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Assessment

• The act of assessing appraisal.
• An amount assessed, as for taxation.
• The qualified opinion of a healthcare provider,
  informed by patient feedback and examination
  results, with regard to a specific health issue,
  whether critical, pending, or routine. Dental
  Dictionary

7
Assessment

• Assessment is the process of documenting, usually
  in measurable terms, knowledge, skills, attitudes
  and beliefs. Children's Health Encyclopedia
• The act or result of judging the worth or value
  of something or someone(Thesaurus )

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Description

• Assessment is used in both an educational and
  psychological setting by teachers, psychologists,
  and counselors to accomplish a range of
  objectives. These include the following
• to learn more about the competencies and
  deficiencies of the individual being tested
• to identify specific problem areas and/or needs
• to evaluate the individual's performance in
  relation to others
• to evaluate the individual's performance in
  relation to a set of standards or goals
• to provide teachers with feedback on
  effectiveness of instruction
• to evaluate the impact of psychological or
  neurological abnormalities on learning and
  behavior
• to predict an individual's aptitudes or future
  capabilities

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Types

• Assessments can be classified in many different
  ways.
• The most important distinctions are
• (1) formative and summative
• (2) objective and subjective
• (3) referencing (criterion-referenced,
  norm-referenced )
• (4) informal and formal.

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Formative and summative

• There are two main types of assessment
• Summative assessment - Summative assessment is
  generally carried out at the end of a course or
  project. In an educational setting, summative
  assessments are typically used to assign students
  a course grade.
• Formative assessment - Formative assessment is
  generally carried out throughout a course or
  project. Formative assessment, also referred to
  as educative assessment, is used to aid learning.
  In an educational setting, formative assessment
  might be a teacher (or peer) or the learner,
  providing feedback on a student's work, and would
  not necessarily be used for grading purposes.

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Objective and subjective

• Assessment (either summative or formative) can be
  objective or subjective.
• Objective assessment is a form of questioning
  which has a single correct answer.
• Subjective assessment is a form of questioning
  which may have more than one correct answer (or
  more than one way of expressing the correct
  answer).

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Formal and Informal

• Formal assessment usually implicates a written
  document, such as a test, quiz, or paper. Formal
  assessment is given a numerical score or grade
  based on student performance.
• Whereas, informal assessment does not contribute
  to a student's final grade. It usually occurs in
  a more casual manner, including observation,
  inventories, checklists, rating scales, rubrics,
  performance and portfolio assessments,
  participation, peer and self evaluation, and
  discussion.

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Psychological Assessments

• Psychological assessment of children is used for
  a variety of purposes, including diagnosing
  learning disabilities and behavioral and
  attention problems. Psychologists can obtain
  information about a child in three general ways
  observation, verbal questioning or written
  questionnaires, and assignment of tasks.

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What is the Difference between Assessment and
Evaluation?

• Assessment is an on-going process aimed at
  improving student learning, programs, and
  services that involves a process of
• 1) publicly sharing expectations,
• 2) defining criteria and standards for quality,
• 3) gathering, analyzing, and interpreting
  evidence about how well performance matches the
  criteria, and
• 4) using the results to documents, explain, and
  improve performance.
• Evaluation appraises the strengths and weaknesses
  of programs, policies, personnel, products, and
  organizations to improve their effectiveness.
• Evaluation is to determine significance or worth
  or judge the effectiveness of educational
  programs. Assessment is to determine a rate or
  amount and is used as an activity to measure
  student learning and other human characteristics.

