Nbcot Review Ch 2: Service Delivery Models And Practice Settings

Front 1

What are the 3 Models of Practice?

Back 1

1. Medical Model
2. Education Model
3. Community Model

Front 2

Explain the Medical Model.

Back 2

- Views person with disability as someone who has a physiological insult resulting in reduced functional capacity.
- Treatment addresses the disease or dysfunction.
- OT frames of reference address the pathological process (biomechanical, neurodevelopmental).

Front 3

Explain the Education Model.

Back 3

- Views the individual with a disability as lacking knowledge or skills.
- Focus on learning, behavioral change for interacting successfully in environment.
-OT frames of reference based on learning theories to facilitate adaptation in the environment (role acquisition, cognitive remediation).

Front 4

Explain the Community Model.

Back 4

- Views individual with disability as lacking skills, resources, and supports for community integration.
- Focus on identifying and developing skills for one's expected environment.
- OT frames of reference promote development within the individual's performance contexts (life-style performance, occupation adaptation).

Front 5

What are the 8 types of Institutional Practice Settings?

Back 5

1. Acute care hospitals
2. Sub-acute care/intermediate care facilities (ICFs)
3. Long-term acute care (LTAC).
4. Rehabilitation hospitals
5. Long-term hospitals
6. Skilled nursing facilities (SNFs)
7. Forensic settings
8. Outpatient/ambulatory care

Front 6

Describe Acute Care.

Back 6

- LOS: 1-7 days
- Discharge to: Ongoing care -> subacute

Front 7

Describe Sub-Acute Care / Intermediate Care Facilities.

Back 7

- LOS: 5-30 days
- Discharge to: Ongoing care -> rehab facility/home

Front 8

Describe a Rehabilitation Hospital.

Back 8

- Person is medically stable but has residual functional deficits requiring skilled rehabilitation.
- LOS: week - months
- Discharge to: SNF, community residence, home

Front 9

Describe a long-term hospital.

Back 9

- A medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis.
- LOS: month - years
- Discharge to: state run long-term hospital, SNF, home, supportive residence

Front 10

Describe a Skilled Nursing Facility.

Back 10

- A medical or psychiatric diagnosis that is chronic and requires skilled care, but the illness is stable with no acute symptoms.
- People admitted for medical care and rehabilitation as well.
- LOS: 1 month - lifetime
- Discharge to: home if stable and can safely access/maintain

Front 11

Describe Forensic settings.

Back 11

- Admitted due to criminal activity.
*Jail (sentences less than 1 year)
*Prison (sentences greater than 1 year)
*Psychiatric hospital (mentally ill or not guilty by reason of insanity)
-LOS: determined by court

Front 12

Describe Outpatient / Ambulatory Care.

Back 12

- Focus: diagnostic evaluations, interventions to increase functional performance, consumer education, prevention.

Front 13

What are the 14 Community-Based Practice Settings?

Back 13

1. Early Intervention
2. Schools
3. Supportive Education
4. Prevocational Programs
5. Vocational Programs
6. Residential Programs
7. Partial hospitalization/day hospital programs
8. Clubhouse
9. Adult day care
10. Outpatient/Ambulatory care
11. Home Health Care
12. Hospice
13. Case management programs
14. Wellness and prevention programs

Front 14

Discuss early intervention programs.
- Evaluation Criteria
- Intervention Criteria
- LOS

Back 14

Evaluation Criteria - based on at-risk status of child under age of 3:
- Birth complications, suspected delays in development, failure to thrive, maternal substance abuse during pregnancy, birth to teen mother, established disability/diagnosis.

Intervention Criteria
1. The extent of the developmental delay (typically 33% delay in one area or 25% in two areas)
2. An established diagnosis/disability

LOS: create infant family service plan. 6 month reviews submitted to determine if services should continue.

Front 15

Discuss early intervention programs.
- Eval and Intervention process

Back 15

Evaluation: assess cognitive, physical, communication, social-emotional, adaptive. Determine effects of current development on play and ADLs.

Intervention: develop cognitive, psychosocial, communication, interaction, sensorimotor skills, play, ADL skills. Family education, advocacy/training, transition planning.

Front 16

Discuss school programs.
- Criteria for OT services

Back 16

Criteria:
- Child requires special ed and OT will enable child to benefit from special ed
- OT will facilitate participation in educational activities and enhance functional performance.
- Referrals from previous agency that provided early intervention
- School reviews referrals and decides if OT warranted.

Front 17

Discuss school programs.
- LOS

Back 17

LOS
- If OT can improve child's abilities to participate in education activities and allow full access to the general ed curriculum, services can be continued.
- Annual review of services and progress made toward IEP.

