across both settings, play is a foundational occupation and is frequently one of our primary targets.
As we frame our treatment plan, we must also understand the contributing factors that influence performance in these areas. For example, if a child struggles with handwriting, we must dig deeper to identify why. Is it a fine motor issue? A visual motor integration challenge? Sensory processing difficulties? Postural instability? These underlying factors will guide the treatment goals and the interventions we select.
By using a structured approach that begins with a problem statement, incorporates data from both occupation-based and skills-based assessments, and reflects the child’s functional priorities, we can develop treatment plans that are focused, collaborative, and rooted in real-life occupational participation. This ensures our goals are measurable and meaningful to the child and family.
Writing Problem Statements
When we begin formulating a problem statement, we create a bridge between our evaluation findings and treatment plan. A clear and well-structured problem statement helps organize our clinical reasoning and guides goal setting. One simple and effective format you can use is: Your client requires [level of assistance] in performing [occupational task] due to [contributing factors].
For example, let’s say a child is having difficulty with handwriting. Based on your evaluation, your problem statement might read: Johnny requires maximum assistance with handwriting tasks due to decreased fine motor control and poor postural stability. This becomes your baseline—your foundation for setting meaningful goals and tracking progress.
The key elements here are: how much assistance the child needs, what specific occupational task is impacted, and what the contributing factors are. These contributing factors might include client factors (such as strength, coordination, or sensory processing), performance skills (like motor planning or visual perception), performance patterns, or aspects of the context and environment.
If you're ever unsure how to define or categorize these contributing elements clearly, this is a perfect time to return to the Occupational Therapy Practice Framework, Fourth Edition (OTPF-4). It’s easy to lose track of the distinctions between client factors and performance skills once immersed in day-to-day practice. The OTPF-4 provides clear definitions and examples to help you ensure your language and clinical reasoning align with current professional standards.
Referring back to this framework supports clarity in your documentation and reinforces best practice as you move from evaluation into effective, occupation-based intervention planning.
Writing Occupation-Based Goals
Once we've crafted our problem statements, the next step is translating them into occupation-based goals. One of the most valuable aspects of writing clear problem statements is that they orient us toward occupation-centered thinking. They help us stay grounded in what truly matters—functional performance and meaningful participation, rather than drifting into overly clinical or skills-only territory.
Suppose you’ve written three strong problem statements based on your evaluation. In that case, you’re already positioned to write three corresponding, well-structured goals—each tied directly to an area of occupational performance that needs support. This keeps your treatment focused and aligned with the client's needs and priorities.
As a reminder—something we all know but sometimes need to reinforce—our goals should always be client-centered, occupation-based, and grounded in the reality of the child’s life. They need to be realistic, achievable within your service context, measurable so that progress can be tracked, and objective so that another therapist can read them and understand what you’re working toward.
Strong problem statements naturally lead to strong goals. They give us a clear direction and ensure that our treatment planning isn’t just a checklist of skills to improve, but a meaningful roadmap for helping a child engage more fully in their daily life.
Writing Goals: The COAST Method
Many of you may have learned to write SMART goals in OT school. I like to use the COAST method. So, if you've never heard of this, some of you may have learned it this way, and this will be reviewed. I did not learn it this way. I came across this later as I started teaching this at Hofstra.
The COAST method is specific to OT and ensures that our goals are occupation-centered. Coast stands for the C, which stands for client. The client will perform, and O stands for occupation. What occupation?
A is an assist level. S is a specific condition. This one gets a little bit confusing. This is like if you're using highlighted lines for handwriting or having a child eat, but using adaptive utensils. This gives a little more information for our goal.
The timeline is when we all know our goals have to have a timeline. If we're working in schools, typically, it's by the end of the marking quarter or the end of the school year.
So, suppose we have, for example, a problem statement that says Sam can write one sentence with 25% accuracy for line targeting due to a non-functional pencil grasp and decreased visual perceptual skills. In that case, we can turn that into a functional goal. Again, the problem statement is our baseline. This is the information that we got from our assessment. Sam can write one sentence at this point during our evaluation.
This is what we saw. Again, this is based on an occupation-based assessment and potentially some skills-based assessments. He can write one sentence with 25% accuracy for line targeting due to a non-functional pencil grasp and decreased visual perceptual skills. So now we have a really good central focus, right? We have a good start to creating an occupation- and client-centered goal.
