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Facilitator notes Participation guide

Presenter study handout

The VPA™: Assessment & Clinical Reasoning

4 contact hours · 0.4 AOTA CEUs · Module 1 · 18 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 1

1.1 — Welcome — set up before we start

Welcome

Welcome

Welcome — set up before we start

The VPA™: Assessment & Clinical Reasoning · 4.0 contact hours · 0.4 AOTA CEUs

Have ready

  • Participation & Reflection Guide
  • A blank VPA™ protocol and the administration-fidelity checklist
  • Tape measure or ruler for working distance
  • A student profile you plan to assess next

Before we begin

  • This course is procedural — pause the video and practice as you go.
  • Fidelity checklist scoring happens in Module 4; have it open early.
  • Polls, reflections, and self-checks do not affect your exam score.
  • Keep your testing space at the standard working distance and lighting.

Visual Minds Learning · AOTA Approved Provider #0000001618

The VPA™: Assessment & Clinical Reasoning
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Housekeeping while people arrive.

Materials to have ready:

• Participation & Reflection Guide

My notes

1.2 — What you will be able to do

Learning outcomes

Learning outcomes

What you will be able to do

So you can administer, score, and interpret the VPA™ with fidelity — and defend every disposition you reach.

  • 1Administer a criterion-referenced, performance-based visual assessment protocol following standardized procedure — setup, working distance, stimulus presentation, prompting limits, and observation recording — achieving at least 90% procedural fidelity, so that findings can be used to describe a client's occupational performance.
  • 2Select developmentally and contextually appropriate assessment conditions (age band, stimulus set, environment) for a given client and state, in writing, the two client or contextual factors that drove the selection, so that assessment conditions match the client's actual occupational context (classroom, home, clinic, work).
  • 3Apply basal and ceiling rules and a hierarchical progression of visual performance demands during performance-based assessment, correctly identifying the stopping point and the client's achieved performance level to produce a profile that guides occupation-based intervention planning.
  • 4Score a completed performance-based visual assessment protocol and interpret the results in terms of the occupational performance breakdown they produce, naming the visual performance factor most likely accounting for the breakdown with a written rationale for each of three case vignettes.
  • 5Translate visual assessment findings into a written occupational performance statement that names the occupation (e.g., copying from the board, sustained silent reading, legible written output), the visual performance factor limiting it, and the observed impact on participation, meeting all three elements of the provided rubric.
  • 6Document visual assessment results in occupational therapy scope language suitable for an IEP present-levels statement or plan of care, including at least one occupation-based measurable statement of current performance, without using terminology reserved for medical eye care or optometric vision therapy.
  • 7Apply scope-of-practice and referral decision rules, consistent with the AOTA scope of practice and the 2025 AOTA Occupational Therapy Code of Ethics, to determine for each of five completed protocols whether the client proceeds to further occupational therapy assessment, to occupation-based intervention, or to referral for medical eye care, and justify each disposition as the next occupation-based step.
  • 8Identify validity threats to any performance-based visual assessment — incomplete basal or ceiling, environmental deviation, fatigue, attention, and unfamiliar stimulus content — and describe in writing how each is recorded and how it constrains interpretation, so that a client's participation in reading, written work, and other daily occupations is not misjudged and occupational therapy services are not misallocated.

Visual Minds Learning · AOTA Approved Provider #0000001618

The VPA™: Assessment & Clinical Reasoning
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Say this

Read the filed learning objectives verbatim — this is the AOTA-approved wording.

Objectives:

• Administer a criterion-referenced, performance-based visual assessment protocol following standardized procedure — setup, working distance, stimulus presentation, prompting limits, and observation recording — achieving at least 90% procedural fidelity, so that findings can be used to describe a client's occupational performance.

My notes

1.3 — How this session runs

How the session runs

Your learning experience

How this session runs

Session schedule

  • Eight modules, 4.0 contact hours total
  • Procedure → demonstration → practice → self-check
  • Scored fidelity checklist and scenario sets
  • Post-course exam, evaluation, certificate

Participation & Reflection Guide

  • Record your fidelity scores and scenario answers
  • Note every validity flag you observe
  • Entries save and print with your handout

Discussion & engagement

  • Opening poll in every module
  • Think / Process / Share after each procedure block
  • Three full clinical reasoning walkthroughs
  • One knowledge check per module

Visual Minds Learning · AOTA Approved Provider #0000001618

The VPA™: Assessment & Clinical Reasoning
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Say this

Explain how the session runs.

