Fundamentals of OT ((Exam #2))

ASBOT Supervision of OTAs

(1) "Occupational therapy assistant" means a person licensed to assist in the practices of occupational therapy under the supervision of, or with the consultation of, a licensed occupational therapist whose license is in good standing. (2) "Supervision" means a collaborative process for the responsible periodic review and inspection of all aspects of occupational therapy services. Responsibility of supervision is shared between the supervising occupational therapist(s) and the occupational therapy assistant(s) and/or all unlicensed personnel involved with the provision of occupational therapy services, including aides and students. (3) An occupational therapist may assign an increased level of supervision if necessary for the safety of a patient or client. The levels of supervision are: a. Direct Supervision: the supervising occupational therapist is in the immediate area of the occupational therapy assistant while performing supportive services. b. Close Supervision: the supervising occupational therapist provides initial direction to the occupational therapy assistant and daily contact while on the premises at least 50% of the occupational therapy assistant's direct patient care hours per month. c. General Supervision: the supervising occupational therapist has face-to-face contact with the occupational therapy assistant at least once every 30-calendar days, with the supervising occupational therapist available by telephone, electronic, or written communication. (4) Supervision Ratios: An occupational therapist may supervise up to three (3) full-time occupational therapy assistants, but never more than two (2) occupational therapy assistants who require "direct" level of supervision. The total number of supervised occupational therapy assistants, occupational therapy personnel on a limited permit, and non-licensed occupational therapy personnel (including any occupational therapy students, occupational therapy assistant students, licensee applicants required to perform a perceptorship, and/or aides) may not exceed five (5) without prior Board approval. The Board may permit the supervision of a greater number by an occupational therapist if, in the Board's opinion, there would be adequate supervision to protect public health and safety. (5) Only a licensed occupational therapist shall: a. Prepare a written initial treatment plan prior to implementation by the occupational therapy assistant, initiate or re-evaluate a client or patient's treatment plan, or authorize in writing a change of a treatment plan b. Delegate duties to a licensed occupational therapy assistant, designate an assistant's duties, and assign a level of supervision; and c. Authorize a patient discharge. (6) A licensed occupational therapy assistant shall not: a. Evaluate or develop a treatment plan independently; b. Initiate a treatment plan before a client or patient is evaluated and a written treatment plan is prepared by an occupational therapist; c. Continue a treatment procedure appearing harmful to a patient or client until the procedure is reevaluated by an occupational therapist; or d. Continue or discontinue occupational therapy services unless the treatment plan is approved or re-approved by a supervising occupational therapist. (7) A supervising occupational therapist shall supervise a licensed occupational therapy assistant as follows: a. Supervision should be "Direct" at the discretion of the supervising occupational therapist. b. Supervision should be "Close" if the occupational therapy assistant has less than 12 months of experience. c. Supervision should be at least "General" if an occupational therapy assistant has more than 12 months of experience. d. For occupational therapy assistants employed by state agencies and those employed by public schools and colleges of this state who provide screening and rehabilitation services for the educationally related needs of the student, the "Direct" and "close" supervision mandate based on work experience does not apply. In these instances, supervision should be at least "General". e. The following levels of supervision are minimal. An occupational therapist must assign an increased level of supervision if the occupational therapy assistant is new to a practice setting or particular skill. An occupational therapist must assign an increased level of supervision if necessary for the safety of a patient or client. f. All occupational therapist(s) who delegate to occupational therapy assistants must participate in the supervision of that occupational therapy assistant. g. Occupational therapy assistants working part-time should have no less than one hour of direct supervision per calendar month, and meet all other supervision requirements within this section. h. Occupational therapy assistants who work with more than one employer must notify the board of the supervisor(s) for each employer. i. The occupational therapist shall ensure that the occupational therapy assistant is assigned only those duties and responsibilities for which the assistant has been specifically educated and which the occupational therapy assistant is qualified to perform.

