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1) History of OT: When and where was occupational therapy founded?

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a. Founded in 1917 i. Consolation house ( a workshop for convalescent: Skilled workers)- Clifton Springs, NY, 1917* George Barton invited the seven original founders of the Nation association for the promotion of OT to gather at consolation house.

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George Barton (1871-1923)

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- First President and founder of AOTA. - Architect, cured self through carpentry (woodworking & gardening) - Organized first national OT organization and became its first President.

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William Rush Dunton, MD (1868-1950+)

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- Physician, educated in psychiatry at Univ of Pennsylvania. - Provided OT with initial Connection to medicine. - Wrote many books about OT- 1919 outlined the use of crafts and other occupations in restoring productive functioning to wounded soldiers.

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Thomas Kidner (1866-1932)

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- Canadian - Architect - Contributed knowledge about the vocational retraining of war veterans using graded occupation and adapted environments. - AOTA President 1923-1928 - Helped align OT practice with that of medicine.

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Eleanor Clarke Slagle (1871-1942)

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- At John Hopkins. Developed her own OT technique of "Habit Training" and established it at several hospital. - AOTA President (1919-1920) and many years as sec and treasurer. - Established educational standards for OT education programs & worked with AMA to develop guidelines and a national registry of qualified practitioners. -1955- AOTA created an annual lectureship in memory of Elanor Clarke Slagle.

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Susan Tracy (1878

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- Nurse from Mass. first organized OT classes for nurses in Boston, NY and Chicago. - Created an OT program for patients with Neurasthenia. - OT Founder -Invalid occupations textbook

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Susan Johnson (1876-1932)

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- Nurse who taught OT at Columbia Univ. in NY. Educator and craftswoman expanded the scope of OT in the treatment of physical chronic illness.

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Herbert Hall (1870-1923)

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- Promoted the benefit of OT, such as instilling initiative and interest, improving concentration and endurance, and providing a sense of pride and accomplishment with learning new skills and trades that prepared patients to reenter the working world. - AOTA President (1920-1923) - Not diversion but recovery. P. 11

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OT Practice Framework

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- Consists of 2 parts: Domain and Process - The categories include performance areas of occupation (7), Performance skills (2), performance patterns (3), contexts (7), activity demands (7), and client factors (2).

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International Classification of Function (ICF)

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- Created by the World Health Organization. - Reflects the shift to a holistic and systems perspective of global health care from a reductionistic view. Health condition (disorder/disease) ^ ^ ^ Body Functn&StructrActvtyParticipation (impairment) (limitations) (Restriction) ^ ^ ^ Environmental & Personal Factors

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Purpose of ICF

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- To provide a scientific basis for studying health and health determinants. - Establish a common language - Provide systematic coding for purposes of record keeping and research.

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New Definitions- ICF

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- Handicap is changed to " participation restriction". - Disability " " "activity limitation." - Impairment " " "health condition." - Global Health care model

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Client-Centered Model

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- Emerged in 1960's - Founded by Canadian Occupational Therapy Association (CAOT) - It is the basic therapy model for the AOTA Practice Framework. - Carl Roger's "person-centered" therapy approach. - Collaborative partnership - Holistic and global

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Six Principles of Client-centered Practice

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1. The client is capable of choice. 2. Flexible & individualized approach 3. Therapist's role as enabler ( Therapist shares power & empowers client). 4. Success measured by client's attainment of goals (client set own priorities)- realistic goals. 5. Need for contextual congruence- (interventions have meaning in client's own life settings.) 6. Client readiness to use therapist expertise.

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Canadian Model of Occupational Performance

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- Illustrates how occupational performance evolves from the interactions between the person, the environment, and the occupation itself.

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CMOP Six Points

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1) Functioning ability is based on the interactive effects between person, occupation, and environment. 2) Changes in any part of the system can impact occupational performance. 3) Motivation is considered, to be intrinsic (within) and facilitated by clients' participation in identifying meaningful goals and occupational priorities. 4) There is not a specific plan for how to apply the therapeutic process. 5) "Facilitating, guiding, coaching, prompting, listening, reflecting, encouraging, or otherwise collaborative with people are general intervention strategies. 6) Therapeutic process is guided by the 6 general principles of client centered practice.

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3 Paradigms Shifts of OT

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1) Paradigm of Occupation (1900-1940s) 2) Mechanistic Paradigm (1950s-1970s) 3) New Emerging Paradigm (1980s-2000)

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(Initial) Paradigm of Occupation (1900-1940s)

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- Moral treatment (advocating for persons with mental illness by participating in occupations that "normalized" behavior. - Origin: Consolation House & Hull House - Occupation: was the central phenomenon of interest referring to balance of work, play, self-care, & rest; holistic view. - Based on common sense. Evidence was absent.

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Mechanistic Paradigm (reductionist) (1950's-1970's)

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- Medical model (reductionistic) replaces "occupations" of moral treatment ( disability oriented) - OT's seek to gain professional respect as a scientific discipline by focusing on disease. - Specialization is a popular trend. - Loss: commitment to occupational performance. ( Gave up vocational training) - Gain- New assistive devices, technology, techniques (SI:sensory integration: NDT: neural developmental treatment.)

