Professor Lunn OT Final

occupational therapy

therapy based on engagement in meaningful activities of daily life (as self-care skills, education, work, or social interaction) especially to enable or encourage participation in such activities despite impairments or limitations in physical or mental functioning

occupational science

an academic discipline that offers support, reason, and scientific data that legitimizes the work that is done within that profession

form

direct, observable aspects of occupation objects and tools used steps involved environmental factors

function

human development health quality of life adaptation

meaning

looks at how people think, feel, and experience what they do discovered through qualitative measures such as interview encompasses the personal and cultural significance of occupations looks at how it influences choice through occupation we develop a sense of competence, self-esteem, and identity

occupation

the focus of occupation therapy and the unit of measure for occupational science

clinical reasoning

process used by practitioners to plan, direct, perform, and reflect on client care

William Rush Dunton

father of OT

Eleanor Clarke Slagle

mother of OT

George Edward Barton

leader of Arts and Crafts Movement

Susan cox Johnson

showed occupation can be positive for health

Thomas Bessel Kidner

established OT in Vocational Rehab.

Phillipe Pinel

conceived Moral Treatment Movement

Adolf Meyer

physch. who developed basis of OT

WWI

provided a motivation to the concept of OT (crafts, habit training)

WWII

provided more functional activities to enhance return of daily life; goal was rehab.

Biomechanical Frame of Reference (FOR)

emerged (Medical Model)

OT as a profession

seeks to improve the quality of life for individuals who are experiencing or are at risk for physical, cognitive mental, or psychosocial impairments

OT as art

it is different for every person - the therapist must learn to enter a client's life to understand

client-centered practice

the client determines what is meaningful and important for therapy

occupational-based practice

separates us from other allied health professionals; we use occupation as an end as well as a means

evidence-based practice

the use of research to guide clinical reasoning

thinking about the client

OT understanding their motivation, goals, developmental level, and personal expectations; OT needs to be realistic, ask Qs, and seek support

thinking about the family

the OT needs to perceive family members as listeners , supporters, motivators, and adaptable when necessary

OT role

respecting family values, beliefs, and routines not judging comm. with clean goals, expectations, and education to promote health, safety, and independence listening and trying not to fix everything being realistic HIPAA advocating for client/family establishing a professional relationship being human

thinking about the team

comm. with each other, the client, and the family everyone needs to be on the same page educate the family and client about outcomes, illness, disability, comm. resources, etc. provide necessary intervention/services

philosophy

a set of basic principles/concepts underlying someone's practice or conduct

metaphysical

the Qs concerned with the nature of humankind

epistemology

related to nature, origin, and limits of human knowledge; provides a base for understanding motivation, change, and learning; investigates how we know things and how do we know that we know?

axiology

examines the value of a profession and what's considered just and right; OT this = client-centered care, quality of life, ethics; explores Qs of desirability and ethics

reductionistic approach

humankind is reduced to separately functioning parts; successful in producing cures and technological advancements; inefficient and costly

holistic approach

emphasized the organic and functional relationship between parts and the whole being; core concept to our profession - this means that evaluations and intervention plans should reflect the needs of the whole person

active beings

how OT views humans; actively involved in controlling and determining their own behavior and are capable of changing behavior as desired; viewed as open systems in which there is continuous interaction between the person and environment

occupation as a means

the use of a specific occupation to bring about a change in the client's performance

occupation as an end

the desired outcome or product of intervention

culture

a set of shared distinct beliefs, values, and behaviors that help individuals to recognize who belongs and who does not belong to the collective group

culture is...

learned - not inherited real - influence can be felt shared - be group individuals dynamic - changes over time in response to politics and economics invisible - taken for granted until a different culture makes our own visible NOT race or ethnicity

cultural sensitivity

cultural differences impact OT assessment and intervention; if we are not addressing important occupations - why would the client continue participating in OT treatment?

spirituality

fundamental orientation in a persona's life; what inspires and motivates; may result in a connection with others; linked to hope, faith, coping, and self-transcendence; may imply religion

religion

an organized and culturally shaped avenue for spiritual expression

social position

the differences and inequalities among people or groups of people; can shape one's values, beliefs, and view of the world as they participate in it

social/material qualities

resources such as education, jobs, housing, food, sources, and health care

socioeconomic status

the occupational, educational, and income achievements by individuals or groups

poverty

lack of material resources that are necessary to live

working poor

people who work full time but still live within the poverty line

new poor

when an unplanned life change occurs and effects the resources required to meet basic needs

1960s

when medicare and medicaid are established

medicare

for people 65+, disabled of any age, and end-stage renal disease part A: inpatient hospitalization SNFs HHC hospice part B: physician and outpatient services HHC DME

medicaid

insurance for all who are unable to afford health care (requirements) federally and state funded varies by state with coverage/usage

SCHIP (State Children's Health Insurance Program)

established in 1997 to provide health care to uninsured children of working families who earn too little to afford private insurance but too much to be eligible for medicaid.

