Module 2: Program Development in Community-based Practice Barry University MSOT Program OTR 675: models of service delivery Fall semester

Overview 1. Health is impacted when social participation is limited due to disruption of occupation, occupational habits, and occupational routines 2. Social & cultural trends create opportunities for occupational therapy 3. The program development process – how will you relate conceptual models or frameworks to support the need in your community?

1. Health is impacted when social participation is limited due to disruption of occupation, occupational habits, and occupational routines

What is your Program Development Idea? From current practice area From request of employer, individuals Observed need in community or population From personal interest May come from request of community members that have identified a need and have ideas.

Look to the barriers or areas of disruption to identify the focus of your program

2. Social & cultural trends create opportunities for occupational therapy

Historical Overview Consider some of the health care trends in response to events of past decades (slides follow) Think about: What are some of the events today that may lead to a response from the health care industry? OTs can help impact policy, access, and reimbursement through program development that will support consumers’ in having their health care needs met.

1960s Events Health Care Responses Vietnam war Poverty Space Technology Payor models Health Care Responses Hospice care Nutrition Social Medicine Mental Health

1970s Events Health Care responses Diplomatic Relations HMOs Community health care centers Access for economically deprived Child abuse programs MRDD programs

1980s Events Health Care Responses AIDS DRGs Geriatrics Palliative Pain Management Sport Injury and Recovery Mental Health in Secondary Schools Obesity Management

1990s Events Health Care Responses Internet Technology War Aging Society School Violence Medically un-insured grow in number Health Care Responses Program evaluation & outcomes Teleconferencing Under-nutrition programs ADA International Year of Older Persons

2000s Events Health care responses Natural disasters Global conflicts Increased world wide access and advanced technology Continued obesity rates Aging population Health care responses Increased focus on mental health Aging in Place

3. The program development process – how will you relate conceptual models or frameworks to support the need in your community?

Activity/Participation Program Development Treatment Plan Impact on Individual Physical Socio-emotional Environmental Activity/Participation Program Evaluation Measures: Outcomes Satisfaction Financial Evaluation Program Concept Needs assessment

Element: Needs Assessment Describe the community Describe the target population Identify needs Identify Resources

Clarify the Purpose of the Needs Assessment What do you know? Think you know? Want to know? Why are you doing a needs assessment? What will you do with this information? What are you trying to measure? How will you report this information? Are all groups included in the planning and conducting of the needs assessment? Who is responsible for various steps?

Analyze the Data from the Needs Assessment What are strengths and weaknesses? What are the barriers? Can this information help you develop reasonable and appropriate program goals?

Element: Program Planning and Implementation Define Focus Adopt frame of reference Establish goals and objectives Identify expected volume Allocate resources ( develop a budget for evaluation, treatment and support) Identify equipment that is needed Identify level of staff that is required (OT, COTA, etc.) Establish methods to integrate into existing systems Develop Referral system

Assessment of Impact on Performance How does the disability, injury, illness, situation affect the persons ability to participate in their occupations?

Element: Program Evaluation Goals and objectives Patient Specific Outcomes Functional Skill attainment Financial Client/Customer satisfaction

Data from Evaluation Process Enables process improvement Provides guidance to enhance program Able to demonstrate impact of program for clients, community leaders, and payor sources

An Example of the Program Development Process Clinical Need Area: Low Vision

Program Concept Environmental Scan #1: Aging Population

Demographics of Older Population United States: 35 million: increase 11% from 1999- 2000– 65 + (AOA, 2002)

United States Number of people 80+ yrs: 11 million in 2000; 33 million in 2050

Environmental Scan #2 Vision Rehabilitation: covered service May 2002 by CMS Created reimbursement source

Market Segment Two chronic health conditions occurring in elderly: Cataracts Diabetes Both can result in visual impairment Visual impairment: Loss in independence

Process- Key Informant Completion of a Focus Group made up of Interdisciplinary professionals serving clients with low vision at community clinic Asked the group three questions 1. What are the needs of the older adults with low vision? a. Identify services already available. 2. What are the ideal services for older adults with low vision? What is missing from current low vision service?

1. What are the needs? Optical device training Safety assessment and intervention Technology access Work/leisure Volunteer opportunities Case Management: Caregiver issues Access to services Transportation

a. Services already available Low vision exams Large print materials and training Radio reading services

2. What are the ideal services? Coordinated services in various service delivery environments involving multiple disciplines: Centralized Satellite Client’s home Community based

3. What is missing? Coordinated services with Occupational Therapists

Result: OT Program implemented in the following areas Activities of Daily Living Functional communication Functional mobility safety

Vision Services for Older Adults with Low Vision Goals and objectives Provide OT services to improve Satisfaction with engagement in activities in the home Improve independence in ADL’s, including reading, & writing, using prescribed optical aids and compensatory strategies

Program Services- OT Optical Aid training: ADL compensation strategies Static Dynamic ADL compensation strategies Environmental assessment for safety

Program Evaluation Constructs: Reading Writing Use of Aids Quality of Life ADL’s

Tools Functional Vision Performance Test (FVPT) The Functional Assessment Questionnaire (FAQ) Daily Living Tasks Dependent on Vision Questionnaire (DLTV) Patient Specific Functional Scale (PSFS)

The End