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Name the 3 stages of the OT Process. 1) evaluation process 2) intervention process 3) outcomes process
What does the Evaluation Process include? 1) referral 2) screening 3) developing an occupational profile 4) analyzing occupational performance
What does the Intervention Process include? 1) intervention planning 2) implementation 3) review
What is included in the Outcomes Process? 1) measurement of outcomes 2) decision making related to future direction of intervention (i.e., continue, modify, or discontinue)
What is the purpose of the Evaluation Process? To find out what the client wants & needs (client-centered care), and to identity those factors that support or hinder occupational performance.
What is essential to the Evaluation Process? observation & interviewing
The steps of the Evaluation Process include? 1)referral 2) screening 3) evaluation (occupational profile, occupational performance analysis, & interview)
When does the OT process begin? It begins when a referral is made.
Who determines the type of referral that's required & also the role that an OTA can have in the referral process? Federal, state, & local regulations, and the policies of 3rd party payers
Through this process, the OTP gathers prelim info about the client & determines whether further evaluation & OT intervention is warranted. Screening Process (it's a hands-off process, snapshot, review charts, etc)
What does screening involve? 1) review of records 2) brief screening test 3) interview w/ client or caregiver 3) observation 4) discussion of client w/referral source
Who initiates & directs the screening process? OT
What must an OTA achieve before performing screening tasks? Service competency in the particular tasks (must demonstrate the same results 3x)
If screening suggests the client is in need of services, a comprehensive evaluation is arranged. T/F true
What does a Model of Practice help the OTP to do? organize thoughts
From the Model of Practice, the OTP selects a _____ & chooses _____ consistent with the _______. Frame of Reference; Assessment Instruments; Frame of Reference
What are the clinical techniques & instruments used to determine the strengths & weakness of a client for therapeutic purposes called? Assessment procedurs
What does the Occupational Profile provide to the OTP? HX of the client's background & functional performance w/which to design intervention
What initial info about the client is obtained for the Occupational Profile? Age, gender, & reason for referral; DX & medical HX (including date of onset); prior living situation & level of function; & social, educational, & vocational background; precautions; client priorities & desired targeted outcomes.
What does the Analysis of Occupational Performance do, and where is the information for the Analysis of Occupational Performance derived ? It provides direction to the OTP as to the areas that need to be further examined. The info is derived from the Occupational Profile.
What does the OTP used to gather info on a client's occupational performance? Assessments
What forms the basis of the intervention plan? Assessment evaluation info
What involves analyzing all aspects of the occupation to determine the client factors, patterns, contexts, skills & behaviors required to be successful? Occupational Performance Analysis
What is an essential part of clinical-decision making? Evaluation
The techniques used during the Evaluation Process can be classified into 3 basic procedures. What are they? 1) interview 2) skilled observation 3) formal evaluation procedures
What is the focus of OT? Occupations
What are the 3 stages of an interview? 1) initial contact 2) information gathering 3) closure
The interest checklist (Neuropsychiatric Institute [NPI] Interest Checklist - developed Matsutsuyu) for interviews enable clients to report on _________ . hobbies & interests
The activity configuration also provides info on how a client_______. spends their day
What does the OTP use to ensure that the desired info is obtained during an interview? Interview outline
The OTP obtains info about the the client through _____. Observation (ex. observing the person's posture, dress, social skills, tone, behavior, & physical abilities)
Observation may be either ________ or __________. Structured or unstructured
Watching the client perform a predetermined activity is known as a _________. structured observation
When do OTPs typically use structured observation? OTPs use this to gain knowledge of what the person can or can't do in relation to the demands of the task of the task.
OTP evaluates self-care activity like shaving; client is asked to shave his normal way. While observing, OTP learns what's needed to improve function; identify extent of limitation; make plan for correction/improvement. This is an example of what? Structured observation
OTP examines the quality of performance through observation of the process, not just by examining the end product. True/False True
Formal Assessment Procedures help determine the existing performance level of the client. True/False True
Formal Assessment Procedures include what? 1) tests 2) instruments 3) or strategies that provide specific guidelines; this all informs OTP abut what's to be examined, how it's examined, how data are communicated, & how info is applied in clinical problem-solving.
