Ch. 12 Occupational Therapy Process: Evaluation, Intervention, and Outcomes

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Occupational profile

To determine what the client's needs are, gain an understanding of the client's background, the occupational therapy practitioner develops an __________________.

Collaborative

The relationship between the practitioner and the client is a ____________________ one that involves problem-solving to support an enhancement in the occupational performance of the client.

Occupational performance analysis

____________________ entails examining all aspects of the occupation to determine the client factors, patterns, contexts, skills, and behaviors required to be successful.

Interviewing

The skill _________________ blends the formal accumulation of information and informal person-to-person communication.

Observation

The means of gathering information about a person or an environment by watching and noticing is called ________.

Structured observation

Occupational therapy practitioners frequently use _____________ to gain knowledge of what the client can or cannot do in relation to the demands of the task.

Non-standardized tests

_______________________ have guidelines for administering and scoring, but may not have established reliability and validity.

Central concern

A therapeutic relation should always have the interests of the client as its _______________________.

Interview

The __________________ is the primary mechanism for gathering information for the occupational profile.

Measures

Occupational therapy practitioners use outcome _______________ to determine whether goals have been met.

Screening

The process, by which the OT practitioner gathered preliminary information about the client and determines whether further evaluation and occupational therapy intervention are warranted.

Test retest reliability

A measure of the consistency of the results of a given test from one administration to another.

Discharge plan

The plan developed and implemented to address the resources and supports that may be required upon
discontinuation of services.

Interrater reliability

A measure of the likelihood that test scores will be the same no matter who is the examiner.

Validity

Having a true measure of what it claims to measure.

Outcomes

The third component of the Occupational Therapy process (involves measuring how the client has changed).

Normative data

Information collected from a representative sample that can then be used by the examiner to make comparisons with his or her subjects

Intervention

An approach that involves working with the client through therapy to reach client goals.

The means of gathering information about a person by watching the client perform a predetermined activity.

What is structured observation?

Reliabilty

A measure of how accurately the scores obtained from the test reflect the true perfomance of the client.

Transition services

The coordination or facilitation of services for the purpose of preparing the client for a change.

Referral

A request for service for a particular client or change in the degree and direction of service.

The primary mechanism for gathering information for the occupational profile, acheived by the OT practitioner asking the client questions.

Definition for Interview?

Evaluation

The first component of the occupational therapy process (involves determining strengths and weaknesses).

Occupational therapy process

Is the interaction between two active agents, the practitioner and the client, involved in a course of action.

Interaction

The ____________ is not something done to the client, rather the interaction engages with the client.

It's not viewed as a linear step-by-step process, but rather as a dynamic, nonlinear interaction.

Occupational therapy process?

The focus is on occupation and on the client as an occupational being. Whether the client is an individual, a caregiver, a group, or a population, the same basic process is followed.

Throughout the occupational therapy process?

Evaluation process, intervention process, and outcomes process

The occupational therapy process can be divided into three components.

The first component.

What component number is evaluation process in the occupational therapy process?

The second component.

What component number is intervention process in the occupational therapy process?

The third component.

What component number is outcome process in the occupational therapy process?

Evaluation process

What component of the occupational therapy process includes referral, screening, developing an occupational profile, and analyzing occupational performance?

Intervention process

What component of the occupational therapy process includes intervention planning, implementation of the plan, and intervention review?

Outcome process

What component of the occupational therapy process includes measurements of outcomes and decision-making related to the future direction of intervention?

Usually initiates & terminates intervention; finds out what the client wants and needs (age, education, cultural background).

Evaluation process

(1) To find out what the client wants and needs; and (2) to identify those factors that support or hinder occupational performance.

The purpose of the evaluation process is twofold.

To determine what the client's needs are and to gain an understanding of the client's bachground.

What is the occupational profile use for?

Occupational performance

An analysis of _______________ provides information related to the client's skills and ability to carry out activities of daily living.

Evalution

The OT bases the _____________ procedures on the client's age, diagnosis, developmental level, education, sociaeconomic status, cultural background, and functional abilities.

Referral

The occupational process is initiated when a _____________ is made.

A request for service for a particular client or a change in the degree and direction of service.

What is the definition of referral?

Referral

Transfer of patient care from one physician to another.

Referral

An authorization from a medical practice for a patient to have special services performed by another practice

Occupational Therapist

The _________ is rsponsible for accepting and responding to the referral.

Physician, another professional, or the person himself or herself.

Referrals may come from a?

Depending on the setting.

Referrals may range from a specific prescription for a dynamic splint to general suggestions for fine-motor problems.

OTA

Federal, state, local regulations, and the policies of third-party payers determine the type of referral (e.g., whether a physician's referral is necessary) and the role an _______________ can have in the referral process.

