Methods of Assessment and Sources of Assessment Data Nisrin Alqatarneh MSc. Occupational therapy

Methods of Assessment and Sourcesof Assessment DataNisrin Alqatarneh

MSc. Occupational therapy

Assessment in OT 2015

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• Assessment methods used by OT to collect data include:• Interacting informally with the client• Observing activity in the client’s own living, working or

social environments or in the clinical setting• Setting the client specific tasks• Carrying out standardised tests• Interviewing clients and carers• Asking questions and discussing the situation informally


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Qualitative methods:

• Qualitative data-collection methods include:• Informal observations (e.g. to look at the person’s facial

expression, quality of movement or social interactions with others)

• Casual conversations with the client and their carers using open-ended questioning techniques

• The use of semi-structured interviews or questionnaires.


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• Qualitative information usually focuses on things like feelings, values and perceptions related to what has taken place or the significance of a problem


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Quantitative methods:

• Quantitative data might comprise:• The raw or converted scores obtained • Administering a standardised outcome measure• Data collected from observation testing methods, such as

the range of movement of a joint• Structured self-report or proxy report data, such as the

number of times a particular daily-living problem occurs over a set time period.


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• The data collected focus on factual information and are often expressed in the form of numerical scores


8Direct methods

• Therapist observations• Client self-report given direct to the therapist• Administration of a standardised test to the client by the

therapist• Administration of a standardised test to the carer by the

therapist to assess the carer him/herself (e.g. to examine level of carer burden or parental stress)


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Indirect methods

• Referral information (written, faxed or via a letter or referral form)

• Patient/client’s previous records, such as medical records, therapy records, social services records; these might be accessed electronically, e.g. Through a Single Assessment Process (SAP)

• Proxy reports from formal sources, such as the patient’s GP, doctor, other members of a multidisciplinary team, workers from other statutory services, teacher

• Proxy reports from informal sources, such as the patient’s parent, spouse, children, neighbour, friend, voluntary worker or religious leader (e.g. priest)


10SELF-REPORT

• The World Health Organization WHO states that ‘disability and functioning are viewed as outcomes of interactions between health conditions (diseases, disorders and injuries) and contextual factors’


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• Contextual factors are divided into:

1. External environmental factors

2. Internal personal factors


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Internal personal factors

• Include gender, age, coping styles, social background, education, profession, past and current experiences, overall behaviour pattern, character and other factors that influence how disability is experienced by the individual’

• The person is usually the most reliable source for this information


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Self-report assessment

• Provide the therapist with:

1. The person’s description of his roles, occupations, routines and values

2. His living situation (including the physical environment and sociocultural influences)

3. His goals for the future

4. The presenting condition and his experience of illness or disability and the symptoms associated with any current problems

5. His opinion about his current and previous level of function and occupational performance.

6. Self-report can also be used to help with the identification of available resources (financial, social and emotional) that might be used to support the client


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Self-report is important because:

1. It enables the therapist to access information that only the client knows

2. Assesses what the client says about what he or she is thinking, feeling or doing

3. It is our only measure of cognitive activity (such as obsessions or negative self-statements)

4. Our Only access to subjective experiences (such as pain. . .)


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• Self-report data can be collected using a range of methods, including:Structured, semi-structured or informal interview, given either face to face

or via telephoneA written format provided by standardised and non-standardised

questionnaires, checklists and surveys, which can be given to the person or sent via mail, fax or email for completion

Self-ratings, e.g. on a visual analogue scale to rate painSelf-monitoring through client journals, e.g. to record symptoms, feelings

or activities undertakenNarrativesPlay activities and the use of toys (e.g. dolls, dolls houses) for imaginary

play and role play; joining children and participating actively in their play activities, particularly when the child is encouraged to direct the therapist and lead the play activity, can be very effective for opening up channels of communication

The arts, such as drawing, painting, sculpture, music to movement and improvised drama


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• Self report is:• Cost-effective in terms of time and resources• Very flexible • Only a few materials are required (a pen and paper or a test

form if a standardized test is being applied)• The data can be collected easily in various environments• Data are crucial for developing intervention goals


