School Systems Specialty Certification

SCHOOL SYSTEMS SPECIALTY CERTIFICATION Occupational Therapist Assistant Table of Contents: ACTIVITY EVIDENCE FORMS

Guidelines: Instructions:  Applicant must address 6 of the 11 criteria,  Please complete 1 form for each criterion selected. including #9 – ethical practice, by choosing one  Combine completed forms in a single document (1) available option for each. (e.g., Word or .PDF) and submit with the  Please note that the term “ensures” can refer to completed Part 1 application to direct service delivery or the supervision or https://www.filesdirect.com/AOTACertification teaching of others.  Please do not include unused forms.  Reflections should demonstrate an advancement in professional development from initial certification.

Criterion 1: Knowledge: Diagnostic  Publication – Reviewed by Expert(s) Considerations Criterion 5: Assessment: Performance Skills  AOTA Certification Application Reviewer  Expert Witness  Analysis of Recording or Observation  Formal Learning (Min. 10 contact hours needed)  Case Study  Independent Learning (Min. 10 contact hours  Mentee (does not include supervisory needed) relationship)  Mentee (does not include supervisory  relationship)  Publication – Reviewed by Expert(s)

Criterion 2: Knowledge: Assessment

 AOTA Certification Application Reviewer  Expert Witness Criterion 6: Intervention: Performance Skills  Formal Learning (Min. 10 contact hours needed)  Independent Learning (Min. 10 contact hours  Analysis of Recording or Observation needed)  Case Study, Client-Based  Mentee (does not include supervisory  Case Study, Instructional relationship)  Formal Specialized Consultation for Intervention  Publication – Reviewed by Expert(s)  Program Development Criterion 3: Knowledge: Intervention  Research   AOTA Certification Application Reviewer Criterion 7: Intervention: Critical Reasoning  Expert Witness  Analysis of Recording or Observation  Formal Learning (Min. 10 contact hours needed)  Case Study, Client-Based  Independent Learning (Min. 10 contact hours  Case Study, Instructional needed) Formal Specialized Consultation for Intervention  Mentee (does not include supervisory  relationship)  Program Development  Publication – Reviewed by Expert(s)  Research  Criterion 4: Knowledge: Regulation & Payers Criterion 8: Psychosocial Critical Reasoning

 AOTA Certification Application Reviewer  Analysis of Recording or Observation  Expert Witness  Case Study, Client-Based  Formal Learning (Min. 3 contact hours needed)  Case Study, Instructional  Independent Learning (Min. 3 contact hours  Formal Specialized Consultation for Psychosocial needed)  Program Development  Mentee (does not include supervisory  Research relationship)  © 2016 The American Occupational Therapy Association, Inc. All rights reserved. Criterion 9: Ethical Practice  Criterion 11: Advocating for Change  The 3 ethical practice scenarios are found within the application itself.  Advocacy Efforts   Case Study, Advocacy Criterion 10: Establishes Networks  Volunteer Leadership  Formal Specialized Consultation  Marketing Activities  Presentation  Volunteer Leadership

Criterion 1–Knowledge: Diagnostic Considerations Demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems.

Guidelines  Complete required training for reviewers at the time of the review period, or once every 2 application cycles if reviewing more than once per year.  Serve as a reviewer for 3 AOTA Specialty Certification applications in school systems in the last 5 years.

1. Please verify activity information:

Date(s) of reviewer training Date(s) of application review Total number of applications reviewed

2. Describe how the knowledge acquired from this activity helped you “demonstrate knowledge of primary and secondary conditions that impact occupational engagement related to school systems.” How did the activity influence the way you practice, or how did it affect your outcomes? (average word guideline–350) EXPERT WITNESS Back to Criteria

Guidelines  Serving as an expert witness in a civil or criminal legal case court or in arbitration.  Providing expert testimony in official hearings at the local, state, or national level.

1. Describe the expertise which you were able to share relevant to school systems. (average word guideline–200)

2. Describe how the knowledge acquired from this activity “demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)

3. Submit verification of activity as a separate attachment. May include any 1 of the following:  Transcript of the testimony.  Notice of deposition.  Letter from the attorney. FORMAL LEARNING Back to Criteria

Guidelines  Minimum of 10 contact hours required.  Multiple activities may be used to meet the hour requirement for the criterion.  Learning must have occurred in the past 5 years.

Please identify the type of activity in which you participated:

☐ AOTA CE: Participation in CE course from AOTA. Does not include courses from AOTA Approved Providers. Completion of course will be verified by AOTA. Submission of additional documentation beyond this form not required.

☐ Non-AOTA CE: Attending workshops, seminars, lectures, or professional conferences with formal established objectives.

☐ Participation in post-professional academic coursework. Attach unofficial transcript.

1. Activity information.

Activity Title

Provider/Instructor

Activity Date(s)

No. of Contact Hours

2. Activity Learning Objectives. List up to 5. A)

E) 3. Describe the relevance of the activity to your practice in school systems. (average word guideline– 200) 4.

5. 6. 7. Describe how the knowledge acquired from this activity “demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 8.