Screening

Through ____________, the OT practitioner gathers preliminary information about the client and determines whether further evaluation and occupational therapy intervention are warranted.

Collection of data to decide whether there is a problem that will require more in-depth assessment; results are usually pass/fail; fail gernerally resulsts in a followup assessment.

What is meant by screening?

Occupational therapy

The objective of screening is to determine whether the person can from ______________ in that setting.

Client's records, the use of a brief screening test, an interview with the client or caregiver, observation of the client, and/or a discussion of the client with the referral source.

Screening typically involves a review of the?

Questions

In the screening in the evaluation process the client should also have the opportunity to ask _____________.

Function in performance of occupations, his or her current level of occupational performance,and the future occupational performance needs of the client.

Information gathered during the screening includes the client's prior level of?

Screening process

The OT is resposible for initiating and directing the ______________, using methods that are appropriate to the client's developmental level, gender, cultural background, and medical and functional status.

OTA

The ___________ contributes to the screening process under the direction of an OT. Before screening tasks are performed, he or she must achieve service competency in the particualar tasks.

Evaluation

If screening suggests the client is in need of services, a comprehensive ____________ is arranged. The OT identifies a model of practice from which the evaluation is based.

Model of practice, assessment instruments

The _____________ helps organize the practitioner's thinking. From the model of practice the practitioner selects a frame of reference and chooses _____________
sonsistent with the frame of reference.

Model of practice

A way of organizing, that takes the philosophical base of the profession and provides terms to describe practice, tools for evaluation, and a guide for intervention

Assessment instruments

Standardilzed or nonstandardized measurements used to obtain information about clients?

Frame of reference

A system that applies theory and puts principles into practice, providing practitioners with specific clients.

Occupational profile

Age, gender, reason for referral. Diagnosis, date of onset, med history are all examples of questions that OT's may ask to complete the____________ for the client.

Occupational profile

The initial step in the evaluation process that provides an understanding of the client's occupational history and experiences, patterns of daily living, interests, values, and needs. The client's problems and concerns about performing occupations and daily life activities are identified, and the client's priorities are determined.

(1.) Who is the client (individual, caregiver, group, or population? (2.) Why is the client seeking service, and what are the client's current concerns relative to engaging in occupations and daily life activities? (3.) What areas of occupation are successful, and what areas are causing problems or risks? (4.) What is the client's occupational history (i.e., life experiences, values, interests, previous patterns of engagement in occupations and daily life activities, the meanigs associated with them)? (5.) What are the client's priorities and desired targeted outcomes?

Questions from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile

Who is the client (individual, caregiver, group, or population?

Question #1 from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile

Why is the client seeking service, and what are the client's current concerns relative to engaging in occupations and daily life activities?

Question #2 from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile

What areas of occupation are successful, and what areas are causing problems or risks?

Question #3 from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile

What is the client's occupational history (i.e., life experiences, values, interests, previous patterns of engagement in occupations and daily life activities, the meanigs associated with them)?

Question #4 from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile

What are the client's priorities and desired targeted outcomes?

Question #5 from the Occupational Therapy Practice Framework (OTPF) help the practitioner develop the occupational therapy profile

Analysis of occupational performance.

From the information gathered during the occupational profile (e.g., client's needs, problems, and priorities), the practitioner makes decisions regarding the ____________.

Occupational performance analysis

This information provides direction to the practitioner as to the areas that need to be further examined. From this information, the practitioner can select the specific assessment instruments that will be used to collect further information.

Assesssment

The OT practitioner employs these ___________ instruments to gather information on the individual as related to the individual's performance areas, performance skills, performance patterns, contexts, client factors, and activity demands.

Occupational therapists

Evaluation is seen as a critical decision-making role requiring a depth of understanding of many factors; as a result, the final responsibility of the evaluation rests with the?

Complete evalution

The OTA, though not responsible for the ______________,
may be delegated responsiblity for certain evaluation procedures and thus may contribute to an evaluation under an OT's supervision.

OT

The overall evaluation, or the process of compiling all of the information to form a composite picture of the client, however, is the resposibility of an ___________.

(1.) Interview, (2.) skilled observation, and (3.) formal evaluation procedures.

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

Data

Interviewing the client and his or her significant others provides more ___________.

Planned

The interview is ___________ and organized way to collect pertinent information.

Checklist or questionaire

In some instances, the client is asked to fill a __________ (focusing on the person's interests and activities) before the interview.

Interviewer and the client

The interview should take place in a setting that is quiet and allows for privacy. Ideally the interview should be relaxed and confortable for both the ________________.

Initial contact, information gathering, and closure

Three stages of an interview can be identified:

Initial contact

1st stage of an interview?

