Occupational Therapy in the Community

Created by kellera2 

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Incidence___

refers to the number of new cases of disease, injury or disability within a specified time frame, typically a year

Prevalence___

refers to the total number of cases of disease, injury, or disability in a community, city, stare or nation exisiting at one point in time

Occupational imbalance, occupational depriviation, and alienation are__

risk factors for health problems in and of themselves. They also may result from or lead to the development of other risk factors, which in turn can result in larger health and social problems

Public health:____

concerned with optimizing the health status of populations. Detels and Breslow stated that public health is the process of mobilizing local, state, national and international resources to ensure the conditions in which people can be healthy

Public Health Strategies:___

1. promoting health and preventing disease
2. improving medical care
3. promoting health- enhancing behaviors
4. controlling the environment

Community health___

refers to the physical, emotional, social, and spiritual well-being of people who are linked together in some way, possibly through geographical proximity or shared interests

Community health interventions___

can be defined as any combinations of educational, social, and environmental supports for behavior conducive to health

Educational interventions: directed at___

high risk individiuals, families or groups or whole communities

Social interventions:___

economic, political, legal and organizational changes designed to support actions conducive to health

Environmental supports:___

include the structure and distribution of physical, chemical, and biological resources and facilities and substances required for people to protect their health

Practitioner roles in community health___

1. promotion of healthy lifestyles for all clients and their familieis
2. complementing existing health promotion efforts by adding the unique perspective of occupation to programs developed by experts in areas such as health education, nutrition and exercise
3. development of occupation-based health promotion programs, targeting a variety of constituences and levels of society, including individuals (both with and without disabilities), groups, organizations, communities, and governmental policies

Health promotion defined as___

the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment. Health, therefore, is sean as a resource for everyday life, not the objective living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being.

A key purpose of health promotion is the___

prevention of disease and disability in individuals and populations. Prevention is categorized into three levels: primary, secondary, and tertiary

Primary prevention is defined as___

education or health promotion strategies designed to help people avoid the onset and reduce the incidence of unhealthy conditions, diseases, or injuries. Primary prevention attempts to identify and eliminate risk factors for disease, injury, and disability

Examples of occupation-based primary prevention intervention that target individuals___

-musculoskeletal injury prevention
-anger management and conflict resolution training for parents, teachers, and school-aged youth to reduce the incidence of violence
-fall prevention programs for community-dwelling seniors

Secondary prevention includes____

early detection and intervention after disease as occured and is designed to prevent or disrupt the disabling process

Examples of occupation-based secondary prevention intervention that target individuals____

-education and training regarding eating habits, activity levels, and prevention of secondary disability subsequent to obesity
-education and training on stress management and adaptive coping strategies for people with mood disorders and post traumatic stress disorder

Tertiary prevention refers to___

treatment and services designed to arrest the progression of a condition, prevent further disablity, and promote social opportunity

Examples of occupation-based tertiary prevention intervention____

-trasitional or independent-living skills training for people whoe have mental illness and those with cognitive impairments
-stroke support groups

Organizational- level interventions___

providing consultation to businesses to promote emotional well-being through identification of problems and solutions for balance among work, leisure, and family life

Community or population-level interventions___

-consulting on accessible public transportation
-conducting needs assessments and implementing intervention strategies to reduce health dispartities in communities with high rates of disease or injury; intervention strategies may include lifestyle management programs addressing issues such as hypertension, diabetes, and obesity

Occupation-focused health promotion interventions at each level may include but are not limited to___

-individual-level interventions
-group-level interventions
-organizational-level interventions
-community-level interventions
-governmental-policy interventions

Occupation-based health promotion interventions: Individual-level interventions____

adaptation of physical activities/exercises for people with disabilities
-education of caregivers about proper body mechanics for lifting to prevent back injuries
-driving evaluation and training for persons with physical or cognitive impairments

Occupation-based health promotion interventions: group-level interventions___

-repetitive strain injury education and prevention and management programs for workers
-parenting skills training for adolescent mothers
-education of day-care providers regarding normal growth and evelopment, handling behavioral problems, and identifying children at risk for developmetal delay

