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The VPA™: Assessment & Clinical Reasoning — participation guide

4 contact hours · 0.4 AOTA CEUs · Module 8 — follow along, take notes, and complete the reflection prompts.

Module 8

Documentation, Disposition, and Referral

Follow along

What this module covers

A defensible VPA™ report
Referral decision rules
How the profile actually defines the intervention
From achieved level to an IEP-ready goal
Three rules that keep the activity honest

Key ideas

Capture these as you listen

Three dispositions: refer for medical eye care, proceed to deeper assessment (Full VPA™ or a norm-referenced instrument), or proceed to occupation-based intervention. Referral and intervention routinely run in parallel.
Refer on: Domain 1 below criterion, two-line interocular difference, pain/diplopia/headache with near work, observed strabismus or nystagmus, receding NPC, or no eye exam on record.
Documentation needs four elements: named occupation, observable current performance, criterion-referenced visual factor, and participation impact.
Never write "vision therapy," a lens/prism/filter recommendation, or a binocular diagnosis as your own finding. The practice does not shrink; the vocabulary changes.
Retain the protocol, observations, validity flags, mode, band, and any deviations, a report nobody can reconstruct is a file defect.
The entry point names the activity: L1 access/contrast changes, L2 pursuit-saccade-convergence work under the endurance ceiling, L3 perceptual work carried onto a real page, L4 graded visual-motor plus output accommodation, L5 treated inside the occupation. All named activities live in the Vision Library.
Grading rules: treat at the lowest unstable level but measure at Level 5, change one variable at a time, and embed before you drill.
Building the full plan of care from the profile is Course 3, Intervention Planning Using the Five-Level Framework.

Notes

My notes for this module

Reference figures

Keep these for practice

Screenshot — generated VPA™ clinical report

VPA™ clinical report (de-identified)

Reason for referralDifficulty copying from the board; incomplete written work.

Occupational demandSustained near copy work, 20–30 min blocks, 4× daily.

FindingsEfficiency L2, visual-motor integration L2, foundation L5.

InterpretationPerformance breaks down at efficiency under sustained near demand, not at acuity.

PlanLevel-2 entry, 3× weekly × 15 min, embedded in copy tasks; re-probe at 8 weeks.

DispositionRefer to eye care for binocular evaluation; OT services continue.

The generated report keeps one chain visible end to end: occupation → level of breakdown → dose → probe. Anything that does not serve that chain is trimmed.

Screenshot — referral letter template

Re: Referral for eye care evaluation

I am the occupational therapist working with this student on written productivity and reading stamina in the school setting.

During structured performance testing, the student demonstrated reduced accuracy and endurance on sustained near tasks, with reported blur after approximately six minutes, loss of place during line-to-line tracking, and a near point of convergence receded to 12 cm.

These observations describe performance only and are not a diagnosis. I am requesting your evaluation to determine whether an underlying visual condition is contributing, and any recommendations you would like reflected in the educational plan.

Thank you — I am glad to share the full performance summary on request.

Scope-safe referral wording: describe performance and the pattern observed, state why eye care input is needed, and ask a question — never name a diagnosis or recommend a specific treatment.

Apply it

Case prompt

Write a complete IEP present-levels statement from Case B in Module 7. Include all four documentation elements and no out-of-scope language. Then read it back and delete any word an OT licensure board would question.

Practice

Mini exercise

List the referral triggers from memory. Then check the list. Any trigger you forgot is a student you would have kept instead of referred.

Take it to work

Action step this week

Draft your standing referral letter template for eye care, the one you will reuse, with a blank slot for the specific functional observations. Having it written before you need it is the difference between referring and meaning to refer.