Continuing Education Article

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.
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(one contact hour and
1.25 NBCOT PDU).
See page CE-8 for details.

The Occupational Profile as a Guide to

Clinical Reasoning in Early Intervention:
A Detective’s Tale
Rondalyn Whitney, PhD, OTR/L, FAOTA 3. Describe the distinct value of occupational therapy in early
Director of Faculty Development and Scholarship intervention using terminology from the Framework
West Virginia University’s School of Medicine 4. Recognize the process of using inductive and deductive rea-
Department of Human Performance, Morgantown, WV soning as part of the clinical reasoning process during early
intervention cases
This CE Article was developed in collaboration with AOTA’s Children & Youth
Special Interest Section. INTRODUCTION TO THE OCCUPATIONAL PROFILE
The occupational profile helps create a summary portrait of a
ABSTRACT client viewed as an occupational being, organizes the evaluation
According to the Occupational Therapy Practice Framework: Domain around the activities the client wants to do but has difficulty with
and Process, 3rd Edition (Framework; American Occupational or cannot do, and frames the process of inductive reasoning. The
Therapy Association [AOTA], 2014), all initial client evaluations occupational profile is an essential tool to improve the quality of
must include an occupational profile and a subsequent analysis of occupational therapy services and demonstrate the profession’s
occupational performance. It is through the process of completing distinct value to other health care providers, reviewers, and
the profile that the therapist begins to learn about the client’s back- payers.
ground, priorities, and desired therapeutic outcomes. Completion The American Occupational Therapy Association (AOTA;
of the profile also begins dialogue regarding the possible effect of 2017) has developed an Occupational Profile Template to assist
factors, patterns, skills, and context and environment on the client’s occupational therapy practitioners with this process regardless of
ability to fully participate in activities of daily life. their practice setting. Interventions developed by occupational
One can think of the occupational profile as a systematic way therapists (OTs) must always be based in theory and focused
to organize the therapist’s clinical reasoning. When presented on meeting the unique occupational needs of the client and, if
with a client with complex needs, having a methodology to guide applicable, their family, rather than on a condition. Completed
evaluation and develop an informed intervention is critical for occupational profiles can be incorporated into an electronic
effective outcomes. Take the case of a child with complex medical medical record.
concerns who lives in an underserved, rural environment: Having The purpose of this continuing education article is to demon-
a tool to guide one’s reasoning process becomes essential for iden- strate how the occupational profile can be used in early interven-
tifying and resolving the unique barriers limiting occupational tion. The case example is based on a real client and the profile
engagement. developed for that family. As such, some of the specifics may not
generalize to all children. Still, the process of using the Occu-
LEARNING OBJECTIVES pational Profile Template to articulate and describe the distinct
After reading this article, you should be able to: value of occupational therapy during early intervention is offered
1. Recognize how using the AOTA Occupational Profile Template as a contribution to the larger scholarly discussion within the
guides clinical reasoning profession.
2. Identify key decision points using clinical reasoning to assess The evaluation data is obtained from the client’s perspective
and develop a plan of care for a child with a complex medical or, in the case of a child, through observation and interview with
disorder the family and caregivers. These formal and informal conver-