Levels of Supervision

(1) *Direct or Continuous*: The supervising OTR is in the immediate area at all times; required for OT and OTA students, persons with limited permits, and OT aides. (2) *Close Supervision*: Daily, direct contact at the site of work. (3) *Routine Supervision*: Face-to-face contact at least every two weeks at the work site, with interim supervision via some form of telecommunication. (4) *General Supervision*: Initial direction and face-to-face contact with the supervising OTR at least once a month, interim supervision as needed by telecommunication. - Supervision is an ongoing process that changes with the setting and the individuals involved. The frequency, method, and content of supervision depends on several parameters. --> Parameters = regulatory requirements / requirements of the practice setting that pertain to supervision, level of competence, experience, education, and credentials. After parameters have been established, supervision is based on the following: - The complexity of the clients needs - The number and diversity of clients - The skills of the OT and OTA - The type of practice setting

AOTA Standards of Continuing Competence

(1) *Knowledge*: Roles, AOTA documents, integration of knowledge, practice, and evidence from the literature (2) *Critical Reasoning*: Problem solving, application of evidence, research results, and outcome data in making decisions (3) *Interpersonal Abilities*: Professional relationships, collaboration, communication, cultural competency (4) *Performance Skills*: Practice skills based on OT principals and philosophy, quality improvement processes, therapeutic use of self (5) *Ethical Reasoning*: Understand and apply code of ethics, adhere to state regulatory laws, make ethical decisions

Three ways in which career development occurs:

(1) *Vertical Movement* within a setting: The practitioner moves up in the organization to progressively higher positions. (2) *Lateral Movement* across settings: Might involve an expert clinician transitioning to the role of a clinician instructor in a university setting. (3) *Maturation* within a role: From entry level, to intermediate level, to an advanced level.

Areas of Occupation

(1) ADLs (2) IADLs (3) Rest and Sleep (4) Education (5) Work (6) Play (7) Leisure (8) Social Participation

ASBOT Supervision of Occupational Therapy Aides

(1) An occupational therapy aide/support personnel is an unlicensed person who assist in the practice of occupational therapy, who works under the supervision of a licensed occupational therapist and whose activities require an understanding of occupational therapy but do not require professional or advance training in the basic anatomical, biological, psychological, and social sciences involved in the practice of occupational therapy. An occupational therapy aide is a worker who is trained on the job to meet the specific needs of the facility. (2) A licensed occupational therapist may delegate to occupational therapy aides only specific tasks which are neither evaluative, assessive, task selective nor recommending in nature, and only after insuring that the aide has been appropriately trained for the performance of the task. (3) Any duties assigned to an occupational therapy aide must be determined and appropriately supervised by a licensed occupational therapist and must not exceed the level of training, knowledge, skill, and competence of the individual being supervised. The licensed occupational therapist is totally and wholly responsible for the acts or actions performed by any occupational therapy aide functioning in the occupational therapy setting. (4) Duties or functions which occupational therapy aides may perform include, but are not limited to: a. Routine department maintenance task; b. Transportation of patients/clients; c. Preparation or setting up of treatment equipment and work area; d. Taking care of patient's/client's personal needs during treatment; e. Clerical, secretarial, administrative activities. (5) Duties or functions which occupational therapy aides shall not perform include, but are not limited to, a. Interpret referrals or prescriptions for occupational therapy services; b. Perform evaluative procedures; c. Develop, plan, adjust, or modify treatment procedures; d. Act on behalf of the occupational therapist in any matter related to direct patient care which requires judgment or decision making. e. Act independently or without supervision of an occupational therapist. (6) An aide/support personnel may assist in the delivery of occupational therapy; however, may not provide direct patient treatment. (7) Care rendered independently by an occupational therapy aide/support personnel shall not be charged as occupational therapy.

Five Intervention Approaches used in Occupational Therapy

(1) Create / Promote (2) Establish / Restore (3) Maintain (4) Modify (5) Prevent

OT Framework is divided into:

(1) Evaluation (2) Intervention (3) Outcome

Evaluation requires that the OT gather accurate and useful information to identify the needs and problems of the client to plan intervention . The techniques used during the evaluation process can be classified into three basic procedures:

(1) Interview (2) Skilled Observation (3) Formal Evaluation Procedures

Developmental Tasks (Childhood)

(1) Motor skills (2) Play - Parallel - Imaginative - Games with rules - Cooperative (3) Education - Follow rules - Cognitive skills - Social - Behavior - Motor skills

Diagnoses (Adolescence)

(1) Psychological disorders (2) Physical disabilities - Sexuality - Body image - Future goals and aspirations

ASBOT Supervision of Therapists/Assistants With Limited Permits

(1) Supervision of limited permit holders shall consist of one-to-one on-site supervision a minimum of 50% of direct patient time by an Occupational Therapist who holds a current license in this State. (2) Supervision of limited permit holders who are in the reentry process, as stated in 625-X-3-.08, shall consist of 100%, in-sight supervision by an Alabama licensed Occupational Therapist with no less than five years continuous experience.

