Ch 13 Psychosocial Frames of Reference & Models of Practice NBCOT

Types of abuse

1. physical abuse 2. emotional abuse 3. economic abuse : making the other ask for money, giving an allowance and or preventing the other from taking a job 4. intimidation and coercion 5. using children 6. stalking 7. sexual abuse Patterns of abuse: impuslive premeditated abuse

How are the TOA and SIS scores used?

Used as indicators of overall func. perf. and provide info. about person's cog., affective, social and perceptual motor skills

Ecology of Human Performance (EHP) Model Evaluation:

Utilizes checklists that were designed along with this model Includes checklists for person, the environment, task analysis and personal priories

Cognitive Performance Test

Was designed to assess the func. perf. of indiv.'s w/Alzheimer's disease; the focus is on the identification of effects that particular deficits have on ADL perf.

Sensory Models Evaluation

assessments used are: Adolescent/Adult Sensory profiles Allen Cognitive Level screen (OTA can administer evals w/ supervision)

Developmental groups: project groups:

common, short term activities requiring some interaction and cooperation

goal-setting groups

consists of activities designed to identify personal objectives and treatment goals and the steps to their achievement

discharge planning groups

focuses on activities to problem solve potential obstacles and identify resources for successful community reintegration

MOHO evaluation:

focuses on exploring the individuals occupational history, goals, volition, habits, and occupational performance

coping skills group

focuses on identifying the problem-solving and stress-management techniques needed to cope with life stressors

Life-Style Performance Model (frame of reference) Evaluation:

focuses on obtaining an activity history and a lifestyle performance profile related to the four skill domains. Environmental factors are explored

MOHO intervention focus

focuses on occupational engagement and includes activities that are purposeful, relevant, and meaningful to people and their social context

Mildred Ross' Five Stage groups (purpose and 5 stages)

*Expanded on work of Lorna Jean King and extended use of sensorimotor approaches to other chronic pop. (intellectual dissabilities , Alz, neuro impairment, etc) *for sensory distortions, postural disturbances, vestibular stimulating act *to normalize movement patterns, increase strength and flexibility and facilitate adaptive behavior - 1: orienting members to session and each other - 2: GM activ. that are stimulating/alerting - 3: brief activities (30 mins or less) that utilize perceptual-motor skills designed to be calming and inc. focus - 4: activities to provide cog. stim to promote org. thinking - 5: discussions to promote satisfaction/closure

Managing acting out behavior in children

*acting out is the expression of thoughts and feeling through maladaptive behavior instead of verbalizing - interpretation: put words to observed bx allows kids to express their feelings -redirection: refocuses-cues to appropriate bx -limit setting: informing what is acceptable and not -time-out : removing child from problem

Cognitive Disabilities Model Intervention

- Activities used to elicit indiv.'s highest cog. level - Therapy focus to maintain highest level of func. - Compensation through environ. changes and activ. adaptation to allow for greatest degree of independence - OT meets w/family or caregivers to develop understanding of indiv.'s abil./deficits/care needs - OT and team develop approp. d/c plan

Managing akathisia

- Allow person to move around PRN w/p disturbing group -participation on may levels and in many forms can be beneficial - When possible, select GM activ. over FM or sedentary ones

Role Acquisition (frame of reference) p 302

- Ann Mosey - Interv. focused on acquis. of specific skills an indiv. needs to function in his/her environ. - Performance addressed through func/dysfunc in 7 categories: (1) task skills, (2)interpersonal skills, (3)family interaction, (4)ADL, (5) school, (6) work, (7) play/leisure/rec. - Principles of learning used to promote skill development .

Managing escalating behavior

- Avoid what can be perceived as challenging bx (eye contact, standing directly in front of person) - Maintain comfortable distance, actively listen, calm tone, speak simply and clearly, do not judge indiv. thoughts/feelings/bx, clearly present what you would like person to do, avoid pt/you feeling trapped *if ind continues to escalate; ensure other pts safety -remove other patients from area -get or send for other staff

Psychoeducational group

- Classroom format and principles of learning to provide info. to members and to teach skills - Teacher/student relationship exists - Homework encouraged to facilitate skill development and generalization of learning

