Mental Health Practice With Adults Flashcards

Question

How do stress disorders impact occupational performance?

Answer 1

**Difficulty engaging in occupations that are related to the experience of trauma** (e.g., may avoid specific environments, experiences, or situations that are related to or mimic where and how the trauma occurred). May have **difficulty leaving spaces where they feel safe or in control** of the environment or have challenges in managing symptoms related to triggers to engage in occupations. May also have **difficulty with social engagement** or discerning between safe and unsafe situations.

Answer 2

**Schizophrenia spectrum and other psychotic disorders** *Conditions* -- Schizotypal (personality) disorder -- Delusional disorder -- Brief psychotic disorder -- Schizophreniform disorder -- Schizophrenia -- Schizoaffective disorder -- Other specified and unspecified schizophrenia spectrum disorders -- Catatonia

Answer 3

May have **challenges with engaging in ADLs and IADL** due to low motivation or initiation. May have **challenges in sequencing and completing tasks** or attending to details of an activity due to disorganized thinking or preoccupation with thoughts. **May become highly focused on an activity or on responding to hallucinations** and not engage with other needed or priority occupations. Symptoms such as **paranoia may make it difficult for the client to engage in social relationships** or to feel safe while engaging in occupations (e.g., they may believe that others are following them or that someone has searched through their personal belongings).

Answer 4

Somatic symptom and related disorders

Answer 5

May have **challenges engaging in priority occupations due to pain, discomfort, fatigue, and low energy.** **Chronic pain and discomfort can impact self-efficacy and affect**, resulting in low motivation to initiate activities/occupations or avoidance of activities that trigger or cause discomfort/pain due to anxiety or desire to minimize negative physical effects. **Mental health may be affected** if the person is not able to find compassionate health care providers or if their symptoms are frequently dismissed and untreated due to stigma or lack of knowledge surrounding somatic disorders.

Answer 6

**TRUE** Having a cup of coffee or glass of wine are examples of substance use. A *substance use disorder* is when the substance use “affects a person’s brain and behavior, leading to a person’s inability to control their use of substances”

Answer 7

1. Alcohol 2. Stimulant use 3. Opioid use 4. Other: Induced disorders, Withdrawal

Answer 8

Having a substance use disorder means the **person is physiologically dependent on the substance** and that use is integrated or central to their routines. **Acquiring, using, and experiencing the substance may become the priority occupation**; the person may no longer engage in previously valued occupations, or their performance in those occupations may decline (e.g., no longer able to complete their worker role). Substance use **may occur alongside other occupations** (e.g., binge-drinking in social settings) or to manage symptoms or uncomfortable experiences (e.g., to reduce physical pain or symptoms of trauma); but may still affect occupations (e.g., disrupt sleep or routines or social relationships). The person **may engage in unsafe activities while under the influence** (e.g., driving after drinking alcohol).

Answer 9

**FALSE** Serious mental illness can decrease life expectancy by 15 to 25 years. In part due to the diagnoses themselves, and in part due to the effects of medications used to treat mental health disorders.

Answer 10

**TRUE** ... such as traumatic and acquired brain injury, Parkinson’s disease, diabetes, and autoimmune disorders. These risks can be from changes in the client’s brain due to the diagnosis, or due to changes or loss in function related to physical health. For example, someone with chronic pain and fatigue may also experience symptoms of depression, such as low mood or negative thinking, because of their chronic symptoms or limitations in doing preferred occupations. Without appropriate treatment for chronic pain, the client may be at risk for developing substance dependence or abuse to address their pain and depression.

Answer 11

**Stigma** Stigma can result in people with behavioral health diagnoses experiencing discrimination (e.g. in housing or the workplace), and also contributes to people not seeking mental health services. Stigma can result in people not receiving adequate health care (e.g., a woman who seeks health care for chronic pain may be told she has anxiety) or equal opportunities based on assumptions or stereotypes associated with their diagnosis (e.g., that someone with schizophrenia can never live independently).

Answer 12

1. Health care access and quality 2. Education access and quality 3. Social and community context 4. Economic stability 5. Neighborhood and built environment. Social determinants of health are the main drivers of a person’s health status, and they can increase the risk of illness or disability. Can influence the development of behavioral health; people who are more impacted by a negative SDOH are at a higher risk for developing psychiatric diagnoses. Experiences such as generational trauma, systemic racism, ACEs, and lack of access to resources to meet basic needs significantly impact a person’s mental health. People negatively affected by SDOH are also less likely to access needed behavioral health services.

Answer 13

**TRUE** This resulted in harmful practices (e.g., conversion therapy) that aimed to deter people from living as their full identities. Psychiatry has also been used to enforce systemic racism and perpetuate harmful stereotypes. Black individuals, especially Black men, have been diagnosed with “schizophrenia” and portrayed as dangerous at higher rates than the White population, which is rooted in practice to perpetuate systemic racism.

