Kohlman Evaluation of Living Skills (KELS)

Overview 

Authors: Linda Kohlman Thomson & Regi Robnett

Year of Publication: 2016 - 4th edition (original 1978)

Publisher: American Occupational Therapy Association, Inc.

Type of Assessments: 

• Standardized

• Interview-based; minimal Performance-based

• Observation-based

Cost: $$ - $112 for AOTA member/$162 non-member

How to Access: https://www.sralab.org/rehabilitation-measures/kohlman-evaluation-living-skills 

Age: Adolescents, Adults, Older Adults

Diagnoses: Alzheimer's disease, dementia, traumatic brain injury, mental health conditions

Setting: Inpatient units, acute care in hospitals, nursing facilities, outpatient settings, living skills training programs

Areas Assessed:

• ADLs

• Cognition

• Communication

• Life Participation

• Occupational Performance

• Self-care

• Safety & health

• Money management

• Community mobility & telephone

• Employment & leisure participation

Administration 

Time: 30-45 mins

Group/Individual: Individual

Subtests: 17 skills in 5 areas 

• Self-care (frequency of activities & appearance)

• Safety & health (awareness of dangerous household situations, identification of appropriate action for emergencies, accidents, health, and knowledge of location of medical & dental facilities)

• Money management (use of cash for purchasing, payment of bills, obtaining & maintaining source of income)

• Community mobility & telephone (mobility within community, basic knowledge of public transit system, use of telephone)

• Employment & leisure (plans for future employment, leisure activity involvement)

Instructions: Evaluator will ask specific instructions & questions that are printed in boldface italic letters and should be stated as written to establish reliability & validity.

• Before administering, obtain client information: 

  • Client's residence? (address & type of residence, e.g. single family, apartment)

  • Client live alone, with other people, or in a facility where assistance is provided?

  • Does client use cell phone and is it accessible?

  • Does the client use electronic banking for paying bills? If yes, have a device with bill-paying program open.

Notes:

• Limit conversation to the item being evaluated & be brief in questioning

• Additional comments should be avoided unless needed to maintain the client's attention

• Do not give feedback concerning scores given or notes made. If the client asks, restate that results will be discussed following the completion of the evaluation.

• Client should sit on the non-dominant hand side of the evaluator (e.g., if the evaluator is left-handed, the client should sit on the right) or across the table; the score form should not be between the evaluator and client to create distractions

Materials: Manual, Score form, Household situation pictures, Telelphone book, cell phone, tablet/notebook/laptop/personal computer, Toothbrush, Deck of cards, 5 $1 bills, 1 quarter, 1 dime, 1 nickel, 2 pennies, Utility bill with current due date*, erasable pen, check form*, envelope, banking item*, price tags*, money order form*, nickel bank information card*, rock power & light information card, landline telephone, sample recorded message card*, Reading & writing form*

• *Available within KELS Flash drive

User Qualifications: Any health professional with skilled interpretation is needed 

Scoring Procedures 

How to Score: There are two scoring categories: (1) independent and (2) needs assistance. Specific criteria for determining the client's score on each separate item are given at the end of the administration directions for each item.

• Scoring criteria are based on the minimum standards to live independently in the community

• Independent: level of competency needed to perform basic living skills in a manner that maintains the client's safety and health without the direct assistance of other people

• Needs assistance: DOES NOT mean the person is incapable of living independently; however, the score applied to that particular item shows that the individual needs assistance for that living skill; it is a reflection of his/her current status

• After a score for an item is determined, a check of "X" is made in the appropriate box on the score form. Notes sections should include important additional information

  • "Not Applicable" - used for any item that does not pertain to the client's specific living situation (e.g. someone who is retired does not need "plans for future employment")

  • "See Note" - used for any item that cannot clearly be scored "independent" or "needs assistance"

• Areas of Concern section is available if evaluator wants to comment from observations on cognition, regular assistance by another person (who and frequency)

• Summary section:

  • determine whether the client needs assistance in any areas to be safe and meet basic needs

    • can then recommend types of living situations (e.g. skilled nursing facilities) or specific living situations (e.g. living with a spouse)

  • match the client's strengths and areas of assistance needed to an appropriate living situation that is the least restrictive environment 

Score Indications:

Psychometrics

Reliability: 

• Interrater: Adequate to excellent

  • ICC = .74-.98

Validity: 

• Concurrent

  • Spearman: High (against FIM, RTI, & MMSE)

  • -.76 (p < .001) - KELS v. MMSE - higher/better MMSE score = lower/better KELS score

• Convergent

  • Moderate

  • r=-.508 (p < .001)

Pros & Cons

Strengths: 

• Takes into account environments that clients will be most successful in to increase satisfaction, motivation, & sense of independence

• Provides a quick, short assessment of basic living skills

• Interview-based - provides a real response to ADL performance to find appropriate ways to accommodate for

• Allows for recommendations to be made for living situations to promote independence in function - useful for discharge planning

• Easily assemble the equipment required and transport it with little effort

• Scoring is easy to read and effectively communicates the results of the evaluation

• Sensitive to address the many ways people currently access and use different methods of completing activities, like telephone use and monetary transactions

• No overall score - does not rely on a single score to apply to all types of living situations

• Multidisciplinary team approach involving the slient in the decision-making process

Weaknesses: 

• Not a comprehensive evaluation of living skills

• Not recommended to be used in settings that involve long lengths of stay, as individuals' financial, transportation, work, & leisure resources have changed as a result of the length of stay

• Does not specify the level of assistance needed

• Not applicable to rural areas, as "urban-based" items may not be applicable

• Not culturally translatable 

• Not useful if hospital or institutional stays are >1 month

• Not largely performance-based, more knowledge-based, and may not be an accurate representation of their abilities - requires additional performance-based testing to follow-up

References

• Thomson, L. K., & Robnett, R. (2016). KELS: Kohlman Evaluation of Living Skills. AOTA Press. 

• Shirley Ryan Ability Lab. (2019, April 26). Kohlman evaluation of living skills. https://www.sralab.org/rehabilitation-measures/kohlman-evaluation-living-skills