Chapter 14: Psychosocial Approaches

Front 1

MODEL OF HUMAN OCCUPATION (MOHO)

Back 1

Principles = Occupation is dynamic and context dependent; Personal occupational choices & engagement in occupation shape the individual.

Three elements are inherent to humans

1. Volition

2. Habituation

3. Performance capacity

Environment impacts on the individual through the opportunities, demands, resources and constraints it provides.

Front 2

MOHO: What is Volition?

Back 2

Thoughts & feelings that motivate people to act & is comprised of personal causation, values, and interests

Front 3

MOHO: what is habituation?

Back 3

organized, recurring patterns of behavior and is comprised of roles and habits

Front 4

MOHO: what is performance capacity?

Back 4

the physical & mental skills needed for performance and the subjective experience of engaging in occupation.

Front 5

What does the evaluation and intervention focuses on in MOHO?

Back 5

Evaluation focuses on exploring individuals occupational history, goals, volition, habits & occupational performances

Intervention focuses on occupational engagement & includes activities that are purposeful, relevant & meaningful to ppl & their social context

Evaluation:

Intervention:

Front 6

LIFE-STYLE PERFORMANCE MODEL

Back 6

Seeks to identify and describe the nature and critical "doing" elements of an environment that supports and fosters achievement of satisfying , productive life-styles

Front 7

What are the 10 fundamental human needs to enhance QOL in the Life-style performance model?

Back 7

1. Autonomy : self-determination'

2. Individuality : self-differentiation

3. Affiliation: evidence of belonging

4. Volition: having of alternatives

5. Consensual validation: acknowledgement of achievements.

6. Predictability

7. Self-efficacy: evidence of competence

8. Adventure: exploration

9. Accommodation

10. Reflection

Front 8

How is performance measured in the quality of functioning?

Back 8

In the Life-style performance model it is measured in four domains.

1. Self-care & maintenance

2. Intrinsic gratification

3. Service to others

4. Reciprocal relationships

Front 9

The life-style performance model evaluation and interventions entails...?

Back 9

evaluation: focuses on obtaining an activity history and life-style performance profile; env. factors are explored

Intervention address 5 main questions that ID the focus on intervention

1. What does the person need to be able to do?

2. What is the person able to do?

3. What is the person unable to do?

4. What interventions are needed and in what order?

5. What are the characteristics and patterns of activity and of the env. that will enhance QOL?

Front 10

ECOLOGY OF HUMAN PREFORMANCE

Back 10

Emphasizes the role of an individual's context and how the environment impacts a person and his/her task performance

Applicable to people across the life-span

The four main constructs of this model include the person, tasks, context and personal-context-task transaction

Front 11

What evaluation for the Ecology of Human performance model entails...?

Back 11

Checklists that were designed specifically for this model such as the checklist for the person, the environment, task analysis & a priority checklist.

The sensory profile also comes out of this model.

Front 12

Intervention for the Ecology of Human Performance Models include?

Back 12

Fall into 5 specific strategies:

1. Establish & restore: enhance abilities thru teaching skills lost/never learned

2. Alter: determine best match for persons ability

3. Adapt/modify: changing context or task to lead to successful performance

4. Prevent: minimize risks

5. Create: assisting the person by promoting enriching/complex performances

Front 13

OCCUPATIONAL ADAPTATION

Back 13

Occupational adaptation is concerned with the processes that the individual goes through to adapt to his/her environment

Three elements: the person, the occupation and the environment

Front 14

ROLE ACQUISITION

Back 14

Intervention is focused on the acquisition of the specific skills an individual needs in order to function in his/her environment

The individual employs a task and social skills to meet the demands of personally desired and necessary roles.

Front 15

In Role Acquisition how is performance addressed?

Back 15

Performance is addressed through function/dysfunction continuums in 7 categories:

1. task skills

2. interpersonal skills

3. Family interaction

4. ADL

5. School

6. Work

7. Play/leisure/recreation

Front 16

Role Acquisition Evaluation & Intervention

Back 16

Evaluation is focused on gathering data indicative of function/dysfunction in the 7 categories.

Intervention: principles of learning used to promote skill development.

