Psychosocial approaches (ch 14)

Question 1

ACL level 1

Answer 1

Automatic Actions: automatic motor responses and changes in the autonomic nervous system. Conscious response to the external environment is minimal.

Question 2

ACL level 2

Answer 2

Postural Actions: movement that is associated with comfort. There is some awareness of large objects in the environment, and the individual may assist the caregiver with simple tasks.

Question 3

ACL level 3

Answer 3

Manual Actions: beginning to use hands to manipulate objects. The individual may be able to perform a limited number of tasks with long-term repetitive training.

Question 4

ACL level 4

Answer 4

Goal Directed Actions: the ability to carry simple tasks through to completion. The individual relies heavily on visual cues. He may be able to perform established routines but cannot cope with unexpected events.

Question 5

ACL level 5

Answer 5

Exploratory Actions: overt trial and error problem solving. New learning occurs. This may be usual level of functioning for 20% of the population.

Question 6

ACL level 6

Answer 6

Planned Actions: absence of disability. The person can think of hypothetical situations and do mental trial-and-error problem solving.

Question 7

The 3 components of CBT are didactic aspects, cognitive techniques, and behavioral techniques… define them…

Answer 7

• didactic aspects involve the therapist explaining the basic concepts and principles of CBT to the client.
• cognitive techniques involve eliciting automatic thoughts, testing automatic thoughts, identifying maladaptive underlying assumptions, and testing the validity of maladaptive assumptions.
• behavioral techniques are used with cognitive techniques to test and challenge maladaptive and inaccurate cognitions.

Question 8

In CBT, what is the “cognitive triad”?…

Answer 8

A pattern of negative thinking… comprised of negative self-evaluation, pessimistic world view, and sense of hopelessness regarding the future.

Question 9

Dialectical Behavior Therapy (DBT) is a form of CBT that focuses on…

Answer 9

addressing suicidal thoughts and actions and self-injurious behaviors. Commonly used with borderline personality disorder; also used to treat patients with depression, substance abuse, and/or eating disorders.
DBT uses assertiveness, coping, and interpersonal skills training.

Question 10

The goal of psychiatric rehabilitation is…

Answer 10

to help individuals develop the skills necessary to compensate for, adapt to, and/or control the influence symptoms have on function, including any disability caused by social or enviro barriers.

Question 11

The recovery model’s primary focus is…

Answer 11

to improve quality of life and the ability to attain desired life goals through self-advocacy.

Question 12

Short Portable Mental Status Questionnaire (scoring)

Answer 12

1-10. 0 is intact intellectual functioning; 8-10 is severe intellectual impairment.

Question 13

Hamilton Depression Rating Scale (population, focus, method, scoring)

Answer 13

Population: individuals with mood disorder.
Focus: measures severity of illness and changes over time in people with depressive illness.
Method: interview and consultation with family/staff.
Scoring: each item rated 0-2, with 0= absent and 2= present; 17 items rated. No significance to score, just notes changes.

Question 14

Bay Area Functional Performance Evaluation (BAFPE)

Answer 14

Population: adults with psychiatric, neurological, or developmental diagnoses.
Focus: assess the cognitive, affective, performance, and social interaction skills required to perform ADLs
Method: interview, Task Oriented Assessment, Social Interaction Scale.
Scoring: scores of TOA and SIS are not combined. Scores give idea of overall function and person’s cognitive affective, social, and perceptual motor skills.

Question 15

Comprehensive Occupational Therapy Evaluation Scale (COTE scale)

Answer 15

Population: adults with acute psych diagnoses.
Focus: structured method for observing and rating behaviors and changes in areas of general, interpersonal, and task skills.
Method: behavior observed during therapy session while person does a task.
Scoring: each item rated 0 (normal) to 4 (severe)

Question 16

Activities Health Assessment

Answer 16

Population: adults through elders
Focus: time usage, patterns and configurations of activities, roles, and underlying skills and habits.
Method: person completes a schedule (color-coded chart) depicting the way his time is spent during a typical week
Scoring: not scored. Determination of person’s activities health made by person and OT based on schedule, questionnaire, and interview.

Question 17

Adolescent Role Assessment

Answer 17

Population: ages 13-17
Focus: assess the development of internalized roles within family, school, and social settings.
Method: semi-structure interview.
Scoring: indicates behavior that is appropriate, marginal, or inappropriate.

Question 18

Barth Time Construction (BTC)

Answer 18

Population: adolescent through elder
Focus: time usage, roles, and underlying skills/habits
Method: person makes a color-coded chart depicting the way his time is spent during typical week.
Scoring: not scored. significance of info based on appropriate use of time and discussion with person.