Formal Assessment Procedures have specific guidelines, & they are easily duplicated & critically analyzed. True/ False True
A test is said to have ______ if research testing shows it to be a true measure of what it claims to measure. validity
_______ is a measure of how accurately the scores obtained form the test reflect the true performance of the client reliability
What is an indicator of the consistency of the results of a given test from one administration to another? Test-retest reliability
What is an indicator of the likelihood that test scores will be the same no matter who is the examiner? Interrater reliability
What type of test has gone through the rigorous process of scientific inquiry to determine its reliability & validity, and has a carefully established protocol for its administration? Standardized test
Standardized tests may based on _______. Normative data
How is Normative Data complied? It's compiled by administering the test to a large sample of subjects.
Name 2 standardized tests developed by OTs. Miller Assessment for Preschoolers (MAP) & Sensory Integration & Praxis test (SIPT)
What type of test is used to for measuring function? Nonstandardized test
Name 2 examples of Nonstandardized Tests. Manual Muscle Testing & Sensory Testing
What is the aim of OT? It's to enable the person w/a disability to function more independently in their environment.
What does the OT Intervention Process require? 1) OTP to develop goals 2) select activities 3) direct intervention to guide client to learn ways of engaging in occupational performance 4) monitor the results of the intervention
What is the intervention plan based on? An analysis of the info accumulated during the evaluation
What are the 3 steps in developing the Intervention Plan? 1) problem identification 2) solution development 3) plan of action
During Problem Identification, the OT identifies _________. Strengths & deficits
Problem Identification can also include forming a _____ about the cause of the problem. Hypothesis
What is the process of identifying alternatives for intervention & forming goals & objectives? Solution Development
What are important components of Solution Development? Selecting a MOP & FOR.
How is the Plan of Action determined by the OTP? It's based on the problems & the identified FOR along w/input received dorm the client.
What is the 1st step in developing a Plan of Action? What comes next? Creation of long- & short-term goals; Intervention methods that will help the client achieve the goals are determined (tools, equipment, positioning, location, etc.)
What are intervention methods based on? the selected FOR
What is the outcome of the Intervention Planning Process? Written report (or intervention plan)
What does the written plan address? strengths/weakness, expected outcomes (goals), interests, rehab potential, frequency/ duration, recommended methods & media, enviro & time constraints, ID of plan for reveal, & discharge plan.
What involves working w/the client through therapy to reach client goals? Intervention
What are the 5 intervention approaches in OT? 1) Create/ Promote 2) Establish/ Restore 3) Maintain 4) Modify 5) Prevent
What are also important parts of intervention? Consulting & Education
The implementation of the Intervention Plan is the responsibility of both the OT & OTA, it is the CENTRAL responsibility of the _____. OTA
The OTP organizes a handwriting group for kids. The OTP recommends the group of kids in his/her caseload who have difficulty w/handwriting. This is an example of which Intervention Approach? Create/ Promote
The OTP works w/Galen, 67 yr. old man who lost use of his RT side since his CVA. The OTP works to help Galen to return to his typical morning routine. This is an example of which Intervention Approach? Establish, Restore
After performing a home visit, the OTP makes recommendations so 90 yr. old Harry can stay at home. This is an example of which Intervention Approach? Maintain
The OTP provides 35 yr. old Karen, who has CP, w/adapted feeding equipment so that she can feed herself. This is an example of which Intervention Approach? Modify
The OTP explains proper lifting techniques to a group of workers at a factory w/the goal of preventing injuries. Prevent
What is the coordination or facilitation of services for the purpose of preparing the client for a change? Transition Services; these may involve a change to a new functional level, life stage, program or environment; vary depending on client's ability & support level
What is the last step of the Intervention Process? Discontinuation of Services
When is the client discharged from OT? 1) When they reach goals delineated in the Intervention Plan 2) When they realized the max benefit of OT services 3) or When they don't wish to continue services
The Discharge Plan is developed & implemented to address the resources & supports that may be required upon discharge. True/ False True
What does the Discharge Plan include? 1) Recommendation for continued services 2) equipment recommendations 3) any therapy the client is required to follow after discharge; may also include training for family and/or caregivers
Why are Outcome Measures used? To determine whether goals have been met & to make decisions regarding future intervention; provides objective feedback to OTP & client
Who formulates & documents the TX plan? OT
Implementation is the responsibility of the OT. True/ False False - it's the responsibility of the OT & OTA
What functions are essential components of professional practice Service management functions
What are the various Service Management Functions in which the OTP participates maintaining safe & efficient workplace, documenting OTS, reimbursement for services, planning & evaluating prog., integrating prof. development activities and Evidence-based practice into the workplace, marketing & public relations.