9. 10. Submit documentation that verifies completion of the activity, such as certificate of completion or unofficial transcript. Not required for AOTA courses. 11. a. INDEPENDENT LEARNING 12. Back to Criteria

13. Criterion 1–Knowledge: Diagnostic Considerations 14. Demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems. 15. 16. 17. Guidelines  Minimum of 10 contact hours required.  Multiple activities may be used to meet the hour requirement for the criterion.  Learning must have occurred in the past 5 years. 18. 19. Please identify the type of independent learning activity in which you participated:

20. ☐ Independent reading of recent peer-reviewed, professional articles, or chapters in textbook not associated with a formal learning course. 21. ☐ Independent review of professional electronic resources (e.g., NIH, CDC, CanChild). 22. ☐ AOTA Journal Club Toolkit (reading & discussion time). Must be AOTA member to access the kit. 23. ☐ AOTA Critically Appraised Paper (CAP, includes submission to the AOTA Evidence Exchange). 24. 1. Why did you choose this activity?

25. ☐ Clinical reference for specific population, program, or individual 26. ☐ Invited peer review of scholarly work or publication (print or online) 27. ☐ Preparation for poster or presentation 28. ☐ Preparation for academic lecture 29. ☐ Literature review for research project 30. ☐ Preparation for serving as a mentor 31. ☐ Other, please specify: 32. 2. Bibliography (APA Format) or list and objectives of select item(s) used for independent learning. 33.

34. 3. Date(s) of independent learning 35.

36. 4. Time spent engaged in independent learning.  For reading, estimate 8–12 published pages/hour.  For journal club, discussion time counts toward 10-hour requirement. 37. 38. 5. Describe the relevance of the independent learning activity to your practice in school systems. (average word guideline–200) 6.

7. 8. Describe how the knowledge acquired from this activity “demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 9.

10. 11. 12. a. MENTEE 13. Back to Criteria

14. Criterion 1–Knowledge: Diagnostic Considerations 15. Demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems. 16. 17. 18. Guidelines  Must represent a minimum of 10 hours over a minimum of 2 months.  Does not include supervisory relationships.  Relationship must have occurred in the past 5 years.  May be with a non-occupational therapy professional if appropriate to goal(s) of relationship. 19. 1. Dates of mentoring relationship 20. 21. 2. Approximately how many hours did this represent in total? 22. 23. 3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application. List no more than 3. 24. A)

25. 4. 27. 26. Mentor 29. 28. Position/Role of Mentor 31. 30. Workplace of Mentor 32. Contact Information for 33. Mentor (email or phone number) 34. 5. State why the mentor was selected to help you meet the goals identified above relative to the criterion. (average word guideline–50) 6.

7. 6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of primary and secondary conditions that impact occupational engagement related to school systems.” (average word guideline–200) 8.

9. 10. a. PUBLICATION – REVIEWED BY EXPERT(S) 11. Back to Criteria

12. Criterion 1–Knowledge: Diagnostic Considerations 13. Demonstrates knowledge of primary and secondary conditions that impact occupational engagement related to school systems. 14. 15. 16. Guidelines  Examples of publication reviewed by experts include journals such as AJOT or OTJR.  May include a chapter in an occupational therapy or related professional textbook, if chapter has gone through peer review (a process in which subject matter experts, using a formal system and defined guidelines, provide content guidance to an author and recommend publication, revision, or rejection of a work). 17. 18. 1. Submit APA reference for the publication. For in-press publication, also include a verification letter or e-mail identifying applicant and anticipated date of publication. 19.

20. 21. 2. If applicant is not identified as first or second author, please describe your contribution/involvement in the development of the publication. (average word guideline–200) 22.

23. 3. Provide a reflection indicating why this publication was chosen to represent “knowledge of primary and secondary conditions that impact occupational engagement related to school systems.” (average word guideline–200) 24.

25. a. AOTA CERTIFICATION APPLICATION REVIEWER 26. Back to Criteria

27. Criterion 2–Knowledge: Assessment 28. Demonstrates knowledge of relevant evidence specific to assessment in school systems. 29.

30. Guidelines  Complete required training for reviewers at the time of the review period, or once every 2 application cycles if reviewing more than once per year.  Serve as a reviewer for 3 AOTA Specialty Certification applications in school systems in the last 5 years. 31. 32. 1. Please verify activity information: 33. 34. Date(s) of reviewer 35. training 36. Date(s) of 37. application review 38. Total number of 39. applications reviewed 40. 41. 2. Describe how the knowledge acquired from this activity helped you “demonstrate knowledge of relevant evidence specific to assessment in school systems.” How did the activity influence the way you practice, or how did it affect your outcomes? (average word guideline–350) 42. 43.

44. 45. 46. a. EXPERT WITNESS 47. Back to Criteria

48. Criterion 2–Knowledge: Assessment 49. Demonstrates knowledge of relevant evidence specific to assessment in school systems. 50. 51. 52. Guidelines  Serving as an expert witness in a civil or criminal legal case court or in arbitration.  Providing expert testimony in official hearings at the local, state, or national level. 53. 1. Describe the expertise which you were able to share relevant to school systems. (average word guideline–200) 54.

55. 2. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to assessment in school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 56.

