281 terms

Occupational Therapy in the Community

refers to the number of new cases of disease, injury or disability within a specified time frame, typically a year
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
process by which persons are motivated toward and choose what they do
3 areas of volition (MOHO)____
-personal causation
Model of Human Occupation (areas)____
-performance capacity
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
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
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)
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)
Social Learning Theory was established by___
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___
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)
-motor replication
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 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)___
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____
-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
Assessments for vocation programs____
-allen cognitive level test
-jacob's prevocational skills assessment
-Bay Area Functional Performance Evaluation
-Cognitive Assessment of Minnesota
-Assessment of Motor and Process Skills
-Self-assessment of Occupational Function
Case mgmt (home health services)___
-to ensure access to community services and resources, he or she also assists in the development of independent living skills such as money mgmt, social interaction, cognitive skills (decision making and problem solving) to varying degrees
Specialized Occupational Therapy Roles____
-direct service provider
-program manager
-case manager
Community impact of substance use disorders___
-major factor in many medical, public health, social, and safety issues within a community
-medical problems associated with substance use including alcoholism
-substance use disorder linked to AIDS, TB, neonatal defects, respiratory, nervous, and cardiovascular systems
-high rates of comorbidity with other psychiatric diagnoses
Stages of change____
1. precontemplation
2. contemplation
3. determination
4. action
5. maintenance
6. relapse
Community interventions____
-brining the risky behaviors to the person's attention
-helping the person to determine the need to change these risky behaviors
-facilitation the decision to change and selecting strategies for change
-implementing the change strategies
-maintaining new healthy behaviors
-reinstituting the health behaviors when lapsing into old habits
The goal of OT prevention programs is to___
improve such general life skills as healthy coping abilities, interpersonal communication and successful occupational performance. Can target pts: to evaluate their current value system to incorporate the following beliefs
Beliefs incorporated to target pts to evaluate their current value____
-using substance is not essential for occupational performance (unless for medical reasons)
-using substances uncontrollably is a health problem that interferes with occupational performance
-using substance to solve emotional problems is dangerous and may lead to permanent impairments in performance components, skill erosions and habit dysfunction
-achieving an artificially altered emotional and cognitive state is not acceptable and disrupts occupational performance
-learning coping strategies in important for managing life problems and facilitating occupational performance
Crisis intervention____
management of alcohol or other drug emergencies
Brief interventions___
stages of change theory has led to creative thinking about ways that professional can change the environment and change interactions with the client so that the client must eventually face the need to change the substance using behaviors
Interventions include (brief interventions)____
-educational materials
-conducting health screening
-discussing information about substance use and providing information about resources
Formal intervention programs____
-in-pt medical detoxification
-out-pt and partial hospitalization programs
-dual-diagnosis programs
-after care programs
-cocaine anonymous
-narcotics anonymous
Adult Day-Care program models, basic services include____
-general nursing
-social work
-recreational activities
-ADL assistance
-supervision of personal hygiene
-referral to community agencies
Noational institute on adulte day care (1990) identified the following goals:____
-promote the person's maximum level of independence
-maintain the person's present level of functioning as long as possible
-restore and rehabilitate the person to the highest possible level of functioning
-provide support, respite, and education for families and other caregivers
-foster socialization and peer interaction
National Standards and guidlines for an individual based on functional assessments are developed through____
an interdisciplinary care planning process
"the variety of programs can best be conceptualized as a continuum, with social model centers serving frail, at-risk, or semi-independent participants on one end and medical/ restorative model centers serving significantly impaired participants at the other end____
Adult day-care programs
Therapeutic milieu___
interdisciplinary focus by program staff, services are provided for an individual based on functional assessments and developed through an interdisciplinary care planning process
Social Model Centers provide___
supportive, social, and recreational services for participants with stable health conditions who may be at risk due to social isolation, lack of family support, physical frailty or other similar characteristics
Social model centers' services often limit to___
the provision of meals, transportation, recreation and social meetings
Prevention is___ (social model centers)
