OTA 220 Final Exam

otas can

Associate's degree-level training Support role in patient assessment and intervention planning May meet with patients regularly, and then report back to the OT

theory of object relations

Based on the work of Sigmund Freud, psychoanalytical. Mental illness is determined by our relations with objects in our environment, human and nonhuman. Way someone relates gives clues to lifelong pattern of object relations, developed very early. Humans have inborn drives to satisfy needs

moseys levels of group intervention

Benefit from interacting with peer in groups. Skilled leadership, learn and practice skills in peer group.

cycle of violence that consist of 3 phases

Buildup of tension Violent actions Contrition and appeasement of victim

demands of instincts

Drives for sex and self-preservation Conscience or internalized moral rules and standards Significant other people The real external world

eriksons theory

Erikson's 8 stages of psychosocial development provide the foundation for occupational therapy approaches. First - analyze the developmental stage of lag. Erickson - mental health problems occur when developmental tasks are not successfully mastered Failure at one stage may have resulting deficits. OT would design situations to facilitate growth in the deficient area.

essence of psychiatric ot is

Helping the client explore, discover, master, and manage the occupations that give life purpose and direction for that individual.

parents stressors and challenges

Often feel tremendous guilt and responsibility for their child's mental illness. May feel sadness and sense of loss. Difficulty setting realistic and limits and expectations.

populations in economic distress

Those with limited money or education have different experience of the world. This difference impacts participation in therapy.

what happened prior to moral treatment

asylums and torture

ot practitioner interactions

caring partnering informing directing

culture

is the combination of the learned patterns of interactions and the shared beliefs of a particular group.

manipulation

manipulation of adults

ot practitioners must address what

"man's goal directed use of time, interest, energy, and attention" · Occupation is activity with a purpose, a meaning unique to the person performing the activity · Engagement in occupation as essential to both physical and mental health · Evaluation of occupational functioning......

moral treatments founding principles

1.Development of "self restraint" through the use of rewards to increase self-esteem and confidence. 2.Elimination of the use of force. 3.Providing a comfortable and humane existence.

Human response to the environment:

1.Volition (Motivation) 2.Habituation (Roles and Habits) 3.Performance (Skills of the mind, brain and body)

powerful therapy

Activity that engages the entire human being - heart, mind, and body

pyschiatric rehabilitation

Adopted by some states as model for tx in the state mental health system (New York). Intensive Psychiatric Rehabilitation Treatment (IPRT). Goal: Helping persons with mental disorders to function at their best in the environments of their choice. Methods are teaching skills and providing resources Current political effort.

domestic violence

Anyone can be a victim/survivor of domestic violence, although most likely to be women. Any violence that occurs in the home between family members. Forms of domestic violence include: Physical, emotional, or sexual Economic Destruction of property or pets' Stalking

Coping Strategies for Persons with Physical Disabilities

Appraisal method of coping with physical disability Coping response may be emotion focused, problem focused, and/or perception focused OT practitioners teach coping strategies that generalize to multiple skills and occupations Goals need to be client-focused

keilhofners view

Argues that object relations theory is inadequate as a basis for practice in psychiatric OT. Believes it ignores the essential therapeutic value of individually chosen productive activity. Instead exploits the symbolic elements of activities that are not linked to functional participation in real life.

OT/OTA collaboration

Both involved in all stages of intervention process from screening and eval to d/c planning. OT take the leadership role. Differencing education prepares both for roles. OTA's expertise is performance in areas of occupation. An experienced OTA with established service competency can be very independent

Consumer movement Currently

Clarify theoretical understanding of occupations - also aware of other therapies adopting ideas: vocational rehab and therapies such as dance, music, and poetry. Increasing nursing, social work, psychology, and PT are addressing daily life activities and function in mental illness as well as physical disabilities. OTs have unique skill base in activity analysis.

consumers, families and mental health

Combined effort of consumers, their families, and professionals to reduce stigma and improve QoL. Represented and embraced by NAMI (1979). Advocate for housing, care, employment, and other services. Family support & education for mental health & illness. Recovery movement focuses on recovery with time and support. 2008 Mental Health Parity and Addiction Act 2010 Affordable Care Act

focus for mental health in family

Common problem with pediatric psych disorders is sensory modulation OR misperception of normal sensory stimulation. Affects handling and touching in parent-child relationship. Parent can control and limit sensory input for the child. OT can teach parent about compensatory techniques for sensory modulation. Psychoeducational groups on this and other topics are emergent roles and practice areas for OTs.

cota required content must include

Communication and interpersonal skills Biological and behavioral sciences Diseases and conditions treated Human development Areas of Occupation: work, play, leisure, ADLs, education, social participation Performance skills and patterns Performance contexts Client factors Activity analysis Adaptation and gradation of activities Instructional techniques Evaluation and intervention Adapting the environment

PBS (Positive Behavior Support)

Considers the environment, how it may be used to strengthen and support the student. Recognize and prevent problem behavior by early intervention. Clearly communicates rules, praises, redirects focus.

mid to late century methods in ot

Development of tranquilizers gave mental health professionals a way to restrain the body and mind without resorting to abusive methods. Led indirectly to the Community Mental Health Act of 1963 (Public Law 88-164) Research shifted emphasis from the severely mentally ill to the needs of "normal" people with milder mental health problems. Pharmaceutical industries began developing new drug treatments for both mild and severe mental illness.