Each practitioner assumes responsibility for maintaining a safe & efficient work environment T/F True
What is Accreditation a form of regulation that determines whether an organization meets a prescribed standard.
Occupational therapy clinics do not have to adhere to accreditation standards set by specific accreditation bodies. T/F False
What body sets the accreditation standards for rehabilitation settings CARF (Commission on Accreditation of Rehabilitation Facilities)
What are some factors for safety in the clinic Settings large & clutter free, sharp corners should not protrude into walking areas. Clinic should have non-slip flooring. Bathrooms should be equipped w/grab bars & emergency buttons.
What are some factors for safety in the clinic Proper storage of flammable & sharp objects. Food must be safely stored & handled. Staff should be trained in use of proper lifting techniques. Staff must be aware of who’s in clinic at all times. Staff should be trained in proper use of equipment.
OSHA Occupational Safety & Health Administration
What does OSHA monitor Compliance of employers & fines those not following regulations.
What does OSHA require manufacturers of toxic chemicals and flammable substances to provide Material safety data sheet (MSDS)
What is the purpose of the MSDS Outlines info on the proper procedures for working w/the material & describes procedures for storage and disposal.
Emergency Procedures Actions to follow in case of an injury or accident in the clinic.
Keeping track of supplies & inventory is often the responsibility of the OTA T/F True (Staff use an inventory system to track the supply.)
What does the CDC monitor Individuals’ exposure to disease in the workplace
What is the set of guidelines designed to prevent the transmission of HIV, HBV and other blood-borne pathogens to health care providers Universal Precautions
What are the 5 Universal Precautions 1.wash hands 2.Wear gloves 3.Wear full-protection 4.Proper disposal of contaminated sharp objects 5.Proper disposal of contaminated protective equipment.
What provides a justification for OT intervention Documentation
What is the purpose of documentation Justification of services, record of service, description of client’s journey, record of outcome of intervention, billing, communication.
What are common types of documentation during the evaluation process Eval or screening report, reeval report
What are common types of documentation during the intervention process Intervention plan, OT service contacts, progress report, transition plan
What are common types of documentation used in the outcome process Discharge/discontinuation report.
Documentation of service contacts records the specific interactions between the OTA and the OT. T/F False between the client and the OTP
What format for writing the progress note, includes: “S” subjective information, “O” objective information, “A” assessment, & “P” plan SOAP note
What documentation is designed to meet the unique educational needs of a child, tailored to the individuals needs as identified by the eval process. IEP (individualized education plan)
What is the common method of documentation used in medical settings that is based on a list of problems identified by the Tx team during assessment POMR (Problem-Oriented Medical Record)
What form of documentation summarizes the intervention and the client’s progress towards the goals progress report
What are the fundamental elements of documentation Client’s full name & case # on each page, date & type of OT contact, identification of type of documentation, agency, & department name, OT & OTAs signature, Signature directly at end of notes or record, countersignature of OT on student or OTA notes
Fundamentals of documentation Cont. Acceptable terminology, acceptable abbreviations, errors corrected by drawing a line and initialing, adherence to professional standards of technology, disposal of records w/in requirements, compliance w/confidentiality, compliance w/storage require.
What funding sources include, federal, state, and local sources Public funding sources.
What funding sources include health insurance, worker’s compensation, casualty insurance and disability insurance Private Funding Sources
What are some types of other sources of funding for OT services or equipment service clubs, private foundations, & volunteer organizations.
What are diagnosis codes based on the client’s medical condition or the medical justification for services.
What is classified by The International Classification of Diseases, 9th Revision, Clinical Modification (IDC-9-CM) Diseases according to anatomical systems.
