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Involves the interaction between the practitioner and the client.

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Occupational therapy process

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The occupational therapy process focuses on

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occupation and the client as an occupational being. The relationship between the practitioner and the client is a collaborative one that involves problem solving to support the client's occupational performance.

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How can the occupational performance be divided?

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1. Evaluation 2. Intervention 3. Outcome

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The evaluation process includes;

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1. Referral 2. Screening 3. Developing an Occupational Profile 4. Analyzing Occupational Performance

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The intervention process includes

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1. Intervention planning 2. Implementation 3. Review

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The outcomes process includes

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1. Measurement of outcomes 2. Decision making related to the future direction of intervention-continue, modify or discontinue

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Finding out the clients wants and needs and to identify those factors that support or hinder occupational performance is the purpose of:

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Evaluation process

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The OT practitioner develops an occupational profile of the client and analyzes the

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occupational peformance to determine the client's skills and ability to carry out activities of daily living.

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The OT bases the evaluation procedures on the client's...

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1. Age 2. Diagnosis 3. Developmental level 4. Education 5. Socioeconomic status 6. Cultural background 7. Functional abilities

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The OT process begins with a

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referral

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Referral

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request for service for a particular client is made

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Who can make a referral?

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Physcian, another professional, or the client.

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Referrals may range from:

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a specific prescription for a dynamic orthosis to general suggestions to improve fine-motor problems

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Who determines the type of referral provided?

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Federal, state, and local regulations and the policies of third-party payers determine the type of referral required. For example whether a physician referral is necessary.

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During this the OT practitioner gathers preliminary information about the client and determines whether further evaluation and occupational therapy intervention are warranted.

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Screening

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Screening typically involves a:

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-review of the client's records - the use of a brief screening test -an interview with the client or cargiver -observation of the client -and/or a discussion of the client with the referral source.

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What does the OT practitioner investigate during the screening?

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client's prior and current level of occupational performance and determines the client's future occupational performance needs.

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Who does the OT communicate the screening with?

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Appropriate individuals, including the party who made the referral

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The OT initiates and directs the screening process, using methods that are appropriate to the client's :

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1. Developmental level 2. Gender 3. Cultural background 4. Medical and functional status

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The OTA _______ to the screening process underneath the OT.

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contributes and performs some screening tasks

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If screening suggests the client is need of services...

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a comprehensive evaluation is arranged

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What does the OT identify to help them through the Evaluation?

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1. Identifies a model of practice from which the evaluation is based. The model helps organize the OT's thinking. 2. Frame of reference 3. Chooses assessment instruments consistent with the Frame of reference.

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What is the goal of the occupational profile?

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gather information on the client

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What kinds of information does the OT gather for the occupational profile?

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Initial info. about the client; gender, age, reason for referral -Diagnosis and medical history, including date of onset -Prior living situation and level of function (independent at home or in a care home) -social, educational, and vocational background

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What else may included in an initial review of the client?

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may provide information regarding precautions that need to be adhered to during the occupational therapy process.

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Where is this background information recorded?

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- client's occupational therapy chart -evaluation form

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The occupational profile provides the practitioner with a

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history of the client's background functional performance with which to design intervention.

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What questions are included in the Occupational Therapy Practice Framework?

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1. Who is the client (individual, caregiver, group or population)? 2. Why is the client seeking service? 3. What are the client's current concerns relative to engaging in occupations and daily life activities? 4. What areas of occupation are successful, and what areas are causing problems or risks? 5. What is the client's occupational history (i.e. lfie experiences, values, interests, previous patterns of engagement in occupations and in daily life activities, and the meanings associated with them)? 6. What are the client's priorities and desired targeted outcomes?

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From the info. gathered during the occupational profile, the practitioner makes decisions regarding the

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analysis of occupational performance

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The occupational performance analysis povides

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direction to the practitioner as to the areas that need to be further examined. The practitioner selects specific assessment instruments to collect further information

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OT's use assessments to gather information on a client's occupation in regards to:

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1. Areas 2. Performance Skills 3. Performance Patterns 4. Contexts 5. Client factors 6. Activity demands

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The evaluation forms the basis for the

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intervention plan

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Occupational Performance Analysis

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involves analyzing all apsects of occupation to determine the client factors, patterns, contexts, skills, and behaviors required to be successful

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Once the practitioner has thoroughly analyzed the _______, the practitioner can more easily determine what is interfering with the client's ability to engage in occupations.

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occupation

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The final responsibility of evaluation rests with the ____

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OT

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What is the OTAs responsibility during the OT evaluation?

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The OTA, though not responsible for the complete evaluation, may be delegated responsibility for certain procedures, and thus may CONTRIBUTE to an evaluation under an OT's supervision.

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The overall evaluation, or the process of compiling all of the information to form a composite picture of the client is the responsibility of the ____

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OT

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The techniques used during the evaluation process can be classified into three basic procedures:

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1. Interview 2. Skilled observation 3. Formal Evaluation procedures

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The primary mechanism for gathering information for the occupational profile and is a planned and organized way to collect pertinent information.

