ASSESSMENTS
Occupational Self-Assessment (OSA)
The Occupational Self-Assessment (OSA) tool is an assessment that I was first introduced to on my Level 1 clinical placement. Working on an acute in-patient Adult Mental Health unit, my preceptor used this assessment with clients to develop an occupational profile and set therapy goals with the client. What I liked about this assessment was that that it uses a client-centered, therefore offering the client the opportunity to experience self-control in intervention planning.
The OSA is based on an occupation-focused model, the Model of Human Occupation (MOHO). The MOHO conceptualizes the person as being an open, dynamic system, receiving input from the environment. The MOHO emphasizes how 4 main factors influences occupational behaviour:
Volition: process by which a person experiences and chooses occupational behaviours (personal causation, values, interest)
“Doing activities I like“
“Working towards my goals”
Habituation: processes that maintain pattern in everyday life (roles and habits)
“Having a satisfying routine”
Performance: innate capacities, foundation for skilled performance
“Concentrating on a task, physically doing”
Social and physical environment
Based on the available evidence, practitioners can confidently use the OSA as an effective tool to help construct an occupational profile and engage the person in a collaborative evaluation process. This assessment is designed to capture clients’ perceptions of their own occupational competence in the occupations they consider important. By providing the client with a fixed set of items representing areas of performance, the occupational therapist communicates to the client something about the kind of issues he/she is prepared to address in therapy. OSA serves as an important purpose of revealing to the client what occupational therapy is and what kind of concerns the therapist is prepared to address. MOHO is a central part of how the therapist thinks about and interacts with the client – actively using the model as a way of theoretically understanding the client.
The OSA has been applied in various studies as an outcome measure to show the efficacy of an occupational therapy program (Chen, Pan, Hsiung, & Chung, 2015; Chen, Pan, Hsiung, Chung, Lai, et al, 2015) and as a predictor for quality of life (Kielhofner & Forsyth, 2001; Kielhofner, Forsyth, Kramer, & Iyenger, 2009). Research testing the psychometric qualities of the OSA demonstrated adequate construct validity, sensitivity, discriminative validity, and internal consistency (Pan, Chen, et al, 2012; Pan, Chung, Chen, Hsiung, & Deepa, 2011).
Interviews - COPM and OCAIRS
Interviews serve to expand on information gained from standardized assessments and inventories. Interviews allow the therapist to use clinical reasoning in the selection of interventions. Interviews may be conducted on a formal or informal basis and may include the use of structured interview guides, an open-ended interview, or specific interview tools.
Occupation-based tools such as the Canadian Occupational Performance Measure (COPM) and the Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS) are tools that I learned about in my OT 851 Client-Centred Communication course, and are helpful to provide a client-centered focus on perceptions of occupational performance as related to psychoemotional well-being and quality of life.
The COPM is an assessment that I used to conduct my first client interview in the CEC in first semester. It is an individualized, client-centred tool that measures performance and satisfaction in self-care, productivity, and leisure from the perspective of the client. The COPM is based on the occupation-focused model, the Canadian Model of Occupational Performance (CMOP). It is more structured than the OCAIRS as it follows a specific format, however, it also allows for elements of a semi-structured interview. I found this to be a useful tool with its broad focus on occupational performance problems across different areas, affording a comprehensive understanding of an individual’s challenges. This assessment is impactful because it allows the client to rate the importance of the activities they have identified, which will show me what they would personally like to work on in order to remain client-centred. However, it still gives me a holistic view of their life by touching several areas. I enjoyed using this assessment and will continue to use it when I want to understand a client’s occupational performance problems.
The Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS) provides a structure for gathering, analyzing, and reporting data on the extent and nature of an individual's occupational participation. It can be used with a wide range of clients, and would be appropriate for any adolescent or adult client who has the cognitive and emotional ability to participate in an interview. The OCAIRS is theoretically based on the Model of Huma Occupation. Use of this assessment in the future will allow me to establish initial rapport with clients which is important for establishing a therapeutic relationship in subsequent sessions. This assessment is impactful because the format allows for a semi-structured interview, providing open-ended questions to facilitate meaningful responses that I can continue to prompt and build on as I see fit. Without the pressure to follow a specific structure, I am able to facilitate a more candid conversation that leads to the individual’s occupational performance problems in its own unique way. I found that this helps create a more authentic and comfortable environment that is conducive to participation from the client. I appreciate that it looks at various components of the person’s life with questions to guide me under each category (roles, habits, interests, personal causation, values, goals, physical environment, social environment, readiness to change). Administration of this assessment will look different for everyone which will give me a unique picture of that client I am working wit. It will also be beneficial for the client themselves as they will be guided to reflect on their life in a way they may not have before. This assessment will be particularly useful to use during initial conversations with clients to build rapport and gain an overview of their occupational functioning.
Although these instruments do not explicitly focus on psychoemotional determinants of occupation, responses to questions within the interview provide the therapist with relevant information related to the client’s perception of function, life satisfaction, and goal areas. As with inventory measures, interviews do have limitations of self-report, yet they have advantages in their ability to expand and explore personal appraisal of the psychoemotional determinants to a deeper level than traditional checklists.
Depression: Patient Health Questionnaire (PHQ-9)
I was introduced to this symptom assessment in my OT 882 Psychosocial Determinants course. This assessment tool is a "bottom-up" symptom-based assessment that an OT could administer pre and post-intervention to monitor client progress and demonstrating the efficacy of therapy. The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression in adults. The PHQ-9 incorporates DSM-IV depression diagnostic criteria with other leading major depressive symptoms into a brief self-report tool. The tool rates the frequency of the symptoms which factors into the scoring severity index. Question 9 on the PHQ-9 screens for the presence and duration of suicide ideation. A follow up, non-scored question on the PHQ-9 screens and assigns weight to the degree to which depressive problems have affected the patient’s level of function.
The PHQ-9 is brief and useful in clinical practice. The PHQ-9 is completed by the patient in minutes and is rapidly scored by the clinician. The PHQ-9 can also be administered repeatedly, which can reflect improvement or worsening of depression in response to treatment.
The Young Mania Rating Scale (YMRS)
I was introduced to this symptom assessment in my OT 882 Psychosocial Determinants course. This assessment tool is a "bottom-up" symptom-based assessment that an OT could administer pre and post-intervention to monitor client progress and demonstrating the efficacy of therapy. The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient’s subjective report of his or her clinical condition over the previous 48 hours. Additional information is based upon clinical observations made during the course of the clinical interview. The items are selected based upon published descriptions of the core symptoms of mania. The YMRS follows the style of the Hamilton Rating Scale for Depression (HAM-D) with each item given a severity rating. There are four items that are graded on a 0 to 8 scale (irritability, speech, thought content, and disruptive/aggressive behavior), while the remaining seven items are graded on a 0 to 4 scale. These four items are given twice the weight of the others to compensate for poor cooperation from severely ill patients. There are well described anchor points for each grade of severity. The authors encourage the use of whole or half point ratings once experience with the scale is acquired.
Strengths of the YMRS include its brevity, widely accepted use, and ease of administration. The usefulness of the scale is limited in populations with diagnoses other than mania.
The scale is generally done by a clinician or other trained rater with expertise with manic patients and takes 15–30 minutes to complete.
