Therapy Ed Ch. 3 The Process of Occupational Therapy

in school/educational settings, assessment information must be related to the multiple aspects of educational performance such as....

(1) academic (2) mobility (3) psychosocial (4) behavioral (5) self care

areas of occupation categories include

(a) ADLs (b) IADLs (c) work (d) education (e) play/leisure (f) social participation (g) rest and sleep

two types of topical groups are?

*Anticipatory and Concurrent*. Anticipatory Groups focus on what the patient needs to be prepared for in the future. Concurrent Groups focus on education and training that is immediately helpful.

medicare criteria for group leadership

-Provides active leadership -Instructs members as a group -Monitors and documents individual's participation and response to intervention -Provides individualized guidance and feedback -Documents person's progress toward goals defined in the individual intervention plan in objective, measurable, functional terms

ethical considerations for selection and use of OT assessments: OTA

-complete the assessment data collection that they are responsible to perform -*determine that their training and supervision is adequate to carry out assigned assessment procedures* -report the assessment data in an accurate manner -*contribute to evaluation process*

ethical considerations for selection and use of OT assessments: OT

-determine assessment foci based on the needs and goals of the person being assessed -select, administer, and interpret assessment results using established evaluation guidelines -complete standardized assessments according to protocol -*supervise other OT personnel in their collection of assessment data* -ensure all delegated assessment tasks are completed in a competent manner -*document the assessment in a manner that accurately describes its procedures and outcomes.*

ethical considerations for selection and use of OT assessments: client/consumer and/or their caregiver/guardian vested interests

-have provided input about their needs and goals to inform the assessment process -have been fully informed about the purposes and administrative procedures of an assessment -understand how the assessment results will be used to inform intervention -have been provided the opportunity to decide if the assessment should be administered -know how the assessment will be billed

ethical considerations for selection and use of OT assessments: payer

-the assessment is a necessary and billable service that is accurately documented for reimbursement -if there is no third-party reimbursement, the person being assessed knows this and has given consent before the completion of an assessment -payment is requested only for the services provided

ethical considerations for selection and use of OT assessments: employer and inter-disciplinary team members' vested interests

-the assessment is consistent with the mission of the setting and helps attain desired outcomes -the assessments findings, interpretation, and recommendations are effectively communicated to team members and meaningful contribute to an inter-disciplinary intervention plan

Group leadership styles include

1. directive leadership 2. facilitative leadership 3. advisory leadership

medicare indicators for group membership

1. engage willingly in group 2. attend to group guidelines/procedures 3. Actively participate in group process 4. Benefit from group leadership input 5. Benefit from group membership/peer input 6. Respond appropriately throughout group process 7. Incorporate feedback 8. Complete activities toward goal attainment 9. Attain greater benefit from the group intervention than from 1:1 intervention

Intervention includes...

1. intervention plan 2. intervention implementation 3. intervention review

during the evaluation process, what needs to be done?

1. obtain history and PLOF 2. select appropriate standardized/non-standardized evaluation tools 3. administer assessments based on guidelines 4. score/rate assessment results 5. interpret results 6. identify strengths/weaknesses 7. collaborate with client/families/caregivers and other team members to apply results to a larger context.

when the *screening stage* is the current OT process within a question scenario, you can immediately rule out which of the following answer choices? A. goal setting B. intervention planning C. implementation/managing interventions D. all of the above

D- all of the above, goals cannot be established or treatment implemented/managed until AFTER evaluation is completed.

face validity

Establishes how well the assessment appears to measure it purpose. ex. an activity configuration looks like it measures time use. Looks good based upon face value.

during the teaching/learning process, learning goals are more likely to be met if....

they are made by the individual, and the individual understands reason and purpose of learning activity, all while also recognizing current functional level.

types of clinical reasoning

Procedural, Interactive, Conditional, Narrative

Mosey: developmental group

Purpose/focus: a continuum of groups consisting of parallel, project/associative, ego-centric-cooperative, basic cooperative, cooperative/supportive cooperative, and mature groups. -Each of the types of groups listed under the Developmental Groups Category builds upon the previous group. Each type of group adds another level of self-awareness for the group participants. Therapist role: The role of the OT decreases with each type of group as the members develop more leadership and interpersonal skills.

