INTRODUCTION
Just living is an occupation people everywhere participate in daily activities that are the occupations of life. Growing, playing, learning, exercising, caring for the family and working make lives full and enjoyable but when unexpected things happen to change that level of participation, what can be done? Occupational therapy is there to restore the joys of living without pain or suffering. Occupational therapists are increasingly taking on supervisory roles due to rising health care costs that are beginning to encourage occupational therapy assistants and aides to take more hands-on responsibility, the cost of therapy should be more manageable for those needing service. Occupational therapy provides the bridge that allows the health client to cross the gap between decreased ability and living a full life and represents the best of applied science in health care practice and its needed assessment tools. The goal of occupational therapy (OT) assessment tools as well as services is to provide educationally related services that will assist in benefiting from therapy which is designed to enhance the development of skills necessary for academic learning and vocational training within the child’s current and future educational settings. Several highly trained professionals work closely with teachers, parents and other service providers to enable students with exceptional needs to realize their potential both in and outside of the classroom.
DISCUSSIONS
The paper will critically evaluate a certain occupational therapy assessment tool – the Canadian Occupational Performance Measure (COPM) being used to facilitate useful process such as children affected by autism as it can involve this intervention program and goals related to the domains of communication, behavior and social interaction. The COPM was found to be a useful tool for enabling parents to identify goals for their children, when used and understood from a strong client and family-centered philosophical perspective. Pre- and post-intervention parent ratings of goal performance and satisfaction are presented to demonstrate the use of the COPM as an outcome measure. Implications for practitioners in early childhood and special education settings and areas for further research are also discussed ( 1998). Fundamental to a family-centered approach is the importance of matching early intervention support with the unique characteristics of each child and family (1990). As stated by (1994), ‘the greatest impact on child, parent, and family functioning is most likely to occur when interventions are based upon the needs, aspirations, and desires a family considers important’ .
The Canadian Occupational Performance Measure (COPM) (1998) is used to identify priorities for therapy and to document the client’s self-rating of occupational performance and satisfaction. It is embedded in an understanding of client- and family-centered practice (2002; 1995) and the Canadian Model of Occupational Performance, which highlights the importance of the transaction between the client, occupation, and the environment (1990). (1998) and (1993) reported good utility of the COPM across a wide range of occupational performance dysfunctions such as orthopaedics, pain, traumatic brain injury). The scoring of the COPM has been found to be responsive to changes in perceived occupational performance over time (1999; 1994; 1999). When used as an outcome measure, pre- and post-performance and satisfaction ratings and change scores can be determined. A change score of two to three points is considered indicative of clinically significant change (1998). To date, there has been some use of the COPM with children (aged over seven years) (2001; 2001). However, limited use with families has been reported in the literature. A modified version of the COPM (2003) was used with parents to facilitate the identification of priorities and goals for intervention.
Certain study aimed to:
Ø Consider the utility of the Modified COPM (M-COPM) in assisting parents to identify and prioritize their goals
Ø Demonstrate the utility of the M-COPM as a self-report outcome measure, pre- and post-intervention.
Modified Canadian Occupational Performance Measure (M-COPM)
Two modifications were made to the COPM to create the M-COPM. First, when working with children, it was important to reframe occupations as the things children need to do, want co do and are expected to do in their daily lives. For young children with compromised language and communication abilities, parents are in the best position to identify their child’s occupational performance issues, prioritize these and in collaboration with professionals, identify realistic intervention goals. The modified version of the Canadian Occupational Performance Measure (M-COPM) (2003) which can be obtained from the corresponding author–was administered during the first visit following the two-day workshop. This visit was scheduled, where possible, at a time convenient to both parents. In the majority of cases, both parents were involved in the administration of the M-COPM. The second, post-intervention, administration occurred within two weeks of the completion of the home visits.
Administration of the M-COPM:
Ø Parents were asked to identify occupations that were difficult for their son/daughter in regard to self-care, play and relaxation
Ø Parents then rated the difficulties using a 10-point scale to identify priorities for intervention
Ø Parents then rated current performance and satisfaction of their son/daughter on three to five of the priority areas using a 10-point scale and rated performance and satisfaction post-intervention.
In addition to describing their goals, the M-COPM enabled parents to prioritize these goals, using the rating scale format for importance. Second, the M-COPM was clinically useful, enabling facilitators to help parents reflect upon their children’s occupations and consider the difficulties they experience. The modifications that enabled this reflection appear to have been successful in assisting this process. Specifically, the structure of the M-COPM interview helped parents consider communication, behavior, play, self-care, routines and transitions, as well as family socialization. Important prerequisites in utilizing the M-COPM include the establishment of rapport with parents and ensuring that the interviewer embodies the underpinning philosophies of family-centered practice and have developed excellent listening skills.
Professionals need to be sensitive to language use and ensure that other practices involved in goal setting are parent friendly such as keeping goal-setting meetings small in size by minimizing the number of professionals’ present and holding meetings at convenient times and in a family-friendly location (1994;2001). The M-COPM provides a clear yet flexible structure for both parental goal identification and prioritization. Measurement tools that provide information regarding how the child performs in the educational setting have become the focus of attention in recent years in support of the client-centered approach to measuring performance (2001). Developmental and diagnostic assessments may be beneficial in providing more in-depth information for a particular deficit area, but these assessments do not provide information about performance in context. Recommendations regarding interpretation of test results from the Developmental Test of Visual Perception-Second Edition (1993) indicate that diagnosis regarding a child’s visual perceptual skills cannot be made by test data alone. Thus, these test authors, along with others (1998), have stressed the need to validate findings with objective measures of the student’s performance of daily life activities (1998) and provides information about the barriers that may be interfering with the child’s performance in the educational setting. The unique tool affords the therapist working with adolescents in a school-based practice the opportunity to receive first-hand information from the adolescent regarding performance issues in daily life.
