Occupational Therapy News OTnews April 2019 | Page 43

OUTCOME MEASURES FEATURE
There is a core scoring scale and a range of condition-specific
been important to maintain inter-rater reliability in the context of
‘adapted scales’, which can help the clinician to rate an individual
the children’s therapy service to ensure therapists continue to trust
with a specific diagnosis or presentation. These include conditions
in the process of scoring accurately.
such as Cerebral Palsy, Autistic Spectrum Disorder (ASD), and
This has been achieved through case study presentations
Developmental Co-ordination Disorders.
at staff meetings. Clinicians all rate the case being presented
However, during the pilot stage, it became apparent that there
and then the data is fed back to the steering group. So far, the
were occasions when a child did not fit neatly into one of the
reliability has been good, and scores tend to be within 0.5 to 1.0
available scales.
of the target.
For instance, while there is an adapted scale for children
Moving into the second year, the aim is to use the data in a
with ASD, this was not always adequate when scoring children
more sophisticated way by looking at trends across teams and
with discrete sensory processing difficulties, or with
also in terms of different conditions. The intention is also to
children whose sensory processing
look at the national picture and, ultimately, to share
difficulties were more dominant than
good practice with similar services.
the problems they were experiencing
Looking further into the future, one of
The ultimate
related to their autism.
the core aims of the steering group is to
goal is to manage quality,
Consequently, the Sensory
actively involve service users and families
Processing Difficulties (SPD) adapted
and to find ways to communicate
but you cannot manage it
scale was developed; based on the
outcomes more effectively with them.
‘‘
until you have a way to
principles of the TOM and following
To this end, a focus group will be
measure it, and you cannot
the processes advocated for
created in order to obtain the views of
development of a new scale.
families and to put ideas into practice.
measure it until you can
This has now been used
In summary, the implementation
monitor it.
extensively within the team and,
of TOM has taken the service on a
Florence Nightingale
following a presentation at the
journey of discovery, but has also provided
RCOT-Specialist Secion – Children,
assurance to clinicians in terms of providing
Young People and Families (RCOT-CYPF)
data to support their interventions. It has
conference in 2017, the scale has also been
reminded therapists about what is really important –
distributed to other services nationally.
making a real difference to children and families.
Other scales currently in development within the service include
Despite the simple scoring mechanism, it has been important
a selective mutism scale and an adapted scale for children having
to reflect that the TOM does not work in exactly the same way for
adaptations made to their homes.
every service and, in this case, innovation has been required in
There have been a number of challenges in rolling out the
order to get the most out of it.
measure; some technical and some philosophical.
Finally, it has provided a means of measuring outcomes
Technical issues have included how to effectively record the
that are integrated and client centred, which is a good fit with
data within the existing data management systems available. The
occupational therapy theories of practice. It has also helped
more philosophical issues have centred around how and when to
occupational therapists to collaborate with other disciplines and
score a child – particularly if more than one discipline is involved.
to see how all of the pieces of the puzzle come together for the
For instance, the occupational therapist may be providing an
child.
intervention related to provision of a piece of equipment, whilst
a speech and language therapist might be looking at speech
References
sounds.
Enderby P, Murphy J and Boa S (2012) Testing the reliability and validity of
These issues have generally been overcome through
the Therapy Outcome Measure for AAC. NHS Education for Scotland
discussion with members of the steering group and also an
– Final Report. Available online at: www.talkingmats.com/wp-content/
online question and answer document, which aims to respond to
uploads/2014/11/TOM-AAC-Final-report-Oct-2014.pdf [accessed July
queries as they arise.
2018].
In the first year, the aim of the steering group was simply to get
Enderby P and John A (2015) Therapy Outcome Measures for
basic systems in place to record information and to start gathering
rehabilitation professionals (3rd ed). J&R Press Ltd
as much data as possible. This was broadly achieved, and it
Hesketh A, Long A and Bowen A (2011) Agreement on outcome:
was possible to provide consistent feedback to staff about the
Speaker, carer, and therapist perspectives on functional
percentage of children making progress and in which domains.
communication after stroke. Aphasiology, (25): 291-308
TOM has been shown to be a valid and reliable tool (Enderby
John A (2001) Therapy outcome measures for benchmarking in speech
et al 2012; Enderby and John 2015; Hesketh et al 2011; John
and language therapy. Unpublished PhD Thesis. University of Sheffield:
2001; Roulstone et al 2004) in other contexts. However, it has
Sheffield, UK
OTnews April 2019 43