Podcast
Questions and Answers
What is essential for maintaining competence when using assessment tools?
What is essential for maintaining competence when using assessment tools?
Which of the following best describes the importance of cultural competency in assessment practices?
Which of the following best describes the importance of cultural competency in assessment practices?
Which criterion is NOT important when selecting a Client-Specific Standardized Test (CSST)?
Which criterion is NOT important when selecting a Client-Specific Standardized Test (CSST)?
What should be considered when interpreting scores from cognitive assessments?
What should be considered when interpreting scores from cognitive assessments?
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Which of the following is a key component of the psychometric properties of assessment tools?
Which of the following is a key component of the psychometric properties of assessment tools?
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What is crucial for addressing client or family concerns effectively?
What is crucial for addressing client or family concerns effectively?
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What is a recommended consideration when assessing a client's educational profile?
What is a recommended consideration when assessing a client's educational profile?
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Which level of qualification requires no special qualifications?
Which level of qualification requires no special qualifications?
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What is a critical consideration when translating test results to clients?
What is a critical consideration when translating test results to clients?
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What is essential for creating an appropriate testing environment?
What is essential for creating an appropriate testing environment?
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Which of the following represents an ethical obligation related to testing outcomes?
Which of the following represents an ethical obligation related to testing outcomes?
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Which of the following qualifies as a Level B requirement?
Which of the following qualifies as a Level B requirement?
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Why is it important to consider the regional or cultural context of tests?
Why is it important to consider the regional or cultural context of tests?
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What should be avoided during conversations with clients and families?
What should be avoided during conversations with clients and families?
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What is a potential outcome of assessments revealing sensitive information?
What is a potential outcome of assessments revealing sensitive information?
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What aspect of item difficulty and discrimination is most relevant to test theory?
What aspect of item difficulty and discrimination is most relevant to test theory?
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What is one aspect that should be considered in psychosocial adaptation to driving cessation?
What is one aspect that should be considered in psychosocial adaptation to driving cessation?
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What is the primary factor to consider regarding a client's sensory abilities?
What is the primary factor to consider regarding a client's sensory abilities?
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What is the primary focus of a bottom-up approach in cognitive assessment?
What is the primary focus of a bottom-up approach in cognitive assessment?
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Which of the following assessments is an example of a bottom-up approach?
Which of the following assessments is an example of a bottom-up approach?
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What is one of the consequences to consider when deciding on testing?
What is one of the consequences to consider when deciding on testing?
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Which of the following is a potential trigger for initiating cognitive testing?
Which of the following is a potential trigger for initiating cognitive testing?
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What is an important consideration regarding a doctor's referral for cognitive testing?
What is an important consideration regarding a doctor's referral for cognitive testing?
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Which statement best describes standardized testing in cognitive assessment?
Which statement best describes standardized testing in cognitive assessment?
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Which of the following best identifies an inappropriate referral scenario?
Which of the following best identifies an inappropriate referral scenario?
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What is a key characteristic of a comprehensive test like the NOTCE?
What is a key characteristic of a comprehensive test like the NOTCE?
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Study Notes
Ethical Formal Cognitive Assessment
- Jennifer Krysa, Registered Occupational Therapist (AB), Occupational Therapist Registered (USA), Designated Capacity Assessor (AB) presented on Ethical Formal Cognitive Assessment.
Formal Cognitive Assessment
- Administration, scoring, and interpretation of a clinical scale, score, or tool developed to assess cognition.
- Typically standardized.
- Uses a bottom-up approach.
Bottom Up or Top Down
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Bottom Up:
- Focuses on performance skills and client factors, often impairment-focused.
- Emphasizes body structure and function for participation in occupations.
- Sample assessment: MoCA.
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Top Down:
- Focuses on client's participation in meaningful activities.
- Examines occupational dysfunction and the context of the occupation.
- Sample assessment: COPM.
Standardized Testing
- Administration and scoring parameters are defined and controlled.
- Often uses scripts or written procedures.
- Improves assessment reliability and validity.
- Can include simple screens (e.g., MoCA) or comprehensive tests (e.g., NOTCE).
Considerations for Testing
- Reasons for considering testing.
- Is testing appropriate?
- Client characteristics.
