OYH Assessment Manual

OCCUPATIONAL THERAPY

ASSESSMENT MANUAL

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Acknowledgements We would like to extend our thanks to Orygen Youth Health, especially Sonya Vargas and Gina Woodhead, for supporting and guiding this project, as well as contributing their time, expertise, and invaluable knowledge and resources that helped shape this Assessment Manual.

In addition, thanks is given to the occupational therapy staff at Orygen Youth Health, Barwon Health, Latrobe Regional Hospital, Alfred Health and Monash Health for their contributions both in person and via phone/email correspondence, to aid our understanding of the assessment process in adolescent mental health. We value their contribution towards the project objectives, and we thank them sincerely for sharing their time, suggestions and knowledge with us.

Without the assistance of the aforementioned people, the success of the Assessment Manual would not have been possible.

Antigone Koutoulas, Elizabeth Pattison and Joshua Woollard

La Trobe University Masters of Occupational Therapy Students

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Contents Page:

INITIAL ASSESSMENT 4 Occupational Performance History Interview Model of Human Occupation Screening Tool (MOHOST) Occupational Circumstances Interview and Rating Scale (OCAIRS)

5 7 9

INDEPENDENT LIVING SKILLS AND FUNCTIONAL ASSESSMENT 11

Assessment of Motor and Process Skills (AMPS) Assessment of Occupational Functioning

12 13

COMMUNITY AND DOMESTIC ACTIVITES OF DAILY LIVING 14

Domestic and Community Skills Assessment- Revised Addition Orygen Youth Health Modified DACSA Interview Assessment Cooking Assessment Summary

15 17 19

SENSORY MODULATION 20

Adult / Adolescent Sensory Profile NWMH Sensory Safety Tool

21 23

SOCIAL SKILLS 24

Evaluation of Social Interaction Assessment of Communication and Interaction Skills

25 26

INTERESTS, LEISURE AND GOAL SETTING 28

Modified Interest Checklist Adolescent Leisure Interest Profile Canadian Occupational Performance Measure (COPM) Volitional Questionnaire

29 30 31 33

HABITS, ROLES AND ROUTINES 34 Role Checklist Occupational Self Assessment Routine Task Inventory

35 37 39

SCHOOL/ VOCATION ASSESSMENT 41 School Setting Interview Worker Role Interview

42 44

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REFERENCES

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INITIAL ASSESSMENT

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Occupational Performance History Interview – II (OPHI – II) Assessment Overview: The OPHI – II is informed by the Model of Human Occupation (MOHO) and involves the use of a semi-structured interview approach to help an Occupational Therapist understand their client as an occupational being. Key areas of this Assessment: The OPHI – II is a three-part assessment that includes:

Ø A semi-structured interview that explores a client’s occupational life history. § The OPHI – II manual provides a set of interview questions, which

are organised into five different areas: o Occupational Roles o Daily Routine o Occupational Behaviour Settings o Activity/Occupational Choices o Critical Life Events

Ø Rating scales which provide measures of a client’s occupational identity, occupational competence and the impact of their occupational settings/occupational environment.

Ø A life history narrative which is designed to identify and discuss all prominent features of their occupational life history.

This assessment is appropriate for use with people from adolescence through to older adulthood, which means it is appropriate for use within the youth population. The main consideration when using this assessment is whether or not the young person is able to meaningfully and effectively engage in a history-taking interview. Mental Illness symptoms or medication side effects may affect their ability to participate. When should it be used? This assessment can be used as a guide for an initial consultation with a client in order to gain an understanding of the client as an occupational being. It covers all aspects of a client’s life and allows a client to express what is important to them in their lives. This interview also allows an Occupational Therapist to identify the interaction between the person, environment and occupational. How to Administer/Scoring:

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Firstly, the therapist conducts the semi-structured interview using the interview questions provided as a guide. Once all of the relevant sections of the interview have been conducted the therapist scores the three rating scales based on the information gathered. The therapist rates each of the items on a four point rating scale which indicates the client’s level of occupational adaptation and environmental impact. The therapist selects the rating (1, 2, 3 or 4) that corresponds most accurately to the criteria outlined for each item for that client. These scales create a profile of the client’s strengths and challenges related to occupational identity, competence and environmental impact. This profile is used in developing an intervention plan for the client. Following the completion of the scales the life history narrative form (provided in the manual) is completed. This involves plotting the client’s life story in both written and graphic form. This is a fairly lengthy assessment, however each part can be done at a separate time and the interview itself can be conducted in stages or sections if the client struggles to engage and concentrate. Is Training Required? No training is required. A detailed manual is used to educate the therapist on how to administer the assessment. The manual provides guidelines on how to conduct the interview, as well as detailed instructions for completing the rating scales and life story. Length of Assessment (Average Duration): The Interview part of the assessment takes approximately 45 to 60 minutes, however the interview process can be broken up into parts. The three rating scales consist of 29 items which can take 10-15 minutes to complete. Benefits/Strengths:

Ø The OPHI-II gives a therapist a great overall understanding of the client as an occupational being.

Ø This assessment can be broken up into smaller parts if a client struggles to engage.

Evidence supporting the Assessment The OPHI-II has been developed over the past 25 years. The OPHI-II has been found to have a good level of inter-rater and test-retest reliability, as well as construct and predictive validity. An international study of the OPHI-II found evidence supporting the internal consistency and the construct validity of the assessment. Studies have shown that the OPHI-II has been beneficial with the adolescent population across a number of different settings. The OPHI-II is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website. Please be

aware that it is $40 to purchase. http://www.cade.uic.edu/moho/products.aspx

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THE MODEL OF HUMAN OCCUPATION SCREENING TOOL (MOHOST)

Assessment Overview: The Model of Human Occupation Screening Tool (MOHOST) is an assessment which is used to gain an understanding of a client’s strengths. The screening tool emphasises the impact that MOHO concepts such as volition, habituation, skills and the environment can have on occupational performance and participation. Key Areas of Assessment: The MOHOST is made up of 24 items representing MOHO areas such as volition, habituation, skills and the environment. Each item has its own four point rating scale, and the criteria for these rating scales are shown for each item. When should it be used? This assessment should be used to gather information about a client when screening referrals, determining the need for future assessment or developing an intervention plan for that client. This assessment can be used to gain an understanding of the factors that can impact upon a client’s occupational performance and participation. How to Administer/Scoring: The information required to fill in this assessment is often gained through observation, however information can also be gathered through conversation with clients, their relatives, or a carer. Information can also be gathered from medical records or files. The MOHOST is designed so that the therapist conducting the assessment can gain information through the most practical means. The therapist scores each of the 24 items in the MOHOST on a four point scale. Criteria for each rating are specified for each item, which makes the process of filling out the form more straightforward for the therapist. Ratings are recorded on the summary forms which are provided with the assessment. Is Training Required?