Mental health providers use DSM-IV-TR
What are procedure codes based on the specific services performed by health providers.
What is the most commonly used procedure coding system Current Procedural Terminology (CPT)
Who publishes the CPT AMA
What are the two types of claim forms used in OT to bill third-party payers (1) the uniform bill (UB-92; CMS-01450) (2) the CMS-1500
Which type of claim form is used by hospitals, skilled nursing facilities and home health agencies the uniform bill
Which type of claim form is primarily used by physicians or OTP in private practice CMS-1500
What does program evaluation measure the effectiveness of programming
What is involved in program evaluation ”determining the extent to which programs are achieving the goals and objectives established for them and using that info as necessary to modify activities.”
Accreditation is a form of regulation that determines whether an organization or program meets a prescribed standard
Why do organizations seek accreditation in order to be reimbursed by third-party payers
What are the two most widely known accreditation bodies in health care the Joint Commission (TJC) and the Commission on Accreditation of Rehabilitation Facilities (CARF)
TJC is also known as Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
JCAHO/TJC develops and accredits health care organizations such as Hospitals, health care networks, & organizations that provide long-term care, behavioral care, & lab & ambulatory services
What is CARF aimed at improving the quality of services provided to individuals w/disabilities
What does program evaluation include examination of program structure, program process, and outcome measure.
Program structure refers to the system in which the services are delivered
Program process refers to the stages of referral, evaluation, and intervention. Examines such things as how timely the eval was performed.
Outcome measures refer to the results of intervention.
What is Evidence-based practice refers to “finding, appraising, and using research findings as the basis for clinical decisions.”
What is used by OTP to determine the interventions that are effective for a particular client Research evidence in conjunction w/clinical knowledge & reasoning.
What are the four steps in evidence-based practice (1) forming clinical question that can be researched (2) searching literature for best evidence (3) appraising the evidence for validity & applicability to practice (4) applying evidence to practice
What month is designated as National Occupational Therapy Month April
What is the purpose of marketing and public relations to help increase the visibility of OT
How does marketing differ from public relations it involves the development & implementation of a marketing plan
What considerations are required when developing a marketing plan (1) Clients (2) Referral sources (physicians) (3) Administration (facility) (4) Third-party payers
What helps a practitioner organize their thinking? Model of Practice – MOP
What is the tool that guides one’s intervention (tells you what to do & how to evaluate & intervene w/clients), & is supported by research? Frame of Reference – FOR
What is essential to Evidence-Based Practice (EVB)? The use of a FOR
What refers to choosing intervention techniques based upon the best possible research? EVB
What is a set of ideas that helps to explain things & is the analysis of a set of facts in their relation to one another? Theory (research is used to support or refute theories)
What are the 2 major components of theory? Concepts & Principles
What are ideas that represent something in the mind of the individual & are expressed through the use of symbols & language? Concepts; Example: Kids develop categories for concepts such as that clothing is a category that can be divided into shoes, pants, shirts, etc.