Thus, examinations of the student’s performance in context, such as assessment techniques, yield valuable information in the evaluation process when the OT is required to provide input regarding the need for assistive technology. Using the information from relevant assessment tools facilitates the development of outcome measures that enable children to be active participants in the school day. It is believed that occupational therapists are taking on supervisory roles. Due to rising health care costs, to encourage occupational therapy assistants and aides to take more hands-on responsibility under the guidance of a therapist, the cost of therapy should be more manageable for those needing service. The emergence of more opportunities where occupational therapy is needed guarantees the future of the profession and creates a better job process. The focus is to assist the person in achieving maximum independence through individualized adaptation to health care challenges and that practitioners in the field must have these strengths: high level critical thinking, the ability to creatively adopt tools, make observation of daily life skills and the ability to recognize the unique needs of work therapy as it provides the bridge that allows the health client to cross the gap between decreased ability and living a full life and represents the best of applied science in health care.
Implications
Parent-identified goals in the domains of communication, behavior, play and social interaction frequently pervade all environmental contexts in which the child with ASD functions. Knowledge of these goals can assist early childhood educators in both special education and inclusive settings to discuss with parents how they envisage these goals being supported with specific interventions ( 1998), This enables a consistent approach across home, early childhood and community settings. Awareness of the parents’ goals for a child in a child care setting can also assist early childhood professionals to make the most of their time in this environment, which is frequently highly sought after and valued by parents (1994) and offering frequent requesting opportunities. The involvement of family and professionals in all of the contexts in which the child engages is recognised as one of the key components of effective programs for young children with autism ( 1997).
The COPM is a useful method for identifying parents’ priorities in both inclusive and special educational settings. It also provides a structure for discussing parents’ expectations of what they wish their child to achieve in inclusive settings. This can assist educators to clarify expectations of how they will support the child in various settings to achieve priority goals, as well as to determine realistic expectations of each educational setting. The COPM could also be used for such discussions in transdisciplinary team settings, where one team member as primary case manager may undertake the COPM with parents to assist with goal identification, and report back to the team who can then identify the necessary. It would seem that the tool provides a useful means for identifying and prioritizing goals in home-based programs, early special education and regular early childhood settings. In addition, it provides a means of documenting outcome of intervention by way of addressing parental perception of change, in both the child’s performance in relation to specific goals as well as their satisfaction with that performance as used within a framework of family centered practice, the COPM appears to have potential in assisting parents to identify and prioritize early intervention goals for their children with Autism Disorders.
A patient may express more than one desired outcome of treatment. In such cases, we contend it is important for the therapist to have the patient rank which outcomes are most important. The Canadian Occupational Performance Measure (COPM) was designed for use by occupational therapists, but it can be useful for physical therapists to help patients to identify and rank goals of intervention. The COPM provides a standardized format for assisting patients to identify goals that are most important to them in the areas of self-care, productivity (work, household management, play/school), and leisure. Following intervention, the tool is again used to rate patients’ perceived change in their performance and change in satisfaction with performance. Assessment that describes studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions randomly selected from the PEDro database generated a set of individual and consensus ratings of individual and consensus ratings repeated the process.
In such a situation, both sides of the base rate problem debate would agree that the estimates of reliability provided by the kappa statistic are misleading. In both studies, we randomly selected a sample of trials from the population of trials on the PEDro database. Not surprisingly, the base rates in the 2 samples were very similar to the base rate for the population was justified and did not produce misleading inferences about reliability of ratings for items on the PEDro scale. An understanding of the error associated with the PEDro scale can be used to guide the conduct of a systematic review that uses a minimum PEDro score as an inclusion criterion. In our studies, we noted that repeated PEDro consensus scores were within one point on 85% of occasions and within 2 points on 99% of occasions. We believe it is sensible to conduct a sensitivity analysis to see how the conclusions of a systematic review are affected by varying the PEDro cutoff. For example, in Maher’s review of workplace interventions to prevent low back pain, reducing the PEDro cutoff from the original strict PEDro cutoff of 6 to a less strict cutoff of 5 (or even 4) did not change the conclusion that there was strong evidence that braces are ineffective in preventing low back pain. Readers should have more confidence in the conclusion of a review that is unaffected by changing the quality cutoff.
CONCLUSION
The precision of the PEDro scale also should be considered by users of the PEDro database. None of the scale items had perfect reliability for the consensus ratings displayed on the PEDro database; users need to understand that the PEDro scores contain some error. Readers who use the total score to distinguish between low- and high-quality RCTs need to recall that the standard error of the measurement for total scores is 0.70 units and consider the standard error of the measurement, a difference of 1 unit in the PEDro scores provides confidence that truly had different PEDro scores (1998;1996; 2004). M-COPM was clinically useful, enabling facilitators to help parents reflect upon their children’s occupations and consider the difficulties they experience. The modifications that enabled this reflection appear to have been successful in assisting this process. Specifically, the structure of the M-COPM interview helped parents consider communication, behavior, play, self-care, routines and transitions, as well as family socialization. Important prerequisites in utilizing the M-COPM include the establishment of rapport with parents prior to the underpinning philosophies of family-centered practice and have developed listening skills and expertise in perspective, aiming all the time to understand the parents’ perspectives (1994;2001). The M-COPM provides a clear yet flexible structure for both parental goal identification and prioritization.
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