Ethical Formal Cognitive Assessment

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

• Bottom Up:
  • Focuses on performance skills and client factors, often impairment-focused.
  • Emphasizes body structure and function for participation in occupations.
  • Sample assessment: MoCA.
• 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.

• 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.

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.