AOTA Mental Health Definitions

Identify a problem and the factors that will motivate the people in the group to change.

What is the FIRST step in the process of designing a group protocol for clients with mental illness?

Interpretation

conveys the OTR’s understanding of the client’s motive for his or her behavior. An example of interpretation in this example could be “I see that typing is not your favorite work task.”

Metaphor

is a way to convey a concept to a client without a lengthy explanation. In this example, saying, “I would rather be a tortoise than a hare” would imply that being slow is better than being fast.

Encouragement

which is sometimes confused with reframing, primarily involves positive regard by the therapist for what the client is doing and is capable of doing. An example of an encouraging response is, “It’s OK that you type slowly. Just because you type slowly does not mean that you cannot complete the task. Come on, let’s keep working.”

Tardive dyskinesia

involves facial movements and writhing motions of the tongue and fingers as a result of antipsychotic medication. It can persist even after medication discontinuation.

puts the locus of control on the members. When designing groups, the members formulate the goals, and the OTR® acts as an advisor.

The Clubhouse Model

A group leader as facilitator

maintains control over goals and decision making

in a supported living arrangement but would be expected to complete habitual routines independently (e.g., morning self-care).

A client with an ACL of 4.0 should be

information on the client’s former and current roles and the value the client places on these roles, consistent with the Model of Human Occupation.

Role Checklist gathers

reveal a client's personality.

projective test such as the House–Tree–Person

clients identify their perceptions of their own occupational performance.

Canadian Occupational Performance Measure helps

advisory style

the group knows its goals, works well together, and has been established for a while. The OTR can help the group by providing additional knowledge and resources for further action.

directive style

is best with clients who have low cognition, low motivation, and low insight.

advisory style

the group has been meeting for 6 months and is mature.

person with an ACL of 4.0 can perform

only simple tasks and will have difficulty with problem solving. A model with clear instructions should be provided along with supervision for cues and guidance when needed.

ACL of 5

A project with mostly familiar steps; no more than two steps of the task should require new learning.

carrying out tasks together over time toward a goal of completing a discrete project. It is a way of promoting group identity and mutual support. 

Cooperative participation involves

self-mutilation and destruction, unstable mood, and fears of abandonment that lead to instability.

Diagnostic symptoms for borderline personality disorder are

self-centeredness and grandiosity but not typically by self-destructive behavior, self-mutilation, and fear of abandonment.

Narcissism is characterized by

long-standing suspicion and mistrust.

Paranoid personality disorder is characterized by

anxiety, hypersensitivity, intrusion, arousal, and avoidance.

PTSD is characterized by

appropriate for a client with an ACL of 3

-A project that is unstructured; the client should be given opportunities for hands-on manipulation of materials

-do best with projects that are unstructured and focus on object manipulation and tactile cues. 

ppropriate for a client with an ACL of 6

A project that encourages relatively independent planning and organizing to complete.

cognitive–behavioral approach to intervention.

Discussing task performance

psychoeducation

A hallmark of cognitive–behavioral therapy is use of

a client-centered approach to recovery that encourages the supports necessary for a person to recover within a context that is comfortable for that person. It may include peer support and teaching.

The Recovery Model is

is intended for education of professionals providing services for substance abuse clients.

ProjectMAINSTREAM

is a model of occupational performance that focuses on the interaction between the person, the person's environment, and the person's desired occupations.

The PEO model

cognitive–behavioral

frame of reference works on the thoughts and reactions related to environmental triggers. Through journaling and reflection, the client can identify triggers that cause the anxiety to escalate.

cognitive disability

frame of reference uses the client’s strengths to allow for function. An example of a cognitive disabilities intervention is training caregivers to provide appropriate environmental supports for the client.

behavioral

• frame of reference relies on the idea that behavior is learned and that it can be unlearned.

• Tokens for reifnorcement of desired behavior

storming phase

-It is common for disagreements to occur

-setting up roadblocks and questioning the task at hand are normal during this stage

-characterized by conflict competition along with challenges to group

performing stage

Participants are able to problem solve through challenges. The disagreements that are the hallmark of the storming stage have been resolved.

forming stage.

