Chapter 4: Professional Standards and Responsibilities
what is one thing to remember about ethical dilemmas
it never involves just one person so identify all the stakeholders that could be affected by your decision
what about subjective statements
it should be clear which statements are objective data and which are subjective opinions
how does the education model view the individual with a disability
lacking knowledge or skills
define "reasonable accommodation"
must be provided by businesses of 15 or more employees to persons with disabilities to enable them to perform essential job functions unless such accommodations would impose an undue hardship on the business
define felt needs
needs as stated by the individual members of the target population
define perceived needs
needs of the population as reported by others (family, physicians, other professionals)
what does negative correlation mean
negative correlations range from -1.00 to 0.00; indicates as variable X increases, variable Y decreases - an inverse relationship
the role of an acute care OT can be a generalist or a specialist (what would be two types of specialties)
neonatology burns specialized practice roles require advanced knowledge and skills and therefore would not be evaluated on the NBCOT exam
are OT aides considered OT practioners
no
what does it mean that all members of the team are equally important
no one's opinion or area of competence takes precedence over the other. facility chain of command guidelines will determine who is ultimately responsible for the team's decision
is Part B free
no, Part B is considered a supplemental medical insurance program and therefore must be purchased by the beneficiary usually as a monthly premium. It is optional
all persons must be informed of the setting's privacy policies. is written acknowledgment from each person necessary
no, but a good faith effort must be made to obtain written acknowledgement from each person. if a person refuses to sign, the provider should document the efforts made; failure to obtain written acknowledgement is not a violation of the rule.
describe HIPAA
sets standards and safeguards to assure the individual's right to continuity in health care coverage and to ensure privacy and security of health care records.
define price
the financial, physical, and psychological cost of doing business
define program evaluation and quality improvement
the systematic review and analysis of care provided to determine if this care is an acceptable level of quality
how do you attain rigor in qualitative research
the trustworthiness of a study should be critiqued and strategies to increase trustworthiness should be employed.
what should you identify on the documentation
the type of note - eval, progress note, discharge plan, etc
what does "red flag" mean in terms of documentation
the use of certain words, terms and/or physician errors can result in delay, denial, and/or discharge from services. avoid these in all documentation unless they are true and accurate representations of a clien't status
define undifferentiated marketing
the use of the same marketing strategies and activities with the complete market (e.g. promoting the OT profession to the general public)
what constitutes the dependent variable in a true-experimental design
the variable that is measured - it is the variable that is influenced by the independent variable or treatment (i.e. grip strength)
describe non-experimental/correlational design
there is no manipulation of independent variable; randomization and researcher control are not possible. used to study the potential relationships between two or more existing variables (e.g. attendance at a day program and social interaction skills). describes relationships, predicts relationships among variables without active manipulation of variables.
what is the significance of technology-specific legislation
these acts support the funding and development of technological aids to compensate for performance skill deficits and client factors that can help attain OT intervention goals related to education, work, and social participation
LOS for transitional living programs (e.g. quarterway and halfway house programs) is determined by the agency's funding. what about long-term and permanent housing options (i.e., group homes and supportive apartments)
these are funded through the individual's social service benefits
describe OT eval at rehab hospitals
they can be extensive and focus on all performance skills and patterns, areas of occupation, and occupational roles that will be required in the expected environment.
how can OTA contribute to the evaluation process
they can contribute to the process but they cannot independently evaluate or initiate treatment prior to the OT's evaluation
what does Title III state about private services that serve the public. give 3 examples.
they cannot discriminate in the provision of services this includes restaurants, stores, and theaters
what are variable expenses
they change in direct proportion to the amount of services provided (e.g. splinting materials)
to be reimbursed, OT services must be properly coded and billed, as required by payers. practioners must represent their services in terms of diagnosis and procedure codes. briefly explain diagnosis codes
they describe a person's condition or medical reason for requiring services (in the US, the International Classification of Diseases is used - ICD)
what does Title III state about public places operated by private entities
they must be designed, constructed, and altered to comply with accessibility standards 1) all new construction of public accommodations must be accessible 2) physical barriers in existing facilities must be removed if removal is able to be carried out without much difficulty or expense 3) The United States Government, Indian Tribes, religious organization, and/or private tax-exempt membership clubs are exempt from ADA accessibility standards
what does AOTA Code of Ethics say about fees (2)
they must be fair and reasonable
what is the time frame on employee assistance programs (EAPs)
they provide ongoing support, intervention, and referrals as needed to a company's employees to enable these individuals to maintain this employment
how can OTA contribute to development of an intervention plan and document individual's response to intervention
under the OT's supervision
short and long term goals can also be written in the RUMBA format. what does the U stand for
understandable
describe pearson product-moment coefficient (r)
used to correlate interval or ratio data
what are correlational statistics
used to determine relationships between two variables .e.g compare progression of radiologically observed joint destruction in RA and its relationship to demographic variables (gender, age), disease severity, and exercise frequency.
describe predictive research
used to develop predictive models
how long is treatment provided in outpatient care
usually provided in short 30-60 minute sessions once a day for up to five days a week
when does LOS end at a rehab hospital
when coverage is expended. the client is then discharged to the appropriate environment.
when are nonparametric statistics used
when parametric assumptions cannot be met; less powerful than parametric tests, more difficult to reject the null hypothesis
what does OASIS stand for
Outcome and Assessment Information Set (OASIS)
who gets Part A Medicare
Part A is automatically provided to all covered by the Social Security System that meet the four Medicare medical coverage criteria
what are paraprofessionals
Personal Care Assistants and home health aides - individuals who provide primary care to enable a person with a disability to remain in his or her own home. due to the tremendous importance that these individuals have in assisting a person with disability to remain in home, OT collaboration with the personal care assistants is essential
describe Title III of the ADA
Public Accommodations and Services operated by Public Entities mandates that places of public accommodation may not discriminate against persons with disabilities with respect to their participation in or ability to benefit from the service, goods, facility, use, or other programming aspects.
explain Title II
Public Services Mandates that state and local government and their departments, agencies, and/or component parts may not discriminate against, exclude, or deny persons with disabilities participation in or benefit from the services, programs, or activities of these public entities. this includes transportation, public education, employment, recreation, social services, health care, courts, town meetings and voting
what is reimbursement in SNFs based upon
Resource utilization groups (RUGs)
what does SRB stand for
State Regulatory Board
name 3 types of parametric statistics
T test analysis of variance analysis of covariance
describe two stipulations required by Title IV of the ADA
Telecommunications 1) all televisions must include closed captioning 2) telephone companies must provide telecommunications relay services (TRS) to persons with hearing or speech impairments 24 hours per day, 7 days per week
define utilization review
UR - a plan to review the use of resources within a facility. determination of medical necessity and cost efficiency. often a component of a QI or PAI system
describe case-study design
a single-subject or a group of subjects is investigated in an in-depth manner. purpose can be description, interpretation, or evaluation. this method is easy to use in most practice settings.
define clinical/critical pathway
a standardized recommended intervention protocol for a specific diagnosis
define goal attainment scaling (GAS)
an evaluation tool that attains client's goals for intervention and measures goal attainment and intervention outcomes after a specific time period.
what is RtI
an evidence-based, structured intervention approach that uses Early Intervening Services and Positive Behavioral Supports to address behavioral problems early in a child's education.
describe assessment/treatment according to the education model
an individual's skill deficits are determined, and related goals are established to promote learning to adequately perform within a particular environment.
in Hispanic and Asian cultures,it is considered an honor to provide primary care to an elder who needs it. so what would be met with resistance.
an intervention plan that emphasizes the elder's development of independence in ADLs
how often must the transition plan be updated
annually (with appropriate service revision provided)
how does the medical model view the individual with disability
as a person who has a physiological insult that has resulted in reduced functional capacity
how does the community model view the individual with a disability
as lacking skills, resources, and supports for community participation
SOAP notes. explain A
assessment: therapist's interpretation and clinical reasoning based on objective data includes analysis of client's status and goals and prioritized problem list
how does a student receive his/her OT services if s/he is suspended
at home
describe general supervision
at least monthly direct contact with supervision available as needed by other methods
when does transitional planning begin
at the age of 14 (or younger if indicated) to help the student play a course of stud that will lead to post-school goals.
when do transition services begin
at the age of 16 or younger, if indicated to provide the student with a coordinated set of services to attain post-school goals. these services can include community experience, specific instruction and/or ADL and vocational assessment and intervention
short and long term goals should be written in the SMART manner. what does the A stand for
attainable as to what can be realistically achieved. for example, one hundred percent return is unlikely
short and long term goals can also be written in the RUMBA format. what does the A stand for
attainable/achievable
define retrospective review
audits of medical records after intervention were rendered. method to ensure appropriate care was given. a utilization review (UR) tool for third party payers that can be time consuming and costly
name 6 acceptance criteria for an early intervention evaluation
based on "at risk" status of the infant or toddler who is under the age of three 1) birth complications 2) suspected delays in development 3) failure to thrive 4) maternal substance abuse during pregnancy 5) birth to an adolescent/teen mother 6) established disability/diagnosis
what are degrees of freedom
based on a number of subjects and number of group; allows determination of level of significance based on consulting appropriate tables for each statistical test.
short and long term goals can also be written in the RUMBA format. what does the B stand for
behavioral
what did ADA Amendments Act (ADAAA) of 2008 accomplish
enacted to rectify the problems resulting from post-ADA Supreme Court decision, which drastically narrowed the ADA definition of disability and substantially limited ADA protections
what must be completed at rehab hospitals
environmental assessments of planned discharge environments
define health insurance marketplace
established by the ACA to allow consumers to compare the cost of insurance plans in their area. also known as health care exchanges
describe productivity standards
establishes the amount of direct care and reimbursable services each therapist is to provide per day. managed care pressures have increased productivity expectations in some practice areas resulting in ethical dilemmas and/or ethical distress
what's the difference between ethical distress and ethical dilemma
ethical distress is when a therapist knows the correct action to take but an existing barrier prevents the therapist from taking this course of action. ethical dilemma occurs when there are two or more potentially morally correct ways problem but each solution precludes the other
what are the rules regarding legibility and spelling/grammar
handwritten notes should be legible. correct grammar and spelling is required because errors detract from a professional presentation
what is required on documentation written by an OTA or a student (if required by law or facility)
co-signer
what is person first language
"a parent with schizophrenia" not the schizophrenic
correlational research can be "ex post facto" what does this mean
(after the fact) variables are studied after their occurrence
name 6 steps to a needs assessment
1) describe the community: its physical, social, cultural, and economic factors; and populations at risk 2) describe the target population's demographics, disorders, functional levels, and presenting problems 3) identify specific needs of target population (this includes perceived needs, felt needs, and real needs) 4) determine discrepancy between real, perceived, and felt needs 5) establish unmet needs according to priority 6) identify resources available for program implementation (can be formal or informal)
what is the LOS of a clubhouse program
indefinite and members can exit and reenter a clubhouse community at will
describe non-skilled client tasks
(e.g. contact guarding a client during transfers) can only be delegated to an OT aide after the OT has determined that the following conditions have been met: 1) anticipated result of delegated task is known 2) performance of delegated task is predictable and does not require any adaptation, judgment, and/or interpretation by the aide 3) the patient's situation and the practice environment are stable and will not require adaptation, judgment, etc 4) patient has previously demonstrated some capabilities in performing the task 5) aide has been appropriately trained in the competent performance of the task and is able to demonstrate service competency in task performance 6) aide has received specific instructions on task implementation relevant to the specific client with whom the aide will be performing the delegated task 7) the aide knows the precautions of the designated task and patient signs and symptoms that could indicate the need to seek assistance from OTA or OT
during the exam, if an exam item has the clinic hiring an OT aide to decrease staff workload, what would the correct answer entail and not entail
-correct answers would involve having the aide prepare the clinic area for intervenion -incorrect answers would have the aide doing transfer training Aides CANNOT evaluate or provide intervention!