AOTA Speciality Certification

*A credential for OTs and OTAs that indicates advanced knowledge in a particular area of practice*. - Requires 2000 hours of experience as an OT/OTA, and 600 hours of delivering OT services within 3 years. - Offered in driving and community mobility; environmental modification, feeding eating, and swallowing; and low vision

*Intervention*

*An approach that involves working with the client through therapy to reach client goals*. (1) Intervention Planning (2) Implementation (3) Review - *Intervention Plan*: *Create / Promote (Health Promotion)*: Provides opportunities for people with and without disabilities. The OT practitioner sets up a program or activity in the hope that all those who participate will benefit by enhanced performance. *Establish / Restore*: Practitioner uses strategies and techniques to change client factors to establish skills that have not yet developed or to restore those that have been lost. *Maintain*: Provides support to allow the client to continue to perform in the manner in which her or she is accustomed. OT practitioners using this approach help clients keep the same level of performance and not decline in functioning. *Modify (Compensation, Adaptation)*: The changing demands of the activity or the way the client performs the activity. This is useful when client factors are not changeable in a practical amount of time and the client wishes to engage in the activity. *Prevent*: Practitioners are interested in keeping clients well, and as such they may help clients engage in activities to prevent or slow down disease, trauma, or poor health.

AOTA Board Certification

*Certification for the OT or OTA that incorporates more generalized areas of practice that have an established knowledge base in OT*. - Requires 5000 hours of experience as an OT in last 7 years, and 500 hours of delivering OT services (paid or voluntary) in last 5 years. - Targeted specifically for OTs. - Offered in gerontology, mental health, pediatrics, and physical rehabilitation.

Development

*Child growth*: Refers to the size of a child *Developmental Milestones*: A set of functional skills or age-specific tasks that most children can do at a certain age range. (1) *Gross motor*: Using large groups of muscles to sit, stand, walk, run, etc., keeping balance, and changing positions. (2) *Fine motor*: Using hands to be able to eat, draw, dress, play, write, and do many other things. (3) *Language*: Speaking, using body language and gestures, communicating, and understanding what others say. (4) *Cognitive*: Thinking skills: including learning, understanding, problem-solving, reasoning, and remembering. (5) *Social*: Interacting with others, having relationships with family, friends, and teachers, cooperating, and responding to the feelings of others.

Analysis of Occupational Performance

*Client Factors*: Components of activities consisting of body functions and body structures; used to assess functioning, disability, and health. *Performance Skills*: Small units of observable action that are linked together in the process of executing a daily life task performance. Examples = Sensory, motor, cognitive and communication skills *Performance Patterns*: The clients habits, routines, rituals, and roles. *Context & Environment*: The setting in which the occupation occurs; includes cultural, physical, social, personal, spiritual, temporal, and virtual conditions within and surrounding the client that include performance. *Activity Demands*: The aspects of an activity needed to carry out that activity, such as objects used and their properties, space demands, social demands, sequencing and timing, required actions, required body functions, and required body structures.

Supervision

*Cooperative process in which two or more people participate in a joint effort to establish, maintain, and/or elevate a level of competence and performance*. - OTAs require supervision from an OT to deliver occupational therapy services. The OT is ultimately responsible for all aspects of the services provided by the OTA, the occupational therapy aide, and the OT student.

How often must practitioners complete NBCOT requirements for certification renewal to continue to use the OTR or COTA credential?

*Every 3 years* - Renewal of certification with NBCOT is voluntary, yet may be required by employers or for state licensure. - To renew, practitioners submit proof of having completed a minimum of 36 professional development units (PDUs) within each 3-year certification renewal cycle. At least 50% of those units must be directly related to the delivery of occupational therapy services.

Developing Observation Skills

*Observation*: The means of gathering information about a person or an environment by watching and noticing. Ex = the OT can observe the persons posture, dress, social skills, tone of voice, behavior and physical abilities (use of the limbs and ambulation). - Observation is an important professional skill and can be developed through practice. *Structured Observation*: involves watching the client perform a predetermined activity. Frequently use to gain knowledge of what the person can or cannot do in relation to the demands of the task.

