Development of OT FACT began with a review of the literature, to ascertain whether there were any existing functional assessment packages which would meet the need of the occupational therapy profession. It was clear to the development team that locating the proper assessment or finding an assessment that could be modified to meet the needs of the profession would be preferable to developing a new functional assessment from the ground up. Investigations of the countless numbers of functional assessments being used throughout the profession, however, showed that current functional assessments tended to be limited in scope in at least one of four ways.
- Specific populations: since many functional assessments are devised within a particular treatment setting, the content tended to reflect only a focused population sample.
- Specific settings: for example, the Klein-Bell ADL Scale, which goes into substantial detail in bathing, toileting, and personal hygiene activities, is not oriented to higher-level functioning outpatients who might be seen.
- Specific functional areas: some functional assessments target fine motor skills or gross motor skills, while others examine higher-level functions such as home-making and community living skills.
- Non-standardized: some functional assessments have attempted a fairly global approach in the populations they target, the settings in which they are applicable, and the functional areas which they address. However, these global assessments tend to give up standardization of administration and fail to meet reliability and validity requirements, due to their open orientation.
Since existing functional assessment instruments did not appear to be satisfactory, the developers of OT FACT determined that a new design was necessary. The AOTA Uniform Terminology served as a basis for the resulting hierarchical model.
A key concept used for the design and development of OT FACT has been a multi-phase, iterative revision cycle using feedback from the field. The current OT FACT is the result of five major revisions and numerous sub-revisions within each major version. The three-year core development timeline included surveying fieldwork supervisors, and presenting the conceptual framework and terminology of the functional assessment to dozens of regional groups throughout the country and at national conferences. In all cases, feedback was solicited regarding the design of OT FACT. This extensive feedback was incorporated into each subsequent version of the system.
Pilot field tests were also run on both a local and national basis to obtain data for clarifying and revising instructions for administering OT FACT. Finally, a nation-wide field test provided preliminary investigations of validity and reliability issues of the assessment, as well as finalizing the administrative features of the system.
The field testing confirmed that the functional assessment approach was effective and stimulated activity in several areas of further development. Much of the research and development effort in 1989 and 1990 focused on computerizing the system. Computerization served three purposes. First of all, it increased the efficiency of the assessment. Secondly, it improved the face validity of the system. (Many practitioners did not require many of the pages of the system so it seemed to them as if it was not targeted for their population.) Thirdly, computerization allows a revolutionary new approach to assessment permitting consistency across the profession, yet tailoring assessments for every specialty area.
Since the release of the computerized OT FACT Version 1.0 in 1990-91, the paper and pencil version has become obsolete. Immediately after the release of version 1.0 of OT FACT, development of Version 2.0 was initiated to better target the needs of specialty areas and to utilize computer technology for assistance with report and documentation needs (enable faster report generation from within the OT FACT program). OT FACT Version 2.0 is designed for the Apple Macintosh and IBM compatible computers running Microsoft Windows. A number of advanced features had been included in OT FACT Version 2.0 for the Macintosh.