1. Evolution of Psychosocial Practice in OT OT 460A Fall 2012

2. Psychosocial concepts Humanism –People live and make choices from the inside out based upon one’s unique personal perspective. –People can and do take responsibility for their lives by the actions they take Humanitarian –A belief that society has an obligation to help those that are ill or disabled –Value and dignity of each individual Holistic intervention –Patients are treated kindly and involved in activities that help them resume a more normalized life

3. Role of Activity and occupation Adolf Meyer, Tracy, Slagle, Dunton, and others discuss “moral” treatment and the development of habits, routines that enable engagement in life WWI- brings about “problems in living” activities help people resume participation in daily life 1930-1940’s Therapist aid’s in diagnosis, activities used to facilitate adjustment to the hospital, for diversion, and for development of skills and habits

4. Evolution of theory and philosophy 1940’s and 1950’s- New legislation re: rights of the mentally ill. OT oriented toward scientific approaches. Physical rehab area grows in OT. Psych OT emphasizes Psychodynamic and behavioral perspectives 1960’s- group and therapeutic milieu concepts come into being. OT’s begin working in groups. Beginning of deinstitutionalization- more community based programs develop, hospitals downsize

5. Patient rights and self-determination NAMI ADA

6. Lifestyle redesign Promotes engagement in community by looking at: –Physical environment –Social factors –Resources in the community –Knowledge / skills of individuals

7. Trend toward community based care: As positions were more community based, many OT’s used to working in large institutions, did not make the switch to community based settings Switch to community based services warranted more individualized care planning and less “group” mentality Required OT’s to do less “formula” based care

8. Community Based OT practice Vocational rehabilitation Community integration Acute care hospital stay –Medical stabilization- 3-6 days –Can last up to 12 weeks for serious illness –Community programs can last years OT’s assume case management roles

9. Socio-political factors in Mental Health Occupational Therapy

10. Money Lack of program funding Other disciplines took positions from OT’s after many OT’s went into the Geriatric market in the 80’s Reimbursement of services is difficult, Medicaid/ Medicare billing systems are not in place for reimbursement Poor third party reimbursement of OT for private insurers In inpatient settings, OT’s were typically part of the “package” plan and they outpriced themselves so other disciplines such as TR, AT began to take up the slack Lack of evidence re: effectiveness in MH OT yielded decrease in positions

11. Issues that affect quality of care overall, and more specifically quality of OT services Lack of funding Reduction in the educational level of care providers Poor interdisciplinary coordination of services Larger system issues, such as poor potential of deinstitutionalized persons being able to be productive citizens ? Overdependence on medication as the be-all and end-all in care of the mentally ill

12. Future trends and fixes for the mental health system: Further community based programming, (e.g. Assertive Community Treatment teams) More non-traditional settings where we might find mental health consumers (e.g. shelters, correctional facilities, schools, church based services) Improved case management Continued focus on outcomes, effectiveness, and what really matters to consumers and society (e.g. more of a focus on practical application, life skills, etc).

13. Concerns re: Psych OT Maintaining professional competence Funding structures –Reimbursement –Health care delivery models Civil rights movement

14. Paradigm, Models, FOR’s Paradigm- –Guiding premises and theories behind the profession as a whole Model of practice –Articulates unique OT theory, knowledge Frame of reference –Set of internally consistent and related concepts, postulates, and principles used to guide practice Theoretical base Delineates function/dysfunction continuums Postulates regarding evaluation and how OT facilitates change

15. The Importance of Language ICIDH OT 460A Fall 2012 Relates to C & M (2013) Chaps 4 & 6 or Chaps 2 & 3 in C & M (2008)

16. Aims of the ICIDH-2 to provide a scientific basis for consequences of health conditions to establish a common language to improve communications to stimulate better care and services to improve the participation in society of people with disablements to permit comparison of data across countries, health care disciplines, services and time

17. Aims of ICIDH to provide a systematic coding scheme for health information systems; to stimulate research on the consequences of health conditions to collect data on facilitators and barriers in society that affect the participation of people with disablements.

18. Key Concepts of Functioning & Disablement BODY PERSON SOCIETY BODY PERSON SOCIETY Function/ Activities Participation Structure (limitation) (restriction) severity, localization difficulty, duration extent, facilitators duration assistance needed barriers in environment IMPAIRMENTS ACTIVITIES PARTICIPATION

19. Attention Deficit Disorder Poor attention, doing homework “Problem kid” Problems in waiting turn exclusion from concentration, class activities Increased arousal IMPAIRMENTS ACTIVITY PARTICIPATION LIMITATIONS RESTRICTION LIMITATIONS RESTRICTION

20. Applications of the ICIDH statistical tool research tool clinical tool social policy tool educational tool

21. Interaction of Concepts 1997 Impairment Activities Participation (function/structure) (Activity Limitation) (Participation Restriction) Health Condition (disorder/disease) Contextual Factors A. Environmental B. Personal

22. Impairments in ICIDH-2 Body parts - “system” orientation instead of “organ” Body includes the brain and its functions Structure & Function: Eye & Vision, Ear & Audition Biological foundation considered; limit is observation Biomedical norms are the basis of evaluation

23. Impairments (continued) Impairments may be – Temporary/permanent – Progressive, regressive or static – Intermittent or continous Not contingent on etiology Impairment does not indicate illness or sickness Impairment may be part of a disease, or may cause another impairment

24. Activities in ICIDH-2 Activities associated with everyday life - tasks, actions can range from simple to complex Actual performance (execution of a task or activity) - not a potential Basic senses can be seen both as “functions” and “activities” vision and seeing Difficulties - qualitative or quantitative alterations Qualifiers: Difficulty and assistance needed

25. Participation in ICIDH-2 Lived “experience” of people with a health condition, impairment or activity limitation Interaction between “Person’s health condition” and “contextual factors” Ecological/environmental interaction model Standard for participation: UN Standard rules on the Equalization of Opportunities Participation is classified according to the “domains of experience which enables identification of facilitators and barriers Terms “roles”, “survival roles” are deprecated