Mental Health Conditions - Adults (NBCOT prep)

Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5)

lists all mental illness diagnoses and provides detailed descriptions of categories of disorders and specific characteristics of each diagnosis in each category

Characterizations of Delirium, Dementia, and Amnesia

characterized by clinically relevant changes in thinking and memory in contrast to previous thinking and memory abilities

Definition of Major Neurocognitive Disorders

- loss of cognitive function that decreases independence in occupational performance- previously classified as dementia

Cognitive Domains of Major Neurocognitive Disorders

Include 1 or more of the following:- complex attention- EF- learning and memory- language- perceptual-motor- social cognition

Major Neurocognitive Disorders and the Effect on Occupational Performance

- all areas of daily functioning affected- ADLs, IADLs, work, leisure, social participation, and sleep all require assessment

OT Interventions for Major Neurocognitive Disorders

- environmental adaptations for safety- caregiver education- behavioral intervention to manage fatigue and sleep-wake cycles

Substance-Related and Addictive Disorders

relates to various classes of drugs, including alcohol, caffeine, drugs of abuse (e.g. street drugs, illicitly obtained substances), meds, and other toxins (e.g. inhalants, paint fumes, heavy metals), and gambling disorders resulting in combo of cognitive, behavioral, and physiological symptoms that lead to addiction and compulsive actions to obtain desired substances and maintain ongoing use

Related Disorders

substance, alcohol, caffeine, cannabis, hallucinogen, inhalant, opioid, sedative/hypnotic/anxiolytic, stimulant, tobacco, other (or unknown), nonsubstance- Use disorders- Induced Disorders- Intoxication- Withdrawal

Substance-Related and Addictive Disorders and the Impact on Occupational Performance

- all areas of occupational functioning negatively affected- routines and roles negatively affected- substance use heavily interwoven in daily life

OT Interventions for Substance-Related and Addictive Disorders

- psychosocial therapies, including coping, stress management, and social skills training- cognitive-based interventions geared toward increasing client's motivation and control of life

Characterization of Schizophrenia Spectrum and Other Psychotic Disorders

psychotic symptoms, including delusions and hallucinations, primarily characterize this category or disorders

DSM-5 Criteria of Schizophrenia Spectrum and Other Psychotic Disorders

At least 2 of the following symptoms lasting for at least 1 month:- Delusions- Hallucinations- Disorganized thinking (speech)- Grossly disorganized or abnormal motor behavior (including catatonia)- Negative symptoms

Types of Schizophrenia Spectrum and Other Psychotic Disorders

- Schizotypal (personality) disorder- Delusional disorder- Brief psychotic disorder- Schizophreniform disorder- Schizophrenia- Schizoaffective disorder- Other specified and unspecified schizophrenia spectrum disorders- Catatonia

Schizophrenia Spectrum and Other Psychotic Disorders and the Impact on Occupational Performance

- cognitive impairments, including problems with attention, memory, EFs, and screening of relevant vs irrelevant info- compromised health and wellness- recovery and reintegration hindered by community barriers and social stigma

OT Interventions for Schizophrenia Spectrum and Other Psychotic Disorders

- Illness management and recovery, including group and individual programs- Assertive community treatment to provide support and skills training in natural environments- Family psychoeducation- Supported employment- Integrated dual diagnosis treatment for co-occurring mental illness and substance abuse

Pharmacological Treatment for Schizophrenia Spectrum and Other Psychotic Disorders

- Typical antipsychotics: chlorpromazine, haloperidol, fluphenazine- Atypical antipsychotics: clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole

Depressive Disorders (Depression) and Bipolar and Related Disorders

- primary characteristics are presence of sadness and hopelessness, feelings of emptiness, or irritable mood, with accompanied somatic and cognitive changes that affect ability to function- severity and sustained presence of symptoms determine specific diagnoses

Categories of Depressive Disorders

- Disruptive mood dysregulation disorder- Major depressive disorder- Persistent depressive disorder (dysthymia)- Premenstrual dysphoric disorder- Other depressive disorders

Categories of Bipolar Disorders

- Bipolar I: 1 or more manic episodes or mixed episodes- Bipolar II: 1 or more major depressive episodes and at least 1 hypomanic episode- Cyclothymic disorder: chronic (at least 2 years) mood disturbance, with fluctuating hypomanic and depressive symptoms