57. 3. Submit verification of activity as a separate attachment. May include any 1 of the following:  Transcript of the testimony.  Notice of deposition.  Letter from the attorney. a. FORMAL LEARNING 58. Back to Criteria 59. 60. Criterion 2–Knowledge: Assessment 61. Demonstrates knowledge of relevant evidence specific to assessment in school systems. 62. 63. 64. Guidelines  Minimum of 10 contact hours required.  Multiple activities may be used to meet the hour requirement for the criterion.  Learning must have occurred in the past 5 years. 65. 66. Please identify the type of activity in which you participated:

67. ☐ AOTA CE: Participation in CE course from AOTA. Does not include courses from AOTA Approved Providers. Completion of course will be verified by AOTA. Submission of additional documentation beyond this form not required.

68. ☐ Non-AOTA CE: Attending workshops, seminars, lectures, or professional conferences with formal established objectives.

69. ☐ Participation in post-professional academic coursework. Attach unofficial transcript. 70. 1. Activity information. 71. 73. 72. Activity Title 75. 74. Provider/Instructor 77. 76. Activity Date(s) 78. No. of Contact 79. Hours 80. 2. Activity Learning Objectives. List up to 5. A)

81. 3. Describe the relevance of the activity to your practice in school systems. (average word guideline– 200) 4.

5. 6. 7. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to assessment in school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 8.

13. Criterion 2–Knowledge: Assessment 14. Demonstrates knowledge of relevant evidence specific to assessment in school systems. 15. 16. 17. Guidelines  Minimum of 10 contact hours required.  Multiple activities may be used to meet the hour requirement for the criterion.  Learning must have occurred in the past 5 years. 18. 19. Please identify the type of independent learning activity in which you participated:

7. 8. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to assessment in school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 9.

14. Criterion 2–Knowledge: Assessment 15. Demonstrates knowledge of relevant evidence specific to assessment in school systems. 16. 17. 18. Guidelines  Must represent a minimum of 10 hours over a minimum of 2 months.  Does not include supervisory relationships.  Relationship must have occurred in the past 5 years.  May be with a non-occupational therapy professional if appropriate to goal(s) of relationship. 19. 1. Dates of mentoring relationship 20. 21. 2. Approximately how many hours did this represent in total? 22. 23. 3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application. List no more than 3. 24. A)

7. 6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of relevant evidence specific to assessment in school systems.” (average word guideline–200) 8.

12. Criterion 2–Knowledge: Assessment 13. Demonstrates knowledge of relevant evidence specific to assessment in school systems. 14. 15. 16. Guidelines  Examples of peer-reviewed publication include journals such as AJOT or OTJR.  May include a chapter in an occupational therapy or related professional textbook, if chapter has gone through peer review (a process in which subject matter experts, using a formal system and defined guidelines, provide content guidance to an author and recommend publication, revision, or rejection of a work). 17. 18. 1. Submit APA reference for the publication. For in-press publication, also include a verification letter or e-mail identifying applicant and anticipated date of publication. 19.

23. 3. Provide a reflection indicating why this publication was chosen to represent “knowledge of relevant evidence specific to assessment in school systems.” (average word guideline–200) 24.

25. a. AOTA CERTIFICATION APPLICATION REVIEWER Back to Criteria

Criterion 3–Knowledge: Intervention Demonstrates knowledge of relevant evidence specific to intervention in school systems.

2. Describe how the knowledge acquired from this activity helped you “demonstrate knowledge of relevant evidence specific to intervention in school systems.” How did the activity influence the way you practice, or how did it affect your outcomes? (average word guideline–350) EXPERT WITNESS Back to Criteria

2. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to intervention in school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)

Activity Title

Provider/Instructor

Activity Date(s)

5. 6. 7. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to intervention in school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 8.

13. Criterion 3–Knowledge: Intervention 14. Demonstrates knowledge of relevant evidence specific to intervention in school systems. 15. 16. 17. Guidelines  Minimum of 10 contact hours required.  Multiple activities may be used to meet the hour requirement for the criterion.  Learning must have occurred in the past 5 years. 18. 19. Please identify the type of independent learning activity in which you participated:

7. 8. Describe how the knowledge acquired from this activity “demonstrates knowledge of relevant evidence specific to intervention in school systems.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 9.

14. Criterion 3–Knowledge: Intervention 15. Demonstrates knowledge of relevant evidence specific to intervention in school systems. 16. 17. 18. 19. Guidelines  Must represent a minimum of 10 hours over a minimum of 2 months.  Does not include supervisory relationships.  Relationship must have occurred in the past 5 years.  May be with a non-occupational therapy professional if appropriate to goal(s) of relationship. 20. 1. Dates of mentoring relationship 21. 22. 2. Approximately how many hours did this represent in total? 23. 24. 3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application. List no more than 3. 25. A)

7. 6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of relevant evidence specific to intervention in school systems.” (average word guideline–200) 8.

9. a. PUBLICATION – REVIEWED BY EXPERT(S) 10. Back to Criteria

11. Criterion 3–Knowledge: Intervention 12. Demonstrates knowledge of relevant evidence specific to intervention in school systems. 13. 14. 15. Guidelines  Examples of publication reviewed by experts include journals such as AJOT or OTJR.  May include a chapter in an occupational therapy or related professional textbook, if chapter has gone through peer review (a process in which subject matter experts, using a formal system and defined guidelines, provide content guidance to an author and recommend publication, revision, or rejection of a work). 16. 17. 1. Submit APA reference for the publication. For in-press publication, also include a verification letter or e-mail identifying applicant and anticipated date of publication. 18.

