PsychoSocial & Community Settings Midterm
Terms in this set (93)
State of well being in which:
-the individual realizes his/ her own abilities
-can cope with the normal stresses of life
-can work productively and fruitfully
-can contribute to the community.
*focuses on our emotions, our thoughts and feelings, our ability to solve problems and overcome difficulties, our social connections, and our understanding of the world around us
an illness that affects that way people think, feel, behave, or interact with others
-a mark of shame or disapproval that results in an individual being shunned or rejected by others
1. Labeling theory
2. Normalization theory
3. Minority group perspective
4.Rite of passage theory
4 theories of stigma
views those individual's w/ disability as passive recipients of discrimination. Focus too much on values of independence, self-reliance, beauty and health
ex: I see a person and view them as an individual who needs help
attempts to reduce elements that emphasize difference and develop social participation in the broader community. Critiques of this theory say there is too much emphasis on change and to 'fit in' rather than requiring the society to accept differences
ex. I see a person and expect them to be able to do the same things as me even though they have disabilities
sees disablement as consequence of oppression, demoralization, and marginalization
minority group perspective
need to understand culture and their view on mental illness
o Asian and African Americans considered people w/MI to be more dangerous and wanted more social distance than did Caucasians
oLatinos had the least stigmatizing attitudes
cultural influences on stigma
-Patients are hesitant to discuss concerns
-Physicians are reluctant to ask
Individuals ability to successfully navigate challenging bureaucracies
-Supports/funding in community, insurance companies and how expensive medications are
impact of stigma on mental health treatment
o Disrupted household routines
o Don't want to discuss son's issues with others
o Neglect of other family needs
o Focus being only on one member
o Reduced social contacts
o Concealing info about the family member's MI
o Trying to deter stigma
impact of stigma on families
o MI is not covered by insurance at same rate of physical illness
o Individuals with MI are the only Americans who can have their freedom taken away and be institutionalized or incarcerated w/o being convicted of crime
o Inequitable housing, edu, and income support
public policy impact of stigma
-it is client-centered
-proven to have better long-term results
-should guide all our interactions/how we do business
-based on principles and values to guide practice
hope and optimism about the future
meaning in life
5 recovery processes
4 dimensions that support recovery
Planned interaction with another person to alleviate fear or anxiety, provide reassurance, or obtain necessary information
Interaction to promote growth and development, improve and maintain function, foster greater ability to cope with the stresses of life
Conscious use of self different to spontaneous response that is typical in our daily interactions
therapeutic use of self
a client projects feelings and emotions of another person onto the therapist
a therapist projects feelings and emotions of another person onto the client
ensures clients have needed interpersonal and material resources; acts as facilitator or consultant; ensures opportunities for participation and access; approaches interpersonal difficulties by adjusting and accommodating to the needs of the client; may engage in consciousness-raising about legal rights and disability oppression; may be willing to be involved in civil rights and other social and legal activities on behalf of their clients
make decisions jointly with clients; involve clients in clinical reasoning; expect clients to actively participate; solicit ongoing feedback from clients; encourage autonomy & independence
emphasize educational aspects of therapy and assume a teaching stance; be skilled at sharing information and structuring therapy; style is active and directive; train, coach, and provide feedback and recommendations; be unafraid to state professional options, set limits, or disagree with clients; therapist tend to approach interpersonal difficulties by re-stating their own point of view, providing evidence from research, and explaining their rational
significant effort in striving to understand a client's perspective accurately; listen, watch, and adjust their approach; use intermission from "doing" for processing and communicating; notice and respond to nuances in clients affect and behavior; accept and validate negative emotions; approach interpersonal difficulties by listening and striving for understanding; pacing of therapy tends to be slower due to focus on the interpersonal process
technically skilled; highly creative; focus on biomechanical approaches, cognitive rehabilitation, and assistive devices; approach interpersonal difficulties by reasoning with clients, engaging in pragmatic problem solving, or by using other logical and strategic approaches
problem solving mode
instill clients with hope, courage, and the will to explore, participate, or perform a given activity
The client-centered approach to assessment considers each person's unique occupational performance status. A first step in the process is to synthesize evaluation information to develop an occupational profile. In order to develop the profile, the therapist consider the day-to-day activities that are central to the person's identity and that give meaning to his or her life. The profile reflects the occupations the individual considers important in life and his/her sense of competence in these activities.
Semi-structured interview. Obtain an occupational history, determine how well the person is functioning in occupational roles, and estimate the balance between occupational and leisure activities.
Three (3) parts: a semi structured interview, rating scales, and a life history narrative.