- Long term goals are set based on person's expected environment

- any treatment activity or strategies that employ the teaching-learning principles are acceptable

Front 17

COGNITIVE DISABILITIES

Back 17

Based on stages of cognitive development as described by Piaget and the neurobiological science

Cognitive ability is determined by biological factors and the potential for improvement is dictated b those factors

Once the maximum level has been achieved, compensations must be made biologically, psychologically or environmentally

Front 18

AUTOMATIC ACTIONS, LEVEL 1
(COGNITIVE DISABILITIES)

Back 18

Characterized by automatic motor responses and changes in the autonomic nervous system. Conscious response to the external environment is minimal

Front 19

POSTURAL ACTIONS, LEVEL II
(COGNITIVE DISABILITIES)

Back 19

Characterized by movements that is associated with comfort. There is some awareness of large objects in the environment, and the individual may assist the caregiver with simple tasks

Front 20

MANUAL ACTIONS, LEVEL III
(COGNITIVE DISABILITIES)

Back 20

Characterized by beginning to use hands to manipulate object. The individual may be able to perform a limited number of tasks with long-term repetitive training

Front 21

GOAL DIRECTED ACTIONS, LEVEL IV
(COGNITIVE DISABILITIES)

Back 21

Characterized by the ability to carry simple tasks through to completion. The individual relies heavily on visual cues. He/she may be able to perform established routines but cannot cope with unexpected events

Front 22

EXPLORATION ACTIONS, LEVEL V
(COGNITIVE DISABILITIES)

Back 22

Characterized by overt trail and error problem solving. New learning occurs. This may be the usual level of functioning for 20% of the population

Front 23

PLANNED ACTIONS, LEVEL VI
(COGNITIVE DISABILITIES)

Back 23

Characterized by the absence of disability. The person can think of hypothetical situations and do mental trial-and-error problem solving

Front 24

COGNITIVE DISABILITIES EVALUATION

Back 24

1. Focus is on identifying the individual's current cognitive abilities and their implications for performance, independence, and the need for assistance.
2. Observation during functional tasks is emphasized
3. Tools that can be used: ACLS, Routine Task Inventory, Cognitive Performance Test

Front 25

COGNITIVE DISABILITIES INTERVENTION

Back 25

1. Activities are use to elicit the individual's highest cognitive level
2. Therapy focuses on maintaining the individual's highest level of function
3. Environmental changes and activity adaptations are made to compensate for deficits and allow the greatest degree of independence
4. The OT works with the team to develop an appropriate discharge plan
5. The OT should meet with the family or other caregivers to develop understanding of the individual's abilities, deficits and care needs

Front 26

COGNITIVE BEHAVIORAL FRAME OF REFERENCE/ COGNITIVE BEHAVIORAL THERAPY (CBT)

Back 26

CBT is effective with diversity of clinical populations, especially effective in treatment for depression

CBT combines principles of cognitive therapy and behavioral therapy

Cognitive restructuring is a key concept in CBT, which alters cognitions and cognitive processes in order to facilitate behavioral and emotional changes

Front 27

CBT INTERVETION

Back 27

1. Assisting the client in the identification of current problems and potential solutions
2. Using active and collaborative therapist-client interactions as an essential part of the therapeutic process
3. Helping client learn how to identify distorted or unhelpful thinking patterns, recognizes and change inaccurate beliefs, and relate to others in more positive ways
4. Gaining insight and acquiring skills that maximize client functioning and quality of life
5. Facilitating the client's active role in the therapeutic process by frequently providing homework and assignment as part of intervention

Front 28

Beck Depression Inventory (BD-II)

Back 28

A self-completed questionnaire that assess level of depression.

NO special training required to administered

Must be scored by a mental health professional that has training and acquired knowledge of BD-II

Front 29

DIALECTICAL BEHAVIOR THERAPY (DBT)

Back 29

Focus of DBT: addresses suicidal thoughts and actions and self-injurious behaviors, commonly used with individuals with borderline-personality disorder, depression, substance abuse, and/or eating disorders

Intervention:
1. Programming using DBT teaches assertiveness, coping and interpersonal skills
2. DBT groups address how the acquisition of skills affects occupational performance and provide opportunities to practice new skills
3. A strong therapist-client relationship is essential

Front 30

Model of Sensory Processing by Winnie Dunn

Back 30

Looks at how sensory input was processed & then responsed to in one of four patterns of neurological thresholds:

1. sensory- seeking

2. Sensory-avoiding

3. Sensory sensitivity

4. Low registration

Also known as Sensory Modulation

Front 31

Interventions for Sensory processing

Back 31

1. use of Snoezelen multi-sensory env. to calm/alert individuals w/ psychiatric illness, autism, pervasive development disorder and dementia.