what number range would indicate high correlations
.7 to 1.00
what number range would indicate low correlations
0 to .34
what number range would indicate moderate correlations
0.35 to 0.69
how many years of experience must a practitioner have to independently supervise fieldwork students
1 year
what types of things are OTs frequently consulted for in nursing homes (6)
1) ADL treatment 2) seating adaptations 3) positioning ideas 4) environmental modifications 5) psychosocial interventions 6) activities programming
Describe the accreditation process (4)
1) Accreditation is initiated by the organization submitting an application for review or survey by the accrediting agency 2) a self-study or self-assessment is conducted to examine the organization based on the accrediting agency's standards 3) an on-site review is conducted by an individual reviewer or surveyor or a team visiting the organization 4) once accredited, the organization undergoes periodic review, typically every three years
name three forensic setting and their admission criteria
1) Jail - a city or county facility which is the individuals first entry into the criminal justice system and the placement for those convicted of crimes with sentences of less than a year 2) prison - a state or federal facility for individuals found guilty of crimes with sentences greater than a year 3) forensic psychiatric hospital or unit - a specialized hospital or unit within a hospital which provides inpatient psychiatric care for individuals convicted of a crime and found guilty but mentally ill or not guilty by reason of insanity
describe 11 aspects of the principles of procedural justice
1) OTs will abide by all local, state, and federal laws, institutional policies and AOTA Code of Ethics. 2) practioners are responsible for ensuring that those they supervise provide just services and administrators and employers understand OT's Code of Ethics and its relevance to practice 3) respond to referrals in a timely manner as determined by law, regulation, or policy 4) maintain awareness of current laws and AOTA policies and official documents that apply to the profession of OT - inform employers, employees, colleagues, etc of applicable policies and laws 5) hold requisite credentials for OT services 6) provide appropriate supervision in accordance with AOTA official documents and relevant laws, regulations, policies, procedures, standards, and guidelines 7) obtain all necessary approvals prior to initiating research activities 8) report to appropriate authorities any acts in practice, education, and research that are unethical or illegal 9) bill and collect fees legally and justly in a manner that is fair, reasonable, and commensurate with services delivered 10) documentation for reimbursement needs to be done in accordance with applicable laws, guidelines, and regulations 11) refrain from participating in any action resulting in unauthorized access to educational content or exams
name three coefficients used in correlational statistics
1) Pearson product-moment coefficient (r) 2) Spearman's rank correlation coefficient (rs) 3) intraclass correlation coefficient (ICC)
name three places an individual at a rehab hospital can be discharged to
1) SNF 2) supportive community residence 3) home/independent living
name 3 entities exempt from ADA employer guidelines
1) US government 2) Indian Tribes 3) Private tax-exempt membership clubs
name 8 motivating job characteristics a manager can use to motivate and retain staff
1) a fair and competitive salary and benefits package 2) job security, realistic performance expectation, and fair employment policies 3) a good working environment with a relaxed, friendly atmosphere, adequate physical space, and sufficient current equipment and supplies 4) challenging, satisfying work and diverse caseloads 5) competent supervision with adequate feedback on job performance 6) active mentorship and support for professional development 7) tuition reimbursement and financial support for conferences, workshops and/or post-professional education 8) recognition of contributions and achievements
name the three criteria for classifying an individual as disabled
1) a person with a physical or mental impairment that substantially limits one or more major life activities. 2) a person having a record of such an impairment 3) a person regarded as having such an impairment
name three things the AOTA's Code of Ethics and HIPAA have in common
1) a person's right to confidentiality 2) a person's right to privacy 3) a person's right to informed consent
what needs to be in the intervention plan documentation (5)
1) a prioritized problem list 2) goals related to problem list and indicating potential for function and improvement 3) activities and/or treatment procedures and methods related to stated goals and problems 4) type, amount, duration, and frequency of treatment needed to accomplish goals 5) explanation of treatment plan to client and a provision of statement of goals in client's words
describe 7 aspects of the principle of fidelity
1) accurate representation of colleagues' contributions and qualifications and the prevention, correction, exposure, and reporting of ethical breaches in conduct are required. 2) safeguard private information about employees, colleagues, and students unless otherwise mandated or permitted by relevant laws 3) address incompetent, unethical, illegal practice that jeopardizes the safety or well-being of others 4) avoid conflicts of interest or conflicts of commitment in employment, volunteer roles, or research 5) do not exploit resources of employer for personal gain 6) do not harass peers - no derogatory communication 7) use conflict resolution an internal dispute resolution resources as need to resolve interpersonal conflicts
name 5 types of reasonable accommodation
1) acquisition or modification of equipment or devices 2) modifications or adjustments to exams, training materials, or publications 3) provision of ancillary aids or services 4) modified or part-time work schedules, job restructuring, or reassignment to a vacant position 5) improvement of existing facilities used by employees so they are usable by and accessible to persons with disabilities and/or other similar accommodations
OT practitioners are competent in many domains of concerns but our scope of practice does have limits. be prepared to recognize these limits. for example, an exam item is about a parent distraught over her child's TBI angrily questions the meaning of life and the relevance of her faith. a correct answer would include what two things
1) active listening AND 2) referral to pastoral care
name 5 disorders not protected by the ADA
1) actively abusing substances 2) compulsively gambling 3) kleptomania 4) pyromania 5) sexual behavior disorders
name 10 things that must be in the intervention implementation documentation
1) activities, procedures, and modalities used 2) pt's response to treatment and the progress toward goal attainment as related to the problem list 3) goal modification when indicated by the response to treatment. rationale for changes in goals needed. 4) change in anticipated time to achieve goals with rationale for change and new time frame specified. 5) attendance and participation with treatment plan 6) statement of reason for individual missing treatment 7) assistive/adaptive equipment, orthoses, and prostheses if issued or fabricated and specific instructions for the application and/or use of the item, including wearing schedule and care. 8) patient-related conferences and communication with physicians, third party payers, case manager, team members, etc 9) home programs developed and taught to client and/or caregivers 10) client's and/or caregiver's compliance with home program
name 6 ways to attract potential qualified applicants
1) advertise in trade publications, state and national OT association newsletters, and/or online 2) network internally within own organization and externally at local, state, and/or national OT meetings and conferences and through established OT contacts 3) conduct open houses, job fairs, and workshops 4) direct mail recruitment information to OT practitioners. 5) use placement agencies 6) train and educate fieldwork students
name 5 things you cannot ask (they will violate civil rights legislation or ADA)
1) age 2) sexual orientation 3) marital status or family composition 4) race or national origin, religion or political beliefs 5) physical, mental, or cognitive disabilities
describe interdisciplinary teams
1) all disciplines relevant to the case at hand agree to collaborate for decision-making. evaluation and intervention is still conducted independently with defined areas of each profession's expertise. however, there is greater understanding of each discipline's perspective. members are directed toward a common goal and not bound by discipline-specific roles and functions. members tend to use group process skills effectively (during team treatment planning meetings). the exchange of info, prioritization of needs, and allocation of resources and responsibilities are based on members' expertise and skills
the IDEA Improvement Act provided for increased flexibility in IEP meetings. describe 3 ways it does that.
1) allows IEP team members to be excused from IEP meetings if their area of concern is not being addressed or modified at the meeting or if a written report is submitted prior to the meeting. district and parental approval for a team member's absence is required. 2) allows IEP revisions and/or amendments to be made by parents and districts after an annual IEP meeting. parents must be provided with a written copy of the revised/amended IEP 3) allows the use of technological alternatives to face-to-face IEP meetings (videoconferences, conference calls)
name 4 major marketing tasks
1) analyze market opportunities 2) analyze the market to be targeted for purchase of products or services 3) develop marketing strategies to address the Ps of a market plan for the OT service 4) implement and evaluate marketing plan
what is common variance in correlational statisitics
a representation of the degree that variation in one variable is attributable to another variable
written consent must be obtained from a person before what 3 circumstances. also name two exemptions
1) any personal health information is used or disclosed in the provision of treatment, 2) obtainment of payment or 3) the carrying out of any health care related operations. 2 exemptions 1) emergency treatment 2) language barriers preclude signed acknowledgement, treatment can occur if the physician believes consent is implied. an interpreter must be sought. if an interpreter is not available, treatment can be implemented if the provider believes that consent is implied by the person's actions. documentation of this determination is required.
name 4 important steps in performance appraisal
1) articulate specific and clear expectations for performance 2) document positive performance to substantiate quality care and to support recommendation for merit pay, raises, bonuses, and/or promotions 3) document substandard performance to identify areas requiring quality improvement, further training, increased supervision, and/or disciplinary action 4) meet privately with employee to discuss written performance appraisal, allow employee feedback and develop a plan for remediation, if needed, and a plan for ongoing professional development.
name two aspects of OT evaluation in the schools
1) assess client factors, performance skills and patterns, and areas of occupation that impact on the education and functional performance of the child within the school. findings are used to contribute to the IEP, in which goals and objectives are formulated to address the overall educational needs of the student 2) assess the child's functional and developmental level to contribute to the Functional Behavioral Analysis
name 5 staff development steps
1) assess employees' development needs and interests 2) assess organization's strategic plan to identify existing and new areas planned for OT service that may require staff training 3) provide mentorship and supervision 4) provide educational in-services, workshops, and practical on-site experiences 5) support self-directed learning, such as journal reviews, self-study courses, only networking, teleconferencing, off-site workshops and/or post professional education
name 7 things that need to be in evaluation and reevaluation documentation
1) assessments administered and the results 2) summary and analysis of assessment findings in measurable, functional terms (in reevaluation, compare findings to initial findings) 3) references to other pertinent reports and information including relevant psychological, social and environmental data. 4) occupational therapy problem list, specific and sufficient to develop intervention plan 5) recommendations for OT services (can include recommendation that no OT services are indicated) 6) client's understanding of current status and problems, his or her subjective complaints 7) client's interest and desire to participate in therapy
The IEP can include what two things that OT can assist with
1) assistive technology 2) behavioral interventions
name 7 areas of focus for OT intervention in the schools
1) based on an educational model versus a medical model 2) addresses the student's functional performance along with academic performance 3) activities are utilized to address the goals and objectives documented in the IEP using both corrective and compensatory methods 4) assistive technology and transition services, in accordance with the regulations of IDEA, are provided 5) performance skill deficits and client factors (i.e., sensorimotor, cognitive/process, and psychosocial/communication/interaction) are treated to improve the child's ability to participate in and perform education-related activities within a school setting 6) skills in the performance areas of ADL, school, and play are developed to improve the child's ability to participate in and perform education-related activities within a school setting 7) skills for adult life post-school are developed in accordance with the student's transition plan.
describe 8 aspects of the principle of veracity (8)
1) be honest, fair, complete, and accurate 2) practioners must always accurately represent their credentials, experience, competence, and qualifications and must fully disclose any potential conflicts of interest that may occur 3) record and report in an accurate and timely manner 4) identify and fully disclose to all appropriate persons errors or adverse events that compromise the safety of service recipients 5) ensure that all marketing is truthful, accurate, and carefully presented to avoid misleading recipients of service 6) describe the type and duration of OT services accurately in professional contracts 7) be honest, fair, accurate, respectful and timely in gathering and reporting fact-based information regarding employee job performance and student performance 8) give credit and recognition when using the work of others
describe beneficence (5 aspects of this principle)
1) beneficence refers to the well-being of individuals and the advocacy of well-being for others. services need to be fair, ethical, unbiased with reasonable fees commensurate with the services provided - 2) make sure eval and intervention techniques are evidence-based and within scope of OT practice. 3) take steps to ensure one's own proficiency (maintain competency) 4) terminate OT services when services are no longer beneficial 5) research must be ethical too
what is the role of OT in the case of child abuse (2)
1) child welfare advocate 2) OTs can also provide services to treat the emotional and physical disorders that can result from abuse
name 7 words to avoid because they do not reflect progress
1) chronic 2) status quo, no change in status 3) maintaining 4) little change 5) plateau 6) making slow progress 7) stable or stabilizing
what are the two different focuses of case management programs
1) clinical case management 2) administrative case management
supervision occurs along a continuum - name the 4 types of supervision on that continuum from most supervised to least supervised
1) close 2) routine 3) general 4) minimal
OT eval for early intervention services consists of assessment of five developmental areas. what are they?
1) cognitive 2) physical 3) communication 4) social-emotional 5) adaptive
name 5 major personnel management tasks
1) design work roles and write job descriptions 2) recruit, select, and orient personnel to perform the roles 3) supervise and evaluate personnel to ensure adequate role performance and the attainment of organizational goals. 4) support personnel's outgoing professional development 5) deal with difficult personnel issues as they arise
define tests of significance
an estimation of true differences, not due to chance; a rejection of the null hypothesis
name 6 fieldwork education managerial tasks
1) collaboration with the academic education program to develop specific fieldwork learning objectives and activities consistent with the facility's and school's philosophies and missions 2) development of professional development plans and activities for the students' clinical supervisors to ensure adequate fieldwork supervision 3) establishment of departmental policies and procedures for a student program and its supervision 4) assurance of quality care provided by students according to established program standards and professional ethics 5) evaluation and supervision of students' performance and completion of ACOTE's evaluation tool. 6) completion of cost-benefit analysis to collect data for institutional support of clinical education
name 4 ways to analyze market opportunities
1) conduct a self-audit to assess strengths and weaknesses of oneself and/or one's organization 2) conduct a consumer analysis to determine consumer needs and desires for services or products 3) identify potential competitors to clarify areas of service overlap/product similarity and to identify areas that are underserved or unserved 4) assess the environment to determine political, sociocultural, economic, and/or demographic factors that may impact on the products or services
name 7 ways to enhance dependability
1) conducting a dependability audit 2) triangulation of data 3) comprehensive description of research methods 4) peer review 5) member check 6) code-recode procedures 7) step-wise replication
name 5 areas of focus in residential programs
1) consultation to and/or supervision of residential program staff 2) remediation of underlying performance skill deficits and compensation for client factors that impact independent living skills 3) ADL training, activity adaptation, and environmental modifications to facilitate community living skills. 4) referral to appropriate residential services along the continuum of care as individual's functional level improves. 5) education about ADA, the Fair Housing Act, and Section 8 housing
what must be included in medicare documentation. (7)
1) content must indicate that the treatment shows a level of complexity that requires the judgment, knowledge, and skills of a qualified therapist. 2) skilled rehab intervention is mandatory (delineate the specific skilled care rendered. this is the biggest cause for retroactive denial) notes must show therapeutic intervention. for example, dressing does not indicate therapeutic concerns. Decreasing extensor tone to enable dressing meets these criteria 3) skilled care rendered must match the diagnosis and the physician's order 4) services must be unique to OT and not sound like PT or SLP. Medicare does not pay for duplication of services 5) document honestly but not over-optimistically. medicare reviewers are interested in determining the need for continued intervention. if a person has improved but can benefit from further intervention, document this need, rather than emphasizing the improvement. provide behavioral observations that substantiate need for further care. 6) practical improvement should be noted with functional change - if improvements are not made, the client should be discharged in timely fashion. if there is a reason for the lack of progress, it should be noted. 7) the service must be reasonable and necessary - was the service effective and completed in a timely fashion? in long-term care, if the treatment does not lessen the amount of care needed by the staff, what made the service worthwhile.
results of program evaluation should result in the initiation of appropriate program actions. name three.
