PEDIATRIC OCCUPATIONBASEDFOCUSED EVALUATIONS WHY WE NEED THEM LEARNING

PEDIATRIC OCCUPATIONBASED/FOCUSED EVALUATIONS WHY WE NEED THEM?

LEARNING OBJECTIVES • There are three learning objectives for this continuing education. • Identify two occupation-based evaluations for use in pediatric practice. • Articulate the value of occupation-based evaluations in daily practice. • Identify information derived from occupation-based evaluation relative to the development of a treatment plan.

OUTLINE • The Evaluation Process: Where does occupation fit? • Occupation-Based Evaluations: Review of Select Occupation -Based Evaluations. • Integrating findings from Occupation-Based Evaluations.

THE EVALUATION PROCESS

OCCUPATIONAL THERAPISTS AND EVALUATIONS • Occupation is the cornerstone of intervention. (Fisher, 2013) • Therapists evaluate impairments in the performance of occupations. • Therapists identify underlying client factors/performance skills contributing to these impairments AOTA (2014 b)

THE FRAMEWORK III • Dynamic Interaction client factors, performance patterns, performance skills … • …. Enables Occupation • … In the desired context and environment (AOTA, 2014 a)

HOW DO OCCUPATIONAL THERAPIST SELECT EVALUATIONS? • Practitioners begin the evaluation process with an agenda of things you want to know which includes: • Information about the child, • Information about the child’s environmental context. (Kramer, Bowyer, O’Brien, Kielhofner, & Maziero-Barbosa, 2009)

WHAT PRACTITIONERS WANT TO KNOW. • Demographic information • Client’s age and diagnosis • Medical history • History of intervention • Current abilities (Kramer et al. , 2009)

WHAT PRACTITIONERS CHOOSE TO ASSESS AND HOW • “Fitting the child” • “Balancing formal and informal information” • “Professional Context. ”

PROFILE OF OCCUPATIONAL THERAPY PRACTICE • Occupational therapists value the use of standardized evaluations. • Occupational therapists in United States select standardized evaluations that focus on the body structure/function level (Piernik-Yoder & Beck, 2012)

PROFILE OF OCCUPATIONAL THERAPY PRACTICE • Additional studies confirm therapists’ use of a bottom-up approach. • Further implication include that therapists may be challenged by the process of to “fitting the child” with the assessment as described in Kramer et al. , (2009). (Bagatell, Hartmann, & Meriano, 2013)

CLIENT AND CAREGIVER PERCEPTIONS • Parents’ value accuracy in the evaluation. • Parents’ value the use of common understandable language in their child’s evaluations. • Parents’ value evaluations addressing the primary concern for referral to occupational therapy services. (Makepeace, & Zwicker, 2014)

WHAT DO WE DO?

INTEGRATING OCCUPATION BASED EVALUATION • Integrating occupation based evaluation has been an objective within the profession since the early 1990 s • Historic assumption correlating improvement in client factors with improvement in occupational therapy. • This assumed correlation may contribute to an assessment process without occupation-based evaluations. (Hocking, 2001)

APPLYING OCCUPATION • Occupation has been valued by therapists as a both an intervention and an outcome since the beginning of the profession. • We are an occupation centered profession. (Fisher, 2013) • Therapist find occupation-centered intervention rewarding. (Estes & Pierce, 2012)

OCCUPATION-BASED EVALUATIONS

OUTLINE • We will review occupation-based evaluations based on their area of focus. • Evaluations fall into one of 4 categories which include • Education, • ADL, • Play and, • Performance and Participation.

OVERVIEW • Evaluations will be examined for • General purpose; • General administration; • Psychometric Properties; and • Implication for Occupational therapy

EDUCATION

SCHOOL FUNCTION ASSESSMENT (SFA) • Measures the students performance of tasks associated with the occupation of education. • Utilizes proxy report based on the professional judgment of school professionals. • Developed for children in kindergarten through sixth grade. (Coster, Deeney, Haltiwanger, & Haley, 1998)

SCHOOL FUNCTION ASSESSMENT (SFA) • The SFA may take up to two hours to complete for new respondents. • Respondents should familiarize themselves with the purpose and content prior to completing the SFA. • Rating should be based on the student’s typical level of participation/ performance. • Respondents should make sure to complete the entire form. (Coster et al. , 1998)

SCHOOL FUNCTION ASSESSMENT (SFA) • The SFA consists of three parts: • Participation, • Task Support and, • Activity Performance. (Coster et al. , 1998)

