Module One

B. Yes, Beneficence.
Beneficence. Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Beneficence includes all forms of action intended to benefit other persons. 1A- Provide appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs.
1C- Use, to the extent possible, evaluation, planning, intervention techniques, assessments, and therapeutic equipment that are evidence based, current, and within the recognized scope of occupational therapy practice.

D. Autonomy- Principle 3. Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent.
The Principle of Autonomy expresses the concept that practitioners have a duty to treat the client according to the client’s desires, within the bounds of accepted standards of care, and to protect the client’s confidential information.

D. Yes, Veracity.
Veracity. Principle 5. Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. Veracity is based on the virtues of truthfulness, candor, and honesty. The Principle of Veracity refers to comprehensive, accurate, and objective transmission of information and is based on respect owed to others, including but not limited to recipients of service, colleagues, students, researchers, and research participants. This includes avoiding plagiarism of others’ work (AOTA, 2010b). 5H- Give credit and recognition when using the ideas and work of others in written, oral, or electronic media (i.e., do not plagiarize).

C. Justice- Principle 4. Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services.

https://www.pacificu.edu/sites/default/files/documents/Code%20of%20Ethics%202015.pdf

B. “The patient is learning techniques and is progressing towards the long-term dressing goal for dressing”.
Low-Cervical Nerves (C5 – C8). The “A” portion of the SOAP note represents the assessment which reflects the patient’s progress, functional limitations, and expected benefits from skilled OT interventions and to justify continuation in rehabilitation. The assessment describes the clinician’s interpretation of the “S” and “O” of the SOAP note and reflects the clinician’s clinical judgement.

A. If a patient is being treated by an OT practitioner who is a family member.
C. During a telehealth consultation.
D. If an OT practitioner treats a friend that they know through social media.

A. As a relative’s OT practitioner, you might have access to information that as a family member the patient did not want to share with you or any family member.
C. One of the risks related to providing services via telecommunication include the potential for loss of client privacy or confidentiality. Practitioners should consider all these risks as well as benefits when determining whether to provide occupation therapy services via telehealth technology. When it comes to telehealth, patients have the right to know that, despite efforts to protect their privacy and confidentiality, breaches may occur. In these instances, practitioners should understand and adhere to appropriate procedures addressing the compromise of the patient’s privacy and confidentiality of protected health information (AOTA, 2013). To maximize privacy and confidentiality, organizations and practitioners should use authentication or encryption technology. Authentication technology ensures that people accessing the technology are whom they claim to be, and encryption ensures that no one can copy information transported via the Internet.
D. As stated in the AOTA Advisory Opinion on social networking, those who “engage in online friendships with clients can jeopardize professional boundaries by involvement in a dual relationship with service recipients” (AOTA, 2011, p. 2). It is best to avoid this type of relationship, when possible, because of perceived conflict of interest and concerns about privacy and confidentiality. Although it may not be unlawful to have a client who is a friend, it may provoke ethical challenges and is not recommended.

B. To be considered “de-identified”, ALL of the 18 HIPAA Identifiers must be removed from the data set.
The HIPAA Privacy Rule sets forth policies to protect 18 identifiers that are considered Personally Identifiable Information (PII). These are data points that can be used to identify, contact, or locate an individual. When one of these identifiers is used in conjunction with a person’s healthcare information, or a payment method used for that healthcare, it becomes Protected Health Information (PHI).
These are the 18 identifiers designated under HIPAA:
1. Name
2. Geographical element – street address, city, county, or zip code (smaller than state)
3. Dates – birthdate, admission date, discharge date, date of death, and exact age if over 89
4. Telephone number
5. Fax number
6. Email address
7. Social Security Number
8. Medical record number
9. Health plan beneficiary number
10. Account number
11. Certificate or license number
12. Vehicle license plate and other identifiers
13. Device serial number
14. Website URL
15. Internet Protocol (IP) Address
16. Finger or voiceprint
17. Photographic image (any body part)
18. Any other characteristic that could uniquely identify the individual (like a tattoo)
E. For digital documents that need to be sent to a third party, you can either email or use a file sharing program. If you use a file sharing program, then it’s very important to encrypt the documents and make sure you use a trusted service provider.
F. For any information that’s stored digitally it’s incredibly important that you control access to it by using passwords, firewalls and encryption. This is especially important when the information is contained on smaller storage devices such as USB drives that are easily misplaced.

