Methods to the peds madness

As someone who is used to working primarily with adults, the lack of structure that seems to occur with peds treatment sessions can be confusing and frustrating. When I evaluate an adult, I can rate their performance on a number of measures quickly and easily. In an hour, I can easily complete my facility eval, get FIM ratings, grade an MMSE, and even an interest checklist or such if the mood strikes me. And as they improve, I feel that I can document that effectively, using those measures or others. But with kids, it's a whole new ballgame.

We do not have a lot of standardized assessments or methods that are routinely used at my site. The only non-facility assessments that we have are the Peabody (which does technically contain treatment ideas), and the infant/toddler/school age sensory profile. These have been used pretty sparingly in the past. I did manage to find a box of Handwriting without Tears (HWT) materials, which to my knowledge has never been used.

I find this frustrating on multiple levels. For one, taking over an entire caseload without the support of the previous therapist is difficult, and having no standardized measure of client performance at the eval makes it hard for me to come in 6 months later and determine progress. Secondly, I wonder how much carryover there has been between the previous therapist's treatments and mine, what works better or doesn't work. With OT so often ridiculed as a profession with no basis in research and all in anecdotal report, consistency and measured improvement seem like they could only help matters.

Of course, I know that it's more important to work to the child's own personal needs rather than spend a great deal of time on testing or cookie-cutter treatment. And I also know from experience that trying to administer a standardized test to a child is a hair-raising and time-consuming experience. But especially if you have more than one therapist seeing the child, doesn't having some sort of truly objective plan help you really know how they're progressing? I'm seeing this issue especially in handwriting performance. I know little about previous therapists' methods for our shared clients... I know that there was some hand over hand work, some connect the dots, some tracing... but it's hard to say exactly what was working (this is probably also related to documentation, but that's another topic). Today I got to try some HWT methods with a kid, and actually felt at the end of the session that not only did we make progress, but here was something I could easily have a replacement therapist do and be assured of same presentation.

Is anyone else facing difficulty objectively evaluating peds? The subjective and qualitative changes are great, but I feel like I'm likely to get an improved understanding by non-OTs when I can show quantitative changes. What about the issues with carryover between multiple therapists, same patient? What are some great (or awful) tools that you're familiar with?

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