The VPA™: Assessment & Clinical Reasoning

Transition: "Documentation, disposition, referral decisions, and post-course examination."

Open here. "Documentation, Disposition, and Referral." Closing the loop before the post-course examination.

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

Frame the slide: "A defensible VPA™ report."

Walk each point, one sentence each:

• Occupational profile and referral question stated first.

• Setup conditions and any validity threats recorded.

• Achieved level per skill and the domain profile shape.

• Occupation-based goals with FITT-P dosage.

• Explicit disposition for every flagged finding.

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

Frame the slide: "Referral decision rules."

Walk each point, one sentence each:

• Any ocular symptom, pain, or unexplained acuity loss — refer to eye care now.

• Persistent near-work discomfort despite clean OT-side performance — refer.

• Deeper skill-specific measurement warranted — consider adjunct standardized tools.

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

Frame the slide: "How the profile actually defines the intervention."

Walk each point, one sentence each:

• Bottom-heavy (floor unstable, top low): treat at the lowest unstable level. Efficiency work inside a reading or writing task, not isolated drill — and the referral goes out the same week.

• Notch (one level down, floors and ceiling intact): treat that level directly. A Level 3 notch means discrimination and figure-ground inside real page layouts, not oculomotor work.

• Top-heavy (L1–L3 intact, L4–L5 down): a production problem. Split the plan between graded visual-motor practice and output-format accommodation, weighted toward accommodation as age increases.

• Flat and low across all five: suspect a validity threat or a global factor before you write any plan. Re-probe on a different day first.

• Flat and high with a persistent complaint: the limiter is probably not visual. Say so, and hand the question back to the team.

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

Contrast the two columns: The five decisions versus Worked example.

The five decisions:

• Frequency — how many sessions per week.

• Intensity — how hard, set by the level just above the achieved level.

• Time — minutes per session, capped by the endurance you measured.

• Type — the occupation the practice is embedded in (reading, copying, worksheet navigation).

• Progression — the criterion that moves the student up a level, decided before you start.

Worked example:

• Finding: Level 2 efficiency achieved, reading decay at 4 minutes.

• F: 2×/week direct, plus a daily 3-minute classroom routine.

• I: L3 saccade demand — grade-level print, 8 items per column.

• T: 6 minutes of near work per block, below the measured decay point.

• Type: place-keeping within the student’s actual reading assignment.

• P: re-probe at 6 weeks; advance when reading holds 6 minutes without place loss on two consecutive sessions.

Ask: "Which column is your student living in right now?"

Frame the slide: "From achieved level to an IEP-ready goal."

Walk each point, one sentence each:

• Name the occupation first: "During independent silent reading of grade-level text…"

• Name the measurable visual behavior: "…will maintain place without loss for 6 minutes…"

• Name the condition you measured under: "…at a 40 cm working distance with habitual correction…"

• Name the criterion and the schedule: "…on 3 of 4 consecutive data days by the annual review."

• The goal sits at Level 5 (the occupation) even when the treatment sits at Level 2 (the limiter).

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

Contrast the two columns: Levels 1–2 — access and efficiency versus Levels 3–5 — processing, production, occupation.

Levels 1–2 — access and efficiency:

• L1 Access: contrast-graded search (Hidden Shapes in Contrast), print and lighting changes, seat and board-copy substitution. Referral runs in parallel when the finding is new.

• L2 Pursuits: Follow the Ball and Tracking Patterns, then the same demand embedded in a line of text.

• L2 Saccades: Saccade Sweep, Arrow / Zigzag Tracker, Z-Pattern Scan Grid, then Jumping Words in the student’s own assignment.

• L2 Convergence: Convergence Zoom under the endurance ceiling you measured — never past the decay point.

Levels 3–5 — processing, production, occupation:

• L3 Discrimination / form constancy: Shape Shifter Safari, Form Constancy Challenge, Letter Hunt.

• L3 Figure-ground and closure: Hidden Treasure Hunt, Complete the Object, Mystery Object Reveal — then the same demand on a real worksheet page.

• L3 Visual memory: Visual Memory Grid, Object Sequence, graded by set size and exposure.

• L4 Visual-motor: Visual Motor Skills and Follow the Path, graded from copy to dictation to generative writing.

• L5 Functional: place-keeping and endurance inside the actual reading or writing assignment, timed against the measured decay point.

