Service Delivery Models and Institutional Practice Settings

• type of setting
• philosophy and mission of setting/dept
• role therapist plays in setting

individual w/ disability as person who has incurred physiological insult that has resulted in reduced functional capacity

placed on identifying disease or dysfunction

addresses disease or dysfunction (performance components) contributing to decreased functional skills

address the pathological process of the disease or dysfunctions (biomechanical, neurodevelopmental)

individual w/ a disability lacks knowledge or skills

placed on learning and making the behavioral changes needed to interact successfully in the environement

skill deficits determined and related goals established to promote learning to adequately perform w/in a particular environment

behaviors measured in terms of obtaining skills, knowledge, and competency to successfully meet the demands of the environment

based on learning theories to facilitate adaptation in the environment (role acquisition, cognitive remediation)

individual w/ disability lacks skills, resources, and supports for community participation

• 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

promote development of performance skills and/or areas of occupation w/in the individual's performance contexts (life-style performance, occupational adaptation)

can include features of all models by providing medical, rehab and/or educational services to persons via telecommunications technologies

• 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

• limited to 1-7 days
• longer requires documentation to justify
• ongoing need results in discharge to another setting

focus on quick and accurate screening of major difficulties impeding function

• 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

• generalist
• specialist

medical or psychiatric diagnosis that has progressed from acute stage but has not stabilized sufficiently to be outpatient

• 5-30 days
• longer requires documented justification
• ongoing need for intervention results in discharge to another setting

in-depth assessments and more thorough observations of client's functional performance

• 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

housed in hospitals or SNFs

• chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators
• multiple diagnosis with major complications

greater than 25 days to maintain Medicare certification

• limited by medical need
• palliative care
• prevention and tx of complications
• mastery of the environment and the attainment of client-centered goals

disability that is medically stable but which has residual functional deficits requiring skilled rehab services

• a week to months
• extension are dependent upon institutional, state, and 3rd party payer guidelines
• ends when coverage is expended

• SNF
• supportive community residence
• home/independent living

• 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

• 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

medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis

• a month to years
• extended LOS dependent upon institutional, 3rd party payer, and/or state guidelines
• private hospital LOS determined by insurance coverage

• state run long-term hospital
• SNF
• home or supportive residence

extensive due to increased LOS

• 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

medical or psychiatric diagnosis that is chronic and requires skilled care, but the individual's illness is stable w/ no acute symptoms

1 month to the individuals lifetime

• progression of illness
• availability of family or community supports
• insurance coverage

• guided by Medicare standards
• good rehab potential = same as rehab
• no rehab potential = palliative care and maintenance of QOL

due to engagement in criminal activity by a person

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

a state or federal facility for individuals found guilty of crimes w/ sentences greater than a year

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

determined by court-ordered directives and criminal sentences

• 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

does not require hospitalization but has functional deficits requiring eval and intervention

• diagnostic eval
• interventions to increase functional performance
• consumer education
• prevention