OCTH 236 Midterm 1: intro, education, goals, legislation, work & IADLs, comm living services

Transitional age youth age range

15-25

IDEA

Individuals with disabilities education act

IDEA part B

3-21 years

IDEA Part C

Early intervention; birth-3 yrs

Individualized transition plan (ITP)

section of the IEP that outlines transition goals and services for the student

Facilitates transition from high school, process starts at 14-by 16 years age required for any student with IEP

-post secondary eduction, employment, ILS, self-determination skills

Individualized education plan (IEP)

Educational services to students with disabilities, blueprint for special education experience; 13 categories of eligibility, requires specific goals and objectives

-Falls under IDEA

-students who do not qualify for accommodations under 504 would not be able to qualify for IEP

OT service provision process

Referral

Evaluation

Eligibility review

IEP development

Service provision

Annual review/tri-annual re-evaluation

What happens during the eligibility review?

IEP team meets, first sped eligibility, then OT eligibility

What happens during IEP development?

Annual: review

Triennial: re eval

Service: continue, modify, discharge

-Discussion at the IEP/ITP/504 meeting and consensus is required

LEA

Local education agency

RTI

response to intervention; multi-tier approach to the early identification and support of students with learning and behavior needs

FAPE

free appropriate education; says that all children are entitled to an adequate free education despite how severe their disabilities may be

LRE

Services are to be provided in the Least restrictive environment

Occupational therapy school-based is defined as...

Improving, developing or restoring functions impaired or lost through illness, injury or deprivation

Improving ability to perform tasks for independent functioning when functions are impaired or lost

Preventing through early intervention, initial or further impairment or loss of function

Erikson's Theory

Development of psychosocial skills across the lifespan

Piaget's Theory

The development of cognitive function across the lifespan

Bronfenbrenner theory

The influences on the family system

Interactional or systems theories

Provide an explanation of how combined forces or events impact human performance

Occupation-based models

Explain occupational performance across the lifespan and across diagnoses; guide therapists thinking and assist in intervention planning

Ex: MOHO, OA, CMOP-E

MOHO

Seeks to explain how occupation is motivated (volition), patterned (habituation) and performed (performance capacity)

-dynamic and open system of human actions

-interaction w environment

Occupational adaptation (OA)

Focuses on the integration of occupation and adaptation within the client

-emphasizes the clients experience of self in occupational contexts

Canadian model of occupational performance

An optimal fit of the occupation and environment to a persons goal, interests and skills can lead to optimal participation and health

Person, environment, occupation, function-dysfunction continuum

-spirituality is at the core of the person

Services provision may be....

Direct or indirect

Direct service's include...

Working directly with the student

Ex: small group activities, modifying the environment, modifying the task or instruction

Indirect services include...

Working with other professionals in support of the student

ex: teachers, classroom staff, transportation (bus drivers), parents

Who can refer a child for consideration for evaluation under section 504?

Anyone (parents, teacher, physician), school district must have reason to believe the child is in need of services under 504 due to disability

Who decides whether a student is qualified and eligible or services under section 504?

Decision made by a group of persons who are knowledgeable about child; eval info, placement options, LRE,

504 plan process

Identification

Training

Monitoring

Review and revision

Section 504 of the Rehabilitation Act

Removed barriers to give persons with disabilities a level of playing field; plan for how child will have access to regular education; specific goals and objectives are not required

-Falls under ADA

-students who do not qualify for IEP may qualify for 504

ADL that would be addressed under IDEA

Swallowing, eating, feeding, dressing/showering, personal hygiene & grooming, personal device care, toileting & toilet hygiene, functional mobility and sexual activity

IADL that would be addressed under IDEA

Meal prep/cleanup, driving/comm mobility, financial management, safety awareness, home establishment and management, safety awareness, home establishment/management, health management, shopping, child rearing

Barries to addressing ADL/IADL in school

Lack of understanding of OT

Lack of funding

Lack of info on assessment tools

Caseload issues

ADHD (Attention-Deficit Hyperactivity Disorder)

Persistent pattern of inattention or hyperactivity impulsivity; onset before 12 yrs

-across 2 or more settings

-symptoms interfere with function

-differential dx

Intellectual disability (ID)

Deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgement)

difficulties with conceptual, social and adaptive function impact independence/meet social responsibilities

-onset in childhood

Goals should be...

Client-centered

Functional

Focused on engagement in occupation

RUMBA goals

Relevant, Understandable, Measurable, Behavioral, Achievable

SMART goals

Specific, Measurable, Attainable, Realistic, Timely

Problem list

List all the areas of difficulty the client is experiencing; include clients stated goals

-occupation based and functional

Ex: difficulties maintaining prosocial peer relationships, limited safety awareness

Goal area

Prioritize the problem list and choose areas to focus on; identify a relevant area of occupation (# is dependent on setting, LOS, client factors)

Ex: ADLs, IADLs, education, work

Long Term Goals (LTG) vs short term goal (STG)

LTG-focus on a specific occupation, (Ex: IADLs-meal preparation)

-the expected outcome of therapy, the timeframe is dependent on setting

STG focus on component skill (client factor, performance skills, etc); what interferes with clients ability to achieve goal

-building blocks of LTG, opportunity to highlight more fundamental skills required

The highest unemployment rates for young adults with disabilities

Psychiatric disabilities 70%-90%

Autism 42%

What are some of the barriers to work?

