Community-Based Practice Settings

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brau2308
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300811
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Community-Based Practice Settings
Updated:
2015-04-16 12:32:44
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Ch. 4
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  1. Early intervention programs
    acceptance criteria:
    • 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
  2. Early intervention programs
    Children considered "at risk":
    • birth complications
    • suspected delays in development
    • failure to thrive
    • maternal substance abuse during pregnancy
    • birth to adolescent/teen mother
    • established disability/diagnosis
  3. Early intervention programs
    length of service provision:
    • IFSP completed by service coordinator
    • six month reviews are submitted by all professionals to determine if services should continue
  4. Early intervention programs
    evaluation:
    • developmental areas
    • determine effects of current development on play and ADL
    • written in strength-oriented manner
    • goals in family friendly terms
  5. Early intervention programs
    intervention:
    • 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
  6. Schools
    acceptance criteria:
    • 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
  7. Schools
    Length of services
    • dependent on the impact of services on child's abilities and prevention of loss of abilities
    • reviewed annually
  8. Schools
    evaluation
    • 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
  9. Schools
    intervention:
    • 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
  10. Schools
    OT roles:
    • address education-related services and psychosocial needs
    • prevent school violence
  11. Behavioral Intervention Plan:
    includes RtI, early intervening services, and positive behavioral supports
  12. Response to Intervention (RtI):
    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
  13. Supported education programs
    participant criteria:
    adolescents or dults who require intervention to develop skills that are needed to succeed in secondary and/or post-secondary education
  14. Supported education programs
    Length of stay:
    determined by agency's funding and person's attainment of goals
  15. Supported education programs
    discharge:
    discharge upon entry into, or completion of, an educational program or the attainment of a graduate equivalency degree (GED)
  16. Supported education programs
    evaluation:
    focus on client factors, performance skills and patterns that impact on the role of student
  17. Supported education programs
    focus:
    • 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)
  18. Prevocational programs
    participant criteria:
    adolescents or adults who require intervention to develop skills that are prerequisite to work
  19. Prevocational programs
    length of stay:
    determined by agency's funding and person's attainment goals
  20. Prevocational programs
    discharge:
    • to vocational program
    • to work setting can occur if sufficient abilities are developed
  21. Prevocational programs
    evaluation:
    focused on the individual's task skills, social interaction skills, work habits, interests, and aptitudes
  22. Prevocational programs
    intervention:
    • 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
  23. Vocational programs
    acceptance:
    • 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
  24. Vocational programs
    length of stay:
    determined by agency's funding and attainment of goals
  25. Vocational programs
    types:
    • rehabilitation workshops (sheltered workshops)
    • supportive employment programs
    • transitional employment programs (TEPs)
    • employee assistance programs (EAPs)
  26. Vocational programs
    discharge:
    not always a goal
  27. Vocational programs
    evaluation:
    focused on individual's functional skills and deficits related to work in his/her current and expected vocational environment
  28. Vocational programs
    intervention:
    • 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
  29. Residential programs
    admission:
    developmental, medical, or psychiatric condition that has resulted in functional deficits that impede independent living but are not severe enough to require hospitalization
  30. Residential programs
    continuum:
    from 24-hour supervised quarter way houses, halfway houses, or group homes, to supportive apartments with weekly or biweekly "check-in" supervision
  31. Residential programs
    Length of stay:
    • determined by agency's funding
    • long-term and permanent housing options are available
  32. Residential programs
    evaluation:
    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
  33. Residential programs
    interventions:
    • 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
  34. Partial hospitalization/day hospital programs
    admission:
    • 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
  35. Partial hospitalization/day hospital programs
    frequency:
    up to 5 days/wk w/ multiple interventions schedule each day
  36. Partial hospitalization/day hospital programs
    length of stay:
    • determined by diagnosis, presenting symptoms, and response to tx
    • vary from 1 week to 6 months
    • documentation required for extension
