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OTA 140 - Pediatrics > Settings > Flashcards

Settings Flashcards

1
Q

Early Intervention Setting Basics

A
  • Ends at age 3 (goes into school system)
  • Purpose: to head off issues before child grows/develops
  • Largely about coaching families of children/incorporating interventions into daily life
  • For children with: 1) developmental delay, 2) diagnosed disability that might cause delay, and 3) at the state’s discretion who are deemed at risk of delay
  • Services may be offered in NICU, pediatric outpatient center, hospital or clinic; supported through private/other funding
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2
Q

Early Intervention Services under IDEA Part C

A

• Age 0-3
• At risk of delay, or having disabilities
• Offered in home, daycare, early head start, or community settings
• IDEA Part C offers grants to states for these services, under state’s lead agency
• Includes: family training, special instruction, OT, service coordination, assessments, assistive tech
• Provided by qualified personnel, in natural environments
• Services must address:
1) Physical development
2) Cognitive development
3) Communication development
4) Social/emotional development
5) Adaptive development

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3
Q

OT under IDEA Part C

A

• Designated as PRIMARY SERVICE under Part C in 2004; specifically listed in statute
• OTPs may be SERVICE COORDINATOR as well as SERVICE PROVIDER
• Part of team to build family’s capacity to care for child/promote development in natural environments where they live, work and play
***OTP can provide: Direct Service, Service Coordination, Consultation, or Education/Training

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4
Q

OT Process in Early Intervention

A

1) Evaluation (screenings, assesments, interview, collab with family /team)
2) Intervention (collab with family/team, develop IFSP, use evidence-based practice)
3) Outcomes (promote function, meet family/child’s goals and needs)

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5
Q

Individualized Family Service Plan (IFSP)

A

Plan of care for child under early intervention (when entering school at age 3). Emphasis:
• Team approach
• Family/child centered
• Natural environments (home, preschool, etc.)
• Multidisciplinary
• Collaborators review every 6 months
• Emphasize goals of child

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6
Q

Early Intervention: Play Time

A
  • Increases social skills
  • Advances motor coordination
  • Develops problem-solving abilities
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7
Q

Early Intervention: Meal Time

A
  • Promotes independence in self-feeding
  • Improves ability to eat a variety of foods/textures
  • Creates family-friendly schedules
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8
Q

Early Intervention: Bath Time

A
  • Addresses positioning needs
  • Ensures safety during ADLs
  • Promotes sensory-rich experiences
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9
Q

Early Intervention: Social

A
  • Manages emotions
  • Develops self-advocacy skills
  • Strengthens family bonds
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10
Q

Settings for OT in Early Intervention

A
  • DAYCARE (peer interaction, coaching daycare providers, promote play skills)
  • HOME (establish healthy sleep schedule, design safe play areas, support family caretaking)
  • COMMUNITY (promote safe transport., increase ease in transitions, facilitate participation in activities)
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11
Q

School Based Practice for OT

A
  • Ages 3-22
  • Work with teachers, aides, speech path., PT, principal, parent/caregiver
  • FRONT OFFICE SECRETARY is your link to all!
  • Only instance of OT where the family is not #1; agenda must work with TEACHERS
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12
Q

Principles of IDEA

A
  • Free and appropriate public education
  • Least restrictive environment
  • Appropriate evaluation
  • Individualized Education Program (IEP)
  • Parent and student participation in decision making
  • Procedural safeguards
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13
Q

OT and IDEA

A
  • OT is related service that may be required to enable student to benefit from spec ed.
  • Services designed to enhance student’s abilities to participate in educational process
  • OT improves developing or restoring functions impaired/lost
  • OT improves ability to perform tasks for indep functioning
  • OT offers prevention thru early intervention, initial, or further impaired/lost function
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14
Q

Least Restrictive Environment (LRE)

A

Most appropriate education with non-disabled peers/regular classroom.
• May require classroom modification(s)
• Can still include time in 1:1 with OT, PT, SLP
INCLUSION: either full or part day integration as much as possible into general population

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15
Q

School Based Evaluation

A

• Multi-factored Evaluation (MFE): multidisciplinary team conducts eval to determine if child warrants special ed services
• Can be initiated by parents or school team; sometimes physician
• Can include observations, standardized tests, parent/teacher questionnaires
• Federal law mandates reeval every 3 years
• Initial questions may be:
- What are child’s present levels of performance?
- What are child’s educational needs?
- Does child need special ed/related services?
- What additions/mods are needed to meet annual goals in IEP and participate in general curriculum?