Cognitive Disabilities Model p. 303

- Claudia Allen (based on Piaget development) - Cog. abil. is determined by biological factors and the potential to improve dictated by those factors -functional behavior is based on cognition -if person's cognitive level cannot change, adapting the activity or task provides opportunities for the individual to succeed - *Once max. level achieved, compensations must be made* (bio/psychologically and environmentally)

Managing hallucinations pg. 313

- Environ. free of distractions that trigger hallucinatory thoughts/interfere with reality-based activ. - Highly structured, simple activ. that hold attn. - Attempt to redirect to reality-based thinking

Managing effects of Alzheimer's disease/ dementia

- Eye contact to show interest - Positive and friendly facial expressions and tone of voice during all communications - Do not speak about indiv. as if he/she not there -do not give orders -use short, simple words and sentences -do not argue or criticize - Routine that uses familiar/enjoyable activ. - Note effects of time of day on bx and activ. perf. - Attend to safety issues at all times

CBT Intervention: Dialectical Behavioral Therapy

- Form of CBT - Focuses on identifying suicidal thoughts and actions and self injurious behaviors commonly used with individuals with borderline personality disorders - Used to treat individuals who have depression, substance abuse issues, and/or eating disorders. - Teaches assertiveness, coping and interpersonal skills

Life-Style Performance Model (frame of reference) p. 300

- Gail Fidler - Proposes method to look at match b/t environment and individual's needs - Four hypothesis (p. 300-301) - Performance and QOL can be enhanced by envir. that provides for 10 fundamental human needs: *autonomy= self determination *individuality=self differentiation *affiliation=evidence of belonging *volition=the having of alternatives *consensual validation=acknowledgement of achievement and verification or perspectives *predictability=discernment and evaluation of cause and effect *self-efficacy= evidence of competence *adventure= exploration of the new and unknown *accommodation= freedom from physical and mental harm and compensation for limitations *reflection= contemplation of events and the meaning of things - Performance measured in quality of functioning in 4 domains: self-care/maintenance, intrinsic gratification, service to others, reciprocal relationships

Model of Human Occupation (MOHO) (frame of reference) p. 300

- Gary Keilhofner - Personal occupational choices and engagement in occupation shape the individual - 3 elements inherent to humans: volition, habituation, performance capacity - Environmental impact through opportunities, demands, resources, constraints - Intervention focus is on occupational engage., includes activ. that are purposeful, relevant and meaningful to people and their social context

Managing lack of initiation/participation

- Identify w/indiv. the reasons for lack of participation - Motivational hints exp food, praise, ensure success etc

Psychodynamic/Psychoanalytic Intervention

-magazine picture collages -projective and functional tasks to promote self-awareness and identification and exploration of intrapsychic content - bring unconscious conflicts to consciousness-conflict resolution -further specialized training is needed

Occupational Adaptation (frame of reference) p 302

- Janette Schkade and Sally Schultz - Concerned w/processes that indiv. goes through to adapt to his/her environment - 3 elements: person, envir., interaction b/t the 2 * person: consists of the sensorimotor, cognitive and psychosocial components of the individual * environment: physical, social and cultural systems within which work, play/leisure and self-maintenance take place * outcome of interaction: between person and environment = occupational response - Two assumptions: (1) occupation provides the means by which humans adapt to changing needs and conditions (2) occupational adaptation is a normative process that is most pronounced in periods of transition

General level criteria for scoring of Allen Cognitive Level Test

- Level 2: unable to imitate running stitch - Level 3: running stitch - Level 4: whip stitch - Level 5: cordovan stitch Scores correspond to Allen cognitive scales Population: adults with psychiatric or cognitive dysfunction

Sensory Models (psychosocial frame of reference) p. 303

- Lorna Jean King based on work of A. Jean Ayres Lorena King - Sensory distortions, postural disturbances and vestibular stimulating activities similar to that seen in learning disabled children were observed in indiv. w/chronic schizophrenia - Mildred Ross - Added movement patterns to calming and lerting sensory input of King - Pat and Julia Wilbarger - approach for children and adults with sensory defensiveness (brushing and sensory diets) - Winnie Dunn (Sensory-seeking, sensory-avoiding, sensory sensitivity, low registration) - Tina Champagne - Sensory modulation approaches and program * Sensory modulation approaches are used by OT practitioners to prepare, enhance, and or maintain the person's ability to engage actively in meaningful roles and activities -approaches include use of sensory-related assessment tools, sensorimotor activities, sensory modalities, environmental modifications, and assistance in learning hot to self-regulate through the process of self-organization and positive change * implementation of sensory modulation program requires the use of Strength-based, person centered and relationship centered model of care. -essential to assist the individual recognize not only symptoms but problem area,s but also his/her unique strengths that are utilized when following through with exploration, practice, and integration of sensory modulation approaches into one's daily life.

