presented by Tracy Stackhouse
Financial: Tracy Stackhouse receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.
Non-Financial: Tracy Stackhouse has no competing non-financial interests or relationships with regard to the content presented in this course.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
Tracy Stackhouse, MA, OTR/L
Tracy Stackhouse is a clinical pediatric occupational therapist who has specialized in working with children, adults, and families affected by fragile x syndrome (FXS) and Fragile X related conditions since the late 1980s. Through this work, first at Children's Hospital in Denver, continuing at the UC Davis MIND Institute, and now at the nonprofit center…Read full bio
1. Clinical Reasoning in Occupational Therapy
What is clinical reasoning in occupational therapy and how does the process set up excellence in clinical practice? These are the questions addressed here. The course begins with an overview of the key concepts of clinical reasoning and how occupational therapists use the dynamic interaction between themselves, the client, and valued occupations, activities, and contexts to promote a person’s participation and satisfaction in life (AOTA, 2008). The demand for a pediatric OT is that they bring multiple levels of knowledge in an occupational context while delivering relationship-based and client-centered interventions that are up to date in terms of the science – this is a tall order and requires guided clinical reasoning to implement.
2. A Conceptual Model for Clinical Reasoning in Pediatric OT
Utilizing the Model of Spatial-Temporal Adaptation provides a general developmental framework for considering any developmental skill. This is a foundation for pediatric therapy, especially a practice that is grounded in neuroscience and in the dynamic of therapeutic use of self. These elements are brought together in a conceptual model presented here. The Pediatric Clinical Reasoning Flow takes basic neural networks and applies them to identifying patterns of strength and need, so that treatment can be tied to the individual needs of the client. The conceptual framework builds on work across pediatric occupational therapy and, in particular, weaves in ASI from Ayres and the DIR framework from Greenspan to create a flow for fostering progress in basic developmental capacities. This conjunction of frames of reference streamlines modern pediatric OT clinical reasoning in a systematic way to increase consistency across providers.
3. Pediatric Clinical Reasoning Flow
Summarizing strengths and needs across developmental domains in a quasi-quantifiable manner allows for clarity in the treatment planning process and accuracy in progress monitoring. This produces a general developmental summary. This summary is then taken and utilized to devise a treatment plan following the STEPSI format (Stackhouse, et al. 1997). Finally, from the STEPSI process, intervention including direct treatment, activity selection, and selection of specialized intervention programs or protocols can occur. The intervention is extended to include connection to occupational roles, skills, and capacities and for home or community programming and includes consultation or coaching that might allow for implementation. This flow allows the clinician to integrate treatment and select appropriate methodologies based on the client’s profile, which is the aim of clinical reasoning. The flow includes progress monitoring with a modification of the COPM process, so that goal attainment guides the entirety of the reasoning model.