2. Use of therapeutic weighted blanket, dolls, stuff animals as a modality to assist in self-soothing

3. Use of comfort rooms in mental health

4. Psychoeducation

5. Sensory diets including alerting/calming stimuli, and heavy work patterns.

Front 32

PSYCHODYNAMIC/PSYCHOANALYTIC

Back 32

-Proper use of this approach requires specialized training
-Individuals protect themselves through the use of defense mechanisms, some are healthy, some are not
-Understanding the function of defensive mechanisms is useful for therapeutic relationships

Front 33

Psychosocial assessments address what areas?

Back 33

1. Performance skills (cognitive, perceptual, psychological & social) and their impact on performance in areas of occupation

2. Client factors/physical conditions or limitations that impact functional behavior & performance

3. Impact of individuals social, cultural, spiritual, and physical contexts

4. ID roles/behaviors that are required of the individual by society or themselves to achieve goals

5. Precautions and safety issues such as suicidal and/or aggressive behavior.

6. History of behavior patterns

7. Individual's goals, values, interests & attitudes

Front 34

What assessment methods do psychosocial assessments employ?

Back 34

1. Interviews - structured & unstructured

2. Standardized tests

3. Clinical obs and rating scales

4. Questionnaires

5. Self-report inventories

Front 35

SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE

Back 35

Focus: Intellectual function

Population: Individuals with cognitive or psychiatric dysfunction

Method: Questionnaire

Front 36

ALLEN COGNITIVE LEVEL SCREEN-5 (ASLS-5)

Back 36

Focus: Assesses the cognitive level of the individual according to the Allen cognitive levels

Population: Adults with psychiatric or cognitive dysfuction

Method: Lacing stitches following instructions and/or demonstrations

Front 37

BECK DEPRESSION INVENTORY

Back 37

Focus: Measurement of the presence and depth of depression

Population: adolescents and adults

Method: Interview

Front 38

ELDER DEPRESSION SCALE

Back 38

Focus: Assesses depression in the elderly

Population: Elders

Method: 30 item checklist

Front 39

HAMILTON DEPRESSION SCALE

Back 39

Focus: Measures the severity of illness and changes over time in individuals diagnosed with a depressive illness

Population: Individuals with a diagnosis of a mood disorder

Method: info gathered thru interview & consultation w/ family, staff and others.

Front 40

List the assessments of task performance?

Back 40

1. Bay area functional performance evaluation (BAFPE)

2. Comprehensive Occupational Therapy Evaluation Scale ( COTE Scale)

Front 41

BAY AREA FUNCTIONAL PERFORMANCE EVALUATION (BAFPA)

Back 41

Focus: Assesses the cognitive, affective, performance, and social interaction skills required to preform activities of daily living

Population: Adult individuals with psychiatric, neurological, or developmental diagnoses

Front 42

BAFPE Methods

Back 42

Start with a brief INTERVIEW

1. The Task Oriented Assessment (TOA)

- measures cognition, performance, affect, qualitative signs, & referral indicators

2. Social Interaction Scale (SIS)

- assess general ability to relate appropriate to other ppl w/in the env. thru obs of individual in 5 situations.

3. Perceptual motor screening

4. Optional self-report social interaction questionnaire.

Front 43

COMPREHENSIVE OCCUPATIONAL THERAPY EVALUATION SCALE (COTE SCALE)

Back 43

Focus: A structured method for observing and rating behaviors and behavioral changes in the areas of general, interpersonal and task skills

Population: Adults with acute psychiatric diagnoses

Front 44

List the assessments of Occupational Performance & Occupational Roles

Back 44

1. Activity Card Sort

2. Activities Health Assessment

3. Adolescent Role Assessment

4. Barth Time Construction

5.Canadian Occupational Performance Measure

6. Occupational Circumstances Assessment Interview Rating Scale

7. Occupational Performance History Interview

8. The Role Checklist

Front 45

ACTIVITY CARD SORT

Back 45

Focus: The identification of person's level and amount of involvement in instrumental, leisure and social activities

