Final Exam Flashcards
A framework of psychosocial Factors
core domain:
Performance:
Experience:
core domain is occupation
integral to the performance and experience of all activities of occupation
Performance: observed behaviours
Experience: self-agency, sense of belonging and contributing, integrity, pleasure, investment, sense of well-being
A framework of psychosocial Factors
Foundation:
Motivation:
Meaning:
Foundation of occupational engagement
Motivation: a natural human process for directing energy to accomplish a goal
Meaning: our search for uniqueness and self-hood with our search for community and belonging
Psychological emotional and social elements of occupation
what are the 5 circles
Elements that enable occupation, and are enabled by occupation:
- Self-perceptions
- Affect/mood
- Thought processes
- Interpersonal processes
- coping processes
Occupational self-evaluations
such as:
self-esteem Body image Self-comparison self-identity -Locus of control
Occupational mood/affect
Emotions:
- Happiness, love, joy
- Flow
VS
- Distress
- Anxiety
- Fear
- Boredom
- Grief
Occupational Thought Processes:
- Perceptions
- Interpretations
- Reasoning
- Logic
- Rationality
Occupational Interpersonal Processes:
Receiving and interpreting social information
- Empathy and understanding of the needs and feelings of others
- Respect
- Trust
- Interactional style
Occupational actions:
- Coping/resilience
- Self-regulation
- Self-monitoring
Context:
Context can both enable and interfere
Such as: access to resources, economic status, family. relations, social networks, cultural influence, life experiences
-Developmental factors are important too
The recovery model:
Common Ideas about recovery
4 points
- It is a process s well as an outcome
- it is a personal journey….. People recover - We can’t male them recover
- Recovery does not depend on a “cure”
- Involves (re)defining self identity with illness conceptualized as only one element of the self
Recovery Model (key points 4)
hope is powerful
- recovery can occur even when symptoms persist
- Recovery can occur even when symptoms persist
- Recovery is not linear process
- The consequences of the illness may be more difficult to recover from than the illness itself
Stages of Recovery (4 stages)
- Discovering a more active self
- Taking stock of the self
- Putting the self into action
- Appealing to the self
The recovery Benefits of activity participation (look at slide)
- Becoming empowered and exercising citizenship
- Finding social support
- Assume Control
- Manage symptoms
- Overcome Stigma
- Live a full life not an illness
- Redefine self
- Renew hope
Criteria of recovery
Criterion
- Hope
- Taking Personal Responsibility
- Getting on with Life ( OT)
Components:
- Spirituality
- Illness Management and Healthy Lifestyle
- Identity, Relationships, Work Recreation
OT interventions in Mental Health
identifies 7 categories
- employment/education ;
- psychoeducation
- creative occupations/activity;
- Time use/occupational balance
- skills/habit development;
- Group/family approaches; and animal-assisted therapy
The continuum (experiences with Indigenous)
Cultural Awareness --> Acknowledging Differences Cultural Sensitivity --> Recognition of importance of respecting differences Cultural Competence --> skills --> Knowledge --> attitudes
Cultural Competence
A compilation of attitudes, knowledge, and skills necessary for a person to interact effectively with individuals and groups of the same and different cultures
Cultural Safety
is an outcome based on respect engagement that recognizes and strives to address power imbalances inherent in the health care system . It results in an environment free of racism and discrimination, where people feel safe when receiving health care.
Cultural Humility
A lifelong process of slef-reflection and critque that emcompasses the recognition of power imbalances and the development of mutually beneficial partnerships between client and provider”
Model of Cultural Humility
Cultural Humility
- -> openness
- ->self-awarness
- ->egoless
- ->supportive interactions
- Self-Reflections and Critique
Lifelong learning
- –>empowerment
- ->Mutual Benefit
- -> Partnership
- -> Optimal care
- -> Respect
These two things have double arrows than surrounding them to make a circle is Diversity and Power Imbalance.
