Occupational Therapy Evaluation Tools and Processes

Occupational Self-Assessment (OSA)

• Person-centered approach: Provides individuals with opportunities to experience self-control in intervention planning.
• Outcome measure: Used in studies to show the efficacy of occupational therapy programs (Chen, Pan, Hsiung, & Chung, 2015; Chen, Pan, Hsiung, Chung, Lai, et al., 2015).
• Predictor: Can predict quality of life (Kielhofner & Forsyth, 2001; Kielhofner, Forsyth, Kramer, & Iyenger, 2009).
• Psychometric qualities: Demonstrates adequate construct validity, sensitivity, discriminative validity, and internal consistency (Pan, Chen, et al., 2012; Pan, Chung, Chen, Hsiung, & Deepa, 2011).
• Effective tool: Helps construct an occupational profile and engages the person in a collaborative evaluation process.
• Focus for Intervention: Practitioners should address valued occupations where the person feels least competent.
• Predicts quality of life: Evidence shows that the OSA can predict the quality of life for persons with depression (Chen, Y. L., et al., 2015).

Role Checklist

• Measures past and current participation in 10 common roles (e.g., worker, caregiver, student, homemaker).
• Future participation: Asks the person to project future participation in the same roles.
• Prioritization: Asks the person to prioritize the importance of these roles.
• Model of Human Occupation: Tool designed to apply the Model of Human Occupation.
• Habituation: Assists the practitioner to address habituation based on the person's perception of role participation (Oakley et al., 1986).
• Conversation starter: Used to open a conversation about role functioning and its connection to participation in society (Dickerson, 2008).
• Role balance: Helps identify role balance, role overload, or an absence of roles (Liu, Chen, Chung, & Pan, 2004).
• Time use: Initiates a conversation about the connection between role participation and time use (Dickerson, 2008).

Newer Version (2008)

• Quality of role performance: Ranks the quality of current role performances (worse, better, same) against the person's highest level of performance in the role (Scott, 2013).
• Outcome measure: Can be used as an outcome measure when the intervention goal addresses participation and satisfaction with participation in an occupational role.

Third Version (In Development)

• Prioritized roles: Evaluates the degree to which the person wants to engage in various roles now or is willing to delay participation, adding another way to focus on prioritized roles (Scott, McFadden, Yates, Baker, & McSoley, 2014).

Child Occupational Self-Assessment (COSA)

• Children's version of the OSA (Kramer et al., 2014).
• Person-directed assessments: Designed to gather data on a person's values and sense of competence when completing everyday activities of daily life.
• Intervention priorities: Deliberately engages the person in setting priorities for intervention (Baron et al., 2006; Kramer et al., 2014).
• Parallel processes: Uses parallel processes in the administration, scoring, and interpretation of results compared to the adult version.

Assessment Focus

• Competence: Assesses how a child perceives his or her own level of competence when completing everyday activities.
• Value: Assesses the value the child places on these various daily activities (Kramer et al., 2014).
• Rating Scale: ("Not really important to me," "Important to me," "Really important to me," "Most important of all to me")
• Examples: Activities include keep my body clean, dress myself, buy something for myself, and follow classroom rules.
• Visual scales: Accompanied by visual scales featuring stars and happy or sad faces.
• Administration: Practitioner may choose a paper-and-pencil checklist or a card sort format.
• Goal: Maximizing the child's opportunity to identify and engage in planning for how to address prioritized and meaningful occupations.

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

• Focus: Sensory processing that may impact occupational functioning.
• A/ASP Age Range: 11 to 90 years old (Brown & Dunn, 2002).
• Sensory Profile 2 Age Range: Birth to 14 years of age (Dunn, 2014).
• Sensory Profile 2 Versions: Specific to infants, toddlers, and children.
• Assessment by Proxy: Assessment completed by parents, caregivers, teachers, and other professionals based on their observations and interactions with the child (Dunn, 2014).
• A/ASP: Self-report assessment designed to measure a person's sensory processing preferences and responses to sensory events in everyday life.
• A/ASP Items: Examines sensory processing profile when participating in activities including reactions to taste, smell, vision, touch, or auditory or kinesthetic input.
• Response Set: nearly never, seldom, occasionally, frequently, or almost always.
• Dunn's Model: Responses are interpreted using Dunn's model of sensory processing, which categorizes behavioral responses into four quadrants: sensation seeking, sensation avoiding, sensory sensitivity, and low registration (Dunn, 1997).

Therapeutic Reasoning Assessment Table: Self-Report Assessments

Occupational Self-Assessment (OSA)

• Designed for: People older than 12 years of age diagnosed with a wide range of disabilities.
• Client Requirements: Persons can concentrate to rate occupational performance, self-reflect, and participate in goal planning.
• Measurement: Self-perceived competence of performance, value attributed to occupational performance and environmental situations.
• Time: Around 10 to 15 minutes to administer checklist and 15 to 20 minutes to review and set priorities for intervention.
• Practice Model: Model of Human Occupation.