Elder Depression Scale (method and scoring)

- Method: completion of 30 item checklist which looks at presence of char. assoc. w/depression - Scoring: items scored yes or no, score of 10-11 is threshold most often used to indicate depression Population: older adults

Managing delusions

- Redirect to reality-based thinking and actions - Avoid discussions and other exper. that focus on and validate or reinforce delusional material -do NOT attempt to refute the delusion

Role of OT in domestic abuse pg. 314

- Refer to domestic shelters/safe houses - Develop trusting relationship - Provide info. about tx and support programs - Tx for phys/emotional injuries and to develop indep. living skills - Discuss: stress and safety, fear and abuse, family/friends/support network, emergency plan Use RADAR approach R - routinely ask exp during interviews A - Affirm and ask exp ask direct questions. "Do you feel safe?" D- Document objective findings- exp the person has multiple bruises) and record client statements in quotes A- assess and address person's safety exp "Has abuse become more violent? Are there weapons in the home?" R - Review options and referrals Intervention: for physical and emotional injures and to develop skills needed to live an independent empowered life. * inform supervisor and or other treatment staff * mandatory reporting

Managing manic or monopolizing behavior

- Select/design highly structured activ. that hold attn. and require shift of focus from pt to pt - Thank indiv. for participation and redirect attn. to another group member -set limits

Managing offensive behavior (physical or verbal)

- Set limits and immediately address the bx - Reasons that bx is not acceptable should be clearly presented in non-confrontational manner - Consequences of continued offensive bx should be understood - Req. that staff protects all pts from threat/harm

Ecology of Human Performance (EHP) Model p. 301

- Winnie Dunn -Emphasizes role of an individual's context (person's culture, physical and social environments) and how the environment impacts a person and his/her performance - Applicable to people across lifespan - 4 main constructs (person, tasks, context, personal-context-task transaction) - 11 assumptions (related to context, person, and task) pg 301 * this model defines independence as using the supports in a person's context to meet his/her needs and wants * range of person's performance is based on the transaction between the person and the context

Recovery Model Intervention:

- development/ implementation of a Wellness Recovery Action Plan (WRAP) is essential - storytelling to decrease stigma and support others by sharing experiential life experiences -Advocacy through dissemination of knowledge, skill development and forming support groups to prevent discrimination and improve acceptance in society

play groups

- used in pediatric settings for observation, assessment and to teach and develop a variety of skills -play groups provide an opportunity to develop play, task, and social skills at the child's developmentally appropriate outlet for children to express thoughts and feelings.

prevocational group

-focuses on identification of personal skills, limitations, and interest and the development of work habits and behaviors -desired outcome is the development of the knowledge and skills that are prerequisite for participation in vocational training, vocational rehabilitation, or for the acquisition of competitive employment

social interaction groups

-include interventions to develop communication skills, socially acceptable behavior, and interpersonal relationship skills -conducted in a modular or psychoeducational format

CBT Intervention

-intervention goals: help client monitor and refute negative thoughts about him or herself -Behavioral techniques used: *scheduling activities -increasing mastery and pleasure -grading tasks to enable client success *cognitive rehearsal *self-reliance training - facilitate by performing ADLs *role playing *diversion techniques and visual imagery *engaging in physical, work. leisure/play and or social participation activities

Psychiatric Rehabilitation pg 308

-psychiatric rehabilitation and occupational therapy share common goals of eliminating barriers and promoting health and wellness. -strength focus: building on one's strengths rather than focusing on weaknesses. - Vocational focus: develop work skills, habits and resources needed to become successful - skills training: actions or behaviors necessary to accomplish a task exp: computer skills -club house: for ind's who have psychiatric disability. outreach, transitional employment, education, meal prep and advocacy -vocational rehabilitation: supported employment affords services to the individual where they are needed: on the actual job or as a consultation

