Process of Occupational Therapy

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chalford23
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227473
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Process of Occupational Therapy
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2013-08-02 11:43:03
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Groups
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  1. Stages of Group Development
    • 1. Origin Phase
    • 2. Orientation Phase
    • 3. Intermediate Phase
    • 4. Conflict Phase
    • 5. Cohesion Phase
    • 6. Maturation Phase
    • 7. Termination Phase
  2. Origin Phase
    Phase 1:  leader composing the group protocol & planning for the group (size, member characteristics, location of meetings).
  3. Orientation Phase
    Phase 2: members learn about what the group is about, making preliminary commitment, developing initial connections
  4. Intermediate Phase
    Phase 3: developing interpersonal bonds, groups norms, & specialized member roles through involvement of goal-directed activities & clarification of group's purpose
  5. Conflict Phase
    • Phase 4: members challenge the group's structure, purpose, and/or processes; characterized by dissension & disagreements among members.
    • Unsuccessful resolution=dissolution of the group
    • Successful resolution=modifications to the group that are acceptable to members, enabling the group to proceed to the next phase
  6. Cohesion
    Phase 5: members regroup with a clearer sense of purpose & reaffirmation of group norms & values; leads to group stability
  7. Maturation
    Phase 6: members use their energies & skills to be productive & achieve group goals
  8. Termination
    Phase 7: dissolution, due to lack of engagement, inability to resolve conflict, administrative constraints (only 4 sessions allotted for D/C planning group), goal attainment, or task completion.
  9. Group Roles (3)
    Describe the patterns of behavior that are typical within groups
    • 1. Instrumental roles: functional & assumed to help group select, plan, and complete the group's task (initiator, organizer).  
    • 2. Expressive roles: functional & assumed to support & maintain the overall group & to meet member's needs (encourager, compromiser)
    • 3. Individual roles: dysfunctional & contrary to group roles, serve an ind. purpose & interfere with successful group functioning (agressor, blocker).
  10. Group norms-Therapeutic norms
    • 1. Encourage self-reflection, self-disclosure, & interaction among members
    • 2. reinforce value of being on time & well prepared
    • 3. establish atmosphere of support & safety
    • 4. maintain confidentiality & respect
    • 5. Regard group members as effective agents of change; don't place group leader in expert role
  11. Establishment of _______, ______, ______, ______ are priority in all group situations
    norms, safety, confidentiality, respect
  12. Group cohesiveness
    • degree in which members are committed to a group & extent of members' liking for the group 
    • sense of we-ness
  13. Directive leadership styles
    • therapist is responsible for the planning/structuring
    • cognitive, social, verbal skills, engagement are limited 
    • parallel or project group
    • select act.to be used
    • clear verbal/demo to complete task
    • provide maintenance & feedback 
    • leader's role is task accomplishment
  14. Facilitative leadership
    • therapists shares responsibility
    • members' skill levels of engagement are moderate
    • ego-centric-cooperative or cooperative
    • collaborate with members to select act.
    • share instruction
    • maintenance & feedback by members with leader facilitating process
    • Leader's role is to have members acquire skills through the expereince
  15. Advisory leadership
    • therapist is resource
    • members set the agenda, structure
    • members skills & engagement are high
    • members select & complete act. with advice from therapist
    • maintenance roles indepent by members
    • feedback occurs as natural part of the groups self-directed process
    • Therapists goals is to have members understand & self-direct the process
  16. Medicare indicators for group membership
    • engage willingly in group
    • attend to group guidelines/procedures
    • actively participate
    • benefit from group leadership input
    • benefit from group membership/peers input
    • respond appropriately
    • incorporate feedback
    • complete act. toward goal attainment
    • greater benefit from group versus 1:1
  17. Medicare criteria for group leadership
    • provides active leadership
    • instructs 
    • monitors & documents participation & response
    • provide ind. guidance & feedback
    • document ind. progress toward goals
  18. Altruism
    giving of oneself to help others
  19. catharsis
    relieving of emotions by expressing one's feelings
  20. universality
    recognizing shared feelings & one's problems are not unique
  21. existential factors
    accepting the fact that the responsibility for change comes from oneself.
