Model of Human Occupation Archived List Serv Discussion MOHO Interviews as outcome measures? Date: Fri, December 8, 2006 10:01 am Hi I would be interested to hear people's views on whether it is valid to use the rating scales in some of the MOHO interviews (OCAIRS, WRI & WEIS) in a pre-post way to evaluate outcomes. My reticence is that it seems mildly unethical to ask a client the same set of questions (unless there has been a significant gap between pre & post intervention). In which case are the rating scales valid as objective scales (as in the MOHOST) which can be completed independent of an interview? Many thanks regards David Date: Mon, December 11, 2006 2:07 pm Hi David, Thank you for your question. I am not sure if I understand your question completely. My initial reactions are as follows: The decision about wether the OCAIRS, WRI and/or WEIS can be used in a pre - post manner isn't always about there being a "significant gap" between pre and post - it is a therapist judgement call based on asking reflective questions about the specific circumstances - for example, * has the clients situation changed and there is a need to capture this outcome? * has the client situation not changed and it would be helpful for the client to have a structured & supportive way of having this limited progress reflected back to them? * would it feel inappropriate to the client to be asked these questions again? (bearing in mind these interviews can be carried out in a casual/conversational way and dovetailed into other therapeutic conversations). * is there a transition approaching [transitioning out of one service into another service] for the client and an up to date interview would help support the client with this transition & capture their
change within the current service? * Is a readministraiton appropriate? for example time constriants allows for only one adminstration in order to support the clients transition back into the comunity on discharge from acute care. I would argue the therapist need to be reflective about their re administration of any assessment through reflective questions. Other issues to bear in mind: The OCAIRS, WRI & WEIS rating scales hold validity and reliability based on the interview format. The psychometric research behind the OCAIRS, WRI and WEIS are based on the interview method as described in the manuals. If you want observational data to be a significant part of the assessment you need to choose a MOHOST, VQ, AMPS or ACIS to be assured of psychometric properties. Certainly a principle would be "do NOT go after outcome data if it will interfere with your therapeutic relationship with the client". MOHO assessments, however, are specifically constructed not to feel like "tests" and to be more naturalistic for this reason - it allows you to go after outcomes data while preserving your therapeutic relationship with your client. Hope this helps, Kirsty Date: Mon, December 11, 2006 7:44 pm David- Very interesting question. It is certainly valid to use any MOHO tool as an outcome measure- all MOHO tools were developed with the potential to be used as outcome measures. However, they certainly catch different outcomes than the "FIM"! The OPHI-II, an interview, has paper and pencil keyforms that "convert" the therapist ratings on the assessment to client measures in the newest version of the manual (v2.1). A therapist could ideally, given the time, re-do interviews after the completion of a program or a long course of therapy, and use the client measures from the two assessment administrations to determine outcomes. The OSA, a self report, also has these keyforms that can be used in the same way. The OCAIRS and WRI are both moving to having these keyforms- however, the keyforms require very large databases (of 500+ once the instrument is fully developed). Hopefully, in the next 5 years, both the OCAIRS and WRI will have these keyforms. Keyforms will also be developed for the MOHOST.
I was hoping you could clarify what you mean by "mildly unethical". I feel it is certainly appropriate to ask a client to re-visit questions asked at the beginning of a program or intervention, and to reflect on any changes they feel occurred during the intervention. Perhaps you are concerned about the ability of interview assessments to show change in a short period of time? I do agree with you- unless there has been some time (3 months/6 months?) between pre and post intervention interviews, it may be hard to track changes in a client's "perceptions of abilities" using an interview format every week! Not the mention time consuming! In that case, for weekly progress or for tracking more subtle changes, certainly an assessment like the MOHOST/SCOPE would be appropriate. The VQ/PVQ and the ACIS can also be used more often to track change, as they are observation based. The upcoming 4th edition of the MOHO text has a revised chapter on assessment, and even outlines how different assessments can be used to capture information that is either more broad or more specific in order to reach a better understanding of the client's current circumstances and occupational challenges. I hope this answers your question David! Let me know if you have others. Best- Jessica Kramer Date: Tue, December 12, 2006 8:36 am Hi Kirsty/Jessica Many thanks for your very thoughtful and helpful replies. Just a few further comments: * As I suspected you are saying that it is not valid to use the rating scales from the MOHO interviews without carrying out an actual interview * Re the 'ethical' issue - my reservation relates mostly to whether it could be construed as wasting the clients time, or compromising the therapeutic relationship to repeat the same (or similar) interview, though I take on board Kirsty's helpful reflective questions * Whilst I accept that one of the strengths of the MOHO interviews is the way they lend themselves to a very conversational style, my other ethical query is whether we can use the findings from such conversations to complete a formal assessment, unless we inform the client that this is what we are doing. My feeling is that it is generally good practice to share a summary of the assessment with the client. * Re 'Key forms': whilst I have heard this term mentioned, I must confess that I don't know anything about key forms and how they differ from Rating Scales. We only have version 2.0 of the OPHI manual - I will order the updated version and check this out.