Occupation-based health promotion interventions: organizational-level interventions____

-consultation with industrial managers regarding the benefits of ergonmic workspace design and worksite injury prevention strategies
-disability awareness training for service-industry personnel such as airlines, hotels, restaurants, etc

Occupation-based health promotion intervention: community-level interventions____

-modification of community recreational facilities to increase accessibility for persons with disabilities
-consultation with contractors, architects, and city planners regarding accessibility and universal design

Occupation-based governmental-policy interventions____

-promotion of full inclusion of children with disablities in schools and day-care programs
-lobbying for public funds to support programs to improve the quality of life for at-risk populations

Example of individual- level intervention____

caregiver education about proper body mechanics for lifting

Group-level interventions____

repetitive strain injury prevention for workers

Organizational-level interventions____

consultation with industrial managers regarding benefits of ergonomic workspace design

Community-level interventions____

consultation with contractors, architects, and city planners regarding accessibility and universal design

Governmental-policy interventions___

lobbying for public funds to support programs to improve the quality of life for at-risk populations

The cous on changing individuals with disabilitites must give way to a systems perspective on____

changing all elements such as environmental attitudinal, and sociopolitical that perpetuate disability in society

Community model:____

Shift from mdical model to community model. The community model is dedicated to supporting individuals and communities and empowering them to make their own choices. It redefines the role of professionals as facilitators rather than decision makers

Community-based rehabilitation___

refers to a strategy within community development for the rehabilitation, equalitation of opportunities and social integration of all people with disabilities intervational labor organization, UN, educational, scientific and cultural organization.

Community-based service is ____

more comprehensive than community-based rehabilitation

Community-based services include a____

broad range of health-related services such as prevention and health promotion, acute and chornic medical care, habilitation and rehabilitation, direct and indirect service provision, all of which are provided in community settings

Community Health Promotion____

any combination of education, social and environmental supports for behavior conducive to health

Community-built practice_____

when skilled services are delivered by health practitioners using a collaborative and interactive model with clients. This model emphasizes the stregths of a client and is wellness oriented

Roles in community based practice____

move into new settings, four emerging roles: evaluator, consultant, supervisor, research

four emerging roles:____

evaluator, consultant, supervisor, research

Other roles in community-based practice____

planners, staff trainers, community health advisors, policy makers, case managers, primary care providers, private practice owner, advocate

TRUE OR FALSE, OTs are not the expert in community-built practice

TRUE

Volition___

process by which persons are motivated toward and choose what they do

3 areas of volition (MOHO)____

-personal causation
-values
-interests

Model of Human Occupation (areas)____

-volition
-habituation
-performance capacity
-environment

Performance capacity refers to___ (MOHO)

underlying mental and physical abilities and how they are used and experienced in peformance

The capacity for performance is affected by the status of____ (MOHO)

musculoskeletal, neurological, cardiopulmonary, and other bodily systems that are called on when a person does things

Ecology of human performance was developed by ____

faculty at the university of Kansas to address their concerns regarding the "lack of consideration for the complexities of context" in both evaluation and intervention

EHP____

Ecology of Human Performance

Occupational adaptation was developed by___

Schkade and Schultz

Occupational adaptation is an____

integrative frame of reference.... that provides an additional dimension to the understanding of occupation and adaptation and their relationship to health

Occupation and adaptation are____

woven together into an integrated phenomenon that describes an innate human process

PEOPM___

Person-Environment-Occupational Performance Model

The PEOPM was developed by___

Christiansen and Baum

Performance results from___ (PEOPM)

complex interactions between the person and the environments in which he or she carries out tasks and roles

Developmental stage influences___ (PEOPM)

perfomance

Intrinsic enablers (in person), environmental factors and the meaning of ____ (PEOPM)

the occupation facilitate performance

OT intervention can facilitate a person's____ (PEOPM)

adaptation when he or she encounters problems in performance

A personal sense of competence influences (PEOPM)

performance

Social Learning Theory was established by___

Rotter

Bandura renamed this model social cognitive theory and expanded on Rotter's work and developed an integral component of SLT