  37. Partial hospitalization/day hospital programs
    discharge:
    usually to a less intensive community day program
  38. Partial hospitalization/day hospital programs
    evaluation:
    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)
  39. Partial hospitalization/day hospital programs
    intervention:
    • 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
  40. Clubhouse programs
    membership:
    • 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
  41. Clubhouse programs
    exclusion:
    individuals who pose a significant and direct threat to the safety of the clubhouse community are the only persons excluded
  42. Clubhouse programs
    staff role:
    engage membership, provide needed support and structure, and enable recovery
  43. Clubhouse programs
    schedules:
    • 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
  44. Clubhouse programs
    length of stay:
    indefinite and members can exit and re-enter a clubhouse community at will
  45. Clubhouse programs
    evaluation and intervention:
    not provided in formalized manner
  46. Clubhouse programs
    role of OT:
    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
  47. Adult day care
    admission:
    adults and elders with chronic physical and/or psychosocial impairments, and/or for individuals who are frail but semi-independent
  48. Adult day care
    schedules:
    • individual schedules vary
    • flexibility provided to address needs and allow for planned respite
    • range from one afternoon per week to 5 full days
  49. Adult day care
    length of stay:
    ongoing services are provided to individuals which chronic conditions who might otherwise be institutionalized or to individuals who are frail and need ongoing support
  50. Adult day care
    evaluation:
    focused on individual's functional skills and deficits in the areas of occupation, his/her home environment, and the adult day center's environment
  51. Adult day care
    intervention:
    • 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
  52. Outpatient/ambulatory care
    admission:
    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
  53. Outpatient/ambulatory care
    session duration:
    tx usually provided 30-60 minute sessions once a day for up to 5 days a week
  54. Outpatient/ambulatory care
    length of stay:
    determined by diagnosis presenting symptoms, response to tx, and insurance coverage or ability to pay a fee for service
  55. Outpatient/ambulatory care
    evaluation:
    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
  56. Outpatient/ambulatory care
    intervention:
    • 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
  57. Home health care
    acceptance:
    • 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
  58. Home health care
    sessions:
    • 60-minute sessions, once a day for up to 5 days a week
    • determined by insurance coverage
  59. Home health care
    length of stay:
    determined by diagnosis, presenting symptoms, response to tx, insurance coverage, or ability to pay a fee for service
  60. Home health care
    evaluation:
    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)
  61. Home health care
    intervention:
    • 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
  62. Hospice
    acceptance:
    terminal illness that has a life expectancy of 6 months or less
  63. Hospice
    length of stay:
    determined by the person's terminal outcome
  64. Hospice
    evaluation:
    focused on determining the individual's occupational functioning and his/her physical, psychosocial, spiritual, and environmental needs that are most important to him/her
  65. Hospice
    intervention:
    • 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
  66. Case management programs
    two focuses:
    • clinical
    • administrative
  67. Case management programs
    clinical:
    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
  68. Case management programs
    administrative:
    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
  69. Case management programs
    length of stay:
    determined by the individual's ability to independently access needed services and by funding availability
  70. Case management programs
    evaluation:
    • 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
  71. Case management programs
    interventions:
    • 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
  72. Case management programs
    discharge:
    to an environment that will best serve an individual's needs
  73. Wellness and prevention programs
    acceptance:
    individual's self-referral to meet a personal need or by an institution's provision of a program to its members or employees
  74. Wellness and prevention programs
    populations served:
    at risk
  75. Wellness and prevention programs
    length of stay:
    • determined by individual
    • influenced by program's planned length or by individual's achievement of desired outcome
  76. Wellness and prevention programs
    evaluation:
    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
  77. Wellness and prevention programs
    intervention:
    • disease prevention and health promotion
    • interventions can range from the traditional domain of OT, to contemporary areas of concern
  78. Private/Independent Practice
    a provider number is required for a private practitioner to receive third party payment

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