OT521 Exam #1
-Concern that research is largely conducted by professionals who have never experience mental illness-> lead to now needing someone who has experience a MI a part of the research
"Nothing about us without us"
-Introduced habit training in New York State Hospitals in 1920's -Goal of habit training was to establish a well-balanced day and return the individual to the community if possible
Eleanor Clarke Slagle
ongoing striving to understand the clients thoughts, feelings, and behaviors while suspending any judgment. Ensuring that the client verifies and experiences the therapists understanding as truthful and validating.
Empathizing Therapeutic Modes
-Seizing the opportunity to instill hope in a client. Celebrating a client's thinking or behavior through positive reinforcement. Conveying an attitude of joyfulness, playfulness, and confidence.
Encouraging therapeutic modes
-Guide for assessment and diagnosis of mental disorders -Facilitates research and improves communication among clinicians and researchers -Supports teaching and learning of psychopathology
Evolution of the Diagnostic and Statistical Manual of Mental Disorders
uStigma also experienced by the family, spouse, partner, and network of friends of a person with a mental illness. uPsychological distress related to caring for the family member with a mental illness uBelieve others blame them for their family member's mental illness uKey attributes uUnusualness uOthers believe the family poses a danger or threat of being potentially harmful to the health and well-being of others
Family Stigma
Mental health is a component of all occupational therapy interventions with a continued focus on ______________ and __________
Function and independence
-through a recovery-oriented lens provides opportunities to manage both emotional and physical health. Interventions include: -Social support group focused on building coping skills -Creation of a medication management plan -Peer wellness coaching to encourage physical activity
HEALTH
-Concepts of ______ are uniquely defined by the individual. -Practitioners can facilitate skill development to maintain a home: bill paying, home maintenance, cooking.
HOME
People with acute symptoms - depression, psychosis, mania, alcohol or drug toxicity
Inpatient acute or psychiatric specialty hospital (3-7 days)
-Carefully structuring therapy activities and being explicit with clients about the plan, sequence, and events of therapy. Providing clear instruction and feedback about performance. Setting limits on a client's requests or behavior.
Instructing Therapeutic Mode
-"Provides a scientific basis for understanding and studying health and health-related states, outcomes, and determinants" (WHO, 2001, p. 5). -Establishes a common language for describing health and health-related states -Permits comparison of data across countries -"Provides a systematic coding scheme for health information systems" (WHO, 2001, p. 5). -Disease and dysfunction are NOT synonymous
International classification of functioning, disability, and health (ICF)
•Fundamental to the use of self because it allows a therapist to develop stable, predictable relationships with their clients. •It allows a clients to trust that the therapist has the ability to place his or her own interpersonal reactions and expectations aside to best fulfill the clients wishes/goals.
Interpersonal self-discipline is fundamental to effective use of self
Can begin in the hospital setting Lack of control of one's own body Lose freedom to spend time as wish, come and go as please, wear own clothes Can exist long after discharge from hospital Activity restriction Architectural barriers Limited employment opportunities
Isolation
•Responding to a client from the heart is intuitively, spontaneous and emotional and should be considered an indulgence and a privilege earned by the therapists rather than an entitlement. •Responding from the heart must be accompanied by sufficient development of critical self-awareness and interpersonal self-discipline.
It is necessary to keep head before heart
A judgment occurs, particularly by individuals with power and authority to decide that the behavior deviates from the norm.
Labeling Theory
-Worked with long-term mental health patients in institutional settings initially -Instrumental in transitioning services to community mental health programs -Highlighted occupational therapy services in the milieu of mental health services throughout her work
Lela Llorens
People who continue to experience severe symptoms or are considered dangerous after a short hospital stay
Long-term "locked" facilities - public or private (3 months to several years
Participation in _______________________- is not an outcome, but a critical, even foundational, element of recovery
Meaning activities
v"A state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity" (DHHS, 1999, p. 4).