-A group meeting for the first time

-Reliance on the group leader is common

-group has not yet taken ownership of the task and instead expects the leader to solve all issues.

Performing

characterized by the group working together as an efficient, interdependent unit with clearly defined roles.

ACL 5.6 and above.

Volunteer activities would be more appropriate for clients at

ACL 5.6 and above.

Long-term budgeting and house maintenance would be more appropriate for clients at

Vocational retraining and job seeking would be appropriate for clients at

Validation

affirms the client’s perspective; an example of validation in this case would be, “Yes, some of my questions are dumb and make me appear stupid.”

Limit setting

creates boundaries for the client’s behavior; in this case, an example of limit setting would be, “If you say this to me one more time, I will not work with you any more today.” Confrontation may include limit setting, but this particular example did not use limit setting.

Reframing

gives the OTR an opportunity to take a client’s perceived negative quality and reinterpret it as a positive trait. For example, the OTR could reframe the client’s anger as something positive, for example, by saying, “I am glad that you are being assertive about your feelings.” Because the client is directing anger toward the OTR, reframing is not an appropriate option in this example.

knowing the “how-to” of the therapeutic process.

Procedural reasoning is

blending of other forms of reasoning that reflect on interactive and procedural reasoning successes.

Conditional reasoning involves

guides other forms of reasoning through an understanding of the client’s personal narratives or life story.

Narrative reasoning

Functional neurologic disorder

An OTR® working in a neurology unit was referred a client with low back pain and weakness in one leg, causing difficulty walking. During the interview, the client mentions that the low back pain started after several stressful life events, but the client does not recall a specific injury. The medical team has ruled out physical causes for the pain. Malingering and fear of illness do not seem to be a part of this scenario, because the client is eager to resume exercise and other activities. What is the client’s likely diagnosis?

A closed-membership group for war veterans that meets daily to facilitate coping with the impact of posttraumatic stress disorder by engaging in expressive media and discussion and reflection

In which of the following groups is group process MOST essential to the effectiveness of the intervention?

Cognitive disability

An OTR® is providing intervention to a client with an anxiety disorder who hyperventilates when faced with difficult work tasks. The OTR (with the client’s permission) works with the employer to identify work tasks in which the client can be successful. What frame of reference does this intervention suggest?

-Review notes and personal histories because they are the basis of the client’s current responses

-Hold the client responsible for making changes in life

-Develop strategies with the client about setting boundaries for maintaining respect of others while seeking to meet needs

An inpatient client in a psychiatric facility has been diagnosed with dependent personality disorder and depression. During the interview, the OTR® learns that the client has been unemployed for 4 months, has transferred from one similar job to another because of an inability to meet deadlines, and has recently gone through a difficult relationship breakup.

Question

The client appears to be responding well to cognitive–behavioral strategies. The OTR® decides to use dialectical behavior therapy (DBT) to further help the client identify behaviors that affect successful work performance. What actions must the OTR take to be consistent with principles of DBT? Select the 3 best choices.

Supporting the client’s participation in daily routines and work tasks based on current skills and abilities

A client who has an enduring mental illness arrives late for an initial occupational therapy evaluation at a community mental health facility. The client’s appearance is unkempt and dirty. The client lives with family members, spends the majority of leisure time drinking with friends, and has been terminated from multiple jobs. One of the client’s goals is to “get a job.” What should be the PRIMARY focus of this client’s intervention when using the Model of Human Occupation?

-Ask whether the client is feeling overwhelmed about how to manage group input but remain “in charge.”

-Ask whether the client is feeling overwhelmed about how to manage group input but remain “in charge.”

-Note the client’s behavioral responses and reflect on them with the client during individual therapy sessions

An inpatient client in a psychiatric facility has been diagnosed with dependent personality disorder and depression. During the interview, the OTR® learns that the client has been unemployed for 4 months, has transferred from one similar job to another because of an inability to meet deadlines, and has recently gone through a difficult relationship breakup.

