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Referral

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The basic request for occupational therapy services. This may also be termed an order or a consultation.

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Sources of Referrals

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include the individual, family or caregivers, physicians, social workers, physical therapists, nurse practitioners, allied health professionals, teachers, administrators, insurance companies, employers, state and local/public and private agencies.

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If an OTA receives a referral, what should the OTA do?

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The OTA must give the referral to the OT supervisor who is responsible for responding to the referral.

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Screening

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The acquisition of information to determine the need for an in depth evaluation and to obtain a preliminary understanding of the individual's needs, limitations, assests, and resources.

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During a screening, the OTA can do what?

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The OTA can collect screening data and report information with OT supervision. The amount of supervision required will depend upon the OTA's experience and service competency.

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Data collected during a screening can be analyzed by who? OT or OTA?

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The OT will analyze the data to determine the areas of performance, performance components and or performance contexts that require further eval.

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Evaluation

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The comprehensive process of obtaining and interpreting the data necessary to understand the individual, system or situation.

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How does the OTA contribute to the eval process?

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The OTA can assist with the collection of eval data once service competency is proven with OT supervision. Level of supervision is based on OTA's experience + service competency.

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If the individual and the OT practitioner do not share a common language, what must they do?

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an interpreter must be used to ensure validity of the information obtained.

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Who (OTA or OT) determines which assessment will attain information essential for setting goals and planning intervention?

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OT supervisor. However, the OTA contributes to this determination process. The OT has the final say.

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Observation (assessment tool)

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involves visual assessment of an individual, his/her behavior, and environmental contexts.

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Interviews (assessment tool)

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involve the practitioner asking the individual specific questions.

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Self report (assessment tool)

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requires the individual to disclose personal information in an organized manor (eg. through the completion of a questionnaire)

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Checklists (assessment tool)

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require the use of predetermined listing of items against which a person's performance is checked to determine the presence or absence of these items.

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Rating Scales (assessment tool)

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require the use of a predetermined listing of items against which a person's performance is checked to determine the presence or absence of these items

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Performance tests (assessment tool)

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involve the structured guidelines and/or standardized procedures for engaging the individual in performing an activity and for scoring this activity.

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Norm-referenced assessments

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produce scores that compare the individual's performance to a set population's performance.

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Criterion-referenced assessments

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provide scores that compare the individual's performance to a pre-established criterion.

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The OTA can utilize assessment tools only after _____ _______.

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service competency

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Prevention (type of intervention)

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interventions designed to promote wellness, prevent disabilities and illnesses and maintain health.

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Primary prevention [create/promote, health promotion] (type of intervention)

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the reduction of the incidence or occurrence of a disease or disorder within a population that is currently well or considered to be potentially at risk. interventions focus on providing enrichment to enhance person's occupational performance in their natural contexts.

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Secondary prevention

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the early detection of problems in a population at risk to reduce the duration of a disorder/disease and or minimize its effects through early detection/diagnosis, early appropriate referral and early/effective intervention (eg. the screening of infants born prematurely for developmental delays and the immediate implementation of intervention for identified delays)

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Tertiary prevention (disability prevention)

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the elimination or reduction of the impact of dysfunction on an individual (eg. the provision or rehabilitation services to maximize community integration) used to designate interventions that address the needs of persons with or without disabilities who are considered at risk for problems with their occupational performance. interventions focus on preventing the occurrence or minimizing the effects of barriers to occupational performance.

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Meeting health needs (type of intervention)

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Psycho-social needs, temporal balance and regularity: balance between work/productive activities, safety, love + acceptance, group association, mastery, esteem, sexual, pleasure, self actulization

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The change process [establish/restore/remidiate/restoration] (type of intervention)

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this type of intervention is the most commonly used in OT practice and is the most reimbursable. this process is often the only form of intervention discussed or documented. Guidelines for intervention implementation relate directly to this process. intervention focuses on establishing a skill or ability that a person had never developed an or restoring a skill or ability that a person had lost due to impairment.

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Management [modify/compensation/adaptation] (type of intervention)

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interventions designed to reduce or minimize disruptive or undesirable behavior that interfere with therapeutic activities or procedures needed to change areas of dysfunction that are the main focus of intervention (ex an individual becomes excessively anxious during his/her first use of a wheelchair in an environment outside of the hospital. supportive interventions are needed to decrease anxiety, thereby enabling the person to work on essential community mobility skills)

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Maintenance (type of intervention)

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interventions designed to support and preserve the individual's current functional level (ex a reminiscence group to maintain the cognitive and social skills of individuals with early to mid-stage Alzheimer disease) no improvement in function is planned due to the chronicity of the disorder or the progression of the disease. A decline in function is prevented as much and for as long as possible. while maintenance is not often reimbursed by third party payers, it is a major type of OT intervention due to the chronic and progressive nature of many disorders we work with.