Schedule:

• Eight modules, 4.0 contact hours total

My notes

1.4 — Why performance-based visual assessment: what norm-referenced batteries miss

Transition

Module 1

Why performance-based visual assessment: what norm-referenced batteries miss

0:00 – 0:20

The VPA™: Assessment & Clinical Reasoning
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Say this

Transition: "Why performance-based visual assessment: what norm-referenced batteries miss."

My notes

1.5 — Why Performance-Based Visual Assessment

Title

Module 1

Why Performance-Based Visual Assessment

What norm-referenced perceptual batteries do not tell you about the school day.

Visual Minds Learning · AOTA Approved Provider

The VPA™: Assessment & Clinical Reasoning
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Say this

Open here. "Why Performance-Based Visual Assessment." What norm-referenced perceptual batteries do not tell you about the school day.

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

My notes

1.6 — What are you using now?

Poll

Poll

What are you using now?

Which tool do you currently reach for when vision is the referral question?

Select one.

The VPA™: Assessment & Clinical Reasoning
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Say this

Ask the poll: "Which tool do you currently reach for when vision is the referral question?"

Options:

• A norm-referenced visual perception battery

My notes

1.7 — What a standard score misses

Teaching slide

The gap

What a standard score misses

  • A single accuracy score cannot show endurance decay across a work period.
  • Item-level batteries rarely sample the occupation the referral was written about.
  • Pass/fail cut scores hide the level at which performance actually breaks down.
  • Observation of strategy, prompting, and error type carries the clinical signal.
Norm-referencedCriterion-referenced
Question answeredWhere does this student rank?What can this student do, and under what conditions?
ConditionsQuiet room, fixed distance, untimedNear/far demand, time pressure, motor load
Efficiency floorRarely sampledSampled directly
OutputStandard score / percentileLevel-and-domain performance profile
Best useEligibility, medical necessityPlan of care, progress monitoring
Two legitimate instrument classes answering different questions. Eligibility needs the left column; Monday-morning planning needs the right.
The VPA™: Assessment & Clinical Reasoning
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Say this

Frame the slide: "What a standard score misses."

Walk each point, one sentence each:

• A single accuracy score cannot show endurance decay across a work period.

My notes

1.8 — Two complementary sources of evidence

Comparison

Two complementary sources of evidence

Norm-referenced batteries

  • Population comparison
  • Eligibility support in some settings
  • Single-session snapshot
  • Limited occupational context

Performance-based VPA™

  • Level-by-level breakdown point
  • Endurance and rate under demand
  • Error-type and strategy observation
  • Direct line to goals and dosage
Standard score report
Visual perception (total)92 · 30th %ile
Visual-motor integration88 · 21st %ile
Motor-reduced perception95 · 37th %ile

“Within normal limits.” No statement about copying from the board, near endurance, or output rate.

VPA™ domain profile
L1Acuity & sensory foundationincl. field & scanning
strong
L2Visual efficiency
limiting
L3Visual processing
emerging
L4Visual-motor integration
limiting
L5Functional integration
breaking down

Shape, not a single number: efficiency and output fall away while foundation holds.

A norm-referenced score answers “how does this student compare?”. A VPA™ profile answers “where in the visual performance chain does the school day break down?” Both are evidence; only one tells you what to change on Monday.
The VPA™: Assessment & Clinical Reasoning
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Say this

Contrast the two columns: Norm-referenced batteries versus Performance-based VPA™.

Norm-referenced batteries:

• Population comparison

My notes

1.9 — What an OT measures — and what we do not

Teaching slide

Scope

What an OT measures — and what we do not

  • We measure performance, conditions, endurance, and occupational impact.
  • We do not diagnose binocular vision disorders or recommend lenses.
  • We refer in parallel whenever an ocular trigger appears.
  • Every recommendation traces to a recorded score or observation.
1Systematic reviews & meta-analysesSets the default direction of practice.
2Randomized controlled trials (e.g., CITT)Supports specific dosed interventions.
3Cohort & case-control studiesDescribes patterns and associations, not cause.
4Practice guidelines & consensus (AOTA, AOA)Defines scope and role boundaries.
5Expert opinion & single-case designsFills gaps; documented as such in the plan.
Claims in this course are labeled by tier. Where the evidence is consensus or emerging, the course says so rather than overstating it.

Occupational therapists hold an independent scope; measurement discipline is what protects it.