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16
Q

Categories of Disability under IDEA (1997)

A
  • Intellectual Disability
  • Hearing Impaired (HI)
  • Speech Language Impaired (SLI)
  • Vision Impaired (VI)
  • Emotional Disturbance (ED)
  • Orthopedic Impairments (OI)
  • Autism
  • Traumatic Brain Injury (TBI)
  • Other Health Impaired (OHI)
  • Specific Learning Disabilities (SLD)
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17
Q

What OT Evaluates in School Setting

A
  • Level of Participation (in school activities)
  • Assessment of Performance in: motor, sensory responsiveness, perceptual processing, psychosocial/cog abilities, school environment
  • Teacher expectations and curriculum standards
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18
Q

Components of an IEP

A
  • Present levels of performance
  • Goals
  • Special ed and related services
  • Explanation of non-participation
  • Participation assessments
  • Dates, frequency, location, duration of services
  • Transition services
  • Measuring/reporting of student progress
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19
Q

IEP Team

A 
Collaboration between:
• Individuals familiar with child
• Regular education teacher
• Special education teacher
• Local educ agency representative (LEA)
• Individual to interpret eval results
• Parents
• Any other individuals who parents/LEA feel have knowledge/expertise about child including related services (OT)
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20
Q

IEP Goals

A
  • Reflect a holistic picture of child and understanding of what is required to function in school and knowledge of curriculum
  • Establish overall goals to maintain student’s health/vitality
  • Enhance student’s participation in this and future inclusive environments
  • Increase student’s social integration
  • Refer to essential functional skills that have frequent/multiple apps across environments and activities
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21
Q

Service Delivery of OT in Schools

A
  • Direct Service: integrated or pull-out
  • Monitoring: development of program to be carried out by others
  • Consultation: primary method of service, or supplemental to direct service; cooperative partnership with other professional or parent to engage in reciprocal problem solving
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22
Q

OT in Preschool

A
  • OT supports child to successfully participate in roles/requirements of that setting
  • Process: Referral > Screening > Evaluation
  • Areas: play, self-help and classroom maintenance, and pre-academic skills
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23
Q

Main Intervention Strategies for OT in Schools

A
  • Change the task
  • Change the environment/context
  • Change the child’s skills/abilities
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24
Q

OT Service Delivery Models in Schools

A
  • Collaborative teams
  • Consultation
  • Group intervention sessions
  • Individualized treatment
  • Partnering with families
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25
Q

School Settings where Services are Mandated

A
  • Public Schools
  • Charter Schools
  • Preschools
  • Early Start
  • Home Based Charter Schools
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26
Q

OTA’s Role in Schools

A
  • Demonstrate service competency in areas delegated by OT
  • Assist with data collection
  • Score tests
  • Develop/administer intervention plans
  • Consult/collaborate with educational staff
  • Develop goals in collab with OT
  • Develop schedules
  • Train staff/parents to implement programs and strategies in class and/or home
  • and MORE!
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27
Q

Occupational Therapist’s (NOT OTA) Role in Schools

A
  • Evals, interpretation of assessments
  • IEP meetings
  • All of OTA role/responsibilities
  • Development of goals
  • Supervision of OTA
  • Reviewing/co-signing OTA notes
  • Collab with other team members
  • Working with parents
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28
Q

Tips for Providing OT Interventions at School

A
  • Make use of any space given to you
  • Use class/school equipment, but provide materials necessary
  • Be aware of class schedules, teacher/child’s needs
  • Be aware of child’s self-perceptions
  • Small groups make interventions less intrusive
  • Be flexible and think on your feet
  • Grade activities to match/challenge skills
  • Email may be best way to collaborate
  • Get teacher feedback
  • Pull out service can occur on playgrounds, closets, hallways, etc.
  • Create continuum betw tx sessions and classroom by communicating with teachers/parents
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29
Q

Public Law 94-142 (1975) – Education of Handicapped Act (EHA)

A
  • Free and appropriate public education (FAPE) - students 5 to 21
  • Least restrictive environment (LRE)/inclusion
  • Due process for parents (impartial mediator resolves differences with school if needed)
  • Individualized Education Program (IEP)
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30
Q

Services Available to Special Education Students:

A
  • Transportation
  • PT/OT
  • Assistive technology
  • Psychological services
  • School health services
  • Social work services
  • Parent counseling/training
  • Speech Therapy (ST)*Also/only standalone service for other students
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31
Q

Rehabilitation Act 1973 (Section 504)

A

Any school receiving federal aid cannot discriminate against persons who have disabilities.
• Student with disability not eligible for special ed but requires reasonable accommodations in regular education may be eligible for services through 504.
• Must have condition that “substantially limits one or more major life activities” such as learning.