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No training is required to conduct this assessment; however it is important to be familiar with the assessment items and process before administering it. Length of Assessment (Average Duration): The duration of the MOHOST is dependent upon the means of information gathering. It may take a therapist a number of sessions to develop an understanding of all items included in the assessment. Benefits/Strengths:

Ø The MOHOST can be used for screening referrals, identifying the need for future assessment and planning future intervention.

Ø Easy to administer and can be used as an outcome measure. Ø This assessment can be used with a wide range of clients including

those with psychosocial and/or physical impairments. Evidence supporting the Assessment Research has shown that the MOHOST items and rating scales are able to distinguish between patients who have differing levels of occupational participation. The MOHOST has also been proven to be used in a valid manner across a number of different settings such as in the community, forensic mental health and acute mental health settings. Further research is needed into the psychometric properties of this assessment; however the assessment is currently used in other services.

The MOHOST is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website.

Please be aware that it is $40 to purchase. http://www.cade.uic.edu/moho/products.aspx

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OCCUPATIONAL CIRCUMSTANCES INTERVIEW AND RATING SCALE

(OCAIRS) Assessment Overview: The OCAIRS assessment uses a semi-structure interview and rating scales to gather information about a client’s life and their occupational performance and participation. The OCAIRS assessment has been designed so that it is relevant to both adolescent and adult clients who may be from a wide range of backgrounds. Key Areas of Assessment: The OCAIRS provides three different semi-structured interviews which are targeted at different population groups. These population groups are physical rehabilitation, mental health and forensic mental health. The appropriate semi-structured interview is conducted and the information is used to rate clients on 12 different items using a four point rating scale. When should it be used? The OCAIRS, like the OPHI-II, is used to identify and gain an understanding of the factors that are impacting upon a client’s occupational performance and participation. It can also be used to allow the therapist to gain a greater understanding of the client’s current circumstances if these are not yet known or are unclear. How to Administer/Scoring: The OCAIRS assessment manual has detailed information with regards to completing the interview as well as how to complete the scales. The semi-structured interview has been developed so that it can be tailored to each client. After the interview has been conducted using the interview guide, the therapist completes the rating scales for the 12 items. Each item is rated according to how it facilitates, allows, inhibits or restricts occupational

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participation. Each of the ratings has descriptive statements which help the therapist to make a decision about the rating. Following the completion of both parts of the assessment, the therapist can fill out an OCAIRS summary form which will determine the need for intervention. Is Training Required? No training is required to administer this assessment; however it is important for the therapist to have an understanding of the assessment and its purpose, and to use the assessment manual. Length of Assessment (Average Duration): With practice the OCAIRS interview can be completed in approximately 20-30 minutes. Obviously this depends on the level of engagement of the client, as well as the therapist’s familiarity with the assessment. The rating scales then take a further 5-15 minutes to complete. Benefits/Strengths:

Ø Once a therapist is familiar with the assessment it does not take long to complete.

Ø It is suitable for use with client’s from different backgrounds and clients with a variety of impairments.

Ø The descriptors for each rating save time for the therapist and allow more time to reflect on what is next for the client.

Ø The OCAIRS can be administered simultaneously with assessments like the Worker Role Interview and the MOHOST.

Evidence supporting the Assessment Research has established that the OCAIRS has good inter-rater reliability, as well as internal, construct and person response validity. The OCAIRS is internationally recognised as being a cross-cultural assessment of occupational functioning, meaning it is a useful assessment for young people from a variety of backgrounds. OCAIRS scores have also been used to establish whether a client is in need of occupational therapy services or not.

The OCAIRS is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website.

Please be aware that it is $40 to purchase. http://www.cade.uic.edu/moho/products.aspx

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INDEPENDENT LIVING SKILLS AND

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FUNCTIONAL ASSESSMENT

AMPS (ASSESSMENT OF MOTOR PROCESS SKILLS)

Assessment Overview: The AMPS is an assessment that considers both motor and process skills directly affecting occupational performance by observing the client performing selected ADLs, including PADLs, DADLs or IADLs. When should it be used? Key areas of this Assessment: The AMPS can help to determine a client’s performance of motor and process skills; specific to ADLs the client would usually participate in. The client is asked to select three ADL tasks from a list of over 50. Motor and process skills are scored using a four-point rating scale that considers the effectiveness, efficiency and safety of the client’s performance. How to administer / Scoring: The therapist is required to observe the client participating in the chosen activities; therefore it is important either the client or the client’s carer is aware of that before testing begins The AMPS is scored by a computer and identifies what parts of the activity the client found difficult (i.e. skills) and how difficult a task is for the client to perform. There are 16 motor and 20 process skills items. AMPS scoring takes into consideration how difficult the task is. Training Required?

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Training is required to complete the AMPS Time to administer: The AMPS takes approximately 30-60 minutes to administer Strengths/Benefits:

Ø The AMPS can be used for the adolescent population Ø Tasks are chosen by the client, therefore the assessment is client

centred Ø The computer program takes into account what activities are deemed

more difficult than others when scoring Evidence supporting the Assessment (Reliability and Validity)

Ø Evidence suggests that the AMPS demonstrates validity as a cross-cultural measure.

Ø Fisher (2003) documents inter-rater reliability as excellent (r=0.93). Test-retest reliability to be r=0.88 for motor skills and r=0.86 for process skills.

