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ch 4 inst pract sett
| Question | Answer |
|---|---|
| Admission to acute care hospitals | Admission is for a medical or psychiatric dx that can't be treated on an outpatient basis |
| Dx that warrant admission to acute care hospital | initial onset of a new illness or maj health prob. acute exacerbation of chronic illness, involuntary admission in psych if he is considered to be danger to self or others |
| Leng of stay in Acute care hospital | Determined by dx and presenting symptoms. Can be limited to 1-7 days |
| What would cause a longer LOS in an acute care hospital? | requires significant documentation to justify need for further hospitalization. ongoing need for care frequently results in discharge to other setting. |
| OT eval in Acute hospital | Focuses on quick and accurate screening of major difficulties impeding fx. (cog status, home safety skills) |
| OT intervention focus in acute hospital | Stabilization of status. Engagement of client in ther relationship and purposeful activities/meaningful occupations so that he/she can see that change is poss. thereby encouraging follow up. |
| OT intervention focus in acute hospital (2) | Discharge planning and after-care referrals. Family, caregiver, and consumer education. |
| The role of an acute care OT practitioenr can be a generalist or a specialist (neonatology, burns) | specialized practice roles require advanced knowledge and skills that won't be covered on NBCOT test. |
| Admission basis for sub-acute care/intermediate care facilities (ICFs) | Adfmission is for a medical or psychiatric dx that has progressed from an acute stage but has not stabilized sufficiently to be treated on an outpt. basis |
| LOS in a sub-acute care/intermediate care facility (ICF) | Is determined by dx and presenting symptoms. LOS range from 5-30 days. |
| What would cause a longer LOS in a sub acute care/intermediate care facility? | Longer LOS require significant doc to justify need. Ongoing need for intervention or long-term care frequently results in dx to another setting. |
| OT eval in subacute | can include more in-depth assessmetns and more thorough observations of client's functional performance |
| OT intervention focus in subacutes | fx improments in performance components and and performance areas. Acctive engagement of client in tx planning, inmplementation, and reeval. Discharge planning |
| SUB acute care and ICFs can be housed in hospitals or skilled nursing facilities (SNFs) | |
| Admission bases for long term acute care hospital (LTAC) | For chronic or catastrophic illnesses or disabilities that requrie extensive medical care and or dependency on life support ventilators. Patients often have multiple dx. with complications |
| Ave LOS in LTAC | greater than 25 days to mainta9in medicare certification |
| OT eval and intervention is often limited by the populations' sever and complex medical needs | For all clients, eval and interventions are palliative care and prevention of and tx. of complications (positioning) |
| OT eval and intervention for patients who are cognitively intact in LTAC | Mastery of the env and the attainment of client-centered goals |
| Admission basis for rehabilitation hospitals | Disability that is medically stable but which has residual functional deficits requring skilled rehab services |
| LOS in Rehab hospial | determeined by deficits and rehab potentional. Can last a week to months. Documentation to extend LOS dependent on institutional, state, 3rd party payers guidelines |
| When does LOS end in a Rehab facility | When coverage is ended. Pt. is then discharged to either a SNF, supportive community residence or home/ind lvining |
| OT eval in rehab hospital | Can be extensive and focus on all areas of occ, performance skills and occ roles required in expected env. Home EVAL PRIOR TO DX |
| OT intervention in rehab hospt. | 1. functional improvement in performance areas, performance skills, and occupational roles. 2. development of compensatory strategies for residual deficits. |
| OT intervention focus in rehab hospital | provision of AE and training in use of equip. modification of discharge env, as needed. Family and pt. educ |
| Admission to long term hospital | admission is for a medical or psych dx that is chronic w/ the presence of symptoms that cannot be treated on an out patient basis |
| LOS in long term hospital | Determined by dx and presenting symptoms, range month-years. Doc required for increased stay. |
| Dx from Long term hospital | When insurance coverage is expended pt may be discharge to state run long term hospital, SNF, home or supportive residence |
| OT eval in long term hospital | Can be extensive 2/2 increased LOS. |
| OT intervention focus in long term hospital | functional improvemens in performance skills, perform areas. Dvlpmt compensatory strategies for residual deficits, maintenace of QOL, dvlpmt skills for discharge into least restrictive env. |