Population: Originally developed for older adults with dementia; three versions are currently available: for adults and older adults residing in an institutional setting, living in the community or recovering from an incurred illness, injury or disability

Front 46

ACTIVITIES HEALTH ASSESSMENT

Back 46

Focus: Time usage, patterns and configurations of activities, roles, and underlying skills and habits

Population: Adults through elders

Ax's looks at balance, satisfaction, & comfort each activity contributes; determines person's activities health

Front 47

ADOLESCENT ROLE ASSESSMENT

Back 47

Focus: Assesses the development of internalized role within family, school and social settings

Population: Adolescents ages 13 to 17

Scoring indicates behavior that is appropriate, marginal or inappropriate

Front 48

BARTH TIME CONSTRUCTION (BTC)

Back 48

Focus: Time usage, roles and underlying skills and habits

Population: Adolescent through elder

Front 49

CANADIAN OCCUPATIONAL PERFORMANCE MEASURE (COPM)

Back 49

Focus: Identifies the individual's perception of satisfaction with performance and changes over time in the areas of self-care, productivity and leisure

Population: Individuals over the age of 7 or parents of small children

Scores are used to ID problem areas, treatment focus & outcomes and individual satisfaction.

Front 50

OCCUPATIONAL CIRCUMSTANCES ASSESSMENT INTERVIEW RATING SCALE (OCAIRS), VERSION 4

Back 50

Focus: The nature and extent of an individual's occupational adaptation, based on MOHO

Population: Originally designed for adults through elder persons with psychiatric diagnoses, it is now used in a boarder context

3 interview formats for 3 specific populations:

physical disabilities, mental health & forensic mental health.

Front 51

OCCUPATIONAL PERFORMANCE HISTORY INTERVIEW-II (OPHI-II)

Back 51

Focus: Gathers information about an individual's life history, past and present occupational performance, and the impact of the incidence of disability, illness or other traumatic event in the person's life.

Population: Individuals who are able to participate in a comprehensive interview from adolescents to elders (not recommended for children under 12)

Front 52

THE ROLE CHECKLIST

Back 52

Focus: Assesses self-reported role participation and the value of specific roles to the individual

Population: Adolescent through elder individuals with physical or psychosocial dysfunction

Front 53

INDICATORS FOR ONE-ON-ONE INTERVENTION

Back 53

1. Refusal to attend groups
2. Inability to tolerate group interaction
3. Presence of behaviors that would be disruptive to the goals of the group
4. The issues that must be addressed are specific to the patient/client only

Front 54

INDICATORS FOR GROUP INTERVENTION

Back 54

1. More cost effective
2. Effective at assisting members to learn to live in social environments
3. Takes advantage of group dynamics and therapeutic milieu

Front 55

FACTORS THAT INFLUENCE THE EFFECTIVENESS OF INTERVENTION

Back 55

1. Skillful therapeutic use of self
2. An understanding of the individual's cognitive abilities
3. Exploration of the needs and wants of the individual
4. Skill with activity analysis
5. An understanding of the realities of the treatment conditions and intervention context
6. Prioritization of the most goal-directed use of the person's time

Front 56

RELATIONSHIP OF INTERVENTION ACTIVITIES TO DESIRED GOALS

Back 56

1. Initial intervention may need to focus on the performance skills needed for desired occupational performance
2. Once basic skills are in place, intervention focuses on performance of functional activities specifically relevant to the individual
A. Activities that require the actual desired skills or behaviors, in their natural environment, are often the most effective
B. Activities that simulate desired behaviors in clinical settings may be less effective
C. Activities that utilize the performance skills of desired behaviors and rely on generalization may be the least effective

Front 57

EVALUATION GROUPS

Back 57

1. Designed to gather information about the individual's task and group interaction skills that can be used to establish goals and plan interventions
2. The primary purpose is evaluation, however, they are often therapeutic through process or content

Front 58

TASK-ORIENTED GROUPS

Back 58

1. The purpose is to assist the members in becoming aware of their needs, values, ideas and feelings through the performance of a shared task and recognition of the importance of healthy use of instructed time

Front 59

DEVELOPMENTAL GROUPS

Back 59

1. The purpose is to assist the members to acquire and develop group interaction skills
2. Developmental groups offer five levels of interaction: parallel, project, egocentric cooperative, cooperative, mature