primary goal
Social model centers are funded under ____
title XX of the social security act of title III of the older American Act
Social model centers consist of___
longer term mainenance and episodic restorative services
Medical/ restorative model centers are often classified as___
day hospitals or day treatment centers
Medical/ restorative model centers serve participants with____
unstable health conditions and specific functional impairments
Medical/ restorative model centers' participants may have a wide range of___
disabilities including Alzheimer's disease, Parkinson's disease, RA, CVA, and MS
Medical/ restorative model centers are usually located in___
hospitals, rehabilitation centers, skilled nursing facilities or as separate programs in medical model centers
Medical/ restorative model centers are funded through____
medicaid and some private insurers. Most often use their personal financial resources
Medical / restorative model centers services include____
-on-site nursing care
-one or more therapies on a consult or contract basis
-medical social work
-therapeutic recreation
-adapted social or recreational activities
-occasionally, medical services, psychiatry, dentistry, or podiatry may be available
Occupational therapy roles in Adult Day-Care Programs
-direct care
-activity program coordinator
-case manger
Citizen participation___
The bottom-up, grassroots mobilization of citizens for the purpose of undertaking activities to improve the condition of something in the community
Community development____
A process designed to create conditions for economic and social progress for the whole cmmunity with its activite participation and the fullest possible reliance on the community's initiative
Community organization____
The method of intervention whereby individuals, groups, and organizations engage in planned action to influence social problems. It is concerned with the enrichment, development, and/or change of social institutions
Community participation____
A process of involving people in the institutions or decisions that affect their lives
Empowerred community____
One in which individuals and organizations apply their skills and resources in collective efforts to meet their respective needs
Grassroots participation____
Bottom-up effocts of people taking collective actions on their own behalf, which involves the use of a sophisticated blend of confrontation and cooperation in order to achieve their ends
Macro practice___
The methods of professional change that deal with issues beyond the individual, family, and small group level
Work-related practice:____
-rehabilitation approach, traditional, medical model (work hardening, work conditioning, functional capacity evaluations
Transition to community-based work programming examples___
-on-site therapy program focuses on providing vocational rehab at the employment site of the injured worker or worker with a disability
-individuals living with HIV/AIDS
High-quality community-based work programs____ (three facotrs influence the development of high-quality, contemporary work program____
1. Considering the worker role in relationship to other roles in the client's role repertoire
2. Addressing work dysfunction as multidimensial problem in assessment
3. Employing an occupational therapy theory that addresses the multifactorial nature of work dysfunction
Worker Role in Relation to Other Roles___
Work, disability, and succcess at work are interconnected with other dimensions of a person's life. Need to consider the influence of other life roles.
Work Dysfunction as a Multidimensional Problem____
Work-related evaluation: frame or name the problems currently interfering with a person's engagement in work
Velozo noted that the studies that have included biomechanical factors in their predictive models of return to work, ____ has shown physical performance to be statistically related to return to work
Unwise to base evaluations of return to work entirely on____
physical capacity and work capacity assessments
Recommendations for return to work, in addition to standard work evaluations that provide only information on the physical or mental capacities of a worker, the therapist should also use____
psychosocial and environmental assessments
OT Assessments of returning to work community programs____
-occupational performance hisotyr interview (OPHI-II)
-occupational self-assessment (OSA)
-Assessment of communication and interaction skills (ACIS)
-Worker Role Inventory/ Interview (WRI)
-Work Environment Impact
OT theory used with Work Community Programs____
General Caracteristics essential to a sound community-based work program____
1. team approach
2. Client-centered focus
3. Community-centered approach
Six critical components for planning effective community based services for client-centered focus____
-program values that max choice, increase competency and provide unconditional support
-a focus on client goals rather than solely on service system goals
-afocus on the clients' perceived needs for assistance rather than on needs for predetermined services
-a focus on the clients' preferred level of intervention rather than requiring that consumers take "all or nothing"
-Identification of the essence of service delivery in terms of what intervention is provided by whoem for what purpose, not simply the conficuration or structure of the service
-a vision of consumer involvement and growth in the community rather than one of the community care and maintenance
Community-centered approahc____
-services must be an integral part of the community in which they are based by meeting the needs of specific individuals within the community, building on the strengths and unique resources of the community, and developing relationships with multiple businesses rather than adopting any single marketing approach