Depressive Disorders and Bipolar and Related Disorders and the Impact on Occupational Performance

- low self-esteem and motivation levels, compromising successful completion of daily tasks- family and work roles affected by mood- daily routines disrupted during manic episodes- high work loss rates

OT Interventions for Depressive Disorders and Bipolar and Related Disorders

- Cognitive-behavioral therapy to uncover distorted beliefs and faulty thinking patterns- Interpersonal psychotherapy to improve interpersonal and psychosocial functioning

Pharmacological Intervention for Depressive Disorders

- Selective serotonin reuptake inhibitors (SSRIs): citalopram, escitalopram, fluoxetine, paroxetine, sertraline- Serotonin-norepinephrine reuptake inhibitors: duloxetine, venlafaxine- Antidepressants: bupropion, mirtazapine

Pharmacological Intervention for Bipolar and Related Disorders

- Mood stabilizers: lithium carbonate- Anticonvulsants: carbamazepine, divalproex sodium, gabapentin

Electroconvulsive therapy (ECT)

controversial treatment with cognitive side effects for depressive disorders and bipolar and related disorders

Anxiety Disorders

characterized by panic, stress, and generalized anxiety, resulting in alteration of behavior, emotions, and cognitive processing for purpose of avoiding associated negative physiological, emotional, and psychological impact

General DSM-5 Categories: Anxiety Disorders

- Separation anxiety disorder- Selective mutism- Specific phobia- Social anxiety disorder- Panic disorder- Panic attack specifier- Agoraphobia- Generalized anxiety disorder- Substance/medication-induced anxiety disorder- Anxiety disorder caused by another medical condition

General DSM-5 Categories: Obsessive-Compulsive Disorders

- Obsessive-compulsive disorder (OCD)- Body dysmorphic disorder- Hoarding disorder- Trichotillomania- Excoriation disorder- Substance/medication-induced obsessive-compulsive and related disorder- Obsessive-compulsive and related disorder caused by another medical condition

General DSM-5 Categories: Trauma- and Stressor-Related Disorders

- Reactive attachment disorder- Disinhibited social engagement disorder- Posttraumatic stress disorder (PTSD)- Acute stress disorder- Adjustment disorders

Anxiety, Obsessive-Compulsive, and Trauma- and Stress-Related Disorders and the Impact on Occupational Performance

- Physical impairments: difficulty physically responding to stress in PTSD and cardiac problems in panic disorder- Cognitive impairments: difficulty following directions and concentrating because of hyper-aroused states and lowered memory capacity because of trauma- Psychosocial impairments: disruptions in relationships and career development

OT Interventions for Anxiety, Obsessive-Compulsive, and Trauma- and Stress-Related Disorders

- Cognitive-behavioral training to enable clients to approach situations that cause anxiety, understand fear cycle, and challenge distorted cognitions related to fear- Relaxation therapy, including breathing, meditation, visualization, and progressive muscle relaxation- Expressive writing to help client understand and accept occurrence of stressors

Pharmacological Intervention for Anxiety, Obsessive-Compulsive, and Trauma- and Stress-Related Disorders

- Benzodiazepines: alprazolam, lorazepam- SSRIs: fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram- Tricyclic antidepressants

Somatic Symptom and Related Disorders

- experience physical symptoms that have psychiatric source- clients frequently encountered in settings outside mental health practice settings because of association of disorders with physical illness- OT practitioners may be first health practitioners to recognize symptoms related to these disorders- pain and discomfort related to these disorders are real and should not be mistaken for malingering or symptom magnification for secondary gain

Feeding and Eating Disorders

- severe disturbances in eating and behaviors related to eating characterize these disorders, which are life threatening- Anorexia nervosa and bulimia nervosa are primary diagnoses encountered in this category

Subtypes of Feeding and Eating Disorders

- Pica- Rumination disorder- Avoidant/restrictive food intake disorder- Anorexia nervosa: condition characterized by intense fear or being fat, disturbance of body image, and obsession with food and thinness- Bulimia nervosa: condition characterized by recurrent binge eating and frenetic compensatory behaviors- Binge-eating disorder- Other specified and unspecified feeding and eating disorder

Feeding and Eating Disorders and the Effect on Occupational Performance

- maladaptive eating habits and impaired meal prep skills- maladaptive lifestyle habits and impaired independent living skills- impaired communication and assertion skills- impaired stress management skills- resistance to change