SCHOOL FUNCTION ASSESSMENT (SFA) • Scores from the SFA can be used to identify areas of impairment in the student’s current participation, task support needs, or functional performance. • Scores can be interpreted at a basic level to identify areas of deficit. • Scores can be interpreted at an advanced level to determine progress. (Coster et al. , 1998)

SCHOOL FUNCTION ASSESSMENT (SFA) • The SFA was shown to have good test-retest reliability and good construct validity. (Coster et al, 1998) • More recent studies have confirmed the validity of the SFA. (Hwang & Davies, 2009)

SCHOOL FUNCTION ASSESSMENT (SFA) • Contributes to meeting occupational needs of the student. • Identifies student impairments using a top-down, occupation-centered approach. • Easily integrates into treatment planning process. • Easily incorporated alongside traditional pediatric evaluations.

TEST OF HANDWRITING SKILLS (THS-R) • Measures constructs that contribute to handwriting skills. • Provides standard scores and percentile ranks against a normative sample. • Measures specific handwriting skills for students age 6 years to 18 years. • Used to assess characteristics of letter formation. (Milone, 2007)

TEST OF HANDWRITING SKILLS (THS-R) • The THS-R takes approximately 10 minutes to administer and 15 minutes to score. • The THS-R is divided into ten subtests. • The examiner should ensure that the client has adequate environmental supports for handwriting tasks. • (Milone, 2007)

TEST OF HANDWRITING SKILLS (THS-R) • The THS-R scores each letter based on a Likert scale of 0 -3. • The THS-R can be utilized to identify areas of deficit in handwriting. • The THS-R can be used to monitor progress for intervention focused on the task of writing.

TEST OF HANDWRITING SKILLS (THS-R) • THS-R has fair-good reliability • Test-retest reliability was high (0. 49 -0. 82) • Interrater reliability was high (0. 75 -0. 90) • Construct validity was sufficient to support the validity of the THS-R to evaluate the child’s neurosensory integration for the related task of handwriting. (Milone, 2007)

TEST OF HANDWRITING SKILLS (THS-R) • Contributes to meeting occupational needs of the student. • Identifies student impairments using a top-down, occupation-centered approach. • Easily integrates into treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

CASE STUDY: JAMES

CASE STUDY: JAMES • What evaluation could be utilized to assess James? performance of occupations related to the education? • What information can be gained from this evaluation to contribute to your evaluation and treatment plan? • Why is this information important?

ACTIVITIES OF DAILY LIVING

WEEFIM® INSTRUMENT • The Wee. FIM® uses therapist observations to assess children aged 6 months to 7 years in ADL, cognitive and mobility domains. • Supplementary proxy rated modules are available for children age 0 -3. • (Uniform Data Systems, 2011 a) • The Wee. FIM® rates children on their level of independence in performance of various occupation based activities. (Uniform Data Systems, 2003)

WEEFIM® INSTRUMENT • Scoring is completed manually or using computerized software with a paid subscription to Uniform Data Systems. • Scoring involves rating observations on a seven-point ordinal scale which correlate to a level of assistance. • Items can be divided among rehab team members or completed by a single therapist. (Uniform Data Systems, 2003)

WEEFIM® INSTRUMENT • Information from the Wee. FIM® is valuable in identifying deficits in the performance of activities of daily living skills. • The Wee. FIM® can be used to chart client progress between admission and re-evaluation. (Uniform Data Systems, 2003)

WEEFIM® INSTRUMENT • The Wee. FIM® demonstrates good psychometric properties. • Test-retest & Interrater (ICC-0. 73 -0. 99). • Good Validity concurrent with PEDI and VABS. • (Ottenbacher, Msall, Lyon Duffy, Granger & Braun, 1999) • While information on the re-standardization of the Wee. FIM® is limited, the Wee. FIM® continues to be utilized as an outcome measure in current research. • (Recla et al. , 2013; Kaya-Kara et al, 2015).

