The Measurement Properties of the Model of Human Occupation Screening Tool and Implications for Practice

Article excerpt

Over the past decade, occupational therapy leaders have increasingly articulated the importance of occupation focused practice (Christiansen & Baum, 1991; Creek, 2003; Fisher, 1993; Hagadorn, 1997; Polatajko, 1994; Trombly, 1995). Such practice aims to engage clients in the occupations of life--self care, productivity and leisure. If such a practice is to be developed and valued, it will be necessary to document the specific impact of therapy on everyday occupational life. As Creek (2003) stated, we should seek ways of measuring the effectiveness of our interventions in terms of enhanced engagement in occupation. In order to achieve this, occupational therapists need to develop occupation focused assessments that can be reliably and validly used in practice (Bower, 2005; Last, 2001; Melton, 2001; Parrott, 2001; Rey, 2001).

In addition to the challenge of designing and implementing more occupation-focused practice, therapists face other contemporary expectations for practice. Firstly, there have been calls for client-centred practice that embraces a philosophy of respect and partnership with clients (Law, 1998). The client-centred approach recognises the need to understand the motives and unique circumstances of each client (Kielhofner, 2002). Secondly, the health profession council (HPC, 2004) has also detailed the need for therapists to "use the established theories, models, frameworks and concepts of occupational therapy" (p. 11). Being able to develop a theoretically driven understanding Kramer, L. Summerfield Mann, and E. Duncan. of a client's occupational circumstances is the sign of a profession (Curry & Wergin, 1993; Sibeon, 1991). A further consideration is the burden of documentation for therapists in the context of increasing demands for productivity (Hagedorn, 1995). Finally, therapists are urged to engage in evidence-based practice that uses the highest quality knowledge to guide practice decisions (HEFCE, 2001; Scottish Exec, 2002; Creek & Ilott, 2002).

Taken together, these expectations create multiple demands in the context of everyday occupational therapy practice. Consequently, therapists require a range of practice resources and tools which allow them to operationalise expectations for best practice. This paper discusses the development and investigation of one such tool, the Model of Human Occupation Screening Tool (MOHOST version 1.0) (Parkinson, et al, 2002). The MOHOST is designed to be an occupation focused, evidence based, client centred, theory driven assessment that can be readily integrated into and be useful for practice. The purpose of this study was to empirically test the MOHOST (version 1.0) inclusive of clinical utility.

Development of the MOHOST

The MOHOST is based on the Model of Human Occupation (MOHO) (Kielhofner, 2002). MOHO is concerned with embracing the complexity of a client's occupation (Creek, 2003). Moreover, MOHO is an occupation focused (Pedretti, 1996), evidence based (Lae et al., 1997) theoretical framework that has associated assessments and interventions (Hagadorn, 1997). Practitioners report that MOHO provides both a theoretical understanding of occupation and the tools for doing occupationally focused practice (Forsyth, 2001), thereby providing a framework for "thinking" in practice. MOHO has been built on a scholarship of practice philosophy that encourages partnerships between academia and practice in order to deliver and generate evidence based practice (Forsyth, 2004; Forsyth, Duncan & Summerfield Mann, 2005a, Forsyth, Melton & Summerfield Mann, 2005b; Harrison & Forsyth, 2005; Taylor, Braveman & Forsyth, 2002). The scholarship of practice partnership which developed the MOHOST was initially between the second author and the University of Illinois at Chicago (led by the first and third authors). It was later expanded to include UK therapists within Central North West London Mental Health NHS Trust; Gloucestershire NHS Partnership NHS Trust; The State Hospital, Carstairs; NHS Lanarkshire; NHS Lothian; and Coventry Teaching Primary Care Trust. …