| Admissions criteria within forensic settings | Admission due to engagement in criminal activity. Person can be on nature of crime and if he she has psyc dx |
| Forensic setting- possible settings | 1. Jail - sentence less than year and 1st entry into criminal just syst. 2. Prison - sentence greater than year 3. Forensic psych hosp or unit- spec hospital or unit w/in hosp |
| Availability of OT services in forensic setting | Varies - none in jail to extensive services in forensic hospitals. Due to serious gaps in mental health services, incarceration of persons with mental illness has increased significantly (homeless schizophrenic pt. steals bread - goes to jail) |
| OT eval and intervention focus in forensic setting | 1. determine competency to stand trial in forensic psych settings. develop comm living skills for community reintegration. Facilitation of skills and provision of structured programs for person to function at highest level w/in current setting. |
| OT intervention focus in forensic setting | Restoration of competency to stand trial in forensic psych settings |
| Requirements for outpt/ambulatory care | An indivdiaul who does not require hospitalization but has fucntional deficits requiring eval and intervention may receive ot services on an outpt. basis in private clinics, medical offices, and/or hospital satellite centers. |
| Focus of outpatient care | Diagnostic evaluations, interventions to increase functional performance, consumer ed, and prevention |
| Community Based Practice settings | 1. Early intervention programs, 2. Schools 3. Supported ed programs 4. Prevocational 5. Vocational programs 6. Residential programsPartial hospitalization/day hospital program 8. Clubhouse 9. Adult day care 10 Outpt./ambulatory care 11. Home health |
| Community Based Practice settings | 12 Hospice. 13 Case mgmt. 14. Wellness and prevention |
| Acceptance criteria for early intervention eval based on "at risk" status of infant/child | 1. Birth cvomplications 2. Suspected developmental delays 3. Failure to thrive 4. maternal substance abuse during pregnancy 5. Birth to adolescent/teen mom 6. est disability dx |
| Acceptance criteria for early intervention based on follow criteria | 1. Extent of delay (33% delay in one area or 25% delay in 2 areas) 2. An est. dx/disability |
| Length of service provision for early intervention program | infant family service plan completed by service coordinator after review of all assessments and in collab with family and early intervention team. 6 mo reviews submeitted by all professionals to determine cont. services |
| Occ therapy eval looks at 5 developmental areas | A. Cognitive B. Physical C. communication D. Social-emo E) Adaptive and how they affect play and self care. |
| OT eval for early intervention program | must be written in strength-oriented manner. Fx goals written in family friendly terms including level of fxing, uniqque needs, recommended services |
| OT Intervention process for early intervention program | Dvlpmt cog, psychosocial, sensorimotor components. Dvlpmt of play, self-care and developmental skills. Family ed. Advocacy and advocacy training. Transition planning from early intervention to preschool if needed. |
| Acceptance criteria for OT services as a related service in educational setting - schools | Kid needs special education, and OT will enable child to benefit from special education. OT will facilitate kid's participation in ed activities. |
| Source of referral for OT services in school setting | Previous agency that provided early intervention services, the child's teacher, and/or school's child study team. |
| Who reviews the OT referral | School reviewsthe referral and, if indicated, recommends an OT eval. If OT eval already completed, need for OT discussed. Frequency , length of session, and duration are also determined |
| Length of OT services in school setting | Dependent upon impact of OT servcies on the child's abilities and prevention of loss of abilities in the pursuit of education. Review of servcies and progress in IEP which is done annually |
| OT evaluation | assess client factor, performance skills and patterns and areas of of occ that impact ed performance of child w/in school finding are used in IEP. Assess functional dvlpmtl level to contribute to functional Beh analysis |
| OT intervention focus in school setting | Educational model. child's functional and academic performance. Activities address goal in IEP using corrective and compensatory methods. AT and transition servcies. |
| OT intervention focus in school setting | Impared client factors and performance skills treated to increase ability in school.Skills for adult life post-school in accordance with individual transition plan |
| True or false? the role of OT in school based practice has expanded beyond IDEA related servcies to include programs that address students' psychosocial needs and prevent school violence | True |
| Behavioral intervention Plans | Include Response to Intervention (RtI), Early Intervening Services (EIS), and Positive Behavioral Supports (PBS) may be a component of school-based OT services |