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Long term goals

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the change in activity limitations and participation restriction that will occur, prior to the termination of intervention, in order to achieve the desired functional occupational performance outcome

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Short term goals/objectives

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the component subs kills which are to be achieved over shorter time frames, leading to attainment of the long term goal. must be directly related to the LTG.

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Reevaluation

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the process of determining whether the individual's occupational performance has improved, declined or remained the same after intervention. frequent monitoring of an individual's response to intervention. a. effective interventions will result in progress and require intervention plan modification of upgrading goals. b. if individual is not progressing, different intervention methods are tried, referrals to other experts are given and or discharge from intervention may be warranted.

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Discharge planning

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the process for plannning for discontinuation of services.

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Who (OT or OTA) is responsible for the discharge planning process?

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OT supervisor

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Reasons for discharge from services

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1. the individuals foals have been met 2. the individual has reached a functional plateau 3. the individual does not require skilled services, for maximum benefit has been achieved 4. an exacerbation of an illness or a medical crisis requires discharge to a higher level of care. 5. the person's allotted length of stay in the setting has expired and extension of LOS is not possible.

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When does discharge planning begin?

answer

begins with the initial evaluation and is an inherent part of the intervention planning process.

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Occupations

answer

goal directed pursuits which typically extend over time. they have purpose, value, and meaning to the performer, and involve multiple tasks. they are ordinary and familiar things that people do every day.

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Areas of occupation

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1. Activities of daily living 2. Instrumental activities of daily living 3. Work 4. Education 5. Play/leisure 6. Social participation

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Purposeful activities

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Doing processes that are directed toward a desired and intended outcome and require energy and thought to engage in and complete. the goal directed tasks and or behaviors that make up occupations. are composed of identifiable parts that can be identified, are holistic, and can be manipulated and adapted.

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clinical reasoning

answer

the complex mental processes the therapist uses when thinking about the individual, the disability and the personal, social, and cultural meanings the individual gives to the disability, the uniqueness of the situation and him/herself.

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Procedural reasoning/scientific reasoning (type of clinical reasoning)

answer

involves identifying OT problems, goal setting and treatment planning. involves implementing treatment strategies via systematic gathering and interpreting of client data. the actual technical "doing" of practice. The reasoning that is documented the most for reimbursement.

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interactive reasoning (type of clinical reasoning)

answer

deals with how the disability or disease affects the person; focuses on the client as a person. involves the therapeutic relationship between the OTA, the individual and the caregiver. facilitates effective treatment as it focuses on the personal meaning of illness and disability which can influence how a person engages in treatment. congruent with the profession's philosophy and heritage of caring

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Narrative reasoning (type of clinical reasoning)

answer

deals with the individual's occupational story and focuses on the process of change needed to reach and imagined future. identifies what activities and roles were important to the person prior to illness/injury. analyzes what valued activities and roles the individual can perform now. explores what valued activities and roles are possible in the future given the person's disability. asks what valued activities and roles the individual would choose as priorities for the future. neglects larger practice area issues in which the client/practitioner interaction is occurring.

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Pragmatic reasoning (type of clinical reasoning)

answer

considers the context in which the OT practitioner's thinking occurs. States that mental activities are shaped by the situation. considers the treatment environment and OT practitioner's values, knowledge, abilities, and experiences. focuses on the treatment possibilities within a given treatment setting. re frames understanding of the influence of personal and practical constraints on OT practice. the most effective OT practitioners are able to negotiate pragmatic contextual issues in favor of quality care.

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Conditional reasoning (type of clinical reasoning)

answer

involves an ongoing revision of treatment. focuses on current and possible future social contexts. represents an integration of interactive, procedural, and pragmatic reasoning in the context of the client's narrative. requires multidimensional thinking.

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transference

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is an unconscious response to an individual that is similar to the way one has responded to a significant person

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countertransference

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is an unconscious response to transference in which the individual response in a manner that is expected and desired by the person who has transference towards him/her

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Origin phase (group development)

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involves the leader composing the group protocol and planning for the group

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Orientation phase (group development)

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involves members learning what the group is about, making a preliminary commitment to the group and developing initial connections with other members.

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Intermediate phase (group development)

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involves members developing interpersonal bonds, group norms, and specialized member roles through involvement in goal-directed activities and clarification of group's purpose.

