Midterm Flashcards
What are the 3 steps to process?
- Evaluation
- Intervention
- Targeting of outcomes
Evaluation Process
- Screening (client/referral information)
- Occupational Profile
- Assessments used and results (objective)
- Analysis of occupational performance
Intervention Process
- Plan
- Implement (treatment)
- Review (re-evaluation)
OTA/OTR Relationship
- OTR can do the screening, evaluation (includes occupational profile, analysis of occupational performance, assessment), intervention, and targeting of outcomes
- OTA delivers services under the supervision and partnership of the OTR. Cannot do screening or evaluation, can perform some assessments that may contribute
Approaches for Intervention Implementation
- Create: Promote
- Establish: Restore
- Maintain: Preserve current skills
- Modify: Compensation, Adaptation
- Prevent: Disability Prevention
Psychometrics Terminology
What are 4 types of evaluator biases?
- Background
- Severity or Leniency
- Central Tendency
- Halo Effect
Background (evaluator biases)
values/beliefs
Severity or Leniency (evaluator biases)
Rates extremely high or low
Central Tendency (evaluator bias)
Choosing middle score bc can’t make a decision
Halo Effect (evaluator bias)
Prior experiences influence your current situation
-ex. Everything about your grandma makes you smile; you have a client who resembles her; you give the client the benefit of the doubt with everything
Evaluator Biases
Background severity or leniency, central tendency, and halo effect (bias on someone you might have known in past or previous experience)
Hawthorne effect
Happens to person who test is given to/ when person changes behavior and performance bc they are being watched can be good or bad
Observer expectation
If we want them to do better we grade more leniently or give more chances/ invested in development and influences how we rate them
Test biases
Gender education level, SES, ethnicity and culture, geographic location, medical status/ some tests are appropriate for certain patients (kids vs adults testing)
Scoring errors
Generosity, ambiguity (could go in different directions not sure what it means) halo, central tendency, leniency, severity, proximity (how an event influences performance)
Logical error and Contrast error
Insufficient info to decide on answer/too much divergence totally different scores
Errors of Measurement
- Item Bias
- Rater Error
- Individual Error
- Standard Error of Measurement
Item bias (errors of measurement)
Some may be easy some may be harder depending on person (language items)
Rater Error (errors of measurement)
Errors in judgment that occur in a systematic manner when an individual observes and evaluates another.
Individual error (errors of measurement)
Inability to perform test
Standard Error of Measurement (errors of measurement)
Best prediction of how much error still exists (can’t eliminate all error)
Reliability
Accuracy and stability or consistency of measure
- Intrarater
- Interrater
- Test-Retest
- Reliability Coefficient
- Internal Consistency/Homogenity
Intrarater (Reliability)
Ability to perform same assessment on same client twice and no change same results
Interrater (reliability)
When you and another therapist gets same results
Test-Retest (reliability)
At one point measure client as therapist and another time still accurate no
Reliability Coefficient
(+.80=good)
0-1 scale
Internal consistency or homogeneity (reliability)
- Items in test can be pulled apart and reliable compared to each other
- Split half and covariance
Validity
Does a test measure what it says it does
-Face
-Content
-Criterion Related (concurrent, predictive, sensitivity/specificity)
-Construct
(has to have validity, should be reliable)
Face (validity)
Weakest type means it appears to measure what it says it does
Content (validity)
Enough items to represent construct
Concurrent (Criterion related Validity- most objective)
Performance on one assessment as it relates to another
Predictive (Criterion related Validity- most objective)
Your performance on one item predicting your performance on another
Sensitivity (Criterion related Validity- most objective)
True positive/higher more likely
Specificity (Criterion related Validity- most objective)
False negative
Construct (validity)
Test is measuring true construct theoretically based and true representation of what is tested
Raw scores
- Initially obtained by calculating the points obtained based on scoring methods outlines by assessment
- Can be converted to standard scores compare over time
- Allow to compare results between assessment over time
- Help compare performance of client to a larger sample who have similar characteristics
Standard error
Amount of potential error that is reported for each score and should be taken into account when interpreting results
Therapeutic Modes
- Advocating
- Collaborating
- Empathizing
- Encouraging
- Instructing
- Problem Solving
Advocating (Therapeutic Modes)
Understanding that disability is a result of environmental barriers and as a therapist responding to physical, social, and environmental barriers that a client encounters
Collaborating (Therapeutic Modes)
To make decisions jointly with the client and involving the client in reasoning expectations, and having the client participate actively in these decisions
Empathizing (Therapeutic Modes)
To bear witness to and fully understand a client’s physical, psychological, interpersonal, and emotional experience?
Encouraging (Therapeutic Modes)
To provide the client with hope, courage, and the will to explore or perform a given activity?