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 CE Article, exam, and certificate
Continuing Education Article are also available ONLINE.
Register at http://www.aota.org/cea or
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sations are examples of strategic interviews that lead to an For example, inductive reasoning would be used when con-
individualized, routines-based, client-centered approach to sidering how a specific child behavior can help move the family
intervention. The Occupational Profile Template provides an to understand and form more generalized conclusions about the
outline of occupational concerns that should be addressed when behavior, whereas deductive reasoning might be used to take a
completing the occupational profile for an individual (AOTA, larger theoretical construct—say the use of Ayres’ Sensory Inte-
n.d., 2017). gration (ASI) theory to support a specific conclusion (Schaaf et
Occupational therapy practitioners are mystery solvers and al., 2018; Whitney, 2018).
problem solvers. When conceptualizing the approach to inter- Each detective has their tools. One of my favorite mystery
vention, therapists must start with an evaluation of the client to writers uses cooking to help her organize, categorize, and syn-
better understand what they can and cannot do, and what inter- thesize her reasoning when solving murders (so many murders!)
vention would enable functional participation. You might say in her small town (Davidson, 1992). OTs have our own tools to
occupational therapy practitioners are “lifestyle detectives,” who shape our reasoning on the best ways to help each client.
search for clues, test hypotheses, interpret findings, determine
conclusions, and disseminate discoveries. Occupational therapy THE FIVE STEPS OF CLINICAL REASONING
practitioners solve mysteries by profiling or creating portraits Clinical reasoning follows a five-step process of decision making:
of clients, examining clues within contexts, and synthesizing all 1. Appraise the evidence, including the data provided in a refer-
the collected data points that are then summarized and provided ral and through strategic interviews.
to the client in the form of a plan (Whitney & Luebben, 2014). 2. Develop a clinical hypothesis to organize and guide
The art and science of the evaluation process guides the thera- assessment.
pist to develop functional goals that meet the needs and values 3. Use the data collected.
of the client (Reynolds et al., 2017), but as with all great sleuths, 4. Problem solve to evaluate the clinical hypothesis.
a formula for inductive and deductive thinking is essential. 5. Test the clinical hypothesis (Cronin, 2018).
A great deal of what occupational therapy practitioners
learn is associated with specific conditions, but people often The Occupational Profile Template organizes clinical reason-
have complex patterns of dysfunction. The mystery facing ing, beginning with the purpose of the referral and prompting
occupational therapy practitioners is: What is the problem that the therapist to consider areas of occupational competence
needs to be overcome, and what are the barriers this person is (function) and challenge (dysfunction) as part of the client
experiencing that block them from what they want to accom- report. Ideally, as the therapist works to gather data about func-
plish? Once the OT identifies the problem of the case, they must tion and dysfunction and notes the influence of the environ-
isolate what they know and what they need to know; suggest ment and context, a clinical hypothesis begins to emerge from
a strategy and a theoretical approach; and after implementing the well-organized data collected. The profile leads the therapist
the strategy, again evaluate to determine whether the client to create client-centered goals specifically directed toward
perceives their problem has been solved. resolving areas of occupational dysfunction documented in the
Fans of mysteries may recognize this process as a profile used profile. The final step of intervention is to return to the client’s
by detectives, and many of the most popular TV dramas today goals to assess whether they have been met.
take viewers through the journey of expert FBI profilers who The template organizes and serves to frame the client as an
gather data from a crime scene and use that data to profile the occupational being, one with occupational potential and capaci-
unknown subject, who will, oftentimes, be found through the ties. A client report is developed to document the client’s reasons
use of this articulated profile. FBI profilers use environmental for seeking services, occupational strengths, values, history,
and contextual clues for recording and analyzing the psychologi- and performance patterns (routines, roles, habits, and rituals).
cal and behavioral characteristics of a person to build a pic- These constructs are operationalized in the Occupational Therapy
ture—a portrayal of the unknown subject involved in the crime. Practice Framework: Domain and Process (3rd ed.; AOTA, 2014).
The profiler uses this picture to narrow down the potential per- Occupational engagement is profiled by evaluating the client’s
petrator and to solve “who done it.” OTs are mystery solvers who environment and context, specifically what supports or impedes
also use a systematic evaluation, the occupational profile, to occupational engagement in the physical, social, cultural, per-
record and analyze a client’s mental and physical characteristics, sonal, temporal, and virtual contexts. Data from the profile guide
assess and predict capabilities, and deduce the best intervention the generation of client goals and priorities, as well as outcomes
to optimize functional outcomes. targeted for intervention, intervention type, and approach.
As with a detective, gathering client information follows a Bandura (1986) postulated that people learn by observing,
systematic approach to critically evaluate and clinically portray imitating, and modeling others. The social context, the expecta-
the function and dysfunction of the individual. OTs use both tions and relationships with others in the environment, and the
inductive and deductive reasoning to understand and resolve cultural context, including expectations of society and routines
barriers of occupational engagement. When combined, these within the family, create the cultural context that, in turn, influ-
two forms of reasoning result in clinical reasoning within the ences client identity and activity patterns. Together, these create
profession. a profile or portrait of a client as an occupational being.