IDEA (Individuals with Disabilities Education Act)

a school-based program that focuses on care in school systems; highest % of OTs work in school-based programs; partnerships between state and federal gov. and school systems

workman's compensation

state-run; pays for healthcare related to a work injury; pays for medical services, salaries, vocational training, and for disability if determined by an MD; uninsured

JCAHO (Joint Commission on Accreditation of Healthcare Organizations)

evaluates an organization's compliance with the standards established; organization being evaluated must comply with essential standards in order to receive Medicare reimbursement; hospitals utilize this organization by choice

NCQA (National Committee for Quality Assurance)

assesses and reports on the quality of managed care plans; voluntary service for MCO's; standards relate to member satisfaction, quality of care, access., and services provided

CARF (Commission on Accreditation of Rehab Facilitates)

a voluntary organization for rehab providers

NBCOT (National Board for Certification in Occupational Therapy)

credentials OT's and COTA's to be able to work within the profession; and examination in taken after a master's education and 6 of fieldwork

State Regulatory Board

after passing the certification exam (NBCOT) an OT/COTA can apply for licensure within the state in which they want to practice; each state has specific criteria regarding the duties and responsibilities of the OT/COTA.

NHOTA ( )

advances the profession within the state; provides continuing education opportunities independent from AOTA, but they collaborate

CHT

certified hand therapist

CPE

certified professional ergonomist

SCLV

specialty certification in low vision

supervision

depends on skill, knowledge, and experience; promotes learning, autonomy, and professional growth; includes respect and trust; comm. needs and type of supervision

service competency

demonstration and verification of skills and knowledge of treatment; this can be done by: - co-treatment - observation - individual education

collaboration

respect, understanding, clear expectations, dependability

interdisciplinary

team members have shared responsibility for providing services and support one another's goals for treatment. Separate assessments, then shared results to develop integrated and coordinated care

multidisciplinary

team members work side-by-side one another. Roles are clearly defined and team members are aware of each others' scope of practice

transdisciplinary

team members work together to develop goals, and carry out patient care. Family interacts with a primary provider, based on patient needs

ethics

clinical decisions based on professional judegment

dilemma

involves personal and social morals and values; not a right/wrong answer

OT code of ethics

(AOTA 2000) common set of values/principles that promote high standards of behavior and professional responsibility

beneficience

demonstrates concern and well-being for the recipients of services

nonmaleficence

do no harm to the recipients of service

autonomy and confidentiality

respect the right of the individual to self determination; collab with all, inform recipients of potential risks of intervention, respect decisions, HIPAA

social justice

providing service in a fair/equitable manner

procedural justice

compliance with laws/policies

veracity

the duty to tell the truth

fidelity

treating colleagues and others with fairness, discretion, and integrity

OT values

Altruism Equality Freedom Justice Dignity Truth Prudence

process of ethical reasoning

- identify the ethical dilemma - gather relevant facts about the case - apply ethical theories and guiding principles to analyze the case - problem solve practical alternatives - decide on an action - act on that choice - evaluate how to prevent or cope with the dilemma should you encounter it again

professional reasoning

used by practitioners to plan, direct, perform, and reflect on client care; complex' multifaceted; effected by the amount of experience one has

metacognitive

thinking about thinking

schemata

building up a representation of what to expect based on experience

scripts

rules to guide thinking (initial treatment to discharge)

scientific reasoning

focuses on the diagnosis of the illness or condition; guided by theory; considers evidence from research to guide practice; does not consider the patient on a personal level

narrative reasoning

personal; includes info from the patient and family; focuses on the patient's history and story; considers the patient's culture; helps the therapist make sense of the patient's circumstances

pragmatic reasoning

practical; considers scheduling options, payment, equipment needed/available, therapist's skills, organizational policies; not focused on the client's condition, but the realities of providing services

ethical reasoning

a systematic approach to a moral conflict; analyzes the dilemma; helps generate alternative solutions; determines actions needed

interactive reasoning

thinking that helps the therapist build a positive relationship with the patient; uses positive communicative skills; allows for collaboration in treatment; identify and solve problems