Ø Excellent reliability and validity. Effective response rate, as the client chooses tasks, therefore they are meaningful to them and their real life situations

Specific Training is required to perform the AMPS; if you receive this

training you will be given the AMPS User Manual ASSESSMENT OF OCCUPATIONAL FUNCTIONING (AOF)

Assessment Overview: The AOF is a screening tool used by clinicians to collect a range of information believed to influence and be indicative of a person’s occupational performance, which is useful in identifying what areas require a more in depth evaluation. When should it be used? Key areas of Assessment: The AOF should be administered when a client is capable of responding to an interview. Based on responses the therapist will rate the client on core components of MOHO - Volition, Habituation and Occupational Performance Skills. This screening tool is based on MOHO and does not evaluate specific ADLs or environmental variables, but more so creates a picture of numerous complex interrelated factors that influence a person’s ability to function. How to administer/Scoring: The AOF can be administered either by a therapist as a semi-structured interview or self-report, with follow up from a therapist. Therapists are encouraged to obtain clarification from the client if answers are ambiguous or not clear. The assessment comes with it’s own Rating Form, on which therapists rate the client’s ‘Communication/Interaction Skills’ initially. Following this, the

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therapist must use a 5-point scale to rate the client on the core components of MOHO mentioned above, as each question answered relates specifically to one of these components. Training required? No training is required to administer the AOF, but therapists administering this assessment are encouraged to be familiar with the theoretical framework of MOHO. Time to administer: The AOF takes approximately 20-30 minutes when administered as an interview, or 12 minutes as a self-report tool with follow up. Strengths/Benefits:

Ø Screening tool that can highlight specific barriers in occupation and guide the intervention process.

Ø Results show both strengths and weaknesses of clients Ø If the clinician is time limited the assessment can be self-reported, and

therefore given as homework and discussed in the next session. Evidence supporting the Assessment:

Ø Content validity revealed that the instrument covered domains adequately (Brollier, Watts, Bauer & Schmidt, 1989).

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COMMUNITY AND DOMESTIC ADL ASSESSMENTS DOMESTIC AND COMMUNITY SKILLS ASSESSMENT REVISED EDITION

2 (DACSA-R2)

Assessment Overview: The Domestic and Community Skills Assessment- Revised Edition 2 is a comprehensive set of task-area assessments that are considered essential for living in the community. This assessment is based on the Domestic and Community Skills Assessment (Collister & Alexander, 1991), and has been revised for individuals with a psychiatric illness. When should it be used? Key areas of this Assessment: The DACSA-R2 should be used when occupational therapists are assessing an individual’s capacity to live in the community. Furthermore, the DACSA-R2 enables occupational therapists to determine the level of assistance the

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individual requires for tasks carried out in the home and wider community settings.

Occupational therapists should use the DACSA-R2 when determining, Ø The most appropriate future accommodation for the client Ø Baseline functional abilities for domestic and community tasks Ø Level of community support required to assist the client to maintain

safe community living Ø Making recommendations to legal bodies (e.g. Guardianship and

Administration Board) The Key Areas of this Assessment include:

Ø Meal Planning Ø Grocery Shopping Ø Meal Preparation Ø Personal Presentation Ø Budgeting Ø Bill Paying Ø Banking Ø Laundry Ø House Cleaning Ø Telephone Use Ø Making and Keeping Appointments Ø Basic First Aid Ø Communication Services Ø Medication Management

How to administer/Scoring When commencing the assessment, the occupational therapist uses the DACSA Screening Assessment Tool to determine which task areas require assessing. This is established using semi-structured interviews to identify areas of concern. After these areas are identified, further assessment is required through practical, descriptive and observational tasks. The tasks assist the occupational therapist in identifying skill strengths and deficits that enable or impair a client’s performance in the task area. Whilst the task is being completed, the occupational therapists completes an Observational Checklist which allows the therapist to record their observations related to the quality of the client’s task performance. Furthermore, overall task performance is measured using a three-point rating scale to determine the level of intervention required for the client to live in the community, 3= no intervention required, 2= basic intervention required and 1= direct support required. All relevant information obtained during the assessment is transferred to the DACSA Report. The DACSA Report also contains the client’s background information, reason for referral, strengths and weaknesses and area for recommendations.

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Training Required? No formal training is required but the DACSA-R2 must only be administered by a qualified occupational therapist Time to Administer: The DACSA-R2 Screening Tool takes approximately 10 minutes to administer. Following this, the DACSA-R2 will take 30-45 minutes to complete, depending on the number of areas being assessed. Strengths/Benefits

Ø Designed for the psychiatric population over the age of 16 Ø The DACSA-R2 contains a screening tool, which allows therapists to

identify areas of concern, followed by completion of further assessment in these target problem areas. This saves time for both the therapist and client, promoting client engagement in this assessment.

Ø Covers a variety of community and domestic skill domains Ø DACSA-R2 is a recently revised edition of the DACSA (Collister &

Alexander, 1987), and has been updated to ensure relevance to today’s adolescent and adult population.

Evidence supporting the Assessment There is currently no evidence supporting the use of this Assessment as it was revised in 2010 by La Trobe University. However, it is supported by occupational therapists working in the field of youth mental health as the preferred assessment of community and domestic skills.

ORYGEN YOUTH HEALTH DOMESTIC AND COMMUNITY SKILLS ASSESSMENT INTERVIEW

Assessment Overview: The Domestic and Community Skills Assessment Interview has been developed by occupational therapists at Orygen Youth Health, based on the DACSA Assessment (Collister & Alexander, 1987). This semi-structured interview assessment aims to assess skills that are considered essential to living in the community, and has been used by occupational therapists at Footscray Inpatient Unit.

