Mental Health Practice With Adults

Question 1

“The promotion of mental health, resilience, and well-being; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions” is called…

Answer 1

behavioral health

Question 2

_________________ are “characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior. Mental health conditions may result in distress and/or problems functioning in social, work or family activities”

Answer 2

Mental health conditions

Question 3

__________________ is a mental health condition causing major functional impairment, such that participation in functional daily life activities is significantly limited

Answer 3

Serious mental illness

Question 4

___________________ is “the use of selected substances, including alcohol, tobacco products, drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects.”

Answer 4

Substance use

Question 5

The _______________________ provides detailed descriptions of all categories of mental health disorders and includes the characteristics of and diagnostic criteria for the disorders in each category.

Answer 5

The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-V-TR)

Question 6

Person-first and nonstigmatizing language is a hallmark of our documentation.

Instead of using terms like “schizphrenic” or “addict,” how might you change this to fit the preferred documentation rule?

Answer 6

Client has a diagnosis of schizophrenia…

Client acknowledges use of substances…

Confirm with the client their preferred identity language. Use of person-first language is one way to decrease stigma for people with mental health and substance use disorders and maintain client-centered care.

Question 7

________________ (legislation) and _________________ (legislation) sought to increase mental health parity; however, insufficient mental health providers and inconsistent application of the (second legislation) result in significant geographic disparities in access to behavioral health care.

Answer 7

Patient Protection Act

Affordable Care Act

Question 8

Lack of _____________ and parity for mental health services has restricted the creation of and maintenance of occupational therapy practitioner roles in mental health settings.

Answer 8

funding

Question 9

True or false: Criminalization of behavioral health symptoms often results in people not receiving care until they are engaged in the justice system; humane, community-based treatment is often difficult to access.

Answer 9

True

Question 10

True or false: Occupational therapy practitioners in behavioral health settings may have small caseloads, allowing for greater group treatment or individual interventions to select clients.

Answer 10

FALSE

Occupational therapy practitioner in behavioral health settings may have large caseloads, limiting group treatment or individual interventions to select clients.

Question 11

Name the mental health diagnosis/diagnosis category.

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Answer 11

Attention deficit hyperactivity disorder (ADHD)

To be diagnosed with ADHD, adults need to have at least 5 symptoms present. Symptoms experienced in adulthood may differ from those the client experienced in childhood.

The DSM-5-TR identifies three categories of ADHD:
– Inattentive
– Hyperactive-impulsive
– Combined presentation

Question 12

How does ADHD impact occupational performance?

Answer 12

Challenges with executive functioning (e.g., initiation, organization, or completion) can affect a client’s ability to start, follow through, and complete occupations (e.g., home management or time management).

Impulsivity may impair time management or social skills and engagement with others.

The person may become focused on preferred occupations (e.g., leisure or hobbies) at the expense of completing other activities.

Adults may find it challenging to stay organized or engage with higher education or work activities.

Question 13

Name the mental health diagnosis/diagnosis category.

Characterized by panic, stress, and generalized anxiety, resulting in alteration of behavior, emotions, and cognitive processing for the purpose of avoiding the associated negative physiological, emotional, and psychological impact.

Answer 13

Anxiety disorders

General categories in the DSM-5-TR
– Separation anxiety disorder
– Selective mutism
– Specific phobia
– Social anxiety disorder
– Panic disorder
– Panic attack specifier
– Agoraphobia
– Generalized anxiety disorder
– Substance/medication-induced anxiety disorder
– Anxiety disorder caused by another medical condition.

Question 14

How can anxiety impact occupational performance?

Answer 14

Decreased engagement in priority and preferred occupations, and challenges with initiating and engaging in new occupations due to distorted thought processes or concerns about potential effects of doing the occupation or activity.

Difficulty initiating and participating in social activities or engaging in activities in public places or outside of the home.

May have difficulty communicating needs with others or modifying routines.

Question 15

Name the mental health diagnosis/diagnosis category.

