Wellness & Recovery Models, Applied Behavioral FOR Module 10

What are the historical perspectives for the Wellness FOR?

• Humanistic roots - promoting health through occupation

• Founder’s vision - occupation = holistic health

• Prevention of impairing conditions

• Midcentury: Less focus on prevention, promotion, in favor of reductionsim

• 1970s onward - call to action, return to health prevention, promotion

What are influential societal factors in paradigm shift to focus on prevention, health promotion, and community focus?

• Aging of population

• Increased rates of chronic disease

• Soaring health care costs

• Increased rates of survival from spinal cord injury, head injury, and other traumas

What can health be defined?

• “The complete state of physical, mental, and social well-being and not just the absence of disease”

• Health is not just the absence of disease

“Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector but goes beyond healthy lifestyles to well-being.” (World Health Organization)

What are the levels of prevention in OT?

• Health promotion can occur before, during, or after a health problem emerges

• 1. Primary prevention

  • Before a problem occurs

  • Reduced risk and support health before illness, injury, or disability develops

  • OT example: Accessible playground design, fall-prevention education

• 2. Secondary prevention

  • When risk is emerging

  • Identify risk early and intervene before the problem becomes more severe

  • OT example: Fall-risk screening, early support for sensory overload

• 3. Tertiary prevention

  • After a condition exists

  • Reduced the impact or an established condition and prevent secondary complications

  • OT example: Energy conservation for ME/CFS, adaptation after injury

How can wellness be defined?

• An active process; clients “become aware of and make choices toward a more successful existence”

• Dynamic way of life in which good health habits are incorporated into one’s life-style to improve both health and the quality of life

• Context for living, a state of being, a place from which to come as individuals commit themselves to improve life for all of humanity…the possibility that one’s life, health, and well-being contributes to the health and well-being of others

How can well-being be defined?

• The ultimate goal of health promotion

• Well-being is an evolving concept that includes “the presence of positive emotions and moods (e.g. contentment, happiness), the absence of negative emotions (e.g. depression, anxiety), satisfaction with life, fulfillment, and positive functioning (CDC)

What are the eight dimensions of well-being?

• In OT, well-being includes satisfaction with participation and occupations and daily activities that enhance quality of life

• 1. Emotional

• 2. Environmental

• 3. Financial

• 4. Intellectual

• 5. Occupational

• 6. Physical

• 7. Social

• 8. Spiritual

• OT asks: Which dimensions support participation? Which dimensions create barriers? What can change in the person, occupation, or environment?

What is an OTs role in health promotion?

• Occupational therapy promotes health by helping people participate in meaningful activities in ways that support health, quality of life, and agency

• 1. Center the person

  • Begin with the person’s priorities, values, culture, strengths, and meaningful occupations

• 2. Adapt the context

  • Modify tasks, routines, tools, environments, and social supports to reduce barriers

• 3. Support participation

  • Build sustainable habits and opportunities for health, connection, purpose, and quality of life

• OT can promote health within individuals, groups, communities, and systems

What can health promotion address?

• Prevention

  • Illness, injury, accidents, and secondary conditions

• Mental health

  • Resilience, coping, competence, and emotional well-being

• Healthy routines

  • Sleep, activity, self-care, stress management, and energy management

• Access and equity

  • Environmental barriers, health disparities, and self-advocacy

• Participation

  • Meaningful occupations, social connection, and quality of life

• Health communities

  • Inclusive programs, culturally relevant services, and occupational justice

How do OTs promote health and well-being?

• Work

  • Work with people in or recovery from, cancer treatment to mitigate the side effects on daily functioning

• Perform

  • Perform assessments for health risks, such as the potential for falls, the effect of low vision and/or cognitive issues on safety in daily tasks, and how well the home accommodates current and potential disabilities

• Evaluate

  • Evaluate children for gross and fine motor, sensory processing, or adaptive behavior deficits that may result in or from developmental delays

• Teach

  • Teach strategies to incorporate healthy habits and routines into daily activities for clients of all ages and abilities

• Identify

  • Identify solutions to personal and environmental barriers (e.g. mental health issues, lack of community mobility), limiting clients from engaging in healthy activities

• Provide

  • Provide skills training in areas such as socialization, caregiving, parenting, tie management, stress management, etc.

