**4. Assessment in forensic occupational therapy services**

Occupational therapy process commences with contiguity between the offender and occupational therapy service. Collecting information about the person and making special evaluations is the first step in this process. Gathering information about the individual and special assessments helps to determine the problems and needs, as well as the reason for the intervention. It also allows for the setting of intervention targets and the determination of the intervention plan. In the process of occupational therapy, the intervention plan is followed by the implementation of the intervention. The intermediate evaluation may be needed to determine the effectiveness of the intervention or to reveal new intervention goals and plans. After intervention plans that have been modified or reorganized after the interim evaluation are applied, the intervention is assessed. As seen in the abovementioned occupational therapies process, information gathering and evaluation also play an important role in the intervention for forensic occupational therapy applications. In summary, an occupational therapist working with prisoners should use a three-stage assessment of initial assessment, interim evaluation and outcome measurement during the occupational therapy intervention process [15, 21].

Occupational therapy sees people as active and social entities and treats the person, his occupations and the environment holistically in order for the individual to achieve or regain well-being. It is also important to assess the individual as a whole in the information gathering and evaluation process for the creation of a suitable intervention plan [15] . According to the occupational therapy reference frame written by AOTA [15], personal factors include the individual's values, interests, and spirituality as well as body structure and functions. Having knowledge about the boundaries and areas of internal energy in prisoners' participation in occupations can be useful to guide activity preferences and motivation processes. The things that constitute the meaning of prisoners' lives are values and beliefs they believe to be worth trying and taking the time. The occupational therapist in forensic setting desires recreates occupational identification of offenders who lose their roles by being isolated from the social environment. For this reason, it is very important to understand the value, relevance, strengths and limitations of the individual [4, 16, 22].

It is also necessary to assess the sensory, motor and cognitive skills involved in the body structure and functions of the person in need to meet the occupation requirements they wish to perform. These skills can make or break an individual's daily life. One point that should not be overlooked here is that during the process of occupational therapy collecting and evaluating information, the prisoner does not play a passive role, so the occupational therapist does not seem to be running a process alone. The occupational therapist and the prisoner are in the business association during the presentation of information, evaluation and outcome measures, and the prisoner is actively involved in this process.

effective assessments and interventions. Although the literature is still limited; different occupational models such as KAWA model, creative ability model, PEOP (Person, environment, occupation, performance), the Canadian model of occupational performance and engagement and the individual placement and support model with can be effectively used with standardized assessments and outcome measures in various individuals, situations, cultures and environments in provision of occupational therapy services in a cost-effective way [6, 15, 16].

Occupational therapy process commences with contiguity between the offender and occupational therapy service. Collecting information about the person and making special evaluations is the first step in this process. Gathering information about the individual and special assessments helps to determine the problems and needs, as well as the reason for the intervention. It also allows for the setting of intervention targets and the determination of the intervention plan. In the process of occupational therapy, the intervention plan is followed by the implementation of the intervention. The intermediate evaluation may be needed to determine the effectiveness of the intervention or to reveal new intervention goals and plans. After intervention plans that have been modified or reorganized after the interim evaluation are applied, the intervention is assessed. As seen in the abovementioned occupational therapies process, information gathering and evaluation also play an important role in the intervention for forensic occupational therapy applications. In summary, an occupational therapist working with prisoners should use a three-stage assessment of initial assessment, interim evaluation and outcome measurement during the occupational therapy intervention process [15, 21]. Occupational therapy sees people as active and social entities and treats the person, his occupations and the environment holistically in order for the individual to achieve or regain well-being. It is also important to assess the individual as a whole in the information gathering and evaluation process for the creation of a suitable intervention plan [15] . According to the occupational therapy reference frame written by AOTA [15], personal factors include the individual's values, interests, and spirituality as well as body structure and functions. Having knowledge about the boundaries and areas of internal energy in prisoners' participation in occupations can be useful to guide activity preferences and motivation processes. The things that constitute the meaning of prisoners' lives are values and beliefs they believe to be worth trying and taking the time. The occupational therapist in forensic setting desires recreates occupational identification of offenders who lose their roles by being isolated from the social environment. For this reason, it is very important to understand the value, relevance,

It is also necessary to assess the sensory, motor and cognitive skills involved in the body structure and functions of the person in need to meet the occupation requirements they wish to perform. These skills can make or break an individual's daily life. One point that should not be overlooked here is that during the process of occupational therapy collecting and evaluating information, the prisoner does not play a passive role, so the occupational therapist does not seem to be running a process alone. The occupational therapist and the prisoner are

**4. Assessment in forensic occupational therapy services**

60 Occupational Therapy - Therapeutic and Creative Use of Activity

strengths and limitations of the individual [4, 16, 22].

