Alternative Outcome Measures (with Examples) to Behavioral Reward-Based Approach in School Occupational Therapy

Why Not Behavioral in School

In a recent blog post, I discussed the limitations of the rewards-based behavioral approach commonly used in schools. I highlight how relying solely on external incentives can have negative effects, such as a short-term focus, dependency on rewards, diminished interest in learning, unrealistic expectations, competition, narrow task focus, and a loss of intrinsic satisfaction. Extrinsic motivation techniques has a potential to undermine students’ overall motivation in the long run.

Instead, occupational therapists can play a crucial role in addressing these concerns by adopting a strengths-based and intrinsic motivation approach. By focusing on students’ individual strengths, setting personalized goals, promoting autonomy and competence, and creating a supportive learning environment, therapists can foster intrinsic motivation, self-determination, and meaningful engagement. The post also mentions the importance of incorporating cooperative learning strategies, problem-solving initiatives, and relevant activities to further enhance students’ motivation and academic performance.

One way we as occupational therapy practitioners can assess the success of our interventions is with outcome measures. The following is a list of measures that fit well with an alternative or complementary approach to behavioral reward-based approaches for students in schools.


While there isn’t a specific standardized measure for assessing engagement in meaningful activities, therapists can use qualitative methods, such as structured interviews or activity logs, to gather subjective information about the individual’s level of interest, enjoyment, and motivation in activities that are personally meaningful to them.

Engagement in meaningful activities captures the holistic nature of occupational therapy. It considers the individual’s unique interests, values, and goals, recognizing that each person has different motivations and aspirations. By focusing on meaningful activities, therapists assess the overall impact of interventions on an individual’s life satisfaction and well-being. For example, a student who finds social interactions challenging may be encouraged to engage in activities such as cooperative group projects, peer mentoring programs, or participation in extracurricular clubs aligned with their personal interests. By focusing on meaningful activities that address their socialization difficulties, therapists can gauge the impact of interventions on the student’s overall well-being and social integration.

Meaningful activities inherently tap into intrinsic motivation. When individuals engage in activities that align with their personal values and interests, they are more likely to be intrinsically motivated to participate and invest effort. This differs from a reward-based approach that relies on external incentives, as intrinsic motivation is driven by internal factors, such as enjoyment, curiosity, and a sense of autonomy. For instance, an occupational therapist may introduce therapeutic activities that incorporate the student’s favorite hobbies or interests. If a student is passionate about art, the therapist could incorporate art-based projects that involve fine motor skills development, social collaboration, and attention to detail. By aligning interventions with the student’s intrinsic interests, therapists can foster engagement and motivation to participate in meaningful activities.

Engagement in meaningful activities promotes sustainable behavior change. When individuals find purpose and satisfaction in the activities they perform, they are more likely to continue engaging in them over time, even in the absence of external rewards. For example, this could involve writing letters to pen pals, creating personalized journals, or engaging in collaborative writing projects with peers. This is in contrast to a reward-based approach, which may yield short-term compliance but may not foster long-term engagement and growth.

Meaningful activities allow for personalized goal setting. By understanding an individual’s interests, strengths, and aspirations, therapists can collaboratively set goals that align with the person’s values and desires. For instance, a student struggling with attention difficulties may work with the occupational therapist to set goals related to staying focused during classroom activities. These goals could involve engaging in interactive learning tasks that align with the student’s interests, such as hands-on science experiments or project-based assignments. This promotes a sense of ownership, self-determination, and intrinsic motivation to work towards these goals, enhancing the individual’s engagement and investment in the therapy process.

Measuring engagement in meaningful activities for students in school with socialization, play, handwriting, attention, and behaviors involves focusing on practical application and real-life situations. For example, an occupational therapist may introduce play-based interventions that target social skills development, such as participating in structured group games or collaborative role-playing activities. By simulating real-world social interactions and providing opportunities for the student to practice and apply social skills in a supportive environment, therapists facilitate the transfer of these skills to everyday situations.

Measuring engagement in meaningful activities aligns with the client-centered approach of occupational therapy. It places the individual at the center of the therapy process, valuing their unique experiences, preferences, and priorities. By assessing the extent to which individuals are actively involved in activities that hold personal meaning, therapists can ensure interventions are tailored to their specific needs and aspirations. For instance, an occupational therapist working with a student who displays challenging behaviors may collaborate with the student, their teachers, and parents to identify activities that can positively influence behavior management and self-regulation. This could involve implementing strategies like incorporating sensory breaks, incorporating movement-based learning activities, or providing opportunities for the student to engage in self-selected tasks aligned with their interests. By involving the student in the decision-making process and tailoring interventions to their unique needs and preferences, therapists empower students to actively participate and achieve meaningful outcomes.


Canadian Occupational Performance Measure (COPM): The COPM is a client-centered measure that evaluates an individual’s self-perceived performance and satisfaction in daily activities. It allows the individual to identify and prioritize meaningful goals and assess their progress and satisfaction over time.

An occupational therapist uses the COPM (Canadian Occupational Performance Measure) to help a student named Emily with her handwriting difficulties. They talk to Emily, her parents, and teachers to understand her concerns and set meaningful goals. The therapist works with Emily using personalized strategies, adaptive tools, and specific writing exercises tailored to her interests. They regularly reassess Emily’s progress and satisfaction with her handwriting, making adjustments as needed. This approach focuses on Emily’s individual needs, empowering her to take ownership of her progress and make meaningful changes in her handwriting skills.