The VPA™: Assessment & Clinical Reasoning
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Say this

Frame the slide: "What an OT measures — and what we do not."

Walk each point, one sentence each:

• We measure performance, conditions, endurance, and occupational impact.

My notes

1.10 — Address it, refer it — or both

Comparison

The standing rule

Address it, refer it — or both

Already diagnosed and medically managed → OT addresses it

  • Documented low acuity: magnification, enlarged print, working distance, seating, decluttered materials.
  • Documented contrast loss: high-contrast materials, bold-line paper, reverse polarity, glare and lighting control.
  • Documented field loss: systematic scanning, anchoring, line tracking, materials placed in the intact field.
  • The VPA™ documents the functional limitation and the conditions under which performance breaks down.

Undiagnosed, unverified, unclear, or changing → refer

  • No comprehensive eye exam on file, or correction not worn, outgrown, or unverified.
  • Assessment performance does not match the documented diagnosis.
  • Anything new: new eye turn, new double vision, new field complaint, sudden change, pain.
  • Referral is the action for these — OT addresses acuity, contrast, or field limitations only once they are diagnosed and managed.
Finding
Diagnosed & managed → OT addresses
New / undiagnosed / changing → refer
Reduced acuity
Magnify (optical, electronic, or digital), enlarge print, increase working-distance control, reduce visual clutter, seat for viewing angle.
No comprehensive eye exam on file, correction not worn or outgrown, or a new drop in near/distance performance.
Reduced contrast sensitivity
High-contrast materials, bold line paper, dark-on-light or reverse-polarity screens, glare and lighting control, edge marking on stairs and thresholds.
Contrast difficulty never evaluated, or a functional loss that is new, worsening, or does not match the documented diagnosis.
Field loss
Teach systematic scanning, anchoring, and line-tracking; position materials and seating into the intact field; organize the workspace; travel-safety routines with the O&M specialist.
Field loss suspected but never documented, or new field complaints, bumping, or missed content on one side.
Ocular alignment, oculomotor, accommodation
Grade the visual demand of the occupation, build near-point stamina, chunk and space text, schedule visual breaks.
New eye turn, new double vision, headaches or pain with near work, or no eye care follow-up in place.

OT addresses diagnosed, medically managed limitations. A new or undiagnosed finding is a referral — the diagnosis has to come first before we treat that finding as a known visual limitation.

The standing rule: OT addresses the functional limitation only when the ocular condition is already diagnosed and medically managed. If the finding is new, undiagnosed, unclear, or changing, the appropriate OT action is referral.

Diagnosed and medically managed = OT addresses it. New, undiagnosed, or changing = refer it; diagnosis comes first.

The VPA™: Assessment & Clinical Reasoning
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Say this

Contrast the two columns: Already diagnosed and medically managed → OT addresses it versus Undiagnosed, unverified, unclear, or changing → refer.

Already diagnosed and medically managed → OT addresses it:

• Documented low acuity: magnification, enlarged print, working distance, seating, decluttered materials.

My notes

1.11 — Why performance-based measurement holds up

Teaching slide

Evidence

Why performance-based measurement holds up

  • Repeated measurement of the same task documents change more defensibly than a single score.
  • Condition-dependent performance is the signal payers and teams act on.
  • Occupation-embedded probes carry the transfer argument with them.
  • Graded reference list with levels of evidence is published in the PD documentation.
1

Ocular structures

Cornea, lens, retina, extraocular muscles — image quality and eye alignment.

Looks like: Blur, fatigue, suppression, head tilt.

2

Pathways & processing

Optic nerve → chiasm → LGN → V1, then ventral "what" and dorsal "where" streams.

Looks like: Recognition errors, spatial disorganization, place-losing.

3

Visual performance

Efficiency under real demand: sustaining near work, scanning, copying, moving through space.

Looks like: Slow output, avoidance, careless-looking errors.

4

Occupation

Reading, writing, math layout, PE, cafeteria, hallway navigation, self-care.

Looks like: The referral you actually receive.

OT does not diagnose the first two columns; we measure the third and change the fourth. Eye care partners own structure and pathway health — our contribution is performance under occupational demand.
The VPA™: Assessment & Clinical Reasoning
11 / 18

Say this

Frame the slide: "Why performance-based measurement holds up."

Walk each point, one sentence each:

• Repeated measurement of the same task documents change more defensibly than a single score.

