ATTACh OT Tier 2: Mapping the Terrain:
Attachment and Trauma-Informed Assessment and Clinical Decision-Making in OT
When: On Demand
Description
You’ve built a strong foundation in attachment, trauma, and sensory regulation in Tier 1. Tier 2 helps you apply that understanding with clarity and confidence. This next step in the ATTACh OT Certificate pathway focuses on assessment, clinical reasoning, and intentional intervention planning for complex trauma presentations. It supports occupational therapists in translating neurobiological and relational insight into ethical, effective practice.
In Tier 2, you will learn how to:
- Read nervous system states and attachment strategies during assessment
- Interpret OT assessment tools without pathologizing survival responses
- Develop integrated case formulations that guide treatment decisions
- Understand the impact of empathy, shame, and resilience on participation
- Sequence interventions from bottom-up regulation through executive functioning
- Navigate multiple trauma frameworks while maintaining a strong OT identity
Tier 2 is designed for occupational therapists who work with complex developmental histories and want greater confidence in what to assess, what to prioritize, and what to do next. If Tier 1 helped you understand why clients respond the way they do, Tier 2 helps you decide how to respond, and when
Outline / Agenda:
Session 1: Reading the Nervous System – Assessment Through an Attachment Lens
Key Content:
- Attachment as a system of safety and survival
- Reading engagement, avoidance, control, and shutdown
- State-dependent performance and variability
- Distinguishing sensory, trauma, and developmental signals
- Ethical considerations when safety is fragile
Session 2: Trauma-Informed OT Assessment Tools & the Therapist as Instrument
Key Content:
- Review of common OT assessments through a trauma lens
- What standardized tools capture — and what they miss
- Interpreting inconsistent or fluctuating results
- Therapist nervous system as part of the assessment field
- How countertransference and bias show up during assessment
- Avoiding:
- Over-pathologizing
- Over-accommodating
- Rushing to “fix”
- Integrating:
- Observation
- Caregiver narrative
- Developmental and relational history
- Writing trauma-responsive assessment summaries
Session 3: Case Formulation & Treatment Planning in Complex Trauma
Key Content:
- What case formulation means in OT
- Integrating:
- Nervous system profile
- Attachment strategies
- Sensory processing patterns
- Occupational participation
- Identifying what is maintaining dysregulation
- Prioritizing safety and regulation over performance
- Writing goals that reflect:
- Capacity
- Engagement
- Participation
- Deciding what not to target yet
Session 4: Empathy, Shame, and Resilience in Trauma-Informed OT
Key Content:
- Empathy as a regulatory tool (and a risk)
- Shame in children, caregivers, and therapists
- How shame distorts assessment results and participation
- Recognizing resilience as adaptive survival
- Avoiding resilience bypassing
- Supporting dignity, agency, and relational safety
- Using empathy to pace intervention appropriately
Session 5: From Regulation to Participation – Trauma-Informed OT Interventions Across Levels
Key Content:
- Bottom-Up Foundations (Safety & State Regulation)
- Co-regulation as the primary intervention
- Movement, rhythm, breath, and sensory-motor strategies
- Using proprioception and vestibular input
- Environmental modifications that support safety
- When bottom-up work is enough and when it isn’t
- Relational & Mid-Level Interventions
- Using play, shared activity, and routines to support engagement
- Scaffolding interaction without control or compliance
- Supporting transitions and flexibility
- Working with avoidance, control, and testing behaviors
- Top-Down & Executive Functioning Supports (When the System Is Ready)
- Executive functioning as state-dependent, not only skill-deficient
- Supporting:
- Planning
- Sequencing
- Emotional regulation
- Cognitive flexibility
- Avoiding EF demands during dysregulation
- Integrating sensory, relational, and cognitive strategies
- Matching intervention level to nervous system capacity
- Clinical Decision-Making
- How to know when to shift levels
- When EF work is premature
- Recognizing therapy-induced stress
- Ethical pacing and dosage
Session 6: Navigating Trauma Frameworks – Integration Without Fragmentation
Key Content:
- Overview of major trauma and attachment frameworks
- What each contributes — and what they don’t
- Overlap vs. contradiction
- Risks of model-hopping and identity diffusion
- How the ATTACh OT pathway integrates:
- Sensory
- Relational
- Developmental
- Neurobiological perspectives
- Communicating OT reasoning across disciplines
- Preparing for Tier 3 advanced intervention work
Learning Objectives:
Session 1 – Reading the Nervous System
Participants will be able to analyze client engagement, avoidance, and regulation patterns during occupational therapy sessions using an attachment- and state-based lens to inform trauma-responsive assessment
Session 2 – Trauma-Informed Assessment Tools & the Therapist as Instrument
Participants will be able to interpret standardized and non-standardized OT assessment data while accounting for state-dependent functioning and therapist–client relational dynamics
Session 3 – Case Formulation & Treatment Planning
Participants will be able to develop an integrated, trauma-informed OT case formulation that guides ethical prioritization of intervention goals and treatment planning.
Session 4 – Empathy, Shame, and Resilience
Participants will be able to identify the influence of empathy, shame, and resilience on occupational performance and therapeutic engagement to support attuned and effective intervention planning
Session 5 – From Regulation to Participation
Participants will be able to select and sequence trauma-informed OT interventions from bottom-up regulation strategies through executive functioning supports based on client readiness and nervous system capacity
Session 6 – Navigating Trauma Frameworks
Participants will be able to differentiate and integrate trauma and attachment frameworks within occupational therapy scope of practice to maintain coherent, occupation-centered clinical reasoning
Assessment: 20-point Q and A
Provider Name: ATTACh
Contact: www.attach.org
Presenter: Maude Le Roux, OTR/L, SIPT, ADHD-RSP, DIR Champion and Expert Training Leader
Bio: Maude Le Roux is a global trainer in multiple methodologies and a mentor to therapists from multidisciplinary teams. She opened her practice, A Total Approach in Glen Mills, PA, USA in 2001. Maude started her training career in 2007 and opened her online academy in 2019. She has designed the Developmental Pathways Model (DPM), which she applies to her own unique assessment and intervention protocol for major diagnosis such as Dyspraxia, ADHD and Executive Functions, Autism, Reading and Writing Disorders, and Trauma and Attachment. Maude served 9 years on the Board of Directors for ATTACh and currently serves on their Advisory Board. She also serves on the Advisory Board for LSWorks (Neuralign program). She is a co-author of two books and more recently wrote a chapter on Trauma and the Body in “Healing Connections” which launched in September 2024. Maude received an award for “Continued child advocacy” through the ATTACh organization in September 2024. She also received the Champion Award through ICDL in November 2024. Maude has a “whole child” approach to care and intervention and equipping the child, while empowering the parent is at the core of who she is as a clinician and trainer.
Target Audience: Occupational Therapists
Educational Level: Intermediary
Instructional Methods: PowerPoint, Video
Contact Hours: 9 hours
Fee: TBD
Contact: https://attach.org/training/
