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HIV and Disability: Updating the Social Security Listings
the extent to which he can independently initiate and maintain participation in an ongoing manner. Physical assessments may be as simple as testing an individual’s ability to lift objects and sit or stand for periods of time, or can be as complicated as testing the ability to independently manage a medication regimen or shop for groceries. Employment-related assessments may also be administered, such as asking the individual to take apart an object and reassemble it.
For example, the Occupational Performance History Interview (OPHI-II) is designed to provide information about a patient’s ability to perform and participate in activities of daily living (Levin et al., 2007). The instrument includes three scales of self-measurement (see Box 1-2) and a qualitative measure for the interviewer to record the patient’s life history (often described as “narrative”) and any patterns the patient may exhibit (described as the “narrative slope”).
Persons with HIV can also develop or have a preexisting mental health impairment. A wide range of impairments exists in people infected with HIV, including major depression, anxiety, bipolar disorder, HIV-associated mania, schizophrenia, apathy, and delirium. Structured psychiatric evaluations that lead to diagnoses and care regimens include the interchangeably used Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV-TR) and the International Classification of Disorders (ICD-10). Standardized, validated, and widely used diagnostic protocols include self-report scales such as the Beck, Hamilton, or Zung Depression inventories. Clinician-administered protocols include the Composite International Diagnostic Interview and the Profile of Mood States, which are more comprehensive assessments of multiple emotional domains.
Specific tests are available to measure the impact of the neurocognitive challenges associated with HIV infection. These include the California Verbal Learning Test (verbal memory), Benton Visual Retention Test (visual memory), Finger Tapping Test (psychomotor skills), Halstead Category Test (concept learning), and the Wisconsin Card Sorting Test (executive func-
Three Scales of Self-Measurement
Occupational Identity: Perceptions of self; an opportunity for participation in culturally recognized and named roles
Occupational Competence: Perceptions of ability to engage in and sustain a pattern of productive and satisfying occupational behavior