Following a referral for occupational therapy, a CBIT certified therapist will schedule an initial comprehensive evaluation. This evaluation usually takes between 1 ½ -2 hours. The caregiver or client completes an intake form and a parent/patient tic questionnaire prior to the evaluation. When necessary, anxiety, depression, and/or sensory questionnaires will also be completed prior to the initial evaluation session.
What to expect during the initial Evaluation
The first session is a time for the therapist to educate the child/client and support person on CBIT and to provide psychoeducation about tics and tic disorders. Questions are asked, and information is shared regarding the nature of the person’s tics, when or if a tic diagnosis has been made, whether or not there are co-occurring conditions, and to determine a tic hierarchy if treatment is appropriate. An occupational profile is generated based on a person’s developmental and medical history, daily routines, skills and abilities, hobbies, values, beliefs, and environments in which the person spends his/her day. Different assessments may also be administered during this two-hour time period. Following this session, a full report is written and reviewed with the client/caregiver and treatment goals are established.
There can be up to 11 sessions using the CBIT approach. Sessions 1-6 occur weekly. There are two weeks between sessions 7 and 8 and sessions 9-11 are considered booster sessions that can be used 4 weeks after session 8 and continue for 3 consecutive months.
Following the initial evaluation, weekly sessions are scheduled to tackle one tic per week and to do a functional assessment and determine functional interventions for that particular tic. These sessions last one hour in duration and are focused on determining a competing response and to make suggestions on environmental and task modifications/accommodations so that antecedents and consequences are minimized.
Additionally, other therapeutic strategies are taught such as relaxation training and self and emotional regulation techniques. Occupational therapists are uniquely qualified and excellent health care providers to deliver CBIT because of their unique approach to look at the whole person and their understanding of physical, neurology, physiology, and cognitive processes.