WEEFIM® INSTRUMENT • Contributes to meeting the occupational needs of the client. • Identifies client impairments using a top-down, occupationcentered approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

ROLL EVALUATION OF ACTIVITIES OF LIFE (REAL) • The REAL is designed for children ages 2 years, 0 months to 18 years 11 months. • The REAL measures client’s performance of ADL’s and instrumental activities of daily living skills (IADL’s) using parent of caregiver report. • Is not a comprehensive list of ADL’s/ IADL’s as defined by AOTA. (Roll & Roll, 2013)

ROLL EVALUATION OF ACTIVITIES OF LIFE (REAL) • Administration of the REAL takes 15 -20 minutes to complete. • The REAL assesses 10 separate areas under the ADL section. • The REAL assesses 12 separate areas under the IADL section. (Roll & Roll, 2013)

ROLL EVALUATION OF ACTIVITIES OF LIFE (REAL) • Caregivers score the REAL by rating the child using a Likert scale to describe the child’s ability to complete the desired task. • Total scores from the ADL and IADL section can be converted to standard score and percentile rank. (Roll & Roll, 2013)

ROLL EVALUATION OF ACTIVITIES OF LIFE (REAL) • The REAL has good test-retest reliability (r=. 977 -. 989) • The REAL has good Interrater reliability (. 939 -. 965) • The REAL has evidence to support its construct validity to assess ADL and IADL skills. (Roll & Roll, 2013)

ROLL EVALUATION OF ACTIVITIES OF LIFE (REAL) • Contributes to meeting the occupational needs of the client. • Identifies client impairments using a TOP-down approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

ASSESSMENT OF MOTOR PROCESSING SKILLS (AMPS) • A standardized observation based assessment. • Based on the observation of two ADL tasks selected by the client to perform. • Can be utilized for individuals with a developmental age greater than two years. (Center for Innovative OT Solutions, 2016)

ASSESSMENT OF MOTOR PROCESSING SKILLS (AMPS) • The AMPS takes between 30 and 40 minutes to administer (Asher, 2014). • Scoring is completed using software. • Results generate an ADL Motor Ability Measure and ADL Process Ability Measure. (Center for Innovative OT Solutions, 2016)

ASSESSMENT OF MOTOR PROCESSING SKILLS (AMPS) • Fisher reported the initial test-retest reliability of the AMPS (r=. 90). (as cited in Asher, 2014) • Since then the AMPS continues to show good reliability and validity. (Fisher & Merritt, 2010) • Studies support the validity of the AMPS for use with children and its use internationally. (Fisher& Merritt, 2010; Gantschnig, Fisher, Page, Meichtry and Nilsson, 2015).

ASSESSMENT OF MOTOR PROCESSING SKILLS (AMPS) • Contributes to meeting the occupational needs of the client. • Identifies client impairments using a top-down, occupationcentered approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

PEDIATRIC EVALUATION OF DISABILITY INVENTORY COMPUTER ADAPTIVE TEST (PEDI-CAT) • The PEDI-CAT utilized parent or caregiver report to measure function in four domains. • The PEDI-CAT is intended for individuals from age one to twenty one years old. • The PEDI-CAT utilizes computer adaptive technology and is administered using either a tablet or computer. (Haley, Coster, Dumas, Fragala-Pinkham & Moed, 2014)

PEDIATRIC EVALUATION OF DISABILITY INVENTORY COMPUTER ADAPTIVE TEST (PEDICAT) • The PEDI-CAT measures function in four domains: • Daily Activities • Mobility • Social/Cognitive • Responsibility (Haley et al. , 2014)

PEDIATRIC EVALUATION OF DISABILITY INVENTORY COMPUTER ADAPTIVE TEST (PEDICAT) • There are two versions of the PEDI-CAT available, the Speedy Cat and the Content-Balances-CAT. • The PEDI-CAT can be administered by proxy, interview, or observation. • Caregivers rate the child's ability using a nominal scale. (Haley et al. , 2014)

PEDIATRIC EVALUATION OF DISABILITY INVENTORY COMPUTER ADAPTIVE TEST (PEDICAT) • The PEDI-CAT generates normative and scale scores for each of the four domains. • Additionally, fit scores are generated to identify any scores that are unexpected based on previous responses within the domains. • The PEDI-CAT can be administered at initial evaluation, re-evaluation or discharge. (Haley et al. , 2014)

PEDIATRIC EVALUATION OF DISABILITY INVENTORY COMPUTER ADAPTIVE TEST (PEDICAT) • The PEDI-CAT demonstrated good discriminate validity. • The PEDI-CAT demonstrated good test-retest reliability using intraclass correlations yielding values between. 958 -. 997. • Psychometric properties support the use of the PEDI-CAT for pediatric and adolescent clients. (Haley et al. , 2014; Dumas et al. , 2012)

PEDIATRIC EVALUATION OF DISABILITY INVENTORY COMPUTER ADAPTIVE TEST (PEDICAT) • Contributes to meeting the occupational needs of the client. • Identifies client impairments using a top-down, occupationcentered approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

CASE STUDY: RANDY

CASE STUDY: RANDY • What evaluation could be utilized to assess Randy’s performance of occupation-based activities such as ADLs? • What information can be gained from this evaluation to contribute to your evaluation and treatment plan? • Why is this information important?