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Interview

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What is the focus for occupational therapy?

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occupations

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What does occupations include?

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the activities in which a person engages throughout the day.

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What is included in the interview process?

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- The OT asks questions regarding the client's function in daily activities before the onset of the problem that resulted in the referral. -The interview is also used as a means of developing trust and rapport with the client. -In some cases the client is asked to fill out a checklist or questionnaire before the interview. -Activity configuration

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What is included in the Activity configuration?

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provides information on how a client spends the day. The client compiles a list of all the different activities in which he or she participates and classifies activities according to the area of performance ( ADLS, IADLs, education, work, play, leisure and social participation). The client then rates whether the activity is one he or she has to do or wants to do and how adequantly the activity is performed.

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What is required for the interview process?

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1. needs to take place in a setting that is quiet and allows for privacy 2. The skill of interviewing involves blending the formal information gathering with informal person-to person communication.

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What are the stages of the interview?

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1. Initial contact 2. Information gathering 3. Closure

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What does the skilled interviewer spend the first few minutes of the interview doing?

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putting the subject at ease; often a person is worried and anxious at an interview

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See page 116 for an OT initial assessment chart or evaluation form

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...

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The interview creates the ____

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first impression of the therapy process

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Information gathering in Interview process:

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After discussing the purpose of therapy, the OT gathers info. about the client. The skilled interviewer guides the conversation in a way that yields the desired data yet keeps the flow easy and comfortable. The OT explains that they will be taking notes and does not read directly from notes.

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Closure in Interview process:

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The interviewer signals when the interview is about to end by summarizing the information gathered and reviewing the next steps in the process. The technique avoids the discomfort of an abrupt "time is up" ending.

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The means of gathering info. about a person or an environment by watching and noticing.

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Observation

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What are some things that an OT may observe with a patient?

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-Posture -dress -social skills -tone of voice -Behavior -Physical abilities

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Watching the client perform a predetermined activity.

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Structured observation

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Why do OT's use structured observation?

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to gain knowledge of what the person can and cannot do in relation to demands of the task

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An example of a structured observation?

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the client is asked to shave the way he usually does

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OT's examine the quality of performance through observation of the process not just by examining the end product. What is an example of this?

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The clinician may observe how the person responds to directions, approaches the activity interacts with others, deals with frustration, and engages in the task during the activity.

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help determine the existing performance level of the client

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Formal assessment procedures

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What are some formal assessment procedures?

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tests, instruments, or strategies that provide specific guidelines

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A test is said to have _____ if research testing shows it to be a true measure of what it claims to measure.

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Validity

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Test ____ is a measure of how accurately the scores obtained from the test reflect the true performance of the client.

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reliability

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indicator of the consistency of the results of a given test from one administration to another.

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Test-retest reliability

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indicator of the liklihood that test scores will be the same no matter who is the examiner

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Interrater reliability

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OT's can place more confidence in instruments that have high ____ and ____.

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validity and reliability

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_____ test is one that has gone through a rigorous process of scientific inquiry to determine its reliability and validity. OT follow set procedures for administering and scoring the test.

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Standarized test

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Standarized tests may be based on ____ data.

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normative data

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Normative data

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often called norms, collected from a representative sample that can then be used by the examiner to make comparisons with his or her subjects. Normative data are compiled by administering the test to a large sample of subjects.

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What are some examples of standarized tests developed by OTs.

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The Miller Assessment for Preschoolers and the Sensory Integration and Praxis Tests

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These tests have guidelines for administering and scoring but may not have established normative data, or established reliability and validity. These are more subjective and rely on clinical skill, judegement and experience of the therapist.

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Non-standarized tests

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Examples of Non-standarized tests

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manual muscle tests and sensory testing

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OT's use ____ to guide the selection of a test instrument as well as consideration of the client's background, diagnosis and needs.

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frame of reference

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The occupational therapy intervention process requires the practitioner to develop

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goals for the client, select activities, direct intervention to guide the client to learn ways of engaging in occupational performance and monitor the results of the intervention

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The intervention plan is based on the

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analysis of the information accumulated during the evaluation

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What is the initial step for the intervention plan?

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Problem identification

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The OT reviews the results of the evaluation and identifies the client's

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strengths and deficits in occupational performance areas, performance skills performance patterns, client factors, and contexts. From this the OT determines the problem areas that need to be addressed through intervention.

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The Problem identification also includes

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developing a hypothesis about the cause of the problem. Understanding the problem helps the OT select the most appropriate approach to treatment

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Process of identifying alternatives for intervention and forming goals and objectives.

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Solution development

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What are two important components of Solution development?

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1. Selecting a model of practice 2. Frame of reference From which the OT operates

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Frame of reference

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Each frame of reference is based on a body of knowledge that identifies principles and processes of change. It provides the practition planning. Exploring intervention strategies based on different frames of reference will help the practitioner develop potential solutions.

