Ch4: Assessing Roles and Competence Flashcards
Occupational Performance
The ability to carry out basic activities of daily living (BADL) or activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, or leisure, and social participation
Evaluation of Occupational Performance
-Begins with semistructured interview to assess clients needs, problems, and concerns regarding role participation in daily life tasks and activities; During this, OT gathers info about the tasks and roles that are most important to them and activities the client can or can’t do
-After identifying areas of difficulty in occupational performance, OT completes further assessments (either impairment-based or disease-specific) to clarify factors that limit performance
-If limiting factors can be improved or eliminated by direct intervention, an intervention approach can be chosen that is appropriate for the problem
-If not, OT teaches them to compensate for these limitations by adapting the task or changing the environment
Occupational Performance is dependent on…
-Culture, Gender, and Roles that the individual wishes to undertake as well as the environment (personal concept)
Assessments should be done using what approach?
Top-Down
Top-Down Approach to Assessment
-Begins with eval of roles, tasks, and activities
-Includes consideration of the individuals environment and incorporates consideration of personal, social, and cultural context
-Assessment does not ignore more basic abilities or performance skills that enable occupational performance (strength, endurance, problem solving, or depth perception) but rather begins with a function based assessment of the tasks and activities the client needs, wants, or is expected to accomplish and is having difficulty performing
Life Roles
-Self Maintenance (independent person, caregiver and home maintainer)
-Self Enhancement (friend and moviegoer)
-Self Advancement (worker and student)
World Health Organization’s International Classification of Functioning, Disability, and Health (ICF)
-OT first assess activities and participation, evaluating impairments in body functions (performance skills) as needed to explain difficulties in performance
-Beginning with focus on needs and considering roles and environment, OT acknowledges their values and goals
Timing, Sequence, and Settings for Evaluating Occupational Performance
-Competence in occupational performance areas is evaluated over time based on clients needs and interests
-Assessments of self-care and personal mobility are done early to form the basis of planning restorative therapy and/or adaptations to optimize ADL
-As recovery continues and discharge plans are considered, further evals are used to assess clients ability to manage a home, child care responsibilities, gain access to home and community, engage in leisure and family rec, or return to valued work or education
Evaluation of a clients performance should take place in…
The environment in which tasks typically occur when possible (individuals perform differently in different settings)
Measurement Concepts
Include whether the assessment is a standardized measure with established reliability and validity, its responsiveness to change, level of measurement, and clinical utility, and whether is involves direct observation or self-report
Standardized Assessment (properties of the assessment)
A published assessment tool that provides detailed instructions on test administration and scoring and has published results of reliability and validity
Reliable Assessment (properties of the assessment)
Consistently measures the attribute under study, no matter who is scoring (interrater reliability) or when the assessment occurs (test-retest reliability)
Valid Assessment (properties of the assessment)
Measures what it claims to measure
-Content Validity: Test items represent the area being tested (some may be more important than others)
The Centers for Medicare and Medicaid Services (CMS) recommend the use of…
Validated tests and measures when assessing a clients functional abilities and needs
-Many private insurers follow these guidelines so it is critical that OT use objective measures to reliably document occupational performance for all clients receiving services
Responsiveness of Assessment
Directly related to the number of items on an assessment and the number of categories on the scoring scale
Level of Measurement
Contributes to the tests responsiveness or sensitivity in detecting clinical change
Ordinal (level of measurement)
Scores are rank ordered to indicate the clients performance
(Used for most evals of roles, tasks, and activities)
Reevaluation
Performed to monitor clients response to therapy
At a minimum, performance should be recorded at admission and discharge to be used for program eval, to justify OT services to third-party payers, in legal actions, or to determine if patient should be discharges home or to an extended care facility
Discharge Evals
Can aid transitions from one level of care to the next (rehab hospital to home-based therapy) by providing valuable info about the clients abilities ad occupational performance needs
Clinically Significant Change Score
Difference exceeds the measurement error that typically occurs during routine test administration
Minimal Clinically Important Difference (MCID)
-More commonly used index of change
-Can be calculated for a standardized assessment and used to demonstrate that changes in occupational performance exceed measurement error and are clinically meaningful
(used by many standardized tests)
Clinical Utility
All of the practical factors of an instrument including cost, the amount of training needed, availability of a manual with clear instructions, and ease of administration and interpretation
-Most managers in OT settings prefer to use assessments that efficiently provide useful info for treatment planning and evaluating client outcomes
Direct Observation vs. Self-Report
-Observation of activities that are important to the client is the most direct method of assessing competence in occupational performance
-Preferred for accuracy, detection of insufficient or unsafe methods, and determining the underlying reason(s) that a task cannot be performed; Can be time consuming and costly
-Self-Report of ones competence in occupational tasks and roles through interviews is often the easiest, fastest, and least expensive method of assessing functional abilities and may inform the direct observation of selected activities (concern these may not reflect what the person can do)
If a client reports questionable data and does not allow direct observation, the OT should…
Verify the report with others who have knowledge of the license actual performance
-False info may be related to lack of insight and limited awareness of abilities and needs, not necessary a conscious intention to deceive
-In these cases, proxy reports and interviews with family members or caregivers can provide additional info about client performance from the family’s perspective
Assessment Method chosen for a client will depend on…
The nature of the disability, supportiveness of the clients environment, and time constraints encountered during rehab
Assessing outcomes
Some measures are administered to quantify the overalll benefits or outcomes of intervention
(ex. Austrlian Therapy Outcome Measures for Occupational Therapy (AusTOMS-OT)
Austrlian Therapy Outcome Measures for Occupational Therapy (AusTOMS-OT)
Developed with ICF consistent terminology and provides a snapshot of the clients occupational performance across four domains of functioning (Impairment, activity, participation and distress/well-being)
-Suitable for clients of varied diagnoses and ages across treatment settings, and consists of 12 function focused scales (learning and applying knowledge, upper limb use, self-care, and domestic life etc.)