*Chapter 10*

*Occupational Therapy Across the Life Span*

*Chapter 9*

*Occupational Therapy Practice Framework: Domain and Process*

*Chapter 12*

*Occupational Therapy Process: Evaluation, Intervention, and Outcome*

*Evaluation Process*

*Purpose is to find out what the client wants and needs, and to identify those factors that support or hinder occupational performance*. - Practitioner bases evaluation procedures on the client's age, diagnosis, developmental level, education, socioeconomic status, cultural background, and function ability. - Steps of the evaluation process: (1) Referral (2) Screening (3) Evaluation

Roles

*Specific positions or sets of stipulated job-related responsibilities* - An individuals ability to function in a role is based on educational preparation, professional boundaries, and prior experience in the role. *Examples*: Practitioner Educator Field Work Educator Supervisor Administrator Consultant Academic Fieldwork Coordinator Academic Program Director Researcher / Scholar Entrepreneur - Often OT practitioners function in more than one role - at times within the same job.

*Chapter 7*

*The Occupational Therapy Practitioner: Roles, Responsibilities, and Relationships*

Occupational Performance

*The ability to carry out activities in the areas of occupation*

Service Competency

*The determination, made by various methods, that two people performing the same or equivalent procedures will obtain the same or equivalent results. In test development, this is known as interrater reliability*. - *Interrater Reliability*: A measure of the likelihood that test scores will be the same no matter who is the examiner. --- Tested, then tested again. Can use Kohlman Evaluation of Living Skills. "How consistent am I as an evaluator?" Methods may include: - Independent scoring on standardized tests - Observation - Videotaping - Co-Treatment - Service competency is established when the practitioner meets the acceptable standard of performance on THREE successive occasions. It is important that service competency is established for each procedure.

*Evaluation*

*The process of obtaining and interpreting data necessary to understand the individual and design appropriate treatment *. (1) *Referral*: Have to have referral from Dr. to treat. Can be generic or specific. (Dr, patient, anyone can refer themselves) (2) *Screening*: Brief evaluation. Results determine if patient needs OT or not. (3) *Developing Occupational Profile*: Part of formal evaluation. (4) *Analyzing Occupational Performance*: BASELINE - assessing ability to perform certain tasks. "How well are they functioning?" - Involves a client centered approach: Practitioner is interested in the clients viewpoint, narrative, and desires.

Types of Occupational Therapy Interventions

*Therapeutic Use of Occupations and Activities*: The selection of activities and occupations that will meet the therapeutic goals. *Preparatory Methods*: Techniques or activities that address the remediation and restoration of problems associated with client factors and body structure, with the long-term purpose of supporting the clients acquisition of performance skills needed to resume his or her roles and daily occupations. Ex = stretching, ROM, exercise, and applying heat or ice *Purposeful Activity*: An activity used in treatment that is goal directed; individual is an active voluntary participant; has both inherent and therapeutic goals. Ex = folding towels for the occupation of household maintenance *Occupation-Based Activity*: The performance of occupation related activities by the client, including activities of daily living, instrumental activities of daily living, work and school tasks, and play or leisure tasks. Requires that the activity be completed in the actual context in which it occurs. *Consultation*: A type of intervention in which practitioners use their knowledge and expertise to collaborate with client, caregivers, significant others, or other providers. *Education*: The process of gaining knowledge and education.

*Outcome*

*What do we want to see happen as a result of intervention*? Measurement of outcomes and decision-making related to the future of the direction of intervention (i.e. continue, modify, or discontinue)

Occupational Therapy Process

- Involves the interaction between the practitioner and the client. - The process is dynamic and the focus is on occupation and the client as an occupational being. *Evaluation --> Intervention --> Outcome*

Intervention (Infancy)

- Problem: developmental delays - close the gap - Guides intervention decision making: developmental frame of reference - Focus of intervention: family-centered

Outcomes may include measurable increments of progress...

... in factors related to occupational performance, such as balance, endurance, and motor skills

Occupational Therapy Practice Framework (OTPF) uses a top-down approach...

...The OT practitioner evaluates the areas of performance and occupations in which the client hopes to engage first, followed by an analysis of the performance skills or client factors interfering with performance. This approach differs from reductionistic approaches that analyze components first and subsequently design intervention based upon deficits.

Developmental tasks change over time...

...and influence the occupations in which a person engages.

Intermediate-level practitioner

...has increased responsibility and typically pursues specialization in a particular area of practice. - More indepence in the OT process; engaged in the supervision of OT students (must have 1 yr experience to be a level II fieldwork instructor), COTAs, and OT aides. At this stage, OTR may have identified an area of interest of specialization and ready to pursue. *Major Focuses* - Increased independence - Mastery of basic role functions - Ability to respond to situations based on previous experience - Participation in the education of personnel - Specialization is frequently initiated, along with increased responsibility for collaboration with other disciplines and related organizations. - Participation in role-relevant professional activities is increased.