Points from Dana S. Edge
-Co-existing of tradition and western medical beliefs (the pregnant lady tradition )
-Importance of language and not making assumptions i.e.misuse of alcohol - go beyond the immediate questions so you don’t miss things
-Recognize the importance of culture i.e singing group on saturday morning
-Harmless Beliefs - occur in every culture and you just have to let it go, you will run into these things during work and you have to make a decision is something to intervene in and most of the time it’s not (i.e chewing gum when pregnant causes baby to drool)
You need to know the context»»»> try to understand their story
-Indian health service -sunk into the permafrost
Humor to discipline children
Profound effect of poverty
-Vicariously experienced blatant racism
How history really affects the present - federal and provincial government took care (presence of the missionary presence) really affected health-care
What contributions does employment make to health and well-being ?
IDK
What differences does paid work va unpaid (volunteerism)?
IDK
Employment and mental health
Mental Health commision of Canada reports
- Individuals with a mental illness are much less likely to be employed than other canadians. Unemployment rates are as high as 70% to 90% for people with the most severe mental illnesses
- In any given week, at least 500, 000 employed Canadians with long term or temporary disability are unable to work due to mental health problems
- The cost of a disability for mental illness is about double the cost of a leave due to a physical illness
What are the personal barriers for people with Mental Disability
- Gaps in educational/vocational preparation
- Performance challenges due to medication, symptom management, attention and concentration, energy level
- Intrapsychic factors (eg. Low self esteem, Self stigma, paranoia)
What are the environmental barriers for people with mental disabilities
- Stigma
- Structure of HR/workforce entry procedures
- Lack of needed supports/services
- Lack of financial resources to manage diert, dental health, clothing, transportation
Cognitive Work Hardening (CWH)
A return-to-work intervention for people on disability leave associated with pression * (and other health conditions associated with cognitive, psychological and emotional issues)
Theoretical Basis: CMOP-E PEO Social learning theory recovery
Intervention matches job demands to address job-specific challenges
- ->cognitive performance and energy
- -> interpersonal Abilities
- ->coping skills
CWH- Multi-element Intervention
Collaborative identification of desired behavioural and environmental outcomes
-Therapist/worker together determine meaningful work simulations
-Gradual progression of work schedule
-Work receive feedback to build insight and self-efficacy
-Focused interventions addressing, assertiveness, time management, organization on the job etc.
Workplace specific return to work places
4 Identified categories of employment status
Work challenges experienced by employed persons
employment interruption or separation
Developmental Disruption in productivity roles
Employment Marginalization
Work challenges in employed persons
Employed in community workforce; evidence of employment continuity
Experiencing health-related disturbances of work performance (presenteeism)
-Disruption may not be”public” or know to others
-The disruption may be temp or ongoing, even while work participation continues (intermittent work capacity)
Key Issues:
Worsening of condition in absence of treatment
-Employer/workplace uncertainty; financial loss
-Fractured social relationships in workplace
Employment Interruption Or Seperation
Employment is interrupted by disability, injury or health condition and involves time away from work beyond regular sick days, vacations, etc
The absence from work typically has a formalized status (as in work/sick leave, short or long term disability
-once formalized can involve multiple systems: workplace, financial , health care, social services
Key issues:
Time away from work is predictive of return to work status - extended absence = low probability of return
-Impact of leave on participation in non-work roles and activity
Developmental Disruption in productivity role
work-related disruption occurring pre-or early work years
- Disruptions in typical age and socially expected norms
- Concerns arise about course of the health-related issues
- Social and economic dependence emerges
- Future social and economic status threatened
Examples: Early onset Psychosis street youth School-work transition Mental Illness in post secondary setting
Employment Marginalization characterized by individuals who
Lack formal/informal connections to employment (on the fridges of the workforce)
- have limited work experiences or lengthy periods of absence from work roles
- social position leads others to not “expect” employment/culture of low expectations
- significant material deprivation, poverty conditions
- social and self-devaluation
- Financial dependency (often on the government) and financial disincentives to working
Employment Attached- Person focused interventions
Individuals Level
cognitive work hardening
CBT with a work focus
-adjuvant work-focused occupational therapy
-work focused collaborative care
Employment attached - Employer/workplace strategies
Employment as if people and their health mattered
- Workplace anti-stigma programs
- National standards for psychological health and Safety in the workplace
Employment Unattached- person focus interventions
Supported employments/supported education
Social enterprises and other forms of entrepreneurship
paid positions within the mental health system
Historical approaches employment
Vocational assessment
Work adjustment training
Sheltered work
Current Approaches employment
Rapid place and train
Supportive treatment to help maintenance and growth of worker role
Principles Of Supported Employment