Persistent presence of sadness and hopelessness
Feelings of emptiness or irritable mood. Accompanying somatic and cognitive changes that affect the ability to function. Severity and sustained presence of symptoms determine specific diagnoses within this group of disorders.

Answer 15

Depressive disorders

Categories of depressive disorders
– Disruptive mood dysregulation disorder
– Major depressive disorder
– Persistent depressive disorder (dysthymia)
– Premenstrual dysphoric disorder
– Bipolar disorder – Bipolar I: one or more manic episodes or mixed episodes. Bipolar II: one or more major depressive episodes and at least one hypomanic episode. Cyclothymic disorder: chronic (at least 2 years) mood disturbance, with fluctuating hypomanic and depressive symptoms.
– Other depressive disorders

Question 16

How do depressive disorders (not including bipolar) impact occupational performance?

Answer 16

May have challenges initiating and engaging in desired occupations due to low motivation and initiation, or challenges with establishing and following routines.

May require increased time to complete occupations and activities due to low energy.

Relationships and ability to engage socially with others may be affected by feelings of low self-worth.

May have decreased engagement in leisure activities due to decreased ability to enjoy or actively engage in activities.

Question 17

How do bipolar disorders impact occupational performance?

Answer 17

May have similar challenges related to low mood as other depressive disorders.

Manic or hypomanic episodes may result in engaging in occupations that have negative effects on the client (e.g., overspending while shopping or gambling) or decreased safety (e.g., driving too fast).

Social interactions may be affected by the client sharing inappropriate information or not applying social skills appropriate for the situation.

The client may make unsafe or impulsive decisions or become engaged in activities at the risk of not taking care of other needed occupations (e.g., the client may work on a project for work for several days straight but not eat meals or care for their home).

Question 18

Name the mental health diagnosis/diagnosis category.

Characterized by severe disturbances in eating and behaviors related to eating that are life threatening.

Answer 18

Eating and feeding disorders

Primary diagnoses
– Anorexia nervosa: characterized by intense fear of being fat, disturbance of body image, and obsession with food and thinness.
– Bulimia nervosa: characterized by recurrent binge eating and frenetic compensatory behaviors.

Subtypes
– Pica
– Rumination disorder
– Avoidant/restrictive food intake disorder
– Binge-eating disorder
– Other specified and unspecified feeding and eating disorder.

Question 19

How do eating and feeding disorders impact occupational performance?

Answer 19

Eating and meal time occupations may be highly affected based on the client’s symptoms (e.g., avoiding meal preparation and feeding).

The client may have decreased social engagement in order to conceal behaviors related to their diagnosis (e.g., not eating at a restaurant in order to hide after-meal purging).

The client may have challenges completing ADLs due to self-perceptions of their body and body image.

They may overengage in health-related activities (e.g., exercise) at the expense of engaging in other occupations, or they may have rigid habits and routines.

May have decreased cognitive performance in school or work activities based on insufficient nutrition.

Question 20

Name the mental health diagnosis/diagnosis category.

Characterized by persistent, recurring, and unwanted intrusive (involuntary) thoughts, images, memories, and/or urges (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing the anxiety or distress caused by intrusive thoughts.

Answer 20

Obsessive–compulsive and related disorders

General DSM–5-TR categories
– Obsessive–compulsive disorder
– Body dysmorphic disorder
– Hoarding disorder
– Trichotillomania
– Excoriation disorder/dermatillomania
– Substance/medication-induced obsessive–compulsive and related disorder
– Obsessive–compulsive and related disorder caused by another medical condition.

Question 21

How do obsessive compulsive disorders impact occupational performance?

Answer 21

The client may have challenges initiating and engaging in priority and desired occupations due to thoughts or urges related to the diagnosis.

They may have rigid habits and routines surrounding occupations, which may require increased time to complete activities or inhibit them from being able to do the activity or occupation.

May have particular challenges with home management (e.g., excessive time spent maintaining arbitrary standards, or decreased safety and cleaning related to hoarding of items or pets).

Question 22

Name the mental health diagnosis/diagnosis category.

