Linda Kohlman Thomson developed the Kohlman Evaluation of Living Skills in 1977. In was initially put into practice and intended for use in a short-term psychiatric unit. Trisha Thompson developed the living skills evaluation that preceded KELS. Kohlman based the development and practice of KELS on Thompson’s evaluation tool, which is now widely used and accepted in the profession of Occupational Therapy as an evaluation tool for clients (Kohlman, 1992).
Kohlman Evaluation of Living Skills (KELS) is a standardized assessment tool that measures mastery of areas of concern for entering or re-entering the community with intention to live independently (Kohlman, 1992). KELS is a criterion-referenced test that assesses self-care, safety and health, money management, transportation and telephone, and work and leisure (Kohlman, 1992). The self-care component of KELS (1992) tests Activities of Daily Living under the areas of occupation in the Occupational Therapy Practice Framework (2008). The health and safety component along with the transportation component in KELS (1992) tests both Activities of Daily Living and the Instrumental Activities of Daily Living (AOTA, 2008). The money management and telephone components of KELS (1992) tests Instrumental Activities of Daily Living under the OTPF (AOTA, 2008).
The self-care component is looking at appearance and frequency of self-care activities (Kohlman, 1992). The health and safety component of KELS looks at awareness of dangerous household situations, identification of appropriate action for sickness and accidents, knowledge of emergency numbers, and knowledge of location of medical and dental facilities (Kohlman, 1992). In general, KELS (1992) is looking to assess health and safety through a balance of all of these components, which is what the OTPF (2008) hopes to accomplish by looking at an individuals’ areas of occupation, performance skills, performance patterns, environment and context, activity demands, and client factors.
Transportation under KELS (1992) looks at mobility within the community and basic knowledge of transit systems, which is testing IADLs according to the OTPF (AOTA, 2008). Money management, which is testing one’s use of money in purchasing items, ability to obtain and maintain a source of income, ability to budget money for food, ability to budget a monthly income, ability to use banking forms, and ability to pay bills within KELS (Kohlman, 1992). The telephone component looks at one’s ability to use a phone book and telephone (Kohlman, 1992). The work and leisure component of KELS is looking at an individual’s plans for future employment and leisure activity involvement (Kohlman, 1992).
In using KELS, each living skill evaluation item is divided into four sections. These sections are method, equipment, administration procedures, and scoring criteria. The administrator will read the prompts from an instruction manual to account for instructor bias. It is important that the administrator only say what is provided in the instruction manual to maintain reliability and validity. The instructor will go through the five sections of the test, which are self-care, safety and health, money management, transportation and telephone, and work and leisure. Within these five sections the administrator will score the patient based on two categories. These two categories are “independent” and “needs assistance”. Giving a client an “independent” score means that the client has a level of competency required to perform the basic living skills in a manner that maintains the safety and health of the individual without the direct assistance of other people. A “needs assistance” score is given when the client needs assistance from someone else around them. There are several special scoring situations, which are “not applicable” and “see now”. “Not applicable” means that a section does not pertain to the client’s specific living situation. “See now” is used for those items that cannot be clearly scored as “independent” or “needs assistance” and that require additional explanations (Kohlman, 1992).
KELS is intended to assess and evaluate the elderly population who are going to be discharged back into the community in the future. However, it can be used within any population or individual that has encountered a cognitively disabling condition. Specifically, it is regularly used with organic brain syndrome, Alzheimer’s, and traumatic brain injuries. The settings that KELS is most used in are nursing facilities, inpatient units, and outpatient settings. It can also be used in acute care units in hospitals and with adolescents in training programs. For example, this could be used on an adolescent with a cognitive disability whom is about to move out into the world and live independently. KELS could be used to evaluate whether or not this person is ready to live independently and what areas they could stand to improve upon (Kohlman, 1992).
KELS has many strengths with regards to evaluating clients within Occupational Therapy. First, KELS is standardized. It can be applied to a wide range of clients and situations while still giving strong reliability and validity in terms of results. KELS can be generalized to all education levels and to a wide range of different types of people. It has face validity, which means that just by looking at this evaluation tool it seems to be valid. KELS is easy to follow by both the client and the administrator. It is a timely evaluation tool. KELS can be administered in 30 to 45 minutes. It’s not costly and the equipment can be easily assembled. Also, KELS is not gender-biased (Kohlman, 1992).
There are a few limitations or weaknesses to consider when using KELS. It should be avoided in long-term care settings, with individuals whose living situation frequently changes, and with individuals who live in rural areas. KELS should not be used in long-term care facilities with clients who are expected to stay for an extended period of time, specifically, clients who are staying in a facility for longer than one month. KELS should not be used with people whose living situation changes frequently, because it is difficult to fully comprehend all complications that would go along with the various different living situations. KELS should not be used with clients who live in rural areas, because scoring items may not be applicable while other items may not be included that would apply for them. Finally, KELS is not a comprehensive evaluation tool. This evaluation tool only gives a snapshot of the clients that it is aimed to help evaluate. It looks at a few specific situations, but it does not give suggestions or account for situations not listed within the evaluation (Kohlman, 1992).
KELS applies to the Cognitive Disabilities Frame of Reference. It is based on the idea that how one thinks affects the way you move and perform. This frame of reference requires the therapist to consider the patient within their context/ environment in assessing their performance. KELS applies to the Occupational Adaptation theory of Occupational Therapy. KELS is a criterion-referenced test that measures mastery of an area of concern or content. OA involves a press for mastery in the interaction between the person and the occupational environment. They both look at measuring mastery of areas that affect an individual’s life and well-being.
The necessary equipment for successfully completing this evaluation is included in the KELS manual. The necessary equipment for KELS includes pictures, budget forms, scoring sheet, checking account form, savings account forms, and bills examples. KELS interventions focuses attention at areas that were scored as “needs assistance”. Upon completion of KELS, you can compare the results from the evaluation to assistance that will be available to the client to determine an appropriate setting or environment for that client. The options available upon completion of the evaluation are to discharge the client to community living with others, discharge to a place where the client will receive supervision, or to a place where transportation is provided if they are incapable of transporting themselves (Kohlman, 1992).
American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683.
Kohlman, L.K. (1992). Kohlman Evaluation of Living Skills. Maryland: The American Occupational Therapy Association, Inc.