Intervention Planning, Clinical Reasoning, Implementation, and Review

Clinical Reasoning

-Developing a plan that mental health clients will find meaningful and empowering requires: 1.Logical approach to gather information 2.Logical approach to Develop Goals 3.Logical approach to Selecting Interventions

OT Process 7. Transition Planning

-OT works with client, family, and others to arrange for successful transition out of the treatment program. -May include living arrangements, daily transportation, and continuation of other treatments.

OT Process 2. Screening

-Process to determine whether OT is needed, and if so, what approaches would be most beneficial. -The OT is responsible for screening. However, the OTA may collect data during as part of the screening process.

OT Process 5. Intervention Implementation

-The treatment plan is carried out -OTA's play a major role for this aspect of the treatment process.

Multiple types of reasoning in clinical practice

1. Procedural reasoning 2. Interactive reasoning 3. Conditional reasoning 4. Narrative reasoning 5. Pragmatic reasoning

OT Process (8 Stages)

1. Referral 2. Screening 3. Evaluation 4. Intervention Planning 5. Intervention Implementation 6. Intervention Review 7. Transition Planning 8. Discontinuation of service

The five important points of the OT Practice Framework Process

1. The process is dynamic and evolving. 2. Context is embedded in our understanding of intervention. 3. Clients are individuals, whether they receive services as individuals or ass members of groups/ populations. 4. The client must be an active participant (client centered process) 5. The outcome is engagement in occupation

Narrative Reasoning

A style of clinical reasoning that creates and shares the vision of what a clients life story may become, to cultivate hope and motivation. -Attempts to figure out how the clients life story will develop moving forward from the injury, illness, or life changing event. Attempts to answer the question: "What life story does the client want to start creating now?"

Pragmatic Reasoning

A style of clinical reasoning that focuses on what is practical (Pragmatic), and is about getting things done. -Practical problem solving of issues that might arise.

Interactive reasoning

A style of clinical reasoning that understands the client as a holistic human being and looks at issues from the clients perspective. -Focuses on the relationship with the pt. The therapist is receptive to communication with the Pt. Therapist accepts the clients needs and concerns.

Conditional Reasoning

A style of clinical reasoning that uses a holistic approach to understanding the person, his or her illness, and intervention. -A combination of the other types of reasoning -Allows therapist to respond to ever changing environments, client, context, or experience of the disability. A more advanced style of reasoning typical of more experienced therapist.

Procedural Reasoning:

a style of clinical reasoning that focuses on the clients diagnosis and performance -Consider the disability and its treatment options in the setting. Question might be: how does this hospital typically handle clients with schizophrenia? What protocols or procedures are followed here?

OT Practice Framework:

OTPF is separated into two parts, 1. Domain 2. Process

OT Process 4. Intervention Planning

- Approaches and methods for achieving the goals are identified. E.g. behavioral approaches, like skills training, sensory integration, etc. - Specific treatment activities are chosen that should help reach goals. E.g. activity groups, coping skills group, relaxation group, grooming group, etc. -Considerations include time frames, applicable standards, and other guidelines. OT selects specific treatment activities

OT Process 6. Intervention Review

- Consider if the Intervention plan is working; What progress has been made; what changes might be appropriate. This process is usually happening continuously -The plan may be modified as needed.

Roles of the OTA

- OTA may provide additional information and ideas -OTA may contribute to decisions about which methods to employ -OTA shares observations of the client -OTA makes suggestions of what intervention methods to use.

Roles of OT

- OTR is responsible for the intervention plan -OTR discusses the plan with the COTA -OT may delegate implementation of the plan to the OTA -The OT determines the general intervention goal, and the OT chooses the overall intervention approach and methods

OT Process 3. Evaluation

- Purpose is to learn about client wants, needs, and challenges -The OT will complete the following 1. Occupational Profile: The clients occupational history and goals 2. Analysis of Occupational Performance: a study of how the client performs to determine his or her limitations and strengths. OTA's ma be directed to: - Conduct reviews - Collect certain types of data (standardized assessments) for the OT as part of the eval. -Goals are identified and written.

OT Process: 1. Referral

-Request for service by physician or other referring professional. -OTA's should relay referral requests to the OT supervior.

OT Process 8. Discontinuation of Service

-The Pt. is discharged from the program -OT handles final documentation with input from the OTA

The OT Process uses a HOLISTIC perspective

1. During the intervention process, OT staff should maintain a CLIENT CENTERED approach. -This approach means that the client should be involved at very step as much as possible. The client is a PARTNER in the intervention process -This requires the therapist to use COLLABORATIVE COMMUNICATION SKILLS to invite maximum client participation client should be encouraged to ask questions and give opinions 2. Activities should be OCCUPATION CENTERED: focused on occupations important to the clients life. -Therapy practitioners use ACTUAL OCCUPATIONS & occupational tasks, and therapeutic activities, to develop the client's ability to engage in occupations While some methods used may not be activities or occupations.. these are always connected to occupational functioning and goals. 3. Intervention plans should be OUTCOME ORIENTED, or developed with a clear focus toward successful transition and discontinuation of service. -The main outcome of interventions should be.. improved ability to engaged in occupations. -uses for outcomes: to compare functioning before and after intervention. to communicate to the client the achievement made in therapy. to establish an understandable, measurable result. serves as a basis for program evaluation. may provide evidence for research. to document effectiveness and ensure reimbursement. The OTA assists the OT in the development of outcomes and the collection of outcomes data

Role of the OTA

Advanced OTAs in mental health use all types of reasoning just presented. 1. OTA's are often close to the Pt. during treatment situations 2. OTA's may spen more time with Pt.'s and may have information not available to staff who spends less time with the Pt. 3.OTA's may be viewed by the Pt. as less threatening than some other staff, which may cause the P.t to share more information. *OTA's should recognize, cultivate, and tap into their power to clarify and contribute to the clinical reasoning process.

Clinical Reasoning Questions to ask

First question: What is the Pt.s Status? Second Question: What are the available options? Third Question: What ought to be done?