The VPA™: Assessment & Clinical Reasoning: facilitator notes

Presenter cues

• Start with the limits of a standard score, not with the VPA™ — participants must feel the gap first.
• Say plainly: this is not anti-standardized-testing. The two evidence sources answer different questions.
• Reinforce the scope line before any assessment content: we measure performance, we do not diagnose the eye.

Answer key

What does a performance-based measure add over a norm-referenced battery?

Location of breakdown by level, endurance and rate under sustained demand, error type and strategy, and a direct line from the finding to a goal and a dose. Norm-referenced data still answers "how far from peers" when a payer or eligibility decision requires it.

Watch-outs

• Participants assume performance-based means informal. Correct it: fixed setup, verbatim scripts, defined basal/ceiling rules, and repeated identical probes are exactly what makes it defensible.

Presenter cues

• Repeat the canonical phrasing every time: 15 skills across 5 domains.
• Mini VPA™ flags; Full VPA™ measures. Say it before and after the instrument slide.
• Show the Mini administration screenshot and point at the three regions: Say/Do script, level ladder, scoring panel.

Answer key

Which instrument, when?

Mini VPA™ when you need to decide whether measurement is warranted — one probe at each of Levels 1–5, caseload-scale. Full VPA™ when a flag exists, when you are writing present levels or goals, or when a re-assessment must be comparable to a prior battery. The Mini is never a stand-alone plan of care.

When do you add a standardized adjunct?

When one flagged skill needs depth for eligibility, when a payer or district requires a norm-referenced score, or when the team disagrees about whether a finding is real. Adjuncts deepen a flagged area; they do not replace the level profile.

Presenter cues

• Run the setup list as a physical rehearsal — have participants set a 40 cm distance at their table.
• Explain why distance-specific cards exist: substituting a near card at 60 cm invalidates the acuity measure.
• Note the band boundaries out loud: 5–7, 8–11, 12–16, 17+; ages 3–4 use the Pre-K Quick Screen.

Answer key

A 4-year-old is referred. What do you run?

The Pre-K Quick Screen, not a compressed 5–7 protocol. Document functional observations, provide simple activities or accommodations, refer if any ocular trigger is present, and set a re-check date. Forcing the school-age battery produces data that will not hold.

The student left glasses at home. Do you proceed?

You may proceed only if you record it as a validity threat and treat every result as provisional; otherwise reschedule. Never write present levels from an uncorrected session without stating the condition explicitly.

Watch-outs

• Chronological age selects the band, not grade placement or perceived ability. Deviating from that is a fidelity break.

Presenter cues

• Demonstrate one probe live, verbatim, including the Do line, before discussing anything.
• Model the single permitted repetition and then model recording an extra prompt rather than giving it freely.
• Direct attention to positioning: you must be able to see the eyes, not just the answer sheet.

Answer key

The student passes the L2 probe but re-reads constantly. Pass or flag?

Both — score the pass, and flag it. A degraded pass (rate loss, heavy strategy, place loss) meets the Full VPA™ trigger. Record the observation cue that made it degraded; that sentence is what justifies the full battery.

Teacher reports difficulty but every probe passes. What now?

Conflicting report is itself a trigger. Run the Full VPA™ or, at minimum, observe the actual classroom task the teacher is describing under real conditions — the screen may simply not have sampled that demand.

Watch-outs

• Scoring effort instead of performance. Effort is an observation field, not a score.

Presenter cues

• Basal and ceiling in plain language: basal is the highest clean level; ceiling is where it breaks and stays broken.
• No adaptive skipping — every skill runs L1 → L5 in order. Say why: the shape of the ladder is the finding.
• Teach the fatigue rule before the validity slide, so participants hear the pacing advice as protection of their own data.

Answer key

Performance dips at L3, recovers at L4. Where is the ceiling?

There is no ceiling at L3 — a ceiling requires breakdown that persists. Record the L3 dip as an observation, continue the ladder, and re-probe L3 later in the session or on another day. A single-level dip with recovery usually means attention, item familiarity, or a momentary state change.