Information gathering

2nd stage of an interview?

Closure

3rd stage of an interview?

Interviewer

At this point of the initial contact, the skilled ___________
spends the first few minutes of the interview putting the subject at ease. Often, a person is worried and anxious at the therapy interview. A client may experience stress related to the illness or trauma, or he or she may feel threatened by the prospect of entering into therapy.

Initial contact of an interview.

The practitioner begins the interview by introducing him or herself and informing the client about the clinic, the program, and standard procedures.

Information gathering

After an informative discuaaion about the center or therapy process, the OT practitioner begins to gather information about the client. The skilled interviewer guides the conversation in a way that yields the desired data yet keep the flow conversational, rather than cold and rote.

Closure

Effictively putting __________ on the interview is also a learned skill. The OT practitioner must remain aware of the time so that the necessary details are covered.

Closure

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

Developing observation skills

Observation is the means of gathering information about a person or an environment by watching and noticing. Observation may occur through a structured series of steps introduced by the OT practitioner, or it may intentionally left unstructured to see what takes place.

Observation skills

The practitioner can observe the person's posture, dress, social skills, tone of voice, behavior, and physical abilities (i.e., use of the limbs and ambulation).

Observation skills

Monitoring appearance, dress, expressions, health, tension, responses, behaviors, anxiety, fear, anger, inappropriate affects and personal responses.

Structured observation

Differs from naturalistic observations in that the researcher creates a setting that is likely to elicit the behavior of interest. Structured observations are particularly useful for studying behaviors that are difficult to observe naturally.

Formal assessment procedures

_____________ help determine the existing performance level of the client.

Formal assessment procedures

These are tests, tools intruments, strategies that provide specific guidelines for what is to be examined, how it is to be examined, how data are to be communicated, and how the information is to be applied in clinical problem-solving.

Formal assessment procedures

The clinical techniques and instruments used to determine the strengths and weaknesses of a client for therapeutic purposes

Validity and reliabilty

OT practitioners can place more confidence in instruments that have high ______________.

Standardized tests

A test that comes with a standard set of instructions and scoring procedures

Standardized tests

Is one that has gone through a rigourous process of scientific inquiry to determine its reliabilty and validity. Each test has a carefully established protocol for administering the test.

Standardized tests

Some _____________ require clinicians say the exact words to each client.

Normative data

Norms; collected from an example that can be used by an examiner to make references to.

Miller Assessment for Preschooler (MAP) and the Sensory Integration and Praxis Tests (SIPT)

Are examples of standardized tests developed by OTs.

Sensory Integration and Praxis Tests (SIPT)

Administered by OTR- measures sensory integration process that affects learning and behavior in kids 4-9. looks at visual perception, praxis, vestibular skills.

Non-standardized tests

Test that do not provide specific guidelines based upon a normative sample; do not require standardized procedures.

Test

Under the direction of an OT, an OTA may administer the ___________ once service competency has been established.

Intervention process

The aim of occupational therapy process is to enable the person with a disability to function more independently in his or her enviorment. This requires problem-solving methods to improve occupational performance.

Occupational therapy intervention process

To grasp the __________________ requires an understanding of how the practitioner develops goals for the client, selects activities, directs intervention to guide the client to learn ways of engaging in occupational performance, and monitors the results of the intervention.

Problem identification, solution development, plan of action

Intervention planning steps are?

Problem identification

1st step of intervention planning?

Solution development

2nd step of intervention planning?

Plan of action

3rd step of intervention planning?

Intervention plan

The initial step in developing the __________ is problem identification. The OT reviews the results of the evaluation and identifies the client's strengths and deficits in occupational performance areas, performance skills, erformance patterns, client factors, and contexts.

Problem identification

Understanding the root of the problem will help the OT practitioner select the most appropriate approach to treatment.

Solution development

Is the process of identifying alternatives for intervention and forming goals and objectives.

Model of practice and frame of reference

Selecting a ____________________ from which the OT practitioner operates is an important component of solution development.

Intervention strategies

Exploring ______________ based on the different frames of reference will help the practitioner develop potential solutions.

Plan of action

Based on the problems and the identified frame of reference along with input received from the client, the practitioner determines a _____________ for intervention (expected outcomes).

First

The __________ step in developing a plan of action is the creation of long- and short-term goals that address the problems identified.

Second

The ________ step in developing a plan of action is intervention methods that will help the client achieve the goals are determind. This invovles consideration of the tools or equipment needed, any special positioning, where the activity will take place, how it will be structured and graded, and whether it is selected frame of reference.