OCCUPATIONAL PERFORMANCE & PARTICIPATION

CHILD OCCUPATIONAL SELF ASSESSMENT General Description (COSA) • The COSA is a theory-driven evidence-based, self-assessment of occupational performance for children age 7 -17 years old. • The COSA can provide therapists with an understanding of the client’s perceptions of his/her abilities and what activities are meaningful to the client. • Can contribute to a TOP-down approach to the evaluation process. (Kramer, Velden, Kafkes, Basu, Federico, & Kielhofner, 2014)

CHILD OCCUPATIONAL SELF ASSESSMENT Administration (COSA) • Administration time varies by individual. • Three versions available for clients of different abilities: • Youth rating form with symbols, • Youth rating form without symbols, and • Card sort version. (Kramer et al. , 2014)

CHILD OCCUPATIONAL SELF ASSESSMENT (COSA) • Introduce the client to the COSA. • Determine which form is appropriate. • Gather additional information. • Interpret results.

CHILD OCCUPATIONAL SELF ASSESSMENT Psychometric properties (COSA) • The COSA shows good test reliability for total competency and value scores (ICC. 72 -. 77)(Ohl, Crook, Mac. Saveny, & Mc. Laughlin, 2015). • The COSA shows poor to good test-retest reliability for category scores (ICC. 48 -. 78) (Ohl et al. , 2015). • The COSA shows good content, structural and substantive validity using Mean fit Statistics (Kramer, Kielhofner, & Smith, 2010).

CHILD OCCUPATIONAL SELF ASSESSMENT Implications for Occupational Therapy. (COSA) • Contributes to meeting the occupational needs of the client. • Identifies client impairments using a top-down, occupationcentered approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

CHILD ASSESSMENT OF PARTICIPATION AND ENJOYMENT (CAPE)/ PREFERENCE FOR ACTIVITIES OF CHILDREN (PAC) • The CAPE /PAC are evaluations for children ages 6 -21 to assess clients’ participation in day to day activities and their preference for these activities. • The CAPE can be used as an outcome measure to assess the effectiveness of intervention designed to increase participation. • The CAPE /PAC can be administered as a child report assessment with no input from the practitioner or in an interview format. (King, Law, King, Hurley, Rosenbaum, Hanna, Kertoy, & Young, 2004)

CHILD ASSESSMENT OF PARTICIPATION AND ENJOYMENT (CAPE)/ PREFERENCE FOR ACTIVITIES OF CHILDREN (PAC) • The CAPE contains 55 items which are examined for: • Diversity of participation, • Intensity of participation, • With whom the activities are completed, • Where the activities are completed, and • The client’s enjoyment of these activities. (King, et al. , 2004)

CHILD ASSESSMENT OF PARTICIPATION AND ENJOYMENT (CAPE)/ PREFERENCE FOR ACTIVITIES OF CHILDREN (PAC) • Determine which administration method is appropriate. • Introduce material to client if using an interview format. • Verify completion of administration. • Score and interpret results. (King, et al. , 2004)

CHILD ASSESSMENT OF PARTICIPATION AND ENJOYMENT (CAPE)/ PREFERENCE FOR ACTIVITIES OF CHILDREN (PAC) • The CAPE/PAC have psychometric properties to support their use in the clinic. • Test –retest reliability was measured using intraclass correlation coefficients (ICC) which ranged between. 82 -. 99 and. 47 -. 78 (King, et al. , 2004). • Additional studies have confirmed the construct validity of the CAPE as a direct measure of participation (King, Law, King, Hurley, Hanna, Kertoy, & Rosenbaum, 2006).

CHILD ASSESSMENT OF PARTICIPATION AND ENJOYMENT (CAPE)/ PREFERENCE FOR ACTIVITIES OF CHILDREN (PAC) • Contribute to meeting the occupational needs of the client. • Identify client impairments using an occupation-centered approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

SHORT CHILD OCCUPATIONAL PROFILE Genera; Description (SCOPE) • Gives a broad view of the client’s occupational participation and is appropriate for clients birth to 21. • Can be used to establish a occupational profile or assess child progress. • Does not assess child development. (Bowyer, Kramer, Ploszaj, Ross, Schwartz, Kielhofner, & Krammer, 2008)

SHORT CHILD OCCUPATIONAL PROFILE Administration (SCOPE) • Administration time: 10 -20 min based on experience with the SCOPE. • Therapist rates twenty five items in six categories. • Ratings correlate to a numeric value which allows therapist to record a score for each subsection. (Bowyer, et al. , 2008)