1) continue and/or expand programs that have demonstrated good efficacy/positive outcomes. 2) change or modify programs that have demonstrated limited efficacy/satisfactory outcomes 3) discontinue programs that have demonstrated poor efficacy/unsatisfactory outcomes.
there are three categories of One-Stop services. name these three types of services
1) core services 2) intensive services 3) training services
name 4 criteria of trustworthiness
1) credibility 2) transferability 3) dependability 4) confirmability
describe 7 purposes of research
1) critical evaluation and consumption of research literature enhances one's theoretical and philosophical foundations, improves clinical reasoning, and critical thinking, increases professional knowledge and skills, and facilitates evidence-based decision-making 2) application of research literature ensures practice is current, meaningful, and competent which ultimately improves the quality of life of individuals receiving OT services 3) knowledge of research provides opportunities to address questions that arise daily in professional practice 4) the development and implementation of research projects that test and establish the efficacy of OT evaluation and intervention is essential to the provision of evidence-based practice (EBP) 5) acquisition of scientific knowledge can provide answers to practice questions and help solve problems encountered in practice 6) development of a body of professional research contributes to the science of a profession and provides a body of knowledge to guide practioners. 7) participation in research to evaluate program outcomes is a requirement of most practice settings and accrediting bodies
describe the 6 steps of program planning
1) define a focus for the program based on the needs assessment results 2) adopt a frame or frames of reference that are most likely to successfully address and meet the needs that are the program's focus 3) establish objectives and goals of the program specifically related to primary focus 4) describe integration of program into existing system of care 5) develop a system of referral for entry into, completion of, and discharge from the program 6) describe the fiscal implications of program plan
name four social movements that have precipitated federal legislation (and also affect OT practice and people with disabilities)
1) deinstitutionalization 2) early intervention 3) mainstreaming 4) full inclusion
name 10 methods (steps) of program evaluation
1) describe program objectives and goals to determine program outcome criteria 2) identify measurable indicators based on objectives and goals 3) describe population, staff, services provided, intervention methods, scope of care, and length of treatment 4) design an evaluation study 5) select methods to collect data 6) collect and organize data 7) evaluate and analyze results and limitations of the study 8) report results, highlighting information to determine program's efficacy 9) use results to initiate appropriate program actions 10) evaluate effectiveness of these actions
name 4 areas of OT evaluation and intervention for individuals in forensic settings
1) determination of individual's competency to stand trial, in forensic psychiatry settings 2) areas similar to those described under rehabilitation hospitals to develop community living skills needed for successful community reintegration upon release. 3) facilitation of skills and provision of structured program to enable the person to function at his/her highest level within their current environment since discharge may be delayed or not possible, depending on the nature of the crime 4) restoration of competency to stand trial in forensic psychiatry settings
what other area is considered in the eval for early intervention services
1) determination of the effects of current development on the occupational areas of play and ADLs
what three fiscal things do you need to consider
1) determine projected volume or service demand to estimate revenue 2) identify resource utilization and projected expenses to estimate cost 3) directly compare estimated revenue and estimated expenses to determine financial viability of the program
name 7 fiscal management tasks
1) develop revenue and volume projections 2) use cost-effective charging procedures and fee structures 3) manage payroll and staffing budgets 4) schedule staff in a cost-effective manner that meets productivity standards 5) plan for short and long-term program needs including capital expenses 6) manage general, administrative, and operating expenses 7) meet organization's revenue expectations
name 5 aspects of OT intervention for early intervention programs
1) development of cognitive/process, psychosocial/communication/interaction, and sensorimotor skills 2) development of play and activities of daily living skills 3) provision of family education 4) provision of advocacy and advocacy training 5) transition planning from early intervention to preschool is essential
describe the two methods of supervision
1) direct - face-to-face contact between supervisor and supervisee - includes co-treatment, observation, instruction, modeling and discussion 2) indirect - non face-to-face contact between supervisor and supervisee - includes electronic, written and telephone communications
name 6 methods to collect data during program evaluation
1) direct observation and/or review of client charts 2) safety checklists, incident reports and/or client/family complaints 3) surveys of clients, families, and/or staff 4) review of treatment sessions and missed treatments 5) initial, discharge and follow-up assessments 6) review of statistics on costs and service volume
name 14 community-based practice settings
1) early intervention programs 2) schools 3) supported education programs 4) prevocational programs 5) vocational programs 6) residential programs 7) partial hospitalization/day hospital programs 8) clubhouse programs 9) adult day care 10) outpatient/ambulatory care 11) home health care 12) hospice 13) case management programs 14) wellness and prevention programs
name 3 areas of OT intervention focus for adult day care programs
1) engagement in purposeful activities that provide appropriate stimulation, reflect lifelong interests, develop new interests, and foster a sense of community with other participants. 2) caregiver education, support groups, home visits, consultations, and referrals to community resources 3) modifications to the day care center's environment and the individual's home environment to maximize the person's comfort in and master and control of these environments
name 6 ways to integrate a new program into existing system of care
1) establish a realistic timetable for program implementation 2) define staff roles, responsibilities, and assignments 3) identify methods for professional collaboration 4) determine the physical setting and space requirements 5) consider potential barriers to program implementation 6) develop methods to effectively deal with identified obstacles before program implementation
name 5 things to consider for the implementation and evaluation of your marketing plan
1) ethics - ie truth in advertising 2) undifferentiated marketing 3) differentiated marketing 4) concentrated marketing 5) ongoing assessment and periodic review is needed to determine market plan's effectiveness and to modify, as needed
what is a prospective review and who uses it
1) evaluation of proposed intervention plan that specifies how and why care will be provided used by third party payers to approved proposed OT intervention program
what three types of criteria do you need to establish for a new program
1) evaluation protocols to standardize information to be obtained from each person referred to the program and to assess the type of program services needed 2) criteria for acceptance into program and for movement through program levels 3) discharge criteria to determine when an individual has achieved maximum gain from the program, usually defined as the achievement of program goals
name two rules about documenting evals for early intervention services
1) evaluations need to be written in strength-oriented manner 2) functional goals must be written in family friendly terms and include levels of functioning, unique needs, and recommended services.
define the 4 aspects of negligence
1) failure to do what other reasonable practioners would have done under similar circumstances 2) doing what other reasonable practioners would not have done under similar circumstances 3) the end result was harm to the individual 4) every individual (OT, OT student, OTA, or OTA student) is liable for their own negligence
OT eval and intervention in long-term acute care hospitals (LTAC) are limited by the population's severe and complex medical needs. tell me 2 things about OT evaluation and intervention in this setting
1) for all clients, evaluation and intervention is concerned with palliative care and the prevention and treatment of complications (positioning to prevent decubiti and contractures. 2) for individuals who are cognitively intact, the focus of evaluation and intervention is mastery of the environment and the attainment of client-centered goals.
name two common circumstances OTs find in eval and intervention at SNFs
1) for individuals with rehabilitation potential, the focus of evaluation and intervention is the same as identified under rehab hospitals 2) for individuals without rehabilitation potential, evaluation and intervention is more concerned with palliative care and maintenance of quality of life.
name 5 foci of OT intervention in rehab hospitals
1) functional improvement in performance skills and patterns, areas of occupation, and occupational roles. 2) development compensatory strategies for residual deficits and client factors 3) provision of adaptive equipment and training in use of the equipment to promote independent function 4) modification of the discharge environment as needed to enhance function 5) education of the individual, family, and caregivers on abilities, limitations, compensatory techniques and advocacy skills
what is the focus of OT intervention (3)
1) functional improvements in performance skills and areas of occupation 2) active engagement of the client in the treatment planning, implementation, and re-evaluation process. 3) discharge planning to expected environments
detail 4 areas of OT intervention focus
1) functional improvements in performance skills and patterns and areas of occupation 2) development of compensatory strategies for residual deficits and client factors 3) maintenance of quality of life 4) development of skills for discharge to the least restrictive environment
name five potential reasons for d/c to put on d/c plan
1) goals attained 2) client no longer making functional gains 3) client refuses or is noncompliant with intervention 4) client moves to another location 5) setting not appropriate to individual's needs
what are the Medicare documentation guidelines for homecare
1) homebound status due to functional limitations must be clearly delineated. if the diagnosis may not render the individual home bound, explain why this particular person is homebound. do not give a reviewer any doubt that this person does not meet Medicare homebound criteria (e.g. do not state client not at home when you arrive. rather state there was no answer to a locked door)
name 6 places of public accommodation
1) hospitals 2) health care providers' offices 3) schools 4) day care centers 5) restaurants 6) theatres
name 8 steps (in order) of the research process (before data collection)
1) identification of a broad issue, topic, or problem of interest and relevance that warrants scientific investigation 2) review and synthesis of research literature related to identified area of interest 3) utilization of a theoretical base to frame the research problem or area of concern to ensure that the resulting research contributes to, or builds upon, theory 4) development of a specific question or focus for research 5) selection of a research design 6) formulation of methodology 8) determination study's length 9) identification of study's participants/population sample
name 4 ways to gather information when making ethical decisions
1) identify all individuals affected by the issue 2) determine prior history of the issue 3) analyze the dynamics and culture of the setting 4) ask open ended questions to obtain descriptive data
describe the 6 steps of ethical decision making
1) identify the ethical issues and potential dilemmas 2) gather relevant information 3) determine conflicting values and areas of agreement 4) identify as many relevant alternative courses of action as possible 5) determine all positive and negative outcomes for each possible action 6) weigh, with care, the consequences of each outcome. 7) seek input from others 8) apply best professional judgment to choose the actions recommended 9) contact any and all agencies that have jurisdiction over a practioner if there are questions about potential ethical violations that could cause harm or have potential to cause harm to a person 10) determine desired and/or potential outcome of filling an ethical complaint
when is the institution liable (2)
1) if the individual was harmed as a result of an environmental problem (falls resulting from slippery floors, poorly lit areas, lack of grab bars) 2) if an employee was incompetent or not properly licensed.
what is the length of service provision in early intervention programs
1) if the infant/child qualifies for services, an infant family service plan is completed by the service coordinator after a review of all assessments and collaboration with the family and early intervention team. 2) six-month reviews are submitted by all professional to determine if services should continue
name 3 areas of OT intervention for supported education programs
1) improvement in performance skills and patterns that are needed for the occupational role of student (e.g. time management and task prioritization) 2) education and training in compensatory strategies to support academic performance (e.g. studying in a quiet room) 3) exploration of participant's educational interests and aptitudes to ensure self-determined engagement in a school, college, technical training program, or community-based adult-education classes.
name three areas of OT intervention focus for prevocational programs
1) improvement in task skills and social skills that is prerequisite to vocational training or work 2) development of work habits and abilities 3) exploration of work interests and aptitudes to ensure discharge to a relevant vocational training program, school or work setting.
the development of a question - how does this differ in qualitative vs. quantitative research
1) in quantitative research, this is very specific, detailing the exact variables to be studied. 2) in qualitative research, this is a broad question called a "query" that will develop specificity over the course of the study
errors in physician's orders can result in denial or delay of payment in OT services. name 8 circumstances in which this can happen
1) incomplete or non-specific orders 2) orders with a span of frequency over the duration of intervention (e.g. 2-3 times/week for 4-6 weeks) 3) orders that do not state a specific type of intervention (e.g. activities, splint or equipment as needed) 4) orders that cover only evaluation but intervention has been initiated 5) order is specific to a certain type of treatment, but the treatment plan does not include it. 6) order does not include the duration of treatment 7) the plan changes mid-month but the order is not updated to meet the new plan change 8) there is no discharge order or there is no order immediately after treatment ends
name 2 areas of OT intervention focus unique to homecare
1) increasing ability to resume occupational roles outside of the home 2) prevention of hospitalization and avoidance or delay of residential institutional placement
name two types of goals you need to make in program planning
1) individual goals which will be met by the program 2) programmatic goals which will establish standards for program evaluation
name 16 signs of patient/client abuse
1) individual's report of abuse and/or neglect 2) frequent unexplained injuries or complaints of pain without obvious injury 3) burns or bruises suggesting the use of instruments, cigarettes, etc. 4) passive, withdrawn, and emotionless behavior 5) lack of reaction to pain 6) sexually transmitted diseases or injury to the genital area 7) unexplained difficulty sitting or walking 8) fear of being alone with caretakers 9) obvious malnutrition 10) lack of personal cleanliness 11) habitually dressed in torn or dirty clothes 12) obvious fatigue and listlessness 13) begs for food, water, or assistance (especially in regard to toileting) 14) in need of medical or dental care 15) left unattended for long periods 16) bedsores and skin lesions
name four components of program implementation
1) initiate program according to timetable and steps set forth in the program plan 2) document program activities, procedures, and use 3) communicate and coordinate with other programs within the system 4) promote program to ensure it reaches target population
name 6 mandated Medicaid services
1) inpatient and hospital services 2) outpatient (laboratory work, x-rays, skill nursing) and physician's services 3) Home health (level and amount of care can vary) 4) early periodic screening diagnosis and treatment services (EPSDT) for persons 21 years and younger. 5) services identified as needed to treat a condition during EPSDT (including OT) must be provided 6) SNFs receiving Medicaid must provide skill rehab services (including OT) to resident who require them.
name three things in the conclusion section
1) interpretation of the results 2) comparison of study's findings to those presented in the lit review 3) analysis of findings supportive and nonsupportive of the hypothesis
name four types of teams
1) intradisciplinary 2) multidisciplinary 3) interdisciplinary 4) transdisciplinary
name 2 disadvantages of survey research
1) limited or poor response rate 2) missing or inaccurately completed data
name 3 areas of OT intervention that are unique to hospice services
1) maintenance of the individual's control over life. 2) facilitation of engagement in meaningful occupations and purposeful activities that are consistent with the individual's roles, values, choices, interests, aspirations, abilities, and hopes that contribute to a satisfactory quality of life. 3) reduction or removal of distressing symptoms and pain
name three things in the summary
1) major contributions, practical or theoretical implications that can be drawn from the study 2) brief suggestions for improvements to the study's design and procedures 3) proposals for new research based on study's findings
there have been multiple acts that have provided the foundation for current early intervention and education services. name five mandates of these types of acts
1) mandates free and appropriate education for all children regardless of ability or disability (ages 3-21) in the least restrictive environment. mainstreaming (integrating children with disabilities into classrooms) was the means to ensure education is provided in the least restrictive environment. 2) requirements for public schools to provide OT to special education students if OT is needed for the student to benefit from the special education. 3) the designation of OT as a primary early intervention service 4) funding for family support services and programs to train professionals in early education 5) recommendations for states to develop infant and toddler programs (birth - 3 years). these programs are voluntary and vary from state to state but all states participate in some degree. OT is considered a primary developmental service.
