Service Delivery Models and Institutional Practice Settings

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  1. Criteria for determining a model of practice:
    • type of setting
    • philosophy and mission of setting/dept
    • role therapist plays in setting
  2. Medical model
    individual w/ disability as person who has incurred physiological insult that has resulted in reduced functional capacity
  3. Medical model
    placed on identifying disease or dysfunction
  4. Medical model
    addresses disease or dysfunction (performance components) contributing to decreased functional skills
  5. Medical model
    address the pathological process of the disease or dysfunctions (biomechanical, neurodevelopmental)
  6. Education model
    individual w/ a disability lacks knowledge or skills
  7. Education model
    placed on learning and making the behavioral changes needed to interact successfully in the environement
  8. Education model
    skill deficits determined and related goals established to promote learning to adequately perform w/in a particular environment
  9. Education model
    behaviors measured in terms of obtaining skills, knowledge, and competency to successfully meet the demands of the environment
  10. Education model
    based on learning theories to facilitate adaptation in the environment (role acquisition, cognitive remediation)
  11. Community model
    individual w/ disability lacks skills, resources, and supports for community participation
  12. Community model
    • placed on identifying and developing the skills needed for one's expected environment
    • community resources and supports identified and developed to enable functioning w/in one's chosen environment
  13. Community model
    promote development of performance skills and/or areas of occupation w/in the individual's performance contexts (life-style performance, occupational adaptation)
  14. Telehealth model:
    can include features of all models by providing medical, rehab and/or educational services to persons via telecommunications technologies
  15. Acute care hospitals
    • for medical or psychiatric diagnosis that can't be treated in outpatient
    • initial onset of new illness or major health problem
    • acute exacerbation of chronic illness
    • danger to self or others
  16. Acute care hospitals
    • limited to 1-7 days
    • longer requires documentation to justify
    • ongoing need results in discharge to another setting
  17. Acute care hospitals
    focus on quick and accurate screening of major difficulties impeding function
  18. Acute care hospitals
    • stabilization of client's status
    • engagement in therapeutic relationship and purposeful activities so they can see change is possible, increase motivation
    • discharge planning
    • family, caregiver, and consumer education
  19. Acute care hospital
    role of OT:
    • generalist
    • specialist
  20. Sub-acute care/intermediate care facilities (ICFs)
    medical or psychiatric diagnosis that has progressed from acute stage but has not stabilized sufficiently to be outpatient
  21. Sub-acute care/ICFs
    • 5-30 days
    • longer requires documented justification
    • ongoing need for intervention results in discharge to another setting
  22. Sub-acute care/ICFs
    in-depth assessments and more thorough observations of client's functional performance
  23. Sub-acute care/ICFs
    • functional improvements in performance skills and areas of occupation
    • active engagement of the clients in the treatment planning, implementation, and re-evaluation process
    • discharge planning to expected environment
  24. Sub-acute care/ICFs
    housed in hospitals or SNFs
  25. Long-term acute care hospital (LTAC)
    • chronic or catastrophic illnesses or disabilities that require extensive medical care and/or dependency on life support or ventilators
    • multiple diagnosis with major complications
  26. LTAC
    greater than 25 days to maintain Medicare certification
  27. LTAC
    evaluation and intervention:
    • limited by medical need
    • palliative care
    • prevention and tx of complications
    • mastery of the environment and the attainment of client-centered goals
  28. Rehabilitation hospitals
    disability that is medically stable but which has residual functional deficits requiring skilled rehab services
  29. Rehab
    • a week to months
    • extension are dependent upon institutional, state, and 3rd party payer guidelines
    • ends when coverage is expended
  30. Rehab
    • SNF
    • supportive community residence
    • home/independent living
  31. Rehab
    • extensive and focus on all performance skills and patterns, areas of occupation, and occupational roles that will be required in the expected environment
    • environmental assessments of planned discharge environment must be completed
  32. Rehab
    • functional improvement in performance skills and patterns, areas of occupation, and occupational roles
    • development of compensatory strategies for residual deficits and client factors
    • provision of adaptive equipment and training in use of the equipment to promote independent function
    • modification of discharge environment
    • education of individual, family, and caregivers on abilities, limitations, compensatory techniques and advocacy skills
  33. Long term hospitals
    medical or psychiatric diagnosis that is chronic with the presence of symptoms that cannot be treated on an outpatient basis
  34. Long term hospitals
    • a month to years
    • extended LOS dependent upon institutional, 3rd party payer, and/or state guidelines
    • private hospital LOS determined by insurance coverage
  35. Long term hospitals
    • state run long-term hospital
    • SNF
    • home or supportive residence
  36. Long term hospitals
    extensive due to increased LOS
  37. Long term hospitals
    • functional improvements in performance skills and patterns and areas of occupation
    • development of compensatory strategies for residual deficits and client factors
    • maintenance of quality of life
    • development of skills for discharge to the lease restrictive environment
  38. Skilled nursing facilities (SNF)/Extended care facilities (ECFs)
    medical or psychiatric diagnosis that is chronic and requires skilled care, but the individual's illness is stable w/ no acute symptoms
  39. SNF/ECFs
    1 month to the individuals lifetime
  40. SNF/ECFs
    influences of LOS:
    • progression of illness
    • availability of family or community supports
    • insurance coverage
  41. SNF/ECF
    • guided by Medicare standards
    • good rehab potential = same as rehab
    • no rehab potential = palliative care and maintenance of QOL
  42. Forensic settings
    due to engagement in criminal activity by a person
  43. Forensic settings
    city or county facility which is the individual's first entry into the criminal justice system and the placement for those convicted of crimes with sentences of less than a year
  44. Forensic settings
    a state or federal facility for individuals found guilty of crimes w/ sentences greater than a year
  45. Forensic settings
    forensic psychiatric hospital or unit:
    specialized hospital unit w/in a hospital which provides inpatient psychiatric care for individuals convicted of a crime and found guilty but mentally ill or not guilty by reason of insanity
  46. Forensic settings
    determined by court-ordered directives and criminal sentences
  47. Forensic settings
    evaluation and intervention:
    • determination of individual's competency to stand trial, in forensic psychiatry settings
    • areas similar to those described under rehab to develop community living skills needed for successful community reintegration upon release
    • facilitation of skills and provision of structured programs to enable the person to function at his/her highest level w/in their current environment since discharge may be delayed or not possible, depending on the nature of the crime
    • restoration of competency to stand trial in forensic psychiatry settings
  48. Outpatient/ambulatory care
    does not require hospitalization but has functional deficits requiring eval and intervention
  49. OP/ambulatory care
    • diagnostic eval
    • interventions to increase functional performance
    • consumer education
    • prevention
Card Set
Service Delivery Models and Institutional Practice Settings
Ch. 4
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