C. Integrate bimanual activities such as waxing the hood of the car with a large towel.
D. Place cans of food in upper cabinets using the affected hand while wearing a hand mitt on the unaffected hand.
E. Organize coins onto a collectors coin mat while stabilizing the mat vertically against a wall with scheduled rest periods.
A bottom -up approach aims to recover underlying skills.
The goal in this scenario, is to reduce the underlying deficit of spasticity and increase functional use of the affected arm through remediation by engaging the patient in voluntary practice with the impaired side. Bilateral integration including weight bearing and stabilization of the affected upper extremity reduces spasticity and improves motor function necessary to perform cooking skills.

A. Uses a compensatory approach to maximize skills by using tools that take the place of the patient’s ability to safely stabilize and cut food.
B. Focuses on support and not improving underlying deficit.
F. Does not utilize the dominant upper extremity.

Pass the OT Study Materials – Module 1: “Bottom-Up and Top-Down Approaches”
Siebers, A., Oberg, U., & Skargren, E. (2010). The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke. Physiotherapy Canada. Physiotherapie Canada, 62(4), 388–396. doi:10.3138/physio.62.4.388

B. Cultural context
This is an example of a cultural tradition for the patient’s family.

D. The improvements in the patients’ function or level of independence pre-discharge.
Continuous quality improvement is a system-oriented approach that views limitations and problems proactively as opportunities to increase quality. The use of accurate and appropriate measures to evaluate the quality of service provided by occupational therapists is essential to promote the implementation of evidence-based decisions that lead to desired health outcomes. Effective evidence-based decision-making in occupational therapy is dependent upon critical thinking and problem solving, awareness of end-user needs and priorities, as well as consideration of data gathered through objective measurement. Quality performance in occupational therapy relates to the degree to which services increase the likelihood of desired outcomes and are consistent with professional knowledge and evidence-based practice.
An initial assessment provides the baseline against which a later measurement can be compared when considering the outcome for the service user.
Examples of outcomes that can be measured include:
• Improvements in health or quality of life.
• Improvements in function or level of independence.
• Attainment of intervention goals.
• Service user satisfaction.
• System changes such as reduced hospital length of stay, waiting lists, and readmission rates.

B. Report the information to the physician.
It is important to report this information to the physician so that the physician can do further testing. The physician needs to be made aware of the patient’s deficits, so that he/she can assess further assess the patient and discuss the matter with the patient. Besides the patient possibly needing further testing, it is typically the physician’s legal responsibility to report impaired drivers. It is not within the scope of practice, for an OT to make recommendations for driver training in this scenario, or to report the driver to the authorities.

B. Grounded theory.
Grounded Theory is an inductive method of research in which data is collected first. The data is analyzed and then the hypothesis is drawn from the results of the analysis. This is often misidentified as qualitative research.

C. Using clinical and ethical reasoning skills.
Prudence—The concept of prudence means that occupational therapy personnel “use their clinical and ethical reasoning skills, sound judgment, and reflection to make decisions in professional and volunteer roles.
https://www.aota.org/~/media/Corporate/Files/Practice/Ethics/Advisory/state-licensure-professionalism-and-ethics.pdf

B. Inform the woman of the coverage limitations and the costs for paying out of pocket.
If a patient’s insurance coverage runs out before a course of therapy has ended, the OT should inform the patient of their options regarding continued treatment. The patient can then decide whether to discontinue treatment or pay for treatment out of pocket.

B. Enabling. Enabling Activities are exercises or ways to condition the body in order to get to the patient’s end goal. Strengthening exercises, such as those completed using an exercise band, prepare patients for purposeful activities such as dressing, so they are an enabling activity.

If the p-value is less than or equal to .05, then the data is significant. In this example the p-value is .04, therefore the data in this research article is considered statistically significant.

B. Screening.
Occupational therapy evaluation should begin with a screening. This initial screening identifies aspects which could hinder future engagement in occupations if not addressed in the immediately. This initial screening is not a top-down, bottom-up or contextual approach, it is concerned with understanding the patient. Based on the findings from this screening, the OT can determine what the best course of action is. If the major concern is a health problem, the therapist would begin with a bottom-up approach. Examples include aspiration, a newly repaired tendon, or a patient with a fall risk. If the major concern is the ability to participate in a life activity, the therapist would begin with a top-down approach. Examples include taking care of one’s personal self-care, participating in a social group, or writing poetry.