My notes

1.12 — Module 1 video — why performance-based assessment

Video

Lecture

Module 1 video — why performance-based assessment

VIDEO SLOT

Framing lecture on the gap between scores and school-day performance.

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

The VPA™: Assessment & Clinical Reasoning
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Say this

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

My notes

1.13 — Screenshot — a standard score report vs. a VPA™ profile

Visual

Import

Screenshot — a standard score report vs. a VPA™ profile

Standard score report
Visual perception (total)92 · 30th %ile
Visual-motor integration88 · 21st %ile
Motor-reduced perception95 · 37th %ile

“Within normal limits.” No statement about copying from the board, near endurance, or output rate.

VPA™ domain profile
L1Acuity & sensory foundationincl. field & scanning
strong
L2Visual efficiency
limiting
L3Visual processing
emerging
L4Visual-motor integration
limiting
L5Functional integration
breaking down

Shape, not a single number: efficiency and output fall away while foundation holds.

A norm-referenced score answers “how does this student compare?”. A VPA™ profile answers “where in the visual performance chain does the school day break down?” Both are evidence; only one tells you what to change on Monday.
The VPA™: Assessment & Clinical Reasoning
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Say this

Describe what belongs here: Side-by-side comparison illustrating what each source of evidence shows..

My notes

1.14 — Photo — the referral in context

Visual

Import

Photo — the referral in context

Copy from the boardRepeated far↔near shifts, place-holding, sustained saccades
Worksheet completionNear endurance, figure-ground on a dense page, line tracking
Silent reading blockFixation stability, convergence comfort over 20+ minutes
Chromebook workContrast/glare tolerance, scrolling scan, screen-to-paper shifts
Hallway & lunch transitionsPeripheral awareness, depth on stairs, moving-crowd scanning
Referrals arrive as behavior (“loses place”, “refuses writing”). Name the occupational demand first — the demand is what you assess and what you later document as educational relevance.
The VPA™: Assessment & Clinical Reasoning
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Say this

Describe what belongs here: Classroom photo showing the occupational demand behind a typical referral..

My notes

1.15 — So what? A standard score does not tell you what to change

So what?

So what?

So what? A standard score does not tell you what to change

Norm-referenced batteries tell you where a student ranks. They rarely tell you which condition to change on Monday.

Performance-based assessment manipulates conditions — distance, duration, size, complexity — so the result names the demand that breaks performance.

What you do with it

  • Ask what decision the score will drive before you administer anything.
  • Record the condition under which performance changed, not only the score.
  • Pair any norm-referenced result with a performance observation in the same report.

Watch for

A percentile in the average range beside a student who cannot complete a page — that gap is the finding.

The VPA™: Assessment & Clinical Reasoning
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Say this

Land the "so what": Norm-referenced batteries tell you where a student ranks. They rarely tell you which condition to change on Monday.

Explain the mechanism plainly: Performance-based assessment manipulates conditions — distance, duration, size, complexity — so the result names the demand that breaks performance.

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

My notes

1.16 — Two-minute case: average score, failing student

Mini case

Two-minute case

Two-minute case: average score, failing student

A Grade 3 student scores in the average range on a norm-referenced visual perception battery, yet cannot complete grade-level written work.

What did the battery miss, and what do you do next?

The VPA™: Assessment & Clinical Reasoning
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Say this

Two-minute case. Read it aloud:

A Grade 3 student scores in the average range on a norm-referenced visual perception battery, yet cannot complete grade-level written work.

Put the question to them: "What did the battery miss, and what do you do next?" Give 60 seconds, no talking.

My notes

1.17 — Reflect and share

Reflection

Reflect and share

Reflect and share

Recall a standard score that did not match what you saw in the classroom. What did the battery miss?

THINKPROCESSSHARE
The VPA™: Assessment & Clinical Reasoning
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Say this

Reflection prompt: "Recall a standard score that did not match what you saw in the classroom. What did the battery miss?"

Offer the sentence starter: "The battery score was... but in the classroom I saw... The battery missed..."

Think for one minute, write, then take two shares.

My notes

1.18 — Knowledge check — why performance-based

Self-check

Knowledge check

Knowledge check — why performance-based

What does a norm-referenced perceptual battery not tell you?

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

The VPA™: Assessment & Clinical Reasoning
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Say this

Knowledge check: "What does a norm-referenced perceptual battery not tell you?"

Options:

• How the student compares to same-age peers

My notes