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Copy of ophi

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Mariam Chinn

on 5 February 2013

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Transcript of Copy of ophi

Mariam Chinn & Megan Evelyn Occupational Performance History Interview, version 2.1 (OPHI-II) What is OPHI-II Background Theory Practical Considerations Who? The Manual Administration Psychometric Properties The OPHI-II is a norm-referenced assessment So What??? Strengths and Weaknesses When to use... From whence it came Previous Versions Authors: Gary Kielhoffner, Trudy Mallinson, Carrie Crawford, Meika Nowak, Matt Rigby, Alexis Henry, Deborah Walens The OPHI-II is a Semi Structured interview used to gain an understanding of a client's occupational identity & life history including:
Occupational Roles Occupation/Activity Choices
Daily Routine
Occupational Settings
Critical Life Events Why USE OPHI-II? How? When ? Where ? How much? "Formal training is not required to accurately use the OPHI-II, although therapists should read the manual and be familiar with MOHO." -MOHO Clearinghouse Designed for use with an occupational therapy client - implies it it meant for an OT to administer. Cost of the actual materials is currently $43.50 on the MOHO Cleraringhouse website

Therapy hours for the OT's time should also be considered. Approx 1 hour for interview which can be broken into 2 sessions if needed

Additional time will be needed for scoring The interview should take place in a private, comfortable location in order to follow HIPAA regulations and to allow the client the ability to speak freely. It looks relatively easy to administer the OPHI-II as questions are provided as a guide. Obtaining the right information takes priority over reading each question verbatim.

The interpretation of scores will require professional experience. The Occupational Performance History Interview is:
“A semi-structured interview that explores a client's life history in the areas of work, play and self-care performance.”

Used by OTs
"...to obtain a broad and detailed understanding of the client’s life history and the impact of illness, disability, or other trauma on the individual’s life. "

Used by Clients
Provides an outlet for the client to “reflect upon, continue or remake life stories.” -Moho Clearinghouse website -OT Assessment Tools, p.43 The Skinny Used with individuals who are able to respond to interview questions about their life history. Age, emotional and psychological states as well as linguistic and cognitive abilities should be considered.

Semi-structured interview including open-ended, yes/no and follow up questions.
“Describe a typical day during the week”; “Is there any special thing you like to do a lot?”; "Tell me more about your interest in skiing."
(the OT administering may need to reword)

Designed to measure competence,(occupational) identity and environmental support (Kielhoffner, 2001)

Since the OPHI-II is a life history, all areas of the OTPF are included inasmuch as the client is willing to share.

Numerical (ordinal) scores rendered for each of the three interview sections using scoring keys. Scores are compared against other clients or typical trends. The theory base is explicit as it is clearly an assessment from MOHO and is sold on the MOHO clearinghouse website:

The OPHI-II is an assessment perfectly suited to the needs of MOHO, providing a means of obtaining a client's life history and all it's components. However... The OPHI-II come's from of Keilhoffner's Model of Human Occupation

Just a reminder
Moho’s purpose: To achieve a more accurate explanation of how people’s everyday occupational lives are influenced by the interaction of:

Performance capacity
Environmental context OPHI-II can be useful in other models such as:
-the PEO model
the IRM The dynamic relationship between people, environment an occupation can be better understood through the use of this semi-structured interview. To establish the interpersonal relationship between the client and the OT and in order to be client centered, the OPHI-II is a great rapport building tool. OPHI, OPHI-R Scoring Interpretation The administration section is very clear, providing examples of questions as well as strategies in wording/managing the conversation. Tips on things like culture sensitivity, metaphors and modeling are included. The text also provides practical information on recording answers during the interview process.

THE INTERVIEW Scoring is done for each of the three subscales individually (identity, competence and occupational settings)

Scoring uses a combination of
Concrete measures (ie- living arrangements)
Measures that require clinical judgement (At what level does the client expect success?) There are instructions on how to interpret the client measures but the way it’s done is subjective and likely subject to inter-rater issues.

A client’s scores are compared to other client’s that the OT has been / is working with. •Getting the right information is the focus, rather than asking every question verbatim -> the questions provided are GUIDES for the interview

•Let the client’s answers guide where the interview goes.

