GL1 Occupation Centred Practice, Information and Goal Setting Flashcards
What factors have shaped the development of occupation centred practice in occupational
therapy? What do they mean for the way OT’s approach intervention planning and
implementation with children and youth?
Frames of reference such as the ICF (International Classification of Functioning, Disability and Health) has shaped the development of occupation centred practice as it highlights personal characteristics impacting experience of a health condition and how these may help or hinder engagement in activities and participation. This enables unified/standard language and framework for discussion and description between professionals- this allows for greater occupation centred practice in OT. In regard to this relation for children and youth, the ICF-CY (International Classification of Functioning, Disability and Health for Children and Youth) allows for a new classification for children and youth disease/disability which enables recording characteristics of the developing child and influence of the child’s environment and recognises each stage of development. Furthermore, it recognises that parents/carers/teachers exercise significant control over children’s opportunity for engagement. The ICF-CY provides useful guide to directing information gathering and type of information required and purpose for which it can be used- this is a key aspect in the intervention planning and implementation.
What key things do you need to consider when you implement an occupation centred approach to practice?
Key features that need to be considered when implementing an occupation centred approach to practice includes adopting a profession-specific perspective (a world view of occupation and what it means to be an occupational being) where occupation is placed in the centre and ensures that what OT’s do it linked to the core paradigm of Occupational Therapy. Along with this, the focus needs surround understanding children occupation and optimal participation as well as the appreciation of the contexts of childhood occupations.
What are the characteristics of occupation centred practice? For each characteristic identify at least one way in which practice is implemented to ensure the characteristic is met (i.e., what you do to make sure practice is occupation centred).
1) Client-centered orientation- child and family centered: partnership with family
2) Based on collaborative relationship: share decision making process
3) Client chosen goals: family and client choose goals rather than OT
4) Contextual reference: make sure you understand the context of children’s occupations
5) Active engagement of children and parents: support and encourage the involvement of family members in the occupational therapy process
6) Individualisation of intervention: all families and clients are unique and different and have individualised values
7) Focus on occupational performance and participation throughout intervention
8) Information gathering- roles, occupation, occupational performance and environment
9) Intervention- roles, occupation, occupational performance and environment
10) Interventions are finite
11) Occupation centred evaluation of intervention outcomes
Outline the differences in practice if you were working with a child using top down vs bottom up approaches to intervention?
The top down approach is more consistent with occupation-centred practice as it places emphasis on a child’s value of tasks, roles and foundational skills, it adopts a general problem-solving structure and plans for transfer and generalisation of skills to relevant contexts. Furthermore, the top down approach views occupation as ends through being directed, goal focussed and uses naturalistic interventions which are aimed to improve occupational performance and participation. On the other hand, in a bottom up approach an occupational therapist would evaluate the foundation components of function and develop a treatment plan based on these issues which may neglect functional outcomes.
What is the difference between an assessment that is directed by a top-down approach and one that is directed by a bottom-up approach?
In the top-down approach, the foundational factors (performance skills, performance patterns, context, activity demands, and client factors) are considered later within the therapy process but within a bottom-up approach considered the foundational factors first to obtain an understanding of the client’s limitations, real disabilities and strengths.
Describe the process you would use to when deciding on the different types of assessment to
use during the information gathering process and the sequence in which you may use these.
?? When deciding on the different types of assessment to use during the information gathering process it is important to consider the aspects of occupation addressed. This considers for key points: meaning (of client’s occupation), function (purpose or importance), form (observable characteristics that are problematic) and performance components (if cause of dysfunction not evident). The sequence would follow as stated.
How do you collaboratively set goals with children and their families? Can you describe a tool you would use in this process and how you would use this tool in an occupation centred manner?
In order to collaboratively set goals with children and their families, one needs to work together to make informed decisions. It is important to respect and listen to their values, wishes and priorities and ensure that the parents are provided with the opportunity to be involved in the decision-making process. It is also important to know that parents know their children best and that they should have the opportunity to be involved in the decision-making process. Strategies for goal setting include using an individualised approach for each family, using a common language (avoid paraphrasing and jargon), honour and work towards the family’s goals and involve the child in goal setting
Why might there be a disparity between goals identified by parents, the child and teacher when they all complete the same goal setting tool? What are the implications of this for the goal setting process?
Goal setting involves placing value judgements in the importance of different potential goals. Goals are quite different amount children, their parents and teachers as children’s perceptions may differ from those of the adults around them. Thus, each of the participants in the therapy process brings very different perspectives, priorities and values therefore the goals that are set will also differ.
How are goal setting tools used in an occupation centred manner for evaluation of intervention outcomes?
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