KELS- Kohlman Evaluation of Living Skills Inservice!

Main ideas / concepts conveyed

• KELS (Kohlman Evaluation of Living Skills) is an occupational therapy assessment used to evaluate a person’s:
  • Independence
  • Ability to live safely on their own
• It is widely used across many care settings, including:
  • Acute care
  • Skilled nursing facilities
  • TBI
  • Mental health
  • Transitional housing
  • Substance use
  • Developmental/cognitive delays
  • …and other OT-related environments
• The video focuses on older populations and on people likely to be:
  • Discharging from rehabilitative services
  • Transitioning to skilled nursing / assisted living
• The assessment relates to OTPF-4 and frames “problem areas” in terms of:
  • Occupations
  • Client factors
  • Performance skills
  • Performance patterns
• KELS scoring is based on observation of performance and/or self-report across five key domains:
  1. Self-care
  2. Safety and health
  3. Money management
  4. Community mobility and telephone
  5. Employment and leisure participation

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Scoring / performance criteria (methodology)

General structure

• The KELS score sheet contains 17 items.
• Each skill/item is rated as one of:
  • Independent
  • Needing assistance
  • Not applicable
  • “Further note” (as indicated on the sheet)

Point values described

• Independent and Not applicable: 0 points
• Needing assistance: 1 point
• Last two domains (work/leisure):
  • Half a point each when scored as “needing assistance”

Interpretation of total score

• Total score between 6 and 17: the client needs assistance to reintegrate into the community
• Total score less than 5.5: the client is able to live independently

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Domain-by-domain instruction / procedures demonstrated

1) Self-care domain (example procedures and criteria)

Setup

• Client completes a reading and writing form.
• The therapist completes another part of self-care via observation/assessment while the client fills out the form.

Independence examples (as described in the subtitle list)

• The client is considered independent if no more than one condition is present.
• Conditions listed as concerns include:
  • Hair dirty/unkept
  • Ragged or torn clothing
  • Clothing/shoes not fastened properly
  • Unpleasant body odor not consistent with culture
  • Dirty fingernails/ungroomed hands
  • Visible dirt on the body
  • Dirty clothing
  • Obvious dental decay
  • Open/untreated wounds

If the client can’t fill out the form

• Therapist asks questions verbally.
• To meet independent standards for self-care activities, the client must meet minimum frequency expectations, including:
  • Shower/bathe/sponge bathe: at least once per week
  • Wash face: once per day
  • Wash hair: once every 7–10 days (tailored to hair type/culture)
  • Combing/brushing hair: once per day
  • Brush teeth or dentures: once per day

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2) Safety and health domain (example procedures and criteria)

Part A: Dangerous situations using pictures

• Therapist shows four pictures.
• Client decides whether each photo contains dangerous elements.
• Client explains what is dangerous and why.
• Example dangers identified in the demonstration:
  • Multiple cords and an outlet → risk of fire
  • Reaching over boiling water → could catch robe on fire
  • Cord between couch and coffee table → trip hazard
  • Child reaching for pills → potential for dangerous exposure/side effects

Part B: Appropriate actions for accidents/emergencies

The therapist asks what the client would do in scenarios, including:

• If sick with a cold
  • Example response: take cold medicine, eat soup, rest
• If burned and wound becomes infected
  • Example response: apply Neosporin; if worsening, go to urgent care
• If severe chest pain and shortness of breath
  • Example response: call 911
• If house catches fire
  • Example response: call fire department + provide the appropriate phone number

Part C: Knowledge of location of medical/dental facilities

• Therapist asks where to go for:
  • Doctor (example: Dr. Sabra’s office in “Cington, Washington”)
  • Dental care (example: Dr. Smith’s office in “Cington”)

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3) Money management domain (not fully demonstrated)

• The video skips a full demonstration due to time constraints.
• It notes key items typically scored include:
  1. Use of cash and purchasing items
     • Receiving correct amount of change
  2. Paying bills appropriately on time
     • Includes handling bill/payment tasks (examples implied by forms shown)
  3. Obtaining and maintaining an appropriate source of income

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4) Community mobility and telephone domain (example procedures)

Item 1: Mobility within the community

• Therapist asks questions about getting around (example):
  • How do you get from one place to another in Yakama?
  • Last time you drove your car?
• If the person doesn’t use public transportation, that part is treated as:
  • Not applicable (example: “No” to using public transit)

Item 2: Basic knowledge/use of public transit system

• Confirm whether public transportation is used.
• If not used: not applicable

Item 3: Use of telephone

• Therapist presents a phone number (demonstration uses a modern scenario).
• Client calls and asks for closing time.
• Example response obtained: closing time 8:00
• Client is scored independent for correct telephone use.

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5) Employment and leisure participation domain (example procedures)

Item: Obtaining/maintaining a source of income (employment)

• Therapist asks:
  • Last job (example: “Six months ago”)
  • Type of job (example: registered behavioral technician)
  • Future job goals (example: healthcare)
  • How the person will find a job (example: resume, Indeed, LinkedIn)

Item: Leisure activity involvement

• Therapist asks:
  • What do you do in your leisure/free time?
• Example response: hanging out with friends, cooking, working out
• Both items scored independent when responses are appropriate.

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Demonstration outcome / key conclusion

• In the demonstration, the client(s) were scored as independent across demonstrated areas.
• Final overall statement given:
  • The client scored as zero, which means the client is able to live independently in the community.

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Noted modifications / limitations in the demonstration

• Due to time constraints, the team:
  • Skipped the money management domain demonstration
  • Made “alterations” to some items to fit a more modern scenario
• Example modification:
  • Telephone portion: the manual suggests a landline, but they used a more modern/realistic alternative.

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Speakers / sources featured (as named in the subtitles)

• Landry (therapist/evaluator; also referenced as the “client” in parts of the scoring dialogue)
• Jamie (client in the self-care and safety/health demonstration portions)
• Vie (referenced during mobility questions)
• Vani/Vanny/Fanny (appears to refer to the same person during community mobility/telephone; subtitles have inconsistencies)
• Chipotle (used as the phone-number scenario in the demonstration)
• Andrea (mentioned as showing forms in the money management section)
• OTPF-4 (referenced as the framework/source for occupation-related problem areas)
• KELS manual / “manual in the classroom” (referenced as the source document for administration details)