OT 540 - Mental Health Midterm
Occupational Therapy begin in the "Age of Enlightenment" around the 1700s. William Tuke was outraged by the poor treatment that the mentally ill received in insane asylums.
"Age of Enlightenment"
Assessment of ability to complete ADLs with assistance or independently- evaluate living situation Used to assess whether or not an individual may be appropriate to go back home Older adults
-Kohlman Evaluation of Living Skills -Milwaukee Evaluation of Daily Living Skills -Functional Needs Assessment
how long must symptoms persist fro acute stress disorder to be diagnosed as PTSD
1 Month or longer
Psychotropic medications reduced the length of stay in asylums.
1950's
Community Mental Health Movement began massive de-institutionalization and social integration little stress on where patients will discharge too leading to homelessness
1960's
1960's - 1970's - State and federal policies emphasized human rights of persons with mental illness and in 1972 a federal court ruled that patients in mental health facilities could not work without pay.
1960's - 1970's
Overcrowding developed because there were no established criteria for admitting patients and asylums became dumping grounds for unwanted people in society.
19th Century- Humane and restorative treatment declined.
1. Out of bed 2. First contact (in person or by phone...maybe via text or social media...it depends) with another 3. Start work, school, housework, volunteer activities, child or family care 4. Have dinner 5. Go to bed neg 5 to positive 5 rating is given at each interval of the day for a week social rhythem disruption is a stronger predictor of bipolar episode onset than psychological stress
5-Item Social Rhythm Metric (SRM)
Assessment: Identify Leisure Issues Assist: Problem Solving Structural and Environmental Barriers Confront: Attitudinal Barriers : The addicted person has an "irrational belief system" intact. This belief system, unless uncovered and dismantled in treatment, will remain intact and may prevent sober leisure satisfaction Plan: Leisure Involvement :Through the course of their illness progression, addicted persons learn not to plan. This is as dysfunctional as the disease progression itself Participate: Behavior Change New Involvement in Leisure Alternatives and/or Re-involvement in Past Leisure Activities. Recollection: Identify Feelings and Rewards Related to Leisure Model may work with any mental illness Model is repettive and cyclic
A Leisure Education model for Addicted persons
Using visual representations of occupations- client chooses what used to do, does now, would like to do in various settings, rehabilitation assisted living, independent. Older Adult PACS - pediatrics activity card sort
Activity Card Sort
Similar in nature but shorter in occurrence to PTSD
Acute Stress Disorder
How sensory processing patterns impact occupational performance Adults and Adolescents Only Norm-referenced Assessment
Adult-Adolescent Sensory Profile
self regulation
Alert program
Assess cognitive functioning and ability to learn new tasks; assess environmental compensation necessary Adults and Elderly commonly used in psychiatric settings
Allen Cognitive Level Test (ACL) and Diagnostic Manual (ADM)
Underlying the development of depression and anxiety may be disengagement from recreation activities and social relationships
Anxiety and Leisure participation
Motor (e.g. Psychomotor activity) Sensory (e.g. Hallucination, Delusion) Cognitive (e.g. Decision making, Problem solving) Intrapersonal (e.g. self-concept, feelings) Interpersonal (e.g. socialization, communication) Self-care (e.g. Basic and instrumental activities of daily living) Productivity (e.g. Work, job) Leisure (e.g. Interest, enjoyable activities)
Areas that Need Assessment in Mental Health Occupational Therapy
(Also Categories of the COPM) Self Care Productivity Leisure Activities of Daily Living Instrumental Activities of Daily Living Education, work, play, leisure and social participation
Aspects of Occupation in the PEO model
Physical Sensory social cultural institutional Families and neighborhood Community access- transportation, housing, and social networks Work and educational access Lived environment - home Institutional - health insurance, health care systems
Aspects of the environment
Person: Rethink the person by: hearing the person's narrative (unique story) respect the person's expertise of lived experiences relate to the person as an equal member of society What to assess: roles, habits, routines cognition (skills eg. executive functioning and beliefs eg. ear-piercing example) sensation - auditory, tactile, visual hallucinations communication- the ability to talk (collage example if the individual is unable to communicate -Card sort or PACS can be used coping motivation emotion pain
Assessing the Person in the PEO model
Assess communication and social skills in various client contexts Adults
Assessment of Communication and Interaction Skills
Suggested Activities Since communication and interaction skills may differ substantially with setting and role, it is important to consider when and in what circumstances to conduct observation. The observation situations are described below. 1. Open: Client is in an unstructured situation. 2. Parallel Task: Client works on an individual task in the presence of others in the same workspace. 3. Cooperative Group: All group members work together to accomplish a common goal. 4. One on One: Client engages in one on one interaction, e.g., therapist/client, client/client, or client/family member. A. Natural Setting: The communication and interaction happens in the usual environment of the client. B. Simulated Life Role Situation: The therapist attempts to simulate communication and interaction situations that reflect the client's life roles. C. Unrelated To Life Roles: Communication and interaction situations occur that don't directly link to life roles of the client.
Assessment of Communication and Interaction Skills (ACIS)
Assess motor and planning skills for daily living- tasks and evaluator calibrated Toddlers, Children, Adults
Assessment of Motor and Process Skills
The Model of Human Occupation Screening Tool (MOHOST) Occupational Self Assessment (OSA) Worker Role Interview (WRI) Canadian Occupational Performance Measure (COPM) The Short Child Occupational Profile (SCOPE) Role Checklist Interest Inventories Activity Configurations The Volitional Questionnaire (VQ) The Occupational Performance History Interview-II(OPHI-II The Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS) Child Occupational Self Assessment (COSA
Assessments Measuring Occupation under PEO
Barfls? CATS?