What explains the relationship between 2 or more concepts? Principles; Example: the concept of color is learned, such as blue & yellow, a child learns the principle that mixing these 2 colors produces green
Theory is defined as: ”a set of interrelated assumptions, concepts, & definitions that presents a systematic view of phenomena by specifying relationships among variables, w/the purpose of explaining & predicting the phenomena”
What provides the basis for practice? Theory
Why do OTP appreciate theory? It’s required to clinically reason & develop effective intervention; used for problem solving; tool used to “name it & frame it”
Theory also serves to: 1) validate & guide practice 2) justify reimbursement 3) clarify specialization issues 4) enhance growth of the profession 5) educate practitioners
Theories specific to OT originate in: biology, chemistry, physics, psych, & occupational science
What takes the philosophical base of the profession & organizes the concepts of practice? Model of Practice – MOP
What is the best-researched MOP in OT? Model of Human Occupation – MOHO
Which MOP views occupational performance in the terms of volition, habituation, performance, & environment? MOHO
What refers to the person’s motivation, interests, values, & belief in skills? Volition
What refers to one’s daily patterns of behaviors, roles (rules & expectations of those positions), & everyday routines? Habituation
What refers to the motor, cognitive, & environmental aspects required to act upon the environment? Performance
What refers to the physical, social, & societal surroundings in which the person is involved? Environment
Which MOP has a core of spirituality (broadly defined as anything that motivates or inspires); also includes person, enviro, & occupations & client-centered care? Canadian Model of Occupational Performance (CMOP)
Which MOP was developed by Christiansen & Baum, & provides definitions for each term & describes the interactive nature of the human being? Person-Environment-Occupation-Performance (PEOP); provides generic, broad terms for each area
Which MOP is articulated by Schkade & Schultz, & proposes that OTP examine how they may change the person, environment, or task so the client may engage in occupations? Occupational Adaptation
In which MOP is occupation viewed as the primary means for the individual to achieve adaptation? Occupational Adaptation
Which MOP focuses on the person, the occupational environment, & the interaction, and supports compensatory techniques as needed?Occupational Performance Occupational Performance
Raven enjoys family events, singing, & cooking, lives close to family & sees them daily; attends church services, & is active in the choir. This is an example which MOHO occupational performance? Volition
Raven works 5 days/week as a assistant manager at a grocery store; attends grandkids’ school events & helps w/their childcare; also attends church every Wednesday & Sunday. This is an example which MOHO occupational performance? Habituation
Before aneurysm, she completed occupations w/o difficulty. Now, she's can't use RT side, slurs speech, has diff. maintaining conversation & easily confused; unable to be active over 20 min, shows signs of fatigue. EX. which MOHO occ. performance? Performance
Raven lives in a small apt. in the city w/her husband. She lives on the 3rd floor; building has elevators, but she’s afraid to use them. Her family visits a lot & holds lots of gatherings. This is an example which MOHO occupational performance? Environment
Raven attends church Wednesday & Sunday. She’s active in the church & sings in the choir & is a devoted Christian. This is an example which CMOP occupational performance? Spirituality
Raven is 27 married woman who suffered an aneurysm & is in a rehab hospital. , She is unable to use her RT side, slurs speech, & shows poor memory & concentration. This is an example which CMOP occupational performance? Person
Raven works for a grocery store chain. She must follow institutional policy & procedures. She has med insurance. She also follows the church’s institutional policies. This is an example which CMOP occupational performance? Environment
Raven enjoys spending time w/family; active in the church & is a choir member. She works at a grocery store. She attends grandkids school events. This is an example which CMOP occupational performance? Occupations
Raven lives w/her husband; married for 20 yrs. She sees family regularly & enjoys cooking, family events, & singing. This is an example which PEOP occupational performance? Person
Raven lives in a small apartment on the 3rd floor. Her family lives close by. This is an example which PEOP occupational performance? Environment
Raven works 5 days/week at a grocery store. She attends church & sees family often. She attends grandkids school events. This is an example which PEOP occupational performance? Occupations
Raven slurs her speech & has difficulty using her RT side. She fatigues easily. This is an example which PEOP occupational performance? Performance
Raven works as an asst. mgr. at a grocery store; takes care of her family & is involved in church; likes to socialize. She’s unable to engage in these occupations. This is an example which Occupational Adaptation occupational performance? Occupation
OTP changes demands of occupation of socializing by allowing Raven to sit & visit w/family. OTP provides her w/short projects w/grandkids-helps her continue her nurturing occupations. This is an ex. of which Occupational Adaptation occ. perform.? Adaptation
Frame of reference describes the process for change in the client & the principles for moving a client along a continuum from dysfunction to function.
A practitioner may use several FOR at one time or sequentially over time. T/F True
What is one of the most efficient & practical ways to conduct evidence-based practice To examine FOR, which apply theory & put principles into practice. FOR provide specifics about how to treat specific clients.
What are necessary parts of a Frame of Reference Population, continuum of function/dysfunction, theory regarding change, principles, role of practitioner, & assessment instruments.
Population refers to types of diagnoses that would benefit from the intervention (FOR). Also describes the age, condition, & type of deficit addressed in intervention.
What FOR are clients who experience decreased strength & endurance typically treated under Biomechanical FOR
What does the biomechanical FOR state providing repetitive movements, increasing the weight, & providing gradual resistance are all techniques that improve strength.