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When should it be used? Key areas of the Assessment The OYH Domestic and Community Skills Assessment Interview should be used by occupational therapists when assessing an individual’s capacity to live in the community. Key areas of this Assessment include:

Ø Client’s living situation Ø Budgeting Ø Activities of Daily Living Ø Meal Preparation Ø House Cleaning Ø Laundry Ø Personal Presentation Ø Support Services Ø Community Contacts Ø Making and keeping appointments Ø Transport Ø Telephone Use Ø Medication Management Ø Sleep Ø Employment Ø Education

How to administer / Scoring This assessment is administered via interview and requires no scoring. The client is asked a number of questions for each domestic and community skills domain. The occupational therapist documents the client’s responses and any key observations noted throughout the assessment. To help build rapport, the Occupational Therapist should use it more as a guide, as opposed to a questionnaire, as it could be difficult to elicit responses from the client. This assessment is used as a screening tool and helpful to generate conversation with clients Training required? No formal training is required to complete the OYH Domestic and Community Skills Assessment Interview Time to administer The OYH Domestic and Community Skills Assessment Interview takes approximately 30-45 minutes to administer Strengths / Benefits

Ø Covers a variety of community and domestic skill domains Ø Administered via informal interview Ø Allows therapists to identify areas of concern and target intervention

specific to these problem areas

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Evidence supporting the Assessment As this assessment has been developed internally by OYH occupational therapists, there is currently no evidence supporting the use of this Assessment

COOKING ASSESSMENT SUMMARY

Assessment Overview: The Cooking Assessment Summary has been developed by North Western Mental Health and is currently used at Footscray Inpatient Unit. This assessment aims to assess an individual’s cooking skills and the level of assistance and supervision required when cooking a meal.

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When should it be used? Key areas of the Assessment The Cooking Assessment Summary should be used by occupational therapists when assessing an individual’s cooking abilities and safety in the kitchen environment. Key areas of the Assessment include:

Ø Hygiene Ø Safety, and Ø Cooking Process

How to administer / Scoring This assessment is administered through the client partaking in practical cooking tasks whilst the occupational therapist observes. Whilst the task is being completed, the occupational therapist observes the client’s performance in three key domains, hygiene, safety and cooking process. Each domain contains a number of subdomains of which a score is given and comments noted. Scoring is utilised to determine the level of assistance, supervision or prompting required to complete the cooking tasks. Scores range from

Ø 0= needs maximum assistance Ø 1= supervisions/verbal prompting/demonstration Ø 2= minimal supervision/occasional verbal prompting Ø Independent

Training required? No formal training is required to complete the Cooking Assessment Summary Time to administer The Cooking Assessment Summary takes approximately 30-45 minutes to administer Strengths / Benefits

Ø Allows the therapist to observe the client’s cooking abilities firsthand and determine the level of assistance needed

Ø Areas of concern are easily identified and thus, intervention is targeted to these problem areas

Evidence supporting the Assessment As this assessment has been developed internally by North Western Mental Health, there is currently no evidence supporting the use of this assessment

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SENSORY MODULATION ASSESSMENTS

ADOLESCENT/ADULT SENSORY PROFILE

Assessment Overview:

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The Adolescent/Adult Sensory Profile is a self-report measure that is used to evaluate behavioural a client’s responses to everyday sensory experiences. This assessment is a standardised measure and allows the clinician and client to understand the effect sensory processing can have on functional performance. Key Areas of Assessment This assessment measures how a client generally responds to specific sensations, as opposed to how they respond to specific events or situations. The profile is used to develop a client’s awareness of their sensory processing needs, and strategies to create the most beneficial sensory environment. When should it be used? The Adolescent/Adult Sensory Profile can be used when it is suspected that a client may be experiencing sensory processing issues which may be impacting their functional performance in their everyday activities (e.g., self-care, family relationships, bonding with friends and family, job satisfaction/performance, school performance). How to Administer/Scoring: The Adolescent/ Adult Sensory Profile produces four scores which correspond to the four quadrants of sensory processing proposed in Dunn’s model of sensory processing.

Ø Low registration Ø Sensation seeking Ø Sensory sensitive Ø Sensation avoiding

Each quadrant is assessed using 15 questions which cover sensory processing, visual, auditory, touch, taste, smell, movement and a general category for activity level. There are a total of 60 items or questions in the profile. Individuals complete the questionnaire by reporting how frequently they respond in the way described by each item by using a 5 point Likert scale (nearly never, seldom, occasionally, frequently or almost always). It is scored by an occupational therapist or professional trained in sensory processing theory. Scores that fall within one standard deviation of the mean for each category represent “Typical Performance.” Scores that fall between one to two standard deviations below the mean fall into the “Probable Difference” category. Finally, scores that fall more than two scores below the mean indicate a “Definite Difference.” Scores that fall in the probable or definite difference categories may warrant intervention. Is Training Required?

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No training is required; however it is helpful to have an understanding of sensory processing theory. The assessment manual contains information regarding rationale, theory and development of the profile. It also contains information about administration, scoring and interpretation of results, as well as suggestions for interventions for each of the four categories of sensory processing. Length of Assessment (Average Duration): This assessment takes 10-15 minutes to complete, however the duration of the assessment depends on the client’s ability to engage. Benefits/Strengths:

Ø Gives an understanding with regards to why individuals engage in certain behaviours.

Ø Gives an understanding as to why an individual prefers certain environments and experiences compared to others.

Ø Enables informed intervention planning, which takes into account the results of the assessment and the individual’s preferences.

Ø Can be used in a variety of settings à schools, clinics, hospitals, long term care facilities, community based centres and wellness centres.

Ø Non-intrusive and quick and easy to use. Evidence supporting the Assessment Psychometric evidence with regards to this assessment has shown that the scores provided by the Adolescent/Adult sensory profile can be used to provide reliable and valid interpretations about a client’s sensory processing patterns and preferences (Brown & Dunn, 2002).

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NORTH-WESTERN MENTAL HEALTH SENSORY SAFETY TOOL

Assessment Overview: The North-Western Mental Health Sensory Safety Tool has been developed by North-Western Mental Health for use with clients who are on the Inpatient Unit of Orygen Youth Mental Health in Footscray. The tool is designed as a questionnaire which is used to gain an understanding of a client’s sensory preferences, triggers for certain behaviours, warning signs and prevention strategies. It is also used to gain a better understanding of the client’s history. The tool is used to better understand a client’s unique needs and provide them with the best possible care and treatment plan. Key Areas of Assessment: The assessment covers areas such as:

Ø Triggers to becoming angry or upset à e.g. being touched, loud noises, being ignored, yelling or sudden movements.