OT process

involves the interaction between the practitioner and the client; collaborative; dynamic process with the focus on

evaluation process

to find out what the client wants/needs; based on age, diagnosis, developmental level, education, socioeconomic status, cultural background, and abilities

referral

starts the OT process; a request for service for a particular client is made from a medical prof.

screening

OT practitioners gather prelim. info about the client and determine whether further evaluation and intervention are needed; involves interview, screen test, observation, discussion, and referral

occupational profile

gather basic demographics: age, gender, diagnosis, reason for referral, etc.; provides OT with a history of the client's background and functional performance with which is to design interventions

occupational performance analysis

uses the occupational profile to provide a direction to the practitioner to the areas that need further examination; involved analyzing all aspects of the occupation to determine the client factors, patterns, skills, and behaviors required to be successful

observation

the means of gathering info about a person or an environment by watch/notice; ex: posture, dress, social skills, voice, behavior, physical abilities, etc.

structured observation

watching the client perform a predetermined activity

intervention

working with the client through therapy to reach client goals

occupational justice

to develop an understanding of the political potential of OT to create situations in which all individuals, regardless of race, ethnicity, socioeconomics, class, or disability status, can engage in meaningful occupations by choice that support their participation in everyday life

occupational dysfunction

impaired or disordered occupations

occupational apartheid

segregation of groups of people through restriction or denial of participation in occupations if daily life; can be based on race, color, disability, sexual preference, political beliefs, etc.

occupational injustice

alienation, deprivation, marginalization, imbalance

alienation

a period of undefined time when a person is disconnected from others, lacks a clear identity, and cannot find meaning in his/her life

deprivation

prevention of participation in meaningful occupation - control is outside of the individual; ex: Lavin's curfew in Bethlehem

marginalization

the lack of choice/control which limits participation (invisible force); ex: homeless population

imbalance

being "under/over-occupied" which causes the individual to lose meaning or empowerment in their other daily occupations

occupational analysis

a person's values, beliefs, interests, habits, routines, and goals are taken into account; the use of narrative reasoning; incorporate a person's natural context

occupational-based activity analysis

person/their goals are central; who are they? what do they wanna do? what are the demands of the activity within the person's context and how to relate to their current skill level; how OT bridges the gap between skills and demands

activity analysis

thought processes OT's use when they are thinking about activities in general; examining properties of an activity such as potential demands, range of skills, and meanings; thinking about therapeutic potential of an activity

activity analysis format

-identifies activity demands: objects, space, social -performance skills: motor, process, communication -required steps -required body functions -safety hazards

performance skills

what able to do; observable; actions have purpose; occur within the intersection of the person, demands of an activity, within a context -motor, process, communication

motor skills

skills in moving and interacting with tasks, objects and environment; observe as persons moves and interacts with objects and the environment; involves posture, movement, strength, etc.

process skills

skills used in managing and modifying actions during task performance; mental processing is focus rather than only physical activity; maintaining attention, choosing appropriate tools and using them correctly, etc.

communication/interaction skills

refers to conveying intentions and needs and coordinating social behavior to act together with people; these skills are those that enable people to get along with others, make their needs known, ask Qs, etc.

grading

to improve the patient's capabilities (function) to participate in occupation by increasing or decreasing the demands in a sequential order; a variable

adaptation

process of changing the demands of an activity so that the client in capable of performing it through changes in the occupation of environment; the goal is to allow the person continual involvement in a valued occupation that can no longer be pursued based on their functional capacity

OT in early intervention

promoting the functions and engagement of infants and toddlers and their families in everyday routines by addressing occupations; enhancing a family's capacity to care for their child and promote his/her development and participation

early intervention patients

infants 0-3

why early intervention?

the infant is not reaching certain milestones in their first years of life

OT in hospital acute care

secondary healthcare for those who have a severe injury or illness; treatment is quick and effective

hospital acute care patients

all ages, critical conditions, trauma, new diagnoses, worsening condition, etc.

hospital acute care stay time

less than 30 days

OT in home health

when a medical professional provides someone with medical care but goes to them

OT in mental health

the goal is to promote quality of life, independence, social interactions/participation, improving behavior, self-care, homemaking, etc.

mental health patients

PTSD, bipolar, depression, autism, mental health recovery, etc.

why mental health?

some are incapable of functioning in normal life, need help engaging with others, accomplishing tasks, etc.

OT in pediatric outpatient

teaching the patients to engaging in activities that allow them to learn, develop life skills, be creative, and have positive relationships with others

pediatric outpatient patients

0-18YO, ADHD, autism, premature, behavioral disorders, etc.