Ask: "Which column is your student living in right now?"

Frame the slide: "Three rules that keep the activity honest."

Walk each point, one sentence each:

• Treat at the lowest unstable level, but measure progress at Level 5. If reading did not change, the activity did not matter.

• Grade one variable at a time — duration, print size, item density, or motor demand. Change two and you cannot tell what worked.

• Embed before you drill. Ten minutes of isolated saccade practice with no transfer step is the most common failure in school-based vision intervention.

• Stop below the endurance ceiling you measured. Training through fatigue trains the compensation, not the skill.

• Every remedial target gets a paired access change the teacher can keep whether or not the remediation works.

Close with: "If you only take one of these back, take the first one."

Land the "so what": Every completed VPA ends in one of four decisions: treat, refer, monitor, or reassess. Naming it is what makes the assessment actionable.

Explain the mechanism plainly: Assessment without a stated disposition puts the decision back on a team that does not have your training.

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

• State the disposition in the first paragraph of the report.

• Name the referral separately from the OT plan so scope is visible.

• Set the reassessment date before you close the file.

Tell them what success looks like: A report the team reads and then asks "so what do we do?" — that means the disposition was buried.

Ask: "Who has a student this describes right now?" Take one answer, then move.

Knowledge check: "Aiden, 15: Levels 1–3 at criterion, Level 4 achieved L2, Level 5 writing slow and disorganized, refuses written work. What does the plan lead with?"

Options:

• Oculomotor efficiency drills, since output problems usually start with tracking.

• Graded visual-motor practice at Level 4 plus output-format accommodation now, weighted toward accommodation given his age and the course-credit cost.

• A processing program, since disorganized writing implies a perceptual deficit.

• Wait for the eye examination before writing any plan.

Correct answer: option 2. Rationale: Levels 1–3 are stable, so efficiency and perception are ruled out as limiters. The unstable level is 4, and that is the entry point. At age 15 the occupational cost of continued illegible output is measured in refused assignments and lost credit, so compensation cannot wait on remediation — and nothing in this profile triggers a hold for eye care.

Transition: "Intervention Planning Using the Five-Level Framework."

Preview:

• FITT-P protocols written out by domain and age band, not just the one worked example.

• Long-term goals, short-term objectives, and the progress-monitoring data set that defends them.

• Selecting and grading Vision Library activities against a specific achieved level.

• Transfer design: how each activity gets carried into reading, copying, and written output.

• Knowing when to advance a level, when to hold, and when to stop and re-assess.

Contrast the two columns: Team and family versus Eye care provider.

Team and family:

• One-sentence occupational impact statement

• The conditions that improved performance

• The support to keep in the classroom

• Re-probe date and what will be measured

Eye care provider:

• Observed performance and the conditions it occurred under

• Symptom report in the student’s words

• The specific question you are asking

• No diagnosis, no lens or therapy recommendation

Ask: "Which column is your student living in right now?"

Frame the slide: "When to run the VPA™ again."

Walk each point, one sentence each:

• At the end of each intervention block, using the identical probes.

• After any change in correction, medication, or medical status.

• Before an annual review or eligibility decision.

• Never mid-block on impression — it corrupts your own comparison.

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

Frame the slide: "Writing the address-vs-refer decision into the report."

Walk each point, one sentence each:

• State the functional limitation in occupational terms, then the OT plan that addresses it now.

• For diagnosed and managed acuity, contrast, or field loss: name the modification, dosage, and where it is used — no referral needed for that item.

• For anything undiagnosed, unverified, mismatched, or newly changing: write a scope-safe referral with the observations that triggered it.

• For an undiagnosed or new finding, document the referral as the action; add the vision-specific modification once a diagnosis is on file.

• Re-state the rule for the team: OT owns the occupational performance problem; the eye care provider owns the diagnosis.

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

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

Describe what belongs here: De-identified report pages showing profile, goals, and disposition..

Describe what belongs here: Scope-safe referral wording you use with eye care providers..

Reflection prompt: "Name the two students you will assess in the next two weeks, the depth you will use, and the fidelity items you will watch."

Offer the sentence starter: "Student 1: [depth] with fidelity watch on... Student 2: [depth] with fidelity watch on..."

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

Talk through this close step in Module 8.