Lecture 5 OTA 1: The OT Treatment Approach (2)

1. Lecture 5 OTA 1: The OT Treatment Approach (2) GOALS Treatment Implementation Roles of the OT and OTA Referral restrictions Re-Evaluation, Discharge and Termination OT Process and Flow

2. Treatment Planning – Goal Setting • Goals must be defined jointly by the client and the therapist • Goals must identify steps toward realizing occupations that are valued by the client • Therapist can assist the client to refine broadly indentified goals into treatment objective that are “SMART”; • Specific • Measurable • Attainable • Realistic • Timely

3. Goal Setting • Therapist must avoid setting goals that indicate functional restoration in the absence of an occupational dimension • A goal statement such as “increase elbow flexion by 20 degrees” focuses on functional restoration but does not say why this is important. • By writing instead, “increase elbow flexion by 20 degrees so that client can eat finger foods independently”, the therapist provides an occupational dimension and a functional context.

4. Long-Term vs. Short-Term Goals Long-Term Goals Short-Term Goals: Treatment Objectives What does the client want to achieve as an outcome of the therapy regime? What are you going to be working on during the specific therapy session, and how does this tie to the long-term goal?

5. Treatment Goals and Objectives • Treatment Goals: Are a description of the general changes in function at some time in the future – can be identified in the referral as well. • Ex. The patient will be independent in self care • Treatment Objectives: Are the steps in the process of achieving goals. • Ex. The patient will transfer to and from the toilet without assistance. • Objectives should reflect the patient needs and should be consistent with the general goals stated on the referral and determine by the evaluation. • Clear objectives permit the therapist to measure the degree to which the patient has achieved them.

6. Writing Treatment Objectives: • The objective should convey the client’s future functioning and performance once the objective has been achieved. It should do so in simple language and should be understandable to anyone who reads it. • Includes 4 elements: • Occupational-based functional outcome • Statement of terminal behaviour • Conditions • Criterion

7. Occupational-based functional outcome Describes the “real life” occupation or occupational task that the client will be able to engage in as a result of achieving the goal Ex. To participate in religious services. The statement may include the context if this makes the outcome clearer – for example to cope with the cognitive demands of receptionist job in a medical office.

8. Statement of terminal behaviour • Specifies the physical changes, type of behaviours or performance skill that the client is expected to display. The terminal behaviour consists of an action verb and the object receiving the action. • Ex. The client will: • don (action verb) • a shirt (object)

9. Conditions States the circumstances required for the performance of the terminal behaviour Ex. Given verbal prompts (condition), the client will don a shirt.

10. Criterion States the degree of competence or the performance standard by which the client’s behaviour is to be measured. Ex. Given verbal prompts the client will don a shirt within 5 minutes with no errors (criterion). Other criterion might include muscle grades, increases in ROM and speed

11. In-class activity Critique Sample objectives based on the 4 elements outlined.

12. Role of the Registered OT • OT designs, develops and documents the treatment plan including: • Formulating a list of strengths and weaknesses • Estimating rehabilitation potential • Identifying measurable short-term and long-term goals • Collaborating with the individual, family, other caregivers, professionals and community resources • Selecting the media, methods, environment, and personnel needed to accomplish the intervention goals. • Determining the frequency and duration of OT services • Identifying a plan for re-evaluation • Planning for discharge

13. Roles of the OTA • A co-participant in the entire OT process, at the discretion of the supervising OT and depending on the experience of the OTA • With respect to the referral, the OTA can educate physicians and other potential referral sources about how to initiate OT referrals. • OTA may carry out part of the screening under OT supervision, ie. Initial interview to collect information about the client’s occupational performance issues • OTA may administer some evaluation instruments with appropriate training and must be able to communicate results both verbally and in written format.

14. Roles of the OTA Cont’d • OTA can contribute to the treatment plan; especially in terms of identified occupational performance issues in areas such as self-care, productivity and leisure • Treatment of occupational performance is planned by the OT and any treatments carried out by the OTA are supervised by the OT • OTA may have responsibility for transition services, which help the client change from one environment to another; ie. Client with a brain injury moving towards independent community living. OT will design the transition plan and can delegate certain tasks to the OTA as deemed appropriate and as agreed upon by the client.

15. Re-Evaluation • Re-evaluating the patient to see: • Are the objectives suitable to the patients’ needs and capabilities? • Are the methods most appropriate for fulfilling the treatment objectives? • Does the patient relate to treatment methods and see them as worthwhile and meaningful? • Are the treatment objectives realistic and are they consistent with the patients personal objectives?

16. Re-Evaluation • Reevaluation • With the same instruments used in the evaluation, the OT again evaluates the client to determine what changes have occurred since the previous evaluation • This measurement of the outcomes of treatment is critical in showing the effectiveness of the therapy • Treatment plan may be changed or continued based on the results of the re evaluation

17. Discharge and Termination • Discharge Planning • Working with the client, the clients family and the treatment team, OT and OTA develop a plan for the client once discharge occurs • Discharge may be to the client’s home or to a care facility either temporarily or permanently. • Termination of Treatment • Client is discharge from the treatment program • Final outcomes are analyzed and documented • Follow up information is given to the client should problems arise in the future

18. Process and Flow OT process more closely resembles a flowing or fluid current then a stepwise progression Referral generally first, however OT/OTA may initiate referral in which case screening completed prior to Referral. Evaluation and treatment is interwoven throughout the process Depending on setting discharge planning may be considered throughout.

19. Break! See you at 12:30

20. Lab Activity: SMART Goals • In groups of 2: • Consider the case study • Develop 3 SMART goals • Use SMART goal resources to help guide your decisions • Present your Case study and SMART goals to the class • Critically appraise SMART goals of your classmates