Advanced-level practitioner

...is considered an expert, or a resource, in the respective role. - Based on experience (clinical, administrative, research, professional contribution, leadership, mentoring, education) is considered an expert, resource person, or consultant within a role. *Major Focuses* - Refinement of specialized skills - Understanding of complex issues affecting role functions - Contribution to the knowledge base and growth of the profession results in being considered an expert, resource person, or consultant within a role. This expertise is recognized by others inside and outside of the profession through leadership, mentoring, research, education, and volunteerism.

Entry-level practitioner

...is expected to be responsible for and accountable in professional activities related to the role. In states with licensure laws, entry-level practice is defined by the licensure law and supporting regulations. - Typically new to profession as an OT practitioner, having completed all educational requirements, including passing certification examination. Considered as a generalist with respect to knowledge and work experience. *Major Focuses* - Development of skills - Socialization in the expectations related to the organization, peer, and profession. - Acceptance of responsibilities and accountability for role-relevant professional activities is expected.

*Adolescence*

12-20 years of age Turmoil and peer pressure Sense of self and independence from parents Role confusion Sexual identity

OT Process

A collaborative relationship between the client and OTR

Continuing Competence

A dynamic, multi-dimensional process in which the professional develops and maintains the knowledge, performance skills, interpersonal abilities, critical reasoning skills, and ethical reasoning skills necessary to perform his or her professional responsibilities.

Activities of Daily Living

Activities involved in taking care of ones own body and include things such as dressing, bathing/showering, toileting, swallowing/eating, feeding, functional mobility, personal device care, personal hygiene / grooming, and sexual activity.

Instrumental Activities of Daily Living

Activities that may be considered optional and involve the environment. Examples = care of others, care of pets, child rearing, communication device use, community mobility, health mgmt, financial mgmt, home establishment & mgmt, meal prep / clean up, emergency procedures, religious observance, and shopping.

Interview (Information Gathering)

After discussing the purpose of therapy, the OT gathers information about the client. The interviewer guides the conversation in a way that yields the desired data yet keeps the flow easy and comfortable. - To ensure that the desired information is secured, the OT works from an interview outline.

Diagnoses (Later Adulthood)

Alzheimer's Parkinson's Strokes Cardiac Rheumatoid arthritis

Outcome Measures

An aspect of program evaluation that evaluates the results of the intervention after the service has been provided. *Examples*: - Lymphedema could be measured by: A tape measurer (precision is important to make sure there is reliability) Volumeter (uses water displacement) - ROM could be measured by: Goniometer - Pain could be measured by: A Pain Scale - Self Care could be measured by: FIM scale KELS Scorable Self-Care Evaluation - Health & Well-Being could be measured by: Short Form 36 Interest Checklist - Role Competence could be measured by: Worker Role Interview - Client Satisfaction could be measured by: Program specific questionnaires Client Satisfaction Questionnaire and the Therapist Evaluation Form

When a student graduates from an accredited educational program and passes the National Board for Certification in Occupational Therapy (NBCOT) exam, there is a basic level of competence that is assumed, and a state license is granted. At this point, the practitioner is considered to be...

An entry-level practitioner

Play

An spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion.

Education

Area of occupation that includes formal and informal learning.

Intervention Review

As the intervention is implemented, the OT reevaluates the clients progress in therapy. - Reevaluation may result in changing activities, retesting, writing a new plan, or making needed referrals.

Diagnoses (Childhood)

Autism Down syndrome Intellectual disabilities Developmental coordination disorder Head injuries Amputation Burns

*Infancy*

Birth to 1 year of age Babies: By the Age of 1 - Reflexes (grasping/sucking/stepping/startle) - Make discoveries with objects (like shaking a rattle) - Roll a ball and throw objects - Reach, grasp, crawl, roll over, and sit and stand up (without support)

Diagnoses (Infancy)

Cerebral palsy (Largest referral to OTs) Down syndrome Genetic disorders Failure to thrive Developmental delay Congenital anomalies

What is the role most commonly assumed by the OT practitioner who is just entering the field?

Direct Client Care

At what 3 levels do OT practitioners perform?