General Principles for OT Interventions for Feeding and Eating Disorders

- physical harm reduction- cognitive reconstruction- psychosocial functional enablement

Specific OT Interventions for Feeding and Eating Disorders

- Menu planning and meal prep- Lifestyle redesign and independent living skills training- Communication and assertiveness training- Stress management- Projective artwork and use of crafts- Relapse prevention- Body image improvement

Personality Disorder

enduring pattern of inner experience and behavior that deviates markedly from expectations of individual's culture, is pervasive and inflexible, has onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

Personality Disorders: Cluster A

- Paranoid personality disorder- Schizoid personality disorder- Schizotypal personality disorder

Personality Disorders: Cluster B

- Antisocial personality disorder- Borderline personality disorder- Histrionic personality disorder- Narcissistic personality disorder

Personality Disorders: Cluster C

- Avoidant personality disorder- Dependent personality disorder- Obsessive-compulsive personality disorder

Personality Disorders and the Impact on Occupational Performance

- Social participation: limited interpersonal skills, negative interactions a. Cluster A: eccentricity, distrust, lack of interest in social contact b. Cluster B: intense emotions, lack of empathy, unpredictable behaviors c. Cluster C: low social drive, sensitivity to criticism- Emotional modulation: difficulty effectively modulating emotions and responding to situations with appropriate affect- Coping: limited skills to meet daily life challenges

OT Interventions for Personality Disorders

- Development and maintenance of collaborative relationships- Consistency during treatment- Validation of client's feelings- Development and maintenance of motivation for change- Mood stabilization and expression of appropriate emotions- Promotion of increased self-concept, self-esteem, insight, and judgement- Development of interpersonal relationships

General Focus of OT Evaluation and Intervention across settings

- improving engagement in occupation by increasing psychological and behavioral awareness- encouraging collaboration with social support network and mental health system- increasing self-confidence

Inpatient (Traditional Mental Health Setting)

- clients admitted to psychiatric unit of acute care hospital, usually as result of active and uncontrolled symptoms related to mental illness- hospitalizations are brief and designed to manage behavior, stabilize clients on meds, and refocus clients on engagement in occupation

Long-term Hospitalization (Traditional Mental Health Setting)

- in cases of severe, distressing, and uncontrollable symptoms (e.g. psychosis) or serious threat to self and others, clients may be hospitalized for extended periods of time (2 weeks-2 months)- interprofessional teams work closely with client to stabilize symptoms, ensure adherence to med protocols, and habitualize patterns of daily activity and self-care

Community-based Mental Health Clinics

- designed for clients to meet with mental health professional for ongoing med management, lifestyle management, self-care activities, and group therapies- general monitoring of health conditions and referral to other health professionals often component of these clinics

Consumer-based, Nonprofit, or Health system-based Day Treatment Programs

lifestyle management programs designed to assist clients over extended period and provide meaningful occupational engagement, as tolerated, for clients with more chronic mental health conditions

Skilled Nursing Residential care and Home Health care (Mental Health Settings)

- clients with chronic mental illness may reside in SNFs to receive ongoing care when conditions not suitable for living independently or with family or friends- in some cases, home health care required for clients with chronic mental illness to continue aging in place or residing in their homes

Community Residential Settings (Mental Health Settings)

- EX: halfway houses and adult foster care- clients transitioning from, for example, long-term hospitalization or period of residence in SNF may move to halfway house or adult foster care setting- some halfway houses more permanent than temporary; however, concept of halfway houses is to provide temporary supervision under group living conditions to encourage healthy occupational engagement and independent living- adult foster care does much the same thing but with smaller group or with one person at a time

Supported Employment, Transitional Employment, and Prevocational and Vocational Rehabilitation (Mental Health Settings)

- variety of clubhouse programs been used to engage people with mental health conditions, typically of chronic nature, in employment- supported employment (in which on-the-job assistance and therapeutic intervention provided and strong collab occurs among client, therapist, and employer) seems to work best- clubhouse model offers physical space in which people with mental illness can receive support for community living and explore work potential

Occupation-Based Models


Model of Human Occupation (MOHO)

classical model of OT practice describes effect of volition, performance, and habituation on engagement in occupations

