6640 Theory Application Midterm

definition of SDOH

conditions in environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and QOL outcomes and risks

SDOH categories

• economic stability

• neighborhood and physical/built environment

• education access and quality

• food

• community and social context

• health care system

2 definitions of paradigm

1) significant periods of time in OTs history

2) formal documents that inform our understanding of the profession

what are the 4 paradigm time periods names

1) occupation

2) mechanistic

3) new emerging

4) current trends

paradigm 1: occupation (1900s-1940s)

• keywords: industrial revolution, arts and crafts, mental hygiene, occupation, WWI/WWII

• Industrial Revolution → led to arts and crafts movement

• humanistic philosophy and moral treatment → people w/disabilities have the right to engage in occupations

• move towards deinstitutionalize near the end of this time

paradigm 1: occupation (what is happening outside of OT)

• industrial revolution (not safe working conditions)

• great depression unions began forming and were looked down upon (advocate for each other and set standards)

• vets returning from war (increased need for organized medicine)

paradigm 2: mechanistic (1950s-1970s)

• keywords: medical model, fragmented constructs, new FOR, Medicare/Medicaid

• 50’s → psychological and sensory FOR, development in medicine and neurology

• 60’s → task-oriented therapy, community reintegration, Jean Ayres SI, long hospitalization → increase in group therapy, PASSAGE OF MEDICARE/MEDICAID

• 70’s → decade of FOR, presence in peds/geriatrics/hand, fragmented constructs, NEW FOR's (acquisitional psychoanalytic, developmental), justify what we do (medical model)

what 3 new FORs emerged in the mechanistic paradigm (1970s)

1) acquisitional

2) psychoanalytic

3) developmental

paradigm 3: new emerging (1980s-2000s)

• keywords: standardized assessments, occupational science, occupation-based models, 1st practice framework, OBRA, ADA

• 80’s → standardized assessments emerge, move towards state licensure, birth of OCCUPATIONAL SCIENCE, clinical reasoning, MOHO

• 90’s → most occupational-based models developed, growth of ct centered care and job market

• uniform terminology published → 1st PRACTICE FRAMEWORK

paradigm 3: new emerging (what is happening outside of OT)

• Important legislation passed

  • OBRA passed

  • ADA passed

paradigm 4: current trends (2000s and beyond)

• keywords: merging biological and social theories, context/environment, occupational justice, complex/holistic occupation, advocacy

• include context and environments within intervention

• increased recognition of complex and holistic nature of occupation

• increasing role of OT and advocating (non-medical, medical, prevention/wellness, etc.)

what are the 3 core documents of a paradigm

1) code of ethics

2) philosophical base

3) practice guideline

purpose of code of ethics core document

• provide aspirational core values to guide OTs in professional and volunteer roles

• delineate ethical principles and enforceable standards of conduct (actionable)

NBCOT: 8 core values in code of ethics

• altruism

• equity

• freedom

• justice

• dignity

• truth

• prudence

• advocacy

altruism

unselfish concern for welfare of others

equity

fair and just treatment for all

freedom

right to exercise autonomy and demonstrate independence, initiative, and self-direction

justice

services for all persons in need of those services and maintain goal-directed and objective relationship

dignity

importance of valuing, promoting, and preserving the inherent worth and uniqueness of each person

truth

faithful to facts and reality, accountable, honest, forthright, accurate, and authentic in attitudes and action

prudence

ability to govern and discipline oneself through use of reason

advocacy

actively promoting occupational rights of individuals, groups, and populations

NBCOT: what are the 6 principles listed in the code of ethics

• beneficence

• nonmaleficence

• autonomy

• justice

• veracity

• fidelity

beneficence

concern for well-being and safety of persons

nonmaleficence

refrain from actions that cause harm

autonomy

right to self-determination, privacy, confidentiality, and consent

justice

promote equity, inclusion, and objectivity in provision of OT services

veracity

provide comprehensive, accurate, and objective information when representing the profession

fidelity

duty one has to keep a commitment once it has been made; respect, fairness, discretion, integrity

purpose of philosophical base core document

• justify or give examples about the core construct of OCCUPATION → explain the WHY of OT

  • definitions of occupation and meaning we give to them

• more of an umbrella term, in the background of practice/paradigm

• may be used for pt, family, or testimony in court (*although OT Scope of Practice is more patient facing)

purpose of practice guideline core document

for PRACTITIONERS to support OT domain and process (what & why)

what is the comparable document to practice guideline for everyone else

OT Scope of Practice

• shorter

• used when services are questioned/denied

• to delineate domain

• provide structures around our practice (actionable)

• for payers, insurers, consumers, communities, & funding agencies

what are slagle lectures and their purpose

• given once a year at AOTA

• share innovative ideas and/or moments where people have dove into curiosity and what has come from that → meant to be novel and innovative to profession to an extent

• patterns in past 100 years: return to occupation and who we are

  • marketing, research, curious mindset are all important

main points of Fischer’s slagle lecture: uniting practice and theory in an occupation framework