Entry, intermediate, and advanced

Interventions (Later Adulthood)

Fall prevention Safety Driving Aging in place Sensory changes Staying engaged

Developmental Tasks (Adulthood)

Finding significant relationship Securing employment Determining career path Establishing a home Raising family

Intervention (Adolescence)

Firm limits Expression Follow through Trust issues Peer groups Work-related activities Healthy leisure

Occupational Performance Analysis

From the information gathered during the occupational profile (clients needs, problems, and priorities) the practitioner makes decisions regarding the analysis of occupational performance. This information provides direction to the practitioner as to the areas that need to be further examined. - Uses assessments to gather information on a clients occupational performance in regards to areas, skills, patterns, contexts, client factors, and activity demands. This evaluation information forms the basis for the intervention plan. - Involves analyzing all aspects of the occupation to determine the client factors, patterns, contexts, skills, and behaviors required to be successful.

Developmental Tasks of Infancy

Growth and development Gross and fine motor Sleep/wake Sensory regulation Social Cognitive

Formal Assessment Procedures

Help determine the existing performance level of the client. Include tests, instruments, or strategies that provide specific guidelines (can be easily duplicated and critically analyzed). *Validity*: Having a true measure of what it claims to measure. *Reliability*: Measure of how accurately the scores obtained from the test reflect the true performance of the client. *Test-retest Reliability*: A measure of the consistency of the results of a given test from one administration to another. *Interrater Reliability*: A measure of the likelihood that test scores will be the same no matter who is the examiner. *Standardized Test*: One that has gone through a rigorous process of scientific inquiry to determine its reliability and validity (Ex = The Miller Assessment for Preschoolers (MAP), and the Sensory Integration and Praxis Tests (SIPT) both developed by OTS). *Normative Data*: Information collected from a representative sample that can then be used by the examiner to make comparisons with his or her clients. *Non-Standardized Tests*: Tests that do not provide specific guidelines based upon a normative sample; do not require standardized procedures. Help to measure function (Ex = manual muscle testing and sensory testing). - Some tests even require special training or certification before they can be administered by an OT.

*Childhood*

Includes early childhood (1-6 years old) Late childhood (6-12 years old) - Refining skills - Coordination and strength - Play

Implementation of the Plan

Intervention involves working with the client though therapy to reach client goals. *Consulting*: OTs frequently consult with other professionals, family members, and clients regarding intervention strategies. Consultation requires advanced knowledge, the ability to communicate clearly with others, and knowledge of the context in which the consultation occurs. *Education*: OTs educate the client, family, and caregivers about activities that support the intervention plan. May be formal or informal in nature.

Intervention Planning

Intervention plan is based on an analysis of the information accumulated during the evaluation. (1) *Problem Identification*: Initial step. OT reviews the results of the evaluation and identifies the clients strengths and deficits in occupational performance areas, performance skills, performance patterns, client factors, and contexts. Includes developing a hypothesis about the cause of the problem. (2) *Solution Development*: Process of identifying alternatives for intervention and forming goals and objectives. Select a model and frame of reference is an important component. (3) *Plan of Action*: Determined based on the problems and the identified frame of reference along with input received from the client. First: Create long and short term goals Second: Intervention methods that will help achieve the goals are determined - Outcome of the intervention planning process is a written report (or intervention plan). - The OT is responsible for analyzing and interpreting the data from the evaluation and formulating and documenting the intervention plan. The OTA contributes to this process.

Interview (Closure)

Interview signals when the interview is about to end by summarizing the information gathered and reviewing the next steps in the process. This technique avoids the discomfort of an abrupt "time is up" ending.

What is a practitioners level of performance based on?

It is based on attaining a higher skill level through work experience, education, and professional socialization.

Discontinuation of Services

Last step in the intervention process. - Client is discharged when he or she has reached the goals delineated in the intervention plan, when he or she has realized the maximum benefit of OT services, or when he or she does not wish to continue services. *Discharge Plan*: developed and implemented to address the resources and supports that may be required upon discharge. Plan includes recommendations for continued services (including OT, if necessary), equipment recommendations, and any therapy the client is required to follow after discharge. OT writes a discharge summary of the clients functional level, changes that were made throughout the course of OT intervention, plans for discharge, equipment and services recommended, and follow-up. The OT prepares and implements with input from the OTA.

*Later Adulthood*

Late Adulthood (65 years old +)

Outcomes may be subjective in nature

Motivation, confidence, hope, or perceived well being

Workplace Settings (Infancy)

NICU Hospitals Early intervention centers Home

Leisure

Nonobligatory activity. Includes planning as well as participation in the activity. Exploring areas of interest in considered part of leisure.