Person-Environment-Occupation-Performance (PEOP) Model

- emphasizes essential interaction among person; performance of desired, meaningful occupation; and context in which person engages in occupation- key model of OT practice that describes experiences of individuals and populations and explains effect of key components of model on health, wellness, and quality of life (QoL)

Canadian Model of Occupational Performance and Engagement (CMOP-E)

- human spirit is central organizing structure of person- physical, cognitive, and affective factors also found within person- occupations surround person and emphasize self-care, productivity, and leisure- environment surrounds both person and occupations to include physical, institutional, cultural, and social components- occupations that are essential to person's spirituality are critical in producing client-centered practice

Intentional Relationship Model (IRM)

- about therapeutic use of self and effect therapist-client relationship has on improving function- describes triad among client, OT practitioner, and occupation and includes following principles: a. critical self-awareness and interpersonal self-discipline fundamental to intentional use of self b. practitioners must keep head before heart c. practitioners must practice mindful empathy d. client defines successful relationship e. practitioners must balance focus on activities with focus on interpersonal

Allen Cognitive Disabilities Model

- uses hierarchical continuum of cognitive ability derived from Piaget's developmental theory (called Allen's Cognitive Levels)- functional abilities improve and cognitive levels increase

Behavioral approaches to learning

- behavioral framework and behavior modification based on operant conditioning- behavior shaped by connecting positive or negative reinforcement to behavioral response- positive reinforcement, commonly thought as reward, is favorable outcome that occurs after desired behavior (e.g. praise, increased privileges, high five)- negative reinforcement involves removal of unfavorable outcome to produce desired outcome (e.g. person calls in sick because report not finished yet, thereby avoiding difficult questions from boss and reducing anxiety in short term)- Rewards (positive reinforcement) shape behavior more effectively than do negative reinforcements- intermittent positive reinforcement improves behavior better than continuous positive reinforcement- controversy surrounds use of rewards to shape behavior, esp. with adult mental health clients, because approach implies passive response by client and little cognitive processing- particularly beneficial with social skills training in psychosocial practices

Processes of thought and occupation through Cognitive Behavioral Theory (CBT)

- has at its foundation the idea that distorted thinking leads to behavioral and emotional problems related to mental illness- focus of therapy to increase awareness of (and eventually change) cognitive distortions to ultimately alter behavior and emotional impact on function- intervention strategies include goal setting, homework, mindfulness, and restructuring cognitive thoughts

Kawa Model

- serves as example of how culture has effect on mental health intervention in OT practice- developed by Japanese OTs- presents concept of cultural safety as key component of model- notion that healing must come from within safe cultural context emphasized as foundation for practice with clients with mental illness

Expression and occupation through Psychoanalytic and Psychodynamic Theory

- used primarily in contemporary mental health interventions and within OT as mechanism for improving self-identity and interpersonal relationships- concepts are cornerstone of mental health practice, from which many other theoretical principles and models have derived- esp. useful for exploring underlying, deep-seated origins of human emotion and motivations- although many concepts of the theory have been refuted, they continue to have strong historical value and application to understanding group dynamics, relationships, and feelings- interventions that emphasize expression in OT include creative and expressive media and journaling for reflection

Concepts related to Clinical Reasoning in Psychosocial practice

understanding and responding to thinking processes and related behaviors of people with mental illness, solving problems, and making decisions about how to respond and act to improve behavior, increase awareness of feelings and actions, and improve engagement in occupations

Scientific Reasoning

use of applied logical and scientific methods

Diagnostic Reasoning

use of investigative reasoning and analysis of cause and nature of conditions

Procedural Reasoning

consideration and use of intervention routines for identified conditions

Narrative Reasoning

understanding people's illness as it relates to their particular life circumstances

Pragmatic Reasoning

practical reasoning used to fit therapy possibilities into realities of service delivery

Ethical Reasoning

reasoning directed toward analyzing ethical dilemmas

Interactive Reasoning

reasoning directed toward building positive interpersonal relationships

Conditional Reasoning

blending of all forms of reasoning to flexibly respond to changing conditions and to predict client futures

Role of OT in Pharmacological Treatment

- physician, most frequently psychiatrist for clients with mental illness, prescribes meds- side effects frequently have such negative impact on function that clients refuse to take meds and reexperience symptoms of their mental illness- OT practitioners assist with med management through educational interventions

