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23 Cards in this Set

  • Front
  • Back

The OTPF has two main sections

i. Domain

ii. Process

There are 5 main ideas that are to be considered throughout intervention:

-The process is dynamic and evolving.

-Context is embedded in our understanding of intervention.


-Clients are individuals, whether they receive services as individuals or asmembers of groups or populations.


-The client must be an active participant (client-centered process).


The outcome is engagement in occupation.


Eight Stages in the OT Intervention Process:

-Referral

-Screening


-Evaluation


-Intervention Planning


-Intervention Implementation


-Intervention Review


-Transition Planning


-Discontinuation of Service

Referral

The physician or other referring professional requests OT service foran identified patient. The OTA may relay the referral to the supervising OT butshould not accept the referral independently. The OT documents receipts ofreferral in compliance with state laws and other regulations.

Screening

The purpose is to determine whether the patient needs further OTevaluation and treatment. OT practitioners observe and briefly interview thepatient and/or collect information from the medical record. The OT isresponsible for screening and may direct the OTA to collect specific data.

Evaluation

The purpose is to find out more about the client, what he or shewants and needs to do, and the obstacles to occupational engagement. Theoccupational profile (the client’s occupational history and goals) and theanalysis of occupational performance (a study of how the client performs todetermine his or her limitations and strengths) are the two major parts ofevaluation. Information is collected form the patient and other sources. The OTdetermines what information is needed and how to obtain it and may assign theOTA to carry out structured interviews, distribute and collect questionnaires,search the medical record, and administer structured evaluations-provided theOTA has demonstrated service competency. The OT is responsible forsynthesizing, analyzing, and documenting the entire evaluation.

Intervention Planning

Based on the results of evaluation, a plan is developed inkeeping with the patient’s goals. Specific outcomes are identified, andapproaches and methods for achieving these are identified. Working with thepatient, the OT and/or OTA (depending on the focus of treatment) determineshort- and long-term goals based on the identified problems. Consideration isgiven to time frames, applicable standards, and other guidelines. The OTpractitioner selects the methods and specific treatment activities to be used towork toward these goals.

Intervention Implementation

The treatment plan is carried out. In manysettings, the OTA is responsible for this aspect of the treatment process,involving the patient in activities to support participation in occupation.Intervention may be directed at modification s of the task or the environment.Documentation of intervention is essential and flows with state laws and otherguidelines.

Intervention Review

At regular intervals or continuously (depending ontreatment setting), the OT practitioners consider whether the intervention planis working, what progress has been made, and what changes might beappropriate. The plan is modified as needed. Additional referrals or evaluationsmay be ordered.

Transition Planning

OT practitioners work with the client, the family whenappropriate, and the rest of the treatment team to make sure that the patientwill be able to function optimally after leaving the treatment setting. Transitionplans may include living arrangements, transition from school to work,employment and leisure, and/or continuing treatment, depending on theconsumer’s need. All OT practitioners who have worked with the patient shouldcontribute to the transition plan.

Discontinuation of service

The patient is discharged from the program.Achievements in the program and plans are discussed. A final note is written bythe OT with contributions from the OTA, documenting changes in the client’sstatus from the initial evaluation to the final service intervention. Any follow-upplans are also documented. Outcomes are documented in a manner consistentwith local guidelines and program evaluation priorities.

Screening is designed to answer the following questions:
-Does this person have any problems functioning in daily life activitiesand occupational roles?

-Are these problems treatable by occupational therapy?


-Does the person demonstrate readiness to attend occupational therapyand benefit from it?


-If not, should the person be evaluated for occupational therapy aftermedication begins to take effect or the person is medically stable?

Occupational Profile

Describes the person’s occupational history andinterests, what is currently important to the person, and other informationrelevant to the person’s experiences and goals related to engagement inoccupation.

Analysis of Occupational Performance

A study of the person’s ability toengage in the desired occupations.

Deficit

A behavior that interferes with meeting the client’s needs and doingthe things he or she needs and wants to do.

Social Support

The way in which and the extent to which relationships withother people help the person meet needs and carry out daily activities.

Personal Context

Includes such features as age, gender, education, andsocioeconomic status.

Spiritual Context

Includes those things that the person believes givehigher meaning and purpose.

Temporal Context

Locates the performance of occupation in time, whetherby time of day, time of life, the season, or other time orientation.

Top-down Evaluation

Begins with the client’s goals. No other data arecollected until the client’s perspective is understood. The occupationalprofile is a clear example of this.

Bottom-up Evaluation

Begins with the factors that appear to impedeoccupational engagement. An example in a burn unit is the assessmentof wounds and the need for specific splinting to prevent contractures.Clearly in this case, the medical necessity cannot wait for an interviewto learn the client’s goals. In a psychiatric setting, the assessment ofcognitive level would represent a bottom-up evaluation.

Environment-first Evaluation

Is appropriate when safety is a factor, asfor example when assessing the home environment for an elderly clientto reduce the risk of falls.

Service Competency

Can be established by using standardized or criterion-referenced tests and comparing the results obtained by the OTA with thoseobtained by the OT.