Top-Down Eval Flashcards
This is the initial step in the evaluation process
Occupational Profile. This provides an understanding of the client’s occupational history and experiences, patterns of daily living, interests and values, and needs. The client’s reasons for seeking services, strengths and weaknesses in relation to performing occupations and daily life activities, areas of potential occupational disruption, supports and barriers, and priorities are also identified.
The step in the evaluation process during which the client’s assets and problems or potential problems are more specifically identified.
Analysis of occupational performance. Actual performance is often observed in context to identify supports for and barriers to the client’s performance. Performance skills (e.g., coordination and trunk stability when performing occupation), performance patterns (habits, routines, roles), context or environment, client factors ((Values, Beliefs, Spirituality, Body Functions (sensory, mental, cardiovascular), and Body Structures)), and activity demands are all considered, but only selected aspects may be specifically assessed/ Target outcomes are identified (OTPF-3)
The steps to Top-down eval include:
- Chart Review
- Occupational History Interview
- Assessment of Occupational Performance
a. occupations
b. context and environment
c. performance patterns (habits, routines, rituals,
roles) - Assessment of Client Factors and Performance
-Client Factors: values, beliefs, spirituality, body
functions (sensory, mental, cardiovascular), and
body structures - Synthesis and Summary
-Assets and areas for improvement
-Long-term and short-term goals
-Intervention Plan
T/F: Interventions that seek to improve performance component function without evaluating and improving occupational performance cannot be considered OT
True. This Top-Down approach is essential to occupation-centered care
This process begins with occupational performance and follows with occupational performance skills, client factors, and performance contexts
Top-Down approach!
This process identifies and treats components or client factors/skills interfering with occupation, moves into occupation
E.g., with SCI start strengthening to work towards dressing
Bottom-Up approach
During an evaluation, you are trying to capture four major pieces of information:
activities with specific performance limitations, cause of the limitations, ability to modify the performance, and kinds of intervention that may work to improve performance
Upon completion of the assessment, what does the OT do?
Work on an intervention Plan. Information from the occupational profile and various assessments is analyzed and a problem list is generated.
During assessment, problem statements should include…
Problem statements should include a description of underlying factor (performance skill, pattern, client factor, contextual or environmental limitation, activity demand) and its impact on the related area of occupation
The intervention plan is based upon…
Problems
Process of Evaluation results and establishing an intervention Plan includes:
Use information from occupational profile and various assessment
Obtain the client’s/family’s goals for OT
Use theoretical knowledge and professional reasoning skills
Determine the client’s assets and limitations
Develop long-and short-term goals
Decide upon intervention approaches
Determine interventions to be used to achieve stated goals
Identify intensity, frequency, and duration of treatment (could be site-dependent)
Include recommendations and referrals to other professionals or agencies
“…directed by the client’s goals, values, beliefs, and occupational needs…a collaborative effort between the therapist and the client or, if the client is unable, the client’s family or caregivers” (Smith, 2013, p.123).
In acute rehab, you have to use this assessment:
FIM
What assessments you use depend mostly upon what?
Where you work
This assessment includes 10 categories of activities of independence rating. Gives a broad profile, based on a point system (gives overall score), concrete yes/no (operational definitions), used for research, placement
The Barthell Index (BI). Pretty good validity and reliability?
Used a lot more than some of the others…
Good for research… specific data – not in clinic for small changes
Not used as much as FIM b/c/ FIM is required for adult inpatient rehab
If can do it alone get score of 10, if needs help gets 5
This assessment addresses ADL’s e.g., dressing, mobility, elimination, bathing and hygiene, eating, and emergency communication. It is an objective assessment and describes items in behavioral terms
Klein-Bell ADL Assessment.
Objective… describes items in behavioral terms
Validity and reliability established
Sensitive–reflects small changes over time
Scoring: achieved or failed
Provides information for treatment planning
Scoring: achieved = with/without equipment, no verbal or physical assistance.
170 items—time consuming
May not be appropriate for acute care where very fast paced
