Assessment is an essential part of the occupational therapy process. It facilitates the therapist’s choice of intervention with a client, provides the setting of a baseline and allows measurement of progress. When used as an outcome measure it permits evaluation of the effectiveness of an intervention. Indeed, whilst Hagedorn (2000) observes, an experienced therapist may find formal assessment simply verifies information gained from informal conversation, observation and good clinical knowledge, she also acknowledges that “assessment remains the foundation of the occupational therapy process” (p.141). There are a wide range of assessment tools and outcome measures available. When choosing one, a therapist has to use their clinical reasoning to consider the necessity and purpose of the assessment. It is imperative that it is carried out at the correct time for the client, whilst considering the environment (both physical and social) in which it is performed and the service within which the client is engaged (Hagedorn, 2000). Recently, occupational therapy has encompassed a client-centred approach, resulting in the development of a number of client-centred assessments, such as the Canadian Occupational Performance Measure (COPM) (Law et al., 2005). This essay will critically explore the usefulness of the COPM as an outcome measure, when used with clients with severe and enduring mental health problems and in relation to the case study regarding John, a client with a diagnosis of paranoid schizophrenia. The COPM is an individualised outcome measure which focuses on the three performance areas of self-care, productivity and leisure. It allows the client through a simple scoring system to identify problem areas and to be involved in prioritising with the therapist the five most important areas on which they would like to work. Waters (1995) concludes that the COPM encourages client and therapist to become equal partners in the treatment process. However, for a client such as John, completing a self report may be problematic, as his lack of motivation and low self esteem could affect his scoring. Schofield (2006) explains it is particularly difficult for clients experiencing delusions during periods of psychosis; because of their lack of insight, to complete this type of self report and concludes that in such situations, the assessment would be better conducted as an interview. The COPM is appropriate to use in a variety of practice situations (both physical and mental health), in clinical and community settings, across a wide range of ages and within different cultural environments. It is used in more than thirty-five countries and has been translated into over twenty languages (Pollock et al., 2006, cited in Sumsion, 2006). Research has shown that most therapists who use COPM find with very little training, it is easy to administer, with it taking approximately twenty to forty minutes to complete (McColl, 2000). Although, this might vary according to the client’s cooperation and cognitive ability, with age, personality and education all affecting their understanding. A client with paranoid schizophrenia such as John, may well experience cognitive impairment, with the possibility that memory, attention, executive function and language are all affected (Chapleau, 2012, cited in Atkinson and Dirette, 2012). Therefore, it would be necessary for the therapist to explain the aim and content of the COPM, along with the difference between performance and satisfaction (Chen et al., 2002). The COPM can be utilised as an initial assessment, helping to identify problem areas of occupational performance and assisting to set appropriate goals in therapy. When used in reassessment as an outcome measure, the COPM can over time establish the effect of an intervention on occupational performance (Pollock et al., 2006, cited in Sumsion, 2006). After using COPM, therapists have reported an increased awareness of their client’s needs,...
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