Presenter study handout

8.1 — Documentation, disposition, referral decisions, and post-course examination

Transition

Module 8

Documentation, disposition, referral decisions, and post-course examination

3:40 – 4:00

The VPA™: Assessment & Clinical Reasoning

1 / 20

Say this

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

My notes

8.2 — Documentation, Disposition, and Referral

Title

Module 8

Documentation, Disposition, and Referral

Closing the loop before the post-course examination.

The VPA™: Assessment & Clinical Reasoning

2 / 20

Say this

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

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

My notes

8.3 — A defensible VPA™ report

Teaching slide

Report

A defensible VPA™ report

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.

Reduced acuity, suspected pathology, or new-onset changeRefer — optometry / ophthalmology

Meanwhile OT addresses it: magnification, enlarged print, working distance, seating.

Diplopia, receded NPC, suppression signsRefer — binocular vision evaluation

Meanwhile OT addresses it: shortened near-work bouts, task rotation, print size and spacing.

Field loss or neurological signsRefer — medical, same day if acute

Meanwhile OT addresses it: scanning and anchoring, line tracking, materials in the intact field.

Diagnosed and medically managed acuity, contrast, or field lossOT addresses it — no new referral

High-contrast materials, glare and lighting control, magnification, placement — treat the functional limitation.

Efficiency or perceptual limiter, eye health clearedOT plan of care

Goal, dosage, and condition-specific supports drawn from the recorded performance profile.

Environmental or task mismatch onlyConsultation and adaptation

Change the material, the lighting, or the task demand — no direct service required.

Disposition rules. A referral is never the whole OT output — the modification goes in the same day the referral is written.

The VPA™: Assessment & Clinical Reasoning

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Say this

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

Walk each point, one sentence each:

• Occupational profile and referral question stated first.

My notes

8.4 — Referral decision rules

Teaching slide

Referral

Referral decision rules

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.

Stage	What it is	What it gives you
Observation	What you can do after today	Describe visual performance, refer, modify the task
Structure	What a level-based framework adds	Order of examination, meaning of a finding, sequencing language
Measurement	What standardized assessment adds	Fixed administration, scoring, basal/ceiling, re-measurable baseline
Plan of care	What the combination produces	Defensible goals, documentation, and progress statements

Each stage constrains the next. Observation without structure is unordered; structure without measurement cannot show change.

The VPA™: Assessment & Clinical Reasoning

4 / 20

Say this

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.

My notes

8.5 — How the profile actually defines the intervention

Teaching slide

Profile → plan

How the profile actually defines the intervention

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.

Flat low

Global limiter or validity threat — check conditions first.

Bottom-heavy

Efficiency floor unstable; perception intact. Grade near-point demand.

Top-heavy

Floors stable; processing and integration limit output.

Notched

Single-level deficit — the cleanest intervention target.

Read shape before you read any single score. Shape names the limiter; the limiter names the plan.

The shape names the entry point. The entry point names the intervention. Nothing in the plan should come from the composite alone.

The VPA™: Assessment & Clinical Reasoning

5 / 20

Say this

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.

My notes

8.6 — FITT-P — turning an entry point into a dose

Comparison

Dosage

FITT-P — turning an entry point into a dose

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.

VML Treatment Template · Level 2 entry

LTG · Complete 80% of assigned copy lines in 20 minutes with ≤2 losses of place.

STO · Sustain accurate line-to-line tracking for 3 × 60 s trials with a line guide.

Frequency

3× / week

Intensity

Line-isolated → full page

Time

15 min embedded

Type

Copy task within academics

Progression

Fade guide at 80% × 3

A treatment template forces dosage to be explicit. FITT-P (frequency, intensity, time, type, progression) turns “work on visual skills” into something a colleague could replicate and a district could fund.

Write the re-probe date into the plan on the day you write the goal. A dose without a progression criterion is a habit, not an intervention.

The VPA™: Assessment & Clinical Reasoning

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Say this

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

The five decisions:

• Frequency — how many sessions per week.

My notes

8.7 — From achieved level to an IEP-ready goal

Teaching slide

Goal writing

From achieved level to an IEP-ready goal

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).

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.

The VPA™: Assessment & Clinical Reasoning

7 / 20

Say this

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…"

My notes

8.8 — What the plan actually looks like at each level

Comparison

Entry point → activity

What the plan actually looks like at each level

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.