OPHI - II
Individualized interview; measure designed for use by an OT to identify problem areas in occupational performance, rate client priorities in occupational performance, evaluates performance and satisfaction related to problem areas, and measure changes in client's perception of occupational performance.
24 item brief assessment covering areas related to occupational participation. Information can be collected by interview, review of medical records, casual conversation, consultation with members of the team, an other methods.
Model of Human Occupational Screening Test
Short written inventory that can be completed by people who have basic literacy and intact cognition.
List 10 major life roles and an unspecified 11th that can be added. Ask client to indicate which roles have been performed in the past, present or will be performed in the future.
Most widely used. Maybe used for a single observation or a series of observations of a client performing a task. It lists 25 behaviors and provides a scale for rating them. Behaviors are divided into 3 areas: General behaviors (7 items), interpersonal behavior (6 items), and task behaviors (12 items).
Comprehensive occupational therapy evaluation
21 subtests; administered individually, using equipment that maybe provided by the client.
The Milwaukee Evaluation of Daily Living Skills (MEDLS)
Assesses skills related to basic shopping skills for groceries, looking at item identification, price selection, organization, and path finding.
Test of grocery shopping skills
Assess several areas of personal care, safety and health, money management, transportation, use of the telephone, and work and leisure.
The Kohlman evaluation of living skills
A simple index of independence reflects the functional status of hospital clients in ADLs and assess change. Used to predict length of stay and level of nursing care needs for rehab clients.
Attempts to qualify the degree of intellectual and personality deterioration in individuals with dementia, based on their ability to deal with practical tasks of everyday life.
Blessed dementia scale
Indicates a level of independence and dependence and the type of assistance required for ADLs. Used most often as a screening tool, because of the general nature and can support discharge planning.
Katz index of independence in activities of daily living
A measure used to determine impairment as it relates to performances of ADLs. This method uses the ratings from Allen's theory of cognitive levels
routine task inventory
Designed to measure the severity of depression in adolescents and adults given the criteria compatible with the DMS-5.
Beck depression inventory
Seeks information about how an individual spends time. Person fills out a grid of time blocks for each 30-minute period from 5:00 a.m. to 11:30 p.m. and to list the major activity for each time period for a typical weekday. After grid is complete client is asked 4 questions.
Standardized instrument that assess some of the general skills needed for independent functioning. Begins with a brief interview to orient the person to the purpose of the assessment and to collect basic information, followed by a task oriented assessment (TOA) consisting of 5 tasks, sorting shells, a money and marketing task, drawing a house floor plan, constructing nine block designs from memory, and drawing a person. Also looks at how the client relates to other people on a separate social interaction scale (SIS).
The bay area functional performance evaluation (BAFPE)
Uses the client's performance of progressively more difficult leather-lacing stitches to assess cognitive level. Includes the running stitch, the whip stitch, and the single cordovan stitch. Allen warns that visual problems, blurred vision as a side effect of medication, and hand impairment or motor incoordination can result in a score that is lower than the person's real cognitive abilities.
Allen cognitive level test
A quick screen to detect mild cognitive impairments in clients before development of dementia, including those within normal ranges on the Mini-Mental State Examination.
Montreal Cognitive Assessment
Performance-based test that assesses cognitive functional performance.
The clinician observes while the patient completes the task of making two different hot beverages. Following the task, the clinician and the client discuss the task, how the client performed, and how difficult the client found the task.
A tool to indicate whether a doctor should consider further testing to diagnose dementia.
