An effective treatment plan for children with sensory processing challenges, always begins with a thorough and comprehensive assessment. Some significant challenges exist however, in how to define “thorough and comprehensive” and once defined, how to make the process feasible for families and reasonable for professionals within the time constraints that are present in many treatment environments.
The gold standard for assessment and treatment of sensory processing challenges was for many years, administration and scoring of a “Sensory Integration and Praxis Test (SIPT)” followed by intervention provided by an Ayres Sensory Integration (ASI) certified therapist. A new test called the “Evaluation in Ayres Sensory Integration (EASI)” has been developed and while the SIPT remains available for use and remains relevant, the EASI is the most current and internationally recognized means of standardized assessment for children with sensory processing challenges. That said, therapists not certified in sensory integration can have much advanced training in sensory processing and can also very effectively create a comprehensive approach to assessment and treatment in a variety of settings.
I myself completed my certification in ASI in 2005 and administered the SIPT for many years to many children. I began to shift away from using it when I expanded my private practice for a number of operational and clinical reasons. As the volume of clients we saw in my practice grew, I no longer had the time for administration of a 3 hour assessment and 7+ hours of scoring and report writing per new client. I also needed a way to bring more children through the door more quickly and the therapists I hired were not ASI certified. Additionally, fewer families desired or could afford the gold standard 3 hour assessment. Clinically, I found it wasn’t always necessary to get started in working with a child, because I obtained sufficient and very relevant information from other means of standardized and non-standardized assessment. For all these reasons I offered what I call a tiered assessment model. The tiered approach offered families choice which supported safety and promoted connection and meeting them where they were in regards to their life and their resources.
A “tiered assessment model” is one where we give families the option of a one hour screening, a basic two hour assessment, or the longer more comprehensive three hour assessment like the SIPT or a combination of other standardized tools selected based on the needs of the client. The tools I used in each option are as follows:
- Screening (1 hour) included parent interview most often completed at the time of the intake/discovery call, scoring and interpretation of a Sensory Processing Measure (SPM), non-standardized clinical observations of SI-Function and free-play in our sensory gym. If we felt further assessment was needed after completion of a screening we always recommended and additional hour.
- Basic (2 hour) included parent interview, SPM, Miller-Function and Participation Scales (M-Fun) or GOAL, Beery Test of Visual Motor Integration (VMI), and non-standardized clinical observations and free-play
- Comprehensive (3 hour) included Sensory Integration & Praxis Test (SIPT) OR all that the basic assessment includes AND additional standardized tools such as the SCAN3:C, ABAS, TVPS or others that were needed or relevant to that child.
Regardless of the type of assessment I completed, my priority was to get enough information that I felt able to tell a story about what I sensed and learned was going on for this child and so that I felt able to recommend next steps with confidence. I didn’t always know what my intervention would look like at the time I was recommending intervention. I did know however, that we’d figure that out. I also didn’t always know what I felt was enough, but I always desired to know enough to get started.
The other lessons I realize I learned over the years is that I approached every client with curiosity and with the desire to get to some root contributing cause for their struggle. Sometimes I was unable to identify ALL the factors resulting in difficulty but every time, I felt able to offer something helpful…even if it meant ruling out sensory processing challenges and offering a referral and resources to the parent(s).
Assessment tells us where to start. It isn’t about getting all the answers from the start. Assessment is an ongoing and complicated thought process. Some clients are more or less complex. It is our job to navigate the complexities in a way that is supportive to each and every family and to build connection, trust and hope along the way. If all we do is start with connection, families are more likely to trust and then we are better able to build and hold hope for change as we figure out the rest together.
(Assessment is one area of practice we discuss in greater depth inside the Sensory Collective Mentorship program. If you are an OT working in the areas of sensory integrative processing and you are interested in more information or want to join the waitlist, you can CLICK HERE We’d love to help make private practice easier!)