Interviewing as an Assessment Tool in Occupational Therapy

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					Oct1141 – Required Reading                                                           September 21/04


Interviewing as an Assessment Tool in Occupational Therapy (Marilyn Page, pp 19-39)

Objective of Chapter: give therapists knowledge and understanding needed to use an interview to
effectively to use an interview as an assessment tool

Introduction
 There are 4 methods used in gathering information for a complete evaluation of a person’s ability to
    function – 1. Interview 2. Testing 3.Case History 4.Observation
 The assessment tool used should be consistent with:
        o Therapists frame of reference
        o Match the ability of the patient
        o Promote patient-therapist relationship
        o Be effective in collecting necessary data

Definition of an Interview
 Interview technique is used in a variety of professions and thus there is no one specific definition that
    can be used
 OT combines a number of definitions to define interview “as an assessment tool that is planned oral
    communication that has a clear purpose, specific content, and a format that allows patents to tell their
    stories” (pg. 20)
 The interview enables the OT to understand patients perspective, their current level of occupational
    performance, what further functional assessment is required and how OT will help the patient

The Interview as a Screening Tool
 The first part of evaluating a client is called screening; screening is the first time that the client and OT
   meet
 Interview is often used as screening tool in order to gather initial information about the client
 Interview is used because clients find it less threatening then other assessment methods as it does
   not require doing
 It is important if interview is the assessment tool used upon first contact with client that the interviewer
   can develop a rapport with the client and a relationship of trust as this will influence the information
   that is given by the client but client and OT’s future relationship (it is important to note that the client is
   also forming a judgment about the therapist as well during this first contact)

The Interview as an Assessment Tool
 Most treatment approaches include an interview in developing a comprehensive evaluation
 According to the Occupational therapy standards the assessment tool should be used to determine
   an individuals level of functioning as related to occupational performance areas
 Using interview as the assessment tool early on in the evaluation allows the therapist to work with the
   client to assess the clients needs, functional liabilities and the relevance of occupational therapy to
   the client
 After an interview is completed as part of an initial evaluation, it should be followed up by active
   assessment tools for further assessment
 It is important that an OT structure the interview so that the client will discuss their occupational
   performance
 This “occupational” structuring of the interview is important because clients are likely to be
   interviewed by a number of individuals so it is important that they see the different focus between
   interviews
 To give an interview a occupational focus Fidler suggests that an interview address the following four
   questions:
        1. What must the patient be able to do? What specific performance skills are essential for the
             patient at this time?
        2. What can the patent do? What are the strengths, abilities, and interests of the patient, and
             does the social structure support these?
        3. What can the patient not do? What are the internal and external factors that limit
             performance?
Oct1141 – Required Reading                                                        September 21/04

          4. What intervention, what specific purposeful activity, and in what priority, needs to be taken to
              enable the patient to develop the needed skills and performances?
   It is not suggested that these questions be proposed directly to the client but that the questions guide
    the therapist in what type of information they wish to gain from the client with the specific focus of
    occupational performance
   Part of using interview as an assessment tool is observation
   Although observation is stated as a separate assessment tool it is an important part of every type of
    assessment procedure
   Observing is using one’s senses to attend to the behaviour of a client – it is up to the OT whether to
    bring up these observations with the client but the observations gained from an interview should be
    part of the information that an OT takes away from the interview
   Interview is a tool that can happen at any time or place and does not require any special equipment
    and as an assessment tool it gives the interviewer the ability to observe and discuss a wide variety of
    areas from behaviours and goals to cultural and social norms
   The information gained is useful in planning treatment as well as can provided guidance when
    evaluation performance on other assessments

The therapist as an Interviewer
 A skilled clinical interviewer needs: specific skills, attitudes and knowledge. This allows the
   interviewer to adapt an interview to each clients unique needs thus allowing for a rapport to be build

The Interviewers Attitudes
 Therapist needs to be non-judgmental and open and accepting to what patient may say during an
   interview
 Therapist needs to strive for emotional objectivity so that therapists feelings, thoughts and values
   don’t take away focus from clients values and needs
 Therapists need to respect their clients despite possible unusual behaviour and treat them as human
   beings
 Therapists should have attitude of hope – belief that people do have the ability to change
 Therapists should have compassion so that they can easily and genuinely express their concern for
   patients
 With the integration of these attitudes and using communication techniques therapists can experience
   empathy
 If a therapist comes to an interview with these attitudes an environment of safety, trust and respect
   can be developed where clients feel they can hope and have the ability change their behaviour or
   circumstance
 It is important that the interview also be self-aware and having the ability to examine themselves and
   their own assumptions and how these assumptions have influenced their understanding of the client
 Part of being self-aware is also being culturally-sensitive – being aware of one owns cultural
   assumptions will make it easier for the therapist to accept differences and respect them
 Education and experience allow the therapist to speak in professional context and this is important for
   OT’s so that they can frame their interview from an occupation perspective as well as using
   theoretical constructs to interpret information gained from interview
 It is also important for the therapist to know the dynamics of the patient care setting that they are in as
   this setting my influence their conclusion. Possible influences may be time pressure, colleagues
   opinions, team dynamics and reimbursement criteria.