You are two skills from the end and the student is visibly fatigued. What do you do?

Stop and split the battery across two sessions, documenting the break point and conditions. Pushing through yields a low profile you cannot distinguish from a real deficit, and re-testing later will not un-do the record.

Watch-outs

• Ordering all fatigue-sensitive probes last, then interpreting the resulting decline as endurance deficit.

Presenter cues

• Read the shape before the numbers — say it, then show it on the profile chart.
• Composite is a summary. Interpretation lives in the domain spread and the observation notes.
• Every recommendation must trace to a recorded score or observation; ask the room to find the trace on your sample report.

Answer key

Domain average is Level 3, but the three skills are 5, 3, and 1. How do you report it?

Do not report the average as the finding. Report the spread: the domain is unstable, with one skill at floor. The Level 1 skill drives the plan; the average would have hidden it. This is why spread is read before composite.

What may the report not say?

No binocular vision diagnosis, no naming or implying a specific ocular condition, no lens/prism/vision-therapy recommendation, and no claim that is not traceable to recorded data. Symptom reports go in as quotes, attributed to the student.

Presenter cues

• Run all three cases with the same four questions so the reasoning becomes a habit, not a memory.
• After each case, ask which sentence goes in the report and which goes in the referral.

Answer key

Case A — which level is the breakdown point, and what does the clean floor rule out?

Breakdown is Level 5 functional writing (L3 with 40% legibility loss after five lines), on clean L1 floors and L4 processing. The clean acuity and discrimination/form constancy performance rules out a sensory access problem and rules out a pure perceptual discrimination explanation for the "reversals." The signal is output under sustained demand — endurance and motor grading, not letter knowledge.

Case A — what is the disposition: OT plan, referral, or monitor?

OT plan. No ocular triggers are present and the floors are clean, so there is nothing to refer. Target graded motor output inside the writing occupation, dose it, and set the re-probe at the same five-line sample. Reversals themselves are not the goal — legibility retained across the writing bout is.

Case B — which findings are OT-reportable and which trigger an eye-care referral?

OT-reportable: the 38% rate decay between minute 1 and minute 8 and the 9 place-loss events, both recorded under a stated condition. Referral trigger: self-reported blur at 40 cm. Report the first two as performance data; route the third out immediately while your OT plan continues.

Case B — how do you word the referral without naming a diagnosis?

Model: "During an 8-minute near reading task at 40 cm, this student’s reading rate declined 38% with 9 loss-of-place events, and the student reported that print became blurry. We are requesting an eye examination and are sharing these observations; we are not offering an ocular diagnosis." Observations, conditions, the student’s own words, and a clear question.

Case C — what does the condition-dependent change tell you about intervention targets?

Capacity is intact — L1–L2 performance is clean in a quiet room. The deficit is tolerance for environmental load. Intervention targets graded exposure to noise, glare, and screen demand while holding the task constant, plus self-monitoring and pacing strategies. Working on the visual skill itself in a quiet room will not touch the problem.

Case C — what accommodations follow directly from your recorded data?

Only those you tested: matte screen/anti-glare and reduced screen brightness, seating away from high-noise and high-glare zones, scheduled breaks aligned to the minute at which decay appeared, and extended time or reduced volume for sustained near work. Each one is written with the condition and the measured change beside it.

Watch-outs

• Participants will want to name post-concussion "convergence insufficiency" in Case C. Redirect to condition-dependent performance language plus referral.

Presenter cues

• Walk the report skeleton in order; the order itself is the argument.
• Distinguish the family/team hand-off (one sentence, one support to keep) from the eye-care hand-off (observations plus a question).
• Close by orienting participants to the post-course examination and passing criterion.

Answer key

When do you re-run the VPA™?

At the end of each intervention block using identical probes, after any change in correction/medication/medical status, and before an annual review or eligibility decision. Never mid-block on impression — it destroys your own comparison.

What single sentence goes to the classroom teacher?

One condition and one support: "Copy accuracy holds for about four minutes; give a chunked copy task with a line guide and a check-in at minute four." Teachers implement one thing reliably; protocols get abandoned.