| Response to intervention (RtI) | an evidence-based, structured intervention apporach that uses early intervening services (EIS) to address academic difficulties and Positive Behavioral Supports (PBS) to address behavioral problems early in a child's education. |
| Participation in supported educ programs | Adolescents or adults who require intervention to develop skills that are needed to succeed in secondary and/or post-secondary education - person may have never developed skills or lost them d/t dis mental health problems |
| Length of participation in supported ed program | determine by agency's funding and person's attainment of gaols. Discharge is upon entry into, or completion of ,ed program or GED. |
| OT intervention focus in supported ed programs | Ed and training in compensatory strategies to support ac performance. Exploration of participant's ed interests and aptitudes to ensure self-determined engagement in school, college or other adult ed program |
| Participant criteria for Prevocational Program | Adolescents or adults who require intervention to develop skills prerequisite to work d/t never having the skills d/t developmental delay, env insufficiencies, illness or disability or having lost skills d/t illness or disability |
| LOS in prevocational program | determined by funding and attainment of goals. Discharge to a vocational program. Discharge to work setting can happen if sufficient abilities are developed |
| OT eval | focused on task skills, social interaction skills, work habits, interests, aptitudes |
| OT intervention focus | improve task skills and social skills. Develop work habits and abilities3. explore work interest and aptitudes |
| Participation critera in vocation prgram | Good prerequisite skills to work but requires training for specific job, and or ongoing structure, support and/or supervision to maintain employment. Need to build up work skills to be competitively employed |
| LOS in vocation program | Discharge may not be a goal. Instead maintenance of person in specific work env. may be the goal for some. Others will be discharged to other programs or to work |
| Transitional Employment PRograms (TEP) | One of the vocational programs. time limited 3-6 months with discharge to competitive employment, supportive employment, or rehab workshops |
| Employee Assistance Programs (EAPS) | provide ongoing support, intervention, and referrals as needed to a company's employees to enable these ind. maintain employment |
| OT intervention in vocational program | Remediation; developmetn of general work abilities and specific job skills, consultation to and or supervision of voc direct staff, ID and implementation of reasonable accommodations, Referral to vocrehab or one stop centers |
| Admission to residential programs | For a developmental, medical, or psych condition that has resulted in functional deficits that impede ind. living but not severe enough for hospitalization |
| Continuum of residential programs | 24 hour supervised quarter way houses>halfway houses>group homes>supportive apts with weekly or biweekly "check-in"supervision. Degree of functional impairment determines residential level of care |
| Length of stay in residential programs | transitional living programs determined by agency's funding. Long term and permanent housing available and funded through individual's social security benefits. |
| OT evaluation for residential programs | assess indivdual's skills for living in the community and determination of the soc and env resources and supports needed to maintain the indivdiual in his/her current and expected living env. |
| OT intervention focus for residential programs | Consultation or supervision of program staff. Remediation for independent living skills. ADL training, activity adaptation, env mod. Referral > residential services. Educ about ADA, Fair housing act and Section 8 housing. |
| Admission to partial hospitalization/day hospital programs | For medical or psych condition that has been sufficiently stabilized to enable an indivdiual to be discharged home or to a community residence but pt. still has symptoms requirng tx. |
| Length of tx. in partial hospitalization/day hospital programs | Up to 5 days of week with multiple interventions each day. |
| LOS in partial hospitalization/day hospital programs | determined by dx, presenting symptoms, response to tx. 1 week- 6 months. Once LOS expendend discharge to less intensive comm day program and/or clubhouse |
| OT evaluation in partial hospitalization/day hospital programs | Focused on functional skills and deficits in peformance areas and occupational roles required in patient's current and expected env. |
| OT intervention focus in partial hospitalization/day hospital programs | Fuxl improvement in performance areas and occupational role functioning. Remediation of underlying performance skill deficits. Developmetn of skills for community living and id of community supports for comm integration |