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 Continuing Education Article
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In the case of pediatric practice, children live within the Effect on Occupation
context of their families and participate in the routines of that Rose’s mother described her as “fully dependent” on the family,
family within the sociocultural environment (Primeau, 1998; with the mother as the primary care provider of Rose and her
Schaaf et al., 2011). In the area of West Virginia where this 6-year-old brother. The father worked at a grocery store and, as
article’s case example takes place, the social ecology is char- the family only had one car, the mother had limited access to
acterized by family networks, traditional gender roles, and a community resources for assistance in caregiving. The mother
complex fatalism (a belief that all events are predetermined was an artist and musician who hoped to return to work once
and inevitable, and personal power is impotent in terms of the children were in school.
changing one’s fate; Rural and Appalachian Youth and Fam-
ilies Consortium, 1996). The Appalachia Regional Commis- What are the occupations in which the client is successful (i.e.,
sion defines Appalachia as being made up of sections of 12 function) or areas that are not at the expected level of function
states spanning New York to Mississippi. West Virginia is the (i.e., dysfunction)? In what occupations does the client feel suc-
only state in which all of its counties are part of Appalachia. cessful, and what barriers affect their success?
In the case example presented in this article, contextual clues
are essential to closing the case of occupational dysfunction Rose was described by her parents as a “very picky eater.”
(West Virginia Early Childhood Transition Steering Commit- She was still nursing and used nursing as a primary coping
tee, 2008). strategy when she felt overwhelmed or stressed. Her mother
stated this limited her own ability to pursue her interests
CASE EXAMPLE: ROSE away from Rose.
Rose was a 3-year-old girl with complex medical needs who lived Communication with Rose was primarily through simple
in rural Appalachia. The occupational profile was completed gestures, with some basic signs used for words such as father,
for Rose as part of a larger, multidisciplinary team assessment more, all done, music, fish (for Goldfish crackers), and sing. For
provided as part of a summer camp program specifically for instance, Rose placed two hands on her head to request a favor-
children with complex medical disorders. The cost for partici- ite song. Many of these communication strategies were idiosyn-
pants is covered through a grant from the U.S. Department of cratic and understood only by the family.
Education. Families initially meet with multidisciplinary team Volitional movement was limited: the family carried Rose
members, who conduct an evaluation and plan treatment. everywhere, using a front-pouch baby carrier. Her mother and
Throughout the week the families move between various labs, father took turns carrying her.
each of which provides specialized services. Rose could crawl short distances and walk about five steps
The Occupational Therapy Template provided an under- with help (the mother or father would hold her hand). After
standing of Rose’s perspective and background and helped five steps or so, Rose would typically sit on the floor and then
identify priorities and desired targeted outcomes that the family crawl to her mom to nurse. Attempts to place her in mobility
believed would lead to Rose’s engagement in occupations and devices such as strollers or grocery carts were unsuccessful—
support her participation in family routines (AOTA, 2017). Rose would thrash to get out, cry, and otherwise appear very
distressed.
Client Report All self-care tasks were dependent, and the sleep schedule
was erratic given Rose was still in diapers and not yet able to
Articulate the reason the client is seeking service: What are control her bowels or bladder.
the concerns related to engagement in occupations? Why is The family had several routines that engaged Rose in play
the client seeking service, and what are the client’s current and social interaction, including singing, simple signing, and
concerns relative to engaging in occupations and in daily playing with a toy drum. Rose enjoyed it when her dad swung
life activities? (This may include the client’s general health her between his legs and up above his head. Overall, Rose had
status.) a limited range of play schemes. She was able to retrieve 10/10
mini M&Ms from a busy patterned blanket. However, she
• Rose presented with autism, cortical visual impairment, and retrieved 0/10 non-candy items from a solid background.
hypotonia. Rose was referred for an occupational therapy Rose’s performance with novel tasks improved when they
evaluation as part of a comprehensive, interdisciplinary team were presented in quiet environments. She was intolerant of the
evaluation to determine appropriate interventions. sound and vibration from rolling wheels. She was provided pink
• Rose’s parents were not sure she could hear, and they high-top tennis shoes that lit up, and a walker. With these mod-
expressed additional concerns about her vision. Sometimes ifications, she was willing to stand and demonstrated bilateral
she seemed to hear, sometimes she seemed to see, and other reciprocal movement in the lower extremity (walking about 10
times she was unresponsive to auditory or visual input. The steps). Combining noise-cancelling headphones with a stroller
family was seeking services to improve functional mobility improved her tolerance.
and communication and to learn strategies to reduce Rose’s Rose’s vision and hearing were tested as within normal lim-
frequent meltdowns during family routines. its, with behaviors (avoidance) affecting functional use.