Mosey: task-oriented group

Purpose/focus: increase clients' awareness of their needs, values, ideas, feelings, and behaviors as they *engage in a group task*. Type of client: individuals who's primary dysfunction is in the cognitive and socio-emotional areas due to psychosocial or physical trauma. Therapist role: The goal of the OT should be to support the group members and specifically encourage them to change their behaviors. Discussions should be focused on feelings, thoughts, and behaviors that happen during group interactions. Example: A group of patients at an assisted living community work together to plant a garden. The goal of the group is to encourage exercise and outdoor activity. The OT spends time discussing the project with each group members and reinforces positive behaviors and interactions.

Mosey: evaluation group

Purpose/focus: is to enable the client and the therapist to assess the client's skills, assets, and limitations *regarding group interaction*. Type of client: all individuals who will be involved in groups or lack group interaction skills. Therapist role: The OT is an observer. The OT documents the group member's behaviors and interactions in order to determine their functional levels. Example: An OT observes a group of autistic teens while they complete an art project. The OT is watching to assess each teen's level of social skills and their type of interaction with the group.

Mosey: Topical group

Purpose/focus: on issues and activities group members face in their daily lives. Education, skills training, problem solving, and expectations are all important themes for this type of group. Discuss specific activities outside the group that enable them to engage in these activities in a more effective, need-satisfying manner. Type of client: individuals who share similar current or anticipatory problems in functioning, must be @ a cooperative group level. Therapist role: Facilitate activities that help to promote a forward thinking attitude. Help the group to plan ahead, anticipate issues, brainstorm and problem solve. Educate the client and the caretaker on expectations and challenges to care. Example: A group is offered for patients who are diagnosed with cancer. The leader works to educate the group on the resources available to them, including emotional, financial, spiritual support. The group members share experiences and help each other cope with the specific demands of the diagnosis.

Mosey: thematic group

Purpose/focus: to assist members in acquiring the knowledge, skills, and/or attitudes needed to *perform a specific activity*. Type of client: (a) determined by the specific goals of the group (b) members' needs, concerns and goals must match the objectives of the group (c) member must have a minimal group interaction skill level equal to a parallel group skill level. Therapist role: The OT provides direction and support while teaching strategic skills and providing a safe environment. Example: A group of new amputees learn together how to get in and out of a wheelchair.

T or F: group norms can be expressed verbally and non verbally

true, they can also be explicit and non-explicit

norms

used for comparative analysis of an individuals score. An individual's characteristics must match the characteristics of the population used to establish the norms.

pragmatic reasoning

considers context, states that the mental activities are shaped by the situation (setting). Considers treatment environment and OT practitioners values, knowledge, abilities, and experiences. Focuses on the treatment possibilities within a given treatment setting.

reliability is scored as

correlation or a percentage to identify the degree to which the two items agree/relate.

curative factors in group therapy

The commonalities among diverse group therapy approaches proposed by Yalom to be the source of the positive treatment effect. These factors include imparting information, instilling hope, universality, altruism, interpersonal learning, imitative behavior, corrective recapitulation of the primary family, catharsis, and group cohesiveness. p.55 therapy ed

criterion validity is reported as

correlation. the higher the correlation, the better the criterion validity.

interactive reasoning

deals with how the disability or disease affects the person; focuses on the client as a person. Focuses on the personal meaning of illness and disability which can influence how a person engages in treatment. Congruent with the profession's philosophy and heritage of caring.

who can refer to OT?

a person can refer themselves, or family, caregivers, physicians, social workers, physical therapists, nurse practitioners, allied health professionals, teachers, administrators, payers, employers, and private, state, and local public agencies.

predictive validity

a type of criterion validity that compares the degree to which an instrument can predict performance on a future crierion.

concurrent validity

a type of criterion validity that compares the results of two instruments given at about the same time.