C. The bottom-up approach considers foundational factors first to obtain an understanding of the patient’s limitations, real disabilities, and strengths. “A bottom-up approach to assessment and treatment focuses on the deficits of components of function, such as strength, range of motion, balance, and so on, which are believed to be prerequisites to successful occupational performance or functioning” (Trombly, 1993, p. 253). An assumption inherent in the bottom-up approach is that acquisition or reacquisition of motor, cognitive, and psychological skills will ultimately result in successful performance of activities of daily living.
D. Top-down assessments take a global perspective and focus on the patient’s participation in their living contexts to determine what is important and relevant to them. Top-down assessments should focus on critical roles as well as occupational performance issues, which include the ability to engage in activities of daily living, education, work, play, leisure, and social participation.
https://journals.sagepub.com/doi/pdf/10.4276/030802210X12682330090334
https://ajot.aota.org/pdfaccess.ashx?url=/aota/content_public/journal/ajot/930189/594.pdf

A. Help the patient acquire specific skills needed to function in her environment.
It will be best to help the patient acquire specific skills needed to function in her environment.
Lifestyle performance model: Intervention focuses on enhancing the environment and the patient’s needs
Psychoanalytic and Psychodynamic theory: Intervention should help improve a patient’s self-identity and improve interpersonal relationships.
Biomechanical Frame of Reference: Intervention focuses on range of motion, strength, endurance, and restoring functional skills

C. Did the intervention promote a positive change in a client’s engagement in occupation?
At the completion of intervention services, outcome measurements are reviewed to evaluate the effectiveness of the intervention. The outcomes measurement data can be used to improve or create cost-effective programs. A measure of quality is based on how patients’ expectations and needs are met, i.e. supports for patient engagement due to maximal functional level requiring minimal assist, change in functional performance and occupational participation due to carryover of use of breathing techniques.

A, B and D. Are a part of the process and design of patient services to improve the quality of patient care.

https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf pp 3-7.
Law, M. C., & McColl, M. A. (2010). Interventions, effects, and outcomes in occupational therapy: adults and older adults. Thorofare, NJ: Slack Inc, pp 2-8.

D. Expert Opinion.
An expert is a professional who has acquired knowledge and skills through study and practice over the years, in a particular field or subject, to the extent that his or her opinion may be helpful in fact finding, problem solving, or understanding of a situation. The expert opinion method provides validity and reliability of the research when it is necessary to obtain evidence of the research. Therefore, the results of the expertise, i.e., evaluation and opinion of competent and experienced experts on the subject matter becomes the basis for adopting serious decisions, including implementation of innovations recommended by a researcher in order to obtain the necessary results.The expert opinion method can be used both as a separate research and as a stage of a structured research.

http://llufb.llu.lv/conference/REEP/2018/Latvia_REEP_2018_proceedings_ISSN2255808X-74-80.pdf

C. Principle 5: Veracity. The code of ethics principle of veracity (principle 5) states that occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession. The OT has misrepresented her skills on her resume by exaggerating her involvement with the outcomes process, so she has violated this principle.

B. Find another study with exactly the same research design to see if the results are the same as the first study. Reliability in research refers to how well a study can be repeated by another researcher to obtain the same results.

A. Day 1.
Planning for a successful discharge from therapy services begins at admission. In order to establish clear goals for your patient, you need to have a wholistic picture of your patient’s needs during their period of OT intervention, as well as their possible needs post-discharge. By starting to plan for your patient’s discharge right away, you will be ensuring that your patient will be able to transition smoothly to the next stage of their recovery.

D. Biomechanical.
The theoretical base of biomechanical frame of reference (FOR) is considered as a remedial approach focusing on impairments that limit occupational performance. This FOR assumes clients are able to acquire the voluntary motor skills necessary to perform the desired human occupation, meaning that the underlying impairment is amenable to remediation. It also assumes that engaging in occupation and therapeutic activities has the potential to remediate the underlying impairment, and results in improvement in occupational performance. The goals are to prevent deterioration and maintain existing movements for occupational performance, to restore movements for occupational performance, and to compensate/adapt for loss of movements in occupational performance. Individuals who have limitations in performing occupations due to limitations in movements, inadequate muscle strength, loss of endurance, or other biomedical conditions are suitable to use this FOR. The goals are to prevent limitation of range of motion, to move the target body part through full range of motion, either passively or actively appropriately, and to position the body to prevent contractures and edema. Assessment includes assessing the performance components on movements, strength and endurance. Some assessments associated with this FOR include standardized objective tests of occupational performance, pain scales, examination of skin/wounds, sensory testing, etc. Interventions associated with this FOR include ADL retraining, work hardening, static and dynamic orthoses, active, active assistive, passive range of motion exercises, nerve gliding, etc. The variety of interventions aims to amend underlying impairment and result in enhanced occupational performance in desired occupations.

https://ottheory.com/therapy-model/biomechanical-frame-reference

B. The OT should treat the patient and allow the student to observe the session.
The Principle of Autonomy expresses the concept that practitioners have a duty to treat the client according to the client’s desires. This includes respecting and honoring the expressed wishes of recipients of our service. By allowing the student the opportunity to observe the session, the student’s needs are being met, although in a passive way.