Mental Health
GW Bush established the New Freedom Commission on Mental Health 1.The stigma of mental illness 2.Disparities in mental health benefits in health insurance 3.A broken mental health system
Mental Health Reform (2002)
-Began at the turn of the 20th century Adolf Meyer, a philosophical founder of occupational therapy and a prominent psychiatrist, placed responsibility on states and communities for providing needed services to individuals with mental health issues
Mental Hygiene Movement
_____________ often leads to disability because it causes a decrease in a person's daily functioning, decreased productivity
Mental Illness
Mental Illness leads to:
dec. functioning and decreased productivity
Guiding Principles of Recovery
1.Self direction 2.Individualized and person-centered 3.Empowerment 4.Holistic 5.Nonlinear 6.Strength based 7.Peer support 8.Respect 9.Responsibility 10.Hope
People dx. With serious mental illness die ___years earlier than their counterparts on average
25 years
-Flourished from 1880 to 1914 -Became the therapeutic media in psychiatric hospitals -Offered the person experiences of joy, pleasure, self-esteem, and self-worth
Arts and Crafts Movement
-Expecting the client to be an active and equal participant in therapy. Ensuring choice, freedom, and autonomy to the greatest extent possible
Collaborating Therapeutic Modes
-Support of individual mental well-being by addressing social strategies beyond traditional occupational therapy interventions
-Advocacy -Knowledge of civil rights -Formation of strategic community alliances -Working to remove attitudinal and other barriers in "regular" work environments -Developing meaningful supported employment -Exploring volunteerism and consumer-run businesses
Psychiatric Conditions Associated with Physical disability
-Depression and anxiety -PTSD -Substance abuse -Suicide Ideation
Therapists responsibility to the therapeutic relationship:
-Ensure the appropriate definitions and boundaries of the therapeutic relationship are sustained -Ensure positive interpersonal relating, such as trust, mutual respect, and honesty, characterize the relationship
-Reduction in mental health hospital beds results in increased number of individuals with mental illness in:
-Forensic settings -Homeless
Mental illness and significant psychosocial factors
-Substance related disorders -Schizophrenia -Mood disorders -Anxiety disorder -Somatoform disorders -Sexual and gender identity disorders -Eating disorders -Adjustment disorders -Personality disorders -Sensory modulation disorder -Learning disorder
-This model explains how components of the client-therapist relationship interact and can be enhanced in the face of everyday challenges to that relationship - views the therapeutic relationship as being comprised of WHAT four central elements
-The intentional relationship model (IRM) -1. The client -2. The interpersonal events that occur during therapy -3. The therapist -4. The occupation
Occupational therapy practitioners should consider the various aspects of stigma in order to be more effective in
1. Understanding their clients' lived experience of stigma 2. Collaborating with their clients and their families to address the impact of stigma in culturally responsive ways
Ways to be admitted
-Voluntary admission -Involuntary civil commitment -Involuntary criminal commitment
Founding of Occupational Therapy: Moving Towards Occupation
-William Rush Dunton, Junior -Eleanor Clarke Slagle -Susan Edith Tracy -Lived Experience: Lela Llorens
_______________ years had the highest prevalence of mental illness (22.3%) compared to _______________ (22.2%) and ____________ (13.8%).
-Young adults aged 18-25 -adults aged 26-49 years -aged 50 and older
OTs roles are to help individuals do what?
1 Develop and maintain positive mental health 2 Prevent mental illness 3 Recover from mental health challenges
Exploring the dimensions of recovery
1 Health 2 Home 3 Purpose 4 Community
Psychosocial and environmental stressors
1 Problems with primary support group 2 Problems related to the social environment 3 Educational problems 4 Occupational problems 5 Housing problems 6 Economic problems 7 Problems with access to health care services 8 Problems related to interaction with legal systems 9 Other psychosocial stressors
Types of Therapeutic Modes:
1. Advocating 2. Collaborating 3. Empathizing 4. Encouraging 5. Instructing 6. Problem-Solving
Factors related to psychosocial and disability
1. Isolation 2. Pain 3. Body image 4. Lack of relational intimacy and gender role issues 5. Cognition
-Occupational therapy core values (AOTA, 1993) and ethics (AOTA, 2005) must inform application of the IRM in practice.
Application of the model must be informed by core values and ethics
•Not all clients benefit from the same level of emotional intensity or closeness in the therapeutic relationship. • refers to responding to interpersonal events that emphasize "doing" over "feeling" •Interpersonal focusing refers to strategies that emphasize the latter over doing issues.
Activity focusing must be balanced with interpersonal focusing
limited number of beds and short length of stay
Acute inpatient hospital-based services
Ensuring that the client's rights are enforced and resources are secured. May require the therapist to serve as mediator, facilitator, negotiator, enforcer, or other type of advocate with external persons and agencies
Advocating Therapeutic Modes
Personal vs. Clinical interpretation of recovery
Clinical interpretation: Recovery from mental illness Personal interpretation: Being in recovery"
-Includes the ways individuals engage, participate, and give back to the ______________-. -Practitioners can help individuals identify interests, then -Develop skills necessary to participate or -Create a supportive environment so the individual can participate
Community
opportunity to work with clients in real life environments; however, limited positions for occupational therapist as case manager
Community case management
People with serious mental illness who need ongoing support to maintain community living
Community support/peer support programs (Indefinite)
Practitioners should assist family members to learn to consider and prioritize their own needs, access available supports, and strive for balance as they endeavor to meet the demands of caring for a loved one.