-services must offer a broad array of choices or continuum of options for individuals at different livels of functioning
Worksite program example___
University of Illinois at Chicago
Worksite Program team and service providers:___
OT, PT, UIC case manager, program manager, physicians, occupation health nurse practitioners
Service Receivers:____ (work model)
Injured workers, family members and employmer
Referral Soures:___ (work model)
Physicians, workers' compensation case manager, risk management lawyers
Program design____ (work model)
used MOHO and biomechanical model as the theoretical basis for the program
Work programs provide a comprehensive continuum of services including____
injury prevention, evaluation, work site intervention, ADA consultation, program evaluation
The independent living movement grew out of a need for persons with disabilities to have___
more autonomy, better services, and self-determination
Independent living is ____
"control over one's life based on the choice of acceptable optionals that minimize reliance on others in making decisions and performing everyday activities, including managing one's affairs, participating in day-to-day life in the community, fulfilling a range of social roles and making decisions that lead to self-determination and the minimization of physical and psychological dependence upon others"
Advocates of independent living continually work to bridge the gap between___
medical rehabilitation and covational programs to allow persons with disabilities to live independently in the community
Medical model characteristics___
-physician is the primary decision maker and team expert who is ultimately responsible for services provided to the patient by the health care team
-problems are usually viewed in terms of the persons' in ability to perform ADLs or to participate in employment
-the problem is assumed to reside in the individual. It is the individual who needs to be changed
-the solution lies in the individual's compliance with prescribed therapeutic program
Independent living model___
-the consumer (person eceiving services) is the primary decision maker who determines the services in which to participate-ultimate goal far exceeds ADL performance or gainful employment, with individuals seeking slf-direction and full integration into society
-the problem resides....in the solution offered by the rehabilitation paradigm, most notably in the dependent-inducing features of the relationship between professional and client
-the solutions to these problems are self-help, consumer control, removal of barriers, peer counseling and advocacy
Independent living movement, a social movement that adovocates ____
equality for disadvantaged individuals, was a outgrowth of several other social movements including the civil rights movement, consumerism, demedicalization, deinstitutionalization, and self-help
1973 Rehablitation Act:___
-established a service priority for severely handicapped persons
--provided affirmative action amployment programs
-banned discrimination of the basis of disability
1978 Amendments to the rehablitation act____
-provided funding for establishment and operation of independent living centers
-included provision for comprehensive services
1986 Amendments to the rehablitation act___
Established criteria for individuals receiving independent living services
1990 Americans with Disabilities Act___
Extended civil rights protection for persons with disabilities
Philosophy of independent living____
Emphasizes freedom of choice and equality for persons with disabilities. "Disabled persons including the most severely disabled have both the capacity and desire to be self directing and independent in all aspects of their lives
Philosophy of indpendent living vocab___
-consumer control
-freedom of choice
Consumer control (philosophy of independent living)____
allowing persons with disabilities to decide what course of action, if any, is best
Normalization (philosophy of independent living)_____
imply the right to live as normal of a life as one chooses and to have opportunities to live normally
Freedom of choice (philosophy of independent living)____
includes both the right of a person with a disability to have the same option as nondisabled persons and the right to make choices for oneself given those options. Example: equal employment opportunities "A person with a disability should be able to choose to attend or not attend therapy on a given day without externally imposed rewards or consequences"
The philosophy of independent living also wants to increase awarenness of ____
handicapping nature of the environment
Community orientation___
independent living differs from taditional rehablitation in its community orientation, traditional medical rehablitation programs have focuse don ADLs and IADLs, some vocational programs attempt to integrate the individiaul back to the work environment, independent living programs address issues such as housing, personal attendant mangagement , transportation, and physical access to the community and all it offers
Independent living programs____
most programs are community based, nonprofit, nonresidential, and consumer controlled (ie a majority of persons involved in the program develoment and service provision are persons with disabilities
Independent living programs: medical treatment services, sheltered workshops and medical equipment suppliers are ____
independent service providers, serve as referral sources for independent living programs
Types of Independent living programs____
-Indepenent living center- nonresidential program
-Independent living transitional program
-Independent living residential program