Ø Warning signs of when a client feels they may lose control à e.g. sweating, clenching fists, crying or swearing.

Ø Crisis prevention strategies à e.g. listen to music, watching TV, talking to a family member or friend.

Ø Any medical conditions a client may have. Ø Client’s trauma history. Ø History of violence and suicidality/self-harm. Ø History of seclusion and restraint. Ø Medications.

When should it be used? This tool should mainly be used on an in-patient unit; however parts of the assessment may also be useful in an out-patient setting or crisis team. It is a good tool for both the client and therapist to identify triggers and warning signs, and then determine ways these can be prevented. How to Administer/Scoring: The tool can either be completed by the client with the therapist there as a guide, or a therapist can answer the questions on the client’s behalf. It is recommended that the tool is completed with as much input from the client as possible. If this is not possible, the therapist can complete the form through observation, obtaining information from a client’s file or possibly through consultation with a significant other if this is appropriate. Is Training Required? Training is not required. The questionnaire is quite self-explanatory. The therapist should be familiar with the assessment and be able to explain its purpose to a client. Length of Assessment (Average Duration): This assessment tool takes approximately 20-30 minutes to conduct.

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SOCIAL SKILLS ASSESSMENTS

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Evaluation of social interaction (ESI) Assessment Overview: The ESI aims to evaluate a client’s quality of social interaction during natural social exchanges with typical social partners. The ESI tests the client as they engage in social situations prioritised by them, as they interact with other social partners. The ESI helps to measure to what extent the interaction is polite, respectful, well timed, relevant and mature. When should it be used? Key areas of this Assessment: The ESI is appropriate to use for the adolescent population, and for anyone who is or is at risk of experiencing challenges with social interaction and/or behaviour in social contexts. How to administer/scoring The ESI is an observational assessment that scores the quality of 27 social interaction performance skills. Performance skills include: motor skills, process skills and social interaction skills. Training required? Yes, training is required to perform the ESI. Once this is completed, the therapist is provided with a manual, which includes computer software and scoring sheets. Time to administer: The ESI takes up to 1 hour to administer Strengths/Benefits:

Ø Can be used before intervention to obtain baseline results and again after intervention to document the effectiveness of the intervention

Ø Can be used in any relevant and familiar environment. Hargie (2006) advocates for the assessment of social interaction skills in the context of “real” social interactions.

Evidence supporting the assessment: Simmons, Griswold and Berg (2010) reported excellent internal scale validity, with 95% of the observations fitting the Rasch model A separation reliability of .89 and item separation reliability of .98 was reported (Simmons et al., 2010)

Specific Training is required to perform the ESI; if you receive this training you will be given the ESI User Manual, computer software and

scoring sheets

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Assessment of Communication and Interaction skills (ACIS) Assessment Overview: The ACIS (Forsyth et al., 1998) is a formal tool designed to measure an individual’s performance in an occupational form/task within a social group. The Occupational Therapist is able to determine the client’s strengths and weaknesses whilst interacting and communicating with others during daily occupations. When should it be used? Key areas of assessment: The ACIS can be used when clients appear to have issues communicating and interacting in social situations. The ACIS contains a single scale that consists of 20 skill items divided into three communication and interaction domains:

Ø Physicality Ø Information exchange Ø Relations

These items are rated on a 4-point scale. The scale considers whether others are made comfortable, appropriately informed and helped by the client’s actions. How to administer/ Scoring: The ACIS is administered via observation, where 20 communication and interaction skills are observed. It is important that the context closely resembles a situation that is meaningful to the client. Following training the therapist is provided with a details manual designed to instruct and guide the tools use. Training required? Training is not required to administer the ACIS. Time to administer:

Ø Administration time can range from 20-40 minutes. Ø Observation time ranges from 15-45 minutes Ø Rating time ranges from 5-20 minutes

Strengths/Benefits:

Ø Observations are carried out in settings that are meaningful and relevant to the client’s lives.

Ø No training required Ø MOHO based assessment

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Evidence supporting assessment:

Ø Forsyth et al (1999) determined the ACIS had both intra-rater and inter-rater reliability, but some raters were inconsistent in their rating. This was due to a lack of rater understanding of how communication and interaction were defined.

Ø Construct validity is supported as the items are arranged in an order that makes clinical sense. The easiest items that reflect simple communication skills are toward the beginning of the assessment, but get harder, and require more sophisticated responses as the assessment continues (Forsyth et al., 1999).

Ø Internal validity was also established (Forsyth et al., 1999)

The ACIS is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website. Please be


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INTERESTS LEISURE & GOAL SETTING ASSESSMENTS

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MODIFIED INTEREST CHECKLIST

Assessment Overview: The Modified Interest Checklist is a leisure interest inventory appropriate for adults and adolescents and indicates clients’ current interests, how interests have changed and desired future interests. When should it be used? Key areas of this Assessment: The Modified Interest Checklist gathers information about a client’s level of interest and participation in 68 different activities, such as football, dancing and gardening. How to administer/Scoring For each activity, clients indicate their level of interest over the past year, and past ten years. The rating given to each item ranges from no interest to some interest to strong interest. Furthermore, clients indicate whether they currently participate in this activity and if they would like to pursue each potential interest in the future. Training Required? No formal training is required to administer the Modified Interest Checklist. Time to Administer: The Modified Interest Checklist takes 10-15 minutes to administer Strengths/Benefits

Ø Quick to administer Ø Relevant to the youth population Ø Wide range of activities can be assessed Ø Provides activity ideas for treatment planning

Evidence supporting the Assessment Reliability and Validity:

Ø Evident face validity Ø Good test-retest reliability (0.92) within 3- week interval of using the

Modified Interest Checklist

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ADOLESCENT LEISURE INTEREST PROFILE

