Occupational Therapy and Mental Health

OCCUPATIONAL THERAPY AND MENTAL HEALTH Note: The occupational therapist hopes to identify client goals and priorities as well as strengths, supports, resources, and barriers that impact occupational performance. EVALUATION AND DATA COLLECTION ●​ ●​ EVALUATION ●​ Evaluation is the foundation of intervention in occupational therapy (OT). ●​ OT practitioners assess: ➤Current and past occupational performance. ➤ Client goals and challenges. ➤ Factors affecting performance (internal and external). ●​ Evaluation helps identify: ➤ Problems clients are facing. ➤ Goals clients want to achieve. ➤ Resources clients have to reach their goals. ➤ Contexts and environments that affect occupational participation. ●​ EVALUATION ASSESSMENT Planned process of collecting, interpreting, and documenting information needed to plan intervention. Is used to identify specific tests, instruments, interviews, and other measures used to evaluation. Methods may include observation, interview, review of medical records, and testing. ●​ Intervention stages are interconnected, forming a unified process. Evaluation is not isolated; experiences therapists link all stages from the start. Upon referral, therapists begin: ➤ Analyzing information. ➤ Considering treatment options. ➤ Planning for continuity of care. Context matters: ➤In acute care, evaluation focuses on transition planning and readiness for discharge due to short stays. ➤ In long-term care, evaluation may be ongoing and updated with new information or changes in health status. OT PROCESS 1. CLIENT-CENTERED “What is currently important and meaningful to the client” Also important to consider past experiences to better understand the present situation. Active client involvement is essential, as it respects their values and priorities and allows them to contribute valuable insights through collaborative communication. 2. OCCUPATION-CENTERED Use actual occupations and occupational OCCUPATIONAL THERAPY AND MENTAL HEALTH tasks, and therapeutic activities, with the aim of improving or maintaining the client’s ability to engage in occupations. 3. OUTCOME-ORIENTED The most important result or outcome is improved ability to engage in occupation. Some of the uses of outcome are: ➤To compare some aspects of the client’s occupational functioning before intervention and after intervention ➤ To communicate to the client the achievements in therapy ➤To establish an understandable and measurable desired result ➤As a basis for program evaluation ➤To provide evidence for research. ➤ To document effectiveness to ensure reimbursement. CONCEPTS CENTRAL TO THE EVALUATION PROCESS CONTEXTS ●​ ●​ ●​ Describe the conditions that surround and give meaning to occupational functioning. 7 aspects: cultural, physical, social, personal, spiritual, temporal, and virtual. Context influences what you are able to do and what you have to do. ●​ Consider the extent to which the person makes use of available opportunities, For example, the person who stays indoors, most of the time while venturing out only to do routine and predictable chores, is using very little of the available contexts. PATTERNS ●​ ●​ ●​ What are the person’s habits, routines, roles, and rituals? How does the person budget time among different activities? How and why the person pursues each activity are equally important Remember that habits can be classified as useful, impoverished, or dominating. EXPECTED ENVIRONMENT ●​ ●​ When the expected environment is different from the most recent previous environment, the contexts for performance will be different. The person may need to develop new skills or refine or modify the way everyday activities are done. EVALUATION PROCESS Where to start? ●​ Top-down evaluation begins with the client’s goals. No other data are collected until the client’s perspective is understood. (Uses the occupational profile and then analysis of occupational performance first) ●​ Bottom-up evaluation begins with the factors that appear to impede occupational engagement. The medical necessity cannot wait for an interview to learn the client’s goals. In a psychiatric setting, the assessment of cognitive level would represent a bottom-up evaluation. OCCUPATIONAL THERAPY AND MENTAL HEALTH ●​ Environment-first evaluation is appropriate when safety is a factor, as for example, when assessing the home environment for an elderly client to reduce risk of falls. METHODS OF DATA COLLECTION 1.