Occupational Performance Problems

A recent inquiry on the website raised an issue that might be of interest to many readers. The inquirer asked “What do you do when COPM problems that were initially identified are no longer relevant at the time of re-assessment? For example, a client wanted to be able to make Christmas dinner for her family, and now that the holidays are past, that goal is no longer meaningful.”

The underlying issue here relates to the decision about what constitutes an appropriate reassessment interval, and it comes up often in our conversations with therapists and students. There is no correct, pre-designated reassessment interval – it is entirely a function of clinical judgement. It is typically based on a number of factors, such as:

  • How demanding and complex are the problems the client has identified?
  • How does the client’s condition affect the progress he or she will be able to make toward the desired goal?
  • Are there external factors that will determine what can be achieved?
  • How often can you see the client and what sort of therapy intensity can you realistically offer?
  • Do you have an externally-governed window of treatment time – eg., 6 visits, one month?

We recommend setting goals that can realistically be achieved within a reasonable period of therapy. This tends to keep both therapist and client motivated and to ensure that goals remain relevant. It may mean setting sub-goals for larger projects, but isn’t that what OTs do anyways as part of the process of activity analysis?

We also recommend going ahead and re-scoring the now obsolete problem, even if it wasn’t achieved. Then a discussion can take place about why it wasn’t achieved, and a decision can then be made about the way ahead, and changing the plan for therapy if necessary.

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