Assessment Overview: The Adolescent Leisure Interest Profile (ALIP) is the only leisure assessment tool that was designed for adolescents and includes activities relevant to present-day teenagers. It is similar to the Modified Interest Checklist, however is designed specifically for adolescents. When should it be used? Key areas of this Assessment: The Adolescent Leisure Interest Profile will enable occupational therapists to determine leisure interest or satisfaction and establish leisure goals for adolescents. This assessment tool contains 86 items, grouped into 10 categories; exercise activities, social activities, creative activities, sport activities, family activities, outdoor activities, relaxing activities, intellectual activities, clubs and organizational activities and other activities. How to administer / Scoring For each item, the respondent is asked, ‘How interested are you in this activity?’ and ‘How often do you do this?’ on a Likert scale of 3 points and 5 points respectively. Participants who indicate that they are interested or participate regularly in this activity and asked to complete questions related to how well they feel they perform the activity, how much they enjoy it, and with whom they do it. Training Required? No formal training is required to complete the Adolescent Leisure Interest Profile Time to Administer: The Adolescent Leisure Interest Profile takes approximately 30 minutes to administer Strengths/Benefits

Ø Only assessment tool specific to the adolescent/youth population Ø Effective in establishing leisure goals with clients

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Ø Covers a wide range of activities Evidence supporting the Assessment (Reliability and Validity)

Ø Henry (1998) supports the use of the Adolescent Leisure Interest Profile in clinical settings amongst adolescents with psychiatric, learning and physical difficulties, as well as adolescents without any apparent difficulties. The internal consistency, 0.93, and test-retest reliability, 0.83-0.93, were proven, highlighting that the ALIP is a valid and reliable assessment tool

Ø Trotter, Brown, Hobson and Miller (2002) highlights that the ALIP is a useful assessment tool during initial assessment, intervention and outcome evaluation.

CANADIAN OCCUPATIONAL PERFORMANCE MEASURE (COPM)

Assessment Overview: The Canadian Occupational Performance Measure (COPM) is a semi-structured interview assessment that is widely used to evaluate a client’s perception of his/her occupational performance. When should it be used? Key areas of this Assessment: This assessment will enable occupational therapists to identify client’s concerns with occupational performance, assist in goal setting and measure change in defined problem areas over the course of therapy. The COPM is client-centered and addresses roles, role expectations, and activity performance within the client’s own environment. Specifically, this assessment evaluates a client’s occupational performance issues within the areas of self-care, productivity and leisure occupations. How to administer // Scoring This assessment is administered via semi-structured interview. The client is asked to identify any activities that are difficult to perform across the areas of self-care, work and leisure. The client is then asked to identify the five most important problems on a scale of 1 (not important at all) to 10 (extremely important). Following this, the client scores his or her performance (1= not being able to perform the task, to 10= able to complete the task well) for each identified problem area and their level of satisfaction in these activities (1= not satisfied, to 10= extremely satisfied). The performance and satisfaction scores of the selected activities are summed and averaged over the number of problems, to produce scores out of 10. A difference between the initial and subsequent score (change score) of two or more is considered clinically significant. Training Required?

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No formal training is required to administer the COPM. Time to Administer: The COPM takes 20-40 minutes to administer Strengths/Benefits

Ø Client-centred assessment; this assessment considers the importance to the client of the occupational performance areas, as well as the client’s satisfaction with present performance

Ø The COPM supports the notion that clients are responsible for their health and own therapeutic process

Ø Studied across a wide range of diagnoses Ø Used in more than 35 countries around the world Ø Available in 20 languages

Evidence supporting the Assessment Ø Test-retest reliability demonstrates the COPM is a reliable assessment

tool (0.80) Ø COPM is a valid assessment measure of occupational performance as

Boyer et al (2000) state that the COPM was a helpful addition to their planning and intervention

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VOLITIONAL QUESTIONNAIRE

Assessment Overview: The Volitional Questionnaire assesses the person’s inner motives and the environment’s impact on motivation. This observational assessment for adolescents and adults rates the individual in terms of three stages of volitional development: exploration, competency, and achievement. When should it be used? Key areas of this Assessment: The Volitional Questionnaire can be used with clients who are experiencing difficulty formulating goals or expressing interests and values. The Volitional Questionnaire is composed of 14 items that describe behaviours reflecting values, interests and personal causation. How to administer/Scoring Occupational therapists administer this scale by observing and rating patients while they engage in work, leisure or daily living tasks. Each item is scored using a four-point rating (passive, hesitant, involved and spontaneous). Due to the nature of this scale, the observing therapist can provide support and structure if it is necessary to elicit volition. Training Required? No formal training is required. Occupational therapists are advised to be familiar with the Volitional Questionnaire manual and guidelines prior to administering the assessment. Time to Administer: The Volitional Questionnaire takes approximately 30 minutes to administer and score

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Strengths/Benefits

Ø The sole assessment tool that indicates the extent to which a client readily exhibits volitional behaviours versus the amount of support, encouragement and structure that is necessary to elicit them

Ø Allows the therapist to determine the environmental contexts and strategies that enhance the individual’s volition

Ø Can be administered as part of a therapy session Evidence supporting the Assessment

Ø Research demonstrates that the volitional questionnaire has good content validity, as well as sensitivity, as it is able to detect differences between patients with different levels of volition.

Ø Kielhofner (2004) states that therapists must be familiar with the Model of Human Occupation concepts and Remotivation Process when administering the volitional questionnaire to ensure consistency amongst assessors.

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HABITS, ROLES AND ROUTINE ASSESSMENTS

ROLE CHECKLIST

Assessment Overview: The Role Checklist was developed in order to gain information regarding a client’s participation in occupational roles throughout their life, and the value that they place on these occupational roles. The checklist is used to identify problems with continuity of role performance. Key Areas of Assessment: Client’s respond to each of the ten roles listed in the assessment tool with one of the following responses:

Ø Whether they have held the role in the past.

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Ø Whether they are currently in the role. Ø Whether they expect to be in the role in the future.

The client then indicates how much they value that role with one of the following responses:

Ø Not at all valuable. Ø Somewhat valuable. Ø Very valuable.

