Comprehensive Occupational Therapy Evaluation 

Overview

Author(s): Brayman, S.J., Kirby, T.F., Misenheimer, A.M., & Short, M.J.

Year of Publication: 1976

Publisher: The American Journal of Occupational Therapy

Type of Assessment:

• Non-standardized

• Observation-based

• Behavior Rating Scale

Cost: $$

How to Access: https://archive.org/details/assessmentsinocc0000unse_i6l8/page/n9/mode/1up 

Age: Adolescents, Adults (18-64), Geriatrics (65+)

Diagnoses: mental health conditions/concerns

Setting: acute rehab, mental health programs, inpatient psychiatric rehab, home health, outpatient rehab, SNF

Areas Assessed:

• General behaviors

  • Appearance

  • Nonproductive behavior

  • Activity level - hypoactive v. hyperactive

  • Expression - body language, facial expression, tone, posture

  • Responsibility 

  • Attendance/Punctuality

  • Reality orientation

  • Conceptualization

• Interpersonal behaviors

  • Independence

  • Cooperation

  • Self-assertion - passive v. aggressive

  • Sociability - withdrawn v. socially active

  • Attention-getting behavior

  • Negative response from others

• Occupational behaviors

  • Engagement

  • Concentration/Attention

  • Coordination

  • Follow Direction

  • Activity Neatness/Attention to detail - lack of attention to detail v. overfocused/detailed

  • Problem-solving

  • Complexity & organization of task

  • Initial learning

  • Interest in activities

  • Interest in accomplishment

  • Decision making

  • Frustration tolerance

Administration 

Time: 20 mins (depends on client's performance)

Group/Individual: Individual

Subtests: 3 main categories - general behavior (7), interpersonal behavior (6), task behavior (6)

Instructions: Directions will vary with the task chosen to be observed. Prompting and intervening should be kept to a minimum to determine what the client can do independently unless safety becomes a concern

Materials: evaluation form, pencil, materials vary based on activity being observed (e.g. pudding mix, milk, bowl, whisk, measuring cups)

User Qualifications: OT

Scoring Procedures

How to Score: Each item is scored on a 5-point scale (0-4) 

• Normal = 0

• Minimal = 1

• Mild = 2

• Moderate = 3

• Severe = 4

• Scores are determined based on the definitions given in the appendix where the behavior is correlated with a score

• Obtain sub-totals by adding the totals of each category within each subsection

• Obtain an overall total from the sub-totals

Score Indications: 

• Higher scores indicate greater dysfunction in the specific behavior

Psychometrics

Reliability: 

• Test-retest reliability

  • ICC= 0.91-0.97

Validity: Adequate

• changes in scores aligned with the observations made by professions between the first and last days of treatment

Pros & Cons

Strengths:

• Can be useful to address behaviors and progression over time with different trials

• Version available for children & adolescents (KidCOTE)

• Glossary of definitions ensures consistency across raters in terms of what they should be observing

• Useful in treatment planning

Weaknesses:

• Non-standardized

• Limit info/evidence and accessibility which could impact implementation & results

References

• Hemphill-Pearson, B.J., & Urish, C.K. (2019). Assessments in occupational therapy mental health: An integrative approach (3rd ed.). SLACK Incorporated.

• Chiu, E.C., Lee, S.C., Lai, K.Y., & Gu, F.Y. (2020). Test-retest reliability and minimal detectable change of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in people with Schizophrenia. The American Journal of Occupational Therapy, 74(5), 1-7. https://doi.org/10.5014/ajot.2020.040154