Developmental Disabilities

A Handbook for Occupational Therapists

David A Ethridge,Jerry A Johnson

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136554513
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

This significant volume provides broad coverage of the spectrum of problems confronted by patients with developmental disabilities and the many kinds of occupational therapy services these individuals need. Experts identify exemplary institutional and community service programs for treating patients with autism, cerebral palsy, epilepsy, and mental retardation. A welcome contribution to the meager professional literature on the subject, Developmental Disabilities: A Handbook for Occupational Therapists will be an enormously helpful resource for therapists who work with both children and adults, ranging from mild to severe levels of impairment. You will learn how to establish a therapeutic environment for children with autism, develop a pre-vocational program in a pediatric skilled care facility, use qualitative research to obtain insight into the world of adults with significantly limiting cerebral palsy, and provide early intervention for your developmentally disabled patients.

On the Formative Stages of the Adult Screening Questionnaire: A Managerial Approach for Screening Adult Developmentally Disabled Clients

DOI: 10.4324/9780203056547-6

Sharon Lefkofsky MS, OTR

Tamara E. Avi-Itzhak DSc

SUMMARY. This article describes the formative stages of a screening tool for developmentally disabled adults, the Adult Screening Questionnaire (ASQ). ASQ offers occupational therapists a uniform approach for screening clients. Employing the ASQ will result with a client profile that leads to improved capability in screening outcomes for service delivery: prioritizing caseloads, identifying domains of need for comprehensive evaluation, facilitating clinical decision making, and reporting population needs to administrators. These screening outcomes contribute to determining the client evaluation and program intervention necessary for the service delivery process.

Reported are rationale for the development/use of the instrument, previous validity studies, modifications, and pilot study testing for reliability. The Clients Profile will enable the clinicians to establish three priority levels according to clients’ needs. In addition, each client’s needs are identified on nine domains of occupational therapy programmatic concern. A summary of findings for five outcomes for service delivery is introduced. Limitations and plans for further modification and study are discussed.

Introduction

This article describes the formative stages of the development of the Adult Screening Questionnaire (ASQ). The ASQ makes it possible for occupational therapists to employ a uniform approach for screening a new group of adult developmentally delayed adults. Employing this screening tool will result in a client profile that leads the individual therapist to improved capability in the following screening outcomes for service delivery: (a) prioritize caseloads, (b) identify domain/s of need for occupational therapy service, (c) assist in determining further areas for assessment, (d) facilitate clinical decision making, and (e) report population needs to administrators. These screening outcomes along with client evaluation, program intervention, and program evaluation constitute the service delivery process. These screening outcomes contribute to determining the client evaluation and program intervention necessary for the service delivery process (Halpern et al., 1982; Halpern, 1986).

Since developmentally delayed individuals present a complex set of problems and services to these individuals are not unlimited, identifying such a tool is essential. Even an experienced occupational therapist can feel overwhelmed when confronted with the difficulties of prioritizing a caseload from the total existing population. In addition to establishing a priority caseload, the therapist must make a clinical decision with regards to which domain occupational therapy intervention should be focused upon for a given client.

The above concerns, plus the need for a uniform approach to screening, led to the search for an existing screening tool that would give focus to the occupational therapist in the management of his/her caseload. The rationale for the choice of the ASQ was based on convincing validity tests performed by its originators.

The ASQ was developed by Charlotte Exner for the Kennedy Institute, Department for Community Services, Baltimore, Maryland. The Kennedy Institute granted written permission for the first author to modify the ASQ in 1986. Further elaboration will follow later in this paper.

The article includes a section on background information which provides rationale for the development/use of the instrument. Previous validity studies, modifications made by the authors, and pilot study testing for reliability are reported. Clients Profile, the summary of findings, demonstrates the ASQ’s capacity for improving the five outcomes for service delivery mentioned above and will be introduced. Finally, limitations and plans for further modification and study are discussed.

Background and Need

Measurement of Outcome in Developmental Disabilities

In his chapter, Halpern (1986), has offered an analysis of the issues of measurement in mental retardation and use of uniform terminology along with a decision-making model for the service delivery process. This analysis and the decision-making model reflect shifts which have occurred in the past two decades from emphasis on classification and diagnosis of mentally retarded to the assessment of the service delivery process.

Measurement of Outcome in the Context of Service Delivery

Traditional measurement of persons with mental retardation (hereinafter referred to as M.R.) were mainly psychometric ones and were driven by the concept and definition of mental retardation. Due to the psychometric nature of these measures, they concentrated on incidence, prevalence, and prevention. In addition, the assessments were often not originated for the specific needs of persons with M. R. Furthermore, these assessments were often administered in isolated settings removed from the environment where the behavior usually occurs. Such assessments did not have characteristics for testing skill attainment and community adjustment.

Another related issue of measurement is format. The two basic formats which appear representative of contemporary assessment of persons with retardation are tests and rating scales (Halpern et al., 1982, p.9–99). While tests require some behavior on the part of the person being tested, rating scales involve judgement of a reporter, a third person, who describes the behavior of the client being evaluated. Each format has strengths and weaknesses: the rating scale is criticized as being more susceptible to errors of judgement. The rating scale is generally considered a better estimate of performance over time. Tests permit a limited number of opportunities to respond to test items. The advantage is that one has the opportunity to view actual performance. The chosen format for the ASQ is the rating scale. This decision was based on time restraints, client availability, and performance variances.

These traditional measurement practices did not contribute to the service delivery process as presently perceived. Furthermore, these measurements posed methodological problems related to their validity and reliability.

The most current definition of mental retardation issued in 1983 by the American Association of Mental Retardation (Grossman, 1983) essentially has three components which contribute to the service delivery process. These are intelligence, developmental period, and adaptive behavior. Intelligence serves only for the purpose of documenting an impairment whereas raising the intelligence is not considered as a goal of the habilitation process (Halpern, 1986, p.30). Developmental period is generally interpreted to mean the initial diagnosis which occurred before the age of eighteen. Adaptive behavior, replacing the traditional term of social competence, serves as an indicator for the repertoire of social skills. This term was changed because of ...