An attack on evidence-based assessment in occupational therapy
Posted Jan 14 2009 8:56pm
In the past I have blogged about evidence based practice so I don't really feel the need to revisit the topic at length. The use of evidence is not a passing fad but rather represents a real shift in the sophistication of our science. This shift was not just restricted to occupational therapy but occupational therapy was caught up in it. That was a good thing.
I am revisiting this tonight because I was visiting the WFOT website and I saw one of their banner ads. The ad was for Schoodles, and the ad said "Changing the way therapists around the world assess children." Kudos to the advertising people at Schoodles because I almost never click on banner ads but I never heard of this assessment tool and was intrigued by the claim.
Perhaps the Schoodles people will be sorry that I clicked because I don't really have anything flattering to say about their statements or philosophy.
This Schoodles product is antithetical to evidence based practice. Although I understand and appreciate the uses of qualitative and informal assessment methods, I was disturbed by the statements made on the website. Here is a sample of what I found that was particularly objectionable:
"Standardized test scores can be valuable, but don't give enough information about classroom problems or starting points for intervention."
"Most of the time occupational therapists don't need numbers and standardized scores to 'qualify' children for services or show continued need. Deciding which children could benefit from our services is really an art, not a science."
"What do I do when teachers and parents want numbers? Give them numbers! You can give approximate age ranges for most of the skills on the tool. Parents typically understand terms such as '1-2 years below age level' much better than 1.5 standard deviations below the mean or 5th%ile. We have found that approximate age ranges satisfy most recipients of our information. You can also draw the focus away from numbers and instead stress classroom function, which is really what we need to look at for any student."
I suppose that their banner ad is correct, and that their assessment system would change the way that therapists assess children. In my opinion, it sets us back around 20 years or so in the sophistication of our assessments. That is a real change - unfortunately, in a negative direction.
The Schoodles approach is unfortunate. Even in the absence of norm-referenced assessments there are many wonderful criterion referenced tools that can be used. Why would anyone abandon these in favor of non-standardized methods???? Even worse, why be so flippant about using standardized methods? If someone asks for numbers the Schoodles people tell us to just 'Give them numbers!' Precision in measurement is not something that is important to the Schoodles people, apparently.
I do not know about the world that the Schoodles people operate in, but in my world school districts want to have norm referenced testing to determine eligibility for services. The same is true for early intervention and preschool services. Insurance companies also like to know where a child is functioning in relationship to a norm or established age criteria.
Most importantly, when parents want to know about the functioning of their children I don't blow smoke at them. Instead, I educate them about what statistics mean.
I wouldn't mind if this was marketed as 'an informal functional assessment tool to supplement your standardized measurements.' Instead I am disappointed with the grandiose claim of 'changing the way therapists evaluate children.' I am disappointed with the attack on evidence-based practice. I am disappointed with the flippant perspective on the value of standardized tools.
And IF WFOT has any control over the banner ads on their site, I am kind of wondering who is asleep at the wheel over there. In some ways, that is the most disappointing.