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What are the client’s values and interests (i.e., personal interests was supported by her parents, who held her by the hands as
and values)? she walked. Rose seemed very pleased with these shoes, step-
Rose had a small musical toy drum that played a song she ping to create the sound and light. Once seated, Rose raised
enjoyed, and she would dance (seated) when the music was her leg to show first her mother then her father her shoes.
played. When challenged to perform a novel task, Rose crawled When asked to try the communication devices, Rose cried
into her mother’s lap to nurse. Rose appeared to be easily and crawled to her mother to nurse. Testing was discontin-
engaged by music. ued and resumed the following day. The testing room and
situation were modified—the lights were dimmed, the music
What is the client’s occupational history (i.e., life experiences)? of the communication devices was turned off, and Rose was
The mother stayed at home to care for the two children (Rose provided the opportunity to swing in a spandex hammock
and her 6-year-old brother) and stated she missed her own work before participating in the testing. Reducing sensory input
as a musician. She reported feeling “trapped” at times as well as and making environmental modifications resulted in clear,
feeling guilty for these feelings. consistent, and observable increase of purposeful perfor-
The mother was limited in her ability to participate in her mance: Rose was able to follow cues to touch the device
son’s community and school activities due to her responsibilities with 80% accuracy and to persist with the task for 8 minutes
with Rose and lack of independent transportation. before asking to swing. Her performance improved when in a
The dad was the sole financial supporter of the family, work- quiet area with minimal distractions.
ing at the local grocery store as a checker, a position that did not
provide health care benefits. What aspects of the client’s environments or contexts do they
Rose’s parents were very concerned about Rose’s ability to see as supports and barriers to occupational engagement?
learn (e.g., could she see or hear, what were her developmental
delays, why was she so avoidant of noise from the stroller or Physical (e.g., buildings, furniture, pets)
grocery cart?). • Rose was fearful of being moved in a stroller or other device
with wheels (she appeared to be fearful of the noise or
What are the daily routines in the family and habits within vibration). She was extremely avoidant (her parents used the
those routines (i.e., performance patterns—routines, roles, word “terrorized”) of the sound and movement of a grocery
habits, and rituals)? cart if they attempted to put her in one to complete their
shopping.
• Rose could imitate simple, familiar gestures. She was overly • Avoiding movement limited the family’s ability to participate
avoidant of novelty and got overwhelmed quickly. in many activities outside the home.
• Her parents reported that Rose loved M&Ms. Her mother
carried a container of mini M&Ms to motivate Rose to Social (e.g., spouse, friends, caregivers)
behave in certain ways. • Rose had a supportive family who had been receiving ser-
• Rose could manipulate familiar items, such as a small favor- vices through the Birth to Three program. Her mother felt
ite toy drum that played music. Her performance improved isolated at home as Rose’s primary care provider for most of
when she was in a quiet area with minimal distractions. the day and with limited interaction with friends and family.
• Rose was able to demonstrate understanding the expectation • Rose used immature strategies to get her needs met, such as
to point to picture cards and select icons for preferred activi- crying and using avoidant behaviors when challenged by a
ties (e.g., swing, M&M, Goldfish). task. There were few children in the area and none within
• Rose was unable to isolate her index finger for pointing. Her walking distance.
mother was shown how to provide facilitated guidance (sup-
porting Rose’s arm to reduce gravity), which compensated Cultural (e.g., customs, beliefs)
for limited shoulder strength/mobility and improved Rose’s • The family and community network was strong—the
ability to isolate her right index finger and point to provided extended family provided financial and respite support.
visual prompts (90% accuracy). Rose signed “more” to con- • The rural, low socioeconomic setting had limited access to
tinue with this task for several trials, clapped, and seemed resources (no public transportation, educational resources
pleased with her success. were limited). The mother was hesitant to express her own
• In the motor lab, the therapists tested an adapted bike. With needs as she didn’t want to complain or sound like she wasn’t
her feet strapped to the pedals, Rose’s parents pushed Rose grateful for Rose.
down the hall while she held onto the handles and her feet
moved with the pedals. Rose appeared to enjoy the move- Personal (e.g., age, gender, supplemental educational services, edu-
ment provided as her legs moved with the bike, guided by her cation)
parents. • Rose was a 3-year-old child in rural Appalachia. She had an
• Next, Rose was fitted with pink high-top tennis shoes that lit older brother (age 6) and lived with her mother, father, and
up and made a squeak sound when she stepped. Her weight brother in a small (1,000-square-foot) home.

