the application of assessment and evaluation procedure in

using occupation centered practice

PRESENTED BY GUIDED BY
TAMILARASI.D Mr. D.ANBARASU MOT, Ph.D.
MOT-1st YEAR ASSOCIATE PROFESSOR
SRMCOT SRMCOT
 outline:
1.What is an occupation
2.Occupation centered practice
3. Domains of occupation centered practice. ( areas of occupation )
4. Evaluation and assessment tools.
5. Process of OCP
6. Characteristics of occupation centered practice.
7. Application of occupation centered practice.
8. Case study
9. Journal
10. References
 What is an occupation?
1. Occupations are when specific effort is made or put to achieve something
worthwhile to note (driving a car, organising a party, any routine like bedtime
stories)
2. It is also based on tradition, culture and belief of a particular person.
 OCCUPATION CENTERED
PRACTICE:
Occupation-centered practice means that occupation is at the core of everything
that we do. We believe that it is through occupation that health and well-being
( Wilcock, 2006 ) and justice ( Townsend and Polatajko, 2007 ) are influenced.
Other professional bodies keep the body structures and functions as the main
perspective of their treatment. Whereas we are distinct in those aspect as we
concentrate of the occupation.
It is anticipated that improvements in body functions and structures will lead to
improvements in occupation and participation
Therefore, if you want to see improvements, your interventions need to focus on
occupation and participation. It may also be that through engaging in one’s
occupations, body functions and structures change.
Cont.…
There is growing evidence regarding the benefits of using an occupation-
centered approach with children and adults who experience a range of
occupational performance challenges.

Practicing from an occupation-centred perspective has also shown improvements

in job satisfaction for occupational therapists as it aligns with our profession’s
unique perspective
 Domain of occupational therapy:
The DOMAIN provides a common language used to describe the scope of occupational
therapy practice.
Under the DOMAIN , the OTPF-1V identifies the following eight areas of occupation in
the occupation centered practice:
1. Activities of Daily Living (ADL)
2. Instrumental activities of daily living (IADL)
3. Rest and sleep
4. Education
5. Work
6. Play
7. Leisure
8. Social participation.
Areas of occupation include categories of activities or occupations in which people ,
organizations and populations engage on a regular basis (AOTA 2008)
 OTHER AREAS OF DOMAIN
ARE
Performance Contexts : Environmental :
Factors
Personal Factors.
Performance Patterns : Habits
Routines
Roles
Rituals
Performance Skills : Motor Skills.
Process Skills
Social interaction skills
Client factors : Values, beliefs, spirituality, Body Functions, Body structures
 Domains evaluation ….
CONTEXT FACTORS : It includes
1. Environmental factors like natural and human made changes to environment.
2. Personal factors like age, sex, gender, culture, social background, habits,
education, lifestyle, profession, health condition.
PERFORMANCE PATTERNS : It includes
1. Habits which are specific automatic behaviours performed repeatedly,
automatically .
2. Daily routine of the individual.
3. The roles as a person.
4. Rituals that symbolises spiritual, cultural or social meaning.
PERFORMANCE SKILLS : It includes
1. Motor skills ( positioning the body, obtains and holds objects, moving objects and
sustained performance)
2. Process skills ( sustaining the performance, applying knowledge to do the task,
timing sequence etc.)
3. Social interaction skills ( producing social interaction, verbally supporting it,
speaks fluently)
CLIENT FACTORS :
1. Values : The acquired beliefs, commitments, and what is good, right or
important to do.
2. Beliefs : Something which is accepted, considered to be true.
3. Spirituality : Religious nature, a personal search for purpose and meaning in
life.
4. Body functions and structures.
 process
The 3-part process includes:
1. Evaluation
2. Intervention
3. Targeted Outcome
evaluation
Evaluation occurs during the initial and all subsequent interactions with the
client.
The evaluation consists of the occupational profile and the analysis of
occupational performance
The occupational profile includes information about the client’s needs,
problems, and concerns about performance in occupations.
The analysis of occupational performance focuses on collecting and interpreting
information specifically to identify supports and barriers related to occupational
performance and establish targeted outcomes.
Using a client-centered approach, the occupational therapy practitioner gathers information to
understand what is currently important and meaningful to the client (i.e., what the client wants
and needs to do) and to identify past experiences and interests that may assist in the
understanding of current issues and problems. During the process of collecting this information,
the client, with the assistance of the practitioner, identifies priorities and desired targeted
outcomes that will lead to the client’s engagement in occupations that support participation in
daily life. Only clients can identify the occupations that give meaning to their lives and select the
goals and priorities that are important to them. By valuing and respecting clients’ input,
practitioners help foster their involvement and can more effectively guide interventions.
Occupational therapy practitioners collect information for the occupational profile at the
beginning of contact with clients to establish client-centered outcomes.
For clients who are unable to participate in this process, their profile may be compiled through
interaction with family members or other significant people in their lives. Information for the
occupational profile may also be gathered from available and relevant records.
 Intervention
The intervention process consists of services provided by occupational therapy