data can by analyzed and interpreted with descriptive statistics and inferential statistics. name two measures used in descriptive statistics
1) measures of central tendency - a determination of average or typical scores 2) measures of variability - a determination of the spread of a group of scores
due to managed care constraints on acute hospital stays, many individuals are being admitted to SNFs for what two things
1) medical care 2) rehabilitation
name 7 factors that influence effective team functioning (remember correct exam items will adhere to these principles of team collaboration)
1) membership skill and knowledge 2) membership stability 3) commitment to team goals 4) good communication 5) membership composition 6) common language 7) effective leadership
when is DME covered by Medicare
1) must be used in beneficiary's home 2) must be necessary and reasonable to treat an illness or injury or to improve functioning 3) a physician's prescription is needed and must include diagnosis, prognosis, and reason for DME need 4) repeated use can be withstood 5) primarily and customarily used for a medical purpose (e.g.w/c or walker) 6) *****generally not useful to a person in the absence of injury or illness ****
what identification and background information needs to be included in documentation (5)
1) name 2) age 3) gender 4) date of admission 5) treatment diagnosis 6) case number 7) referral source, reason for referral, chief complaint relevant to OT's domain of concern 8) pertinent history that indicates prior level of function and support systems. Including applicable developmental, educational, vocational, socioeconomic, and medical history 9) secondary problems or pre-existing conditions that may affect function or treatment outcomes 10) precautions, risk factors, and contraindications, medications and surgery dates
name the four basic steps of program development
1) needs assessment 2) program planning 3) program implementation 4) program evaluation
describe 5 aspects of the principle of nonmalefience
1) no harm is done to patient. relationships between OTs and the recipients of their services must be non-exploitative, objective, and professional at all times. 2) ensure appropriate transitions when unable to provide services for any reasons 3) avoid dual relationships - esp. avoid sexual activity with a recipient of service - including the client's family or significant other, student, research participant, or employee while a professional relationship exists 4) avoid compromising the rights or well being based on arbitrary directives (unrealistic productivity expectations, falsification of documentation, etc) 5) avoid bartering for services when there is the potential for exploitation and conflict of interest
name 7 methods of data collection
1) observation 2) interview 3) written questionnaire 4) survey instruments 5) artifact and record review 6) hardware instrumentation 7) tests and assessments
name 6 tips for interviewing the screened applicants
1) obtain information about relevant experience and career goals 2) verify knowledge and skills 3) use open-ended semi-structured questions to facilitate discussion 4) ask the same questions to every candidate 5) take notes of applicant's responses 6) share info about the position's salary, benefits, work hours, job description, and advantages and limitations of the organization
name 2 benefits of survey research
1) obtain large number of participants at low cost 2) ability to measure numerous variables with one instrument
name 4 qualities of successful management
1) open communication 2) team-building 3) decentralization of resources 4) sharing of power
describe core services (7)
1) outreach 2) intake and orientation 3) initial assessment 4) eligibility determination for services 5) assistance with job search and placement 6) job market information 7) career counseling basically, think prevocational skills screening
name 3 responsibilities of the paraprofessional team member
1) personal care such as bathing, grooming, dressing, and feeding 2) home management such as shopping, cleaning, cooking 3) supervision of home programs as directed by health care professional (therapist, nurse)
name 4 types of people eligible for Medicare
1) persons 65 years or older 2) individuals of all ages with end stage renal disease/permanent kidney failure that may require dialysis treatment or a kidney transplant 3) persons with a long-term disability who have received government-funded disability benefits for 24 months may be eligible. 4) retired railroad workers
name 4 types of qualitative design types
1) phenomenological 2) ethnographic 3) heuristic 4) case-study
how do you write a job description
1) position's title and department 2) skilled and non-skilled requirements of the job including education, special training, experience, physical demands, and licensure requirements 3) specific responsibilities, duties, and performance standards in detail 4) supervisor and supervisory relationships: decision making authority and degree of autonomy
what does the degree, amount, and pattern of supervision required depend on (4)
1) practioner's knowledge and skill 2) complexities of client needs and caseload characteristics and demands 3) State laws, licensure requirements and other regulatory mandates 4) practice setting type and facility procedures
name 5 criteria for coverage of OT services under Medicare*
1) prescribed by a physician or furnished according to a physician-approved plan of care. 2) performed by a qualified OT or OTA under the general supervision of an OT 3) service is reasonable and necessary for treatment of the individual's injury or illness 4) diagnosis can be physical, psychiatric or both. there are no diagnostic restrictions for coverage. 5) OT must result in a significant, practical improvement in the person's level of functioning within a reasonable period of time. OR services provided by a therapist which prevent or slow deterioration and maintain a person at the highest functional level possible, if these services cannot be performed safely and effectively by unskilled personnel.
name two ways to define a focus for the program based on the needs assessment
1) problem areas, functional limitations, and unmet needs that are relevant to the majority of the target population are the priority focus 2) program level of difficulty as determined by the range of population's functional levels and the level required by the current and expected environment so . . . content and difficulty level
what are 5 Ps of a market plan
1) product 2) price 3) place 4) promotion 5) position
name 4 administration functions of management
1) program development 2) fiscal management 3) personnel management 4) program evaluation
name three things established by the Rehabilitation Act of 1973
1) prohibits discrimination on the basis of disability in any program or activity that receives federal assistance 2) required all federal agencies to develop actions plans for hiring, placement, and advancement of persons with disabilities 3) required contractors who received federal contracts over a pre-set amount to take affirmative action to employ persons with disabilities
what two things does the Age Discrimination in Employment Act prohibit
1) prohibits employment practices that discriminate or unfairly affect workers 40 years and older. 2) prohibits mandatory retirement of older workers. employers cannot fix a retirement age.
what do the participants need to be aware of before giving their consent to participate in study (informed consent) (5 things)
1) provided with full disclosure of study's purpose, methodology, and the nature and scope of expected participation 2) must be informed of any potential risk or discomforts and a plan to remediate risk or discomfort must be developed and provided to participants 3) participation in study must be voluntary 4) the subject should know that he/she has the right to withdraw from a study at any time and that s/he can refuse to answer certain questions and/or participate in specific procedure 5) confidentiality of all participants identifying info must be ensured at all times
describe 5 purposes of documentation
1) provides a legal, serial record of client's condition, evaluation and re-evaluation results, course of therapeutic intervention, and response to intervention from referral to discharge. 2) justifies the necessity of skilled services to payers by providing a rationale for service provision 3) serves as an information resource for client care, can be used by a covering therapist in absence of primary therapist. 4) enhances communication among health care or educational team members. 5) provides data for use in intervention, program evaluation, research, and education
according to the OBRA of 1990, what must be considered along with the resident's physical condition and cognitive abilties (2)
1) psychosocial well-being 2) activity pursuit
name 6 sampling methods
1) random 2) systematic 3) stratified 4) purposive 5) convenience 6) network/snowball
name 5 areas of OT intervention focus for vocational programs
1) remediation of underlying performance skill deficits and compensation for client factors that affect the work performance area. 2) development of general work abilities and specific job skills 3) consultation to and/or supervision of vocational direct care staff 4) identification and implementation of reasonable accommodations in accordance with the ADA 5) referral to state offices of vocational and educational services (One-Stop Centers) for persons with disabilities for further evaluation, education, and training
when the AOTA, NBCOT, and/or a SRB determine that a person has violated their standards for ethical practice, different actions can be used as a disciplinary measure - name and define 6
1) reprimand - the private communication of the respective agency's disapproval of a practioner's conduct 2) censure - the public statement of the respective agency's disapproval of a practioner's conduct 3) ineligibility - the removal of eligibility for membership, certification, or licensure by the respective agency for an indefinite or specific amount time 4) probation - the requirement that a practioner meet certain conditions (e.g. further education, extensive supervision, individual counseling, participation in a substance abuse rehab program, etc) to retain membership, certification, or licensure by the respective agency 5) suspension - the loss of membership, certification, or licensure for a specific amount of time 6) revocation - the permanent loss of membership, certification, or licensure
name 3 important things to know about prescription documentation for Medicare reimbursement
1) required from a physician as defined by state practice acts 2) the certification could be a signature on the bottom of the note, an MD or OD signed 700 or 701 form, a sheet stapled to the not with the MD signature and a statement reading "I certify that I approve of the attached treatment plan" 3) diagnoses should be acute not chronic (rephrase the diagnosis for the physician if needed. instead of RA x 10 years, write "acute exacerbation of RA as of 1/12/14(
the Individuals with Disabilities Education Improvement Act (2004) directly addresses the student's functional performance along with academic performance. explain four ways it accomplishes this
1) requires the evaluations for IDEA eligibility include relevant functional and developmental information, not just academic achievement data. 2) expands the IEP's annual goals to include academic and functional goals 3) specifies that accommodations must be provided as needed to measure the functional performance and academic achievement of all students with disabilities. 4) enables services to be provided to students as soon as learning needs become apparent via Response to Intervention (RtI) approach. RtI provides evidence-based early intervention services to children who are having difficulty learning to prevent academic failure.
how do you analyze the market to be targeted for purchase of product or services
1) research selected target market(s) to determine validity of perceived market needs and wants 2) divide market into segments to identify groups of consumers with similar characteristics, interests, and needs that will influence their purchase of the product or service
describe 5 aspects of the principle of autonomy (and confidentiality)
1) respect the right of the individual or the individual's designated representative to choose, self-direct, or refuse intervention. 2) full disclosure of the potential outcomes - benefits and risks of interventions and the obtainment of informed consent are required 3) all records and communications concerning a recipient of OT services must maintain confidentiality 4) collaboration is key 5) a research participant has the right to withdraw from a research study without penalty
after data analysis, one reports on the research findings - name the three sections of a research article this encompasses
1) results section 2) conclusion section 3) summary
name 4 types of correlational research
1) retrospective 2) prospective 3) descriptive 4) predictive
name 14 words to avoid because they do not reflect potential for improvement
1) same as 2) uncooperative, noncompliant 3) dislikes therapy 4) confused/disoriented 5) inability to follow directions 6) patient refused to participate 7) custodial care needed 8) treatment repeated 9) repeated instruction 10) unmotivated 11) extreme depression 12) fair to poor potential 13) chronic/long-term condition 14) general weakness
what does TWIIA emphasize (2)
1) self-determined work plans 2) community-based vocational services
name 5 types of survey questions
1) semantic differential 2) likert scale 3) guttman scale rank ordering 4) multiple choice 5) incomplete sentences
describe 4 aspects of the principle of social justice
1) service provision is provided in a fair and equitable manner to all persons regardless of the economic status, age, ethnicity, race, geography, disability, marital status, sexual orientation, gender, gender identity, religion, culture, and political affiliation. OT practioners must recognize existing societal inequities and advocate for just treatment for all 2) assist those in need of OT services in securing access through available means 3) address barriers in access to OT services by referring or offering clients financial aid, charity care, or pro bono services within the parameters of occupational therapy services 4) refrain from accepting gifts that would unduly influence the therapeutic relationship or have the potential to blur professional boundaries and adhere to employer policies when offered gifts
documentation should demonstrate that the patient is making significant functional improvement in the reasonable and generally predictable period of time. give 4 tips on how to accomplish this through your documentation. this is especially important for Medicare
1) some improvement must be made at least on a weekly basis; otherwise treatment will be considered maintenance. documentation to support the provision of services of persons not expected to improve must substantiate the need for skilled services to prevent deterioration and maximize function 2) if progress is slower than expected, document extenuating circumstances and/or limiting factors (e.g. a secondary diagnosis) 3) Medicare does not reimburse for OT practioners to implement a maintenance treatment; this is considered unskilled service 4) payment for designing a maintenance program and making periodic but infrequent evaluations of the program's effectiveness is provided
what is the focus of OT intervention in acute care hospitals (4)
1) stabilization of client's status 2) engagement of the client in the therapeutic relationship and purposeful activities/meaningful occupations so that s/he can see that change is possible, thereby increasing motivation to pursue follow-up 3) discharge planning and after-care referrals 4) family, caregiver, and consumer edcation
name 2 important aspects of risk management
1) staff education and training (certification/recertification in CPR) is required 2) effective communications with consumers (e.g. informed consent) and with team members is required.
LOS in private long-term hospitals is determined by insurance coverage. when coverage is expended an alternative discharge environment is need for the client. name three alternative discharge settings
1) state run long-term hospital 2) a SNF 3) home or supportive residence
name 9 things that must be in the discharge plan documentation
1) summary of evaluation and intervention 2) compare initial and discharge status 3) specify number of sessions, goals achieved, and functional outcome 4) reason for discharge 5) home programs to be followed after discharge 6) client and family education 7) equipment provided and/or ordered 8) follow-up plans/recommendations with rationales 9) referrals to other health care providers and community agencies
the performance of tasks performed by OT aides requires what 2 conditions
1) supervision by OTA or OT 2) this supervision MUST be documented
name 5 methods that can be used to determine needs (needs assessment methods)
1) survey, interview, or self-report of target population. a representative sample is required 2) key informant, which involves the surveying of specific individuals who are knowledgeable about the target population needs 3) community forums to obtain information through public meetings or panels 4) service utilization review of record and reports 5) analysis of social indicators to identify social, cultural, environmental, and/or economic factors that can predict problems
name 4 types of auxiliary aids and services
1) taped texts, qualified readers or other methods that can effectively make visually delivered materials accessible to persons with visual impairments 2) qualified interpreters or other methods that can effectively make aurally delivered materials accessible to persons with hearing impairments 3) modification or acquisition of devices or equipment 4) similar actions or services that increase accessibility
name 5 things the OT eval is focused on for prevocational programs
1) task skills 2) social interaction skills 3) work habits 4) interests 5) aptitudes
name 4 types of inferential statistics
1) tests of significance 2) parametric statistics 3) nonparametric statistics 4) correlational statistics
what is the criteria for coverage of partial hospitalization (PHP) services in a hospital-affiliated or community mental health psychiatric day program. (3)
1) the beneficiary would otherwise have required inpatient psychiatric care 2) OT services are covered under Medicare guidelines (MD's prescription, reasonable and necessary function expected to improve) 3) active treatment incorporating an individualized multi-disciplinary intervention plan to attain measurable, time-limited, medically necessary, functional goals directly related to the reason for admission must be provided. psychosocial programs that provide structured diversional, social, and/or recreational services or vocational rehabilitation do no meet the criteria for active treatment in a PHP and are not reimbursable under Medicare.
name the acceptance criteria for OT services in an educational setting (schools)
1) the child requires special education services, and OT will enable the child to benefit from special ed 2) OT will facilitate the child's participation in educational activities and enhance the child's functional performance 3) referrals are received from the previous agency that provided early intervention services, the child's teacher, and/or school's child study team.
