Occupational Therapy Assessment Interview and Rating Scale Mental Health

Occupational Therapy Assessment Interview and Rating Scale Mental Health

1. Occupational Circumstances Assessment Interview & Ratings Scale Mental Health

2. A User's Manual for the Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS ) The OCAIRS provides a structure for gathering, analyzing, and reporting data on the extent and nature of an individual's occupational participation. It can be used with a wide range of clients , and would be appropriate for any adolescent or adult client who has the cognitive and emotional ability to participate in an interview. The OCAIRS provides a structured and theoretically based means of developing interview skills in evaluation and treatment.

3. OCAIRS MENTAL HEALTH INTERVIEW FORMATS There are four different formats included in Appendix A: 1 ) OCAIRS Mental Health Interview (Form 1) Questions 2) OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form 3) OCAIRS Mental Health Interview (Form 3) Questions and Rating Scales 4) OCAIRS Mental Health (Form 4) Kev Words Form

4. 1) OCAIRS Mental Health Interview (Form Questions: Some therapists may prefer to use the Interview Questions format. This format provides a range of questions that will elicit OCAIRS information. The therapist may change, add or delete questions to better address the issues and suite his/her own style of phrasing questions. Therapists may also wish to change the order of the questions or the sequence of the interview.

5. 2) OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form: This format contains abbreviated versions of the questions, the full rating scales and a section for notes. The addition of the rating scales provides a visual prompt to ensure all information is collected. Additionally, the notes section provides the therapist with space to take notes during the interview,

6. 3) OCAIRS Mental Health Interview (Form 3) Questions and Rating Scales: This format contains the abbreviated versions of questions and the full rating scales. It may be beneficial to use with clients who may become anxious by interview formats that appear to be longer and thus more time intensive.

7. 4) OCAIRS Mental Health (Form 4) Kev Words Form The Key Words Form summarizes key concepts from MOHO that have been used in the OCAIRS. Therapists may wish to use it as a reference to glance over while conducting the interview to remind themselves of the areas of information needing to be gathered.

8. OCAIRS Mental Health Interview (Form 1) Questions Roles W hat do you do? W hat are y our major responsibilities? (Parent? Spouse? Worker? Student? Homemaker?) D o you belong to any groups? ( For each role mentioned ) H ow important is to you? D o you enjoy it? H ow well are y ou able to (for each role mentioned)? W hat else do y ou do? W hat other roles do you fill?

9. OCAIRS Mental Health Interview (Form 1) Questions Habits D escribe a typical weekday (before you began treatment/ this program/were hospitalized). D escribe a typical weekend day (before you began treatment/this program/were hospitalized). D oes your daily schedule let you do the things you need and want to do? H as your daily routine changed (over the last 6 months/ since your accident/since your divorce etc —pick some pivotal event if possible)? How? A re you satisfied with your current daily routine?

10. OCAIRS Mental Health Interview (Form 1) Questions Personal Causation W hat things in your life do you feel y ou do well, or are proud of? W hat are some things that have been difficult for you? H ow did y ou handle it? W hat is the biggest challenge you are currently facing? H ow successful do you think y ou will be over the next six months?

11. OCAIRS Mental Health Interview (Form 1) Questions Values W hat do you value most in your life? (What is most important to you?) W hat are other things or ideals that you value (are important to you)? H ow important are these to you? W hat about your life reflects these values? A re you able to live life in ways that fit with the values you think you should have or try to live up to? I s there anything about y our life that you feel goes against y our values?

12. OCAIRS Mental Health Interview (Form 1) Questions Interests I s your major occupational role such as, worker, student, volunteer, caretaker something y ou enjoy? W hat about it interests or satisfies you? W hat do y ou like to do with your time outside of (work or major occupational role)? D o you have any other interests or hobbies? ( For interests mentioned ) H ow often do y ou ? A re y ou satisfied with the amount of time you are able to spend

13. OCAIRS Mental Health Interview (Form 1) Questions Skills: Motor Skills, Process Skills, and Communication & Interaction Skills A re you able to do the things you want or need to do? (If no) Wh at limits your ability to do things? A re you able to concentrate, problem-solve, and make decisions to get things done? D o you have the physical ability to accomplish what you need and want to do? A re you able to over come these limitations and barriers? D o you prefer to work alone or with others? H ow well do you work with others?