Front 60

PARALLEL GROUPS

Back 60

Type of a developmental group

1. Uses individual tasks with minimal interaction required

Front 61

PROJECT GROUPS

Back 61

Type of developmental group

1. Consists of common, short-term activities requiring some interaction and cooperation

Front 62

EGOCENTRIC COOPERATIVE GROUPS

Back 62

Type of developmental group

1. Require joint interaction on long-term tasks; however, completion of the task is not the focus. The members are beginning to express their needs and address those of others

Front 63

COOPERATIVE GROUPS

Back 63

Type of developmental group

1. Learn to work together cooperatively, not specifically to complete a task, but to enjoy each other's company and meet emotional needs.

Front 64

MATURE GROUPS

Back 64

Type of developmental group

1. Responsive to all members' needs and can carry out a variety of tasks. There is good balance between carrying out the task and meeting the needs of the memebrs

Front 65

THEMATIC GROUPS

Back 65

Designed for the learning of specific skills

Front 66

TOPICAL GROUPS

Back 66

On the discussion of activities and issues outside of the group that are current or anticipated

Front 67

INSTRUMENTAL GROUPS

Back 67

Concerned with meeting health needs and maintaining function

Front 68

CONSIDERATIONS IN GROUP PLANNING

Back 68

1. Members demographics including gender, age, culture and ethnicity
2. Individual characteristics of members: cognitive level, functional skill level, individual goals and contraindication and safety issues
3. Logistical considerations: number of people in groups, length of sessions, number of sessions, space availability, environmental characteristics, budget and material required, number of leaders, frame of reference, open v. closed groups

Front 69

PROCEDURE FOR DEVELOPING A GROUP

Back 69

1. Conduct a needs assessment
2. Develop a protocol
3. Present the protocol to the treatment team or program administration
4. Select potential members who would benefit from the group
5. Meet with each potential member to explain the purpose and circumstances of the group
6. Hold introductory sessions of the group and revise the protocol as needed

Front 70

CONSIDERATIONS FOR ACTIVITY SELECTION

Back 70

1. Degree of structure (inherent or imposed)
2. Type(s) and degree of instructions provided
3. Degree of new learning required
4. Complexity of the activity
5. Length of time for completion
6. Nature and degree of skill required for engagement and completion
7. Degree of challenge to the members' skills

Front 71

DIRECTIVE GROUPS

Back 71

1. Highly structured groups designed to assist low functioning patients in developing basic skills
2. Each session is divided into 5 parts followed by a 15 minute review of the session
-Part 1: Consists of an orientation to the purpose and goals of the group (max 5 mins)
-Part 2: Involves a review of everyone's name and the introduction of new members (5-10 mins)
-Part 3: Consists of warm-up activities to make members comfortable and engage them in the group (5-10 mins)
-Part 4: Involves one or more activities designed to address the goals of the group and the needs of its members (10-20 mins)
-Part 5: Includes activities designed to give meaning to the activities and closure to the group (10 mins)

Front 72

MILDRED ROSS' FIVE STAGE GROUP

Back 72

1. Expands on sensory integration theory, used with chronic schizoprenia, intellectual disabilities, Alzheimer's disease and neurological impairments
2. Each of the five stages of this group follows a clear structure to attain a specific aim:
-Stage I: Orientation - to session and each other
-Stage II: Movement - uses a variety of vigorous gross motor activities designed to be stimulating and alerting
-Stage III: Perceptual Motor - Uses 30 minutes or less activities that utilize visual perceptual-motor skills designed to be calming and to increase ability to focus
-Stage IV: Cognitive - Includes activities to provide cognitive stimulation to promote organized thinking
-Stage V: Closure - Consists of brief discussion to promote a sense of satisfaction and closure

Front 73

MODULAR GROUPS

Back 73

The focus of each session is rotated in a way that allows an individual to join the group at any time and still cover each topic

Front 74

PSYCHOEDUCATIONAL GROUPS

Back 74

1. An intervention approach that uses a classroom format and the principals of learning to provide information to members and to teach skills
2. Teacher/student relationship exists
3. The use of homework assignments is encouraged to facilitate skill development and generalization of learning

Front 75

BASIC TASK SKILL GROUP

Back 75

1. Include intervention activities designed to develop the basic cognitive skills necessary for the completion of simple tasks
- Uses skill acquisition approach which differs from the psychodynamic approach