Question 19

Occupational Circumstances Assessment Interview Rating Scale (OCAIRS), version 4

Answer 19

Population: most anyone with psychiatric diagnoses, and now phys dis, mental health, and forensic mental health
Focus: the nature and extent of a person’s occupational adaptation. 12 areas of occupational adaptation explored.
Method: semi-structured interview.
Scoring: each item rated 1-4 (4 highest). Case analysis method used to interpret data according to MOHO to make a profile of person’s strengths/weaknesses.

Question 20

Occupational Self-Assessment

Answer 20

Population: 18+
Focus: self-report checklist of person’s perceptions of efficacy in areas of occ performance and their importance.
Method: two=part self reports. Clients give list of 21 everyday activities.
Scoring: clint uses 4-point scale to rate how well they do each activity, then 4-point scale to report how important activity is.

Question 21

The Role Checklist

Answer 21

Population: adolescent+ with physical or psychosocial dysfunction
Focus: assesses self-reported role participation and value of specific roles to the person.
Method: checklist completed by person alone or with OT. Asks person to identify major roles in life, and degree to which he values each role.
Scoring: not scored; used to address goal identification and tx planning, QoL, and discharge planning.

Question 22

what are projective assessments?

Answer 22

based on psychodynamic/psychoanalytic models, they allow clients to project intrapsychic content for discussion and resolution in therapy by bringing unconscious intrapsychic conflicts to consciousness through the completion and processing of an activity.

Question 23

Managing problem behaviors:

Hallucinations

Answer 23

• create an environment free of distractions that trigger hallucinatory thoughts and interfere with reality-based activity.
• use highly structured simple, concrete, and tangible activities that hold the individual’s attention.
• when the person appear to be focusing on a hallucinatory experience, attempt to redirect him to reality-based thinking and actions.

Question 24

Managing problem behaviors:

Delusions

Answer 24

• do not attempt to refute the delusion.
• redirect the individual’s thoughts to reality-based thinking and actions.
• avoid discussions and other experiences that focus on the validate or reinforce delusional material.

Question 25

Managing problem behaviors:

Akathisia (need to be in constant motion)

Answer 25

• allow the person to move around as needed if it can be done without causing disruption to the goals of the group.
• keep in mind that participation on many levels and in many forms can be beneficial to the individual
• whenever possible select gross motor activities over fine motor or sedentary ones.

Question 26

Managing problem behaviors:
Offensive behavior (physical or verbal)

Answer 26

• set limits and immediately address the behavior during a session.
• reasons the behaviors are not acceptable should be clearly presented in a manner that is not confrontational/judgmental
• the consequences of continued offensive behavior should be clearly communicated
• it is required that staff protects all patients from the threat of harm or abuse by another patient. The needs of the entire unit and/or group membership must be kept in mind.

Question 27

Managing problem behaviors:

Lack of initiation/participation

Answer 27

• together with the person, identify the reasons for lack of participation
• motivational hints: people are more likely to participate in things that interest them; give more ownership to patients; allow them to success; make it fun; give positive feedback/rewards; identify the patient’s motivators; curiosity is motivating; food is often motivating; give choices; encourage patient to remain in group and participate when ready.

Question 28

Managing problem behaviors:

Manic or monopolizing behavior

Answer 28

• select/design highly structured activities that hold the person’s attention and require a shift of focus from patient to patient.
• thank the person for their participation and redirect attention to another group member
• limit-setting!!

Question 29

Managing problem behaviors:

Escalating behavior

Answer 29

• avoid what can be perceived as challenging behavior (ex. eye contact, standing directly in front of person).
• maintain a comfortable distance
• use a calm, but not patronizing tone (speak in a softer tone than the person)
• speak simply, clearly, and directly. Avoid miscommunication.
• do not make value judgments about the person’s thoughts, feelings, or behaviors
• clearly tell the person what you want them to do.
• avoid positions where you or the patient feel trapped.

Question 30

Managing problem behaviors:

Acting out behavior in children

Answer 30

• interpretation: therapist puts words to observed behavior, enabling the child to appropriately express the feelings he is having.
• redirection: refocus the child on the assigned or current activity that provides cues for appropriate participation.
• limit setting: inform the child of what is permissible and what is not.
• time-out: remove the child from a problematic situation to a specific area.

Question 31

Managing problem behaviors:

Effects of dementia

Answer 31

• make eye contact and show you are interested in the person
• validate what the person says
• maintain a positive and friendly facial expression and tone of voice during ALL communication. do not give orders; use short sentences; do not argue
• do not speak about the person as if he wasn’t there.
• use non-verbal communication
• create a routine that is familiar and enjoyable to the person. do not rush activities.
• always attend to safety issues.

Question 32

RADAR approach to screen for and respond to domestic abuse…

Answer 32

R= routinely ask. ask everyone.
A= affirm and ask. acknowledge and support person who discloses abuse. ask direct questions to determine risk.
D= document objective findings and record client statements in quotes
A=assess and address the person’s safety.
R= review options and referrals. refer person to hotlines, shelters, etc.