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32
Q

Americans with Disabilities Act (ADA 1990)

A

Prohibits discrimination in employment, transportation, accessibility, and telecommunications
• Protects persons with disabilities

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33
Q

Public Law 99-457

A

Part C addition to EHA (1975)/renamed IDEA (1990)
• For birth to age 3
• Includes indentification and referral, evaluation, determination of eligibility, development of individual family service plan (IFSP), and transition plans.

34
Q

No Child Left Behind Act (NCLB), 2001

A

Supports use of scientifically based practices
• “Adequate Yearly Progress” report (single accountability standards)
• OTs must consider research when selecting intervention/instruction practices
• Collaborate/consult with team to prioritize child’s needs

35
Q

Rights of Parents and Children

A
  • Notification of all proposed actions in writing
  • Parental consent to evaluate/reevaluate
  • Notification and right to attend all IEP mtgs
  • Right to independent evaluation
  • Right to appeal school decisions
  • Informed of rights in writing
36
Q

Transition Plan (Schools)

A
  • Includes steps taken to support students and families as changes occur
  • Educating families/students about resources available and their rights
  • When student turns 14, transition services focus on vocational education
37
Q

Tips for Working with Parents

A
  • Listen
  • Use plain language
  • Put parents at ease in meetings
  • Highlight child’s strengths
  • Speak to them before meeting
  • Be clear about what has been done
  • List main problems (not all of them)
  • Ask parents for suggestions/advice
  • Provide suggestions
  • Follow up with parents
38
Q

Tips for Working with Teachers

A
  • Respect teacher’s style, rules, classroom
  • Spend time in the classroom
  • Ask the teacher’s opinion
  • Prioritize strategies
  • Provide short written strategies
  • Respect teacher’s time
  • Communicate in short emails/writing
  • Help determine child-teacher fit
  • Present self as resource
  • Use OT resources to help teachers
  • Provide solutions
  • Use plain language
39
Q

Discontinuing Services in School Setting

A
  • Often difficult due to rapport built
  • Ease out by decreasing frequency
  • Discharge or decrease in frequency decided with IEP team
  • May continue on a consultative basis
40
Q

Transition Services

A
  • Entering a variety of adult roles/activities
  • Transition Team: interdisciplinary and interagency team responsible for IEP and transition services
  • Student is most crucial member of team!
41
Q

OT Contributions to Transition

A
  • Help student access, participate in, benefit from OT’s specialized educ and transition services
  • Understand educ performance and participation demands
  • Positive future-oriented and student-centered
  • OT services can occur at multiple levels to help child transition
42
Q

Policies (Laws) for Transition Services

A
  • IDEA of 2004
  • Section 504 of Rehabilitation Act
  • ADA
  • Ticket to Work, and Work Incentive Improvement Act
43
Q

Evidence-Based Practice in Transition Services

A
  • Collaborative interdisciplinary and interagency teamwork
  • Ecologic approaches
  • Self-determination, self-regulation, social competence training
  • Recommended practice: paid work experience during high school
44
Q

Aspects of Transition

A

OPPORTUNITIES
• Employment, Postsecondary School, or Living

NEEDS
• Financial/Income
• Friendship/socialization
• Transportation
• Health/Medical
• Legal and Advocacy
45
Q

Ecological Approach in Transition

A
  • Specify environments
  • Prioritize performance environment
  • Identify activities
  • Divide responsibility
  • Conduct assessments
  • Record evaluation findings
  • Share findings
46
Q

Active Involvement of Student in Transition

A
  • Take part in planning/decision-making
  • Self-determination
  • Become positive agents of change in own lives
  • Actively pursue their own goals
  • Direct support and preparation in process
  • Professionals must relinquish control
  • Collaborate to implement strategies
  • Social competency
47
Q

Social Competency in Transition

A
  • Self-regulation
  • School environment that recognizes/addresses bullying
  • Explicit training/programming to address work skills needed for success
  • Social skills training
  • Job-related social skills training
48
Q

Transition: Paid Work During High School

A
  • Evidence supports this
  • Supported employment
  • On-the-job training
  • Job carving (creating duties to match child)
  • Customized employment (negotiate job to match child)
49
Q

Community Systems

A
  • Any facility outside of traditional medical model that provides health-related services or programs.
  • Schools, camps, homeless shelters, faith-based centers, clinics, mental health orgs, foster care centers, sensory clinics
  • Service delivery models: direct, individual, group, coaching, mentoring, education
  • Community is part of person’s natural environment
  • Area with geographic and political boundaries
  • Where members have identity and sense of belonging
50
Q

Community-BASED Practice vs. Community-BUILT Practice

A

Community-BASED:
• Skilled services provided by practitioner using interactive model
• Focus on deficits
• Initiated by medical model (referral from health care providers)

Community-BUILT:
• Skilled services provided by practitioner using collaborative/interactive approach
• Focus on wellness and health promotion from a public health perspective
• Referrals from variety of community sources

51
Q

Health in Community Setting

A

Complete physical, emotional and social well-being. OT must understand community in which child functions to support optimal health.