Mosey's 6 types of group in OT

a. evaluation b. task oriented group c. developmental group: d. thematic group e. topical group f. instrumental

If the occupational therapist and client do not share the same language what should occur during the evaluation and intervention process?

an interpreter must be used to ensure the *validity* of the information obtained and that no cultural or religious norms are violated that may compromise the therapeutic process.

criterion validity

compares the assessment tool to another one with already established validity. There are 2 types 1. concurrent 2. predictive

therapist's interpretation of their observations must be validated by...

the individual and/or caregiver (s)

narrative reasoning

deals with the individuals occupational story and focuses on the process of change needed to reach an imagined future. Identifies what activities and roles were important to the person prior to illness/injury, explores how these activities can be done now and in the future with current level of functioning, anticipated level of functioning in the future.

screening

determines the need for an evaluation, can be with the client, family or caregivers. Outcome determines further eval.

secondary prevention

early detection, screening, and management of disease to minimize effects.

content validity

establishes that the content included in the evaluation is representative of the content that could be measured. ex. does the content of the role checklist provide an adequate listing of roles?

three main aspects of OT service delivery

evaluation, intervention, outcomes

T or F: Individual roles are functional and contrary to group roles, for they serve an individual purpose and do not interfere with successful group functioning (ex. aggressor, blocker)

false- Individual roles are *DYSFUNCTIONAL* and contrary to group roles, for they serve an individual purpose and do not interfere with successful group functioning (ex. aggressor, blocker)

procedural reasoning

identifying OT problems, goal, setting, treatment planning. Involves implementing treatment strategies via systematic gathering and interpreting of client data. Technical "doing" of practice.

conditional reasoning

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

Conflict phase of group development (initial beginnings to termination)

involves members challenging the groups structure, purposes, and/or processes, and is characterized by dissension and disagreements among members. *unsuccessful resolution in this phase results in dissolution of the group*

Transference: common issues of therapeutic sense of self

is an unconscious response to an individual that is similar to the way one has responded to a significant person (ex. the therapist is responded to as a parent).

Countertransference: common issues of therapeutic sense of self

is an unconscious response to transference in which the individual responds in a manner that is expected and desired by the person who has transference toward him/her (ex. the therapist assumes a parental role toward a client).

what does maladaptive group communication entail?

it can include seeking to control the group by controlling the channels of communication and/or avoiding specific issues or persons.

although anyone can refer to OT, the OT can only act upon a referral when...

it is determined by state licensure laws and/or third part payers. This varies state to state. The only thing that is constant is medicare guidelines, AOTA standards of practice.

directive leadership

members cognitive, social and verbal skills as well as engagement are limited, therapist is main facilitator of group activities.

facilitative leadership

members' skill level and engagement are moderate. Leader collaborates with members to select activities and lead the group.

advisory leadership

members' skills and engagement are high (mature groups). Members select and complete the groups activities with leader's advice (if needed).

interrater reliability

or inter-observer reliability, establishes that different raters using the same assessment with achieve the same results.

evaluation

process of obtaining and interpreting data necessary for intervention. Includes planning for and documenting the ______________ process and results. INCLUDES: A. occupational profile B. analysis of occupational performance

norm-referenced assessments

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

criterion-referenced assessments

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

primary prevention

reduction of risk factors before occurrence of disease, condition, or injury. "create/promote", "health promotion"

test-retest reliability

reliability establishes that the same results will be obtained twice by the *same* adminstrator.

tertiary prevention

the elimination or reduction of the impact of dysfunction

goal attainment scaling (GAS)

uses interviews and rating scales during initial sessions to facilitate clients' participation in the goal-setting process by identifying intervention outcomes that are personally relevant to them. *used during post-treatment sessions to assess client progress toward desired goals*.

Are maintenance interventions covered by third party payers?

usually not, but it is a major type of OT intervention. Centers for Medicare and Medicaid Services (CMS) has recognized that OT services to prevent or slow deterioration and maintain a person at their highest possible functional level are skilled and covered if these services are *reasonable and necessary*.