Fig. 7.1
Items 1–5 of the self-assessment form (Keller et al. 2006, p. 29)
The ‘Intended Meaning Reference Guide’ can be used to further clarify the meaning of the COSA statements when a child needs it. It also gives a good overview of the 25 items of the self-assessment form, at the end of which there are also three open questions. These give the child additional possibilities of expressing him-/herself regarding any other strengths or problems he/she may have in his/her occupational competence.
After the COSA has been completed, the child and therapist interpret and discuss the results together and identify the strengths and problems of the child. At the end of the discussion they decide together which areas the child would most like to change. In this way the therapist and client together establish treatment goals. A time is also recorded by when a goal is to be achieved. A follow-up should be completed 3–6 months after intervention, and this will establish whether the goals have been attained (cf. Keller et al. 2006).
As children live in close context with their families/parents, an extended version of the COSA was made in German as mentioned above. In this version the parents may fill out the form at the same time but independently of the child and in another room. It is then possible to discuss the opinions of both parents and child, and this may flow into the planning of the intervention (cf. Pätzold et al. 2008).
7.2.1.1 COSA Intended Meaning Reference Guide
Fig. 7.2
COSA Intended Meaning Reference Guide (Keller et al. 2006, p. 10–11)
7.3 Client-Directed Assessment and Therapy for Children with EB Using the COSA
Using the COSA for children with EB, it very soon became apparent that some additions were needed, e. g. extending some explanations to the items or adding more items.
Some items of the COSA are not very relevant for the assessed children with EB. Children have the freedom to leave out non-relevant items, so that that there was no need to remove them from the assessment. They might still be relevant to other children and also most of the less relevant items were marked with ‘I do this OK’ or ‘I am really good at doing this’. It is important for children and youths with EB to have some items that they can mark in this way, as there are a great many items, especially those concerning physical abilities (movement, mobility, dexterity) that may be expected to have a negative evaluation. The children experience that there are areas in which they are very good alongside the many items that without question present difficulties. They are able to have a new view of their resources and are then not only concerned with their deficits.
The discussion of the self-assessment results with the children has been shown to be extremely important. The child should express his/her thoughts and judgement about each of the items. The therapist notes the issues which, according to the child and his/her personal situation, abilities and environmental conditions, lead to difficulties (cf. Pätzold et al. 2008; Keller et al. 2006).
Because many issues specific to the condition of EB are the cause of problems, the discussion between the therapist and the child is a vital basis for the analysis of problems and planning of the intervention. The therapist learns more details as to why an item was marked in the way it was.
For example, item 7, ‘Have enough time to do things I like’, was marked by the child ‘I have a little problem doing this’. The value scale was marked ‘most important of all to me’. In the discussion it turned out that the daily changing of bandages took 2 h, and eating also needed a long time because of the problems with the oesophagus. There was less time left for other activities.
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