OT Behavioral Health & Mental Health Review

MOHO

Model of Human Occupation; explains how motivation, habits, roles, abilities, and environment affect occupational participation.

What are the 4 main parts of MOHO?

Volition, habituation, performance capacity, and environment.

Volition

A person's motivation, interests, values, and belief in their abilities.

Habituation

A person's habits, routines, and roles.

Performance capacity

The physical and mental abilities a person uses during occupations.

Environment in MOHO

Physical, social, cultural, economic, and political surroundings that affect participation.

PEO Model

Person-Environment-Occupation Model; focuses on how well the person, environment, and occupation fit together.

What are the 3 parts of PEO?

Person, environment, and occupation.

Main goal of PEO

Improve occupational performance by improving the fit between the person, environment, and occupation.

Kawa Model

Uses a river as a metaphor for a person's life and occupational well-being.

River water in Kawa

Life flow, health, and well-being.

Rocks in Kawa

Problems, barriers, illnesses, or difficult life circumstances.

Driftwood in Kawa

Personal characteristics, strengths, weaknesses, and resources.

River walls/banks in Kawa

Physical and social environmental factors.

Spaces in the Kawa River

Opportunities for improved occupational participation and life flow.

Psychoeducational Model

Uses education and skill-building to help clients understand and manage their condition.

Examples of psychoeducation

Coping skills, stress management, medication education, sleep hygiene, communication, and relapse prevention.

Recovery Model

Focuses on hope, strengths, choice, empowerment, meaningful roles, and building a satisfying life.

Does recovery mean all symptoms disappear?

No. Recovery focuses on living a meaningful life even if symptoms remain.

Transtheoretical Model

Describes the stages a person moves through when changing a behavior.

Precontemplation

The client does not believe there is a problem or is not considering change.

OT approach during precontemplation

Build rapport and increase awareness without arguing.

Contemplation

The client recognizes there may be a problem but is unsure about changing.

OT approach during contemplation

Explore pros and cons and use Motivational Interviewing.

Preparation

The client intends to make a change and begins planning.

OT approach during preparation

Help create a plan, goals, and identify resources.

Action

The client is actively changing their behavior.

OT approach during action

Reinforce progress and support new healthy routines.

Maintenance

The client works to continue the new behavior and prevent relapse.

Relapse

Returning to an old behavior after attempting change; it can be part of the recovery process.

Stages of Change in order

Precontemplation, Contemplation, Preparation, Action, Maintenance.

Memory trick for Stages of Change

PCPAM.

Forming stage

Members are getting to know each other and often need more structure from the leader.

Storming stage

Conflict may develop and members may challenge roles or boundaries.

Norming stage

Members develop trust, expectations, and group cohesion.

Performing stage

Members work effectively together toward group goals.

Adjourning stage

The group ends and members process closure.

Role of an OT/OTA group leader

Provide structure, maintain safety, encourage participation, redirect behavior, and support interaction.

What should a group leader do if one member dominates?

Respectfully redirect the conversation and encourage other members to participate.

Trauma-informed approach

Care that recognizes the impact of trauma while promoting safety, trust, choice, collaboration, and empowerment.

Key principles of trauma-informed care

Safety, trustworthiness, transparency, choice, collaboration, empowerment, and peer support.

Trauma-informed alternative to "What's wrong with you?"

Consider "What happened to you?" and "What will help you feel safe?"

Why ask before touching a behavioral health client?

Unexpected touch may trigger trauma or make the client feel unsafe.

Cultural humility

Lifelong self-reflection, learning from the client, recognizing biases, and avoiding assumptions.

Cultural humility vs. cultural competence

Competence focuses on gaining cultural knowledge; humility emphasizes ongoing learning and self-reflection.

Social determinants of health

Non-medical conditions that influence health, functioning, and quality of life.

Major social determinants of health

Economic stability, education, healthcare access, neighborhood/environment, and social/community context.

Economic stability examples

Employment, income, and food security.

Healthcare access examples

Insurance, transportation, provider availability, and ability to obtain medications.

Environmental SDOH examples

Housing, safety, transportation, and neighborhood resources.

Why are SDOH important to OT?

They can create barriers to occupational participation even when a client has the skills to perform a task.

CBT

Cognitive Behavioral Therapy; focuses on the relationship between thoughts, feelings, and behaviors.

CBT basic sequence

Thoughts influence feelings, which influence behavior.