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• The family income was less than $20,000 per year, with adaptive way. When sensation is perceived and processed in a
health care provided through Birth to Three and Medicaid. disordered way, responses to that sensation are disordered as
well (Whitney, 2018).
Temporal (e.g., stage of life, time, year) The function–dysfunction continuum within this theory
• Rose was in the pre-operational period of cognitive develop- characterizes function as the ability to regulate daily responses
ment. She did not attend pre-school or day care—there were to sensory events and dysfunction as nonadaptive responses to
no programs in the area that her parents believed could meet sensory situations. OTs assess the function within each sensory
Rose’s needs at that time. system as well as the person’s ability to integrate multiple sen-
sory information for functional use (Kramer & Hinojosa, 2010;
Virtual (e.g., chat, email, remote monitoring) Schaaf & Mailloux, 2015).
• The family had one cell phone that they shared. They had The postulate regarding change guides intervention to
limited access to the Internet (they could use the comput- support the child in achieving an optimal level of arousal
ers at the library). There were three radio channels in their by facilitating the child’s development of self-regulation;
community, and they did not have access to cable channels improving sensory processing; and providing opportunities to
on television. integrate sensory, motor, affective, communicative, and high-
• No broadband was available in the rural community, limiting er-level skills through developmentally appropriate play-based
access to communication and services. learning opportunities. Behavioral modification is identified
as a secondary approach. This theory postulates that behavior
Client Goals: Client’s Priorities and Desired Targeted Outcomes is a response that is strengthened when a reinforcement is
Rose’s parents wanted her to be able to communicate with oth- provided. Reinforcements can be positive or negative (Skin-
ers outside the family as well as improve her ability to express ner, 1976). The postulates for change addressed by these two
her needs to them. They were concerned about functional theories are then used to frame the intervention—that is, to
mobility and hoped to find a way to make a stroller or similar organize the theoretical material and translate that informa-
device acceptable to their daughter. They expressed a desire to tion into practice.
find strategies that would help Rose develop a greater range of The occupational profile provides a document that allows
frustration tolerance. the next therapist or reader to deconstruct the clinical reason-
Approaches included: ing of the original interventionist. The five steps of clinical
Reduce impairment: Improve functional mobility by address- reasoning can be identified through the occupational profile
ing sensory motor development. Reduce sensory-adverse barri- created for Rose. Step one of clinical reasoning is to assess the
ers to participation and exploration. evidence. For the OT, part of the detective work was aimed
Compensatory strategies: Provide opportunity for exploratory at differentiating Rose’s patterns of performance—were her
play on stomach and other planes to facilitate performance. habits because of underlying dysfunction, learned behavior,
Assistive technology: Provide assistive technology to promote or immature sensory processing and integration? The occupa-
communication and mobility. tional profile helped guide the clinical reasoning to generate a
Adapt environment/occupation: Construct environments that clinical hypothesis.
entice play and engagement using sensory exploration, follow- For example, Rose’s parents provided information about
ing Rose’s lead. their child that the therapist combined with information
Provide assistance/caregiver training: Provide training for par- in the reports from the early intervention team. Additional
ents in safe movement/input for Rose. Promote understanding data was gathered through observation and testing (step 1).
of expected developmental milestones and setting up senso- The function–dysfunction continuum was created—what
ry-friendly learning experience using routines-based activities one might expect from a child of this age given the resources
(i.e., stirring batter while making weekly pancakes). available in the environment and the contextual influences.
The evidence was organized in the client report section of
Profiling Rose: Solving the Case the profile and a hypothesis was generated (step 2). The OT
Theory helps move the steps of clinical reasoning from the- began to form a hypothesis—a profile of the client in this
ory to intervention. ASI theory was identified as the primary case.
theoretical approach to guide intervention with Rose. ASI When observing Rose’s response to visual stimuli, and
is a developmental theory that assumes children acquire using the assumptions outlined in behavioral theory (reward-
sensory-based motor function in predicable order (Ayres, ing participation with M&Ms or songs; step 3), the OT
1979). In Ayres’ theory, SI is an individual’s ability to respond hypothesized that Rose’s willingness to respond to tasks
adaptively to sensation over a broad range of intensity and when rewarded did not support engagement in the presented
duration. When sensory input is “integrated,” the individ- activities (step 4). The detective needed a different hypothe-
ual can use sensory information to support optimal arousal, sis (step 5).
attention, and activity levels to meet the demands of the Understanding Rose’s poor frustration tolerance as a
environment in a fluid, flexible manner or respond in an response to feeling overwhelmed by sensations in the environ-