22. 3. Provide a reflection indicating why this publication was chosen to represent “knowledge of relevant evidence specific to intervention in school systems.” (average word guideline–200) 23.

24. a. AOTA CERTIFICATION APPLICATION REVIEWER Back to Criteria

Criterion 4–Knowledge: Regulation & Payers Demonstrates knowledge of laws and regulations relevant to school systems, including payer sources.

2. Describe how the knowledge acquired from this activity helped you “demonstrate knowledge of laws and regulations relevant to school systems, including payer sources.” How did the activity influence the way you practice, or how did it affect your outcomes? (average word guideline–350) EXPERT WITNESS Back to Criteria

2. Describe how the knowledge acquired from this activity “demonstrates knowledge of laws and regulations relevant to school systems, including payer sources.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200)

Activity Title

Provider/Instructor

Activity Date(s)

5. 6. 7. Describe how the knowledge acquired from this activity “demonstrates knowledge of laws and regulations relevant to school systems, including payer sources.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 8.

13. Criterion 4–Knowledge: Regulation & Payers 14. Demonstrates knowledge of laws and regulations relevant to school systems, including payer sources. 15. 16. 17. Guidelines  Minimum of 3 contact hours required.  Multiple activities may be used to meet the hour requirement for the criterion.  Learning must have occurred in the past 5 years. 18. 19. Please identify the type of independent learning activity in which you participated:

7. 8. Describe how the knowledge acquired from this activity “demonstrates knowledge of laws and regulations relevant to school systems, including payer sources.” How did the activity influence the way you practice, or how did it affect your client outcomes? (average word guideline–200) 9.

14. Criterion 4–Knowledge: Regulation & Payers 15. Demonstrates knowledge of laws and regulations relevant to school systems, including payer sources. 16. 17. 18. Guidelines  Must represent a minimum of 10 hours over a minimum of 2 months.  Does not include supervisory relationships.  Relationship must have occurred in the past 5 years.  May be with a non-occupational therapy professional if appropriate to goal(s) of relationship. 19. 1. Dates of mentoring relationship 20. 21. 2. Approximately how many hours did this represent in total? 22. 23. 3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application. List no more than 3. 24. A)

7. 6. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “demonstrate knowledge of laws and regulations relevant to school systems, including payer sources.” (average word guideline–200) 8.

12. Criterion 4–Knowledge: Regulation & Payers 13. Demonstrates knowledge of laws and regulations relevant to school systems, including payer sources. 14. 15. 16. Guidelines  Examples of publication reviewed by experts include journals such as AJOT or OTJR.  May include a chapter in an occupational therapy or related professional textbook, if chapter has gone through peer review (a process in which subject matter experts, using a formal system and defined guidelines, provide content guidance to an author and recommend publication, revision, or rejection of a work). 17. 18. 1. Submit APA reference for the publication. For in-press publication, also include a verification letter or e-mail identifying applicant and anticipated date of publication. 19.

23. 3. Provide a reflection indicating why this publication was chosen to represent “knowledge of laws and regulations relevant to school systems, including payer sources.” (average word guideline–200) 24.

25. 26. a. ANALYSIS OF RECORDING or OBSERVATION 27. Back to Criteria 28. 29. Criterion 5—Assessment: Performance Skills 30. Administers standardized assessments as delegated by the supervising occupational therapist specific to school systems, consistently integrating clinical observations.

31. 32. 33. Guidelines  Submission of actual recording is not required for application; however, appropriate permissions should be obtained by applicant whenever engaging a client in a recorded session.  Observation should be consultative or instructive in nature and a minimum of 1 hour. It may occur over multiple sessions. 34. 1. 36. 35. Age of Client 37. Client 38. Diagnosis(es) 39. Setting for 40. Evaluation 41. Date of 42. Recording or Observation 43. 44. 1. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “ensure that standardized assessments specific to school systems are administered correctly and include the integration of clinical observations throughout the evaluation process.” (average word guideline–200) 45.

46. 2. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to evaluation – performance skills. (average word guideline–400) 3.

4. 5. 1) CASE STUDY 6. Back to Criteria 7. 8. Criterion 5—Assessment: Performance Skills 9. Administers standardized assessments as delegated by the supervising occupational therapist specific to school systems, consistently integrating clinical observations. 10. 11. 12. Guidelines  Client-based case study should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information.

13. 14. 1. Date(s) case study represents 15. 16. 2. Describe the client, client factors, and case contexts for the identified case. The context of the case should be adequately communicated so that relevance and merit of the case to the criterion is easily determined. (average word guideline–500) 17.

18. 3. Articulate how this case demonstrates how you “ensure that standardized assessments specific to school systems are administered correctly and include the integration of clinical observations throughout the evaluation process.” (average word guideline–500) 4. o MENTEE 5. Back to Criteria 6. 7. Criterion 5—Assessment: Performance Skills 8. Administers standardized assessments as delegated by the supervising occupational therapist specific to school systems, consistently integrating clinical observations.