  22. self-understanding (insight)
    discovering & accepting the unknown parts of oneself
  23. family reenactment leads to
    understanding what it was like growing up in one's family thought the group expereince
  24. guidance comes from
    accepting advice from other group members
  25. identification invloves
    benefiting from imitation of the positive behaviors of other group members
  26. instillation of hope is
    experiencing optimism through observing improvement of others in group
  27. interpersonal training occurs when
    receiving feedback from members regarding one's behavior (input)
  28. interpersonal learning occurs by
    learning successful ways of relating to members (output)
  29. Evaluation Group
    • Purpose: enable client & therapist to assess client's skills, assets, & limitations regarding group interaction
    • Assumption: one must observe the ind. in setting where skills can  be observed
    • Type of client: all ind. who will be involved in groups or lack group interactions skills
    • Role of therapist: 1) selects & orients memb. to purpose 2) selects act. require collaboration & interaction & provides supplies 3) doesn't participate or intervene (except for safety) 4) observes, reports 
    • 5) asks for clients input 6) validates assessment & establishes tx goals with each ind.  
    • Activities: tasks completed in one session & requires interaction to complete
  30. Thematic Group
    • Purpose: assist members in acquiring knowledge, skills, & attitudes needed to perf. specific act.  
    • Assumptions: 1) improvement of ability to engage outside the group results from teaching act. in group 2) learning is facilitated by practice & experiencing needed behaviors, with reinforcement of app. behaviors
    • Type of client: 1) Det. by specific goals of the group 2) needs, concerns, goals must match objectives of the group 3) must have min. group interaction skill level  PARALLEL GROUP
    • Role of therapist: 1) select, structure, grade act. to teach needed skills
    • 2) range from highly structured to advisor
    • 3) reinforce skill dev.
    • Activities: simulated, clear, structured act. to enable members to practice & learn needed skills, attitudes knowledge
    • act. directly related to needed skills-Cooking group to learn how to cook
  31. Topical Groups
    • Purpose: discuss act. members are engaged in outside of group to enable them to engage in more effective, need-satisfying way
    • 1) Concurrent topical groups-already engaged in (parenting skills group)
    • 2) anticipatory-expected to be done in future (D/C planning group for ind. completing short-term rehab)
    • Assumptions: 1) improvement of ability to engage in specific act. outside group result from discussion of these act.
    • 2) discussion of problem areas & potential solutions facilitate skill aquisition
    • Type of client: 1) ind. share current or anticipatory problems in functioning
    • 2) Ego-centric-cooperative group
    • 3) Sufficient verbal, cognitive skills to engage in discussion & problem-solve
    • Role of therapist: 1) facilitate group discussion 
    • 2) help members problem-solve, give feedback & support, reinforce skill aquisition
    • 3) share leadership with members; act as role model
    • Activities: 1) verbal discussion on circumscribed act. that members are engaged in or will be (parenting, homemaking, D/C from hospital, work, leisure)
    • 2) discussion of fears, problems, solutions, coping
    • 3) role play & homework
  32. Task-oriented group
    Purpose: 1) increase ind. awareness of their needs, values, ideas, feelings, & behaviors while engaged in group task.  

    • 2) improve intra-and interpsychic functioning by focusing problems which emerge in the process of choosing, planning, & implementing group activity.
    • Assumptions: 1) act. elicit ind. feelings, thoughts, behaviors
    • 2) act. are means help ind. explore & experience  these thoughts, feelings, behaviors
    • 3) through act. increase self-awareness & practice new behaviors
    • Type of client: 1) Ind. whose primary dysfunction is cognitive & socioemotional due to psychological & physical trauma
    • 2) fair verbal skills & can interact with others
    • Role of therapist: 1) initially-very active, defines group goals & structure
    • 2) assists with act. section, offers guidelines, and suggestions
    • 3) facilitates discussion among members
    • 4) feedback & support
    • 5) assists members in exploring relationships between thoughts, feelings, actions
    • 6) experiment with new behaviors 
    • 7) as group develops, therapist is less active, but continues to ensure task is means to an end, not end itself
    • Activities: 1) act. chosen by members & will create an end product or demonstrable service for the group itself or for persons outside the group
    • 2) act. selected, planned, carried out by members with understanding that task is means to study, understand, & practice behavior.
  33. Developmental Group-Levels
    • Continuum of groups-parallel, project,  egocentric-cooperative, cooperative, mature
    • Purpose: teach & develop members group interaction skills
    • 1. Parallel
    • 2. Project
    • 3. Egocentric-cooperative
    • 4. Cooperative
    • 5. Mature
    • Type of clients: ind. with decreased group interaction skills
    • Overall role of therapist: 1) assess level & place in app. group
    • 2) orients all members to goals, structure, norms
  34. Parallel Group (developmental)
    • Level 1
    • Purpose: 1) ind. complete tasks in presence of others
    • 2) min interact
    • 3) dev. basic level of awareness, trust, & comfort with others
    • Role of therapist: 1) unconditional positive regard to develop trust
    • 2) all leadership functions
    • 3) reinforce all behaviors app. to group no matter how small
    • 4) structure
    • 5) facilitate interaction
    • Activities: 1) similar act. that utilize common tools to facilitate sharing, interactions
    • 2) relevant to ind. abilities, age, gender
  35. Project Group (developmental)
    • Level 2
    • Purpose: 1) develop ability to perform a shared, short-term act. with another member in comfortable, cooperative manner
    • 2) develop interactions beyond what act. requires
    • 3) enable members to give/seek assistance
    • Role: 1) select, structure act shared by 2 or more ind.
