OCT 507 Exam 1

Activity

objective form of action that can be selected to enhance occupational engagement, has little to no personal meaning

Ex: putting on socks

Health

a state of complete physical, mental, and social well-being and not merely an absence of disease

Occupation

central to life and well-being, personalized and meaningful engagement in daily life, can be used as both a means and an end

Occupational therapy

practice that uses goal directed activity to promote independence and function

3 goals of OT we must understand

1. What they need to do

2. What they want to do

3. What is expected for them to do

Main categories of occupation

1. ADLs

2. Instrumental ADLs

3. Health management

4. Education

5. Work

6. Play

7. Leisure

8. Sleep

9. Social participation

3 ways OT contributes to health

warn of problems, protect and prevent, prompt and reward

4 types of OT practitioners

OTR/L, OTA, OT aide, OTS

Barriers to health-giving occupations

poverty, disease, social discrimination, natural disasters

Influences that OT arose from

social reform, industrialization, civil rights, economic shifts, globalization, world wars

Age of Enlightenment

Ideas rapidly spreading, great artists and composers flourished at this time, corruption was challenged

Moral treatment movement

1700s-1800s

All people entitled to consideration and human compassion, engagement in simple work tasks promoted health

William Tuke - father of MTM

Arts and crafts movement

Started in England late 1800s, return to artistic design, value of using one's hands to make items

Connected people to their work = physically and mentally healthier

William Rush Dunton

coined "occupation therapy" and is father of OT, introduced crafts for hospitalized patients

Settlement House Movement

Originated in London, England at Toynbee hall in 1884

Hull House

Established by Jane Adams and Ellen Gates in 1889 in the US, became a hub for social reform

Eleanor Clark Slagle

mother of OT, influenced by Hull House, known for habit training

George Barton

changed term to "occupational therapy"

National Society for Promotion of OT (NSPOT)

1917, mission was to study and advance curative options, OT founded in the midst of WW1

Adolf Meyer

Swiss physician who came to US, offered holistic perspective, wanted to use meaningful activity to promote health

Habit training

Slagle and Meyer

Came from WW1- reconstruction movement and biomechanical approach

Herbert Hall

Massachusets physician, had a work-based approach, had patients engage in weaving, basketry, pottery

WW1 significance for OT

1914-1918, first time OT was being used in rehab for physical disability rather than mental disability, role of rehab aide was developed

NSPOT became AOTA in what year

1921

WW2 significance for OT

New demand for OTs, shifts from arts and crafts movement to rehab techniques based on scientific methods

New demand led to War Emergency courses to quickly train OTs

Development of prosthetics

Medicare

Established in 1965, increased the demand for OT, provided healthcare to seniors and those with disabilities, changed in 1988 to allow treatments to include OTs

Rehabilitation movement

1940-1960s

Increase in VA hospitals, increase polio cases with epidemic

1956- demand for OTA programs

1960s- modernization of medical equipment

Capitol Crawl

March 12, 1990

Convinced Congress to pass the ADA

Demonstrated need for ramps, wider bathroom stalls, etc

Jennifer Keelan-Chaffins

born with cerebral palsy, crawled up steps of Capitol during Capitol Crawl

Americans with Disabilities Act -1990s

Provided civil rights to all individuals with disabilities

Individuals with Disabilities Education Act (IDEA)

Requires school districts to educate students with disabilities in the least restrictive environment

Trends from Slagle lectures

Holism, social connections and contexts, therapeutic relationship, professional continuity, evidence, promoting OT

OT's Professional Paradigm Holistic

client-centered, evidence-based, systems-oriented

1930s and 1940s significance

Great Depression

Diseases on the Rise - TB & Polio

Behaviorists: Watson, Skinner, Pavlov

Psychoanalytic: Freud, Jung, Erikson

1950s significance

- WFOT founded- World Federation of OTs

- Object relations theory

- Therapeutic use of self

- Margaret Rood- Sensorimotor therapy model

Social reform

1960s

Medicare & Medicaid

Group Dynamics

A time of models and theory development

1980s significance

Standardized Assessments and Clinical Reasoning

- Emergence of clinical reasoning

- Birth of occupational science

MOHO- occupation based model

2000-2009

Health as more than just an absence of disease, global perspectives, AOTA makes the OTPF

2010-2020

Time of social participation and professional advocacy

- Expand public awareness of the value of our OT

- Advance and expand our role inside and outside medicine

OTPF- Occupational Therapy Practice Framework

Official document of the AOTA, in its 4th edition

- Describes focus of the profession

2 parts: Domain and process

OTPF domain

range of OT body of knowledge and expertise

OTPF process

how practitioners deliver services within that domain

5 aspects of OTPF domain

occupations, client factors, contexts, performance patterns, performance skills

Client Factors

values, beliefs, spirituality, body functions and structures

- can be impacted by context and absence of body structure or function

Contexts

environment (physical or social) and personal factors (cultural, virtual, temporal)

