An important focus of occupational therapy in a community-based mental health setting is supporting individuals in the performance of activities of daily living. Engagement in activities of daily living, which includes grooming and hygiene, meal preparation, and home management tasks, contributes directly to increased independence and community participation. To implement effective interventions that contribute to measurable improvement in activity performance and accurate recommendations for community-based living, the evaluation process must precisely determine an individual’s strengths and areas of need as related to activities that are relevant to the person’s daily life. However, it is important to accomplish this with a person-centered and collaborative approach that empowers the individual and contributes to decreased stigma of mental illness.
In traditional mental health services, evaluations are conducted with a focus on deficits and assess discrete underlying components of performance separately from global performance in meaningful tasks (Pan & Fisher, 1994). This method of evaluation requires the therapist to infer the relationship between underlying functional ability and actual task performance, which is subjective and possibly inaccurate. In a study that explored the experiences of individuals in recovery from mental illness, participants reported perceptions that there was a lack of depth in assessments and that they desired a more comprehensive evaluation process (Donal et al., 2018). Participants in this study also expressed frustration at their lack of autonomy and power over their own care, while also recognizing that “trust was fostered when practitioners personally invested in them and expressed a respectful curiosity about their lives” (Donal et al., 2018, p.6).
The Assessment of Motor and Process Skills (AMPS) is an innovative occupational therapy-specific observational assessment of performance in activities of daily living. The AMPS was developed based on the assertions that occupational therapy services must center on understanding the client’s perspective, that evaluations and interventions must be based on the activities that an individual performs in daily life, and that the occupational therapy process is most effective when beginning from a top-down approach (Fisher & Jones, 2010).
The AMPS evaluation begins with an interview so that the occupational therapist can develop a keen understanding of the client’s life and the meaningful activities that the person engages in on a daily basis. The client chooses two activities to perform that are relevant to his or her daily life; the occupational therapist then observes the client performing the tasks in the client’s natural environment and rates the quality of performance based on the observable motor and process skills that comprise each task. “Motor skills relate to how the person moves him/herself, tools, and materials during the task, such as walking, bending, lifting, and manipulating items. Process skills relate to applying knowledge, organizational ability, and adaptation when problems occur, such as logically sequencing steps of the task, heeding the goal, and organizing the workspace” (Ayres & John, 2015, p.472).
The opportunity for the client to make choices during the evaluation process, while also considering the impact of the environment, contribute to the innovative nature of the AMPS and allow occupational therapy to stand out in the field of functional assessment. “The AMPS use of tasks that are familiar and ecologically relevant to the client avoids the limitations inherent in the use of highly standardized, often contrived tests in which all persons perform the same tasks whether the tasks are related to the person’s interests and values or the tasks have any apparent relationship to the ability to live independently” (Pan & Fisher, 1994, p.780).
A study on the use of the AMPS with individuals with schizophrenia found that clients were generally accepting of this type of assessment (Ayres & John, 2015). Initially, the study included 78 participants; one person was not able to tolerate the assessment process, and 7 others later declined. The researchers reported initial concern that “the intense scrutiny and note taking by the observing occupational therapist during the task performance would be off-putting for people, particularly those with anxiety or paranoia; however, the vast majority reported that this was not so. [The researchers] found that the client-centered nature of task selection has contributed to a willingness to participate” (Ayres & John, 2015, p.475).
The ability of occupational therapists to conduct person-centered observational assessments of relevant tasks in natural environments using a tool such as the AMPS contributes to the discipline’s uniqueness and value in community-based mental health services, and directly supports individuals with mental illness in realizing their full potential as independent and positively contributing members of society.
Sharon Vincuilla, OTR/L
Occupational Therapy Doctoral Resident
**The AMPS is now available at Painted Brain **
References
Ayres, H. & John, A. P. (2015) The Assessment of Motor and Process Skills as a measure of ADL ability in schizophrenia. Scandinavian Journal of Occupational Therapy, 22(6): 470-477, DOI: 10.3109/11038128.2015.1061050
Donal, O., Sheridan, A., Kelly, A., Doyle, R., Madigan, K., Lawlor, E., & Clarke, M. (2018). ‘Recovery’ in the real world: Service user experiences of mental health service use and recommendations for change 20 years on from a first episode psychosis. Administration and Policy in Mental Health and Mental Health Services Research https://doi.org/10.1007/s10488-018-0851-4
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