To view the assessment tool and information on measures, click the heading above.
The occupational therapist’s task is to discover who the person (client) is, in terms of occupational identity (roles, interests, values, aspirations, occupational history) and his/her current level of ability. This includes identifying the person’s motivation and occupational performance.
Assessment identifies what the person has volition and motivated towards, the behaviors and skills that s/he has and is motivated towards developing, and the influence of the environment. This is identified for four occupational performance areas: personal management, work ability (ability to effectively carry out life roles, and includes identification of whether a person has the ability to work), social ability and constructive use of free time.
Assessment also identifies the phase of the level, indicating how far through the level the person has progressed - this is helpful for knowing how much input the therapist needs to provide in order to enable the person to participate in activity and occupation.
It is possible to be on a level and phase for one occupational performance area and on a different level and phase for another. The model helps occupational therapists through assessment, to understand these differences in performance and guides us in how to develop all occupational performance areas.
To effectively assess and provide intervention, requires knowledge and skills for undertaking a holistic, detailed analysis of the person in relation to the environment. It is necessary to receive training in order to understand the components of creative ability, how they relate to each other and manifest in the different levels of creative ability.
VdTMoCAF (UK) Position Statement no. 1 Assessment
This Position Statement has been written to provide guidance on best practice in relation to the use of the Creative Participation Assessment tool (CPA). Position Statement no. 1 Assessment
As for all occupational therapy, therapists should refer to notes, the family/carers and others involved in the person’s care for information on the person's occupational history, diagnosis, culture, social and occupational circumstances etc. In addition to this, the OT assesses by using the following assessment methods:
Observation is the key assessment method, because you are looking for motivation and skills and behaviours that indicate a level of creative ability. Observation takes place every time you see the person - literally. The therapist is observing to assess the components of creative ability evidenced in the person’s actions in relation to the occupational performance areas.
The model asks you to find information from the person about his/her occupational life and performance. An interview guide is not provided, but therapists should be able to identify questions that enable information gathering about a person's occupational identity and occupational performance, gain an occupational narrative and establish who the person is as an individual; how has s/he become who they are; what has been his/her occupational past, what is the present from his/her perspective, and what is his/her future image and likely circumstances?
As an occupational therapist, what do you usually ask your clients about their occupational lives? Perhaps questions such as: how do you spend your time? Do you work? What is your social life like – do you have one? Are you close to your family or have close friends? What are your interests – do you have any hobbies – how do you spend your spare time? What are the most important aspects of your day to day life? What do you feel you are good at / have problems with? – and so on. Ask questions about whether the client does domestic chores/tasks for role fulfilment independently and without prompting - consider how motivated they are to do tasks/activities; how egocentric is s/he? Does s/he spend time meeting his/her own needs only/most of the time? The levels of creative ability are along a continuum from egocentric to contribution, therefore it can be helpful to seek information on how much the client is motivated for meeting own needs or contributing to others/wider participation.
There is nothing in the model to suggest that usual questions about occupational performance, roles, routines are not valid – they must be. As occupational therapists, we are all concerned with the same, core issues. That is, a person’s occupational performance in the occupational performance areas of their lives. If you wish to conduct a comprehensive interview, you may find MOHO useful – it is a model that many therapists use alongside the VdTMoCA (see Hosier (2009) conference presentation in the Members’ area, or the Hosier et al. (2012) chapter on OT in Forensic Issues as an example).
Using the VdTMoCA, your thinking with regards to the questions you ask and the answers you receive will be influenced by the model’s theory - the answers will contribute to your understanding about the client’s level - the way that the person gives his/her answers and responds to/engages in the interview, will provide some indication of his/her level.
The person’s narrative can provide valuable information about him/her as a person. However, this will depend on how able the person is to provide a narrative – depends on his/her level of creative ability.
Some therapists start with an interview and follow this with one or more short activities in order to gain information via task assessments (Sherwood 2005). For example, using Rush Hour or a simple craft activity for assessing cognitive function, Task Concept, handling materials and tools etc. This assessment information is enough for experienced therapists to have a sense of the client's level and to suggest OT interventions that may be suitable as a starting point - as the client engages in those interventions, assessment is ongoing, providing greater depth and range of information.
There is no set sequence for using the assessment methods - therapists select and use the methods with best utility in their setting with a particular client, but using all of the assessment methods allows for a comprehensive assessment leading to the making of an initial assumption about the person's level and phase of creative ability to inform therapy (SHerwood 2005).
To interview or not to interview?
Clients that are on the level of Tone could not be interviewed as they cannot respond. Clients on the level of Self-differentiation can provide very limited information about themselves, and are most likely to be able to talk about their lives during ‘informal interviews’ or talking during activity. From Self-presentation upwards, it becomes increasingly possible for clients to engage in conversation and more formal interviews.
As therapists, you may talk informally about their day, what they like to do etc (informal ‘interview’), or you may be able to sit and have a lengthy discussion about a broad range of issues and for quite a long time (formal interview / gaining a person’s narrative about their lives and abilities). You judge how to handle an interview and whether it should be formal or informal ‘chat’.
What the model provides for you, is a means of making use of informal or casual conversations/interviews as well as the more planned, formal interviewing. How much a person can engage in a discussion and the quality of his interaction is an indicator of a level, as is how much effort you have to put in to make the conversation work/how much you have to adapt to the presentation of the person. This is a great aspect of the model: no experience or information is wasted. Everything about the person is made use of and very clearly assists with the assessment.
Social Evaluative Task and Task assessment
A social evaluative group is a group situation that presents opportunities for social interaction and awareness of others. OTs observe clients in social, group situations such as meal times, in lounge areas or within OT groups (as part of on-going assessment during intervention), to gain assessment information.
In terms of using a group specifically for assessment, many OTs perform a task assessment within a group setting and therefore use these two assessment methods at the same time.
The task assessment is considered a formal assessment that helps to identify the level. Whilst information from ward rounds, notes, interviews and observation leads to being able to ‘sense’ the level of creative ability, the task assessment helps to identify the level more clearly, or confirm that one’s assumptions were correct (or not).
The task assessment consists of facilitating the person’s participation in performing a task(s) (activities). It is important to see clients doing familiar and unfamiliar activities - at least one activity that the person would not normally do. This is to minimise the assessment findings being skewed by the person using habituated skills – for example, putting on shoes is a task undertaken everyday and can be done almost without thinking about it.
Furthermore, the use of unfamiliar tasks/activities enables the therapist to assess all of the components of creative ability. For example, unfamiliar tasks/activities have the potential to evoke anxiety and other emotions (e.g. frustration), providing an opportunity to assess ability to manage anxiety/emotional responses. Unfamiliar tasks/activities require effort, providing an opportunity to assess effort. Unfamiliar tasks/activities are more likely to require cognitive skills that familiar and mastered activities do not e.g. decision-making, problem-solving. Unfamiliar tasks/activities provide more of an opportunity to assess task concept than familiar activities - task concept is a core component of creative ability.