practitioners in collaboration with clients to facilitate engagement in occupation

related to health, well-being, and achievement of established goals .

TYPES OF OCCUPATIONAL THERAPY INTERVENTIONS:

Interventions to support occupations

Education and training
Advocacy
Group interventions
Virtual interventions.
outcomes
Results of occupational therapy services are established using outcome
performance measures and outcome tools. Outcomes are directly related to the
interventions provided and to the targeted occupations, performance patterns,
performance skills, client factors, and contexts. Outcomes may be traced to
improvement in areas of the domain, such as performance skills and client
factors, but should ultimately be reflected in clients’ ability to engage in their
desired occupations.
Outcomes should be measured with the same methods used at evaluation and
determined through comparison of the client’s status at evaluation with the
client’s status at discharge or transition. Outcomes targeted in occupational
therapy can be summarized:
Cont…
 Occupational performance
 Prevention
Health and wellness
Quality of life
 Participation
Role competence
 Well-being
Occupational justice
EXAMPLE
client who has a distal radius fracture with decreased pronation. I could choose an exercise like
Figure 1. put a weight in her hand to allow gravity to pull down on her forearm and increase her
pronation.
I might achieve my goal of increasing her pronation. We could take this up a
notch and do something like have a person pour beads from one container into
another as seen in Figure 4.
We are again seeing that great forearm pronation in that right arm. In this scenario,. This person
is pouring soil to repot a plant as part of an occupation. Are there materials being used? Are
they consistent with the occupation? There is a plant, a pot, and soil. This example shows how I
can bring an occupation into therapy and add meaning and purpose. This brings me to the next
construct which is meaningful and purposeful value.
Evaluation and assessment tools for adl &
iadl :
The OTPF (AOTA 2008) defines ADL as the activities that are oriented
toward taking care of one’s own body that includes: Self care activities,
Functional Mobility, Sexual Activity, Sleep/ rest, Toilet Hygiene.
The OTPF (AOTA,2008) defines IADL as activities oriented towards
interacting with the environment and often complex that includes : Care of
others, pets, Child rearing, Use of communication devices, Community
mobility, financial management, health management, home establishment,
meal preparation, shopping etc.
 Standardized assessment tools for adl and iadl
NAME OF ASSESSMENT AREAS ADDRESSED METHOD/ RATING

ASSESSMENT OF LIVING SKILLS AND ADL skills Interview with guiding questions: uses a
RESOURCES (ALSAR) three point ordinal scale .

CANADIAN OCCUPATIONAL ADL, IADL, Leisure Interview that identifies 2 or 3 tasks for
PERMORMANCE MEASURE (COPM) performance testing rated on 16 motor skills

FUNCTIONAL INDEPENDENCE ADL Seven point ordinal scale, grading amount of

MEASURE (FIM) assistance to complete the activity.

CHILD OCCUPATIONAL SELF Child ADL Self report assessment composed of 24

ASSESSMENT (COSA) statements related to everyday activities.
INDEPENDENT LIVING SCALE ADL & IADL Observation over a course of a
week.
KOHLMAN EVALUATION OF LIVING ADL & IADL Combination of interview and
SKILLS (KELS) performances , uses a 3 point
ordinal scale.

MELVILLE – NELSON SELF CARE ADL Performance based. Tasks are

ASSESSMENT rated on 2 scales : how much the
client does and how much/ what
type of assistance is given.

MILWAUKEE EVALUATION OF DAILY ADL & IADL Screening based on information

LIVING SKILLS (MEDLS) from clients , clients family health
care team and medical record to
determine items to be examined.

OUTCOME AND ASSESSMENT ADL & IADL Data to be obtained through

INFORMATION SHEET (OASIS) various methods.