-Rapid entry to real work setting dynamic assessments in context ongoing employment support -work accommodations -Integrated vocational and treatment services -Employer education -Financial Literacy
Work Integration Social Enterprise (WISE)
Businesses created to build employment capacity
- ->Created by community agencies
- ->created by mental health consumers themselves
Best Practices in WISE
Fair remuneration
Opportunity for skill development and career building
contact with the public, stigma reduction
sense of belonging and empowerment within the business
Key messages from Employment Lecture
There is a need for shared meanings in discussion employment challenges for persons with mental health related disabilities
- Think about the individual and their connection to the labour market
- Identify assets and weaknesses, opportunities for success
- Consider not only the person but their social role;seek to minimize marginalizing forces
Skills for Retail
A college-based program that provides classroom-based and practical training in retail sales and service
-Developed based on observed needs
Program Design:
-12 week classroom instruction
-3 week (unpaid) internship in local Businesses
-Fitness Program through SLC “FItness and Health Promotion” program
Skills For Retail -Outcomes
Programs was repeated at least 4X
- Wait lists for the program entry
- 70% of trainees gained and retained competitive employment
- Partnership seen as beneficial to both the agency and the college
What was similar between Skills for Retail and Cognitive Work Hardening
- both helped with transition to work
- both provided physical and cognitive or behavioural skills
- -> both provided an internship job so they could feel successful
What are the differences between Skills for Retail and Cognitive Work Hardening
Skills for Retail:
- Fitness program
- pretty bad mental illness
- trying to build experience
- entry level program
Cognitive work Hardening:
- Simulated environment
- Are attached to a workplace
- Insurance wants them back
One’s connection to the labour market
Foundational preparation
–> education work experiences
Work Stability
–> Consistency of involvement in work activities and role
-Level of prosperity, security, self-sufficiency
–> social connections related to employment
–> within the workplace
–> in society broadly
Employment Challenged Goals
- Maintenance of work role
- Disability prevention
- Disability Management
Employment Interrupted Goals
Enabling successful return to work
- Facilitating employee-employer relationship
- Building skills/confidence for work re-entry
Development Disruption Goals
Skill development
Help create work role entry pathway
-Establish age appropriate work experiences
Employment Marginalized goals
Enable participation in the mainstream workplace
-Establish work Identity
Environmental and occupational Therapy Practice Models
Ecology of Human Performance
Occupation adaptations
Kawa Model
Person-Environment-Occupation
Components of the Environment
Cultural Personal Physical Social Temporal Virtual
Environmental Obstacles to Recovery and Empowerment (a lot of things but I didn’t know how to break it down)
Attitudinal barriers -->stigma Poverty War and violence --> Serving military members -->refugees Complex physical environments -->Accessibility for Ontarians with Disabilities Act (AODA) -->Advances in technology Lack of integrated physical and mental health care --> Occupational therapy practitioners are trained to address both physical and mental health and can work in settings such as primary care Lack of Choice Segregation and isolation Criminal justice system
Environmental Resources
Peer-led organization and other support -->Increasing in numbers -->Clubhouse -->Day programs -->Families Community Resources -->Food pantries and soup Kitchens
Features of environments
In-patient
short stay Acute -->illness/disorder/disruption Intensity of services Number of services Number of people to be served Space Separation from natural occupations and environments
features of Environments Community
Occupational issues unfold in natural but dynamic context
Length of service/time opportunities for meaningful occupations/real citizenship
Enable occupation within natural environments
Philosophy/vision of the service
Influence of client resources
In-patient OT Practice Individual Level
- Engage the individual in a therapeutic relationship
- Identify (community) occupational problems and plans
- Evaluate community occupational performance in relation to needed community support
- Engage the individual in meaningful occupations through individual and program level activities
- Evaluate (“test out”) occupational performance
- Provide “best practices” to enable positive change in occupation and its determinants (psycho emotional)
- Prepare reports related to the OT process that are consistent with the approach of the program
- Ensure that the individual establishes a link with community resources to support occupation
In Patient Program Level
Development of a program that allows for engagement in a range of meaningful occupations, connected to community life
Deliver best practices consistent with the identified occupational needs of the client population served
Community-Individual Level
- Engage the individual in a therapeutic relationship
- Identify occupational goals-problems and strengths
- Evaluate community occupational performance
- Engage and support the individual in personally and socially meaningful occupations
- Provide “best practices” to enable positive change in occupation and its determinants (psycho emotional)
- Prepare reports related to the OT process that are consistent with the mission/approach of the program
- Implement environmental interventions to support occupation
- Link to and support engagement in resources to enable occupation
Community- program Level
Engage in community development
- Design and deliver program to be consistent with best practices in the field
- facilitate program evaluation and development related to client-centred processes and occupational outcomes
What si Transition?