9. 10. 11. Guidelines  Must represent a minimum of 10 hours over a minimum of 2 months.  Does not include supervisory relationships.  Relationship must have occurred in the past 5 years.  May be with a non-occupational therapy professional if appropriate to goal(s) of relationship. 12. 1. Dates of mentoring relationship 13. 14. 2. Approximately how many hours did this represent in total? 15. 16. 3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application. List no more than 3. 17. A)

7. 8. Briefly describe how the knowledge acquired from this mentoring activity influenced your practice specific to your ability to “ensure that standardized assessments specific to school systems are administered correctly and include the integration of clinical observations throughout the evaluation process.” (average word guideline–200) 9. a. ANALYSIS OF RECORDING or OBSERVATION 10. Back to Criteria 11. 12. Criterion 6—Intervention: Performance Skills 13. In collaboration with the supervising occupational therapist, performs interventions that are unique to school systems while integrating impact of varying client factors and contexts.

14. 15. 16. Guidelines  Submission of actual recording is not required for application; however, appropriate permissions should be obtained by applicant whenever engaging a client in a recorded session.  Observation should be consultative or instructive in nature and a minimum of 1 hour. It may occur over multiple sessions. 17. 2. 19. 18. Age of Client 20. Client 21. Diagnosis(es) 22. Setting for 23. Evaluation 24. Date of 25. Recording or Observation 26. 27. 3. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “ensure that interventions are performed competently and include the integration of varying client factors and contexts within school systems.” (average word guideline–200) 28.

29. 4. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to intervention – performance skills. (average word guideline–400) 30. a. CASE STUDY, CLIENT-BASED 31. Back to Criteria 32. 33. Criterion 6—Intervention: Performance Skills 34. In collaboration with the supervising occupational therapist, performs interventions that are unique to school systems while integrating impact of varying client factors and contexts.

35. 36. 37. Guidelines  Client-based case study should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information.

43. 3. Articulate how this case demonstrates how you “ensure that interventions are performed competently and include the integration of varying client factors and contexts within school systems.” (average word guideline–500) 4. a. CASE STUDY, INSTRUCTIONAL 5. Back to Criteria

6. Criterion 6—Intervention: Performance Skills 7. In collaboration with the supervising occupational therapist, performs interventions that are unique to school systems while integrating impact of varying client factors and contexts.

8. 9. 10. Guidelines  Instructional case study refers to teaching that was provided to other practitioners that will be delivering interventions in school systems. should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information. 11. 12. 1. Date(s) case study represents 13. 14. 2. Describe the audience and context for the identified case. The context of the case should be adequately communicated so that relevance and merit of the case to the criterion is easily determined. (average word guideline–500) 15.

16. 3. Articulate how this case demonstrates how you “ensure that interventions are performed competently and include the integration of varying client factors and contexts within school systems.” (average word guideline–350) 4.

5. 6. How was learning of the audience to whom you were instructing measured? (average word guideline– 150) 7.

8. 9. a. FORMAL SPECIALIZED CONSULTATION FOR INTERVENTION 10. Back to Criteria 11. 12. Criterion 6—Intervention: Performance Skills 13. In collaboration with the supervising occupational therapist, performs interventions that are unique to school systems while integrating impact of varying client factors and contexts.

14. 15. Guidelines  This should not be confused with consultation that is part of the ongoing services provided in your routine job duties. It is a request to address a particular issue at a particular site, either external or internal.  Consultation may include (but is not limited to) developing or evaluating a program or service, developing a strategy for long-term planning, establishing outcomes measures, incorporating national guidelines into internal policies and procedures, assessing and addressing staff educational needs, assessing and addressing resource needs, and validating program/service delivery with current evidence.  Applicant must have had a minimum of 10 hours working with the site. 16. 1. 17. Entity for Which 18. Consultation Was Completed 20. 19. Date(s) of Consultation 21. No. of Hours Completed 22. During Consultation 23. 2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3. A)

24. 3. Summarize the consultation results. (average word guideline–200) 25. 4. Summarize how this professional development activity influenced your ability to “ensure that interventions are performed competently and include the integration of varying client factors and contexts within school systems.” (average word guideline–400) 5.

6. 7. 8. A) PROGRAM DEVELOPMENT 9. Back to Criteria

12. Guidelines  Program development refers to the creation of a new program or development of an evolving program.

1. Dates of program development 13.

14. 2. Briefly describe the program purpose, services offered, and clients served. (average word guideline– 250) 15.

16. 3. Describe how this program development activity, including description of resources used, demonstrates your ability to “ensure that interventions are performed competently and include the integration of varying client factors and contexts within school systems.” (average word guideline– 500) 17.

18. A) RESEARCH 19. Back to Criteria

22. 23. What type of research was conducted? Please choose 1.

24. ☐ Scientific inquiry–Qualitative, quantitative, or mixed-methods approach.

25. ☐ Methodological research/instrument development–Scientific inquiry to establish psychometric properties of (1) a new tool, (2) an existing tool with a new population, or (3) an existing tool translated to a new language.

26. ☐ Systematic review of the literature–Comprehensive search, review, and analysis of the existing literature to answer a focused question. 27. 1. Title of research conducted 28.

29. 2. Mechanism of dissemination:

30. ☐ Publication ☐ Evidence-Based Practice

31. ☐ Peer-reviewed presentation ☐ Project Web site

32. ☐ Grant funding ☐ Dissertation/thesis

33. ☐ Critically Appraised Topic (CAT, e.g., AOTA) 34. 35. Citation: 36.

37. 3. Role of applicant in the research. (average word guideline–25) 38.

39. 4. Purpose and rationale of the research. (average word guideline–250) 5.