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Measurement

• Measurement refers to the process by which the
  attributes or dimensions of some physical object
  are determined. However, when we measure, we
  generally use some standard instrument to
  determine how big, tall, heavy, voluminous, hot,
  cold, fast, or straight something actually is.
  Standard instruments refer to instruments such as
  rulers, scales, thermometers, pressure gauges,
  etc. We measure to obtain information about what
  is. Such information may or may not be useful,
  depending on the accuracy of the instruments we
  use, and our skill at using them. There are few
  such instruments in the social sciences that
  approach the validity and reliability of say a
  12" ruler. We measure how big a classroom is in
  terms of square feet, we measure the temperature
  of the room by using a thermometer, and we use
  Ohm meters to determine the voltage, amperage,
  and resistance in a circuit. In all of these
  examples, we are not assessing anything we are
  simply collecting information relative to some
  established rule or standard . Assessment is
  therefore quite different from measurement, and
  has uses that suggest very different purposes.

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Assessment

• Assessment is a process by which information is
  obtained relative to some known objective or
  goal. Assessment is a broad term that includes 
  testing. A test is a special form of assessment.
  Tests are assessments made under contrived
  circumstances especially so that they may be
  administered.  In other words, all tests are
  assessments, but not all assessments are tests.
  We test at the end of a lesson or unit. We assess
  progress at the end of a school year through
  testing, and we assess verbal and quantitative
  skills through such instruments as the SAT and
  GRE. Whether implicit or explicit, assessment is
  most usefully connected to some goal or objective
  for which the assessment is designed. A test or
  assessment yields information relative to an
  objective or goal. In that sense, we test or
  assess to determine whether or not an objective
  or goal has been obtained. Assessment of skill
  attainment is rather straightforward. Either the
  skill exists at some acceptable level or it
  doesnt. Skills are readily demonstrable.
  Assessment of understanding is much more
  difficult and complex. Skills can be practiced
  understandings cannot. We can assess a persons
  knowledge in a variety of ways, but there is
  always a leap, an inference that we make about
  what a person does in relation to what it
  signifies about what he knows.

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Evaluation

• Evaluation is perhaps the most complex and least
  understood of the terms. Inherent in the idea of
  evaluation is "value." When we evaluate, what we
  are doing is engaging in some process that is
  designed to provide information that will help us
  make a judgment about a given situation.
  Generally, any evaluation process requires
  information about the situation in question. A
  situation is an umbrella term that takes into
  account such ideas as objectives, goals,
  standards, procedures, and so on. When we
  evaluate, we are saying that the process will
  yield information regarding the worthiness,
  appropriateness, goodness, validity, legality,
  etc., of something for which a reliable
  measurement or assessment has been made. For
  example, I often ask my students if they wanted
  to determine the temperature of the classroom
  they would need to get a thermometer and take
  several readings at different spots, and perhaps
  average the readings. That is simple measuring.
  The average temperature tells us nothing about
  whether or not it is appropriate for learning. In
  order to do that, students would have to be
  polled in some reliable and valid way. That
  polling process is what evaluation is all about.
  A classroom average temperature of 75 degrees is
  simply information. It is the context of the
  temperature for a particular purpose that
  provides the criteria for evaluation. A
  temperature of 75 degrees may not be very good
  for some students, while for others, it is ideal
  for learning. We evaluate every day. Teachers, in
  particular, are constantly evaluating students,
  and such evaluations are usually done in the
  context of comparisons between what was intended
  (learning, progress, behavior) and what was
  obtained

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Assessment, Measurement, Evaluation

• To sum up, we measure distance, we assess
  learning, and we evaluate results in terms of
  some set of criteria.
• These three terms are certainly connected, but it
  is useful to think of them as separate but
  connected ideas and processes.
• Collecting data (assessment), quantifying that
  data (measurement), making judgments
  (evaluation), and developing understanding about
  the data (research) always raise issues of
  reliability and validity

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Summary of Differences
Dimension of Difference Assessment Evaluation
Timing Formative Summative
Focus of Measurement Process-Oriented Product-Oriented
Relationship Between Administrator and Recipient Reflective Prescriptive
Findings, Uses Thereof Diagnostic Judgmental
Ongoing Modifiability of Criteria, Measures Thereof Flexible Fixed
Standards of Measurement Absolute Comparative
Relation Between Objects of A/E Cooperative Competitive
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Process Evaluation and Adjustment
Assess
Prioritize
Analyze problem and propose model to address
Develop Intervention goals, objectives,
implementation plan
Evaluate outcomes
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(AAC)

• Augmentative and Alternative Communication (AAC)
  strategies assist people with severe
  communication disabilities to participate more
  fully in their social roles including
  interpersonal interaction, learning, education,
  community activities, employment, volunteerism,
  care management, and so on.

