lecture 1: core concepts of assessments intro Flashcards
what is occupation?
- everything people do to occupy themselves
- groups of activities and tasks of everyday life
- named, organized, given value and meaning by individuals and culture
- occupations fulfill specific purposes and bring meaning to life
- some are universal; some are idiosyncratic (individual)
what are examples of occupations?
- cooking
- shopping
- cleaning
- traveling
what are the types of occupations?
- self-care
- ex. get dressed, shower, eat - leisure
- ex.socializing, reading, playing music - productivity (contribute to home or community)
- ex. working, going to school, childcare
what is occupational performance?
the ability to choose, organize and satisfactorily perform meaningful occupations
what are occupational performance issues?
OPIs
any problems or issues related to meaningful and purposeful doing
- issue with ability to do; NOT issue with performance component
what is optimal occupational performance?
- satisfactory performance of a person participating in everyday occupations
- derived from values, roles, and interests
satisfaction = subjective
what is occupational therapy?
- enabling engagement in everyday living through occupation
- allow people to perform the occupations that foster health and well-being
- enabling a just and inclusive society that all people may participate to their full potential
what is the goal of occupational therapy?
- concern for actual performance of an occupation but also the level of satisfaction it brings the individual
- concern for potential and possibility for occupational engagement that is afforded by the person-occupation-environment interaction
what is an assessment?
- overarching set of tasks
- involved in finding out about a client and their occupational performance
- collection, analysis, interpretation and classification of information gathered in organized manner
- determines OPIs
> directs us to what to measure to determine therapy outcomes
what do OTs assess?
- what people need to do, want to do, and are expected to do in their everyday lives
- what motivates people (interests, values, roles)
- how personal characteristics interact with the environment to affect occupational performance
- what peoples level of occupational engagement is
why do OTs assess?
- to DESCRIBE a clients status at one point in time
- used to classify individual in respect to norms
- find where biggest performance problems are
- compare to normative performance
ex. functional memory assessment - to PREDICT a clients future performance/status
- used to determine eligibility for service or risk
ex. falls risk assessment - to EVALUATE a change in status over time or outcomes of an intervention
- used at more than on point in time
ex. occupational performance assessment
how to OTs assess? - class response
- talking/asking about occupations
- observation of client as they engage in occupations
- ask family or friend to comment on occupations
- formal structured assessment
- read chart/consult with other disciplines
how do OTs assess?
- organizing frameworks
- theoretical considerations
- guiding principles
organizing frameworks: what is the CPPF?
Canadian practice process framework
organizing frameworks: what are the info gathering stages of the CPPF?
- enter and initiate - client identified, consent obtain, initiate relations and partnerships, determine if referral is appropriate
- set the stage - conduct interview
- structured or semi-structured
- discuss OPI and goals
- develop rapport
- set out ground rules and review roles on both sides - assess and evaluate
- in depth evaluation on personal and environmental factors that impact OPIs
- provide recommendations on how to proceed in therapy
organizing frameworks: what is the ICF?
international classification of function, disability, and health
organizing frameworks: how is the ICF beneficial for assessment?
- helpful for communicating with other disciplines
- recognizes participation in society
- cues you to assess other areas
- includes…
> health condition
> body function and structure
> activities
> participation
> enviro factors
> personal factors
organizing frameworks: what are other organizing frameworks used?
- person-environment-occupation (PEO) model
- Canadian model of occupational performance and engagement (CMOP-E)
- model of human occupation (MOHO)
theoretical considerations: what are theoretical considerations?
- theory of clients disability and corresponding frame of reference can guide choice of assessments
- ex. you might not choose to assess a client’s grip strength if your theory is disability is related to mental health
theoretical considerations: what do OT frames of reference include?
- biomechanical - movement factors
- compensatory - enviro factors
- cognitive-behavioural - thought and emotions
guiding principles: what is COTO?
- regulatory body for OTs in Ontario
- protect people and make sure people receive adequate OT care
- provide standards for OT assessments presented by COTO
guiding principles: what measurement types are used?
- a systematic (and often numeric) approach to assessment is preferred
- assessment, calculation, or judgement of the magnitude, quantity, or quality of a characteristic in a non-subjective way
guiding principles: why is it important to measure?
- supports EBP
- increases accountability and credibility
- shows effectiveness
- informs your treatment planning
- improves decision-making
- makes you a better OT
guiding principles: what is client-centered practice?
