Abstract
Presently, there is no research examining the efficacy of home OT evaluations done prior to the start of therapy, as a means to support the therapeutic process. A new service model is warranted that provides contextual information that supports care and promotes skill transference to natural environments. Clients and OT students within a student-led, faculty-supervised OT center were interviewed to determine the impacts of a piloted initial in-home OT evaluation program.
Primary Author and Speaker: Margaret Flynn
Additional Authors and Speakers: Mary Hildebrand
Presently, there is no research examining the efficacy of home OT evaluations done prior to the start of outpatient therapy, as a means to support the therapeutic process. Literature has primarily focused on the benefits of home evaluations for environmental modifications and safety, with little consideration to how this valuable information can improve practitioners' clinical reasoning and clients' therapeutic progress (Atwal et al., 2014; Lockwood, Taylor, & Harding, 2015; Somerville, Smallfield, Stark, Seibert, Arbesman, & Lieberman, 2016). As therapists, it is imperative to be aware of how a client's occupational performance and participation at home may change when compared to their performance in the clinical setting. A new service model is warranted that provides contextual information that supports care and promotes skill transference to natural environments. While OT practitioners support performance and participation in various contexts, clients' transference of skills to the home and other non-clinical settings is limited (Babulal, Foster, & Wolf, 2016). Thus, researchers sought to determine whether an in-home evaluation pilot program, followed by visits in a student-led, faculty-supervised, pro-bono OT center would have 1) an impact on the delivery of services by OT students in the student-led, faculty-supervised, OT center, and 2) an effect on clients' perception of their therapeutic experience. Researchers utilized a mixed method design with purposive sampling to recruit clients who would be receiving OT services in the student-led, pro-bono center. Each participating client (N = 4) received one in-home OT evaluation at the beginning of their services in the pro-bono, student-led OT center. The home evaluation involved administration of the I-HOPE, WHO-QOL, and Patient Specific Functional scale, as well as informal observations of their performance in their home. The information obtained was then relayed to the client's treating OT student in the center; usual outpatient services were then performed by students. Due to COVID-19, clients were unable to be re-evaluated using those assessment tools. Therefore, researchers used a Likert-scale questionnaire to determine the clients' perceived benefits of the in-home evaluation. The five OT students who treated the clients in the pro-bono OT center were also interviewed to determine the impact the in-home evaluation had on their clinical reasoning in treatment sessions with their client. Based on the results of the questionnaire, clients felt the in-home evaluation benefited their care, by supporting their progress in the OT center, bringing up information not previously discussed in the OT center, and helping establish more relevant goals. The treating OT students believed the home evaluation was critical in their client's ability to transfer skills. The students also expressed how it created a bridge to discussing deeper issues limiting their client's performance and participation in daily activities that would not have been identified without the home evaluation. The in-home evaluation positively influenced the care provided by the treating OT students by reframing their thinking process and allowing a more personal and collaborative relationship to be built with their client. The participating clients similarly perceived the evaluation to be beneficial to their therapeutic experience, as they felt it contributed greatly to their therapeutic progress. This study piloted a novel approach of performing an initial OT evaluation in the home. Study findings serve not only as a basis to further examine this service delivery approach, but advocate for greater use of this in-home OT evaluation method and support viewing the client with a more contextually complete lens.
Atwal, A., Spiliotopoulou, G., Stradden, J., Fellows, V., Anako, E., Robinson, L., McIntyre, A. (2014). Factors influencing occupational therapy home visit practice: A qualitative study. Scandinavian Journal of Occupational Therapy, 21, 40-47. https://doi.org/10.3109/11038128.2013.821162
Babulal, G. M., Foster, E. R., & Wolf, T. J. (2016). Facilitating transfer of skills and strategies in occupational therapy practice: Practical application of transfer principles. Asian Journal of Occupational Therapy, 11(1), 19-25.
Lockwood, K. J., Taylor, N. F., Harding, K. E. (2015). Pre-discharge home assessment visits in assisting patients’ return to community living: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 47(4), 289-299.
Somerville, E., Smallfield, S., Stark, S., Seibert, C., Arbesman, M., & Lieberman, D. (2016). Evidence Connection- Occupational therapy home modification assessment and intervention. American Journal of Occupational Therapy, 70, 7005395010. http://dx.doi.org/10.5014/ajot.2016.705002