Using the DLA-20 Assessment with Therapy Clients

Developing proficiency in everyday activities is essential for sustaining overall health and well-being. Tasks like eating, dressing, personal hygiene, and managing finances might appear ordinary, but they are key to mental well-being. Successfully performing these tasks on one's own enhances self-worth and autonomy. In contrast, difficulty with these activities can result in frustration and a sense of powerlessness, potentially leading to mental health challenges such as anxiety and depression.

For a therapist, assessing a client's daily living skills and functioning plays a key role in effective treatment planning and monitoring progress over time – and the Daily Living Activities-20 Clinician Report (DLA-20) can help do exactly that. Let’s take a more in-depth look at the DLA-20 assessment: its purpose, application, how to interpret the results, and incorporate them into your clinical practice to help client outcomes.

What is the DLA-20 assessment?

‍The Daily Living Activities–20 Clinician Report (DLA-20) is an assessment that evaluates 20 domains of daily living affected by mental illness or disability. Examples of domains include Health Practices, Safety, Problem Solving, and Coping Skills. Using observation and the client’s DLA-20 Self-Report, clinicians rate clients’ management of activities of daily living (ADLs) in each domain (e.g., “Uses options for coping, preventing relapse, restoring feelings of self-worth, competence, and being in control.”) over the past 30 days on a scale from 1 to 7. This assessment of the clinician’s perceptions of the client’s functioning and well-being is ideally used in conjunction with the DLA–20 Self-Report to support important clinical dialogue about progress, goals, and treatment planning.

When to Use the DLA-20

‍One of the primary uses of the DLA-20 is assessing daily living skills. The assessment evaluates a client’s abilities in crucial areas of daily life, such as health practices, safety, and communication. By identifying specific areas of strength and weakness, the DLA-20 helps clinicians determine where additional support or intervention may be necessary. Regular use of the tool also enables clinicians to monitor progress over time, tracking changes in a client’s functioning and adjusting treatment plans as needed.

The DLA-20 is designed for use with adults aged 18 and older, making it an appropriate tool for assessing a wide range of adult clients. It is particularly beneficial for those with mental health conditions that impact their ability to manage daily activities. For example, this might include clients with a wide range of diagnoses including but not limited to schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, and substance use disorders.

To ensure effective treatment planning and monitoring, the recommended frequency to administer the DLA-20 is monthly, or as clinically indicated. Administering the DLA-20 regularly plays a critical role in creating personalized treatment plans, justifying the level of care provided, and demonstrating outcomes to insurance companies or accrediting bodies. Ideally, the DLA-20 Clinician Report is used in conjunction with the DLA-20 Self-Report to identify similarities and differences between client and clinician perceptions of domains of strength and weakness. Involving clients in the assessment process, particularly through self-reporting, not only improves engagement but also ensures that care is tailored to their unique needs.

What You Can Learn from Using the DLA-20

‍The DLA-20 assessment provides valuable insights into a client's daily functioning and well-being. The DLA-20 scores can help you:

• Identify specific challenges: Pinpoint areas where the client struggles, such as health practices, communication, or relationships.
• Highlight strengths: Recognize domains where the client excels, which can be useful in treatment planning.
• Inform treatment decisions: Use the scores to create targeted interventions and personalized treatment plans.
• Facilitate meaningful discussions: Share the results with clients to encourage open communication and collaborate on goal-setting.

Administering the DLA-20 assessment over time provides even more valuable information. Regular assessments allow you to:

• Track progress: Compare scores across different time points to see improvements and areas still needing attention.
• Adjust treatment plans: Modify interventions based on the client's changing needs and progress.
• Measure treatment effectiveness: Evaluate the impact of your interventions and make informed decisions about care.
• Demonstrate outcomes: Use the data to show the effectiveness of your services to stakeholders, such as insurers or accrediting bodies.
• Support recovery goals: Help clients recognize their progress and maintain motivation in their recovery journey.

