The Seeds OT Model · Introduction · 3:06
A way to hold the whole picture
Nisha Bal’s clinical reasoning framework for paediatric OT: understanding conditions and patterns, and finding a thoughtful place to begin.
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0:00When the picture is complex
A child manages well at home but finds school overwhelming. A strategy helps for a few weeks, then seems to stop helping. The family is working hard, and several explanations make sense, but none seems to hold the whole picture. This is the kind of clinical situation the Seeds OT Model is designed to help an occupational therapist think about. It begins with curiosity about what is happening around a recurring difficulty.
0:26A reasoning framework
Developed by occupational therapist and Seeds founder Nisha Bal, the model is a clinical reasoning framework. It sits alongside the frameworks a clinician already uses. It does not replace assessment, diagnosis, professional judgement or evidence for a particular intervention. Its role is to organise thinking: what are we noticing, which conditions might be contributing, and where could useful work begin? It offers orientation without pretending that a complicated situation has become simple.
1:00Conditions shape each other
The model looks across six connected domains: biology and the nervous system; family and relationships; daily occupations; the environment; school and peers; and culture and society. These are prompts for looking, rather than separate boxes to tick. Sleep can affect the energy available for play. A demanding school day can affect what is possible at home. Looking across the domains helps us notice connections as well as the conditions that already support a child.
1:33Look for the pattern
A second idea is to look at a recurring difficulty as a pattern. When does it appear, when does it ease, and what tends to be present around it? The difficulty is real. Calling it a pattern does not dismiss it. It reminds us to investigate the circumstances, including the ways a difficult experience can change what happens next. The response, the exhaustion and the expectations can all become part of the next encounter.
2:01Find what is within reach
The next question is practical. Which conditions matter, and which can this child, family and team realistically influence now? Some can be changed. Some call for accommodation. Others need to be recognised and respected while effort goes elsewhere. That distinction matters when families are already carrying a great deal. A useful plan cannot depend on resources, time or control they do not have. The model asks us to stay clear about those limits.
2:29Keep returning to daily life
What keeps this occupational therapy is the return to daily life: sleep, meals, play, self-care, school, relationships and participation. The five parts take the reasoning further, from interacting conditions, to patterns, to choosing where to work, to the clinician’s way of seeing, and finally the formal structure. You can watch in order or read alongside each video. As you go, keep one question nearby: what does this help me notice about the activity this child is trying to take part in?