Week 11

Question 1

Interpretation

Answer 1

-extraction of meaning from data collection (qualitative or quantitative)
-required for using inductive and deductive reasoning to inform service delivery decisions
-put meaning to our numbers
-fundamental to evidence-based intervention planning
-fundamental in the transition from evaluation to intervention

Question 2

We must be able to…

Answer 2

-apply a theoretical framework
-account for test bias
-synthesize multiple data points
-defend results

Question 3

True or False: Interpretation must occur with the context of the client

Answer 3

True

Question 4

Results of standardized assessments are useful in…

Answer 4

documenting the presence and degree of deficits however, OTs must correctly interpret the results to assess how functional deficits interfere with the performance of daily skills and occupations

Question 5

Discrepancy Analysis

Answer 5

-step by step examination of a between-subtest and between quotient variance that involves consultation of a table of significance
-OTs should be suspicious when one section of a test is much higher than another, related subtest score, especially when such scores are averaged
-if wide differences is present explanation of should be considered
-taking an average of scores that vary widely is not to be interpreted as meaningfully “average”

Question 6

True of False: you should NEVER just see numbers on document/results

Answer 6

True: there should also be an explanation of numbers

Question 7

Interpreting Discrepancies

Answer 7

-when this occurs, consult manuals for guidance
-often reinterpretation occurs
-be a detective and use data to determine clients skill level and why they are struggling
-“tests dont diagnose; people do” basing decisions solely on a test results is ill advised- this is only one form of observation
-accurate interpretation combines data about the client, contextual factors, the testing environment and test outcomes

Question 8

Application of theory

Answer 8

-we must consistently link theory and practice
-evaluation and intervention must be ground in theory
-use theory to organized thoughts and begin the clinical reasoning process
-carefully consider the client, their reason for referral, and presenting problems
-an appropriate theoretical rationale guides the complete evaluation and intervention and supports identification of methods for measuring treatment outcomes

Question 9

Test Bias

Answer 9

-May be/include: cultural, lack of adherence to test specifications, distractions in the environment
-strive to control as much bias as possible
-when changes to assessment procedures or the environment is a barrier that impacts performance, you must include this in the evaluation report
-think P.I.E. –> Person, Item, Environment when considering all biases

Question 10

Synthesizing Multiple Data Points

Answer 10

-Refers to evaluating and putting data together in a meaningful way
-Provide a holistic and accurate picture of the client’s occupational performance
-Failure to do so can lead to misinterpretation of the data
-OTs are highly valued because of their ability to accurately synthesize evaluation data and develop a targeted and effective intervention plan
-Clinical observations must also be synthesized with an understanding of the individual test items so that a comprehensive picture can be effectively presented in the report
-Can impact eligibility for service if not completed correctly
-Ensure that you include all relevant information and that your report is defensible

Question 11

Documentation

Answer 11

-tells a story of clients experiences with the OT

Question 12

Documentation includes the…

Answer 12

-discovery of new ideas and connections between concepts
-creates new perspectives
-ultimately empowers thought

Question 13

Documentation tends to follow conventional narrative structure…

Answer 13

-client (main character)
-what problems the client needs to solve
-OT (narrator)
-observations or measures of the client
-intervention plan: how the clients problem will be solved
-if the OT has made a difference thats worthy of reimbursement- discharge summary

Question 14

Purpose

Answer 14

-primary purpose is communication
-evaluations and documentation occurs in all settings (needs to generate accurate and complete reports that clearly communicate process of therapeutic engagement)
-provides a legal record of services as a memory

Question 15

Types of Evaluation

Answer 15

-initial documentation
-progress documentation
-discharge documentation
-formative evaluations
-summative evaluations

Question 16

Evaluation Report

Answer 16

-provides a detailed portrait of the client as an occupational being (summarize and synthesize assessment findings, explains therapists clinical reasoning, lists goals and functional outcomes)
-begins the therapeutic intervention- sets the stage for selection of functional measures
-a plan for reassessment and discharge is initiated during the initial evaluation

Question 17

Progress notes

Answer 17

-usually after each session
-can vary by setting and is required by reimbursement systems

Question 18

Reassessment Report

Answer 18

-often includes standardized assessments
-generally done periodically during intervention through data collection, reflection and decision making

Question 19

Reevaluation

Answer 19

-standardized assessments and qualitative information gained through the collaborative relationship with client and their families (when appropriate)

Question 20

Discharge Summary

Answer 20

-completed once the client has reached the previously set goals
-requires:
- noting where the patient started with a short review of the evaluation data
- review of progress made
- discussion of the reassessment process that demonstrates progress
- includes data and a statement as to whether the client has completed therapy or is going to another facility, and whether therapy should be considered at the new placement

Question 21

Styles and Setting

Answer 21

-no one-size fits all when considering documentation
-narrative documentation
-template based documentation
-SOAP notes
-DAP notes
-Again, setting dependent so ensure you have an understanding of policies and procedures