SHORT CHILD OCCUPATIONAL PROFILE Psychometric properties (SCOPE) • Psychometric properties of the SCOPE indicates: • Good construct validity • Fair to good interrater reliability (Bowyer, Kramer, Kielhofner, Maziero-Barbosa & Girolami, 2007)

SHORT CHILD OCCUPATIONAL PROFILE Implications for Occupation Therapy (SCOPE) • Contributes to meeting the occupational needs of the client. • Identifies client impairments using a top-down, occupationcentered approach. • Easily integrates into evaluation and treatment planning process. • Easily incorporated alongside commonly used pediatric evaluations.

CASE STUDY: JOHN

CASE STUDY: JOHN • What evaluation could be utilized to assess John’s occupational performance / participation? • What information can be gained from this evaluation to contribute to your evaluation and treatment plan? • Why is this evaluation important?

PLAY

TEST OF PLAYFULNESS (TOP) • The TOP assesses the occupation of play. • The TOP is designed for children ages 6 months to 18 years. • The TOP is scored after observing the child’s free play, both indoor and outdoors preferably. (Bundy & Skard, 2008)

TEST OF PLAYFULNESS (TOP) • Administration consists of unstructured observation of the client in free play for 15 -20 minutes. • Careful attention should be taken by the administrator to structure the environment to be conducive to play activities. • The TOP consists of 21 items that are scored using a Likert scale on the domains of Extents, Intensity, and Skillfulness. (Bundy & Skard, 2008)

TEST OF PLAYFULNESS (TOP) • Scores are plotted on the TOP Keyform where the examiner circles scores from the TOP protocol sheet. • A line is drawn through the point created by the protocol so half of the items are on top of the line and half are on the bottom. • The line that passes through the measure score which correlates to a scales scores can be used for further statistical analysis. (Bundy & Skard, 2008)

TEST OF PLAYFULNESS (TOP) • Previous research has shown the TOP to have moderate test-retest coefficients (Bundy & Skard, 2008). • Current research confirms this reliability and supports moderate test-retest reliability with 15 minute observation periods (Brentnall, Bundy, & Kay, 2008).

REVISED KNOX PRESCHOOL PLAY SCALE (RKPPS) • The Revised Knox Preschool Play Scale is an occupationbased assessment for children between the ages of birth to six years of age. • The RKPPS’s scores are based on observations of the child involved in free play in an outdoor setting and an indoor setting. (Knox, 2008)

REVISED KNOX PRESCHOOL PLAY SCALE (RKPPS) • The RKPPS contains test items grouped into 4 dimensions including space management, material management, pretense symbolic, and participation. • Administration requires that the child be observed both indoors and outdoors for two 30 -minute periods. • Careful attention should be paid to assure minimal adult interference in the child’s play. (Knox, 2008)

REVISED KNOX PRESCHOOL PLAY SCALE (RKPPS) • Items are scored based on the highest level observed under each factor. • To score each dimension, take the mean of the factor score. • To derive an overall play score take the mean of the dimension scores. (Knox, 2008)

REVISED KNOX PRESCHOOL PLAY SCALE (RKPPS) • Interrater agreement was shown to be within 8 months on the overall play age approximately 90% of trials. • Interrater agreement was within 12 months on each dimension measured by the RKPPS for 91. 7100%. • Construct validity was supported as 92%-100% of play ages correlated to the child’s chronological age. (Knox, 2008)

IMPLICATION FOR ASSESSMENT OF PLAY • Assessing play can give therapists important information regarding the child's participation in an important occupation. • The assessment uses observation to collect information on play. • Contributes to meeting the AOTA’s (2007) Centennial Vision. • Contributes to a top-down, occupation-centered approach for evaluation planning.

CASE STUDY: ABBY

CASE STUDY: ABBY • What evaluation could be utilized to assess Abby’s Play skills? • What information can be gained from this evaluation to contribute to your evaluation and treatment plan? • Why is this information important?

SUMMARY • There a number of occupation-based evaluations. • These evaluations cover a broad area of interest. • Many evaluations are quick to administer and easily integrated with current practice methods. • All of these evaluation have evidence of reliability and validity.

SUMMARY • These evaluations are compatible with AOTA’s (2014 a) Framework-III. • These evaluations contribute to meeting AOTA’s (2007 Centennial Vision. • These evaluations contribute to your progression as a practice scholar.

