Canadian Model of Occupational Performance Cue Sheet
This is a copy of the cue sheet I developed throughout my occupational therapy education to assist in initial assessments! Please feel free to use it if it helps!
Living Situation – Who does the client live with?
Support Systems – Has the client got any friends or family to support through dysfunction or crisis?
Relationships – Has the client got a partner? Has the client got a strong relationship with their extended family? Does the client have any
friends? Are there any strains to these relationships?
Opportunities and Limits – Are there any issues related to ethnicity or race? Any issues related to age, the clients background or their
gender issues E.G. Transgendered? Do they live in a threatening environment?
Accommodation – What kind of property does the client reside in? Is this an owner occupied or council property? What is the physical state
of the property? Is the property hygienic and safe?
Community – Does the client have an awareness of their community environment and facilities? Are there close links to shops and local
services? Are there bus routes?
Religious Practices – Does the client follow any religious rituals? Do they attend a Church, Synagogue or Mosque? Does the client live in a culturally appropriate environment?
Financial – Can the client manage their own finances? Do they have debt?
Benefits – Is the client in receipt of any benefits E.G. Disability Living Allowance (DLA), Incapacity benefit, Jobseekers Allowance?
Legal – Is the client currently detained under the Mental Health Act 1983? Opportunities related to legislation E.G. Disability
Discrimination Act (1995)? Is the client currently undergoing court proceedings?
Mood – Is the client experiencing low mood at present? Are there fluctuating moods? Has the client any thoughts of suicide or self harm?
Behaviour – Is the client displaying any inappropriate behaviour? Is the client agitated E.G. twitching or pacing? What is the client’s tone of voice? Does the client have accelerated speech?
Emotional Defences – Is the client able to form emotional relationships?
Self Concept – Does the client posses a high or low opinion of oneself?
Interpersonal Skills – Does the client engage with others? Is the client able to maintain eye contact? Has a rapport been established? Does the client have communication skills?
Orientation – Is the client orientated to time, place and person?
Concentration – Is the client experiencing reduced concentration? Can the client concentrate enough to read newspapers or magazines? How long for if so? Is the client easily distracted? Does the client require verbal prompts to engage?
Memory – Does the client experience any short-term memory problems? Can they recall long-term memories?
Form and Content of Thought – Does the client hear any external auditory hallucinations? If so, how do these voices make them feel?
Does the client experience flights of ideas? Is the client displaying disorganised thinking?
Motivation – Does the client have motivational issues related to their activities of daily living (ADLs) E.G. washing, dressing, cooking?
Insight – Is the client aware of their dysfunction? Are they aware of any physical threats? If the client experiences physical health conditions E.G. diabetes, are they aware of the threats related to these?
Physical Conditions – Is the client able to hear or see? Are there any other physical health conditions?
Personal Hygiene – Does the client currently engage in showering/bathing? Is the client dressed appropriately? How often does the client change their clothing? Is the client physically able to dress? Does the client brush their teeth? How often did the client wash, dress and brush teeth prior to now?
Eating Pattern/Diet – Does the client eat on a regular basis? Does the client require a special diet E.G. for diabetes? Are there any issues related to eating? Did the client have a regular eating pattern before now? Is the client aware of health eating?
Health Maintenance – Is the client taking care of their physical health? Does the client exercise in any way?
Sleep Pattern – What is the clients sleeping pattern? How do they feel regarding if any issues are experienced related to sleep? What was
the client’s regular sleeping pattern before now?
Safety – Is the client vulnerable? Are they open to risk? Have they got a history of overdoses?
Functional Mobility – Is the client independently mobile?
Functional Communication – Can the client engage face to face, over the telephone or within groups?
Meal Preparation – Is the client engaging in kitchen activities? Can the client cook? Do they know how to use a microwave? Is the client physically able to initiate kitchen activities?
Shopping – Has the client got any shopping skills? Did the client do their own shopping? Do they still do this? Do they know how much
items are in the shops?
Household Management – Does the client engage in domestic tasks? What was their level of household management prior to now E.G
Transport – Can the client access public transport? If not, what are the reasons? Do they drive? Do they experience any difficulties now
related to travelling E.G. anxiety, physical disability?
Managing affairs – Does the client manage their finances well? Has the client got the ability to budget?
Ability to Maintain Routines – Is there any disruption to the clients routines?
Sexual Expression – Is the client practicing safe sex? Is the client educated about sexual health? Are they happy with their sex life? Is the client unhappily celibate? Can the client express themselves sexually? Are there any issues regarding culture, impotence, or side effects from medication?
Employment – Is the client currently employed? Are there any barriers to employment? Did the client previously work, either paid or
voluntary? Does the client want to return to employment?
Domestic Tasks – Does the client cook meals for others? Are they a homemaker? Does the client fulfil their roles at present?
Education – Has the client undertaken any adult education? Is the client interested in accessing college facilities?
Leisure Pursuits – Does the client currently engage in any leisure occupations? What are these? If not, what leisure occupations did the
client previously engage in? Are there any barriers to carrying these out now E.G confidence?
Value and Beliefs – What does the client value? What do they believe? This is not necessarily related to religious practice unless client
Goals – Has the client identified any goals to work by? What is the client’s inner motivation?