7 Elements of a Therapeutic Relationship

1. Belief in and respect for dignity and worth of individual2. Belief in clients' innate potential for change and growth3. Effective communication of empathy and empowerment4. Cultivation of humor and laughter5. Adherence to values of profession, articulated in Occupational Therapy Code of Ethics - altruism, equality, freedom, justice, dignity, truth, and prudence6. Appropriate therapeutic touch guided by ethics and practitioners and paying close attention to nonverbal and verbal communication of clients7. Competence in theoretical, technical, practical, and cultural realms

Therapeutic Use of Self

- use of one's self in therapeutic manner to enter into relationship that has therapeutic outcome- central to this is style of communication that places client in position of informed, equal responsibility for any positive outcomes in helping process- OT is client-centered process with client-centered assessments, such as COPM

Foundations of Therapeutic Use of Self

- practitioners who are aware of their own personality, leadership, and communication styles (self-knowledge) better able to establish rapport with clients in helping relationship- self-awareness allows practitioners to understand values they acquired growing up and tole that dysfunction (if any) plays in ability to form meaningful therapeutic relationships- self-awareness critical to moral development and moral reasoning as clinician and to development of good clinical reasoning skills and ethical professional behavior necessary to form effective therapeutic relationships

Elements of Therapeutic Use of Self

- rapport- empathy- sympathy- pity


enables practitioners to establish atmosphere of trust and confidence with client and is essential to effective therapeutic relationship


- momentary merging with another person in unique moment of shared meaning- practitioners able to empathize can see things from client's perspective


ability to feel about something as another person does


sorrow about suffering of another person, and because it is frequently interpreted as condescension, can be destructive to therapeutic relationship

Active Listening

helps foster effective therapeutic relationship and consists of following:- Restating or paraphrasing what client says to confirm accuracy of what practitioner understood- Reflecting to confirm implied feelings in what client communicated- Clarifying to clear up any confusion by summarizing what client said in clear concise statements

Definition of Occupations

- everyday personalized activities people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life- goal directed pursuits necessary for existence and well-being- participation in those that are meaningful to client has health benefits, supports participation in life, and increases motivation and success in achieving goals- require effort, drive, and attention

Definition of Tasks

steps involved in performing activity

Definition of Contexts

broad construct defined as environmental and personal factors specific to each client (person, group, population) that influence engagement and participation in occupations

Types of ADLs

- Bathing, showering- Toileting and toilet hygiene- Dressing- Eating and swallowing (or keeping and manipulating food in mouth and swallowing it)- Feeding (or moving nourishment from vessel to mouth- Functional mobility (or movement from one position or place to another, including ambulation)- Personal hygiene and grooming- Sexual activity

Instrumental Activities of Daily Living (IADLs)

activities that support daily life within home and community

Types of IADLs

- Care of others, including selection and supervision of caregivers- Care of pets and animals- Child rearing- Communication management, including use of writing tools and technology- Driving and community mobility- Financial management- Home establishment and management- Meal prep and cleanup- Religious and spiritual expression- Safety and emergency maintenance- Shopping

Types of Health Management Occupations

- Social and emotional health promotion and maintenance- Symptom and condition management- Communication with health care system- Med management- Physical activity- Nutrition management- Personal care device management

Types of Rest and Sleep Occupations

- Rest- Sleep prep- Sleep participation

Types of Educational Occupations

- Formal educational participation- Informal personal educational needs or interests exploration (beyond formal education)- Informal educational participation

Types of Work Occupations

- Employment interests and pursuits- Employment seeking and acquisition- Job performance and maintenance- Retirement prep and adjustment- Volunteer exploration- Volunteer participation

Types of Play Occupations

- Play exploration- Play participation

Types of Leisure Occupations

- Leisure exploration- Leisure participation

Types of Social Participation Occupations

- Community participation- Family participation- Friendships- Peer group participation- Intimate partner relationships

Occupation and Activity Demands

components of occupations and activities that OT practitioners consider in professional and clinical reasoning process

Types of Occupation and Activity Demands

- Relevance and importance to client (match with client's values, beliefs, and needs)- Objects used and their properties (tools, supplies, equipment, and resources)- Space demands (related to physical environment), such as physical space required- Social demands (related to social and attitudinal environment), such as rules and expectations- Sequencing and timing demands- Required actions and performance skills, such as motor, process, and social interaction skills- Required body functions for performing activity- Required body structures, such as anatomical parts, for performing activity