14. OCAIRS Mental Health Interview (Form 1) Questions Goals D o you ever set goals for yourself/make plans for the future? H ave you followed through on any of them? W hat goals do you have for the next week? The next month ? W hat are you doing to accomplish that? D o you have any long-term goals? (1 year, 5-10 years) H ow will you accomplish those?

15. OCAIRS Mental Health Interview (Form 1) Questions Interpretation of Past Experiences O verall, do you feel you have had the typical ups and downs in your life or do y ou feel your life has been exceptionally better or worse than typical? G ive an example of the best period of your life G ive an example of the worst period of your life H ow was your life affected by these ups and downs? H ave you been able to choose the important things in your life?

16. OCAIRS Mental Health Interview (Form 1) Questions Physical Environment W here do you live? (Location, house, apartment?) I s it easy to get around and get things done? I n the area where you live, are there things to do/places to go that interest y ou? I s there someplace you go to on a regular basis (e.g., work, school, church, the park district, the doctor's office)? I s it easy to get to from your home? A re there any physical barriers at (from above) or at home that prevent you from getting things done?

17. OCAIRS Mental Health Interview (Form 1) Questions Physical Environment I n terms of activities you would like to participate in, p laces you would like to go, w hat if anything prevents you from doing so (Money, transportation, safety concerns, physical barriers)? A re there resources available to help you overcome barriers to getting things done?

18. OCAIRS Mental Health Interview (Form 1) Questions Social Environment D o you spend a lot of time alone? W ho do you spend most of your time with? W ho are the most important people in your life right now? D oes what they expect from you match what y ou like or would like to do? W ould y ou describe your (work, school, community) setting as supportive? D o the people or situations in your life place limits on you? I f you need help/support, can you count on family/friends/ community?

19. OCAIRS Mental Health Interview (Form 1) Questions Readiness for Change T ell me about a time when you experienced a big change in your life (moving, going away to school, death of a parent/spouse/child). W as it difficult to adjust? H ow do you handle it when your daily routine changes (If needed, use an example from response given in Habits section) W hen someone gives you feedback (ask to change your behavior) H ow do you react?

20. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form W hat do y ou do? Your major responsibilities? (Parent? Spouse? Worker? Student? Homemaker?) B elong to any groups? F or each role: Importance? Enjoyment? How well done? F) O ccupational Roles reflect a highly productive lifestyle F) H igh level of satisfaction with current roles F) F ulfill a wide range of role responsibilities A) O ccupational roles reflect a somewhat productive lifestyle A) S ome satisfaction with current roles A) M inor difficulty in fulfilling a wide range of role responsibilities

21. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form I) O ccupational roles fail to constitute a productive lifestyle I) V ery little satisfaction with current roles I) M ajor difficulty in fulfilling a wide range of role responsibilities R) N O occupational roles R) A lienated from roles R ) C annot fulfill a wide range of role responsibilities

22. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form HABITS D escribe typical weekday (before treatment/program/hospitalization). D escribe a typical weekend day {before treatment/program/hospitalization). D oes your daily schedule let y ou do things y ou need/want to do? H as y our daily 'routine changed (over 6 months/ since your accident/divorce, etc P ick pivotal event if possible)? How? A re Y ou satisfied with your current daily routine? > F) H ighly organized daily schedule > F ) G ood balance between work, rest, self-care and leisure > F) S atisfied with daily routine > A) S ome organization of daily schedule > A ) S ome balance between work, self-care and leisure > A) S omewhat satisfied with daily routine

23. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form HABITS I) V ery little organization of daily schedule I) V ery little balance between work, self-care and leisure I) V ery little satisfaction with daily routine R) N O organized daily schedule R) N O balance between work, self-care and leisure R) D issatisfied with daily routine

24. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form PERSONAL CAUSATION W hat thing' in your life do you feel you do well, or are proud of? W hat are things that have been difficult? How did y ou handle it? W hat is the biggest challenge you are currently facing? H ow successful do you think will be over the next six months? F) S trong confidence in abilities F) A nticipates success in next six months F) I dentifies a number of things (3 or more) done well/proud of A) S ome confidence in abilities A) A nticipates somewhat successful outcomes within next six months A) S ome difficulty in identifying something done well/proud of

25. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Personal Causation I ) V ery little confidence in abilities I) S ignificant concerns about failures within next six months I) M ajor difficulty in identifying something done well/proud of R) N o confidence in abilities R) A nticipates failure in next six months R) D oes not identify anything done well/proud of

26. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Values W hat do you value most in your life? (What is most important to you?) W hat are other things or ideals that you value (are important to you)? H ow important are these to you? W hat about your life reflects these values? A re you able to live life in ways that fit with the values you think you should have or try to live up to? I s there anything about your life that you feel goes against your values? F) I dentifies distinct and specific values F) S trong conviction about expressed values F) E xpresses complete congruence between own values and current life situation A) I dentifies somewhat ambiguous values A) S ome conviction about expressed values A) E xpresses some congruity between own values and current life situation

27. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Values I) L oosely identifies very ambiguous values I) V ery little conviction about expressed values I) E xpresses very little congruity between own values and current life situation R) D oes not identify any values R) N o conviction/alienation about expressed values R) E xpresses no congruity between own values and current life situation

28. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Interests I s your major occupational role such as, worker, student, volunteer, caretaker something you enjoy? W hat about it interests or satisfies you? W hat do you like to do with your time outside of (work or major occupational role)? D o you have any other interests or hobbies? ( For interests mentioned ) H ow often do you ? A re you satisfied with the amount of time you are able to spend F ) P articipates in many interests regularly outside of work F ) H igh level of interest in primary occupation F ) H igh level of satisfaction with level of participation in an interest(s)

29. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Interests A) P articipates in few, but clearly expressed, interests regularly outside of work A) S ome interest in primary occupation A) S ome satisfaction with l evel of participation in an interest(s) I) F ew & vaguely defined interest outside work, no regular participation I) V ery little interest in primary occupation I) V ery little satisfaction with participation in an interest(s) R) D oes not participate in any identified interests outside of work R) N O interest in primary occupation R) D issatisfaction with level of participation

30. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Skills: Motor Skills, Process Skills, and Communication & Interaction Skills A re you able to do the things you want or need to do? (If no) What limits your ability to do things? A re you able to concentrate, problem-solve, and make decisions to get things done? D o you have the physical ability to accomplish what you need and want to do? A re you able to over come these limitations and barriers? D o you prefer to work alone or with others? H ow well do you work with others? F) N o limitations in performance due to good skills F) E ffectively compensates for any limitations in skills (if any) Participation is allowed but there are some limitations in performance of: A) M otor Skills A) P rocess Skills A) C ommunication/ Interaction Skills

31. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Skills: Motor Skills, Process Skills, and Communication & Interaction Skills Participation is inhibited due to significant limitations in: I) Motor Skills I) Process Skills I) Communication/ Interaction Skills Participation is restricted due to severe limitations in: R) Motor Skills R) Process Skills R) Communication/ Interaction Skills

32. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Goals D o you ever set goals for yourself/make plans for the future? H ave you followed through on any of them? W hat goals do you have for the next week? The next month ? W hat are you doing to accomplish that? D o you have any long-term goals? (1 year, 5-10 years) H ow will you accomplish those? SHORT-TERM GOALS F) I dentifies achievable yet substantial short-term goal(S) F) C oherently discusses realistic plans for meeting goals F) A ctively participating in the execution of the plan(s) A) I dentifies goal(S) that may be difficult to achieve or, if readily achievable, are insubstantial A) D iscusses somewhat unrealistic plan(S) for meeting goal(S) A) S omewhat participating in the execution of the plan(s)

33. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form SHORT-TERM GOALS I) Identifies vague or conflicting goals that will be very difficult to achieve I) Discusses a plan that is not realistic I) Very little participation in the execution of the plan(s) R) Does not identify any short-term g oal(s) or has unachievable goal R) Does not discuss plan, abandons his/her plans easily R) NO participation in the execution of the plan(s), doing nothing to achieve goal(S)

34. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form LONG-TERM GOALS F) I dentifies achievable yet substantial long-term goal(s) F) C oherently discusses realistic plan(s) for meeting goals (i.e. Short- term goals correspond to tong-term goals) F) A ctively participating in the execution of the plan(s) A) I dentifies long-term goal(s) that may be difficult to achieve or, if readily achievable, are insubstantial A) D iscusses somewhat unrealistic plans) for meeting goal(s), i.e. short- term goals somewhat related to long-term goals A) S omewhat participating in the execution of the plan(s)

35. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form LONG-TERM GOALS I) I dentifies vague or conflicting long-term goals that will be very difficult to achieve I) D iscusses a plan that is not realistic. S hort-term goals unrelated to long-term goals I) V ery little participation in the execution of the plan(s) R) D oes not identify any long-term goal(s) or has unachievable goal R) D oes not discuss plan, abandons his/her plans easily R) N o participation in the execution of the plan(s), doing nothing to achieve goal(s)

36. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Interpretation of Past Experiences O verall, do you feel you have had the typical ups and downs in your life or do you feel your life has been exceptionally better or worse than typical? G ive an example of the best period of your life G ive an example of the worst period of your life H ow was your life affected by these ups and downs? H ave you been able to choose the important things in your life? F) E xpresses very positive feelings about past experiences F) C haracterizes past as time of great performance and accomplishment A) E xpresses somewhat positive feelings about past experiences A) P resents best and worst period(s) With equal emphasis

37. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Interpretation of Past Experiences I) E xpresses mostly negative feelings about past experiences I) P laces more emphasis on worst period(s) than best period(s) of life R) E xpresses only negative feelings about past experiences R) D iscusses only worst period(s), unable to identify best period(s)

38. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Physical Environment W here do you live? (Location, house, apartment?) I s it easy to get around and get things done? I n the area where you live, are there things to do/places to go that interest you? I s there someplace you go to on a regular basis (e.g., work, school, church, the park district, the doctor's office)? I s it easy to get to from your home? A re there any physical barriers at (from above) or at home that prevent you from getting things done? I n terms of activities you would like to participate in, places you would like to go, what if anything prevents you from doing so (Money, transportation, safety concerns, physical barriers)? A re there resources available to help you overcome barriers to getting things done? F) D emands/Constraints in the physical environment provide strong support for successful role performance F) A mple resources/opportunities (money, transportation, facilities etc.) to support participation in desired activities

39. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Physical Environment A) D emands/Constraints in the physical environment provide some support and allow role performance A) S ufficient resources/opportunities (money, transportation, facilities etc.) which provide some support and allow participation in desired activities I) D emands/Constraints in the physical environment provide very little support and inhibit successful role performance I) L imited resources/opportunities (money, transportation, facilities etc. ) provide very little support and inhibit participation in desired activities R) D emands/Constraints in the physical environment provide no support and restrict successful role performance R) I nadequate resources/opportunities (money, transportation, facilities etc.) provide no support and restrict participation in desired activities

40. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Social Environment D o you spend a lot of time alone? W ho do you spend most of your time with? W ho are the most important people in your life right now? D oes what they expect from you match what you like or would like to do? W ould you describe your (work, school, community) setting as supportive? D o the people or situations in your life place limits on you? I f you need help/support, can you count on family/friends/ community? F) O ther persons (family/friends/co-workers) provide strong support which facilitates participation F) H as ample opportunities for social participation A) O ther persons (family/friends/co-workers) provide some support which allows some participation A) H as some opportunities for social participation

41. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Social Environment I) O ther persons (family/friends/co-workers) provide very little support which inhibits participation I) H as very few opportunities for social participation R) S ocial support (family/friends/co-workers) is missing from social environment which restrict participation R) D oes not have opportunities for social participation

42. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Readiness for Change T ell me about a time when you experienced a big change in your life (moving, going away to school, death of a parent/spouse/child). W as it difficult to adjust? - H ow do you handle it when your daily routine changes (If needed, use an example from response given in Habits section) W hen someone gives you feedback (ask to change your behavior) How do you react? F) A djusts well to feedback/changes in personal/environmental circumstances F) H ighly motivated to make positive changes; clearly identifies areas client wants to work on A) S ome difficulty in adjusting to feedback/changes in personal/ environmental circumstances A) S ome motivation to make positive changes; has some difficulty in identifying areas client wants to work on