Function the ability to perform
Dysfunction limitation in the ability to perform
According to the biomechanical FOR, function includes strength, endurance, & ROM that is adequate to perform occupations
How is dysfunction measured in the biomechanical FOR it is measured in limitations to strength, ROM, and endurance.
How does the behavioral FOR define function as the absence of abnormal behaviors
How does the behavioral FOR define dysfunction the presence of behaviors that interfere w/function
What is abnormal behavior according to the behavioral FOR they may be socially unacceptable behaviors or those defined by the team as interfering w/function
The FOR describes the theory and hypotheses regarding change. T/F True
What is brain plasticity? refers to the phenomenon that the brain is capable of change & through activity one may get improved neurological synapses, improved dendritic growth, or additional pathways.
What are some FOR based on brain plasticity? Neurodevelopmental theory (NDT), sensory integration (SI), motor control
What is intervention aimed at in FOR based on brain plasticity? improving neuronal firing & generating improved brain activity through repetition.
What do principles do, in regard to FOR Guide the evaluation & intervention. They relate back to the theoretical base & describe how an individual is aided to make changes & progress from a state of dysfunction to function.
How does understanding the principles of the FOR help the OTP Allows practitioner to use clinical reasoning to determine the FOR would benefit their client.
What are principles based on theory & research
The FOR does not clearly describe the principles surrounding the techniques. T/F F The FOR SHOULD clearly describe the principles surrounding the techniques.
What is the principle of strengthening The principle behind strengthening is the recruitment of more muscle fibers. By repetitive muscle contractions, more fibers are recruited & the muscle is able to lift more.
What is the role of the practitioner based upon the principles and theories of the FOR.
What do the principles and theories provide a guide as to how the practitioner will interact w/the client & the environment.
How does examining the research of a FOR help the practitioner helps the practitioner fully understand the intricacies of the FOR and the role of the practitioner.
The FOR does not describe how the practitioner interacts w/clients. T/F False the FOR describes how practitioners interact w/clients.
The FOR provides the OT with a variety of instruments to operationalize the principles. T/F True for ex: Allen’s Cognitive Levels was designed to ID the level of cognitive functioning for clients & to be used w/the cognitive disability FOR
The sensory Integration and Praxis Tests, Miller Assessment for Preschoolers, Adult Sensory Profile, & clinical observations are based on what and are designed for what purpose SI principles & are designed to help the practitioner determine how a client would benefit from the FOR.
The Occupational Self-Assessment, Volitional Questionnaire, & Model of Human Occupation Screening Test are examples of assessments designed to operationalize concepts associated with what theory and practice MOHO theory and practice
What FOR was the principle of gradual stretch to elongate muscles the muscles fibers developed under Biomechanical FOR
What is considered essential to evidence-based practice Reviewing principles and previous research, is part of critically analyzing the research & explaining what OT practitioners do.
OT practitioners must become critical consumers of research so they can critique and analyze current practices. T/F True
Biomechanical FOR This FOR is derived from theories in kinetics & kinematics (sciences that study the effects of forces and motion on materials and bodies).
On the function-dysfunction continuum, what individuals in the biomechanical FOR used with individuals who have deficits in the peripheral nervous, musculoskeletal, integumentary or cardiopulmonary system.
What might these deficits cause posture and mobility problems, impairment in ROM & strength, & decreased endurance.
What conditions might benefit from the biomechanical approach RA, OA, fractures, burns, hand traumas, amputations & SCI
Who proposed the cognitive disability FOR Claudia Allen
What is the cognitive disability FOR based on the premise that cognitive d/o in those with mental health disabilities are caused by neurological defects or deficits related to the biologic functioning of the brain.
What is its theoretical base derived research in neuroscience, cognitive psychology, info processing, & biologic psychiatry.
When does function exist Along the function-dysfunction continuum function exists when an individual is able to process information to perform routine tasks demanded by the environment.
When does dysfunction result when the persons ability to process info is restricted and carrying out routine tasks is impossible.
Why would an OTP re-examine the goals and the FOR if progress is slow or not being made.
Created by: Cindy Lou Who