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Facilitator notes Participation guide

Presenter study handout

Vision in OT Practice

3 contact hours · 0.3 AOTA CEUs · Module 4 · 17 slides

Presenter-side material. Each block shows the slide as the audience sees it, the talk track, and space for your own notes. Model answers appear here — do not hand this version to learners.

Module 4

4.1 — IEPs, Medicaid, and Occupation-Based Documentation

Transition

Module 4

IEPs, Medicaid, and Occupation-Based Documentation

1:18 – 1:44

Vision in OT Practice
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Transition: "IEPs, Medicaid, and Occupation-Based Documentation."

My notes

4.2 — IEPs, Medicaid, and Functional Documentation

Title

Module 4

IEPs, Medicaid, and Functional Documentation

Turning visual performance findings into defensible educational relevance.

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Say this

Open here. "IEPs, Medicaid, and Functional Documentation." Turning visual performance findings into defensible educational relevance.

Say why this section matters for their caseload, then advance.

My notes

4.3 — Documentation reality check

Poll

Poll

Documentation reality check

What most often gets your vision-related goals pushed back?

Select one.

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Ask the poll: "What most often gets your vision-related goals pushed back?"

Options:

• Educational relevance is questioned

My notes

4.4 — What a reviewer needs to see

Teaching slide

Present levels

What a reviewer needs to see

  • The occupation: what the student is expected to do in the school day.
  • The observed performance gap, quantified (rate, accuracy, endurance, prompts).
  • The conditions under which performance changes (distance, time on task, contrast, print size).
  • The educational impact statement tying the gap to access and participation.
Condition

During grade-level copy tasks from the board

→ Occupation-based context

Learner

the student will

Behavior

accurately copy 5 sentences with correct spacing and letter placement

→ Level 4 — Visual-Motor Integration

Criterion

in 4 of 5 opportunities across 3 consecutive sessions

→ Measurable, defensible

Support

with slant board and visually-simplified target as needed

→ Adapt & Refer language (Level 1)

Anatomy of an OT-authored IEP goal that survives Medicaid audit and speaks to the Five-Level Framework.
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Frame the slide: "What a reviewer needs to see."

Walk each point, one sentence each:

• The occupation: what the student is expected to do in the school day.

My notes

4.5 — Occupation-based goals, not skill-drill goals

Teaching slide

Goal writing

Occupation-based goals, not skill-drill goals

  • Target the occupation: copying, sustained reading, worksheet completion, note-taking.
  • Condition + behavior + criterion + timeframe, all measurable from your own data.
  • Progress monitoring uses the same probe you used at baseline.
  • Avoid goals that read as vision therapy protocols.

Occupation

During a 10-minute copying task from the board,

Observed performance

the student lost place 7 times and copied 12 of 30 words

Condition

at a 3 m board distance under overhead fluorescent lighting.

Level attribution

Findings are consistent with a Level 2 efficiency limiter.

Disposition

Referral to optometry for binocular vision evaluation is recommended.

Every clause earns its place: occupation, observed performance, condition, level attribution, disposition. No diagnostic language, no untested inference.
Vision in OT Practice
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Say this

Frame the slide: "Occupation-based goals, not skill-drill goals."

Walk each point, one sentence each:

• Target the occupation: copying, sustained reading, worksheet completion, note-taking.

My notes

4.6 — From finding to goal

Case

Applied

From finding to goal

Grade 3 student: near copying accuracy 92% for the first 3 minutes, dropping to 58% by minute 9, with 7 place-loss events. Acuity screen passed.

  • Q1.Which level does this pattern implicate, and which levels must you clear first?
  • Q2.Write the present-level statement in one sentence, with numbers.
  • Q3.Write one annual goal that a reviewer would call educationally relevant.

Present level

Completes 40% of assigned copy lines in 20 minutes with 6 losses of place; 75% with an enlarged, line-isolated model.

Annual goal

By 05/2027, during 20-minute near copy tasks with standard classroom materials, the student will complete 80% of assigned lines with no more than 2 losses of place, across 3 consecutive data collection sessions.

How it is measured

Same 20-minute copy probe, same distance and lighting, collected every 4 weeks.

