Community-Based Practice Settings

• based on "at risk" status of the infant or toddler who is under age of 3
• extent of the DD (typically a 33% delay in one area of development or a 25% delay in two areas)
• established diagnosis/disability

• birth complications
• suspected delays in development
• failure to thrive
• maternal substance abuse during pregnancy
• birth to adolescent/teen mother
• established disability/diagnosis

• IFSP completed by service coordinator
• six month reviews are submitted by all professionals to determine if services should continue

• developmental areas
• determine effects of current development on play and ADL
• written in strength-oriented manner
• goals in family friendly terms

• develop cognitive/process, psychosocial/communication/interaction, and sensorimotor skills
• develop play and ADLs
• family education
• advocacy and advocacy training
• transition planning from EI to preschool

• child requires special education services, and OT will enable the child to benefit from special education
• OT will facilitate child's participation in educational activities and enhance the child's functional performance
• referrals are received from the previous agency that provided EI services, the child's teacher, and/or school's child study team
• the school reviews the referral and, if indicated recommends an OT evaluation

• dependent on the impact of services on child's abilities and prevention of loss of abilities
• reviewed annually

• assess client factors, performance skills and patterns and areas of occupation, that impact on the educational and functional performance of the child w/in the school
• assess child's functional and developmental level to contribute to the Functional Behavioral Analysis

• based on educational model
• address student's functional performance along w/ academic performance
• activities utilized to address goals and objectives documented in the IEP using both corrective and compensatory methods
• AT and transition services
• performance skill deficits and client factors to improve ability to participation in school
• ADL, school and play to improve ability to participate in school
• skills for adult life post-school developed w/ transition plan

• address education-related services and psychosocial needs
• prevent school violence

includes RtI, early intervening services, and positive behavioral supports

evidence-based, structured intervention approach that uses EI services to address academic difficulties and Positive Behavioral Supports (PBS) to address behavioral problems early in a child's education

adolescents or dults who require intervention to develop skills that are needed to succeed in secondary and/or post-secondary education

determined by agency's funding and person's attainment of goals

discharge upon entry into, or completion of, an educational program or the attainment of a graduate equivalency degree (GED)

focus on client factors, performance skills and patterns that impact on the role of student

• improve performance skills and patterns that are needed for occupational role of student
• education training in compensatory strategies to support academic performance
• exploration of participant's educational interests and aptitudes to ensure self-determined engagement in a school, college, technical training program, or community-based adult education class(es)

adolescents or adults who require intervention to develop skills that are prerequisite to work

determined by agency's funding and person's attainment goals

• to vocational program
• to work setting can occur if sufficient abilities are developed

focused on the individual's task skills, social interaction skills, work habits, interests, and aptitudes

• improvement in task skills and social skills that is prerequisite to vocational training or work
• development of work habits and abilities
• exploration of work interests and aptitudes to ensure discharge to a relevant vocational training program, school, or work setting

• for development of specific vocational skills
• prerequisite abilities to work, but requires training for a specific job and/or ongoing structure, support and/or supervision to maintain employment
• person has to develop his/her work capacities to a level acceptable for competitive employment

determined by agency's funding and attainment of goals

• rehabilitation workshops (sheltered workshops)
• supportive employment programs
• transitional employment programs (TEPs)
• employee assistance programs (EAPs)

not always a goal

focused on individual's functional skills and deficits related to work in his/her current and expected vocational environment

• remediation of underlying performance skill deficits and compensation for client factors that affect the work performance area
• development of general work abilities and specific job skills
• consultation to and/or supervision of vocational direct care staff
• identification and implementation of reasonable accommodations in accordance with ADA
• referral to state offices of vocational and educational services for personas with disabilities for further evaluation, education, and training

developmental, medical, or psychiatric condition that has resulted in functional deficits that impede independent living but are not severe enough to require hospitalization

from 24-hour supervised quarter way houses, halfway houses, or group homes, to supportive apartments with weekly or biweekly "check-in" supervision

• determined by agency's funding
• long-term and permanent housing options are available

focused on assessment of the individual's skills for living in the community and determination of the social and environmental resources and supports needed to maintain the individual in his/her current and expected living environment

• consultation to and/or supervision of residential program staff
• remediation of underlying performance skill deficits and compensation for client factors that affect independent living skills
• ADL training, activity adaptation, and environmental modifications to facilitate community living skills
• referral to appropriate residential services along the continuum of care as individual's functional level improves
• education about ADA, the Fair Housing Act, and Section 8 Housing

• medical or psychiatric condition that has been sufficiently stabilized to enable an individual to be discharged home or to a community residence
• however, individual still has symptoms remaining which require active treatment

up to 5 days/wk w/ multiple interventions schedule each day

• determined by diagnosis, presenting symptoms, and response to tx
• vary from 1 week to 6 months
• documentation required for extension

usually to a less intensive community day program

focused on the individual's functional skills and deficits in his/her performance areas and the occupational roles that are required in his/her current and expected environment(s)

• functional improvement in areas of occupation and occupational role functioning
• remediation of underlying performance skill deficits and compensation for client factors that affect functional performance
• development of skills for community living and identification of community supports for community participation