Examples of OT interventions to promote health and well-being?

• Community-based fall prevention programs for seniors

• Workplace injury prevention and wellness programs

• Ergonomic assessments for computer workstations to decrease repetitive motion and musculoskeletal disorders

• Stress and anger management programs for children in juvenile detention programs

• Parenting classes for teens, parents in homeless shelters, or those recovering from drug dependency

• Self-management programs to enable those with chronic diseases like diabetes, rheumatoid arthritis, and cardiac conditions to optimize health through appropriate routines (modifications when necessary) and participate in meaningful occupations

• CarFit programs for drivers to accommodate their needs (e.g. limited neck mobility) through minor adaptations and adjustments to the car

• Caregiver education to prevent injury and/or burnout

What are the goals of Health People 2030?

1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death

2. Achieve health equity, eliminate disparities, and improve the health of all groups

3. Create social and physical environments that promote good health for all

4. Promote quality of life, healthy development, and health behaviors across all life stages

5. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all

What is Lifestyle Redesign (FOR)?

• A type of occupational therapy that guides you through the process of creating habits and routines that are personally meaningful and health promoting

• The expert clinicians start with the basic principles of healthier lifestyles, and then help you create customized plans to achieving your health goals while supporting you every step of the way

• Changing behaviors takes time and is a complex process. But we know that lifestyle choices directly influence the state of our physical, mental, cognitive, and emotional health

• Utilizes cognitive behavioral change, motivational interviewing, other biopsychosocial models

What is the Spoon Theory? How can it be applied in OT?

• A framework for energy awareness

• A metaphor created by Christine Miserandino (2003) to explain limited energy resources in chronic illness and neurodivergence

• “Each activity throughout the day uses a ,,spoon. When you run out of spoons, you must rest and recharge before continuing”

• Applications in OT:

  • Build awareness of personal energy limits

  • Use planning and pacing to conserve spoons

  • Prioritize meaningful occupations over “shoulds”

  • Teach energy accounting (planning, rest breaks, alternating high/low-demand tasks)

  • Support self-advocacy - communicate limits without quilt or stigma

What is the International Classification of Functioning Disability, and Health (ICF) Model?

• Developed by the World Health Organization (WHO)

• Creates standard language to describe health and health-related states

  • Changes in body function and structure

  • What a person can do in a standard environment (capacity)

  • What a person can do in their usual environment (performance)

• Named to stress health and function, not disability

• Used internationally

What are the positive and negative terms in the ICF?

• Overall health condition

  • Positive term: Function

  • Negative term: Disability

• Body functions and structures

  • Positive term: Functional and structural integrity

  • Negative term: Impairment

• Activities

  • Positive term: Activities participation

  • Negative term: Activity limitation, participation restriction

• Environmental factors

  • Positive term: Facilitators (fixed or modifiable)

  • Negative term: Barriers (fixed or modifiable)

What is the medical model?

• Power in hands of medical professional

• Focus on illness, symptoms, deficits

• Informed by medicine, pathology

• Reductionist approach

• Outcomes - focus on clinical recovery, “cure”

What is the social model?

• Individual empowerment

• Focus on strengths, wellness

• Informed by lived experience

• Holistic approach

• Outcomes - focus on personal acceptance, quality of life, self-direction

What is the occupational therapy approach?

• Power in hands of collaborative partnership

• Focus on function

• Informed by strengths, contexts, pathology

• Reductionist and occupation-based approaches; skills developed “in vivo”

• Outcomes- focus on functional recovery, adaptation

How can recovery be defined?

• Process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential

What are the 10 components of recovery?

1. Self-direction

2. Individualized, person-centered

3. Empowerment

4. Holistic

5. Nonlinear

6. Strengths based

7. Peer support

8. Respect

9. Responsibility

10. Hope

What are clubhouses in mental health?

