Occupational Therapy Lecture 3 PDF

OT PROCESS: EVALUATION, INTERVENTION, & OUTCOMES Jordan University of Science & Technology OT 201 - Occupational Therapy Fundamentals Lecture 3 1  LEARNING OBJECTIVES List and define the component...

OT PROCESS: EVALUATION, INTERVENTION, & OUTCOMES Jordan University of Science & Technology OT 201 - Occupational Therapy Fundamentals Lecture 3 1  LEARNING OBJECTIVES List and define the components of the OT process Differentiate between the components of the OT process Appreciate the Importance of each component of the OT process steps Understand the flow/organization of the OT services delivery Appreciate the importance of outcome monitoring 2  PROCESS OF OCCUPATIONAL THERAPY The occupational therapy process is the client-centered delivery of occupational therapy services. The OT process describes the actions practitioners take when providing services that are client centered and focused on engagement in occupations. 3  PROCESS OF OCCUPATIONAL THERAPY The OT process involves collaboration among the occupational therapist and the client. Guides OT practitioners as they seek to support clients’ participation in daily living. 4  THERAPEUTIC USE OF SELF Therapeutic Use of Self, in which occupational therapy practitioners develop and manage their therapeutic relationship with clients by using professional reasoning, empathy, and a client- centered, collaborative approach to service delivery 5  THERAPEUTIC USE OF OCCUPATION Therapeutic Use of occupations, in which occupational therapy practitioners focus on occupations as primary methods of intervention to promote health throughout the process Analyzing occupational performance requires an understanding of the complex interaction among the client’s contexts, performance patterns, performance skills, and client factors to perform daily activities. 6  CLINICAL AND PROFESSIONAL REASONING Clinical and professional reasoning is a broad term to apply knowledge and reasoning skills in all settings to: Identify the multiple demands, required skills, and potential meanings of the activities and occupations Gain a deeper understanding of the interrelationships among aspects of the domain that affect performance 7  PROCESS OF OCCUPATIONAL THERAPY The three-part process includes: (1) Evaluation (2) Intervention to achieve (3) Targeted outcomes and occurs within the purview of the occupational therapy domain 8 OCCUPATIONAL THERAPY PROCESS: EVALUATION 9  EVALUATION Focused on finding out the: 1. Client needs, problems, and priorities 2. Abilities of the client 3. Factors that act as supports or barriers to health and participation. Evaluation often occurs both formally (assessment tools) and informally (observation) during all interactions with the client. 10  EVALUATION VS. ASSESSMENT Assessment: “Specific tools or instruments that are used during the evaluation process” Evaluation: “The process of obtaining and interpreting data necessary for intervention. This includes planning for and documenting the evaluation process and results” 11  EVALUATION 1. Occupational profile. 2. Analysis of occupational performance. 3. Synthesis of Evaluation Process 12  EVALUATION The evaluation consists of: 1. Occupational profile: includes information about the client and the client’s needs, problems, and concerns about performance in areas of occupation. 2. Analysis of occupational performance: focuses on collecting and interpreting information using assessment tools designed to observe, measure, and inquire about factors that support or obstruct occupational performance. 13  EVALUATION 3. Synthesis of Evaluation Process: The occupational therapist synthesizes the information gathered through the occupational profile and analysis of occupational performance. 14 15  OCCUPATIONAL PROFILE Collect information through occupational Profile includes: Why is the client seeking services, What are the client’s current concerns relative to engaging in occupations and in daily life activities? What occupations does the client feel successful, and what barriers are there? What is the client’s occupational history (i.e., life experiences)? What are the client’s values and interests? What aspects of their contexts (environmental and personal factors? How are the client’s performance patterns supporting or limiting performance? What are the client’s patterns of engagement in occupations, and how have they changed over time? What client factors does the client see as supporting or inhibiting engagement (e.g., pain, active symptoms)? What are the client’s priorities and desired targeted outcomes related to occupational performance, prevention, health and wellness, quality of life, participation, role competence, well-being, and occupational justice? 16  ANALYSIS OF OCCUPATIONAL PERFORMANCE Synthesizing information from the occupational profile to focus on specific areas of occupation and contexts that need to be addressed: 1. Synthesizing information from the occupational profile to determine specific occupations and contexts that need to be addressed 2. Completing an occupational or activity analysis to identify the demands of occupations and activities on the client 3. Selecting and using specific assessments to measure the quality of the client’s performance or performance deficits 4. Selecting and using specific assessments to measure client factors that influence performance skills and performance patterns 5. Selecting and administering assessments to identify and measure more specifically the client’s contexts and their impact on occupational performance. 17  SYNTHESIS OF EVALUATION PROCESS Synthesizing information from the occupational profile to focus on specific areas of occupation and contexts that need to be addressed; 1. Determining the client’s values and priorities for occupational participation 2. Interpreting the assessment data to identify supports and hindrances to occupational performance 3. Developing and refining hypotheses about the client’s occupational performance strengths and deficits 4. Considering existing support systems and contexts and their ability to support the intervention process 5. Determining desired outcomes of the intervention 6. Creating goals in collaboration with the client that address the desired outcomes 7. Selecting outcome measures and determining procedures to measure progress toward the goals of intervention, which may include repeating assessments used in the evaluation process. 18  ACTIVITY ANALYSIS Activity analysis is an important process used by OT practitioners to understand the demands that a specific desired activity places on a client. Activity analysis addresses: 1. Demands of an activity. 2. Range of skills involved in its performance. 3. Various cultural meanings that might be attributed to it. 19 OCCUPATIONAL THERAPY PROCESS: INTERVENTION 20  INTERVENTION The intervention consists of the skilled actions taken by OT practitioners in collaboration with the client to facilitate engagement in occupations. OT practitioners use the information gathered during the evaluation to direct interventions. 