Midterm B Unit 4 Flashcards
unit 4
Theory in evaluation and intervention
theory has an evidence base and it has clinical applications that have been proven, so using theory to help us understand what types of evaluations we should choose is appropriate. Part of theory is thinking about how we’re going to approach the evaluation process and the choosing of assessments.
clear choice approach
when it’s very obvious how you’re going to address the person’s needs. a particular frame of reference that is the only appropriate frame of reference to use with the client.
top down approach
when we need to look at what occupations are being impacted and then break down the skills that might be causing that occupational deficit. For example, we do a screen and we understand that the client is having deficits or problems in their everyday occupations, so the first thing we do is look for assessments that will help us identify which areas of occupational performance they are having trouble with and how much trouble they’re having. Do we need to assess how well they’re performing in ADLs, or do we need to do a work-related assessment?
Once we’ve done that and we establish that there could be a problem in the way that
they’re performing their ADLs and it’s a pretty significant problem because they need a lot of assistance to complete their everyday tasks, then we need to figure out why they need that much assistance. So, we may need to assess specific performance skills, or client factors, or even the environment or performance patterns to help us understand why the client’s having those problems. So, from the assessment of ADLs, we observe or recognize that they seem to be having problems with a lot of the fine motor tasks and functional mobility tasks. So, now, we need to evaluate the performance skills and client factors that may be causing them to have a problem with fine motor performance and a problem with functional mobility. From there, we generate a frame of reference that we’re going to use to work with a client, and we move on to a theory-based intervention to address those needs.
bottom up approach
we first screen the person and determine that they need an evaluation, but our first step in the evaluation is to look at their performance skills and client factors that may be impacting their occupational performance. Perhaps the first thing that we do is evaluate their balance, their muscle strength, their flexibility, their range of motion, their cognitive skills. These are all client performance skills and client factors that we may first assess before we determine how much of an impact those are having on their occupation. Then we’re assessing their occupation to determine what is the impact. How much of the occupations of their choice are they unable to do because of these deficits of performance skills and client factors? From there, we choose a frame of reference and move on to a theoretically based intervention.
idiosyncratic approach
when there’s really no right way to do the assessment and we’re looking for options by evaluating many things at one time, or we may start with evaluating a performance skill at the same time that we’re evaluating an occupation, and we’re also thinking about the client factors, context, and environment, or performance skills that may be appropriate. The idiosyncratic approach may require you to go outside of the profession of occupational therapy to find appropriate evaluations that meet the client’s needs.
idiosyncratic approach continued
takes the most amount of investigation, research, and flexibility of thought to move beyond our understanding as occupational therapists to perhaps bring in an assessment from a psychologist, or a social worker, an early education assessment, or a physical therapy assessment, perhaps even speech, because maybe what’s available within occupational therapy doesn’t meet exactly the client’s needs, but you know what types of things they have, what types of needs that they have, and you go and seek out something that meets those needs at the same time that you’re addressing the underlying contributing factors and the occupations.
a few considerations when choosing an assessment one
need to think about
what is the characteristic of interest and importance to the client? Where are the
client’s characteristics in general? What’s their context and environment? How old are
they? What is their educational level? What setting are you seeing them in? What
occupational performance needs or occupations are most important for them? How do
these client characteristics align with the properties of the assessment tool that you’re
going to choose?
a few considerations when choosing an assessment two
You also need to think about the intended purpose of the assessment.
Why are you using it to assess the client? You should be able to justify your choice of
assessment, not just that this was what was available within the clinic, but why is this
particular assessment appropriate for this client, and how do you know that?
a few considerations when choosing an assessment three
What do you plan to do with the data? Is this information for the discharge or for treatment planning? What did the authors of the assessment say the intended purpose was?
a few considerations when choosing an assessment four
What are the user qualifications for the assessment? Can you perform the assessment
without specific training or certification? Can you perform the assessment without
paying for it? Sometimes we find copies of assessments at our work and you may not be able to use that assessment unless you have a true copy that was given by the publisher. Some assessments require specific training or certification in order to use them. Have you checked to make sure that you qualify? What are the practical considerations? Is the assessment time-consuming? Is it costly? Does it require any unnecessary amount of equipment or space?
a few considerations when choosing an assessment five
Once you determine your needs for an assessment tool, you then
have to locate those in the literature. How do you find appropriate assessment tools?
Do you investigate occupational therapy and occupational science websites or journals? Do you look to other professions? Is there something else that
may be better suited? Explore professional associations and networks for resources.
AOTA will have a lot of resources or examples of different types of assessments that
have been used. Search major databases, like PubMed or the library website, for
resources on what appropriate assessments may be available for the particular person
you’re working on or that you’re trying to treat.
a few considerations when choosing an assessment six
You also need to think about the client’s emotional state and how they will respond to
the assessment. Will they be able to tolerate the full assessment in one setting? If not,
can it broken up? Some assessments specify that it can’t. How will you prepare the
client? What will you say to explain the assessment and why you’re performing it?
Perhaps you’ve chosen to assess their risk of depression. How are you going to explain to a client who may have no awareness that they are expressing thoughts that make you believe that they might have depression, that you are now going to assess their depression? Will they understand? Do they have the cognitive capability to understand the directions to the assessment, the assessment questions themselves, the tasks that you’re asking them to do, or why you’re doing the assessment? Remember, clients still need to consent. Can they consent to you doing the assessment that you’ve chosen, or is it too complicated or complex?
different types of assessment
standardized versus non-standardized, norm reference versus
criterion reference, descriptive versus evaluative versus predictive.
What is going to be the best type of assessment for your client and for the setting that you’re evaluating them in? What’s going to give you the most amount of information and meet the client’s needs the best
the methods of assessment
often use multiple methods of assessment when we’re working with a client. We may do a combination of the interview, observation, and performance measures, which can be based on skill performance or self-report. We’ll probably do a combination, as we need to develop an occupational profile, which is typically based on interviews and maybe some observation. These interviews can be structured, unstructured, or semi-structured. Using something like the Canadian occupational performance measure is going to be a semi-structured interview where there’s a guide that helps you understand what types of questions you may need to ask a client in order to get the information that you need from them. This guide is just the form of the assessment tool itself because there are specific things that you need to go through with the client, but there’s no set of questions that you have to ask them in order to get those answers.
Observation could be part of your performance measure
may be observing them perform a skill, or it can be an unstructured observation where you ask them to get dressed and you’re simply watching them see how they do and observing whether or not they struggle in any area. This type of unstructured observation can be very useful when you’re trying to determine where to start with a client if you have very little information about them.