Role Checklist

• Designed for: Adults with mental illness; can be used with adolescents and elderly individuals in a variety of settings.
• Client Requirements: Person can concentrate to self-rate participation, satisfaction, and quality of performance in 10 common occupational roles; people have a sense of time.
• Measurement: Person's perception of past, present, and future patterns of role participation; the value each role holds for the person and his or her self-assessment of the quality of current role performance versus highest level of past performance.
• Time: Around 10 to 15 minutes to administer the paper-and-pencil checklist and 15 to 20 minutes to review.
• Practice Model: Model of Human Occupation.

Adolescent Adult Sensory Profile

• Designed for: Age 11 to older adult
• Client Requirements: Self-report completed by the participant independently or therapist can read items and circle responses
• Measurement: Sensory processing preferences as observed through participation in daily life
• Time: Around 30 minutes at home or clinic
• Practice Model: Dunn's Model of Sensory Processing

Performance Assessments

• Observation: Occupational therapy practitioners use their senses to observe occupational performance.
• Data Collection: Supports the practitioner's assessment of whether a person can demonstrate competent occupational performance.
• Natural Environments: Assessing the frequency, strength, and pervasiveness of both problem and positive behaviors.

Characteristics of Performance Assessment Tools

• Environments: Can be completed in natural or contrived environments.
• Noninvasive: Can be completed in a noninvasive manner.
• Procedures: Procedures for making observations and ratings are defined.
• Data: Rating scales offer quantifiable data that complement other methods of data collection.
• Therapeutic reasoning: Guide therapeutic reasoning.

Allen Cognitive Level Screen (ACLS-5)

• Cognitive Disabilities Model: Test of functional cognition designed to help a practitioner apply the Cognitive Disabilities Model (Allen et al., 2007).
• Assumption: Global cognitive functioning can be inferred by observing a person's functional performance (McCraith, Austin, & Earhart, 2011).
• Screening: Provides a quick screening of functional cognition using a series of three visual motor tasks.
• Directives: Practitioner offers directives in a graded fashion beginning with visual demonstration and verbal instruction and moving to asking the person to complete the task using only a visual model.
• Leather-lacing stitches: Practitioner systematically observes the person's performance as she or he attempts three increasingly complex leather-lacing stitches.
• Scoring rubric: Observations are then compared with the ACLS-5 scoring rubric that matches a person's performance with the ACLS.
• Ordinal scale: Features six levels of cognitive function and is hypothesized to reflect a hierarchy of increasingly complex cognitive ability.
• Cognitive Levels: Someone functioning at cognitive level 1 represents the least and most simplistic cognitive abilities and a person functioning at cognitive level 6 does not demonstrate cognitive limitations (Allen & Blue, 1992).
• Large Allen Cognitive Level Screen (LACLS): Designed to accommodate individuals whose visual acuity is limited or who may have fine motor problems (Allen et al., 2007).
• Screening tools: Continued assessment with this and other tests of cognitive processing are required to determine specific areas of dysfunction and monitor changes in cognitive functioning.

Assessment of Motor and Process Skills (AMPS)

• Performance assessment: Designed to simultaneously measure motor and cognitive processing skills of an individual while engaged in routine activities of daily living (Fisher & Bray-Jones, 2014).
• Observation mode: Standardized assessment that uses observation mode to obtain information related to a client's basic activities of daily living (BADL) and IADL performance.
• Motor and process skills: Rated on 16 motor (e.g., walks, lifts) and 20 process (e.g., chooses, sequences) skills items.
• School AMPS: Measures children's performances on common school tasks (e.g., writing, cutting, and computer tasks).
• Quality of participation: Both AMPS measures assess the quality of participation.
• Psychometric qualities: Evaluated extensively and standardized on an international sample (Ayres & John, 2015; Fisher, Bryze, Hume, & Griswold, 2005; Lindström, Hariz, & Bernspång, 2012; Merritt, 2011).
• Diagnoses: Can be applied to persons with schizophrenia, drug addiction, and other diagnoses to identify the functional deficits.
• Service needs: Can also serve to identify the needs of service (Fisher et al., 2005).
• School AMPS Validity: Practitioners can use the School AMPS as a valid and reliable measure of a student's occupational performance in tasks commonly completed in a classroom environment.
• Intervention planning: Clinicians can confidently use the AMPS to help plan intervention, to develop intervention goals, and as an outcome measure to assess change.
• Task selection: Part of the process of administering this assessment is working with the person to select standardized tasks that the person is familiar with yet which also challenge the person's performance abilities.
• Rating rubric: Practitioner observes the person completing these tasks and uses the AMPS four-point rating rubric (deficit, ineffective, questionable, competent) to assess occupational performance across 16 motor (e.g., walking, reaching, lifting, transporting, etc.) and 20 processing skills (e.g., choosing, using, sequencing, accommodating, etc.).
• Software: Practitioner can use a computerized software program to generate a comprehensive report of motor and process performance skills (www.Innovativeotsolutions.com).
• Reliability and Validity: The AMPS has been researched extensively and found to have very high levels of reliability and validity when persons are appropriately trained.