OT in outpatient

where patients can receive medical care without having to stay overnight at the facility

outpatient patients

patients can be any age but can only be admitted with a referral from a DR or specialist

outpatient stay time

2wks - 6mths

OT in schools

goal is to provide the children in their care with the tools and skills necessary for them to independently perform tasks

school stay time

varies according to IEP (individualized education plan)

OT in hospice

when the professional works to make the patient as comfy as possible before death when there is no further treatment for the illness

OT in hospital inpatient

a basic hospital visit; rooms vary from semi-private to full with meals and nurse service provided

OT in skilled nursing facilities

a facility that often houses the elderly, those suffering from traumatic injury, mental or physical disability, or something similar; cannot discriminate

skilled nursing facilities setting

patient's rooms can be adapted for their needs (ex: kitchen, office, gym, etc.)

SaMol's story

suffered from a brain injury and died; son-in-law took over; his OT was invited to the funeral; learning how other cultures cope with death

Mary Weber's story

successful, play-write/tv star and engaged women who got in a car accident and suffered from a brain injury; problems communicating, coordination, etc. she started to paint to express herself with the help of her OT, Anna

Alex's story

went to UNH; didn't want to stop living his "normal" life because of is cerebral palsy

Minnie Mae's story

suffered from Parkinson's Disease; 1st Doctor was not helpful; poor therapeutic rapport; didn't LISTEN; she found a new doctor; husband is Don: a UNH professor-retired (love story)

John Banks's Story

an African American who wanted technology to benefit him while his white OT believed in play and leisure; gender and racial differences

Ashley

bipolar teenager; trouble getting to school on time but mostly get to school on time now behavior issue; therapy; therapeutic day school

Brett

MS; neuroscientist; wheelchair; enjoys painting

Dana

ATV head injury; coma for 6wks; impaired speech and balance

Martha

78YO; weakness on right side; transient ischemic attack (TIA) was diagnosed; flat effect, motor deficit, farsightedness, wheelchair dependent, loss of communication, etc.

Susan Tracy

first occupational therapist; a nurse who was involved in the arts and crafts movement and in the training of nurses in the use of occupations; wrote first book on OT

habit training

a re-education program designed to overcome disorganized habits, to modify other habits, and to construct new ones, with the goal of restoring and maintaining health

remediation

an educational program designed to teach a person to overcome a disability through training and education

intristic motivation

a desire to perform a behavior for its own sake and to be effective

March 1917

birth of OT

April 1921

name changed to AOTA

routine supervision

face to face contact at least every 2 weeks at the site of work, with interim supervision through methods of telecommunication

close supervision

daily, direct contact at the site of work

general supervision

initial direction and face to face contact with the supervising therapist at least once a month, interim supervision as needed by telecommunication

OTA

an allied health paraprofessional who under the direction of an OT, directs and individuals participation in selected tasks to restore, reinforce, and enhance performance, and promote to maintain health

William Tuke

leisure therapy advocate, created the moral treatment and occupation movement

Helen Willard

co created the the "bible" of OT, Willard and Spackman's Occupational Therapy

Herbert Hall

developed the arts and crafts movement for medical purposes

AOTA (American Occupational Therapy Association)

the nationally recognized professional association for occupational therapy practitioners

AOTF (American Occupational Therapy Foundation)

purpose is to serve public interest by supporting OT research and education the public about occupation's important relationship to health; they accomplish this with grants, scholarships, programs, and publications

ACOTE (Accreditation Council for Occupational Therapy Education)

recognizes education institutions and professional programs to ensure that integrity and quality performance is being received by the public community

Balanced Budget Act

1997: drastic cuts in Medicare reimbursement, including areas of occupational therapy service 2000: restoration of some Medicare benefits due to patient, family, and provider pressure

reflection

aspect of meaning vs. spirituality, aspect of two areas

3 divisions of OT process

evaluation, intervention, outcomes

5 intervention approaches

create/promote, establish/restore, maintain, modify, prevent

components of the evaluation process

purpose, procedures, referral, screening, OP, OPA, Interview, observation, formal assessment,

Jodie Heath

-Owner of Swing for the Stars Pediatric Therapy Center -Went to UNH -Worked at Adam's Camp Some Challenges of working with kids: -they don't always want to play what/when you want to play -having difficult conversations with families/parenting styles/home carryover and how it impacts progress -Behaviors, behaviors, behaviors!

Alicia Wood

-Worked in skilled nursing/long term care for 20+ years -Now works in home care -Went to Utica College of Syracuse in 2001 -Worked at Genesis Hackett Hill Center with Prof Lunn -Initially worked under a temp license until taking the NBCOT exam