The Interviewers Communication Skills
 Communication is to “send and receive messages in a way that the sender feels understood. Every
   communication interchange consists of a sender, a receiver, and the channel through with the
   message is sent” (pg. 24)
 Communication is essential to an effective interview; it is the larges single factor determining what
   kind of relationship one will have with others. Thus to have ah effective interview it is important that a
   therapist know communication techniques and be able to determine whether communication is
   effective
Oct1141 – Required Reading                                                         September 21/04

The Art of Asking Questions
 It is important that the question type, pace and length be adapted to each individual interviewee
 It is recommended that the interviewer begins with open ended question so that the patient is
   required to contribute information
 This technique allows patents to reveal information that is most important to them or information that
   they feel comfortable revealing
 Interviewers should avoid asking why? Especially in the beginning of the interview as this puts most
   people on the defensive
 Once patients begin telling their story the therapist needs to guide them so that they talk about
   occupational performance. Closed ended questions then can be used to clarify or request particular
   information but it is important not to use closed ended questions to soon as this may influence
   amount of information shared and or type
 A good interviewer then lets patient tell their story but guides them into sharing information needed
 If questions are asked that are not relevant to focus of interview this may result in irrelevant
   information being given and can result in inaccurate interpretations
 If an interview does begin to loose its focus interviewer should wait for a pause then support clients
   concerns and then restate purpose of interview and return to occupational therapy topic

Listening to Understand
 As an interviewer it is important to listen and then talk – listening is an active skill not passive
 When therapists are actively listening they are not aware of thoughts other then related to client.
    Therapist has put aside their personal concerns and clinical assumptions. They are not interpreting
    or thinking of questions while the client is speaking
 The focus is on understanding the patients response and after the patient finishes their response the
    therapist silently analyzes the information and forms the next step of the interview
 Primary goal of listening is to understand the message of the patient and let them know that the
    message was received

The Sounds of Silence
 Silence is part of communication not the absence. Silence can reflect a number of things such as
   anger or reflection
 Once a patient finishes a response silence will occur. This silence allows therapist to reflect,
   assimilate and analyze the message being given by the client and then continue to guide the
   interview
 A reflective silence may encourage client to add more info but silence could also be angry or hostile if
   client doesn’t feel interview is relevant or that the interviewer is listening to them. Overexposed
   silence may occur when individuals feel they have revealed too much and when a client is
   disoriented, forgetful a topic may be ended abruptly and they will sit in silence. A patient may also feel
   that a topic is covered and a comfortable silence of completion can occur
 Each silence carries and emotional message and an interviewer needs to listen and respond to this
   message
 It is difficult especially for new therapists to fill the silence with talk but it is important to be able to
   learn to be silent, to listen, and to value the silence.

Identifying Thoughts and Feelings
 “Feelings are a person’s responses to his or her experiences in the world” pg. 27
 “Thoughts are a person’s interpretation of the response and the experiences” pg. 27
 Every core message has an experience or behaviour and an affect (emotional response) according to
    Egan who developed a guide to help therapists respond to core messages, “You feel (affect) because
    of (experience/behaviour)
 People often relate their experience with out saying anything about their feelings. It is helpful for the
    therapist to try and identify the feeling that went along with the experience. The therapist can do so
    by observing the clients non-verbal behaviour and may start with more general category of feeling
    then become more specific
Oct1141 – Required Reading                                                       September 21/04

The Use of Reflection
 Reflection is stating the essence of the message in a few words an in a changed format allowing the
   sender (client) to hear the message from a different perspective
 Reflection may also help the client to validate, clarify, elaborate or refute the therapists understanding
 It is important not to parrot what the client said but to hear what the therapist believes the clients
   message is in different words then their own
 It may take a few interactions btwn. Therapist and client before the message is understood

Clarifying a Message
 Several message may be lumped together by a patient due to the patient not being able to sort them
    out or not being able to identify which is the most important
 “Clarification is the process of making the a message clear” (pg.28)
 Clarification involves the therapist listening for different messages and then having the client clarify
    different aspects until the message is clear
 Clarification may be needed if a patient skims over a topic which the therapist knows is related to the
    patients functional patter or when specific topics are referred to or culture-specific language is used
 It is helpful when requesting clarification to state why you are doing so and to keep the request open
    ended