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Current Assessment Theory

• Moved from candidacy criteria to focusing on an
  individuals need for improved communication
• Communication Needs Model (Beukelman, Yorkston,
  Dowden, 1985)
• Examines individuals natural environment, and
  recommends implementation of AAC intervention
  when unmet communicative needs are present

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Purpose of Assessment

• Purpose of assessment
• Determine the skills that an individual has or
  needs to develop in order to communicate
  effectively
• Identify communication system individual
  currently uses
• Determine effectiveness
• Refine current methods identify new methods
• Determine optimal way to configure system
• Goal of AAC assessment intervention
• Independent, functional interactive communication
  
• Achieved through assessment, system trials,
  instruction

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Main Function of AAC Assessment

• to determine whether an individual with
  communication impairment requires augmentative
  communication intervention
• During an assessment, an individual's
  communication needs, as well as his or her
  capabilities, are evaluated in order to implement
  the assistive technology as soon as possible to
  enable the individual to begin immediate
  communication interaction.
• The appropriate augmentative communication system
  is selected to meet the needs of the individual,
  and an intervention plan is developed

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Identification of Present Ways of Communicating
-gt limitations and needs

1. Oral Speech - actual production of words.
2. Linguistic Knowledge - language reception and
   expression.
3. Reading Writing Ability - The interpretation
   and generation of written symbols.
4. Cognition - ability to recall information,
   reason, problem solve, and follow directions.
5. Non-Oral Communication - use of gestures, signs,
   facial expressions, body language, and current
   augmentative communication usage.
6. Communication Effectiveness - types of messages
   successfully communicated.
7. Communication Partners - ways to communicate with
   familiar and unfamiliar partners.
8. Communication Settings - contexts in which
   communication devices will be used (i.e. school,
   work, home).
9. Message Needs - Ways to initiate, comment,
   request, convey, or reply to conversation.
10. Developmental Educational/Vocational Needs -
    Literacy development.

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Comprehensive Assessment

• Based on the screening, which areas require more
  indepth information/testing?
• Where do I need to target my interventions?

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Self Care Assessment

• Personal care (feeding, bathing, grooming,
  dressing, toileting)
• Community management (shopping, finances,
  transportation/driving)
• Functional mobility (transfers, current aids used
  - home and community, seating and positioning
  needs)
• Functional communication (writing or computer
  use, telephone use)

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Productivity Assessment

• Paid or unpaid work (job, volunteer work, school,
  etc)
• Household management (cleaning, laundry, cooking,
  etc)
• Child Care/Parenting

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Leisure Assessment

• Activities enjoyed previously and currently
• Socialization (visiting, phone calls,
  correspondence, etc)
• Quiet recreation (hobbies, reading, crafts, etc)
• Active recreation (sports, outings, travel, etc)

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Assessment of Environment

• Physical environment possible barriers
• Consideration of social support systems available
• Consideration of cultural factors

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Fatigue Assessment

• MS fatigue
• Other factors contributing to fatigue
• Impact of fatigue
• Expectations for self

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Cognitive Screening

• Primarily assess functional cognition
• Attention
• Ability to follow directions
• Memory difficulties
• Executive function
• If more indepth assessment needed then refer on
  to Neuropsychology

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Assessment of Physical Status

• U/E tone
• U/E ROM
• U/E strength
• U/E sensation
• U/E coordination
• Functional balance (more of a screen)
• Pain (more of a screen)
• Often work together with PT on this area

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How do I use the assessment data?

