Service Delivery Flashcards
Medical Model
Views pt as a pt who has incurred a physiological insult that has resulted in reduced fx’al capacity. Focus on ID disease or dysfun, tx addresses what is affectig fx’al skills, OT FORs address pathological process of disease/dysfun
Edu Model
Views pt as lacking knowledge or skills. Focus is placed on learning/making behavioral changes needed to interact successfully in environment. OT FORs based on learning theories to facilitate environmental adaptation
Community Model
Views pt as lacking skills, resources and supports for comm participation. Focus is placed on ID & developing skills needed for one’s expected environment & if skills cannot be developed comm resources/supports are ID’ed and developed to enable fx’ing w/in ones chosen enviornment. OT FOR promo development of performance skills and/or areas of occ w/in performance context
Telehealth Model
Service delivery model which can include features of above models by providing med/rehab/edu services to person via telecom techs
Acute Care
Admis for medical/psych dx that cannot be tx outpt. Initial onset of illness/major health prob, acute exacerbation, or invol admin w psych if danger to self or others. LOS can be lim 1-7days, ongoing care freq results in d/c to diff setting. OT eval: focus on quick/accurate screening on major diffs impeding fx. OT tx: stabilization of status, engagement in meaningful acts/occs, d/c plan & after referrals & pt/fam edu. OT role can be general or specialized
Subacute/Intermediate Care Facilities (ICFs)
Admis for medical/psych dx has progressed from acute but not ready for outpt. LOS: 5-30days. OT eval: more in depth assessments/observations. OT tx: fx’al improvements in performance skills/areas of occ & active engagement of pt in tx planning, implementation & re-eval & d/c process. Can be housed in hospitals or SNFs
Long-term Acute Care (LTAC) Hospitals
Admis is for chronic/catastrophic illness or disability that req extensive medical care and/or dependency of life support/vents (often multiple dx/complications). LOS: 25days+ to maintain Medicare cert. OT eval/tx: often lim by severe & complex medical needs - concerned w palliative care and prevention of complications
Rehabs
Admis for disability thats medically stable but which has residual fx’al deficits req skilled rehab services. LOS can range from 1wk-months. LOS ends when coverage expended & then pt is d/c’ed to appropriate setting. OT eval: can be extensive/focus on all performance skills & patterns, ares of occ and occ roles req. OT tx: fx’al improvement in performance, dev of compensatory strategies, provision of AE, environmental mod, pt/fam edu.
LT Hospitals
Admin for chronic med/psych dx with symptoms present tht cannot be tx outpt. LOS: month-yrs. OT eval: extensive; OT tx: fx’al improvement in performance, dev of compensatory techs, maintenance of Q of L, development of skills for d/c
SNF/Extended Care Facilities (ECFs)
Admis for med/psych dx that is chonic and req skilled care but not acute symptoms. LOS: 1mo-lifetime. OT eval/tx is guided by medicare standards.
Forensic Settings
Admis d/t engagement in criminal activity: jail, prison or forensic psych hospital/unit. LOS: court-ordered. Services vary greatly from none in most jails to extensive in FPU. OT eval/tx focus: determine pt competency/restoration to stand trial, developing skills needed for community.
Outpt/Ambulatory Care
Does not req hosp but has fx’al deficits req eval/tx: private clinics, med offices & hosp satellite centers
Acceptance criteria for EI Eval
Based on “at risk” status of u3y/o. Birth comps, suspected delays in development, failure to thrive, maternal sub abuse, birth to adolescent mom, est disability/dx
Acceptance Criteria for EI Tx
Extend of develop delay (33% delay in 1 area and 25% in 2), est disability/dx
EI length of services
infant/child quals for services, an IFSP is completed by service coordinator after review of all assessments in collab w fam & EI team. 6mo revs are submitted by all professionals to determine if cont services are needed
EI OT Eval
Assessment of 5 dev areas: cog, phsy, comm, soc-emo & adaptive. Determination of effects of current dev level on occ areas of play & ADLs. Evals written in strengths oriented manner. Fx’al goals must be written in fam friendly terms & inc levels of fx’ing, unique needs & recommended services
EI OT Tx
Dev of cog/process, psychosoc/comm/interaction & sensorimotor skills. Dev of play/ADLs skills. Fam edu/advocacy & training & transition to school planning
School Setting OT Acceptance Criteria & LOS
Child req sped services & OT will enable child to benefit, OT will facilitate childs participation in edu acts & enhance fx’al performance, referrals received from EI agency, teach or school study team, school reviews referral and recomm OT eval - LOS is dependent on impact of services on childs abilities & prevention of loss of abilities (& make gains on IEP)
School Setting OT Eval
Assess pt factors, performance skills/patterns & areas of occ that impact edu/fx’al performance (findings contrib to IEP) & assess fx’al/dev level to contrib to fx’al behavioral analysis
School Setting OT Tx
Edu model, addresses fx’al performance & academic, acts used to address goals/objectives doc’ed by IEP w corrective/compensatory methods, AT, increase participation w edu acts, increase ADL performance & play, & skills for post-school life
Behavioral Intervention Plan
May be inc in school-based OT service provision. Inc: Response to Intervention (RtI), EI Services (EIS) & Pos Behavioral Supports (PBS)
Prevoc Programs
Participant criteria: adolescents/adults who req tx to develop skills to get job- may have never developed or may have lost. LOS: is determined by agency funding/goal attainment. OT eval: focused on current skills & Tx: improve/development of skills and exploration of work interests
Voc Programs
Dev of specific voc skills. Person has good pre-req skills but req training for specific job & has ability to further develop work capacities. LOS: determined by agency funds: Rehab workshops, Trans Employment Programs (TEP): 3-6mo, Employee Assist Progs (EAPs).
