Frequently Asked Questions

Here you can find answers to common questions about the COPM. If you can’t find what you’re looking for here, please contact us.

When is the best time to do the COPM with my clients?When is the best time to do the COPM with my clients?

The COPM works very well as an initial assessment. It sets the tone of the therapeutic relationship, lets the client know you will be working as partners, and helps to focus your further assessment and intervention on the issues that the client feels are priorities.

When doing the COPM reassessment, do I show the person their original scores?When doing the COPM reassessment, do I show the person their original scores?

There is ongoing debate about this issue in the field of measurement and evaluation with advantages and disadvantages both ways. In all our studies with the COPM, we have not showed participants their original scores. We suggest that you not show the clients their previous scores and have them rate their performance and satisfaction based only on their current perceptions.

I don’t seem to have enough time to do the COPM.I don’t seem to have enough time to do the COPM.

Time is a scarce commodity for all of us. However, something we have found in using the COPM is that the time invested up front doing the COPM saves time in the long run. By focusing on the issues of concern for the client, you may be able to eliminate some further assessments and by completing the COPM, the goals or targeted outcomes for the intervention are established. Additionally, the client may be more motivated to participate in therapy and you may see faster progress towards the goals.

Is there a style of COPM interview that works best?Is there a style of COPM interview that works best?

It is important for the therapist to develop his/her own style for doing the COPM and then to adapt that to the particular needs of the client. Some clients may need more structure to be able to think about their occupational performance issues, while others may be very comfortable with a more open ended approach. It is important that you get across the main idea which is to hear what the client needs to do, wants to do or is expected to do and the difficulties experienced. There is not one ìrightî way to do the COPM.

What if I identify an issue but the client does not (e.g. safety)?What if I identify an issue but the client does not (e.g. safety)?

If it is a safety issue, then you need to consider your responsibility as a professional practitioner and raise that issue with the client and/or caregiver if you are concerned. If it is not an issue around safety, then we would suggest you accept the issues raised as priorities for the client and move on from there. The other areas of concern may emerge for the client as you work together.

Can you use it with children? Do you have to change the scoring scale with children?Can you use it with children? Do you have to change the scoring scale with children?

In our experience, children younger than eight years have difficulty with the self assessment required to complete the COPM, i.e., identifying where they are experiencing difficulties. The scoring system can be explained using examples from a child’s experience, e.g., olympic judging or applied to a more concrete topic e.g., preferred foods, but it is usually the self assessment piece that is difficult for children rather than the scoring. Some research is underway at McMaster University to develop a different method to access young children’s goals and priorities.

What do you do if the person does not understand the scoring scale?What do you do if the person does not understand the scoring scale?

You can try to help the person understand the notion of scoring through the use of other examples from daily life where we rate things, e.g., sports judging, restaurant or movie ratings. However, if the client does not have the capacity to do this then you may need to just complete the interview to determine where their concerns are, but accept that the COPM cannot be scored for this client, and therefore cannot be used as an outcome measure.

What if the person does not identify any occupational performance issues?What if the person does not identify any occupational performance issues?

If you feel the client has understood the process and does not feel they are any issues, then there is no need for occupational therapy intervention. If there are others in the clientís environment (e.g. family member) who feel differently, then you may want to do a COPM with them. The COPM is a reflection of a client-centred model of practice. If the client does not articulate occupational performance issues that he/she is interested in addressing, then you will not go further with that client.

What do you do if the persons says that it is your job to identify their problems?What do you do if the persons says that it is your job to identify their problems?

Often, people are used to others in the health system identifying their problems. With the COPM, you can clarify with the clients that they are the experts on their own lives and what is important for them, so it is best for them to identify what they want to work on. Your expertise as an occupational therapist comes into play when addressing “why” these problems are occuring. You help with the issues of why the client is experiencing difficulties and what are some options you can explore together to resolve the difficulties. It is a partnership where each partner brings expertise.

