Want to know one of the biggest bummers as an occupational therapist? Getting an insurance denial calling your sensory integration intervention “experimental.” Our profession is actively moving into an entry level doctorate, and yet we are still facing feedback that makes it appear as if we’re practicing something we made up on the fly.
Of course, we all need to be using evidence-based practice, and it would be great if we could all actively contribute to the body of available research. But in the day to day grind it’s easy to get caught up in the moment, trying to solve problems, innovate creative solutions, and be the resource our families need. So how about that one thing we all have to think about as therapists, something we encounter every single day – our short term and long term goals?
When a child comes in for an evaluation due to sensory processing concerns, how are you writing your goals?
Are you writing that a child will tolerate a certain hierarchy of tactile input, or did you select a specific piece of clothing that they want to wear without aversion? Is their goal to tolerate a certain number of revolutions on a spin board, or a specific nystagmus response? Maybe you are using that wide range of norms for supine flexion and prone extension to guide your observations. Or are you simply choosing items from the PDMS-2 or other standardized test that they didn’t complete in the evaluation?
I have encountered every single one of these approaches in my practice, and I guarantee we are all doing things a little bit differently. Some of us look to measure the underlying sensory systems, others look to gauge the functional outcomes, and some do a little of both. So, what’s the right thing to do?
While I have noticed my goal writing evolve over the years (especially dependent upon the setting in which I worked), my focus has always been geared towards keeping goals functional and occupation based. I mean, isn’t that the whole reason a family is seeking intervention in the first place, when sensory processing issues have interfered with function and development? If we are documenting measurable progress towards functional goals, the evidence for OT intervention builds upon itself.
Although I have to admit, even this approach can create a delicate balancing act. Parents might feel confused when we discuss goals, as some prefer the fancy-sounding jargon, (I’ll admit, words like vestibular, nystagmus, and proprioception DO make me sound super smart), but what do those words really mean for their child’s life?
For example, a family might wish a child could tie their own shoes, but how could that be related to their sensory issues? I work to shape their focus to see that functional goals can be a way of measuring things like self-regulation for a high level motor planning task. Or maybe their child’s tactile processing is the thing that’s impacting their ability to hold a pencil, and as we address the underlying issue, the functional skill improves.
But alas, I can’t claim to know all the answers in a subject as nuanced and delicate as sensory integration and insurance approval.
So, how do you write your sensory goals?