Screening

OT practitioner gathers preliminary information about the client and determines whether further evaluation and occupational therapy interventions are warranted. - Typically involves a review of the clients records, the use of a brief screening test, an interview with the client or caregiver, observation of the client, and / or a discussion of the client with the referral source. - OT initiates and directs the screening process and the OTA contributes to the screening process under the direction of an OT. Before screening tasks are preformed by an OTA, he or she must achieve service competency in the particular tasks. - If screening suggests the client is in need of services, a comprehensive evaluation is arranged. The OT then identifies a model of practice from which the evaluation is based. The model of practice helps organize the practitioners thinking. From the model of practice, the practitioner selects a frame of reference and chooses assessment instruments consistent with the frame of reference. *Assessment Instruments*: Standardized or non-standardized measurements used to obtain information about clients

Referral

OT process begins when a referral (*a request for service for a particular client*) is made - May come from a physician, another professional, or client. - May range from a specific prescription (ex = dynamic orthosis) or general suggestions ( ex = improve fine motor skills) - Federal, state, and local regulations and the policies of third party payers determine the type of referral required (ex = whether a physicians referral is necessary) and the role an OTA can have in the referral process.

*Outcomes Process*

OTs use outcome measures to determine whether goals have been met and to make decisions regarding future intervention. Outcome measures provide objective feedback to the client and the practitioner. - OTs are also interested in measuring occupational performance, client satisfaction, quality of life, role competence, prevention, and health and wellness.

Professional Development

Organizing and personally managing a cumulative series of work experiences to add to one's knowledge, motivation, perspectives, skills, and job performance. Can also to referred to as career development.

Work

Paid or volunteer activities and includes the entire range of employment activities (job seeking, job performance, retirement planning, volunteer exploration and participation)

Diagnoses (Adulthood)

Physical illnesses Psychological challenges Unhealthy habits

Intervention (Childhood)

Play as tool Play as goal School system Related services Least restrictive environment Inclusive

Developmental Tasks (Adolescence)

Puberty Social participation Career paths Identity

Intervention (Adulthood)

Re-engagement in occupations

Developmental Tasks (Later Adulthood)

Reflection and Evaluation of Life Retirement Decrease in workload Physical declines Loss Cognitive changes Family and community involvement

*Intervention Process*

Requires the practitioner to develop goals for the client, select activities, direct intervention to guide the client to learn ways of engaging in occupational performance, and monitor the results of the intervention.

Rest and Sleep

Restorative activities that support healthy participation in occupations.

Relationship

The connection of different roles to one another

Transition Services

The coordination or facilitation of services for the purpose of preparing the client for a change. - May involve a change to a new functional level, life stage, program, or evaluation. - OT is involved in identifying services and preparing an individualized transition plan to facilitate the clients change from one place to another. - Transition plan needs to be individualized to meet the goals, needs, and environmental considerations of the individual client.

Occupational Profile

The goal of this step is to gather information on the client so that an occupational profile can be developed. - Initial information: Age, gender, and reason for referral; diagnoses and medial history; prior living situation and level of function; social, education, and vocational background. - Provides the practitioner with a history of the clients background and functional performance with which to design intervention. - Who is the client? - Why is the client seeking service? - What are the clients current concerns relative to engaging in occupations and daily life activities? - What areas of occupation are successful, and what areas are causing problems or risks? - What is the clients occupational history? (i.e. life experiences, values, interests, previous patterns of engagement in occupations and daily life activities, and the meaning associated with them) - What are the clients priorities and desired targeted outcomes?

Interview (Initial Contact)

The practitioner uses the first few minutes of the interview to put the subject at ease. - Begins the interview by introducing him or herself and informs the client about the clinic, the program, and standard procedures. - Interview creates "first impression" - The client who feels welcome will begin therapy prepared to become a partner in the therapy process!

Interview

The primary mechanism for gathering information for the occupational profile. It is a planned and organized way to collect pertinent information. - The practitioner gathers information related to the individuals occupations. The practitioner asks questions regarding the clients functions in daily activities before the onset of the problem that resulted in the referral. The interview is also used as a means of developing trust and rapport with the client. In some instances, the client is asked to fill out a questionnaire or checklist before the interview. - The stages of an interview include: Initial contact Information gathering Closure

Career Development

The process of advancing within the service discipline path or transitioning into a role outside of service delivery.