A. Utilization review.
Utilization review (UR) is the process of making sure health care services are being used appropriately. The goal of utilization review is to make sure patients get the care they need, that it’s administered via proven methods, provided by an appropriate health care provider, and delivered in an appropriate setting. This should result in high-quality care administered as economically as possible and in accordance with current evidence-based care guidelines.Occupational therapy utilization review focuses on reviewing clinical records and documentation to ensure that patients of occupational therapists receive required services and an appropriate level of clinical care. Utilization review can be done while the care is being given, known as concurrent UR, or after the care has been completed, known as retrospective UR.

B. Prospective review is conducted at the onset of a service or treatment and is also referred to as precertification or prior authorization.
C. Peer reviewers primarily focus on ensuring that an article is factually accurate, provides new information in a specified field and meets the proofreading and editorial guidelines of the publication.

A. Commode chair.
B. Hospital beds.
F. Patient lifts.
Durable medical equipment (DME) is equipment that helps you complete your daily activities. It includes a variety of items, such as walkers, wheelchairs, and oxygen tanks. Medicare usually covers DME if the equipment:
– Is durable, meaning it is able to withstand repeated use
– Serves a medical purpose
– Is appropriate for use in the home, although you can also use it outside the home
– And, is likely to last for three years or more
To be covered by Part B, DME must be prescribed by your primary care provider (PCP). If you are in a skilled nursing facility (SNF) or are a hospital inpatient, DME is covered by Part A.
Commode chairs, hospital beds, and patient lifts are all covered under Medicare as durable medical equipment. Reachers, universal cuffs, and raised toilet seats are not viewed as durable medical equipment by Medicare and are not covered.

B. Skilled nursing facilities.
D. Hospice/Palliative Care.
E. Home Health Care.
Occupational therapy services are covered in skilled nursing facilities under Medicare Part A when a patient requires occupational therapy services for a minimum of 5 days per week. It is also covered as an outpatient service under Medicare Part B when provided in a Medicare certified facility. Occupational therapy is covered by Medicare in hospice and palliative care facilities when provided to patients who have less than 6 months to live. Occupational therapy is also covered by Medicare when provided through home health care agencies, as long as the patient is homebound and is receiving skilled nursing care, physical therapy, or speech therapy prior to initiating occupational therapy services. Continued occupational therapy services are also covered if any of the other services are discontinued. Occupational therapy services in group homes, assisted living facilities, and adult day care centers are not covered under the terms of Medicare, but may be covered under the terms of Medicaid or private insurance.

C. Observation is the most objective way to gather information about dressing skills.

A. A water exercise program for people with multiple sclerosis.
C. Education in relaxation techniques for a woman with fibromyalgia.
E. Teaching joint protection techniques and providing a pamphlet on joint protection techniques to a man with rheumatoid arthritis.

A. A water exercise program for people with multiple sclerosis. This is a tertiary prevention. The patients have been diagnosed with MS, a disease that is progressive. Tertiary prevention focuses on people who are already affected by a disease. The goal is to improve their quality of life by reducing disability, limiting or delaying complications, and restoring function, if possible.
C. Education in relaxation techniques for a woman with fibromyalgia. This is a tertiary prevention. The woman has been diagnosed with Fibromyalgia which is a chronic disease. The goal is to improve her quality of life. Tertiary prevention aims to reduce the severity of the disease. It targets ways to reduce the effects of the disease once it has already been established.
E. Teaching joint protection techniques and providing a pamphlet on joint protection techniques to a man with rheumatoid arthritis. This is an example of tertiary prevention which aims to reduce the effects of the disease once it has been established in an individual.

B. An educational program on safety at home for senior citizens. This is a primary prevention. The goal is to prevent injury from occurring. Educational and fall prevention programs are examples of primary prevention.
D. Screening oral motor skills of a 2-year-old who was born prematurely. Secondary prevention often occurs in the form of screenings. The goal is early detection of problems in a population which is at risk, to reduce/ minimize developmental delays.
F. Recommending a patient wear wrist brace while typing to prevent repetitive stress injury. This an example of primary prevention which aims to prevent the onset injury before the disease process begins.