what is the acceptance criteria for early intervention services (2)
1) the extent of the developmental delay (typically a 33% delay in one area of development or a 25% delay in two areas) 2) an established diagnosis/disability
what must long term goals indicate (2)
1) the final desired functional outcome before discharge, regardless of LOS. 2) a clear reason for skilled therapeutic intervention
what must the IFSP include (6)
1) the infant's or toddler's developmental level 2) family priorities, concerns, and resources 3) the infant's or toddler's natural environments 4) measurable outcomes 5) projected length, frequency, and duration of research-based services 6) transition plans to pre-school or other services, as appropriate
describe the four criteria for homebound status
1) the person is typically not able to leave the home, i.e. is confined to the home. Confinement may be due to the need for the aid of ambulatory devices, the assistance of others, or special transportation. It considers medical, physical, cognitive, and psychiatric conditions. 2) if the person leaves the home it requires "considerable and taxing effort" 3) a person may leave his/her home for medical appointments (kidney dialysis) and non medical short term and infrequent appointments (hairdresser, religious services) 4) the need for adult day care does not a preclude a person from receiving home health services
how is the goal statement structured
1) the person who will exhibit the skill, almost always written as "the patient/client will". However, the caregiver, family member and/or teacher may be the focus of the goal 2) the desired functional behavior that is to be demonstrated or increased as the outcome of intervention 3) the underlying factors (performance component deficits) that must be remediated to achieve functional outcome. 4) the circumstances under which the behavior must be performed or the conditions necessary for the behavior (e.g. independent, with cueing, with assistance 5) the degree at which the behavior is exhibited (e.g. 3 out of 4 times, minimum number of repetitions)
name 3 factors influencing LOS at SNFs
1) the progression of illness 2) availability of family or community support 3) insurance coverage
name the three criteria for determining which model of practice to use
1) the type of setting 2) the philosophy and mission of the particular setting and department 3) the role the therapist plays a team member within that particular setting
name the four purposes of developing specific program
1) to directly meet the needs of a specific population or group(s) 2) to clearly focus evaluation and intervention efforts and activities 3) to increase visibility and use of available services (offering an outpatient cardiac rehabilitation is more visible than individual referrals, resulting in increased recognition and utilization of this service 4) to convert an idea into a practice reality
name 3 purposes of fiscal management
1) to ensure cost-effective services and programs are planned and implemented 2) to meet the demands of a managed health care system 3) to remain competitive in a market-driven practice environment
name 4 purposes of program evaluation
1) to measure effectiveness of a program; that is, were program goals accomplished 2) to use information obtained in the evaluation to improve services and assure quality 3) to meet external accreditation standards 4) to identify program problems/limitations and to resolve them
name 5 interventions to victims of abuse and/or neglect
1) treatment for physical and emotional injuries 2) development of a trusting relationship 3) provision of support to family and loved ones 4) referral to appropriate disciplines and agencies 5) contribute to staff training programs to prevent abuse (through the use of activity adaptations and environmental modifications, an aide could decrease agitated behavior of persons with Alzheimer's disease, resulting in decreased aide frustration - this can prevent elder abuse
name three types of quantitative methodology/design types
1) true-experimental 2) quasi-experimental 3) non-experimental/correlational
how can a researcher enhance transferability (3)
1) use of a nominated sample 2) comparison of sample characteristics to available demographic data 3) dense description of the study's participants and contexts
when can OT be covered as an outpatient service by Medicare (2)
1) when provided by or under arrangements with any Medicare Certified provider (hospital, SNF, home health agency, rehabilitation agency, a clinic) 2) when provided as part of comprehensive rehab facility (CORF) services
name two limitations of non-experimental/correlational design
1) with the non-experimental design, you cannot establish cause and effect relationships (which is the whole point of the experimental designs) 2) may fail to consider all variables that enter into the relationship
name 5 criteria for fair disciplinary action
1) written documentation of problem behaviors and expectations for improvement 2) referral to counseling and/or other services needed to improve performance 3) clear and documented warnings of consequences for unremediated behavior 4) consequences that are impersonal, immediate, and consistent 5) continuous documented monitoring of employee's behavior until the employee achieves satisfactory job performance, resigns voluntarily or is terminated
for home health care, how much must be paid by patient
20%
the onset dates of illness/injury must be within how man days of admission to services
60 days
how is treatment provided in home care
60 minute sessions once a day for up to 5 days a week, as determined by insurance coverage
describe p-value
A p-value is the probability that the results from your sample data occurred by chance. P-values are from 0% to 100%. They are usually written as a decimal. For example, a p value of 5% is 0.05. Low p-values are good; They indicate your data did not occur by chance. For example, a p-value of .01 means there is only a 1% probability that the results from an experiment happened by chance. In most cases, a p-value of 0.05 (5%) is accepted to mean the data is valid.
what's the difference between ANOVA and T-test
A t-test compares means, while the ANOVA compares variances between populations.
define diagnostic related groups
DRGS - the descriptive categories established by CMS that determine the level of payment at a per case rate.
what kind of coding does outpatient OT services utilize under Medicare Part B
G-codes
what does HIPAA stand for
Heath Insurance Portability and Accountability Act
what is used to determine an episode payment rate for home health services
Home Health Resource Groups (HHRGs)
what does the IDEA improvement act do about individuals who do not require special ed services but need additional supports to succeed in school
IDEA Improvement Act allows for this by providing early coordinating intervening services for general education students from kindergarten to 12th grade
Medicaid covers EPSDT for persons 21 years-old and younger. what other federal provision does this overlap with ? and what are the implications of this overlap
IDEA legislated services. this overlap leads to questioning as to whether OT services provided to individual children should be funded as an educational or a health care service.
name three accrediting agencies
JCAHO (Joint Commission) CARF (Commission on Accreditation of Rehab Facilities) HFAP (Healthcare facilities accreditation program)
what are potential risks
client or employee injury and property loss or damage with resulting liability and financial loss
what is the LOS at a rehab hospital
LOS can range from a week to months. documentation requirements supporting the need for LOS are dependent upon institutional, state, and third-party payer guidelines.
what is the LOS for prevocational programs
LOS is determined by agency's funding and person's attainment of goals. discharge is usually to a vocational program. discharge to a work setting can occur if sufficient abilities are developed
what is the LOS for sub-acute care
LOS is determined by diagnosis and presenting symptoms. LOS can range from 5-30 days. longer LOS requires significant documentation to justify the need for further hospitalization. ongoing need for intervention or long-term care frequently results in discharge to another setting.
what is the LOS for outpatient care
LOS is determined by diagnosis, presenting symptoms, response to treatment, and insurance coverage or ability to pay a fee for service.
what is LOS for wellness and prevention programs
LOS is determined by the individual. it is usually influenced by program's planned length (eg. a six-week joint protection program) or by individual's achievement of a desired outcome (smoking cessation)
name three models of practice
Medical Model Education Model Community Model
what is OT eval and intervention in SNFs guided by
Medicare standards
describe intraclass correlation coefficient (ICC(
a reliability coefficient based on an analysis of variance
who determines the amount of supervision
OT
what OT FORs are used in medical model
OT FORs address the pathological process of the disease or dysfunction (e.g. biomechanical, neurodevelopmental)
which OT FORs are utilized under the education model
OT FORs are based on learning theories to facilitate adaptation in the environment (role acquisition, cognitive remediation)
what OTs FORs are utilized in the community model
OT FORs promote development of performance skills and/or areas of occupation within the individual's performance context (e.g. life-style performance, occupation adaptation)
who can OTAs supervise
OT aides
what is the role of OT at a clubhouse
OT eval and intervention is not provided in a formalized manner. the role of OT is integrated into the clubhouse model which has staff acting as generalists who contribute to the development and enrichment of members' abilities and the promotion of their recovery.
what is the goal of OT evaluation in vocational programs
OT eval is focused on the individual's functional skills and deficits related to work in his/her current and expected vocational environment
what is the focus of OT evaluation in sub-acute care
OT evaluation can include more in-depth assessments and more thorough observations of client's functional performance
All OT practitioners must abide the OT Professional Code of Ethics. What are OT practioners expected to do about the professional behaviors (or lack thereof) of colleagues
OT practitioners are expected to bring concerns about the professional behaviors (or lack thereof) of colleagues to the attention of appropriate oversight bodies when and if these concerns cannot be directly resolved with the offending practitioner
what about Medicare coverage for OT services rendered in a physician's office
OT service fees are included on the physician's bill to medicare. the service is furnished under the physician's direct supervision and the services are directly related to the condition for which the physician is treating the patient.
what are the guidelines regarding OTAs and documentation
OTAs are qualified to write notes in medical charts and other documentation formats. OTA notes are not required to be co-signed by an OT (by the AOTA) but state and federal governments may mandate co-signing as a tangible way to demonstrate compliance with OTA supervisory laws and regulations
who is generally not eligible for direct payment
OTAs because they require supervision and do not perform evals
who can practice autonomously without requiring any supervision to provide OT services
Occupational Therapists - they are responsible and accountable for all aspects of OT service delivery
define diagnosis code
a code that describes a patient's medical reason or condition that requires health service
who can give consent for treatment
a competent adult. minors or adults determined to be incompetent must have written consent provided by a parent, legal guardian, person with power of attorney, or proxy.
what is OASIS
a comprehensive assessment that must be completed to verify the person's eligibility for Medicare home health benefits, the continuing need for home care, and to plan for the person's nursing, medical, social, rehabilitative, and discharge needs.
what doe OBRA of 1990 mandate
a comprehensive resident assessment system, the Minimal Data Set (MDS) which is administered upon admission and thereafter on an annual basis, unless there is a significant change in the resident's conditions.
describe standard deviation
a determination of variability of scores (difference) from the mean. the most frequently used measure of variability
what should be on every page
client's name and ID number
what did the Work Investment Act (WIA) establish
a federally sponsored national employment and vocational training system a "One-Stop" delivery system for all adults aged 18 and older seeking access to employment and training services. this means traditionally separate unemployment offices and vocational rehabilitation services are now available at a One-Stop center
describe qualitative methodology/design types
a form of descriptive research that studies people, individually or collectively, in their natural social and cultural context. a systematic, subjective approach to describe real-life experiences and give them meaning. it is rich in verbal descriptions of people and phenomena based on direct observation in naturalistic settings. the process of the study is considered as important as the specific outcome data.
define preferred provider organization (PPO)
a form of managed care that is similar to an HMO but usually offers a greater choice of providers. However, as choices increase, percentage of payments decreases
what is the No Child Left Behind Act (NCLB)
a general education law which emphasizes standards-based education.
define team
a group of EQUALLY important individuals with common interests collaborating to develop shared goals and build trusting relationships to achieve these shared goals
define marketing/promotion
a managerial process that analyzes consumer needs, plans and designs a service or product to meet the identified market need(s), and implements strategies and actions to promote consumer use of the service or product.
define managed care
a method of maintaining some control over costs and utilization of services while providing quality health care. managed care organizations (MCOs) include HMOs and PPOs.
define perdiem
a negotiated per day fee for service. typically used for inpatient hospital stays and SNFs.
what is a chi square test
a nonparametric test of significance use to compare data in the form of frequency counts occurring in two or more mutually exclusive categories. e.g. subjects rate treatment preferences
describe spearman's rank correlation coefficient (rs)
a nonparametric test used to correlate ordinal data
describe multidisciplinary teams
a number of professionals from different disciplines conduct assessments and interventions independent from one another. members' primary allegiance is to his/her discipline. some formal communications occur between team members. limited communication may result in lack of understanding of different perspectives. resources and responsibilities are individually allocated between disciplines, therefore, competition among team members may develop
describe T test
a parametric test of significance used to compare two group means and identify a difference a selected probability level The t test (also called Student's T Test) compares two averages (means) and tells you if they are different from each other. The t test also tells you how significant the differences are; In other words it lets you know if those differences could have happened by chance. a drug company may want to test a new cancer drug to find out if it improves life expectancy. In an experiment, there's always a control group (a group who are given a placebo, or "sugar pill"). The control group may show an average life expectancy of +5 years, while the group taking the new drug might have a life expectancy of +6 years. It would seem that the drug might work. But it could be due to a fluke. To test this, researchers would use a t-test to find out if the results are repeatable for an entire population.
what is an analysis of variance (ANOVA)
a parametric test used to compare two or more treatment groups or conditions at a selected probability level examples - A group of psychiatric patients are trying three different therapies: counseling, medication and biofeedback. You want to see if one therapy is better than the others. Students from different colleges take the same exam. You want to see if one college outperforms the other.
explain analysis of covariance (ANCOVA)
a parametric test used to compare two or more treatment groups or conditions while also controlling for the effects of intervening variables. for example, two groups of subjects are compared on the basis of UE functional reach using two different types of assistive devices; subjects in one group have longer arms than subjects i the second group; arm length then becomes the covariate that must be controlled during statistical analysis
what does "qualified individual with a disability"mean
a person with a disability who is able to perform the essential functions of a job (that is, the tasks fundamental to the position) with or without reasonable accommodations
what are semantic differential questions
a point scale with opposing adjectives at two extremes, measuring affective meaning
define risk management
a process that identifies, evaluates, and takes corrective action against risk and plans, organizes and controls the activities and resources of OT services to decrease actual or potential losses
For Medicare Part A, what do services provided in acute care hospitals receive from Medicare
a prospective, predetermined rate based on DRGs. The DRG per case rate covers all services including OT. It is a fixed dollar amount for patient care for each diagnosis regardless of LOS or number of services provided. Treatment supplies, (adaptive equipment, splints) are included in the per case rate.
what is accreditation
a status awarded for compliance with established standards. Accreditation ensures the public that a health care facility is adequately equipped and meets high standards for patient care and employs qualified professionals and competent staff
describe phenomenological design
a study of one or more persons and how they make sense of their experience. minimal interpretation by the investigator. meanings can only be ascribed by participants.
describe normal distribution
a symmetrical bell-shaped curve indicating the distribution of scores; the mean, median, and mode are similar. half the scores are above the mean and half are below the mean. most scores are near the mean, approximately 68% of scores fall within +1 or -1 SD of mean. frequency of scores decreases further from the mean.
define peer review
a system in which the quality of work of a group of health professionals is reviewed by their peers
define quality improvement (QI)
a system-oriented approach that views limitations and problems proactively as opportunities to increase quality. prevention is emphasized. blame is not attributed to persons. problems are related to organizational improvement needs
performance assessment and improvement (PAI)
a systematic method to evaluate the appropriateness and quality of services. utilizes an interdisciplinary systems focus. a client-centered approach which focuses on the rights, assessment, care, and education of the person. organization performance, leadership, and management are emphasized
what is the acceptance criteria for vocational programs
acceptance is for the development of specific vocational skills. person has the prerequisite abilities to work (e.g. good task skills and work habits) but requires training for a specific job and/or ongoing structure, support, and/or supervision to maintain employment. person has to develop his/her work capacities to a level acceptable for competitive employment (e.g. strength and endurance)
what is the acceptance criteria for wellness and prevention programs
acceptance is most often by individual's self-referral to meet a personal need or by an institutional's provision of a program to its members or employees (e.g. a parenting skills class for pregnant teens in a school)
what is the role of staff in the accreditation process (3)
accreditation and re-accreditation involves all staff. tasks include 1) document preparing 2) hosting the site visit team 3) interviews with the accreditors
correct answers to exam scenarios about OTA documentation must have the OTA . . .
adhering to all documentation standards/guidelines
what is the admission acceptance criteria for forensic settings
admission is due to engagement in criminal activities by a person. the person can be remanded to a variety of settings depending on the nature of the crime and if s/he has a psychiatric diagnosis
what is the admission criteria for residential programs
admission is for a developmental, medical or psychiatric condition that has resulted in functional deficits that impeded independent living but are not severe enough to require hospitalization.
