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What is Occupational Therapy?

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on 6 November 2013

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Transcript of What is Occupational Therapy?

What is Occupational Therapy?
Reasoning for this in-service:
Advocacy for the profession
Decline of OT in Mental Health Setting
Unknown job description
“Occupational therapists have had to cope with changes in their work settings, roles, knowledge base, and the job activities expected of them” due to the shift to community-based care in the mental health setting (Vax, Schreuer, & Sachs, 2012).
In a study done by Smith & Mackenzie (2009) on how occupational therapists are perceived within inpatient mental health settings, a nursing staff member reported,
“Occupational therapists are a bit mysterious. I am not sure if there is any significant depth of understanding of the occupational therapists amongst the staff in the environments I have worked in.”
“This uncertainty may have negative implications for service delivery and for the occupational therapy profession more generally” (Smith & Mackenzie, 2011).
What is the best definition of Occupational Therapy?
A) Solely providing group intervention to consumers who require some form of rehabilitation

B) Helping consumers across the lifespan learn how to participate in the things they desire and need to do through the therapeutic use of everyday activities

C) Helping consumers establish skills and provid necessary education to avoid relapse and frequent re-hospitalizations as a result of disease, illness, injury, and/or surgery

D) Educating consumers about various job opportunities, developing skills required to participate in these jobs, and assistance in finding and maintaining employment

E) All of the above

Roots and History of Occupational Therapy
Occupational Therapy's main goal of intervention is to promote:
A) Leisure and recreation
B) Entertainment and something to occupy a consumer's time
C) Engagement in productive groups
D) Engagement in daily activities
E) All of the above
Definition of OCCUPATION:
Occupation = meaningful activity
Meaningful = has significance, purpose, or worth

"Occupation is a broad construct that is meant to capture 'how people do daily life'" (Krupa, Foseey, Anthony, Brown & Pitts, 2009).

"The actual 'doing' of occupations is believed to be transformative, promoting adaptation, creating personal and social identities, connecting people to their communities and enabling ongoing and personal growth and development" (Krupa et al., 2009).
A Glimpse at OT's Framework:
Areas of Occupation
ADLs
IADLs
Education
Work
Play
Leisure
Social Participation

Performance Skills
Motor skills
Process skills
Communication/Interaction skills

Performance Patterns
Habits
Roles
Routines
Domain
Process
Evaluation
Occupational profile
Analysis of occupational performance
Intervention
Plan
Implementation
Review
Outcome
Seeing the results
Context
Cultural
Physical
Social
Personal
Spiritual
Temporal
Virtual

Activity Demands
Objects and their properties
Space demands
Social demands
Sequencing and timing
Required actions
Required body functions
Required body structures

Client Factors
Body functions
Body structures
Where is OT?
Institutional
Rehab hospitals
Inpatient hospitals
Inpatient mental health
Inpatient rehab
Skilled nursing facilities
Prisons
Research facilities
Outpatient
Driver's rehab programs
Hospital outpatient
Low vision clinics
Outpatient rehabilitation
Partial hospitalization
Mental health outpatient
Home and Community
Community mental health centers
Community agencies
Daycare centers
Department of Motor Vehicles
Early intervention (First Steps)
Group homes
Home health
Hospice care
Independent and assisted living
Industry and business
School systems
Shelters
Subsidized housing and halfway houses
Wellness and fitness programs
Work rehabilitation programs
OT in Mental Health
At Wishard Midtown, our services are utilized for education and skill development
“Individuals with persistent mental illnesses frequently experience extreme occupational disturbances, and OTs will likely use a combination of detailed occupational analyses:
1) activities graded to meet personal needs,
2) explicit time use planning to encourage balanced participation,
3) education to provide individuals with the information about their occupational situations, with which to empower an individual to effect change,
4) focused efforts to capitalize on strengths and build skills,
5) and consultation and environmental modification to secure the best match between the person and the occupation in which he or she is seeking to participate” (Krupa et al., 2009).
Goal of all disciplines working in mental health setting is preparing the consumer for discharge and community re-entry.
Intervention provided by OT in the mental health setting has four core elements (Lloyd & Williams, 2020).
Individual Assessment
Initial assessment form completed and personal interview performed at Wishard Midtown

Based off of chart review, staffing notes, observation, and 1:1 interview with consumer

OT also offers functional assessments including the KELS, ACLS, and OTAPS

Group Therapy
Multiple studies of consumers in acute mental health treatment reported "arts and crafts, community meetings, relaxation, cooking, activity-based education, and exercise" as being the most helpful and beneficial groups (Lloyd & Williams, 2009).
Individual Treatment
Room for more individual intervention:
Client-centeredness Occupation-based interventions

Individual treatment would give consumers another personal opportunity outside of group therapy to "build confidence and self-esteem through the use of purposeful activity" (Lloyd & Williams, 2010).

Addressing specific sills pertinent to the consumer leads to providing more adequate care.
Discharge Planning
This is the goal of everyone on the treatment team, but specific to OT it is one of the education topics we are required to cover.