INTEGRATING OCCUPATION BASED EVALUATIONS

INTEGRATING OCCUPATION-BASED ASSESSMENT • Integrating occupation based assessments has historically been a problems. (Hocking, 2001). • We have identified it as a current problem within the profession. • (Kramer et al. , 2009). • (Piernik-Yoder & Beck, 2012) • (Bagatell et al. , 2013).

INTEGRATING OCCUPATION-BASED ASSESSMENT • Therapists should relinquish the bottom-up approach. • Therapists should select an occupation based model. • Therapists should select an occupation-based evaluation.

INTEGRATING OCCUPATION-BASED ASSESSMENT • Transitioning into treatment planning • Analyze impairments in occupation • Collaborate with clients to establish goals • Assimilate information to establish occupation-centered intervention.

RELINQUISH BOTTOM-UP APPROACH • AOTA recommends an occupation-centered approach. • Contribute to AOTA’s (2007) Centennial Vision. • Contribute to Client-Centered Intervention (AOTA, 2014 a).

OCCUPATION BASED MODEL • Using an occupation based model reduces the possibility of: • Not knowing our client’s occupational needs. • Poor match between client and outcome measure. • Using non-occupation based assessments. • Failure to document progress meaningful to the client. (Joosten, 2015)

SELECTING AN OCCUPATION BASED ASSESSMENT

OCCUPATION AS A MEANS AND AN END • Occupation-based evaluation methods contribute to determining occupational performance and participation. • Occupation-based evaluations provide the basis for activity analysis. (Fisher, 2013)

THE POWER OF OCCUPATION Utilizing occupation-based methods, evaluation and intervention, sends a message that articulate the value of the profession.

POWER OF OCCUPATION Will you be one of the voices?

REFERENCES Academic Therapy Publications. (2016). Test of handwriting skills -Revised. Retrieved from https: //www. academictherapy. com/ths_sample. jpg. American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 613– 614. American Occupational Therapy Association. (2009). Scholarship in occupational therapy. American Journal of Occupational Therapy, 63(6), 790 -796. American Occupational Therapy Association. (2014 a). Occupational therapy practice framework: Domain and process (3 rd. ed. ). American Journal of Occupational Therapy, 68(Suppl. 1), S 1 -S 48. http: //dx. doi. org/10. 5014/ajot. 2014. 682006 American Occupational Therapy Association. (2014 b). Scope of practice. American Journal of Occupational Therapy 68 (3), p. S 34 -S 40. doi: 10. 5014/ajot. 2014. 686 S 04.

REFERENCES American Occupational Therapy Association (2015). Academic programs annual date report: Academic year 2014 -2015. Retrieved from http: //www. aota. org//media/corporate/files/educationcareers/educators/2014 -2015 -annual-data-report. pdf Asher, I. (2014). Asher’s occupational therapy assessment tools. (4 th Ed. ). Bethesda, MD: American Occupational Therapy Association Inc. Bagatell, N. , Hartmann, K. , & Meriano, C. (2013). The Evaluation Process and Assessment Choice of Pediatric Practitioners in the Northeast United States. Journal Of Occupational Therapy, Schools & Early Intervention, 6(2), 143 -157. doi: 10. 1080/19411243. 2012. 750546 Bureau of Labor Statistic. (2015). Occupational therapists. Retrieved from http: //www. bls. gov/ooh/healthcare/occupational-therapists. htm Bowyer, P. L. , Kramer, J. , Kielhofner, G. , Maziero-Barbosa, V. , & Girolami, G. (2007). Measurement properties of the Short Child Occupational Profile (SCOPE). Physical & Occupational Therapy In Pediatrics, 27(4), 67 -85.

REFERENCES Bowyer, P. , Kramer, J. , Ploszaj, A. , Ross, M. , Schwartz, O. , Kielhofner, G. , Kramer, K. (2005) The user’s manual for the short child occupational profile (SCOPE). Chicago, IL: Model of Human Occupation Clearinghouse University of Illinois of Chicago and UIC Board of Trustees. Brown, T. , & Bourke-Taylor, H. (2014). Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, 2009– 2013: A Content, Methodology, and Instrument Design Review. American Journal Of Occupational Therapy, 68(5), e 154 -216 1 p. doi: 10. 5014/ajot. 2014. 012237 Brentnall, J. , Bundy, A. , & Kay, F. (2008). The effect of the length of observation on test of playfulness scores. OTJR: Occupation, Participation & Health, 28(3), 133 -140. Bundy, A. , Skard, G. (2008) The Test of Playfulness (TOP). In L. D. Parham & L. S. Fazio (Eds. ), Play in occupational therapy for children (2 nd ed. , pp. 71 -93). St. Louis: Mosby/ Elsevier. Case-Smith, J. (2015). An overview of occupational therapy for children. In J. Case-Smith & J. C. O’Brien (7 th Eds. ), Occupational therapy for children and adolescents (pp. 1 -26). St Louis, Missouri: ELSEVIER MOSBY. Center for Innovative OT Solutions. (2016). Assessment of motor and process skills [Power Point]. Retrieved from http: //www. innovativeotsolutions. com/content/amps/materials-and-resources/in-service/ Center for Innovative OT Solutions. (n. d. ). Introduction to the assessment of motor and process skills [Video]. Retrieved from http: //www. innovativeotsolutions. com/content/amps/materials-and-resources/in-service/

