OT 17-SERIES

THE EVALUATION
PROCESS

CORE LECTURE VER. 2024

PAULYNNE T. AGUHOB
PTAGUHOB@UP.EDU.PH
INFORMATION
This module is prepared for the BS Occupational
Therapy students enrolled in the OT 17-assessment
courses (172, 174, 176, 178). This is intended to be a
review material and guide and, therefore, should
not be considered or cited as a standard reference
for studies and presentations.

Prepared by Paulynne Angelie T. Aguhob.

Property of the Department of Occupational
Therapy, College of Allied Medical Professions,
University of the Philippines Manila. Obtain
permission from the Department before use. 01 OVERVIEW

02 THE OCCUPATIONAL THERAPY

© 2024, 2023, 2022
PROCESS

07 THE EVALUATION PROCESS

12 SUMMARY

13 EXERCISE

14 REFERENCES

14 ANSWERS
OVERVIEW

THIS MODULE PROVIDES A REVIEW OF THE OCCUPATIONAL THERAPY (OT)

PROCESS AND A BRIEF OVERVIEW OF THE EVALUATION PROCESS IN PREPARATION
FOR THE MORE DETAILED ASSESSMENT COURSES TACKLING DIFFERENT CLIENT
FACTORS, ENVIRONMENTS, AND CONTEXTS IN VARIOUS AGE GROUPS.
As this module serves as a refresher to strengthen the OT core skills and tools taught to you in the
previous years, you are expected to read through your notes and other references gathered in the
previous courses (e.g., OT 122, 123, 124, 125). Guide questions, and exercises are provided to elucidate
points and aid you in understanding and embodying the essence of these core skills.

LEARNING OBJECTIVES WHAT YOU NEED

The objective of this module is to equip This module will take about two hours
you with the necessary skills and to complete. To help you accomplish
principles as you delve into the specific this module, you may need the
assessment courses. At the end of this following:
module, you are expected to:
Describe the occupational therapy Person
process. Motivation to finish - this module is
Describe the evaluation process and easy; so this should not be a
its components. problem!
Discuss the different factors Time management
influencing the OT and evaluation Knowledge from previous courses
processes including personal and
contextual factors, and use of Environment
evidence. Comfortable work area, e.g., good
lighting and ventilation, less to no
distractions
May work with classmates or pet
for support
Highlighters, pens, notepads (digital
or otherwise)
Snacks for the peckish ones
Materials from previous courses

01
THE OCCUPATIONAL
THERAPY PROCESS
The occupational therapy process is COMPONENTS
the backbone that facilitates our
delivery of services as occupational The OT process is dynamic and
therapists. It serves as the guide in our iterative. The best routes can change –
professional reasoning to address the think of Waze and Google Maps when
concerns of our client to promote their they update on the road to give you
health and occupational participation. the best route! As occupational
therapists, we constantly evaluate and
Think of the OT process as a map to think of the outcomes when we go
get our clients (with us as guides) from through the process with our clients, so
one stop to another in a trip. The map we keep on customizing/rerouting with
shows the road we must take to get to the end goal of supporting our client’s
our destination. We have a starting health and occupational participation
point – the evaluation, and an endpoint in mind.
– the outcome. Without this map,
traveling would be difficult and However, despite this nature of the
nontherapeutic. The trip would be a process, it still has definitive
disservice to the clients we cater. components – a start and an end point,
and milestones in between. See figure 1
As occupational therapists, we must for an overview of the OT process.
build our skill in reading this map. We
must be able to identify the best route
in the evaluation and intervention parts
of the trip to achieve the goals we set
with our clients. Once we understand
the map and the best routes we could
take with our clients, we could
effectively communicate with them the
process and services they are going to
undertake. This promotes active
collaboration and participation with
them since they know where they are
going in this trip.

REMEMBER:
OCCUPATIONAL THERAPY IS A TRIP THAT
YOU AND YOUR CLIENT DO TOGETHER.

02
COMPONENTS
EVALUATION
1
refers to the systematic collection and analysis of subjective and
objective data from our clients to make sound therapy decisions. Results
from the evaluation are used to plan and implement interventions for our
clients and their goals. It is also a period of relationship-building,
especially during our initial contact, with our clients.