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Conflict phase (group development)

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involves members challenging the group's structure, purposes and/or processes and is characterized by dissension and disagreements among members. unsuccessful resolution of this phase results in dissolution of the group. successful resolution of this phase results in modifications to the group that are acceptable to members, enabling the group to proceed to the next phase of development.

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Cohesion phase (group development)

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involves members regrouping after the conflict with a clearer sense of purpose and reaffirmation of group nor,s and values, leading to group stability.

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Maturation phase (group development)

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involves members using their energies and skills to be productive and to achieve group's goals.

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Termination phase (group development)

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involves dissolution of the group due to lack of engagement of members, inability to resolve conflict, administrative constraints, goals attainment or task accomplishment.

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Instrumental roles

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are functional and assumed to help the group select, plan, and complete the group's task (ex: initiator, organizer)

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expressive roles

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are functional and are assumed to support and maintain the overall group and to meet members needs (ex; encourager, compromiser)

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individual roles

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are dysfunctional and contrary to group roles, for they serve an individual purpose and interfere with successful group functioning (ex: aggressor, blocker)

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group norms

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the standards of behavior and attitudes that are considered appropriate and acceptable to the group.

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group goals

answer

the desired outcomes of the group that are shared by a sufficient number of group's members. provides focus for the group and guidelines for group activities and interactions.

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group cohesiveness

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the degree to which members are committed to a group (ex: the sense of we-ness)

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factors that contribute to group cohesiveness

answer

1. extensive interaction between members 2. similarity or complementariness in member characteristics 3. perception of relevance of group to individual needs 4. members' expectation of goal attainment and successful group outcome. 5. democratic leadership and member cooperation

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types of group leadership

answer

directive, facilitative, advisory

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directive group leadership

answer

takes place when the OT practitioner is responsible for the planning and structuring of much of what takes place in group. this style is needed when the members' cognitive, social and verbal skills as well as engagement is limited (parallel, project). leader selects the activities to be used in group and provide clear verbal and demonstrated instruction to complete tasks. group maintenance roles and feedback is mostly provided by the leader. leader's goal is task accomplishment.

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facilitative leadership

answer

occurs when the OT practitioner shares responsibility for the group and for the group process with the members. this style is advised when memebers' skill levels and engagement are moderate (ego-centric cooperative, cooperative). leader collaborates with group members to select the activities to be used in a group. members and leader share instruction throughout the group's process. group maintenance roles and feedback are provided by members with leader facilitating the process.

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advisory leadership

answer

takes place when the OT practitioner functions as a resource to the members, who set the agenda and structure the groups' functioning. this style is assumed when member's skills and engagement are high (mature). members select and complete the group's activity with leader's advice if needed. group maintenance roles are independently assumed by group members. feedback occurs as a natural part of the group's self directed process.

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co leadership

answer

occurs when there is sharing of group leadership between two or more therapists/and or OTAs.

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advantages of co-leadership

answer

1. each leader can assume different leadership roles, tasks and styles. 2. both leaders can provide and obtain mutual support 3. observations and objectivity can increase 4. co-leaders can share knowledge and skills 5. co-leaders can model effective behaviors

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disadvantages of co-leadership

answer

1. splitting by group members of one leader against the other 2. excessive competition among co-leaders. 3. unequal responsibilities resulting in an unbalanced work load among co-leaders

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altruism

answer

the giving of oneself to help others

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catharsis

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is the relieving of emotions by expressing one's feelings

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universality

answer

comes from recognizing shared feelings and that one's problems are not unique.

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existential factors

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address accepting the fact that the responsibility for change comes from within oneself.

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self understanding (insight)

answer

involves discovering and accepting the unknown parts of oneself.

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family reenactment

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leads to understanding what it was like growing up in one's family through group experience

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guidance

answer

comes from accepting advice from other group members

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identification

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involves benefiting from imitation of the positive behaviors of other group members

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instillation of hope

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is experiencing optimism through observing the improvement of others in the group

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interpersonal learning - input

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occurs when receiving feedback from group members regarding one's behavior

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interpersonal learning - output

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occurs by learning successful ways of relating to group members

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evaluation group

answer

a group to enable client and OT practitioner to assess client's skills, assets and limitations regarding group interaction.

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type of client in evaluation group

answer

all individuals who will be involved in groups or who lack group interaction skills

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role of OTA as group leader in evaluation group

answer

1. orients client to groups purpose 2. provides needed supplies for activities that were selected by the OT for their collaborative and interactive aspects. 3. does not participate or intervene in group (except to maintain safety) but observes and reports members' interaction and functional skill level to OT supervisor

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suitable activities for evaluation group

answer

tasks that can be completed in one session and require interaction to complete

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thematic group

answer

a group to assist members in aqcuring the knowledge, skills, and or attitudes needed to perform a specific activity.

