Service Delivery Models and Institutional Practice Settings

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brau2308
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300784
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Service Delivery Models and Institutional Practice Settings
Updated:
2015-04-14 17:29:19
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nbcot
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Description:
Ch. 4
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  1. Criteria for determining a model of practice:
    • type of setting
    • philosophy and mission of setting/dept
    • role therapist plays in setting
  2. Medical model
    view:
    individual w/ disability as person who has incurred physiological insult that has resulted in reduced functional capacity
  3. Medical model
    Focus:
    placed on identifying disease or dysfunction
  4. Medical model
    treatment:
    addresses disease or dysfunction (performance components) contributing to decreased functional skills
  5. Medical model
    FOR:
    address the pathological process of the disease or dysfunctions (biomechanical, neurodevelopmental)
  6. Education model
    view:
    individual w/ a disability lacks knowledge or skills
  7. Education model
    focus:
    placed on learning and making the behavioral changes needed to interact successfully in the environement
  8. Education model
    goals:
    skill deficits determined and related goals established to promote learning to adequately perform w/in a particular environment
  9. Education model
    outcomes:
    behaviors measured in terms of obtaining skills, knowledge, and competency to successfully meet the demands of the environment
  10. Education model
    FOR:
    based on learning theories to facilitate adaptation in the environment (role acquisition, cognitive remediation)
  11. Community model
    view:
    individual w/ disability lacks skills, resources, and supports for community participation
  12. Community model
    focus:
    • placed on identifying and developing the skills needed for one's expected environment
    • community resources and supports identified and developed to enable functioning w/in one's chosen environment
  13. Community model
    FOR:
    promote development of performance skills and/or areas of occupation w/in the individual's performance contexts (life-style performance, occupational adaptation)
  14. Telehealth model:
    can include features of all models by providing medical, rehab and/or educational services to persons via telecommunications technologies
  15. Acute care hospitals
    admission:
    • for medical or psychiatric diagnosis that can't be treated in outpatient
    • initial onset of new illness or major health problem
    • acute exacerbation of chronic illness
    • danger to self or others
  16. Acute care hospitals
    LOS:
    • limited to 1-7 days
    • longer requires documentation to justify
    • ongoing need results in discharge to another setting
  17. Acute care hospitals
    evaluation
    focus on quick and accurate screening of major difficulties impeding function
  18. Acute care hospitals
    intervention:
    • stabilization of client's status
    • engagement in therapeutic relationship and purposeful activities so they can see change is possible, increase motivation
    • discharge planning
    • family, caregiver, and consumer education
  19. Acute care hospital
    role of OT:
    • generalist
    • specialist
  20. Sub-acute care/intermediate care facilities (ICFs)
    admission:
    medical or psychiatric diagnosis that has progressed from acute stage but has not stabilized sufficiently to be outpatient
  21. Sub-acute care/ICFs
    LOS:
    • 5-30 days
    • longer requires documented justification
    • ongoing need for intervention results in discharge to another setting
  22. Sub-acute care/ICFs
    evaluation:
    in-depth assessments and more thorough observations of client's functional performance
  23. Sub-acute care/ICFs
    intervention:
    • functional improvements in performance skills and areas of occupation
    • active engagement of the clients in the treatment planning, implementation, and re-evaluation process
    • discharge planning to expected environment
  24. Sub-acute care/ICFs
    location:
    housed in hospitals or SNFs
  25. Long-term acute care hospital (LTAC)
    admission:
    • chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators
    • multiple diagnosis with major complications
  26. LTAC
    LOS:
    greater than 25 days to maintain Medicare certification
  27. LTAC
    evaluation and intervention:
    • limited by medical need
    • palliative care
    • prevention and tx of complications
    • mastery of the environment and the attainment of client-centered goals
  28. Rehabilitation hospitals
    admission:
    disability that is medically stable but which has residual functional deficits requiring skilled rehab services
  29. Rehab
    LOS:
    • a week to months
    • extension are dependent upon institutional, state, and 3rd party payer guidelines
    • ends when coverage is expended
  30. Rehab
    discharge:
    • SNF
    • supportive community residence
    • home/independent living
  31. Rehab
    evaluation:
    • extensive and focus on all performance skills and patterns, areas of occupation, and occupational roles that will be required in the expected environment
    • environmental assessments of planned discharge environment must be completed
  32. Rehab
    intervention:
    • functional improvement in performance skills and patterns, areas of occupation, and occupational roles
    • development of compensatory strategies for residual deficits and client factors
    • provision of adaptive equipment and training in use of the equipment to promote independent function
    • modification of discharge environment
    • education of individual, family, and caregivers on abilities, limitations, compensatory techniques and advocacy skills
  33. Long term hospitals
    admission:
    medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis
  34. Long term hospitals
    LOS:
    • a month to years
    • extended LOS dependent upon institutional, 3rd party payer, and/or state guidelines
    • private hospital LOS determined by insurance coverage
  35. Long term hospitals
    discharge:
    • state run long-term hospital
    • SNF
    • home or supportive residence
  36. Long term hospitals
    evaluation:
    extensive due to increased LOS
  37. Long term hospitals
    intervention:
    • functional improvements in performance skills and patterns and areas of occupation
    • development of compensatory strategies for residual deficits and client factors
    • maintenance of quality of life
    • development of skills for discharge to the lease restrictive environment
  38. Skilled nursing facilities (SNF)/Extended care facilities (ECFs)
    admission:
    medical or psychiatric diagnosis that is chronic and requires skilled care, but the individual's illness is stable w/ no acute symptoms
  39. SNF/ECFs
    LOS:
    1 month to the individuals lifetime
  40. SNF/ECFs
    influences of LOS:
    • progression of illness
    • availability of family or community supports
    • insurance coverage
  41. SNF/ECF
    evaluation:
    • guided by Medicare standards
    • good rehab potential = same as rehab
    • no rehab potential = palliative care and maintenance of QOL
  42. Forensic settings
    admission:
    due to engagement in criminal activity by a person
  43. Forensic settings
    jail:
    city or county facility which is the individual's first entry into the criminal justice system and the placement for those convicted of crimes with sentences of less than a year
  44. Forensic settings
    prison:
    a state or federal facility for individuals found guilty of crimes w/ sentences greater than a year
  45. Forensic settings
    forensic psychiatric hospital or unit:
    specialized hospital unit w/in a hospital which provides inpatient psychiatric care for individuals convicted of a crime and found guilty but mentally ill or not guilty by reason of insanity
  46. Forensic settings
    LOS:
    determined by court-ordered directives and criminal sentences
  47. Forensic settings
    evaluation and intervention:
    • determination of individual's competency to stand trial, in forensic psychiatry settings
    • areas similar to those described under rehab to develop community living skills needed for successful community reintegration upon release
    • facilitation of skills and provision of structured programs to enable the person to function at his/her highest level w/in their current environment since discharge may be delayed or not possible, depending on the nature of the crime
    • restoration of competency to stand trial in forensic psychiatry settings
  48. Outpatient/ambulatory care
    admission:
    does not require hospitalization but has functional deficits requiring eval and intervention
  49. OP/ambulatory care
    focus:
    • diagnostic eval
    • interventions to increase functional performance
    • consumer education
    • prevention

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