Occupational Therapy Process: Evaluation, Intervention, and Outcomes



Occupational Therapy Process


Evaluation, Intervention, and Outcomes




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I was attracted to the profession when I realized the power of its medium—occupation. Life is, essentially, a chain of occupations. Occupation gives the context in which people build their skills, discover their interests, and reveal their hopes. Purposes in life are worked out through occupation. At the same time, occupation can influence and transform these purposes. The power of occupation lies in its intertwining of the person’s body, mind, soul, and world. The work of the occupational therapist is to be an expert on the complexity of occupation and to use that knowledge artfully to help others achieve a life that is purposeful and meaningful. It is within this process that the therapist finds purpose and meaning; it is within this process that curiosity and wonder about how people create occupation grow.


RENÉ PADILLA, PhD, OTR/L, FAOTA


Associate Professor


Department of Occupational Therapy


Creighton University


Omaha, Nebraska


The occupational therapy process involves the interaction between the practitioner and the client. The relationship between the practitioner and the client is a collaborative one that involves problem-solving to support the client’s occupational performance. The process is dynamic and the focus is on occupation and the client as an occupational being.2 The client may be an individual, caregiver, group, or population.


The occupational therapy process can be divided into the evaluation, intervention, and outcome (Figure 12-1). The evaluation process includes referral, screening, developing an occupational profile, and analyzing occupational performance. The intervention process includes intervention planning, implementation, and review. The outcomes process includes measurement of outcomes and decision-making related to the future direction of intervention (i.e., continue, modify, or discontinue). In this chapter, we describe the components of each stage and delineate the roles of the OT and the OTA throughout the process.




Evaluation Process


The purpose of the evaluation process is to find out what the client wants and needs, and to identify those factors that support or hinder occupational performance.2 The OT practi-tioner develops an occupational profile of the client and analyzes the occupational performance to determine the client’s skills and ability to carry out activities of daily living.


The OT practitioner bases the evaluation procedures on the client’s age, diagnosis, developmental level, education, socioeconomic status, cultural background, and functional abilities. The steps of the evaluation process include referral, screening, and evaluation. Observation and interviewing are essential to this process.



Referral


The occupational therapy process begins when a referral, a request for service for a particular client, is made.3 The OT is responsible for accepting and responding to the referral. Referrals may come from a physician, another professional, or the client. Referrals may range from a specific prescription for a dynamic orthosis to general suggestions to improve fine-motor problems. Federal, state, and local regulations and the policies of third-party payers determine the type of referral required (e.g., whether a physician’s referral is necessary) and the role an OTA can have in the referral process.



Screening


Through screening, the OT practitioner gathers preliminary information about the client and determines whether further evaluation and occupational therapy intervention are warranted. Screening typically involves a review of the client’s records, the use of a brief screening test, an interview with the client or caregiver, observation of the client, and/or a discussion of the client with the referral source. The practitioner investigates the client’s prior and current level of occupational performance and determines the client’s future occupational performance needs. The practitioner communicates the screening results to the appropriate individuals, including the party who made the referral.1,3


The OT initiates and directs the screening process, using methods that are appropriate to the client’s developmental level, gender, cultural background, and medical and functional status.1,3 The OTA contributes to the screening process under the direction of an OT. Before screening tasks are performed by an OTA, he or she must achieve service competency in the particular tasks.


If screening suggests the client is in need of services, a comprehensive evaluation is arranged. The OT identifies a model of practice (see Chapter 14) from which the evaluation is based. The model of practice helps organize the practitioner’s thinking. From the model of practice, the practitioner selects a frame of reference and chooses assessment instruments consistent with the frame of reference.



Occupational Profile


The goal of this step is to gather information on the client so that an occupational profile can be developed. The OT practitioner obtains initial information about the client, including the client’s age, gender, and reason for referral; diagnosis and medical history (including date of onset); prior living situation and level of function (e.g., independent at home or in a care home); and social, educational, and vocational background. The initial review may provide information regarding precautions that need to be adhered to during the occupational therapy process. This background information is usually recorded in the client’s occupational therapy chart and on the evaluation form. Figure 12-2 illustrates an example of an evaluation form used in an occupational therapy setting.



An occupational profile provides the practitioner with a history of the client’s background and functional performance with which to design intervention. The following questions from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile2:




Occupational Performance Analysis


From the information gathered during the occupational profile (e.g. client’s needs, problems, and priorities), the practitioner makes decisions regarding the analysis of occupational performance. This information provides direction to the practitioner as to the areas that need to be further examined. The practitioner selects specific assessment instruments to collect further information.


The OT practitioner uses assessments to gather information on a client’s occupational performance in regards to areas, skills, patterns, contexts, client factors, and activity demands (see Chapter 9).2 The results are documented on a form typical to that shown in Figure 12-2. This evaluation information forms the basis for the intervention plan.


Occupational performance analysis involves analyzing all aspects of the occupation to determine the client factors, patterns, contexts, skills, and behaviors required to be successful. Once the practitioner has thoroughly analyzed the occupation, the practitioner can more easily determine what is interfering with the client’s ability to engage in occupations.


Evaluation is an essential part of clinical decision-making requiring a depth of understanding of many factors. As a result, the final responsibility of evaluation rests with the OT. The OTA, though not responsible for the complete evaluation, may be delegated responsibility for certain procedures and thus may contribute to an evaluation under an OT’s supervision. The OTA communicates the results of all evaluation procedures to the OT. As with the screening process, service competency for tasks performed by an OTA needs to be established. The overall evaluation, or the process of compiling all of the information to form a composite picture of the client, is the responsibility of an OT.


The evaluation requires that the OT gather accurate and useful information to identify the needs and problems of the client to plan intervention. The techniques used during the evaluation process can be classified into three basic procedures: (1) interview, (2) skilled observation, and (3) formal evaluation procedures.



Interview


The interview is the primary mechanism for gathering information for the occupational profile. The interview is a planned and organized way to collect pertinent information. The focus of occupational therapy is occupations, which include the activities in which a person engages throughout the day. Therefore, the practitioner gathers information related to the individual’s occupations. The practitioner asks questions regarding the client’s function in daily activities before the onset of the problem that resulted in the referral. The interview is also used as a means of developing trust and rapport with the client.


In some instances, the client is asked to fill out a checklist or questionnaire before the interview. For example, the interest checklist (Figure 12-3) developed by Matsutsuyu8 has served as a model for others. Interest checklists enable clients to report on hobbies and interests. The activity configuration also provides information on how a client spends the day. The client compiles a list of all the different activities in which he or she participates and classifies activities according to the area of performance (e.g., activities of daily living, instrumental activities of daily living, education, work, play, leisure, and social participation). The client rates whether the activity is one he or she has to do or wants to do and how adequately the activity is performed. The practitioner uses the data to determine how the person spends his or her day and in what types of activities he or she is involved.


Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Occupational Therapy Process: Evaluation, Intervention, and Outcomes
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