Occupational Therapy Evaluation Methods and Tools

Validity Checking in Clinical Practice

• Occupational therapists observe clients performing activities (e.g., money management).
• Practitioners may notice difficulties in organizing information when clients repeat the same mistake.
• The therapist interprets the client's struggle with organization, linking it to other tasks like morning routines.
• Validity checking involves sharing this interpretation with the client to see if it aligns with their perspective.
• Example: "John, I have noticed that in doing your daily routines you seem to have trouble organizing the materials to get the job done. Do you think that is an accurate picture of what is happening?"
• This approach may not be effective for clients lacking awareness but can still provide insights into their perspective.

Using Valid and Reliable Tools

• Using valid and reliable tools is crucial for validating therapeutic reasoning and ensuring a complete occupational picture.
• Both reliability and validity are essential for practitioners to have confidence in their measurements.
• Reliability and validity are not static; they depend on who the tool is administered to and how it is administered.
• If a tool is used with a population different from the one it was designed for (e.g., using a dementia tool on a schizophrenia patient), the tool's properties may not be reliable.
• Lack of proper training on tool administration can compromise inter- and intrarater reliability.
• Occupational therapists must understand the theoretical and practical aspects of assessments to ensure reliable and valid data collection.

Practice Models for Holistic Evaluation

• Occupational therapists require a holistic approach during evaluation, considering the entire person and their context.
• Selecting a practice model provides a lens through which to view various characteristics and factors.
• Model of Human Occupation (MOHO) example:
  • Assesses internal factors like volition (values, interests), habituation (roles, habits, routines), and performance skills (range of motion, cognition).
  • Examines external contexts like economic, cultural, and political conditions (Kielhofner, 2008).
• Using an occupational therapy model ensures data collection on components impacting occupational performance.

International Classification of Functioning, Disability and Health (ICF)

• The concept of holistic evaluation is expanding to other professions.
• The ICF provides a common language for health professionals to discuss health and disability (WHO, 2002).
• The ICF includes internal elements (body structure, body function, client factors) and external elements (environment).
• Occupational therapists benefit most from using an occupational model of practice for a complete understanding of a client's occupational performance.
• The ICF does not fully define personal factors necessary for a holistic occupational therapy evaluation.

Assessment Methods

• Occupational therapists use various tools for data gathering.
• Tools can be specialized orVersatile.
• Choosing the right tool for the right purpose is crucial.
• Factors influencing the evaluation process affect therapeutic reasoning.
• Primary data gathering methods in psychosocial practice: interviews, self-reports, and performance assessments.
• Methods can be combined or used informally.
• Informal observations and eliciting a person's perspectives are basic assessment tools.
• The focus is on the intentional use of published, valid, and reliable assessment tools.

Interviews

• Interviews gather data to create an occupational profile and understand a person's self-perception of occupational performance.
• Skilled practitioners build rapport to facilitate relaxed conversations.
• Effective interviews have a purpose.

Interviews and Practice Models

• Some interviews align with specific occupational therapy practice models.

Model of Human Occupation (MOHO) Based Interviews:

• OPHI-II: Generates a broad occupational profile, including the person's perception of their historical occupational performances (Kielhofner et al, 2004).
• Occupational Circumstances Assessment Interview and Rating Scale: Determines the person's perception of their current occupational performances (Forsyth et al, 2005).
• School Setting Interview: Examines the impact of the school environment on students with disabilities (Hemmingsson, Egilson, Lidström, & Kielhofner, 2014).
• Worker Role Interview and Work Environment Impact Scale: Focuses on work, vocational history, worker role identity, and the impact of the work environment (Braveman et al, 2005; Moore-Corner, Kielhofner, & Olson, 1998).
• Canadian Occupational Performance Measure (COPM): Elicits a person's perception of and satisfaction with their performance in self-care, work, and leisure (Law et al, 2014). Based on the Canadian Model of Occupational Performance and Engagement (Polatajko, Townsend, & Craik, 2007).

Evidence-Based Practice: Canadian Occupational Performance Measure (COPM)

• The COPM uses a client-centered approach to gather information about a client’s perceived occupational performance through a semi-structured interview.
• Studies have extensively examined the COPM for validity and reliability across various diagnoses (Colquhoun et al, 2012; Gustafsson et al, 2012).
• Results have demonstrated accepted validity, reliability, sensitivity, and responsiveness (Gustafsson et al, 2012).
• The COPM has been applied as an outcome measure for vocational rehabilitation and assisted device use (Gustafsson et al, 2012; Nieuwenhuizen et al, 2014).
• Grounded in the client-centered Canadian Model of Occupational Performance, the COPM reinforces occupation-focused evaluation and interventions.
• Evidence indicates that the COPM is sensitive to changes in a person's self-assessment of occupational performance over time.
• Practitioners can confidently use the COPM as an outcome measure for individual occupational therapy interventions and program evaluations.