Front 76

SOCIAL INTERACTION GROUPS

Back 76

1. Include interventions to develop communication skills, socially acceptable behavior, and interpersonal relationships
2. May be conducted in a modular and/or pschoeducational format

Front 77

ADL/IADL GROUPS

Back 77

1. Focus is on self-care and independent living skills such as cooking, money management, transportation, etc
2. May be conducted in a modular and/or psychoeducational format

Front 78

COMMUNITY PARTICIPATION/REINTERGRATION

Back 78

1. Focuses on identification and use of resources
2. May be conducted in a modular and/or psychoeducational format

Front 79

PREVOCATIONAL GROUPS

Back 79

1. Includes such topics as identification of skills, limitations, interests, work behaviors and job hunting

Front 80

LEISURE GROUPS

Back 80

1.May include indentification of interests, development of activity specific skills, identification of resources, and recognition of the importance of healthy use of unstructured time

Front 81

REMINISCENCE GROUPS

Back 81

1. Activities are designed to review past life experiences to promote cognition and a sense of person worth
2. Current memory is not necessary nor is it facilitated

Front 82

SENSORY AWARENESS GROUPS

Back 82

1. Includes activities to promote sensory functions and environmental awareness

Front 83

SELF-AWARENESS GROUPS

Back 83

1. Includes such activities as values clarification, awareness of persona assets, limitations, and behaviors; and the individual's impact on others

Front 84

GOAL SETTING GROUPS

Back 84

1. Consists of activities designed to identify personal objectives and treatment goals and the steps to their achievement

Front 85

COPING SKILLS GROUPS

Back 85

1. Focuses on identifying the problem-solving and stress-management techniques needed to cope with life stressors

Front 86

DISCHARGE PLANNING GROUPS

Back 86

1. Focuses on activities to problem-solve potential obstacles and identify resources for successful community reintergration

Front 87

MANAGING HALLUCINATIONS

Back 87

1. Create an environment free of distractions that trigger hallucinatory thoughts and interfere with reality-based activity
2. Use highly structured simple, concrete activities that hold the individual's attention
3. When the person appears to be focusing on a hallucinatory experience, attempt to redirect him/her to reality-based thinking and actions

Front 88

MANAGING DELUSIONS

Back 88

1. Redirect the individual's thoughts to reality-based thinking and actions
2. Avoid discussions and other experiences that focus on and validate or reinforce delusional material

Front 89

MANAGING AKATHISIA

Back 89

1. Allow the person to move around as needed if it can be done without causing disruption to the goals of the group
2. Keep in mind that participation on many levels and in many forms can be beneficial to the individual
3. Whenever possible, select gross motor activities over fine motor or sedentary ones

Front 90

MANAGING OFFENSIVE BEHAVIOR (PHYSICAL OR VERBAL)

Back 90

1. Set limits and immediately address the behavior during a session
2. Reasons the behaviors are not acceptable should be clearly presented in a manner that is not confrontational or judgmental
3. The consequences of continued offensive behavior should be clearly communicated
4. It is required that staff protects all patients from the threat of harm or abuse by another patient. The needs of the entire unit and/or group membership must be kept in mind

Front 91

MANAGING LACK OF INITIATION/PARTICIPATION

Back 91

1. Together with the individual identify the reasons for lack of participation
2. Individuals are more likely to participate in activities that address issues that are of interest or concern to them
3. Positive reinforcement
4. Use fun activities that give patients success and a feeling of ownership

Front 92

MANAGING MANIC OR MONOPOLIZING BEHAVIOR

Back 92

1. Select or design highly structured activities that hold the individual's attention and require a shift of focus from patient to patient
2. Thank the individual for their participation and redirect attention to another group member
3. Set limits

Front 93

MANAGING ESCALATING BEHAVIOR

Back 93

1. Avoid what can be perceived as challenging behavior (e.g. eye-contact, standing directly in front of patient)
2. Maintain a comfortable distance
3. Actively listen
4. Use calm, but not polarizing tone
5. Speak simply, clearly, and directly, avoid miscommunication
6. Do not make or communicate value judgement
7. Clearly present what you would like the person to do
8. Avoid positions where either you or the patient feels trapped
9. If escalation continues, remove other patients from the area OR get/send for other staff