Psychodynamic/Psychoanalytic Narcissistic mechanisms

1. Denial: failure to acknowledge the existence of some aspect of reality that is apparent to others 2. Projection: seeing your own unacceptable desires in other people 3. Splitting: rigid separating of positive and negative thoughts and/or feelings (all black and white, no in between (all people good or bad))

Types of groups pg. 310

1. Evaluation Groups (deigned to gather info) 2. Task-oriented groups (increase ind's awareness of needs, values, ideas, feelings) 3. Developmental groups (parallel, project groups, egocentric cooperative groups, cooperative groups, mature groups)- ind's acquire and develop group interaction skills 4. Thematic groups (learning specific skills) 5. Topical groups (discuss issues outside of group that are current or anticipated) 6. Instrumental groups (meet health needs and maintain function)

Psychodynamic/Psychoanalytic Mature mechanisms

1. Humor: using comedy to express feelings and thoughts w/out provoking discomfort in self/others (laughing at self for coming to function dressed inapprop.) 2. Sublimation: redirecting energy from socially unacceptable impulses to socially acceptable activity (angry individual channels it into aggressive sport) 3. Suppression: consciously or semiconsciously avoiding thinking about disturbing problems, thoughts or feelings

Psychodynamic/Psychoanalytic Immature mechanisms

1. Passive-aggressive: aggression towards others which is indirectly or unassertively expressed 2. Regression: returning to earlier stage of development to avoid tension/conflict of the present one 3. Somatization: conversion of psychological symptoms into physical illness

Psychosocial Assessment what to assess?

1. Performance skills (cognitive, perceptual, psychological and social) and their impact on performance areas of occupation. 2. client factors and physical conditions or limitations that impact functional behaviors and performance in areas of occupation 3. impact of the individual's social, cultural, spiritual and physical contexts 4. identification of roles and behaviors that are required of the individual either by society or self-determined goals 5. precautions and safety issues such as suicidal and or aggressive behavior 6. history of behavior patterns 7. individual's goals, values, interest and attitudes * assessment Methods: interviews standardized tests clinical observation and rating scales questionnaires self report interventions

Psychodynamic/Psychoanalytic Neurotic mechanisms

1. Rationalization: creating self-justifying explanations to hide the real reason for one's own or another's behavior 2. Repression: blocking from consciousness painful memories and anxiety-provoking thoughts 3. Displacement: redirecting emotion or reaction from one object so similar but less threatening one (child angry w/parents and hits younger sis) 4. Reaction formation: switching of unacceptable impulses into its opposite (hugging someone you want to hit)

Phases of adjustment to disability

1. Shock 2. Anxiety 3. Denial 4. Depression 5. Internalized anger 6. Externalized anger 7. Acknowledgment 8. Adjustment

OT intervention for adjustment to disability

1. awkknowledgement of individua's losses 2. identificaqiton of what the idividual is able to do w. emphasis on personal accomplishments 3,. assistance ot the individual inhis/her assumption of an active role in shaping their life 4. use of person-centered approaches based on empowerment theory is critical 5. reduction of limitations through changes in the physical and social environment 6. development of the skills necessary to participate in valued activities and meaningful occupations -stress management and coping skills - cognitive reframing/ restructuring : process of altering cognitions and processes (usually maladaptive thoughts and thinking) to facilitate changes in emotions and behaviors -acquisition of resources and supports to enable full social participation -development of peer supports

Procedure for developing a group:

1. conduct needs assessment 2. develop protocol 3. present protocol to treatment team/program administrator 4. select potential members who would benefit group 5. meet w/ each potential member and explain purpose and circumstance of the group 6. hold introductory sessions of the group and revise the protocol as needed.

Considerations in group planning:

1. demographics: gender, age, culture, ethnicity 2. ind characteristics: cog level, funct. level, goals, safety issues/contraindications 3. logistical considerations: number of ppl in group, length and # of sessions, space, environment, budget/materials, # of leaders, open group vs. closed group 4. Frame of Reference exp: MOHO, biomechanical etc