Intervention Planning: Problem identification, Solution development, Plan of action

The outcome of this intervention planning process is a written report (or intervention plan). The written plan addresses the strengths and weaknesses of the individual, interests of the client and caregivers, estimate of rehabilitation potential, expected outcomes (short- and long-term goals) along with frequency and duration of treatment, recommended methods and media, apparent enviormental and time constraints, identification of a plan for re-evaluation, and discharge planning.

Implementation of the plan

Five intervention approaches are used in occupational therapy: create/promote; establish, restore; maintain; modify; and prevent .

Intervention Planning

The OT is responsible for analyzing and interpreting the data from the evaluation and formulating and documenting the intervention plan. The OTA contributes to this process.

Create/Promote (health promotion)

This approach provides opportunities for people with and without disabilities. The OT practitioner sets a program or activity in the hope that all those who participate will benefit by enhanced performance.

Establish/Restore (remediate)

The OT practitioner uses strategies and techniques to change client factors to establish skills that have not yet developed or to restore those that heve been lost.

Maintain

This intervention approach provides support to allow the client to continue to perform in the manner in which he or she is accustomed. OT practitioners using this approach help clients keep the same level of performance and, therefore, not decline in functioning.

Modify (compensation, adaptation)

Sometimes activities are changed so that the clients may continue to perform them despite poor skill level. Compensation refers to changing demands of the activity or the way the client performs the activity. This is useful when client factors are not changeable in a practical amount of time and the client wishes to engage in the activity.

Prevent

OT practitoners are interested in keeping clients well, and as such they may help clients engage in activities to prevent or slow down disease, trauma, or poor health.

Create/Promote (health promotion)

The OT practitioner organizes an afternoon handwriting group for school-aged children. The practitioner recommends the group to children in his or her caseload who have difficulty with handwriting.

Establish/Restore (remediate)

The OT practitioner works with Galen, a 67-year old who has lost use of his right side since his cerebral vascular accident. The clinician works to help Galen return to his typical morning routine.

Maintain

After performing a home visit, the OT practitioner makes recommendations so 90-year old can stay at home.

Modify (compensation, adaptation)

The OT practitioner provides 35-year old Karen, who has cerebral palsy, with adapted feeding equipment so that she can feed herself.

Prevent

The OT practitioner explains proper lifting techniques to a group of workers at the blanket factory with the goal of preventing injuries.

Consulting

____________ is also an important part of intervention. Practitioners frequently consult with other professionals, family members, and clients regarding intervention strategies.

Consults

When the OT practitioner ____________ others, he or she is not directly resposible for the implementation and subsequent outcome of the intervention.

Consultation

______________ requires advanced knowledge, the ability to communicate clearly with others, and knowledge of the context in which the consultation occurs.

Consultation

Involves a type of intervention in which the practitioners use their knowledge and expertise to collaborate with the client. The collaborative process involves identifying the problem, creating possible solutions, and altering them as necessary for greater effectiveness.

Education

Involves imparting knowledge to the client. This intervention type involves providing clients information about the occupation, but it may not result in actual performance of the occupation.

Education

Another important aspect of intervention is ____________.

OTA

Although the implementation of the intervention plan is the resposibility of both OT and OTA, it is the central responsibilty of the ______________.

Occupational Therapy Assistant

Educational programs are designed to ensure that OTAs develop an understanding of the philosophy and skills of occupational therapy to enable them to interpret and implement intervention plans. The ___________ conducts intervention under the supervision of the OT.

Intervention review

As intervention is implemented, the OT practitioner re-evaluates the client's progress in therapy. The practitioner continually monitors the client's needs, circumstances, and conditions to identify whwther any permanent or temporary change in the intervention plan is required. Re-evaluation may result in changing activities, re-testing, writing a new plan, or making needed referrals.

Transition services

Are the coordination of facilitation of services for the purpose of preparing the client for a change. May involve a change to a new functional level, life stage, program, or enviorment.

Discontinuation

The last step of the intervention process is the __________ of the client from occupational therapy services.

Discontinuation of services

The last step of the intervention process?

Discontinuation of services

The client is discharged from occupational therapy when he or she has reached the goals delineated in the intervention plan, when he or she has realized the maximum benefit of occupational therapy services, or when he or she does not wish to continue services.

Discharge plan

Projects the need of the patient after he/she has been discharged from the facility.

Discharge plan

The OT writes a discharge summary of the client's functional level, changes that were made throughout the course of occupational therapy intervention, plans for discharge, equipment and services recommended, and follow-up (including occupational therapy services). The OT prepares and implements the discharge plan with input from the OTA.

Outcome process

OT practitioners use outcome measures to determine whether goals have been met and to make decisions regarding future intervention. Outcome measures provide objective feedback to the client and practitioner.

Outcome process

OT practitioners are also interested in measuring occupational performance, client satisfaction, adaptation, quality of life, role competence, prevention, and health and wellness.

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