SMART
specific measurable attainable relevant time-limited
RUMBA
realistic understandable measurable behavioral achievable
characteristics of standardized assessment
- Description of purpose
- Administration and scoring protocol
- Established norms and validity
validity
accuracy of measuring what assessment intends to measure
content validity
content included in evaluation is representative of content that could/should be measured
criterion validity
compares assessment to another one with already established validity; reported as a correlation
types of criterion validity
concurrent validity
predictive validity
concurrent validity
compares results of two instruments given at the same time
predictive validity
compares degree to which an instrument can predict performance on a future criterion
reliability
establishes consistency of the assessment
measured as a correlation or percentage
primary prevention
reduce incidence in a well population that is at risk
AOTA framework terms as: “create/promote” and “ health promotion”
secondary prevention
early detection in at-risk population to minimize effects
tertiary prevention
elimination/reduction of impact of dysfunction (ie. rehab services)
universal human needs
psychophysical temporal balance and regularity safety love and acceptance group association mastery esteem sexual pleasure self actualization
types of intervention
Prevention Meeting health needs The change process Management Maintenance
Prevention interventions
designed to promote wellness, prevent disabilities and illnesses, and maintain health
meeting health needs interventions
designed to satisfy inherent, universal human needs that are not inherently met
change progess interventions
designed to achieve behavioral changes and functional outcomes (most commonly used, documented, and reimbursable interventions in OT practice)
management interventions
designed to reduce or minimize disruptive or undesirable behavior that interfere with therapeutic activities or procedures needed to change ares of dysfunction that are the main focus of intervention
psychophysical needs
need for adequate shelter, food, material goods, sensory stimulation, physical activity, and rest
temporal balance and regularity needs
need for a satisfying balance between work/productive activities, leisure/play, and rest
safety needs
need to be in an environment free from hazards or threats
love and acceptance needs
need to be accepted and loved for one’s personal attributes and uniqueness, not for one’s accomplishments
group association needs
need to feel a connection to others who share similar interests and goals
mastery needs
need to successfully complete an activity or meet a goal because it is interesting and challenging
esteem needs
need to be recognized for one’s accomplishments
sexual needs
need for recognition of one’s sexuality and the satisfaction of sexual desires
pleasure needs
need to do things just for fun
self actualization needs
need to engage in activities just for one’s self and for personal satisfaction
maintenance interventions
designed to support and preserve the individual’s current functional level
- no improvement in function is expected due to the nature of disease
- often critical in long term care settings
- reimbursed by medicare IF skill required for safe and effective intervention (ie eval and re-eval of programs)
purpose of screening
to determine need for further evaluation in a given area
reasons for discharge
- goals have been met
- pt has reached a functional plateau
- pt does not require skilled services; maximum benefit has been achieved
- exacerbation of illness or medical crisis requires d/c to higher level of care
- pt’s allotted length of stay has expired and extension is not possible
occupation
goal-directed pursuits which typically extend over time
- have purpose, value, and meaning
- Are the ordinary, familiar things people do everyday
areas of occupation
ADLs IADLs Work Education Play/Leisure Social Participation
ADLs
activities that involve care of self
IADLs
activities that involve environmental interaction, are more complex than ADLs
purposeful activities
doing processes that are directed toward a desired and intended outcome; goal directed tasks/behaviors that make up occupations
procedural reasoning/scientific reasoning
involves identifying OT problems, goal setting, and treatment planning via systemic gathering and interpreting of client data.
The actual technical “doing” of practice that is most often documented for reimbursement purposes
interactive reasoning
deals with how the disability or disease affects the person; focuses on the client as a person
Involves the therapeutic relationship between the therapist, the individual, and caregivers
narrative reasoning
deals with the individual’s occupational story and focuses on change needed to reach an imagined future.