6. 7. Describe how this research demonstrates your ability to “ensure that interventions are performed competently and include the integration of varying client factors and contexts within school systems.” (average word guideline–400) 8. a. ANALYSIS OF RECORDING or OBSERVATION 9. Back to Criteria 10. 11. Criterion 7—Intervention: Critical Reasoning 12. In collaboration with the supervising occupational therapist, selects, plans, and modifies interventions in school systems based on evidence and evaluation data.

13. 14. 15. Guidelines  Submission of actual recording is not required for application; however, appropriate permissions should be obtained by applicant whenever engaging a client in a recorded session.  Observation should be consultative or instructive in nature and a minimum of 1 hour. It may occur over multiple sessions. 16. 5. 18. 17. Age of Client 19. Client 20. Diagnosis(es) 21. Setting for 22. Evaluation 23. Date of 24. Recording or Observation 25. 26. 1. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “ensure that the selection, planning, and modification of interventions in school systems are based on evidence and evaluation data.” (average word guideline–200) 27.

28. 2. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to intervention – critical reasoning. (average word guideline–400) 29. a. CASE STUDY, CLIENT-BASED 30. Back to Criteria 31. 32. Criterion 7—Intervention: Critical Reasoning 33. In collaboration with the supervising occupational therapist, selects, plans, and modifies interventions in school systems based on evidence and evaluation data.

42. 3. Articulate how this case demonstrates how you “ensure that the selection, planning, and modification of interventions in school systems are based on evidence and evaluation data.” (average word guideline–500) 4. a. CASE STUDY, INSTRUCTIONAL 5. Back to Criteria 6. 7. Criterion 7—Intervention: Critical Reasoning 8. In collaboration with the supervising occupational therapist, selects, plans, and modifies interventions in school systems based on evidence and evaluation data.

9. 10. Guidelines  Instructional case study refers to teaching that was provided to other practitioners that will be delivering interventions in school systems. should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information. 11. 12. 1. Date(s) case study represents 13. 14. 2. Describe the audience and context for the identified case. The context of the case should be adequately communicated so that relevance and merit of the case to the criterion is easily determined. (average word guideline–500) 15.

16. 3. Articulate how this case demonstrates how you “Ensure that the selection, planning, and modification of interventions in school systems are based on evidence and evaluation data.” (average word guideline–350) 4.

5. 6. How was learning of the audience to whom you were instructing measured? (average word guideline– 150) 7. a. FORMAL SPECIALIZED CONSULTATION FOR INTERVENTION Back to Criteria

Criterion 7—Intervention: Critical Reasoning In collaboration with the supervising occupational therapist, selects, plans, and modifies interventions in school systems based on evidence and evaluation data.

Guidelines  This should not be confused with consultation that is part of the ongoing services provided in your routine job duties. It is a request to address a particular issue at a particular site, either external or internal.  Consultation may include (but is not limited to) developing or evaluating a program or service, developing a strategy for long-term planning, establishing outcomes measures, incorporating national guidelines into internal policies and procedures, assessing and addressing staff educational needs, assessing and addressing resource needs, and validating program/service delivery with current evidence.  Applicant must have had a minimum of 10 hours working with the site.

1. Entity for Which Consultation Was Completed Date(s) of Consultation No. of Hours Completed During Consultation

2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3. A)

3. Summarize the consultation results. (average word guideline–200) 4. Summarize how this professional development activity influenced your ability to “ensure that the selection, planning, and modification of interventions in school systems are based on evidence and evaluation data.” (average word guideline–400) 5.

6. 7. 8. A) PROGRAM DEVELOPMENT 9. Back to Criteria 10. 11. Criterion 7—Intervention: Critical Reasoning 12. In collaboration with the supervising occupational therapist, selects, plans, and modifies interventions in school systems based on evidence and evaluation data.

17. 3. Describe how this program development activity, including description of resources used, demonstrates your ability to “Ensure that the selection, planning, and modification of interventions in school systems are based on evidence and evaluation data.” (average word guideline–500) 18.

19. A) RESEARCH 20. Back to Criteria 21. 22. Criterion 7—Intervention: Critical Reasoning 23. In collaboration with the supervising occupational therapist, selects, plans, and modifies interventions in school systems based on evidence and evaluation data.

6. 7. Describe how this research demonstrates your ability to “ensure that the selection, planning, and modification of interventions in school systems are based on evidence and evaluation data.” (average word guideline–400) 8. a. ANALYSIS OF RECORDING or OBSERVATION 9. Back to Criteria 10. 11. Criterion 8—Psychosocial Critical Reasoning 12. In collaboration with the supervising occupational therapist, recognizes immediate and long-term implications of psychosocial issues related to conditions clients in school systems and modifies therapeutic approach and occupational therapy service delivery accordingly.

13. 14. 15. Guidelines  Submission of actual recording is not required for application; however, appropriate permissions should be obtained by applicant whenever engaging a client in a recorded session.  Observation should be consultative or instructive in nature and a minimum of 1 hour. It may occur over multiple sessions. 16. 6. 18. 17. Age of Client 19. Client 20. Diagnosis(es) 21. Setting for 22. Evaluation 23. Date of 24. Recording or Observation 25. 26. 1. Provide a brief summary of the recording contents or observation and how it demonstrates your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients in school systems and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–200) 27. 28. 2. After reviewing this recording or observation, describe the insights you gained, and reflect on how the analysis experience validated or supported change in your practice related to psychosocial critical reasoning. (average word guideline–400) 29. a. CASE STUDY, CLIENT-BASED 30. Back to Criteria 31. 32. Criterion 8—Psychosocial Critical Reasoning 33. In collaboration with the supervising occupational therapist, recognizes immediate and long-term implications of psychosocial issues related to conditions clients in school systems and modifies therapeutic approach and occupational therapy service delivery accordingly.

