Chapter 3: The Process of Occupational Therapy – Flashcards
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Referral Process
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Basic request for OT services; can range from highly specific to general; referral sources can include the individual, social worker, PTs, nurses, MDS, teachers, etc.
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3 aspects of service delivery
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1. Evaluation 2. Intervention 3. Outcomes
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Screening Process
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Acquiring information to determine the need for services (or evaluation); obtaining a preliminary understanding of needs, limitations, assets, and resources.
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Screening methods
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Screening tools measure broad performances abilities: chart, medical history, checklists, brief interviews.
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Evaluation Process
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Comprehensive process of obtaining and interpreting data that allows OT to understand the individual. This includes administering assessments; interpreting results; collaborating with individual, family, other health professionals; prioritizing problems with individual, writing up report, and referring out.
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Questions to consider to determine if the assessment is appropriate
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1. Baseline function 2. Environmental context of setting (LOS, resources, primary focus, etc.) 3. Context of individual (culture, temporal, values, physical ability, home environment etc.)
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Validity vs Reliability
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Validity: accuracy; does the tool measure what it intended to measure Reliability: consistency across time, place, and evaluations
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Types of Validity 1. Face Validity 2. Content Validity 3. Criterion Validity
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Face Validity: how well the assessment appears to meet the stated purpose Content Validity: establishes the content being used is representative of the content being measured Criterion Validity: compares the assessment to another assessment with high validity
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Types of Reliability 1. Inter-rater Reliability 2. Test-retest Reliability
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Inter-rater Reliability: establishes that different raters will achieve the same results Test-retest Reliability: establishes that the same results will be obtained when the evaluation is administered twice by the same administrator
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Assessment tools
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-observation -interviews -self reports -checklists -rating scales -performance tests -specific assessment tools -norm-referenced assessments -criterion-referenced assessments
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Three types of prevention: 1. Primary 2. Secondary 3. Tertiary
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Primary: reduction of incidence within a population that is currently well. (e.g. Educational classes for teen parents) Secondary: early detection of problems in a population at risk to reduce duration/effects through identification and intervention. (e.g. screening infants born prematurely) Tertiary: the reduction of the impact of dysfunction on an individual. (e.g. rehabilitation services for independence)
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Personal Protective Equipment (PPE)
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1. Wear when anticipating contact with blood or other bodily fluids 2. Remove PPE before leaving patient's room Gloves: change gloves between patients, when moving between contaminated/uncontaminated surfaces; use proper removal techniques Gowns: when when appropriate to the task; secretions/excretions are not contained; often routine donning of gowns in high risk units Mouth, nose, eye protection: when splashes or sprays of bodily fluids are anticipated
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Airborne precautions and droplet precautions
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1. Respiratory isolation room (airborne); isolation room (droplet) 2. Wear respiratory protection (mask) 3. Limit movement and transport of patient
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Contact precautions
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1. Isolation room 2. Wear gloves when entering the room, wear a gown substantial contact is anticipated 3. Single-patient use 4. Limit movement and transport of patient
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5 Types of clinical reasoning
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1. Procedural Reasoning 2. Interactive Reasoning 3. Narrative Reasoning 4. Pragmatic Reasoning 5. Conditional Reasoning
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Procedural Reasoning
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Aka scientific reasoning -identify problems, set goals, treatment plan -"doing" -systematic gathering and interpreting client data
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Interactive Reasoning
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-Focuses on the client as a person -How is the disability/disease affecting the person -focuses on personal meaning (motivation, etc.)
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Narrative Reasoning
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-Occupational story -What was important prior injury/illness? -What can be performed now? -What can be performed in the future? -
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Pragmatic Reasoning
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-Considers treatment setting in regards to LOS, access, intervention possibilities, -Looks at the context of how the OT's thinking occurs: values, knowledge, abilities, experiences
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Conditional Reasoning
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-Ongoing revision of treatment -Current and future context -Multidimensional thinking
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Group Development 1. Origin 2. Orientation 3. Intermediate 4. Conflict 5. Cohesion 6. Maturation 7. Termination
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1. Origin: composing and planning the group 2. Orientation: learn what the group is; commitment to group; develop connections with members 3. Intermediate: develop interpersonal bonds, group norms, member roles 4. Conflict: members challenge the structure, purpose, and processes; disagreement amongst members 5. Cohesion: regroup after concflict 6. Maturation: Use energy and skills to achieve group goals 7. Termination: dissolution of group; can be due to various reasons: disagreement, lack of commitment, resources, time, etc.