    • 2) fullfill all ind. needs while encouraging members to give/seek assistance & interact beyond act. requirements
    • 3) reinforce cooperation, mild competition, sharing, interactions
    • Activities: 1) short-term, participation 2 or more ind.
    • 2) shareable, requires interaction to complete
    • 3) group interaction, not project completion is emphasized
  36. Egocentric-cooperative group (developmental)
    • Level 3
    • Purpose: 1) enable members to select, implement long-term act. which requires group interaction
    • 2) meet needs of themselves & others (safety, esteem)
    • Role: 1) less active, direct leader
    • 2) facilitate allow ind. to fullfill leadership roles to fun. independently
    • 3) provide guidelines & assistance if needed
    • 4) reinforce meeting needs of self & others
    • 5) serve as role model
    • Activities: 1) 5-10 people to work together
    • 2) selected, implemented by members
    • 3) long-term, more than 2 meetings to complete
  37. Cooperative Group (developmental)
    • Level 4
    • Purpose: 1)allows free expression & ideas
    • 2) develop trust, love, belonging, cohesion
    • 3) identify & meet socio-emotional needs
    • Role: 1) advisor
    • 2) leader & members mutually responsible for giving feedback, identifying & meeting needs, reinforcing behaviors
    • Activities: 1) allow/facilitate free expression of ideas & feelings
    • 2) act. secondary to need fullfillment &  may not produce end product
  38. Mature Group (developmental)
    • Level 5
    • Purpose: 1) assume all fun. socio-emotional & task roles
    • 2) members reinforce behaviors which result in need satisfaction & task completion
    • Role: 1)acts as peer, equal, group member
    • 2) members assume all roles, therapist only filling in if needed
    • 3) all members satisfy needs & reinforce behaviors while maintaining balance btwn need satisfaction & task completion
    • Activities: 1) number of people working together
    • 2) requires end product or time limit 
    • 3) act. may be stopped to explore what is going on within the group
  39. Instrumental Group
    • Purpose: 1) help members fun. at highest level as long as possible
    • 2) meet mental health needs
    • Assumption: 1) ind. at highest level, cant change/progress
    • 2) supportive, structured env. which provides app. act. can prevent regression, maintain function, & meet mental health needs
    • Client: 1) ind. who have demonstrated in tx inability to change/progress
    • 2) Ind. cant ind. meet their mental health needs &/or assistance to maintain function due to cognitive, psychological, perceptual-motor, &/or social deficits.  
    • Role: 1) unconditional positive regard, support, structure to create comfortable, safe env.
    • 2) select, design act. meet health needs & maintain highest possible fun.  
    • 3) assist as needed
    • 4) make no attempt to change client
    • Activities: 1) successfully complete act. with structure, & assistance as needed
    • 2) non-threatening, non-demanding
    • 3) interesting, enjoyable, attractive
    • 4) meet mental health needs enable to exp. pleasure, fun, & socialize with others
    • 5) maintain fun. with sensory, cognitive, perceptual-motor, & social act.
  40. Group used to acquire the knowledge & skills to perform a specific occupational performance "active doing"
    Thematic Group
  41. Group members discuss act. that they are engaged in outside of the group
    Topical group
  42. group with a psychodynamic frame of reference used to increase intra & inter psyhic function.