52
Q

Intentional Relationship Model

A 
Therapeutic modes of interacting; part of the therapeutic relationship/trust/rapport between client and therapist.
• Advocating
• Collaborating
• Empathizing
• Encouraging
• Instructing
• Problem solving
53
Q

Healthy People 2020

A

Provides framework for prevention of illness and premature death.
• Goals to: increase healthy years of life for all; achieve health equity and end health disparities; create healthy social/physical environments; promote health behavior and quality of life.

54
Q

Community Mental Health Center Act (1963)

A

Community-based services rather than institutionalization. (See: Ikuigu’s Model)

55
Q

Ikuigu’s Model for Designing Community Mental Health Programs

A

1) Educating about OT
2) Establishing referral system
3) Identifying/administrating appropriate assessments/evals
4) Integrating key persons into therapeutic process
5) Implementing individualized interventions
6) Supporting community reintegration

56
Q

Challenges to Practices in Community Systems

A
  • Funding
  • Ability to maintain communication among service providers
  • Cultural competence
57
Q

Team Members in Medical Systems

A

Children, families, specialists, generalists, nurses, OT, PT, etc.

58
Q

Continuum of Care in Pediatric Medical Settings

A 
(Most critical to least):
• Neonatal Intensive Care Unit (NICU)
• Pediatric Intensive Care Unit (PICU)
• Subacute Care
• Home-Based Care
• Residential or Long-Term Care

(Also: Pediatric Rehab and Hospital OT Clinics)

59
Q

Models of Medical Care

A

1) PRIMARY: Preventative; visits to primary care physician (PCP)
2) SECONDARY: When child becomes ill and requires medical intervention; when referred to specialist
3) TERTIARY: Hospitalization
4) QUARTERNARY: Less common extension of tertiary; severe trauma, burns, transplants

60
Q

Neonatal Intensive Care Unit (NICU)

A

• Necessitated by complicated births
• Neonate who is physiologically unstable (unable to maintain temp, heart rate, breath rate)
• Neonatologist is medical team leader
• Symptoms:
- Cyanosis (blue from lack of oxygen)
- Bradycardia (less than 110 beats/min)
- Low Birth Weight (less than 2500 G)
- Very Low Birth Weight (less than 1500 G)
- Extremely Low Birth Weight (less than 750 G)
- Others: Respiratory difficulties, surgeries, injuries

61
Q

Pediatric Intensive Care Unit (PICU)

A
  • Also called a Step-Down Nursery
  • Address acute symptoms (after heart surgery, brain surgery, significant illness, etc.)
  • Wean patients off external medical supports
  • Sensorimotor stimulation given as tolerated
  • Pediatric intensivist (AKA pediatric critical care medicine specialist) is medical team leader
  • OT encounters children with wide range of diagnoses/ages
62
Q

Medical/Surgical/General Care Units

A
  • Children who require 24-hour medical attn
  • Diagnoses include: trauma, drowning, falls, sports-related injuries, flu, cardiac conditions
  • OT documents medical status/progress during rounds to other professions
  • Frequency/duration varies from 2-5x per week for 30-60 minutes.
63
Q

Hematology/Oncology Units

A
  • Children with blood-related diseases or cancer
  • OT focuses on interventions directed toward ADLs, IADLs, Sleep/Rest, Play/Leisure, and Education
  • OTs evaluate client factors such as strength, ROM, endurance, visual perception
  • OTs recommend AE, modifications to activities, energy conservation
64
Q

Speciality Services or Units

A
  • Beds in a unit for particular procedures or a particular speciality (prep for surgery, addressing issues after surgery)
  • Palliative Care: comfort care for dying child (and family)
  • Child life services before procedures that cause pain, depression, anxiety
65
Q

Subacute Setting

A
  • Patients more medically stable but not ready to go home for medical/family reasons
  • Continue to monitor/treat acute symptoms
  • Wean off external medical supports
  • Provide developmentally appropriate interventions
  • Pediatrician as medical team leader
66
Q