Using Prompts
 Assistance may be needed for a discussion to continue on a thought or topic and communication is
   encouraged by using a manner, gesture or words that are not specific in the kind of info they seek
   out.
 Prompts are techniques that that facilitate communication and can be verbal or non-verabal (nod of
   head)
 When using non-verbal gestures it is important to use them appropriately (i.e nodding as a prompt as
   opposed to nodding head to indicate agreement) and be aware of cultural differences that may exist

The Interviewer’s Non-Verbal Communication Skills
 Therapists posture and general body language is a significant factor in communication process
 Therapists should be positioned so that they are at a client’s eye level and positioned in such a way
   that both client and therapist can see each others non-verbal behaviour
 Therapist needs to sit in a way that there body is relaxed but alert – body language communicates a
   lot so it is important to not only be aware of facial expression but body language as well
 It is also important to be aware of a clients culture and how body language may be interpreted
   through that cultural perspective

Structure and Control of the Interview
 The interview must be structured (set boundaries, identify the primary topics, develop a time frame,
    and provide a confidential, comfortable environment) and the interviewer must maintain control (to
    mange and regulate the achievement of the interview) of the interview
 With the effective use of communication techniques allows for an interview where the client has
    control over what the share within the structure laid out by the therapist

Preparation for an Interview
 Quality of interview is related to preparation is related to quality of therapist preparation although
   preparation time may depend on experience (novice vs. experience)
 One part of planning is to establish the structure, set the boundaries, the topics and the time frame
 The therapist needs to clearly understand the purpose of the interview, the information that is needed,
   and the priority of the different topics
 Interview should take place where patient feels physically and emotionally safe and knows the
   conversation is private and confidential
 Room used for interviewing should be neutral in its demand for competence
Oct1141 – Required Reading                                                       September 21/04

Giving the Interview
 Three parts to an interview: introduction, where the relation ship is initiated; body, where major info is
    gathered; and closing, where the outcome of the interview is summarized and next step stated. Each
    of these parts is important for a successful interview and thus cannot be cut

Introduction
 Vital part of any interview is clearly stating therapists name and role to the patient and should be done
    immediately
 Next validating the patients name, pronunciation and how the patient would like to be addressed
 Then explain purpose of interview and the clients understanding of it
 Patients may express concerns not related to occupational therapy despite knowing the purpose of
    interview and the therapist needs to listen and respond to it
 The intro only takes a few minutes but is crucial especially in personalizing the interview which can be
    done by the interviewer finding out something unique about the client that shows to the client that the
    therapist sees them as unique (i.e. is that a picture of your son? Does he live at home with you?)
 Therapist should avoid making comments to offer false reassurance
 Establish a time frame for the interview and state that how much time the interview will take
 Should make patient aware if testing methods are going to be used
 The introduction part of the interview will save time, as it encourages patient involvement in the
    evaluation process.

The Body of the Interview
 Involves largest block of time and where oral interactions are directed to establish a positive patient-
   therapist relationship and to gather desired information
 Therapist follows a planned sequence of topics, but is flexible to where patient may take topic
 Summary of core message at the end of each topic occurs, and encourage patient to validate,
   elaborate, or correct any information
 Begin body of interview with open-ended question then narrow discussion to function area.
 If therapist needs to make an obvious change in topics, he or she should state it so patient can follow
   theme of interview.

Closing the Interview
 Therapist must be aware of the time and start closing the interview by stating how much time remains
   this cue will allow patient to have some control over how much more they want to reveal and say what
   they may not have known when to say it
 Therapist summarizes content of the interview and gives patient chance to correct or clarify
 Do not open any more areas of exploration
 Ask patient if they have any questions, and inform what happens to the information
 Thank patient and complete interview on positive emotional level using warm personal comments
   about patient so they feel accepted and cared.

Documenting the Interview
    Focus of therapist is on patient not note taking (have choice to take notes during interview or do it
     afterward). If so, use clipboard or check sheet, not a laptop
    Must inform patient if do take notes and tell that they can see them at any time during interview
    Must get permission from client to use audio or videotaping
    Complete documentation of interview needs to be done immediately afterward.

Techniques for specific interviewing situations

Note: I’m just going to list the type of interview situations. I found I couldn’t really summarize
these situations as they were suggested responses and why you should do certain things so I
suggest skimming them over

       People who are Hostile or Aggressive
       People Who are Frightened or Suspicious
Oct1141 – Required Reading                   September 21/04

      People Who are Silent
      People Who Have Incoherent Speech
      People With Rapid Tangential Speech

				
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