21  INTERVENTION The intervention process is divided into three steps: 1. Intervention plan 2. Intervention implementation 3. Intervention review 22 INTERVENTION 23  STEP 1: INTERVENTION PLAN The intervention plan directs the actions of the occupational therapist. The intervention plan is developed collaboratively with the client based on his goals and priorities. 24  STEP1: INTERVENTION PLAN (CONT.) Intervention planning includes the following steps: 1. Developing the plan: a. Writing realistic, functional, and measurable goals with a time-frame (Long-term goals & Short-term goals) b. Selecting the best OT intervention approach based on the theory and evidence c. Determining mechanisms for service delivery 2. Considering potential discharge needs and plans 3. Selecting outcome measures 4. Making recommendation or referral to others as needed. 25  STEP 2: INTERVENTION IMPLEMENTATION Intervention implementation is the process of putting the plan into action. Intervention implementation includes the following steps: 1. Determining and applying the type of OT intervention(s) to be used 2. Monitoring the client’s progress based on ongoing assessment and reassessment. 26  STEP3: INTERVENTION REVIEW Intervention review is the continuous process of reevaluating and reviewing the intervention plan, the effectiveness of its delivery, and the progress toward outcomes. The intervention review includes the following steps: 1.Re-evaluating the plan and how it is implemented 2.Modifying the plan as needed 3.Determining the need for continuation or discontinuation of OT services, or referral to other services. 27  TYPES OF OCCUPATIONAL THERAPY INTERVENTIONS Therapeutic use of self: Occupational therapy practitioner’s planned use of his or her personality, insights, perceptions, and judgments as part of the therapeutic process. Therapeutic use of occupations or activities: Occupations and activities selected for specific clients that meet therapeutic goals. 1. Occupation-based interventions (e.g.: Purchasing groceries and preparing a meal ) 2. Purposeful activity (e.g.: Practices how to select clothing and manipulate clothing fasteners) 3. Preparatory methods. (e.g.: Administers physical agent modalities to prepare muscles for movement ) 28  TYPES OF OCCUPATIONAL THERAPY INTERVENTIONS (CONT.) Consultation process: Type of intervention in which OT practitioners use their expertise to collaborate with the client to identify the problem, create possible solutions, and try these solutions. (e.g.: Advises family how to create pre-sleep routines for their children ) Education process: An intervention process that involves teaching knowledge and information about occupation, health, and participation and that does not result in the actual performance of the occupation/activity (e.g.: Teaches staff at a homeless shelter how to structure daily living) Advocacy: Efforts directed toward empowering clients to seek and obtain resources to fully participate in their daily life occupations (e.g. Collaborates with a person to acquire reasonable housing at worksite ) 29  CLIENTS TERMINOLOGY Actual term used for clients receiving OT varies among practice settings and delivery models. For example, 1. In a hospital, client may be called a patient 2. In a school, client might be a student, teacher, parent, or administrator. 3. In an organization, client may be called a consumer. The term person includes others who also may help or be served indirectly, such as caregiver, teacher, parent, employer, or spouse. 30  OUTCOMES Outcomes are defined as important dimensions of health, attributed to interventions, and include the ability to function, health perceptions, and satisfaction with care. outcomes are the end-result of the occupational therapy process and describe what occupational therapy intervention can achieve with clients. 31  OUTCOMES MONITORING To determine the client’s success in achieving health and participation in life through engagement in occupation, OT practitioners assess observable outcomes. For example, a client’s improved ability to incorporate performance skills into a routine (performance pattern) and improved strength or range of motion (body functions) enables engagement in home management (IADL). 32  OUTCOMES MONITORING PROCESS Implementation of the outcomes process includes the following steps: 1. Selecting types of outcomes and the outcome measures. Selecting the type of outcome including occupational performance, adaptation, health and wellness, participation, prevention, self- advocacy, quality of life, and occupational justice) Selecting outcome measures that are valid, reliable, and sensitive to change in the client’s occupational performance early in the intervention process 33  OUTCOMES MONITORING PROCESS Implementation of the outcomes process includes the following steps: 2. Using outcomes to measure progress and adjust goals and interventions Comparing progress toward goal achievement to outcomes throughout the intervention process Assessing outcome use and results to make decisions about the future direction of intervention (e.g., continue intervention, modify intervention, discontinue intervention, provide follow-up, refer to other services). 34  OUTCOMES TYPES 1- Occupational Performance: The act of doing and accomplishing a selected activity or occupation. Example: the ability of a child with autism to play interactively with a peer 2- Adaptation: A change in response approach that the client makes when encountering an occupational challenge. 3- Health and wellness: It is a state of physical, mental, and social well- being, as well as a positive concept emphasizing social and personal resources and physical capacities 35  OUTCOMES TYPES (CONT.) 4- Participation Engagement in desired occupations in ways that are personally satisfying and congruent with expectations within the culture. 5- Prevention: Health promotion is equally and essentially concerned with creating the conditions necessary for health. Outcome example may include appropriate seating and play area for a child with orthopedic impairments to prevent deformity development. 6- Quality of life: The dynamic appraisal of the client’s life satisfaction, hope, self-concept, health, and functioning. Outcome example includes full and active participation of a deaf child during a recreational activity 36  OUTCOMES TYPES (CONT.) 7- Role Competence: The ability to effectively meet the demands of roles in which the client engages. 8- Self-advocacy: Actively promoting or supporting oneself or others. Outcomes example includes a student with a learning disability requesting and receiving reasonable adjustments such as textbooks on tape. 9- Occupational Justice: Access to and participation in the full range of meaningful and enriching occupations afforded to others. 37 Thank You!