Activity library · filtered by level

L1Contrast-enhanced single-symbol cardCan the signal get in?

L2Line-isolated tracking strip, 30 s trialsEfficiency under time

L3Figure-ground search on a dense pageProcessing under clutter

L4Copy-from-model grid with spacing cuesPerception → motor output

L5Timed board-to-paper copy in the classroomReal occupational demand

Every activity in the library is tagged to the level it actually loads. Tagging is what keeps intervention entering at the level where performance broke down instead of defaulting to worksheets.

Every activity named here is in the Vision Library inside this platform, and the age-band filter already hides the pediatric-voiced items for teen and adult clients. The activity is never the plan — the level is the plan, and the activity is one way to dose it.

The VPA™: Assessment & Clinical Reasoning

8 / 20

Say this

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.

My notes

8.9 — Three rules that keep the activity honest

Teaching slide

Grading rules

Three rules that keep the activity honest

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.

The VPA™: Assessment & Clinical Reasoning

9 / 20

Say this

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.

My notes

8.10 — So what? Disposition is where certification becomes practice

So what?

So what? Disposition is where certification becomes practice

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

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

What you do with it

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.

Watch for

A report the team reads and then asks "so what do we do?" — that means the disposition was buried.

The VPA™: Assessment & Clinical Reasoning

10 / 20

Say this

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:

My notes

8.11 — Pick the entry point

Self-check

Check

Pick the entry point

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?

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

The VPA™: Assessment & Clinical Reasoning

11 / 20

Say this

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.

My notes

8.12 — Intervention Planning Using the Five-Level Framework

Transition

Course 3

Intervention Planning Using the Five-Level Framework

This course ends where the plan begins. Course 3 takes the profile you just learned to read and builds the full plan of care from it.

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.

The VPA™: Assessment & Clinical Reasoning

12 / 20

Say this

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.

My notes

8.13 — Who gets what from the report

Comparison

Hand-off

Who gets what from the report

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

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.

The VPA™: Assessment & Clinical Reasoning

13 / 20

Say this

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

Team and family:

• One-sentence occupational impact statement

My notes

8.14 — When to run the VPA™ again

Teaching slide

Re-assessment

When to run the VPA™ again

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.

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.

The VPA™: Assessment & Clinical Reasoning

14 / 20

Say this

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.

My notes

8.15 — Writing the address-vs-refer decision into the report

Teaching slide

Disposition

Writing the address-vs-refer decision into the report

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.

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

15 / 20

Say this

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.

My notes

8.16 — Module 8 video — documentation and disposition

Video

Lecture

Module 8 video — documentation and disposition

VIDEO SLOT

Report structure, referral wording, and re-assessment timing.

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

The VPA™: Assessment & Clinical Reasoning

16 / 20

Say this

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

My notes

8.17 — Screenshot — generated VPA™ clinical report

Visual

Import

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.

The VPA™: Assessment & Clinical Reasoning

17 / 20

Say this

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

My notes

8.18 — Screenshot — referral letter template

Visual

Import

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.

The VPA™: Assessment & Clinical Reasoning

18 / 20

Say this

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

My notes

8.19 — Before you test — plan your first administrations

Reflection

Reflect and share

Before you test — plan your first administrations

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

THINKPROCESSSHARE

The VPA™: Assessment & Clinical Reasoning

19 / 20

Say this

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.

My notes

8.20 — Where you go from here

Next steps

Where you go from here

Fidelity comes from repetition. Schedule your first two administrations this week.

Do this next

1.Pass the post-course examination (80%, unlimited retakes).
2.Submit the course evaluation to release your certificate.
3.Run one Mini VPA™ scored against the fidelity checklist.
4.Bring one profile to interpretation and write the disposition.

Resources

Administration-fidelity checklist (20 items)
Printable VPA™ protocols and worksheets
Interpretation rubric and referral decision rules
Course reference list and evidence table

Questions: jeff@visualmindslearning.com · Certificates verify at visualmindslearning.com/ceu/verify

Visual Minds Learning · AOTA Approved Provider #0000001618

The VPA™: Assessment & Clinical Reasoning

20 / 20

Say this

Talk through this close step in Module 8.

My notes