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INTERVIEWING AS A MEANS OF COLLECTING SELF-REPORT DATA

1. Interviewing is a crucial component of any assessment used to plan treatment

2. There are multiple ways to conduct an interview and not any one method is correct

3. The initial method of data collection and is a very useful method for collecting self-report data

4. An initial interview forms the foundation for building rapport and forming the beginnings of an effective therapeutic relationship


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• It provides for:• Collection of information about the patient to help develop

objectives and plans for treatment• Establishment of understanding on the part of the patient

about the role of the therapist and the purposes of the . . . therapy process

• An opportunity for the patient to discuss the particular situation and think about plans for change


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• Introductory information given within interview, include:• Introducing herself to the client• Outlining her role as an occupational therapist • Explaining the purpose of the interview• Describing the type of occupational therapy service that can

be provided in that practice setting• Discussing the degree of confidentiality that applies by

letting the client know with whom the therapist might share interview information.


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Setting an Interview:

• It is important that therapists provide a quiet, private interview environment that is free from interruptions and distractions

• It is important for the therapist to consider her body language

• Set up two comfortable chairs at a 90-degree angle to each other; removing the barrier of the desk and the direct confrontation of sitting opposite the person can help facilitate the sharing of information


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• There are four filters that influence the interactions between people and can be significant in distorting the interview or observation process. These are:1. Perceptual: how sensory stimuli (colour of clothing,

perfume) affect the way the other person is perceived;

2. Conceptual: the knowledge base brought to the interaction;

3. Role: the way each person perceives the role he or she is to play in the interaction;

4. Self-esteem: the way each person feels about himself or herself.


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The environmental factors

• Selecting an atmosphere that conveys a feeling of warmth• Ensuring a minimum of distractions by putting a sign on

the door indicating that an interview is in progress and by switching mobile/office phones to silent and letting the answerphone pick up messages during the course of the interview

• Pre-planning so that any questionnaire, task or test materials that might be required during the interview are collected in advance and easily accessible during the interview.


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The influence of the therapist

• Includes the therapist’s interview skills, personal values, beliefs and theoretical orientation

• Good interviewing skills:• The therapist being an active listener; verbal and non-verbal

communication, facial expression


24Client influences

• The client brings a unique set of values, beliefs and experiences to the assessment

• The client comes with needs, expectations and perhaps some anxiety

• It is important for the therapist to allow sufficient time for an initial interview to explore and understand any client-focused influences


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Dynamic interactions between therapist and client

• The dynamic interactions that occur while establishing the therapeutic relationship

• Affected by;• The nature of the client’s presenting problem (eg, mental

health problems)• Therapist–client responses and time-pressure


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The initiation phase of an interview

• Involves:• The therapist explaining the purpose of the interview,

including its parameters, how long it should take, the type of topics to be discussed and how the therapist plans to use the information

• The therapist describing her role in relation to the client in the clinical setting

• The therapist endeavoring to establish mutual understanding, respect and trust with the client in order to build rapport and set the foundations for an effective therapeutic relationship


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The development phase of an interview

• Involves:• The therapist, in the role of interviewer, poses a series of questions to elicit

information and to explore issues with the client• Having a list of planned questions or an outline of topics to be covered to help

focus the interview and ensure important information, vital to an accurate baseline assessment and identifying relevant treatment objectives, is not omitted

• The therapist asking open questions that elicit a descriptive response, as opposed to closed questions that produce a one-word (yes, no, maybe) answer while specifically providing guidance on communicating with people with speech deficits,

• Asking one question at a time, focusing on one subject at a time (and so encouraging a client to do the same), using short, simple sentences, being an active and patient listener and being prepared to rephrase a question in order to clarify a respondent’s answer.


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The closing phase of an interview

• Involves:• The therapist identifying that either the questions/topics to be addressed

have all been covered and that she has obtained the necessary information for this stage of the assessment process or that the allotted time has expired

• The therapist indicating to the client that the interview is coming to a close• The therapist making clear that the interview is finishing and that there is

no further opportunity at this time to bring up new issues• Identifying another time for continuing with the interview if there is further

relevant information to be discussed• The therapist summarizing the key points that have been discussed to

double-check that she has correctly understood and interpreted the information gained, if time allows.


