Tier 3: Navigating Complexity 
Advanced Clinical Mentorship in Attachment, Trauma and Occupational Therapy 

Description

After completing the foundations of attachment, trauma, and sensory regulation in Tier 1, and developing integrated assessment and clinical reasoning skills in Tier 2, you are ready for the most transformative stage of the ATTACh OT Certificate pathway. Tier 3 is not another course; it is an immersive clinical mentorship experience. 

Over five weeks, participants move beyond theory and assessment into the realities of complex clinical practice. Each session focuses on one authentic pediatric case presented by a participant, creating an opportunity for collaborative reasoning, reflective discussion, and advanced problem-solving. Rather than searching for the "correct" intervention, this mentorship explores the questions experienced clinicians ask every day: 

• What am I really seeing?  

• What is driving this child's participation?  

• What should I address first?  

• What am I missing?  

• How do I adapt when my original plan is no longer working?  

Together we will examine each child through multiple lenses—including attachment, trauma, sensory processing, developmental capacity, nervous system regulation, occupational participation, family relationships, environmental influences, and therapeutic process. Participants will learn not only from their own case presentations but from the collective wisdom generated across ten diverse clinical situations. Each discussion is designed to strengthen clinical confidence while embracing the uncertainty and complexity that characterize real-world occupational therapy. This experience emphasizes thoughtful reflection, respectful dialogue, and collaborative clinical reasoning rather than evaluation or critique. The goal is to cultivate therapists who can think flexibly, reason deeply, and make intentional decisions with confidence and compassion. 

By the end of this mentorship, participants will have developed a richer capacity to integrate evidence, clinical observation, therapeutic intuition, and occupational therapy reasoning into coherent, individualized intervention planning. Expert clinicians are not created by attending more lectures. They are shaped through thoughtful reflection, collaborative discussion, and the courage to examine real clinical complexity. Tier 3 is where knowledge becomes wisdom. 

Outline / Agenda:

Tier 3 consists of ten live, interactive clinical consultation sessions conducted over five weeks. 

Each two-hour session centers on one participant's comprehensive case presentation using the ATTACh OT Case Study Framework. Participants will present their case presentation according to specific guidelines provided in advance, followed by interactive discussion to focus on collaborative clinical reasoning, discussion, and advanced intervention planning rather than simply presenting information.Every session follows a similar structure while exploring the unique complexities of each child and family. 

Session Structure (2 Hours) 

1. Case Presentation 

• Brief overview of developmental, medical, educational, and relational history  

• Review of assessment findings  

• Occupational profile  

• Current intervention approaches  

• Clinical hypothesis and questions  

2. Collaborative Clinical Reasoning 

• Identifying underlying nervous system patterns  

• Understanding attachment and relational dynamics  

• Differentiating trauma, sensory, developmental, and behavioral contributors  

• Exploring occupational participation strengths and barriers  

3. Intervention Planning 

• Prioritizing intervention targets  

• Matching intervention to nervous system readiness  

• Integrating sensory, relational, developmental, and occupation-based approaches  

• Caregiver collaboration and environmental considerations  

4. Reflection and Clinical Integration 

• Discussion of therapeutic decision-making  

• Review of supporting evidence  

• Clinical questions from participants  

• Application of learning to participants' own caseloads  

Learning Objectives:

Participants will be able to analyze complex pediatric case presentations by integrating developmental, attachment, trauma, sensory processing, relational, and occupational perspectives to develop comprehensive clinical formulations. 

2.   Participants will be able to evaluate assessment findings, clinical observations, caregiver narratives, and occupational performance data to differentiate underlying factors influencing participation and prioritize intervention needs. 
3.   Participants will be able to formulate individualized, occupation-centered intervention plans that integrate neurobiological, relational, sensory, developmental, and evidence-informed approaches while supporting caregiver collaboration and therapeutic safety. 
4.   Participants will be able to critically reflect on their own clinical reasoning through collaborative case consultation, integrating peer discussion, current evidence, and therapeutic self-awareness to strengthen ethical, occupation-centered decision-making in complex clinical practice. 

Research 

1. Doherty, R. F., and Rotelle, O. (2024). Let's talk about ethics: Addressing ethical tensions and building moral resilience in the occupational therapy profession. American Journal of Occupational Therapy, 78(2), 7802347010. https://doi.org/10.5014/AJOT.2024.050566 

1. Nelson, M., Jaegers, L., Tyminski, Q. P., Kiepek, N., and Dieleman, C. (2023). Teaching critical reflection in occupational therapy: A quantitative pre/post evaluation of student learning. The Open Journal of Occupational Therapy, 11(3). https://doi.org/10.15453/2168-6408.2102 

1. Burke, H. K., Bundy, A. C., and Lane, S. J. (2023). If reasoning, reflection, and evidence-based practice are essential to practice, we must define them. The Open Journal of Occupational Therapy, 11(1), Article 15. https://doi.org/10.15453/2168-6408.2044 

1. Newson, A. L. (2024). Clinical decision making within occupational therapy: A critical reflection of providing palliative care for a patient in the community. International Journal of Therapy and Rehabilitation, 31(4). https://doi.org/10.12968/ijtr.2023.0032  

Assessment: A rubric will be completed on key points of each case presentation in support of reflective learning 

Provider Name: ATTACh 

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: Advanced 

Instructional Methods: PowerPoint, Video 

Contact Hours: 20 hours 

Fee: TBD 

Contact: https://attach.org/training/

[email protected]