what is the admission acceptance criteria for rehab hospitals
admission is for a disability that is medically stable but which has residual functional deficits requiring skill rehabilitation services.
describe admission acceptance criteria for partial hospitalization/day hospital programs
admission is for a medical or psychiatric condition that has been sufficiently stabilized to an enable an individual to be discharged home or to a community residence; however, the individual still has symptoms remaining which require active treatment
what is the admission criteria for outpatient care
admission is for a medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from the hospital but remaining symptoms require active treatment
what is the admission acceptance criteria for Sub-acute care/intermediate care facilities (ICFs)
admission is for a medical or psychiatric diagnosis that has progressed from an acute stage but has not stabilized sufficiently to be treated on an outpatient basis
what is the admission acceptance criteria for SNFs or Extended care facilities (ECF)
admission is for a medical or psychiatric diagnosis that is chronic and requires skilled care, butt he individual's illness is stable with no acute symptoms.
what is the admission acceptance criteria for long-term hospitals
admission is for a medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis
what is the admission criteria for adult day care.
admission is for adults and elders with chronic physical and/or psychosocial impairments and/or individuals who are frail but semi-independent. services are provided in a group setting. an individual can get services for one afternoon or 5 full days or anywhere in between
what is admission acceptance criteria for Long-term acute care hospitals (LTAC)
admission is for chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators. patient often have multiple diagnoses with major complications
what is the admission acceptance criteria for acute care hospitals
admission is for medical or psychiatric diagnosis that cannot be treated on an outpatient basis
what is the participant criteria for supported education programs
adolescents or adults who require intervention to develop skills that are needed to succeed in secondary and/or post-secondary education. the person may have never developed these skills or lost them due to a psychiatric disability or mental health problems
what is the participant criteria for prevocational programs
adolescents or adults who require intervention to develop skills that are prerequisite to work. the person may have never developed these skills due to developmental delays, environmental insufficiencies, illness, or disability. the person may have lost these skills due to illness or disability
define third party payers
agencies and companies who are the primary reimbursers for health care in the US (e.g. Blue Cross). HMOs and PPOs are also third party payers.
what is the aim of the "One-Stop Centers"
aimed to provide universal access to employment and vocational services to persons with disabilities
what does OBRA of 1990 state about resident self-determination
aims to guarantee that residents have the right to choose how they want to receive care and live their lives. residents should have a choice in determining their ADL, including community activities. Residents should be able to function as independently as possible.
define promotion
all efforts to communicate information about the product or service to target market or market segment that makes the product or service visible and desirable
what does IDEA Improvement Act allow states to do
allows each state to define developmental delay criteria to determine if an infant or toddler is eligible for early intervention in that state. typically, states define developmental delays qauntitatively (percentage of delay according to a standardized developmental assessment)
name 3 tests of significance
alpha level degrees of freedom errors
what's another name for break-even analysis and what is it
also called cost-volume-profit analysis determines the volume of services needed to be provided for revenues to equal cost and profits to equal zero.
when it comes to SNFS, what is the policy on maintenance programs
an OT can be reimbursed for the development of a maintenance program, the training of caregivers to implement the maintenance program, and the periodic reevaluation of the maintenance program. in the past, Medicare did not cover OT implementing a maintenance program. However, now, services provided by a therapist which prevent or slow deterioration and maintain a person at the highest functional level possible are now covered (if a non-skilled professional cannot do it)
who coordinates the MDS
an RN. OTs can contribute info
an employer does not need to provide reasonable accommodations if it would impose an "undue hardship" on the business. define "undue hardship"
an action that would be significantly difficult or overly expensive given the financial resources of the employer, its size, and major functions
an exam scenario includes an retiree who is not adjusting well to the loss of the worker role. and expresses grief over the loss of the worker role. what type of answer should I look for
an answer that has the OT encouraging the elder to solely explore avocational pursuits would be incorrect. the person can explore vocational pursuits. it would not impact the person's SS benefits so the correct answer would include the exploration of the elder's vocational interests and capabilties
what is standard error of measurement
an estimate of expected errors in an individual's score; a measure of response stability or reliability
what are the 7 principles of the Code of Ethics
beneficence nonmaleficence autonomy and confidentiality social justice procedural justice veracity fidelity
what does Title III say about transportation
both public and private transportation systems must be accessible and non-discriminatory
budget periods - how long are they
budget periods vary from multi-year (5-10 years) for capital expenses to annual for personnel and supply expenses.
how can OTAs expand their role beyond entry-level practioner
by establishing service competency, establishing the OTA's ability to perform a task that is beyond OTA entry-level competence
ADAAA of 2008 - how did it strengthen the definition of disability
by stating the use of mitigating measures (w/c, hearing aids, taking insulin) to address a disability or remediation of a condition (recovery from cancer, a repetitive stress disorder, or schizophrenia) does not negate the person's ability to be protected by the ADA
what is LOS at SNFs/ECFs
can range from 1 month to the individual's lifetime
what is the LOS for long-term hospitals
can range from a month to years. LOS in private long-term hospitals is determined by insurance coverage. when coverage is expended an alternative discharge environment is need for the client
describe case management OT intervention
case-management intervention can be purely referral-based int eh administrative model or encompass the full range of interventions in the clinical model. both models aim to prevent regression and re-hospitalization and promote optimal functioning and quality of life. both models actively engage the individual and family in the treatment planning, implementation, and re-evaluation process. both models plan discharge, if appropriate to an environmental that will best serve an individual's needs
describe transdisciplinary teams
characteristics of interdisciplinary teams are maintained and expanded upon. members support and enhance the activities and programs of other disciplines to provide quality, efficient, cost-effective service. members are committed to ongoing communication, collaboration, and shared decision making for the client's benefit. evaluations and interventions are planned cooperatively, yet one member may take on multiple responsibilities. role blurring is accepted. ongoing training, support, supervision, cooperation, and consultation among disciplines are important to this model, ensuring that professional integrity and quality of care are maintained.
what is meant by reflectivity
clarifying bias - good qualitative research contains comments by the researcher about how their interpretation of the findings is shaped by their background, such as gender, culture, history, and socioeconomic origin
define procedure codes
codes that describe specific services performed by health professionals
under the community model, what happens if skills cannot be developed
community resources and supports are identified and developed to enable functioning within one's chosen environment
what must be provided on documentation
complete date (day, month, year)
describe heuristic design
complete involvement of the researcher in the experience of the subject(s) to understand and interpret a phenomenon. aim is to understand human experience and its meaning. meanings can only be understood if personally experienced.
what happens if risk management fails and an incident occurs
completion of an incident report according to the setting's standards is required.
what must you do after the applicant accepts the position
confirm the following things . . . terms of employment starting date salary LICENSURE requirements
name 4 ways to enhance confirmability
confirmability audit member check researcher reflexivity triangulation of data
explain administrative case management
connects a person with a serious illness to the appropriate and needed community services and/or therapeutic programs, overseeing this service provision to ensure that quality of care in a cost-effective manner is achieved
name two lay team members
consumer family/primary caregiver
in handwritten notes, how must errors be recorded
crossed out with one line, initialed, and dated. black or blue ink must be used at all times.
define professional review organization (PRO)
groups of peers who evaluate the appropriateness of services and quality of care under reimbursement and/or state licensure requirements
describe close supervision
daily, direct contact at the site of work
describe percentiles
data is divided in 100 equal parts; position of score is determined
what is an "episode" in home health care
defined as a 60-day period beginning with the first billable visit and ending 60 days after the start of care.
How does the Child Abuse Prevention and Treatment Act (CAPTA) define child abuse and neglect
defined as mental or physical injury, negligent treatment, maltreatment or sexual abuse of a child less than 18 years of age by a person responsible for the child's welfare under circumstances that indicate that a child's welfare or health is being threatened or harmed
define abuse
deliberately hurting a patient physically, mentally, or emotionally
define neglect
deliberately withholding services that are necessary to maintain an indivudal's physical, mental, and emotional health
what is the length of stay in vocational programs
determined by agency's funding and attainment of goals
what is the length of stay for forensic settings
determined by court-ordered directives and criminal sentences.
what is the LOS for day hospital programs
determined by diagnosis, presenting symptoms and response to treatment. LOS can vary from 1 week to 6 months. documentation requirements supporting the need for an extended LOS are dependent upon institutional, state, and/or third party payer guidelines. once LOS is expended, discharge is usually to a less intensive community day program
what is LOS for home care
determined by diagnosis, presenting symptoms, response to treatment, insurance coverage or ability to pay a fee for service.
what is the LOS for supported education programs
determined by the agency's funding and person's attainment of goals. discharge is upon entry into or completion of an education program or the attainment of a GED
what is the LOS for case management programs
determined by the individual's ability to independently access needed services and by funding availability
what is the LOS for hospice services
determined by the individual's terminal outcome
describe inferential statistics
determines how likely the results of a study of a sample can be generalized to the whole population
what do electronic medical records (EMRs)/electronic health records (EHRs) provide
digital versions of paper charts
describe routine supervision
direct contact at least every two weeks at the site of work, with interim supervision occurring by other methods such as telephone and written communication
an OT moonlights as an adaptive equipment sales representative. she is asked to conduct a workshop on activity adaptations and environmental modifications to an arthritis support group. what must she do
disclose her sales position and identification of potential conflict of interest
what is the last step in the research process
dissemination of research
what does the distribution look life if the mean, median, and mod are different
distribution may be skewed (not symmetrical) rather than normal; scores are extreme, clustered at one end or the other.
why are capital items separated from other expenses
due to depreciation of value and possible tax credits for purchases and investments
what does Title 1 of the ADA prohibit during hiring process
employment tests that tend to screen out people with disabilities
what does the Freedom to Work Act enable
enables persons receiving SS to work without any effect on their SS income. There are no income restrictions upon this eligibility
Medicare Title 18-PL 89-97 established Medicare and Supplemental Security Income (SSI). what does SSI allow
enables persons with disabilities to receive a monthly income that enables them to live in the community. obtaining this benefit is often a precursor to independent living and money management skills
define concurrent review
evaluation of ongoing intervention program during hospitalization, outpatient or home care treatment. method to ensure appropriate care is being delivered. often a component of a QI or PAI system.
describe random sampling
every individual in the population has an equal chance of being sampled. individuals are selected through the use of a table of random numbers
what is a standard error
expected chance variation among the means, the result of sampling error
name 6 ways to enhance credibility
extended and varied field experience reflexivity via completion of a field journal, sampling triangulation of data interview techniques member checks
what is the role responsibility of the consumer's family/primary caregiver
family's sociocultural background, socioeconomic status, and caregiving tasks, needs and skills must be considered as they can impact on the outcome of intervention
what is a key service management function we have not talked about yet
fieldwork education
what is a budget (in the context of, say, private practice)
financially projects, for a specified time period, the costs of managing a program and the anticipated revenue from service provision
what about therapist's signature
first and last name with professional designations should directly follow documentation content with no space left between content and signature.
what are fixed expenses
fixed expenses remain at the same level even when there are changes in the amount of services provided (e.g. rent)
what is the focus of the community model
focus is placed on identifying and developing the skills needed for one's expected environment
what is the focus of the medical model
focus is placed on identifying the disease or dysfunction
what is the focus of the education model
focus is placed on learning and making the behavioral changes needed to interact successfully in the environment
what is the focus of OT evaluation for residential programs
focused on assessment of the individual's skills for living in the community and determination of the social and environmental resources and supports needed to maintain the individual in his/her current and expected living environment.
describe OT eval for hospice
focused on determining the individual's occupational functioning and his/her physical, psychosocial, spiritual and environmental needs that most important to him/her.
what is OT evaluation like for supported education programs
focused on the individual's client factors and performance skills and patterns that impact on the occupational role of student
what is the focus of OT evaluation in acute care hospitals
focuses on quick accurate screening of major difficulties impeding function (cognitive status, home safety skills)
there can be formal and informal resources available for program implementation - describe each
formal - institutional resources such as staff, supplies, money, and space informal - friends, family, friends, cultural or religious figures, self-help/consumer groups
who funds worker's comp
funded jointly by individual employers or groups of employers and state governments
describe the Technology Related Assistance for Individuals with Disabilities Act
funded the development of technology and technologic aids for persons with disabilities to improve communication, mobility, self-care, transportation, and education
what's the time frame are transitional employment programs (TEPs)
generally limited from 3-6 months with discharge to competitive employment, supportive employment, or rehab workshop
give an example of hardware instrumentation
goniometers - physical instrument with established reliability and validity
what is the average LOS at Long-term acute care hospitals
greater than 25 days to maintain Medicare certification
what is member checking
having the participants review the finished product - especially the themes
what does the rate per episode of care include for home health services
health services including OT and medical supplies. DME is excluded
OTs can assist consumers in the hiring, training, and supervision of . . .
home health care aides
when will Medicare cover OT in hospice care
hospice care is provided to persons certified as terminally ill (medical prognosis of fewer than 6 months to live). OT services are provided to enable a patient to maintain functional skills, and ADL performance and/or to control symptoms
be aware that sub-acute care and ICFs can be housed in . . .(2)
hospitals or SNFs
what is transferability
how well other researchers can fit a study's findings into similar contexts: the "goodness of fit" between the contexts of two studies. transferability is evident when a researcher provides sufficient descriptive data to allow comparison by other researchers
HIPAA guidelines for research are congruent with standards for . . .
human subject research set by IRBs
explain g-codes
identify the primary issue being addressed by therapy; modifiers are used to report the person's impairment/limitation/restriction. all G-codes are available to be used by all therapy disciplines (OTs can use the codes for mobility, memory, swallowing, and cognition). G codes also track patient outcomes over time
when is DME not covered by Medicare
if it can bee useful to a person in the absence of injury or illness. This includes self-help items, bathtub grab bars, and raised toilet seats. They are not reimbursable because other people can use them and they are not considered MEDICALLY necessary.
when can patients and/or their caregivers file malpractice suits against OTs
if the OT is viewed to be personally responsible for negligence or other acts that resulted in harm to the client
when is OT in home care covered
if the individual is home-bound and needed intermittent skilled nursing care, PT, or ST before OT began. OT services can continue after need for skilled nursing, PT or ST has ended.