Specialized Roles

These roles are typically outside of the profession. Examples = case manager, supervisor of other allied health care professionals, consultant, and activity director.

Infancy (2 months of Age)

What Most Babies Do at this Age: *Social/Emotional* - Begins to smile at people - Can briefly calm himself (may bring hands to mouth and suck on hand) - Tries to look at parent *Language/Communication* - Coos, makes gurgling sounds - Turns head toward sounds *Cognitive (learning, thinking, problem-solving)* - Pays attention to faces - Begins to follow things with eyes and recognize people at a distance - Begins to act bored (cries, fussy) if activity doesn't change *Movement/Physical Development* - Can hold head up and begins to push up when lying on tummy - Makes smoother movements with arms and legs

6 months of age

What Most Babies Do at this Age: *Social/Emotional* - Knows familiar faces and begins to know if someone is a stranger - Likes to play with others, especially parents - Responds to other people's emotions and often seems happy - Likes to look at self in a mirror *Language/Communication* - Responds to sounds by making sounds - Strings vowels together when babbling ("ah," "eh," "oh") and likes taking turns with parent while making sounds - Responds to own name - Makes sounds to show joy and displeasure - Begins to say consonant sounds (jabbering with "m," "b") *Cognitive (learning, thinking, problem-solving)* - Looks around at things nearby - Brings things to mouth - Shows curiosity about things and tries to get things that are out of reach - Begins to pass things from one hand to the other *Movement/Physical Development* - Rolls over in both directions (front to back, back to front) - Begins to sit without support - When standing, supports weight on legs and might bounce - Rocks back and forth, sometimes crawling backward before moving forward

9 months of age

What Most Babies Do at this Age: *Social/Emotional* - May be afraid of strangers - May be clingy with familiar adults - Has favorite toys *Language/Communication* - Understands "no" - Makes a lot of different sounds like "mamamama" and "bababababa" - Copies sounds and gestures of others - Uses fingers to point at things *Cognitive (learning, thinking, problem-solving)* - Watches the path of something as it falls - Looks for things he sees you hide - Plays peek-a-boo - Puts things in her mouth - Moves things smoothly from one hand to the other - Picks up things like cereal o's between thumb and index finger *Movement/Physical Development* - Stands, holding on - Can get into sitting position - Sits without support - Pulls to stand - Crawls

4 months of age

What Most Babies Do at this Age: *Social/Emotional* - Smiles spontaneously, especially at people - Likes to play with people and might cry when playing stops - Copies some movements and facial expressions, like smiling or frowning *Language/Communication* - Begins to babble - Babbles with expression and copies sounds he hears - Cries in different ways to show hunger, pain, or being tired *Cognitive (learning, thinking, problem-solving)* - Lets you know if she is happy or sad - Responds to affection - Reaches for toy with one hand - Uses hands and eyes together, such as seeing a toy and reaching for it - Follows moving things with eyes from side to side - Watches faces closely - Recognizes familiar people and things at a distance *Movement/Physical Development* - Holds head steady, unsupported - Pushes down on legs when feet are on a hard surface - May be able to roll over from tummy to back - Can hold a toy and shake it and swing at dangling toys - Brings hands to mouth - When lying on stomach, pushes up to elbows

12 months of age

What Most Children Do at this Age: *Social/Emotional* - Is shy or nervous with strangers - Cries when mom or dad leaves - Has favorite things and people - Shows fear in some situations - Hands you a book when he wants to hear a story - Repeats sounds or actions to get attention - Puts out arm or leg to help with dressing - Plays games such as "peek-a-boo" and "pat-a-cake" *Language/Communication* - Responds to simple spoken requests - Uses simple gestures, like shaking head "no" or waving "bye-bye" - Makes sounds with changes in tone (sounds more like speech) - Says "mama" and "dada" and exclamations like "uh-oh!" - Tries to say words you say *Cognitive (learning, thinking, problem-solving)* - Explores things in different ways, like shaking, banging, throwing - Finds hidden things easily - Looks at the right picture or thing when it's named - Copies gestures - Starts to use things correctly; for example, drinks from a cup, brushes hair - Bangs two things together - Puts things in a container, takes things out of a container - Lets things go without help - Pokes with index (pointer) finger - Follows simple directions like "pick up the toy"

*Adulthood*

Young Adulthood (20-40 years old) Middle Adulthood (40-60 years old) Assume responsibility for own development Time of achievement Family, social, interest, civic