Definition of Activities

goal-directed actions

Activity Analysis

- analysis of component parts of activity, skills required to complete activity, activity's meaning to client, and therapeutic potential of activity- helps practitioners anticipate areas of potential concern for client

Approaches to Altering Activities and Occupations

- grading- scaffolding- fading- coaching- adaptation- modification


- involves sequentially increasing task demands to stimulate person's function or reducing occupational demands to respond to client difficulties in performance- used to improve client's underlying capacities and skills with just-right challenge


practitioner helps client by doing parts of task that are too hard, but then has client do rest so task may be completed


gradual withdrawal of support as client gains improved skills


providing explicit expectations and support to enable client to complete activity


changing requirements of occupation to be more congruent with client's abilities


reduction of demands of occupation

Use of Groups in OT

- help clients develop skills needed to participate in ADLs- unique in focus on activity, which is aspect that produces change- unique in emphasis on occupations, which involves changing areas of occupation and performance skills and patterns

Task-oriented groups

- focus on process of producing something (as group), such as picnic lunch or clinic newsletter- intention is to provide shared working experience wherein relationship between feeling, thinking, and behavior; group members' impact on others and on task accomplishment; and group members' productivity can be viewed and explored- feedback immediate because problems confronted in group addressed when they happen

Definition of Task (as it relates to groups)

any activity or process directed toward creating or producing end product or demonstrable service for group as whole and/or for people outside group

Activity groups

focus on function and replicate living in community or family, with emphasis on direct experience and use of activity to develop skills

Group Dynamics

- properties of group that emerge from interactions among group members- involve ways in which individual members relate to one another in here and now and enable members to explore and develop skills necessary to be successful in daily pursuits

Group Process

how things are said and done and how group goes about accomplishing goals

How OT groups differ from Natural groups

therapeutic groups used in OT practice differ from natural groups (e.g. church group, group of friends) because they from for specific therapeutic purpose (with measurable outcomes) and have defined structure that includes time frame

Types of Leadership Styles (for groups)

- directive- facilitative- advisory

Directive Leadership

- used if participants have low cognitive abilities- practitioner provides more directions and structure and more prescriptive in directing way group activities unfold

Facilitative Leadership

- used if group demonstrates fair to good insight and motivation- practitioner allows participants to take responsibility for some group activities while maintaining control over goals and decision making

Advisory Leadership

- used if group is mature (i.e. able to work effectively in resolving conflicts) and has high verbal abilities- practitioner works alongside group participants in coaching capacity- enable group members to perform and highest capacity

Tuckman's 5 Developmental Stages of Groups

1. Forming2. Storming3. Norming4. Performing5. Reforming or Transforming

Forming (Tuckman Stage 1)

participants become acquainted with one another and familiarize themselves with task

Storming (Tuckman Stage 2)

participants challenge one another and leader

Norming (Tuckman Stage 3)

participants develop trust in one another and leader and avoid conflict as they focus on task at hand

Performing (Tuckman Stage 4)

- participants work together as cohesive unit- conflict may be present but effectively resolved

Reforming or Transforming (Tuckman Stage 5)

- review group history and make changes as needed- participants reflect on their history, evaluate what when well and what caused problems, and adjust themselves as group in response to this review

Cara and MacRae's 4 Developmental Stages of Groups

1. Initial Stage2. Transition Stage3. Working Stage4. Final Stage

Initial Stage (Cara and MacRae Stage 1)

participants learn expectations, get to know one another, may be preoccupied with how much to disclose, and concerned with trust

Transition Stage (Cara and MacRae Stage 2)

- participants wonder about being accepted and about whether they will be safe- they struggle with conforming vs risk-taking behavior

Working Stage (Cara and MacRae Stage 3)

- trust built, and group becomes more cohesive- participants demonstrate ability to share responsibility and communicate effectively

Final Stage (Cara and MacRae Stage 4)

task completed, and participants evaluate experience and deal with feelings surrounding completion

Mosey's Group Sequence

according to skills of interaction required or demonstrated:1. Parallel2. Project3. Egocentric-cooperative4. Cooperative5. Mature

Parallel Group (Mosey)

participants complete tasks side by side with little or no interaction between or among them

Project Group (Mosey)