| Membership to clubhouse program | Open to adults and elders with a current or hx of mental illness. All have equal access to clubhouse fx and opportunities regardless of dx and functioning level. Only violent persons excluded |
| Services provided in clubhouse | staff and members responsible for operating clubhouse equally under oversight by director |
| Purpose of staff in a clubhouse | to engage membership and provide support and structure |
| Schedule of clubhouses. | Vary to meet members' needs. Typically open 5-7 days a week. Daily schedule around 9-5 work ordered day. Evening and weekend schedule focused on interests and recreation. |
| Services provided in clubhous | literacy and education programs, transitional employment placements, independent employment assistance, community support and outreach, housing programs, legal and financial advisement |
| OT eval and itnervention in clubhose | NOt formal. Role of OT is integrated itno clubhouse model which has staff acting as generalist who contribute to the developmetn and enrichment of members' abiliities |
| Admission to adult day care | For adults or elders with chronic physical or pschysocial impairments and for persons frail but sem ind. |
| Services in adult day care | Group. Can be one afternoon a week to 5. |
| LOS in adult day care | Indepfinite. servcies provided to indivdiauls with chronic cond who might otherwise be institutionalized or to indivdiuals who are frail and need ongoing support |
| OT eval for adult day care | focused on client factors, functional skills and deficits in performance areas, home env., and adult day cente's env. |
| OT intervention focus for adult day care | Maintenance of abilities and facilitation of adaptation to impairments. Engagement in purposeful appropriate releveant activities which help foster community. Caregiver ed, support groups, home visits, consultations, referral, Home and day ctr mod |
| Admission to outpt./ambulatory care | For medical or psych condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from hospital but remaining symptoms require active tx. |
| Duration and LOS for tx | tx 30-60 min session 1-5 times a week. LOS determined by dx, presenting symptoms, response to tx, and insurance or ability to pay |
| Acceptance criteria for home health care | medi or psych cond not serious enough for hospitalization or that has stabilized after hospitalization. Strict rules by medicare |
| Duration and LOS for tx | 60 min sessions 1-5 days a week as determined by insurance. LOS determinedby dx, presenting symptoms, response to tx, insurance, or ability to pay |
| OT intervention in home health | Engage client and family in tx planning, implementation and reeval. improvemnt in areas of occu and occ roles related to home. Remediation. Family pt. education. Env mod and activity adapt. Increase ability to resume roles outside home. |
| OT intervention in home health | Prevent hospitalization and avoidance or delay of residential institutional placement |
| Acceptance criteria for hospice | Terminal illness that has a life expectancy of 6 months or less |
| Where are hospice services provided? | In home or an independent facility or a special unit of a SNF or hospital |
| OT eval for hospice | focus on determining indivdiual's occ functioning and his/her physical, psychosocial, spiritual, and env needs that are most imp to him/her. |
| OT intervention focus for hospice | Maintance of pt control over his/her life. Engagement in menainful occs and activities. Reduction or removal of distressing symptoms and pain. |
| OT intervention focus for hospice | Environmental modifications and activity adaptations that maintain optimal functioning and improve QOL. Caregiver and family ed |
| Two focuses of case magaemtn programs | Clinical or administrative |
| Clinical case management | Provides individualized support and intervention to a client with serious illness which significantly limits ability to access and/or engage in existing comm services or ther program, ensuring pt can stay in comm and not be hospitalized |
| Administrative case management | connects person with a serious illness to the appropriate and needed community services and/or therapeutic programs, overseeign this service provision to ensure that quality of care in a cost-effective manner is achieved |
| Location of services for case mgmt. | office, indivdiaul's home and community |
| OT eval for case mgmt | focused on indivdiual's functional assets and deficits in his/her performance sklls, areas of occupation, and the occupational roles that are requried in his/her current expected env. Assessment of supports and barriers to comm integration is critical |
| Case mgmt interventions | Referral based in the administrative model or encompass the full range of itnerventions in the clinical model (e.g., one-on-one counseling, family ed, ADL training, community re-entry) |