The EFPT serves three purposes: 1) to determine which executive functions are impaired, 2) to determine an individual's capacity for independent functioning, 3) to determine the amount of assistance necessary for task completion using four tasks cooking, telephone use, medication management, and bill paying
Executive function performance test
Jean Ayers studied motor dysfunction and believed that deficits were neurologically based & interventions to improve responses to stimuli could affect performance
Interventions include body perception, bilateral coordination, motor planning, activity level, attention to task, emotional responses, and visual motor integration; designing environments to meet the individuals SP preferences
Assessments: Southern California Sensory Integration Test (SCSIT); Sensory Integration Praxis Test (SIPT); Sensory Profiles (self or caregiver report) - several different versions available for different age groups
provides a framework for understanding how individuals respond to stimuli; grouped by patterns of sensory processing, divided into four quadrants
dunns model of sensory processing
low threshold, less stimuli or less intense stimuli for the nervous system to fire; with a very low threshold, we have hypersensitivity
sensitization (Dunn's Sensory Processing)
high threshold, more increased intensity for the nervous system to fire; with a very high threshold, we have hyposensitivity
habituation (Dunn's Sensory Processing)
Individual response in accordance with his/her threshold
passive response (Dunn's Sensory Processing)
controlling, choosing, or changing the environment to manage sensory input
active response (Dunn's Sensory Processing)
describes the human being as an open system; it describes how the human being interacts with other systems (culture, tasks, social norms, human and non-human environments)
ccupational choices of performance areas; guides the occupational behavior of the individual in ways that are meaningful and pleasurable and are likely to have a desired effect on the environment - the MOTIVATING force
occupational performance patterns; organization of activities throught the day (roles & habits)
both performance skills and client factors; the ability for doing things
- Performance capacity - intrinsic part of the performance
- Occupational competence - extrinsic part of the performance
is concerned with the individual's thought or distorted beliefs and how those beliefs influence behavior; the intent of CBT is to have the individual question their distorted beliefs and open the door for a more effective way of viewing a more or issue thus leading to improved behavior
cognitive behavioral model
A = stimulus situation, B = beliefs/thoughts by which clients interpret the situation, and C = response or behavior
*Albert Ellis added "D": disputing irrational beliefs
Acknowledging our responsibility for creating own problems
Accepting our ability to change
Recognizing that emotional problems stem from faulty thinking
Clearly perceiving our beliefs
Rigorously disputing beliefs
Working hard to change beliefs
Continued cognitive monitoring and restructuring
cognitive restructuring (albert ellis)
exaggerations or misinterpretations of an environmental interaction
Three types: over generalizing, emotional reasoning, and fortune telling
chronic anger, anxiety, or depression due to a focus on a group of automatic thoughts and exclusion of all contrary thoughts; preoccupation creates a kind of tunnel vision in which you think one kind of thought and look only at one set of environmental cues
o Relaxation training - deep breathing, progressive muscle relaxation, yoga, tai chi
o De-catastrophizing - or de-awfulizing and de-horribilizing
o Challenging absolutes - uncovering irrational beliefs Ellis labeled as "musterbation"
o Visualization - mental imagery to decrease anxiety and fear, ex. The ROM dance
o Thought stopping - preventing automatic thoughts by yelling "stop"
o Self instruction - involves four steps: 1) mentally rehearsing the movements or steps 2) sequencing the multi-step task 3) remembering to use specific cognitive strategies 4) replacing negative thoughts with positive thoughts
Cognitive behavioral techniques
Is culturally safe model grounded in an east asian worldview
Challenges OTs to explore how concepts typically found in OT practice models
The self is decentralized in response to the assumption that harmony and balance in life are not individually determined but are dependent on the fluidity of all elements of the social, cultural, and environmental contexts
Imbalance reflects a disruption of the collective synergy of these contextual elements
The central focus in OT treatment is to restore harmony of the person within their surrounding contexts
o Mizu: water, life is like a river flowing from birth to end of life
o Kawa no suku heki: river side wall; represents social and physical context
o Kawa no zoko: river floor; represents social and physical context
o Iwa: rocks; represent life circumstances such as symptoms of mental illness or stigma
o Ryuboku: driftwood; attributes of the person and resources within sociocultural context
o Sukima: space b/t obstacles; occupations which are meaningful and valuable to the person; *where OT is going to make a difference
Is a comprehensive cognitive behavior treatment that combines individual and psychotherapy with psychosocial skills training
Originally designed to treat individuals who repeatedly engaged in suicidal or parasuicidal behaviors and frequent hospitalizations
Used with borderline personality disorder
Has been adapted for emotion dysregulation and substance dependence, depressed elderly, suicidal adolescents, and binge eating
Tend to focus on populations in which impulse control and/or suicidal and self-harm behaviors are prevalent
dialectical behavior therapy
focuses on an individual's behaviors; many behaviorist argue that our behavior is a direct result to what we have seen and experienced in the environment
Most ideal when addressing the need for learning or changing client performance patterns; contexts are examined in identifying "cues" which can facilitate function or trigger maladaptive behaviors
process for helping children gain critical skills for life effectiveness, such as developing positive relationships, behaving ethically, and handling challenging situations. (5 framework items)
Social and Emotional Learning (SEL)
identify one's emotions, thoughts, interests, and values; understand how internal characteristics influence actions; maintain a sense of self-confidence and self-efficacy
Self awareness (SEL Framework)
regulate emotions, thoughts, and behaviors across contexts; cope with stress and manage impulses; set goals
Self Management (SEL Framework)
understand subtle social and cultural norms and rules of engagement; take others' perspectives; respect and empathize with others
Social Awareness (SEL Framework)
establish and maintain relationships with others; resist inappropriate social pressure; work cooperatively; prevent and resolve interpersonal conflict; seek help when needed
Relationship Skills (SEL Framework)
accurately identify and evaluate problems; make decisions based on ethical and social norms; consider context in decisions; contribute to well-being on school and community
Responsible Decision Making (SEL Framework)
allows clients to engage in social interactions, while learning from peers, discovering new skills, building on talents, overcoming challenges, and addressing areas of need.