PERFORMANCE ASSESSMENT OF ADL & IADL Performance based, uses 4 point

SELF CARE SKILLS (PASS ) ordinal scale.
 Evaluation of rest & Sleep :
REST : Identify the need to relax and engaging in quiet and effortless actions that
interrupt physical and mental activity.
SLEEP : Sleep is a naturally occurring altered state of consciousness
characterized by decrease in awareness and responsiveness to stimuli
 Assessment tools for sleep:
The Stanford Sleepiness Scale : Quick way to test how alert someone is feeling
at a given time. it is a one-item self-report questionnaire measuring levels of
sleepiness throughout the day. The scale, which can be administered in 1–2
minutes, is generally used to track overall alertness at each hour of the day.
The Epworth Sleepiness Scale : This scale is used to assess a person’s level of
sleepiness in daytimes.like sitting and reading, sitting and talking with someone,
or being in a car while stopped in traffic.
 Evaluation and assessment of education :
FORMAL EDUCATIONAL PARTICIPATION : participating in academic, (eg-
maths, reading), nonacademic, extracurricular, technological, vocational
educational activities.
INFORMAL PERSONAL EDUCATIONAL NEEDS : identifying topics &
methods for obtaining topic related information or skills.
INFORMAL EDUCATION PARTICIPATION : Participating in classes
programs, and activities that provide instruction in the areas of interest.
 Standardized assessment tools for education:
Assessment of Motor and Process Skills (school version (AMPS)
Children’s Assessment of Participation & Enjoyment (CAPE)
Canadian Occupational Performance Measure (COPM)
Making Action Plans (MAPs)
Miller fun scales
Perceived Efficacy and Goal Setting Scale (PEGs)
School Function Assessment (SFA)
Vermont Interdependent Services Team approach (VISTA)
 Evaluation of work
EMPLOYMENT INTERESTS : Identifying and selecting work opportunities
with personal assets, limitations, goals and interests.
EMPLOYEMENT SEEKING : Completing, submitting and reviewing
application materials, preparing for interviews, participating in interviews,
discussing job benefits.
JOB PERFORMANCE & MAINTAINENCE : Maintaining required work
skills and patterns, managing time, managing relationship with co-workers,
responding to feedback.
 Assessment TOOLS of work :
FUNCTIONAL CAPACITY EVALUATION : It is classified into 2 types :
Comprehensive and Job specific. A comprehensive assessment includes a
complete set of tasks that cover 20 physical activity.
Job specific testing, the evaluator tests the tasks that are related to the job.
INSTRUMENT DESCRIPTION TIME TO ADMINISTER

VALPAR Component Work Sample Direct observation of work tasks 20-90 minutes
Series & Dexterity Modules selected to evaluate client’s
specific job requirements and
needs.

WORKER ROLE INTERVIEW A semi structured interview that 30-60 minutes and 15 minutes for
assesses psychosocial or scoring.
environmental factors related to
injured worker or client.
 Evaluation of play & leisure :
PLAY EXPLORATION : Identifying play activities, including exploration play,
pretend play, various games etc.
PLAY PARTICIPATION : Participating in play, obtaining, using and
maintaining toys, equipment and supplies.
LEISURE EXPLORATION : Identifying interest, skills, opportunities and
leisure activities.
LEISURE PARTICIPATION : Participating in leisure activities, maintaining the
balance of leisure activities with other occupations.
 Assessment tools for play & leisure :
Assessment of Children’s Participation ( APCP )
Child Initiated Pretend Play Assessment (CHIPPA)
Children’s Playfulness Scale.
Child Occupational Self Assessment.
McDonald Play Inventory
Play in Early Childhood Evaluation Systems (PIECES)
Preschool Play Scale.
Penn Interactive Peer Play Scale (PIPPS)
Leisure Assessment
Activity Card Sorting (ACS)
Children’s Assessment of Participation and Enjoyment (CAPE)
Interest Checklist/ Activity Checklist.
Leisure Activity Profile (LAP)
Leisure Attitude Scale
Leisure Competence Measure
Leisure Boredom Scale
Leisure Diagnostic Battery 1 & 2
Leisure Satisfaction scale
Preferences for Activities of Children (PAC)
 evaluation of social participation :
Community Participation : engaging in the activities in neighbourhood or
community.
Family Participation
Friendships
Peer group Participations
 Assessment tools for social participation :
ASSESSMENT AND COMMUNICATION OF INTERACTION SKILLS ( ACIS) : Used to
accomplish ADL.
BAY AREA FUNCTIONAL PERFORMANCE EVALUATION : scale during interview of
the individual, in a group situation
COMPREHENSIVE OCCUPATIONAL THERAPY EVALUATION ( COTE) : Individuals
evaluates client factors, performance skills and behaviour patterns affecting
occupation.
COMMUNICATION SKILLS QUESTIONNAIRE
EVALUATION OF SOCIAL INTERACTION
INDEPENDENT LIVING SKILLS SURVEY( ILSS)
MARYLAND ASSESSMENT OF SOCIAL COMPETENCE.

