Dream Home Assessment

example home created with the DHA

The Dream Home Assessment is a performance-based measure of executive functioning (Raphael-Greenfield, Gutman & Baltich, 2020).   The Dream Home Assessment (DHA) was created as a functional performance based OT assessment that efficiently enables an occupational therapist to evaluate executive function skills within the mental health population in a non-threatening way. It was inspired by the Build a City (BAC) assessment that was developed in 1975 as a constructive, projective evaluation of social interaction skills for mentally ill clients (Clark, 1999). The DHA measures executive functions in a non-routine, novel activity, which does not require reading, which is unusual for many standardized executive function assessments. The creation of this test was to address the gap in lack of ecological validity of many existing tests of executive function, which do not predict actual difficulties in everyday living where one must often negotiate the unexpected.

The specific executive capacities measured by the DHA include: initiation; persistence (sticking with a project and completing it); perseveration and error detection (getting “stuck” on a particular task, repetition of the same action over and over, using the same problem-solving approach even if it is not working, or correcting mistakes); stamina (becoming weary or exhausted by a task more than most people); planning; problem solving; organization; generation of ideas; abstraction; and flexibility (Lezak, Howieson, Bigler & Tranel, 2012). The open-ended, after-task questions are intended to reveal the client’s self-monitoring skills – recognition of performance deficits and a self-assessment of strengths and problem areas. Correcting perceptions of performance is often the first step toward improving occupational performance (Toglia, 2015). The DHA is meant to be an ipsative assessment because it is based on the participant’s previous performance rather than against an external criteria or any established normative standards.

Psychometric Properties of the Dream Home Assessment

Content Validity: Content validity has been established for the DHA (CVI=.85) by obtaining ratings and feedback from five occupational therapists who are experts in cognition. Preliminary inter-rater reliability among nine raters was high with an ICC = .98, p < .000. Internal consistency was high with a Cronbach’s alpha of .99, p < .000 based upon an unpublished pilot study involving 12 participants.

Construct Validity (internal validity): established using Rasch analysis with 59 adults; Goodness of fit analysis and analysis of standardized residuals revealed infit and outfit MnSq values within reasonable 0.6-1.4 logit values, and mean residual values near 0.0 logits (Raphael-Greenfield, Grajo, Westover, & Fong, 2019).

Test Reliability: established using Rasch analysis. The Construction scale showed strong test reliability and ability to identify at least 3 distinct levels of executive functioning ability; the Performance Scale showed very strong test reliability and ability to identify at least 5 distinct levels of executive functioning; and the Executive Functioning Questionnaire showed good test reliability and the ability to identify at least 2 distinct levels of executive functioning ability.

Published Studies on the Dream Home Assessment

Raphael-Greenfield, E., Grajo, L., Westover, L. & Fong, C. (2019). Determining the internal validity and test reliability of the Dream Home Assessment: A performance-based measure of executive function for adults with mental illness. Occupational Therapy in Mental Health. Advanced online publication. doi: https://doi.org/10.1080/0164212X.2019.1678446

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To cite the Dream Home Assessment in medical reports, presentations, and research:

Raphael-Greenfield, E., Gutman, S., & Baltich, K.  (2020). The dream home assessment. Available at: https://www.ps.columbia.edu/education/academic-programs/programs-occupat...

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