The person with mental illness experiences

Discomfort (rage or sadness, for example) Disability (impaired functioning at work or at home) Risk (for self-injury or other inappropriate acts) Inability to care for oneself (hygiene or grooming)

ot and moral treatment era

Early OT - arts & crafts, classroom instruction, manual labor, games, sorts, social and self-care activities. Provide a balanced daily program of work, rest, and leisure. Occupations planned and graded for the individual. Habit and skill development emphasized. Hx of Psychiatry was important to OT.

moral treatment era

Engaged as many inmates as possible in productive work (laundry, kitchen, hospital grounds). Resulted in improved mental health for observed inmates. Became the underpinnings of the profession now known as psychiatric occupational therapy.

community mental health act

Establish community based treatment facilities. To move the mentally ill from institutions to community living. Inadequate planning and funding large numbers of deinstitutionalized patients released into the community without resources. "Transinstitutionalized" to jails, prisons, nursing homes.

occupational science since 1980

Florence Clark at USC - Occupational Science is the systematic study of the occupational nature of humans. Research in Occupational Science is generating data that helps understand the nature of occupation and validates the effectiveness of Occupational Therapy. Mental Health OT is now using and studying Sensory Processing or Sensory Modulation related to mental illness and health: Brown: Evaluation to identify sensory sensitivities and differences with strategies for compensation. Serious mental disorders often acutely sensitive to the environment, causing them to miss cues.

political environment and effort

Force at work is combined political effort of persons with mental disorder and their families - consumers!

20th century ot methods

Freudian psychoanalysis was heavily reliant on talking; many severely mentally ill patients are incapable of engaging verbally. Ice water baths and confinement with restraints served only to silence, not treat, mental illness. Prefrontal Lobotomies, insulin shock treatment, and Electroconvulsive (ECT) shock therapy similarly aimed only at controlling the body, not healing the mind.

family challenges and what they face

Guilt and fear Grief and loss Uncertainty about setting limits Uncertainly about responsibilities and boundaries Fear of getting sick themselves Fear of having children with the illness Fear that the family member may leave or become homeless Fear of the inability to manage daily family and individual occupations

families and veterans

Have higher rates of diagnosed mental disorders and experience of multiple psychological, emotional, and financial difficulties. Long separations Returning family member with PTSD "Broken hero" stereotype a barrier to community reintegration

National Alliance on Mental Illness (NAMI), 1979

Helped reduce stigma. Improve quality of life. Advocate for housing, care, employment, and other services. Peer and family support and education for mental health and illness.

focus for mental health in pediatrics

Home, early intervention, school programs. School MUST be educationally relevant. Fine motor, coping communication, sensory modulation, social skills, interpersonal interaction, all in IEP. Focus on eval of occupational behaviors. Vineland Adaptive Behavior Scale (VABS) and other tests screen for problems in occupational functioning.

chronic pain

Little in OT literature on chronic pain. Pain may result from birth defect, back injury, spinal cord injury, arthritis, fibromyalgia, and cancer. Chronic pain may lead to depression, fatigue, inactivity, isolation, loss of valued occupations, and a sense of helplessness.

FBA (Functional Behavior Assessment)

Looks at the students behavior, what purpose does behavior serve and how to intervene.

children stressor and challenges

Loss over nurturing relationship. Wonder if caused the illness. "Parentfied" child. Roles of custodian, bystander, or adversary.

ots can

Master's degree-level training Leadership role in patient assessment and intervention planning May supervise OTAs who meet with patients regularly

aging in mental disorders

May be seen at home, in community senior centers, in nursing homes, in assisted-living facilities, or in inpatient programs. Neurocognitive disorders and depression are the most common psychiatric diagnoses. Dementia and depression are common diagnoses. The type of care provided varies by location.

veterans and mental disorders

May be seen in military hospitals Veteran Administration hospitals, skilled nursing facilities, and the community. A major issue is posttraumatic stress disorder (PTSD). Veterans from different foreign wars have particular issues.

adults and mental health disorders

Normal occupations of work, family, home activities, and leisure are disrupted. Many adults are able to continue working and need accommodations. Social relationships a challenge. Mental disorders that impair social participation are a barrier to establishing relationships. As a spouse or parent, problem behaviors may be disruptive and distressing to the rest of the rest of the family.

