精神科作業療法における評価の構造に関する検討

An examination of the structure of assessment in psychiatric occupational therapy

要旨：海外の作業療法(以下OTと略)評価尺度の構成を分析し，また，全国の精神科施設から収集した133尺度の項目分類を試みた．これを通して我々は，患者の適応機能に関連した3領域を2段階の手続きで行う2段階OT評価システムを提案した．3領域とは，(1)ADL，(2)対人関係，(3)個人的要因であり，評価の2段階とは，(1)OT場面での患者の適応機能評価，(2)実社会の中で患者が示しうる適応機能評価である．このシステムでは，OT評価とは，1人の患者について複数回行われるOT場面観察評価の結果を統合することによって，実社会における患者の適応可能性を推測評価することとされた．

　We attempted to analyze items for OT assessment in psychiatric settings. Following theoretically examining the rationale of OT assessment scales that have been developed by western researchers, we analyzed the items of OT assessment used in psychiatric hospitals. Based on these empirical and theoretical analyses of OT assessment, we distinguished 3 fields of adaptive functions and 2 steps of assessment procedures. Three fields of adaptive functions include ADL, interpersonal relations, and personal factors determining ADL and interpersonal relations. And, the first step of OT assessment involves the evaluation of adaptive behaviors (ADL and interpersonal relationship), in which patients are actually engaged in OT settings. The second step involves the evaluation of adaptive behaviors, in which patients can be engaged in social settings outside hospitals. Then, we provided our definition of OT assessment: "OT assessment is an attempt to evaluate the level of abilities and skills which enable a patient to independently live in society, that is, to evaluate the patient's social adaptive functions and the related personal factors, and an OTR makes the evaluation based on the assessment of the patient's behaviors and products in OT settings, considering information from other sources." In an illustration of the conceptual structure of the two-step OT assessment, we assumed that an OTR repeatedly makes the observational evaluation for a patient in OT settings and then attempts to make the inferential evaluation of the patient's social adaptive functions by integrating the results of multiple observational evaluations.