Performance patterns

habits, routines, roles

Performance skills

motor, process, social interaction

Demonstrates a client's abilities

Habits

automatic patterns of behavior, established with repetition

Routines

sequence of occupations that provide structure for daily life

Rituals

symbolic actions with spiritual, cultural or social meaning contributing to individual identity

Roles

set of expected behaviors shaped by societal and cultural norms

OTs help people construct or reconstruct these

Arts and Crafts movement arose from what events?

industrial revolution in Europe and US

Main aspects of the OT process

1. Evaluation

2. Intervention

3. Re-evaluation

4. Targeted outcomes

*a cycle that may repeat, requires regular attention

Reconstructionist movement and OT

focused on retraining soldiers returning from WW1

Life course perspective

from birth we have different occupations that change over time

impact of time and place on the physical, mental, social, and emotional changes occurring within the individual

Transactional perspective

person, occupation, and environment constantly influence one another

Occupational development

interpersonal, cultural, and societal influences on our occupations

Evaluation

who is my client and do they need OT services?

What an evaluation includes

patient’s occupational profile, analysis of occupational performance, targeted outcomes

What we need to know for an evaluation

occupational history, prior level of function, daily routines, occupations, significant people in their life, fall history

occupational profile

summary of client’s history, resources, and performance

Targeted outcomes

what OT interventions can best help my client?

Create short and long-term goals, determine procedures to measure process towards goals, collaborating with client and understand their motivation

Intervention

what OT interventions can best help my client?

Intervention plan- address client’s performance problems and match client’s occupational profile

Intervention implementation: plan in action, carrying out interventions and monitor client responses

Different types of role assessments

The Role Checklist

The adolescent role assessment

The role activity performance scale

The role change assessment

Worker role interview

Useful habits

help organize time and resources, ex: brushing teeth

Dominating habits

performed even if they interfere with optimal performance, can occur with OCD or autism, ex: compulsively checking stove to see if it is off

Impoverished habits

difficulty learning new useful habits because of dysfunctional internal state

Assessment of life habits (LIFE-H)

interview that levels client’s participation in daily activities

Direct observation of patient completing habit

Examples of helpful routines

medication management, morning skin care

Examples of damaging routines

impact health and well-being, ex: too much screen time before bed

Examples of family routines

observable and repetitive patterns that occur regularly- help to define family roles, organize daily life, reflect family identity

Assessments for routines

The model of human occupation screening tool MOHOST

The family routines inventory

The scale of older adults’ routine – SOAR

The social rhythm metric- SRM-5- measures 5 daily events

occupational balance

balance among dimensions of challenge and rest occupations, balance relative to one’s image of occupational self

Life balance

more universal, pattern of daily activity that is healthful, meaningful, and sustainable to an individual

Need to be rewarding, challenging, engaging, and have meaning

Life imbalance

limit or compromise participation in relationships or health, spending too much time on mundane tasks

“Just-right challenge”

ideal in practice, activities are challenging but not too much

culture

interconnection of significant meanings we use to understand events of daily life

Equality

recognition of others as equal, everyone entitled to same rights

Equity

individuals have different needs or circumstances; to achieve the same outcome we need different resources

Exclusion

form of discrimination, individuals or groups are excluded from full participation in society in which they live

could be economic, political, or social

Definition of inclusive care in OT

provide services that foster engagement in meaningful occupations such that individuals experience, full citizenship with access to resources and opportunity

Stereotyping

certain characteristics are attributed to an entire group

Ethnocentrism

put people in your own group as superior to other groups

Cultural humility

openness, self-awareness, absence of ego, interacting willingly with diverse people

This is a process-oriented approach

Being a lifelong learner, reflective practitioner, build confidence for navigating diverse populations

Cultural competence

content-oriented, increasing knowledge, confidence, self-efficacy regarding other cultures

Social economic status

marker between health and wealth, social position is strongly linked to health outcomes like stress, heart disease, diabetes

Upward mobility

doing better or having more than our parents- wealth gap is growing in US = negative effects on health

Health disparity

unfair gap in access to healthcare and treatments provided

intersection of multiple inequalities

this can happen in practice, ex: patient that is disabled and a minority

US health system is also heavily weighted towards

Acute care, not home health

Health insurance

US is a private medical system, access to care requires a job or pay out of pocket, in 2019 44 million Americans had no health insurance

Paradigm of occupation

value in using activities, work, crafts as a therapeutic agent 1900s-1940s

Mechanistic paradigm

1950s-1970s – looking for scientific evidence

New emerging paradigm

1980s-2000s - returned to occupation and had a broader domain

Re-evaluation

how has OT affected my client’s performance?

Includes: reanalysis of occupational performance, review of targeted outcomes- did they meet their goals?, identification of action

Professional reasoning

process that practitioners use to plan, direct, perform, and reflect on client care

More than just thinking but also engaging

transaction of multiple factors- practitioner lens, client lens, practice context

Scientific reasoning

What evidence do we have? What if we try this?

Procedural reasoning

How is this typically done?

Conditional reasoning

What are the possible futures?

Narrative reasoning

What story is this person in?