Adopting the Perceive, Recall, Plan and Perform Assessment into Practice in Aotearoa New Zealand: Influences on Clinical Reasoning

Abstract

The Perceive, Recall, Plan and Perform Assessment (PRPP-A) is a standardised, contemporary occupational therapy assessment of occupational performance and cognitive strategy application. In recent years in Aotearoa New Zealand, there have been growing numbers of occupational therapists completing the PRPP-A training. Despite this interest in the PRPP-A, however, there is a scarcity of information about the practical application of the assessment, including the relevance, affordances, and utility of the PRPP-A in practice. Further, neither the clinical reasoning involved in using the PRPP-A, nor its cultural applicability for cultural practice in Aotearoa New Zealand is well understood.

Currently occupational therapists receive PRPP-A training without information to guide them, their managers, or funding agencies about what is involved following the training and the commitment needed to translate the PRPP-A into real-world contexts. Given the increased uptake of the PRPP-A training, there is a need to better understand the gaps in knowledge regarding PRPP-A implementation. Therefore, I designed a two-phase investigation; Phase One explored occupational therapists’ experiences of applying the PRPP-A in Aotearoa New Zealand; and Phase Two sought insights into how using the PRPP-A shaped therapists’ clinical reasoning through the assessment process. The intended outcomes of the study included obtaining practice-based understandings relevant to PRPP-A training, aiding knowledge translation, and improving post-course training support.

A constructivist approach with qualitative interpretive description methodology guided this exploratory study. Purposeful sampling was used to recruit 13 and 8 PRPP-A trained occupational therapists for Phase One and Phase Two respectively. Data collection occurred through a focus group with two Māori participants, written reflective logs, and semi-structured interviews. Inductive thematic data analysis was used to identify five themes in Phase One and four themes in Phase Two.

This study revealed that the PRPP-A is the type of assessment participants want to use, with the ecological and flexible nature of the assessment valued in practice. Participants reported that the PRPP-A enhanced the occupation-focus of their practice and had sufficient flexibility for use with clients with diverse cultural backgrounds, including tangata whenua (Māori-Indigenous people). Task flexibility was necessary for cultural applicability; however, the relevance of the PRPP-A depended on therapists’ ability to attend to cultural safety, humility, and their cultural competency. Selecting assessment tasks necessitated collaboration and honed questioning skills to find ‘just right’ assessment tasks.

Translating the PRPP-A to practice involved initially returning to being novice assessors which was experienced as a demanding process that required commitment, dedicated time and support from others. Participants had learnt to use occupation-focused, context specific, and dynamic clinical reasoning to design bespoke client-centred assessments which were influenced by their own values and beliefs. Specific clinical reasoning skills and strategies were developed, and occupational performance was automatically viewed through a ‘PRPP lens’ that enhanced reasoning. The identified knowledge translation and clinical reasoning strategies will inform future occupational therapists in advance of PRPP-A training and guide PRPP-A Instructors designing courses. Overall, findings of this study contribute to the profession’s growing understandings of practice realities and skills associated with translating occupation-based assessments, like the PRPP-A.