What is the SpIRiT?

The SpIRiT© (Sensory processing/Integration Reasoning interactive Tool) is a mindful clinical reasoning tool for ensuring best practice in pediatric occupational therapy.

Clinical Reasoning for pediatric occupational therapists should be informed by many sources and levels of evidence, including the basic neuroscience, developmental theory, occupational therapy literature, and OT clinical practice.  All provide rich sources of evidence and inspiration. However, combining all of these sources of information into a format useful for in the moment clinical use can be daunting.  Hence, the necessity of a comprehensive clinical reasoning process, the SpIRiT©!  

The SpIRiT© was originally devised for OT practitioners, but is generalizable for other disciplines.  It offers a useful tool for clinicians, educators, and parents interested in how sensory, affective, and motor difficulties may be understood in terms of how they impact development; and, perhaps most importantly, how this understanding leads to comprehensive, efficacious intervention from an interpersonal neurobiological standpoint.

The SpIRiT introduces a clinical reasoning framework for combining sensory, affective, and motor (SAM) processing into a relationship-based, sensory integrative model of intervention. The SpIRiT© is an extension of the STEPSI© model, originated by Stackhouse, Wilbarger, and Trunnell in 1998, as the first fidelity to treatment model devised for sensory integration and pediatric occupational therapy. The SpIRiT© model draws from developmental science and current neuroscience to create an evidence-based model to guide clinicians in developing and monitoring efficacious intervention. It also encourages reflective clinical reasoning as a way of practice.

Learning Objectives

Upon completion of this course, participants will be able to:

  • Define clinical reasoning and summarize why it is important in everyday practice

  • Recognize the core underpinnings encompassed within the SpIRiT process

  • Identify the 5 neurodevelopmental domains addressed within the SpIRiT

  • Analyze which of the S-A- M elements apply to the case studies presented

  • Demonstrate the ability to generate a comprehensive, individualized treatment plan based upon the SpIRiT process

Meet your instructor:

Executive Director, Occupational Therapist

Tracy Stackhouse

Tracy Murnan Stackhouse, MA, OTR is the executive director of Developmental FX (DFX) in Denver, Colorado, a non-profit organization providing clinical and training services to engage and elevate pediatric therapeutic practice. She is a leading pediatric occupational therapist (OT) involved in clinical treatment, research, mentoring, and training regarding OT intervention for persons with neurodevelopmental disorders, especially Fragile X Syndrome and autism. Tracy has a master’s degree in developmental psychology/neuroscience. She received her NDT training with Lois Bly. She is SIPT Certified and was the clinical specialist in sensory integration at The Children’s Hospital in Denver as well as the OT for the Fragile X Research and Treatment Center. Tracy continued her clinical and research work with Dr. Randi Hagerman at the UC Davis M.I.N.D. Institute during its start-up year prior to starting Developmental FX. Tracy has written several book chapters on sensory integration and neurodevelopmental disorders and teaches nationally and internationally on sensory integration, autism, fragile X and related topics. She is the lead author for the SpIRiT & S.T.E.P.S.I. Clinical Reasoning Tools which are leading-edge evidence-based models in pediatric OT. These models are utilized in OT practices around the globe and included in the model at Camp Jabiru in Australia. The tools are shared through the “Spirited Conversations’ Podcast as well as through DFX’s training platform, Learning Journeys. Tracy has ongoing courses offered through Medbridge and iLS/Untyte (remote training use of the Safe and Sound Protocol). Tracy is a member of the National Fragile X Foundation Clinical Research Consortium, the Scientific And Clinical Advisory Committee, and the NFXF Advisory Council and an expert advisor to the CDC and RTI Fragile X Priorities Panel. Tracy is the co-founder of Developmental FX, which is a non-profit organization that is governed according to our mission and bylaws with a board of directors providing fiduciary and general oversight. All proceeds from trainings and publications are paid to the non-profit and not directly to Tracy to ensure that there is no conflict of interest and no disclosure.

The SpIRiT Is A Revolutionary Clinical Reasoning Tool For Pediatric Practice

But Don't Take It From Us, Take A Look At What Others Have To Say:

  • "I sometimes get a little stuck in the beginning process of working out where to start with a kiddo but it was so helpful to really see the connections being drawn between the different domains and how interrelated it can be - that its more of a process and journey rather than seeking to have all the answers at once."

  • "Tracy, I love your brilliant mind! You make all of this seem so simple and so clear. I enjoyed the online course very much as I could take in a bit at a time & think it through myself. "

  • "I love how I can always find a few anecdotes, reminders and a more coherent explanations to what I often already do and maybe even know, though not as thoroughly, whenever I listen to you."