In a behavioral reward-based approach for handwriting difficulties, Emily would receive rewards, such as stickers or points, for completing handwriting assignments. While this may initially motivate her, there is a risk of her becoming dependent on external rewards. Without rewards, her motivation may decline, and intrinsic satisfaction from improving handwriting skills may be overlooked.


Goal Attainment Scaling (GAS): GAS is a flexible and individualized approach to goal setting and outcome measurement. It involves collaboratively setting specific, measurable goals with the individual and assigning a numerical scale to measure progress and achievement. GAS allows for customization of goals based on the person’s strengths and intrinsic motivation.

An occupational therapist uses Goal Attainment Scaling (GAS) to help a student named Jack who struggles with cutting with scissors. The therapist collaborates with Jack, his parents, and teachers to identify specific goals related to cutting skills. They define different levels of achievement for each goal, ranging from minimal progress to significant improvement. Together, they develop a plan that includes specific strategies, practice sessions, and adaptive tools tailored to Jack’s needs. Over time, the therapist evaluates Jack’s progress based on the agreed-upon goals and assigns scores to measure the extent of goal attainment. This approach focuses on individualized goal setting, tracking progress, and celebrating achievements based on Jack’s unique abilities and challenges.In a behavioral reward-based approach for improving cutting skills, Jack would receive rewards or incentives for completing cutting tasks or demonstrating progress. For instance, he might receive a sticker or a small prize each time he successfully cuts along a line. While this approach may provide short-term motivation, there is a risk of Jack relying solely on external rewards to engage in cutting activities. Over time, his intrinsic motivation to develop cutting skills may be overshadowed by the desire for rewards, potentially hindering long-term progress.


Perceived Efficacy and Goal Setting System (PEGS): PEGS is a self-report measure that assesses an individual’s perceived self-efficacy in goal attainment. It focuses on their confidence in their abilities to achieve specific goals and can be used to track progress and changes in self-efficacy over time.

An occupational therapist uses the Perceived Efficacy and Goal Setting System (PEGS) to support a student named Emily who has ADHD. The therapist works closely with Emily to identify her strengths and challenges related to attention and task completion. They engage in a collaborative goal-setting process, where Emily expresses her aspirations and the therapist helps her establish realistic and attainable goals. Together, they develop strategies, such as breaking tasks into smaller steps or using visual aids, to enhance Emily’s attention and task management skills. Throughout the intervention, the therapist regularly assesses Emily’s perceived efficacy and progress towards her goals, providing feedback and guidance as needed. This approach focuses on empowering Emily, building self-confidence, and facilitating her active participation in setting and achieving meaningful goals.

In a behavioral reward-based approach for addressing ADHD symptoms, Emily would receive rewards or incentives for demonstrating improved attention or completing tasks on time. For example, she might earn points, tokens, or privileges for staying focused during class or finishing assignments promptly. While this approach may yield short-term behavioral changes, there is a risk of Emily becoming overly reliant on external rewards to sustain attention and task completion. Over time, her intrinsic motivation to engage in activities and develop self-regulation skills may diminish, potentially hindering her long-term growth and independence.


Self-Determination Theory measures: Self-Determination Theory (SDT) is a framework that emphasizes intrinsic motivation, autonomy, and competence. Several measures are aligned with SDT principles, such as the Basic Psychological Needs Scale (BPNS), which assesses an individual’s satisfaction of autonomy, competence, and relatedness needs, and the Intrinsic Motivation Inventory (IMI), which measures the individual’s intrinsic motivation across different domains.

An occupational therapist utilizes the principles of Self-Determination Theory (SDT) to support a student named Ethan who experiences socialization challenges related to autism. The therapist works collaboratively with Ethan to understand his individual strengths, interests, and goals related to social interactions. Together, they identify activities or settings where Ethan feels motivated and comfortable engaging with others. The therapist encourages and supports Ethan in taking ownership of his socialization goals, such as initiating conversations or participating in group activities. They provide a safe and supportive environment that promotes autonomy, competence, and relatedness, which are essential components of SDT. The therapist acknowledges Ethan’s efforts and progress, fostering his sense of self-determination and intrinsic motivation to develop social skills and connections.

In a behavioral reward-based approach to address socialization symptoms related to autism, Ethan would receive external rewards or reinforcements for engaging in desired social behaviors. For instance, he might earn tokens, stickers, or praise for initiating conversations or participating in group activities. While this approach may elicit immediate behavioral changes, there is a risk of Ethan becoming overly dependent on external rewards and losing sight of the inherent value of social interactions. This could potentially hinder the development of genuine social skills, intrinsic motivation, and meaningful connections with others.


In conclusion, the limitations of the rewards-based behavioral approach commonly used in schools call for alternative approaches that prioritize intrinsic motivation and self-determination. Occupational therapists can play a crucial role in addressing these concerns by adopting alternative measures that work in the classroom and can generalize to other settings. By adopting these alternative outcome measures and approaches, occupational therapists can create positive and empowering educational experiences for students. The focus on different approaches such as intrinsic motivation, meaningful activities, personalized goal setting, and self-determination allows for tailored and client-centered interventions that promote long-term growth and well-being.