Answer 14

trauma-informed care

Answer 15

**Health**: managing one’s disease or symptoms, and making informed, healthy choices that support physical and emotional well-being. **Home**: having a stable, safe place to live **Purpose**: engaging in meaningful daily activities, and having the independence, income, and resources to participate in society. ****Community: having relationships and social networks that provide support, friendship, love, and hope.

Answer 16

Harm reduction

Answer 17

**Acceptance and commitment therapy (ACT)** ACT seeks to *increase psychological flexibility and promote a tolerance for uncomfortable events* to minimize the effect of not addressing these events over time. ACT includes the development of six core skills: 1. Flexibly and purposefully remaining in the present moment 2. Keeping a balanced and broad perspective on thinking and feeling 3. Clarifying fundamental hopes, values, and goals 4. Cultivating commitment to doing things in line with identified hopes, values, and goals 5. Willingly accepting the unwanted feelings inevitably elicited by taking difficult actions 6. Defusing (stepping back from interfering thoughts)

Answer 18

**FALSE** Abstinence is NOT an inherent goal of harm reduction unless that is the client’s focus.

Answer 19

**Cognitive–behavioral therapy (CBT)** CBT is primarily used for depression, anxiety, obsessive-compulsive disorders, and substance use disorders, although strategies may be useful for managing chronic physical conditions.

Answer 20

**Exposure** Exposure provides systematic contact with a feared stimulus or situation to facilitate extinction, or the reduction in the conditioned fear response to conditioned stimuli that represents threat.

Answer 21

**Cognitive restructuring** Cognitive restructuring creates the process to recognize, evaluate, and modify maladaptive or unhelpful thinking.

Answer 22

**Behavioral activation** Behavioral activation helps a client actively re-engage in their lives by doing things to take care of themselves, engage with families and communities, and participate in desired life roles, which results in feelings of accomplishment and increases motivation for further engagement.

Answer 23

**Dialectical behavior therapy (DBT)** *DBT is made up of four treatment modes:* 1. Individual therapy 2. Skills training, as needed 3. Consultation 4. Practitioner consultation team meetings. These modes aim to address 5 functions of treatment: -- Increase the client’s motivation to change -- Enhance the client’s capabilities -- Generalize the client’s gains to their larger environment -- Structure the environment to reinforce the client’s gains -- Increase therapist motivation and competence.

Answer 24

Dialectical behavior therapy (DBT)

Answer 25

**Antianxiety** Can be taken alongside antidepressants Usually interact with alcohol or certain drugs Generally cause side effects; some are drowsiness, confusion, impaired judgement, nausea

Answer 26

**Antidepressants** May take 4-8 weeks to see improvement in symptoms Monitoring changes is key

Answer 27

**Electroconvulsive therapy (ECT)** Administered with consent of the person. The person is monitored by medical professionals to assess for its positive and negative effects. The person will experience nausea, dizziness, and cognitive effects (e.g., memory loss, decreased learning). Memory loss may be permanent after treatment. Can be administered while hospitalized or as an outpatient.

Answer 28

Transcranial magnetic stimulation (TMS)

Answer 29

**Acute care/Acute inpatient** Acute inpatient hospitalizations are *usually for 24 hours and designed to manage behavior, stabilize clients on medication, and refocus clients on engagement in occupation*. These units exist within a hospital setting and are often locked units where the *client is unable to leave until they are discharged*. Acute inpatient units may address all behavioral health diagnoses or may be specialty units that provide a specific set of services (e.g., medical detox from substances).

Answer 30

**State hospitals** Admitted through *volunteer admission, involuntary civil commitment, or involuntary criminal commitment* (forensic commitment). Hospitalizations are *often extended admissions of several weeks to several months*. Interprofessional teams work closely with the client to stabilize symptoms, develop medication protocols, and develop patterns of daily activity and self-care.

Answer 31

**Forensic settings** May include incarceration (jail or prison), probation, parole, and diversion programs. The client’s behavioral health symptoms or diagnosis may be directly involved in their engagement with the criminal justice system, or their diagnosis may not a contributing factor but needs to be treated or managed while they are incarcerated.

Answer 32

Inpatient substance use and recovery programs

Answer 33

**Long-term institutionalization** With the *Olmstead decision* and increases in community services, people have been moved out of institutions and into the community. However, availability of community-based supports can be limited, making this transition more difficult. Those who move into long-term-care institutions require increased care and support due to medical conditions, progression of diagnoses, or decreases in function due to aging.

Answer 34

They often provide **medication monitoring** and **substance use-oriented programs** may also offer **medication-assisted treatment services**.

Answer 35

Clubhouse programs

Answer 36

**Homeless services** These programs often provide integrated services, including behavioral health care or harm reduction services, to address the client’s needs and move them from homelessness into housing.