​ REVIEW OF MEDICAL RECORDS Information about a person: age, gender, family situation, education, occupation, work history, leisure habits and history, self-care habits, social relationships, cultural background, diagnosis, medical history, psychiatric history, current medications, and medication history. 2.​ INTERVIEWING ●​ Beginning the interview Start any interview by saying hello and introducing yourself if you do not already know the person. Always explain the purpose of the interview. Make the person comfortable before you start asking questions. ●​ Obtaining and Remembering Information Should be especially observant of the client’s behavior, facial expression, tone of voice, and body language. Discuss with the client the fact that you have to take notes to be accurate about important details. ●​ Ending the Interview Prepare the person at the beginning of the interview by explaining how long the interview will take. Indicate that the time is up or that the interview is complete. Encourage the person to ask you questions and try to answer them. 3.​ QUESTIONNAIRES AND CHECKLISTS Another type of structured assessment that the client completes independently and later discusses with the therapist. DO not add to ot change the directions or help the client interpret them, unless this is part of the standard procedure. 4.​ OBSERVATION A method of collecting information by watching what a person does. It foe son throughout the intervention process. Interpretation or inference is the process of giving meaning to what we have observed, not to be confused with an “observation” 5.​ TESTS AND ASSESSMENTS Each test will include a procedural manual with a detailed guide as to how the test is to be administered. Frequently, the test also includes materials, scoring sheets, and other items. The OT should study the test well in advance of using it and work with someone experienced, so that service competency is ensured. SAMPLE ASSESSMENT TOOLS 1.​ ●​ ●​ 2.​ ●​ 3.​ ●​ ●​ 4.​ OCCUPATIONAL HISTORY AND PERFORMANCE INTERVIEWS Occupational Performance History Interview The Canadian Occupational Performance Measure OBSERVATION CHECKLISTS Comprehensive Occupational Therapy Evaluation (COTE) scale ASSESSMENTS OF DAILY LIVING SKILLS The Kohlman Evaluation of Living Skills The Test of Grocery Shopping Skills ASSESSMENT OF PATTERNS: HABITS, ROUTINES, ROLES, AND RITUALS ●​ Occupational Questionnaire ●​ The Role Checklist ●​ The Activity Card Sort 5.​ ASSESSMENT OF SOCIAL SUPPORTS ●​ The Medical Outcomes Study: Survey of Social Support ●​ Multidimensional Scale of Perceived Social Support 6.​ ASSESSMENTS OF PROCESS SKILLS AND MENTAL FUNCTIONS ●​ The Bay Area Functional Performance Evaluation ●​ Allen Cognitive Level Screen ●​ Routine Task Inventory Expanded OCCUPATIONAL THERAPY AND MENTAL HEALTH ●​ 7.​ ●​ 8.​ ●​ 9.​ ●​ Saint Louis University Mental Status Examination ASSESSMENT OF SENSORY FUNCTIONS Adolescent/Adult Sensory Profile ASSESSMENTS OF LEISURE INTERESTS AND SOCIAL PARTICIPATION Modified Interest Checklist NONSTANDARDIZED ASSESSMENTS Tasks like constructing a mosaic tile ashtray or a paper mobile or a collage. ➤ require strong clinical reasoning skills. USING MULTIPLE REASONING TRACKS Type of Clinical Reasoning Description Focus Example Procedural Reasoning Focuses on the diagnosis, condition, and intervention methods. Understanding the illness and selecting appropriate interventions. Considering schizophrenia’s effects and using sensory integration or psychosocial programs. Interactive Reasoning Centers on building rapport and understanding the client as a person. Relationship-buil ding, empathy, communication. Listening to the patient’s concerns and showing acceptance. Conditional Reasoning Envisions the person’s life context, past, present, and future. “What if” scenarios, life story, possibilities for change. Imagining how the client;s life might improve with certain interventions. Narrative Reasoning Uses storytelling to give meaning Creating a meaningful Framing tasks as part of the client’s INTERVENTION PLANNING CLINICAL REASONING ●​ ●​ A process of analysis using thinking and feeling. OT needs a logical approach to gathering information and using it to generate intervention goals and methods