Acute Rehabilitation Setting

A
  • Specialty services found in children’s hospital or rehab hospital
  • Programs directed by PT, OT, SLP, 5-6x/wk for 3 hours per day
  • Work on rehab for children who have sustained serious injury/illness
  • Maximize independence in meaningful activities
67
Q

Home Care Setting

A
  • OTs help develop discharge plans to help children return home
  • Promote caregiver/child bonding
  • Medical services on an outpatient/home-delivered basis
  • Communication with caregivers and children
  • Community-based supports and resources vary with child’s age
  • Continue to facilitate acquisition of developmentally appropriate skills
68
Q

Outpatient Services Setting

A
  • Varies depending on child need/diagnosis
  • Interventions focus on meaningful activities and skill acquisition
  • Education for parents/caregivers for activities to complete at home
  • In some cases, monitor medical need of children (ie: GI tube in stomach)
  • Consult with other professionals (ie: wheelchair)
69
Q

Long-Term Care Facility/Hospice

A
  • Sometimes in form of residential care
  • Provide necessary medical care (oxygen, positioning, ventilator support)
  • Provide appropriate therapeutic interventions
  • Prevent contractures, encourage interaction, optimize positioning, etc.
70
Q

Patient and Child Support Groups

A
  • Community supports focused on variety of issues: bullying, grieving, coping, etc.
  • May focus on specific condition (SCI, CP, etc.)
  • OT may lead group or provide consultation
  • Sometimes in form of camps for children with specific diagnoses
71
Q

Assistive Technology Setting

A
  • Provide devices and services for children with disabilities
  • May be at hospitals, schools, or in community
  • OT requires specific certification to provide services in this area
72
Q

Role of OTA in Medical Settings

A
  • Conduct initial screenings
  • Collaborate with OTR on eval, intervention planning, and implementation
  • Gather/review preadmission info to increase understanding of child’s status
  • Collaborate on discharge plan
  • NO role in NICU
  • Active role in PICU with adequate training/supervision; must know equipment, standards of care (ie: sign-out practices, medical supervision), and medical status signs
  • Acute role in Subacute, Home, Long-term care, but MUST be aware of signs of physiologic stress and be trained to respond!
73
Q

Functional Independence Measure (FIM) for Children

A
  • Standardized assessment
  • Gives uniform language for all those working with a child
  • Conducted by direct observations or interviews with caregiver
  • NOT to be used as only diagnostic tool
74
Q

Challenges in Medical Setting

A
  • Number of specialists involved
  • Medical terminology
  • Incorporating preadmission habits, roles and routines into interventions
  • Palliative care
  • Reimbursement (can be from variety of sources: insurance, private pay, donations)
75
Q

Characteristics of a Successful Health Care Practitioner

A
  • Compassionate
  • Empathetic
  • Honest
  • Uses proper manners
  • Effectively communicates
  • Actively listens
  • Advocates
  • Uses sound clinical reasoning/problem solving
76
Q

Prescriptive/Directive Role (of OTP)

A

Instructing clients or providing advice for the client to follow. This is one of the main roles when working directly with a child. (ie: Providing a family with a schedule for child’s splint wearing.)

77
Q

Consultative Role (of OTP)

A

This is the OTP’s role when working with the family. Consults with the family on possibility of achieving desired goals for the child and for family. (ie: developing child’s splint-wearing schedule incorporating family’s natural routines.)
• Builds collaboration and trust, key to success with families.

78
Q

Recent changes in service delivery have expanded OTP roles to now include:

A
  • Assessing family interests, priorities, concerns
  • Observing/gathering info about daily routines of children/families in their homes and in classrooms
  • Gathering/sharing info w/families about development and intervention strategies
  • Implementing therapy in collab with parents, caregivers, and general educators
79
Q

OT Role in NICU

A
  • Address positioning for function, ROM, and age-related motor/sensory development
  • Make recommendations re: environment for high-risk infants
  • Promote positive oral experiences for feeding
  • Provide ongoing parent education and support related to infant behavior/development
  • May address feeding/swallowing concerns or provide support for breastfeeding
  • May work with family members to help adjust to new parenting roles
80
Q

Related Services

A

Designation given to services such as OT, PT, ST, school health and social work: required services for child in special education program (as stated in EHA).

81
Q

Role of OTA in the IEP Team

A

• To report findings and recommendations under direction of the OT
(OT is responsible for completing evaluation—with input from OTA—interpreting the info and presenting the report to the IEP team.)

OTA 140 - Pediatrics (18 decks)

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