Occupational therapists are aware that the occupational performance of an individual is influenced by factors related to the individual as well as by the performance patterns and the environment. Roles, routines, rituals, and habits constitute performance patterns [15]. Routines and habits allow the individual to perform his/her daily activities without thinking about how to move, without trying to remember. Occupational therapists working in forensic health services care about whether the prisoner has useful habits and routines for him. It is necessary to know how individuals spend their days and which routines they create from day to guide to get new routines and habits to use the time and energy more efficiently when the living conditions change [11]. Roles are the whole of the behaviors that an individual imposes on his/her responsibility, which is imposed by the environment and culture. Rituals are symbolic behaviors that are understood by social, cultural and spiritual values that shape the occupational identity of the individual. During the evaluations, the roles of the prisoner and the importance of these roles and the determination of meaningful rituals in the individual's life provide significant benefits for the therapist's intervention plan. Changes in location and time can also cause changes in the roles and rituals of individuals. The change in the role and ritual of the individual after conviction can cause occupational alienation in the individual. In the context of a forensic health service, acquisition of the prisoner's new skills and habits, and the new roles and rituals that are well integrated with the environment make an important contribution to the occupational balance of the individual [3, 16, 23].

Understanding the environments in which occupational performance takes place, it is important for occupational therapists to understand the underlying effects of occupational participation. The environment includes dimensions related to physical, social (including individuals in the individual's life) and policies, and at the same time creates a supportive or restrictive effect for the occupational adaptation of the individual. Situations such as an absence of freedom for the individual, individual secrecy, and the meaningful and socially acceptable occupations constitute a barrier to prisoners' participation in their environment and occupation [15, 24]. Occupational therapists should also be thoroughly evaluating the environment of individuals who are establishing an intervention plan with prisoners applying to the occupational therapy service.

We have already mentioned the preferred models for forensic occupational therapy applications. MOHO, one of these theories, includes structured and unstructured assessment and information gathering tools [3, 4, 11] for collecting and evaluating information about offenders. Some of those:


• The Model of Human Occupation Screening Tool (MOHOST)—gives the client a holistic view of his or her motivation to achieve occupation, communication and interaction skills, occupation patterns and the individual's process and motor skills as well as the environment. MOHOST also allows a highly effective assessment of the effectiveness of occupational therapy interventions [26];

development (such as ADLs, IADLs, and health management), occupational development, awareness (such as self-awareness and social awareness), self-management, skill-building

The GLM is a model that overlaps the humanistic point of view of occupational therapy. Although the GLM is a psychology-based model, it supports occupational therapies' application models such as PEO, MOHO, CMOP and role acquisition model. Occupational therapists may develop interventions taking into account the GLM's the primary human goods components. Some intervention recommendations based on the 'primary human goods' are given in **Table 3**.

**Aim:** Understand themselves, reach personal satisfaction, live life better and

Occupational Therapy in Forensic Settings http://dx.doi.org/10.5772/intechopen.79366 63

**Aim:** Identify one's emotions, thoughts, interests, and values; understand how internal characteristics influence actions; maintain a sense of self-confidence and

**Aim:** To keep the physical, psychological and social needs of the individual together, to increase the independence of the individual and to work with a

holistic and customer-centric approach in the role of the worker.

Vocational rehabilitation: work preparation, voluntary and paid work

**Aim:** To build up hobbies, recreational pursuits

(such as social, relationship, vocational skills), education etc.

**The 'primary human goods' Intervention recommendations**

achieve their goals **Occupational strategies:** Functional life skills Role development Independent living skills Literacy and education

Health management Gender-specific issues Money management

**Occupational strategies:**

Drug and alcohol awareness

**Occupational strategies:** Prevocational training Job search skills Work-related practice

Work hardening

**Occupational strategies:** Recreational skills Time management

self-efficacy

Self-awareness

ADLs IADLs

**1. Life** (including healthy living and optimal physical functioning, sexual

**2. Knowledge** (how well informed one feels about things that are

**3. Excellence in work** (including

**4. Excellence in play** (hobbies and

recreational pursuits)

important to them)

mastery experiences)

satisfaction)


Evaluations such as Canadian occupational performance measurement, assessment of motor and process skill, independent living scale, and the role checklist are other measures preferred by occupational therapists [3, 24].

Another assessment heading in the forensic occupational therapy process is risk assessment. When considering the evaluation processes mentioned earlier, a prisoner who has forensic settings should be considered as a means of risk assessment to determine the potential for another crime or previous crime. Occupational therapists take into account the risk assessment and management of risks posed by each client and to increase the occupational involvement of individuals by taking environmental precautions and managing them to manage risks in environments such as high-risk kitchens and workshops to improve individual skills as well as providing positive risk-taking opportunities to enhance the capabilities of both individuals.

Current risk factors such as age and gender, substance use status, criminal history and potential risk factors such as marital status, occupational participation level in the forensic setting, family support should be considered in the risk assessment. Occupational therapists pay attention to the influence of the person-environment-occupation interaction on the occupational adaptation of the individual. Occupational therapists can estimate the effects of individual's personality and sociodemographic characteristics (physical, cognitive and psychological), their level of skill and the environmental risk factors, including interpersonal interaction, social support network, hospice environment, social security status on the possible risk factors. For this reason, they may play an active role in providing counseling to minimize the risks faced by prisoners and these risks' adverse effects on occupational adaptation [3, 21].