Course Overview

Continuing Education: We are eager to share our SpIRiT clinical reasoning tool with clinicians around the world. A course certificate awarding 12.0 contact hours is issued at the completion of the full course that may be used for professional continuing education depending on each country's own requirements. The course includes measurement of proficiency and completion standards to address professional continuing education requirements.  

Developmental FX is an AOTA Approved Provider of professional development. PD activity approval ID# 0000007700 This online course is offered at 1.2 AOTA CEUs, intermediate level, in the OT Service Delivery category. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.

Course Level: Intermediate. There are no prerequisites for this course


Completion Requirements: Participants need to view all of the recorded videos, complete the Integration of Learning Activities throughout the course (including receiving passing, 60% or higher scores, scores on quizzes) and submit the final case study assignment (pass/fail) in order to receive a certificate and continuing education hours for this course. A learner must complete the course in entirety to receive continuing education credit. No partial credit will be awarded at this time.


ADA/Section 504: Please contact us at [email protected] if you require specific accommodations.

Downloads and Course Structure: All of the downloadable resources and information will be provided at the beginning of this course in order to simplify your printing process. At the beginning of each chapter, you will find a Chapter Preview that highlights which materials will be covered in each chapter as well as the estimated time for completion.

Price: $450

Learning in Community

We recognize the value of shared learning experiences. The SpIRiT model inherently provides a unique opportunity for rich group learning and elevated clinical reasoning discussions. Be on the lookout for " Learning Journey Community meetings" in 2024

If you are an organization or group that would like to take The SpIRiT course together (outside of the general cohort offering in Fall of 2024) we would love to support your learning. Please reach out to [email protected] to discuss large group registrations on a case by case scenario. 

Course curriculum

  • 1

    Developmental FX Learning Journeys: The SpIRiT of Pediatric Therapy

    • A message from the instructor

    • Before You Begin Your Journey- Course Overview and Helpful Information

    • Copyright Guidelines and The SpIRiT- Please Read Prior To Downloading Provided Resources

    • SpIRiT Slides/ Handouts

    • SpIRiT Slides/ Handouts- Large Version

    • Materials to support you during the SpIRiT process- To Print

    • SpIRiT Definitions

    • Selected SpIRiT References

  • 2

    Chapter 1: Introduction to Clinical Reasoning- Why is it important?

    • Chapter 1 Preview

    • Chapter 1: Introduction to Clinical Reasoning

    • Chapter 1: Integration of Knowledge

    • Chapter 1: Pause and Practice

  • 3

    Chapter 2: Why the SpIRiT?

    • Chapter 2 Preview

    • Chapter 2: Why the SpIRiT?