Our goal is for Sam to write one sentence with 75% accuracy for line targeting and no more than three verbal cues using paper with highlighted lines and a pencil grip by the end of the school year. So our client is Sam. The occupation is writing a sentence, right? Handwriting. It's an academic, school-based occupation with no more than three verbal cues as our level of assistance.
Our special condition is to use highlighted lines and a pencil grip because, based on my evaluation, I think those will be successful methods for him. And then by the end of the school year, we have our own, and then of course, depending on the student and the child, you may be using benchmarks that, you know, depend on where you work and the child and if they are getting alternately assessed and all of that good stuff. So that's that, you know, is individual.
Intervention Planning
We know where to direct our intervention now that we’ve developed a solid, occupation-based goal. In Sam’s case, for example, we know he’s having difficulty with handwriting, and we understand why—issues with his pencil grasp and visual motor integration. With that insight, we now have a holistic understanding of what’s impacting his occupational performance, and we can move forward with purposeful, evidence-based intervention planning.
At this point, revisiting your frames of reference is always a good idea. They act as our clinical compass. In Sam’s case, maybe you start with a biomechanical frame of reference to address fine motor control, but then remember that he also exhibits sensory integration difficulties. That may prompt you to incorporate sensory-based strategies into your treatment. These clinical models help us stay grounded in our reasoning and make thoughtful decisions about addressing multiple, interrelated areas of need.
It’s easy to get caught up in the complexity of our work—deciding what to assess, what to prioritize, and how to manage competing needs. But turning back to foundational tools like our frames of reference and the Occupational Therapy Practice Framework can simplify that decision-making and reinforce a structured, occupation-centered approach.
Another critical element at this stage is making sure our interventions are supported by evidence. While we may not always have the luxury of time to dig into research during a busy day, it’s still essential to remain informed. Attending continuing education courses, staying engaged with new developments in the field, and even setting aside just a few minutes here and there to review current evidence can go a long way. If it’s been a while since you last reviewed the literature on handwriting interventions, for instance, take a moment to explore what's new. Even brief updates can lead to more effective and defensible intervention choices.
This is where resources like AOTA membership show their value. Access to AJOT and other member tools allows you to quickly search for evidence to support your clinical decisions. It reinforces your practice with data and helps ensure that what you’re doing is grounded in the current best practice, not just based on experience or tradition.
We owe it to our clients to deliver meaningful, targeted, and evidence-based care, and keeping these resources and strategies in mind helps us do just that.
Case Study
Sam is a seven-year-old student referred for an occupational therapy evaluation due to challenges with fine motor tasks, attention, and classroom participation. His teacher reports difficulty with handwriting, organizing materials, and staying on task during independent work. His parents express concern about his self-care routines at home, including dressing and brushing his teeth, which they describe as inconsistent and frustrating.
The first step is conducting an occupational profile. Using either the AOTA form or your version, gather information from Sam, his parents, and his teacher. Identify what is most important to each of them, Sam’s daily routines and roles, and what barriers are getting in the way of participation. Include strengths, interests, and priorities. These elements will shape your assessment plan and provide context for interpreting results.
Classroom observations follow. Observe Sam during morning routines, writing tasks, transitions, and less structured settings like the cafeteria or specials. These observations give real-time insight into how Sam functions in different environments and help identify discrepancies between standardized test results and actual performance.
Occupation-based assessments include the Canadian Occupational Performance Measure (COPM) and the School Function Assessment (SFA). The COPM helps prioritize performance areas meaningful to the family and child, while the SFA provides a detailed look at Sam’s functioning in school routines. Both give essential context and provide a baseline for progress.
Skills-based assessments include the Beery VMI to assess visual-motor integration and the Sensory Profile to identify sensory processing patterns that may affect participation. These tools help explain why Sam may be struggling with certain tasks, but cannot stand alone in justifying services. The Sensory Profile, for example, reflects someone else's perceptions—it must be weighed alongside clinical observation.
Assessment results show difficulties with visual-motor integration, sensory-seeking behavior during seated tasks, poor pencil grasp, reduced endurance for handwriting, and frustration with multi-step routines at home and school. These findings provide a full picture of Sam’s challenges across contexts.
Using the COAST method, develop goals that are occupation-centered and measurable. Example: Sam will write one sentence with 75% accuracy for line alignment using highlighted lines and a pencil grip, with no more than two verbal cues, by the end of the school year. This goal is rooted in classroom performance and informed by the occupation-based and skills-based assessments.
