OT 432 FINAL

GAS, ch.4,Quality of Life and Health Promotion, Occupational justice,

G.A.S.

Goal

Attainment

Scale

**Goal-**

A statement of the skill you wish to learn/ refine 

**Purpose**-

Discuss why the goal is important to you

G.A.S :Sequence of 5 graded steps

ranging from -2 to +2 are rendered for the two areas: 

\-2

\-1

0- expected outcome → goal met

\+1

\+2

Method–

Relates to what the student will be doing to work on their goal.

ex: what and how of their learning process

Progress Data 

* The student records their ratings daily using the GAS and reflects on their objective/ subjective experience in their weekly log. 

Public health

is what a society does collectively to facilitate conditions that enable its members to be healthy.

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* is different from medicine. 

Public health focuses facilitating health and well being of populations by …

1. Assessing and monitoring health problems 
2. Informing the public and and professionals about health issues
3. developing and enforcing health protecting laws and regulations 
4. implementing at evaluating population-based strategies to promote health and prevent disease 
5. assuring the provision of essential health services

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Acculturation

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– the process by which individuals relinquish aspects of their culture to acquire  those of the surrounding majority culture. 

Cultural competency

having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities 

Ethnicity-

individual, group, and social attributes in the absence of common physical features that lead to categorization

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 Race-

often a proxy for culture. Defined as “combination of physical attributes along with individual, group, and social attributes” 

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Encultruation:

involves learning about culture through direct instruction, observation and modeling. 

Socioeconomic status:

has been defined as categorization based on education, income, wealth and position in the social hierarchy. 

Spirituality-

is an appreciation of presence and purpose that includes a sense of meaning. 

How to establish rapport?

* open-ended questions
* feedback

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how does SES affect us in practice?

The client may not have access to certain things.

ex: wheelchairs

what do you look at in a client?

education

culture

SES

What does quality of Life mean?

An individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals expectations, standards, and concerns.

* person’s physical health
* psychological state
* personal beliefs
* social relationships

**Quality of Life**

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Conceptually, health related quality of life supports assessment and interventions that occupational therapists and occupational therapy assistants use to determine the health and occupational performance of people in the context of their lives.

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**Occupation and Quality of Life**

Not engaging in meaningful can result in fewer experiences that enable people to develop competence in and mastery of occupations.

* ex: disabilities
* an environment

QOL ADULTS

* Perceptions people have about their quality of life can be positive or negative
* Possibilities refers to the significant opportunities and constraints in various aspects of a person’s life.

the Centre for Health Promotion (CHP) Model- ADULT

* It assumes that individuals differ from one another and that each person is a unique human being who should be understood in a holistic way.

(INDV. is unique and have to seen in a holistic way)

**Three major aspects of Quality of Life**

1. Being- physical
2. psychological health and wellbeing;
3.  spiritual (values, beliefs and experiences that sustain us)

QOL Children

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* Play with friends
* Going to daycare/nursery program, school
* Activities in the community
* Learning new things that help him or her grow or develop.

CHP for Children

* ==**Being**== refers to who the child is perceived to be in the view of others, such as family members, the child’s community
* be a child


* ==**Belonging**== refers to the connections the child has to people and places in his or her life.
* make connections with their env.
* ==**Becoming**== refers to the child’s nurtured growth and development.  Centered around the child’s major needs and how well
* the child should be nurtured

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**QOL End of Life Care and Aging**

* The process of dying well is really about living life fully while dying.

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**A Good Death**

is often described as encompassing elements such as 

* having family or significant others present, 
* being without pain,
*  being physically comfortable, 
* maintaining dignity through privacy and caring.

Palliative care

Is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

* You can assist a pt. in getting better
* take efforts to improve
* life prolonging

Hospice care

Is that which can be provided to patients with a life expectancy of six months or less. 

Aims to make their remaining time with us as comfortable and as meaningful as possible.

Interventions allow one to concentrate on the emotional and practical issues of dying.

* Cancer

QOL Assessment for OT(**WHOQOL**)

26 item LIST

Occupation

participating in things that are meaningful to an individual from the minute they wake up until they go to sleep

HEALTH

defines health as a state of complete physical, social and mental wellbeing and not merely the absence of disease or infirmity

Ecological Public Health

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* Interconnections between health and sustainable development as well as global environmental problems and the changing nature of the ill-health. 
* Occupations have changed and altered the environment and it has an effect on future generations. 
* **Meaning the ability for someone to participate in an occupation in one place can change from where they live, as in another country → it can effect the future generations**

An Occupational Perspective in Population Health

* ==Population health is synonymous with public health.==
* Biological →btw economics and the cultural
* access, neighborhood, resources, infrastructure

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Relationship Between Health and Occupation

Evidence supports that there is **definite relationship between** what people do or not do and their experience of health although it may differ from person to person. 

