• Sometimes, specialists and parents explain problems as part of immaturity. It is common to hear that a child is likely to “catch up” to his/her peers.
• School demands on the child increase dramatically after age five. Children are often required to sit for longer periods of time and focus on specific fine motor tasks such as writing.
• Many children begin seeing a child psychologist and problems may be misinterpreted as strictly behavioral problems.

Collaborative teamwork is essential in order for accurate assessment to occur. Federal regulations specified in the Individuals with Disabilities Educational Act (IDEA) provide that all special education services be determined by a team. The team works together to develop an individualized educational plan, (IEP). “The emphasis on team collaboration ensures that no single professional frame of reference, finding, or recommendation outweighs that of the other team members and that responsibility for a student’s IEP does not lie solely on the shoulders of a single member. Sensory integration evaluation procedures, interpretations and intervention recommendations must be considered within this collaborative team framework.” (p. 9) ³

Once the need for an assessment is established, a decision must be made as to who will do the assessment. Occupational therapists who are qualified to do this kind of assessment usually work in a public school, early intervention program, occupational therapy department in a hospital, or private practice. Decisions are effected by several factors such as geographical location and insurance coverage. If problems are present in the school setting, a school based occupational therapy assessment might be warranted. However, if problems occur both at home and school, parents might explore an assessment done by a private institution that specializes in a sensory integration approach.

To decide between school and private facility, it would be helpful to consider the following guidelines:

School Assessments

• School assessments are usually oriented toward the child’s functioning in the educational environment.
• School assessments usually focus on specific skills the child needs to succeed in the school environment, such as improved perceptual and fine motor skills for handwriting.
• In some cases school system occupational therapists will also focus on development of sensory motor foundation skills when they have an impact on skills that effect school performance.
• The child’s strengths are determined and utilized to encourage compensation for areas of difficulty. The need for service is then determined in conjunction with the educational team.

Private Assessments

• In a private facility the assessment would focus on the child’s functioning in all environments, such as home, day care, school and community.
• Assessments also focus on both medical and educational issues, physical and psychological health.
• Assessment of motor development, eating skills, self-care skills, safety awareness, coping and organizational skills would all be considered areas of focus in a private facility.

When assessments are done in a public school setting, recent changes in the IDEA suggest that assessments be environmentally based and look at behaviors in natural settings. Observation or questionnaires about behaviors in natural settings are always considered first and then formal or other informal assessments are considered to help define underlying problems.

Assessments done in a private setting would often involve the use of both informal and formal tests, including questionnaires that look at behaviors in the client’s environment. Determination would be based on the child’s individual needs, testing ability, age, and reason for referral. Sometimes, the private facility acts to provide a second opinion to the school testing and therefore formalized testing would more likely be used.

Exercise 2

For a unique viewpoint from a parent of a child who was assessed and received treatment from both the school and private practice, Click here to read: A Professional and Personal View on OT in the School and OT in a Private Practice Setting⁴.

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