when do OTs complete the OASIS
if the need for OT establishes program eligibility
when is OT in SNFs covered
if the patient requires skilled nursing or skilled rehab on a daily basis (5x per week)
when do supervisors have to assume liability of their workers
if they provided faulty supervision or inappropriately delegated responsibilities - for example, if the OTA is performing a questionable practice, the OT is responsible for ensuring that the practice ceases. Failure to do so would make both the OTA and OT negligent
how are behaviors measured according to the education model
in terms of obtaining skills, knowledge, competency to successfully meet the demands of the environment
what are direct expenses
include costs related to OT service provision, such as salaries and benefits (vacation and sick time), office supplies (e.g. pen, paper), and treatment equipment (e.g. ADL materials)
what are indirect expenses
include costs shared by the setting as a whole such as utilities, housekeeping, and marketing
if the exam item scenario involves a person who is a federal employee, the correct answer choice does not have to . . .
include mandated ADA reasonable accommodations
what is the LOS of adult day care programs
indefinite. ongoing services are provided to individuals with chronic conditions who might otherwise be institutionalized or to individuals who are frail and need ongoing support (e.g. cooked meals, socialization opportunities)
what is the schedule of a clubhouse program
individual schedules will vary to meet each person's unique needs and interests. clubhouses are open at least 5 days per week. many are open 7 days per week. the daily schedule is organized around the work-ordered day, which parallels typical working hours to engage members and staff in the running of the clubhouse. evening and weekend schedules are focused on avocational interests and recreational pursuits. additional services that can be provided include literacy and education programs, transitional employment placements, independent employment assistance, community support and outreach services, housing programs, and legal and financial advisement.
describe purposive sampling
individuals are purposefully and deliberately selected for a study (all consumers of a program for a QI study)
describe systematic sampling
individuals are selected from a population list by taking individuals at specified intervals (every 10th name)
describe stratified sampling
individuals are selected from a population's identified subgroups based on some predetermined characteristic (e.g. by diagnosis) that correlates with the study
describe convenience sampling
individuals are selected who meet population criteria based upon availability to the researcher
so you are an OT and are asked to provide a reference for a former student seeking an OT staff position. you know this student has failed the NBCOT exam and has had her temporary license revoked. you find out this person accepted an OT staff position. what should you do?
inform the state regulatory board of this person's misrepresentation
describe intensive services (4)
intensive services are for individuals who do not attain successful employment after receipt of core services. 1) comprehensive assessments of service needs and skill level 2) development of individualized plan for employment 3) case management 4) counseling so a comprehensive vocational skills assessment would be under this category
which type of teams are most common and considered most effective in today's health care system (2)
interdisciplinary transdisciplinary
describe retrospective research
investigation of data collected in the past
describe descriptive research
investigation of several variables at once; determines existing relationships among variables
how did ADAAA of 2008 broaden the interpretation of "substantially limited"
it broadened the interpretation of a "substantially limited impairment to include the inability to perform one major life activity as it is typically performed by the general population
what does the NCLB state about OTs
it considers OTs to be pupil services personnel and sets no requirements for OT services.
if it is not documented . ..
it does not exist and never happened
in a non-experimental/correlational design, how do you express the degree of relationship
it is expressed as a correlational coefficient, ranging from -1.00 to +1.00 +1 indicates the strongest possible agreement and −1 the strongest possible disagreement
what is Resident Assessment Instrument (RAI)
it is the structured approach to assessment
why is it difficult in human subject research to use a true-experimental design
it is unethical to withhold treatment
is accreditation voluntary or mandatory
it is voluntary however it is mandatory to receive third party reimbursement and to be eligible for federal government grants and contracts
name two things that determine the length of services in the schools
length of services is dependent upon the impact of OT services on the child's abilities and prevention of loss of abilities. 1) if OT services can improve the child's ability to participated in education-related activities and allow full access to the general education curriculum, then services can be continued. 2) a review of services and progress made toward a child's IEP is conducted on an annual basis
what is the different between semantic differential questions and a likert scale
likert scale measures agreement
what is the typical length of stay for acute care hospitals
limited from 1-7 days. longer LOS requires significant documentation to justify need for further hospitalization. ongoing need for care frequently results in d/c to another setting.
in rehab workshops (sheltered workshops) and supportive employment programs, discharge is not always the goal. why
maintenance of the person in these structured work environments can be the desired objective for some individuals while others will be discharged to other programs or to work
know the strategies and techniques used to reduce the use of restraints
make sure I wrote flashcards about this in chapter 16
what is meant by triangulation of data
making sure your themes are from more than one source. one way to do this is to ask the same questions to your subjects
what did the Reauthorization and Amendment of Individuals with Disabilities Education Act do for early intervention services
mandates an Individual Family Service plan (IFSP) for children 0-2. they are now mandated for children aged 0-3 OT is identified as a primary early intervention service.
when do you do budget revisions
may be needed as programs or services change due to ongoing program evaluation
who is responsible for ensuring proper maintenance of equipment and a safe treatment environment
me, the OT
name 3 measures of central tendency
mean mode median
what does 0 indicate in correlational statistics
means no relationship between variables
short and long term goals can also be written in the RUMBA format. what does the M stand for
measurable
short and long term goals should be written in the SMART manner. what does the M stand for
measurable, as to number of times or percent
explain consultation reports
meetings and/or phone conversations with team members, other professionals, the individual, and his/her caregiver
describe membership requirements for a clubhouse program
membership is open to adults and elders with a current mental illness or history of mental illness. all members have equal access to all clubhouse functions and opportunities regardless of functional level or diagnosis. individuals who pose a significant and direct threat to the safety of the clubhouse community are the only persons excluded.
what does the Fair Housing Act state about newly constructed apartments
must be built to meet established accessibility standards
who is responsible for the documentation of the OTA
the supervising OT even if a co-signature is not required
can the provider discuss the case of a competent person aged 18 and older with anyone else (including family members or other providers)
no, not without the person's permission. therefore, OTs should obtain this permission on initial contact to ensure effective team communication. if the person objects or cannot give permission, the provider can use his/her clinical judgment to determine if the case should be discussed without the person's permission. documentation of this determination is required. for example, if an individual expresses suicidal ideation but demands that the OT not tell his/her psychologist. The OT must tell the psychologist anyway in this scenario.
does HIPAA mean that all OT services have to be provided in a private space
no, open clinics, gyms, group settings are allowable as long as all discussion about persons are discreet
what type of details should be left out of documentation
non-important, extraneous details (color of clothing)
what type of task can OT aides perform
non-skilled tasks - they still have to be trained
which types of notes does the AOTA recommend the OT cosign
notes which will be included in medical charts, IEPs and other legal documents because these records may be subject to subpoena
SOAP notes. explain O
objective: diagnosis, medical information and history, and measurable, observable data obtained through formal assessments
describe intradisciplinary teams
one or more members of one discipline evaluate, plan, and implement treatment of the individual. other disciplines are not involved. communication is limited, thereby limiting perspectives on the case. the "team" is at risk due to potential narrowness of perspective
who are members of the team
patient, his family, significant other and/or caregivers health care professionals reimburser's gatekeepers
describe ethnographic design
patterns and characteristics of a cultural group, including values, roles, beliefs, and normative practices, are intensely studied. extensive field observations, interviews, participant observation, exam of literature and materials, and cultural immersion are used. used in health care to understand an insider's perspective to develop meaningful services (e.g. a study of a nursing home)
define capitation
payment system under which the provider is paid prospectively (on a monthly basis) a set fee for each member of a specific population (i.e. health plan members) regardless if no covered health care is delivered or if extensive care is delivered. Payment is typically determined in terms of "Per member per month" (PMPM). the healthier the enrollees, the more the provider retains of the total PMPM payment It pays a physician or group of physicians a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. These providers generally are contracted with a type of health maintenance organization (HMO) known as an independent practice association (IPA), which enlists the providers to care for HMO-enrolled patients. The amount of remuneration is based on the average expected health care utilization of that patient, with greater payment for patients with significant medical history.
describe Part B coverage
pays for hospital outpatient physician and other professional services including OT services provided by independent practitioners.
what is Part A of Medicare (what four things does it cover)
pays for inpatient hospital, SNF, home health rehab facilities, and hospice care
what is a capital expense
permanent or long-term purchases such as an ADL kitchen or for new facilities, such as new wing for a work hardening program. typically an item or action above a fixed amount ($500) is considered a capital expenses
define beneficiary
person receiving services. In SNFs, the term resident is used.
what should all OT practioners have
personal malpractice insurance !!!!
what is an Individualized Training Account (ITA)
persons determined to be eligible for WIA services receive an ITA which is used to obtain services from any approved provider.
SOAP notes. explain P
plan: the therapist's specific plan of intervention to resolve identified problems and meet stated goals
how do you judge strength of relationships in correlational statistics
positive correlations range from 0.00 to +1.00; indicates as variable X increases, so does variable Y
what is alpha level
preselected level of statistical significance. most commonly .05 or .01: indicates that the expected difference is due to chance. eg. at .05, only 5 times out of every 100 or a 5% chance is often expressed as a value of p.
describe the Telehealth model
service-delivery model which can include features of the other models (medical, education, community) by providing medical, rehabilitative, and/or educational services to persons via telecommunications technologies
what is the acceptance criteria for home care
presence of a medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from a hospital but that still has remaining symptoms requiring active treatment think homebound
who is the gatekeeper of services for consumers in managed health care systems
primary care physician (PCP)
what does POMR stand for and what is it
problem oriented medical record - a system of providing structure for progress note writing that is based on a list of problems based on assessment
to be reimbursed, OT services must be properly coded and billed, as required by payers. practioners must represent their services in terms of diagnosis and procedure codes. briefly explain procedure codes
procedure codes describe the specific servies provided by health care professionals (think CPT) the specific codes that most closely describe the service(s) provided should be used. each procedure, modality and/or treatment should be coded.
define supervision
process in which two or more individuals collaborate to establish, maintain, promote, or enhance a level of performance and quality of service. it is a mutually respectful joint effort between supervisor and supervisee. it promotes professional growth and development and facilitates mentoring
why do wellness and prevention programs exist
programs have been developed to serve populations considered at risk and are held in offices or individual's residences and/or community sites.
describe the American with Disabilities Act of 1990 (name the 5 areas)
prohibits discrimination against qualified persons with disabilities in employment, transportation, accommodations, telecommunications, and public services
what is the main tenant of the Fair Housing Act
prohibits discrimination on the bases of disability, religion, sex, color, race, national origin, and familial status
the approval of an Institutional Review Board (IRB) must be obtained for all human subject research - what is a main rule about this and why IRB
proposals for research must be submitted to and approved by an IRB prior to implementation of research study IRBs review research proposals to ensure that all of the above ethical standards for research have been considered by the researcher
what is the best way to seek input from others about ethical dilemmas
provide information in an anonymous fashion which enables the individual to give advice in a more objective manner and to provide recommendations that cannot be construed to be biased or prejudicial.
how did the IDEA Improvement Act change the IEP
provided for the piloting of a multi-year (not to exceed 3 years) IEP to allow for long-term planning and to coincide with a child's natural transitions. (preschool to elementary, middle to high school, etc). this plan is optional for parents.
describe minimal supervision
provided only on a needed basis, can be less than monthly
explain clinical case management
provides individualized support and intervention to a client with a serious illness which significantly limits his/her ability to access and/or engage in existing community services and/or therapeutic programs,ensuring that the person is able to remain in the community and not be re-hospitalized
describe primary care physician (PCP)
provides primary health care services and manages routine medical care makes referrals, as needed, to other health care providers, including rehab services. can be and MD or DO
describe the results section in both quantitative and qualitative research
quantitative - report all factual data with no interpretation. report all findings with no bias toward reporting only results supportive of the study's hypothesis qualitative research - results, conclusion, interpretation are discussed in an integrated manner descriptions, illustrative quotations and brief examples are used. writing format used depends on the qualitative design of the study.
what is the difference between quasi-experimental and true-experimental design
quasi-experimental does not randomly assign subjects to group - they are put into particular groups for particular reasons. often used to study intact groups created by events or natural processes.
what is and is not allowed during an interview
questions about a disability (even if it is a visible disability) are prohibited during a job interview. questions about a person's ability to perform the essential functions of a job are the only inquiries allowed.
describe the clubhouse model
services are provided by staff and members with the responsibilities of operating the clubhouse shared equally by the staff and members under the oversight of a director. due to this role equality, it can be difficult to distinguish between members and paid staff. staff's main role is to engage membership, provide needed support and structure, and enable recovery/
what is the OT eval like in a long-term hospital
quite extensive due to increased LOS
name 4 measures of variability
range standard deviation normal distribution percentiles and quartiles
short and long term goals can also be written in the RUMBA format. what does the R stand for
realistic
describe prospective research
recording and investigation of present data
ADAAA of 2008 - how did it redfine major life activities
redefined major life activities to include major body functions and organ operations performing basic and instrumental activities of daily living, completing physical movements and manual activities, sleeping, working, reading, learning, communicating and interacting, thinking and concentrating
what is the main focus of worker's comp
rehab and disability management to return the person to gainful employment is primary focus
define statistical utilization review
reimbursement claims data are analyzed to determine the most efficient and cost-effective care
short and long term goals should be written in the SMART manner. what does the R stand for
relevant to roles and expected environment
what must an OT do if she suspects or observes incidents of patient/client abuse or neglect
report it
describe continuous supervision to OT aide
required for client-related tasks. a supervisory OTA or OT must be within auditory and/or visual contact in the immediate area of the aide during the aide's task performance.
describe the Telecommunications Act of 1996
required providers of telecommunications systems and manufacturers of telecommunications equipment to make services and equipment useable by and accessible to individuals with disabilities, if at all possible. examples of services and equipment covered by this act are cell phones, pagers, call waiting, caller ID, and operator assistance
what does the NCLB require schools to do regarding testing
requires schools to provide accommodations, if needed by students, for mandated tests. OT practioners can recommend testing alternatives and/or classroom accommodations.
what does the IDEA improvement act state about infants and toddlers who are victims of abuse/neglect
requires states to establish procedures for the referral of infants and toddlers who are victims of abuse and/or neglect to early intervention services
what does the IDEA Improvement Act say about evidence-based practice
requires that recommendations for early intervention, special education, related, and supplementary services and aids be made based on peer-reviewed research to the extent that this is practical - this accomplishes two things - makes sure there is evidence-based practice and to spur research on early intervention and school-based OT to support evidence-based practice. peer-reviewed research is needed to support IFSP and IEP recommendations. so if there is an exam question, the most appropriate answers to exam items about recommended interventions for EI and school-based settings will likely be those that are evidence-based.
describe residential programs
residential programs are on a continuum from 24-hour supervised quarter way houses, half-way houses, or group homes to supportive apartments with weekly or biweekly "check-in" supervision. the degree of functional impairment determines the residential level of care needed
what is an integral part of program evaluation
risk management
describe non-skilled non-client tasks
routine maintenance and clerical activities (preparation of clinic area for intervention, organizing supplies)
describe how an OTA can establish service competency
service competency is the ability to use the specified in a safe, effective, and reliable manner (i.e., the OTA and OT can perform the same or equivalent procedure and obtain the same results). OTAs who establish service competency do not become independent. they continue to work under the OT's supervision
what does OSHA do
sets standards to ensure safety of employees and consumers. correct exam answers must comply with OSHA standards (e.g. the safe storage of flammable materials) the safety of employees and consumers is regulated by OSHA standards for handling infectious materials and blood products, controlling blood borne pathogens, operating machinery, and handling hazardous substances
according to OBRA, what must nursing homes do about restraints
show evidence of consultation by an OT or PT for consideration of interventions that are less restrictive than restraints
explain critical incident reports
significant out of the norm events that may occur during OT evaluation or intervention (e.g. the individual slips during a transfer)
_________notes fall under POMR
soap
short and long term goals should be written in the SMART manner. what does the S stand for
specific. for example, not "increase self-care skills" rather "develop ability to button shirt using non-dominant hand"
what is meant by extended and varied field experience
spending prolonged time in the field - the more experience the researcher has with participants in their actual setting, the more accurate or valid will be the findings
which abbreviations should be used
standard, well-recognized abbreviations should be the only ones used (ROM, MMT)
describe network/snowball sampling
study subjects provide names of other individuals who can meet study criteria
SOAP notes. explain S
subjective: information reported by the client, family, or significant other
OT notes and records are legal documents thus subject to
subpoena
describe intermittent supervision to OT aide
sufficient for non-patient related tasks. it requires periodic discussion, demonstration, or contact between the supervisor and aide on at least a monthly basis
give private transportation systems
taxis, tour bus companies
so you are an OT and are asked to provide a reference for a former student seeking an OT staff position. you know this student has failed the NBCOT exam and has had her temporary license revoked. what should you do?
tell the student to stop misrepresenting herself as capable of fulfilling a staff OT position.
