This week (Monday 25th October to Sunday 31st October) is OT Week 2021, and this year’s theme is participation, inclusion, independence. We have written before about the many ways in which Occupational Therapists help people with disability increase their participation in the community, experience greater inclusion, and live more independently. A big reason OTs are great in this respect is because their role is so holistic: remember a person’s occupation is any activity or task that makes up their daily living, which gives OTs quite a broad scope in which they can help (you can learn more about Occupational Therapy here). A major part of the work Occupational Therapists do is in the area of capacity building to help clients develop the skills and capabilities, and to put the appropriate supports in place that will enable the person to engage in occupations that are important to them. In order to know which areas a client may need to build capacity, an OT will conduct a Functional Capacity Assessment. Because capacity building is such a valuable part of the work OTs do, we thought we would dedicate our OT Week blog to the topic!
What is capacity building?
NDIS capacity building is a process that involves the development of the skills and abilities needed to perform important functions, problem solve, develop and manage tasks, set and achieve objectives, and manage long-term self-development goals across the individual’s life span. Capacity building is a holistic process because it is premised on the idea of empowering the individual across all areas of their life. It addresses the whole person, incorporating their broader support network, and working on unique goals that will allow the individual to participate in meaningful activities both at home and in their community.
What is an NDIS functional capacity assessment?
NDIS functional capacity assessments are designed to ensure NDIS participants are able to access the appropriate support and funding that meets their individual needs and assists them in reaching their goals. The OT will meet with the participant either in clinic, in the participant’s home, or even via telehealth. Because Occupational Therapy is all about helping people to engage in the occupations that make up their daily life, a functional capacity assessment is quite broad in scope, and the OT will address the five main categories of occupations: personal care, instrumental activities, community access, work, and leisure.
Personal care
The OT will explore how their client is managing typical daily activities like bathing, personal hygiene, toileting, dressing, cooking and eating, sleeping and more. This will involve looking at how a person’s disability may impact on their capacity to undertake these tasks (for example, the way a back injury may impact a person’s ability to dress themselves).
Instrumental activities
Instrumental activities include those tasks that a person undertakes as part of daily life in the home. This might include cooking, cleaning, laundry, looking after pets, or paying bills. The OT will discuss the individual’s living circumstances and what supports (if any) are already in place, and identify which challenges are inhibiting independence.
Community access
The OT will assess their client’s capacity to access the community and identify if and how any activities (such as attending appointments, or grocery shopping) are impacted by their disability.
Work
Disability can often impact a person’s capacity to engage in vocational activities like paid work, study, or volunteering. During an Occupational Therapy Functional Capacity Assessment, an OT will investigate whether their client’s disability is impacting their capacity to take part in vocational activities.
Leisure activities
Social inclusion is important for quality of life. An Occupational Therapist will determine whether their client is engaged in, or would like to engage in, recreational or social activities such as exercise going out for coffee, attending church, or participating in community groups or activities they enjoy. The OT will then explore the ways in which their client’s disability may be inhibiting social inclusion.
Practical assessment
After an initial discussion evaluating the five areas above, a practical assessment may be required to gain further insight into specific difficulties an Occupational Therapy client may be experiencing. During a practical assessment, the Occupational Therapist can observe their client undertaking particular tasks, and gain a deeper understanding into the types of challenges their client is encountering in relation to the task.
Functional Capacity Report
Upon establishing a client’s functional capacity, the Occupational Therapist can make a range of recommendations which they will detail in a report. This report will provide a summary of the assessment and describe the functional challenges their client is facing in relation to certain occupations. Importantly, the OT will make recommendations around how the client can improve their functional capacity. This might include a therapy program, assistive technology, skills development or any other supports that will help the client to engage in meaningful activities and increase participation, inclusion and independence.
Importantly, this report must be comprehensive, detailing the client’s specific goals, the ways in which their disability impacts the attainment of those goals, recommendations for which interventions and supports would help the client to achieve their goals, and justifications for those recommendations.
Recommendations
To help a client achieve their mobility, independence and participation goals, an OT can make a range of recommendations.
Therapy programs, rehabilitation, and condition management
As part of a Functional Capacity Assessment, an OT can recommend a therapy program aimed at promoting health and wellbeing by enabling their client to participate in daily living occupations. Because of the broad scope of occupations that make up daily living, a therapy program could be focused upon skill building in anything from cognitive therapies to help with social interaction (community access occupations), to cooking skills so the participant can improve their independence at home (instrumental activities), to something like upper limb therapy for a participant wanting to return to fishing (leisure occupations). It is not uncommon for clients to have a range of goals they are working towards. To this end, their OT can put into place a comprehensive therapy program to help their client work toward multiple goals.
Assistive Technology
Sometimes a Functional Capacity Assessment reveals that a client would gain greater independence through the use of assistive aids. Assistive Technology (AT) incorporates any equipment, system, or design that assists a person to navigate their home, school, workplace or community to engage in daily occupations that they otherwise wouldn’t be able to. AT can range from simple (such as a jar opener or kettle tipper) to the more complex (such as mobility aids like power wheelchairs). If during the Functional Capacity Assessment, the Occupational Therapist determines their client would benefit from some form of AT, then the OT will undertake in-depth research to determine the most appropriate device that will aid their client, and make recommendations about particular brands of equipment. Ultimately, when an OT scripts Assistive Technology, its function is to increase their client’s autonomy and provide opportunities for participation in activities that are meaningful to them.
Home Modifications
An Occupational Therapist can work with their client to promote independence and increase safety in the home by modifying the space. For example, if the functional capacity assessment reveals that a client is unable to enter or exit the shower safely then grab rails can be installed to help the client move independently throughout their home and manage daily occupations while feeling safe doing so. The installation of aids like grab rails or a ramp for wheelchair access are examples of a minor or simple home modification. However, sometimes a functional capacity assessment will reveal that more substantial changes need to be made to a person’s home to allow them to move freely, independently and safely around the house. For example, a person in a wheelchair may need their bathroom made more accessible so that they can move into the shower, access the toilet safely, and use the vanity. In this example the Occupational Therapist would organise a major modification, which involves, in liaison with the client, scoping the works needed, meeting on site with builders, and completing an in-depth report document for approval.
Other outcomes from a Functional Capacity Assessment
The holistic nature of a functional capacity assessment leads to a broad range of supports and interventions that can be organised by an Occupational Therapist. In addition to some of the common outcomes detailed above, OTs may recommend other interventions like assistive animals or vehicle modifications to assist their client in gaining greater independence and access to the community. Occupational Therapists also engage in education, support and skills building – working both with the client and the client’s wider support circle to build knowledge, understanding, and skill development that will benefit their client in terms of participation, inclusion, and independence.
NDIS capacity building helps participants to achieve goals that matter to them. It is a collaborative process, in which the OT, the participant and often the participant’s broader support network will work together to identify and implement tailored supports and interventions aimed at increasing participation at home and in the community, providing greater opportunities for inclusion, and helping an individual live more independently. If you, or someone you know would like to know more about functional capacity assessments, or organise to meet with an Occupational Therapist, you can contact our client services team or visit our website and we will be in touch.