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Recovery Model
Recognizes individuals with experience of mental health issues and supports their potential recovery to improve health, wellness, self-directed life, and reach their full potential
Four dimensions that support a life in recovery
Health
Home
Purpose
Community
What is Mad Pride/Mad Movement
Movement resisting psychiatric oppression and sanism for those who are labelled as mentally ill or mad people
Sanism
discrimination against psychiatrized/mad people
Stigma
negative attitude and behavioral chain that begin by applying a stigmatizing mark to a person and results in discrimination
Public stigma
endorsement of negative stereotypes of people with specific conditions by others
Self-stigma
when stigmatized people agree with and internalize negative stereotypes; people believes in stereotypes
stigma by association
friends and family of person with stigma may also start to feel the devaluation of being stigmatized
structural stigma
when society weaves inequities and injustices into their laws/practices
social distance
how willing someone is to exclude those with a mental illness in social situations
ISMI (Internalized Stigma of Mental Illness)
Measures self-stigma, self-report tool with 29 items and 5 subscales
OMS-HC (Opening Mind Scale for Health Care Providers)
Self-report scale for healthcare workers to report stigma
3 E’s of trauma
Events - actual or extreme threat of physical or psychological harm
Experience - how individual interprets event
Effects - can occur immediately or be delayed
4 R’s of trauma-informed care
Realization - that trauma is pervasive and harmful
Recognize - the signs of trauma in yourself/others
Responds - to trauma/creates safe environment/offer care
Resists - retraumatization (address triggers and understand things can be re-traumatizing)
6 principles of trauma-informed care
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment, voice, and choice
Cultural, historical, and gender issues
Wellness Recovery Action Plan (WRAP)
Self-directed recovery and prevention plans that identify triggers and wellness tools and help people create a daily management plan. Helps people identify their personal warning signs
5 concepts of WRAP
Hope
Personal responsibility
Education
Self-advocacy
Support
10 guiding principles to recovery
hope
person-driven
many pathways
holistic
peer support
relational
culture
address trauma
strengths/responsibility
respect
Person (PEO)
Affective, cognitive, and physical contribute to successful engagement in occupations
Environment (PEO)
Context within which occupational performance takes place: cultural, institutional, physical, and social
Occupation (PEO)
Clusters of activities and tasks in which people engage while carrying out various roles in multiple locations
Occupational performance
Result of relationship between persons, environment and occupation over a person’s lifespan
PEO Fit
the congruence or fit among PEO, elements that support or contain client participation
Dimension of time
How people grow and change over time of lives
Dimension of space
physical space is required to engage comfortably
Labeling theory
groups have power to define or “label” what is and is not socially deviant, judgement occurs
Normalization theory
focuses on reducing elements that emphasize differences and creates opportunities for social participation in naturally occurring groups and settings (believes labels are negative)
Family stigma
many consequences of stigma (self-stigma, isolation, evaluating) are experienced by family members too
Involuntary commitment
locked psychiatric hospital against individual’s will but there is clear evidence of the person being dangerous
emergency hospitalization
state can legally order a person detained against will for 3-5 days while hearing is convened
involuntary outpatient commitment
less restrictive, court-ordered mechanism, that requires personal to submit to outpatient
Acute care
very brief, often the beginning of person’s recovery
inpatient hospital
brief intervention focused on transition into less restrictive care environments
Partial hospitalization programs (PHP)
not in hospital, functions Monday-Friday for 6 hours a day, not residential, mental heath treatments
intensive outpatient programs (IOP)
operate Monday-Friday for 3 hours a day, not residential, mental heath treatments
Psychiatric rehab
meets needs of people diagnosed with psych disabilities
assertive community treatment
team provides community-based treatment, rehab, and support services 24 hours per day, 365 day a year
hyperresponsive
too intense of response to sensory stimulation
hyporesponsive
lack of response to sensory stimulation
Types of sensory systems
visual
auditory
tactile
taste
smell
proprioceptive
vestibular
Dunn’s Model of Sensory Processing
understanding how people respond to sensory stimuli, composed of 4 quadrants of neurological/behavioral responses/thresholds
Sensory sensitivity
low threshold and passive, people that notice things things that others do not
Sensation avoiding
low threshold and active, creates/chooses environment that reduces sensory input
Low registration
high threshold and passive, tends to miss input that others take in
sensation seeking
high threshold and active, people actively engage with their environment to meet their sensory needs
Sensory interventions based on Dunn’s Model
intensity, amount, repetition, competing stimuli, predictability, familiarity, speed, contract of stimuli
Tiers of mental health intervention
Tier 1 - universal
Tier 2 - targeted
Tier 2 - intensive
Tier 1
Primary prevention and promotion for all individuals served, universal, whole classroom interventions
Tier 2
targeted prevention service for at-risk individuals, may show signs of not doing well but generally not identified as needing mental services
Tier 3
individualized intensive mental health interventions for people with identified mental, emotional, or behavioral disorders
Positive Behavior Intervention and Supports (PBIS)
Tier 1 intervention, broad range of systemic and individualized strategies for achieving social and learning outcomes while preventing problem behavior with all students served
What does PBIS do?