• To decide on approach to treatment
  (restoration/remediation, adaptation,
  compensation)
• To determine at which level I intervene
  (impairments, occupational tasks/abilities,
  participation/roles)
• To make recommendations (eg, referrals, workplace
  accommodations, followup care)

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Assessing Severity of Illness

• A brief method of identifying the severity of the
  mentally ill
• suitable for everyday use (feasible)

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Global Assessment of Function (GAF)

• Clinicians judgment of overall level of
  functioning
• Guide treatment need and planning (DSM-IV)
• Rating - clinical dx and sx stronger predictor of
  than social or occupational functioning1
• Minimally associated with treatment outcome1
• No robust association btwn GAF and clinician
  interview or patient self report1

1. Moos RH. Psychiatry Serv 200253, 730-7.
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Threshold Assessment Grid

• Assesses severity of persons mental health
  problems
• Referrals to routine community mental health
  service
• One page assessment
• - 7 domains
• - 4 to 5 point scale for each domain
• Second page provides evidence-based criteria for
  each domain

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Diagnostic assessment

• Self-administered tool that
• help identify and diagnose patients with mental
  illnesses commonly encountered in a primary care
  practice
• allow for reporting of associated stressors
• practical
• reasonable performance characteristics
• easy to average literacy level
• useful in both initial management decisions and
  monitoring treatment outcome

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General Health Questionnaire (12 and 26)1

• Self completed (3 to 4 minutes)
• Validated\reliable, current state, predictive
  validity
• Identifies common underlying elements
• Focuses inability to carry out normal functions
  appearance of new distressing phenomena
• Casernes varies according to threshold
• FP (physically ill) and FN (compared to normal)

1. Goldberg D P et al Psycho Med 19727,191-7.
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Patient Health Questionnaire (PHQ)

• Instrument based on psychiatric disorder criteria
  (reference symptom count)
• Not dependent on threshold of symptom severity
• Offset potential for symptom count not reliable
  indicator of impairment by having scale mode

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Functional assessment tools

• That I use
• Canadian Occupational Performance Measure (COPM)
• Functional Independence Measure (FIM)
• Multiple Sclerosis Self Efficacy Scale (MSSE)
• Doron Simulator
• Interview/observation

• That others use
• Functional Assessment Measure (FAM)
• Kohlman Evaluation of Living Skills (KELS)
• Self Reported Functional Measure (SRFM)
• Worker Role Inventory Checklist

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Environmental/Community assessment tools

• That I use
• Home assessment form developed by our Home
  Service OT

• That others use
• Reintegration to Normal Living Index
• SAFER

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Fatigue assessment tools

• That I use
• Daily activity diary
• Fatigue questionnaire
• Fatigue Impact Scale (FIS)

• That others use
• Modified FIS
• Fatigue Severity Scale (FSS)
• Fatigue Assessment Instrument (FAI)

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Cognitive assessment tools

• That I use
• Cognistat
• Rivermead Behavioural Memory Test (RBMT)
• Cognitive Competency Test (CCT)

• That others use
• Behavioral Assessment of Dysexecutive Syndrome
  (BADS)
• Pepper Visual Skills for Reading Test
• Test of Directed Attention

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U/E measurement tools

• That others use
• Jebson Hand Test
• U/E Performance Test for the Elderly (TEMPA)
• Arm Motor Ability Test (AMAT)
• Action Research Arm Test
• Purdue Pegboard
• Arthritis Hand Function Test
• Box and Block

• That I use
• Nine Hole Peg Test (9-HPT)
• Manual Muscle Test
• Dynamometer
• Pinch meter
• Sensation kit
• Handwriting sample

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Objectives

• Describe the impact of spasticity on function
• Evaluate spasticity using the Modified Ashworth
  Scale
• Understand what makes a patient, a good candidate
  for ITB
• Recognize ITB withdrawal

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Spasticity Assessment
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Spasticity Assessment

