Clinical Governance
VPA™ Scope & Limitations
An honest statement of what the Visual Performance Assessment is designed to do, and what it is not.
Positioning statement
The VPA™ is a structured clinical observation system for licensed occupational therapists. It helps the OT evaluator identify visual performance patterns that affect occupational performance, guide intervention planning within OT scope, and monitor progress over time. Teachers of students with visual impairments (TVIs), developmental optometrists, and other school team members participate as collaborators — they contribute observations and read the resulting profile, rather than administering and scoring the instrument.
1. Intended users
Who administers, scores, and reports
- Licensed occupational therapists (OT / OTR/L)
- Occupational therapy assistants (COTA) under OT supervision
Administration, scoring, level assignment, and reporting of the Mini VPA™ and the Full VPA™ are performed by a licensed occupational therapy practitioner.
Who contributes observations and reads the profile
- Teachers of students with visual impairments (TVIs) and low-vision team members
- Developmental optometrists, as an OT-facing communication tool
- School-based multidisciplinary teams working within their own scope
One exception — the free Fast Screen. The three-task, roughly five-minute Fast Screen is open to teachers, TVIs, and school teams for caseload triage. It answers only whether a closer look is warranted. It produces no levels and no profile, and it should never appear in a report as an assessment finding.
The VPA™ is not designed for lay use, for use by unlicensed aides, or for self-administration by families.
2. Intended use
- Structure observation of visual performance across 5 levels and 15 sections
- Identify functional impact of vision on school occupations
- Guide OT intervention planning within scope
- Support goal writing and service justification
- Provide repeatable pre / post progress monitoring
- Trigger appropriate referrals when red flags appear
- Give teams a shared clinical vocabulary
- A standardized, norm-referenced psychometric test
- A diagnostic instrument for ocular or neurological pathology
- A substitute for a comprehensive medical eye examination
- A replacement for MVPT-4, Beery VMI, TVPS-4, or DEM
- An FDA-cleared medical device
- A tool for diagnosing learning disabilities
- Valid for use outside the clinician's licensed scope
3. Evidence stage
The VPA™ is currently a pilot-stage clinical framework. Descriptive statistics and internal reliability data are reported publicly with sample sizes (n ≥ 30 per age band unless otherwise noted). We do not claim published sensitivity, specificity, or multi-site validation. Ongoing reliability and criterion-validity work is disclosed on the Research page.
4. Scope of practice
The VPA™ is administered by licensed professionals within their own scope. For occupational therapists, this means observing how visual performance affects client factors and occupational performance, reading, writing, ADLs, classroom participation, and delivering intervention within the OT scope. The VPA™ does not extend a clinician's scope; it structures observation within it.
Occupational therapy and optometry are complementary partner disciplines. The OT sends a well-formed referral when findings fall outside OT scope (see red flags below), and in return asks the developmental optometrist for findings the OT can read into the occupational profile and use to guide occupation-centered intervention. This is a two-way collaboration: the VPA™ is designed to route appropriate referrals to optometry and to make optometric findings actionable inside the OT plan of care. The relationship strengthens each profession's contribution rather than blurring the line between them.
5. Red flags: refer to medical eye care first
Stop the VPA™ and refer to a developmental optometrist, ophthalmologist, or primary care provider (as appropriate) when any of the following are present:
- Reduced acuity that has never been evaluated (no eye exam within 12 months)
- Visible strabismus, nystagmus, or lid asymmetry
- Reported diplopia, transient vision loss, or new-onset visual complaint
- Head-injury / concussion history without visual follow-up
- New photophobia, eye pain, headaches with visual triggers
- Suspected amblyopia, refractive error, or accommodative dysfunction
- Progressive neurological signs, sudden regression, or asymmetry between eyes
Referral language: "Consider evaluation by a developmental optometrist for accommodative, vergence, and ocular health assessment." Never diagnose.
6. Recommended use pattern
- Fast Screen (free, 3–5 min). Teacher / parent triage to decide whether OT observation is warranted.
- Mini VPA™ (10–15 min). 7 probes across the five levels — Visual Processing is sampled three ways (figure-ground, visual memory, form constancy) because one probe cannot represent that level. Flags which levels warrant a deeper look. Not sufficient for treatment planning alone.
- Full VPA™ (30–60 min adaptive). 15 sections × 5 levels. Anchor for OT intervention planning, IEP goal writing, and progress monitoring.
- External Assessments section. Attach MVPT-4, Beery VMI, TVPS-4, or DEM scores from your own licensed kits when standardized data are required. These scores add documentation weight and support criterion validity; they do not replace VPA-driven treatment planning.
- Re-administer at 8–9 week intervals for progress monitoring.
7. Documentation & privacy
- Enter student initials or a non-identifying code. Never full names, DOB, MRN, or SSN.
- PHI is not accepted by the platform. See the Privacy Notice and DPA.
- Clinician retains professional responsibility for interpretation and treatment decisions.
Author: Jeff Foster, MS, OTR/L, EdD(ABD). NBCOT-registered occupational therapist licensed in Mississippi and California. Pediatric vision and school-based practice.
Questions or clinical feedback: visualmindslearning.com/contact.