Intervention for Suicide

1. identify motivation behind suicide and identification of alternatives -development of "contract for safety" - plan w. specific actions the pt should take if experiencing suicidal ideation 2. assist in development of problem solving skills and stress management techniques 3. identify positive person attributes and support systems 4. activities that produce successful outcomes (visible end product) promote positive thinking 5. Activities designed for expression and validation of feelings 6. moderate physical activity elevates mood 7. development of skills that increase functional performance 8. future oriented activities (college, baby sitting grandchildren,) 9. Pt/client/family education should include: -develop strategies dealing w/ hopelessness -managing relapse and disappointment -reinforcing and supporting engagement intreatment -maintaining medication compliance -increasing family involvement -identifying support groups and resources 10. developing strategies to handle setbacks in recovery 11. national suicide hotline: 1-800-273-TALK (8255)

Kubler- Ross states of Adjustments to death and dying (and OT intervention for each) pg. 317

1: Denial: Int: allow indiv. to ask questions and discuss situation at his/her own pace 2: Anger: Int: allow indiv. to vent anger while identifying its source and devel. more effective coping strategies 3: Bargaining: Int: involves responding honestly to ?'s 4: Depression: exp says good byes and reverts inward Int: providing phys. and psycho. comfort for indiv. and his/her loved ones 5: Acceptance: Int: provide ongoing support to indiv. and family

Ecology of Human Performance (EHP) Model Intervention:

5 strategies of intervention (342) 1. establish and restore: enhance abilities by teaching skills lost due to illness of disability or never learned 2. alter: determine contexts that are best for person 3. Adapt/modify: Change context to increase success 4. Prevent: Minimize risks so problems in performance do not develop 5. Create: Promote enriching and complex performances in person's contexts

Adult/Adolescent Sensory Profile

60 item questionnaire for ages 11-65 Four Quadrants 1. Sensory sensitivity 2. Sensory avoiding 3. Low registration 4. Sensory seeking

Cognitive Disabilities Model Six levels of cognitive performance Level 4: Goal Directed Actions

Ability to carry out simple tasks through to completion; indiv. relies heavily on visual cues; he/she may be able to perform estab. routines but cannot cope w/unexpected events

Cognitive Disabilities Model Six levels of cognitive performance Level 6: Planned Actions

Absence of disability; person can think of hypothetical situations and do mental trial- and - error problem solving

Basic task skills group

Activ. designed to develop the basic cog. skills necessary for the completion of simple tasks -uses skill acquisition approach

Sensory Model Intervention:

Alternatives to physical restraints - calm rooms - weighted blankets -dolls/stuffed animal for self soothing -weighted blankets for soothing - sensory diets (altering/calming stimuli, heavy work patterns) * can be used for psychiatric illness, autism, pervasive developmental disorders and dementia -psychoeduation to increase personal knowledge of how to self-modulate - sensory diets including alerting/calming stimuli and heavy work patterns

Bay Area Functional Performance Evaluation (BAFPE) (focus, method, scoring, population)

Assesses cog., affective, performance and social interaction skills req. to perform ADL. - Method: brief interview prior to assessment to collect basic demographic data and clinical info and to familiarize indiv. w/the eval then uses Task Oriented Assessment (TOA) and Social Interaction Scale (SIS) - Scoring: TOA and SIS scores are NOT combined for total BAFPE score - Population: adult indiv. w/psychiatric, neuro, developmental diagnoses

The Role Checklist (focus, method, scoring, population)

Assesses role participation and value of specific roles to indiv. - Method: checklist completed by indiv. or alone w/th. (part one identifies roles, part 2 identifies degree to which indiv. values each role) - Scoring: no score, data used to address goal identification and tx planning, QOL, d/c planning - Pop.: adolescent-elder w/physical or psychosocial dysfunction

Adolescent Role Assessment (focus, method, scoring, population)

Assesses the development of internalized roles w/in family, school and social settings. - Method: semi-structured interview that follows interview guide to generate discussion in areas of family, school perf., peer interactions, occu. choice and work - Scoring: indicates bx that is approp., marginal or inapprop. - Pop.: adolescents 13-17

Cognitive Disabilities Model Six levels of cognitive performance Level 1: Automatic Actions

Automatic motor responses and changes in the ANS; conscious response to the external environment is minimal

Occupational Case Analysis Interview Rating Scale (OCAIRS) (focus, method, scoring, population)

Based on MOHO; explores personal causation, values, goals, interests, roles, habits, skills, other areas related to environ./systems dynamics - Method: semi-structured interview - Scoring: items scored 1-5; data analyzed from 4 perspectives: dynamic (interaction b/t various elements), historical (impact of indiv's exper. over time), contextual (indiv.'s interaction w/environ.), system trajectory (where person is headed) - Pop.: originally for adult-elder w/psych diagnosis but currently used in broader context