Economic Marginalization and poverty

OTAs should recognize the role limited means has in patient ability to follow treatment plans. Limited means and education causes some patients to be reluctant to receive services or follow treatment plans: OTAs may need to help patients guard against fatalistic thinking ("Things will never change"). Be aware of differences in family structure from the generic nuclear family that impacts treatment.

developmental theory

People mature through a series of stages that occur in a fixed sequence. If emotional or social growth is interrupted, a developmental lag may result. Erikson's 8 stages of psychosocial development and other developmental theories are consistent with many of the basic ideas of occupational therapy. Developmental lag differentiates the mentally ill person from the mentally healthy one. Factors interrupt development: disease, poverty, malnutrition, trauma, emotional or social deprivation Once a lag is identified, the OT can design situations that will facilitate growth in the deficient area. Erickson's Theory of Psychosocial Development. Piaget's Theory of Cognitive Development.Comprehensive theory about development of intelligence. Gesell's Theory studied developmental milestones.Outlines main concepts common to ALL developmental theories. Focus on Erickson's Theory of psychosocial development.

ego

Performs many mental functions that deal with reality and the conflicts of the id and the superego. Important functions of the ego: Memory Perception Reality testing: ability to tell the difference between reality and fantasy and to share the reality of most Reality involves comparing and testing assumptions Human actions are influenced by defense mechanisms, actions undertaken to ward off anxiety or pain, such as displacement. examples include: displacement and suppression Mental illness occurs when the ego is unable to achieve a successful compromise between the id, the superego, and the demands of reality.

caregiver

Person in the home who provides physical and emotional care to the person identified as ill or disabled. Tend to be female. Reaction to role varies by culture. Benefit from the education, support, and advice of the OTA. OT practitioner interactions: caring partnering informing directing

HIV and AIDS

Pre-Aids: psychosocial support and information about disease transmission. Begin coping strategies. Early to mid-stage: environmental modification, adaptive equipment, other rehab measures. End-Stage: participation in areas of interest, release and exploration of feelings.

moral treatment hospital

Prescribed routine of daily hygiene and meals. Engage in employment or daily occupations

spouse/partner stressor and challenges

Question choice of partner and to leave the relationship. Guilt and grief, concerns about children in common. Difficulty setting limits and expectations.

siblings stressors and challenges

React differently depending on their age at the time of patient's onset of illness, especially young siblings. May feel confused, afraid, angry, or resentful. Adult siblings may have fears of the genetic component of mental illness. May take on the role of custodian, even at a young age.

OT Views during the 60's and 70's

Reilly, Kielhofner, Burke and others wanted a more comprehensive theory that would focus on the Occupational Nature of Human Beings. The Model of Human Occupation (MOHO) created a comprehensive theory for use in ALL practice areas including physical medicine, pediatrics and psychiatry. Human response to the environment: 1.Volition (Motivation) 2.Habituation (Roles and Habits) 3.Performance (Skills of the mind, brain and body)

1960's and 1970's climate trends

Social & political climate generated increased interest in funding for mental health research. Milder mental health issues not seriously mentally ill. New theories founded in psychiatry: Gestault therapy, milieu therapy, behavioral therapy, family therapy. Research into genetics and disorders such as schizophrenia, depression, manic depressive disorder. Genetic and environmental factors involved. Possibly viruses as well.

the future of occupational therapy

Some question regarding the role psychiatric occupational therapy in 21st century medicine. A shortage of therapists in mental health has resulted in lower salaries and perceived status. Lower salaries and status make this field an unappealing choice to the next generation of therapists. Occupational therapists will need to find a new niche in today's health marketplace, perhaps as consultants or as private family or community educators.

moral treatment (19th century)

Stressed respect for the individual. Believed that the mentally ill benefit from daily routines and purposeful work. Arose in response to neglectful and abusive treatment of the mentally ill in large institutional asylums.

the alert program

Taught to identify level of excitement or arousal and manipulate it through sensory input.

homeless adults and mental health

The homeless are extremely marginalized in society. Persons with long-term mental disorders would have been institutionalized 50 years ago. No stable base or environment leads to multiple barriers to occupational performance. Many mentally ill homeless persons have dual diagnoses. Healthcare providers, including OTs, may have difficulty appreciating the homeless.

when does someone have a mental health problem

The person with mental illness experiences: · Discomfort (rage or sadness, for example) · Disability (impaired functioning at work or at home) · Risk (for self-injury or other inappropriate acts) · Inability to care for oneself (hygiene or grooming) Difficulty in performance of human occupation and daily life activities ! "[Mental illness] is considered to be a manifestation of some behavioral, psychological, or biological dysfunction in the person (and in some cases it is clearly secondary to or due to a general medical condition)" -APA

culture difference diagnosis

The population of the United States has increased dramatically through immigration. Most foreign-born persons living in America adopt some American cultural norms while retaining some from their country of origin. Those who are in the United States illegally are cautious of obtaining medical care.