The goal has to be traceable to the present level and measurable with the same probe you already administered. If you cannot state the re-probe, the goal is not measurable.
Vision in OT Practice
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Say this

Read the scenario aloud, slowly:

Grade 3 student: near copying accuracy 92% for the first 3 minutes, dropping to 58% by minute 9, with 7 place-loss events. Acuity screen passed.

Then put these questions to the room:

My notes

4.7 — Educational relevance, two ways to say it

Comparison

Wording

Educational relevance, two ways to say it

Reviewer accepts

  • Copy accuracy falls 34% within one class period
  • Requires 3 adult prompts to re-find place per page
  • Completes 40% of assigned written work in allotted time
  • Access improves 22% with 14-pt print and glare control

Reviewer questions

  • "Poor tracking skills"
  • "Visual perceptual deficits noted"
  • "Needs vision therapy exercises"
  • "Below age level on perceptual testing"

Out of scope

“Student has convergence insufficiency and a visual processing disorder, causing reading failure. Vision therapy is recommended.”

Scope-safe

“During 20-minute near copy tasks, the student completes 40% of assigned lines and loses place an average of 6 times, reporting blur after 6 minutes. Performance improves to 75% with an enlarged, line-isolated model. Referral to eye care has been made.”

Write the present level in performance language. Every clause names an observable task, a condition, and a measured result — none names a visual diagnosis.
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Say this

Contrast the two columns: Reviewer accepts versus Reviewer questions.

Reviewer accepts:

• Copy accuracy falls 34% within one class period

My notes

4.8 — What has to be in the note

Teaching slide

Medicaid / billing

What has to be in the note

  • Skilled reasoning: why an OT was required for this session.
  • Objective data tied to the goal, recorded the same way each time.
  • Response to intervention and the grading decision you made.
  • Plan for the next session, including dose and re-probe schedule.
Competency areaWhat you should be able to doSource
Scope & framingVision is a client factor within OT scopeModule 1
Framework fluencyName and describe the 5 levelsModule 2
Clinical reasoningRoute referrals through screening → assessmentModule 3
DocumentationWrite an OT-defensible IEP goalModule 4
Case applicationInterpret Mini VPA into a plan of careModule 5
Post-course competency map — the quiz samples across every level of the framework. Aim for 8/10 to pass.

Documentation requirements vary by state and payer — verify locally.

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Say this

Frame the slide: "What has to be in the note."

Walk each point, one sentence each:

• Skilled reasoning: why an OT was required for this session.

My notes

4.9 — Write accommodations from measured conditions

Teaching slide

Accommodations

Write accommodations from measured conditions

  • Only list a modification you tested and recorded a change from.
  • Name the condition: distance, print size, contrast, lighting, seating.
  • Give the teacher one sentence, not a protocol.
  • Re-test the accommodation at least annually.
Student reading at a desk with the window to the side, a gooseneck task lamp lighting the page, a matte desk mat, and a slant board

Window beside or behind

Never seat a student facing an unshaded window — silhouetting collapses page contrast.

Task light on the working side

Directed onto the page from over the non-writing shoulder to avoid hand shadow and specular glare.

Matte surface + slant board

A non-glare mat and an angled surface raise effective contrast without changing the material.

Lighting is an intervention. Seat the student so the window is beside or behind them, add a task light on the working side, and use a matte overlay or tilted surface to kill specular glare on the page or screen.
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Say this

Frame the slide: "Write accommodations from measured conditions."

Walk each point, one sentence each:

• Only list a modification you tested and recorded a change from.

My notes

4.10 — Module 4 video — documentation and goal writing

Video

Lecture

Module 4 video — documentation and goal writing

VIDEO SLOT

Walkthrough of present levels, goals, and educational relevance.

Slides tab → set “url” to your YouTube/Vimeo/Loom embed link

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Say this

Set up the clip in one sentence, play it, then debrief with "what did you notice?"

My notes

4.11 — Screenshot — IEP present level and goal

Visual

Import

Screenshot — IEP present level and goal

Present level

Completes 40% of assigned copy lines in 20 minutes with 6 losses of place; 75% with an enlarged, line-isolated model.

Annual goal

By 05/2027, during 20-minute near copy tasks with standard classroom materials, the student will complete 80% of assigned lines with no more than 2 losses of place, across 3 consecutive data collection sessions.