* positive correlation → more social, QOL,

descriptions of health

* Being able to perform physically demanding work
* Working despite advanced age


* being keen
* doing things easily
* feeling like conquering the world
* energy and vitality  

Potential Occupational Therapy Approaches within Population Health  

* Wellness approach 
* Preventative Medicine
* Community Development 
*  Occupational Justice 
* Ecological Sustainability 

Wellness Approach 

\*\*def:\*\*Active process → Indv. self-awareness → make choices → balance btw n work rest and play

**clients:** indv/ groups

Preventative Medicine

**DEF:**


1. primary prevention


1. **promotion:** teaching to prevent
2. **protection:** preventing the ailment
2. secondary prevention


1. identification: finding a disease
2. correction: the active phase of treatment
3. tertiary prevention


1. accommodation: full ailemnt, adapting to it

**Clients**:Idv/ societies

ex: hand washing, masks,

Community Development

**DEF**

* health literacy
* promote socially responsible health
* inc. investment in health development
* Expanding partnerships for health promotion
* Increased community capacity and empowerment of individuals
* Securing an infrastructure for the promotion of health 

 **Clients:** communal/ societal

ex: diabetic pt → walk space in neighborhood, access to transportation, access to food

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Occupational Justice 

**DEF:**

* **Equitable** opportunities and resources for all people to engage in meaningful occupations.
* This approach of for public policy
* Develop infrastructure

**CLIENTS**: Cultural/ political

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Ecological Sustainability 

**Def:**

* Promotion of healthy relationships between humans and other living organisms their environments, habits, and mode of life
* can be done on a global scale

**clients:** global/political

ex: teaching others especially when you’re no longer going to be there

occupational justice examples

Occupational alienation

Occupational apartheid

Occupational deprivation

Occupational justice-

Occupational rights

Classism-

refers to the hierarchical nature of oppression based on economics.

SES, lack of opportunities

Sexism

refers to the social structure of patriarchy and how women internalize its existence.

Homeless

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* approximately 600,000 people reside in homeless shelters every night.
* 50% African American
* 35% Caucasians
* 12% Hispanic
* 1% Asian

Occupational alienation 

prolonged experiences of ==disconnectedness,== isolation, emptiness, lack of a sense of identity or a limited or confined expression of spirit, or a sense of meaningless”

* Ie immigrant farm workers

 

Occupational deprivation 

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* “a state of prolonged ==preclusion from engagement in occupations of necessity and or meaning d==ue to factors that stand outside the control of the individual”.
* ex:Inmates in prison experience prolonged levels social isolation.
* Poverty can lead of occupational deprivation
* Limited access to care
* Exposure to adverse environments (drug abuse, housing, poor water conditions)

Occupational imbalance

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* may occur when the right to benefit from fair privileges for diverse participation in occupations in removed.   
* a population based term to identify groups of people who do not share in the labor and benefits of economic production.
* ex: student that lives on their own

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Occupational Marginalization

* *May occur when the right to benefit from fair privileges for diverse participation in occupations is deprived.*

experiences of inequity from being outside the dominant or mainstream discourse and events of everyday occupations in a particular context; invisible, silent, in the edge of privilege and entitlement to occupational opportunities and resources

Marginalization often occurs when individuals or groups are discriminated

ex: women

Occupational Imbalance

* an individual or group experience in which health and quality of life are comprised because of being over occupied or under-occupiedex.
* This may occur when an individual has no time for any other occupations other than paid work (vocational pursuits).
* ex: inc. patient caseload of causing increased levels of job dissatisfaction and burnout.

Well Elderly Study

allows you to take the concept of occupation & engagement → to be better health outcomes

* **Goal** was to enhance one’s health through conscious decision making about engaging in occupations that promote healthy lifestyles and improve quality of life.

Affective/comfort scale

The parameters of the tend to be more subjective therefore you are not required to define these concepts in measurable terms but qualitatively of descriptively.

Cognitive/ Psychomotor scale

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Each concept in the goal statement is operationally defined (in behavioral/measurable terms)

Objectives

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* Statements both about how to reach goal and how to determine if all or part of the goal has been reached. 
* a systematic approach to attaining the goal as well as the empirical measurement or assessment thereof
* statements that operationalize the goal. 