Assessments for ADL's/IADL's
Work Environment Impact Scale (WEIS) The Model of Human Occupation Screening Tool (MOHOST) Occupational Self Assessment (OSA) The Volitional Questionnaire (VQ) The Occupational Performance History Interview-II(OPHI-II) The Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS) Worker Role Interview (WRI)
Assessments used to measure the enviornment under PEO
Assessment of Work Performance (AWP) Executive Function Performance Test Allen Cognitive Level Screen 5 Assessment of Motor and Process Skills (AMPS) Adolescent/Adult Sensory Profile® Pain Scales - Reciprocal relationship between pain and psychiatric disorders
Assessments used to measure the person under PEO
1. Begin the group by asking all members to mention their names 2. Provide supplies for activities so that members need to share and thus interact briefly 3. Encourage members to carry out an activity in groups of two or three 4. Facilitate trial and error experimentation during the activity 5. Say goodbye at the end of the group, and encourage members to say goodbye to others Community supplies to be shared Small group of two to three Ensure everyone says goodbye
Associative Group Leadership
The members of the group approach each other briefly in verbal and non-verbal interactions during play, activity or work The ability to approach others for brief verbal interactions and to work or play with others with minimal interaction. Members show the ability to manifest some beginnings of cooperation and competition, with the task being paramount. There is minimal interaction outside the task. Members demonstrate the ability to engage in short term tasks, and that to receive help from others they must give help to others. Ex. Older adults with dementia enjoying a pet visit Developmental age 2- 4 years Directed activity by the therapist Ex. Children briefly build a tower together using building blocks Children put chairs in a line and get on the bus for a brief ride Children briefly talk on phones two girls push a stroller together adults engage in a pass the ball game in a circle, calling the names of those to whom they throw the ball teens have brief smart phone contact adult patients play the parachute game, calling out each other's names as they exchange seats under the parachute adult commuters waiting for a train briefly talk about the weather office workers joke at the coffee or copy machine Items: The activities include engagement in brief interaction. there is enjoyment of activities between group members
Associative Level
The client is a "coworker"—you are not an authority figure. The client has the answers and you are simply helping them vocalize. MI is not... Authority Telling the client what to do
Autonomy
BTC is a color-coded time chart in which the client depicts the use of time for a week within 12 categories of activities. The concept of classifying time and time usage patterns has been central to Occupational Therapy since its inception. can be graded down for a day or less Blue = Sleep Black = Watching TV, screen time Yellow = Shopping Green = Active hobbies, leisure Orange = Meal Preparation Purple = meetings Gray = Working/School Brown - Illness Tan = Home Maintenance White = Doing nothing Pink = Grooming, bathing, dressing Red = Drinking/drug use
Barth Time index (Barth time Construction)
1. Foster decision making and planning for the activity or meeting 2. Permit the members to carry out the activity together for one or more sessions 3. Ask the members what the rules of the game, interaction, or activity should be 4. Encourage cooperation of a basic, structured nature within roles of the activity 5. Some competition organized in a cooperative manner can be introduced with teams 6. Provide minimal assistance along the lines of interests and preferences of the group 7. Assume the role of a resource person or moderator to the extent possible. Rules or Group norms formed by group Organized competition Rules are not fluid yet and are still very structured Group norms Group activities will begin to last longer (2 or three sessions)
Basic Cooperative Group Leadership
The members of the group jointly select, implement and execute longer play, activity or work tasks for reasons of mutual self-interest in the goal, project or fellow members Developmental Age: 5-7 years The ability to select, implement and execute longer tasks through joint interaction. Individual response within the group is based on enlightened self-interest. The members of the group understand that their rights and needs will be acknowledged through respect and recognition of the rights of others. Members can identify group NORMS AND GOALS. The group experiments with some membership roles. The members perceive themselves as having a right to belong to the group. Ex. Adults participating in a group game Politicians work at this level: "What can you do for me? What can I do for you? Children say, "let's dress up together and play make-believe", "et's make a fort out of these cartons", or "let's have a tea party" Adult patients in a cooking group each prepare a different vegetable for a salad, with little conversation while working An inaptient group plans a holiday party or weekend activity Items: Members begin to express ideas and try to meet the needs of others. Members respect others rights and follow group rules.
Basic Cooperative Level
Express Empathy Support Self Efficacy Roll with Resistance Develop Discrepancy
Basic Principles of MI
Behavioral Goal : similar to LTG -expected outcome of skill or task that is expected to be achieved over a period of time - typically broad and provide guidance in developing objectives for skill attainment. Definition of an Objective smaller steps needed to accomplish the developed goal, and achieved over a shorter period of time Components of a behavioral objective A) Behavioral task B) Condition of performance C) Frequency or duration D) Criteria for moving up to the next level of performance E) Time frame
Behavioral Goal vs. Objective
COPM and AMPS measure OP across a variety of population groups children and adults
Blue ribbon standards for measuring occupational performance across population groups!
semi structured interview very open ended appropriate for ages 7 and older administered very casually (almost like a conversation) Used to build the occupational profile Recovery oriented assessment useful for inital stages in assessment process _what client is going thru and identify areas a weakness client would like to get help on Assess involvement in occupations self directed and person centered and assist individual in identifying areas of weakness Environment must be conducive to patient, sit at 90 degree angle 1. Begin with do you have any experience with OT? - Yes, tell me about your experiences. - No, elevator speech 2. Start COPM by telling me about your day - run through daily routine 3. In summary take a closer examination of perceived areas of deficit 4. Ensure to give examples for each area of evaluation 5. Rate top 5 occupational problems Assessment that is used to build an Occupational Profile Recovery-Oriented Assessment Useful in the initial stages of the assessment process Semi-structured interview Detailed! Assesses a persons involvement in occupations Gathers info on a clients perception of his/her occupational performance over time Self-directed and Person-centered Assists individual in determining what areas are important to focus Especially helpful in collaborative functional goal setting Client-centered approach allows intervention to be guided by what the client finds meaningful COPM then used after an interventions implemented to detect CHANGE in the clients perception over time Performance areas Importance of performance Level of satisfaction Self-Care Productivity Leisure When rating, a 10 point scale is used. Ages 7yrs and UP Things to know prior to administering: Conducive environment Minimize distractions Causal setting Seating 90`angle
COPM
All interviews • COPM for variety of disabilities and developmental stages • Evaluator develops interview questions based on self-care, productivity, leisure • OPHI-II, OCAIRS detailed questions less development by evaluator, more structured lends itself to more sophisticated clients or those needing more lead
COPM, OPHI, OCAIRS
- Perception of how well, how satisfied with the performance, prioritize problems and goals in occupational performance - Children to adult Outcome Measure (7 and up)
Canadian Occupational Performance Measure (COPM)*
Occupational engagement Occupational performance
Canadian Occupational Performance Model
Divorce Surgery or serious illness Accidents Bullying Separation from loved ones Natural disasters Emotional, Physical, or Sexual Abuse Neglect Loss/Abandonment Isolation within the family Domestic Violence Community Violence Substance Abuse Mental Illness Terrorism Flight from home as a refugee
Causes of Child Trauma
Rain sticks Mouth whistles Stress Balls that Disintegrate Items with a sexual connotation vibrating objects Strobe lights Aromas can be very powerful
Caution and items to avoid
Rulers can be used to determine factors such as a client's readiness to change, willingness to change, importance of the change, and confidence that they can change. Rulers typically use a 1-10 scale. In addition to determining a client's placement on a scale, rulers can be used by the therapist as a tool to elicit change talk. For example: "You stated that quitting smoking is of 3/10 importance to you. Why is it a 3 and not a 10?"
Change Rulers
A sequence of six levels of abilities, a hierarchical sequence of sensorimotor abilities These underlying global cognitive abilities produced clinically observable, qualitative differences in abilities to perform functional activities. Based on her observations of functional performance, Allen hypothesized that this sequence could be observed in the progression and remission of mental illness, dementia, and fatigue in adult individuals.