How to use the AusTOM-OT
-The OT administers standardized assessments, works collaboratively with the client to select goals for therapy, then chooses related AusTOMS-OT scales (Ex. self-care or functional walking and mobility) for scoring
-4 scores are given for each of the selected scales to reflect the OTs perception of performance impairments in relation to the four domains
Purpose for using the AusTOMS-OT
-Quick and easy to use measurement tool
-Strong potential to document change in patients status over the course of therapy and allows the therapist and client to examine the effectiveness of intervention
-Unique approach, focused on occupational performance, allows for a single assessment of the clients strengths and limitations across ICF domains
A comprehensive top-down assessment of occupational performance begins with…
An overview and identification of a clients occupational needs
-Followed by eval of their engagement and competence in life roles and tasks
-Continues with an assessment of the abilities or performance skills (ex. coordination, strength, and organization) needed to accomplish valued activities
Identification of Occupational Performance Needs
A client centered OT assessment recognizes that engagement in life roles and occupations of ones choice is a personal issue and that the clients perception is an important force that drives the OT process
Info about an individual’s occupational roles and tasks, developmental stage, and the environment in which they live in is best obtained through…
Intervier
-Can be done through informal narrative interviews, more structured interview-based assessments are recommended
COPM
(occupational performance)
-A semistructured interview assessment that is widely used to evaluate a clients perception of their occupational performance
-Helps clients to identify concerns with occupational performance, assists in goal setting, and measures changes in client perceptions of occupational performance over the course of therapy
-Generic measure that can be used with clients across all developmental stages who have a variety of disabilities
-Client centered and addresses roles, role expectations, and activity performance within clients own environment
Administering COPM
Administered in a 4 step process that includes problem definition, priority setting, scoring, and reassessment
-During initial COPM interview, clients or caregiver identify activities that are important to them and are in need of OT intervention in the areas of ADL, work, and leisure
-Once all occupational performance problems are identified, clients score them un terms of importance, their perception of current performance, and satisfaction with that performance
-Client with a new illness may not recognize or be able to identify these issues
-OT may begin treatment by working on identifies concerns and can return to this semistructured interview process later to see whether other issues emerge
-Reassessment is completed at discharge or when the client and therapist consider it necessary for further treatment planning
Occupational Performance History Interview II (OPHI-II)
(occupational performance)
-A semistructured interview assessment used to identify occupational performance needs
-A broad assessment of occupational life history in work, leisure, and daily activities that was developed using MOHO
Administering OPHI-II
-Contains 3 valid scales that provide insight into the nature of occupational performance and adaptations
-Test items explore a clients ability to organize time for responsibilities; identify interests goals, and role expectations; recognize personal responsibilities and values; and participate in varied environments (ex. leisure, home, and work)
-Includes paper key forms that can be used to easily obtain interval measures without computer analysis
-These measures can identify when performance in one are (ex. works towards goal) deviated from others, indicating needs for intervention
-An accompanying Life History Narrative Form is used to document qualitative info from the interview
OPHI-II Population
Can be used with adolescents or older adults and who are seen in psychiatry, physical disability, or gerontology practices
Life Balance Model
(occupational performance)
Proposes that a persons activity configuration should meet important needs which include (1) Basic instrumental needs necessary for sustained biological health and physical safety; (2) to have rewarding and self-affirming relationships with others (3) to feel engaged, challenged, and competent; and (4) to create meaning and a positive personal identity
(concept is related to occupational performance)