Explain the relevance of the Beery VMI and Sensory Profile to the team regarding function. For example, while Sam’s Beery VMI score indicates visual-motor difficulty, what we’re seeing in the classroom—missed lines, reversed letters, and low endurance—confirms that these difficulties are impacting his ability to participate in handwriting tasks. The Sensory Profile suggests a sensory-seeking pattern, which aligns with observed movement during seated tasks and difficulty maintaining focus.
Avoid writing goals like Sam will manipulate putty for 30 seconds, unless the task connects directly to an occupation. Reframe: Sam will maintain a functional pencil grasp for one-minute handwriting tasks using therapeutic putty for preparatory hand strengthening.
Avoid negative or deficit-based goal language. Instead of without redirection, use with no more than one verbal cue or with increased independence. This creates a positive, strengths-based framework that supports engagement and growth.
Frames of reference should be revisited as part of intervention planning. Combine a biomechanical approach for motor control, sensory integration strategies for regulation, and executive functioning models for task sequencing. This ensures a comprehensive, evidence-informed intervention strategy tailored to Sam’s needs.
Summary
Exam Poll
1)Which of the following is a primary focus of occupational therapy assessments in Early Intervention (EI) settings?
2)Why should occupation-based assessments be prioritized in pediatric OT evaluations?
3)Which of the following is classified as a skills-based assessment according to the presentation?
4)According to the course, what must occupational therapy evaluation outcomes be clearly linked to?
5)What is the first component of the COAST method for writing occupation-based goals?
Questions and Answers
How do you manage parents’ expectations, especially when the goalposts keep moving?
This is a common challenge. Parents’ expectations vary widely—some may not recognize any concerns, while others may expect rapid progress in areas not supported by the child’s developmental stage or functional abilities. This is where using occupation-based assessments alongside skills-based ones becomes especially helpful. If a child scores well on a standardized test but struggles functionally, occupation-based tools help bridge that gap. Parent education is also key—helping them understand what's developmentally appropriate (e.g., that sentence writing is not expected in preschool) can ease unrealistic expectations.
You mentioned early intervention for ages 0 to 2.11, but then discussed handwriting. Can you clarify?
Yes, thanks for catching that. The assessment process, occupation-centered goal writing, and the distinction between occupation-based and skills-based assessments apply across age groups. I referenced early intervention to outline the age ranges, not to suggest handwriting is relevant for that group.
Have you used PEGS (Perceived Efficacy and Goal Setting System)? If so, what are your thoughts?
I haven’t used PEGS personally, but I have used Goal Attainment Scaling (GAS), which may be similar. GAS is an excellent method for measuring progress and outcomes meaningfully and individually. It could easily be its training session because of its usefulness in evaluating the effectiveness of interventions and supporting collaborative goal setting.
Is there an ethical or HIPAA concern with using ChatGPT to simplify evaluation content?
Great question. I always recommend removing any identifying information before using AI tools. Never include a child’s name or personal identifiers. Rewording a paragraph about test scores or occupational performance with no identifiers is generally acceptable. Use caution and adhere to your organization’s policies.
How do you assess non-verbal children when trying to identify goals?
Start with caregivers, teachers, and anyone who knows the child well. Their input is crucial. In addition, spend time observing the child directly. Please pay attention to what they gravitate toward, what frustrates them, and how they respond to various environments or tasks. For example, if they melt down during paper-pencil tasks but are engaged with technology, it may make more sense to develop typing goals rather than handwriting goals.
What other evidence-based journals do you use to support your practice?
In addition to AJOT, I use my access to Hofstra’s library to explore various databases. One open-access option is the Open Journal of Occupational Therapy (OJOT), free and contains valuable peer-reviewed content. I also recommend looking beyond OT-specific journals. For school-based work, education journals are helpful; for early intervention, caregiver and pediatric development publications offer great insight.
How do you assess a homeschooled child if you can’t observe them in a traditional classroom?
For a homeschooled child, the home is their learning environment. It’s appropriate for the occupational profile and evaluation to focus on function within the home setting. If the child returns to a classroom-based school in the future, that would prompt a reassessment in that new context.
Thanks for joining me today. If you didn’t get a chance to ask your question or want to follow up, feel free to reach out via email. I’m happy to continue the conversation and support you however I can.
References
See additional handout.
Citation
Arnone, L. (2025). Early intervention and school assessment. OccupationalTherapy.com, Article 5807. Retrieved from https://OccupationalTherapy.com