Cognitive Disabilities Model -Claudia Allen
Work with the client, don't confront them. not... Confrontation Imposing awareness and acceptance of "reality" that the client cannot see or will not admit
Collaboration
This can be a great Tier 1 intervention as you could potentially address a whole population with this activity. Community meetings are short and ask three questions: 1) How are you feeling today? (Do you need a check in?) 2) What is your goal for today? 3) Who can you ask/go to for help?
Community Meetings
While they should not be diagnosed in isolation, children who experience trauma may also display conduct disorder, ADHD, mood disorders, etc. As the child ages, it is quite possible to be diagnosed with a personality disorder, most likely cluster B: Antisocial, Borderline, Narcissistic, and Histrionic as they all are thought to be caused by abuse. Splitting: a behavior commonly demonstrated by individuals with a borderline personality disorder Conduct disorder has a very high likelihood of becoming an antisocial personality disorder Eating disorders: the child might turn to eat as a form of comfort, or refuse food as a means of control
Comorbid Disorders
The term that is currently used to describe children and adolescents who have been exposed to repetitive adverse experiences. Toner Cane
Complex Trauma
Behavioral task: Specifies the behavior or task that is to be learned, needs to be written in positive and observable terms Condition of Performance: Outlines what, where, and how an individual will demonstrate attainment of the objective. Frequency or duration: Specified how long or how often the behavior has to occur. Criteria for moving to the next level: for six out of 8 sessions (should include number of percent of consecutive successful trials). -utilize intervals of 10 or 5 for easy math -(4/5=80 percent) Time Frame: in 8 weeks ( include month, day, and year).
Component Parts of an Objective
Individual-level Lack of self-confidence or skills, anger, despair Social Enviornment: Lack of family supports, negative peer influence, family hx of mental illness, ind lives in poverty Community: No access to adult role models, Unsafe neighborhoods, no access to play spaces, program or transportation
Contributions to Leisure Deprivation: Individual, Social environment and community level
O: Open Ended Questions A: Affirmations R: Reflections S: Summaries These are the core skills used to elicit change talk through the spirit of MI.
Core MI Skills: OARS
Focus on client strengths. This may be as simple as expressing appreciation that they made it to their appointment. For example: "Thanks for coming on time today" "That's a good suggestion" "It seems like you are a very kind and generous person" "I've enjoyed talking to you today, and getting to know you a bit" Stay away from I statements
Core MI skill: Affirmations
Open questions require a response that is longer than 1-2 words. Why is this helpful in therapy? Almost any question can be asked as an open question. For example: Do you like school? (closed) vs. What do you like about school? (open)
Core MI skill: open ended questions
These are the core skills used to elicit change talk through the spirit of MI.
Core MI skills: OARS
Activities which produce intrinsic rewards and provide the participant with life-enhancing meaning and a sense of pleasure. Activites we want to do or prefer to do
Define Leisure:
Clusters of activities and tasks in which people engage while carrying out roles in multiple locations (parent, worker, player, friend)
Define Occupation in the PEO model
"Sense of isolation, powerlessness, frustration, loss of control, estrangement from society or self as a result of engagement in occupation that does not meet inner needs (Wilcock, 1998)
Define Occupational Alienation
1970's to Now
Deinstitutionalization dramatically increased the homeless population, including the 1/3 that are mentally ill. Mental illness has become a social welfare problem involving employment and housing which are a burden on a community.
feeling as though the person is outside watching the trauma, is another symptom.
Depersonalization
Discrepancy is the difference between where the client is and where they want to be. By developing discrepancy, the client realizes how unhappy they are now and how happy (successful, healthy, etc.) they could be if they made the effort to change. The client should always make the argument for change! A good tool to use: "On the one hand, _________. On the other hand, _________." the client should always be the one who makes an argument fro change. one method is a decision balance WS Benefit vs cost WS Pros vs Cons WS
Develop Discrepancy
A term to reflect the needs of a child who experienced trauma. Unfortunately, this term was rejected by the DSM. Affective problems Psychological dysregulation Attention , behavior and relational dysregulation
Developmental Trauma Disorder:
Exposure to actual or threatened death Serious injury Sexual violation Experiencing repeated or extreme exposure to trauma Learning about trauma that has affected someone close Witnessing trauma
Diagnostic Criteria for Trauma
Inpatient - short term (2 to 3 days) and stabilization goal. Outpatient/Community - is open and long term (how do they establish themselves in the community, housing, work etc. Assisted Living and Skilled Nursing - may have co-occurring conditions ( how can they live their lives to the fullest?) Locked - inpatient stabilized (may be a danger to self or others).
Different settings may influence evaluation and assessments.
PEO - Persons are embedded in their contexts. An infinite variety of tasks exists around every person. Performance results when the person interacts with context to engage in tasks.
Ecology of Human Performance
Social rhythm therapy: Regularize daily routines Emphasizes the link between regular routines and moods Uses Social Rhythm Metric to monitor routines Interpersonal psychotherapy (What can OT do)?: Emphasizes link between mood and life events Focus on interpersonal problem area (grief, role transition, role disputes, interpersonal deficits)
Essential Elements of Interpersonal and Social Rhythm Therapy (ISRT)
Need to be certified - $795. Measures quality of social interactions at least at developmental age of 2.5 Observe person in 2 types of social interactions OT scores quality of 27 social interaction skills Standardized on 6,500 people Use ESI software to generate report
Evaluation of Social Interaction (ESI)
Everyone has problems with health literacy at some point.
Everyone has problems with health literacy at some point.