Volitional Questionnaire (VQ)

• Designed to assess volition in older children who could not participate in interviews or self-reports because of cognitive, physical, or verbal impairments (de las Heras, Geist, Kielhofner, & Li, 2007).
• Pediatric VQ: Developed to address similar concerns in any child between the ages of 2 and 6 (Basu, Kafkes, Schatz, Kiraly, & Kielhofner, 2008), but it may also be used with older children exhibiting significant developmental delays (de las Heras de Pablo et al., 2017).
• Values and Interests: People who cannot verbally communicate nonetheless express their values, interests, and goals in their actions (de las Heras and colleagues (2007)).
• Structured observation: A practitioner uses the structured observational rating tool of the VQ to systematically make observations.
• Rating form: Composed of 14 different items that assess actions reflecting the person's intrinsic motivation, sense of competence, interests, and values.
• Rating scale: passive, hesitant, involved, or spontaneous.
• High motivation: Behaviors indicative of high motivation would be observable in the person who shows pride in accomplishment, is curious about the environment, takes appropriate risks or seeks a new challenge, or is someone who is motivated to try to solve a problem, fix an error that has been made, or stick with a challenging activity until completion.
• Observation focus: On the degree to which the person spontaneously exhibits behaviors that reflect his or her volition.

Therapeutic Reasoning Assessment Table: Performance Assessments

Assessment of Motor and Process Skills (AMPS; Fisher & Bray-Jones, 2014)

• Designed For: Multiple populations across the life span, including children with at least a developmental age of 2
• Client Can Do: Complete two standardized AMPS tasks that are familiar to the person and relevant to his or her life situation; use motor and processing skills to complete the tasks in familiar environments.
• Measures: Evaluates the quality of a person's motor and cognitive processing performances in activities of daily living
• Time: Depends on the task and the person's abilities but AMPS tasks can be completed in fewer than 40 minutes and School AMPS tasks usually are completed in less than 1 hour
• Tool Model: Model of Human Occupation

Executive Function Performance Test (Baum et al, 2008)

• Designed for: Adults with psychiatric disorders and people with neurological conditions
• Client Can Do: Complete four IADL tasks: paying bills, medication management, use of telephone, and a cooking task; graded cues are provided as needed
• Measures: Assesses executive function skills including safety, organization, sequencing, initiation, and judgment; used to define level of assistance for functional tasks
• Time: Typically 60 to 90 minutes; requires access to a space for cooking; can be used in home, clinical, or community settings
• Tool Model: No specific model, but consistent with several models that include an emphasis on functional performance

Performance Assessment of Self-Care (Holm & Rogers, 2008)

• Designed for: Can be used with adolescents and adults with cognitive, physical, or behavioral impairments
• Client Can Do: Person completes Performance Assessment of Self-Care Skills (PASS) tasks that are relevant to his or her life situation
• Measures: Person's ability to live independently and safely in the community by assessing performance on various ADLS and JADLS
• Time: Can use tasks that are accessible within the space/setting; may not be private space to assess BADLs; requires OTR to have several types of items on hand; must be able to self-develop tasks that fit within setting
• Tool Model: No specific model, but consistent with several models that include an emphasis on functional performance

Evaluation Process

• Evaluation is a complex process but one of the most critical responsibilities of the practitioner.
• Evaluation should always be a person-centered process.
• Different mental health practice settings may dictate different appoaches to evaluation but overall the process of evaluation unfolds in a predictable pattern of steps.
• These include: screen data to guide therapeutic reasoning, consider key outcomes, choose assessments, administer assessments, generate an occupational profile, analyze occupational performance, synthesize data and set goals, reevaluate, and measure outcomes.
• Each step in the evaluation process requires the practitioner to apply therapeutic reasoning processes.
• The practitioner who intentionally reflects on each step in the process is more likely to maintain an evidence-based, occupation-focused, and person-centered approach to evaluation.
• Validation of therapeutic reasoning can occur with triangulating data, performing validity checks, and using valid and reliable tools.
• A variety of valid reliable assessment tools exist and a practitioner must choose intentionally so that the data collected informs key outcomes for the individual and for occupational therapy programming.
• Effective assessment methods include interviews, self-report tools, and performance assessments.