- Testing environment and timing.
- Clinician competency.
- Test characteristics.
- Consequences of the results.
Triggers for Testing
- Doctor's order.
- Client concerns.
- Family concerns.
- Court order.
- Insurance/WCB request.
- Employer requirements.
Doctor's Order
- Understanding the doctor's goals for testing.
- Determining if formal testing is the best, or only, way to obtain the desired information.
- Assessing if the referral is within the scope of practice.
- Determining if the referral is appropriate.
- Relating information back to Occupational Therapy.
- Understanding how the doctor will use the information.
- Identifying if a consultation request is for a diagnostic confirmation.
Example - Inappropriate Referral
- OT performing a MoCA assessment for a patient taking Donepezil (medication for cognitive impairment).
Judging Appropriateness
- Does the testing make a difference?
- Is the potential risk for harm outweighed by the potential benefits?
- Is the testing related to occupational therapy services and will action be taken, if needed?
Example - Appropriate Referral
- OT cognitive assessment for driving.
- Aligns with client goals, wishes, and public safety considerations.
- Can combine with wholistic assessment approach.
- Trouble-shoot alternatives to driving.
- Psychosocial adaptation to driving cessation.
- Rehabilitation of driving-related impairments.
Client or Family Concerns
- Define concerns explicitly.
- Consider parameters and the context of concerns.
- Understand the consequences.
- Communicate openly with the client and family.
- Recognize importance of collateral information.
- A separate conversation may yield crucial information from the patient or family.
Client Considerations
- Educational profile.
- Primary language.
- Sensory abilities and limitations.
- Handedness.
- Previous tests, results, and experience.
- Current health, diagnoses, and social aspects.
Testing Environment & Timing
- Private environment.
- Control ambient noise and lighting.
- Consider familiar or novel settings.
- Allow for time to debrief.
Competence: Qualification Levels
- Level A: no special qualifications required.
- Level B: Masters in relevant fields, formal training in administration, scoring, ethical considerations
- Level C: Doctorate degrees in relevant fields, specific, formal training in specialized assessments.
Competence: Training
- Formal training in administration, scoring, and interpretation of standardized cognitive screening tools.
- Specific training for a specific assessment tool.
- Practice administering with feedback.
- Accuracy and interpretation of scoring.
- Maintenance and updates of competence.
- Advanced competency needed for training others.
Competence - Continued
- Maintaining tool fidelity and validity.
- Recognizing a single measure does not describe cognitive status, integrating with other assessment findings.
- Understanding the meaning of scores and typical range.
- Reporting of results to client and others.
- Explaining recommendations to client and others, meeting standards of practice.
- Cultural competency awareness and consideration of potential bias.
- Respecting individual differences and avoiding potential misuse of results.
Selecting a CSST
- Understanding the measure.
- Consideration of populations designed for and validated for the test.
- Assessing client acceptance and psychometric properties.
- Cost.
Knowledge of Psychometric Properties
- Knowing relevant descriptive statistics is essential for test development and interpretation.
- Understanding psychometric properties of testing tools, such as reliability and validity.
Outcomes of Testing
-
Was the testing standardized correctly?
-
Ensuring client differences (individuals and cohorts) can be appropriately identified.
-
Expressing results in a meaningful way for the client.
-
Acknowledging limitations.
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Potential negative impacts on the client, employees, and the general public.
-
Importance of understanding appropriate and inappropriate testing purposes and settings.
-
Realizing that assessments can sometimes reveal potentially detrimental information to the client.
Final Considerations
- Tests tailored to cultural and regional contexts.
- Consideration of the variety of testing settings and purposes.
- Developing expertise by developing contextual knowledge in various settings. (e.g., school, pediatrics, neurology, geriatrics)
Try It - MoCA
- Consent.
- Gathering educational profile of the client.
- Administration of the assessment.
- Scoring the assessment.
- Interpretation and debriefing with client.
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Description
This quiz explores the principles of Ethical Formal Cognitive Assessment as presented by Jennifer Krysa. It covers both bottom-up and top-down approaches to cognitive evaluation, highlighting the importance of standardized testing and specific assessments like MoCA and COPM. Test your understanding of these concepts and their application in occupational therapy.