- group's emphasis on task- some interaction occurs among participants

Egocentric-Cooperative Group (Mosey)

interaction among participants expected

Cooperative Group (Mosey)

taking care of each other's needs part of group process

Mature Group (Mosey)

participants assume leadership roles and address one another's needs

Explicit norms (group)

articulated and set ground rules (e.g. do not curse, be on time, respect one another)

Implicit norms (group)

unspoken but understood (e.g. do not discuss taboo topics, avoid conflict)

Benne and Sheats 3 Classifications of Group Roles

may be assigned or evolve naturally:1. Group roles that evolve around the tasks of the group (e.g. initiator-contributor, information seeker, coordinator, recorder)2. Group roles that build and maintain group (e.g. encourager, harmonizer, compromiser)3. Group roles that serve individual's rather than group's interest (e.g. aggressor, blocker, recognition seeker, dominator)

Psychodynamic approaches to Group Work

- allow participants to explore symbolic meaning of activities and group process (e.g. group focused on impulse control or self-expression)- leader may select activities using projective media, such as clay, magazine collages, painting, and poetry

Cognitive-Behavioral approaches to Group Work

- focus on: a. Shaping: approximations of desired behavior rewarded or reinforced to facilitate acquisition of behavior b. Chaining: one step in sequence learned and sparks next step until all steps learned c. Reinforcement: positive feedback about desired behavior serves to increase behavior d. Practice: repetition of behaviors often necessary to improve skills, tasks, etc.- some seek to change participant's response or way they think about things, using relaxation and stress management techniques- can teach skills using techniques, such as role-playing, in which participants pretend they are in particular situation (EX: job interview) and rehearse skills needed to be successful- can impart knowledge with primary focus on teaching and learning

Allen's Cognitive Disabilities Groups

- participants placed in activity groups according to five-level cognitive hierarchy- all participants in group must function at same level

Allen's Cognitive Disabilities Group: Level 1

participants would not benefit from dynamics of group

Allen's Cognitive Disabilities Group: Level 2

participants will be successful in situations in which they can move about and copy movement modeled

Allen's Cognitive Disabilities Group: Level 3

participants focus on elements of repetition and manipulation

Allen's Cognitive Disabilities Group: Level 4

participants work on goal-directed activities, such as craft projects

Allen's Cognitive Disabilities Group: Level 5

- participants engage in activities with graded structure (e.g. clay modeling or mosaic project)- activities allow participants to exercise control over medium and require them to control impulses

Developmental approaches to Group Work

- allow participants to engage in group activities structured to present "just-right" challenge for their developmental level- foster participants' progression to next level in developmental sequence- participants in effective groups are homogeneous in terms of developmental level so activities address needs of all

Just-Right Challenge

neither so difficult as to cause enough frustration that person gives up nor so easy as to not enable growth or change

Sensorimotor approaches to Group Work

allow participants to benefit from deliberate and thoughtful design of sensory experiences

MOHO approach to Group Work

- considers individuals to be open systems that can change as result of interaction with environment- groups engage in activities toward therapeutic outcome related to participation in occupations and roles- participants act on their surrounding and receive feedback from these actions- participants adapt to environment and process feedback as they change- can be use in designing group around specific roles (e.g. parenting group)- Role Checklist can assist in clarifying perceived value placed on roles

Functional Group Model

seeks to enhance occupational behavior and thus adaptation by mobilizing dynamic group forces that have potential to positively shape people's understanding of themselves of their abilities

Approaches to Group Therapy according to Cara and MacRae

- Psychoanalytic models allow participants to gain access to their unconscious and develop insight and awareness- Humanistic models emphasize self-actualization, exploration of values, and focus on present- Behavioral models seek to change behavior using techniques such as teaching, reinforcing, and extinguishing- Cognitive-behavioral models seek to change thoughts and provide framework to eliminate maladaptive thinking

Lifestyle Performance Model

- focuses on configuration of activity patterns that constitute lifestyle- good QoL involves sense of balance among and of autonomy withing 4 domains that exist within context: a. Reciprocal interpersonal relatedness (connection to other people) b. Intrinsic gratification (fun and pleasure) c. Societal contribution (activities that benefit others) d. Self-care and self-maintenance (care of oneself and one's surroundings)- group activities help foster sense of autonomy in 1 or more domains or sense of balance among domains- participants can be grouped by similar lifestyles

Definition of Kawa

Japanese for "river", which serves as metaphor for person's life and variable of occupation within it