At Wishard Midtown, this is usually worked on in a group setting but 1:1 services are also provided if necessary.
How does all this relate to you?
"Interdisciplinary teams combine separate disciplines onto one team, all serving the same client; together with the client, they collect history, do assessments, develop treatment plans, and establish roles and responsibilities. In this capacity, each team member primarily serves as a specialist, meaning he or she has been trained in one specific area of practice" (Fox, 2013).
If we continue to work as specialists in our fields together, as opposed to generic, watered-down versions of each other's profession, we will continue to provide the best care possible to our patients.
Part of this effort starts with knowing specifically what each other's roles are, in which YOU are taking the first step now.
An In-Service Presentation by Kelly Hassman at Wishard Midtown, Indianapolis, IN
November, 2013

American Occupational Therapy Association [AOTA]. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609–639.

Casteleijn, D. & Graham, M. (2012). Domains for occupational therapy outcomes in mental health practices. South African Journal of Occupational Therapy, 42(1), 26-34.

Colman, W. (1992). Maintaining autonomy: The struggle between occupational therapy and physical medicine. American Journal of Occupational Therapy, 46, 63-70.

Fox, V. (2013). Professional roles in community mental health practice: Generalist versus specialist. Occupational Therapy in Mental Health, 29, 3-9.

Hagerdorn, R. (1997). Occupational therapy: Perspectives and processes. Edinburgh, Englad: Churchill Livingstone.

Krupa, T., Fossey, E., Anthony, W.A., Brown, C., & Pitts, D.B. (2009). Doing daily life: How occupational therapy can inform psychiatric rehabilitation practice. Psychiatric Rehabilitation Journal, 32(3), 155-161.

Lloyd, C. & Williams, P.L. (2010). Occupational therapy in the modern adult acute mental health setting: a review of current practice. International Journal of Therapy and Rehabilitation, 17(9), 483-493.

Moyer, P.A. & Dale, L.M. (2007). Guide to occupational therapy practice (2nd ed.). Bethesda, MD: AOTA, Inc.

Peloquin, S. (1989). Moral Treatment: Contexts Considered. American Journal of Occupational Therapy, 43(8), 537-544.

Quiroga, V.A.M. (1995). Occupational Therapy: The first 30 years, 1900-1930. Bethesda, MD: AOTA, Inc.

Schwartzberg, S.L., Trudeau, S.A., & Vega, V. (2013). Principles of occupational therapy group outcome assessment in mental health. Occupational Therapy in Mental Health, 29, 134-148.

Smith, E. & Mackenzie, L. (2011). How occupational therapists are perceived within inpatient mental health settings: The perceptions of seven Australian nurses. Australian Occupational Therapy Journal, 58, 251-260.

Townsend, E.A. & Polatajko, H.J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, Canada: CAOT Publications ACE.

Vax, S., Scheuer, N., & Sachs, D. (2012). Work-related self-efficacy of occupational therapists in mental health. Scandinavian Journal of Occupational Therapy, 19, 42-48.

References
OT challenges the viewpoint of typical medicine by attributing dysfunction to a combination of social, economical, physical, and biological factors (Colman, 1992).

William Rush Dunton - "Occupation-based care is a necessity as a basic human need" (Townsend & Polatajko, 2007).
100 BCE - Modalities such as bathing, exercise, and music were used as treatment for people with mental illnesses (Quiroga, 1995).
Early 18th century - Evidence of physicians using leisure and vigorous work for treatment (Peloquin, 1989).
WWI helped OT move into the medical model for rehabilitation of wounded soldiers.
1920 - OT officially deemed a profession (Quiroga, 1995).
Late 19th and Early 20th centuries - Adolph Meyer, a psychiatrist, speaks out about the theology that OT is centered around (Quiroga, 1995).
ACTIVITY ANALYSIS
“This [group intervention] inherent complexity makes it difficult to measure meaningful outcomes to such interventions” (Schwartzberg, Trudeau, & Vega, 2013).
Activity Analysis of Playing UNO:
“Making cards with clients, facilitating groups, planning and preparing a meal, teaching stress management, playing volleyball all seem to be simple tasks or activities. However, the OT is actually employing specific professional skills for example, clinical reasoning, activity analysis, the therapeutic relationship, adapting activities, and the environment, before selecting and using these seemingly 'simple' activities” (Casteleijn & Graham, 2012).
a. Can the consumer follow directions?
b. Does the consumer follow sequence and timing of the game?
c. Is the consumer able to distinguish between different cards?
d. Can the consumer socialize appropriately with peers?
e. Is the consumer able to regulate their emotions to an appropriate level? What about their frustration tolerance?
f. How is the consumer’s activity tolerance?
g. Is the consumer oriented enough to engage in a simple card game?
h. Can the consumer problem solve to figure out which card to play?
i. Does the consumer seem to be enjoying the game or are they disinterested?
j. Does the consumer display the appropriate facial expressions or emotions throughout the game?
k. Is the consumer able to participate in the given environment?
l. Any other things?
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