Screening
In-Home Occupational Therapy Screening Checklist
1. Pediatric & Developmental Needs
Does your child have developmental delays, autism, ADHD, a genetic condition, or another disability that affects participation in daily activities?
Does your child exhibit difficulties with motor skills, sensory processing, social interaction, self-regulation, or self-care?
2. Daily Activities & Fall Risk
Have you or your loved one experienced a fall or near-fall in the past 6 months?
Do you or your loved one have a medical condition that impacts performance of daily activities?
Difficulty with self-care activities such as dressing, bathing, or toileting?
Difficulty with household tasks, such as cooking, cleaning, or laundry?
3. Cognitive & Memory Concerns
Have you or your loved one been diagnosed with dementia, Alzheimer’s disease, or other cognitive impairments?
Do cognitive impairments impact the you or your loved one's ability to safely perform daily tasks?
4. Chronic Health Conditions
Do you or your loved one have a chronic illness that impacts their independence at home?
Are you or your loved one experiencing pain, stiffness, fatigue, or weakness that interferes with their daily activities?
5. Family & Caregiver Support
Do you or your family or caregiver need training, education, or support to assist with the patient’s needs at home?
Are there concerns about caregiver burnout?
6. Home Safety Concerns
Are there potential safety hazards in the home environment (e.g., clutter, poor lighting, lack of grab bars) that could put the you or your loved one at risk?
Do you or your loved one have concerns about safety or independence at home?
If you answered yes to one or more questions, you, your child, or your loved one may benefit from a referral to Rock River Therapy for an in-home occupational therapy evaluation and treatment. Rock River Therapy offers personalized, home-based OT services to enhance independence, support caregivers, and promote safety and engagement in daily life activities.