Bring the argument for change out of the client, don't tell them what they need to do. not... Education Assuming the client lacks key knowledge, provide enlightenment
Evocation
Federal agencies Examine the services they provide Identify any need for services to LEP persons Provide services so LEP persons have meaningful access Recipients of federal financial assistance Programs and activities normally provided in English are accessible to LEP persons
Executive Order 13166 "Improving Access to Services for Persons with Limited English Proficiency (LEP)" (2000) Federal agencies
1. Review information- charts, team* 2. Interview client (with specific instruments) 3. Observe performance areas 4. Assess function (client factors, skills, activity demands) with specific instruments. 5. Synthesize and Summarize 6. Document and Report
General Steps
Social Barriers Access Environmental Barriers Stigma Jobsite Barriers
Health Disparities
36% of U.S. adults have Below Basic / Basic Health Literacy Below basic - 14 percent Basic- 22 percent Intermedidete - 53 percent Proficient - 12 percent Age Ages 16 to 64 = about 30% Below Basic or Basic Age 65+ = 59% Below Basic or Basic Race / Ethnicity White = 28% Below Basic or Basic Black = 58% Below Basic or Basic Hispanic = 66% Below Basic or Basic Education Less than or some high school = 76% Below Basic or Basic High school graduate or GED = 44% Below Basic or Basic 4-year college degree = 13% Below Basic or Basic Income level 150% of poverty or below = average score is Basic $34,575/family of 4 Type of health insurance Medicare = 57% Below Basic or Basic Medicaid = 60% Below Basic or Basic No insurance = 53% Below Basic or Basic
Health Literacy Stats
1. Evolving a daily maintenance plan 2. Understanding triggers and what i can do about them 3. Identifying early warning signs and an action plan 4. Signs that things are breaking down and an action plan -what does it look like when mental health spins out of control -"here is my doctor's phone number" -List of medications 5. Crisis planning "doctors information" -preferred hospital" -preferred method of getting to the hospital -doctors suggestions 6. Post-crisis planning -I'm out of the hospital, what do i need to do to reintegrate back into the community WRAP plan is usually a binder and carried everywhere they go Reviewed weekly, daily or monthly
Identify areas of Wellness Recovery Action Plan check recording
Assess ADLs and Cognitive Functioning Older Adults
Independent Living Scales
The intervention focuses on the links between mood symptoms and quality of social relationships and social roles, the importance of maintaining regularity in daily routines, and the identification and management of potential triggers for rhythm disruption Individuals with schizophrenia/autism/bipolar disorder may have schedules that are off/bipolar disorder changed in schedule may trigger a mood disorder The concept of loss of social demands, or tasks that set the biological clock may disrupt social rhythms, which may result in instability in biological rhythms and could be responsible for triggering the onset of a major depressive episode in persons with bipolar disorder What does the body's clock have to do with mood and mood disorders? the bodies clock has a lot to do with mood disorders. keeping a schedule makes you feel better.
Interpersonal and Social Rhythm Therapy (ISRT)
Long history of use in psychosocial OT Most are semi-structured-recommended questions regarding performance domains Interviewers flexibly frame questions according to clients needs.
Interview Assessments
Having favorite leisure activities that were meaningful (e.g., allowed for self-expression, provided a sense of peace; promote a sense of belonging) significantly predict recovery. Helping individuals with mental illness to identify meaningful personal and social activities that are enjoyable and pleasurable may, therefore, be important in facilitating recovery. Helping individuals to locate enjoyable activities of interest could also work toward lessening boredom and it's potentially negative effects on recovery Leisure as a means for coping with stress predicts lower psychiatric symptoms. Therefore, using leisure, for example, to gain feelings of personal control or help manage negative feelings was evaluated as predicting recovery. Educating individuals with mental illness about leisure's potential for outcomes that contribute to stress coping may be important in facilitating recovery identify favorite/meaningful activities Locate new activities of interest Perceiving oneself as actively engaging (have place to go, people to see, things to do) in various domains of life including personal, family, social, community, and culture domains, significantly predict recovery. Perceiving oneself as actively engaged is also positively correlated with leisure coping and meaning being generated through leisure, and is negatively correlated with leisure boredom. In this way, having places to go, people to see, and things to do may offer opportunities for individuals with mental illness to experience meaning through leisure, use leisure to cope, lessen boredom and further predict their recovery. Working with individuals within communities to ensure they are connected, feel a sense of belonging, and are engaged may be important to recovery from mental illness. Assessments to identify leisure activities and their level of engagement: activity card sort mohost ocairs occ self-assessment COPM OPHI-II
Leisure Boredom and OT's Role
Leisure boredom is negatively associated with recovery. Individuals with mental illness may struggle to use their leisure constructively and this may have a negative effect on recovery. May abuse substances to fill the void. Barth Time Index to fill this void individuals may abuse substances
Leisure Boredom and Recovery
Leisure Deprivation: individuals do not engage in leisure Occupational: the environment is not conducive to engaging in leisure or occupation Ex. Afterschool programs designed to fill in empty hours afterschool -children are placed into safer setting where they are removed from gang activity Ex. A child lives in a rural area on a gravel road and therefore child never learns to ride a bike kids in NYC, never develop important motor skills
Leisure Deprivation vs Occupational Deprivation
The evidence is compelling. Physical activity, recreation, leisure, and sport are not only essential resources for promoting optimal mental health and well-being, but they are critical components of efforts to recover from and stay well when living with a mental illness or addiction. Leisure activities can distract individuals from their mental illness Many individuals with mental illness are not able to differentiate between leisure and self-care A study by Craik and Peters (2006) found that individuals with mental illness had trouble assigning occupations to categories and that context determined whether the category was leisure or not. (Is eating a great meal leisure or self-care?)
Leisure and Occupational Balance Evidence
barriers fro general pop are more external but addiction is more internally based Gen Pop: Social skill barriers communication barriers poor decisions lack of motivation time money lack of opportunity lack of ability poor health accessibility Addicted Pop: Guilt fear lack of resources passive leisure pattern social network of using associates limited practice of sober, social interactions poor activity skills embarrassment intact defenses of past limited leisure use work addiction undeveloped planning skills depression
Leisure barriers with in the general pop vs addicted persons
Living on your Own (Example) - reading rental lease - finding an apartment - monthly budget for independent living based on needs and lifestyle See Resources on Moodle Site
Life Skills Training
IISB - Inventory of socially supportive behaviors (inventory given to self with lecture) - social supports and social isolation (either by themselves or others) ACIS - Assessment of communication and interaction skills -not used as commonly - similar to the social profile - perfromed by OT while observing the individual in group settings - score clients participation in a variety of settings - life role tasks assessed -nonlife role assessed - published by MOHO team ESI - eval of social interaction - published by AMPS group not used as much (needs certification or calibration costs 795) - measures quality of social interaction at least at developmental age of 2.5 years - requires computer Social profile - mary Donahue - what level individuals are able to participate in the group can be used with any age
List the assessments utilized for social support
Goal or Presenting Problem Develop a sense of identify, role and purpose outside of the constraints of having a psychiatric disability Withdrawn isolated Withdrawn from family Social factors are associated with Health Outcomes Social Support Recovery model involving the establishment of social roles and social connections Emotional support- comfort and caring Quality of relationships with other people (friends) Develop social networks - drug abuse pts on holidays (no one to talk to) Family Social Participation
List the common barreirs supports to social paticipation
Homelessness - Maslows hierarchy of needs Access to Mental Health Services Lack of Insurance Poverty/Income Education Occupation Transportation
List the common environmental barriers to socialization and engagement
Support Groups Clubhouses- Advocacy, employment, education, housing, wellness programs, food preparation, building maintenance Medical Home Model-Personalized care plans, medication management, coaching and advice, support and encouragement - all in one medical model
List the common environmental supports to socialization and engagement
The model of human occupation focuses on the motivation for occupation, the patterning of occupational behavior into routines and lifestyles, the nature of skilled performance, and the influence of environment on occupational behavior
MOHO
1. Provide initial direction or focus, permitting the group members to become leaders 2. Present as a moderator or advisor, encouraging members to assume a variety of roles 3. Foster a balance between task accomplishment and expression of feelings or emotions 4. Encourage discussion of members' roles, responsibilities, and choices of activity 5. Facilitate interpersonal concern for the outside lives of group members Group leader may be a participant
Mature Group Leadership
The members of the group may be heterogeneous, taking turns in a variety of complementary roles in order to achieve the goals of the activity harmoniously and efficiently The members of this group are heterogeneous participants whose various roles interact in a complementary manner. The members are flexible enough to take on a variety of roles. They are comfortable with higher and lower level group skill positions. The members balance task accomplishment and members socio-emotional needs. The members take turns teaching and learning, parenting, mentoring and experimenting with new skills and roles. Developmental Age: 15 -18 years group roles are very fluid, friends planning a weekend vacation, book club Ex. Parents of children with learning disabilities coach each other in a multifamily support group, parent participate in parent-teacher associations. Adult patients in a community group meeting discuss forming a group after discharge to help them stay clean of substances. Friends plan a weekend vacation Adults participating in a book club
Mature Participation
MOHO Ecology of Human Performance Occupational Adaptation Person-Environment-Occupational Performance Model Canadian Occupational Performance Model Cognitive Disabilities Model Kawa Model Sensory Processing
Models for OT in Mental Health
Current Interests. Change over time, desire for engagement in the future, pattern of interests that influence choices Adults and Adolescents
Modified Interest Checklist
Individuals who are vulnerable to mood disorders become 'stuck' in this state of pathological entrainment and continue to experience the array of symptoms referred to as major depression It is hypothesized that treatments that re-entrain biological rhythms can speed recovery from mood disorders and prevent their return
Mood Symptoms = Pathological Entrainment of Biological Rhythms
Interventions included forms of literature, physical exercise and work as a method to release the mind from emotional stress and thereby improve the individual's activities of daily living. Moral treatment waned during the civil war until the early 1900's when the rebirth of OT occurred.