How it is measured

Same 20-minute copy probe, same distance and lighting, collected every 4 weeks.

The goal has to be traceable to the present level and measurable with the same probe you already administered. If you cannot state the re-probe, the goal is not measurable.
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Say this

Describe what belongs here: De-identified IEP text showing the present level and matching annual goal..

My notes

4.12 — Screenshot — progress-monitoring data table

Visual

Import

Screenshot — progress-monitoring data table

ProbeLines completeLosses of placeStudent report
Baseline40%6Blur reported at 6 min
Week 452%5Blur at 9 min
Week 866%3No blur reported
Week 1281%2Goal criterion met (1 of 3)
Baseline and re-probe under identical conditions. Trend lines are only interpretable when distance, lighting, materials, and duration were held constant.
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Say this

Describe what belongs here: Baseline vs. re-probe data used to document progress..

My notes

4.13 — So what? Documentation is what survives the meeting

So what?

So what?

So what? Documentation is what survives the meeting

If the present level does not name the occupation, the condition, and the measurable demand, the service does not get funded and the goal does not get taught.

IEP teams and Medicaid reviewers cannot act on "poor visual skills." They act on observable performance under stated conditions.

What you do with it

  • Write present levels as condition + behavior + criterion, in performance language.
  • Tie every goal to a classroom occupation the team already recognizes.
  • Keep the referral trail in the record so scope is visible to the reader.

Watch for

A goal you cannot measure on a Tuesday with what you already have in the room — rewrite it.

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Say this

Land the "so what": If the present level does not name the occupation, the condition, and the measurable demand, the service does not get funded and the goal does not get taught.

Explain the mechanism plainly: IEP teams and Medicaid reviewers cannot act on "poor visual skills." They act on observable performance under stated conditions.

Then give them the moves — say each one as something they can do Monday:

My notes

4.14 — Before / after: the same student, two present levels

Before / after

Documentation

Before / after: the same student, two present levels

Before — not defensible

Reads as a diagnosis, cannot be measured, names no occupation.

  • • "Student has visual processing deficits and convergence insufficiency."
  • • "Needs vision therapy to improve visual skills."

After — defensible

Observation, condition, and measurable classroom demand.

  • • "Given a grade-level worksheet at 40 cm, the student completed 4 of 12 items in 10 minutes, losing place 7 times."
  • • "Referred to eye care 9/12 for reported doubling; OT is addressing near-work endurance and page navigation."

Same student, same session. Only the second version tells the team what to do and lets you show change.

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Say this

Set up the contrast: "Before / after: the same student, two present levels."

Point at the before panel first. Reads as a diagnosis, cannot be measured, names no occupation.

Then the after panel. Observation, condition, and measurable classroom demand.

My notes

4.15 — Two-minute case: rewrite this line

Mini case

Two-minute case

Two-minute case: rewrite this line

A draft IEP present level reads: "Student demonstrates poor visual tracking and visual perceptual weakness affecting academics."

Rewrite it in one sentence you could defend in a Medicaid audit.

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Say this

Two-minute case. Read it aloud:

A draft IEP present level reads: "Student demonstrates poor visual tracking and visual perceptual weakness affecting academics."

Put the question to them: "Rewrite it in one sentence you could defend in a Medicaid audit." Give 60 seconds, no talking.

My notes

4.16 — Reflect and share

Reflection

Reflect and share

Reflect and share

Draft one goal now: name the occupation, the visual performance factor limiting it, the condition, and the criterion.

THINKPROCESSSHARE
  • · All four elements, one sentence.
  • · Use the student you brought with you today.
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Say this

Reflection prompt: "Draft one goal now: name the occupation, the visual performance factor limiting it, the condition, and the criterion."

Cues:

• All four elements, one sentence.

My notes

4.17 — Knowledge check — documentation

Self-check

Knowledge check

Knowledge check — documentation

Which element is missing? "Student will improve visual tracking to 80% accuracy."

Self-check only — it does not affect your post-course quiz score.

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Say this

Knowledge check: "Which element is missing? "Student will improve visual tracking to 80% accuracy.""

Options:

• The criterion

My notes