| Purpose of case mgmt | to prevent regression and re hospitalization and promote optimal functioning and QOL |
| Acceptance into wellness and prevention programs | self referral to meet a personal need or instittuion's provision of a program to its members or employees |
| Evaluation for wellness and prevention programs | focuses on risk factors for illnesses and disabiltiies and the indivdiual's functional skills and deficits in the occupational roles |
| Intervention focus for wellness and prevention programs | disease prevention and health promotion. Can range from home safety to life coaching. |
| Private and ind. practice | OT practitioner can work in entrepreneurial manner in all community and institutional setting by negotiating a fee for service agreement and/or a long term contract |
| Function of OTAs in private ind practice | OTAs must receive supervision from an OT and abide by all state and fed regulations for OT practice |
| Administrative fx of management | Program developmetn, fiscal and personnel managemetn, program evaluation. (p 91) |
| 4 basic steps of program development | Needs assessment, Program planning,, Program implementation, Program evaluation |
| Role of OTA in program development | Colalborate with OT. PErform specific tasks with OT supervision. If employed as activities director, OTA may be primarily responsible for all program development steps. |
| Needs assessment methods | Survey, interview, or self report of targeted pop. Representative sample is required. Key informant. Community forums. Service utilization review. Analysis of social indicators to predict problems. |
| Role of OTA in personnel mgmt | Collaborate with OT and perofrm specific mgmt tasks as delegated by OT and with OT sueprvision. If employed as activities director, OTA may be primarily responsible for all aspects of personnel mgmt in that dept. |
| Role of OTA in program eval and quality improvement | collaborate with OT and contribute to process by performing specific tasks with OT supervision. |
| Role of OTA in program eval and quality improvement | An OTA may assuem primary responsibility for this process if an OTA is directly responsible for program outcome (e.g., as the director of activities program in a SNF) |
| Major types and terms for program evaluations | 1. Continuous quality improvement 2. Total quality mgmt (TQM) 3. Performance assessment and improvement (PAI )Utilization review 5. Statistical utilization review |
| Major types and terms for program evaluations | 6. Peer review 7. prospective review 8. concurrent review 9. retrospective review 10. risk management |
| Continuous quality improvement (CQI) | system-oriented approach that views limitations and probs proactively as opportunities to increase quality |
| Goals of continuous quality improvement | 1. Prevention is emphasized 2. blame is not attributed to person; problems are related to organizatioal improvement needs |
| Total quality mgmt (TQM | creation of an organizational culture that enables all employees to contribute to an env. of continuous improvement to meet or exceed consumer needs |
| Performance assessment and improvement (PAI) | systematic method to eval the appropriateness and quality of service |
| Distinction of PAI | Utilization of interdisciplinary systems focus. client-centered approach focuses on the rights, assessment, care, and education of person. org ethics, improved organizational performance, leadership and mgmt emphasized. |
| Utilization reveiw | plan to review the use of resources w/in facility. |
| Purpose of utilization review | determine medical necessity and cost efficiency. Often a component of a CQI or PAI |
| Statistical utilization reveiw | reimbursement claims data are analyzed to determine the most efficient and cost-effective care |
| Peer review | system in which the quality of work of a group of health professionals is reviewed by their peers |
| Professional review organization )PRO) | Group of peers who eval the approrpiateness of services and quality of care under reimbursement and/or state licensure requirements |
| Prospective review | evaluation of proposed intervention plan that specifies how and why care will be provided. Used by third party payers to approve proposed OT inetervention programs |
| Concurrent review | eval ongoing intervention program during hospitalization, outpatent or home care tx. Method to ensure appropriate care is being delivered. Compoentn of CQI or PAI |
| Retrospective review | Audits of med records after intervention rendered |
| Purpose of retrospective review | method to ensure approrpiate care was given. A UR tool for 3rd party paers tha can be time consuming and costly |
| Risk mgmt | process that identifies, evaluates, and takes corrective action against risk and plans, organizes and controls the activities and resources of OT services to decrease actual or potential losses. |
| Potential risks identified by risk mgmt | clietn or employee injury and property loss or damage with resulting liability and financial loss. |
Created by:
Marselephant