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 CE Article, exam, and certificate
Continuing Education Article are also available ONLINE.
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ment provided the family with a new way of supporting Rose’s frames the process the therapist will use to gather observa-
engagement in daily routines. tional data during intervention. Using the occupational profile
The profile culminates in articulating client-centered goals supported the OT to highlight the distinct value on the team.
to resolve areas of occupational dysfunction and will allow for Having the parents describe their experience of raising a child
assessing when the client’s goals have been meet. For an FBI with development delay, and understanding their perception
profiler, this would be the moment when the characteristics of how intervention would promote adaptation to their family
of the suspect are released to the public, generating leads that routines, helped inform the quality of care within the larger,
lead to offender’s capture—case closed. For the OT, this is the multidisciplinary team.
point for intervention to be offered, response to intervention Once a detective solves a mystery, they have to share
observed, and data from that observation used to plan future their findings in a way that allows others to follow the line of
intervention strategies. reasoning that connects the disparate clues and resolves the
In the case of Rose, intervention strategies following mystery. Documenting occupational therapy services is equally
ASI theory guided the OT to provide sensory intervention important. Long after the services are provided, documenta-
to prepare Rose to be able to meet sensory challenges and tion remains as evidence of the occupational therapy services a
to improve her occupational engagement. By the end of the client received. Occupational therapy practitioners share their
week, Rose was able to demonstrate understanding the expec- distinct contribution to clients through their documentation.
tation to point to picture cards and select icons for preferred The Occupational Profile Template can be inserted directly into
activities (e.g., getting to swing, receiving M&Ms or Goldfish), the treatment record which allows another therapist to follow
when provided with a quiet, less distracting environment. along with the documented clinical reasoning skills outlined in
After the OT reduced the sensory input from the communica- the profile and learn from the documented therapeutic process
tion device provided to Rose by the speech pathologist, Rose of the practitioners who wrote the documents. Documentation
completed the camp able to use the device without having a can be well written or poorly developed and uninformative.
tantrum. Follow up from the early interventionist will con- Practitioners are wise to note: Both writing styles have equal
tinue to build on this foundation. longevity.
The final steps of clinical reasoning direct the therapist to
return to the clinical hypothesis to assess whether the hypoth- CONCLUSION
esis was correct. This is accomplished in part by assessing the The occupational routines of a family raising a child with
outcome of intervention. In this case, we return to Rose and her complex medical disorders in rural Appalachia benefited
family. from the clinical reasoning approach afforded and framed by
Rose was very pleased with her shoes, stepping to create the Occupational Therapy Profile Template. Intervention is
the sound and light. When seated, she raised her leg to show first guided by the theoretical approach, with assumptions
her mother or father her shoes. Rose benefited from swing- stipulated that align with and follow the evidence provided
ing and other sensory strategies that provided movement through the theory. Data are gathered and analyzed using the
within safe play routines. As her comfort with movement assumptions and expectations proposed or postulated by the
increased, and with the incentive of the sound and light, theory.
Rose become more tolerant of the mobility devices provided Once the function–dysfunction continuum is created for the
and with fine motor activities. Her family demonstrated this client report, a clinical hypothesis can be developed, client goals
new ability to incorporate frequent rest breaks and activities generated, and the intervention planned. These aspects of the
to promote sensory modulation and to compensate for Rose’s client are organized and articulated following the template of
poor endurance (sensory motor dysfunction). Finger isola- the occupational therapy profile. The profile is of critical impor-
tion and hand function improved when Rose was provided tance for early intervention practitioners, who are naturally
with assistance to compensate for limited shoulder strength attuned to the types of and extent to which occupations, habits,
and mobility. routines, and rituals are involved in a typically developing child’s
Her parents were relieved that Rose was able to hear and daily life.
respond to direction when she was afforded a supportive The document allows for a comprehensive record that
environment, and they expressed their excitement to build on demonstrates clinical reasoning and problem solving individu-
this new skill. They were optimistic that Rose might be able to alized to optimize development for the client. Understanding
attend pre-school and benefit from participating in the local day the profile of family routines can strengthen the translation of
care environment. evidence to practice.