REFERENCES Coster, W. , Deeney, T. A. , Haltiwanger, J. T. , & -Haley, S. M. (1998). School Function Assessment user's manual. San Antonio, TX: Therapy Skill Builders. Dumas, H. M. , Fragala-Pinkham, M. A. , Haley, S. M. , Ni, P. , Coster, W. , Kramer, J. M. , &. . . Ludlow, L. H. (2012). Computer adaptive test performance in children with and without disabilities: Prospective field study of the PEDI-CAT. Disability & Rehabilitation, 34(5), p. 393 -401. Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same or different? . Scandinavian Journal Of Occupational Therapy, 20(3), 162 -173 12 p. doi: 10. 3109/11038128. 2012. 754492 Fisher, A. G. , Bray Jones, K. (2014). Assessment of Motor and Process Skills. Vol. 2: User manual (8 th ed. ) Fort Collins, CO: Three Star Press. Fisher A. G. , Merritt, (2010). Current Standardization Sample, Item, and Task Calibration Values and Validity and Reliability of the AMPS. In A. G. Fisher & K. B. Jones, Assessment of motor and process skills Vol. 1: Development, standardization, and administration manual (7 th ed. , p. 15. 1 - 15. 82) Fort Collins, CO: Three Star Press. Gantschnig, B. E. , Fisher, A. G. , Page, J. , Meichtry, A. , & Nilsson, I. (2015). Differences in activities of daily living (adl) abilities of children across world regions: A validity study of the assessment of motor and process skills. Child: Care, Health And Development, 41(2), 230 -238. doi: 10. 1111/cch. 12170 Haley, S. , Coster, W. , Dumas, H. , Frgala-Pinkham, M. , Moed, R. (2012). PEDI-CAT: Pediatric Evaluation of Disability Inventory Computer Adaptive Test. Boston, MA: Boston University School of Public Health.

REFERENCES Haley, S. , Coster, W. , Dumas, H. , Frgala-Pinkham, M. , Moed, R. (2014). PEDI-CAT: Pediatric Evaluation of Disability Inventory Computer Adaptive Test Administration Manual. Boston, MA: Boston University School of Public Health. Hocking, C. (2001). The issue is. Implementing occupation-based assessment. American Journal Of Occupational Therapy, 55(4), 463 -469 7 p. Hwang, J. , & Davies, P. L. (2009). Rasch analysis of the School Function Assessment provides additional evidence for the internal validity of the activity performance scales. American Journal Of Occupational Therapy, 63(3), p. 369 -373. Joosten, A. V. (2015). Contemporary occupational therapy: Our occupational therapy models are essential to occupation centered practice. Australian Occupational Therapy Journal, 62(3), 219 -222 4 p. doi: 10. 1111/1440 -1630. 12186 Kaya Kara, O. , Atasavun Uysal, S. , Turker, D. , Gunel, M. K. , Baltaci, G. , & Karayazgan, S. (2015). The effects of Kinesio Taping on body functions and activity in unilateral spastic cerebral palsy: a single-blind randomized controlled trial. Developmental Medicine & Child Neurology, 57(1), 81. doi: 10. 1111/dmcn. 12583 Kielhofner, G. (2008). Model of human occupation (4 th ed. ). Philadelphia, PA: Lippincott William & Wilkins.