MODEL OF HUMAN OCCUPATION SCREENING TOOL

(MOHOST)

ROLE ACTIVITY PERFORMANCE SCALE (RAPS )

SOCIAL – ADAPTIVE FUNCTIONING EVALUATION ( SAFE )

SOCIAL FUNCTIONING SCALE (SFS)

SOCIAL OCCUPATIONAL FUNCTIONING SCALE (SOFS )

WORK RELATED GROUP SKILLS (WSS )

 Assessment tools for body functions :
Joint ROM : Goniometer
Motor function tests : Jebsen- Taylor Hand Function Test
Purdue Pegboard
Minnesota Rate of Manipulation Test
Lincoln- Oseretsky Motor Development Scale
Crawford Small parts dexterity test
Manual muscle testing
Sensory Function Tests : Developmental test for visual Motor Integration
Purdue Perceptual Motor Survey
Perceptual forms Test
Marianne Frostig Developmental Test for Visual perception
Intelligence tests : Goodenough- Harris Drawing Test
Peabody Picture Vocabulary
Psychological tests :Vineland Social Maturity Scale.
Minnesota Multiphasic Personality Inventory (MMPI)
Activity Configuration
Adolescent Role Assessment
Allen cognitive level
Azima Battery
Bay Area Functional Performance Evaluation
Comprehensive Occupational Therapy Evaluation( COTE )
Goodman battery
Interest checklist
Case study :
Application of the occupation centred assessment with children to a child with
juvenile idiopathic arthritis :

Jill is an 8-year-old girl diagnosed with juvenile idiopathic arthritis (JIA), 2

weeks ago. This is the most common and generally mildest form of JIA, where
four or fewer joints are involved. The most commonly affected joints are the
knee, ankle, wrist and elbow. The clinical course of pauciarticular juvenile
arthritis may involve flares and remissions, but with appropriate treatment, there
is rarely permanent damage to the joints
CONT…
Primary method of treating the juvenile arthritis is by including medications to control joint
inflammations, exercises to keep the joint moving well and the muscles strong, splinting,
steroid injections and pain management strategies

The goals of medical and rehabilitation intervention are: to reduce inflammation, to reduce
pain (usually due to inflammation), to minimize damage to the joints, to ensure that the joints
keep working at an optimal level, to get the child diagnosed with JIA back to his or her
normal activities, to prevent JIA from interfering with the child’s routine lifestyle and to
provide information and education for the family of the child with JIA as needed
 Medical history:
Jill was referred by her general practitioner to a pediatric rheumatology clinic at a regional
children’s hospital, after she presented with a 6-week history of morning stiffness, spiking
fevers and sore swollen joints that included her left knee, both wrists and right elbow. About
1 week before Jill developed her painful swollen joints, she had a mild flu for 3 days. Jill had
also tripped going up the stairs at home and hit her left knee during this time