Front 18

Discuss school programs.
- Evaluation
- Intervention

Back 18

Evaluation
- Assess all areas that impact educational and functional performance of child within the school (including behavioral).
- Findings contribute to IEP and functional goals are made to address educational needs

Intervention:
- Addressing IEP goals (educational and functional performance)
- Includes AT and transition services
- Can include behavioral intervention plans (Response to Intervention RtI, Early Intervening Services, Positive Behavioral Supports)

Front 19

What is Response to Intervention (RtI)?

Back 19

An evidence-based, structured intervention approach. It works on addressing behavioral problems early in a child's education.

Front 20

Discuss supported education programs.
- Criteria
- LOS

Back 20

Criteria
- Adolescents or adults who require intervention to develop skills needed to succeed in secondary and/or post-secondary education
(person may never have developed these skills or lost them due to psychiatric / mental health problems)

LOS: determined by agency's funding and person's attainment of goals. Discharge is upon entry to or completion of an educational program or attaining a GED.

Front 21

Discuss supported education programs.
- Evaluation
- Intervention

Back 21

Evaluation: client factors, performance skills, patterns that impact role of student.

Intervention:
- Improve performance skills and patterns needed to be a student (time management, task prioritization)
- Education/training in compensatory strategies (studying in quiet room)
- Exploring educational interests and aptitudes to ensure self-determined engagement in education.

Front 22

Discuss Prevocational Programs.
- Criteria
- LOS

Back 22

Criteria: adolescents/adults who require intervention to develop skills prerequisite to work (may never have had these skills or lost them due to illness/disability)

LOS: determined by agency's funding/person's attainment of goals (d/c to vocational program or even work setting - if abilities developed)

Eval/Intervention: working on task skills, social interaction, work habits, interests, and aptitudes.

Front 23

Discuss vocational programs.
- Criteria
- LOS

Back 23

Criteria:
1. Person has prerequisite abilities to work (good task skills/work habits) but requires training for specific job/ongoing structure, support, or supervision to maintain employment.
2. Person has to develop his work capacities to a level acceptable for competitive employment (strength, endurance).

LOS:
1. Rehabilitation workshops: d/c might not be a goal
2. Transitional Employment Programs (TEPs): time limited 3-6 months with d/c to employment/rehab workshops
3. Employee Assistance Programs (EAPs): provide ongoing support, intervention, referrals as needed to a company's employees to enable them to maintain their employment.

Front 24

Discuss vocational programs.
- Evaluation
- Intervention

Back 24

Eval/Intervention:
1. remediate skill deficits and compensation for client factors affecting work performance.
2. Develop general work abilities and specific job skills.
3. Consult with / supervise vocational direct care staff.
4. Identify and implement reasonable accommodations according to ADA.
5. Referral to state offices of vocational and educational services (One Stop Centers) for persons with disabilities needing further evaluation/education/training.

Front 25

What are residential programs?

Back 25

Residential programs are on a continuum from 24 hour supervision quarter way housing, halfway houses, or group homes, to supportive apartments with weekly/biweekly check-in.

Front 26

Discuss residental programs.
- Criteria
- LOS

Back 26

Criteria
- Developmental, medical, or psychiatric condition that resulted in functional deficits that impede independent living but not severe enough to require hospitalization.

LOS:
- Transitional living determined by agency's funding
- Long-term/permanent housing funded by person's social security benefits.

Front 27

Discuss residential programs.
- Evaluation
- Intervention

Back 27

Evaluation: assessing skills for living in community (including social, environmental resources and supports to maintain current living environment)

Intervention
1. Consult / supervise residential program staff.
2. Remediate skill deficits and compensation for client factors affecting independent living skills.
3. ADL training, activity adaptation, environmental modifications.
4. Referral to residential services as functional level improves.
5. Education person on ADA, Fair Housing Act, Section 8 Housing.

Front 28

What is a partial hospitalization or day hospital program?

Back 28

A person with medical or psychiatric condition that is stabilized enough to d/c home or to community residence comes back for treatment (no longer inpatient hospitalization).

Treatment is up to 5 days/week with multiple interventions throughout the day.

Front 29

Discuss partial hospitalization/day hospital programs.
- Criteria
- LOS
- Evaluation / Intervention

Back 29

Criteria: medical or psychiatric condition that is sufficiently stabilized to enable a person d/c home or to a community residence
(person still has some symptoms that require treatment)

LOS: 1 week to 6 months. D/c usually to less intensive community day program.

Evaluation/Intervention: attaining skills required in current and expected environments (community supports for community integration, remediating skills and deficits and compensating for factors affecting performance)

Front 30

What are Clubhouse programs?