CLINICAL IMPLICATIONS
The occupational profile enabled the OT to prioritize care in
collaboration with the family and detect barriers to occupational
engagement. The clinical reasoning steps guided the systematic
profiling of this case. Outlining the approach to intervention

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REFERENCES
American Occupational Therapy Association. (n.d.). Improve your documen-
tation with AOTA’s occupational profile template. Retrieved from https://
www.aota.org/Practice/Manage/Reimb/occupational-profile-docu-
How to Apply for
ment-value-ot.aspx
American Occupational Therapy Association. (2014). Occupational thera-
Continuing Education Credit
py practice framework: Domain and process (3rd ed.). American Journal
of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ A. To get pricing information and to register to take the exam online for the
ajot.2014.682006 article The Occupational Profile as a Guide to Clinical Reasoning in Early
American Occupational Therapy Association. (2017). AOTA occupational Intervention: A Detective’s Tale, go to http://store.aota.org, or call toll-free
profile template. American Journal of Occupational Therapy, 71(Suppl. 2), 800-729-2682.
7112420030p1. https://doi.org/10.5014/ajot.2017.716S12
B. Once registered and payment received, you will receive instant email
Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psy- confirmation.
chological Services.
C. Answer the questions to the final exam found on pages CE-7 by
Bandura, A. (1986). Social foundations of thought and action: A social cognitive
theory. Englewood Cliffs, NJ: Prentice-Hall. April 30, 2021.

Cronin, A. (2018). Overview of the clinical reasoning process. In A. Cronin & G. D. On successful completion of the exam (a score of 75% or more), you will
Graebe (Eds.), Clinical reasoning in occupational therapy (pp. 3–20). Bethesda, immediately receive your printable certificate.
MD: AOTA Press.
Davidson, D. M. (1992). Dying for chocolate. New York: Crimeline Books.
Kramer, P., & Hinojosa, J. (2010). Frames of reference for pediatric occupational
therapy (3rd ed.). Baltimore: Lippincott Williams and Wilkins.

Final Exam
Primeau, L. A. (1998). Orchestration of work and play within families. Amer-
ican Journal of Occupational Therapy, 52, 188–195. https://doi.org/10.5014/
ajot.52.3.188
Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M, Miller Article Code CEA0419
Kuhaneck, H., Pfeiffer, B., … Bodison, S. C. (2017). Using a multi-
faceted approach to working with children who have differences in
sensory processing and integration. American Journal of Occupational
The Occupational Profile as a Guide to
Therapy, 71, 7102360010p1–7102360010p10. https://doi.org/10.5014/
ajot.2017.019281
Clinical Reasoning in Early Intervention:
Rural and Appalachian Youth and Families Consortium. (1996). Parenting A Detective’s Tale
practices and interventions among marginalized families in Appalachia:
Building on family strengths. Family Relations, 45, 387–396. https://doi. To receive CE credit, exam must be completed by
org/10.2307/585168
April 30, 2021.
Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A.
(2018). Efficacy of occupational therapy using Ayres Sensory Inte- Learning Level: Intermediate
gration®: A systematic review. American Journal of Occupational
Therapy, 72, 7201190010p1–7201190010p10. https://doi.org/10.5014/ Target Audience: Occupational Therapists and Occupational Therapy
ajot.2018.028431 Assistants
Schaaf, R. C., & Mailloux, Z. (2015). Clinician’s guide for implementing Ayres Sen- Content Focus: Process of Occupational Therapy: Evaluation
sory Integration®: Promoting participation for children with autism. Bethesda,
MD: AOTA Press.
Schaaf, R. C., Toth-Cohen, S., Johnson, S., Otten, G., & Benevides, T. W. (2011). 1. There are five steps in clinical reasoning. Which of the following
The everyday routines of families of children with autism: Examining the
impact of sensory processing difficulties on the family. Autism, 15, 373–389. is the final step?
https://doi.org/10.1177/1362361310386505

