Psychosocial Midterm

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

1. Events - actual or extreme threat of physical or psychological harm
2. Experience - how individual interprets event
3. Effects - can occur immediately or be delayed

4 R’s of trauma-informed care

1. Realization - that trauma is pervasive and harmful
2. Recognize - the signs of trauma in yourself/others
3. Responds - to trauma/creates safe environment/offer care
4. Resists - retraumatization (address triggers and understand things can be re-traumatizing)

6 principles of trauma-informed care

1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment, voice, and choice
6. 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

1. Hope
2. Personal responsibility
3. Education
4. Self-advocacy
5. Support

10 guiding principles to recovery

1. hope
2. person-driven
3. many pathways
4. holistic
5. peer support
6. relational
7. culture
8. address trauma
9. strengths/responsibility
10. 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?

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* 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