Characterized by “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (APA, 2022). Ten personality disorders with specific symptoms and characteristics have been identified.

Answer 22

Personality disorders

Cluster A (odd/eccentric): paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder

Cluster B (dramatic/erratic): antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder

Cluster C (anxious/inhibited): avoidant personality disorder, dependent personality disorder, obsessive–compulsive personality disorder.

Question 23

Name the mental health diagnosis/diagnosis category.

Characterized as “a disorder that may result when an individual lives through or witnesses an event in which they believe that there is a threat to life or physical integrity and safety and experiences fear, terror, or helplessness.”

Answer 23

Posttraumatic stress, trauma, and stress related disorders

General DSM–5-TR categories
– Reactive attachment disorder
– Disinhibited social engagement disorder
– Posttraumatic stress disorder
– Acute stress disorder
– Adjustment disorders

Question 24

How do personality disorders impact occpational performance?

Answer 24

Social engagement and communication are often highly impacted. May have challenges effectively communicating their needs or responding to others. May avoid challenging social situations (which can include work and school environments).

May have challenges self-regulating during stressful situations while engaging in occupations around others (e.g., shopping, using public transit).

May have adopted habits or routines for self-regulation (e.g., self-harm) that affect health and safety during ADLs.

People with a diagnosed personality disorder are likely to have a history of trauma, adverse childhood experiences (ACEs), or other mental health diagnoses, and their occupational performance may be affected by this history.

Question 25

How do stress disorders impact occupational performance?

Answer 25

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.

Question 26

Name the mental health diagnosis/diagnosis category.

Characterized by psychotic symptoms, including delusions and hallucinations.
DSM–5-TR criteria: At least two of the following symptoms lasting for at least 1 month: Delusions, Hallucinations, Disorganized thinking (speech), Grossly disorganized or abnormal motor behavior (including catatonia), Negative symptoms.

Answer 26

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

Question 27

How do schizophrenia spectrum and other psychotic disorders impact occupational engagement?

Answer 27

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).

Question 28

Name the mental health diagnosis/diagnosis category.

Characterized by physical symptoms that have a psychiatric source. These clients are frequently encountered in settings outside mental health practice settings because of the association of the disorders with physical illness. Occupational therapy practitioners may be the first health practitioners to recognize symptoms related to these disorders. The pain and discomfort related to these disorders are real and should not be mistaken for malingering or symptom magnification for secondary gain.

Answer 28

Somatic symptom and related disorders

Question 29

How do somatic symptom disorders impact occupational engagement?

Answer 29

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.

Question 30

True or false: Substance use refers to the “use of substances,” but the term does not necessarily indicate that this use is detrimental to the person.

Answer 30

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”

Question 31

What are the 4 categories of substance use disorders?

Answer 31

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

Question 32

What are some of the impacts of substance use disorder on occupational performance?

Answer 32

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).

Question 33

True or false: Having a serious mental illness, such as schizophrenia, can increase the risk of developing chronic physical health conditions, such as diabetes or heart disease.

Answer 33

True

Question 34

True or false: Having a serious mental illness does not impact life expectancy.

Answer 34

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.

Question 35

True or false: Some diagnoses increase the risk of developing a behavioral health condition.

Answer 35

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.

Question 36

___________ is a form of social discrimination and prejudice, which can create harms for those with mental health conditions

Answer 36

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).

Question 37

Health People 2030 identifies 5 domains of social determinants of health, including…

Answer 37

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.

Question 38

True or false: All trans individuals were once considered by psychiatry to have a gender identity disorder.

Answer 38

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.

Question 39

When “a program, organization, or system . . . realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization,” this is called…

Answer 39

trauma-informed care

Question 40

The Recovery Model aligns with occupational therapy practice, focusing on identifying the client’s priorities and recognizing the need to address the whole person. Practitioners can integrate recovery model principles into their interventions and when developing programs and services.

The Recovery Model has four major dimensions that support life in recovery. They are…

Answer 40

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.

