Personal Communication Update Report - Occupational Therapy Process Training for Psychiatric Clients with Cognitive Impairment - J Lewis Bermuda 2002

Sep 23, 2026

Personal communication update report on extending occupational therapy intervention by adding process training for psychiatric clients with cognitive impairment. The study used inclusion criteria of schizophrenia diagnosis, impaired cognition, and participation in an ongoing O.T./rehab program, excluding unstable mental state or inability to work in a group setting. Clients were assessed with Allen’s Cognitive Level Screen (ACLS) and self-rating scales, with standardized testing for only one participant due to time burden. Results compare lower-level (ACLS level 4) and higher-level (ACLS level 5) groups, highlighting differing pacing needs, facilitation requirements, and sustainability of benefits.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Methodology

Inclusion Criteria and Exclusion Criteria

Assessments

Process and Grouping

Schedule and Results

Lower (ACLS Level 4) Group

Higher (ACLS Level 5) Group

Personal Communication Update Report: To determine the potential benefits of extending occupational therapy intervention to include process training in the rehabilitation of psychiatric clients with cognitive impairment J Lewis Bermuda, 2002 Methodology Each psychiatric consultant was asked to refer suitable clients according to the inclusion criteria Inclusion Criteria -Diagnosis of schizophrenia (DSM IV) -Impaired cognition -Involvement in an ongoing O.T. / rehab program Exclusion Criteria -Unstable mental state -Inability to work in group setting Each client was screened by an O.T. using the Allen's Cognitive Level Screen (ACLS) to determine their cognitive functional level in order to estimate the degree of facilitation required by the client in the learning process. Each client was screened using a self-rating scale to determine the presence (and their subjective experience) of cognitive difficulties. Each client was to be assessed using a battery of standardized assessments to determine the extent of their cognitive deficit in comparison to the normal/TBI population. Support from the Psychologist was to be given in reviewing the data. Assessments included: TEA, LOTCA, DOOR&PEOPLE, RIPA-II, BADS Process In total, 10 clients were referred for the program, 8 from the Rehab service and 2 from the Acute service. 2 Rehab clients were rejected based on the exclusion criteria. All 8 clients indicated difficulties with attention on self-rating scales. Only one client undertook the full battery of assessments. It was found that at that level (ACLS) 4.6 scores were below the scales for the control groups (except on the RIPA-II and since the battery took 10 hours in total to complete it was decided to continue without standardized assessment of the other 7 clients at that time. The 8 clients assessed with ACLS were found to be at the following levels 1- level 4.0 2- level 4.2 2- level 4.6 1- level 5.2 2- level 5.4 Level 4 on the ACLS indicates 'goal directed activity', whereby cognition is moderately impaired and independent new learning does not occur. Therapist intervention and facilitation is required in new activities. Level 5 on the ACLS indicates 'exploration and independent learning'whereby cognition is mildly impaired. Verbal instructions can be given without demonstration and standby assistance only is required. In order to try to accommodate the different functional levels, the clients were split into 2 groups, a higher, level 5 group and a lower, level 4 group. It was necessary however to move the highest functioning of the level 4 clients into the higher level group to even numbers and allow sufficient facilitation to take place in the group. The level 4 group needed to have the material adapted to include a three point rating scale, and less information on the page with simplified instructions. it was anticipated that they would require more facilitation with meta-cognitive components. Schedule Both groups were scheduled to run for 1 hour sessions, three times a week (mon/weds/fri) Results Lower, 'level 4' group Speed of processing was slower in this group and it took longer than anticipated for the group to complete half of the first module. In total it took at least twice as long as projected to complete the 10 sessions. The groups attendance was sporadic and punctuality was a problem, for some clients, however, they did generally express interest and enthusiasm for the intervention. It was found that they did not sustain benefits, this was demonstrated by the poor use of feedback mechanisms within the tasks, their overly high estimates did not change and constant facilitation was needed to compensate for their difficulties with executive functioning. The high ratio of staff to clients (1:2) was another negative factor and although they were able to keep up with the higher group in terms of progress, the length of the sessions to do so, extended to more than

FAQs

What criteria were used to include or exclude psychiatric clients for the intervention?

Inclusion required schizophrenia diagnosis (DSM IV), impaired cognition, and involvement in an ongoing O.T./rehab program. Exclusion included unstable mental state and inability to work in a group setting.

How were clients assessed to determine facilitation needs?

An O.T. screened each client using Allen’s Cognitive Level Screen (ACLS) to estimate their cognitive functional level, and each client completed a self-rating scale to capture cognitive difficulties and subjective experience.

How did outcomes differ between the ACLS level 4 and level 5 groups?

The level 4 group showed slower processing, required more constant facilitation, struggled with sustaining benefits, and feedback mechanisms sometimes exacerbated paranoia, leading to disbanding the group. The level 5 group demonstrated improved meta-cognition and feedback use, with better integration of challenges and continued attendance by some clients.

Sep 23, 2026

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