Directly teaching expected behaviors
Acknowledging students when they demonstrate expected behavior
Provides clear consequences to students when they demonstrate unexpected behaviors
Four Zones of Regulation
Blue zone - sad, sick, tired, bored, moving slowly
Green zone - happy, calm, good to go, focused, ready to learn
Yellow zone - frustrated, worried, silly, anxious, excited, losing some control
Red zone - mad, angry, mean, yelling, hitting, out of control, need time
Work Orientation Readiness Center Program (WORC)
created by OT’s working directly with students involved in employability and vocational training programs; teaches employability skill development to promote successful transition to community employment
WORC Program routines
students are consider “at work”, have hygiene checks, clock in/out, work meetings, work tasks, clean up, paychecks, short lessons, lesson “links” about reminders to focus and become back on track
Every Moment Counts
program used by OTs in school setting to promote inclusion and mental health literacy in the classrooms, cafes, recess, playgrounds, etc. so they can have positive mental health and feel good emotionally, do we functionally, and cope with challenges
Individuals with Disabilities Education Act (IDEA)
schools have to meet mental health needs of students with emotional challenges and provide mental health services to children in healthcare and education institutions
Moral Treatment Movement
response to inhumane treatment of people with mental illness, use of occupations kept people busy, occupied, and less demanding of staff
Mental Hygiene Movement
Adolf Meyer placed responsibility on state and communities for providing needed services to individuals with mental health issues
Arts and Crafts Movement
became therapeutic media in psych hospitals, offered people experiences of joy, pleasure, self-esteem, and self-worth
William Rush Dunton
first to publish analysis of arts and crafts activities for therapy
Eleanor Clarke Slagle
introduced habit training and had lots of historic lectures
Susan Tracy
developed assessment techniques on observations for performance-based
Situated learning theory
client choice and involvement to address skills, didactic learning with modeling and practice in context that is preferred by individual
harm reduction
policies, programs and practices that aim to primarily reduce adverse health, social and economic consequences of the use of legal and illegal psych drugs
transitional housing programs
promote housing stability, provides temporary housing for up to 2 years
homeless shelters
provides temporary, safe housing, typically for 1 night to 30 days
permanent supportive housing
long-term independent living accommodations in the community that provides housing and supportive services to assist homeless persons in transition from the streets to shelters to permanent housing
Americans with Disabilities Act (ADA)
Persons with disabilities be provided services in the most integrated setting and appropriate for their needs
Olmstead Integration Mandate
ensured ADA protections, made sure public entities administer services, programs, and activities in the most integrated setting appropriate to the needs of people with disabilities
Fair Housing Act
prohibits discrimination in the sale, rental, and financing of dwellings based on race, color, religion, sex, national origin, and now disabilities
Custodial housing
congregate living environments that are most often operated for profit by private landowners, including residential care homes, boarding homes, and board and care homes (provides little mental health support)
Occupational identity (MOHO)
sense of oneself in regard to an occupation
Occupational competence
the degree to which the person is able to sustain work consistent with this identity
person-related barriers
person being disrupted due to mental health symptoms
Vocational barriers
lack of access to vocational services, low expectations or limited knowledge among mental health staff
employer and workplace barriers
employer does not hire mentally ill people, limited knowledge among employers about how to provide work accommodations
system related barriers
risk of income loss, complex systems navigation required to access education
skills training approach
can be used to teach variety of ADLs and IADLs (grocery shop, health self-manage, money, parenting, cooking)
place-then-train approach
based on evidence over 20 years, leads to best outcomes, focus on job placement and followed by on-site job training
train-then-place approach
prevocational preparation or training as a prerequisite to entry or reentry into employment
supported employment
Employment service delivery model for improving the employment outcomes of people experiencing persistent mental illness
transitional employment
Time-limited job placements (3-6 months) within mainstream workplaces at the prevailing wage
Worker Role Interview
for inured workers returning to work and those out of work for some time, semi-structured interview for psychosocial and environment factor influencing work
Vocational development
life long process, begin in childhood, person’s development occurs through exploration, mastery, and achievement
What kinds of activities did institutions who ascribed to the tenets of the moral treatment movement engage patients in?
laundry, cleaning, construction
Adolf Meyer, a philosophical founder of occupational therapy, was also engage in which of the following movements?
Eugenics
Which of the following is/are performance-based assessments?
KELS, PASS, EFPT, AMPS
Which of these countries has the lowest percentage of their OT workforce working in specifically mental health settings?
USA
Mental health assessment and interventions are used in which of the following settings?
All: Inpatient rehab, early intervention, school-based practice, acute care, and nursing homes
occupational performance can be used as:
assessment, intervention, and outcome measurement
3 B’s of Positive Behavior Interventions and Supports (PBIS)
be safe, be responsible, be respectful
mental conditions that affect ADLs and IADLs
dementia, depression, schizophrenia, ODC, eating disorders, etc.
Kohl Evaluation of Living Skills (KELS)
interview and performance based, evaluates ability to complete basic living skills, used in clinical setting
Performance Assessment Based Skills Assessment
performance based, measures ability to complete IADLs using props (making soup, medication into pill organizer)
ACS Assessment
reading cards of occupations out loud and putting them in categories of “never done”, “given up”, “doing now”, etc.
Test of Grocery Shopping Skills (TOGSS)
performance based, done in an actual grocery store and tests ability to efficiently and accurately locate 10 items on a list
Adolescent Sensory Profile Assessment
self-report questionnaire assessment on specific sensory stimulations, scored among sensory seeking, sensory avoidant, low registration, and sensory sensitivity
Adult Sensory Checklist
checklist of sensory stimulations that make one more alert or less alert, self-reporting using > and < signs
case management
ensuring person is provided with needed services, assesses needs and strengths of person, plans services needed, referrals, monitors the outcome of services