Front 94

MANAGEMENT OF THE EFFECTS OF ALZHEIMER'S DISEASE

Back 94

1. Make eye contact and show you are interested in the person
2. Maintain a positive and friendly facial expression and tone of voice during all communications
3. Do not speak about the individual as if he/she was not there
4. Use non-verbal communication
5. Create a routine that uses familiar and enjoyable activities
6. Note the effects of the time of day on behavior and activity performance
7. Attend to safety issues at all times

Front 95

OT INTERVENTION FOR SUICIDAL THOUGHTS

Back 95

1. Identification of the motivation behind suicidal intent and the identification of alternatives
2. Development of problem solving skills and stress management techniques
3. Identification of positive goals and interests to increase motivation for recovery
4. Identification of positive personal attributes and support systems to increase hopefulness
5. Activities that produce successful outcomes, especially those with a visible end product, promote positive thinking
6. Moderate physical activity elevates mood
7. Development of skills that increase functional performance

Front 96

OT INTERVENTION FOR DEATH AND DYING

Back 96

1. Assist the individual in maintaining as much control and independence as possible
2. Respond honestly and at the appropriate depth to questions
3. Assist the individual in developing coping skills
4. Encourage positive life review and support the legacies the leaves
5. Assist the individual in pursing interest and maintaining meaningful roles
6. Actively listen
7. Incorporate family and friends in the treatment process
8. While being realistic, the therapist should not deprive the individual of hope

Front 97

DENIAL

Back 97

The failure to acknowledge the existence of some aspect of reality that is apparent to others
(e.g. alcohol abuser is unable to acknowledge that his/her problems are a result of drinking)

Front 98

PROJECTION

Back 98

Attributing attributes or unacknowledged feelings, impulses or thoughts to others
(e.g. someone who feels guilty attributes what others say as blaming him/her)

Front 99

SPLITTING

Back 99

Rigid separating of positive and negative thoughts and of feelings
(e.g. staff members may be seen as all good or all bad when variations of behaviors are anxiety provoking)

Front 100

PASSIVE-AGRESSIVE

Back 100

Aggression towards others which is indirectly or unassertively expressed
(e.g. a patient is late for a treatment session when he/she is angry with the practitioner)

Front 101

REGRESSION

Back 101

Returning to an earlier stage of development to avoid the tension and conflict of the present one
(e.g. an individual becomes needy and/or child-like during a period of stress or illness)

Front 102

SOMATIZATION

Back 102

The conversion of psychological symptoms into physical illness
(e.g. a person who feels stuck in an unhappy marriage develops low back pain)

Front 103

RATIONALIZATION

Back 103

Creating self-justifying explanations to hide the real reason's for one's own or another's behavior
(e.g. a parent believes a lazy adult child is not working because the job market is poor)

Front 104

REPRESSION

Back 104

Blocking from consciousness painful memories and anxiety-provoking thoughts
(e.g. an adult child has no memory of being mistreated by a beloved parent)

Front 105

DISPLACEMENT

Back 105

Redirecting an emotion or reaction from one object to a similar but less threatening one (e.g. child gets angry with his/her parent and hits a younger sibling)

Front 106

REACTION FORMATION

Back 106

The switching of unacceptable impulses into its opposite
(e.g. hugging someone you would like to hit)

Front 107

HUMOR

Back 107

Using comedy to express feelings and thoughts without provoking discomfort in self and others
(e.g. making fun of yourself for coming inappropriately dressed for a specific function)

Front 108

SUBLIMATION

Back 108

Redirecting energy from socially unacceptable impulses to socially acceptable activities
(e.g. an angry individual channels that anger into aggressive sports play)

Front 109

SUPPRESSION

Back 109

Consciously or semi-consciously avoiding thinking about disturbing problems, thoughts or feelings
(e.g. cleaning closets and drawers while waiting for a medical test)

Front 110

What are the 5 stages of grief/loss?

Back 110

Denial

Anger

Bargaining

Depression

Acceptance

(DABDA)

Front 111

OT interventions in each stage.

Back 111

Denial: allow person to ask questions & discuss the situation at their own pace

Anger: allow individual to vent while ID its source & developing more effective coping techniques

Bargaining: Responding honestly to questions

Depression: assist in providing physical and psychological comfort for both the individual and their loved ones

Acceptance: provide ongoing support to the individual and family.