Measuring OT Intervention Outcomes Using the Short Child Occupational Profile (SCOPE)

Occupational therapists work with children who vary in age, abilities, and desired therapy outcomes. To support the distinct value of occupational therapy, therapists measure the effectiveness of interventions at improving a child’s ability to engage in those things that are meaningful (occupations) rather than implying that increasing a client factor (e.g., strength, range of motion) or skill (e.g., bilateral hand skills) increases the child’s ability to engage. Many assessments fail to show the unique contributions of occupational therapy rather they measure a client factor or skill instead of occupational performance.

Kielhofner’s Model of Human Occupation (MOHO) (Taylor, 2017) is a holistic, occupation-centered model of practice that can be applied to all clients. The Short-Child Occupational Profile (SCOPE) (Bowyer et al., 2008), based on MOHO, provides an assessment of the child’s occupational performance by examining volition, habituation, performance capacity (communication/interaction, process, motor), and environment. SCOPE can be used to evaluate performance in children of all ages and abilities. This study measured the effectiveness of occupational therapy intervention using the SCOPE.

This study used a pre-post design with a sample of convenience. Three occupational therapists working at the same site agreed to participate in the study. They were provided training on the SCOPE and a review of MOHO concepts. Children who were evaluated at a pediatric clinic by one of these therapists were assessed using the SCOPE at start and at 3 months. Twelve children with a range of diagnoses and ages from 2 to 13 years were included in the study.

The SCOPE is an assessment of participation that determines how volition, habituation, skills and the environment facilitate or restrict a child’s participation. Using interview, observation, and therapeutic reasoning, therapists rate the child F (Facilitates), A (Assists), I (Inhibits), or R (Restricts) as to how the item relates to the child’s performance. For example, an environment in which the child cannot move around freely would be rated R, meaning the environment restricts the child’s ability to engage in meaningful activities. F and A refer to items that enable occupation whereas I and R discourage occupation. Each score is ranked 4 (Facilitates), 3 (Assists), 2 (Inhibits), 1 (Restricts). Because these do not reflect continuous data, non parametric tests were used to compare children’s performance over time on the SCOPE.

Wilcoxon signed ranks test for non parametric data revealed a significant difference in total before and after (3 -month) scores on SCOPE for children receiving OT intervention (Z = -2.941, p = 0.003). Further analysis using Wilcoxon signed rank tests for each sub-test revealed that Volition (p = 0.003), Habituation (p =0.010), Communication/Interaction (p = 0.030) and Process Skills (p = 0.006) were significantly better at 3 months, whereas Motor and Environment were not significantly different. However, there was a large effect size for motor (r = .55), suggesting clinical significance.

Further studies are warranted with larger sample size, a control group, control over more variables (such as therapists, intervention), and comparison to traditional assessments. This study supports the use of the SCOPE to measure the effectiveness of occupational therapy. This study suggest that occupational therapy improves a child’s ability to engage in those things that are meaningful to him/her. SCOPE evaluates the child’s occupational performance based on an occupation-centered model of practice (MOHO) thereby helping to define the distinct value of occupational therapy.

References

Bowyer, P., Kramer, J., Ploszaj, A., Ross, M., Schwartz, O., Kielhofner, G., & Kramer, K. (2008). A users manual for the Short Child Occupational Profile (SCOPE) [Version 2.2.]. The Model of Human Occupation Clearinghouse. Department of Occupational Therapy. University of Illinois at Chicago

Taylor, R. (2017). Kielhofner's Model of Human Occupation: Theory and application (5th ed.). Philadelphia: Wolters Kluwer.