Occupational Therapy Assessments with Clients

Assessments are a crucial component of the occupational therapy process.

An Overview of Assessments

Occupational therapists (OTs) help enable clients to participate in meaningful activities. Assessments help determine clients' needs, whether they require direct or indirect services or referral to other medical health professionals. Assessments examine behavioural, cognitive, affective, psychomotor, and environmental domains to determine a client's strengths and limitations related to occupational performance issues. Many assessment methods or tools are available, including interviews, observations, standardized and non-standardized assessments, and OTs often use various methods when working with a client.

What are Interviews?

Interviews are often the first assessment method OTs utilize. Interviews help build client rapport and gather information about a client to determine how their issues affect participation in occupations. During the interview, an OT may learn how a client perceives themself in various roles or settings. It also helps set the stage for future interactions and is crucial for developing the client-therapist relationship.

What are Observations?

Observations help to gather additional information about a client's occupational performance. More specifically, observations can be used to identify if a client is processing information necessary to perform a particular activity in the context of their environment. Observation techniques are divided into two categories: naturalistic and structured observation.

Naturalistic Observation

Naturalistic observation is a method that involves observing clients in their natural environment without intervention. The goal is to look at behaviour in a natural setting without intervention. Observation of a child interacting with their friends on a playground without interference is an example of naturalistic observation.

Structured Observation

Structured observations occur primarily in structured environments, like kitchens, where Occupational Therapists have control of contextual factors and can complete assessments in a standardized format.

Naturalistic observation of two children playing in the sand of a playground at school.

What are Standardized Assessments?

Standardized assessments are invaluable clinical tools because test questions and administration methods, scoring, and interpretations are consistent. Consistency allows for a trustworthy comparison of a child's scores from one assessment time to the next. Deviation from standardized procedures can negatively impact any child's test performance conclusions.

Results of the study indicated that there was a significant impact on determining the treatment plan for clients followed standardized assessments. Occupational therapists who select the use of nonstandardized measures must be aware of the limitations related to accuracy and reliability and the potential impact on professional credibility and the welfare of service users. (Moorthy, S. D., 2017)

Occupational Therapy Assessments With Children and Adolescents

Let's look at some assessments used by occupational therapists when working with children and adolescents.

School Assessment of Motor and Process Skills

  • provides a measure of schoolwork task performance

  • assesses tasks such as cutting, writing, drawing

  • is an occupation-focused intervention

  • can efficiently and thoroughly assess children and youth between the ages of 3-15

Functional Independence Measure for Children (WeeFIM)

  • assesses functional ability involving self-care, cognition and mobility

  • measures need for assistance in six areas: self-care, mobility, sphincter control, communication, locomotion, and social participation

  • can be administered in 15 minutes and used with children between six months and seven years of age

Pediatric Activity Card Sort

  • offers an interactive way to develop an occupational profile with youth

  • consists of 75 photocards portraying activities and occupations for children

  • categories include personal care, productivity, hobbies and sports

  • can be used for children between 5 and 14 years of age

Canadian Occupational Performance Measure (COPM)

  • is an outcome measure created for occupational therapists to assess client outcomes in self-care, productivity, and leisure

  • helps occupational therapists and clients develop occupational performance goals based on client perceptions of problem areas

  • can be used with children as young as four years of age

"The Canadian Occupational Performance Measure is an evidence-based outcome measure designed to capture a client's self-perception of performance in everyday living over time. Originally published in 1991, it is used in over 40 countries and has been translated into more than 35 languages." (Canadian Occupational Performance Measure)

Occupational Therapy Assessments with Adults

Let's look at some assessments used by occupational therapists when working with adults.

Functional Independence Measure (FIM)

  • is an 18-item tool to explore a person's physical, psychological and social function

  • examines six areas such as self-care, sphincter control, transfers, locomotion, communication, and social cognition

  • is a reliable and valid tool to help identify problem areas and set goals

Assessment of Motor and Process Skills (AMPS)

  • is an observation assessment that evaluates motor and process skills

  • examines a person's ability to perform instrumental or activities of daily living

  • consists of 16 motor and 20 process items

  • there are 85 tasks to select from and include more manageable tasks like brushing or combing hair and demanding tasks like cleanin