Once again, many thanks for your help regards David Date: Wed, December 13, 2006 20:58 am David, Thanks for your response, Let me be a little clearer - Your Bullet Point Number 1 It is not valid to use the "numbers" in the rating scale when either "measuring" the client at one time point following one administration or examining changes in numbers if the "MOHO interview rating scale" is completed using data collected outwith an interview format. If you want to use a rating scale with more a more flexible data gathering format in order to measure clients - why are you not using MOHOST? If "measurement" is not a consideration - then you have a free reign to use the interview as a qualitative assessment. Cautions to this kind of use are - a) if you use the numbers - people will wrongly assume the numbers can be used as "numbers" rather than a qualitative representation of your thinking, b) if they see you have used an "OCAIRS" they will assume you have gathered the information through an interview format. So there is a large scope for misunderstanding with this approach to using OCIARS in a qualitative manner. Also in the current healthcare context that is pushing for evidence based practice - this approach is challenging. So we go back to - why are you not using a MOHOST? When you can have the best of both worlds without misinterpretation. Your Bullet Point Number 2
If you use the reflective questions previously outlined - and decide to go ahead with doing the interview again - you have made a judgement it won't be a waste of time & therefore ethical to procede Your Bullet Point Number 3 Just because you are taking a conversational style to administering your outcomes measure (as allowed within the parameters of the OCAIRS, WRI and WEIS) it does not relieve you of the obligation of sharing your revised understanding of the client with the client. It is again your choice, however, how you do this - it can be completed in a conversational manner if you feel this is more appropriate given your relationship with the client. The whole point is that either the administration or the feedback doesn't have to feel like a test and not impact on your therapeutic relationship. Your Bullet Point Number 4 Lets talk when you have orientated yourself to the key forms, Just a few reflections on Jessica's response - you cannot use the OPHI-II as an outcome measure - as it contains historical perspective and not designed as an outcome measure. Although you can "measure" the client following its administration at one time point (in the way Jessica described using the key forms) - it is not build for two time point comparisons. I would also stay away from a statement of absolute time when thinking about when you re-administer an assessment - it varies so much depending on the client, context, how rapid the client is changing eg (some of the reflective questions from my previous e-mail). The decision is not made on the absolute "time gap" - it is more about how appropriate it is in the context and with that particular person or a transition out of a service or a case conference coming up ect. ect. Hope this helps, K
Date: Fri, December 15, 2006 12:02 pm Thanks again Kirsty for a another really helpful response. A few further comments: * We are using the MOHOST as well. Your comments raise an interesting issue about when to use the MOHOST and when to opt for the OCAIRS. My feeling is that the OCAIRS is arguably a more indepth tool than the MOHOST (which was after all developed as a Sreening tool) and so I would tend to go with the OCAIRS if a) there is sufficient time to conduct an interview and b) if the client is thought to be sufficiently able to articulate their story & give a reasonably accurate self report. I know that the MOHOST manual contains the OCAIRS interview questions, but as the OCAIRS has been specifically designed as an integrated interview & rating scale I can't see why one would opt for the MOHOST, if you are using interview as your data collection method (unless maybe as you say you are going to be supplementing interview data with other assessment information OR if there are plans to do a pre-post evaluation and there are concerns re the viability/appropriateness of re-interviewing). * I must confess that I don't really understand the thread of your 2nd paragraph under point 1. I am struggling a little with the concept of numbers as a qualitative description of thinking - I may have misunderstood you here - forgive me * The other points are very clear & helpful Thanks again regards David