1. An exploration of The Short Child Occupational Profile (SCOPE)
Fiona Monahan
Occupational Therapist
Linn Dara CAMHS
May 2016

2. SCOPE considers ‘Individual Developmental Trajectory’
This is a child’s unique potential as an occupational being
Rather than compare a child’s performance to ‘normed’ developmental scales practitioners can hypothesise what capacities a child has the potential to acquire in the future given their age, impairment, prior life experiences, environmental context.

3. Purpose
Describe a child’s occupational participation irrespective of symptoms, diagnosis, age, or the treatment setting.
Capture strengths as well as challenges
Assess factors that represent the MOHO concepts of volition, habituation, performance capacity and the environment.
Identify areas needing further assessment and direct the practitioner to complimentary paediatric MOHO assessments in order to gain an increased understanding of a specific challenge.

4. Purpose Be simple and quick to use.
Facilitate communication about the child’s participation with the multidisciplinary team, caregivers, and other stakeholders.
Support occupation-focused intervention.
Assess changes in the child’s occupational participation over time in order to evaluate therapy outcomes.

5. Test Development
Pediatric therapists attempted to use MOHOST, but found it did not meet the needs of pediatric evaluation.
First draft based on team of expert pediatric occupational therapists.
Four years of research and revisions based on therapist and other professional input.
Not a standardized assessment.

6. Psychometric Properties
Type of Reliability
Statistics Used
Value
Rating
Observer: Practitioner Separation Index
MFRM
0.83
excellent
Internal consistency: Item Separation Index
0.99
Client Separation Index
0.95 B
Construct Validity: Confirmed by MFRM analysis

7. Time to Administer Consists of 25 items
Experienced therapists may complete this assessment in minutes depending on methods used to gather information B

8. Gathering Information to Rate SCOPE
informal observation in open settings.
formal observation in 1:1 and/or group settings.
discussion with the child regarding motivation, roles, interests, and routines (this may only be appropriate with some children).
talking with parents, teachers, and other members of the multidisciplinary team during interviews or informal discussion, or when using the parent reporting form.
reading case notes or medical/ rehabilitation records, and/or completing other formal assessments. L

9. Other MOHO assessments that may be needed
Child Occupational Self Assessment COSA
Paediatric Interest Profile PIP
Occupational Questionnaire OQ
Role Checklist
NIH Activity Record (identifies routine in response to pain and fatigue)
Assessment of Communication and Interaction Skills ACIS (observational)
School Setting Interview SSI (explores the student and environment fit)
OT Psychosocial Assessment of Learning

10. Areas of Occupation Addressed
ADLs
IADLs
Education
Work
Play
Leisure
Social Participation

11. Domains (Sub-domains)
Volition (exploration, expression of enjoyment, showing preferences/making choices, response to challenge)
Habituation (daily activities, response to transitions, routines, roles)
Communication and Interaction Skills (non- verbal communication, verbal/vocal expression, conversation, relationships)
Process Skills (Understands and uses objects, orientation to environment, plan and make decisions, problem solving)
Motor Skills (posture and mobility, coordination, strength, energy/endurance)
Environment (how the environment affects the child, physical space, physical resources)

12. FAIR Rating Scale F: Facilitates occupational participation
A: Allows occupational participation
I: Inhibits occupational participation
R: Restricts occupational participation
The SCOPE provides an item definition and it also provides a criteria statement next to each rating category
Unsure? Always judge lower

13. Example of SCOPE Items B

14. Example of SCOPE Interview Items (Optional to gather data)
Parent Interview: Habituation section
Describe your child’s typical weekday and weekend routine at home/school/in the community. Does your child know when to do these daily routines and self-care activities? How does your child actively take part in doing these routines and self-care activities?
Teacher Interview: Volition section
What are some things that you think this student feels he/she does well or that he/she is proud of doing? Does the student enjoy most things, or is he/she frequently frustrated or unhappy when doing things? How do you know when this student is proud of himself/herself?

15. SCOPE Summary Rating FormB

16. SCOPE Ratings Totals FormB

17. Goal Writing and Intervention Planning
Guide for creating occupation-based goals and intervention strategies
Additional form for organising plan of care B

18. Disadvantages: Advantages: Occupation-based, top-down, holistic
Not a widely used instrument
Not standardised
Some concerns measurement can be subjective to therapist judgments and some clients can be more difficult to rate
Advantages:
Occupation-based, top-down, holistic
Wide range of ages, diagnoses, and settings
Facilitates family-centeredness
Useful for children who cannot complete standardised assessment
Results are easy to communicate to parents
Can highlight subtle changes not detected by other outcome measures
Reinforces to the MDT our role in CAMHS and how difficulties with volition, habituation, performance capacity and environment impact on mental health L

19. Case Study
Jimmy is 16 years old and has been attending CAMHS for 3 years,diagnosed with social anxiety, attending appointments with the Psychiatrist, taking anti anxiety medication and medication for sleep, attended Decider group (CBT and DBT based skills), was referred to the Psychologist for CBT but not attending appointments, was discharged.
Jimmy referred to OT by Psychologist as having some difficulty attending school, history of possible motor skills difficulties and sensory processing difficulties, had difficulty with personal care skills like washing and dressing and also with handwriting.
Jimmy has recently been referred by the OT for an ADOS and will have an assessment for possible ASD.

20. How was information gathered
Interview with Mum, Jimmy, teacher, clinicians who worked with Jimmy
SCOPE parent report
Assessments used with Jimmy; OSA, PIP, Recovery Star, Timeline, Self Report Sensory Profile, Movement ABC, Beery VMI, DASH,
Observation throughout

21. Gathering Information
Volition
Personal causation-very low in confidence, some trouble believing can make changes, experienced a lot of bullying in past and changed school many times
Values-his friendships, his relationship with his mother, going to university, having a job as game designer or writer, living independently, having his own family in the future, having a cat, visiting Japan
Interests-creative writing, video games, seeing friends, bowling, cinema, board games, baking

22. Habituation
Habits-poor personal care, poor appetite, not sleeping well, very inactive, not attending school, spending ++ time on computer gaming or talking online, not leaving room much, not seeing friends, poor attendance at appointments
Roles-very few roles, has lost student role, not seeing friends as much, no extended family, close to mother, grandmother has alcohol and prescription medication addiction and finds her difficult to manage

23. Performance capacity
No cognitive difficulties upon NEPS assessment
MABC- 2nd percentile for manual dexterity, 84th percentile for aiming and catching and 16th percentile for balance, Beery VMI -50th percentile for visual motor integration and 53rd for visual perception and 6th percentile for motor co-ordination, DASH- 0.2nd percentile for handwriting speed
Sensory profile indicative of sensory sensitivity in relation to tactile, auditory, vestibular and oral sensory processing
Difficulties communicating with new people or going to new places, in session sometimes engaged and enjoying talking, sometimes withdrawn, not responding to questions or speaking in very low tone
Difficulties with planning and organisation and problem solving

24. Environment
Home-living with mum and grandmother in grandmother’s home, mum used to work as pharmacy technician, gave up career to take care of Jimmy when young, Mum finding Jimmy’s grandmother’s addiction difficult to deal with as she can be emotionally abusive, Mum experiencing anxiety and having difficulty sleeping but no support, financial stress Jimmy’s father living in the US,, all mum’s siblings in the US, Jimmy has some nice friends living nearby from his last Primary School
School-in Junior Cert Year, getting one to one support from home school liaison but finding it hard to go in and has stopped attending, teacher very concerned, has worked with Jimmy throughout secondary school, feels he is very intelligent and has a lot of potential, was trying to integrate him back into main classroom, was trying to get mum and grandmother to attend computer classes in school
Youth Initiative-Jimmy used to go there for some social activities and worked with youth worker when younger

25. Jimmy was referred to TUSLA who started the Meitheal process involving family support worker, social work and local youth initiative (which Jimmy previously attended) and OT from CAMHS
Family Support Worker allocated to visit the home, help with attendance with appointments, support Jimmy’s mother,(this has helped greatly, Jimmy’s mother is calmer and Jimmy is attending all appointments)
Jimmy to attend Youth Initiative to help him to do one hour of school work once per week and build this up to enable him to do some junior cert exams (has tried to go down but did not get out of the car)
Jimmy and Mum got feedback from OT assessment with report and case formulation with possible goals identified, Mum referred to OT parent education sessions

26. Goal setting
Long term goal-Jimmy and his Mum would like to improve balance of activities in their day
Short term goals-
Jimmy and his mother to explore with OT types of activities needed in day- self care, productive, leisure and social, what they are why they are important
Jimmy and Mum to explore with OT current time use using timetable
Jimmy to choose weekly goals with OT support to build more balanced routine (e.g. week 1 Jimmy will go for a walk 3 times per week for 20 mins, Jimmy will take the garbage out on Mon eve and take in on Tue, Jimmy will load and unload dishwasher daily, Jimmy will see a movie with Mum once this week, Jimmy will play scrabble once this week with Mum)

27. Goal setting Long term goal-Jimmy would like return to education
Short term goals-
Jimmy and OT to complete referral for transition group for teens having difficulty returning to school
Jimmy to visit community centre where transition group help with support from OT
Jimmy and Mum to explore with OT option of doing i-scoil from home if needed

28. Goal setting
Long term-Jimmy would like to increase his confidence with social interaction
Short term
Jimmy to explore with OT what tasks might improve confidence with social interaction that he might incorporate into his weekly goals
Jimmy to explore with OT small groups he might join with OT facilitating e.g. Wellness group or communication and friendship, sensory regulation

29. Plan and Outcomes
Jimmy is still attending OT but is engaging well and feels is making some change with weekly goals.
Plan to re-administer SCOPE to measure any change and feedback to MDT.

30. Questions