Pschyosocial Approaches: Eval and Intervention Flashcards
MOHO
- MOHO stresses the importance of the mind/body connection because motivation and performance are
interconnected - MOHO really looks at the person and the environment
- Volition which is the motivation for occupation. It influences the activities and choices clients make
-Engaging a client in occupations that they are motivated to complete results in positive outcomes,
improved carryover, and better motor performance - Habituation is the process by which occupation is organized into patterns and routines. What was once
easy, and a habit may become difficult when cognitive or physical deficits interrupt habits
- Disruptions in habituation may require intervention that addresses structure and routine to reestablish a sense of identity - Performance capacity refers to a client’s physical and mental ability which makes possible the skilled
achievement of occupations. Allows us to act upon the environment.
Evaluating using MOHO
- First assess the client’s occupational history based on the model’s concepts including person (volition,
habituation, performance capacity), environment, and occupation
AMPS (assessment of motor and process skills). Volitional Questionnaire, Role Checklist, Occupational
Questionnaire, Occupational Case analysis interview and rating (OCAIR), Occupational performance
history interview (OPHI), Worker Role Interview, Assessment of Communication and Interaction Skills
(ACIS), The Short Child Occupational Profile (SCOPE), Assessment of Work Performance (AWP)
Interventions for MOHO
- First establish trust (may occur during assessment)
- Developing client-centered goals is central to the philosophy of the MOHO. Relevant, meaningful, and holistic
- The MOHO intervention strategies include validate, identify, give feedback, advise, negotiate, structure,
coach, encourage, and provide physical support
-A variety of adaptive solutions should be offered to substitute for maladaptive solutions. Alter the way
clients do thing
- Overall providing occupations as interventions will innately encourage a client to adapt, change, and
learn about themselves as an occupational being.
Ecology of Human Performance (EHP)
- Establish and Restore *Aimed exclusively at making changes in the person.
- Alter *Targets the context and task.
- Adapt/Modify *Targets the context and task
- Prevent*Takes place before a problem occurs or when no problem exists
- Create*Takes place before a problem occurs or when no problem exists
Person-Environment-Occupation-Performance Model (PEOP)
- The PEOP highlights the complexity of the Person-Environment-Occupation relationship. The focus is on occupational
performance and seeks to understand the client’s perspective on their occupational performance issues. When the “fit” between the three are at their maximum, occupational performance is maximized. Conversely, when the “fit” is
minimal, occupational performance is minimized.
Example of PEOP for client who has experienced trauma resulting in lower limb amputation
Person: components that will likely be impacted include the physical, affective (self-concept), and spiritual
(values, interest)
Environmental: physical (accessibility, mobility), social (acceptance by friends and family), and institutional
(financial benefits, workplace policies)
Occupation: components may include self-care (showering, exercise), productivity (going to work,
driving), and leisure (socializing with friends, participating in preferred sports and activities).
Occupational Adaptation (OA)
- desire to master his or her environment
- environment demands mastery
- “press for mastery
- The most important role of the occupational therapist is to elicit an adaptive response from the client
- Intervention strategies should aim to increase the client’s ability to make adaptations for engaging in occupational activities that are meaningful.
Psychodynamic FOR
- Emphasizes early childhood experiences as having a lasting influence that may not emerge until
adulthood - Help unconscious conflicts become conscious, once available to consciousness, psychological conflicts
can be worked through and resolved
-Promote ‘projective’ activities to promote ‘letting go of trauma’ and transition to productive living
Cognitive Behavioral FOR
-OT will help the person identify cognitive distortions and learn to test personal beliefs
-Graded activities will provide progressive challenges and success experiences
- Clients must be capable of self-awareness in order to apply logic in order to recognize and dispute irrational
thinking
Evaluating using CBT FOR
- Keen observation of performance and behavior in order to gain understanding of how thoughts are processed
and identify areas that change is desirable
-Use observation, assessment, and interview to determine the client’s:
Ability to interpret behavior, knowledge of information related to ADL’s, leisure pursuits, strategies used to
problem-solve, effectiveness of skills for daily function
- Identify rules for living (“I have to do what my spouse wants, or they will get angry”)
- Self-report tests, Mental status tests, Mood inventories, Anxiety scales, Life satisfaction inventories, Cognitive level
tests, Occupation engagement tests including: Task Check List, Beck Depression or Anxiety Inventory, Stress
Management Questionnaire, Rotter’s Internal-External Scale, Lotus of Control for Children, Zung’s Self-Rating
Depression Scale, Dysfunctional Attitude Scale, ACL Screen, Bay Area Functional Performance Evaluation, Kohlman Evaluation of Living Skills. Pre-tests and posts-test may also be used.