Question

The OTR® has worked with the client for a few weeks using dialectical behavior therapy (DBT) principles. The client has been working on self-assertion and being in control of emotions and environmental stressors. During a group activity, the client is nominated by peers to be the group leader in planning a small party for the facility. The client appears anxious about the role assignment but decides to accept the nomination. During the initial planning meeting, the OTR observes that the client has shown improvement in focusing on tasks. However, the client’s pattern of depending on others to facilitate discussion, asking many questions for clarification, and a new behavior, lack of assertiveness, have become apparent as the client organizes the planning phase. Using DBT principles, what actions can the OTR take? Select the 3 best choices.

The client will be discharged home from the inpatient psychiatric unit with daily checks from caregiver to address novel safety needs in the home environment.

An OTR® is working with a client in an inpatient psychiatric facility and decides to use the Allen Cognitive Level Screen to assess cognitive functioning. Which goals would be appropriate on the basis of the Cognitive Disabilities Model?

The activity includes a model of the completed project for the client to imitate.

Using the Allen Cognitive Level Screen–5 for screening, followed by use of the Allen Diagnostic Module and the Routine Task Inventory for confirmation of screening results, an OTR® identifies Level 4 as the current level of functioning of a client in an adult day treatment center. What is the MOST appropriate scenario for activity completion for this client?

place and train approach example

Supportive employment

Planting seeds in induvial pots in a group activity

parallel group activity

organize creation of large quilted wall hanging for reception area to which each participant contributes a square

parallel group/associative participation

cognitive disability

• Frame of reference uses client’s strengths to allow for function

• Example of cognitive disability intervention training CG to provide appropriate environmental supports for client for client

• Example client has anxiety disorder who hyperventilates faced with difficult work tasks and with client’s permission works with employer to identify work tasks which client can be successful

cognitive-behavioral

• Frame of reference works on thoughts and reactions related to environmental triggers

• Through journaling and reflection, client can identify triggers that cause anxiety to escalate

• Deep breathing

psychodynamic

• Frame of reference suggests that unresolved childhood events are reason for dysfunction

• Intervention usually discussion bases

behavioral

• Frame of reference relies on idea that behavior is learned and that it can be unlearned

• Use of breathing and relaxation techniques during stressful event can facilitate change in response

Design of interventions designed at improving executive functions of clients with schizophrenia

practicing strategies for learning and teaching activity specific routines is a potentially effective intervention

Tardive dyskinesia

involves facial movements and writhing motions of tongue and fingers as result of anti-psychotic medications that can occur after prolonged use.

Universality

curative factor gained from other members sharing of similar feelings, thoughts and problems

Altruism

when members feel boss of self-concept form extending help to others

Catharsis

release strong feelings about previous or present experiences

cohesion

feeling of trust and togetherness in a group

ACL 5.2

This pt could be d/c home alone with weekly checks for novel safety issues and health maintenance

ACL 4.0

Ct should be supported living arrangement but would be expected to complete habitual routines independently (morning self care)

working memory and executive function which can interfere with task performance

Clients with schizophrenia have difficulty with

Generalized anxiety disorder

Which disorder is guided imagery most effective for clients

Free form clay building

short term acute care psychiatric hospital leading psychodynamic group which activity most appropriate

norming

• development of trust among group members and successful conflict resolution as group focuses on task at hand

• group process have been agreed upon and group demonstrates shared leadership

• group members bonded and has developed clear process and procedures

confrontation

‘I would like to help you, but I will not tolerate this behavior. You are not being nice to me right now, and I deserve to be treated better than this.”

Validation

“Yes some of my questions are dumb and make me appear stupid.”

Limit setting

creates boundaries “If you say this to me one more time, I will not work with you any more today.”

Reframing

• perceived negative quality and reinterpret as a positive trait

• “I am glad that you are being assertive about your feelings”

statement best describes task oriented group of the storming phase of group development

a participant recently joined the group sets up road blocks and questioning task at hand are normal during this stage

statement best describes performing stage

Because 2 participants were able to work out their differences early on, the group is now running smoothly adn handles problems efficiently

statement best describes forming stage

The group meeting for the first time and participants are asking the group leader for help because they don’t understand the task at hand