What if the person I am interviewing appears to lack “insight”?What if the person I am interviewing appears to lack “insight”?

Judging someone’s level of insight is tricky business. Try to complete the COPM and take what the client has told you at face value. Doing the COPM with others in the client’s environment will help to clarify the issues and perhaps validate the results. Be careful not to pre-judge someone’s level of insight. Try to do the COPM anyway even if you are doubtful about the client’s insight. Therapists have frequently been surprised by client’s ability to identify issues for therapy intervention.

Can you do the COPM with caregivers or other family members?Can you do the COPM with caregivers or other family members?

Absolutely. This will often form a key part of the assessment process. Remember, however, when interviewing other people that you asking for their perceptions. They are not answering the questions as a proxy for the client.

Where does the COPM fit in terms of other assessments I might use (e.g. cognition, strength, self-care)?Where does the COPM fit in terms of other assessments I might use (e.g. cognition, strength, self-care)?

The COPM addresses occupational performance areas. It is the first step in the occupational therapy process. From there, you will likely go on to do further assessment of performance components and/or environmental factors that will help you and the client to understand why the client is experiencing difficulties and to formulate an action plan. This second level of assessment should be guided by the issues identified on the COPM.

Are occupational therapists the only ones who can use the COPM?Are occupational therapists the only ones who can use the COPM?

The COPM is designed for use by occupational therapists because the domain of concern is occupation. However, some multidisciplinary teams use the COPM as an intake tool to identify the client’s concerns and which members of the team need to be involved. In doing this, they often expand the nature of the interview to focus on other issues as well. The interview and scoring methods are transferable to other domains of concern, but then it is no longer the same as the original COPM.

Are there clinical populations for whom the COPM is best?Are there clinical populations for whom the COPM is best?

Occupational therapists have used the COPM with a wide variety of clients in a multitude of settings. It was designed for use with all clients regardless of their diagnosis. It may be of less value when the focus of the therapeutic intervention is very narrow, e.g., wheelchair prescription, splint fabrication or in acute care settings where the intervention time is short and there is no anticipated follow-up. The COPM cannot be used directly with very young children or individuals with severe cognitive deficits. In these cases, proxies will be necessary.

What amount of change in score represents an important difference?What amount of change in score represents an important difference?

In using the COPM as an outcome measure, the change scores from assessment to re-assessment are the most meaningful. The research evidence to date suggests that a change of 2 or more points represents a clinically important change. However, it is important to remember that the COPM is an individualized measure, so the meaning of the change scores may vary by individual. In using the COPM in research, it is best to set a change level, a priori.

Are there cross-cultural considerations in using the COPM?Are there cross-cultural considerations in using the COPM?

The research to date demonstrates that because the COPM is a client-centred measure and the interview is semi-structured, many cultural considerations are addressed within the measure. It appears that the COPM is relatively robust and clients and therapists from a number of different countries have responded very positively. The COPM may be more difficult to use in cultures that are very hierarchical and where the health professions are seen as the unquestioned authority, or cultures where the notions of distinguishing self-care, productivity and leisure are antithetical.

Can we modify the form for use in our health records?Can we modify the form for use in our health records?

This issue is currently under consideration as there are copyright implications. Please contact us with any specific requests.

Can I use the COPM in program evaluation?Can I use the COPM in program evaluation?

A number of the research articles listed in the reference section describe the use of the COPM in evaluating occupational therapy treatment approaches, educational programs, and adaptive devices and equipment. The literature strongly supports the use of the COPM as an outcome measure.

Do I need permission from the COPM authors to use the measure in a school project or in a research study?Do I need permission from the COPM authors to use the measure in a school project or in a research study?

You do not require permission to use the COPM in your project. You will just need to ensure you purchase enough forms for each of your participants. You can purchase the COPM forms here: http://www.thecopm.ca/buy/.

Can an occupational therapy assistant (OTA) administer the COPM?Can an occupational therapy assistant (OTA) administer the COPM?

