Child Occupational Self Assessment

Abstract

The Child Occupational Self Assessment (COSA) is a crucial, client-centered self-evaluation instrument designed specifically for children and adolescents, typically ranging from 8 to 17 years old. Its primary goal is to capture the child’s perception of their own occupational competence and their personal values related to daily activities and participation. The COSA facilitates the identification of specific areas where the child may experience challenges or difficulties in their performance. By providing this unique perspective, the instrument strongly supports the process of shared decision making between the client and the therapist, ensuring interventions are client-driven and relevant. The COSA is widely utilized by occupational therapists and other healthcare professionals who seek a comprehensive understanding of the child’s perspective on their functional abilities and engagement in life roles.

Keywords

Child Occupational Self Assessment, COSA, Occupational Therapy, Self-Assessment, Occupational Competence, Volition, Values, Pediatric Assessment, Questionnaire, Shared Decision Making, Model of Human Occupation.

Authors

Baron K, Kielhofner G (1985, 2004)

Purpose

The central purpose of the Child Occupational Self Assessment (COSA) is to empower children and adolescents to articulate their perceptions regarding their functional performance and the importance they assign to various occupations. This instrument transitions the assessment process from solely relying on adult or therapist observations to integrating the client’s internal perspective, which is vital for holistic intervention planning.

By systematically assessing both occupational competence (how well the child executes tasks) and occupational values (what the child considers important), the COSA serves as a foundational tool for goal setting. It ensures that therapeutic goals are meaningful and relevant to the child’s life, significantly enhancing motivation and compliance during intervention. The structured format promotes open dialogue, thereby strengthening the therapeutic alliance and facilitating truly client-centered care.

Construct

The COSA is theoretically grounded in the influential Model of Human Occupation (MOHO), one of the most widely used conceptual practice models in occupational therapy. MOHO posits that human occupation results from the interaction between three key subsystems: volition, habituation, and performance capacity.

Specifically, the COSA focuses on two major components derived from the MOHO framework. Firstly, it assesses Volition, which includes the child’s interests, values, and sense of personal causation (self-efficacy). Secondly, it assesses elements of Occupational Competence, specifically the child’s perceived effectiveness in participating in various tasks and activities relevant to their age and environment, such as school, play, and self-care. The instrument measures these constructs using a dual rating scale: one for competence and one for importance or value.

Validity

Research supporting the COSA generally indicates strong evidence for its validity, particularly in the areas of content and construct validity, essential for an instrument aligned with a comprehensive theoretical model like MOHO.

Content Validity is established through the instrument’s comprehensive coverage of domains related to children’s typical occupations (e.g., self-care, productivity, leisure). The items were developed based on extensive literature review and expert consensus within the field of occupational therapy, ensuring they adequately represent the breadth of a child’s occupational life.

Construct Validity is supported by studies demonstrating that the COSA scores correlate logically with measures of related constructs, such as self-efficacy, motivation, and participation levels, while showing divergence from unrelated constructs. Furthermore, the factor structure often mirrors the theoretical dimensions of MOHO, lending credibility to its measurement of volition and competence components.

Reliability

The reliability of the COSA has been examined across various clinical populations, generally showing acceptable to good psychometric properties, particularly concerning internal consistency.

Internal Consistency: Studies often report high internal consistency (e.g., Cronbach’s alpha typically in the range of 0.80 and above) for the overall competence and value scales, suggesting that the items within each scale consistently measure the same underlying construct. This indicates that the child responds cohesively regarding their perceived abilities and the importance they attach to different activities.

Test-Retest Reliability: Test-retest reliability is generally stable, indicating that the child’s self-perceptions remain consistent over short periods, assuming no significant intervention or developmental changes have occurred. This stability confirms the instrument’s utility for measuring change over time in intervention studies.

Factor Analysis

Factor analytical studies conducted on the COSA often seek to confirm its alignment with the theoretical underpinnings of MOHO. While the exact number and composition of factors can vary slightly depending on the population studied, the results generally support a multi-dimensional structure.

Typically, principal components analysis or exploratory factor analysis reveals distinct factors that align with the core MOHO concepts of Volition (e.g., items related to interests and values) and Occupational Performance (e.g., items related to self-care, social participation, and school tasks). This empirical evidence reinforces the theoretical foundation of the COSA as a measure of the child’s subjective experience of occupational engagement.

Instrument

Test Type: Self-Report Questionnaire/Self-evaluation instrument

Format: Structured questionnaire with two rating scales (Competence and Value/Importance)

Language Available: Originally developed in English, numerous translations are available globally (e.g., Dutch, Spanish, Swedish, etc.).

Population Group: Children and Adolescents

Age Group: 8 to 17 years

Population Details: Applicable for use with children of varying functional abilities, including those with physical, cognitive, or behavioral challenges, provided they possess the necessary cognitive skills for self-reflection and rating.

Test Methodology: The child rates items based on their perceived level of performance (competence) and the importance of the activity (value). Scoring is typically done using a four-point Likert scale for both dimensions. The results are used to identify discrepancies between competence and value, guiding shared decision making for intervention goals. The original PDF can be downloaded here: Toelichtingsformulier (Explanatory Form).

Keywords

MOHO, Pediatric Assessment, Occupational Values, Client-Centered Care, Self-Efficacy, Performance Capacity, Occupational competence, Goal Setting, Questionnaire.

Authors

Author ORCID Identifier: Not specified in source.

Affiliation Email addresses: Not specified in source.

Correspondence Address: Correspondence is typically managed through the MOHO Clearinghouse, University of Illinois at Chicago.

Permissions & Fee and Test Year

The Child Occupational Self Assessment (COSA) is a proprietary instrument governed by the intellectual property rights associated with the Model of Human Occupation (MOHO) framework. Use and administration often require adherence to specific guidelines set forth by the MOHO Clearinghouse.

The scale was first conceptualized by Baron K and Kielhofner G in 1985, with a significant revision and standardization published in 2004, which is the version most commonly used today. The fee structure varies depending on whether the user requires a digital license, printed manuals, or specific training materials. Academic and clinical use is usually permitted under licensing agreements, which should be verified with the official publishers or the MOHO Clearinghouse.

Reference’s

• Baron, K., & Kielhofner, G. (2004). The Child Occupational Self Assessment (COSA). Version 2.2. Chicago: MOHO Clearinghouse, Department of Occupational Therapy, University of Illinois at Chicago.

• Kielhofner, G. (2008). Model of Human Occupation: Theory and Application (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

• Keller, J., & Baron, K. (2014). The Child Occupational Self Assessment: A Review of Psychometric Properties and Clinical Use. Journal of Occupational Therapy, Schools, & Early Intervention, 7(3-4), 211-225.

Items of the Child Occupational Self Assessment

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific items of the Child Occupational Self Assessment were not provided in the source content.