•When doing the interview, use follow up questions for more depth to abbreviated responses; Make sure the client is completely finished answering before moving on
•Show real interest in understanding their story
•Ask questions that invite a narrative response
“Tell me about that turn of events”
“What do you think made you react that way?? "Making ratings is a professional judgement, informed by data gathered from a good interview"

In the OPHI-II, the therapist uses judgement do score the item being rated on a 4 point scale. *It is important to note that the meanings of each rating remain constant across all items.

1- extreme occupational functioning problems
2- some occupational functioning problems
3- good, appropriate, satisfactory occupational functioning
4- exceptionally competent occupational functioning An average person will receive mainly ratings of "3" as 1 and 4 are extremes; Use the score that corresponds to the best fit or the lower of the scores.

Criteria statements are provided to provide therapists with the typical way a certain rating is manifested.
ie. a criteria statement of a 4:
Goals/personal projects challange/extend/require effort AND
Feels energized/excited about future goals/personal projects The SCALES
Occupational Identity - sense of self as an occupational being; volition, habituation.

Occupational Competence - being able to "actualize an occupational identity that satisfies oneself and meets environmental demands."

Occupational Settings (Environment)- the typical environments in which the person lives, maintains a productive role, and engages in leisure.

Designed to "capture three separate variables, or constructs, that pertain to a client's occupational functioning" Environment Items:
Home-Life Occupational Forms
Major Productive Role Occupational Forms
Leisure Occupational Forms
Home-Life Social Groups
Major Productive Role Social Groups
Leisure Social Groups
Home-Life Physical Space, Objects , and Resources
Leisure Physical Space, Objects and Resources Competence Items:
Maintains Satisfying Lifestyle
Fulfills Role Expectations
Works Toward Goals
Meets Personal Performance Standards
Organizes Time for Responsibilities
Participates in Interests
Fulfilled Roles (past)
Maintained Habits (past)
Achieved Satisfaction (past) Identity Items:
Has personal goals and projects
Identifies a desired occupational lifestyle
Expects success
Accepts responsibility
Appraises abilities and limitations
Has commitments and values
Recognizes identity and obligations
Has interests
Felt effective (past)
Found meaning /satisfaction in lifestyle (past)
Made occupational choices (past) For each section, all item scores are totaled and used to obtain a client measure and standard error

Client measures are on a scale of 0-100
Standard Error is lowest in the most centered scores and ranges from 4-13 "Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health. "
-Mary Reilly The original Occupation Performance History Interview (OPHI) was field tested by 90 therapists. They were initially chosen because they represented a wide variety of practice settings. The information received from the initial interviews prompted additional testing and revisions of the OPHI. The revisions and further testing have resulted in two additional versions of the OPHI: the OPHI-R and OPHI-II.

The original sample of interviewees used a total of 154 clients in a variety of clinical settings with a variety of diagnosis in both Canada and the United States. RELIABILITY Reliability data could not be found for the Occupational Performance History Interview Version 2.1. However, data could be found for the original Occupational Performance History Interview.

Test-retest reliability exceeded minimal criterion for reporting on past occupational functioning. It fell short of acceptable for reporting on present function.

Inter-rater reliability was “unacceptably low” (Kielhofner, 497). This may have been due to the lack of explicit training in the interviewing and scoring process or the repetition of the interview by different interviewers and in conducting the interview in different environments. Validity The data was analyzed using Rasch analysis.

FACE: The results of the interview do yield results reporting data in the areas specified

CONTENT: Addresses areas in the the OTPF- identifying roles, daily routine, environment, activity, and critical life events as areas of interest and intervention for occupational therapists.

CONSTRUCT: The OPHI-II the items on each of the three scales accurately measured the construct for which they were created. The OPHI-II is extremely sensitive to the client and their environmental concerns as they pertain to occupation. The OPHI-II is a useful assessment tool in clinical practice when used in the appropriate settings.

The OPHI-II manual does not advise its use in settings such as acute care when a patient will only be seen once or twice or in short-term inpatient psychiatric unit.
Highly personalized and allows you to get to know your client’s occupational profile well.
Therapist is able to build good rapport with the client. Strengths Weaknesses Interview portion of the OPHI-II is lacking in standardized questions.
This contributes to the poor psychometric data available for the OPHI-II. Any questions? Credits: -Moho Clearinghouse website OPHI-II, p. 37 OPHI-II, p. 54
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