Independent living center-nonresidential program must provide a minimum of four services___
1. information about and referral to agencies supplying applicable services (housing, transportation, and attendant care)
2. Peer counseling
3. Advocacy services
4. Independent living skills training
Independent living transitional program___
the goal is to move the consumer from a more dependent living situation to a more independent situation
Independent living skills training___
trasportation and mobility, money management, medical maintenance, self-advocacy, social skills, living arrangements, sexuality issues, and possibly an exploration of education or vocation opportunities
Independent residential program___
designed to allow a person with a severe disability to alternate to being institutionalized or living with family members. Live in programs that coordinate or directly provide services such as attendant care and transportation
Indepenet living program personnel___
staffing patterns vary depending on a number of variables including the type of program services to be provided, location, number of persons to be served and funding
Independent living director___
chief executive officer of the program
Independent living coordinator or personal attendant services___
recruitment, training, referral, and placement of personal attendants with consumers in the community. Develops orientation programs
Independent living specialist___
assists consumers in a myriad of services, including skills training, counseling, education and referral to other agencies. Specialists are usually the staff members who have the most face-to-face contact with consumers
Independent living programs might also have___
financial benefits counselor, housing, specialists, educational specialists, and a special populations coordinator
Role of occupational therapy in independent living programs___
-can serve as independent living specialist
-case manager
Services for independent living programs are typically provided in ___
the consumer's home or in the community, not in a clinical setting
TRUE OR FALSE Occupational therapy practice in an independent living program is at an advanced level; it is not considered entry-level practice
Early intervention is a___
"federally mandated program implemented by states for children ages birth to 3 years. States are mandated to "develop and implement a statewide comprehensive, coordinated, multidisciplinary, interagency program of early intervention services for infants and toddlers with disabilities and their families facilitate the coordination of payment for early intervention services from federal, state, local, and private sources
Primary purpose of early intervention programs____
identify children with delayed development who may be eligible for services and to provide necessary services to promote the family's ability to care for the child
Early intervention programs also provide services in___
natural environments such as day-care centers, day-care homes, and preschool programs
Children with disabilities should be in the ___
community with non-disablied peers of the same age
The team's responsibility in early intervention is to ____
provide services to support these children's continued development in the community environments
Components of early intervention___
-eligibility determination
-evaluation and assessment
-individualized family service plan
Service coordinator for early intervention___
functions as a consultant to the parents and providers
Team members of EI___
-other individuals such as contracted services providers
Transition Planning must be part of any IFSP:____
-referral to local education agency (LEA) six months or more before the child's third birthday
-LEA will determine preschool programs that are available to the child
-model changes from family-friendly model to a special education school-based model
-EI teams should assist parents in developing assertiveness skills to request necessary services for their child
Occupational Therapy Evaluation___
-curriculum-based measurement measures the academic skills that children are expected to acquire
-ecological evaluation determine the skills needed to be successful in various environments
-lay is assessed by OTs
-SI and sensorimotor functions
-FM, Visual-motor, and self-care skills
Family involvement____ (EI)
family-centered philosophy
Parent Instruction___(EI)
ongoing process that includes modeling the practice of skills and specific behaviors
Equipment and Supplies_____(EI)
-assessment tools
-positioning equipment
-feeding supplies
-developmentally appropriate toys with switch access
-cleaning supplies for standard precautions
Special considerations in EI___
-rural service delivery
-large extended families
-cultural diversity
-professional preparation
Rural service delivery____ (EI)
requires much planning because distances between homes can be significant
Large Extended Families___ (EI)
extended family members can be very helpful with tx, excessive noise and movement may distract or overstimulate some childrern
Cultural diversity___(EI)
practices regarding adaptive skills and social-emotional skills are very much dependent on the culture of the family
Professional Preparation___
consider additional continuing education
TRUE or FALSE Models of client education are rarely used in isolation____
Set of guidelines for combing elements of several practice models___
-incorporate into interventions the concepts that have been shown consistently to be predictors of behavior or to have a strong influence on behavior. These include beliefts, perceived health treat, cues, self-efficacy, attitudes, stages of change, tc