Identifies what activities and roles were important to the person prior to illness/injury and what activities the individual would realistically like to engage in in the future
pragmatic reasoning
considers the context of which the OT practitioner’s thinking occurs
Focuses on the treatment possibilities within a given treatment setting, also considering the OT’s values, knowledge, abilities, and experience
conditional reasoning
involves ongoing revision of treatment, focusing on current and possible future social contexts
Integrates interactive, procedural, pragmatic, and narrative reasoning
therapeutic use of self
the practitioner’s conscious, planned interaction with the individual, family, and/or caregivers
Phases of group development
origin orientation intermediate conflict cohesion maturation termination
origin phase of group development
involves the leader composing the group protocol and planning for the group
orientation phase of group development
involves members learning what the group is about, making preliminary commitment to the group, and developing initial connections with other members
intermediate phase of group development
involves members developing interpersonal bonds, group norms, and specialized member roles through involvement in goal-directed activities and clarification of group’s purpose
conflict phase of group development
members challenging the group’s structure, purposes, and/or processes; characterized by disagreement among group members
this phase must be overcome in order for group to continue
cohesion phase of group development
members regrouping after conflict with a clearer sense of purpose and a reaffirmation of group norms and values, leading to group stability
maturation phase of group development
involves members using their energies and skills to be productive and to achieve group’s goals
termination phase of group development
dissolution of the group due to lack of engagement of members, inability to resolve conflict, administrative complaints, goal attainment, or task accomplishment
instrumental group roles
functional and assumed to help the group select, plan, and complete the group’s task (ie. initiator, organizer)
expressive group roles
functional and are suuemed to support and maintain the overall group and to meed member’s needs (encourager, compromiser)
individual group roles
dysfunctional and contrary to group roles, for they serve an individual purpose and interfere with successful group functioning
group norms
standards of behavior and attributes that are considered appropriate and acceptable to the group (both explicit and non-explicit)
therapeutic norms
- Encourage self-reflection, self-disclosure, and interaction among members
- Reinforce the value and importance of the group by being on time and well prepared
- Establish an atmosphere of support and safety
- Maintain confidentiality and respect
- Regard group members as effective agent of change by not placing the group leader in the expert role
group goals
the desired outcomes of the group that are shared by a sufficient number of the group’s members
group communication
the process of giving, receiving, and interpreting information through verbal and nonverbal expression
group cohesiveness
the degree to which members are committed to a group and the extent of members’ liking to the group
factors that contribute to group cohesiveness
- extensive interaction between members
- similarity or complementariness in member characteristics
- perception of relevance of group to individual needs
- members’ expectation of goal attainment and successful group outcome
- democratic leadership and member cooperation
group decision making
the process of agreeing on a resolution to a problem
types of group decision making
unanimous
consensus
majority rule
compromise
directive leadership
when the therapist is responsible for the planning and structuring of much of what takes place in the group
facilitative leadership
therapist shares responsibility for the group and for group process with the members
advisory leadership
therapist functions as a resource to the members, who set the agenda and structure the group’s functioning
medicare indicators for group membership
- Engage willingly with the group
- Attend to group guidelines/procedures
- Actively participate in group process
- Benefit from group leadership input
- Benefit from group membership/peer input
- Respond appropriately throughout group process
- Incorporate feedback
- Complete activities toward goal attainment
- Attain greater benefit from the group intervention than from 1:1 interventions
Medicare criteria for group leadership
- provide active leadership
- instruct members as a group
- monitors and documents individual’s participation and response to intervention
- provides individualized guidance and feedback
- documents person’s progress toward goals defined in the individual intervention plan in objective, measurable, functional items
advantages of co-leadership
- Each leader can assume different leadership roles, tasks, styles
- Both leaders can provide and obtain mutual support
- observations and objectivity can increase
- co-leaders can share knowledge and skills
- co-leaders can model effective behaviors
disadvantages of co-leadership
- splitting by group members one leader against the other
- excessive competition among co-leaders
- unequal responsibilities resulting in an unbalanced work load among co-leaders
Evaluation group
to enable client and therapist to assess client’s skills, assets, and limitations regarding group interaction
Thematic group
to assist members in acquiring the knowledge, skills, and/or attitudes needed to perform a specific activity
participants must at least have parallel group skill level to participate
Topical group
to discuss specific activities that members are engaged in outside of group to enable them to engage in the activites in a more effective, need-satisfying manner
must be at egocentric-cooperative level
concurrent topical group
concerned with activities already engaged in outside of the group (ie. parenting skills)
anticipatory topical group
concerned with activities that are expected to be done in the future (ie. d/c planning group)
task oriented group
to increase clients’ awareness of their needs, values, ideas, feelings, and behaviors as they engage in a group task. Activities are chosen by the members
for individuals with cognitive and socioemotional deficits; must have at least fair verbal skills and able to interact with others
[Psychodynamic FOR]
Developmental group
a continuum of groups consisting of parallel, project, egocentric-cooperative, cooperative, and mature groups to teach and develop members’ group interaction skills
parallel group
work on task while sharing space with others
minimally interact with other members even though task completion does not require interaction
to develop basic level of awareness
project group
group members cooperate to complete a short term activity together
Enables members to give and seek assistance
OT selects and structures activity
Egocentric-cooperative group
group members (5-10) cooperate to complete a long term activity together that requires cooperation; members select and implement activity
Enables members to identify and meet needs of themselves and others
OT: less active and direct; facilitates members to fulfill leadership roles to function independently; provide guidelines
cooperative group
enables members to engage in group activity that facilitates free expression of ideas and feelings (not always a tangible end product)
OT: advisor
mature group
enable members to assume all functional socio-emotional and task roles within a group. Each member selects, plans, and completes group task, however group needs are more important than individual needs
OT: act as a peer, group member
instrumental group
to help members function at their highest possible level for as long as possible
group makes no attempt to change the client; activity is selected and structured for highest possible level of function