Why Do We Measure Things?
It is important to help us obtain information about the individual to establish a baseline of performance, measure progress, predict future performance, and to identify or measure specific traits or behaviors. Basically, the assessments help to inform our treatment plan and help us understand if what we are doing works.
The other thing I think is really important, particularly with kids, is that the eval session is often our first contact with the patient. It is important that we are establishing rapport and an expectation of how the sessions are going to go based on this evaluation session. What makes this really hard, especially in pediatrics, is that there is a lack of accessible, valid, and reliable tools. Often therapists resort to making their own tools or rely exclusively on parent report.
Standardized measures help us objectify our clinical judgments. They make sure that we are all speaking the same language, and that we are then able to compare the results of these assessments across patients, time, and clinics. Again, it gives us a way to compare and really judge whether or not what we are doing is working.
We also have a responsibility to make sure that our patients are benefiting from treatment and that we are using their resources appropriately. It is not okay to bring a patient in for months of therapy and not know if you have really helped them. Your third party payer, parents, and administration are not going to like it. There is also this mantra in rehab that if you did not document it, it did not happen. We might feel like our patients are getting better and making some changes, but if we are not able to measure those and document appropriately, then it is as if it did not happen. This is particularly true when it comes to third party payers and in this environment of stringent compensation.
Data-Driven Decision Making
As good clinicians, we need to make evidence based data driven decisions.
Figure 1. Data-driven decision making algorithm.
Roseann Schaaf has proposed this data driven decision making algorithm. The first step is to identify participation challenges and goals. These really should come from your families and the patients themselves. We then describe the current level of a patient's functioning and identify the factors affecting participation. This is often done through your observation of a patient and your initial contact. You would then conduct the assessment. Your selection of the items that you are assessing is important as noted by steps 1 through 3 and should be standardized and systematic.
In conducting this assessment, you are going to identify the strength and barriers for your patient. These are both individual and environmental. Next, you will generate a hypothesis. What do you expect to change and how do you think that you will enact that change?
Based on this assessment and hypothesis, you will design your intervention. You are going to use the assessment findings to decide what needs to happen for your patients. You are also going to identify the outcomes that you are going to measure over time; both long term and short term outcomes. Conducting the intervention is the easy part. We then collect, display and analyze the data to decide whether or not our interventions are working. Finally we monitor progress.