REFERENCES King, G. , Law, M. , King, S. , Hurley, P. , Rosenbaum, P. , Hanna, S. , Kertoy, M. , Young, N. (2004). Children’s Assessment of Participation and Enjoyment & Preferences for Activities for Children. San Antonio, TX: Pearson. King, G. , Law, M. , King, S. , Hurley, P. , Hanna, S. , Kertoy, M. , & Rosenbaum, P. (2006). Measuring children's participation in recreation and leisure activities: construct validation of the CAPE and PAC. Child: Care, Health & Development, 33(1), 28 -39. Knox, S. (2008). Development and Current Use of the Revised Know Preschool Play Scale. In L. D. Parham & L. S. Fazio (Eds. ), Play in occupational therapy for children (2 nd ed. , pp. 55 -70). St. Louis: Mosby/ Elsevier. Kramer, J. , Bowyer, P. , O'Brien, J. , Kielhofner, G. , & Maziero-Barbosa, V. (2009). How interdisciplinary pediatric practitioners choose assessments. Canadian Journal Of Occupational Therapy, 76(1), 56 -64 9 p. Kramer, J. M. , Kielhofner, G. , & Smith Jr. , E. V. (2010). Validity Evidence for the Child Occupational Self Assessment. American Journal Of Occupational Therapy, 64(4), 621 -632. doi: 10. 5014/ajot. 2010. 08142 Kramer, Velden, Kafkes, Basu, Federico, Kielhofner, G. (2014) Child occupational self-assessment: User manual. Chicago, IL: Model of Human Occupation Clearinghouse University of Illinois of Chicago and UIC Board of Trustees.

REFERENCES Kramer, J. , Walker, R. , Cohn, E. S. , Mermelstein, M. , Olsen, S. , O'Brien, J. , & Bowyer, P. (2012). Striving for shared understandings: therapists' perspectives of the benefits and dilemmas of using a child self-assessment. OTJR: Occupation, Participation And Health, 32(1), S 48 -S 58. doi: 10. 3928/15394492 -20110906 -02 Law, M. , Cooper, B. , Strong, S. , Stewart, D. , Rigby, P. , & Letts, L. (1996). The person- environment-occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy 63(9). doi: 10. 1177/00084174960630010 Lee, J. (2010). Achieving best practice: a review of evidence linked to occupation-focused practice models. Occupational Therapy In Health Care, 24(3), 206 -222 17 p. doi: 10. 3109/07380577. 2010. 483270 Lee, S. , Taylor, R. , Kielhofner, G. , Fisher, G. (2008). Theory use in practice: A national survey of therapists who use the model of human occupation. American Journal of Occupational Therapy; 62(1), 106 -117. doi: 10. 5014/ajot. 62. 1. 106. Makepeace, E. , & Zwicker, J. G. (2014). Parent perspectives on occupational therapy assessment reports. British Journal Of Occupational Therapy, 77(11), 538 -545. doi: 10. 4276/030802214 X 14151078348396 Milone, M. (2007). Test of Handwriting Skills Revised. Novato, CA: Academic Therapy Publications. Ohl, A. M. , Crook, E. , Mac. Saveny, D. , & Mc. Laughlin, A. (2015). Test–Retest Reliability of the Child Occupational Self-Assessment (COSA). American Journal Of Occupational Therapy, 69(2), 1 -4. doi: 10. 5014/ajot. 2015. 014290

REFERENCES Ottenbacher, K. , Msall, M. , Lyon, N. , Duffy, L. , Granger, C. , & Braun, S. (1999). Measuring developmental and functional status in children with disabilities. Developmental Medicine & Child Neurology, 41(3), 186 -194. Piernik-Yoder, B. , & Beck, A. (2012). The Use of Standardized Assessments in Occupational Therapy in the United States. Occupational Therapy In Health Care, 26(2/3), 97 -108. doi: 10. 3109/07380577. 2012. 695103 Recla, M. , Bardoni, A. , Galbiati, S. , Pastore, V. , Dominici, C. , Tavano, A. , &. . . Strazzer, S. (2013). Cognitive and adaptive functioning after severe TBI in school-aged children. Brain Injury, 27(7 -8), 862 -871. doi: 10. 3109/02699052. 2013. 775499 Roll, K. , Roll, W. (2012). The REAL the roll evaluation of activities of life. Bloomington, MN: Psych. Corp. Uniform Data Systems for Medical Rehabilitation. (2003) Underlying principles for use of the Wee. Fim instrument. Amherst, NY: Uniform Data Systems for Medical Rehabilitation. (2004) WEE-FIM II. Amherst, NY: Uniform Data Systems.

REFERENCES Uniform Data Systems for Medical Rehabilitation. (2011 a) 0 -3 module. Retrieved from https: //www. udsmr. org/Documents/Wee. FIM_0 -3_Module. pdf Uniform Data Systems for Medical Rehabilitation. (2011 b) The Wee. FIM II advantage. Retrieved from https: //www. udsmr. org/Documents/Wee. FIM_II_System. pdf