Ethical Formal Cognitive Assessment PDF

Ethical Formal Cognitive Assessment Jennifer Krysa Registered Occupational Therapist (AB) Occupational Therapist Registered (USA) Designated Capacity Assessor (AB) Formal Cognitive Assessment  Administration, scoring and interpretation of a clinical scale, score or tool develope...

Ethical Formal Cognitive Assessment Jennifer Krysa Registered Occupational Therapist (AB) Occupational Therapist Registered (USA) Designated Capacity Assessor (AB) Formal Cognitive Assessment  Administration, scoring and interpretation of a clinical scale, score or tool developed to assess cognition  Typically standardized  Using a bottom-up approach Bottom Up or Top Down Bottom Up Top Down  Performance skills & Client factors  Client’s participation in meaningful activities  Often impairment focused  Why is there occupational  Emphasis on body’s structure & dysfunction function for ability to perform participate in occupations  Context of the occupation  Sample assessment: MoCA  Sample assessment: COPM   The administration and scoring parameters are defined and controlled Standardized  Often a script or written procedures Testing  Improves assessment reliability & validity  Can be a simple screen like the MoCA or a comprehensive test like the NOTCE Considerations  Why are you considering testing  Is testing appropriate  Client characteristics  Testing environment & timing  Clinician competency  Test characteristics  What are the consequences of the results Triggers for Testing  Doctor’s order  Client is worried  Concern expressed by family  Court order  Insurance/WCB request  Employer requirement (RTW) Doctor’s Order  What is the information the doctor is trying to get  Is formal testing the best way to ascertain that information  Is formal testing the only way  Is the referral within your scope of practice  Is the referral appropriate  Can you relate it back to occupational therapy  How will the doctor use the information you provide  Are they seeking a consultation to confirm a Dx Example – Inappropriate Referral OT to do MoCA for Donepezil  Purpose  Test Judging Appropriateness  Will the results of testing make a difference  Is the potential risk for harm outweighed by the potential benefits  Is it related to occupational therapy services  Are you going to do anything with the results Example – Appropriate Referral OT for cognitive ? Driving  Aligns with client goals/wishes  Public safety consideration  Can combine with wholistic assessment approach  Trouble shoot alternatives to driving  Psychosocial adaptation to driving cessation  Rehabilitation of impairments affecting driving Client or Family Concerns  Define the concerns  Explicitly  Parameters (context)  Consequences  Speak openly with client & family  Collateral is important  May be more forthcoming in a separate conversation  Receive info, don’t give it Client Considerations  Educational profile  Primary language  Sensory abilities or limitations  Handedness  Previous testing: results, experience  Current health, Dx, social asspects Testing Environment & Timing  Private  Ambient noise & lighting  Novel vs familiar  Allows for time to debrief Competence: Qualification Levels  Level A: no special qualifications  Level B:  Masters in psychology, education, SLP, OT, SW, counselling with formal training in ethical administration, scoring & administration of clinical assessments  Certification by CAOT, AOTA, SAC, ASHA, etc  A degree or license to practice in the healthcare or allied health healthcare field  Formal supervised mental health, SLP, OT, SW, counseling, or educational training specific to assessing children or infant development and formal training in ethical administration, scoring and interpretation of clinical assessments  Level C: requires a high level of expertise in test interpretation  Doctorate degree in Psychology  Doctorate degree in Education with formal training on admin, scoring & interpretation  Licensure or certification to practice in your province in a field related to the test https://www.pearsonclinical.ca/en/ordering/how-to-order/qualifications/qualifications-policy.html Competence: Training  Formal training in administration, scoring, and interpretation of CSSTs  Specific training in tool to be used  E.g. MoCA certification course, read test manual, observation of administration, practice administering with feedback  Accuracy of scoring  Interpretation of results  Maintenance of competence  Updates to tool, use of tool  Advanced competency to train students in tool use Competence  Maintain the fidelity the tool to protect validity  A single measure does not describe cognitive status  integrate with other assessments & findings  In interpretation  understand the conceptual meaning of scores and the typical range  clinical implication of the results  Reporting of results to client and others  Explain recommendations to client & others  Meet standards of practice for ACOT or SCOT and COTC Competence – Cont’d  Practice with cultural competency  Awareness of bias  own  client’s  stakeholders’  system  Respect individual differences  Guard against potential misuse of results Selecting a CSST  What does it measure  Population designed for  Population validated for  Client acceptance  Psychometric properties  Cost Knowledge of Psychometric Properties  Descriptive statistics are the foundational knowledge for test construction & interpretation  Thorough working knowledge of psychometric properties of tools you use  E.g. Validity, reliability, central tendency (mean, median & mode), standard deviations & variance, correlations & indices of association (e.g. chi square), degree of convergence & divergence, frequency distributions  Test theory including item difficulty & item discrimination  Scaling scores & transformations  Meaning of tests scores Outcomes of Testing  Was testing standardized  Complete normative comparisons  Understand differences between individuals, groups & cohorts  Translate the results in a meaningful way to client or others  Acknowledge limitations Outcomes of Testing  Potential for negative impact on  Client  Employee  General public  Other professionals  Ethical and perhaps legal obligations  Tests have appropriate & inappropriate uses depending on purpose and setting  Assessments may reveal info that is detrimental to the client Final Considerations  Tests developed within regional or cultural context  Variety of settings & variety of purposes  Develop contextual knowledge in setting where you do testing; can’t be expert in everything  Pediatrics  School  Geriatrics  Neuro   Consent  Educational profile Try It - MoCA  Administration  Scoring  Interpretation with debrief