Compassion fatigue
•Involves having a working knowledge of your interpersonal tendencies while interacting with clients of different personality styles and under different conditions and circumstances. •Requires understanding of your own interpersonal reactions and behavior changes
Critical Self-Awareness
difference between DSM and ICF
DSM in US and ICF is international classification of function (Developed by WHO)
-Developed by the American Psychiatric Association (APA) Purpose -Diagnosis -Professional communication -Expectations -Research criteria WHAT AND WHEN WAS IT PUBLISHED and SECTIONS
Diagnostic and statistical manual of mental disorders (DSM) -1st edition was 1952 -This one published in 2013 1.Basics 2.Diagnoses (22 chapters) 3.Supplemental information
•A therapist's capacity for empathy is a prerequisite for a functional client-therapist relationship. •An objective mode of observation in which the therapist comes to feel and understand a client's underlying emotions, needs and motives while maintaining the objective view point.
Mindful empathy is require to know your client
-Began in the 18th century -Response to the inhumane treatment of people with mental illness -Use of occupations kept patients busy, occupied, and less demanding of staff; started initially to benefit the institution, with secondary benefit to the patient
Moral Treatment
-A label forces an individual into a deviant role, and an individual's subsequent behavior and response to others is determined by expectations surrounding the label. -Inclusive design in environments supporting interventions that emphasize opportunities for social role development. -Critics argue that the theory emphasizes the need of the person with the disability to change and "fit in" rather than requiring society to accept such differences as part of human diversity.
Normalization Theory
-Sense of__________ was found through engaging with others and meeting expectations of valued roles (Sutton et al, 2012). -Practitioners should promote community participation through returning to these valued roles or exploring new ones.
PURPOSE
-more time to work on skill building
Partial Hospitalization
People who are no longer acute but still need daily supports to manage symptoms and begin recovery process
Partial hospitalization and intensive outpatient (2-6 weeks)
¡People in recovery helping others pursue recovery. ¡Offered before, during, or after treatment provided by mental health professionals. AND TYPES
Peer-Led services ¡Self-help: Individual and groups ¡Community services ¡Peer-professional partnerships ¡Peer-led organizations
facilitating pragmatic thinking and solving dilemmas by outlining choice, posing strategic questions, and providing opportunities for comparative or analytical thinking.
Problem-Solving Therapeutic mode
-pertaining to intrapersonal, interpersonal, and social experiences and interactions that influence occupational behavior and development. -can include psychological, cognitive, social, cultural, and spiritual aspects of occupation
Psychosocial
_________________dimensions of human performance are fundamental to all aspects of occupation and occupational therapy, with every client, and across all practice settings.
Psychosocial
-Theory proposes a cognitive, emotional, and social growth are the result of the interaction between social expectations at each life stage (Cherry, 2018)) -Development results from ongoing interaction between an individuals abilities and societal expectations and demands -How you as a therapist can evaluate and assess adjustment to dysfunction
Psychosocial Theory of Development by Erik Erikson
negative stereotypes of individuals with the specific condition by others
Public Stigma
A journey of healing and transformation enabling a person with a mental heath problem to live a meaningful life in a community of his or her choice while striving to reach his or her potential
Recovery
Primary model that guides mental health treatment in the US developed by who? -Facilitate resiliency, health, and wellness in the community of the individualschoice, rather than to manage symptoms -Journey that's end goal is an overall paradigm for achieving wellness and optimal mental health -How the journey looks is up to the individual (benefits the community as a whole)
Recovery Model developed by SAMHSA
¡Connectedness, Hope and optimism, Identity, Meaning and purpose, and Empowerment (C H I M E) ¡Examine the range of roles that families can play when supporting a family member's personal recovery.
Recovery frameworks using Family Focused Care
individuals agree with and internalize negative stereotypes
Self Stigma
-Negative attitudes that begin by applying a stigmatizing mark to a person and result in discrimination. -Labeling leads to prejudice. -Individuals experiencing thismay experience poor self-esteem, negative emotions, and behavioral withdrawal, and they may often conceal their stigmatized status from others.
