Eli's Rehab Report

Here's how to act on your observations of client behaviors.

Evaluation of Social Interaction During Occupational Engagement. C. Douglas Simmons, PhD, OTR/L; Lou Ann Griswold, PhD, OTR/L, FAOTA; Brett Berg, OTR. Am J Occup Ther 2010 Jan-Feb;64(1):10-17.

Occupational therapists already know that a client's social interaction skills can make or break job performance, but many aren't sure which tool is best for assessing and improving those skills.

Best bet: The Evaluation of Social Interaction (ESI) assessment gives an extremely accurate measure of "social interaction as it occurs in the natural context during the completion of desired occupations," according to "Evaluation of Social Interaction During Occupational Engagement," a study published in the American Journal of Occupational Therapy.

The ESI differs from other assessment tools in that the OT observes the patient engaging in the social interaction of his or her choice and the observation takes place during real-world interactions with typical social partners, such as friends or co-workers. The OT also records how noisy or familiar the environment is and the number of social partners involved.

Goals: During the interaction, the OT evaluates six general social-interaction purposes, including gathering information, sharing information, problem solving and decision making, collaboration, acquisition of goods and services, and small talk. Clients are rated on a scale of 1-to-4 with 4 being the top score for consistent demonstration of socially appropriate behavior.

In this study, researchers observed 134 participants (72 males and 62 females) in 181 social interactions that took place in a community-based program for survivors of acquired brain injury, an elementary school, in a community's public area. The natural contexts for interactions were occupations of work, leisure and play, education, social participation, and activities of daily living. Of the total interactions, half were with participants who have a disability.

Outcome: The ESI tool gave an accurate, reliable measure of participants' social interaction skills. The assessment scores also clearly differentiated between participants with a disability and those without one. The measured skill items and intended purposes range in difficulty, making ESI a useful tool for evaluating both children and adults across diagnostic groups.

Based on these results, the study's researchers assert that the ESI could be a powerful tool for quantifying how well a client interacts socially in natural contexts -- including during work performances or occupational environments.

Drawback: The study's sample size is small and includes a limited age range. Future research should examine a larger sample of people across ages and levels of ability. This study also fails to explore the tool's sensitivity to gender, age, and culture.

Despite the limited scope of the study, it does highlight crucial advantages of using the ESI. Namely, OTs can use the tool to target the social interaction skills that are inhibiting a client's ability to carry out his or her job duties. Improving those skills will boost the client's ability to perform well at work, which can lead to naturally improved social interactions and increased occupational satisfaction.

Action plan: To get started, address easier social interaction skills and intentions first. For instance, coaching clients on empathizing and disagreeing with their social partners will boost their confidence and prepare them for more challenging skills like making accommodations to best fit the environment and taking turns during conversations.

Next steps: Future researchers will address how being observed influences the way clients interact in occupational settings and how interaction changes as clients mature.

Resources: View the study at http://ajot.aotapress.net/content/64/1/10. Learn more about the ESI assessment tool, or download the tool and worksheets, at www.socialinteraction.com.