Furthermore, Jill complained of pain, did not want to walk, go up and down stairs or perform
any self-care or school-related activities that involved flexing and extending her wrists
Family history
Jill’s father works as a brick layer in the construction industry and her mother
works as a teaching assistant in a neighborhood pre-school classroom. Jill has a
16-year-old sister and 10-year-old twin brothers. The family rent townhouse with
three bedrooms in a new housing development of a large metropolitan area.
Education and developmental history
Jill attends Grade Three at the local state primary school. Her teacher reported
that Jill is an average student at school, but has difficulties with mathematics.
However, Jill enjoys art, creative writing and social studies. Jill was born at 39
weeks with a birth weight of 2.5 kg. She attained her developmental milestones
at expected ages and has had no previous history of significant health problems.
There is no previous family history of autoimmune type diseases.
 Clinical assessment by occupational
therapist
Paul, the occupational therapist, used an occupation- and client- centred
approach to assessment. Initially, he interviewed Jill and her parents to find out
what issues and factors were important to Jill, and her parents in relation to Jill’s
participation in her routine life and to develop of profile of Jill’s daily
occupations.
Tools used:
COSA – child occupational self assessment
Kids play survey (KPS)
ASK (activities scale for kids)
SSI (school setting interview)
 Journal:
Occupational therapy, cancer, and occupation-centred practice: impact of training in the
model of human occupation (Patricia Bowyer)
AIM:
The aim of this study was to examine the influence of an occupation-centred practice model
group training on the therapeutic reasoning and practice of occupational therapists working
within a cancer hospital
RESEARCH QUESTION:
1. Does knowledge of and group-based training in MOHO influence the way that occupational
therapy practitioners engage in daily practice?
2. What does the MOHO mean for the therapeutic reasoning of therapists in oncology practice?
METHOD:
1. A generic qualitative process was used to frame the study
2. The research occurred in a large cancer institute
3. The 6 hour training was given for MOHO approach for the therapist which was followed
by monthly follow up
DATA COLLECTION:
1. The therapist were committed to a yearlong study
2. Initially a 6 hour group training session occurred during a workday lunch hour
3. It focused on utilisation of MOHO
4. Monthly group meetings were conducted and it was video recorded by principal
investigator
RESULT
Three major themes were extracted from the data during the thematic analysis: understanding
and using MOHO language; challenges in incorporating a conceptual model of occupation-
centred practice in an oncology setting; and therapeutic reasoning implications. Patterns in
the themes indicated a progression from learning the model, to applying the model, to
reflection on practice.
CONCLUSION:
Post-professional training in an occupation-based model influenced the therapeutic reasoning
and practice of occupational therapists in an oncology setting
LIMITATIONS
1. A smaller number of participants
2. Not generalisable
3. Only one model was used.
4. Researcher bias.
Occupation-CENTERED Practice and Its Relationship to
Social and Occupational Participation in Adults With Spinal
Cord Injury
AIM
aim of this study was to increase the evidence regarding the use of occupation-centered practice and its
effects on social and occupational participation in adults with spinal cord injury.
METHODS
Three individuals who had experienced a spinal cord injury 2 to 5 years previously, lived in the community,
and received services from one of the two selected occupation-based occupational therapists participated in
the study. Using a qualitative ethnographic design, they participated in one semi-structured, open-ended
interview that contained questions designed to elicit experiences of life satisfaction, participation in
meaningful occupations, social roles and responsibilities, and participation in occupational therapy.
Cont..
Data were analyzed using thematic analysis, narrative analysis,
literature review.
result
occupation-centered approaches appeared to directly support the
participants' current level of occupational and social participation.
This study provides occupational therapists with a more practical
understanding of how to apply these approaches in their own
practices
 References:
1. Implementing occupation centred practice – a practical guide for occupational therapy – karina dancza and sylvia
rodger
2. Bowyer, P., Muñoz, L., Tiangco, C., Tkach, M., Moore, C., Burton, B., & Lim, D. (2020). Occupational therapy,
cancer, and occupation‐centred practice: impact of training in the model of human occupation. Australian
Occupational Therapy Journal, 67(6), 605-614. https://doi.org/10.1111/1440-1630.12687
3. Fisher, A. (2014). Occupation-centred, occupation-based, occupation-focused: Same, same or
different?. Scandinavian Journal Of Occupational Therapy, 21(sup1), 96-107.
https://doi.org/10.3109/11038128.2014.952912
4. Ford, E., Di Tommaso, A., Molineux, M., & Gustafsson, L. (2021). Identifying the characteristics of occupation‐
centred practice: A Delphi study. Australian Occupational Therapy Journal.
https://doi.org/10.1111/1440-1630.12765
Pierce, D. (2001). Untangling Occupation and Activity. The American Journal Of Occupational
Therapy, 55(2), 138-146. https://doi.org/10.5014/ajot.55.2.138
Willard and Spackman’s occupational therapy- 12 th edition
Occupation centred practice with children : a practical guide for occupational therapy
Occupation Therapy Essentials for Clinical Competence – karen jacobs