INTERVENTION
2
is the implementation of strategies to facilitate client’s participation and
engagement in their occupations. This occurs after the initial evaluation,
when there is sufficient information to plan and implement intervention
strategies to target factors for the achievement of established goals.

REEVALUATION
3
is done to determine the effectiveness of occupational therapy
interventions. This may be done formally – comparison between the
previous evaluation data and the current data after a set period, or
informally – during the intervention phase as the occupational therapist
continuously assesses the effectiveness of interventions given to the
client and the client’s response and progress. Reevaluation also informs us
if there is a need to continue OT services or otherwise.

OUTCOMES
4
are embedded all throughout the OT process. They refer to the results of
the therapy interventions given to our clients. Prior to their realization at
the end of the process, they are first identified as goals or anticipated
outcomes to guide the process itself. They serve as benchmarks of
performance to determine if therapy needs to be continued or revised.
General examples of outcomes include improved occupational
performance and participation on identified occupations, engagement in
activities, and competence on meaningful roles.
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FIGURE 1. THE OCCUPATIONAL THERAPY PROCESS.
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 FACTORS
INFLUENCING
THE OT PROCESS
CERTAIN TOOLS IN OUR OT ARSENAL MUST
BE CONSIDERED FOR AN EFFECTIVE OT
PROCESS. THESE ARE FACTORS THAT
SUPPORT AND INFLUENCE THE OT
PROCESS.

PROFESSIONAL REASONING
otherwise known as clinical reasoning, must be
employed in every component of the OT process.
Professional reasoning includes making sound therapy
decisions and problem-solving. This begins before
meeting your client as you plan your evaluation based
on client documents and referral, your practice
setting, etc., to evaluating whether your client needs
further OT or may be discharged.

EVIDENCE
refers to theory, research, therapist experience, and
client preferences. These comprise evidence-based
practice which combines the best available evidence
with your expertise as an OT and your client’s
preferences to make sound therapy decisions.

We will be delving more into theories (i.e., frames of

reference and conceptual models) in the core
assessment principles modules as this is an important
tool in determining your approach in evaluation and
selecting assessment tools and interventions.

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 THEREAPEUTIC USE OF SELF (TUS)
of an occupational therapist is integral in the
development and management of the therapeutic
relationship with their clients. TUS involves the use of
professional reasoning, empathy, and client-
centeredness in service delivery.

COLLABORATION
between the client and the occupational therapists is
an important factor in effectively accomplishing the
OT process. This collaborative relationship entails
consciously taking into consideration and integrating
the client’s preferences which are influenced by their
life experiences, values, needs, priorities, and choices,
into every component of the OT process since your
client can influence the therapeutic outcomes (see
figure 1).

WHO IS OUR CLIENT?

Remember that we cater to different types of clients.
They may be (1) the “client” - individuals who are
referred for OT services, (2) a “client constellation”
that includes both the individual referred for OT and
people closely connected to the individual, and (3) a
“client group” – people who share similar problems in
occupational performance (Shotwell, 2014).

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THE EVALUATION
PROCESS
The OT process begins at the It is important to note that technically
evaluation. Evaluation is the whole evaluation occurs beyond the initial
process of obtaining and analyzing evaluation of the client and is seen
information needed to proceed to the throughout the OT process as
intervention and reevaluation phases of occupational therapists maintain an
the OT process. It is both a set of evaluative view of the client (Shotwell,
procedures (i.e., performing interviews, 2014). This means that we continuously
observations, assessments, and other evaluate and analyze our client’s
strategies to gather data about your responses to intervention and revise
clients) and a thought process (i.e., the plan to achieve our target
employs professional reasoning). outcomes, as necessary. This is closely
related to reevaluation.
The primary question that must be
answered by the occupational therapist
in this phase is – “Who is my client and
does my client need occupational
EVALUATION VS ASSESSMENT
therapy services?” (Chrisholm & Schell,
2014). To answer this, the occupational These two terms are often
therapist must obtain and analyze interchanged. However, these two
subjective and objective data about the have distinct definitions. Assessment
client and their occupational is part of evaluation and refers to the
performance. This may be done through tools, instruments, or systematic
interviewing and completing an interaction used to complete the
occupational profile, performing analysis occupational profile and collect data
of occupational performance, and regarding occupational performance.
identifying target outcomes (see figure
2).

