The Back on Track Assessment is completed in two stages:
Assess mental health status
First, the Occupational Therapist in Mental Health assesses the individual's mental health status. This includes a comprehensive assessment considering all details of the injury, the diagnosis, history and treatment to date. The Occupational Therapist in Mental Health may also use recognised and standardised mental health assessment tools to help gain the best understanding of the current health status.
Second, the Occupational Therapist will assess function. This component of the assessment looks at habits, routines, roles, values, interests, environment, attitudes, motivation, activities of daily living (ADL), family and relationships.
This two-part assessment provides the Occupational Therapist with a comprehensive picture of the individual's health status and how it is impacting their ability to perform skills and tasks that are important in daily life. A comprehensive and targeted rehabilitation program can then be developed and implemented.
The initial assessment, undertaken at a location negotiated with the individual, uses a range of evidence based assessment tools to determine rehabilitation requirements. Where appropriate a rehabilitation plan will be formulated and detailed in the Initial Assessment Report.
Components of the Initial Assessment may include:
- The individual’s level of function in terms of their work and home roles.
- Determination of the occupational performance components, including how the psychological illness or condition impacts on functioning.
- Whether daily routines can be modified/simplified to improve function.
- If re-organisation and/or modification of the physical environment, use of cues and development of structure/plan for management of day to day activities is required.
- Exploration of factors motivating the individual to engage in activities/occupations.
Some of the tools which may be used during the Initial Assessment include those drawn from the Model of Human Occupation (Kielhofner 2003) which explores the individual’s motivation to engage in occupations (self care, work and leisure), how they structure their time, the physical and mental skills required to perform occupations and the influence of the environment on occupation. These include:
Worker Role Interview (WRI)
A semi structured interview designed for use as the psychosocial/environmental component of an initial rehabilitation assessment process for the individual. It is designed to have the individual discuss various aspects of their life and job setting that have been associated with past work experience.
The theoretical framework that underpins the WRI seeks to explain how human occupation is motivated, patterned and performed and how those components interact with the environment.
Occupational Self Assessment (OSA)
The Occupational Self Assessment captures an individual’s perceptions of their own occupational capability and of the occupations they consider important. It gives an indication of how well the individual is functioning in particular areas, together with how they value the importance of those areas. This enables the individual to identify priorities for change and, working together with occupational therapist, they can establish intervention goals and assess progress and effectiveness of intervention.
The Model of Human Occupation Screening Tool (MOHOST)
The MOHOST is a screening assessment for a broad range of occupational participation issues. It consists of 24 items exploring motivation, occupational patterning, skill (motor, process, communication and interaction skills) and environment.
Other assessment tools
Depression, Anxiety, Stress Scale (DASS-42)
Although not an occupational therapy specific tool, the DASS-42 is a useful 42 item self report designed to measure the three negative emotional states of depression, anxiety and tension/stress.
A four point severity/frequency scale is used to rate the extent to which the individual has experienced each state over the last week.
Domestic and Community Skills Assessment (DACSA)
The DACSA (Collister & Alexander 1991) is used to assess an individual’s performance of essential tasks for living in the community, through a behavioural rating scale and commenting on qualitative aspects of the individual’s performance.
Initial assessment report
A comprehensive Initial Assessment Report is compiled using the results of the tools administered during the initial assessment.