Process of moving from one life phase to another
-unfolds over time
-Change in nature (eg roles, status, etc)
“[A] discontinuity in a person’s life space”
Tied to life course
Occupational History
occupational transitions throughout the life course
Occupational Transitions
shifting from one set of occupations to another
Micro, meso, macro
Self-initiated or triggered by life transitions or events
Occupational Adaptation
Response to challenge (such as a transition)
Transition and mental health includes: (diagram)
mental health transition and surrounding is context
Transitions to miliary, Veteran and Family Populations
- Civilian-to-military transitions
- Military-to-civilian transition
- Transitioning home after combat or other deployment
- Separation cycle in families
- Military related injuries
- Geographic transitions between posting
- School transitions for children in military families
- Employment transitions for spouses
- Other?
What is Military-to-Civilian Transition (MCT)
Generally understood as the process of leaving military services and transitioning to civilian life
(this includes working or running a business)
Elements of MCT: Nature of the transition
voluntary and medical
soldier–> Civilian
- A natural aspect of a military career
- Usually anticipated
Medical:
no disability –> disability
Involuntary/lack of control
May be sudden
Elements of MCT: Trigger/starting point
voluntary and medical
No agreement, but some suggestion include:
- at enlistment
- when member decides to leave service
- Official release process commencement
Medical:
onset of illness/injury
Elements of MCT: Period of Intensity
voluntary and medical
Peri-release period
- can be the most stressful point in the process
- greatest potential for long term health implications
Medical:
Timeframe around the injury/illness onset
-May also include transition from hospital to home/community
Mental Health and MCT stats
Life after service survey 2016
-30% have MH condition
24% have a comorbid MH and PH condition
More likely to have difficult MCT adjustment and health-related activity limitations
Factors Impacting Adjusting to MCT
voluntary and medical
- Military related factors (e.g. service element, rank)
- Available Support and preparation
- Loss and /or change in roles
- Cultural shift
- Personal Identity
Medical Release
- Severity of functional limitations
- Type of functional limitation
- Degree of Independence
- Prognosis `
Using an MCT Framework to understand Mental Health
Look at slide don't want to type it out 3 main parts : well-being domain Life-Course and Phases Roles of veterans and their Families
Role of Occupational Therapy in MCT: Working with Individual CAF Members/Veterans
- Addressing loss of valued and meaningful roles
- Addressing issues related to aspects of well-being
- -> e.g. community engagement and meaningful activity
Role of Occupational Therapy in MCT: Medical Release
- Addressing unique challenges of MCT and injury/disability
- Supporting vocational roles outside the military
Role of Occupational Therapy in MCT: Advocacy
- Addressing stigma and stereotypes associated with veterans
- -> e.g. combating “broken veteran” stereotypes to enable vocational occupations
Role of Occupational Therapy in MCT: Challenges
- Lack of support during peri-release period
- Lack of consensus on a definition/framework for MCT `
CAF and VAC
- canadian forces health services
- Operational Stress Injury Clinics
- VAC rehabilitation Program
OT role expanding in VAC `
Hiring 35 full-time positions over the next two years