The COPM is designed as an initial assessment where the therapist takes the first steps in establishing the therapeutic relationship and gives clients the opportunity to tell us about what is troubling them or what daily routines and activities are both challenging and important to them. This is a step that in most practices is typically done by the therapist. The OTA will often be more involved in later steps where goals have been identified and mutually agreed upon, assessments to understand why the client is experiencing these difficulties are done and a plan is developed.  That being said, this can vary, and we recommend that people check with their own regulatory requirements and regulations.

In locations where this practice is present or being considered, the implications are that the OT is prepared to accept responsibility for the outcomes of the OTA’s appraisal.

When I try to log into the COPM app I receive an error message noting “Invalid email or password”.When I try to log into the COPM app I receive an error message noting “Invalid email or password”.

It sounds like you might be trying to log into our website sign in page which is where you would sign in to access a purchased COPM Learning Module subscription or purchased translations of the COPM. Please ensure you are logging into the COPM App page which can be found here https://app.thecopm.ca.

Do I need to cover all of these areas in one interview?Do I need to cover all of these areas in one interview?

No, you do not. Again, try to make the process as natural as possible. You want to make sure that you’ve discussed what’s important to the client, but you may not need to delve into all of the areas, or you may choose to continue the interview in a second session.

It is important to remember that the COPM is asking for the client’s perspective. If they do not believe something is a problem, even if you do, then you will not pursue it further during the COPM interview. You may wish to document that and discuss it further with the client at another time.

What if a client identifies problem areas to work on which I believe are inappropriate?What if a client identifies problem areas to work on which I believe are inappropriate?

The COPM is an application of the client-centred model of practice; by definition, it identifies the client’s perceptions of problem areas. This assessment is only one part of the total therapeutic process. You may also wish to discuss with the client whether their identified goals are realistic.

What if I am afraid the client will be at risk if they haven’t identified a problem involving a safety issue?What if I am afraid the client will be at risk if they haven’t identified a problem involving a safety issue?

Again, you would need to discuss these concerns with that client and/or caregiver as part of the therapeutic process to recognize and deal with safety issues. You may decide to work on a problem not identified by the client, but only client identified problems appear on the COPM.

How can I be sure the client is answering truthfully?How can I be sure the client is answering truthfully?

You cannot be sure, but initially you must accept what the client has said. If evidence to the contrary comes out later on, then you may wish to discuss this with the client.

What if a person’s perception of what they do is ‘distorted’?What if a person’s perception of what they do is ‘distorted’?

Rendering judgments based on an individual’s level of insight is a difficult area. We must be very careful not to use our own values in making that judgment. Use of the COPM has indicated that clients often have excellent insight about their occupational performance problems. If client insight is a real concern, then doing the COPM with others in the client’s environment may serve to validate the concern or provide a broader picture of the client’s needs.

What do I do if my clients cannot answer the questions themselves, for example, a young child or a client with cognitive impairment?What do I do if my clients cannot answer the questions themselves, for example, a young child or a client with cognitive impairment?

It is important to hear the points of view of all clients, so we suggest that you try the COPM with the client first. The COPM has been used successfully with children as young as eight years old. If it is not possible to use the measure with a client, then look to alternatives. In these situations, it is important to determine the following: Who is the client? Who will be working with you on intervention? Is it the identified client or perhaps the caregiver, parent, spouse, teacher, nurse, etc.? You may need to broaden your thinking with respect to the client. The COPM can be used with caregivers, but remember that you will be gaining their perspective and issues, not those of the referred client. The respondents should be instructed to consider the needs of the client while describing their issues and expectations.

What if the client identifies problems for which I am not able to offer help?What if the client identifies problems for which I am not able to offer help?

That may happen and will allow you to acknowledge that the problem exists and let the client know that you will follow up on it, perhaps through referral to a different discipline or service agency. You should not feel personally responsible for dealing with all the areas that may be identified.