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Example of GAS goal 

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* To improve my interpersonal relationship skills and feel comfortable working with patients in a mental health setting. 

WORLD HEALTH ORGANIZATION (WHO)

The WHO has four current priorities 


1. Ensuring global health security by identifying emerging threats to health and managing them efficiently
2. Reducing tobacco use and promoting healthy nutrition and physical activity to decrease the incidence of chronic diseases 
3. Increasing efforts to support the achievement of MDG's (Millennium Developmental Goals) 


1. MDGs include reduce child deaths, improve maternal health, combat HIV aids, rid of extreme hunger, poverty 
4. Improving health care services including fair access for all

**MDG: millennium development goal** 

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* telehealth 
* homeless 
* long covid 
* vaping
* change insurance in france 
* immigrataion 

“New Public Health”

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* Addressed both interventions and prevention strategies to promote the health of all being of populations communities and individuals including equitable all access to services. 

equitable

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Giving everyone what they need unlike equality

Health promotion

**Any combination of educational ecological supports for action and conditions of living conducive to health**

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**Community health-**

**Community health refers to the physical emotional social and spiritual well-being of a group of people linked together in someway possibly through geographical proximity or shared interest**

**Prevention**

**Has been defined an AOTA is framework as promoting a healthy lifestyle at the individual group organizational community societal governmental policy level.** 

* Three levels of prevention
* Primary
* Secondary
* Tertiary 

**Wellness**

has been defined as a dynamic way of life that involves action values and attitudes that support or improve health equality of life

OCCUPATIONAL JUSTICE (Chapter4)

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* critical perspective of social structures that promote social political and economic changes to enable people to meet their occupational potential add experience wellbeing
* asses to the occupation

What is healthy people 2020?

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* Vision
* A society in which all people can achieve their full potential for health and well-being across the lifespan.


* **Mission**
* Healthy People 2020 strives to:
* Identify nationwide health improvement priorities.
* Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
* **Overarching Goals**
* Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
* Achieve health equity, eliminate disparities, and improve the health of all groups.
* Create social and physical environments that promote good health for all.
* Promote quality of life, healthy development, and healthy behaviors across all life stages.

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IMPLICATIONS FOR OT (chapter 4)

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* Knowledge of this document(HEALTHY PPL 2020) and its objectives is essential for interdisciplinary work and health promotion and public health 
* as well as occupational therapy specific interventions that address the level of context in the framework 
* this knowledge is also very useful when writing grants to secure funding for related work that seeks to enhance community well-being and social participation by community members

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**Healthy community**

Is described as a community that :

* provides access to both preventative and clinical health services to all residents 
* has a safe and healthy atmosphere and

**Healthcare disparities**

are racial or ethnic differences in the quality of healthcare that are not due to access related factors are clinical needs preferences and appropriateness of intervention

OT implication in health disparities

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* 1. participate in AOTA and state associations and promote awareness of the IOM report 
* 2. require review of this and other similar reports within occupational therapy educational programs and fieldwork 
* 3.  monitor service delivery patterns to a sure disparities do not exist 
* 4.  Advocate and be politically active twin sure necessary policies laws and regulations are inactive and implemented 
* 5. engage an evidence-based culturally competent practice and brace and conduct research on ethical issues in service delivery
* Active involvement to eliminate healthcare disparities with in the United States is consistent with the OT code of ethics the core values and attitudes of occupational therapy practice the AOTA  statement on health disparities and AOTA statement occupational therapy's commitment to nondiscrimination and inclusion. 

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OT community programs engage in 

* Prevention 
* restoration 
* Maintenance 
* Health promotion 

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Community 

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* A group of people related by a characteristic such as age, gender, disability culture or social similarities. 

Levels of prevention

1. primary
2. secondary
3. tertiary

Program development

starts with the development of an idea or the identification of a need. 

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Steps in Community Program Development 

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1. know population → skills knowledge, passion
2. what programs could be run & what will the program be
3. make a community profile: talk to those in the community, phone calls, survey(DATA)
4. Conduct Phase I and II of a needs assessment.
5. Review the results of the needs assessment and identify what has been accomplished. 

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Assessing the Need for Services 

Phase I: NEED

Phase II: IDF THE PERCEIVED BROADER COMMUNITY

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Developing a Community Profile. 