Moral Treatment Interventions
1800's - Adolf Meyer (meaningful use of time) movement in Europe based on providing an environment that resembled the real world with an emphasis on literature, physical exercise and work alleviated stress and improved daily living skills in persons with mental illness. Moral treatment waned during the civil war until the early 1900's when the rebirth of OT occurred.
Moral treatment movement in Europe
Criterion referenced Only norm referenced include the Sensory Profile 2
Most assessments i nOT Mental Health are ....
Reflections of a client's statements are very powerful and can be used in many ways. Reflections often make a guess at what the client means. Beware of voice inflection! Do not let your voice rise as if asking a question. Some ways reflections can be used: Overstating (can be taken to the extreme to encourage client to think in a different direction) Understating (encourages client to keep talking about a feeling)
OARS: Reflections
Occupational therapists evaluate clients in areas that contribute to sleep dysfunction, including difficulties in sleep preparation and sleep participation; sleep latency (how long it takes to fall asleep—typically fewer than 30 minutes for someone without a sleep disorder), sleep duration (the number of hours of sleep, which varies by age), sleep maintenance (the ability to stay asleep), or daytime sleepiness; the impact of work, school, and life events, such as shift work or caregiving responsibilities; the influence of pain and fatigue; disturbances in balance, vision, strength, skin integrity, and sensory systems; psycho-emotional status, including depression, anxiety, and stress; the impact of caffeine, nicotine, drugs or alcohol, smoking, or medication (e.g., prescriptions or over-the-counter sleep aids); and the impact of the environment (e.g., those in acute care hospitals and long-term-care facilities report higher rates of sleep disturbance).
OT & Sleep Article: http://www.aota.org/about-occupational-therapy/professionals/hw/sleep.aspx
Screening Evaluation: Occupational Profile of Sleep Interventions Adapting the Environment Sleep Diary Establishing Routines Change Negative thoughts
OT & Sleep process
Cooperation Participation Social Behavior Age-Appropriate Interaction Engagement Self-Regulation Self-Awareness Relationship Skills Responsible Decision Making
OT's Use Groups to Facilitate Social and Communication Skills:
1. Volitional Questionnaire And Pediatric Volitional Questionnaire 2. Assessment of Communication and Interaction Skills
Observation Tools
-Kohlman Evaluation of Living Skills -Milwaukee Evaluation of Daily Living Skills -Functional Needs Assessment Independent Living Scales Assessment of Motor and Process Skills Allen Cognitive Level Test (ACL) and Diagnostic Manual (ADM)
Observation of Performance- Demand or In-context
Occupation Based: Top Down Practitioners may use an occupation-based, or top-down, approach that emphasizes looking at all components of an individual, determining how they relate, and developing a holistic view of the patient that is considered in all aspects of treatment -COPM -OPHI-2 -Card Sort Performance-Based: Bottom Up skills remediation, or bottom-up, approach in which specific sensory and motor deficits are addressed with a goal of general function return across occupations. -Sensory Profile 2 -MMT/ROM
Occupation Based vs Performance based assessments
Extent and Nature of occupational adaptation/functioning Adults and Adolescents
Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS)**
Past and present adaptation, impact of environment, life history narrative Adults
Occupational Performance History Interview-II (OPHI-II)
Daily activities, extent enjoy, importance, how well perform Adults and Adolescents
Occupational Questionnaire
The occupational adaptation practice model is holistic. The patient's occupational environments (as influenced by physical, social, and cultural properties) are as important as the patient's sensorimotor, cognitive, and psychosocial functioning and the patient's experience of personal limitations and potential is validated. holistic model: environments sensory motor cognitive and psychosocial functioning experience of limitations are validated
Occupational Adaptation
The ability to perceive, desire, recall, plan and carry out roles, routines, sub-tasks for the for the purpose of self-maintenance, productivity, leisure, and rest in response to the internal and external environment. Examines how one is able to carry out routines sensory physical social cultural contexs
Occupational Performance Model
Importance and satisfaction with occupations and impact of environment on occupational performance. Goal setting Adults (OSA) Children (COSA) - Children up to 8th grade Children with challenges with role checklist can utilize a card sort activity that comes with assessment
Occupational Self Assessment (OSA) and Childrens (COSA)
Wellness Self-Management Life Skills Training
Other names for Life balance occupations
First described by Mary Law et al 1996 Doesn't prescribe specific assessments or methods of intervention Guides clinical reasoning about what we choose & why The model embodies the client-centered practice Vinn diagram of Person, environment and occupation where occupational performance is at the center intersection of these factors
PEO Model
Person Difficulties with cognition and working memory Unusual sensory processing patterns Emotional factors and self-regulation Lack of roles, habits, or routines Environment Difficulty accessing; mental health services, housing, transportation, medication, health insurance, food, social networks Social isolation from friends and family Loss of cultural role e.g. breadwinner, provider Lost routines for work and leisure Occupation - Problems with: Self-Care Work/School Leisure Food consumption activities Dressing and clothing care Grooming and personal hygiene Household management Leisure planning Social interaction skills Community mobility Health-related behaviors Life safety Work-Related Skills
PEO and Mental Illness
1. Arrange the space so that members have room to participate in the activity 2. Allow the members to participate in the activity independently 3. Supply enough materials for all to use without relating to others present 4. Provide guidance and assistance with the activity when needed 5. Encourage members to carry out the activity that is their own goal
Parallel Group Leadership
The members of the group play, move or work side by side but do not interact with one another. The ability to participate in a parallel-group consists of the capacity to be in aggregate of individuals who are working or playing in the presence of others with minimal sharing of tasks and with some mutual stimulation. The members show some awareness of others, and a minimal verbal or nonverbal interaction with each other. 18 months to 2 yrs - Developmental Age Children eating lunch in a classroom Going to the gym with several friends - also parallel Kite: Memoves/ Storytime Ex. Children use tous, scooters, phones and bikes separately without interaction Children play next to one another in a snad box, pouring sand into cups Adults work at separate computer stations or exercise in lines on mats following a leader at the front of the class without interacting Seniors listen to alacture on prevention of illness Items: The solitary activities provide little participation with group members. members interact very little with other people