Psychodynamic/Psychoanalytic (frame of reference) p. 304

Based on work of S. Freud, A. Freud, Jung, Sullivan - Principle developers: Gail Fidler and Ann Mosey - Rarely used today - Indiv. may protect themselves from anxiety through use of "defense mechanisms" (some healthy, some not) - Projective and func. tasks used to promote self-awareness and identification of intrapsychic content

CBT Evaluation: assessment used

Beck Depression inventory (BDI-II) self completed questionnaire to assess level of depression

Cognitive Disabilities Model Six levels of cognitive performance Level 3: Manual Actions

Begins w/use of hands to manipulate objects; indiv. may be able to perform limited number of tasks w/long-term repetitive training

Reminiscence group

Designed to review past life experiences to promote cognition and a sense of personal worth (current memory not necessary nor facilitated)

Role Acquisition (frame of reference) Evaluation: Intervention:

Eval: focuses on gathering data indicative of function/dysfunction in the 7 categories Interventions: focuses on acquisition of the specific skills an ind. needs in order to function in environment - promote skill development -Guidelines to treatment: 1. LTGs set based on person's expected environment 2. initially, task and interpersonal skills can be taught seperately or they can be taught within the context of the learning of social roles 3. behavior is squired through activities that elicit the desired behavior, are interesting to the client, include socializing, 4. intrapsychic content is shared matter-of-factly w. the client, and reality testing is provided 5. OT must know specifically what kind of behavior he/she wishes to promote or enahnce 6. Any strategies that employ the teaching-learning principles are acceptable.

Occupational Adaptation (frame of reference) Evaluation: Intervention:

Eval: focuses on occupational environment, role expectation, the individual's potential for adaptation and the best means for adaptation to occur Intervention: focuses on increasing the skills needed for occupational adaptation. It addresses both the individual and the environment

Short Portable Mental Status Questionnaire (focus, method, scoring, population)

Focus is intellectual function. - Method: short questionnaire: 9 ?'s (day, president, etc.), subtraction task - Scoring: each item gets point if inaccurate, one point added for edu beyond high school, one subtracted if edu does not go beyond grade school; number of errors totaled w/potential error score of 10 (8-10 is severe intellectual impair.) - Pop.: indiv. w/cog. or psychiatric dysfunction

Cognitive Disabilities Model Evaluation:

Focus is on identifying indiv.'s current cog. abilities and their implications for perf., indep. and need for assistance; observation during functional task emphasized. - Evaluation tools: Allen Cognitive Levels Leather Lacing Task, Routine Task Inventory and Cognitive Performance Test

Activity Card Sort (ACS)

Focus: Identify the level of involvement in IADLs, leisure, and social activities Presented with 89 cards to be sorted into categories (never done, gave up doing, do less than past, do the same, do more than past) Scores- help monitor areas to compare previous and current level of participation. Can be used as initial assessment, goal setting, intervention planning Population - typically older adults

Goal Attainment Scaling (GAS)

Focus: facilitates active participation in goal setting process by having individual and or caregivers identified desired intervention outcomes. Post intervention - assesses the individual's attainment of goals Interview based with each outcome having a score -2 (below expected performance) -->+2 (above expected performance); 0- (expected performance) Population: older children, adolescents, adults, caregivers of younger children.

Occupational Self-Assessment

Focus: self-report checklist of individuals perception of efficacy in areas of occupational performance and their importance. 2 part self report on 21 everyday activities. 4 point scale to rate how well they do each activity and 4 point scale to rate the value of each activity. Population: 18 yrs and older

Occupational Performance History Interview (OPHI) (focus, method, scoring, population)

Gathers info re: indiv's past and present occu. perf. - Method: interview covering 5 areas addressing org. of daily routines: life roles, interests, values and goals, perceptions of ability/responsibility, environ. influence - Scoring: ten items (2 each content area) rated 1-4 (1=dysfunctional); ratings used to identify indiv's life hx pattern (then narrative written) - Pop.: variety (adolescent to elders). Not recommended for those younger than 12.