Question 41

_______________ is a range of interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing them completely.

Answer 41

Harm reduction

Question 42

___________________ is an evidence-based approach that is effective with a range of behavioral health conditions.

Answer 42

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)

Question 43

True or false: Abstinence is an inherent goal of harm reduction.

Answer 43

FALSE

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

Question 44

_______________________ is an active, problem-oriented intervention that seeks to identify and change maladaptive beliefs, attitudes, and behaviors that contribute to emotional distress.

Answer 44

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.

Question 45

An occupational therapy practitioner may accompany someone to the grocery store to support the client in using cognitive behavioral strategies to manage and complete the outing.

Which CBT strategy is this?

Answer 45

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.

Question 46

The practitioner may help the client use reframing to reflect on their performance.

Which strategy of cognitive behavioral therapy is this?

Answer 46

Cognitive restructuring

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

Question 47

The practitioner supports the client by identifying daily routines and supporting engagement in desired activities.

Which strategy of cognitive behavioral therapy is this?

Answer 47

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.

Question 48

_________________ was developed for treatment and use with people diagnosed with borderline personality disorder; however, its use has expanded to other diagnoses.

Answer 48

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.

Question 49

____________ first focuses on reducing potentially harmful or quality-of-life-interfering behaviors, then transitions to skill building to redevelop routines and engagement with desired occupations.

Answer 49

Dialectical behavior therapy (DBT)

Question 50

Benzodiazepines, beta blockers, and SSRI’s are what type of medication?

Answer 50

Antianxiety

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

Question 51

SSRI’s, SNRI’s, and NDRI’s are what type of medication?

Answer 51

Antidepressants

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

Question 52

________________ Involves a brief electrical stimulation of the brain while the patient is under anesthesia. It is typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist, and a nurse or physician assistant.

It was formerly used to treat a range of psychiatric conditions; it was often punitive or administered in a way that was harmful to the client.

In current practice, this technique is used when someone with depression or bipolar disorder has not responded to other types of medical treatments, such as medication.

Answer 52

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.

Question 53

____________ is used to treat depression that has not responded to other therapies but is often not as effective as ECT for very severe illness.
Involves the use of rapidly alternating magnetic fields to stimulate specific areas of the brain. The person remains awake through the noninvasive process.
The side effects of this technique are more mild than those of ECT and include headaches, muscle twitches, and pain at the stimulation site.

Answer 53

Transcranial magnetic stimulation (TMS)

Question 54

Clients are admitted to the psychiatric unit of ____________ hospital, usually as a result of active and uncontrolled symptoms related to mental illness.

Answer 54

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).

Question 55

__________ are public institutions that provide inpatient services to people with serious mental illness.

Answer 55

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.

Question 56

____________ are for clients involved in the criminal justice system.

Answer 56

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.

Question 57

These treatment settings for substance use are provided in special units of hospitals or medical clinics. They offer both detoxification and rehabilitation services. They are focused on supporting a client through detox from the substances that they are using, identifying recovery goals and plans, initiating medication-assisted treatment (when appropriate), participating in individual and group treatment, and beginning to restructure routines without using substances.

Answer 57

Inpatient substance use and recovery programs

Question 58

These facilities typically occurs within a long-term-care or skilled nursing facility
People often move into these facilities when they need assistance for ADLs or medical management.

Answer 58

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.

Question 59

Intensive outpatient (IOP), partial hospitalization (PHP), and day treatment programs are outpatient psychiatric services that provide structured treatment during the day.

These programs can focus on general recovery and stability or may specialize in specific services (e.g., substance use treatment).

What types of substance use treatment do they provide?

Answer 59

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

Question 60

___________________ are community-based service environments that fill a variety of needs across the continuum of recovery supports and services; they are a community of people who share lived experience of mental illness and recovery.

Answer 60

Clubhouse programs

Question 61

_____________________ are a continuum of services that provide support for people experiencing homelessness.
Services range from those centered on meeting basic needs (e.g., daily meal programs) to providing shelter (e.g. emergency housing, transitional housing) or health care services (e.g., street medicine teams or health care for the homeless programs).