3 Levels of Prevention
1. Primary prevention—those preventive measures that prevent the onset of illness or injury before the disease process begins. Trying to prevent the patient from getting a disease.
2. Secondary prevention—those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing. Trying to detect a disease early and prevent it from getting worse. Secondary prevention often occurs in the form of screenings.
3. Tertiary prevention—those preventive measures aimed at rehabilitation following significant illness. At this level health services workers can work to retrain, re-educate and rehabilitate people who have already developed an impairment or disability. Trying to improve the patient’s quality of life and reduce the symptoms of a disease they already have. Tertiary prevention focuses on people who are already affected by a disease. The goal is to improve quality of life by reducing disability, limiting or delaying complications, and restoring function. This is done by treating the disease and providing rehabilitation. Tertiary prevention targets both the clinical and outcome stages of a disease. It is implemented in symptomatic patients and aims to reduce the severity of the disease as well as of any associated sequelae. While secondary prevention seeks to prevent the onset of illness, tertiary prevention seeks to reduce the effects of the disease once established in an individual.

A. The demonstrated ability to use an identified intervention task in a safe and effective manner with a similar outcome as the OT.
Service competency does not mean that the OTA will perform the task in exactly the same manner as the OT, only that the outcomes will be similar. The supervising OT’s view of the OTA’s performance is subjective, whereas the OTA’s ability to achieve a similar outcome as the OT is objective. The amount of continuing education the OTA has had can influence service competency, but does not define it. Similarly, an OTA may only require general supervision but may not demonstrate the same types of outcomes as the OT in certain areas.

Inter-rater reliability is poor.

Inter-rater reliability is a statistical measure ranging from 0 to 1.0. The larger the number, the better the reliability. Values that are closer to zero, such as 0.27, suggest that reliability is poor and scoring methods should be reviewed and revised.

C. Write the missing notes in after the notes that are already written and mark each note as a “late entry”. If treatment notes are missed, they should be written as soon as the error is identified. Notes should not be falsified, but should be entered as the next entry in the notes sequence with the date of the treatment session. Each note should be marked “late entry” to identify that the notes were missed and written at a later time.

B. Stop using the test until the test design has been corrected. Construct validity determines how well a test measures what it is supposed to measure. If the construct validity of the fine motor test is called into question due to errors in test design, then the OT can no longer depend on the test measuring fine motor skills. The OT should stop using the test until the test design is fixed and construct validity is determined to be adequate.

D. All test subjects who chewed sugar free gum experienced an increase in attention to task. A Pearson’s r value of +1 indicates a perfect straight line correlation between the independent variable and the dependent variable in a research study. To achieve a Pearson’s r value of +1, all subjects included in the study would have shown an improvement in attention to task while chewing sugar free gum.

B. An OTR® with at least one year of experience as a certified OT.
In order to supervise a level II fieldwork student, an OTR® must have at least one year of experience.

D. .2 CEUs. 

CEUs are earned as continuing education units.  

1 CEU = 10 hours of education.  If the OT attends a 2-hour lecture, the OT will receive .2 CEUs.  (2/10)

D. Select an evaluation based on the patient’s needs.
After screening comes evaluation in the OT process.
The OT Process follows the following steps, in sequential order:
1. Referral
2. Screening
3. Evaluation
4. Intervention Plan
5. Intervention Implementation
6. Re-evaluation/outcomes
7. Discharge

The evaluation process includes:
a. determining the need for service
b. defining the problems within the domain of occupational therapy that need to be addressed
c. determining the patient’s goals and priorities
d. establishing intervention priorities
e. determining specific further assessment needs
f. determining specific assessment tasks that can be delegated to the occupational therapy assistant

D. Systematic Sample.

In a systematic sample, individuals are selected from a population list at specified intervals. Selecting every fifth name on a list is an example of systematic sampling.

A. Toglia’s Dynamic Interactional Approach
Toglia’s Dynamic Interactional Approach is typically used with patients who have an acquired brain injury. Ie: patients with damage to their CNS who experience perceptual and cognitive deficits (CVA,TBI, and MH).

C. Nonmaleficence.
Nonmaleficence. Principle 2. Occupational therapy personnel shall refrain from actions that cause harm. Nonmaleficence “obligates us to abstain from causing harm to others” (Beauchamp & Childress, 2013, p.150). The Principle of Nonmaleficence also includes an obligation to not impose risks of harm even if the potential risk is without malicious or harmful intent.Nonmaleficence relates to avoiding actions that may cause harm.

A. Case study
Case Studies/Case Series are analyses of persons, events, decisions, periods, projects, policies, institutions, or other systems that are studied holistically by one or more methods.