FIGURE 2.
COMPONENTS
OF EVALUATION
(CHRISHOLM &
SCHELL, 2014)

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COMPONENTS

The evaluation process has several SCREENING

components – from before meeting
Depending on where you work,
with the client until interpreting the
screening may occur before receiving a
collated data for intervention planning.
referral for OT evaluation and
Using the map/trip metaphor earlier,
intervention, or the other way around.
you can think of the evaluation process
Screening involves gathering
as gathering data to design an
preliminary data regarding the
appropriate and effective trip itinerary
client’s occupational difficulties and
for your client. The trip is the
determining whether they may
intervention journey. As an
benefit from OT services and/or
occupational therapist, you may be the
referral to other professionals. There
travel agent and guide tasked to
is less interaction between the client
prepare for and design the trip as well
and the OT in the screening process
as accompany them.
and may involve (1) reviewing client
history through documents/records,
To jumpstart this process, certain
(2) consulting with professionals or the
preparations occur prior to meeting
referring team whom the client is
the client for the initial evaluation.
involved with, and/or (3) using
standardized or structured screening
instruments (OTPF 4th ed., 2020).

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REFERRAL AND regarding their occupational
performance and participation which
DOCUMENT REVIEW would lead to a collaborative
This involves reviewing client records identification of priorities and desired
to gain an understanding of the occupational goals for therapy.
client’s history to guide the
occupational therapist in designing The interview is also an excellent tool
the evaluation plan as well as the in assessing the overall cognitive
intervention. status of your client. Caution must be
practiced in interviewing clients with
In your facility, there may be client files cognitive impairments who may not
where you could review the client’s have accurate insights regarding their
demographic information, medical test occupational concerns and needs. To
results, and medical and therapy address this, you may also interview
records. One key document that you the people closely connected to the
should review is the OT referral, client who may offer accurate and
particularly the reason for the referral. additional insights about the client’s
Why was the client referred for OT occupational performance. However,
services? Once you have reviewed the you should still obtain the client’s
reason for referral, you also go through perspective despite their cognitive
the client’s demographic information – impairments to gain a fuller picture of
name, age, sex, address, diagnoses, their concerns and communicate the
educational level, etc. Your facility may earnestness to understand them. In
have an information form or intake form relation to this, the interview also helps
which the client fills out prior to initial establish rapport and the therapeutic
evaluation, or there may be previous relationship between you and your
records with their demographic data client.
(caution on its recency!). You should
also investigate records that paint the Note that the interview need not be
client’s medical status to anticipate done at one point in time during the
how the client would look like and evaluation and may be interspersed
behave during evaluation and with your observations and
intervention. This includes anticipating assessments with the client. The
difficulties and safety concerns. challenge here is to determine which
questions to ask and when to ask them
so that your clients would not be
INTERVIEW AND distracted. A helpful tip is to ask
interview questions related to the
OCCUPATIONAL PROFILE actions they are performing (e.g., when
Given that you have prepared for the you are observing them as they
evaluation, you are now ready to meet perform occupations). Furthermore, as
your client. The first thing that is usually much as we collect data during the
done is to perform an interview to gain initial evaluation (usually only the first
an understanding of the client’s session), we can and should add more
perspective regarding their data while we work with our clients
occupational life and background. This throughout the process.
is called an occupational profile. The
occupational profile is a summary of
the client’s occupational and
functional history, patterns of daily
living, interests, values, needs, and
relevant contexts. As you build your
client’s occupational profile, you will be
able to identify your client’s concerns

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 ANALYSIS OF OCCUPATIONAL PERFORMANCE
Apart from the subjective data from the interview, objective data must be
collected and analyzed through the analysis of the client’s occupational
performance. We collect objective data through:

OBSERVATION OF CLIENT'S OCCUPATIONAL PERFORMANCE

1
This is done through occupation-based dependent on our practice setting.
activity analysis (OBAA) or dynamic Therefore, we strive to replicate the
performance analysis (DPA) to identify client’s real-life performance context
activity demands and factors (PEO) as much as possible in our setting. We
that support or hinder their also must keep in mind that the
performance. We observe the client performance demands may differ as
perform occupations ideally with the the client performs occupations in the
objects and equipment they use (or clinic compared with them performing
similar), and in the setting/s they in their natural context.
typically perform the occupation/s.
This means ideally, we should observe OBAA and DPA will be further
our client performing occupations in discussed in another core assessment
their context. However, this is almost principles module.
always not feasible in real life and is