Answer 37

**Community residences** Residents may have their own room or a shared room, and the main living space is shared among all residents. Residents typically pay for room and board unless these costs are covered through a waiver or grant program. Residents may receive assistance for household management or meal preparation. Depending on the staff, the resident may also receive support for taking medications, but other medical care occurs within the community.

Answer 38

**Recovery houses** *Note*: They typically require the person to be sober or in recovery from substance use to keep their residence. *Peer support services* are defined as an “incorporated, independent nonprofit organization or a nonincorporated organization that operates independently from a parent organization, 51% of the board of directors or advisory board are peers, the director is a peer; and most staff members and volunteers are peers."

Answer 39

Vocational rehabilitation

Answer 40

Supported employment

Answer 41

**Therapeutic use of self** Occupational therapy practitioners can implement therapeutic use of self to identify the client’s priorities and goals and use those to establish rapport. Use of occupations and occupation-based activities, instead of focusing on the client’s diagnosis or symptoms, can build trust and therapeutic alliance.

Answer 42

Performance-based assessment

Answer 43

Kohlman Evaluation of Living Skills (KELS) Performance Assessment of Self-care Skills (PASS) Activity Card Sort—Inclusive Activities

Answer 44

setting amount of time

Answer 45

**Grading** *Example*: Working with the client to organize one folder of paperwork instead of the entire work desk

Answer 46

**Scaffolding** *Example*: Helping the client gather all ingredients and supplies needed to prepare a recipe and organize everything in the order they will be used, so the client only has to complete the actual cooking

Answer 47

**Fading** *Example*: Sitting with the client while they fill their weekly pillbox, but only intervening or providing support if the client makes an error

Answer 48

**Coaching** *Example*: Noticing the client becoming anxious on a crowded bus and suggesting the identified coping skill of taking a deep breath

Answer 49

**Adaptation** *Example*: Selecting a card game that has simple rules the client can remember and follow

Answer 50

**Modification** *Example*: Using a shower chair and having the client skip washing their hair to decrease the effort needed to shower

Answer 51

Identifying and implementing routines for self-care Identifying strategies to initiate and complete self-care routines Identifying adaptive equipment to manage fatigue and lower energy or adapt to physical function affected by medications or symptoms Identifying resources to support the client’s ability to acquire ADL supplies in the community Providing education on safe sexual activity and/or resources for supplies for safe sex Collaborating with other providers to identify appropriate mobility devices for the client’s community living situation

Answer 52

Identifying coping strategies for symptoms to initiate and complete engagement in activities (e.g., identifying coping strategies to manage anxiety while shopping) Identifying and establishing routines that incorporate identified and priority IADLs (e.g., establishing a daily schedule that includes consistent meal preparation) Developing strategies to support engagement in identified routines (e.g., learning to use technology to provide reminders or cuing to start routine activities) Developing skills for new or less-routine IADLs (e.g., learning how to set and follow a budget) Developing compensatory strategies that support engagement in IADLs that address symptoms or cognitive effects of diagnoses (e.g., setting timers to focus on cleaning one area of the home for a set duration of time) Creating safety monitoring and management plans to identify when symptoms may be created increased risk (e.g., setting up an alarm system to alert if the doors or windows have been left open or unlocked).

Answer 53

**Social and emotional health promotion and maintenance** -- Identifying what well-being looks like to the client -- Identifying barriers to engaging in activities that promote emotional and social well-being -- Identifying coping strategies to increase engagement in health promotion activities. **Symptom and condition management** -- Working with the client to self-identify symptoms of their diagnosis -- Identifying immediate and long-term coping strategies for symptoms -- Identifying wellness and recovery plans to manage symptoms and health long term -- Identifying community and social supports to manage symptoms and diagnosis **Communication with the health care system** -- Developing self-advocacy skills to engage with health care providers and assert needs -- Providing education about different health resources in the community and how to access them -- Providing education and skill building to navigate the health care system (e.g. identifying in-network providers). **Medication management** -- Identifying strategies to increase consistency with taking medications -- Identifying ways to track and monitor positive and negative effects of medications -- Skill building to read and follow medication bottles; refill prescriptions -- Skill building to increase client’s knowledge about medications and where to find information about medications. **Physical activity** -- Providing education on the impact of physical activity on the client’s health -- Identifying personal preferences for physical activity -- Providing education on available resources to support physical activity in the client’s community -- Providing education on safe movement strategies to engage healthily in physical activity. **Nutrition management** -- Skill building to understand effect of diagnosis on overall nutrition and health -- Identifying meal routines that support the client’s overall nutrition -- Providing education on dietary restrictions related to diagnoses or medications -- Skill building to identify and prepare meals that meet the client’s dietary needs **Personal care device management**: Education and training to use devices (as appropriate).

