Frequently Asked Questions

Answer: An outcome is an instrument designed specifically to capture change. In the case of the COPM it has been designed specifically to capture the change in performance and satisfaction. By comparing the COPM scores on performance and satisfaction from before intervention to those after intervention, you can quantify the differences in performance and satisfaction and therefore quantify the changes that have occurred.

Answer: 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 together as partners, and helps to focus your further assessment and intervention on the issues that the client feels are priorities.

Answer: 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.

Answer: If you feel the client has understood the process and does not feel they are any issues, then there is likely no need for occupational therapy intervention at this time. If there are others in the clients 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 likely go further with that client.

Answer: “An occupation that a person wants to do, needs to do or is expected to do, but can’t do, doesn’t do, or isn’t satisfied with the way they do.” (Law et al., 2019)

Answer: 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 occurring. 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.

Answer: 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.

Answer: 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.

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

Answer: 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.

Answer: A number of the research articles listed in the reference section describes 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.

Answer: 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.

Answer: The COPM was originally designed for use by occupational therapists to address occupation. However, many multidisciplinary teams now use the COPM as an intake tool to identify 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 include issues other than occupation. The interview and scoring methods are transferable to other domains of concern, but if the focus is not on occupation, then it is no longer the same as the original COPM. The key is that the COPM interview, even when used by other professionals, still focuses on occupation, i.e., what the client wants, needs, or is expected to do. Other professionals and also OTs, have challenges when identified problems are focussed on impairments. For example, if the problem is labelled as mood or pain or endurance, it is no longer an occupational focus! It is the occupations that those problems are preventing that should be the focus when administering a COPM. Intervention can then focus on addressing issues that are limiting performance of the client’s identified occupations. It is at this stage that other disciplines bring in their specific expertise (e.g., saying sounds, walking a certain distance, strengthening, stress management, language development).

Answer: 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.

Answer: 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 ‘right’ way to do the COPM.

Answer: 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.

Answer: 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.

Answer: 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.

Answer: 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.

Answer: Judging someone’s level of insight is often challenging. 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.

Answer: 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.

Answer: 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.

Answer: 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.

Answer: 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.

Answer: 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.

Answer: 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.

Answer: 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 the amount of change in the COPM scores that is clinically important depends on the population, type of intervention and the environment in which intervention is done. For a full discussion of this, see the November 2021 COPM Newsletter. 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.

Answer: 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.

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.

Answer: 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. However, 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.

Answer: 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.

Answer: An outcome is an instrument designed specifically to capture change. In the case of the COPM it has been designed specifically to capture the change in performance and satisfaction. By comparing the COPM scores on performance and satisfaction from before intervention to those after intervention, you can actually quantify the differences in performance and satisfaction and therefore quantify the changes that have occurred.

Answer: The COPM was originally designed for use by occupational therapists to address occupation. However, many multidisciplinary teams now use the COPM as an intake tool to identify 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 include issues other than occupation. The interview and scoring methods are transferable to other domains of concern, but if the focus is not on occupation, then it is no longer the same as the original COPM. The key is that the COPM interview, even when used by other professionals, still focuses on occupation, i.e., what the client wants, needs, or is expected to do. Other professionals and also OTs, have challenges when identified problems are focussed on impairments. For example, if the problem is labelled as mood or pain or endurance, it is no longer an occupational focus! It is the occupations that those problems are preventing that should be the focus when administering a COPM. Intervention can then focus on addressing issues that are limiting performance of the client’s identified occupations. It is at this stage that other disciplines bring in their specific expertise (e.g., saying sounds, walking a certain distance, strengthening, stress management, language development).

Answer: 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.

Answer: 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.

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.

Answer: 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.

Answer: Modifying the COPM is not permitted as it would be a violation of the copyright and integrity of the COPM. The reliability and validity of the COPM are dependent on it being used the way in which it was developed. It is therefore very important that the measure be used correctly and in the same way that it was tested. Please contact us if you have any questions about this issue.

Answer: If your organization is using an electronic record system, a non-exclusive license to include the COPM directly into an EHR is available. This involves the organization signing a licensing agreement with COPM Inc. and paying a fee which would permit the organization to replicate the COPM Measure into their EHR system. 

The Licensing fees* include the following:

• One-time administrative fee to cover licensing, review of the replication, and support for initial use (including video support calls if necessary)
• Annual fee for a package of Measures 
• Discounted rates are available for multi-year agreements 

*Fees will depend on the number of therapists accessing the COPM and the number of COPM Measures that would be completed over one year. If you are interested in receiving more information on licensing the COPM, please contact us.

Answer: 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: https://www.thecopm.ca/buy/ 

Answer: We are unable to offer a free trial of the COPM or the COPM learning module. Please contact us if you have any further questions about these products.