42. 3. Articulate how this case demonstrates how you “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients in school systems and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–500) 4. a. CASE STUDY, INSTRUCTIONAL 5. Back to Criteria 6. 7. Criterion 8—Psychosocial Critical Reasoning 8. In collaboration with the supervising occupational therapist, recognizes immediate and long-term implications of psychosocial issues related to conditions clients in school systems and modifies therapeutic approach and occupational therapy service delivery accordingly.

9. 10. Guidelines  Instructional case study refers to teaching that was provided to other practitioners that will be delivering interventions in school systems. It should not include any form of standard client documentation (e.g., evaluation summary, discharge plan) or identification of client name(s) or facility information. 11. 12. 1. Date(s) case study represents 13. 14. 2. Describe the audience and context for the identified case. The context of the case should be adequately communicated so that relevance and merit of the case to the criterion is easily determined. (average word guideline–500) 15.

16. 3. Articulate how this case demonstrates how you “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients in school systems and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–350) 4.

5. 6. How was learning of the audience to whom you were instructing measured? (average word guideline– 150) 7. a. FORMAL SPECIALIZED CONSULTATION FOR PSYCHOSOCIAL Back to Criteria

Criterion 8—Psychosocial Critical Reasoning In collaboration with the supervising occupational therapist, recognizes immediate and long- term implications of psychosocial issues related to conditions clients in school systems and modifies therapeutic approach and occupational therapy service delivery accordingly.

Guidelines  This should not be confused with consultation that is part of the ongoing services provided in your routine job duties but is a request to address a particular issue at a particular site, either external or internal.  Consultation may include (but is not limited to) developing or evaluating a program or service, developing a strategy for long-term planning, establishing outcomes measures, incorporating national guidelines into internal policies and procedures, assessing and addressing staff educational needs, assessing and addressing resource needs, and validating program/service delivery with current evidence.  Applicant must have had a minimum of 10 hours working with the site.

1. Entity for Which Consultation Was Completed Date(s) of Consultation No. of Hours Completed During Consultation

2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3. A)

3. Summarize the consultation results. (average word guideline–200) 4. Summarize how this professional development activity influenced your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients in school systems and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–400) 5.

6. A) PROGRAM DEVELOPMENT 7. Back to Criteria 8. 9. Criterion 8—Psychosocial Critical Reasoning 10. In collaboration with the supervising occupational therapist, recognizes immediate and long-term implications of psychosocial issues related to conditions clients in school systems and modifies therapeutic approach and occupational therapy service delivery accordingly.

15. 3. Describe how this program development activity, including description of resources used, demonstrates your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients in school systems and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–500) 16. 17. A) RESEARCH 18. Back to Criteria 19. 20. Criterion 8—Psychosocial Critical Reasoning 21. In collaboration with the supervising occupational therapist, recognizes immediate and long-term implications of psychosocial issues related to conditions clients in school systems and modifies therapeutic approach and occupational therapy service delivery accordingly.

6. 7. Describe how this research demonstrates your ability to “recognize immediate and long-term implications of psychosocial issues related to conditions found in clients in school systems and ensure that therapeutic approach and occupational therapy service delivery are modified accordingly.” (average word guideline–400) 8. a. FORMAL SPECIALIZED CONSULTATION 9. Back to Criteria 10. 11. Criterion 10—Establishes Networks 12. Establishes and collaborates with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems.

13. 14. Guidelines  This should not be confused with consultation that is part of the ongoing services provided in your routine job duties but is a request to address a particular issue at a particular site, either external or internal.  Consultation may include (but is not limited to) developing or evaluating a program or service, developing a strategy for long-term planning, establishing outcomes measures, incorporating national guidelines into internal policies and procedures, assessing and addressing staff educational needs, assessing and addressing resource needs, and validating program/service delivery with current evidence.  Applicant must have had a minimum of 10 hours working with the site. 15. 1. 16. Entity for Which 17. Consultation Was Completed 19. 18. Date(s) of Consultation 20. No. of Hours Completed 21. During Consultation 22. 2. Objectives for consultation. Objectives must have been met by time of application. Please list no more than 3. A)

23. 3. Summarize the consultation results. (average word guideline–200) 24. 4. Summarize how this professional development activity influenced your ability to “establish and collaborate with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems.” (average word guideline–400) 5. A) MARKETING ACTIVITIES 6. Back to Criteria 7. 8. Criterion 10—Establishes Networks 9. Establishes and collaborates with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems. 10. 11. Type of media used for marketing: (check all that apply)

12. ☐ Presentation to potential referral source audience

13. ☐ Presentation to potential clients

14. ☐ Participation in community event such as health fairs

15. ☐ Speaking to community groups

16. ☐ Development and dissemination of marketing materials (e.g., brochures, Web sites, 17. podcasts) 18. ☐ Participation in media interview (e.g., television news, newspaper)

19. ☐ Other 20. 1. 22. 21. Target Audience of Marketing 24. 23. Date(s) of Marketing Efforts 25. Approximate Total Hours 26. Engaged in Marketing Activity 27. 2. Provide a brief summary of the marketing activity. (average word guideline–50) 28.

