When Appearing to do Nothing is the Strongest Intervention
Something I am regularly asked is how to intervene with particular profiles derived from administering a clinical assessment. To clarify: I am an occupational therapist working in the publishing sector, developing assessment materials for clinicians and educators to support children and adults in their everyday life; my occupational therapy background serves me well in this endeavor. So…back to the question…it is a relevant question of course; you have administered an assessment, which in itself yields useful information, and so… WHAT do you do next?
Ahh…now here’s the trick! To consider your options you need to contemplate why you are administering the assessment, and what it means to the individual involved. Some assessments take a top-down approach, i.e. they focus on the person as a whole within the context of their everyday occupations and roles important to them. The risk being that this approach does not always take into consideration how task components may be impacting roles and everyday occupations. Conversely, impairment or diagnostic level assessments can be helpful in determining how task components may affect performance and/or participation, but risk overlooking what is important to the individual in terms of roles and everyday occupations.
As an occupational therapist, I favor the use of a combination of approaches. The core of occupational therapy practice is to support participation and occupational engagement in a person centered way. In order to do this, we need to understand what roles, activities, and tasks the individual defines as important; and all task components which contribute to supporting these. We should not examine or intervene with either in isolation.
Now I return to my original question – you have derived a profile from a clinical assessment, so what do you do next? Our emotional impulse is often to intervene when an individual shows a difference on a profile, but I urge you to stop and think. Have you explored the bigger picture? Is this impacting on the participation needs of the individual involved? Is it a barrier or a strength? By focusing on one performance area are you missing other essential domains and strengths?
To quote Dunn (2014):
“No scores alone tell the story. The scores merely provide for hypothesis development and testing. The child’s life at home and school remains the main focus of interpretation and planning.”
This message could equally apply to those working with adults and/or in different practice settings.
When appearing to do nothing is to do everything
By exploring the bigger picture it can sometimes become apparent that regardless of differences in a profile, these differences do not pose a barrier to participation and engagement, in fact they can often be supportive and enhance participation. Highlighting these successful strategies to individuals and their families can often provide the confidence to accept that we do not need to change the behavior or task, but instead find ways to use those differences positively to support other participation needs.
I’d like to share a story from my own personal life as the parent of a child with additional needs. Several years ago we received intervention from an excellent clinician, during which we agreed a goal of learning to fasten shoelaces, which we dutifully set about implementing.
After several days of attempting this (it was hard work for us all) I came to the realization that this wasn’t important to my daughter; it was important to me (so in that respect the clinician was right to go down this route and consider the needs of the whole family).
We abandoned the shoelaces goal after just a few days; now a few years down the line she can get by just fine without laces, and I am accepting of her choice. If and when this becomes important to her participation needs, then we will return to fastening shoelaces, and be ready with our step-by-step technique to teach her. In the meantime, we can channel our energies to support her in other areas helping her to participate and live a fulfilling life.
Author’s Note: I hope you find this post thought provoking, generating questions for further conversation. The content represents my own thoughts at this moment in time, and not necessarily those of my employer. These thoughts are subject to change as our knowledge and understanding this subject evolves.”
Dunn, W. (2014). Sensory Profile 2 user’s manual. Bloomington, MN. NCS Pearson, Inc.
About the Author
Shelley Hughes is a Senior Product Manager for Pearson Clinical Assessment, responsible for the Occupational Therapy portfolio worldwide. Prior to taking up this position, Shelley was a member of the research and development team with Pearson Clinical Assessment, working as the Lead Research Director on the Sensory Profile 2.
Shelley’s background is primarily as a Children’s Occupational Therapist, working in The U.S. school system, and the UK healthcare system. Shelley is based in the UK. Connect with Shelley on Twitter @ShelleyhughesOT