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* One needs to know the intricacies of each factor and its impact on performance to successfully implement a community program. 
* When preparing to write goals and objectives for developing a program it is important to connect the programming plan, implementation plan, and evaluation plan. 


* In program development 
* Goal: is what is aimed for; what is hoped to be achieved
* Objectives: are attached to each goal to ensure the desired result is accomplished 

Use of Theory to Guide Programming

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* heory is an organized way of thinking about a given phenomenon. 
* Theories and conceptual models provide the foundation for program design and implementation and help set parameters for program evaluation. 
* The development and execution of programs must be rooted in theories. 
* MOHO
* PEO
* PEOP
* OA 

Steps for acquiring evidence

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* A programs ultimate goal is to achieve its desired outcomes. 
* A programmer(s) must be able to answer the following questions: 
* Is the program effective ?
* Is it doing what it was planned to do ?
* Were program goals met ?
* Were the stated Objectives met ?

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Methods of Evaluation

* **Outcome Evaluation:** concentrates on the Results of the services programs treatments or intervention strategies generally following termination of services.
* **Program evaluation** is the broader concept than outcomes of evaluation suggested.
* Program effectiveness
* Efficiency
* Congruence between needs goals and objectives.
* **Formative Evaluation:** Immediate feedback during program planning and implementation to improve and refine the program.(IMMEDIATE)

Occupational justice-

people have the right to be  active, productive participants in society and that society should not hinder the ability of the individual

Occupational Injustice-

was described as individuals, groups, communities and nations experiencing a lack of meaningful occupation for its members in their daily lives.

**Standard practice**-

is the utilization of routine approaches, which evolved from the best practices of yesterday. (proved to be true → routine)

* CVA pt → use of sling

**Best practice:**

the new, emerging ideas to solve problems, may yield better results infissucny and results 

* Best practice includes pursuit of evidence on which to base best practice and therefore must include evidence based practice. 
* CVA pt → learn how to visually scan, don shirts, , EBP 

Evidence based practice in public health

Is defined as the development implementation and evaluation of effect of programs and policies in public health through application of principles of scientific reasoning including systematic use of data and information systems and appropriate use of behavioral science theory and program planning models. 

Two types of evidence relevant for public health practice

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* **1st type of evidence** is data that addresses the relationship between preventable risk factors and specific diseases (smoking and cancer) This type of data indicates the need for intervention.
* **who needs intervention**
* **2nd type of evidence** is data on intervention. What interventions are most effective for what type of public health problems.
* **what is most effective with that population**

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component based assessment

are testing a specific thing: rom, mmt, 

The Framework and ICF

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* common language, purpose to understand that the info youre obtaining are similar 

Standardized Assessments

- Assessment procedures in which processes are clearly identified along with the guidelines for interpretation of results and may have a established and tested normative data with which to compare results

Modified Barthel Index

An ordinal scale used to measure performance in ADLs. It uses 10 variables describing ADLs and mobility.

RAW SCORE IS COMPARED TO A CHART THAT ALLOWS YOU TO ACCESS READINESS TO D/C. ALLOWS ME TO JUSTIFY THE NEEDS FOR SERVICES FOR MY ptS.

AN OBJECTIVE MEASURE

Modified Barthel Index VS. Modified Barthel ADL Index

difference due to setting they take place in 

(Modified Barthel ADL Index→for hospital )

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Contextual Memory Test:

test memory and the strategy that helps them the most

Ethical Considerations in Health Promotion Assessment 

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1. **Competence** – an ethical OT must be knowledgeable in the use of an assessment tool/ seek mentorship when developing a program for a community/ institution


1. duty
2. **Conflict of interest-** supervisor directs her/his employees to routinely use an assessment that doesn’t meets the needs of the client.


1. veracuty
3. **Copyright infringement** copying an assessment tool instead of purchasing it


1. paying for assessment tools
4. **Failure to perform Due Diligence** – properly administer assessment and report results


1. beneficence, malficent
5. **Misinterpretation of results** modifying assessment data for financial gain is unethical and illegal.

add more days to POC, swaying to something that is not true

Performing a needs assessment and misinterpreting the results to create a program that isn't needed, when the community might actually need services from another OT specialty or discipline.

Occupational Therapy Assessments

Many of the well known assessments in occupational therapy measure components or portions of a persons occupational performance. 

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Areas include ADLs, IADLs, Sleep, Education, Work, Play, Leisure, Social Participation. 

Assessment of Motor and Process Skill AMPS

COPD