• Fountain House founded, 1949

  • Former psychiatric hospital patients met informally

• Developed to support people living with mental health diagnoses

• Support system

  • Friendship

  • Employment

  • Resources

  • Recreation

  • Education

  • Support to continue recovery

What is the Clubhouse self-determination case example?

• Clubhouse psychosocial rehabilitation center, Southwest Florida

• Focus on internal locus of control, self-determination

• Ten-week goal-directed occupation-based program to develop psycho-educational strategies that could be integrated into the clubhouse structure for:

  • Personal goal setting and attainment to improve overall health and wellness for community reengagement

• One participant completed all sessions; their results measured

• Pre- and post-test:

  • WHO Quality of Life Measure (WHOQOL-BREF)

  • Connor Davidson Resilience Scale 25 (CD-RISC)

  • Internal Control Index (ICI)

  • Communication Skills Profile

  • Questionnaire About Activities That You Perform Everyday

What are group interventions and outcomes in the self-determination clubhouse case example?

Interventions:

• Psychoeducation

  • Coping skills, relaxation, symptom management

• Expressing feelings and needs

• Setting goals

• Occupations to support health and productivity

  • Healthy eating, budgeting, prevocational skills, leisure

• Peer support

• Build self-determination

Outcomes:

• Improvements noted in:

  • Quality of life

  • Internal control

  • Resilience

• Decrease in

  • Symptoms of depression

What is the core principle of the Applied Behavioral FOR?

• Many behaviors are learned and maintained through environmental conditions and consequences

• The clinician studies what happens before and after a behavior so the person can participate more successfully in meaningful occupations

What is the clinical focus of the Applied Behavioral FOR?

• Observable behaviors that support or interfere with occupational participation

• Environmental conditions that make a behavior more or less likely

• Measurable change connected to the person’s goals and routines

What is the antecedent in assessment?

• What happens immediately before?

• People, demands, setting, sensory conditions, time of day, or internal state

What is behavior in assessment?

• What can we observe and measure?

• Describe the action without judgement or interpretation

What are consequences in assessment?

• what happens immediately after?

• What changes for the person or the environment?

What should assessments do?

• Establish a baseline and identify patterns across contexts

• Use direct observation, behavioral logs, self-monitoring, interviews, and functional assessment as appropriate

• Ask: What information would we need before deciding that a behavior needs to change?

How can reinforcement help support new patterns durnig intervention?

• Reinforcement increases the likelihood of a behavior. The consequence must matter to the client and should connect to meaningful participation

• Build and strengthen skills

What is shaping during reinforcement?

• Reinforce small steps toward a larger goal

What is chaining in reinforcement?

• Link steps into a functional sequence

What is prompting and fading in reinforcement?

• Provide support, then gradually reduce it

How can conditions be changed in reinforcement?

• Adapt the task, routine, cue, or environment

• Use self-monitoring and feedback to build awareness

• Practice in the occupation where the skill needs to transfer

How should behavioral strategies be used in OT?

• Behavioral strategies should serve the person’s occupational goals rather than compliance

• Use behavioral methods to:

  • Build habits and routines

  • Support self-care, attention, task completion, and social participation

  • Make success more likely through environmental supports

  • Track progress and adjust the plan with the client

• Protect autonomy and the therapeutic relationship:

  • Obtain informed consent and support client choice

  • Use meaningful, culturally appropriate reinforcers

  • Utilize co-regulation - ensure clients feel safe, understood, and supported as they learn new patterns and skills

  • Avoid interventions that require masking or simply reward compliance

What are the focus, OT role, and common pitfalls of the Applied Behavioral, Wellness, and Recovery FOR?

• Applied Behavioral

  • Focus: Changing behavior patterns to enable function

  • OT role: Structuring, reinforcing, shaping

  • Common pitfalls: Overemphasis on compliance

• Wellness

  • Focus: Promoting health and balance

  • OT role: Facilitating, proactive, strength-based habits

  • Common pitfalls: Neglecting mental health or other barriers (e.g. “Just"…”)

• Recovery

  • Focus: Reclaiming identity and purpose

  • OT role: Partnering, empowering, co-creating

  • Common pitfalls: Losing structure or measurable outcomes