Ch 14 Psychosocial approaches & Theories Flashcards
Cognitive disabilities model: automatic actions, level 1
Requires total cog assist. automatic motor responses and changes in autonomic nervous system. conscious response to external environment is minimal.
Cognitive disabilities model: Postural Actions, Level II
Requires max cog assist. movement associated with comfort. Some awareness of large objects in environment, may assist caregiver with simple tasks. ADLs are accomplished by imitating the caregiver. Able to eat finger foods.
Cognitive disabilities model: Manual Actions, Level III
Requires mod cog assist. beginning to use hands to manipulate objects, may be able to perform a limited number of tasks with long-term repetitive training. One-step, familiar and action-oriented (not goal oriented).
Cognitive disabilities model: Goal Directed Actions, Level IV
Requires min cog assist. characterized by ability to carry simple tasks through to completion. Can perform 2-3 steps. Cannot problem solve. Task set up is required. Relies on visual cues. perform established routines but can’t cope with unexpected. Can be left alone at level 4.6. Groups: could participate in goal-directed activities such as crafts.
Cognitive disabilities model: Exploratory Actions, Level V
Needs standby or supervision for cognitive assist. trial and error problem solving. are able to follow 4-5 step processes at a time. New learning occurs. Problems with judgment, reasoning, planning, semantic memory, episodic memory. May be the usual level of functioning for 20% of population.
Cognitive disabilities model: Planned Actions, Level VI
absence of disability. Person can think of hypotheticals and do mental trial and error problem solving.
Evaluation groups
used to gather info about task and group interaction skills to establish goals and intervention plan. Often still therapeutic through process/content.
Task-oriented groups
Psychodynamic approach. assist members in becoming aware of needs, values, ideas, and feelings through performance of shared task. A task-oriented group presents opportunities for participants to practice situations they may encounter in daily life. A group environment in which conflicts are likely to occur can help participants practice resolving conflict in appropriate ways
Developmental groups
purpose is to acquire and develop group interaction skills. includes 5 levels of interaction groups: parallel, project, egocentric, cooperative, and mature
Parallel groups (developmental groups)
use individual tasks with minimal interaction required
Project groups (developmental groups)
common, short term activities requiring some interaction & cooperation
Egocentric groups (developmental groups)
require interaction on long term tasks, but completion of task is not the focus. Members beginning to express their needs and address those of others
Cooperative groups (developmental groups)
learn to work together cooperatively, not specifically to complete task but to enjoy each others company and meet emotional needs
Mature groups (developmental groups)
responsive to all members needs and can carry out variety of tasks. Good balance between carrying out task and meeting needs of members.
Thematic groups
designed for learning specific skills
Topical groups
focus on discussion of activities and issues outside of group that are current or anticipated
instrumental groups
concerned with meeting health needs and maintaining function
MOHO key points
3 inherent human elements: volition, habituation, performance capacity. Intervention focuses on occupational engagement that includes activities that are purposeful, relevant, and meaningful. MOHO groups can be focused around specific roles such as parenting (using The Role Checklist)
Modular groups
individual can join anytime and still cover all topics as each session is rotated through a continuous cycle
Life-Style Performance Model
Performance is measured in function in four domains: self-care, intrinsic gratification (fun), service, reciprocal relationships. Focuses on the “doing” or activity patterns that support a satisfying lifestyle.
psychoeducational groups
uses classroom format and the principles of learning to provide information and teach skills.
basic task skills group
develop basic cognitive skills for completion of simple tasks. skill acquisition focus vs psychodynamic approach of task-oriented groups.
PEO key points
Occupational performance is considered the outcome the transactional relationship between people, their occupation, and the environment. Considers the transactional relationship between people, their occupation, and the environment.
Cognitive Behavioral Therapy (CBT), Assessments & Groups
Alter negative thoughts and behaviors about themselves and the world. Evaluation: Beck Depression Inventory is the primary tool. Dialectical Behavior Therapy (DBT) is a form of CBT. Intervention includes DBT teaching assertiveness, coping, and interpersonal skills. Eliminate maladaptive thinking. Groups focus on shaping behavior, chaining steps, reinforcement, and practice. Example: Cognitive–behavioral therapy approaches in OCD include helping the client overcome the tendency toward compulsive behavior by identifying the triggers to a compulsive episode, planning a strategy for overriding the compulsion, and continuing to do the activity or task.
EHP
Emphasizes the role of natural context and how the environment impacts task performance. Understanding how the environment can be adapted, modified, and restored to enable effective performance. Evaluation includes checklists designed for the model and The Sensory Profile. Modifying or adapting task tools is an intervention strategy of the Ecology of Human Performance Model.