- client actively involved in choices related to assessment, intervention and interpreting outcomes
- partnership approach that respects autonomy
- appreciation of the client’s story
- start with occupational issues the client identifies
- not always simple
> who is the client
> what are the risks
> what is the client doesn’t know what OPIs are
what is the first step to identifying OPIs?
- often begins with an interview
- interview sets the tone for the OT process
- fosters trust, rapport, collaboration, validation
- can be structured or unstructured
step 1 and 2 of the CPPF covered in an interview
what is an interview?
- method to gather information about a clients ability to performa activities
what are the goals of an interview?
- learn about clients occupations
- identify issues in patients occupational performance
- establish rapport and trust
- gather subjective information
- understand values, strengths, interests, roles…
what are the pros to interviews?
- flexibility to fine out info relevant to situation
- communicate effectively about priorities
what are the cons to interviews?
- how to ensure you are asking the right questions
- unstructured interviews can get off track
how are interviews split up?
divided into beginning, middle, and end
what is involved in the beginning of an interview?
- set up inviting space (no power dynamic, seats at 90 degrees)
- prepare to listen
- minimize int and ext distractions
- stop talking
- use your body ( active listening)
- put client at ease w/ eye contact, nodding, etc.
- focus on what the client is saying
- keep an open mind about speaking styles
- keep an open mind about the message
what are the steps of an interview?
- introductions
- establish who you are and what an OT is
- establish what they preferred to be called (ex. pronouns) - purpose of interview
- housekeeping details
- informed consent
- length of time
- confidentiality
- note taking
**example in NOTES
what is the COTO standard for consent for assessment?
A) Apply the informed consent process for assessment of the client, including discussing the following as appropriate…
1. scope and reason of referral
2. financial arrangements for payment of assessment
3. purpose/nature of assessment
4. legal authority
5. identity, professional qualifications and role of individuals who will be involved in the assessment
6. potential benefits and limitations of completing assessment
7. risks associated with completing or not completing the assessment
8. expected outcomes of the assessments, how info is used, who is it shared with
9. right of the client to withdraw consent at any time during the process
10. option of client to request another OT to perform the assessment
B) provide an opportunity for the client or substitute decision-maker to ask questions and respond to them in a manner that the client understands
C) confirm consent when moving from one idea to another
D) use interpreters to ensure client/decision maker understands the consent process
what is the importance of cultural differences in setting the tone?
difference cultures have different responses to certain introductions
- greetings
- smiling
- use of space
- eye contact
- hand gestures (ex. pointing)
what is involved in the middle of an interview?
- build rapport
- an exploration
- gather info about occupations and OPIs
- be an active listener
- guide/structure the process
GOAL: be empathetic, listen and understand, be open-minded
what are the types of questions used in interviews?
- open questions
- no options
- usually first to tell you whats relevant - closed questions
- specific options available
- appropriate for those who think open-ended questions are hard
- aid in clarification - direct questions
- looking for specific answer - indirect questions
- invite answer but not direct question on topic
**use of different questions depends on interview purpose
what are other specific techniques to interviews?
- silent: give client time to organize thoughts
- prompts, nudges: confirms listening
- paraphrasing and clarifying: “so i understand you correctly..”
- reflecting and validating: to ensure you are understanding them correctly; “it sounds like you are feeling sad, i can certainly see why”
- summarizing and inviting collaboration: “today we talked about…”, “have i missed anything”
- transition statements: help to change to new topics; “now i would like to get to know more about…”
- sequencing: interview in a logical order
- refocusing: going back to an earlier topic or getting off a certain topic to ensure you get all the info you need; “thank you for the detail on this topic but i’m worried were running out of time…”
what are possible questions about occupation and OPIs?
- how have you occupations changed?
- what occupations are important to you?
- what occupations can’t you do now that you’d like to be able to?
- tell me about what you do in your community
- do you need any help accessing places to go?
- who helps you to access these places?
-etc…
what are 9 potential pitfalls to interviews?
- false reassurance (ex. “its going to be okay”)
- projecting personal values
- giving advice
- bombarding with questions
- changing subject abruptly
- minimizing clients feelings
- cliches
- inappropriate use of language
- using medical terminology that the client doesn’t know
what is involved in the end of an interview?
- keep track of time
- summarize
- ask if there is anything important that you’ve missed
- discuss goals/next steps
- set another appointment, if appropriate
- ask if they have any questions for you
