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Like many other clinicians working in the field of dementia in the community, I became increasingly frustrated with the assessment tools being used to measure a person's cognition and ability to live safely. The available assessment tools, which include the Cognitive Competency Test (CCT), had many limitations. In my role as an occupational therapist on a geriatric assessment outreach team my team members, including geriatricians and geriatric psychiatrists, frequently requested the results of the CCT to aid in diagnosis and to predict functional implications in everyday life. In the climate of increased accountability within the health care system and the need for evidence-based practice, I began to question the rigor of the data underpinning the CCT.
As I began to investigate the reliability and validity of the CCT, I recognized my own lack of skill and knowledge and so as an empty-nester, I decided to embark on what had been a fantasy of mine: to return to the academic world to study and obtain a Master's degree.My goal in pursuing graduate education is to enhance my ability to make decisions regarding my practice and to be able to read and understand research publications. As my quest began, I started to read everything I could getmy hands on regarding the CCT.
Description of the CCT
In 1986,Wang and Ennis addressed the need for an objective and standardized evaluation of cognitive competency and developed the CCT as an assessment tool with the intention that it would reflect the multidimensional concept of mental competency.Wang and Ennis recognized that no one test would be able to measure cognitive competency and therefore viewed the CCT as a component of an overall comprehensive battery of a mental competency evaluation (Wang & Ennis, 1986). Up until 1986, competency was only measured in a medical-legal sense or in the context of psychiatric illness and the information was gained mostly by interview.Wang and Ennis wanted to address the issue of cognitive competency as "an ability to know and to make use of knowledge"(Wang, Ennis & Copland, 1992, p. 1).
The CCT is designed as a test that "incorporates the concept of multidimensionality of cognitive skill and adopts a practical approach by simulating daily living skills"(Wang & Ennis, 1986, p. 120).The test assesses a...