A. Evaluate whether the client perceives their problem has
Skinner, B. F. (1976). About behaviorism. New York: Vintage Books. been solved.
West Virginia Early Childhood Transition Steering Committee. (2008). Individu- B. Appraise the evidence.
alized family service plan (IFSP) and individualized education program (IEP): A
comparison of program components. Retrieved from http://wvearlychildhood. C. Develop a clinical hypothesis to organize and guide
org/resources/IFSP_and_IEP_Comparison_040108.pdf assessment.
Whitney, R. (2018). Sensory integration and sensory processing frames of D. Test the clinical hypothesis.
reference. In A. Cronin & G. Graebe (Eds.), Clinical reasoning in occupational
therapy (pp. 123–142). Bethesda, MD: AOTA Press.
Whitney, R., & Luebben, A. (2014). Interpretation and documentation. In J. 2. After seeing a child rock and hold her ears during circle time,
Hinojosa & P. Kramer (Eds.), Evaluation in occupational therapy: Obtaining and generalizing that the child may find loud noises overly stimulat-
interpreting data (4th ed.). Bethesda, MD: AOTA Press.
ing based on Ayres’ Sensory Integration® theory is an example of:
A. Deductive reasoning
B. Inductive reasoning
C. Problem solving
D. Executive function

ARTICLE CODE CEA0419 | APRIL 2019 CE-7

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3. A child withdraws to his mother’s lap and insists on nursing 9. In a 3-month follow-up with Rose, which one of the following
after being asked to play with a toy that lights up and plays outcomes would you expect her parents to report to you given
music. Concluding that the child finds noise or light to be overly the profile presented for her?
stimulation or frightening is an example of: A. Rose was able to respond to verbal prompts without
A. Deductive reasoning avoidant behaviors in five out of seven trials.
B. Inductive reasoning B. Rose could indicate she wanted more glue for her art
C. Problem solving project from her Sunday school teacher.
D. Executive function C. Rose was able to ambulate 20 feet without fatigue.
D. Rose was now able to dress independently.
4. Data from which one of the following tools guide the generation
of client goals and priorities as well as outcomes targeted for 10. In what way was the virtual context identified in the occupation-
intervention, intervention type, and approach? al profile presented?
A. Sensory profile A. No broadband was available in the rural community,
B. Occupational profile limiting access to information and communication.
C. Therapeutic hypothesis B. The family could not use the Internet for social activity.
D. Master module C. Rose could use the computer for her homework.
D. The family did not have television.
5. Which one of the following was not mentioned in the article as a
contributor to the profile of a child as an occupational being? 11. The primary purpose of documentation as identified in the
article is to:
A. The social context
B. The expectations of and relationships with others in the A. Provide evidence of occupational therapy services
environment received by the client
C. The cultural context B. Advocate for the profession
D. Temperament C. Determine frequency and duration of continued services
D. Connect disparate clues for problem solving
6. The primary purpose of an occupational profile is to:
12. Which of the following is not true of the Occupational Profile
A. Organize the evaluation around the activities the client
Template?
wants to do but has difficulty with or cannot do
B. Document progress for payer A. It can be inserted directly into the treatment record.
C. Ensure reimbursement B. It allows another therapist to follow along with the docu-
D. Promote the distinct role of occupational therapy in mented clinical reasoning skills outlined in the profile.
practice C. It helps the next therapist reading the profile learn from
the documented therapeutic process of the previous
7. Which of the following is not included in the client report therapist.
section of the Occupational Profile Template? D. It provides a release in the health record for future
researchers.
A. Cultural context
B. Occupations in which the client is successful Now that you have selected your answers, you are
C. Personal interests only one step away from earning your CE credit.
D. Performance patterns
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8. Which of the following circumstances would belong in the
context portion of the Occupational Profile Template?
A. The home has five steps leading to the front door.
B. The child is 3 years old.
C. The child cries and uses avoidant behaviors when pre-
sented with a challenge.
D. Social supports and barriers to occupational engagement

CE-8 ARTICLE CODE CEA0419 | APRIL 2019