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New Emerging Paradigm (contemporary or current) (1980s-present)

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- Re-commitment to holistic view and the occupational nature of humans. - Client centered practice including active engagement & empowerment. - Systems theoretical view - Balance of the art(early practice) & science(mechanistic) of practice(reform old thinking and make it more holistic.

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8 Major Trends

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1. Moving away from the Medical Model. ex) reductionistic. 2) Moving towards holistic approach. 3) Expanding the definition of Occupation ex) Looking at wellness, prevention, education and industry. 4) Understanding cognition, sensation, and neuroscience. ex) Increased knowledge in this area to help w/ patient treatment. 5) Embracing occupational science. ex) Looking at evidence and how it related to treatment. 6) Building of evidence based practice. ex) need for research to support & expand OT. 7) Human adaptation in the context of culture and community. Ex) seen in the practice framework. Class ex) completed tub training but she didn't use a tub. 8) Putting client first. Ex) Taking time to talk to the client.

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Occupational Therapy Practice Framework (Domains)

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- Performance in area's of occupation- note that there is a self assessment and a skills portion to managing participation in the activities, not just how well you actually perform the activity. - Each are is defined, in come cases by experts. - Performance patterns are a new section in the framework. - Contexts are both internal and external. - Activity demands are the basis for activity analysis. Ex) Driving. Obj: Vehicle, Space: Road, Socail: License, Seq. & timing etc. *To address performance issues in AREAS OF OCCUPATION you must know what PERFORMANCE SKILLS are needed and what PERFORMANCE PATTERNS are used.

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Occupational Therapy Practice Framework (Process)

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- Process is dynamic: Note: start w/ occupational science and context in relation to Process of practice: Service delivery. - Client centered - Occupation based - Process begins by evaluating client's occupational needs, problems & concerns

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OTPF: Evaluation:

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- Sets stage for all that follows. - Occupational Profile: where the process starts. You get clients perception. Find out about the person from family. First time you talk to them. - Analysis of occupation Performance: we need to understand-> performance skills, client centered, etc.

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OTPF: Intervention- Steps in service Delivery

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- Intervention plan: Approach, outcomes. - Intervention Implementation - Intervention Review

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OTPF: Approach

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- Create or Promote (health promotion) - Establish or Restore (remediation, restoration) - Maintain - Modify (compensation, adaptation) - Prevent (disability prevention)

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OTPF: Types of Occupaitonal Therapy Intervention

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- Therapeutic use of self - Therapeutic use of occupation - Consultation Process - Education Process - Client Education

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OTPF: Outcomes

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- Several Classifications of outcomes - Occupation performance Improvement; Enhancement. - Client Satisfaction - Role Competence - Adaptation - Health and wellness - Prevention - Quality of life - Participation - Self Advocacy - Occupational Justice

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Aspects of Occupational Therapy's Domain of Practice (Area's of Occupation)

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- Activities of Daily Living (ADL)* - Instrumental Activities of Daily Living (IADL) - Rest and Sleep - Education - Work - Play Leisure - Social Participation * Also BADL (Basic activities of daily living)

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Aspects of Occupational Therapy's Domain of Practice (Client Factors)

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- Values, beliefs, and spirituality. - Body functions - Body Structures

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Aspects of Occupational Therapy's Domain of Practice (Performance Skills)

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- Sensory Perceptual skills - Motor and Praxis Skills - Emotional Regulation Skills - Cognitive Skills - Communication and Social Skills.

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Aspects of Occupational Therapy's Domain of Practice (Performance Patterns)

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- Habits - Routines - Roles - Rituals

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Aspects of Occupational Therapy's Domain of Practice (Context and Environment)

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- Cultural - Personal - Physical - Social - Temporal - Virtual

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Aspects of Occupational Therapy's Domain of Practice (Activity Demands)

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- Objects use and Their Properties - Space Demands - Social Demands - Sequencing and Timing -Required Actions - Required Body Functions - Required Body Structures

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Theory

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Describ, explains, and predicts behavior and or relationship between concepts or events.

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Applied Theory

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The result of applied research, intended to address problems of practical interest.

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Paradigm

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A shared vision encompassing fundamental assumptions and beliefs, which serves as the cultural core of the profession.

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Philosophy

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A fundamental belief.

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Model

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A simplified representation of structure and content...that describes or explains complex relationships between concepts.

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Occupational Performance Model

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A framework for understanding the individual's dynamic experience in daily occupation within the environment.

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Occupation-Based Model

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Proposed interaction of person, environment, and occupation that guide the organization of occupational therapy practice.

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Conceptual Models in OT

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Graphic or schematic representations of concepts & assumptions that explain why the profession works as it does.

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Framework Reference

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System of compatible concepts from theory which guides a plan of action within a specific domain of concern.

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Concept

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An idea or notion formed by mentally combining characteristic.

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Construct

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An assembly of observable or directly experienced phenomena.

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Postulate

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A theoretical statement which suggests how tow or more concepts are related.