Instructing (Therapeutic Modes)
To educate the client in therapy and assume a teaching style in their interactions with the client
Problem-Solving (Therapeutic Modes)
To rely heavily on using reason and logic in their relationships with their clients
Types of Assessments
- Formative
- Summative
- Standardized
- Non-Standardized
- Norm-Referenced
- Criterion-Referenced
Formative Assessment (Types of Assessments)
Process for gathering data that can identify potential problems that need to be addressed
Summative Assessment (Types of Assessments)
Process for gathering data at some point in the intervention process to evaluate progress towards goals
Standardized (Types of Assessments)
Follows a prescribed procedure for development, administration, and scoring
Non-Standardized (Types of Assessments)
Do not have a standard protocol, and often use interviews, observations, or questionnaire
Norm-Referenced (Types of Assessments)
Measures how well a person performs against a standardized sample
Criterion-Referenced (Types of Assessments)
Measures how well a person performs against a set of criteria
Canadian Occupational Performance Measure (COPM)
- A client-centered interview that allows individuals to identify and prioritize the problems they are facing in their everyday lives
- Rates their priorities, evaluates performance and satisfaction, and focuses on goal setting
- Appropriate for clients 6 years or older
- Categorizes activities into Self-Care, Productivity, Leisure
Clear Choice Approach
- Screening, clear theoretical approach, frame of reference, assessment, theoretically based intervention
- Don’t have to give a lot of thought rare to have this usually use clinical reasoning and judgment
Top-Down Approach
- Screen, understand clients deficits and then look for assessments that understand which area they have trouble with
- Establish problems and figure out why they need assistance and do performance client and environmental factors to figure out issue
- Evaluate performance skills and client factors that cause the problems with functional mobility
- Then frame of reference and theoretically based intervention
Bottom-Up Approach
- Screen first then look at performance skills and client factors that impact occupational performance
- Ex. balance muscle strength cognitive skills
- Assess this first before we determine the impact it has on occupation
- How much of occupation can they not do bc of these deficits
Idiosyncratic Approach
- No right way looking for options evaluate many things at one time
- Evaluate it all at the same time to see what is appropriate
- Might go outside of OT and takes most amount of investigation and research bring in assessment from psychologist or social worker bc OT doesn’t meet clients needs
Problem Statements (how to write a proper one)
-Identifies the area of occupation that is a concern and the contributing factors that make it a problem
-When writing a problem statement, identify the contributing factors that are affecting performance with a measurement of it when possible
BAD: The client isn’t able to prepare a meal independently due to decrease balance from right CVA
GOOD: The client requires maximal assistance to prepare a meal independently due to decrease balance from right CVA
COAST Goals
-Client
-Occupation
-Assist Level
-Specific Condition
-Time
Ex. Client will perform upper body dressing with minimum assistance for buttoning while seated at edge of bed within one week
Classification of Documentation
- Process Stage: Screening or Evaluation
- Timing Types: Initial, Progress, Discharge
- Settings and Styles: Medical vs Community; Acronym, Narrative, or Template
- Design Formats: Paper or Electronic
Documentation Process
- Screening report
- Evaluation report
- Re-evaluation report
- Intervention plan
- Contact report
- Progress report
- Transition plan
- Discharge report
Pediatric evaluation of disability inventory
- Measures performance in self care mobility and social function
- Looks at functional performance caregiver assistance and modification needs
- Structured interview of parents for children 0-8 years
- Norm referenced see how “normal” kids score and compare
- Standardized
Peabody developmental motor skills
(know child working with any language deficits or shy)
- Performance based
- Observation based
- Examines children’s performance skills reflexes, stationary locomotion, object manipulation, grasping, and visual motor integration
- Overall scores for fine motor performance, gross motor, and general motor
- Standardized- good for concrete info (interrater reliability is high)
- Norm referenced
Kohlman evaluation of living skills
- Observation and interview based
- Evaluated ADL and IADL performance
- Criterion referenced-can’t see how close to typical population performance and compare might gain time and efficiency
- For outpatient or short term stay settings
Dynamometer grip strength
- Standardized
- Performance skill measure
- Performance based
- Norm referenced
- specific way to position person and handle with script and norms
- Helps understand where they are compared to typical peers
Standard Deviation
Based on notmal distribution of scores and indicates the degree variance from the mean (average score)
- When a client falls within 1 SD of the mean (+/-), we typically say they are average (or approximately 68.28% of people would perform the same as them on the assessment)
- 1-2 SD (+/-): Slightly above or below average (approx 95.44% would score simillarly)
- More than 2 SD (+/-): Definite difference in performance (“red flag to assessor”) (less than approx 5% would score simillarly)
- For each test there is a different mean and SD