military culture and mental health

Values athleticism and feats of physical and psychological courage. OT approaches need to fill this need (aqua therapy, horticulture, gardening, etc.) Those with TBI often also have PTSD and major depressive disorder: require extensive inpatient and residential care approaches include art and expressive activities.

occupational engagement and veterans

Veterans of wars in Iraq and Afghanistan face problems in occupational engagement.

veterans, ptsd and suicide risk

Veterans of wars in Iraq and Afghanistan have high rates of PTSD, substance-related disorders, major depressive disorders, and TBIs. Approximately 8,000 veterans per year die from suicide: twice the rate for the general population

Mental health definition

a state of being, relative rather than absolute

American Psychiatric Association definition of mental health

a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities

WHO mental health definition

as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community

eriksons 2-4 years

autonomy v shame and doubt Bowel & bladder control and independence in exploring environment. Motivation shaped by attitude toward bodily functions and control.

DSM-5

contains glossary of terms of mental conditions that occur only in certain cultures.

MOHO

created a comprehensive theory for use in ALL practice areas including physical medicine, pediatrics and psychiatry.

caring

demonstrates friendliness and support for the caregiver and interest in their well-being.

partnering

engaging and involving caregiver in decision making, seeking input, acknowledging, and praising.

veterans and occupational engagement and their top 5 challenges

forming/maintaining leisure and social relationships transitioning to the student or worker role dealing with physical health issues resolving problems with sleep and rest controlling risky or distracted behaviors while driving

moral treatment era was created by who and where

france and by pinel and tukes

informing

gathering information, explain rationales or tx procedures, and clarifying information.

psychiatric rehabilitation movement

has introduced rehabilitation counselors, social workers and others to interventions used by OT's.

is the leading cause of death for African Americans aged 10 to 24

homicide

phenomenology of illness

how the person views what is happening.

id

infantile, driven only to satisfy one's own needs.

eriksons 3-5 years

inititive v guilt Preschool and kindergarten plan and accomplish goals. Develop sense of self direction.

directing

instructing and advising the caregiver, engage caregiver in providing treatment.

occupations of the homeless

living in the woods collecting cans for recycling money finding/building shelters begging busking (performing for tips)

what era did the ot start from

moral treatment era

6 major theories in psych

object relations developmental behavioral cognitive-behavioral client-centered neuroscience

Occupational therapy uses __________ to reverse the negative cycle of inactivity and disease, both mental and physical in nature.

occupation

focus for mental health in adolescence

occupation-based assessment collaborative goal-setting communication and social skills development special-needs education (gender/sexuality, substance abuse prevention) organization skills for school and family responsibility education and career-related activities organization skills for school and family responsibilities leisure and physical education activities social media and online behavior role modeling and training in ADLs and IADLs sensory modulation and cognitive/perceptual training meaningful structure based on adolescent occupations Functioning with sensory & perceptual disorders

ot approaches with aging in mental disorders

occupation-based assessment reality orientation memory-enhancing activities and skills sensory awareness environmental modification training in ADLs social and recreational activities

Eval and Tx should focus on

occupational experience and functioning of the child in the occupational roles of student, player, friend, family member, etc.

triangulTION

occurs when the person won't communicate directly with one person (the bad person) but only with someone who is viewed as "good". Destructive to the team and the patient.

superego

societal, driven to please others by following rules. Conscience or moralizer.

Narrative reasoning

study how people tell story of their life.

idosncrynic symbol

symbols that belong to individuals alone. If you use object relations theory, you must understand and study the theory extensively. Many OTs think the theory has limited use as the theory focuses on the unconscious meaning of symbols in activities, suggesting that patients do not need to develop conscious real-life skills.Developed by men: does not adequately address the psychological development of women. Objects may symbolize phallic symbols, associated with phallic stage of development.

splitting

thinking that is all or none, good or bad, and all or nothing. Not stable, may be good one day and bad on another day.

transinstitutionalized

transferring patients from one type of public institution to another, usually as a result of policy change

Erikson's birth to 18 months

trust vs mistrust Infants need nurture from mother. If needs aren't met, mistrust develops.

basic concepts of mental health

· Ability to control feelings, thoughts, and behavior. Less obvious:difficulty with everyday activities, things that most of us take for granted

people with good mental health excell in

· Daily life activities (working, learning, play) · Relationships (loving) · Exploration and growth (creating) · Conflict resolution (mature manner)

demands of instinct

· Drives for sex and self-preservation · Conscience or internalized moral rules and standards · Significant other people · The real external world