D. Billy should check with the state laws and regulations regarding PAM’s.
Each state has its own regulations on how to incorporate PAMs into practice. The content of these regulations, which varies widely from state to state, is in many cases set with input from occupational therapy boards that closely monitor OT practice-act changes.
AOTA stipulates that PAMs may be applied only by occupational therapists and occupational therapy assistants who have documented evidence of possessing the theoretical background and technical skills for safe and competent integration of the modality into an occupational therapy intervention plan (AOTA, 2003). The foundational knowledge necessary for proper
use of these modalities requires appropriate, documented professional education. Examples of professional education include continuing education courses, institutes at annual conferences, and accredited higher education courses or programs. In some states, applying a superficial PAM such as an ice -pack does not require Governing Board certification e.g. New Hampshire.

B. Grounded theory.
Grounded Theory Method involves the discovery of theory through the analysis of data. Grounded theory method is a research method which operates almost in a reverse fashion from traditional social science research. Rather than beginning with a hypothesis, the first step is data collection through a variety of methods. From the data collected, the key points are marked with a series of codes, which are extracted from the text. The codes are grouped into similar concepts in order to make the data more workable. From these concepts, categories are formed, which are the basis for the creation of a theory, or a reverse engineered hypothesis. This contradicts the traditional model of research, where the researcher chooses a theoretical framework, and only then applies this model to the phenomenon to be studied.

B. The interrelationship of person and context and which tasks fall within the person’s performance range.

The Ecology of Human performance serves as a framework for considering the effect of context. Context is described as a lens from which people view their world. The interrelationship of person and context determines which tasks fall within the person’s performance range. The Ecology of Human Performance framework provides guidelines for encompassing context in occupational therapy theory, practice, and research.

 https://ajot.aota.org/article.aspx?articleid=1873303

C. Intervention planning and intervention implementation.
* Intervention planning- The OT and OTA collaborate with the patient to develop the intervention plan. The OTA is responsible for being knowledgeable about the patient’s evaluation results and for providing input into the intervention plan, based on the patient’s needs and priorities.
* Intervention implementation- The OTA selects, implements, and makes modifications to therapeutic activities and interventions that are consistent with demonstrated competency levels, patient goals, and the requirements of the practice setting.
Only OTs can evaluate (they can delegate selected assessments to the OTA based on competency and if permitted by state law, but the OT is responsible for developing the plan of care, goals, etc.), change the plan of care, make recommendations, and discharge the patient. OTAs always work under the supervision of an OT although they can treat and document independently and contribute to the progress note, evaluation (as noted above), re-evaluation, and discharge plan; again, if permitted by state law and other applicable regulations.

https://www.aota.org/Practice/Manage/Scope-of-Practice-QA/OTA.aspx

B. Secondary prevention. Early detection of problems in a population that is already at risk to reduce the duration of a disorder/disease and/or minimize its effects through early detection (screening of infants born prematurely for developmental delays).

Primary prevention- the reduction of the incidence or occurrence of disease or disorder within a population that is currently well or potentiality at risk.

Tertiary prevention- the elimination or reduction of the impact of dysfunction on an individual who already has an established disease or disorder.

Early intervention – providing therapy and support services to children from birth to 3 years old who have disabilities, or who are at risk for developing them, so that they can succeed later in life. The goal is to enhance development, minimize the potential for developmental delay, and help families to meet the special needs of their infants and toddlers.

B. Sensory integration.
Improved sensory processing provides a foundation for enhanced attention and academic ability.  Responding adaptively to the environment enhances the intake and combining of sensory information

D. Patient outcomes data.
Measures of patient outcomes will show the overall improvement of patients who have received services from the OT, demonstrating quality assurance for her practice.

A. Meta analysis.
Meta analysis: methods that focus on contrasting and combining results from different studies, in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.

D. Extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
Inter-rater reliability: the degree of agreement among raters. It gives a score of how much homogeneity or consensus. For example, by determining if a particular scale is appropriate for measuring a particular variable. If various raters do not agree, either the scale is defective or the raters need to be re-trained. A method of measuring reliability. Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.

B. Stay at a long term care facility.
According to Medicare: Long-term care is a range of services and support for your personal care needs which isn’t medical care. Instead, most long-term care is help with basic activities of daily living. Medicare doesn’t cover long-term care (also called custodial care), if that’s the only care you need. Most nursing home care is custodial care.
Types of care which Medicare do cover:
1. Skilled nursing care. Medicare helps to pay for your recovery in a skilled nursing care facility after a three-day hospital stay
2. Home health care. If you are homebound by an illness or injury, and your doctor says you need short-term skilled care, Medicare will pay for nurses and therapists to provide services in your home. This is not round-the-clock care. Generally, it’s for no more than 28 hours per week. With your doctor’s recommendation, you may qualify for more.
3. Hospice . Medicare covers hospice care. Hospice is care you get to make you more comfortable when you are in the last stage of life with a terminal illness. You’re eligible if you are not being treated for your terminal illness, and your doctor certifies that you probably will live no longer than six months. You can get care for longer than that, as long as your doctor says you are still terminally ill.

https://www.medicare.gov/coverage
https://www.webmd.com/health-insurance/medicare-and-long-term-care

D. Occupational Adaptation. Occupational Adaptation is a complex series of steps and factors that occur when the person is faced with an occupational challenge that takes place within one’s environment and within one’s role capacity. It involves 1) the person, 2) the occupational environment, 3) the interaction or process that takes places between the person and environment. This process depicts how a person can respond adaptively and masterfully when engaged in occupations.