Parallel Participation
Use fewer preventative services Make more medication errors Make more visits to the ER Have more hospitalizations Have poorer health outcomes Have higher mortality rates AHRQ estimates the cost at $106 billion to $238 billion -17% of all U.S. personal health care expenditures
Patients with low health literacy:
Regular physical activity Ex. Run to lexington run group
People who engage in ____________- however intense - are less likely to have symptoms of depression, according to new research published in the November issue of the British Journal of Psychiatry. (See posted article)
Both attachment disorders Reactive Attachment disorder vs. Disinhibited Social Engagement Disorder. Same trauma different reaction/manifestation RAD: Rarely seeks or responds to caregiver comfort - may prefer to be with one adult over another - may have difficulty seeing parents after separation DSED: Inappropriate interaction with unfamiliar adults - Stranger danger is a prevalent issue
RAD vs DSED
Evaluate the progress of treatment • Evaluate the efficacy of interventions • Maybe mandated by third-party payers at specific times • Re-assess clients' goals/desires • Modify treatment, interventions, goals if necessary.
Re-Assessment/Interim evaluation
The ability of an individual to recover from a traumatic event in an adaptive manner. Positive beliefs about oneself Motivation to be effective in one's environment Cognitive and self-regulation abilities Positive attachments and connections to emotionally supportive and competent adults.
Resiliency
Assessment used to examine roles Roles will suffer in periods of psychotic episodes
Role Checklist
Perception of value in roles Adults and Adolescents
Role Checklist
Resistance occurs when the client makes an argument against change. This may happen when the therapist uses the "righting reflex"—the innate human desire to help someone fix a problem. How does the righting reflex hinder change? Resistance is a signal to change your approach!
Roll with Resistance
Periodical summaries used throughout a therapy session reinforce what has been said, show that the therapist has been listening carefully, and encourage the client to elaborate. Summaries allow a client to hear their own change talk again, which further increases motivation and commitment to change. Summaries used throughout and at the end of a session may help a client make connections that had not previously been made. An extension on the reflection
S: Summaries
Occupational Profile of Sleep
Screening for sleep:
Self-efficacy is a person's belief in his or her ability to carry out and succeed with a specific task or activity. The client has the answers and makes the decision to change! The therapist supports the client in creating and reaching goals. Self-efficacy is a good predictor of treatment outcome. The little engine that said, "I think I can". positive mentality.
Self Efficacy
1. Modified Interest Checklist 2. Role Checklist 3. Occupational Self Assessment (adults) (OSA) and Childrens (COSA) 4. Occupational Questionnaire 5. Adult-Adolesents Sensory Profile 6. Activity Card Sort
Self-Report Checklists/Questionnaires
How long it takes to fall asleep (normal person 30 min) -stay asleep
Sleep latency
0-3 months: 14-17 hours a day 4-11 months: 12-15 hours a day 1-2 years: 11-14 hours a day 3-5 years: 10-13 hours 6-13 years: 9-11 hours 14-17 years: 8-10 hours 18-25 years: 7-9 hours 26-64 years: 7-9 hours 65+ years: 7-8 hours
Sleep requirements over the lifespan:
Social exclusion is a risk factor for many mental health problems, whereas being socially included has protective effects (Davies, Davis, Cook & Waters, 2007) Young people who report poor social connectedness are 2-3 times more likely to experience depressive symptoms than youth who report stronger social networks (Davies et al.). A combination of greater depression and delinquency is especially true for youth who perceive themselves to be alienated from their peers, families and/or community and who primarily engage in unstructured free time activities (Bohnert et al., 2009). bullying
Social Exclusion and Leisure
For the Assessment of Social Participation in Children, Adolescents and Adults
Social Profile - assessment used for tinker toys activity
Zeitgebers: german for timekeeper Timekeepers Exogenous environmental factors that set the circadian clock Prototype = rising and setting of the sun Social zeitgebers Social cues that set the circadian clock
Social Zeitgeber Hypothesis
disabilities -autism (may only sleep 2 hrs a night) mental health issues -schizophrenia given auditory hallucinations - individuals may need white noise to sleep
Special risk population at rick of sleep issues
A behavior commonly demonstrated by individuals with borderline personality disorder Good cop vs Bad cop with all individuals in their life
Splitting:
1. Review preliminary information - Diagnosis: important because it informs us of possible functional strengths and weaknesses - Past history: medical, psychiatric - Recent stressors, precipitants, presenting problem - Prior functioning level, work status - Current/anticipated living situation, family, friends - Medications: side effects 2. Interview Client - Introduce self - Explain the purpose of the meeting - Ask client "what brought you to treatment?" - Establish therapeutic rapport: comfort, safety. - Add to information obtained through #1. - Written consent 3. Observe the client's presentation and performance in interview and group or individual treatment 4. Select assessments as needed to identify contexts, environments, activity demands, client factors that influence performance skills and patterns 5. Synthesize and Summarize Information - interpret - collaborate with the client to develop tx. plan and goals - review with the treatment team 6. Document and Report
Steps for Initial Evaluation
1. Initial evaluation- establish baseline information, strengths and weaknesses - establish an occupational profile - develop therapeutic rapport 2. Interim or re-evaluation- establish progress, interventions working? new problems? rationale for modification 3. Discharge - outcomes, future disposition, completion process
Steps in the OT process in Mental Health
Many of the newly insured had never had insurance and are now trying to navigate their options and use the health care system in new ways. Proposed changes to the ACA at the federal and state level have made the issue infinitely more confusing. At the federal level, efforts to repeal the ACA have failed so far, but changes to related taxes and funding keep it in the news and make it very hard for the general public to understand what might happen and how it could affect their health insurance.