Social Learning Theory

Social learning theory, the concept of___

self-efficacy

Social learning theory developed as means of___

explaining the acquisition of new behavios, particulaly from observational learning

Social learning theory includes concepts and strategies that have been used to___

guide the development of programs for skill development related to a wide range of health behaviors including chronic disease management and has been used specifically to support the development to health promotion behaviors in persons with disabilities

Four factors that influence how people learn from watching others in their learn from watching others in their environments____ (SLT)

-attention
-retention
-motor replication
-motivation

SLT: Attention is based on factors such as___

the model's attactiveness or similarity to one's self and one's needs or goals

SLT: Retention is essential for___

future use of the information

SLT: Motivation or reinforcement influences the___

likelihood of initially attempting and continually performing the modeled behavior

The four factors of the SLT influence the likelihood that____

one will attempt to replicate new behaviors

Bandura found that ______(SLT)

actual day-to-day performance is influenced by construct he named self-efficacy

Self-efficacy is defined as____ (SLT)

"the individual's perception that he or she will be able to successfully perform a specific behavior" It is the belief that in one's own competence to execute an action that will achieve the desired outcome

Individuals perform behaviors that result in___ (SLT)

certain outcomes

Both the behavior and the outcomes are mediated by____ (SLT)

expectancies

Expectancies are also referred to as_____(SLT)

incentives, possess a positive or negative value

An expectancy is the value an individual places on a particular outcome, three types of expectancies:____(SLT)

1. efficacy expectations
2. outcome expectations
3. environmental expectations

Efficacy expectations____(SLT)

Whether or not an individual believes in his or her ability to perform a given behavior

Outcome expectations____ (SLT)

are the individual's belief that a given behavior will lead to specific outcomes

Environmental expectations____ (SLT)

are beliefs about how events are related to each other and what one may expect from any given environment

Lifestyle changes will occur if the individual believes:_____

-current behaviors pose a threat to a personally valued outcome (such as health)
-specific behavioral change will be likely to reduce these threats (outcome efficacy)
-their own personal competence will allow them to perform the desired behavior (efficacy expectation)

Health belief model was once____

many models of health-related behavior

The health belief model was originally developed by Hochbaum, Kegeles, Leventhal, and Rosenstock, to explain____

preventive health behaviors, but was quickly adapted to study sick role and illness behavior

The health belief model is based on theories from____

social psychology, most notable Lewin's aspiratioon theory

The health belief model describes the____

relationships between a person's belief about health and his/her health specific behavios. The beliefs that mediate health behaviors are, according to the model, perceived susceptibility, severity, benefits, and barriers

Health belief model: first the client perceives a ____

threat, or perceived threat, is based on the combination of perceived susceptibility to a disease or consequence plus the belief that the consequence is serious

Health belief model: another component of the model is the client's belief about the proposed education. What are the perceived benefits of the clienteducation and___

adopting some new behavior? What are the perceived barriers to engaging in the education and adopting the new set of health behaviors?

Health belief model: the balance ____

ie: the benefits versusthe barriers must be weighed and reconciled

Barriers include (health belief model)_____

cost, the degree of required change, changes in social life, changes in role, changes in self-concept, and the sheer effort involved

The final step of the health belief model is the client's____

belief in his or her efficacy to carry out the recommended actions for the identified health problem

Transtheoretical model of health behavior change is also referred to as the___

stages of change model and the readiness to change model

Transtheoretical model of health behavior change____

-Complex model consisting of stages and processes of change
-provides a way to analyze and predict change behavior
-includes five stages of change, ten processes with each stage and three additional variables

Five stages of change (transtheoretical model of health behavior change)____

1. precontemplative stage
2. Contemplative stage
3. Preparation stage
4. Action stage
5. Maintenance stage

Precontemplative stage_____ (transtheoretical model of health behavior change)

when the client is not considering a change in health behavior in the next 6 months

Contemplative stage___ (transtheoretical model of health behavior change)

characterized by considering the pros and cons of change

Preparation stage ____(transtheoretical model of health behavior change)

the client is ready for and receptive to joining an action-oriented change program