Kawa River Model Interview

• A unique interview process uses the metaphor of life as a river (Iwama, 2006).
• The practitioner guides the person to create an image of a river depicting their life situation, prioritizing discussions on positive or negative impacts.
• River flow: Represents the person's life flow and priorities.
• River banks: Represent the social and physical environment influencing occupational engagement.
• Rocks: Characterize challenging situations or problems.
• Driftwood: Exemplifies factors influencing life flow.
• Spaces between rocks: Symbolize opportunities for growth.
• The interview does not need to unfold in a particular order (Teoh & Iwama, 2015).
• Eliciting explanations and experiences of everyday life is a primary goal.
• Guiding questions support the use of the tool (Teoh & Iwama, 2015).
• The use of metaphor highlights a consideration for practitioners: Interviews may not be suitable for those with cognitive impairments.
• Family, friends, or staff may be interviewed after obtaining consent.
• Eliciting the person's perspective remains a primary goal.

Self-Report Assessments

• The recovery model emphasizes that people with mental illness can control their lives.
• Recovery is person-driven and based on self-direction (SAMHSA, 2012).
• Self-report tools (questionnaires, checklists, surveys) gather data and acknowledge the person's expertise in their illness experience.
• Interviews are also a type of self-report, collecting subjective data directly from an individual.
• Self-report tools allow individuals to share data about their life circumstances, feelings, perspectives, attitudes, and beliefs (Kramer et al, 2017).
• Self-report assessments provide an opportunity for self-reflection.

Example:

• Tools focusing on occupational roles:
  • Enable reflection on current and past roles.
  • Assess the balance (or lack thereof) in current life roles.
  • Prioritize roles.
• Tools focusing on sensory processing:
  • Consider experiences of different environmental situations.
  • Notice patterns in behavioral responses.
• Practitioners can use self-report tools to initiate conversations about specific areas of occupational functioning.
• The choice of tool is intentional, based on the person's needs and priorities.

Occupational Self-Assessment (OSA)

• Uses a person-centered approach, offering individuals opportunities to experience self-control in intervention planning.
• The OSA has been used as an outcome measure to show the efficacy of an occupational therapy program and as a predictor for quality of life (Chen, Pan, Hsiung, & Chung, 2015; Chen, Pan, Hsiung, Chung, Lai, et al, 2015; Kielhofner & Forsyth, 2001; Kielhofner, Forsyth, Kramer, & Iyenger, 2009).
• Research testing the psychometric qualities of the OSA demonstrated adequate construct validity, sensitivity, discriminative validity, and internal consistency (Pan, Chen, et al, 2012; Pan, Chung, Chen, Hsiung, & Deepa, 2011).
• Practitioners can confidently use the OSA as an effective tool to help construct an occupational profile, engage the person in a collaborative evaluation process, and test intervention outcomes.
• Practitioners should recognize valued occupations in which the person feels most competent, but also attend to valued occupations in which people feel least competent.
• The OSA can predict the quality of life for persons with depression (Chen, Y. L., Pan, A. W., Hsiung, P. C., & Chung, L. (2015). Quality of life enhancement programme for individuals with mood disorder: A randomized controlled pilot study. Hong Kong Journal of Occupational Therapy, 5, 23-31).

Role Checklist

• A paper-and-pencil checklist to measure a person's past and current participation in 10 common roles (e.g., worker, caregiver, student, homemaker, etc.).
• Individuals project their future role participation and prioritize the importance of these roles (Oakley, Kielhofner, Barris, & Reichler, 1986).
• Designed to apply the Model of Human Occupation and address habituation (roles and habits) based on the person's perception of their role participation (Oakley et al, 1986).
• Practitioners use the results to discuss role functioning, changes in participation in society, role balance, overload, or absence of roles (Dickerson, 2008; Liu, Chen, Chung, & Pan, 2004).
• Facilitates conversations about the connection between role participation and time use (Dickerson, 2008).
• A newer version (Scott, 2013) maintains the same 10 roles but asks the person to rank the quality of their current role performances (worse, better, same) against their highest level of performance.
• The Role Checklist can be used as an outcome measure when the intervention goal addresses participation and satisfaction in an occupational role.

Child Occupational Self-Assessment (COSA)

• A children's version of the OSA (Baron, Kielhofner, Iyenger, Goldhammer, & Wolenski, 2006; Kramer et al, 2014).
• Both self-assessments gather data on a person's values and sense of competence when completing everyday activities.
• Designed to engage the person in setting priorities for intervention (Baron et al, 2006; Kramer et al, 2014).
• Parallel processes are used in administration, scoring, and interpretation.
• The COSA assesses a child's perceived level of competence when completing everyday activities:
  • "I have a big problem with this."
  • "I have a little problem with this."
  • "I do this OK."
  • "I am really good at this."
• And the value the child places on daily activities:
  • "Not really important to me."
  • "Important to me."
  • "Really important to me."
  • "Most important of all to me."
• Activities are listed in plain language with visual scales.
• The practitioner chooses a paper-and-pencil checklist or card sort format based on the child's abilities.
• The tool maximizes the child's opportunity to identify and plan for prioritized and meaningful occupations.

Adolescent/Adult Sensory Profile (A/ASP) & Sensory Profile 2

• The Adolescent/Adult Sensory Profile (A/ASP; Brown & Dunn, 2002) can be used with persons aged 11 to 90.
• The Sensory Profile 2 (Dunn, 2014) assesses sensory processing patterns in children from birth to 14 years of age.