Person- poverty, lack of confidence

Workplace-reluctant to hire, inflexibility

Service providers-lack of access, low expectations

Systems-complex to navigate

Role of OT in work

•Facilitate clients' engagement in work of their choosing

•Skill development (pre, during, and post)

•Vocational

•IADLs

•Adaptations/accommodations

•Advocacy

Lanterman Act

Gives people with developmental disabilities the right to the services and supports they need to live more independently; CA law passed in 1969

-regional centered are mandated to advocate for and protect these rights while managing and providing necessary services

Rehabilitation Act of 1973

prohibits discrimination based on disability by all agencies that receive federal funds

American with Disabilities Act (ADA)

Prohibits all employers from discriminating against a "qualified individual with a disability who can perform the essential functions of the job w or without reasonable accommodations

Ticket to Work and Work Incentives Improvement Act (TWIIA) 1999

Opportunity for SSI and SSDI recipients to receive vocational services

-Can maintain benefits longer after starting to work

Workforce Innovation and Opportunity Act (WIOA) of 2014

Requires students with disabilities to have access to to DOR to encourage community-based employment as part of transition plan

Mandates increased effort to provide employment services to disconnected youth

Olmstead Decision (1999)

Ruled that segregation people with disabilities was a violation of the ADA

-mandated community-based services when possible

-contributed to the move away from sheltered workshops

What are the types of vocational assessments?

Situational- assessment of work performance (AWP)

Interviews- worker role interview (WRI)

Observations

Dynamic- double OT (DOT)

Types of Vocational Services

School-based vocational services

Sheltered workshops

Job-readiness training

Social enterprises

Supported employment

Competitive employment

School-based vocational services

Available for all with IEP as part of transitional services

Includes:

Career exploration

Work-based learning experiences

Job-readiness training

Instruction on self-advocacy

School-Based vocational services pros

Conveniently located within school

Free service w/ familiar staff

Integrated with educational plan and services

Provides work experience w/o the risk and pressure of competitive employment

School-Based vocational services Cons

Time limited

Little choice of job

Doesn't continue over the summer

Perpetuates low expectations

Sheltered workshops

Long-term employment for people with disabilities

Supervision and assistance

Repetitive tasks without intrinsic value

Focus on development of work skills

Often paid below minimum wage

Fallen out of favor

Sheltered workshops pros

protected environment

guaranteed employment

Something to do during the day/respite care for caregivers

Cheap labor for businesses

Experience for resume

Social opportunity

Sheltered workshops cons

people may get stuck in this position without room for movement

not aligned with the client's values/interests

no interaction with community

pays below minimum wage

Job readiness training

Mix of classroom and community-based, often industry specific (janitorial, construction, etc.)

What are some topics covered in job readiness training?

Work habits, goal setting, vocational exploration, work skills, resource awareness

job-readiness training pros

supportive environments

easier to get than competitive employment

job readiness training cons

doesn't feel like real work

often time limited

reinforces low expectations for individuals and community

not related to client's interests/goals

Social enterprises

community based businesses designed to emply marginalized groups fulfilling market needs

social enterprises pros

inclusive workplace

increases community awareness of skills and potential of identified population

can combat stigma against people with disabilities

skill developing and resume building

flexible

social enterprises cons

more visibility means person must disclose diagnosis

complicated to meet both business and social justice needs of company

may lead to conflict

not as much choice in industry

limited opportunities may not align with person's work preferences

Supported Employment method

A method of integrating people with disabilities who cannot work independently into competitive employment. Includes the use of a job coach who helps the person with disabilities train for and succeed on the job.

supported employment pros

client centered

competitive employment

market rate wages

provides an opportunity for long-term dignity

a chance at upward mobility

disclosure not required

an opportunity to break out of the perpetual problem of unemployment and underemployment

supported employment cons

limited programs available

disappointments with job loss and not getting hired

labor intensive

competitive employment

Person performs all essential job functions with or without reasonable accommodation

Individualized placement and supports (IPS) model

Evidence supported for individuals with serious mental health disorders

8 principles

8 principles of IPS

Competitive employment

Zero exclusion

Systematic job development

Benefits planning

Integrated services

Worker preferences

Time-unlimited support

Rapid job search

Why work on IADLs with TAY?

IADLs are an essential part of community integration

Types of community living services

Independent living

Supported Living Services

Residential care facilities

Residing with relatives

Independent living services (ILS)

Provide out of home placement for youths approaching adulthood during their transition to adulthood

time limited with goal of independence

provide training on IADLs and independent living skills

Supported living services (SLS)

Services that can help a person live in their own home on a long-term basis.

No time-limit on duration of services

Can include 24 hour support

SLS services

Selecting and moving into a home

Choosing personal attendants and housemates

Acquiring household furnishings

Common daily living activities and emergencies

Becoming a participating member in community

Managing personal financial affairs

Family home agency (FHA)

Approved family homes providing up to two adult individuals with developmental disabilities per home to reside with a family and share in the interaction and responsibilities of being part of a family.

family aides in ADLS, IADLS

community care facilities (CCF)

Provide 24/7 non-medical residential care

Level I - limited care, no bx problems

Level II - care, supervision, and training; no major bxproblems• Level III - clients with significant ADL needs and/ordisruptive bx•

Level IV - clients with severe limitations and/orseverely disruptive bx

Adult Residential Care Facilities

24-hour health care and intensive support services

Vendored by Regional Centers

For medically fragile individuals

Homelike setting

Which Community living service do TAY live in own home?

SLS

Which community living services are board and care homes?

community care facilities and adult residential care facilities