Gee, Strickland, Miller

1. Background
• Clinical Reasoning – A creative and flexible way at looking at a client’s
personal characteristics and context then making modifications that will
help him/her function more successfully” (Miller, 2006, p. 69).
• Entry level education related to sensory integration and sensory
processing includes –
• Ayres Sensory Integration
• Dunn’s Model of Sensory Processing
• Sensory Diets
• Sensory based/sensory motor interventions (Reynolds et
al., 2012)
• Gaps in teaching how to reason through challenging behavior related to
sensory processing –
• Clinical reasoning
• A SECRET
• A SECRET is an acronym for the seven steps, arranged as a pneumonic
without order of priority:
• a) Attention, b) Sensation, c) Emotion regulation, d) Culture,
e) Relationships, f) Environment, and g) Tasks (Miller, 2006, 2014; Bailer
& Miller, 2011).
Purpose
• Develop a selected response measure to capture procedural aspects of
clinical reasoning among 1st year Occupational Therapy students
applying the A SECRET approach to a simulated case study.
Methodology
Sample Question
Overview of the Developed Assessment
• Students reviewed a clinical scenario that included background
information and a short video clip.
• Students completed a multiple choice test in which they reviewed six
intervention techniques for each strategy area of A SECRET.
• Identify and rank the two most effective strategies for that element; rank
the two strategies that were poor, and, the remaining two as
intermediate .
• Students were prompted to provide a rationale regarding why their
choices were the most effective or poor given the background
information of the case scenario.
Chronbach’s α
Discussion
• Meaningful process to start measuring reasoning among students.
• Increase sample size to explore issues of reliability/validity.
• Students’ overall average score was 68%; a positive finding given the
novelty of the instruction, assessment, and the content.
• Assesses discrimination of appropriate and inappropriate strategies.
• Allows for a rationale/justification of choices.
• Themes that emerged from the qualitative data were: the A SECRET
Process, Self-Regulation, the Occupational Therapy Process, Participation,
and Safety/Security.
Key References
• Bialer, D. S., & Miller, L. J. (2011). No Longer A SECRET: Unique
Common Sense Strategies for Children with Sensory or Motor Challenges.
United States: Sensory World.
• Gee, B. (2015). Exploring the Effectiveness of an E-learning Module for
Graduate Level Occupational Therapy Students. Idaho State University,
Unpublished Dissertation.
• Miller, L. (2006). Sensational kids: Hope and help for children with sensory processing disorder (SPD). United
States: Perigee Books.
• Reynolds, S., Watling, R., Zapletal, A.L., & May-Benson, T. (2010). Sensory Integration in Entry-Level
Occupational Therapy Education. Sensory Integration Special Interest Section Quarterly Newsletter.
The Development of a Measurement Tool for Clinical Reasoning for Sensory
Processing in Pediatric Occupational Therapy
By
Bryan M. Gee, PhD, OTR/L, BCP, Jane Strickland, EdD, & Lucy Jane Miller, PhD, OTR
Attention .67
(moderate)
Sensation .30
(poor)
Emotion
Regulation -.30
(poor)
Culture .56
(poor)
Relationships
Environment -
.81 (very poor)
Task .67
(moderate)
Assessment .61
(low-moderate)
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