• open to adults and elders with a current mental illness or a history of mental illness
• all members have equal access to all clubhouse functions and opportunities regardless of functional level or diagnosis

individuals who pose a significant and direct threat to the safety of the clubhouse community are the only persons excluded

engage membership, provide needed support and structure, and enable recovery

• vary to meet each person's unique needs and interests
• open at least 5 days per week, sometimes 7 days/wk
• evenings/weekends focused on avocational interests and recreational pursuits

indefinite and members can exit and re-enter a clubhouse community at will

not provided in formalized manner

integrated into clubhouse model which has staff acting as generalists who contribute to the development and enrichment of members' abilities and the promotion of their recovery

adults and elders with chronic physical and/or psychosocial impairments, and/or for individuals who are frail but semi-independent

• individual schedules vary
• flexibility provided to address needs and allow for planned respite
• range from one afternoon per week to 5 full days

ongoing services are provided to individuals which chronic conditions who might otherwise be institutionalized or to individuals who are frail and need ongoing support

focused on individual's functional skills and deficits in the areas of occupation, his/her home environment, and the adult day center's environment

• maintenance of the healthy, functional aspects of the individual and facilitation of adaptation to impairments
• engagement in purposeful activities that provide appropriate stimulation, reflect life-long interests, develop new interests, and foster a sense of community with other participants
• caregiver education, support groups, home visits, consultations, and referrals to community resources
• modifications to the day care center's environment and the individual's home environment to maximize the person's comfort in, and mastery and control of, these environments

medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from a hospital but remaining symptoms require active tx

tx usually provided 30-60 minute sessions once a day for up to 5 days a week

determined by diagnosis presenting symptoms, response to tx, and insurance coverage or ability to pay a fee for service

focused on the individual's client factors and functional assets and deficits in his/her performance skills and patterns, areas of occupation, and his/her home, work and leisure environments

• active engagement of the client in the tx planning, implementation, re-evaluation, and discharge process
• remediation of underlying performance skill deficits that affect functional occupational performance
• functional improvements in performance areas and occupational roles
• compensatory strategies for remaining performance skill deficits and client factors
• consumer, family, and caregiver education

• presence of medical or psychiatric condition that is not serious enough to warrant hospitalization or for a condition that has sufficiently stabilized to enable the individual to be discharged from a hospital but that still has remaining symptoms requiring active tx
• reimbursers can have strict and variable criteria for qualifying for home health care

• 60-minute sessions, once a day for up to 5 days a week
• determined by insurance coverage

determined by diagnosis, presenting symptoms, response to tx, insurance coverage, or ability to pay a fee for service

focused on the individual's client factors and functional skills and deficits in his/her performance skills and deficits in his/her performance skills and patterns, areas of occupation, and the occupational roles that are required in the current and expected environment(s)

• active engagement of the client, family, and caregivers in the tx planning, implementation, and re-evaluation process
• functional improvements in areas of occupation and occupational role functioning w/in the home
• remediation of underlying performance sill deficits and compensation for client factors that affect functional performance w/in the home
• education of the family, caregivers, and/or home health aides to provide appropriate care and/or assistance as needed
• environmental modifications and activity adaptations that maintain optimal functioning and improve QoL
• increasing ability to resume occupational roles outside the home
• prevention of hospitalization and avoidance or delay of residential institutional placement

terminal illness that has a life expectancy of 6 months or less

determined by the person's terminal outcome

focused on determining the individual's occupational functioning and his/her physical, psychosocial, spiritual, and environmental needs that are most important to him/her

• maintenance of the individual's control over his/her life
• facilitation of engagement in meaningful occupations and purpose activities that are consistent with the individual's roles, values, choices, interests, aspirations, abilities, and hopes and that contribute to a satisfactory QoL
• reduction or removal of distressing symptoms and pain
• environmental modifications and activity adaptations that maintain optimal functioning and improve QoL
• caregiver and family education and support to maintain optimal functioning and improve QoL for all

• clinical
• administrative

provides individualized support and intervention to a client w/ a serious illness which significantly limits her/her ability to access and/or engage in existing community services and/or therapeutic programs, ensuring that the person is able to remain in the community and not be re-hospitalized

connects a person w/ a serious illness to the appropriate and needed community services and/or therapeutic programs, overseeing this service provision to ensure that quality of care in a cost-effective manner is achieved

determined by the individual's ability to independently access needed services and by funding availability

• focused on the individual's client factors and functional skills and deficits in his/her performance skills and patterns, areas of occupation, and the occupational roles that are required in his/her current expected environment
• assess supports and barriers for community integration

• referral-based in the administrative model
• encompass the full range of interventions in the clinical model
• both models aim to prevent regression and re-hospitalization and promote optimal functioning and QoL
• engage individual and family in tx planning, implementation, and reevaluation process

to an environment that will best serve an individual's needs

individual's self-referral to meet a personal need or by an institution's provision of a program to its members or employees

at risk

• determined by individual
• influenced by program's planned length or by individual's achievement of desired outcome

focuses on risk factors for illnesses and disabilities and the individual's functional skills and deficits in the occupational roles that are required in his/her current and expected environment

• disease prevention and health promotion
• interventions can range from the traditional domain of OT, to contemporary areas of concern

a provider number is required for a private practitioner to receive third party payment