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Based on the problems and the identified frame of reference along with the input received from the client, the practitioner determines a _____ for intervention.

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plan of action

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What is the first step for developing a plan of action?

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creation of long and short term goals that address the problems identified

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What is the second step for developing a plan of action?

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Intervention methods that will help the client achieve the goals are determined.

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What must you consider when deciding on an intervention method?

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-Considering the tools or equipment needed, any special postitioning, where the activity will take place, how it will be structured and graded, and whether it is to be performed in a group or individually.

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The intervention method is based on the selected

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frame of reference

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The practitioner uses his or her knowledge of the disability and the intervention to predict which

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methods will likely achieve the desired results as stated in the goals

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The outcome of this intervention planning process is a written report or intervention plan. The written plan addresses

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-strengths and weaknesses of the individual -interests of the clients and the caregivers -estimate of rehabilitation potential -and expected outcomes (short term and long term goals) -along with frequency and duration of intervention -recommended methods and media -apparent environmental and time constraints -identification of a plan for reevalation -discharge planning *The plan is formally entered into the client's records

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Involves working with the client through thereapy to teach client goals.

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Intervention

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Five Intervention approaches:

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1. Create/promote 2. Establish/restore 3. Maintain 4. Modify 5. Prevent

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Practitioners frequently_____ with other professionals, family members and clients regarding intervention strategies.

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Consult; important part of intervention

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True or False: When a OT consults with others, he or she is not directly responsible for the implementation and subsequent outcome of the intervention.

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True; for example, the OT may consult with a teacher on how to facilitate handwriting skills in the classroom or an OT may consult in a work setting about ergonomically correct lifting techniques or workspace arrangements.

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Consultation requires:

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1. advanced knowledge 2. the ability to comunicate clearly with others 3. Knowledge of the context in which the consultation occurs

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See Box 12-1 pg. 119: Observation Guide

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...

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An example of the Intervention approach: Create/Promote

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The OT organizes an afternoon handwriting group for school aged children. The practitioner recommends the group to children in his her caseload who have difficulty with writing.

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An example of the Intervention approach: Establish/restore

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The OT works with Galen, a 67 year old man who has lost use of his right side since he cerebral vascular accident. The clinician works to help Galen return to he typical morning routine.

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An example of the Intervention approach: Maintain

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Aftering performing a home visit, the OT makes recommendations so 90 year old Harry can stay at home.

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An example of the Intervention approach: Modify

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The OT provides 35 year old Karen, who has cerebral palsy, with adapted feeding equipment so that she can feed herself.

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An example of the Intervention approach: Prevent

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The OT practitioner explains proper lifting techniques to a group of workers at the blanket factory with the goal of preventing injuries.

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Education: important aspect of Intervention, what is it?

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OT's educate the client, family and caregivers about activities that support the intervention plan.

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Although the implementation of the intervention plan is the responsibility of both OT and OTA, it is the central responsibility of the

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OTA

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Reevaluation of a client may result in

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changing activities, retesting, writing a new plan or making needed referrals

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The OT assesses the client each treatment session by monitoring the

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influence of intervention and evaluating whether the activity has the desired therapeutic effect. For example if the activity becomes too easy for the client, the OT may increase the level of difficulty by adding resistance or by changing the demands of the activity

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When the OT reevaluates the plan and how it is being carried out and achieving outcomes targeted for the client the OT may

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-modifies the plan as needed -determines the need for continuation -or referral to another service *Intervention services change as the needs of the client change

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The coordination or facilitation of services for the purpose of preparing the client for a change

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Transition services

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Transition services may involve :

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-a change to a new functional level, life stage, program or environment

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Transition services: Some patients may need to be transferred to a lower level of care, ________, before returning home.

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Skilled nursing facility

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What is the last step of the intervention process

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discontinuation of the client from occupational therapy services

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When is the client discharged from occupational therapy?

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-When he/she has reached the goals dilineated in the intervention plan -When he or she has realized the maximum benefits of occupational therapy services -Or when he/she does not wish to continue services

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____ developed and implemented to address the resources and supports that may be required upon discharge.

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The discharge plan

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The discharge plan includes:

answer

-recommendations for continued services -equipment recommendations -any therapy the client is required to follow after discharge

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OT's use ____ to determine whether goals have been met and to make decisions regarding future intervention.

answer

outcome measures

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OTs are interested in selecting measures early and using measures that

answer

that may predict future outcomes

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Relative Framework for Intervention

answer

1. Hypothesis validation- critical cues for to confirm/deny 2. Generating options- done by you, brainstorming as many options as possible 3. Considering- for each option you should consider factors that limit suitability, cost restraints and environment 4. Take in consideration of risks 5. Select Intervention- mandatory outcomes(ADLS) or desirable outcomes

Chapter 12: Occupational Therapy Process: Evaluation, Intervention, and Outcomes – Flashcards

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