Action stage___(transtheoretical model of health behavior change)

the client has engaged in the new behavior

Maintenance stage___ (transtheoretical model of health behavior change)

this stage has variable lengths and may last a lifetime

Three additional variables that impact the overall change process _____ (transtheoretical model of health behavior change)

1. The pros and cons of changing- a simple decisional balance equation
2. self-efficacy with respect to the change- relates to confidence. How confidence is the client that she or he can deal with the temptations associated with relapse such as highrisk social situations
3. temptation itself is the third variable. The tempation to return to the original behavior- can lead to behavioral relapse

Precede-proceed model was developed by___

Green Kreuter, Deeds & Partridge with support from the NIH

Precede-proceed model: a planning model for___

health education based on the principles, both theoretical and aplied, from epidemiology, education, administration, and the social behavioral sciences

Precede:____ (precede-proceed model)

Predisposing, reinforcing and enabling causes in educational diagnosis and evaluation

Proceed:____ (precede-proceed model)

policy, regulatory, and organizational constructions in educational and environmental development

Precede-proceed is___

-readily applicable across a variety of settings

The precede-proceed model has an application that occurs in___

several phases and involves the diagnoses of variables in five domains

Phase 1 (precede-proceed model)___

social diagnosis

Phase 2 (precede-proceed model)___

epidemiological diagnosis

Phase 3 (precede-proceed model)___

behavioral and environmental diagnosis

Phase 4 (precede-proceed model)___

educational and organizational diagnosis

Phase 5 (precede-proceed model)___

administrative and policy diagnosis

Phase 6 (precede-proceed model)___

implementation

Phase 7 (precede-proceed model)___

process evaluation

Phase 8 (precede-proceed model)___

impact evaluation

Phase 9 (precede-proceed model)___

outcome evaluation

Community organization theories and models___

defined as "the process by which community groups are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching goals they have set

Communities can develop strategies to___ (community organization theories and models)

respond to their specific needs and problems

Individuals have the ability to change and____(community organization theories and models)

want to change

Changes that internally motivated have more___ (community organization theories and models)

more meaning and are more lasting than changes imposed from the outside

A holistic approach to change is more___(community organization theories and models)

effect than a fragmented approach

Democracy requires the____(community organization theories and models

"cooperative participation and action" of community members and the requisite skills that make this possible

Communities may need assistance to____(community organization theories and models)

effectively organize to meet their needs

The community mental health act and title V training programs for mental health professional established a nationwide system intended to address____

the nation's mental health services in the community as an alternative to state hospitals

The community mental health act of 1963____

federally funded community mental health centers were established to provide mental health services in the community as an alternative to state hospitals

1960s: Passage of federal entitlement programs of medicare and medicaid___

federal dollars to fianance ongoing and fairly unlimited payment for professional services outside state hospitals. State hospitals dependent on funding from state budgets

1977: Nationnal Institutes of mental health established community support programs____

states received funding to set up community-based programs to address the needs of persons with serious mental disorders who had been deinstitutionalized

Community service models____

-programs for assertive community treatment
-foutain house program (clubhouse model)

Intervention Approaches and Models____

-prevention
-medical treatment approaches
-rehabilitation approaches
-psychoeducational approach
-psychiatric or psychosocial rehabilitation
-foutain house model

Prevention intervention____

health promotion and prevention

Medical treatment approaches____

pharmacological intervention

Rehabilitation approaches____

-program for assertive community treatment (PACT) 19472
-AKA as assertive community treatment (ACT) model: comprehensive community-based treatment model for persons with severe mental illness
-multidisiciplinary mental health staff is organized as type of mobile mental health agency, team approach- physician, psychiatric nurse, psychologist, occupational therapist, social worker, couselor and vocational specialist

Occupational therapy use of PACT method____

-helping clients establish and maintain daily routines
-lending side-by-side assistance to establish or re-establish adult role activities
-modeling (demonstration), rehearsal (practice), coaching (prompts) feed back
-environmental adaptation to meet client needs

