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3LPlace Assessment Tool

3LPlace Assessment Tool

Created by Elana Himmelfarb and June Peoples Mallon of 3LPlace with thanks to  Dr. Gary Bedell of Tufts University Department of Occupational Therapy for his review and input.

Use this tool to assess an individual’s current state and to track progress over time.

Assess the first two categories (Regulation and Participation) prior to all work.

If Regulation or Participation are challenged enough to be an impediment, consider delaying work until a time where it is more possible or consider providing accommodations as required.

Assess the other seven categories on a regular basis, either monthly or at a minimum quarterly.

Staff should be instructed in its use and should have ongoing supervision as required so that there can be consistency in how the assessment is applied program-wide.

You can print out this form using the icon to the right and slightly above the page name.

As always, your input and feedback on this form are welcome.  You can become a registered user of the 3LPlace wiki here.

 

Survey and Scale

Name of participant                                                                           

Staff administering                                                                            

Date of assessment                                                                          

 

Regulation  (attention, anxiety, sensory and emotional)

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Participation  (reciprocity, engagement and level of interest)

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Independence (level of facilitation required to initiate and complete task)

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Sequencing (correctly ordering items, events or concepts according to time and progression)

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Critical Thinking  (comprehension, compare/contrast, cause/effect, analysis, drawing conclusions, problem-solving, decision-making)

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Executive Function (planning, previewing, task execution, organization, self-monitoring, strategic thinking, time-management) 

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Motor Planning  (ideation, organization and execution of tasks requiring movement, body awareness and coordination; level of automaticity and flow with coordination and movement) 

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Receptive Language (language input of concrete and abstract verbal information: understanding vocabulary, verbal instructions and meaning while listening and/or reading) 

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

 

Expressive Language (language output surrounding concrete and abstract information: vocabulary/word choice, communicating meaning and reflecting understanding through speaking, movement and writing) 

1 - significant strength

2 - moderate strength

3- average

4 - moderate challenge

5 - significant challenge

© This research and tracking tool is owned and copyrighted by 3LPlace, Inc. Reproduction is permitted for use with individuals or in academic settings. It may not be reproduced for sale. Thank you!

 

3LPlace Curriculum Wiki