29. 3. Applicant’s objectives for the marketing. List no more than 3. A)

C) 4. Describe how this marketing activity demonstrates how you “establish and collaborate with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems.” (average word guideline–200) 5.

6. o PRESENTATION 7. Back to Criteria 8. 9. Criterion 10—Establishes Networks 10. Establishes and collaborates with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems.

11. 12. Type of presentation:

13. ☐ In-service to professionals 14. ☐ Academic program lecture 15. ☐ Professional level workshop (e.g., state conference) 16. ☐ Community 1. Presentation information. 17. 19. 18. Title 21. 20. Target Audience 22. Date and Time of 23. Presentation 24. 2. Brief description of the presentation, including content focus. (average word guideline–50) 25.

26. 3. Applicant’s objectives for networking. Objectives must have been met by time of application. Please list no more than 3. A)

27. 4. Describe how networks were established or strengthened through this presentation and any changes which have occurred as a result of your presentation. (average word guideline–200) 5. a. VOLUNTEER LEADERSHIP 6. Back to Criteria 7. 8. Criterion 10—Establishes Networks 9. Establishes and collaborates with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems.

10. 11. Guidelines  Service with a local, state, national, or international agency or organization that has relevance to the certification area.  Minimum of 25 hours for at least 1 year. 12. 1. Name of organization 13.

14. 2. Dates of service 15.

16. 3. Approximate number of hours of service 17.

18. 4. Identification of the volunteer leadership role served (must be leadership in nature, e.g., officer, chair, committee member, board member) 19.

20. 5. Describe how this leadership activity helped you “establish and collaborate with referral sources and stakeholders so that clients and relevant others may achieve outcomes that support health and participation in the area of school systems.” (average word guideline–200) 21. 22.

a. ADVOCACY EFFORTS 23. Back to Criteria 24. 25. Criterion 11— Advocating for Change 26. Influences services for clients (person, organization, population) in school systems through independent or collaborative education or advocacy activities.

27. 28. Guidelines  Active involvement in or facilitation of advocacy activities at the local, regional, state, or national level for the purpose of influencing decision-makers about policy, procedures, services, reimbursement, or occupational justice issues.  Merely serving as a participant does not constitute advocacy efforts.  Minimum of 10 hours over at least 2 months. 29. 30. Type of advocacy activity: (check all that apply)

31. ☐ Development and dissemination of advocacy materials (e.g., letters, brochures, Web sites, 32. podcasts) 33. ☐ Lobbying to/education for policy-makers 34. ☐ Organizer of community event (e.g., fundraising, health fair) 35. ☐ Subject expert in media interview (e.g., radio, television news, newspaper) 36. ☐ Presentation to stakeholder 37. ☐ Other 38. 1. 42. No. of 39. Description of 40. Target Audience 41. Date(s) Hours Activity Involved 43. 44. 45. 46.

47. 48. 49. 50.

51. 52. 53. 54.

55. 56. 57. 58.

59. 2. Applicant’s objectives for advocating for change. List no more than 3. A)

C) 3. Discuss the results, outcomes, or progress toward change affected by this advocacy effort that demonstrates how you “influence services for clients (person, organization, population) in school systems through independent or collaborative education or advocacy activities.” (average word guideline–350) 4. a. CASE STUDY, ADVOCACY 5. Back to Criteria 6. 7. Criterion 11— Advocating for Change 8. Influences services for clients (person, organization, population) in school systems through independent or collaborative education or advocacy activities.

9. 10. 11. Guidelines  Efforts toward change that influence access to services or promote the health and occupational engagement of clients.  This should not be confused with routine job duties associated with expected occupational therapy service delivery. For example, submitting letters of necessity for equipment would not meet intent. 12. 1. Describe the client (person, organization, population) or program and the context as it applies to an identified need for change. (average word guideline–100) 13.

14. 2. Summarize your efforts to influence change. (average word guideline–200) 15.

16. 3. Describe the change outcomes or progress toward change as a result of your efforts. (average word guideline–200) 4.

5. 6. Articulate how this case demonstrates your ability to “influence services for clients (person, organization, population) in school systems through independent or collaborative education or advocacy activities.” (average word guideline–500) 7. o VOLUNTEER LEADERSHIP 8. Back to Criteria 9. 10. Criterion 11— Advocating for Change 11. Influences services for clients (person, organization, population) in school systems through independent or collaborative education or advocacy activities.

12. 13. Guidelines  Service with a local, state, national, or international agency or organization that has relevance to the criterion.  Minimum of 25 hours for at least 1 year. 14. 1. Name of organization 15.

16. 2. Dates of service 17.

18. 3. Approximate number of hours of service 19.

20. 4. Identification of the volunteer leadership role served (must be leadership in nature, e.g., officer, chair, committee member, board member) 21.

22. 5. Describe how this leadership activity helped you “influence services for clients (person, organization, population) in school systems through independent or collaborative education or advocacy activities.” (average word guideline–400) 23. 24.