A definition of each of the roles is provided in the manual, as well as examples of that role. The roles included in The Role Checklist are:

Ø Student Ø Worker Ø Volunteer Ø Care giver Ø Home maintainer Ø Friend Ø Family member Ø Religious participation Ø Hobbyist/Amateur Ø Participant in organisations

When should it be used? An Occupational Therapist can choose to conduct this assessment if they would like to gain an understanding of the roles a client has undertaken in the past and whether the client has any goals to fulfil specific roles in the future. It can be used as a tool to guide intervention, as fulfilling a certain role can become an important goal for that client. How to Administer/Scoring: Please refer to ‘Key Areas of Assessment’ section above for details. Following explanation of the checklist, the client can choose to either fill out the assessment themselves, or have the occupational therapist go through the assessment with them. Following the completion of the checklist the therapist can facilitate a conversation about the roles in the checklist. This discussion can be about the roles they have been successful in, the roles they have avoided, and determining why some roles are deemed more valuable than others. Is Training Required? No specific training is required. The assessment manual explains how to administer the Role Checklist. Length of Assessment (Average Duration): The Role Checklist can take 15-30 minutes to complete depending on the client’s level of engagement and discussion related to their roles following completion of the checklist. Benefits/Strengths:

Ø Quick and easy to administer. Ø Can be used as a guide for goal setting.

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Ø Helps to determine what a client has been successful in and why a client values one role more than another.

Ø Can be used across a number of different diagnostic categories. Ø Appropriate for use across age groups.

Evidence supporting the Assessment The Role Checklist has been used in numerous research studies as an instrument for examining role performance. A study conducted by Oakley, Kielhofner, Barris & Reichler (1986) concluded that the Role Checklist had satisfactory test-retest reliability. Another study and literature review established that the Role Checklist had satisfactory content validity of role classification.

OCCUPATIONAL SELF-ASSESSMENT

Assessment Overview: The Occupational Self-Assessment is used to identify a client’s occupational competence in performing everyday occupations through client self-report. This assessment also encourages a client to express their personal values and set goals/priorities for change. The OSA gives the client a role in determining their goals and strategies for intervention in collaboration with the

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therapist. Often, client centred practice can be difficult to implement. The OSA is designed to facilitate this client centred practice for therapists. Key Areas of Assessment: The assessment is made up of two self-report scales, where the client indicates how well they believe they perform a task (occupational competence) and how important they believe that task is. The process of administration and scoring is outlined below. When should it be used? This assessment should be used when a therapist feels a client can adopt a larger role in their own treatment process. The OSA has mainly been developed for use with clients who are 18 years of age and older. The Occupational Self-Assessment can be used as an outcome measure, if so then it should be administered at the beginning of therapy and then near the end of therapy to see how far the client has come. How to Administer/Scoring: The Occupational Self-Assessment is made up of a two part self-report. The therapist firstly presents the client with 21 everyday activities, and then using a four point scale the client rates how well they believe they do each activity. This scale is an indication of occupational competence. Following this, the client uses another four point rating scale which gives an indication as to how important an activity is to them. The items on the assessment and the scales are written using simple and easy to understand language to ensure that the client understands what is being asked. Following completion of the scales the responses are reviewed with the client in order to identify priority areas. This can then be used to guide occupational therapy intervention. Is Training Required? No training is required to administer the Occupational Self-Assessment, however the therapist needs to be familiar with the assessment and use the assessment manual as a guide. Length of Assessment (Average Duration): The Occupational Self-Assessment takes 20-30 minutes to administer, however more time is required to explain the assessment to the client. The duration can also vary depending on the level of function and engagement shown by the client. Benefits/Strengths:

Ø Easy, timely and straight forward to administer. Ø Gives the client a role in determining their own goals and ways of

achieving those goals. Ø The OSA can be used as an outcome measure which is able to identify

self-reported client change.

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Evidence supporting the Assessment A study by Kielhofner, Dobria, Forsyth & Kramer (2010) supported the use of the Occupational Self-Assessment as a client directed outcome measure. The study’s results suggest that the constructs of occupational competence and value placed on performance are stable over time (Kielhofner, 2010). The results also suggest that the rating scales are stable over time. Furthermore, the study shows that the OSA is able to detect both increases and decreases in competence and value in everyday tasks over time (Kielhofner et al, 2010).

The OSA is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website. Please be


ROUTINE TASK INVENTORY - EXPANDED

Assessment Overview:

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The Routine Task Inventory-Expanded is an assessment of activities of daily living. The Inventory helps to provide an indication of the client’s cognitive function as well as being a form of activity analysis and a functional evaluation instrument. The assessment determines if a client is able to perform all of the tasks required in their daily lives. Key Areas of Assessment: This assessment looks at routine task behaviour, which can be defined as “Occupational Performance in areas such as self-care, instrumental activities at home and in the community, social communication through verbal and written comprehension and expression, and readiness for work relations and performance” (Katz, 2006). The assessment determines how well a client is able to manage these tasks, and informed intervention planning can take place. When should it be used? The aim of assessing routine task behaviour is to promote safe, routine performance of a client’s valued occupations and to maximise a client’s occupational participation in daily activities. This assessment should be used if a therapist or family member/carer is concerned with a client’s ability to look after themselves in their daily lives. How to Administer/Scoring: The Routine Task Inventory-Expanded is quite a lengthy assessment and can involve the combined utilisation of client self-report, care giver consultation and therapist observation. Ideally the therapist would observe the client performing the ADL task; however this may not always be possible, especially with some of the self-care ADLs. Where observation is not possible the client is consulted, and if this is not appropriate then a reliable care giver is asked how the client manages the ADL tasks outlined in the assessment. The assessment is administered as a checklist during an interview. The client or care giver are given a copy of the RTI-E scoring criteria and asked to pick the best description of what the client is likely to exhibit. The therapist explains items as required and encourages the client/caregiver to give a detailed description of how the client normally performs the task. Each ADL has six options as to how a client may complete a task; the therapist, client or caregiver selects the most appropriate option. The scoring is very similar to a FIM score. A detailed description of the administration procedure and scoring process is outlined in the manual, which is located following this information sheet. Not all of the sections within the assessment may be relevant or necessary for a client, so the therapist can pick and choose which parts of the assessment they deem necessary. Is Training Required?