43. OCAIRS Mental Health Interview (Form 2) Questions, Rating Scales and Notes Form Readiness for Change I) S ignificant difficulty in adjusting to feedback/changes in personal/environmental circumstance I) H as very few opportunities for social participation R) R ejects feedback/changes in personal/environmental circumstances R) M akes inadequate changes or modification: does not identify areas client want to work on

44. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Roles What do you do? What are your major responsibilities? (Parent? Spouse? Worker? Student? Homemaker?) Do you belong to any groups? (For each role mentioned) How well done? F) O ccupational roles reflect a highly productive lifestyle F) H igh level of satisfaction with current roles F) F ulfils a wide range of role responsibilities A) O ccupational roles reflect a somewhat productive lifestyle A) S ome satisfaction with current roles A) M inor difficulty in fulfilling a wide range of role responsibilities

45. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Roles I) O ccupational roles fail to constitute a productive lifestyle I) V ery little satisfaction with current roles I) M ajor difficulty in fulfilling a wide range of role responsibilities R) N o occupational roles R) A lienated from roles R) C annot fulfill a wide range of role responsibilities

46. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Habits D escribe a typical weekday (before you began treatment/ this program/were hospitalized). D escribe a typical weekend day (before you began treatment/this program/were hospitalized). D oes your daily schedule let you do the things you need and want to do? H as your daily routine changed (over the last 6 months/ since your accident/since your divorce etc.—pick some pivotal event if possible)? How? A re you satisfied with your current daily routine? F) H ighly organized daily schedule F) G ood balance between work, rest, self-care and leisure F) S atisfied with daily routine A) S ome organization of daily schedule A) S ome balance between work, self-care and leisure A) S omewhat satisfied with daily routine

47. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Habits I) V ery little organization of daily schedule I) V ery little balance between self-care and leisure I) V ery little satisfaction with daily routine R) N o organized daily schedule R) N o balance between work, self-care and leisure R) D issatisfied with daily routine

48. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Personal Causation W hat things in your life do you feel you do well, or are proud of? W hat are some things that have been difficult for you? H ow did you handle it? W hat is the biggest challenge you are currently facing? H ow successful do you think you will be over the next six months? F) S trong confidence in abilities F) A nticipates success in next six months F) I dentities a number of things (3 or more) done well/proud of A) S ome confidence in abilities A) A nticipates somewhat successful outcomes within next 6 months A) S ome difficulty in identifying something done well/proud of

49. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Personal Causation I) V ery little confidence in abilities I) S ignificant concerns about failures within next six months I) M ajor difficulty in identifying something done well/proud of R) N o confidence in abilities R) A nticipates failure in next six months R) D oes not identify anything done well/proud of

50. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Values W hat do you value most in your life? (What is most important to you?) W hat are other things or ideals that you value (are important to you)? H ow important are these to you? W hat about your life reflects these values? A re you able to live life in ways that fit with the values you think you should have or try to live up to? I s there anything about your life that you feel goes against your values? F) I dentifies distinct and specific values F) S trong conviction about expressed values F) E xpresses complete congruence between own values and current life situation A) I dentifies somewhat ambiguous values A) S ome conviction about expressed values A) E xpresses some congruity between own values and current life situation

51. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Values I ) L oosely identifies very ambiguous values I ) V ery little conviction about expressed values I ) E xpresses very little congruity between own values and current life situation R) D oes not identify any values R) N o conviction/alienation about expressed values R) E xpresses no congruity between own values and current life situation

52. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Interests I s your major occupational role such as, worker, student, volunteer, caretaker something you enjoy? W hat about it interests or satisfies you? W hat do you like to do with your time outside of (work or major occupational role)? D o you have any other interests or hobbies? F) P articipates in many interests regularly outside of work F) H igh level of interest in primary occupation F) H igh level of satisfaction in participation in an interest(s) A) P articipates in few, but clearly expressed, interests regularly outside of work A) S ome interest in primary occupation A) S ome satisfaction with level of participation in an interest(s)

53. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Interests I) F ew & vaguely defined interest outside work, no regular participation I) V ery little interest in primary occupation I) V ery tittle satisfaction with level oft participation in an interest(s) R) D oes not participate in any identified interests outside of work R) N O interest in primary occupation R) D issatisfaction with level of participation

54. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Skills : Motor Skills, Process Skills, & Communication & Interaction Skills A re you able to do the things you want or need to do? (If no) W hat limits your ability to do things? A re you able to concentrate, problem-solve, and make decisions to get things done? D o you have the physical ability to accomplish what you need and want to do? A re you able to over come these limitations and barriers? D o you prefer to work alone or with others? H ow well do you work with others? F) N O limitations in performance due to good skills F) E ffectively compensates for any limitations in skills (if any) Participation is allowed but there are some limitations in performance of: A) M otor Skills A) P rocess Skills A) C ommunication/ Interaction Skills

55. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Skills : Motor Skills, Process Skills, & Communication & Interaction Skills Participation is inhibited due to significant limitations in: I) M otor Skills I ) P rocess Skills I) C ommunication/ Interaction Skills Participation is restricted to severe limitations in: R) M otor Skills R) P rocess Skills R) C ommunication/ Interaction Skills

56. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Goals D o you ever set goals for yourself/make plans for the future? H ave you followed through on any of them? W hat goals do you have for the next week? The next month ? W hat are you doing to accomplish that? D o you have any long-term goals? (1 year, 5-10 years H ow will you accomplish those? LONG-TERM GOALS F) I dentifies achievable vet substantial long-term goal(S) F) C oherently discusses realistic plan(S) for meeting goals (i.e. Short-term goals correspond to long-term goals) F) A ctively participating in the execution of the plan(s)

57. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales SHORT-TERM GOALS F) I dentifies achievable yet substantial short-term goal(s) F) C oherently discusses realistic plan(s) for meeting goal(s) F) A ctively participating in the execution of the plan(s) A) I dentifies goal(s) that may be difficult to achieve or if readily achievable, are substantial A) D iscusses somewhat unrealistic plan(s) for meeting goal(s) A) S omewhat participating in the execution of the plan(s) I) I dentifies vague or conflicting goal(s) that will be very difficult to achieve I) D iscusses a plan that is not realistic I) V ery little participation in the execution of plan(s)

58. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales SHORT-TERM GOALS R) D oes not identify any short-term goal(s) or has unachievable goal(s) R) D oes not discuss plan, abandons his/her plans easily R) N o participation in the execution of the plan(s), doing nothing to achieve goal(s)

59. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales LONG-TERM GOALS A) I dentifies long-term goal(s) that may be difficult to achieve or, if readily achievable, are insubstantial A) D iscusses somewhat unrealistic plan(s) for meeting goal(s), i.e. short-term goals somewhat related to long-term goals A) S omewhat participating in the execution of the plan(S) I) I dentifies vague or conflicting long-term goals that will be very difficult to achieve I) D iscusses a plan that is not realistic. Short-term goals unrelated to long-term goals I) V ery little participation in the execution of the plan(S)

60. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales LONG-TERM GOALS R) D oes not identify any long-term goal(S) or has unachievable goal R) D oes not discuss plan, abandons his/her plans easily R) N o participation in the execution of the plan(s), doing nothing to achieve goals

61. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Interpretation of Past Experiences O verall, do you feel you have had the typical ups and downs in your life or do you feel your life has been exceptionally better or worse than typical? G ive an example of the best period of your life G ive an example of the worst period of your life H ow was your life affected by these ups and downs? H ave you been able to choose the important things in your life? F) E xpresses very positive feelings about past experiences. F) C haracterizes past as time of great performance and accomplishment A) E xpresses somewhat positive feelings about past experiences A) P resents best and worst period(s) with equal emphasis

62. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Interpretation of Past Experiences I) E xpresses mostly negative feelings about past experiences I) P laces more emphasis on worst period(s) than best period(s) of life R) E xpresses only negative feelings about past experiences R) D iscusses only worst period(s), unable to identify best period(s)

63. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Physical Environment W here do you live? (Location, house, apartment?) I s it easy to get around and get things done? I n the area where you live, are there things to do/places to go that interest you? I s there someplace you go to on a regular basis (e.g., work, school, church, the park district, the doctor's office)? I s it easy to get to from your home? A re there any physical barriers at (from above) or at home that prevent you from getting things done? I n terms of activities you would like to participate in, places you would like to go, w hat if anything prevents you from doing so (Money, transportation, safety concerns, physical barriers)? A re there resources available to help you overcome barriers to getting things done? F) D emands(Constraints in the physical environment provide strong support for successful role performance F) A mple resources/opportunities (money, transportation, facilities etc.) to support participation in desired activities

64. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Physical Environment A) D emands/Constraints in the physical environment provide same support and allow role performance A) S ufficient resources/opportunities {money, transportation, facilities etc.) which provide some support and allow participation in desired activities I) D emands/Constraints in the physical environment provide very little support and inhibit successful role performance I) L imited resources/opportunities (money, transportation, facilities etc.) provide very little support and inhibit participation in desired activities R) D emands/Constraints in physical environment provide no support and restrict successful role performance R) I nadequate resources/oppor t unities (money, transportation, facilities etc.) provide no support and restrict participation in desired activities

65. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Physical Environment Social Environment D o you spend a lot of time alone? W ho do you spend most of your time with? W ho are the most important people in your life right now? D oes what they expect from you match what you like or would like to do? W ould you describe your (work, school, community) setting as supportive? F) O ther persons (family/friends/co-workers) provide strong support which facilitates participation F) H as ample opportunities for social participation A) O ther persons (family/friends/co-workers) provide some support which allows some participation A) H as some opportunities for social participation

66. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Physical Environment Social Environment I) O ther persons (family/friends/co-workers) provide very little support which inhibits participation I) H as very few opportunities for social participation R ) S ocial support (family/friends/co-workers) is missing from the social environment which restricts participation R) D oes not have opportunities for social participation

67. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Physical Environment Readiness for Change T ell me about a time when you experienced a big change in your life (moving, going away to school, death of a parent/spouse/child). W as it difficult to adjust? H ow do you handle it when your daily routine changes (If needed, use an example from response given in Habits section) W hen someone gives you feedback (ask to change your behavior) H ow do you react? F ) A djusts well to feedback/changes in personal/environmental circumstances F) H ighly motivated ta make positive changes; clearly identifies areas client wants to work on

68. OCAIRS Mental Health Interview (Form 3) Questions, Rating Scales Physical Environment Readiness for Change A) S ome difficult in adjusting to feedback/changes in personal/ environmental circumstances A) S ome motivation to make positive changes; has some difficulty in identifying areas client wants to work on I) S ignificant difficulty in adjusting to feedback/changes in personal/ environmental circumstances I) V ery little motivation 10 make positive changes; has significant difficulty in identifying areas client wants to work on R) R ejects feedback/changes in personal/ environmental circumstances R) M akes inadequate changes or modifications; does not identify areas client wants to work an

69. OCAIRS Mental Health (Form 4) Key Words Form This sheet summarizes Key concepts from MOHO that have been used in the OCAIRS that the therapist can view at a glance for his/her reference ROLES Primary responsibilities Importance Enjoyment Success HABITS Typical weekday Typical weekend Satisfaction

70. OCAIRS Mental Health (Form 4) Key Words Form PERSONAL CAUSATION What one is proud of Coping abilities Anticipation of success VALUES What is important? Lifestyle match values INTERESTS Interest in primary occupation Interests outside primary occupation Level of participation Satisfaction

71. OCAIRS Mental Health (Form 4) Key Words Form SKILLS: Motor Skills, Process Skills and Communication & Interaction Skills Strengths : physical, mental, social, emotional Limitations : physical, mental, social, emotional Compensating for limitations GOALS Future Plans Short-term Long-term Follow through INTERPRETATION OF PAST EXPERIENCES Good times Bad times Balance Impact of ups and clowns

72. OCAIRS Mental Health (Form 4) Key Words Form PHYSICAL ENVIRONMENT Barriers/Accessibility Resources/Opportunities Demands/Constraints SOCIAL ENVIRONMENT Value and Attitude Congruence Support System Resources/Opportunities Demands/Constraints READINESS FOR CHANGE Adjustment to major life changes Adjustment to change in daily routine Response to feedback