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type of client in a thematic group

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1. determined by the specific goals of the group 2. members' needs, concerns, and goals must match the objectives of the group 3. members must have a minimal group interaction skill level equal to a paralell group skill level

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role of ota leader in thematic group

answer

1. contributes to the selection, structuring, and gradation of suitable activities to teach needed skills. 2. interventions vary according to group's level ,needs and goals 3. may range on a continuum from highly structured, supportive director to a resource advisor. 4. reinforce skill development 5. attention is not paid to intra- or inter- personal conflicts unless they interfere with or are directly related to the activity.

question

suitable activities for thematic group

answer

simulated, clearly defined, structured activities , which enable members to practice and learn needed skills, attitudes, and knowledge within the group. activities selected are directly related to the skills needed to perform the activity outside of the group (a cooking group)

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topical group

answer

a group to discuss specific activities that members are engaged in outside of group to enable them to engage in the activities in a more effective need satisfying manner.

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concurrent topical group

answer

a group concerned with activities already engaged in outside of group (parenting skills group for parents of children with developmental disabilities)

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anticipatory topical group

answer

a group concerned with activities that are expected to be done in the future (a discharge planning group for persons completing short term relationship)

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type of client for a topical group

answer

1. individuals who share similar current or anticipatory problems in functioning. 2. members must be at an ego-centric cooperative group skill level 3. sufficient verbal and cognitive skills to engage in discussion and to problem solve are present

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role of the ota in a topical group

answer

1. facilitate group discussion while maintaining focus on the circumscribed activity. 2. helps members problem solve, gives feedback and support ; reinforces skill acquisition 3. shares leadership with members, acts as a role model.

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suitable activities for topical group

answer

1. group activity is a verbal discussion on a circumscribed activity that members are engaged in or will be engaged in outside of the group 2. discussion may include members current or anticipated fears and problems, potential solutions and coping mechanisms. 3. role-play and homework may be given

question

task oriented group

answer

a group used to increase client's awareness of the needs, values, ideas, feelings and behaviors as they engage in a group task. also used to improve intra- and inter-psychic functioning by focusing on problems which emerge in the process of choosing, planning and implementing group activity.

question

type of client for a task oriented group

answer

1. individuals whose primary dysfunction is in the cognitive and socioemotional areas due to psychological or physical trauma. 2. clients with fair verbal skills who can interact with others

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role of the ota in a task oriented group

answer

1. initially, very active, defines group goals and structure 2. assists with activity selection, offers guidelines and suggestions 3. facilitates discussion among members 4. gives feedback and support 5. assists members in exploring relationships between thoughts, feelings and actions 6. encourages members to experiment with new behavior patterns 7. as the group develops, the leader is less active, helps embers give more feedback however the practitioner still remains the leader and ensures the task is a means to the end, not the end itself.

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developmental group

answer

a continuum of groups consisting of parallel, project, ego-centric cooperative, cooperative, mature. purpose of the groups are to teach and develop members group interaction skills

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parallel group

answer

group purpose: - to enable members to perform individual tasks in the presence of others - to minimally interact verbally and non verbally with others even though task does not require interaction with others in the group

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project group

answer

group purpose: - to the ability to perform a share, short term activity with another member in a comfortable, cooperative manner. - to develop interactions beyond those that the activity requires - to enable members to give and seek assistance

question

egocentric cooperative group

answer

group purpose: - to enable members to select and implement a long range activity which requires group interaction to complete - to enable members to identify and meet the needs of themselves and others

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cooperative group

answer

group purpose: - to enable members to engage in a group activity which facilitates free expression of ideas and feelings - to develop sense of trust, love and belonging and cohesion - to enable members to identify and meet socioemotional needs

question

mature group

answer

- to enable members to assume all functional socioemotional and task roles within a group. - to enable members to reinforce behaviors which result in need satisfaction and task completion

question

instrumental group

answer

a group to help members function at their highest level for as long as possible and to meet mental health needs

question

role of the ota in an instrumental group

answer

1. provide unconditional positive regard, support and structure to create a comfortable, safe environment for patients. 2. select and design activities that will meet members health needs and maintain highest possible level of function 3. assist members with activity as needed 4. make no attempt to change the client

Therapy Ed. Ch. 3 The Process of Occupational Therapy – Flashcards

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