USE OF VALID AND RELIABLE ASSESSMENT TOOLS

2
that assess factors that support or patterns, environment, and context. We
restrict occupational performance. use these tools to identify how
These tools may assess client factors occupational performance is impacted
(e.g., body structures and functions), by various factors.
performance skills, performance

Notice that in evaluation we triangulate the information we gather from our clients
through the (1) interview, (2) observation, and (3) assessments. By doing so, we
can validate the data we have gathered through the different sources which helps
us in synthesizing the evaluation to identify outcomes and plan for intervention.

The different assessments for different client factors, occupations, and

environment and context are the foci of the OT 17-assessment Courses.

ANALYZING OCCUPATIONS:
How do we know what occupations to observe?

CHOOSING ASSESSMENTS:
How do we choose which assessments to use?

Answers at the end of the module.

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 SYNTHESIS OF performance problems that needs to
be addressed for the client to be
EVALUATION PROCESS: discharged. Apart from the creation of
TARGET OUTCOMES goals, outcome measures must also
Once sufficient data has been be determined to measure progress
collected, the occupational therapist towards the attainment of these goals.
will then need to organize and These outcome measures are
synthesize these. In this phase, we assessments done in evaluation that
define the client’s strengths and will be used to check changes
weaknesses and develop a problem throughout the course of therapy. The
list that influence their occupational therapist then uses the synthesized
performance problems which we can information and the established
target in therapy. We then develop an targeted outcomes to plan for and
OT diagnosis as to why their guide the client’s intervention process.
occupational problems are occurring
based on the factors identified. It is
important to have a well-defined
problem list and diagnosis to develop
relevant target outcomes (Chrisholm
OT DIAGNOSIS
& Shell, 2014).
Remember your OT 14-series? This is
Target outcomes include both short- similar to the PAIs you developed,
term and long-term goals developed in but only with a specific client in mind
collaboration with the client. These and considering their real context!
outcomes must reflect the relevant
occupational areas and occupational

USING EVIDENCE IN THE

EVALUATION PROCESS
In every aspect of the OT process and, issues and the ecological model to
therefore, the evaluation process, identify PEO factors that may affect
evidence plays a role. In evaluation, their performance and participation.
evidence-based information is used to Choosing which theory to use may be
support the acquisition of subjective from available studies that address the
and objective data, and development use of such theoretical perspectives
of target outcomes (Chrisholm & with clients like yours.
Schell, 2014).
We also use evidence in identifying
We use theories (i.e., frames of appropriate assessment tools that
reference, conceptual models) that are are valid and reliable to use for our
relevant to our client and practice clients. Studies on the psychometric
setting. For example, we may consider properties of tools are available online.
the biomechanical frame of reference Therapist experience is also
for someone with a forearm fracture considered as your experience in
knowing that they may have mobility evaluation and handling different types
of clients and in administering different
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 assessments would determine your Professional reasoning makes use of
needs to best evaluate your current these evidence to be able to conduct
client. Your client is central to the OT appropriate evaluation strategies and
process; and their preferences is assessments to develop collaborated
another important evidence for a target outcomes and plan for
client-centered and occupation- intervention.
centered evaluation. Their preferences
include their priority occupations, and
occupational performance problems.

SUMMARY
In this module, we discussed the different components of the OT process and the
evaluation process. As occupational therapists, we must be able to navigate, find
the best route, and re-route, if necessary, for our client, from screening to discharge.
The evaluation is the beginning of this process and entails collection and analysis of
subjective and objective data to formulate relevant targeted outcomes for
intervention. The whole process entails professional reasoning, evidence-based
practice, and collaboration with our clients for a client-centered and occupation-
focused therapy.

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 EXERCISE: EVALUATION OF KENTO
Let’s check how much you’ve learned in this module! This is not graded and only serves as a
review of what you have read. The answers are at the end of the module. Note that the answers
are not exhaustive!

CASE:
Kento, a 17-year-old male, is part of the vocational program of your clinic. The goal of the
program is to have the clients be employed in community-based settings. Kento was newly
referred to you, a new consultant to the program. According to your colleagues, Kento is capable
of learning new jobs and could perform multiple-step tasks given minimal to no supervision;
however, they are concerned about his eventual employment because he needs constant cuing
to take a shower, brush his teeth, and change his clothes. Now that he is referred to you for OT
evaluation, what will you do?