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Group norms vs group goals
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Group norms: standards of behavior that are appropriate and acceptable; can be explicit or non-explicit Group goals: desired outcomes of the group that are shared by majority of members
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Leadership styles 1. Directive 2. Facilitative 3. Advisory
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1. Directive: therapist is responsible for planning and structuring of what takes place 2. Facilitative: therapist shares responsibility for group and for group process with members 3. Advisory: Therapist functions as a resource to the members. Members set the agenda and structure
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Order
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A physician may write an order or referral for occupational therapy services. A physician referral is not always necessary. However, reimbursement or state licensure regulations may require a physician referral
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Screening
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To identify whether a person may benefit from OT and determine if evaluation is necessary. Screenings are usually conducted using chart review and client observations
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Evaluation Report
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The process of obtaining and interpreting data necessary for intervention. This includes planning for and documenting the evaluation process and results
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Intervention Plan
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May be included in the initial evaluation report or written as a separate document; contains goals, duration, intensity, and frequency of services, and recommendations for other services; it may or may not be revised at certain intervals as client's condition changes
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Discharge Summary
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Provides a summary of the occupational therapy services including services provided, client's response to services, progress toward goals and since initial evaluation, and recommendations for discharge
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COTA (OTA)
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-Primary role is to implement treatment -Can contribute to evaluation process; cannot independently evaluate -Can contribute to intervention plan under supervision by OT -Can document response to intervention under supervision by OT -Can be trained by OTs to perform specific non-skilled tasks -Cannot supervise OT practice -Must be supervised by all aspects of the service delivery process -Can supervise level I OT students, level I and II OTA students
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Methods of Supervision: Direct and Indirect
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Direct: face-to-face; co-treatment, observation, instruction, modeling, discussion Indirect: non face-to-face; electronic, written, and telephone communication
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Supervision Continuum 1. Close 2. Routine 3. General 4. Minimal
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1. Close: daily, direct contact at the site of work 2. Routine: direct contact at least every 2 weeks at the site of work; interim supervision occurring through other methods 3. General: at least monthly direct contact with supervision available as needed by other methods 4. Minimal: provided only on a needed basis
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OT Roles
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1. Practioner 2. Educator 3. Fieldwork Educator 4. Supervisor 5. Administrator 6. Consultant 7. Academic setting fieldwork coordinator 8. Faculty 9. Program Director
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4 Types of Teams
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1. Intradisciplinary 2. Multidisciplinary 3. Interdisciplinary 4. Transdisciplinary
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Intradisciplinary
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One or more members of one discipline evaluate plan and implement treatment of the individual; communication is limited; narrowed perspective
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Multidisciplinary
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A number of professionals from different disciplines conduct assessments and intervention independent from one other; primary allegiance is to personal discipline; various forms of communication; limited communication can limit understanding of different perspectives
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Interdisciplinary
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All disciplines relevant to the case at hand agree to collaborate for decision making; evaluation and intervention conducted independently; greater understanding of other perspectives; common goal; collaborate as a team, no "turf" wars *most common and most effective
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Transdisciplinary
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Characteristics of interdisciplinary team are maintatined and expanded on; support and enhance activities of other disciplines; committed to ongoing communication, collaboration, and shared decision making; role blurring is accepted; evaluations and interventions are cooperative *most common and most effective
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Treatment in terms of: 1. Frequency 2. Duration 3. Intensity
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Frequency: How many times a week; 3x/week Duration: How long will treatment last; four weeks Intensity: How long the sessions are; 50 minutes
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An OTR® is providing consultative services to develop a new occupational therapy department as part of a comprehensive rehabilitation program for a rural regional medical center. When reviewing the impact of the macroenvironment on the organization, what MUST the OTR® consider? A. Local and national legislative acts and regulatory policies that affect service delivery models B. Internal resource availability, and service delivery goals of the organization C. Corporate culture, supply availability, and organizational staffing policies that relate to quality care D. Organization's vision statement, governance, and internal auditing processes and procedures
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The right answer is A: The macroenvironment includes the external environment including policy, funding, and political services that impact provision of services.
