The VQ (de las Heras, et al., 2007) and the Paediatric VQ (Basu, et al., 1998) are assessments designed to garner information on volition via the observation of the service user. These assessments were developed as traditionally, it had been difficult to assess volition in service users that were experiencing severely restricted volition and/or communication and cognitive limitations. The assessments recognises that volition is unique for each individual and that understanding how each individual is motivated is essential to client-centred services. They also acknowledge that each individual responds differently to different environments and that it is important to understand how factors in the environment may contribute to the client's motivation. And, they attempt to recognise that, while a service user may find it difficult to formulate goals or express their interests and values verbally, they are often able to communicate them through their actions. The PVQ is designed for children aged 2-6 and the VQ for older children, adolescents and adults.
Both assessments are used as part of direct interventions where the service user is ideally observed in a number of occupational behaviour settings but, the VQ can also be used for one of observations if time does not allow for a multitude. However, completing a number of observations in different settings enables a true understanding of how the environment can influence the person's volition to be gained and is best practise. The VQ and PVQ can also be successfully used when a service user receives input from a variety of care givers to account for volitional traits and environmental factors in MDT intervention planning and to identify ways for motivation to be supported and enhanced. Or, used to identify motivational factors that contribute to behaviours that challenge and, therefore, identify effective strategies for reducing or eliminating these.
The VQ consists of 14 items that describe behaviours reflecting values, interests and personal causation. Each item is scored using a four point rating scale (passive, hesitant, involved and spontaneous) with the rating indicating the extent to which the service user readily exhibits volitional behaviours versus, the amount of support, encouragement and structure that is necessary to elicit volitionally relevant action. The scale reflects the fact that the persons with higher volition chooses action and demonstrates positive affect more readily, whereas those with more limited volition need additional environmental resources and supports. The VQ also takes into account that a person's motivation will vary in different types of environment according to how much the features of each environment match the client's interests, values and personal causation and the is why it is recommended that behaviour is observed in more than one environment; an environmental form can be used to record information about relevant features of the environment that affect volition.
Goals of the VQ:
Describe a service user's volition and provide information that can be used in conjunction with other assessments to form a holistic understanding of the person.
Elicit information about the person's specific motivational characteristics (personal causation, values and interests).
Identify environmental factors that support or hinder the person's volition.
Identify ways to support optimal motivation and engagement in occupation.
Determine environmental supports that can be given to enhance a person's performance and experience.
Enable client centred intervention planning and treatment programs
Assist occupational therapists, other members of the MDT, family and carers to effectively facilitate volition in service users.
Document changes in a client's motivation.
Provide an outcome measure that measures efficacy of intervention strategies for actively engaging the client.
Using the VQ in Goal Setting:
The VQ elicits information that can be invaluable to the MDT when goal setting and intervention planning with the service user. By identifying the person's volitional level, their unique motivational characteristics and how their motivation is influenced by their environment, we can better understand what types of environment will support and facilitate occupational engagement. By setting the environment we can instil confidence and facilitate meaning within the occupation, by identify what is of value we can be strategic in the activities that we choose as the foundations of our interventions and by identifying how capable a person feels we can build in the level of support required and grade our interventions accordingly.
By identifying where the person is on the volitional continuum (discussed in Volition; the biological need for action) it can give us a clearer picture as to where to begin; if a person is at the lower end of the volitional hierarchy, the goal would be to elicit the person's active exploration of the environment and this would require an environment that is of interest without a risk of failure. Where as, when working with someone at the competency level would enable the encouragement of development of new skills or, the refinement of those already emerging. And, when working with those at the achievement stage, goals could be set to impose higher volitional demands.
References:
Basu, S., Kafkes, A., Schatz, R., Kiraly, A., and Kielhofner, G. (1998) Pediatric Volitional Questionnaire (PVQ). Chicago, IL: The University of Illinois at Chicago.
De Las Heras, C. G., Geist, R., Kielhofner, G., and Li, Y. (2007) The Volitional Questionnaire (VQ) (Version 4.1). Chicago, IL: The University of Illinois at Chicago.
Comentarios