What does the Fair Housing Act state about modifications to common use areas and private living space
tenants with disabilities are allowed to make reasonable modifications to common use areas and to their private living space to enable access. the housing owner is not required to fund these modifications
what is the acceptance criteria for hospice services
terminal illness that has a life expectancy of 6 months or less. services are most often provided in the home with the type and quantity of services determined by the needs of the individual, his/her family, significant others, and caregivers. hospice services may also be provided in an independent facility or in a special unit of a SNF or hospital
define parametric statistics
testing is based on population parameters - includes tests of significance based on interval or ratio data
what is nonparametric statistics
testing not based on population parameters, includes tests of significance based on ordinal or nominal data
what does CAPTA mandate
that professionals report abuse and neglect to law enforcement officials. OTs are included in this list of mandated reporters.
OBRA of 1990 mandated that the evaluation and treatment of conditions found during the MDS follow specific guidelines called the Resident Assessment Protocols (RAP). these include . . .
that the individualized care plans must be established within specific time frames.
what did the reauthorization and amendment of Individuals with Disabilities Education Act emphasize
that the purpose of the IEP is to address the child's unique needs as related to his/her disability and decide how these needs can be served so the child has full access to the general education curriculum and can participate in the general education classroom.
the IDEA Improvement Act requires that all students with disabilities be assessed in compliance with the No Child Left Behind Act (NCLB) what does this mean
the IEP team determines if the student should take an alternative assessment or the standard assessment with or without accommodations
while many SNFs have not fully implemented OBRA into their institutions, what will NBCOT expect
the NBCOT exam will expect the inclusion of these standards because it emphasizes best practice. correct answers to exam scenarios will include concepts of self-determination and choice. however, the maintenance of the person's health, safety and well-being should be a priority. if an SNF resident with dementia and diabetes continues to eat sugary candies and cookies, the SNF staff can justifiable restrict this person's diet because of the health danger presented by this habit.
who is responsible for the determination and delegation of non-skilled client and non-client tasks an aide performs
the OT
an exam item scenario involves a SNF resident who could benefit from a specialized splint but the SNF administrator pressures the OT to select a less expensive alternative. what would the correct answer entail
the OT advocating for the equipment item that best meets the person's needs
an exam item scenario involves an adminstrator asking an OTA to document that certain residents in a SNF need continued intervention even though they have been evaluated as no longer needing OT services. what would the correct answer entail
the OTA refusing this request and that the OT supervisor inform the administrator that this request is inappropriate
define real needs
the actual disabilities and functional limitations of the target population
what does full-time equivalent (FTE) mean
the amount a full-time staff employee works; in the US, 8 hours/day, 5 days/week. basically it is a budget formula used to determine the number of personnel providing direct care. for example, two practioners who do administrative tasks half of the day and direct care half of the day would equal one FTE. three part-time employees would equal 1.5 FTEs
define deductible
the amount a patient must pay to provider before the insurance benefits will pay; usually expressed as an annual dollar amount
define accounts receivable
the assets within a budget, indicates payments that are owed to the program, setting, or institution (e.g. consultation fees)
usual and customary rate (UCR)
the average cost of specific health care procedures in a geographic area. this is the maximum amount the insurer will pay for a service and covered expense
describe true-experimental design
the classic two-group design which includes random selection and random assignment into an experimental group that receives treatment or a control group that receives no treatment. all other experiences are kept similar
on the exam, if the exam item does not provide info establish an OTA's ability to perform a task that is beyond OTA entry-level competence, what do you do
the correct answer cannot have the OTA doing that task
define total quality management (TQM)
the creation of an organizational culture that enables all employees to contribute to an environment of continuous improvement to meet or exceed consumer needs.
what is operating expense budget
the daily financial activity of a program or service. includes information on revenue, volume, and direct and indirect expenses
define accounts payable
the debts within a budget, indicates payments that are due for purchases or services rendered (eg to an equipment supplier, a landlord)
describe confirmability
the degree to which a study's conclusions are based on the data. confirmability is attained when data is truthful.
define differentiated marketing
the design and use of marketing strategies and activities for different market segments (eg. promoting OT specialties to different consumer self-help groups)
define concentrated marketing
the design and use of specific marketing strategies and activities to concentrate on one market segment (the elderly)
an exam scenario is about a research project in a rehab hospital that utilizes a questionnaire. what must be done before data collection
the determination of a person's cognitive status and literacy level is required to determine if a person can give informed consent
define place
the distribution method for getting a product or service to the target market for providing the target market with access to the product or service
define provider
the entity responsible for the delivery and quality of services. providers bill Medicare, HMOS, and PPOs for services rendered
define vendor/supplier
the entity which supplies services
what is the primary difference between Part A and Part B (besides Part B being optional)
the frequency in which the individual receives services. Inpatient Part A coverage requires services for a minimum of 5 days per week. Part B typically covers 3 days per week outpatient services.
describe dependability
the inclusion of the full range of data, including outlier or atypical findings. dependability is attained when all participants' experiences/perspectives are considered important and reported.
define private payment
the individual receiving services is responsible for payment
define treatment authorization request (TAR)
the medicaid form a primary care provider must complete to document the need for requested medically necessary covered services with a supporting rationale.
all information used or disclosed about a person's status must be limited to . . .
the minimum needed for the immediate purpose
define co-insurance
the monetary amount to be paid by a patient, usually expressed as a percentage of total charge
define health maintenance organization (HMO)
the most common form of managed care. maintains control over services by requiring enrollees to see only doctors within the HMO network and to obtain referrals before seeking specialty or ancillary care.
what is the role responsibility of the consumer
the most important and primary member of the treatment team. the consumer's occupations, values, interests, and goals must be determined and used in all treatment planning.
define prospective payment system (PPS)
the nationwide payment schedule that determines the Medicare payment for each inpatient stay of a medicare beneficiary based on DRGs
what is type II error
the null hypothesis is not rejected by the researcher when it is false, e.g. the means of scores are concluded to be due to chance when the means are truly different guilty person goes free null hypothesis - the person is not guilty null hypothesis is accepted when it is indeed not true
what is type I error
the null hypothesis is rejected by the researcher when it is true; e.g. the means of scores are concluded to be truly different when the differences are due to chance an innocent person goes to jail null: hypothesis - the person is not guilty null hypothesis is rejected - the person is found guilty when they aren't
define personnel management
the oversight of OT practioners and support personnel and the services they provide
what does the IDEA improvement act state about the site of service provision for infants and toddlers
the parent and the IFSP team determine the site for service provision. the IDEA improvement act requires states to maximize the provision of early intervention services in the infant's or toddler's natural environments, as appropriate.
an exam item has a 19 year-old with a disability who wants to live on his own but the family wants him to remain at home for safety reasons - whose wishes does the therapist have to honor
the patient's but provide support for the family's concern
define fee for service
the payment system under which the provider is paid the same type of rate per unit of service. traditionnally, payer pays 80% and patient or provider is responsible for the remaining 20%.
define position (in terms of marketing)
the place the product or service holds in relation to similar products or services available in the marketplace
define staff development
the process of continually upgrading employees' knowledge and skills to provide competent, current, and caring OT services in changing and challenging delivery systems
define recruitment
the process of determining staffing needs, predicting turnover and vacancies, and identifying and recruiting potential replacements to maintain the staffing levels required to meet program objectives
define performance evaluation
the process of evaluating staff performance according to established performance expectations
define disciplinary action
the process of informing an employee that his/her job performance is unacceptable
define denial
the refusal by a payer to reimburse provider for services rendered. reasons for denial include benefits exhausted, duplication of services, and services not indicated.
describe credibility
the researcher's level of confidence that his/her findings truthfully reflect the reality of a study's participants and the study's context. credibility is attained when the researcher does not have preconceived notions about a study and allows for multiple truths to emerge from the findings, as revealed by the participants.
what does the school do with referrals for OT
the school reviews the referral and if indicated recommends an OT evaluation. if an OT evaluation has already been completed, the need for OT intervention services is discussed. the frequency, length of sessions and duration of the intervention are also determined.
define product
the service or thing that is being offered to the market (e.g. a work hardening program, adaptive equipment)
who must be invited to attend the IEP meetings to discuss transition planning and why
the student to allow for self-advocacy and self-determination
what did Ticket to Work and Work Incentive Improvement Act (TWIIA) accomplished
they removed a major work disincentive for persons with disabilities by enabling them to keep their Medicare and Medicaid health benefits if they work as long as their salaries do not exceed established limits also allows an individual with a disability to keep Medicare benefits for an additional 54 months after starting work
what happens if a student with a disabilities commits a serious offense such as carrying illicit drugs or a weapon
they would be punished in the same manner as other students for serious offense. disciplinary prevention measures are stressed.
explain the Omnibus Budget Reconciliation Act (OBRA) of 1990 as it relates to nursing homes
this act is applied to all nursing homes that receive federal money for Medicare or Medicaid patients. it emphasized attending to residents rights, autonomy, and self-determination; providing quality of care; and enhancing quality of life within nursing homes. This act places emphasis on psychosocial well-being, quality of life, restraint reduction, meaningful activities, and self-determination
what does the Reauthorization and Amendment of Individuals with Disabilities Education Act state about transitioning after school is completed
this act states that the education the student receives should prepare him/her for independent living and employment in adult life.
explain Title 1 of the ADA
this is about employment prohibits employers from discriminating against persons with disabilities in any aspect or phase of employment including recruitment, hiring, work conditions, hours, promotion, training opportunities, termination, social activities and other privileges of employment
what must happen if a client has met his/her goals and/or is no longer making significant functional gains
this must be documented and the client needs to be discharged from services. however, under Medicare, services can continue to be provided if they are needed to prevent deterioration and enable the person to function at their maximal potential
how does OBRA of 1990 propose enhancing quality of life
through restraint reduction and the provision of restraint-free environments are strongly emphasized.
short and long term goals should be written in the SMART manner. what does the T stand for
time-limited, anticipated time to achieve goals. time allotted for goal attainment must be relevant to setting's LOS (e.g. in acute care, goals are measured in days whereas in long term care, weekly or monthly goals are acceptable)
what does the IDEA Improvement Act say about screenings done by specialist. what does this mean for OT
to be eligible for IDEA services, an evaluation must be done for those services. a screening done by a specialist is not equivalent. OT practioners can conduct informal classroom-based screenings and provide consultation for classroom modifications and other teaching strategies without completing a formal evaluation.
what is worker's compensation designed for
to compensate employees who have job-related illness or injuries.
what is the OTA's primary role
to implement intervention
what does the Fair Housing Act require of landlords
to make reasonable exceptions to their standard tenant policies to allow individuals with disabilities equal housing opportunities (e.g. allowing a seeing eye or service dog in a no-pets apartment)
name 2 purposes of personnel management
to serve as the link between the individuals working for an organization and the larger organizational structure to attain best practice from personnel
describe training services (4)
training services are for individuals who do not attain successful employment after receipt of core and intensive services. these services are typically provided off-site from the One-Stop Center and can include . . . 1) adult education 2) literacy training 3) on-the-job training 4) individualized vocational training
what constitutes the independent variable in a true-experimental design
treatment (or no treatment)
what does treatment address in the medical model
treatment addresses the disease or dysfunction (performance compenents) contributing to decreased functional skills
describe a day hospital program
treatment is up to 5 days per week with multiple interventions scheduled each day
OTAs can be activities directors in a skilled nursing facility - true or false
true - they do not require supervision because they are employed as activities directors not OTAs
when does Medicare cover private-practice OT services
when services are provided by a Medicare certified OT in independent practice (OTIP). services are provided in therapist's office or in the patient's home. payment is according to the fee schedule entitled the Resource Based Relative Value Scale (RBRVS).
when must the initial assessment be completed for home care
within 48 hours of referral or within 48 hours of the person's return home
can OT open their own free-standing clinic
yes - a provider number is required for a private practioner to receive third party payment. private practioners must abide by all state and third party payer regulations for evaluation, intervention, and documentation
do Part A covered services have specific time limits and also require deductible and coinsurance payments by the beneficiary.
yes - annual deductible fees must be paid by patient
can a limited data set be used in research without patient approval
yes, as long as it does not include any identifiable patient information
what is different about OT eval for case management programs
you need to assess the individual's supports and barriers for community integration
WIA also provides services for who
youth aged 14-21 with disabilities these services assist in successful transition from school to work this provision is a valuable resource to schools, for it means that limited school resources do not have to be used to implement the work aspect of a student's transition