A. Research behind the value of periodic OT evaluations. The nursing staff will gain a great knowledge of the reason for periodic OT evaluations if evidence and research is presented to them.

C. Details of the skilled services that were provided during the patient’s treatment intervention. Insurance companies will not pay for services that are not skilled. Evidence must be shown that skilled services were provided by qualified personnel to ensure reimbursement. Procedure codes, intervention procedures and goal statements can be used to support the claim that skilled services were provided, but any one alone is not sufficient evidence. A key word in this question is “maximum” reimbursement.

The number of continuing education units needed depends on the licensure requirements of the state where Jill lives. Each state sets its own license renewal requirements. While the state may receive input from the national certification board or the American Occupational Therapy Association, the state has the final say on license requirements.

C. Respect the patient’s wishes and document the refusal in the medical record. The OT has done her due diligence in informing the patient of the purpose of OT. The patient has the right to refuse services even if the OT does not believe that it is in her best interests. The OT must document the refusal to show that the patient has refused a service that might help her to regain skills and return home.

C. Respecting a patient’s refusal of therapy services due to the patient feeling ill.
The Code of Ethics Principle of Autonomy reads as follows: “Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent.” (Occupational Therapy Code of Ethics, 2015). Actions taken that respect a patient’s right to privacy and decision making while receiving occupational therapy services reflect this principle.

B. Continued rehabilitation six months after a CVA for a Medicare Part B patient in a skilled nursing facility to focus on dressing.
Medicare Part B removed the therapy cap earlier this year (2019), and occupational therapy services now have unlimited coverage, if deemed medically necessary. 6 months after a CVA, the patient should have been taught and mastered compensatory methods for dressing. Thus OT services is not medically necessary.
Each payor has its own rules and guidelines for occupational therapy reimbursement, but in general therapists must show the medical necessity of the services provided. The hand therapy following a tendon transfer is clearly medically necessary. The inpatient therapy for an eating disorder must be covered under the current (2017) terms of the Affordable Care Act (ACA). Medicaid allows for maintenance therapy for conditions that require skilled services to provide the maintenance, such as management of contractures.

A. A water exercise program for people with multiple sclerosis.
Tertiary prevention focuses on people who have already been affected by a disease. The goal is to improve their quality of life by reducing disability, limiting or delaying complications, and restoring function. This is done by treating the disease and providing rehabilitation. The objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient.
3 levels of prevention:
1. Primary prevention—those preventive measures that prevent the onset of illness or injury before the disease process begins. An educational program for senior citizens on safety at home is an example of primary prevention.
2. Secondary prevention—those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing. Treatment for oral motor skills for a 2-year-old through a birth-to-three program and adapting the home of a man recovering from a total hip replacement are examples of secondary prevention.
3. Tertiary prevention—those preventive measures aimed at rehabilitation following significant illness. At this level health services workers can work to retrain, re-educate and rehabilitate people who have already developed an impairment or disability.

https://courses.lumenlearning.com/diseaseprevention/chapter/three-levels-of-health-promotiondisease-prevention/

A. A randomized controlled trial studying the use of weighted vests by children in a large metropolitan school district.
A randomized control trial (RCT) is a trial in which subjects are randomly assigned to one of two groups: one (the experimental group) receiving the intervention that is being tested, and the other (the comparison group or control) receiving an alternative (conventional) treatment. The two groups are then followed up to see if there are any differences between them in their outcomes. The results and subsequent analysis of the trial are used to assess the effectiveness of the intervention, which is the extent to which a treatment, procedure, or service does patients more good than harm. RCTs are the most stringent way of determining whether a cause-effect relation exists between the intervention and the outcome. Randomized controlled trials are quantitative, comparative, controlled experiments in which investigators study interventions in a series of individuals who receive them in random order. The RCT is one of the simplest and most powerful tools in clinical research. In occupational therapy research, quantitative research uses random selection to assign patients into an experimental group that receives the treatment being studied, and a control group that receives no treatment. Quantitative research is an appropriate model for validating clinical practice and providing evidence of treatment effectiveness.