Back 30

- Services are provided by staff and members with responsibilities of operating the clubhouse shared equally by staff and members.
- Clubhouses open at least 5 days/week (many open 7 days/week).
- The schedule is organized around a "work-ordered" day, which parallels typical working hours. Evening and weekends are focused on other interests /recreation.

Front 31

What is the criteria for entering a clubhouse program?
What is the LOS?
What is OT's role in the clubhouse model?

Back 31

Criteria: open to adults and elders with current mental illness or history of mental illness.
- All members have equal access to all clubhouse functions and opportunities regardless of functional level or diagnosis.
- Those who pose a significant threat to the safety of clubhouse community are the only ones excluded from clubhouse.

LOS: indefinite, members can come and go at will.

OT is integrated into the clubhouse model. Acts as a generalists that contributes to the development and enrichment of members' abilities (no formal evaluation and intervention)

Front 32

What is adult day care?

Back 32

- A day treatment program aimed at adults and elders with chronic physical and/or psychosocial impairments, and/or individuals who are frail but semi-independent.
- Treatment occurs in a group setting.
- Individual schedules vary, as flexibility allows time to address daily caregiver needs and time for rest.
- Schedules of individual persons can very from one afternoon per week to 5 full days.

LOS: indefinite. Services are provided to people who might otherwise be institutionalized or are frail and need ongoing support (cooked meals, socialization opportunities).

Front 33

OT Interventions in adult day care:

Back 33

1. Maintaining healthy, functional aspects of the person and facilitate adaptation to impairments
2. Engagement in purposeful activities that provide stimulation, reflect interests, develop new interests, foster sense of community
3. Caregiver education, support groups, home visits, consultations, referrals to community resources
4. Modify day care center and person's home environment to maximize their comfort, mastery, and control of the environments.

Front 34

What is outpatient/ambulatory care in a community setting?

Back 34

Criteria: medical or psychiatric condition not serious enough to warrant hospitalization, or for a condition that has sufficient stabilized to enable the person to be d/c but remaining symptoms require treatment.

Tx: 30-60 min 1Xday up to 5 days/week.
LOS: depends on diagnosis, symptoms, response to tx, insurance coverage/ability to pay.
Evaluation and Intervention: same as in medical setting.

Front 35

Discuss home health care.
- Criteria
- Treatment duration
- LOS

Back 35

Criteria: presence of medical/psychiatric condition not serious enough for hospitalization, or for condition sufficiently stabilized for d/c from hospital, but remaining symptoms require treatment.

TX: 60 minute sessions, 1Xday, up to 5 days/week.

LOS: depends on diagnosis, symptoms, response to tx, insurance/ability to pay

Front 36

Home Health Care Intervention:

Back 36

1. engagement of client, family, and caregivers in treatment planning, implementation, and re-evaluation.
2. functional improvement in areas of occupation and role functioning w/in home.
3. remediate skill deficits and compensate for factors affecting performance in home.
4. educate family, caregivers, and/or home health aides
5. environmental modifications and activity adaptations to maintain optimal functioning / improve quality of life.
6. increase ability to resume occupational roles outside the home.
7. prevent hospitalization / avoidance or delay of residential institutional placement (SNF).

Front 37

Discuss hospice.

Back 37

- Criteria: terminal illness that has a life expectancy of 6 months or less.
- Services provided most often in home (may be done in SNF or hospital as needed)
- Evaluation: determining person's occupational functioning and physical, psychosocial, spiritual, and environmental needs most important to person.
- Intervention:
1. maintenance of control over his/her life.
2. facilitate engagement in meaningful occupations / purposeful activities
3. reduce or remove distressing symptoms and pain
4. environmental modification / activity adaptations that maintain optimal functioning and improve QoL.
5. caregiver / family education and support for optimal functioning and improved QoL for all.

Front 38

Discuss case management programs.

Back 38

Two Types:
1. Clinical Case management: individualized support and intervention to client with serious illness that limits ability to access and/or engage in existing community services / therapeutic programs, ensuring the person can remain in community and not be re-hospitalized.
- Includes 1:1 counseling, family education, ADL training, community re-entry, etc.

Administrative case management: connects person with serious illness to appropriate and needed community services and/or therapeutic programs, overseeing to ensure quality of care in cost-effective manner is achieved.
- Referral-based.

Front 39

Discuss wellness and prevention programs.

Back 39

- Individual self referral to meet a personal need or an institution's provision of a program to its members or employees.
- Programs for at-risk populations
- Can be held in offices, residences, community sites.
- LOS determined by individual desired outcome (smoking cessation), program length (i.e. 6 week joint protection program).
- Intervention
1. disease prevention and health promotion
2. range from traditional OT (home safety and environmental modifications) to contemporary areas of concern (stress management, life coaching)
3. Refer to primary, secondary, and tertiary prevention notecards.