Managing Difficult Behaviors/MH FORs and Models

AC copy, Modified by SZ (in blue)

safety of patients and all people, including yourself

What is the first, most important thing about dealing with difficult behaviors?

• be aware of the what type of jewelry you wear

• know where doors and windows are (if they are locked)

• can use a table as a barrier between yourself and a client

• keep track of sharps like scissors, pencils, etc.

• know what sets off your clients

• change your tone of voice if people are getting agitated

• be aware of people’s personal space

How do we keep ourselves and our patients safe?

• keeping a key with you at all times if you have on one on your unit

• know the codes in the building

• know the State laws of restrictions (ex. A client picks up a chair, you cannot hit them but you can pick up a chair and block them from hitting you with it → in PA )

What is involved with knowing the rules and regulations of your setting and being prepared to carry out your responsibilities?

You need to decide how to support the person according to their needs and capacities in the moment. (individualized, what they are ready for today, which may not be group participation)

What do you need to decide if the behavior is not likely to cause immediate and significant disruption or harm?

You need to decide whether the behavior should be addressed at a 1:1 level or whether support from the team is needed. (dependent on person and issue)

What do you need to decide about addressing a behavior, given your limitations in time and environment?

Try your best to stay truthful and genuine and try not to feed into thoughts/beliefs that are not reality. (tell them the truth)

Besides safety and making decisions based on the client, their behavior, and situation, what else is important in managing difficult behaviors to keep the therapeutic relationship intact?

• holistic

• client-centered

• systems-oriented

the 3 theoretical trends Cole notes

This explanation makes it possible for OT’s to understand the complexity of occupation and the optimal way to participate in daily life.

Theories explain the relationships among people, health, environment, and other factors. How do theories help OTs in practice?

yes

do theories and frames of references come from different disciplines? (professions outside OT)

No

Do models target specific age groups of health conditions?

occupation-based models

broad, generic, applicable across age groups and practice areas, holistic picture, shows interaction btwn person, environment, & occupation

how OT works and how person, environment, and occupation interrelate as a system

What do occupation-based models explain?

specific age groups & health conditions

what does occupation-based models NOT target

Frames of Reference

offer specific techniques and strategies, narrow focus

no (disappeared from OT literature)

are frames of reference still seen in OT literature

specific disabilities that cause problems with occupational performance

What do Frames of Reference address?

They work together.

Do models and FORs work together or does one replace the other?

• psychodynamic

• behavioral & cognitive frames

• allen’s cognitive disabilities

• developmental frames

• sensorimotor frames

what are 5 FORs that are mentioned in the book

psychodynamic

what FOR is this structure: loosely structured and task oriented

behavioral and cognitive frames

what FOR is this structure: highly structured

allen’s cognitive disabilities

what FOR is this structure: highly structured & groups of similar cognitive level

developmental frames

what FOR is this structure: grouped by similar life stage; structured around stage specific tasks, skills, and challenges

sensorimotor frames

what FOR is this structure: highly structured sequences of sensory motor activities

psychodynamic

what FOR is this goal: develop ego skills, gain insight, emotional and spiritual dimensions

behavioral & cognitive frames

what FOR is this goal: specific, observable, measurable goals; learning skills, changing thoughts and behaviors

allen’s cognitive disabilities

what FOR is this goal: ongoing evaluation, problem solving in ADLs, building safe environments and habits

developmental frames

what FOR is this goal: skill mastery, altering life structure, making successful transitions, establishing growth facilitating environments

sensorimotor frames

what FOR is this goal: stimulate development of CNS, normalize movement patterns, sensory modulation and integration, increasing adaptive response

behavioral & cognitive, allen’s cognitive disabilities, sensorimotor

what FORs is this leadership: directive

psychodynamic

what FOR is this goal: facilitative

developmental frames

what FOR can be facilitative or directive

psychodynamic

what FOR has these activities: creative, expressive, free choice of tasks or activities

behavioral and cognitive

what FOR has these activities: educational sessions, worksheets, learning and practice, reinforcements, social learning sessions

allen’s cognitive disabilities

what FOR has these activities: crafts and tasks of daily life, structured environments

developmental

what FOR has these activities: graded tasks and age-appropriate activities, life review, transitional adaptions

sensorimotor

what FOR has these activities: movement activities, sensory stimulation, activities and games with ,minimal or graded cognitive demands, creating “just right” challenges

• model of human occupation (MOHO)

• ecology of human performance (EHP)

• occupational adaptation (OA)

• person-environment-occupation (PEO)

• kawa

what are the 5 models mentioned in the book

MOHO

what model is this structure: members grouped by common roles, members choose structure

EHP

what model is this structure: groups based on common task interest and skill level

OA

what model is this structure: clients placed in groups according to meaningful life roles

PEO

what model is this structure: members select preferred activities and may form groups based on common interests or occupational issues

kawa

what model is this structure: (eastern cultural model) clients and their immediate families engage in therapy together to overcome the clients disability

MOHO

what model is these goals: restore order in daily occupations, re-establish roles, develop healthy routines

EHP

what model is these goals: alter contexts to facilitate task choices and skill building within optimized natural contexts

OA

what model is these goals: increasing adaptiveness by learning through the process of engagement in occupations

PEO

what model is these goals: find and facilitate best fit btwn person, task. and environment

kawa

what model is these goals: restore harmony with families, social groups, and w/ nature; occupational engagement may not be a goal but the means to restore a social role or status w/in the group

kawa

what model uses this kind of leadership: director or facilitator

PEO

what model uses this kind of leadership: director, facilitator, or advisor

OA

what model uses this like of leadership: facilitator

EHP

what model uses this like of leadership: director or facilitator (depending on age of clients and group goals)

MOHO

what model uses this type of leadership: facilitator, advisor, or consultant

MOHO

what model is this activity: everyday tasks, work, play, and self-care; establishing or restoring meaningful roles in families, social groups, and community

EHP

what model is this activity: activities chosen through collaboration with client groups, related to their preferred interests and roles

OA

what model is this activity: readiness activities or therapeutic occupations of the clients choosing; the OT leader carefully sets up and adaptation-facilitating environment

PEO

what model is this activity: activities that match the skill level of clients are more satisfying; interventions that impact context at various levels may require advocacy as well as negotiation with others

kawa

what model is this activity: family group problem solves together to adjust the task, environment, or social expectation for a client with disabilities so they can make a meaningful contribution to the group