My Top 4 Tips for Observing and Asking Questions When Starting an Evaluation

Uncategorized Jul 03, 2020

So you’re in your first Telehealth evaluation with a parent and child. What are the first steps you should take? How do you know if you’ve done a complete evaluation?

Relax.

I’ll walk you through my assessment process in this blog series.

Let's start with “My Top 4 Tips to Observing and Asking Questions When Starting An Evaluation” I’ll be using peds as my example, but keep in mind this applies to all patients you may encounter!

1) Are you asking the right question(s)?

As a clinician working in paediatrics, it’s important to be focused on the parent interview. You really want to get down to the nitty-gritty and figure out what the parent is having trouble with. I like to ask parents, “What are you struggling with?” This also applies to other clients. Their current struggle is important to focus on because you make their treatment plan individualized to their needs. Here’s how I do it…

Just go straight to the parent/caregiver and ask, “What are you struggling with today, here, now? What are your top three struggles?” If you phrase it like that, you will get a lot of answers to what you can start working on and start helping the family with.

Simple, right?

But I promise, phrasing it this way gives you all the answers and more.

 2) What’s the relationship like between the parent and child?

After you focus on the parent interview, during Telehealth, it’s important to focus on observation.

How does the child interact with their parents? Do they get frustrated when mom or dad gets involved with a session? Do they respond better to parent instructions? Are they independent from their parents or do they rely on their parents for social cues? These are all very important because it tells you a lot about how the parent and child communicate with each other.

3) Environment Inventory- Are you being observant of the home environment?

Next, take an inventory of the environment. Have them walk you around the house, the child’s bedroom, etc. Not only does this give you an overview of the child’s environment, but it also gives you ideas for ways you can make their environment functional and therapeutic for them. For example, you can ask the parent, “Is it okay if in a future session we use your dining room chairs to have your child crawl under as a part of an obstacle course?” Find out what the parent is okay with the child using for therapeutic interventions.

Ask about- Do they help you cook or prepare meals? How does the child get ready for the day? Where do they play? Write all of this down.

4) Review the parent intake form

I like to have this conversation with the parents so we’re on the same page. For example, if they write a certain medication I can ask questions about it so I find out exactly what I need to know about it. Take a good medical history too!

Talk to the parent about the child’s school history. Are they in public school or private school? Are they homeschooled? What kind of classroom are they in? If they’re in public school or private school, are they in a special needs classroom? Do they have push-in or pull-out services during school? What other services do they receive in school? Have they ever had OT before or any other therapy in the past?

Ask about their social history–Who do they live with? Who do they visit with? Do they go to childcare?

Ask about birth history–Was it a vaginal or cesarean birth? Did they have a stay in the NICU? Have they had any surgeries?

All the things that you should ask in a regular evaluation, you want to be asking during a Telehealth evaluation.

I hope this blog post gave you some perspective on how to tackle the initial part of your evaluation! It takes time to develop a process that feels comfortable for you, but once you streamline it, it becomes second nature!

If you’d like to connect further join my Telehealth OT Facebook Group

Or if you’re ready to take the leap into Telehealth, try my Telehealth OT Master Course here.

 

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