Situational Assessments in Practice: A Quick Guide for OTs

As a medical-legal OT, I get a lot of requests to complete situational assessments. Most often, this is for the purpose of determining a catastrophic impairment following a motor vehicle collision (MVC), but I also get requests from lawyers looking for more information about a client’s work-related abilities and limitations.

The Ontario Society of Occupational Therapists (OSOT) has published a helpful document[1] to support OT’s conducting situational assessments, offering the following definition:

A Situational Assessment involves assessing a client in a variety of real-life settings to determine the client’s ability to perform useful function and to adapt to stressful situations. Depending on the needs of the client, the assessment may involve situations at home, work, and/or in the community and therefore is called a “Situational Assessment.”

Conducting a situational assessment is a weighty endeavour. These types of assessments require a lot of advance planning and preparation. Also, the evaluations are long and they can be draining – for both the client and the assessor. In this post, I’m highlighting key steps for completing a situational assessment with intention and efficiency in mind. I hope this basic outline will support fellow OT’s who are currently doing situational assessments or thinking about adding this type of work to their practice.

1.     Know the file: While this may go without saying for any medical-legal assessment, familiarizing yourself with the contents of the medical file is especially important before initiating a situational assessment. Understanding the client’s injuries and recovery course will help you to plan appropriately for functional testing. The more you know, the easier it will be to select the right tools for your assessment.

2.     Customize testing: It’s important to tailor your assessment to the individual by selecting tasks and activities that will highlight that particular client’s functional strengths and limitations. You want to select functional tasks that reflect their typical pre-injury routines and roles. What housekeeping activities did they routinely complete? How often did they engage in meal preparation? If the individual did not do any cooking before sustaining their injuries, asking them to do so during the assessment will not provide you with desired information about how their post-injury function compares to their baseline abilities. It’s also necessary to consider their prior work role(s) so that you can come up with creative ways to simulate job tasks.

3.     Put in the time: It’s important to get a sense of how much activity the client can tolerate over an extended period of time. I typically schedule two back-to-back days of evaluations, amounting to at least eight hours of total assessment time. Some of that time is reserved for interviewing the client, but most of it is dedicated to observation of functional activity. I also take time to follow up with clients after the assessment to collect additional information about the delayed effects of prolonged activity engagement on their symptoms and functioning. Were they able to get back to their usual routines or were they laid up for days in bed due to severe symptom aggravation after the assessment?

4.     Collect collateral information: Talk to a close family member or friend who can provide comment regarding any changes in pre and post-injury function. This is especially important if you suspect that the client’s insight is impaired, or if you see evidence of the client either underestimating or over-reporting functional challenges. Are the comments of collateral sources incongruent with the client’s statements or do they corroborate the self-reports of the evaluee?

Situational assessments are complex and there is a lot to consider beyond what I’ve briefly outlined above. For a deeper dive into the how-to, check out OSOT’s guiding document. It offers a more detailed breakdown into pre, during and post-assessment considerations that any OT should review if doing this type of work.

If you’re interested in reading more about functional assessment, check out my prior blog post: Trusted Medical-Legal Assessment Reports | Rosa Raponi Newton

[1] Ontario Society of Occupational Therapists. (2020, July). Supporting your professional practice: Occupational therapy situational assessments in Ontario’s automobile insurance sector.