Residential Programs
Admis for dev, medical, psych condition resulting in fx deficits that impede I living but are not acute enough to req hosp. On continuum from 24/7 supervision to bi-wkly check in. OT eval: focused on assessment of skills for living in community & determination of soc/environmental resources/supports. Tx: consultation/supervision of residential staff, remed of underlying skills/compensation, ADL training/adaption training, referrals & edu on ADA, fair housing and Sec 8.
Partial Hosp/Day Hosp
Admis for med/psych condition that has been sufficiently stabilized w some symptoms that still req active tx. Tx can be up to 5x/wk w multiple tx scheduled during the day. LOS: 1wk-6mo. Eval: assess current skills/deficits & determine whats req for expected environments. Tx: fx’al improvement, remediation of underlying skills, development of skills
Clubhouse Programs
Membership open to adults/elders w current MI or hx. All members have equal access to club fxs/opportunities regardless of dx. Only exclusion: sig/direct safety risk. Services provided by staff/mems. Staff main role is to engage/provide support. Individual sched to meet unique needs: open 5-7days/wk & daily sched is org-ed around “work-ordered” day w weekend/evenings for a-voc interests. LOS: indef & members can exit/re-enter at will. Eval/tx not formal.
Adult Day Care
Admis for adults/elders w chronic phys/psych impairments and/or frail but semi-I. Services in group. Flex sched of attendance. LOS: indef. Eval: fx’al skills/deficits affecting home/care environment. Tx: maintain healthy, fx’al aspects of pt, engage in purposeful act, caregiver edu/support groups & environmental mods
Outpt/Ambulatory care
Admis for med/psych condition that is not serious enough for hosp or stable w some symptoms. Tx usually provided short 30-60min/day up to 5x/wk. Eval: focused on fx’al assets/deficits/ Tx: active engage, remediation of underlying performance skills , fx’al improvements, compensatory strategies & pt/fam edu
HHC
Acceptance Criteria: Presence of med/psych condition that is not serious enough to warrent hosp or stable but some symptoms present, reimburses can be very strict. Tx usually 60min/day up to 5x/wk. Eval: skills/defs across all environments. Tx: active engage of pt/fam, fx’al improvement, remediation, edu, environmental mods, increase ability to resume roles outside, prevention
Hospice
Accept Criteria: term ill w life expect of 6mo or less. Services most often provided in home w type/quantity of services determined by pt/fam but can be hosp/SNF, LOS: determined by terminal outcome; eval: occ fx’ing for most important; tx: maintenance of control over life, engage in meaningful acts, reduction of pain, environmental/act mod & caregiver/fam edu.
Case Mngt Programs (2 Focuses)
Clinical: provided individualized support/tx to pt w serious ill that sig affects fx’ing in community. Admin: connects person w serious ill to appropriate/needed comm services. Can be provided in office/home/comm. Tx can be purely referral based or encompass full range of tx
Wellness/Prevention Program
Pt self-referallt to meet personal needs or institutional provision. LOS determined by individual - but influenced by program duration
MBO
Mngt by Objective: complete system if mngt based upon core set of goals to be accomplished by program: mission/goals estab, measurable objectives quantified, specific time frames for accomplishments observed, staff training needs ID-ed & program eval instituted
4 Basic Steps of Program Development
Needs assessment, program planning, program implementation & program development.
Q’s that Violate ADA/Civil Rights Legislation when Interviewing
Age, sexual orientation, martial status, fam composition, race/national origin/religion/political views, disabilities of any kind
Criteria for fair disciplinary action
Written doc of prob behaviors/expectations for improvement, referral to counseling and/or other services, clear/doc’d warnings, consequences that are impersonal, immediate and consistent & cont doc monitoring of employee behavior until reaches satisfactory performance
Program Eval: Quality Improvement (QI)
system-oriented approach that views limits /probs proactively as opps to increase quality: prevention is emp and no blame attributed
Total Quality Mngt (TQM)
Creation of org culture that enables all employees to contribute to an environment of cont improvement to meet/exceed consumer needs
Performance Assessment and Improvement (PSI)
Systemic method to eval the appropriateness & quality of services. Interdis system/pt centered focus
Goal Attainment Scaling (GAS)
Eval tool to attain pt goals for tx & measures goal attainment over specific time period.
Utilization review
Rev use of resources in facility: determination of medical necessity/cost efficiency & often component of QI/ PAI
Stat Utilization Review
reimbursment claims data analyzed to determine most most efficient/cost effective care.
Professional Rev Org (PRO)
groups of peers who eval appropriateness of services & qual of care under reimbursement and/or state licensures.
Prospective Rev
Eval of proposed tx plan that specifies how/why for care, used by 3rd party payers to approve proposed OT plans.
Concurrent Rev
Eval of ongoing tx program during hosp/outpt/HHC - ensure appropriate care is being provided often component of QI/PAI
Retrospective Rev
Audits of med records after tx were rendered - ensu. e appropriate care is being provided