Example of CBT in OT

Helping a client recognize negative thinking and use healthier coping strategies or behavioral activation.

DBT (Dialectical Behavior Therapy)

helps clients manage intense emotions, distress, relationships, and present-moment awareness.

Four major areas of DBT

Mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Mindfulness

Staying aware of the present moment without judgment.

Distress tolerance

Managing a crisis or strong emotion without making the situation worse.

Emotion regulation

Recognizing, understanding, and managing emotions.

Interpersonal effectiveness

Communicating needs and maintaining healthy relationships.

Motivational Interviewing

A collaborative approach that helps clients identify their own reasons and motivation for change.

OARS

Open-ended questions, Affirmations, Reflective listening, and Summaries.

Open-ended question

A question that encourages the client to explain rather than answer yes/no.

Affirmation in MI

Recognizing the client's strengths or efforts.

Reflective listening

Restating or reflecting what the client says to show understanding and encourage exploration.

Summary in MI

Bringing together important points the client has shared.

What should you avoid during Motivational Interviewing?

Arguing, lecturing, confronting, judging, or telling the client what they must do.

SMI

Serious Mental Illness; a mental health condition that causes significant functional impairment.

Examples of SMI

Schizophrenia, severe bipolar disorder, and severe major depressive disorder.

Positive symptoms of schizophrenia

Hallucinations, delusions, and disorganized speech or behavior.

Negative symptoms of schizophrenia

Flat affect, decreased motivation, social withdrawal, and decreased initiation.

Hallucination

Sensory perception without an external stimulus, such as hearing voices.

Delusion

A strongly held false belief that remains despite evidence to the contrary.

OT concerns with schizophrenia

ADLs, IADLs, medication management, social participation, employment, safety, and executive functioning.

Mania

Elevated or irritable mood with increased activity, decreased need for sleep, rapid speech, impulsivity, or grandiosity.

OT approach during mania

Reduce stimulation, provide structure, use clear directions, and monitor safety and impulsivity.

Common symptoms of major depression

Low mood, loss of interest, fatigue, sleep/appetite changes, poor concentration, and feelings of worthlessness.

OT focus for depression

Routines, behavioral activation, self-care, sleep, leisure, and social participation.

Possible anxiety symptoms

Excessive worry, panic, restlessness, avoidance, and difficulty concentrating.

OT strategies for anxiety

Breathing, grounding, relaxation, structured routines, and coping skills.

Common PTSD symptoms

Flashbacks, nightmares, hypervigilance, avoidance, emotional distress, and sleep disturbance.

OT approach for PTSD

Trauma-informed, predictable, client-centered care with choice and safety.

Substance Use Disorder

Problematic substance use that causes significant impairment or distress.

Occupations affected by addiction

Self-care, relationships, work, leisure, sleep, routines, and community participation.

OT interventions for substance use disorders

Relapse prevention, coping skills, healthy routines, leisure exploration, stress management, life skills, and community resources.

Why is healthy leisure important in addiction recovery?

It replaces substance-related routines with meaningful, healthy activities.

Common antidepressants

Sertraline, fluoxetine, and escitalopram.

Possible antidepressant side effects

Nausea, headache, sleep changes, dizziness, and sexual side effects.

Common antipsychotics

Risperidone, olanzapine, quetiapine, and haloperidol.

Possible antipsychotic side effects

Sedation, dizziness, orthostatic hypotension, weight gain, and movement-related symptoms.

Tardive dyskinesia

Involuntary repetitive movements, often involving the face, mouth, tongue, or extremities.

Common mood stabilizers

Lithium and valproate.

Possible mood stabilizer side effects

Tremor, fatigue, dizziness, and gastrointestinal symptoms.

Common benzodiazepines

Lorazepam, alprazolam, and clonazepam.

Possible benzodiazepine side effects

Sedation, slowed reactions, dizziness, memory impairment, and increased fall risk.

OT's main concern regarding medication

How medication effects and side effects affect occupational performance and safety.

Orthostatic hypotension

Drop in blood pressure when changing position that can cause dizziness or fainting.

Medication-related OT safety concerns

Balance, alertness, coordination, attention, memory, blood pressure, energy, and fall risk.

OTPF-4

Occupational Therapy Practice Framework: Domain and Process, Fourth Edition.

ADLs

Activities of Daily Living such as bathing, dressing, toileting, eating, and grooming.