1. Task 
2. Building & Maintenance 
3. Individual 
Group Roles (3)
2. Information seeker
3. Opinion seeker
4. Information giver
5. Opinion giver
11. Procedural Technician
Group Task Roles 
6. Group observer and commentator
Group Building & Maintenance Roles 
8. Special interest pleeader
Individual Roles 
implies complete control of the group with little or no input from the members.Resulted in the greatest productivity, but created hostility and resentment, poor quality work,and dependency on the leader.
autocratic group leadership (directive)
allows members to make choices and to have a say in what the group does and becomes. Resulted in the highest morale and the most group cohesiveness.
democratic group leadership (facilitative)
French expression meaning literally "to let do" or to let the people do as they choose. Implies a minimum of control and deliberate noninterference in the natural forces of a group or the freedom of individuals within it. Produced independence in the members, but morale was not very high.
Laissez faire group leadership (advisor)
OT defines a group, selects activities, and structures the group in ways that he or she knows to be therapeutically appropriate for a specific group of clients; this type of leadership is absolutely necessary for lower functioning clients who do not have the cognitive capabilities to make decisions or solve problems
must conceive the members of the group that he or she is on their side and represents their best interests; the facilitator/leader earns the support of the group members by allowing them to make choices and showing care and concern; the therapist is a resource person, providing the group with needed information, needed structure, and needed equipment and supplies
is the most passive leadership style; OTs use this leadership style when working with groups of professionals or community groups; limited to the most highly functional groups working on goals like problem solving or attitude change; motivation comes from the group itself, and change is produced intrinsically as a result of the internal processes of each member or extrinsically as a result of social action
group leader as advisor
Can make or break the group
Introduce therapist, title and name of group, introduce members to each other
Warm up: exercise that captures groups attention, relaxes them and prepares for experience; depends on the goals of the group, psychological aspects that could contribute include the therapist
Setting mood: environment, facial expression and media
Expectations: Therapist's manner and expression should reflect expectations
Explaining the purpose of the group
Brief outline of the session
Cole's 7 steps:
Meaningful & of interest
Have intrinsic values, qualities and characteristics that allow goal achievement
Should last at least ⅓ of the total group time including cleaning up. May be expanded based on patients ability, physical and or mental capacities.
Timing- keep short & simple
Physical and Mental Capacities
Knowledge and Skill of Leader
Cole's 7 steps:
Acknowledge each member's contribution
Varies with Activities being done, usually involves show and tell, forces members to look at each other and develop a sense of cohesiveness.
Leader allows equal time and opportunity for each member to show and tell what they did.
Leader role models how sharing is done, provides support and encourage to all members and emphasis each member is equally important
Cole's 7 steps:
Members express feelings about the experience, leader and each other
Help identify issues that encourage or discourage "engagement in occupation" or emotions that facilitate or present barriers to participation
Discussion of nonverbal aspects of the group and the underlying issues.
Cole's 7 steps:
Cognitive Learning aspects of the group
What are conflicting areas of the group
Cole's 7 steps:
Understand how the principles learned can be applied to everyday life
Verbalize the meaning or significance of the experience.
Cole's 7 steps:
Acknowledge terminations, and issues that need to be addressed
Group or individual patient's energy level when group started and how it changed during the process
Important features, issues, insights, relationships during group process
Members for contribution, participation, and accomplishments, sets mood for next session
Unfinished business, address at the summary
Make appts and goals for the next session
Cole's 7 steps:
One of the most healthy communication styles
Based On on direct statements such as direct feelings, wishes, and most importantly thoughts
An assertive communicator believes in himself and takes into consideration the rights of others while communicating
Occurs when a person expresses their needs and wants without taking into consideration how they make other people feel
The communication may be forceful, insulting/offensive, intimidating, angry, or even interpreted as violent and as a means to get one's own way
Appears passive on the surface but in reality are acting out of anger in a subtle, indirect, or behind the scenes way
The passive aggressive communicator tends to feel powerless, stuck, and resentful and tend to make excuses for refusal or non-engagement in activities and remain silent and resentful, in order to gain attention or sympathy
Passive aggressive communications
Will try to please people in any situation
The passive communicator will avoid conflict and expressing their opinions and feelings
The voice of a passive communicator is soft, they do not make eye contact, they will fidget and try to make themselves appear small
Skilled at influencing or controlling others to their own advantage
The spoken words of a manipulative communicator hides an underlying message, of which the other person may be totally unaware