-consider the organization context and include factors in the work environment most likely to maximize effectiveness. they would include communication, participation, active involvement of organizational leaders, fairness, respect, external and internal reinforces
-use the stages of change to assess individual and group readiness before selecting any interventions
-use a planning framework to track various components and processes in an ongoing evaluation of the effectiveness of interventions
-consider the complexity of individual and organizaitonal factors when designing behavioral interventions, realizing that a multidimensional intervention will have a great impact on behavior
-avoid the use of words such as compliance. Replace with descriptive phrases that promote a sense of active participation and internalization
Transtheoretical model of health behavior change___
also referred to as the stages of change model and readiness to change model
The transtheoretical model of health beavhor change is a complex model consisting of___
stages and processes of change and provides a way to analyze and predict change behavior
Educatior's approach during the Precontemplative stage in the Transtheoretical model of health behavior change_____
-listion to the client's concerns and frustrations
-provide carefully timed behavior options and choice
Educatior's approach during the contemplative stage in the Transtheoretical model of health behavior change_____
-listen and help the client articulate more specific barriers to change
-help the client to articulate the benefits of change
-provide more specific facts and information about the considered changes
-values clarification-looking at what it means to be associated with unhealthy behaviors as opposed to the healthy behaviors
There are __ stages of the Transtheoretical model of health behavior change and __ processes within each stage
5, 10
1st stage of transtheoretical model of health behavior change_____
Precontemplative stage
Precontemplative stage___
when the client is not considering a change in health behavior in the next 6 months
-may have tried in the past with poor results
-may be uninformed or lack knowledge about problem
2nd stage of transtheoretical model of health behavior change_____
Contemplative stage
Contemplative stage___
characterized by considering the pros and cons of change
-the client may be ambivalent about the actions involved in a behavioral change
-may be considered a procrastinator and may find him or herself in a state of chronic contemplation
Consciousness raising (transtheoretical model of health behavior change)
the process of becoming aware of new information related to increased benefits of changing one's behavior or increased risk of not changing
Dramatic relief (transtheoretical model of health behavior change)
is an affective response. It is heightened emotional response, such as fear, worry, or anxiety, associated with the negative effects of not changing health behaviors. The impact of the emotional response is lessened if the appropriate health behavior actions are taken
Self re-evaluation and environmental re-evaluation are similar processes but____ (transtheoretical model of health behavior change)
with different targets
Self-evaluation causes the client to____(transtheoretical model of health behavior change)
consider how comfortable he or she is with the image projected by the unhealthy behavior. For example, would one rather be overweight and inactive or trim and active? The difference between one's values and current behavior may be such that a change would be considered
Environmental re-evaluation looks at the impact of one's current behavior on other people, the type of role model that the client has and the___(transtheoretical model of health behavior change)
potential cost of the unhealthy behavior
3rd stage of transtheoretical model of health behavior change_____
Preparation stage (decision stage)
Preparation stage___
the client is ready for and receptive to joining an action-oriented change program. The client has investigated a change program, collected information, and perhaps purchased some of the supplies or paid the tuition to begin a program
Change process (preparation stage)_____ (transtheoretical model of health behavior change)
self-liberation- a public commitment to change. In therapy, this could take the form of goal setting, a behavioral contract, or verbal pledge to significant others
4th stage of transtheoretical model of health behavior change_____
action stage
Action stage____
the client has engaged in the new behavior. Classically defined as the first six months of behavioral change. Positive behaviors should be reinforced. Educator can assist the client by resolving problems related to barriers
5th stage of transtheoretical model of health behavior change_____
Maintenance stage
Maintenance stage___
variable lengths and may last a lifetime
Four processes facilitate continuation of the positive beavhior (transtheoretical model of health behavior change)_____
-contingency management (working out a reward system. New behavior is rewarding and the old behavior is no longer rewarding)
-helping relationships (estabilsh support system)
-counterconditioning (replace unhealthy behaviors with healthy beahiors
-stimulus control (restructure one's life and context to either deal with or remove those stimuli that perviously led to the problem behaviors
Three additional variables that impact the overall change process (transtheoretical model of health beavhior change)_____
1. the pros and cons of changing- a simple decisional balance equation
2. self-efficacy with respect to the change- relates to confidence.
3. Tempation (to return to the original behavior- can lead to relapse)
The action taken by the health educator must ____
match the client's stage of readiness.