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An OTR®; is developing a professional development plan. The OTR has identified personal needs for growth after completing a self-assessment. What step should the OTR take NEXT in developing the professional development plan? A. Review progress toward current professional development goals and objectives. B. Determine available resources for meeting goals and objectives. C. Determine what learning needs to occur. D. Set new goals for professional development.
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The right answer is C: The steps in developing a professional development plan are to: (1) reflect on current performance to date and determine learning needs on the basis of the self-assessment results (2) review progress toward previous professional development goals (3) ascertain what resources exist to meet identified professional development goals (4) modify previous professional development goals and set new ones (5) take action to meet professional development goals (6) document completed professional development activities.
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An OTR® is presenting an inservice to case managers about the benefits of occupational therapy for patients who have respiratory disorders. What should be the PRIMARY focus of this presentation? A. Differences between occupational therapy and respiratory therapy B. Specific occupational therapy protocols for patients who have respiratory disorders C. Revenue-generating potential of occupational therapy services D. Impact of occupational therapy services on patients' abilities to function at home
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The right answer is D: Presenting intervention outcomes is important in establishing program justification such as expanding occupational therapy services to include patients who have respiratory disorders. Differences between the disciplines may be included in the inservice; however, this area should not be the primary focus of the presentation because case managers will find information on effectiveness of services more beneficial. (Why A is wrong)
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A COTA® is working toward service competency for adaptive feeding equipment instruction. How would the OTR® BEST establish service competency? A. Review the COTA®'s documentation of multiple patients whose feeding impairments warranted adaptive equipment, then discuss the outcomes with the COTA®. B. Observe the COTA® educate clients on how to use adaptive feeding equipment to ensure the COTA® instructs clients in the same manner as would the OTR®. C. Compare outcomes by rating the same client's performance with the adaptive feeding equipment at the same level of independence. D. Collect information from various sources, including other therapists, the COTA®'s documentation, and feedback from clients, to determine competency.
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The right answer is C: Service competency is defined as "the process of teaching, training, and evaluating in which the OTR® determines that the COTA® performs tasks in the same way that the OTR® would and achieves the same outcomes" (Youngstrom, 2009, p. 943). In this example, both the COTA® and OTR® observe the same client performing a task and rate that performance in a similar manner. Comparing outcomes helps to ensure clients receive care of equal quality.
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A client did not attend the occupational therapy session because of an illness. According to the Guidelines for Documentation of Occupational Therapy, what is the BEST type of documentation to note nonattendance in a timely manner? A. Reassessment report B. Service contact C. Plan of care D. Monthly progress report
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The right answer is B: Service contact would be the best type of documentation because it can be completed as soon as the nonattendance occurs. The reassessment report is written based on results of the reassessment. The plan of care discusses the goals and treatment to be provided during intervention. The monthly progress report would not be documenting in a timely manner (as close to the occurrence as possible).
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Levels of Evidence
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Level I: systematic reviews, meta-analyses, and randomized controlled trials Level II: two-group, nonrandomized studies (cohort, case controls) Level III: one-group, nonrandomized studies (pretest-posttest designs) Level IV: descriptive studies that analyze outcomes (single-subject and case designs) Level V: case reports and narrative literature reviews.
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An OTR®; is looking for evidence to support a new mental health intervention. In searching the literature, the OTR finds several pieces of Level IV evidence but no evidence at Levels I, II, or III about the intervention. What can the OTR conclude about the evidence regarding the efficacy of the new mental health intervention? A. The literature contains enough evidence to justify the efficacy of the intervention. B. The literature does not contain enough evidence to justify the efficacy of the intervention C. The literature does not contain the level of evidence necessary to justify the efficacy of the intervention. D. The literature contains the level of evidence necessary to justify the efficacy of the intervention.
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The right answer is C: Only evidence at Level I and Level II can make claims about efficacy. Because the literature review found only Level IV evidence, the OTR cannot draw conclusions about the efficacy of the new mental health intervention under consideration.
