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.
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.
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.
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.
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.
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 childrenís goals and priorities.
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.
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.
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.
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 someoneís 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 clientsí ability to identify issues for therapy intervention.
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.
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 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.
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.
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.
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.
This issue is currently under consideration as there copyright implications. Please contact Mary Law with any specific requests.
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.Return to Main Menu
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