Performance Assessment of Self-Care Skills (PASS)

Purpose

PASS is a performance-based, criterion-referenced, and client-centered observational tool. The purpose of the PASS is to have a holistic snapshot (person-task-environment) of the client’s ability to live independently and safely in the community by assessing performance on various ADLs and IADLs. Independence, adequacy, and safety are rated on four-point scales.

Basic Information

• Title/Author(s):
  Performance Assessment of Self-Care Skills (PASS)
  Developed by: M. B. Holm, J. C. Rogers, K. Killebrew, M. J. Moritz, & A. Darragh
  
  

• Edition and Year:
  Developed in 1994; latest edition widely used since 2010 in rehabilitation and clinical practice.
  
  

Assessment Details

• Identify TWO Types:
  
  

  • Occupation-based assessment
    
    

  • Criterion-referenced, client-centered, standardized assessment
    
    

• Cost & Accessibility:
  
  

  • Cost:
    
    

    • The manual and forms are free for educational and clinical use after completing a request form.
      
      

    • Materials (such as grooming items, cooking supplies) must be purchased separately based on tasks selected.
      
      

  • Access:
    
    

    • Shirley Ryan AbilityLab PASS Overview
      
      

Population & Setting

• Population:
  
  

  • Adults and older adults (18 years and older).
    
    

  • Suitable for individuals with:
    
    

    • Stroke
      
      

    • Alzheimer’s disease and dementia
      
      

    • Parkinson’s disease and movement disorders
      
      

    • Spinal cord injury
      
      

    • Pulmonary disorders
      
      

    • Cardiac dysfunction
      
      

    • Multiple sclerosis
      
      

    • Intellectual disabilities
      
      

    • Mental health conditions (e.g., schizophrenia, major depressive disorder)
      
      

• Settings:
  
  

  • Inpatient rehabilitation
    
    

  • Outpatient rehabilitation centers
    
    

  • Skilled nursing facilities (SNFs)
    
    

  • Home health care (PASS Home Version)
    
    

  • Community-based rehabilitation and wellness settings
    
    

Purpose & Areas Assessed

• Purpose:
  
  

  1. To provide a holistic and functional evaluation of a client's ability to complete daily living activities independently, safely, and adequately.
     
     

  2. Used for treatment planning, discharge recommendations, and monitoring functional changes over time.
     
     

• Domains Assessed (26 tasks in 4 categories):
  
  

  1. Functional Mobility (e.g., bed mobility, stair navigation, transfers)
     
     

  2. Personal Self-Care (e.g., grooming, hygiene, dressing)
     
     

  3. Instrumental ADLs — Physical Emphasis (e.g., shopping, meal preparation, laundry)
     
     

  4. Instrumental ADLs — Cognitive Emphasis (e.g., medication management, bill paying, telephone use)
     
     

Administration & Scoring

• Administration:
  
  

  • Time Required:
    
    

    1. Full administration can take 1–3 hours depending on the number of tasks selected.
       
       

    2. Clinicians can select only the most relevant tasks based on the client’s goals, diagnosis, and setting.
       
       

  • Format:
    
    

    1. Client performs real-world tasks while the therapist directly observes and rates performance.
       
       

• User Qualifications:
  
  

  • Administered by licensed occupational therapists, physical therapists, or other trained rehabilitation professionals.
    
    

• Materials Required:
  
  

  • PASS manual and scoring sheets (free download).
    
    

  • Real-world task materials such as:
    
    

    1. Grooming supplies (comb, toothbrush, toothpaste)
       
       

    2. Cooking items (oatmeal, utensils, stove)
       
       

    3. Financial materials (sample bills, checkbook)
       
       

    4. Laundry supplies (basket, clothing)
       
       

    5. Medication management tools (pill bottles, organizer)
       
       

• Scoring Procedure:
  
  

  • Each task is scored across three dimensions:
    
    

    1. Independence Scale:
       
       

       • 0 = Dependent
         
         

       • 1 = Substantial assistance needed
         
         

       • 2 = Minimal assistance needed
         
         

       • 3 = Independent
         
         

    2. Adequacy Scale:
       
       

       • 0 = Inadequate performance (unable to complete task)
         
         

       • 1 = Poor performance
         
         

       • 2 = Moderately adequate
         
         

       • 3 = Efficient and correct completion
         
         

    3. Safety Scale:
       
       

       • 0 = Unsafe behaviors present
         
         

       • 1–2 = Minor risks
         
         

       • 3 = Safe task performance
         
         

  • Higher scores across all three scales indicate greater independence, adequacy, and safety.
    
    

  • Results are used to guide treatment planning, caregiver training, and discharge recommendations.
    
    

Psychometrics/Standardization

• Reliability:
  
  

  • Demonstrates good to excellent interrater reliability across multiple tasks.
    
    

• Validity:
  
  

  • Shows strong construct validity for assessing functional and cognitive performance in real-world contexts.
    
    

• Norms:
  
  

  • Not norm-referenced; scores are evaluated using criterion-referenced standards rather than compared to population norms.
    
    

Critical Thinking Sections

Strengths

• Comprehensive and holistic — Evaluates a wide range of functional, physical, and cognitive ADLs.
  
  

• Client-centered flexibility — Only relevant tasks need to be selected and administered, saving time.
  
  

• Real-world relevance — Observes clients in meaningful activities that reflect actual life skills.
  
  

• Strong psychometric backing — Good validity and reliability for clinical use.
  
  

• Free to obtain — No licensing fee for the manual (must complete request form).
  
  

• Different versions — Offers both a clinic-based and a home version for flexible administration.
  
  

Weaknesses

• Requires specific materials — Some activities require access to specific supplies, potentially limiting use in low-resource settings.
  
  

• Time-intensive if fully administered — Full PASS takes 1–3 hours, but modular administration is possible.
  
  

• Scoring subjectivity — Clinical judgment needed; slight variability possible between raters without consistent training.
  
  

• Not norm-referenced — Interpretation relies on functional standards and therapist expertise, not statistical averages.
  
  

• Primarily validated for adults — Limited pediatric application.