Strategies for Health Care Providers and Facilities: (11.) Address health insurance/systems
Assume everyone has difficulty with health information Create a safe and shame-free environment Offer help to everyone, regardless of appearance Provide patient-centered care This is the recommendation of the National Action Plan to Improve Health Literacy because low health literacy affects so many patients all the time, and all of us at some time.
Strategies for Health Care Providers and Facilities: 1. Use universal precautions
This is a key piece, to demonstrate the value of the steps your organization takes and to ensure that policy is being followed.
Strategies for Health Care Providers and Facilities: 10. Link to performance measures
Greet patients warmly. Make eye contact. Use plain, non-medical language. - living room language Slow down. Limit content. Repeat key points. Use pictures, illustrations, and 3-D models. These seem straightforward, but it is actually very challenging to use them in every encounter we have with patients. We believe clear verbal communication is not a skill that you can learn once and then move on. In the time-pressured medical environment, clear communication skills require constant practice and attention.
Strategies for Health Care Providers and Facilities: 2. Use clear verbal communication
Use of clear written communication is a Healthy People 2020 objective related to health literacy, similar to the clear verbal communication: Increase the proportion of persons who report their health care provider always gave them easy-to-understand instructions about what to do to take care of their illness or health condition. Objectives - Limit to 2-3 important points Layout -One page vs. brochure Reading level -Aim for 5th to 6th grade More tips -Use short words and sentences -Avoid medical jargon and idioms -Limit fonts -Leave white space -Careful with images and pictures
Strategies for Health Care Providers and Facilities: 3. Use clear written communication
Invite questions using body language Sit Look at your patient Show "I have the time" Try not to interrupt Ask for questions Ask "What questions do you have?" NOT "Do you have any questions?" Patients will say "no" Ask me 3: What is my main problem What do i need to do about it Why is it important
Strategies for Health Care Providers and Facilities: 4. Encourage questions
4 billion prescriptions filled at retail pharmacies in 2014 Age 45-64 uses average of 4.7 unique prescriptions a year Age 65-74 uses average of 6.3 unique prescriptions a year Patients with chronic conditions often use 10 or more Medication errors are the most common medical mistakes, with more than more than 1.5 million adverse events each year. People are using a lot of OTCs! >300,000 OTC medicines available Most users assume all OTCs are safe and don't read instructions Most users are not aware of active ingredient or its importance Many users do not report use to their health provider
Strategies for Health Care Providers and Facilities: 5. Discuss medications clearly
Internet usage About 80% of internet users look for health information online Looking for health information is the 3rd most popular online activity Symptoms and treatments dominate internet users' health searches About 1 in 3 adults in the U.S. owns a smartphone Tell your patients Don't try to diagnose yourself! Don't Google it! Use websites that end with .edu, .org, or .gov Use caution with websites that end with .com Use caution with websites selling a product We do not want people to Google health information - we want them to use MedLine Plus. Medline Plus is from the National Library of Medicine and National Institute of Health. All information and all links are vetted. There is information on health topics and medicines, plus videos and other tools. The information is also available in Spanish.
Strategies for Health Care Providers and Facilities: 6. Promote reliable sources
Immediately after leaving the doctor's office, patients forget 40-80% of what they heard. Almost 50% of what they do remember is wrong.
Strategies for Health Care Providers and Facilities: 7. Use the Teach-Back Method
The Institute of Medicine outlines 10 attributes of a health literate organization Even better, AHRQ developed a toolkit to assess medical practices for those attributes with practical and specific follow up steps for each item. We used this toolkit to assess our clinic in 2010 and 2013 with the help of key informants, staff, and patients and the results have helped us prioritize and justify efforts to make our facilities more health literate.
Strategies for Health Care Providers and Facilities: 8. Assess your practice/facility
FHC Health Literacy Policy Assess and address patient learning needs and health literacy Treat health literacy as a universal precaution Offer all patients help, regardless of appearance Use clear communication with all patients Use plain language, not medical jargon Use pictures to help patients understand Speak more slowly Use the Teach-Back Method Encourage all patients to ask questions Ask "What questions do you have?" FHC Plain Language Policy Plain language guidelines should be followed for all written materials received by patients Includes health education materials, letters, forms Use the "FHC Plain Language Tips" Documents that will be sent to an external printer for formal, large-scale printing must be reviewed first by members of the Health Literacy Workgroup. Documents that will be translated must be reviewed first by members of the Health Literacy Workgroup.
Strategies for Health Care Providers and Facilities: 9. Make it policy
1. Encourage the members to select and organize their activity among themselves 2. Serve as a guide to the group where needed 3. Elicit and permit expression of emotions and feelings fostered by the activity 4. Allow the pace of the activity to place interaction above efficient completion of tasks 5. Facilitate group cohesion as a priority in the group Group leader is a guide Member select and organize activity themselves More interaction a goal and to facilitate group cohesion
Supportive Cooperative Group Leadership
The members of the group are usually homogeneous and aim to fulfill their needs of mutual emotional satisfaction, with the goals of play activity or work viewed as secondary. Feelings are frequently expressed The members of this group share emotions and experiences in order to satisfy psychosocial needs to problem-solve and grow in personal and interpersonal insight. They are homogeneous which meets the needs of mutual satisfaction to the extent that the task is often considered to be secondary to the fulfillment of needs. Members consist of compatible participants who relate to each other with comradery and cooperation. Compatibility, Children with same interests, Cliques at lunch Developmental age: 9 -12 years (pre-adolescent stage ) Ex. Teens make decorations for a dance or express feelings about the lyrics of a song. Informal adolescent cliques hang out in group without adults. Adults describe feelings about charactersina book during a book club meeting Seniors discuss feelings about ailments and prescription prices People participate in alcoholics anonymous, narcotics anonymous, gamblers anonymous and other 12step support groups.
Supportive Cooperative Participation
The child is constantly on "high alert" or in the "fight or flight" state, i.e. hyper aroused. The can cause issues with emotional regulation and sleep. They may demonstrate melt downs, self harm, or may just "freeze" They have poor self concept: unlovable, useless, incompetent, etc. Cognition may be decreased: visual perceptual problems, difficulty with sustained attention, problems with form constancy, delayed language development. The child may lack curiosity The child may demonstrate "parentification"
Symptoms of Abuse
Occupational Performance is the result of a dynamic relationship between persons, environment and occupation over a person's lifetime
The PEO fit-
Often interventions for child mental health are divided up into three tiers. Tier 1 interventions: Whole population Tier 2 interventions: Targeted small group Tier 3 interventions: Intensive individual
Tiered Interventions
Civil Rights Act Title VI (1964) No person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.