Answer 54

Establishing bedtime routines to promote restful sleep and sleep hygiene Establishing morning routines that support sleep hygiene and initiate getting out of bed at identified times Identifying compensatory strategies to support sleep hygiene/routines (e.g., setting a TV timer or “sleep” timer on electronics to prevent staying up too late on devices) Creating a sleep diary to monitor changes in sleep or identify strategies that support better sleep Identifying routines that schedule adequate rest breaks throughout the day to minimize fatigue.

Answer 55

Identifying and using compensatory strategies to manage the cognitive effects of their condition Identifying and using coping strategies to manage barriers to educational engagement Identifying and assisting the client in advocating for accommodations in formal institutional settings, Identifying environmental supports Developing a plan for the client to transition back into educational roles if they have been disrupted by behavioral health. Identifying educational interests (formal and informal) Identifying strategies to support goal identification and plans to address education-related goals.

Answer 56

Exploring and identifying desired work roles Identifying coping strategies to manage symptoms within the workplace Developing skills to be able to work within new roles Identifying skills or strategies to resume work roles that compensate for symptoms or cognitive effects of condition Developing skills to enter or re-enter workforce, such as technology skills to search for jobs, apply for jobs, and create a résumé.

Answer 57

Identifying past or current leisure interests Identifying barriers to leisure participation Identifying strategies to support leisure participation Trying or exploring different leisure opportunities to identify interests Learning about resources to engage in leisure activities in the community, including financial or economic resources Identifying adaptive or compensatory strategies to participate in preferred leisure activities.

Answer 58

Identifying personal boundaries and development of skills to communicate boundaries with social supports Identifying social interests and exploration of social opportunities within the community Identifying coping strategies to support social engagement Identifying peer support groups Developing skills to communicate about health and support needs to support systems Developing and practicing social interaction skills for specific situations

Answer 59

**Psychosocial groups**, which focus on health and symptom management. **Skill-based groups**, which focus on developing skills to engage in activities or occupations, such as IADLs or health management activities (e.g., how to identify and follow a balanced weekly routine). **Leisure or social groups**, which focus on participating in leisure and social activities and support development of social and communication skills. **Activity or task groups**, which focus on engaging in activities or tasks to increase engagement or tolerance for participating in activities and occupations.

Answer 60

**TOOLS** Group leaders should be aware of potential misuses of tools and supplies. Group leaders need to learn any facility or unit restrictions on tools or supplies. All tools and supplies should be counted at the beginning and end of each group and monitored while they are in use. The group leader needs to ensure that all supplies are safely locked and stored at the end of group. If the group includes people who are at a very high safety risk, the group leader should identify alternative activities or have the person attend a different group or individual session. Not everyone with a mental health condition presents with decreased safety; however, some people are at high risk for suicide or harm of self or others. Communication with the treatment team and facility staff is important to understand any safety risks, protocols, and responses to safety concerns. *Tools and supplies that are of high safety risk include the following:* --Sharp tools (scissors, knitting needles) --Small supplies that can be swallowed (such as beads) --Objects that would harmful if thrown (such as heavy putty) Items that can be disassembled for small or sharp pieces. --Policies and procedures should be in place to account for all tools and potentially dangerous materials. **STAFFING** Staffing patterns should be appropriate for the level of complexity of group participants. Participants who are at risk of harming themselves or others may need individual or assigned staffing. Occupational therapy practitioners will need to select activities that are appropriate to the staffing levels and activities of the group. **LOCATION** Groups should be held where staff can easily access other staff for support as needed. Rooms should be equipped with appropriate safety supplies (e.g., cooking spaces should have a fire extinguisher).

Answer 61

Providing redirection to the topic, task, or activity. Reminding the group members of the group expectations, rules, or norms. Shifting the task, topic, or activity if it appears to be challenging or triggering (e.g., leading deep breathing exercises). Requesting or requiring the client to leave the group. Requesting additional staff support to help transition the client out of groups.

Answer 62

**Support Structure Repetition Consistent expectations** In some settings, the therapeutic milieu must provide a balance of ensuring safety for clients and staff while promoting healthy activities and routines. Occupational therapy practitioners can identify sensory-based interventions, strategies, and tools to promote a healing space and potentially reduce the use of restrictive practices, such as seclusion. Examples include the following: 1. Creating specific sensory rooms that have modalities available for the client to self-regulate or de-escalate. 2. Making the entire facility or unit sensory supportive or responsive, such as providing options for seating, calming colors or art on the walls, reducing use of fluorescent lighting, and offering sensory modalities to all clients. 3. Developing and using crisis intervention plans, especially for institutional and long-term settings.

Answer 63

1. Tracks the impact of occupational therapy interventions 2.Ensures progress is being made toward the client’s goals.