Directive groups (purpose and 5 parts) pg. 311

Highly structured, assist low func. patients in developing basic skills. Kathy Kaplan. - Each session divided into 5 parts, 15 min. review of session by leaders - Part 1: orientation to purpose/goals (5 mins) - Part 2: review of names/intro of new members (5-10 mins) - Part 3: warm-up activities to make members comfortable and engage them in group (5-10 mins) - Part 4: one or more activ. designed to address the goals of the group and needs of members (10-20 mins) - Part 5: activities designed to give meaning to activities and closure to group (10 mins)

Community participation/ reintegration group

Identification and use of community resources (leisure facilities) and the development of skills (use of public transportation) to enable full community participation - May be modular or psychoeducational format

Canadian Occupational Performance Measure (COPM) (focus, method, scoring, population)

Identified indiv.'s perception of satisfaction w/perf. and changes over time in areas of self-care, productivity and leisure - Method: semi-structured interview re: the 3 areas, prob. areas identified, identified problems rated by indiv. as to perf. and satisfaction, reassess at approp. intervals - Scoring: items rated 1-10 (highest), total scores for perf. and satisfaction used to identify tx focus, tx outcomes and indiv. satisfaction - Pop.: indiv. over age 7 or parents of small children

Beck Depression Inventory (focus, method, scoring, population)

Measurement of the presence and depth of depression. - Method: admin. by interview or completed as questionnaire by indiv.; indiv. rates feelings relative to 21 char. associated w/depression - Scoring: items scored 0-3 (3 being most severe), score >21 indicates severe depression - Pop.: adolescent and adult

Hamilton Depression Rating Scale (focus, method, scoring, population)

Measures severity of illness and changes over time in indiv. diagnosed w/depressive illness. - Method: info. gathered through interview and consult w/family, staff, etc.; clinician rates info. relative to 17 symptoms characteristics - Scoring: rated 0-2 (0=absent, 1=trivial, 2=present) or 0-4 (absent, trivial, mild, mod, severe); scores for items 1-17 totaled; significance of total score NOT MADE- change in status is focus - Pop.: indiv. w/diagnosis of mood d/o

Cognitive Disabilities Model Six levels of cognitive performance Level 2: Postural Actions

Movement that is assoc. w/comfort; some awareness of large objects in environ. and indiv. may assist the caregiver w/simple tasks

Comprehensive Occupational Therapy Evaluation Scale (COTE Scale) (focus, method, scoring, population)

Observing and rating bhvr. and bhvr. changes in areas of general (e.g., appearance, punctuality, activ. level), interpersonal (e.g., cooperation, sociability, attention-getting bhvr) and task skills (e.g., concentration, following directions, prob-solving) - Method: indiv. bhvr obs during therapeutic session as indiv. completes a task; bhvr rated by therapist according to specific criteria for each item; tasks used are selected/designed by therapist. - Scoring: each item rated 0 (normal)- 4 (severe); results may be used to plan tx and d/c - Pop.: adults w/acute psychiatric diagnoses

What is habituation?

Organized, recurrent patterns of behavior; comprised of roles/habits

Cognitive Disabilities Model Six levels of cognitive performance Level 5: Exploratory Actions

Overt trial and error problem solving; new learning occurs

Social Interaction Scale (SIS) (What does it measure and how is it scored?)

Part of BAFPE. - Assesses general abil. to relate approp. to other people w/in the environ. through obs of the indiv. in 5 situations (1 to 1, mealtime, unstruc. group, struc. activ. group, struc. verbal group) - Scoring: 7 areas of social functioning measured via obs in 5 social situations

Task Oriented Assessment (TOA) (What does it measure and how is it scored?)

Part of BAFPE. - Measures cogition, performance, affect, qualitative signs and referral indicators through completion of 5 standardized, time tasks (sorting shells, bank deposit slip, house floor plan, block design, draw a person); evaluator observes and rate task perf. but does not provide guidelines for task completion - Scoring: utilizes 5 tasks in which 12 functional parameters in cog., perf. and affective areas are rated; norms presented for comparison w/specific adult psychiatric populations

Recovery Model pg. 307

Primary focus - improve quality of life and the ability to attain desired life goals through self-advocacy - Recovery = illness is a journey of healing and transformation that enables individual to live a meaningful life - Concepts to help guide recover: Self-direction, individualized and person-centered, empowerment, holistic, non-linear, strengths-based, peer-support, respect, responsibility, hope, family, community.