Before meeting with Kento, what steps will you do to prepare for the evaluation?

What questions do you want answered during the evaluation?

What subjective data do you want to gather from Kento?

What objective data do you want to gather from Kento?

How will you practice the use of evidence during your evaluation with Kento?
REFERENCES
Chrisholm, D., & Schell, B.A.B. (2014). Overview of the occupational therapy process and outcomes.
In
B.A.B. Schell, G. Gillen, & M.E. Scaffa (Eds.), Willard & Spackman’s Occupational Therapy. Baltimore,
MD:
Lippincott Williams & Wilkins.
Occupational Therapy Practice Framework: Domain and Process (3rd Edition). (2014). The American
Journal of Occupational Therapy, 68(Supplement_1), S1–S48.
https://doi.org/10.5014/ajot.2014.682006
Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. (2020). The American
Journal of Occupational Therapy, 74(Supplement_2), 7412410010p1-7412410010p87.
https://doi.org/10.5014/ajot.2020.74S2001
Shotwell, M.P. (2014). Evaluating clients. In B.A.B. Schell, G. Gillen, & M.E. Scaffa (Eds.), Willard &
Spackman’s Occupational Therapy. Baltimore, MD: Lippincott Williams & Wilkins.

ANSWERS
ANALYZING OCCUPATIONS
We identify occupations to observe based on the client's reported occupations that they need to do,
want to do, or are expected to do but are having difficulty doing currently. The factors why they have
difficulty in participation, performance, or engagement in these priority occupations may vary, so you
the occupational therapist must be able to draw this out during the evaluation.

CHOOSING ASSESSMENTS
We use our professional reasoning in identifying the appropriate assessments for our client. We
consider evidence - such as the data we gathered from our client, the client's condition, theories, the
best available evidence regarding assessments, our practice setting (e.g., availability of assessments),
and our capability/experience with these assessments.

EXERCISE: EVALUATION OF KENTO

Before meeting with Kento, what steps will you do to prepare for the evaluation?
To plan the evaluation, give you an idea on how the evaluation may go, and what possible concerns
could spring up, you can:
Consult with the other professionals who worked with Kento
Review the OT referral, demographic sheet, and previous records of Kento in the clinic
Identify and use screening instruments that may help you determine preliminary concerns of Kento
Research on theory/ies and assessments that you may use during the evaluation

What questions do you want answered during the evaluation?

What is his difficulty with self-care? Is it his performance? Participation? Engagement?
Why does he have this difficulty?
What environmental and contextual factors might be influencing his difficulties in self-care?
What client and personal factors might be influencing his difficulties in self-care?
What are our goals? What can we do as his occupational therapist?

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What subjective data do you want to gather from Kento?
Generally, you would want to gather information regarding the following, but using your professional
reasoning you should be able to identify what relevant information you should obtain during your
evaluation with Kento. You should be able to reflect in and on action!
His occupational and functional histories
His performance patterns, including habits, routines, and roles
His occupations that he needs, wants, and expected to do
His priority occupations
Contexts for occupational performance (may focus on self-care), such as cultural, personal, social,
physical, temporal, and virtual context
Activity demands on priority occupations, such as self-care
Any additional information that may be beneficial for Kento’s evaluation

What objective data do you want to gather from Kento?

His performance in self-care activities, such as bathing and brushing teeth, ideally in his natural
context
Occupational assessments related to self-care and work
Assessments for his home environment and context
Assessment for client factors, such as higher-level cognitive functions, that may affect his
engagement in self-care activities and work

How will you practice the use of evidence during your evaluation with Kento?
Use theories that are relevant to clients like Kento
Use assessment and strategies related to these theories that have good psychometric properties
and are appropriate for the evaluation of Kento
Reflect on my experience on having clients like Kento with certain occupational difficulties and my
experience in evaluating them (e.g., use of theories and assessments)
Collaborate and listen to Kento’s point of view during the evaluation

SHARE YOUR INSIGHTS AND ASK QUESTIONS!

Paulynne Angelie T. Aguhob
ptaguhob@up.edu.ph

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