How do I use the COPM when doing very short-term interventions (e.g., making splint post-op or positioning client in coma from head injury)?How do I use the COPM when doing very short-term interventions (e.g., making splint post-op or positioning client in coma from head injury)?

These activities are enabling activities in preparation for occupational performance. It may be inappropriate to use the COPM in these situations, as your focus here is on reducing or preventing impairment rather than on the client’s occupational performance.

Can I interview more than one person?Can I interview more than one person?

Certainly. This situation can be very valuable for the intervention process. You may choose to interview the client and one or more caregivers and then compare results. The COPM can serve as a valuable communication tool and can be used to negotiate goals with clients during intervention. At the end of Step 1, therapists should have acquired a comprehensive picture of occupational performance areas that are of concern to the client.

What do the scores mean? How can I use them?What do the scores mean? How can I use them?

The COPM is designed as an outcome measure and consequently, the scores are used for comparative purposes at reassessment. Unlike some norm-referenced tests where you compare your client’s score against a population norm, the COPM is an individualized measure, so the client’s scores are compared against their own reassessment scores. Our research has indicated that changes of two or more points on the COPM are clinically important.

How do I use the total scores?How do I use the total scores?

Adding the scores on each problem, then dividing by the number of problems, gives the average score for each domain. These scores provide a summary and may be of interest to you and your clients. More typically, they would be useful in
program evaluation, quality improvement, and research activities where the interest may be on more summative measures of change. Two cautions are important in interpreting the average scores. There may be times when therapy goals will indicate that performance or satisfaction decreases over a period of time (e.g., an increased level of insight may cause clients to rate themselves lower for an activity on the reassessment). Adding negative change and positive change may be misleading.
You may want to consider the two separately. A second concern arises when adding scores across areas of occupational performance. The types of problems identified may vary in complexity (e.g., tying one’s shoes versus finding a new job). It may
not be very meaningful to add scores across a variety of problems, as much of the meaning will be lost. Looking for increases/decreases between Time 1 and Time 2 assessments for each problem provides more relevant information.

If someone chooses a problem to work on but then gives themselves an 8 or 9 on performance and a similar rating on satisfaction, what do you do?If someone chooses a problem to work on but then gives themselves an 8 or 9 on performance and a similar rating on satisfaction, what do you do?

It is suggested that you question if the clients have understood the rating scales, explain that they have indicated that they perform that activity very well and are quite satisfied with their level of performance. Further discussion may serve to clarify whether these are truly goals they wish to pursue.

What am I supposed to do with all the other assessments that I normally do with my clients?What am I supposed to do with all the other assessments that I normally do with my clients?

The COPM is not meant to replace all other assessments. It is meant to focus on occupational performance problems and to exercise a client-centred approach. Once the client has identified problem areas, you may need to further assess performance components and the environment to understand why the client is experiencing these occupational performance problems and to determine how therapy will proceed.

Do you have to do the scoring?Do you have to do the scoring?

No, you may choose only to conduct the interview portion of the COPM. This will help you to gather information about your client’s daily occupational performance. Without the scores, you and the client will not have a sense of the client’s priorities, the basis of intervention goals, or a process to measure the outcome of intervention.

How do I decide when to do a reassessment?How do I decide when to do a reassessment?

That should be a joint decision between you and the client. An expected date of reassessment should be set as therapy begins. The reassessment may take place near the end of therapy, or when significant change has occurred. The client may feel that some issues are resolved and he or she is ready to address some new ones, or you may want to check progress more formally. The COPM can be done as many times as is useful.

What if the client’s priorities have changed by the time of re-assessment?What if the client’s priorities have changed by the time of re-assessment?

This is something that frequently happens as the process of therapy may lead to a shift in priorities. It is important to close the occupational therapy process with the problems as identified in the initial assessment by scoring them at the time of reassessment, but then a new COPM could be completed to address the new priorities.