Mini-Mental State Examination (Folstein Mini-Mental) (focus, method, scoring, population)

Quick screening test of cognitive functioning. - Method: structured tasks in interview format; part one req. verbal responses to assess orientation, memory, attention; part two assesses abil. to write sentence, name objects, follow verbal/written directions, copy complex polygon design - Scoring: point value of each item ranges 1-5, max score of 30 (below 24 is cog. impairment) - Pop.: indiv. w/cog. or psychiatric dysfunction

Modular group

Sessions rotated in way that indiv. can join at any time and still cover each topic (e.g. Independent Living Skills group that addresses nutrition 1st session, money manage. 2nd session, transportation 3rd, then cycle begins again)

What is performance capacity?

The physical and mental skills needed for performance and the subjective experience of engaging in occupation

What is volition?

Thoughts and feelings that motivate people to act and is comprised of personal causation, values, interests

Activities Health Assessment (focus, method, scoring, population)

Time usage, patterns and configurations of activities, roles and underlying skills and habits. - Method: (1) person completes Idiosyncratic Activities Configuration Schedule (color-coded chart depicting how he/she spends time during typical week) (2) completes Idiosyncratic Activities Configuration Questionnaire (3) therapist interviews person - Scoring: not scored; determination of person's activities health made by person and therapist based on schedule, questionnaire and interview; sig. placed on person's interp. of level of balance, satisfaction and comfort to which each activity contributes - Population: adults through elders

Barth Time Construction (BTC) (focus, method, scoring, population)

Time usage, roles and underlying skills and habits. - Method: person constructs color-coded chart indiv. or w/group which depicts way time spent during typical week - Scoring: not scored; percentages of time calculated according to main groupings, discuss w/indiv. - Pop.: adolescent through elder

Elements of a group protocol

Title/name, purpose, rationale, theoretical base/ frame of reference, criteria for membership, goals/ anticipated outcomes, methodology/format, role of therapist, quality assurance

Cognitive Behavioral Frame of Reference (CBT) pg. 305

Widely used. Especially effective with treating individuals with depression. Works to alter dysfunctional thought processes. Also used with individuals with schizophrenia, anxiety, bipolar, panic, OCD, personality, somatoform and eating disorders. Looks at persons thoughts, and beliefs and assists w/ correcting misinterpretations 3 Aspects 1. Didactic - therapist explains principles of CBT 2. Cognitive - elicit thoughts, test thoughts, ID maladaptive thoughts and underlying assumptions 3. Behavioral - used with cog techniques to test and challenge maladaptive and inaccurate cognitions -development of insight is necessary for growth and change 1. thinking influences behavior 2. changing the way a person thinks reduces symptoms 3. thinking can be self-regulated 4. change occurs through clients involvement in learnign and developing skills

self-awareness groups

activities as values clarification, awareness of personal assets, limitations, and behaviors; and the individuals impact on others

Life-Style Performance Model (frame of reference) Intervention;

addresses 5 main questions: 1. what does the person need to be able to do? 2. what is the person able to do? 3. what is the person unable to do? 4. what interventions are needed and in what order? 5. what are the characteristics and patterns of activity and of the environment that will enhance the person's quality of life? any interventions or activities that promote performance in the four domains are acceptable

leisure groups

identification of interests, development of activity-specific skills, identification of resources, and recognition of the importance of healthy use of unstructured time.

MOHO how does the environment impact the individual?

impacts through the opportunities, demands, resources and constraints it provides divided into physical and social components each influenced by culture

Sensory awareness groups

includes activities to promote sensory functions and environmental awareness

Developmental groups: Parallel groups:

individual tasks with minimal interaction required

Developmental groups: Cooperative groups:

learn to work together cooperatively, not specifically to complete a task, but to enjoy each other's company and meet emotional needs

Recovery Model Evaluation:

objective standardized measures and qualitative structured and or semistructured interviews are used to assess the person's self esteem, empowerment level and capacities, living situation, ADL, work/school and leisure activities, family and social relationships, finances, legal and safety issues, general health and over quality of life.

Developmental groups: Egocentric cooperative groups:

require joint interaction on long-term tasks; however, completion of the task is not the focus. The members are beginning to express their needs and address those of others

Developmental groups: mature groups

responsive to all members needs and can carry out a variety of tasks. There is good balance between carrying out the task and meeting the needs of the members.