• need for research that supports theories and intervention methods used in OT

• interest in neurophysiological techniques designed to remediate neuromotor impairments → MOHO felt radical, then became immersed

what are the different continuums of OT intervention

• ecological relevance (contrived, exercise ← → naturalistic, occupation)

• source of purpose (practitioner ← → client)

• source of meaning (practitioner ← → client)

• focus of intervention (remediation ← → occupational performance)

list the different types of occupation in Fischer’s slagle lecture

• exercise

• contrived occupation

  • exercise with added purpose

  • occupation with a contrived component

• therapeutic occupation

  • graded occupation

  • direct intervention

• adaptive/compensatory occupation

types of occupation: exercise

• purpose typically originates with practitioner, not client

• focus is on remediation

types of occupation: exercise with added purpose

• exercise embedded in activity in which both tasks objects AND meanings are contrived

• e.g. placing cones on shelf pretending they are glasses ( cones have little relevance to actual task being simulated)

types of occupation: occupation with a contrived component

• objects are real and not simulated

• purpose and meaning are contrived (more on the side of practitioner in the continuum)

• e.g. throwing bean bags at target without play the actual game, pounding nails into a board but not actually making a birdhouse

types of occupation: graded occupation

• client actively participates and client identifies purpose and meaning, use real objects and natural environments

• focus is on remediation

• e.g. treat impairments of balance or reach → work on problem areas and progressively grade task in terms of challenges to her balance

types of occupation: direct intervention

• client actively participates and client identifies purpose and meaning, use real objects and natural environments

• focus is on remediation

• impairments in the CONTEXT of occupation

• e.g. working on social skills in a social skills group while baking

types of occupation: adaptive or compensatory occupation

• active ct participation

• purpose and meaning chosen by client

• occupational performance is naturalistic and contextual

• focused on improved occupational performance, NOT remediation

• e.g. assistive devices, compensatory strategies, modify physical or social environments

definition of occupation (from Fischer Slagle Lecture)

action of seizing, taking possession of, or occupying space in time; the being engaged in something

basic science

• discipline, something that supports a profession

• e.g. biology, anatomy & physiology, psychology, kinesiology, chemistry, physics, biomechanics

applied science

• profession, apply basic sciences and do something with it

• e.g. OT, PT, SLP, RN, MD/DO, MSW

occupational science

• basic science (OT is applied science)

• studies humans as occupational beings

• generates theories, data, and fundamental knowledge about why and how people engage in occupations

occupational deprivation

lack of access to occupations

• personal limitations → e.g. cognitive or physical

• environmental → e.g.. location, cost, transportation

• occupation → e.g. too hard, don’t have supplies, adapt to make more accessible

occupational repertoire

set of available occupations

• can enhance mental health if you have a larger set

• ct goals should focus on enhancing available occupations

what two countries (from Borders Presentations) have universal health care system

Sweden and China (95% is covered)

other names for models of practice

• occupation-based models

• broad models

• organizing model of practice (OMP)

models of practice characteristics

• reflect part of the paradigm

• define and organize broad concepts addressing all 3 constructs of OT

  • person, occupation, & environment

• have an accompanying flowchart

• subjective and objective

• assist therapists in choosing occupation-based eval and intervention materials

frames of reference are also known as what

complementary model of practice

frames of reference characteristics

• concrete level of theory → meant to clearly address clinical application

• address 1 or 2 main constructs of OT (person, environment, occupation)

• aimed to address specific deficits (e.g., musculoskeletal, tone, sensory, dyspraxia, etc.)

theory characteristics

• well substantiated explanation for a broad range of facts, phenomena, or natural laws that has been repeatedly tested and confirmed through observation and experimentation

• help describe, explain, and predict behavior and relationships between concepts or events

developing theory (cycle)

• gather data and clinically observe

• identify patterns → reflect on areas of clinical frustration & identify cause-effect relationships

• research the scientific background

• draft a hypothetical theory; write hypotheses

• TEST theory

overview of general systems theory (Bertalanffy, 1968)

• opposes scientific/mechanistic/medical view of reductionism

• embraces HOLISM

  • entities cannot be explained by only looking at parts; only when regarded w/in the context of the whole

  • focuses on interdependency b/w parts that make up the entire system

• application to OT: clients are part of many systems that are dynamic and complex

General systems theory states that organism are influenced, exist, and are maintained by what 3 things

• input

• throughput

• output ( → feedback →)

parts of a theory: focus

parts of a theory: theory base

parts of a theory: function-dysfunction

parts of theory: change & motivation

parts of theory: evaluation and intervention guidelines

matching OT process to parts of a theory: what part of theory would be used to initially consider a theory for a client when you initially get the client’s referral information

focus

matching OT process to parts of a theory: chart review

theoretical basis

matching OT process to parts of a theory: evaluation session planning

function and dysfunction

matching OT process to parts of a theory: evaluation

evaluation

matching OT process to parts of a theory: establishing outcomes/goals

• function & disability

• change & motivation

matching OT process to parts of a theory: intervention session planning

change & motivation

matching OT process to parts of a theory: intervention

guidelines for intervention

matching OT process to parts of a theory: discharge

function & disability