OSA Scoring Values. Aug 19, Dear ListServ,

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1 OSA Scoring Values Aug 19, 2014 Dear ListServ, We currently find the OSA an invaluable tool for assessment and as an outcome measure and it is routinely embedded in our practice. We are, though, struggling to understand the purpose for a total value score. Can anyone help explain its use? Having read the archive advice with regard to interpreting the competence key, can anyone guide us in how to interpret the value scores, please? We have found in a number of cases that this decreases after treatment, do we just examine each score individually to understand these changes, or is there a significance in a total score? Thank you for your help, Alison Alison Newport Practice Development Lead for Occupational Therapy Aug 20, 2014 Same here Alison, We use OSA with our veterans with PTSD and follow the manual to the letter, but we are not clear on this so clarification would be great. Karen Miles Lead Occupational Therapist Combat Stress Audley Court Model of Human Occupation Clearinghouse Archived ListServ Discussion 1

2 Aug 20, 2014 Alison and Audley, Although I cannot answer your question directly, I can tell you that I am working with Renee Taylor and Chia- Wei Fan, to explore the reliability of 18 ADL and IDAL items I added to the OSA. So far the results are looking promising. We will let you know when they are ready! Patricia J Scott PhD, OT, FAOTA Associate Professor, Occupational Therapy, Indiana University Aug 24, 2014 Hi Alison, Many thanks for sending such a stimulating question to the listserv, and thanks Patty for letting us know about ongoing work to improve the OSA this sounds very exciting. I am a big fan of the OSA and am really hoping that one of the OSA authors might contribute to this discussion as I think you raise an important issue, Alison. I regularly teach the OSA and encourage participants to use the OSA Competence Key to arrive at a single client measure out of 100, particularly when an individual has answered all the questions. However, from my own experience, I am unable to endorse the use of a single measure for the Values section. Values are relative, as indicated by the wording of the Values rating which is not worded:! not important, important, very important, extremely important but is instead worded as follows:! not so important, important, more important, most important. This means that an individual is unlikely to increase the number of items regarded as most important when repeating the OSA, but is more likely to review the value placed on the items relative to each other (I hope I am making sense here!) The values section is superb when it comes to helping individuals to prioritize the issues that they want to work on, but I am not convinced of the value of deriving a single measure for this section. Even the competence section has its limitations. The measure might decrease when repeated if the individual had reduced insight when first completing the assessment. In fact, a reduced score following intervention may actually indicate improved insight! This possibility can be discussed when reviewing an individual s progress, but if OSA measures are aggregated across a service to demonstrate the effectiveness of occupational therapy, then including such scores may be misleading. Model of Human Occupation Clearinghouse Archived ListServ Discussion 2

3 I also have issues with how the key form is used to arrive at a single measure if the individual has not answered all the questions, and look forward to any further correspondence on this subject. In particular, I d like to know more about the population that was assessed, leading to the OSA item hierarchy being produced. With very best wishes, Sue Parkinson Aug 27, 2014 Hello Alison and Karen, Thank you for submitting this interesting question to the MOHO listserv. It is one that I, too, struggle with at times. As you probably know, in MOHO, the three aspects of volition include interests, personal causation, and values (Kielhofner, 2008). As you know, the OSA competency scale was developed to capture a person s self- perceived sense of competency, or the sense of I can as Dr. Kielhofner used to say. And as you know, the OSA values scale captures a person s perception of what matters or what is important to a person. One could understand how a person would need to reprioritize what matters after a major medical event or new insights gained through OT treatment, for example. Taken together, the competency and values scores are designed to reflect core components of volition as well as the self- perception of performance capacity, from a systems perspective, which is what MOHO embraces. In general, the OSA was developed to measure, then, a more global construct of occupational participation, defined according to MOHO. In collaboration with colleagues, we published two articles applying the OSA. One that may be of interest to you is: Taylor, R.R., O Brien, J., Kielhofner, G., Lee, S.W., Katz, B., & Mears, C. (2010). The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people. British Journal of Occupational Therapy, 73 (11), In this article, we did not use a total OSA score, but instead chose to present and interpret the findings for the competency and values subscales separately. I hope this helps. Renée R. Taylor, Ph.D. Vice Provost for Faculty Affairs Professor of Occupational Therapy Director, Model of Human Occupation Clearinghouse University of Illinois at Chicago Model of Human Occupation Clearinghouse Archived ListServ Discussion 3

4 Aug 28, 2014 Hi all, I too really love using the OSA with people. I have found limitations with the scoring system and don't really tend to use this as much as observe the patterns and shifts of a person's responses. My primary field of expertise and experience with this tool is with mental health clients. There are a number of things that I have found that are worth keeping in mind when considering scores/responses and changes when using the OSA with people: - Frequently at the first point of contact with services a person has a distorted level of insight into their own level of ability, their own self worth and their sense of others' responsibility. This will often change over time and often partially accounts for a person who has rated themselves particularly well or poorly on ability scales swinging back in the opposite direction before starting to change as a result of intervention. A person's mental state may have affected their score. - Often, even where the score is affected by a person's mental state, the pattern of which activities they are more confident with than others are still reflected reasonably accurately - I have been surprised at times to see the distribution of scoring in people who are rather manic still, yet with assessment required during hospital admissions. Results often show a degree of difference between levels of confidence (and sometimes interest) that is likely, despite the possibility that they may/may not be rated with more skill or interest than normal. - Often at the point of first contact, a person has been inactive and/or disengaged for a long time, or simply 'making do' and has really lost much of their sense of their skill level in different areas. Some have not done activities for a while, lost confidence and score themselves down; others have done things very few times or observed household tasks when someone else has done them and figures that its not that hard and then discovers when they come to do these things with a therapist or within a programme or by necessity that they are more challenging than they thought. This will affect how they score themselves and will also affect what meaning they give to categories used for scoring - thus their own internal criteria for scoring themselves may also change. - Remember that interest and motivation will be affected not only by personal interests but by both symptoms, medication and energy levels. Also that confidence will have an effect upon this. - I have observed here that many therapists who score this tool report that it is usual for the score on second administration to drop from the first. They report that it tends to start moving in a growth pattern from there. My suggestion would be to look for patterns in each administration and patterns of change and track these. Even when scoring, these are important to inform you of the reasons for the changes. Model of Human Occupation Clearinghouse Archived ListServ Discussion 4

5 I hope that this is useful. All the best, Jacqui Nettleton Broadford, Australia Model of Human Occupation Clearinghouse Archived ListServ Discussion 5