    • Chapter 2: Integration of Knowledge

    • Chapter 2: Pause and Practice

  • 4

    Chapter 3: Getting into the SpIRiT

    • Chapter 3 Preview

    • Chapter 3: Getting into the SpIRiT

    • Chapter 3: Pause and Practice

  • 5

    Chapter 4: Theory that grounds the SpIRiT

    • Chapter 4 Preview

    • Chapter 4: Theory that grounds the SpIRiT

    • Chapter 4: Integration of Knowledge

    • Chapter 4: Pause and Practice

    • TQEs- Chapters 1-4

  • 6

    Chapter 5: Treatment Planning and the SpIRiT- Introducing the STEPSI

    • Chapter 5 Preview

    • Chapter 5: Treatment Planning and the SpIRiT- The STEPPSI

  • 7

    Chapter 6: Bridging into the domains of the SpIRiT

    • Chapter 6 Preview

    • Chapter 6: Bridging into the domains of the SpIRiT

    • Chapter 6: Pause and Practice

    • TQEs Chapters 5-6

  • 8

    Chapter 7: Domains of the SpIRiT- Posture/ Automatic Motor Control

    • Chapter 7 Preview

    • Chapter 7: Domains of the SpIRiT- Posture/ Automatic Motor Control

    • Chapter 7: Integration of Knowledge

    • Chapter 7: Pause and Practice- Posture

    • TQE's Chapter 7

  • 9

    Chapter 8: Domains of the SpIRiT- Sensory Discrimination

    • Chapter 8 Preview

    • Chapter 8:Domains of the SpIRiT- Sensory Discrimination

    • Chapter 8: Integration of Knowledge

    • TQEs Chapter 8

  • 10

    Chapter 9: Domains of the SpIRiT- Modulation Capacities

    • Chapter 9 Preview

    • Chapter 9 - Part 1

    • Chapter 9-Part 2

    • Chapter 9: Integration of Knowledge

    • Chapter 9: Pause and Practice

    • TQEs Chapter 9

  • 11

    Chapter 10: Domains of the SpIRiT- Social Emotional Capacities

    • Chapter 10 Preview

    • Chapter 10-Part 1

    • Chapter 10-Part 2

    • Chapter 10: Integration of Knowledge

    • Chapter 10: Pause and Practice

    • TQEs Chapter 10

  • 12

    Chapter 11: Domains of the SpIRiT- Executive Functioning Capacities

    • Chapter 11 Preview

    • Chapter 11: Domains of the SpIRiT- Executive Functioning Capacities

    • Chapter 11: Integration of Knowledge

    • TQEs Chapter 11- EF

  • 13

    Chapter 12: The STEPPSI

    • Chapter 12 Preview

    • Chapter 12: The STEPPSI

    • Chapter 12: Pause and Practice

  • 14

    Chapter 13: Putting all the pieces together

    • Chapter 13 Preview

    • Chapter 13: Part 1- Connecting the threads

    • Chapter 13: Part 2- A Case Study

    • Chapter 13: Pause and Practice

    • Course Summary Evaluation- Required- Thank you!

    • Case Study Assignment (REQUIRED)

Meet the SpIRiT Team

Co-Author of The SpIRiT

Angela Sauer Graf

Angela Sauer Graf grew up in Soldotna, Alaska. She received her Bachelor Degree from Gonzaga University and graduated with a Master’s Degree in Occupational Therapy from Arizona School of Health Sciences (AT Still University). Angela began her career at the Texas NeuroRehab Center in Austin before moving to Madison, Wisconsin, where her passion for working with children was realized. Along with providing therapy in a school based setting, Angela had the opportunity to be a part of Camp Avanti, a camp designed and led by occupational therapist to meet the therapeutic needs of children within a joyful camp setting. Angela moved to Denver, Colorado in 2007 to work for the Cherry Creek School District and joined the DFX team in 2013. While at DFX Angela assisted in developing the SpIRiT (Sensory processing/Integration Reasoning interactive Tool) with Tracy Murnan Stackhouse and the amazing team at DFX. Angela loves to expand her knowledge to assist her clients and their families in a safe and supportive way. Outside of work, Angela loves spending time with her family, including her husband Mike, 5 year old daughter, Ayla, and new puppy, Ella. She also enjoys yoga, hiking, snowboarding, mountain biking, reading, and traveling.

OTR/L, Learning Journeys Program Coordinator

Kelsey Forbringer

Kelsey graduated from Illinois Wesleyan University with a BA in Psychology before receiving her Master of Science in Occupational Therapy from Washington University in St. Louis. Kelsey began her career in Chicago working with pediatric clients in the home and outpatient clinic settings. Upon moving to Denver, she worked in the early childhood program at Cherry Creek School District. During a continuing education course in which Tracy presented the SpIRiT, Kelsey knew she wanted to understand the material at a deeper level and needed to be part of the DFX team. Kelsey is passionate about learning and increasing her capacity to support her clients to the best of her ability. In addition to her knowledge of various treatment approaches, Kelsey has completed advanced training in Dr. Stuart Shanker’s Self-Reg curriculum, iLs/Unyte’s Safe and Sound Protocol, and DIR®/Floortime™ Kelsey and her husband recently moved back to the Midwest to be closer to family. She is grateful to continue to be part of the DFX team from afar in her new role as the DFX Learning Journeys program coordinator. Kelsey also provides telehealth based services, consultations, parent coaching, and looks forward to seeing clients in the St. Louis area soon.

SpIRiT Graphic Designer

Rachel Malmquist

Rachel is originally from Fort Collins and attended Colorado State University before receiving her Masters Degree from Dominican University of California in the Bay Area. Although she very much enjoyed her time in California, she is happy to be back in Colorado to be closer to family and the mountains! Rachel has always felt a special connection with kids and is beyond excited to be a part of the brilliant and passionate DFX team! She is eager to learn and grow every day while making a difference in the lives of her clients and families. Rachel is part of the SpIRiT team at DFX and has created all beautiful graphics and forms for this project. Rachel is an adventure and nature enthusiast at heart and loves to be outside and exploring the mountains. She loves spending time with her family and her two cats, Benni & Wally. She is an early bird, and greets each morning with a yoga session and double-shot of espresso before taking on the world!

Coming soon!

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Thank you for the music!

Generosity is a Gift of Spirit! 

With immense gratitude, we thank Colm Mac Con Iomaire for generously allowing us to utilize his music throughout the courses shared here.  It is our hope to share his music and create a special moment of joy and celebration of true artistry and the Irish spirit as inspiration!