Occupational Therapy (OT) Process is an highly skillful process starting from first meeting till the discharge i.e. when child no longer requires active OT sessions.
Step One:
Preparing for the Consultation
First meeting or Consultation is obtained through prior appointment only. Once appointment is obtained, parents should make a list of their concerns on a piece of paper, compel all the reports of any assessments done prior from birth till date in a file sequentially date-wise- to facilitate easy conveying of history to the lead Occupational Therapist (OTist). It is advisable for both parents to attend the consultation to provide complete picture of the child.
Step Two:
Consultation
During the consultation- the therapist takes a detailed history- medical, developmental, academic & leisure/ play history; & document/record the details on a specially prepared Proforma / Case Record Paper. This history helps the Occupational Therapist to give appropriate weightage to different causative factors, make SMART goals and then decide the correct approach, frequency & duration of the OT sessions to be taken for successful treatment to achieve the SMART goals made for the child. Consultation session generally lasts 45-60 mins to complete.
Step Three:
OT Evaluation
Post consultation, OT Evaluation is done. This step of the process may range from 45 mins to several hours depending on the age & concerns of the child. To make this process easier for the child, it may be divided in 2-3 sessions of 45 mins each. OT Evaluation is a uniquely skillful process which includes clinical observations (of the child's performance on certain instructions), formal standardization tests (done to determine the child's developmental age, make a profile of child's sensory processing, cognitive-perceptual skills); analysis of the performance samples - of handwriting, videos of child's performance at home, school, garden, building playground, social events, relative's visit, holiday outings, etc. to understand child's performance in different contexts (environment). All this valuable information is analyzed to understand the cause of child's concerns. Also, the gap between demands placed on child & child's capacities /skill-set is determined.
Step Four:
Occupational Therapy sessions
Once step-three is over, a schedule of Occupational therapy sessions is determined. Each session is documented. It is very important for parents to be regular & consistent in the therapy sessions & also parents should repeat the activities/ exercises or practice the skills taught in the OT session at home to help child generalize the learnt skill effectively & faster. As the therapy progresses & child shows improvements in certain areas or doesn't show improvements in certain areas, parents meetings are scheduled to gain more insight & determine further course of action. Group Therapy sessions for both child (once-a-week) & parent (once-a-month) are conducted on regular basis. It is very important for parents to have trust & confidence in their child & therapists & also important for parents to very consistent, regular, sincere in attending the therapy sessions. This regularity is important not only till child improves but also after that. The entire process may take 6 months or more depending on child's age & concerns. Parents should maintain the schedule of the therapy sessions to help speed-up the learning process.
Step Five:
Discharge / Discontinuing of the OT sessions
When the child starts achieving the goals set for the treatment, a re-assessment is conducted as done earlier. The re-assessment is done to determine qualitatively & quantitatively whether all goals set are achieved; skills are enough to cope with the demands & whether the achieved child's occupational performance is efficient for the child's independent functioning in the society. Sudden discontinuance of the therapy sessions are not advisable, they needs to be weaned off gradually by decreasing the frequency of therapy sessions over another few months & observing for child's use of self-coping mechanisms without supervision. Following discharge from active therapy sessions, parents are advised for 3-6 monthly follow-up for re-assessment to ensure child's development is on track. This helps prevent child's slipping off developmental track & catch child early if the child's struggling or slipping.
The above Occupational Therapy Process is a general outline, the steps may slightly vary or duration of each step may vary depending on the child's age & concerns.
Thanks & regards,
Dr. Pooja Mehta,
M.O.Th (DD), FAOT (NDD), MA (Clinical Psychology)