Beck Anxiety Inventory (BAI)
I was introduced to this symptom assessment in my OT 882 Psychosocial Determinants course. This assessment tool is a "bottom-up" symptom-based assessment that an OT could administer pre and post-intervention to monitor client progress and demonstrating the effectiveness of therapy. This is a self-report inventory used for measuring the severity of anxiety in individuals. In practice if I was working either specifically in a mental health setting or was working with a client who was experiencing anxiety I could use this to explore anxiety with my client and gain insight into their anxiety experience and the prevalence in their life. The assessment also provides the client with this information and we then collaboratively look at goal setting once the client is made more aware of their anxiety symptoms. With a score I would be able to see how severe the anxiety is. This would help me determine the most appropriate step or intervention for the client, for example teaching strategies to reduce anxiety or even referring to another healthcare practitioner. I could also use this tool in practice as an outcome measure to determine if a client’s anxiety symptoms have improved or ceased following an intervention. There are several things that I like about this assessment tool contributing to why I would use it in practice. I like that the tool makes the clients more aware of their symptoms of anxiety, it can be used for a wide range of age groups, is quick to administer, and covers a variety of types of anxiety experienced. What I do not like about this assessment is that it only looks at experience over one month, not one event or moment where they experienced anxiety. Overall, I find more pros than cons to this assessment tool. I think understanding how thoughts and feelings affect occupation is important and this would be an assessment tool that I would use in practice to do so. In future practice areas where I may use this assessment could be mood and anxiety clinics, in patient psychiatric units, an ACT team, general mental health case management, or a drop-in mental health program.
Profiles of Occupational Engagement in People with Schizophrenia (POES)
This assessment tool was first introduced to me in an OT 884 Psychosocial Determinants of Occupation lab. In lab, I learned the following information about the assessment:
Who can you use it with?
People with schizophrenia
Typically adults (must be able to recall last 24 hours)
Can be used with individuals with sensory and cognitive impairments with a supplementary interview
How long will it take?
Time use diary will be completed multiple times until saturation is reached - may occur over a few weeks.
Time use diary appointments scheduled on weekdays (not Monday)
Time use diary (Part I) reported to take about 45 minutes
What information does it capture?
Part I → 24 hour time-use diary (yesterday) with supplemental interview
Covers occupational, personal, and environmental factors, the therapist can collaborate with clients to gain insight about supports and barriers to satisfaction during the day
Part II → Assessment of information gathered in part I
Rank level of engagement (scale of 1 to 4) of 9 items using rubric
Daily Rhythm of Activity and Rest
Place (setting or location occupational performance occurs)
Variety and Range of Occupations
Social Environment (occurrence and type)
Social Interplay (extent of interaction that occurs)
Interpretation (extent of client reflection on occupational experience)
Extent of Meaningful Occupations
Routines (organization of occupations)
Initiating performance (initiation and triggers)
Part III → Occupational balance (Under-occupied? Over-occupied? Balanced?)
Judgement call on the part of the therapist based on sum score from part 2 of assessment (9-36) → low (9-18), medium (19-27), high (28-36)
What are its strength?
Do it multiple times until the data is saturated → “several time-use diaries should be gathered until saturation is reached regarding information about the client’s current living situation”
Interview - able to fill in the blanks (gain more information)
What are some drawbacks?
Highly individualized
Problems with inter-reliability - subjective
24 hours can differ
The time use diary - takes time
Coping Assessments
Coping instruments are fairly simple to administer in both clinical and academic Coping instruments are fairly simple to administer in both clinical settings, but limitations exist as not all clients have insight or are able to engage in self-assessment. Given the limitations of such measures, additional evaluation techniques using observation, interview, history-taking, and formal task assessment provide a more holistic picture of the client’s coping strategies and skills.
Folkman and Lazarus’s (1988) Ways of Coping Checklist–Revised was the instrument of choice used to assess coping; however, newer measures have been developed in an attempt to improve psychometric rigor (Gol & Cook, 2004). Despite development and expansion of coping measures in recent years, the Ways of Coping Checklist– Revised continues to be used heavily within a variety of fields (Penley, Tomaka, & Wiebe, 2002). The checklist consists of 66 items rated on a 4-point Likert scale. Respondents are asked to identify strategies used to deal with life demands.The scale is easy to administer and results in a representation of the client’s style of coping, including (1) problem focused, (2) wishful thinking, (3) distancing, (4) seeking social support, (5) emphasizing the positive, (6) self-blame, (7) tension reduction, and (8) self-isolation.
In addition, an abundance of coping self-assessment tools exist within the human service, health, and business fields. Two popular measures, the Coping Responses Inventory(Moos, 1990) and the Coping Strategies Indicator (Amirkhan, 1990), measure coping responses to daily stressors.