Title 6
1. Canadian Occupational Performance Measure (COPM)* -the most client-centered, outcome measure of performance and satisfaction with re-assessment. - Client lists problems in performance areas, patterns, skills then prioritizes them for treatment. - Least structured by the evaluator, most open-ended of interview assessments. - Can be completed in a short time 2. Occupational Performance History Interview-II (OPHI-II) OPHI-II- elicits information regarding persons past and present functioning rated on a 4 point scale indicating the level of adaptation and environmental impact. - More structured by the evaluator, less open-ended, more detailed questions regarding occupational choices, critical life events, daily routine, occupational roles, and settings. - Longest time to complete than other assessments but more detailed information 3. Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS)** OCAIRS-similar to OPHI-II, more structured elicits information regarding occupational adaptation and participation on a 4 point scale. - More structured by the evaluator, less open ended, more detailed questions regarding self-efficacy, values goals, interests, roles, habits, skills, environment. - Longer time to complete but quicker rating than OPHI-II Uses the same questions as the MOHOST
Top 3 Occupation Based Interviews
A term used to refer to emotional shock following a very distressing event.
Trauma
Sensory Profile-2 Canadian Occupational Performance Measure (COPM) Child Occupational Self Assessment (COSA) Pediatric Activity Card Sort (PACS) School Function Assessment (SFA) School Setting Interview (SSI) Short Child Occupational Profile (SCOPE) Pediatric Volitional Questionnaire (PVQ)
Trauma Assessment Tools
Establishing predictable routines and activities Engaging in age/developmentally appropriate play/leisure activities Allowing choice in activities (remember shared control?) Teach mindfulness activities Teach positive coping skills Promote self-regulation activities Engagement in ADL routines
Trauma Interventions
Taking the fact that the child has experienced trauma into consideration. Children often receive a variety of diagnoses after experiencing trauma to try to label their behaviors: ADHD, OCD, ODD, sensory processing disorder but often the trauma is overlooked Behavior is the result of abuse Example: A child who was neglected might have issues with hoarding food thus affecting mealtime behaviors.
Trauma informed care
Improvements in social behavior Increased attachment with adults and peers Increased ability to process sensory stimuli Improvement in school participation Improvement in cognitive functioning Increased self-esteem and identity Better recognition of roles Any others that you can think of?
Tx Outcomes for Trauma
How well perform daily activities, record importance, and satisfaction of environment Adults Children
Volitional Questionnaire And Pediatric Volitional Questionnaire
Learning about recovery and what it can mean for you • Making the best use of your mental and physical health services • Learning how mental health and physical wellness will help you to achieve your goals and support your personal recovery • Staying well by decreasing symptoms of a mental health problem • Learning how to manage day-to-day stress and prevent relapse • Staying well by connecting with others
Wellness Self-Management
Provides a framework to: Define the scope & boundaries of a profession Describe it's fundamental principles & values Guide assessment, intervention & evaluation practices
What a model of practice does
organization executive function plan and carry out to completion an activity budget time keep a schedule ADHD/Autism pt have difficulty with this Assessment: Barth time index COPM (how they spend their time and how satisfied they are with it) Strategies: Visual reminders (whiteboard) smartphone apps
What are the skills a person must have to manage their time? What are some of the difficulties a person might have in managing their time? What are several assessments that OT's can use to evaluate a persons use of time? What are several strategies that an OT can use in helping clients with time management
"...a collaborative, person-centered form of guiding to elicit and strengthen motivation for change by exploring and resolving ambivalence." Helps clients who are "stuck" Key features: Collaborative Goal-Oriented Strengths-Based Empowering
What is MI?
Motivational Interviewing "...a collaborative, person-centered form of guiding to elicit and strengthen motivation for change by exploring and resolving ambivalence." Helps clients who are "stuck" Key features: Collaborative Goal-Oriented Strengths-Based Empowering
What is MI?
How a person manages the everyday activities that occupy them at home, at school/work or at play/during leisure time. Activities = things we do to fulfill our life roles
What is Occupational Performance
Adverse Childhood Score
What is an ACE score
Summarize treatment, assess outcomes • Recommendations for further or future treatment or services, adaptive equipment, environmental modifications, caregiver training. • May be mandated by third party payers, more treatment? • Review treatment and outcomes with clients' since admission
What is done at Discharge in the OT process?
Acceptance (but not always agreement), understanding, and reflective listening NOT feeling sorry for, feeling bad for, or "feeling the pain" of the client Sympathy is silver lining
What is empathy?
Definition under the affordable care act "The degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make appropriate health decisions." Obtaining = getting health information Processing = using reading skills, math skills, logic skills, and more Communicating = being able to describe a health issue and ask questions Understanding = knowing what the health information means once you have it Making appropriate health decisions = using the health information in everyday life to stay healthy or feel better All the things a patient has to do between doctors visits or hospital stays
What is health literacy
As a way of managing symptoms such as : paranoia auditory hallucinations depression poor energy low self worth
What is the common reasoning behind social withdraw
the context with in which occupational performance takes place
What is the environment in the PEO model
Insomnia occurs in 50 percent
What percentage of individuals who suffer from mental health suffer from insomnia?
What works: Teach Back Method Provider Education Bi-lingual and/or bi-cultural staff Patient education Clinic tours Written materials in native language Videos in native language Audio tapes in native language Interactive slideshows What does not work: Assuming your patient... understands or agrees with care model understands diagnosis will comply with treatment Untrained interpreters or no interpreter Patient education Written materials or medication instructions in English Written materials without pictures Videos in English
What works vs What doesn't with Limited english Proficiency pts
The ability to engage in leisure is often lost in the early stages of mental illness and participation in work activities can enhance self-esteem and serve as a "prompt" for new involvement in activities such as leisure. When leisure is performed in tandem with work it is more meaningful. Self Care needed for Work but Work and Leisure can be concurrent ADL's are typically the first lost in mental illness -work can assist in this
When Leisure is performed in tandem with ____ it is more meaningful
collage activity card sort assessment (activity card sorts) sort pictures based on things they are good/bad at and things they would like to do again
When assessing an individuals narrative, what was the example mentioned in lecture if communication is difficult
Occupational therapy (OT) assessment focuses on functions related to daily living that patients need to perform (eating, hygiene, dressing), want to do (socializing, skiing, attending college), and are expected to do (work, household chores, managing medications)
Why is Functional Assessment so Important in OT?
evidence shows that witnessing trauma is just as destructive as committing trauma to that individual as well as Learning about trauma that has affected someone close
Witnessing trauma
Older Adolesents self regulation - in a group setting
Zones of regulation
feeling with vs feeling for pt sympathy begins with..."at least"
empathy vs sympathy
it is never okay to use a patients child for an interpreter
it is never okay to use a patients child for an interpreter
Age appropriate ADL's and IADL's
parentification tx
tiredness due to inadequate sleep -individuals may require coffee/energy drinks becoming a larger issue in the child population -impacts academic performance Impacts: attention, coordination, irritability etc...
sleep debt
ADLs (activities of daily living)
what is one of the first occupations to go away when suffering from mental health