    Task-oriented groups
  43. Group where activities are selected to help members examine their behaviors to increase self-understanding
    Task-oriented
  44. Group used to prevent decline, maintain function, promote well-being.
    Instrumental
  45. Group used for those with chronic conditions with residual or progressive symptoms where the activities don't remediate rather they are in the moment, enjoyable, and help with QOL
    Instrumental
  46. Purpose of this group is to evaluate group interaction skills
    Evaluation group
  47. Leadership where therapist is responsible for structuring, planning most of what takes place in group
    Directive
  48. Leadership style in acute inpatient psyhchitric unit
    Directive
  49. Leadership style when therapist shares responsibility for the group & group process
    Facilitative
  50. Leadership style in psychsocial clubhouse
    Advisory
  51. leadership style where therapist functions as a resource, members set agenda & structure the group
    advisory
  52. Leadership style in vocational rehab
    facilitative
  53. Type of developmental group in acute units
    parallel or project
  54. Types of developmental groups in community-based setting with stable population & extended stay
    egocentric-cooperative, cooperative, mature
  55. Airborne precautions
    tuberculosis, measles, chickenpox
    • 1. Respiratory insolation room
    • 2. wear mask when entering
    • 3. limit movement/transporting.  If transporting mask patient
  56. Droplet precautions
    mumps, rubella, pertussis, inflluenza
    • 1. isolation room
    • 2. mask when entering
    • 3. limit movement/transport, mask pat. when leaving room
  57. Contact precautions
    • 1. isolation room
    • 2. wear gloves when entering, remove prior to leaving, wash hands
    • 3. wear gown, remove prior to leaving
    • 4. single pt. use of equipment
    • 5. limit movement/transport, precautions when leaving room
  58. What is used for comparative analysis of an individual's score
    • norms
    • Ind. characerists must meet the characteriscs of the population
    • if client is diff. from "normed" populaiton, interpretations would be inaccurate
  59. Measures the assessment's accuracy to determine if the tool measures what its intended to measure
    Validity
  60. Establishes how well the assessment appears "on the face of it" to meet its stated purpose
    (an activity configuaration looks like it measures time use)
    Face validity
  61. establishes that the content included in the eval is representative of the content that should be measured 
    (does the content of a role checklist provide adequate listing of roles)
    Content validity
  62. Compares the measure to another established tool
    • Criterion validity
    • Concurrent-compares results of 2 instruments given at same time
    • Predicitive-compares degree to which an instrument can predict pref. on future criterion.
  63. Reported as a coorelation & higher the coorelation, better the _________ validity.
    Criterion Validity
  64. Establishes the consistency & stability of the evaluation
    Reliability
  65. Reliability is either scored as a _________ or ___________ to identify the degree to which the two items agree/relate
    correlaiton or percentage
  66. Produce scores that compare ind. perf. to a set population's perf.
    Norm-referenced
  67. Provide scores that compare the ind. perf. to a pre-established criterion
    Criterion-referenced
  68. Intervention used to reduce the incidence/occurance of a disease/disorder within a population that is currently well or considered to be at risk
    Primary Prevention
  69. Intervention for parenting skills class for teen parents to prevent child neglect or abuse
    Primary Prevention
  70. Prevention: early detection of problems in a population at risk to reduce the duration of a disorder/disease and/or minimize its effects through early detection/diagnosis, early appropriate referral, and ealry/effective interventions
    Secondary prevention
  71. Screening for infants born prematurely for developmental delays & immediate intervention for the delays
    Secondary prevention
  72. Prevention: Elimination or reduction of the impact of dysfunction on an individual
    Tertiary prevention
  73. Prevention for the provision of rehab services to maximize community participation
    Tertiary
  74. AOTA practice framework __________ __________ is used to designate interventions that address the needs of ind. with or without disabilities who are considered at risk for problems with occ. perf.
    disability prevention
  75. OT tools of practice
    • 1. Occupation-goal directed, ordinary/familiar
    • 2. Purposeful act.-goal-directed tasks that make up occupations
    • 3. Activity/Task analysis-breaking down
    • 4. Teaching-Learning Process-OT designs experiences to help ind. gain knowledge & skills for living
    • 5. Clinical reasoning-complex mental process OT uses when considering the client in relationship to context, disability, social, cultural
    • 6. Therapeutic use of self-conscious,planned use of one's personality to interact with ind. & family
    • 7. Group process
  76. _______ prevention is concerned with promoting wellness & maintaining health
    • Primary
    • If level of prevention is not indicated on test question, primary prevention is the likely answer
  77. T/F Primary prevention is concerned with remediation
    F
  78. In _________ prevention OT would develop violence prevention program for school.  What types of interventions?  (2)
    • Primary
    • Conflict resolution & assertiveness training
  79. Interventions related to occupations & purposeful activities must be __________, ____________, ___________, _____________.
    • goal-directed
    • meaningful
    • task-oriented
    • role-related
  80. _________ _________ are the expected & accepted behaviors in a group.  Ex: Inds. in the group wait to eat before everyone is served, don't smoke during group, & they all clean up.
    Group Norms
  81. A _______ _________ outlines the group's membership criteria, goals, and activities
    Group Protocol.
  82. _________ are implemented only in a group if members' behaviors call outside the group norms & are considered deviant
    Sanctions
  83. Altered task method
    uses same objects in same environment but task is altered to make task more feasible for ind. who has certain injury/disability such as using one handed technique to tie shoes.
  84. Motivational enhance therapy
    • avoids opposing client or arguing for change
    • rolls with it versus opposing resistance directly
    • resistance is sign that OT needs to act differently in responding to client
    • when resistance decreases, then OT can explore ind. feelings toward change

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