OA
Outcome: Increase adaptability, relative mastery, self-evaluation. As person becomes more adaptable, occupational performance improves. Intervention focuses on increasing the skills needed for occupational adaptation.
Role Acquisition Model
Individual employs task and social skills to meet the demands of personally desired and necessary roles. Intervention focuses on the acquisition of specific skills needed to function in an environment.
Cognitive disabilities model evaluation tools (4)
Allen cognitive level screen: leather lacing to determine cognitive level. Allen diagnostic manual: crafts to evaluate or treat. Routine Task Inventory: gathers data about ADL performance from caregiver. Cognitive Performance Test: Assesses functional performance of people with psychiatric or cognitive dysfunction
Recovery Model
Primary focus is to improve quality of life through self-advocacy. Empower people by fostering intrinsic motivation. Conceptualize recovery from illness as a journey of healing transformation. Intervention includes a Wellness Recovery Action Plan (WRAP), storytelling, advocacy.
Activities Health Assessment
Assesses underlying skills and habits, time usage, and life satisfaction by having the person construct a schedule which depicts how their typical week is spent.
Phases of adjustment
shock, anxiety, denial, depression, internalized anger, externalized anger, acknowledgment, adjustment
Managing Problem Behaviors: Hallucinations (generated by the mind)
create environment free of distractions that trigger such thoughts
use high structured simple, concrete activities that hold the client’s attention
redirect person when they are hallucinating to reality-based thinking and actions
Managing Problem Behaviors: Delusions (rooted in reality)
Redirect the person’s thoughts to reality-based thinking and actions.
Avoid discussions and other experiences that focus on and validate or reinforce delusional material.
Managing Problem Behaviors: akathisia (always feeling restless)
Allow the person to move around as needed if it can be done without causing disruption to the goals of the group
Keep in mind that participation on many levels and in many forms can be beneficial to the individual
Whenever possible select gross motor activities over find motor or sedentary ones
Managing Problem Behaviors: akathisia (always feeling restless)
Allow the person to move around as needed if it can be done without causing disruption to the goals of the group
Keep in mind that participation on many levels and in many forms can be beneficial to the individual
Whenever possible select gross motor activities over find motor or sedentary ones
Managing Problem Behaviors: Offensive behavior (physical or verbal)
Set limits and immediately address the behavior during the session
Reasons the behaviors are not acceptable should be clearly presented in a manner that is non-confrontational or judgmental
The consequences of continued offensive behavior should be clearly communicated
All other patient should be protected from any threats - the needs of the other members should be kept in mind
Managing Problem Behaviors:Lack of initiation/participation
Together with the individual identify the reasons for lack of participation (e.g. lack of skill, irrelevance of activity, attention deficits, embarrassment, depression)
pay attention to motivational hints: clients are more likely to participate if they are interested in the activity or have ownership of the activity. Success and fun and motivating. Positive feedback and rewards are motivating. Try to find out with the persons motivators are. Food can be motivating. Curiosity can be motivating. Using secondary motivators such as praise is usually preferable to using primary reinforcers such as food.
Managing Problem Behaviors: manic or monopolizing behavior
Select or design highly structured activities that hold the individuals attention and require a shift of focus from patient to patient. Thank the individual for their participation and redirect attention to another group member. Create boundaries and limits. (see offensive behaviors).
Managing Problem Behaviors: escalating behavior
Avoid what can be perceived as challenging behavior such as eye contact and standing directly in front of the patient.
Maintain a comfortable distance
actively listen
use a calm, but not patronizing tone (speak more softly than the individual to bring their voice down.)
Speak simply clearly and directly
Do you not make or communicate value judgments about the individuals thoughts feelings or behaviors
clearly present what you would like the person to do
avoid positions where either you are the patient feels trapped
individuals most often calm in response to the above interventions- if they do not work, move the patient from the area and get help.
Psychoanalytic & Psychodynamic Theory & Groups
The cornerstone of mental health practice. Use as a mechanism to improve self-identity and to improve interpersonal relationships. Gain control of unconscious and develop insight. Psychodynamic groups allow participants to explore symbolic meanings of activities, such as magazine collages, clay, or painting.
Clubhouse Model
Community centers that provide support and work and recreational opportunities for people with mental illness. Focus on strengths rather than weaknesses. No therapists or psychiatrists are on staff.
Semantic memory
Semantic memory includes things that are common knowledge, such as the names of colors, the sounds of letters, the capitals of countries and other basic facts acquired over a lifetime.
Episodic memory
memory of autobiographical events (times, places, associated emotions, and other contextual who, what, when, where, why knowledge) that can be explicitly stated. It is the collection of past personal experiences that occurred at a particular time and place.
Universality
the curative factor gained from other members’ sharing of similar feelings, thoughts, and problems.
Catharsis
the release of strong feelings about previous or present experience