Interventions using CBT FOR
Three major forms of CBT:
- Rational psychotherapies (rational emotional therapy for irrational thinking, RET, Beck’s cognitive therapy looks at the philosophy of life, and self-instructional training, SIT uses self-talk and think aloud protocol).
- Coping-skills therapies (learning from mistakes, include covert modeling, systemic desensitization, and anxiety
management).
- Problem-solving therapies (collaborate to identify solutions and strategies for problems)
Groups:
- Psychoeducational requires clients to use rational thinking to apply new skills through group problem-solving.
-Social and Life Skills Groups. -Stress management and coping skills groups to change a person's thoughts and belief about stress and practice the skills for managing stress
Socratic Dialogue- collaboration with the client to identify adaptations that would be expected to improve task or
social performance, including changes that can be made to the environment. The purpose is to help clients
generalize their coping and problem-solving skills
Identify cognitive distortions and learn to test personal beliefs
Journaling to identify themes and distorted thinking
A thought record or log of feelings and behaviors that occur during therapy or daily activities. They help
to understand thoughts and the consequences of those thoughts. As well as help client’s problem solve alternative responses
Modeling, rehearsing, coaching, and role playing can provide effective methods for responding to problematic
situations
Homework is considered a strategy with the CBT FOR.
- For example, a child with depression may be assigned homework that requires the child to participate in a pleasurable activity
Cognitive Orientation to Occupational Performance Model uses guided discovery to help children problem solve
Toglia’s Dynamic Interactional Approach (DIA)
-DIA is a restorative cognitive rehabilitation approach.
It assumes that the client is able to learn, but it also uses adaptations and compensatory approaches to
improve performance
-Focuses on the ability to generalize to multiple or complex tasks with emphasis on the cognitive
processing skills
- The model suggests that client’s need to ‘do’ or be actively engaged in meaningful occupations in order
for new learning to occur.
Evaluating using DIA:
- Begins with observation of the client engaging in actual tasks
- Patients predict their performance before beginning the assessment task.
A combination of static (identify and quantify cognitive deficits), qualitative (describes performance and
source of performance problems), and dynamic (identify and specify the conditions that have the greatest
influence on performance) assessments is suggested - Assessment components include: Awareness questioning, strategy investigation (probing), and
determining the impact of cuing and task grading. Examples include: Contextual Memory Test, Toglia
Category Assessment, and the Dynamic Visual Processing Assessment.
Interventions using DIA
- Should begin with awareness building. A client who is unaware will not desire to use strategies
- Use of processing strategies include: External strategies (to do list, journal, calendars), self monitoring
strategies (self questioning, checking performance), task strategies (rehearsal, grouping/categorizing
information, formulating associations, scanning), non-situational strategies (self-talk, visualization), and
cognitive processing strategies (writing things down), task segmentation (simplifying a complex task by
breaking into smaller steps)
-Strategies to increase metacognition (anticipation, self-prediction, self-checking, time monitoring)
- Consists of awareness questioning, cueing and task grading, and strategy investigation (asks questions
about what strategies or approaches the patient is using)
-Practicing new cognitive skills in familiar and novel activities enhances metacognition (ability to judge, plan
ahead, be aware, and predict)
- Performance of a skill can be promoted by changing either the demands of the activity, the environment in which the activity is carried out, or the person’s use of strategies to facilitate skill performance
- Role-reversal is when the therapist demonstrates the client and the client identifies errors
- Group treatment allows clients to practice self-monitoring strategies and to receive and learn from
feedback. Emphasis is on the group process not the end product. Activity, games, and role play
Neurofunctional Approach
- For those with severe cognitive impairment
- Trains clients on compensatory strategies because generalization of new skills is not possible
- Focuses on Task-specific training and not underlying cognitive issues.