Strengths and Limits of the DLA-20
The DLA-20 has undergone validation through research, showing high provider inter-rater reliability. It can evaluate the degree of impairment in daily living skills by assessing the individual's ability to perform various activities that are necessary for independent living, making it a reliable measure for tracking improvements over time. While the DLA-20 has many strengths, it's important to consider some limitations:

• Training requirements: Providers must undergo specific training to ensure consistency and reliability in using the tool, which may be time-consuming or costly.
• Clinician-reported: The assessment relies on the clinician's observations and judgments, which may be subject to bias or subjectivity.
• Focus on functioning: While the DLA-20's emphasis on daily living skills is a strength, it may not capture all aspects of a client's mental health or well-being.

Frequently Asked Questions (FAQ)

Who can administer the DLA-20?
Only trained mental health professionals who have completed the required training and certification should administer the DLA-20. This ensures consistency and reliability in scoring and interpretation. However, there is a complementary self-reported version to use in conjunction with the clinician-administered DLA-20. 

How do I interpret the DLA-20 scores?
The DLA-20 uses a 7-point scale that a clinician uses to rate a client's functioning in each domain:

• Scores of 1-2: Indicate severe to extremely severe functional impairments requiring pervasive supports.
• Scores of 3-4: Suggest serious to moderate impairments needing continuous or intermittent supports.
• Scores of 5-7: Reflect mild impairments to optimal functioning with minimal to no supports needed.

The composite score is calculated by summing all item scores and dividing by the number of activities rated. Composite scores can be interpreted using the following classifications:

• > 6.0: Adequate independence, no significant to slight impairment
• 5.1-6.0: Mild impairments, minimal interruptions in recovery
• 4.1-5.0: Moderate impairment in functioning
• 3.1-4.0: Serious impairments in functioning
• 2.1-3.0: Severe impairments in functioning
• < 2.0: Extremely severe impairments in functioning

How can I use the DLA-20 results in treatment planning?
The DLA-20 results can guide treatment planning in several ways:

• Identify areas for intervention: Focus on domains with lower scores, indicating a need for support or skill-building.
• Set measurable goals: Use the scores to establish specific, achievable targets for improvement in daily living skills.
• Monitor progress: Compare scores over time to evaluate the effectiveness of interventions and adjust as needed.
• Justify level of care: Use the results to demonstrate the need for specific services or supports to insurance providers or other stakeholders.

Similar Assessments to Consider

‍While the DLA-20 provides a thorough look at daily living activities, several other tools can offer helpful insights into a client's functioning and well-being. 

• WHO Disability Assessment Schedule 2.0 (WHODAS 2.0): This assessment covers six domains of functioning (cognition, mobility, self-care, getting along, life activities, and participation) and is available in 12- and 36-item versions. The WHODAS 2.0 offers a wider evaluation of functional abilities compared to the DLA-20. 
• Adult Needs and Strengths Assessment (ANSA): This is a versatile assessment designed to aid in decision-making, such as determining the appropriate level of care and monitoring outcomes. The ANSA utilizes a rating scale to summarize key areas concerning the adult’s needs and identifies the strengths of the adult and their parents/caregivers (if relevant). The ANSA includes seven subscales: Acculturation, Behavioral Health Needs, Life Domain Functioning, Mental Health- Behavioral/Emotional Needs, Risk Behaviors, Strengths, and Family/Caregiver Strengths and Needs (optional).
• Health Related Social Needs Screening Tool (HRSN): The Health-Related Social Needs Screening Tool (HRSN) asks about social needs such as housing, food needs, exposure to violence, transportation needs, safety needs, work needs, and more. Results of the screener are used to inform treatment plans and also to make referrals to community services. Respondents answer a variety of questions about health-related social needs (e.g., “What is your living situation today?”) on a variety of scales. 

When choosing an alternative or complementary assessment to the DLA-20, consider factors such as:

• The specific needs and goals of the individual or program
• The level of detail needed in assessing daily living activities
• The age range and population the assessment targets
• The training and administration requirements for the assessment
• The complexity and method of scoring and interpretation