Psychoeducational Approach

Information about the illness and management is provided to consumers and families to foster active engagement in the treatment and recovery process

Psychiatric or psychosocial rehabilitation____

-psychosocial rehabilitation: "attempt to apply the principles of physical rehabilitation to mental illness in order to achieve independent functioning in the community
-psychiatric rehabilitation: based on the medical model, focused on symptom reduction and pathology, offering little hope for improved function
-two models merged integrating a rehab approach with medication mgmt
-two terms are used interchangeably cara and macrae

Fountain house model (clubhouse)____

-example of a structured psychosocial rehabilitation approach
-founded by group of patients who have been discharged from a state mental facility during the deinstitutionalization movement
-"structures daily occupation into a work until structure in order to perform necessary club functions, including meal preparation, clerical work, and maintenance of the clube house

OT role range from clinical to administrative with the fountain house model____

-member evaluation, interview, observation
-direct interaction (modeling and coaching) with members in work units or social program
-clinical case management
-develop, monitor and revise members' individual service plans
-supervise staff

Treatment settings_____

a continuum of services

Ambulatory Behavioral Health Care Services____

1. designed for people of all ages who do not require 24 hour care
2. comprehensive evaluation
3. Services are delivered in least disruptive manner
4. community and family are involved in treatment process
5. cost effective services delivered in the least restrictive environment

Ambulatory Behavioral Health Care Services: Level 1:____

partial hospitalization programs and other intensive services, such as home based crisis intervention or stabilization, which divert the person from hospitalization

Ambulatory Behavioral Health Care Services: Level 2:____

those that have a structured staff-supported milieu and involved active treatment with a rehabilitation or transitional focus

Ambulatory Behavioral Health Care Services: Level 2 information____

-the program extends in the community and client attendance is flexible, based on need
-includes day-tx or day-care program, possibly involving clients for extended periods and various types of psychosocial rehab programs
-extensive assessment
-gradual return to work program
-milieu providing social interaction and variety of occupational opportunities
-group programs include exercise, social skill development, arts, crafts, prevocational counseling
-recreational activities

Ambulatory Behavioral Health Care Services: Level 3_____

services that are delivered as part of a coordinated tx plan, but do not necessarily involve structured program activities
-less expensive than level 2, but more extensive than outpatient cared, involving more hours of intervention and a variety of tx modalities

Vocational Program Settings____

-place and train model
-volunteer work
-sheltered workshops
-consmer-operated business
-transitional employment
-supported employment
-work support groups

Place and train model (vocational program settings)_____

-"choose, get and keep" model
--consumer is assessed focusing on work history, skills and interests and daily living skills

Volunteer work (vocational program settings)____

-can be used for work adjustmor final outcome by establishing a productive life role for a person living with a mental illness
-some clubhouses have group volunteer programs

Sheltered workshops (vocational program settings)____

-protected environment where persons with disabilities are paid for low-skilled, factory-type assembly work

Consumer- operated business (vocational program settings)____

-part of many clubhouse programs and allow members to earn salaries of varying amounts
-clubhouse staff facilitate the business by assisting members with community contacts, preparing for work assignments, and performing the actual work as needed

Examples of consumer-operated business (vocation program settings)____

-hot dog vendor carts, lawn maintenance services, weekly newspaper delivery service, thrift shops and courier services
-some are partnerships and private individuals or corporations such as coffee shops/ bakeries

Transitional employment (vocational program settings)____

-developed as part of the fountain house/ clubhouse model
-involves the procurement of a job in a normal place of business
-the club guarantees that someone will do the job even if the member is unable to do so

Supported employment (vocational program settings)____

-began in the field of developmental disabilities
-developed to assist persons with developmental disabilities to work in places of competitive employment instead of sheltered workshops
-used extensively in the field of psychosocial rehab in clubhouse program or those providing primarily vocational services
-job coach works with employer to train the individual
-occupational therapists may serve as managers

Work Support groups (vocational program settings)____

-run in many clubhouses or in competitive employment
-similar groups have been held for outpatients after hospital discharge

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