Seif Assessment of Occupational Functioning (SA Model of Human Occupation Bijlage 2 The Children’s Self Assessment of Occupational Functioning NAME: AGE: DATE: OCCUPATIONAL THERAPIST: ‘The reason for asking these questions is to look at what you think you do well and what you would like to change about yourself. This is a way to find out what is important to yoo. It will help you and your occupational therapist plan ways for you to learn more about you. INSTRUCTIONS Lets look at the senteaces below. After each sentence, say whether this is something you do well (a STRENGTH), something you do OK (ADEQUATE), or something in which you would like to pet better (IMPROVEMENT). AREA OF OCCUPATIONAL FUNCTIONING sTreNotus | ADEQUATE | NEEDS (good) (0K) IMPROVE. MENT (get bewer) T. Tknow what fam good at or can do well 2. [feel proud about what I can do. 3. Texpect things T do to turn out well. 4, [think 1 can do or say something to make things happen. 5. Tcan make up my own mind when given choices. 6. Tcan stay with a hard activity ‘7. Lam patient and can wait when something takes a long time. 8. Thave an idea of what I want to be when | grow up. 9. I push myself just enough to do things. 10, Lan get what I want done during the day. 11. Thave good habits (doing my chores, bathing, brushing my teeth). 12. Ican deal with sudden changes in my day. 13.1 plan ahead before I do something, 14. Lean think of something to do when I have a problem. 15. T keep my mind on what | am doing and get my work done. 16. Lam coordinated and can move my body without problems, Hogeschool van Amsterdam, Expertise Centrum Ergatherapie 7 ~ Sabine van Erp, Karin Menzen, Marita Schouten (Juli 999),Seif Assessment of Occupatioral Functioning (SA Model of Human Occupation STRENGTHS | ADEQUATE (e004) (OK) 18. Tknow what like to do for fun. 19. 1am doing the activities I like, 20. 1 can play by myself. 21.1 do active and quiet activises. 22. 1 have interesting and fun things to do around me. Tam par ote ay 24. I spend enough time with my family. 1 do activities with my family. oan tell my family what I think and how I feel 1 get along well with my brother's) and/or sistex(s) 3-1 get along well with my parents. 1 feel my family cares about me. Tam in school 1 think I can do well in school, like my grades. 1 miss very few days of school {can speak up in class and ask for help if T need it. 1 get along with my teaches, 1 get along with my classmates 37.1 spend enough ame on my homework. Hogeschool van Amsterdam, Expertise Canitum Eqgotheraple ‘Sabine van Erp, Karin Menzen Marita Schouten (Juli 1999)Self Assessment of Occupational Functioning (SA Model of Human Occupation STRENGTHS | ADEQUATE | NEEDS (Good) (0%) IMPROVE. MENT (get better) 40, [think 1 can make and keep friends, 41, do activities with my friends, 42.1 spend enough time with my friends 43.1 can talk and get along in a group of friends. ]/44. 1 feel my friends care about me. ‘After reading all the sentences, look at the ones in which you would like to get better. From these, pick the three that are the most important for you to chancre. In the Most Important’ column, pus! by the ove you want to ‘change the most. Next, puta "2" by the second most important one to change end so on, to "3" or “4” Copyright 1986 and revised 1990 by Clare Curtin, WEd, OTR/L and Kathi Brenneman Baron, MS, OTR/L. US Copyright Office: Registration Number TXu 272.717 Hogeschool van Amsterdam, Expertise Centrum Ergotherapie ‘Sabine van Erp, Karin Menzen, Marita Schouten (Juii 1999)Self Assessment of Occupational Functioning (SA Model of Human Occupation [Now talic with your occupational therapist and together decide on your goals for treatment, “Write these goals and what you are going to do for treatment (Plan of Action) below. OCCUPATIONAL THERAPY TREATMENT PLAN GOALS PLAN OF ACTION Child's Signature “Therapist’s Signature copyright 1986 and rvieed 1890 by Clare Curtin, MEd, OTR nd Kathi Brenneman Baron, US Copyright Office: Registration Number TXu 272 717. MS. OTR Togeschoa van Analeram, Experse Centum Ergotaran Sabine von Ep Kenn Menzen, Marta Schotten (ui 1909) i