B. Case Study: An in-depth study of a single subject or group of subjects. Qualitative approach.
D. Case Control Study: An observational study where two groups of people, one with a specific medical condition and one without the condition, are compared to determine factors that may contribute to or affect the medical condition. Researchers look back in time (retrospective) to identify possible exposures. They often rely on medical records and patient recall for data collection.

D. Clubhouse.
Working in a Clubhouse is considered to be a non-traditional OT setting.

Assisted Living Facilities, School-based OT and Outpatient OT Clinics are all considered to be traditional OT settings.

Refer to Module 1. worksheet on OT Settings- https://passtheot.com/ot-settings-2/

C. Read the patient’s medical history record.
After the referral the OT will need to read the patient’s medical history report to gain background information about the patient

Medicaid provides health coverage for children, pregnant women, parents, seniors, and individuals with disabilities.  Blue Cross/Blue Shield PPO is private insurance. Medicare Part A covers patients that are in the acute care setting and need a minimum of 5d/wk of therapy. Medicare Part B covers patients in the outpatient setting that need therapy 3d/wk.

B. Complete a simulated bathing task. In order to be discharged, the OT needs to see certain skills, even if the patient completed them in advance with the nursing staff.

C. Neurodevelopmental Treatment (NDT).
Neurodevelopmental Treatment and Proprioceptive Neuromuscular Facilitation are frames of reference that were developed to address neurological conditions such as a traumatic brain injury (TBI).

A. Psychodynamic Theory is a frame of reference that primarily relates to people with mental health disorders
B. Sensory Integration is a frame of reference developed for use with children and adults who have neuro-psychological conditions that include sensory processing dysfunction.
D. Psychoeducation is a frame of reference commonly used in psychiatric settings and although TBI can result in psychiatric symptoms, it is not necessarily considered a psychiatric diagnosis.

A. Supervision is not required.
Based on their education and training, occupational therapists, after initial certification, are autonomous practitioners who are able to deliver occupational therapy services independently. Occupational therapists are
responsible for all aspects of occupational therapy service delivery and are accountable for the safety and
effectiveness of the occupational therapy service delivery process. Although supervision is not mandatory, occupational therapists are encouraged to seek supervision and mentoring to develop best practice approaches and promote professional growth.
https://ajot.aota.org/article.aspx?articleid=1867156

B. Review the notes and co-sign if in agreement with all of its contents.
It is highly recommended that notes be co-signed by an OT since these notes are subject to subpoena.

A sock aid, grab bars, and a reacher are used for self-help and are not covered by Medicare. DME requires that the item must be medically necessary and reasonable to treat an illness or when the patient has a decline in function.

A. Person-Environment-Occupation-Performance (PEOP).
Person-Environment-Occupation-Performance model (PEOP). Occupational performance is emphasized in the PEOP model and involves three components: (1) characteristics of the person (including physiological, psychological, motor, sensory/perceptual, cognitive, or spiritual), (2) features of the environment (including cultural, social support, social determinants, and social capital, physical and natural environments, health education and public policy, assistive technology), and (3) characteristics of the activity, task, or role. When people perform occupations, they also interact with environment. Thus, there are reciprocal consequences; that is, a person’s goals and intentions influence his/her occupational performance, and the action changes his/her environment and his/her characteristics at the same time. The interaction between the person and environmental components positively or negatively influences occupational performance. When there is a person-environment fit in supporting the valued occupation, success in occupational performance eventually leads to participation and well-being. In addition, the PEOP model is a client-centered model; that is, client must actively set goals and participate in determining a plan that promotes occupational performance.
https://ottheory.com/therapy-model/person-environment-occupation-performance-model-peop

A. Working within a person’s home to modify it for their needs.
Ecology of Human Performance: A focus on the person choosing appropriate tasks within the environment. The environment can be temporal, physical, social, and cultural. How does the context affect the person’s occupational performance. Examples include:
Working within a person’s home to modify it for their needs; In acute care teaching person to select correct self-care tools; ability to choose to sit and knit then gather and prepare a station with necessary tools, lighting, etc.

B. Rehabilitative frame of reference.
Rehabilitative frame of reference: The focus is on what the patient can do, rather than on what they cannot do, and it utilizes adaptation, compensation, and modification in order to facilitate the patient’s ability to participate in the desired activities.  The rehabilitative approach looks at functional problems from a top-down approach and can be utilized regardless of the extent of the patient’s deficits because it does not require the restoration or development of missing skills, but instead focuses on maximizing independence where the patient is now in the recovery process.