• Motor Testing
• 0 No movement
• 1 Trace contraction
• 2 Full AROM gravity eliminated .
• 3 Full AROM against gravity
• 4 Full AROM against gravity with resistance
• 5 Normal power

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Spasticity Assessment

• Modified Ashworth Scale
• 0 no increase in muscle tone
• 1 slight increase in muscle tone (catch or min
  resistance at end range)
• 1 slight increase in muscle resistance
  throughout the range.
• 2 moderate increase in muscle tone throughout
  ROM, PROM is easy
• 3 marked increase in muscle tone throughout
  ROM, PROM is difficult
• 4 marked increase in muscle tone, affected part
  is rigid

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Spasticity Assessment

• Spasm Frequency Scale How many spasms in the
  last 24 hours in the affected extremity?
• 0 no spasms
• 1 1 / day
• 2 1-5/ day
• 3 5-9 / day
• 4 gt10/day

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Spasticity Assessment

• Adductor Tone Rating
• 0 no increase in muscle tone
• 1 increased tone, hips easily abducted 45
  degrees by one person
• 2 hips abducted 45 degrees by on person with
  mild effort
• 3 hips abducted 45 degrees by one person with
  moderate effort
• 4 two people are required to abduct the hips 45
  degrees

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Spasticity Assessment

• Tardieu An ordinal rating of tone which
  measures the angle which the catch is first felt
  (the threshold angle).
• Oswestry Ordinal which rates stage and
  distribution of tone that is addressed by a
  generalized grade of either useful or non-useful
  movement.
• ASIA Examination
• Functional Independence Measure
• Community Integration Questionnaire

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Organisational assessment tool
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Organisational assessment tool
Using methods of full staff participation,
partner organisations are encouraged to carry out
a detailed self-assessment. An assessment tool
guides partners to

• Identify institutional strengths, areas for
  improvement, opportunities and threats
• Assess capacity for effective efficient
  operation
• Monitor institutional progress
• Identify resources other support requirements

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The tool focuses on self assessment of
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Vocational Rehabilitation
66
An Alternative client by client Triage Commissio
ning Assessment Action Plan Authorisation Case
management Service Provision Review
67
CLIENT
Rehabilitation Triage Identify clients in
need Commissioning Refer for rehabilitation
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Rehabilitation Assessment Personal life balance
Health / Internal
Social / external
Work / Institutional
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Rehabilitation Co-ordinating medical and
vocational support
Vocational assessment
Medical assessment
Is there a medical problem?
Is there a vocational problem?
Identify remove the Medical barriers to work
Identify remove the Vocational barriers to work
Job search
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The disability assessment
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Disability pension in Iceland
Disability is assessed by physicians of the State
Social Security Institute according to paragraphs
12 and 13 in the National Social Security
Act. Higher level gt75 (full disability
pension) All Work Test Personal Capability
Assessment Lower level 50-65 (partial
disability pension)
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The disability assessment is based on the British
Personal Capability Assessment (previously
called the All work test). Function is
evaluated by assessing the ability to perform
various activities of body and mind.
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• This functional evaluation is intended to reflect
  the applicants ability to perform all types of
  work.
• The statements of functional ability - the
  descriptors - are graded according to importance,
  giving high points for major and low points for
  minor functional impairment.

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Part one Physical and sensory function Threshold
15 points Part two Mental health Threshold 10
points Combined threshold 6 points from each
part
75
Part one Physical and sensory function Sitting
Standing Walking Walking up and down stairs
Rising from sitting Bending and kneeling
Manual dexterity Lifting and carrying Reaching
Speech Hearing Vision Continence Remaining
conscious
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Part two Mental health Completion of
tasks Daily living Coping with pressure Interactio
n with other people
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WHO-DAS

• Used in the physically ill
• Rheumatology-Ann Rheum Dis 200362.140-145
• Pulmonary Rehab-Chest 2002122.948-954
• SMI-Acta Psych Scand 2002105.196-201. And
  2000102.26-31
• Cost effectiveness- Medical Care Vol.41.2208-217
• Developing Countries-Soc Psychiatry Psychiatry
  Epid (1997) 32 387-390

