Module One

B. Yes, the ethical principle of Beneficence is being violated.
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. Hospital bed.
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.
Examples: 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 therefore not covered.

C. You may be eligible to receive Durable Medical Equipment that makes it easier for you to move around your home, such as a cane or walker, but most equipment designed to make your bathroom safer is not considered “primarily medical in nature” by the Centers for Medicare & Medicaid Services. Grab bars and raised toilet seats, for instance, are considered convenience items and you will have to pay out-of-pocket for these safety devices. Commodes will be covered under Part B’s Durable Medical Equipment benefits if the patient is confined to a room without bathroom facilities.

a href=”https://www.medicare.org/articles/does-medicare-cover-bathroom-safety-devices/” rel=”noopener” target=”_blank”>https://www.medicare.org/articles/does-medicare-cover-bathroom-safety-devices/

C. Place cans of food in upper cabinets using the affected hand while wearing a hand mitt on the unaffected hand.
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. 

A. Training the patient in the use of an adaptive cutting board and a roller knife to slice cheese 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 supporting the affected limb (eg., to prevent subluxation of the shoulder joint) and does not work on improving the underlying deficit.
D. Does not utilize/address 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

A. Hospice/Palliative Care.
Occupational therapy is covered by Medicare in hospice and palliative care facilities when provided to patients who have less than 6 months to live. Other examples: 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 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.

Re: Palliative care. Occupational therapy practitioners provide skilled intervention to improve quality of life by facilitating engagement in daily life occupations throughout the entire life course. Participation in meaningful life occupations continues to be as important at the end of life as it is at earlier stages. The term end of life care has replaced the term terminal care and encompasses both hospice and palliative care that can occur during the final stages of life.
The Role of Occupational Therapy in End-of-Life Care. http://www.cptopr.org/Documents/Role%20of%20Occupational%20Therapy%20in%20End%20of%20Life%20Care.pdf

D. Teaching joint protection techniques and providing a pamphlet on joint protection techniques to a man with rheumatoid arthritis.
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. Teaching joint protection techniques and providing a pamphlet on joint protection techniques is an example of tertiary prevention which aims to reduce the effects of the disease once it has been established in an individual.

Other examples of tertiary prevention: A water exercise program for people with multiple sclerosis and teaching education in relaxation techniques for a patient with fibromyalgia. The goal in these examples is to improve the patients’ quality of life by reducing the severity of their diseases- it targets ways to reduce the effects of the disease once it has already been established.

A. 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.
B. 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.
C. 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.

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.

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.

A. .04.
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.

D. Establishing an occupational profile.
Evaluation refers to the process of obtaining and interpreting data necessary for intervention. This includes planning for and documenting the evaluation process and results. Assessment refers to specific tools or instruments that are used during the evaluation process. Two parts of the evaluation process have been identified: the generation of an occupational profile and the analysis of occupational performance. The assessments chosen help in developing the occupational profile. The OT then analyzes the client’s occupational performance through synthesis of data collected using a variety of means. The evaluation portion begins with the OT and client developing an occupational profile that reviews the client’s occupational history and describes the client’s current needs and priorities.

B. A screening comes before an evaluation in the OT process. After the referral, the occupational therapist needs to screen the patient in order to determine if an evaluation is needed. A screening is used to obtain preliminary information of the patient’s situation.

Pendleton, Heidi McHugh; Schultz-Krohn, Winifred. Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 30). Elsevier Health Sciences. Kindle Edition.

A. The Canadian Model of Occupational Performance and Engagement (CMOPE).
Engagement is one of the main concepts covered in this model because it offers a less restricted focus on occupational performance (Polatajko, Townsend, & Craik, 2007). Although a person may not be able to occupationally perform in their desired occupations, they can still engage in them through the help of modification, adaptation, and caregiver role (Polatajko, Townsend, & Craik, 2007).
Huntington’s disease (HD) is a neurodegenerative disease. Huntington’s disease is delineated by three stages in its progression: early, middle, and late stage. The early stage is marked by the onset of a triad of symptoms including physical, behavioral and cognitive impairments. The middle stage is marked by an increase in motor control problems as well as cognitive deficits that begin to have a greater impact on an individual’s abilities to carry out ADLs. The late stage is characterized as the loss of muscle, the presence of contractures, increased involuntary control of movement, even more severe cognitive deficit, and the need for increased safety precautions. As the disease progresses, independence in activities of daily living decrease and coping with these changes becomes more challenging.

B. Biomechanical Frame of Reference. This is a rehabilitative FOR which is best suited for patients with an intact central nervous system.
C. Dynamic Interactional Model of Cognitive Rehabilitation. This is a restorative cognitive rehabilitation approach, used to enhance the functional performance of patients who have a cognitive impairment.
D. Cognitive Behavioral Frame of Reference. The focus is on replacing behaviors that result from abnormal thought processes with more normal or adaptive thought processes and behaviors.

C. Did the intervention promote a positive change in a client’s engagement in occupation?
OT outcome measures are used to determine value and effectiveness of treatment in therapy. 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. Yes, once the entry-level OTA shows service competency to a supervising OT.

Entry-level OTAs are allowed to supervise aides, technicians, and volunteers once they show service competency in this area to a supervising OT.

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.

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

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.

A screening is the process by which a person’s OT needs are assessed. Whether or not an OTA can complete a screening depends on the information required from the screening. An OTA can state or write observations but cannot make an evaluation or determine a need for occupational therapy services. This must be determined by an OT. The OTA may, if directed by the occupational therapist, and deemed competent, perform designated assessments to contribute to the evaluation, but may not interpret data. The interpretation of assessment results and the overall evaluation is the responsibility of the occupational therapist. In terms of intervention discontinuation, the OT is responsible for determining the need for continuing, modifying, or discontinuing occupational therapy services.

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.
In OT, outcome measures are used to determine the value and effectiveness of treatment in therapy. These measures are often completed at the start of therapy to determine baseline function and then again, at the end of therapy to assess progress and determine treatment efficacy.

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.

A. It depends on the licensure requirements of the state where Jill lives.
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 with ADHD 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

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

C. Medicare Part A.
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 essential to document who provided the service, their qualifications and clinical expertise, and the purpose of the service. Documentation should be signed by the qualified professional (e.g., the COTA® with OTR® co-signature), as indicated by facility policy, third-party payer regulations, and state licensure laws.

https://www.nbcot.org/-/media/NBCOT/PDFs/Practice-Standards-COTA.ashx?la=en&hash=7D24D031D583DBE15E6585A707F2702A84B2DF21

C. A walker for a person who cannot ambulate in the home without one.

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.