Scoring a client with FASD and complex issues
Background:
· Client has a diagnosis of FASD.
· Referred for completion of a FCA and cognitive assessment. No other cognitive assessments were able to be performed due to cultural barriers.
· Aboriginal female from remote region.
· Engaged well in the assessment when administered with cultural supports.
Running Stitch:
Completed the stitches quite loosely initially; to fix/correct, she had to pull out the stitches.
Completed 4, not 3 running stitches when asked how many to complete.
Ended up with the cord on the back of the board.
Scored as 3.4
Question:
Do you score this with the maximum score of 3.4 if able to complete?
Response:
Yes, although I would not be thinking of a score at this point. I would just say that the person meets the Task Completion Criteria for the running stitch, task 1 (or just note T1CC for shorthand).
Question:
Is the person meant to finish on the back of the board? Does this matter?
Response:
No, it doesn’t matter as long as they have completed at least 3 stitches.
Question:
Scoring Whip Stitch and Single Cordovan at Level 4.0 and above for this client.
Whip stitch:
Able to distinguish the ‘shiny’ and ‘dark’ side
The third stitch became twisted; she had to pull it out to fix it
She would pull the lace straight through without making a loop and guiding the lace through to prevent twisting
Able to identify the cross back error by saying “knot here tied around”
Unable to fix the twisted lace error without pulling them all out; she became really frustrated after a while of trying, so had to move onto the final cordovan task
Remembered she had to do 2 more stitches to make a total of 3 whip stitches
She was very persistent and each time she tried again she would say “no/nah, I think I have an idea”
I scored as Level.Mode 4.0
Response:
The ability to correct the twist errors by pulling the stitch all the way out meets the primary rating criteria typically observed at Level.Mode 4.2.
Details from the Single Cordovan:
The client tried to talk herself through the task by saying, ‘Start on this side first (right/front side), got to go over and goes in’. (the hole/loop)
Tried to go through the left hole to the one we were trying to do the single cordovan in.
Tried to go through the hole on the far left of all stitches after saying, ‘I think I may have it, I have an idea’.
After a demonstration, she followed the right steps to go through the correct loop; however, she did not hold the lace at the back to prevent twisting and could not tension right so was always twisted.
To fix the error, she always had to pull the lace out.
A second demonstration and prompt was provided by saying, ‘Pull the lace through but tighten not at the very end as it is becoming twisted’.
Response:
Do not provide a verbal hint here. There is only one hint provided and that occurs BEFORE the demonstration.
· After this, she said, ‘That’s too confusing,’ so I finished the assessment there.
Response:
Finishing at this point was appropriate
This is typical response at both 4.2 and 4.4
Comment:
I scored this client as Level.Mode 4.4.
Response:
I don’t think this helps you to confirm the score on the ACLS. The inability to deal with the twists is consistent with performance at 4.2. At 4.4 people typically:
· Go from back to front through the hole and front to back through the loop, or vice versa
· OR, front to back through the hole and back to front through the loop.
Question:
Based off collateral information regarding functional capacity, I scored the person 4.2 overall based on the marking criteria in the functional cognition Book 2. Can you confirm?
Response:
I agree with your final assignment of the Level.Mode based on the screen.
Question:
I was wondering how best to present the above data, including drop of 0.2 of a score?
Response:
I state something like:
· The ACLS yields a score that is highly accurate within one .Mode. Therefore, we must consider if the person’s functional cognitive performance best reflects abilities predicted at Level.Mode 4.0 or 4.4. This is referred to as the verified Level.Mode of functional cognitive performance.
· The verified score was determined to be ________ based on the following: (then explain how you verified the score such as ADM, clinical observation, collateral) and summarise the information obtained.