December 15, 2008
Dear Colleagues:
I would like to share something important with you regarding the ADM Placemat test. For the past few years, our team has been teaching the administration of this tool as an incomplete test in which we have made the recommendation to administer the step of placing the pieces on the placemat but to eliminate the steps of gluing the pieces and fringing the sides of the canvas. I would like to provide the reasons and history behind our recommendations and then move forward to our current point of view.
Chris Ebell one of our instructors has been using the Allen Cognitive Levels in her practice for over 20 years and she is an Allen Authorized Instructor. When she moved out of psychiatry and into other work environments such as long term care and home health, she found that it was difficult to administer the ADM Placemat as designed due to limitations in budget and time. Chris had concerns about the lack of utility and practicality of the ADM Placemat test in settings where the clinician may have no budget for supplies and the length of therapy sessions are limited.
In search of a solution she began presenting a simplified version in which she only asked the patient to put the pieces down to attempt to match the sample instead of doing all the steps including gluing and fringing. She found in her observations that she was able to obtain valuable indicators of a persons Allen level with this information. However she also recognized that it was very important for the assessor to continue on with the administration of many other Allen assessments and skilled observations before assigning a level. We have consistently informed our students that by modifying the test in this way the assessor is not gathering as much information in order to see a pattern of behavior in one activity but the information obtained was still of value when combined with additional observations.
Chris and I presented our simplified/incomplete variation of the ADM Placemat to one of the theory founders and received their "blessing" to teach this modified version under the guidelines as described above. As a result we have taught this variation of the original test for many years and we believe there is definite value in the information obtained however the administrator must understand the limited results and must document the fact that the test was administered in an incomplete version. In this case the administration of this simplified test would not be considered standardized.
Currently, there has been new research performed on the ADM Placemat test in order to help prove the validity of the tool. This is becoming increasingly important due to the need for evidenced-based work and outcomes. I recently heard Sarah Austin present her findings from her ongoing research project on the ADM Placemat at the latest ACN Symposium in Boston and I was very impressed with the preliminary data. I also spoke to Cathy Earhart, author of the ADM projects, about the variation to the ADM Placemat test that we have taught in the past and we discussed what we both think is best for the future (please click on the link below to read the letter from Cathy Earhart). Therefore, from this point forward we at Dementia Care Specialists, Inc. have revised our recommendation for administration and scoring of the ADM placemat test to the following:
1. The clinician should attempt to administer the ADM Placemat as designed
2. If unable to administer the ADM Placemat as designed the clinician must document the reason why and must also document the steps of the test that were completed (such as placing the pieces down). The administrator will then need to use their clinical reasoning skills to understand that by administering this incomplete version of the test, they were not able to observe the pattern of behavior the complete version would demonstrate and therefore there is a need to continue with an even greater amount of additional tests and observations, as previously discussed.
We are attempting to share this update to our teachings and recommendations with our past students and would appreciate if those of you reading this document would copy and share it with any clinician who may have participated in our trainings.
We enjoy being your partner in the ongoing quest to help those with Alzheimer's disease and related dementias to live a quality life. We intend to always provide you with the most accurate and up to date information which reflects the dynamic nature of the clinical and reimbursement environments in which we work.
Sincerely yours,
Kim Warchol, OTR/L, President
Dementia Care Specialists, Inc.
 Read Letter from Cathy
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