79
WHO-DAS Six Domains

• Understanding and communicating
• Getting around
• Self care
• Getting along with others
• Life activities
• Participation in society

80
WHO-DAS Versions. Self-Administered

• 36 Item. All domains, overall score
• 12 Item. Helpful esp. when domain specific
  information is not required. OUR VERSION
• Other as INTERVIEW and PROXY versions

81
ICF Checklist

• One component- One page
• Salient Categories (169 out of 1494) at-a-glance
• -Impairments with Body Functions
• -Impairments with Body Structures
• -Capacity and Performance in Activity and
  Participation Domains
• -Environmental Factors
• -Other Contextual information
• Additional notes
• Available for Clinicians

82
CIHI Health Indicators Framework
Acceptability Satisfaction questionnaire patients GPs psychiatrist Accessibility Time to first contact, counseling, psychiatrist Crisis access Phone avail. Indirect care Appropriateness TAG of visits Competence adequate skill set feed back, retreat fidelity items academic detailing
Continuity f\u clinicians disposition after episode of care Efficacy Effectiveness PHQ WHO-DAS II Safety TAG Treatment outcome
83
Migraine Disability Assessment Scale (MIDAS)
84
Migraine Disability Assessment Scale (MIDAS)
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(No Transcript)
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Community Assessment
87
Community Assessment

• Includes a data gathering process about the
  community, including all aspects and not
  necessarily related to health issues only.
• Is larger than a community health assessment
  (sometimes called a community health needs
  assessment)
• Frequently done city governments to look at many
  issues including environment, housing, economics,
  education, land use , etc.,etc., and often
  includes health status and needs

88
Community Assessment Process

• WHY??
• To identify and document the opportunities,
  challenges, strengths, and needs of a specific
  geographic community and its residents.

89
Community Assessment Process

• WHY??
• To build and strengthen relationships among
  community leaders, service providers and most
  importantly, community residents.

90
Community Assessment Process

• WHY??
• To have the information needed to make good
  decisions for a community collaborative strategic
  planning.

91
How is the Community Assessment Process Different
from a Traditional Needs Assessment

• Process is as important as the product.
• Residents are involved in design and
  implementation, not just as respondents.
• Assessment focuses not only on needs, but also on
  assets and resources.
• Assessment is multifaceted and uses multiple data
  collection strategies.
• Assessment is about dialogue and consensus
  building as well as information gathering.
• It is not just about social services.
• It is not an academic process.

92
Community Assessment Process

• Form planning and implementation committee.
• Review secondary data.
• Determine need for primary data.
• Develop methods for new data collection.
• Collect new data.
• Analyze data collected.
• Create report using secondary and primary data.
• Share information with the community.

93
Steps to Assessment

• Convene a planning group
• Define community
• Identify Community Assets
• Identify Perceived Needs
• Build Demographic Profile
• Analyze Community Health Status
• Analyze Community Nutrition Status
• Identify Community Resources and Service
  Utilization
• Identify common issues and unmet needs
• Prioritize

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Needs Assessment

• In general, a needs assessment is a systematic
  approach to identifying social problems,
  determining their extent, and accurately defining
  the target population to be served and the nature
  of their service needs (Rossi, P. H., Freeman, H.
  E., Lipsey, Mark, W. L., 1998).

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Three-Phase Plan for Conducting a Needs Assessment

• Phase 1 - Pre-assessment (exploration)
• Phase 2 - Assessment (data gathering)
• Phase 3 - Post-assessment (utilization)
• Within, B. R., Altschuld, J. W., (1995).
  Planning and conducting needs assessments A
  practical guide. Newbury Park, CA Sage
  Publications

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Needs Assessment Tools

• Surveys
• Questionnaires
• Interviewing
• Focus Groups
• Observations
• Performance Measures
• Ranking
• Grading
• Scoring
• Rating

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