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Disadvantage of self-report :

• May not accurately reflect patient performance• The person’s report of his functioning may vary

considerably from actual performance observed by the therapist

• There are a number of conditions might make the interview difficult to conduct and could reduce the reliability of the data collected (communication problems or Cognitive capacity


30Example:

• CANADIAN OCCUPATIONAL PERFORMANCE MEASURE (COPM); • Can be used with a wide range of clients ranging from school-aged

children up to older adults• Used with wide range of diagnoses• Is a measure of performance, including the importance of

performance problems and the client’s level of satisfaction with performance

• Has a semi-structured interview format• Covers the domains of self-care, productivity and leisure• It can also be used successfully as a proxy measure with a carer,

such as a parent or spouse


31PROXY REPORT:

• Information can be obtained from a number of other (proxy) sources• Proxy sources may include:• The person’s primary carer (either an informal carer, e.g. a family

member, neighbour or volunteer, or a formal carer – often referred to as a care-giver – e.g. a warden, nursing home staff or home help)

• Other members of the therapist’s multidisciplinary team (e.g. occupational therapist, physiotherapist, speech and language therapist, psychologist, social worker, nurse, doctor)

• Other health professionals involved with the client’s care (e.g. their GP, health visitor or district nurse)

• Other professionals working with the client (e.g. a case manager, teacher or lawyer).


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Importance of proxy report:

• Proxy report is of great value because:• Other people will spend much more time than the therapist

with the client and will have opportunities to see how the client is managing over a longer period and in a different and/or wider range of settings

• The initial interaction with the person’s family/carer can provide the foundation for building effective partnerships with carers


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• Four main types of interaction categories that occur between therapists and carers during assessment and treatment. These were:

1. Caring interactions that focused on friendliness and support

2. Partnering interactions that involved seeking and acknowledging input and reflective feedback to help carers make changes/modify behaviour or to affirm existing carer practices

3. Informing interactions that involved gathering information, explaining information and clarifying information

4. Directing interactions that involved the provision of instruction and advice.


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EXAMPLES OF ASSESSMENTS THAT USE INFORMATION FROM A PROXY

• PEDIATRIC EVALUATION OF DISABILITY INVENTORY (PEDI)

• SCALE FOR ASSESSING COPING SKILLS• INFANT AND TODDLER SYMPTOM CHECKLIST• CANADIAN OCCUPATIONAL PERFORMANCE

MEASURE (COPM)


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OBSERVATIONAL ASSESSMENT METHODS

• Refers to methods in which the therapist directly uses her senses to assess some aspect of the client’s problem or situation• Active listening (for example auscultation of lung sounds), • Smell (smells can help the therapist identify a problem with

incontinence or the risk of the person consuming food that has gone off)

• Touch (where the therapist is assessing the degree of resistance in a muscle as an indication of stiffness or spasticity)


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• There are several ways of observing clients:• Administer a standardised test that requires the performance

of test items which are observed and recorded• Set up an activity for the person to perform and then

observe from the sidelines• Choose to be a participant-observer who will observe the

client’s performance while engaging in an activity or task with the person.


37Examples:

• Examples include the:• Functional Independence Measure (FIM; Granger et al.,

1993)• Klein–Bell Activities of Daily Living Scale (Klein and Bell,

1982)• Peabody Developmental Motor Scales (Folio and Fewell,

1983)• Assessment of Motor Process Skills (AMPS; Fisher, 2003a)


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GROSS MOTOR FUNCTION MEASURE (GMFM)

• Is a criterion-referenced test that can be used to evaluate change in gross motor function over time with children with cerebral palsy (CP).

• Focuses on how much of an activity the child can accomplish (as opposed to the quality of motor performance)

• The test comprises 88 test items that assess motor activities in five dimensions: lying and rolling, sitting, crawling, standing, and walking

• The items are scored on a four-point rating scale (0 does not initiate, 1 initiates, 2 partially completes, 3 completes

• Can be administered in 45 to 60 minutes


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40Any Questions?

Documents

Methods of Assessment and Sources of Assessment Data Nisrin Alqatarneh MSc. Occupational therapy