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The Assessment

of Communication
and Interaction
MOHO - Model of Human
Three elements:

● Volition
● Habituation
● Performance Capacity
“These three elements, in interaction with the environment, shape what we
choose to do, how we organize our lives and what we are capable of doing.”
(Kielhofner, 2002)
Administration Time

Relatively simple and quick to administer once

familiar with content

20-60 minutes to administer and score

Adults with:

● Psychosocial dysfunction
● Impairments secondary to brain injury, stroke,
CP, dementia, and other factors
● Physical disabilities
Setting and Population

● Open
● Parallel
● Group
● One on One
Setting and Population

● Natural Setting
● Simulated or Unsimulated Life Role Situation
● Adults with interactive, social deficits, and
physical disabilities
Observational Rating Scale

● Individual’s Social Interaction while

participating in meaningful activity
● 20 Observational Skills
● Broken down into 3 domains

Con t Ges s Man es

Gaz Ori s Pos s
Information Exchange

Ar i l e En a s Sha
As e t Ex es Spe
As Mod es Sus s

Col ra Rel
Con m Res t

● Competent (4)
● Questionable (3)
● Ineffective (2)
● Deficit (1)
Gazes- uses eyes to communicate and interact with

● 4 = readily and consistently gazes, which

supports ongoing social action
● 3= questionable gazing ability, however, there
is no disruption in ongoing social action
● 2= ineffective gazing ability, which impacts
social action
● 1= gazing causes breakdown in social action
Results and Why?
Rating Score = 1

Shows no eye contact during interaction; may lower head or look away

Stares inappropriately or makes intense eye contact

Rating Score = 2

Makes inappropriate intense eye contact (no blinking, staring) for a short period

Has difficulty maintaining eye contact

Speaks- Makes oneself understood through use of words,
phrases, and sentences

● 4 = readily and consistently speaks, which

supports ongoing social action
● 3= questionable speaking ability, however,
there is no disruption in ongoing social action
● 2= ineffective speaking ability, which impacts
social action
● 1= speaking causes breakdown in social action
Results and Why?
Rating Score = 1
Word choices are inappropriate- does not talk using
sentences and/or spoken parts are not understood
causing an unacceptable delay or breakdown in social

--Disorganized sentences/ phrases- meanings are

fragmented -- Needs someone else to explain intent
Conforms- Follows implicit and explicit
social norms
● 4 = readily and consistently conforms, which supports
ongoing social action
● 3= questionable conforming ability, however, there is no
disruption in ongoing social action
● 2= ineffective conforming ability, which impacts social
● 1= deficit in ability to conform causes breakdown in
social action
Results and Why?

Rating Score = 4

-Displays non-offensive behavior, avoids poor

manners, and there is no disrespect
Interpreting Results

● Scoring does NOT give underlying reason

WHY client has social deficit
● Holistic Approach
● Goal to be socially acceptable
1989- Simon- interrater reliability for 3 OT raters

● Suggested that definitions of verbs be refined, behavior

examples further clarified, group verbs with domains, reformat
scoring to accentuate ability vs one’s deficits

1993- Salamy- Build on Simon’s findings and suggestions-

decided to regrade scoring criteria to make it harder to obtain
higher scores

1996- Forsyth- Build on Salamy’s recommendations along with

input from 20 OTs working in academia and clinicians-

● 52 Scottish OTs were trained to rate the ACIS in a 2-day

workshop. 117 clients and 244 completed ACIS
assessments were analyzed
● Average measures indicate the ACIS had a valid rating scale
1996- Forsyth

● ACIS can discriminate people into many different levels of

communication and interaction ability in a logical way
● ACIS item difficulty was found to be a good match to a person’s
● Consistency was found between and within raters
● Not diagnostically bound (can be used on physical and mental health
● Occupation based and client-centered
● Easy and efficient to administer (simple instructions and little
equipment to use)
● Corresponds to OTPF
● Affordable ($40)
● Each score allows for collaboration and feedback to the client based on

● Therapist impact on the client performance

● Subjectivity of the observer when scoring
● Non standardized- cannot be compared to similar
ages and sex of client
● Only used to evaluate adults
Forsyth, K., Salamy, M., Simon, S., & Kielhofner,G.
(1998). The Assessment of Communication and
Interaction Skills (ACIS) [Measurement
Instrument]. Chicago, IL: Model of Human
Occupation Clearinghouse.

● The Volitional Questionnaire (VQ) is an observational assessment

designed specifically to assess volition.

● Volition = Motivation

● Focus on “motivation,” not skills.

Purpose of VQ

● Evaluate volition in people who have significant limitations in

cognitive, verbal, or physical abilities.

● Provides insight into a person’s inner motives.

● Provides information of how the environment enhances or

attenuates volition.

● Helps to generate goals and assess outcomes/changes in volition.

● Only for children over 8 years of age

● Individuals who are unable to
self-report their own motives.
● There is no requirement to
standardize the context of

● Virtually any setting in the current

life of the client can be used.
● Examples:
Client’s home, school districts,
community residences, employment
settings, vocational clubhouses,
transition houses, day programs, and
vocational training settings.
A total of 14 items/questions that correspond to the 3 stages of Volitional

Exploration (lowest level) Achievement (highest level)

1. Shows curiosity 11. Pursues an activity to completion
2. Initiates actions/tasks 12. Invests additional energy/emotion
3. Tries new things 13. Seeks additional responsibilities
4. Shows preferences 14. Seeks challenges
5. Shows that an activity is special

Competency For each item, the therapist is required to

6. Indicates goals assign one of the four-point rating scale:
7. Stays engaged -Spontaneous
8. Shows pride -Involved
9. Tries to solve problems -Hesitant
10. Tries to correct mistakes -Passive.
● Spontaneous (4)
■ No support, structure, or encouragement needed.
■ Behavior is spontaneously displayed.

● Involved (3)
■ Minimal amount of support, structure, or encouragement needed.

● Hesitant (2)
■ Maximal amount of support, structure, or encouragement need.
■ Individual shows volitional weakness.

● Passive (1)
■ Does not show behavior even when support, structure, or
encouragement are provided.

● N/O → No Opportunity to Observe

● Time required to Admin
■ No time limit required for each observation, but
observations usually last between 5 to 30 minutes

● Time required to Score

■ About 5 min
Reliability → Inter-rater Reliability (.75 - .95)

Validity → Studies suggest that the instrument can

provide a valid measure of volition, though a
number of limitations of the tool are noted.
Strengths: Weaknesses:
● Easy to score ● Subjective assessment
● Client-centered ● Scoring language unclear
● Occupation-based ● No reliability/validity provided in manual
● No time constraints
● Quick to administer
● Inexpensive
● No formal training needed
● Wide array of settings
● Useful tool to introduce occupations
that can be of interest to the client
Chern, J.-S., Kielhofner, G., De las Heras, C. G., & Magalhaes, L. (1996, July/August ). The Volitional
Questionnaire: Psychometric Development and Practical Use. American Journal of Occupational
Therapy, 50, 516-525. doi:10.5014/ajot.50.7.516

De las Heras, C. G., Geist, R. K., & Li, Y. (2007). Volitional Questionnaire (Version 4.1.). Chicago, IL:
MOHO Clearinghouse.

University of Illinois. (2018). Model Of Human Occupation. Retrieved from The Volitional
Questionnaire (VQ) Version 4.1, 2007:

University of Utah. (2018). Assessment Rating Form. Retrieved from University of Utah: