Mental Health Final Exam

Etiology: genetic, neuroanatomical differences, reduced dopamine, and environmental

Prognosis: 50% recovery, 25% satisfying life, 25% repeat hospitalization

Client Factors: attention, memory, executive functions, sensory processing

Performance Skills/Patterns: difficulties completing ADL, Work, School; Sleep disorders; Cognitive Deficits

Occupations: ADL’s, IADL’s, Rest & Sleep, Work, Education, and Social Participation

Etiology: pre-traumatic (temperamental, environmental, genetic, physiological) peritraumatic (environmental) posttraumatic (temperamental)

Prognosis: 30 % recover- 40 % get better with treatment, but mild-mod symptoms may remain

Client Factors: emotional regulation, memory, sleep

Performance Skills/Patterns: decreased socialization, difficulting sleeping, flashbacks, anxious, inability to concentrate, uncontrollable thoughts

Occupations: Social participation, Work, Education, Leisure, ADL, IADL, Sleep & Rest

Etiology: genes, environment, parent-child relationship

Prognosis: poor; difficult to treat

Client Factors: emotional regulation, temperament & personality, executive functions

Performance Skills/Patterns: poor social skills, show no empathy, feel entitled, don’t work well with others, difficulties managing finances

Occupations: social participation, work, education, IADL’s

Etiology: biological, environmental

Prognosis: moderate stability, can improve over time

Client Factors: emotional regulation, sleep, cognition, temperament & personality

Performance Skills/Patterns: maladaptive behaviors, distorted thinking, decreased self image, social skills, difficulty concentrating, poor sleep, feeling on edge

Occupations: social participation, work, education, IADL’s, ADL’s, Leisure, Sleep & Rest

Etiology: biological, genetic, psychosocial, environmental

Prognosis: 80-90% respond well to treatment. almost all gain some relief

Client Factors: attention, fatigue, sensory processing, temperament & personality, emotional regulation

Performance Skills/Patterns: poor sleep, decrease role functioning, social isolation, lack interest, weight issues, difficulties completing ADL, Work, School

Occupation: ADL’s, education, social participation, sleep & rest

Etiology: genetics, environmental, psychological

Prognosis: most function well despite mistrust of the world

Client Factors: emotional regulation, temperament & personality, cognition

Performance Skills/Patterns: don’t trust anyone, reluctant to confide in others, trouble working with others, angry, hostile, hard time relaxing

Occupations: social participation, work, education, sleep & rest, leisure

measurement of predictable patterns of performance and problem solving ability in relation to occupational performance (processing performance, motor, and cognitive skills)

ADAPTATION ONLY

Use of ACL’s

Coma (Total A)

Automatic Actions-sensory stimulation (Total Assistance) 

• Bedridden, conscious, respond to internal cues (hunger/pain)

• Behavior- habitual or reflexive

• Arousal and response - few responses at a time

• ADL’s done by caregiver

• OT - provides appropriate sensory stimulation/attempt to elicit motor responses 

Postural Actions-proprioceptive stimulation (Max Assistance) 

• Clients can be stimulated to perform changes in position in response to proprioceptive cues

• Imitate gross motor actions (Assist with ADL)

• 24 hr Nursing care

• Can feed self, but messy

• Movement or Exercise groups 

• Cannot benefit from interactive groups 

Manual Actions-tactile cues (Mod Assistance) 

• Manual activities in response to tactile stimuli 

• Objects within arms reach (repeated actions)

• Attention - 30 min 

• Independent with ADL and Supervision with IADL (reminder)

• Repetitive work tasks with demo and practice

• Tools must be supervised 

Goal-Directed Actions- visible cues (min A)

• Goal directedness - makes activity purposeful

• Basic ADL intact, needs help coping with new events, anticipating needs, managing money

• Respond to visual cues

• Environmental cueing - stimulates action

• Attention - up to 1 hr, steps imitated in short sequences

• Familiar routine tasks

• Verbal and written directions not followed

• live alone with daily assistance

• Under 5 - “out of sight out of mind”

Exploratory Actions-related cues encompassing all Senses (Standby Assistance) 

• Use of trial and error 

• Inductive reasoning is used, and new learning is possible 

• Imitate new procedures, remember several task steps 

• Novelty sought/variation explored choices given

• Deficits - anticipation and planning

• Concrete thinkers - can't anticipate long-term consequences of actions/choices 

  • Lack of understanding of illness/medication side effects

• Benefit from activities that promote social awareness, reciprocal relationships, acceptance of supervision

• self-directed learning and living alone, may need memory aids

Planned Actions – highest level; absence of disability (No supervision) 

• Highest Level

• Absence of disability 

• Use deductive reasoning/plan ahead

• Future is anticipated/behavior organized

• Demonstration not needed for verbal or written directions

• Symbolic cues 

• Four main constructs: Client, interpersonal events that occur during treatment, therapist’s use of self, and the occupation

• Six modes of communication: advocating, collaborating, empathizing, encouraging, instructing, and problem-solving

• model shows that OT should be prepared to respond to conflicts in a therapeutic manner with specific modes of communication-based on each specific client

• use is appropriate for any interaction with a client to determine the mode of communication that is the best fit

• common assessments: self-assessments of modes questionnaire or clinical assessment of modes

• Unconscious psychological forces and internal processes are a substantial determining factor of behavior. When these forces are in conflict with one another, an intrapsychic conflict results and abnormal behavior will ensue

• Bring unconscious thoughts and forces to a conscious level to settle the conflict

• “Peeling back the onion”

• When this when an individual is NOT in a psychotic state and has insight and ability to be introspective

• Common assessments: projection assessments, azima battery, or magazine picture collage

• Constructs: occupational performance is the result of interaction between person, environment, and occupations in which they participate

  • Participation improves Occupational Performance

• Use this when there is a deficit in either performance skills, occupations, or the environment (physical or social)

• No specific assessments

• 3 constructs: person, occupational environment, and relationship between person and occupational environment

• 2 assumptions: participation in occupation is how humans adapt to change and the leading motivational factor for adapting and occupational adaptation is most prominent during transitional periods

• A person will interact with the environment for occupational performance (desire for mastering activities and achieving environmental control)

• the client's viewpoint is important. their adaptive responses are assessed using relative mastery (if client perceives their occupational adaptations have led to successful performance)

• often used for individuals in a period of transition and there is a need to increase the skills required for occupational adaptation

• common assessments: Relative Mastery Measurement Scale

• there is input, throughput, and output

• Volition - personal causation, values, interests

• Habituation - roles, habits

• Performance - skills

• Used when client exhibits deficits in either 3 components of volition, habituation, or performance capacity

• common assessments: Occupational Self Assessment (OSA), Occupational Circumstances Assessment Interview Rating Scale (OCAIRS)

• delve into a person's beliefs and thoughts

• people interpretations of events cause their reaction to events (including emotional reactions)

• focuses on altering maladaptive behaviors

• emphasizes behavior modifications to shape an individual's behavior

• “learning can’t occur in the absence of some kind of reinforcement”

• positive and negative reinforcement strengthen behavior while punishment and extinction weaken behavior

• Combination of cognitive and behavioral therapy

• A person’s thoughts and feelings will guide behavior

• Cognitive Restructuring– cognitive thought patterns are altered to enable behavioral changes. Bring negative thought patterns to individuals awareness and then restructure to enable change

• Appropriate for diagnoses with disordered thought patterns: schizophrenia, GAD, Major depressive disorder, eating disorders, personality disorders, etc

• often uses Beck Depression Inventory

• Example: clients with phobias, fears of limitations after injuries (psychological barriers to activity engagement)

  • Someone afraid to drive after an accident 

• addresses motor, sensorimotor, perceptual, and cognitive problems

• generally follow a linear sequence of development

• used to facilitate learning or relearning of motor skill by apply controlled sensory input, to specific body structures

• primary use has been with developmental disabilities affecting the CNS and those who have suffered trauma or disease to the CNS. 

• Activites should be used that stimulate the senses, produce purposeful movement, promote cognition and affect, and use real-life tasks to approach the CNS in a systematic way 

• Concerned with establishing or restoring client chosen, age-appropriate occupation (ages and stages of diagnosis) 

• Stages of life, life structure, regression 

• Groups focused on life stages, life tasks, and transitions

• Example: Child with poor handwriting is given fine motor coordination activities to enhance motor control 

• Ecology= relationship between an individual and their environment

• constructs: person, tasks, contexts, and interaction between the person-context-task

  • performance range is dependent on this interaction

• use when an individual's context is a barrier to their wants and needs

• Strategies: Establish and restore a clients skills, alter their context, adapt/modify the context or task, prevent the risk of performance problems, and create/enhance performance within a person’s context

• Often uses following Assessments: Person Variables worksheet, temporal environment checklist, physical environment checklist, cultural environment checklist, social environment checklist, task analysis worksheet, priorities checklist

• performance-based observational test with a home and clinic version

• assist practitioners in documenting functional status and change 

• 26 core tasks within 4 functional domains: functional mobility, personal self-care, IADL with a cognitive emphasis, IADL with a physical emphasis

• performance rated for independence, safety, and adequacy

• helps to identify type/level of assistance to enable improvement of task-performance (verbal supportive, verbal nondirective, verbal directive, gestures, task object or environmental rearrangement, demonstration, physical guidance, physical support, or total assist)

• instrument was designed for practitioners to assess the types of assistance necessary for a patient to return to the community (PASS-Clinic) or remain in the community (PASS-Home), the instrument has a disproportionate emphasis on IADL

• Self-report (or can be done with therapist) in terms of role participation and value the individual places on the individual roles

• Method: A checklist. There are two parts. Part I has the person identify major roles they have been part of (past-present-future). Part II asks the client to identify the degree to which he/she values each role.

• identify roles that have been continuous, interrupted, changed, present, or desired in the future and if they are valuable, somewhat valuable, and very valuable

• The data ends up being used to discuss with clients how goals can be created to enhance the quality of life, and discharge planning process.

• performance assessment 

• provides an overview of a persons occupational performance in 3 areas: general behaviors, interpersonal communication skills, and task behaviors 

• Assesses task performance (ADL, IADL, work, play, leisure, social participation)

• Influenced by MOHO - how environment affects occupational performance 

• Semi-Structured Interview and rating scale 

• Needs/preferences for performance, satisfaction, and physical/emotional/social well being

• interview-questionnaire 

• Constructs: 

  • Person: spirituality 

  • Occupations: self-care, productivity, leisure 

  • Environment

• Interaction between the 3 results in occupational performance

• Measures perception of satisfaction with performance and changes over time with self-care, productivity and leisure.

• Method: Semi-structured interview identifies the client's perception of his/her occupational performance. 

• Caregivers can participate or give feedback

• Total scores for performance and satisfaction are used to identify treatment focus, treatment outcomes, and individual satisfaction.

•  evaluate the effectiveness of mental health programs 

  • -2 - Initially it is the client’s baseline/current level; At outcome review, it signifies much worse than expected.  The client, after receiving skilled OT services, had no positive changes to note. 

    • Too difficult and might need to reevaluate with a peer therapist for more reasonable goals

  • -1 - Somewhat worse than expected.  Nonetheless, there are some minor areas of progress to note.

  • 0 - Expected level of performance/participation.  The client is performing/participating at the level the therapist expected at the time of evaluation. 

    •  Here is the clinical reasoning sweet spot (AIM for 0) 

  • +1 - The client is performing/participating somewhat better than the therapist predicted or anticipated.

  • +2 - The client is performing/participating much better than the therapist predicted or anticipated. 

    • Unrealistic - client performing much better than expected 

Occupation Based

focused on a client factor, performance skill, or pattern that is preventing them from completing that occupation

• OT defines group, determines the activities, and structures the group according to client needs 

• Required for lower functioning clients (low cognitive level/insight; low motivation; poor verbal skills) 

• Parallel and project groups

• OT allows members to make decisions with guidance for information, structure, and supplies; shared experience of leadership 

• May not be appropriate for groups where the goal is to develop specific skills 

• Used for medium cognitive level, good insight, medium maturity, medium motivation, average verbal skills 

• Egocentric cooperative 

• Passive leadership - offers advice as necessary, but structure and goals are up to members 

• Useful for prevention and health maintenance groups 

• Useful for members with high cognitive level; very good insight; mature groups; high verbal skills and motivation 

• Cooperative and mature groups 

• Forming: Orientation - dependent on leader to guide group

• Storming: Conflict - challenge of task/leader-rules are established

• Norming: Harmony - acceptance and trust prevail 

• Performing: Effectively working together- Conflict is openly discussed

• Reforming: Evaluate past performance/reorganize for future performance 

• Intended for individuals who are ambivalent about changing or not ready to change 

• Key parts: partnership, acceptance , evocation, and compassion 

• Core skills 

  • Open ended questions 

  • Reflective listening 

  • Affirmation 

  • Eliciting change talk 

  • Develop discrepancy 

    • Bring attention to discrepancy between the present behavior and the person’s goals/values 

    • Decisional balance worksheet 

• Purpose: To determine clients’ skills and the level of a group that clients are appropriate for. Looking at person’s ability to socialize

• Clients: This type of group is appropriate for any clients who will be participating in a group.

• Activities that require collaboration are chosen by the therapist; the therapist allows the group to occur naturally and does not intervene (unless there are safety issues).

parallel group, project group, egocentric-cooperative, cooperative, mature

• Purpose: To provide members the opportunity to build skills that are required to perform occupations (e.g., IADLs). The specific goals of the group will determine what activities and types of clients will be in the group.

• Client must be able to function at a parallel level

• Therapist does not attend to conflict unless it hinders group process

• Purpose: Discussion of activities that members participate in outside the confines of the group, to increase their participation in those activities

• The client must be able to function at an egocentric-cooperative group skill level with good verbal and cognitive skills

• Purpose: Increase clients’ awareness of their needs and behaviors while they are participating in a group task with an end product that requires collaboration

• Appropriate for clients who have difficulties with socioemotional areas, and clients with fair verbal skills 

• Purpose: To allow members to continue to function at the highest level that is feasible

• found at psychosocial clubhouse level

• specifically helps those with disabilities

• found at psychosocial clubhouse level

• places individuals in temporary jobs with the goal of preparing them for permanent job placement