OCT 1141HAssessment in Occupational Therapy

“Client-Centered Assessment”

Pollock, N. (1993) Client-Centered Assessment. American Journal of Occupational Therapy, 47, 298-301.

Date Due: September 28 (Session 3)

Occupational Performance: the activities (self-care, productivity, & leisure) carried out by a client; these are influenced by one’s environment and societal factors.

Over the past 20 years, the incidence of chronic disease and access to health care information has caused the public to change their view of health. This shift has altered their focus from a medical model concept (ie. absence of disease), through the WHO’s emphasis on complete physical, mental, and social well-being, and has settled on a definition of health that underscores one’s potential or capacity to achieve preferred goals or perform certain functions.

In addition to performance being based on the interaction of an individual’s mental, physical, sociocultural, and spiritual performance components, it is also related to one’s roles and role expectations. Thus, it is fair to say that occupational performance is unique to the individual.

Gauging occupational performance requires measurement tools that are individualized and sensitive to the varying needs/situations of the client. Furthermore, although the tester often assigns scores for clients’ performance, is this the most appropriate arrangement for measuring indicators that are seemingly subjective in nature and exclusive to the client? Lastly, basing the scores of an assessment on the judgement(s) of the rater may not only increase passivity of clients, but reinforce the notion of the professional as the answer to the problem (if the client does not define the problem, it is doubtful that they will be the problem solver). Allowing the client to set therapy goals through the means of client-centered assessment increases the chances for active participation.

Development of the Canadian Occupational Performance Measure (COPM)

-key players = Can Assoc of Occ Therapists (CAOT) and Health & Welfare Canada (DNHW  Dept of National Health & Welfare)

-three (3) key developments in the progression of the COPM

 developed conceptual model/guidelines for OT which is/are centered around the idea that the client is “a fundamental part of the therapeutic process, and describes a person’s occupational performance as a balance of performance in three areas: self-care, productivity, and leisure.” (1983)

 assessment & intervention guidelines supplemented above model (’83, ’86)

 focused on outcome measures (’87)

The above work resulted in COPM as we know today

  • The COPM:
  • an outcome measure OT’s use to assess client outcome in areas of self-care, productivity, & leisure
  • identifies problem areas in occupational performance, assists in goal setting, & measures changes in occupational performance over course of therapy
  • reflects the philosophy of the model of occupational performance
  • incorporates roles & role expectations within client’s environment
  • considers the importance of the skill/activity to the client
  • measures client-identified problem areas in daily functioning (if unable to identify – ie. child or person with dementia – caregiver may respond)

Features of COPM

-client centered, generic (not diagnosis specific), crosses developmental stages

-used w/physically dependant client to evaluate control over their environment

-considers importance, to the client, of the occupational performance areas

-interested in client’s satisfaction with present performance

-measure development, maintenance/restoration of function, & prevention of change

Administration & Scoring of the COPM

-5-step process; semi-structured interview (therapist & client or caregiver or both)

-Step 1 – Problem Definition

  • determines if client is having any problems in occupational performance
  • client asked if they need to/want to/expected to perform these activities
  • if answer ‘yes’ to any of the above Q’s, client then asked if he or she can/does/is satisfied with how they perform these activities
  • when client identifies a need/inability to perform an activity satisfactorily, this performance area is then identified as a problem
  • if client does not identify a need/expectation to perform an occupation, that area would not be addressed further
  • interested in activities in self-care, productivity & leisure

-Step 2 – Problem Weighting

  • client asked to rate importance to them of each of the identified problem areas on a scale of 1 (not important) – 10 (extremely important)

-Step 3 – Scoring

  • client asked to rate (a) ability to perform, and (b) their satisfaction with that performance of the 5 most urgent problems (1-10)
  • ability and satisfaction ratings multiplied by the importance rating to determine baseline scores
  • client & therapist then decide on goal of treatment (develop, restore, etc.)

-Step 4 – Reassessment

  • client asked to rate their abilities and satisfaction with performance in the activities identified in Step 2
  • these values compared with original values to track change(s) over time
  • this provides a concrete image of changes during the therapy process

-Step 5 – Follow-up

  • purpose is to plan for treatment continuation, follow-up, or discharge
  • therapist asks client/caregiver the 6 Q’s used in Step 1 to determine whether occupational performance problems remain

Notes

-feedback of pilot testing of COPM – approx. 200 clients – has been positive from clients & therapists (easy to administer, took 20-40 min, format & rating scales were clear and easy to employ)

-most therapists thought that the COPM provided a practical framework for initial assessment

  • clients’ true priorities were revealed; sometimes differed from therapists’ initial ideas

-Concerns

  • make sure timing is appropriate (serves well as initial assessment; client may lack insight to be able to respond to the COPM early in treatment)
  • use of caregivers are proxy respondents = who is the real client?