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Assumptions

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Broad general statements that are taken for granted for the sake of argument.

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Epistemology

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The dynamics of know. How we know what we know.

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Taxonomy

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System of classification for organizing theory and knowledge in a field.

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9 Theoretical Components

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Focus, theorists, function, disability, change, motivation, evaluation, intervention guidelines and research.

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Theoretical Base

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Theoretical concepts from both inside and outside OT's body of knowledge.

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Focus

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Selected areas of the Framework Domain form the focus of each fame of reference.

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Function and Disability Continuum

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Serve the purpose of applying concepts from the theoretical base to individual clients or situation.

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Evaluation Process

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working in partnership with the client or clients to set occupational goals and priorities.

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Change and motivation

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Principles or proposed relationships among variables that explain how therapy works.

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Intervention Process

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Doing with the client. Often involves the analysis and synthesis of activities.

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Research

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This last step in the structure of a frame of reference represents the evidence that has been gathered by researchers about validity of the theoretical concepts outlined and the effectiveness of the techniques used by occupational therapists according to its guidelines.

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Community based Practice

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The provision of services in community setting where people live and participate in their daily activities.

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Social Model Systems

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Depicts a community centered focus on wellness. - Collaboration: client & Practioner - Take responsibility and prevent illness

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Current Day Model

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- Independent living center - Vocational & residential - Health & Wellness programs.

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Community Practice

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- OT's to extend their intervention beyond the clients immediate impairments to focus on their long term health needs by helping them develop behaviors to improve their health and well being and minimize long term health are costs associated with dysfunction.

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Overarching Goals of OT in Public Health

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- Enhance & enrich physical, social, mental, emotional, intellectual and vocational capacities among customer and consumers. - Utilize wide ranging age-appropriate, and balanced occupations for all people.

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Public Health

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Process of mobilizing local, state, national, and international resources to ensure the conditions in which people can be healthy.

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3 Occupational Risk factors

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Can lead to disease, illness or death. 1) Occupation Imbalance: People with physiological, sleep, mental and social needs are not met at state of imbalance occurs. 2) Occupational Deprivation: taking from or losing or the influence of an agency or circumstance that keeps a person from using or enjoying something. Ex) lack of employment. 3) Occupational alienation: person's activity is not in accordance with humanity, possible sources: economic, social etc. ex) technology: overload.

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WHO 3 Forms of Prevention

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* action taken to reduce the possibility of an event or condition form occurring or developing or to minimize the result from an event or condition. 1) Primary prevention: Directed at the health of individuals. 2) Secondary prevention: show early signs of a disease. Ex) apply a resting splint. (1&2 ARE COMMUNITY BASED MODEL) 3) Tertiary Prevention: person already in a state of ill health- shows actual signs and symptoms.

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US Health Delivery System

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- Unique health care delivery system. - Lack of central agency to govern the system. - Unequal access to health care services due to private health insurance coverage. - Legal risks - Existence of subsystems that include multiple payers and 3rd party insurers.

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Universal Access to health care

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Canada and Western European countries

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Healthy People 2020

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- Public document that was issued in Jan 2000. - Comprehensive set of national objectives for the decade has a strategic plan of public health priorities. - Represents a systems theory view of health concerns. - Determinants of health: help develop. strategies to improve health in US. 1) Biology 2) Behavior 3) Social environment 4) Physical environment 5) Policies 6) Interventions

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Health Promotion Models for Community- Based Practice.

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Influence health promotion from an occupational perspective. 1) Wellness: associated with health promotion and ill health prevention for industry, business and work sites. 2) Preventive medicine: closest to public health. Western medicine and social science; - Prolong life - promote health - promote health - through intercepting the disease process. 3) Social Justice: Promotion of social and economy change to increase individual, community and political awareness, resources, and equitable opportunities of health. 4) Community Development: Action to provide individual, family, and community wide responsibility for self-sustaining development, health and well being. 5) Ecological Sustainability: issues such as population growth; restructuring of economic and societal values, reformation of resources politics to reflect community interests. 4) Community development: action to provide individual, family, and community-wide responsibility for self sustaining development, health and well-being. 5) Ecological sustainability:issues such as population growth, restructuring of economic and societal values, reformation or resources politics to reflect community interests.

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7 Founders of Occupational Therapy

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1) George Barton 2) Elanor Clark Slagel 3) William Dunton 4) Susan Johnson 5) Isabel Newton: Barton's secretary 6) Thomas Kidner 7) Susan Tracy Trick: WISEST?= G!

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AOTA Presidents

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1) George Barton First president 2) Eleanor Clarke Slagle (1919-1920) 3) Herbert Hall (1920-1923) 4) Thomas Kidner (1923-1928)

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Mission of Healthy People 2020

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- Identify nationwide health improvement priorities. - Increase public awareness and understanding of the determinants of health, disease, and disability, and the opportunities for progress. - Provide measurable objectives and goals. - Engage multiple sectors to take actions to strengthen policies and improve practices - Identify critical research, evaluation, and data collection needs.

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Healthy People 2020

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Is a set of goals and obj. with 10 years targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United states.

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