Outcome_Measures_Ot

Using Outcome Measures in Occupational Therapy (Within a group setting) The purposes of using outcome measures are two - fold: 1) To support evidence-based OT practice “Professional credibility requires the demonstration of efficient and effective interventions. The ability to determine a patient’s functional status through a standardised assessment is essential for effective treatment planning and outcome measurement” (Welch & Forster 2003) 2) To convince powerful others of the value of OT “Greater accountability…including improved quality of care, increased transparency and monitoring of care provided, value for money and improvements in the information available to health care commissioners and the public about the nature and consequences of health care interventions” (Fonaghy et al, 2004, p.13) (Mental Health Outcome Measurement Initiative) Drivers for the use of outcome measures * Government (legislation) * The Department of Health (policy) * Commissioners of services (funding and priorities) * Managers (service budgets and targets) * Practitioners (resources, effectiveness) * Clients/patients (treatment and care) Which outcome measures should we use' * Those which tell us (and others) how effective our intervention is. * What are our intended outcomes' * What about multiple outcomes' (Eakin P, 2008) A standardized assessment has a uniform procedure to administer and score the assessment (Anastasi, 1988; de Clive-Lowe, 1996), and an approach to determine how ‘well’, or how ‘badly’ the client has performed. This may be either through norm referencing or criterion referencing (de Clive-Lowe, 1996). Assessments that are standardized also have information concerning their reliability and validity, which is essential for the correct interpretation of the results (de Clive-Lowe, 1996). They are numerous outcome measures which could be applied to our client group. However for the purpose of our group therapy, we have narrowed it down to four. The standardised outcome measures to be used on our client group and have been authored by an Occupational therapist are one or a combination of the following: The Life Satisfaction Questionaire Fugel-Meyer, Branholm & Fugel-Meyer (1991) ICIDH-2 Level/s: Participation. Purpose: To measure client satisfaction with life as a whole (happiness). Target population: General adult population. Number of items: Nine items examining client’s satisfaction with family life and friendships, financial situation, vocational situation, leisure situation and self-care. Scoring system: Six point scale ranging from 1 (very dissatisfying) to 6 (very satisfying). Provides a client profile that can be monitored and revaluated over time. Authors include an OT: Yes Goal attainment questionaire (GAS) Ottenbacher & Cusick (1990) ICIDH-2 Level/s: Can be at any level of the ICIDH-2. Purpose: An approach to evaluating program effectiveness. Investigates whether individual patient goals developed at admission are met by the time of discharge. Target population: All. Number of items: Any number of goals are set. Scoring system: Assign weights to each of the goals identified, achieved by consensus between client, therapist, family and others. Weighting reflects prioritizing or ranking. If four goals are identified then the most important is +4 and the least important is +1. Determine this at the goal planning stage not at the evaluation stage or it introduces systematic error or bias. A formula to determine outcome is detailed in the reference. Authors include an OT: Yes. The Rivermead Rehabilitation Centre Life Goals Questionaire. Davis et al. (1992) ICIDH-2 Level/s: Participation. Purpose: To measure the individual’s perception of the importance of life roles. Target population: Adults. Number of items: Nine items (question format) related to importance of residential and domestic arrangements, and ability to manage personal care, leisure, work, hobbies and interests, contacts with friends and neighbours, family life, religion and finances. Scoring system: A four-point scale; ‘0’ = no importance to ‘3’ = extreme importance. A client profile is yielded along with qualitative data relating to individual items. Authors include an OT: Yes. (Unsworth C, 2000) The Addiction Severity Index (ASI) is a multidimensional interview used to measure the substance use, health, and social problems of those with alcohol and other drug problems, both at admission to treatment and subsequently at follow-up contacts (McLellan,et al, 2006). In our case, we would ask participants questions such as experienced serious depression, hopelessness, loss of interest, difficulty with daily functioning or have you been in a controlled environment in the past 60 days (jail, medical centre)' How troubled or bothered have you been by these alcohol/drug problems in the past 7 days' The Life Satisfaction Questionaire – This area of assessment that will be used in this outcome measurement will be life participation. The two aspects of life satisfaction we will address will be financial, vocational and self-care management. Although this is a short and simple questionnaire it has been shown to be a reliable assessment of a person's satisfaction with life and an indicator for addressing areas of dissatisfaction (excelatlife, 2013). Goal attainment questionaire (GAS) - This clinical outcome assessment would be used to evaluate individuals progress towards (Schlosser. R, 2003). So in our case, our intervention period will be 8 sessions. Our goal would be to develop team working skills and social interaction through problem solving. Our concern criteria would be group member’s inability to participate in sessions. The Rivermead Rehabilitation Centre Life Goals Questionaire – Will be used to ask individual group members how satisfied with their life and various areas of their lives. As the meetings progress, they should be improvements to their responses as they gain confidence, improve on team building skills and are prepared for employment. Which outcomes should we measure' Exactly the same intervention can be shown to be either effective or ineffective depending upon which outcome you choose to measure. The outcome is related to the intervention so the outcome measure must be related to the objectives of the intervention. ‘Cure’ versus ‘adaptation’ (Eakin P, 2008) We would be measuring to see if our developmental team working skills and social interaction group therapy skill sessions can prepare them for profitable employment and a fruitful all round life. Several outcome measures can be utilised depending on the person in question if we decide to individualise outcome measures rather than generalising. A combination of outcome measures can be deployed in severe circumstances as no outcome measure is perfect and all can be criticised (Eakin P, 2008). All the outcome measures are related and can be applied to our aims and objectives. As the measuring tools are flexible, they can accommodate adults with different diagnosis. This is useful should group members require further treatment and/or more assessment from the health professionals’ team.