Pediatric Occupational Therapy within a Medical Model Flashcards
Characterists and structures of children hospitals - insurance driven
■ Health care cost controlled by managed care organizations which can result in shorter hospital stays, provision of fewer services, or limited reimbursement for services provided
Characterists and structures of children hospitals - Governed by external private accrediting agencies and insurance providers
□ Governed by external private accrediting agencies and insurance providers
■ CMS, JCAHO, CARF, and OSHA set standards regarding hospital operations such as providing professional services, documenting progress, employee safety, and quality improvement
Hospital based services
□ Provide medical care to children with acute or chronic illness, traumatic injury, or special needs
□ Continuum of services
■ Intensive care
■ Acute care
■ Rehab units/pediatric rehabilitation
■ Outpatient care
NICU
OT in NICU setting- high risk & specialized practice
Appropriate for OTs with advanced knowledge & skills in neonatal care
Activity Analysis (Physical, social, sensory, biological, and psychosocial aspects).
Adaptation (modifications/compensatory strategies)
Family centered care
Preventative care
Co-occupation
Feeding
Positioning
Stretching/ROM
Environmental modification
Sensory Integration
Infant Massage
Parent Education/Consult
Medical model and setting
Medical team (ie doctor) recommends and prescribes focus, frequency, and duration of therapy. Third party (insurance carrier) may be the ultimate decision maker.
Therapy focuses on treatment to alleviate or cure specific underlying medical pathologies.
Assessments and outcomes take the child’s performance of all areas into consideration
Treatment settings usually include hospital, rehab center, outpatient clinic and home.
Education Model
Educational team uses educational, psychological and therapeutic evaluations, to determine focus frequency and duration of therapy based on the educationally-related needs of the student
Therapy focuses on intervention to improve the student’s ability to learn and function in the school environment.
Assessments and Outcomes must have a direct link to educational performance
Services are provided primarily on school grounds
what is the difference between medical model and educational model when it comes to ages
Medical model is all ages
education is up to 21y/o
What is the payment like for medical model?
Payment is on a fee-for-service basis, covered by private insurance, government assistance, or family.
What is payment like for educational model
Services are covered by the school district and provided at no cost to parents.
What is the documentation like in medical model?
Documentation of intervention is dictated by guidelines of the setting (JCAHO) and insurance requirements. Emphasis on medical terminology
What is the documentation like in educational model?
Documentation of intervention is based on IEP. Emphasis is placed on educational terminology
How does medical model see intereventions for mobility
Functional mobility crutch training for acute temporary sports injury
Fabrication of splints to maintain range of motion
Providing seating alternatives/durable medical equipment for the home environment (bath chair, shower chair, etc)
how does education model see mobility intervention
Gait training to decrease time student walks from classroom to bus
Fabrication of splints to enable students to participate in educational setting (ex writing, eating lunch etc)
Modifying seating or positioning on the bus and at school
Treatment team involved in medical model
MD
OT
PT
SLP
Parent/Caregiver
Child Life Specialist
Music Therapist
Art Therapist
Teacher
Neuro-psychologist
Psychologist
Social Worker
Case Manager
Provide services in a relatively brief period of time
Insurance driven managed care results in shortened hospital stays, and limited reimbursement for services provided
OTs need to be
highly efficient:
Thorough and streamlined evaluation process
Prioritize treatment goals
Consider discharge plans as part of the initial eval
OT role in pediatric medical model
Evaluate motor, sensory, cognitive, and adaptive skills, and facilitate progress toward developmental milestones.
Collaborate with and train families to reinforce therapeutic skill acquisition.
Develop and implement an intervention plan, based on the child’s needs, to participate in various child-appropriate occupations and environments (e.g., school, home, playground), including socializing with other children.
Medical model OT evaluations
OT services initiated through physician’s orders
Evaluation begins before even seeing the patient
Chart review/discussion with other providers (MD, RN, other therapists on team).
Evaluation consists of:
Asking (Clinical Interview)
Looking (Clinical Observation)
Touching (physical examination)
Testing (Standardized Assessments)
Medical model OT intervention focus is on :
Preventing Secondary Disabilities and Restoring Performance Skills
Maintain or promote range of motion
Enhance positioning
Prevent skin breakdown, pressure sores
Resuming and Restoring Occupational Performance
Activity Analysis
Adaptations needed (assistance, cueing, prompting, instructional aides)
Occur in a natural environment
Making Adaptations for ADL Skills
Reducing complexity, ensuring safety, minimizing complications if errors occur
Intervention used in pediatric rehab (medical model)
Range of Motion
Splinting/Positioning
Fine motor strength/Dexterity
Visual motor/Visual perceptual
Self-Care/ADL’s
Therapeutic Listening
Feeding
Sensory integration
Pediatric Services/ Specialties: NICU
Occupational therapy in NICU setting is high risk & specialized practice
Appropriate for OTs with advanced knowledge & skills in neonatal care
-Neonate development
-Caring for the critically ill
-Medical conditions, procedures & equipment
-Grief reactions, social structures, attachment, & issues
relating to health and well-being of the family unit
-Continuous eval & intervention
-Continuing ed, mentoring
OT in NICU
OTs are able to improve the match between the infant’s capabilities and the physical and social environment in order to foster the infant’s optimal development
Activity Analysis (Physical, social, sensory, biological, and psychosocial aspects).
Adaptation (modifications/compensatory strategies)
Family centered care
Preventative care
Co-occupation
What can OTs offer in the NICU
Assessment/Screening
Feeding
Initiation of a Feeding Protocol
Positioning
Stretching/ROM
Environmental modification
Sensory Integration
Infant Massage
Parent Education/Consult:
Support Co-occupations
Ability to refer to NICU follow-up team
what’st he birthweight that would land a kid in the NICU
under 3.3lbs
Examples of Co-occupation in the NICU
Mothering
Playing
Transitioning sleep
Snuggling
Gazing
Cleaning
Listening
Holding
managing emotions
Comforting
equalizing power differentials
Ensuring Health and Well-being
Caregiving
Communicating
Reading
Bathing
Watching/Looking
Protecting
Touching
Recording the Moments
Feeding in NICU
identify and education on feeding readineness cues.
Positioning for suck, swallow, breath coordination
minimizing aversion to oral stimulation
nipple selection.
Environmental Modification for babies in NICU
Positioning Aids
Splinting
Environmental/Sensory Adjustments
Lighting
Sound
Vestibular Input
Proprioceptive
Olfactory
Tactile
Sensory Integration of babies in the NICU
Provide environmental strategies to decrease sensory stimulation.
Educate parents and nurses on “stress signs” of over-stimulation
Positioning to allow for self-regulation
Infant massage
positioning of babies in NICU
Promote flexion to enhance development
Hand to mouth
Grasping
Stability of the motor system
Feeding
Social interaction
Education on positions to eliminate long-term effects on development