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No training is required; however, the RTI-E should be used by professional occupational therapy personnel. Administering this assessment requires knowledge of the cognitive disabilities model, interview skills, and observation and activity analysis skills. The assessment manual should be used as this details the assessment process, scoring and interpretation of results. Length of Assessment (Average Duration): The duration of the assessment is quite variable, and is dependent upon the information gathering method that is used. If the assessment becomes to lengthy, it can be split up into different parts and can be completed over more than one session if required. Benefits/Strengths:

Ø Gives the therapist an understanding of a client’s cognitive level within functional tasks.

Ø Utilises therapist observation, client self-report and care giver analysis which can develop a holistic picture of how a client performs a task.

Ø Can be used in intervention planning and goal setting. Evidence supporting the Assessment Four separate studies have shown that the original Routine Task Inventory had high inter-rater and test-retest reliability, as well as high internal consistency (Allen, 1985; Heimann et al 1989; Wilson et al, 1989; Allen et al, 1992). However these studies are quite old and the results may not be relevant now. More recent studies were unable to be located. The internal consistency was established in a study by Heimann, Allen & Yerxa (1989) for the original RTI. This led to the authors extending the task analysis to other activities. Activities added to the expanded version were child care, communication and work readiness. The authors believe the RTI-E is a comprehensive assessment of daily activities. For full details of the psychometric properties and a list of research into the assessment please refer to pages 21 and 22 of the assessment manual (Katz, 2006).

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SCHOOL AND VOCATIONAL ASSESSMENTS

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School Setting Interview (SSI)

Assessment Overview: The SSI is designed to assess the impact of the school environment on the student. MOHOs conceptualisation of the social and physical environment is conceptualised within the SSI. The SSI uses a client-centred interview to assist the occupational therapist in intervention planning. The SSI considers the student's occupational performance in all environments. When should it be used? Key areas of this assessment: The SSI is a semi-structured interview designed to assess student-environment fit and identify the need for accommodations for students with disabilities in the school setting. The assessment is made up of 16 items that make up a student’s participation at school and address the following items:

Ø Writing Ø Reading Ø Speaking Ø Remembering things Ø Doing mathematics Ø Doing homework Ø Taking examinations Ø Going to art, gym and music Ø Getting around the classrooms Ø Taking breaks Ø Going on excursions Ø Getting assistance Ø Accessing the school Ø Interacting with staff

When administering the SSI, the student must be able to communicate enough to discuss their experiences How to administer/Scoring: The SSI is administered via interview, where the therapist explores each of the 16 items mentioned above with the student. The therapist investigates how the student has functioned and is currently functioning in the area, whether the student believes there is a need for accommodation to perform in the area and whether anything has been put into place prior to help the student perform. The 16 items are scored on a 4-point rating system. Scoring requires two forms. One allows for identification of whether there is a need for accommodation in each area and whether they are met. The second

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allows recording of recommendations for accommodation. Recommendations could include changes to:

Ø Objects Ø Spaces Ø Occupational forms/tasks Ø Social groups

The assessment also records who is responsible for the changes and how they will be implemented. Training required? No training is required to complete the SSI. It is available for purchase through the MOHO website for $40.00 Time to administer: The SSI takes approximately 40 minutes to administer Strengths/Benefits:

Ø Empowers the students to collaborate with the therapist to determine what accommodations are necessary for them to be able to participate at school

Ø Client centered, allowing the client to verbalize what is not working for them at school

Evidence supporting this assessment:

Ø Hemmingsson & Borell (1996) explored inter-rater reliability, where a kappa between 0.76 and 1.0, which indicated good agreement between pairs of raters.

Ø 10 of the content areas had kappa values between 0.91 and 1 which indicates very good agreement between raters

Ø Content validity was judged as adequate for the assessment’s intended purpose.

Ø Hemmingson, Kottorp & Bernspang (2004) concluded the SSI displays evidence of construct validity.

Ø Hemmingsson & Borell concluded the SSI has 0.96 sensitivity and 0.88 specificity (both adequate) for identifying the needs of students within the school setting.

The SSI is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website. Please be aware

that it is $40 to purchase. http://www.cade.uic.edu/moho/products.aspx

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Worker Role Interview (WRI) Assessment Overview: The WRI was initially developed as part of a study designed to determine psychosocial variables influencing work success. The WRI is a 16 item scale, which rates the client’s likelihood of work success (either returning to a specific job or employment in general). When should it be used? Key areas of Assessment: The WRI should be used when a client is thinking of going into the workforce or returning to the workforce. The WRI collects data on six areas:

Ø Personal causation Ø Values Ø Interests Ø Roles Ø Habits Ø Perceptions of the environment

How to administer/Scoring: The WRI is presented in a manual which provides the therapist with background information, as well as detailed instructions and guidelines for administration. Initially, therapists administer a semi-structured interview in which they can simultaneously conduct the OCAIRS interview. Following this, a rating scale is completed, entering comments as appropriate. Training required? Training is not required to administer the WRI. The assessment can be purchased from the MOHO website for $40.00 Time to administer: Semi structured interview can take 30-60 minutes to administer. Strengths/Benefits: The WRI provides a solid foundation for planning intervention with a worker whose impairments are interfering with their work. The WRI identifies psychosocial factors related to work that are not considered by most work assessments, so can reveal unique strengths and weaknesses, which should be considered when intervention planning.

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Evidence supporting assessment: Haglund, Karlson, Keilhofner & Lai (1997) examined construct validity of the Swedish version of the WRI in psychiatric patients, and found that the WRI was a psychometrically sound assessment besides two items in the environment content area (Perception of boss, perception of co-workers). Inter-rater reliability for the total assessment was found to be acceptable, but three out of six individual content areas received ratings well below the accepted standard of .80. Test-retest reliability displayed high reliability, which shows the assessment’s ability to measure consistently over time when used by one rater.

The WRI is available through the MOHO clearing House. If you would like to use it in practice, please go to the following website. Please be


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Documents

OYH Assessment Manual