Answer 61

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.

Question 62

________________ are typically private facilities, where a set of people with a shared experience or diagnosis live together (e.g., they may be focused on mental health or older adults). Typically the homes are staffed 24/7.

Answer 62

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.

Question 63

___________________ are a support service designed by persons in recovery from substance use issues for those initiating and sustaining recovery.

These organizations mindfully cultivate prosocial bonds, a sense of community, and a milieu that is recovery supportive unto itself.

Those that focus on populations with higher needs often add peer recovery support services and other types of supports, or they actively link residents to recovery or clinical services in the community.

Answer 63

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.”

Question 64

_____________________ is a federal–state program that works with individuals who have disabilities to help them find and maintain employment and enhance their independence.

Answer 64

Vocational rehabilitation

Question 65

_________________ is an approach to vocational rehabilitation for people with serious mental illness that emphasizes helping them obtain competitive work in the community and providing the supports necessary to ensure their success in the workplace.

Answer 65

Supported employment

Question 66

____________________ is an integral part of the occupational therapy process, “in which occupational therapy practitioners develop and manage their therapeutic relationship with clients by using professional reasoning, empathy, and a client-centered, collaborative approach to service delivery”

Answer 66

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.

Question 67

______________ is especially important in the mental health setting because people who have more acute symptoms may not be able to accurately describe their current functioning or performance. For example, occupational therapy practitioners should not complete only a cognitive screening tool—they should include a ______________ to determine how cognition is affecting functional skills.

Answer 67

Performance-based assessment

Question 68

Name 3 assessments commonly used in mental health.

Answer 68

Kohlman Evaluation of Living Skills (KELS)

Performance Assessment of Self-care Skills (PASS)

Activity Card Sort—Inclusive Activities

Question 69

Interventions should reflect the appropriateness of the________________ and the ____________ the occupational therapy practitioner will be able to work with the client.

Answer 69

setting
amount of time

Question 70

Increasing or decreasing the demands of an activity step by step to promote occupational performance with the just-right challenge is called…

Answer 70

Grading

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

Question 71

Breaking the activity into manageable steps so it is not overwhelming is called…

Answer 71

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

Question 72

Gradual withdrawal of support as the client gains improved skills is called…

Answer 72

Fading

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

Question 73

Providing explicit expectations and support to enable the client to complete an activity is called…

Answer 73

Coaching

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

Question 74

Changing the requirements of the occupation to be more congruent with the client’s abilities is called…

Answer 74

Adaptation

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

Question 75

Reducing the activity’s demands is called…

Answer 75

Modification

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

Question 76

Provide an example of an intervention to address ADLs in mental health.

Answer 76

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

Question 77

Provide an example of an intervention to address IADLs in mental health.

Answer 77

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).

Question 78

Provide an example of an intervention related to health management in mental health.

Answer 78

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).

Question 79

Provide an example of an intervention to support rest/sleep in mental health.

Answer 79

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.

Question 80

Provide an intervention to support educational participation in mental health.

Answer 80

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.

Question 81

Provide an example to support work roles in mental health.

Answer 81

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.

Question 82

Provide an example of an intervention to support leisure participation in mental health.

Answer 82

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.

Question 83

Provide an example of an intervention to support social participation in mental health.

Answer 83

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

Question 84

Name 4 different types of groups for mental health settings.

Answer 84

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.

Question 85

Name some ways to manage group safety in mental health settings.

Answer 85

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).

Question 86

What are some ways to deal with challenging behaviors in the group space in a mental health setting?

Answer 86

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.

Question 87

Therapeutic milieus are an intervention strategy used in psychiatric and behavioral care.

A therapeutic milieu includes the following 4 components:

Answer 87

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.

Question 88

Provide 2 reasons it’s important to use outcome measurements in occupational therapy.

Answer 88

1. Tracks the impact of occupational therapy interventions

2.Ensures progress is being made toward the client’s goals.