Kawa Model (related to groups)

groups engage participants in activities to help them more effectively participate in groups in their lives (e.g. family, work group, church group) and deal effectively with "rocks and sticks in their river" which represent challenges they face that interfere with flow of their life

Definition of Clubhouse

- community centers that provide support, work, and recreational opportunities for people with severe and persistent mental illness- not clinical program; no therapists or psychiatrists on staff

Clubhouse Model

- activities focus on members' strengths and abilities rather than their illness- members participate on voluntary basis- built on consensus; members vote to determine programming

Elements of Group Design

1. Needs assessment2. Model or FOR3. Development of Group Protocol

Needs Assessment

- systematic set of procedures to identify and describe specific areas of needs for given population- leads to clear set of goals and objectives for program (group)

Steps of Needs Assessment

1. Gather background data through internet and literature searches2. Collab with potential participants in writing survey, and identify potential participants to take survey3. Administer written survey, which may contain open- or close-ended questions or both4. Face-to-face interviews with potential participants5. Phone interviews with potential participants6. Interview key informants (i.e. people who come in contact with potential participants)7. Conduct focus group with small representative sample of potential participants8. Gather secondary data on potential participants (e.g. prior surveys, medical records)9. Analyze data10. Write profile of typical participant program will serve

Group Protocol

articulates design elements of group to inform others

Elements of Group Protocol

- Group title- Author (group facilitator)- Model or FOR- Purposes of group- Group membership, size, and type- Group goals (measurable statements about what will be accomplished and rationale)- Outcome criteria- Methods used, including media and leadership style- Time and place of meeting- Supplies needed and their cost- Reference citations for sources used to formulate group (e.g. assessment tools, model of practice)

Open Group

members come and go

Closed Group

members stay with group for duration and no new members added after it starts

Cole's 7 Steps of Group Leadership

1. Introduction2. Activity3. Sharing4. Processing5. Generalizing6. Application7. Summary

Step 1: Introduction (Cole)

leader articulates purpose of group so participants have shared understanding with clear expectations

Step 2: Activity (Cole)

group engages in therapeutic activity

Step 3: Sharing (Cole)

each participant invited to share what they produced or experienced during group

Step 4: Processing (Cole)

participants talk about their feelings about group experience and discuss any nonverbal aspects of group, such as power struggles, avoidance, and subgrouping

Step 5: Generalizing (Cole)

leader summarizes cognitive learning and participant sharing that occurred, making note of any common threads

Step 6: Application (Cole)

- leader articulates connection between what transpired in group and how participants can apply new insights and skills in everyday life- asking participants to consider how they can apply what they learned during group to own situation helps them find relevance and meaning in group experience

Step 7: Summary (Cole)

leader reiterates most important points made during group

Role of COTA in Groups

- OTRs responsible for OT services delivered in group setting, including those administered by COTAs- OTR responsible for ensuring COTA has competence in providing OT services in group setting- OTR responsible for initiating OT assessment- COTA may participate in assessment process once OTR has initiated assessment- OTR and COTA must demonstrate service competence- OTR responsible for selecting, measuring, and interpreting outcomes; extends to OT services provided in group setting (group goals and outcome criteria in group protocol related to this guideline)- all guidelines for provision of OT services apply to group setting as well as individual service delivery

Location Considerations in Group Design for Participants who may be Dangerous

should be held in locations where additional help accessible if emergency arises

Tool and Supply Considerations in Group Design for Participants who may be Dangerous

- group leaders should be aware of potential misuses of tools and supplies- leaders should be aware of objects that suicidal participants might use to harm themselves- policies and procedures should be in place to account for all tools and potentially dangerous materials

Staffing Pattern Considerations in Group Design for Participants who may be Dangerous

- should be appropriate for level of complexity of group participants- for participants who may pose threat, higher levels of staffing needed

OT Groups in County Jail

- not as restrictive and max security prisons, and stays often shorter than in other prison settings- inmates typically awaiting trial or serving sentences of less than 1 year

OT Groups in Community Reentry Programs

group members encouraged to resume participation in occupations

OT Groups in Halfway Houses

- participants able to resume community participation and engage in job programs and education- participants assume more responsibility for self-care, such as shopping and cooking

OT Groups in Maximum Security Prisons

inmates experience greatest loss of roles and ability to participate in occupations