Comprehensive Occupational Therapy Evaluation (COTE) Scale

Author(s)

Brayman, S., Kirby, T., Misenheimer, A., & Short, M.

Year of Publication/Publisher

1975, AOTA

Type of Assessment

criterion-referenced, observation based, rating scale

Cost & How to Access

Free, COTE Scale - 2025SP Assessment: Theory & Measures (OTD-523-02)

Population

adults, older adults, mental health conditions

Appropriate Settings

Mental health, inpatient psychiatric, outpatient, community

Purpose of Assessment & Function(s)/Area(s) Assessed

Looks into performance patterns and behaviors that impact function using a scale from 0-4 where 0 is normal and 4 is severe. Areas the COTE looks into are general behavior including appearance, expression, reality orientation; interpersonal behavior including independence, sociability, negative response from others, attention-getting behavior; and task behavior including engagement, coordination, attention to detail, complexity of tasks, interest in accomplishment, and frustration tolerance.

Administration

individually administered, can be assessed across multiple dates and be used for data collection as there are 7 days allotted for dates so it can be administered for a week with any amount of time to collect the data.

User Qualifications

Occupational therapists, psychologists, psychiatrists

Materials Required

COTE Scale scoring form

activity for client to participate in during session (requires different materials that depend on the activity)

writing utensil

Scoring Procedure

Scoring is 0 for normal, 1 for minimal, 2 for mild, 3 for moderate, and 4 for severe. Higher scores indicate higher need for support with behavioral awareness and engagement in functional activities. Lower score means less severe.

Psychometrics/Standardization (norms, reliability/ studies)

Poor face validity upon looking at the assessment form as there is no indication of completing the assessment during a functional or therapeutic activity

Good test-retest reliability for working with people with schizophrenia

No normative data as this is observation and criterion based

Strengths of Assessment

Great social awareness tool for noting nonfunctional behaviors that may not be noticeable for the client. Able to track data for up to 7 days in order to understand performance patterns and areas of improvement

Weaknesses of Assessment

Difficult to find online. Criterion referenced but would be reliant on subjective data to determine the level of severity of behaviors

References

En-Chi Chiu, Shu-Chun Lee, Kuan-Yu Lai, Fang-Yu Gu; Test–Retest Reliability and Minimal Detectable Change of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia. Am J Occup Ther September/October 2020, Vol. 74(5), 7405205110p1–7405205110p7. doi: https://doi.org/10.5014/ajot.2020.040154

Morin, A. & Wells, E. (2025a). Adult COTE Scale Assessment. Kodiak Western New England University. https://kodiak.wne.edu/d2l/le/content/118453/viewContent/1740299/View

Morin, A. & Wells, E. (2025b). COTE terminology & definitions. Kodiak Western New England University. https://kodiak.wne.edu/d2l/le/content/118453/viewContent/1792885/View

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