Stigma
-May intentionally restrict opportunities for people with mental illnesses or create unintentional consequences that limit opportunities for participation -Occupational therapy practitioners can use their skills in advocacy to partner with people with mental illness and their families and other allies to help deconstruct structural stigma
Structural Stigma
Agency taking lead role in the New Freedom Comm. Report is part of the Health and Human Services Department (HHS) Vision Agency Roles $3.3 Billion budget Recovery
Substance Abuse and Mental Health Services Administration (SAMHSA)
People with serious mental illness who need ongoing support to maintain community living
Supported Education (indefinite)
People with serious mental illness who need ongoing support to maintain community living
Supported Employment (Indefinite)
People with serious mental illness who need ongoing support to maintain community living
Supported Housing (Indefinite)
-Developed assessment techniques based on observation of performance through leather making, paper making, plaster designing, and book repair
Susan Edith Tracy
•What is considered a successful relationship in OT must be defined by the client and not the therapist •A successful client-therapist relationship must be based on the achievement of the type of therapeutic relationship the client needs most and is capable of during the time they are in therapy.
The client defines a successful relationship
-Involves thoughtful self-disclosure and non verbal language -Involves determining what is clinically appropriate for the patient
Therapeutic Relationship
-A therapists conscious effort to optimize their interactions with clients; a therapists "planned use of his or her personality, insights, perceptions, and judgements as part of the therapeutic process" (Punwar & Peloquin, 2005, P. 285) -Studies indicate the client-therapist relationship is a key determinant of weather occupational therapy is successful (Cole & McLean, 2003)
Therapeutic use of self
•A therapist greatly benefits from knowing as much about human behavior as possible, particularly as it pertains to more commonly occurring events in the client therapist relationship. •Listening effectively, communicating clearly, overcoming basic conflicts and events, being reliable, predictable
Therapists are responsible for expanding their interpersonal knowledge base
¡Clients come from different areas of a hospital to attend a program. ¡Research from pilot and case studies is encouraging.
Treatment Mall Approach
¡Philosophy grounded in strengths-based community care ¡Individualized needs-driven services ¡Culturally intelligent ¡Trauma-informed ¡Systems-level and child- and family-level intervention ¡Destructive behaviors driven by unmet needs. ¡The greatest unmet need is loneliness. ¡Receiving a service does not necessarily mean an individual's needs are being met. ¡It is harder to institutionalize new ideas than to institutionalize people. ¡Achieving an optimal level of wellness and functioning, enhancing ¡Psychological and physical health ¡Self-worth ¡Productivity ¡Life satisfaction ¡Quality of life
WRAP AROUND SERVICES FOR CHILDREN AND YOUTH
A step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life Others may be included in the process to assist the individual, but individual empowerment comes from self-administration of the plan.
Wellness Recovery Action Plan (WRAP)
-Provided the first published analysis of arts and crafts activities for therapeutic purpose, which became the first examples of activity analysis in occupational therapy
William Rush Dunton, Junior
typically provided to youth with complex mental health needs
Wraparound services
Psychological and emotional challenges must be negotiated not just with the onset of the injury itself, but also with ________________
the traumas and losses that occur as a consequence of the condition.
Treatment team typically
¡Consumer ¡Psychiatrist ¡Registered nurse ¡Social worker ¡Occupational therapist ¡Additional team members
Mental illness in criminal justice system
¡Depression ¡Bipolar disorder ¡Anxiety disorders ¡Posttraumatic stress disorder (P T S D) ¡Personality disorder ¡Schizophrenia
Role of OT in mental health setting
¡Evaluate and screen ¡Establish interventions ¡Select relevant occupations ¡Implement interventions ¡Modify plan ¡Terminate therapy and plan discharge
General Goals of intervention
¡Improve A D L's and I A D L's ¡Develop employment interests ¡Increase job performance ¡Participate in volunteer activities ¡Pursue play and leisure ¡Improve social participation
Primary Diagnosis
¡Schizophrenia (46%) ¡Affective disorders (39%) ¡Personality disorders (3%) ¡Anxiety disorders (2%) ¡Other psychoses (8%)
OT Interventions in criminal justice system
¡Skill development ¡Relapse prevention ¡Community reintegration ¡Primary vocational skills-employment ¡Time management ¡Self-awareness ¡Leisure and life skills ¡Role functioning
•Therapeutic use of self must be informed by human diversity. •Human diversity is defined by differences in sex, age, race, ethnicity, socioeconomic status, religious views, sexual orientation, disability status
•Application of the model requires cultural competence.
•Individuals who enter the profession of OT have a personality that is oriented toward others and desires to support, uplift, empathize with, motivate, advocate for, guide, or otherwise empower people. •Each person has a unique set of interpersonal characteristics that influence their therapeutic mode.
•Provided that they are purely and flexibly applied, a wide range of therapeutic modes can work and be utilized interchangeably in occupational therapy.
