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OT process and the 4 levels of Intervention

By Stephanie Shane OTR/L Pass the OT 

OT Process:

  • Referral: Patients are referred to occupational therapy by a variety of sources, including family members, caregivers, physicians, health care centers, employers, etc. Occupational therapists cannot work with any patient because the patient may have a therapeutic need; patients must be referred. The rules and regulations regarding occupational therapy referrals vary from state to state.
    • Physician’s orders for occupational therapy are required in most states and by most insurance providers.
    • An evaluation may be allowed without physician’s orders, but the occupational therapy treatment plan must be approved by the physician.
    • Public schools might not require a physician’s order for occupational therapy, depending on the regulations in each state.
  • Therapists can also refer to other therapeutic practitioners.
    • Visual acuity issues=refer to the optometrist
    • Eye disorders= refer to the ophthalmologist
    • Not following dietary recommendations=refer to the dietician
    • Speech delay=refer to the speech language pathologist
    • Gait disorders=refer to the physical therapist

A referral can be very specific such as asking for a neoprene splint or general by asking to test for a developmental delay.

  • Screening: 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. A screening is normally quick and easy to administer such as using the ACL screening tool. The screening also includes chart and medical review, checklists, and observation in the classroom, clinic, or hospital.
  • Evaluation: An occupational therapist can use a standardized assessment such as the Peabody, functional independence measure (FIM), or the sensory profile. If a standardized assessment is used, then the therapist needs to follow the assessment word for word and step by step. An occupational therapist can also use a non-standardized assessment.
    • For example, if the therapist is trying to test a patient for visual perception, the therapist can ask the patient to go to the fruit bowl and pick up an orange. If the patient picks up an apple, then it is indicated that the patient does not perceive an orange as an orange.
  • Intervention: In order to incorporate client centered interventions occupational therapists can go through for 4 levels of intervention (adjunctive, enabling, purposeful, and occupation based) for successful treatment.
    • Adjunctive: This is the initial step in the intervention process in order to prepare the patient for occupational performance. These methods are often used to prepare the client for meaningful activity and are often seen in the acute care setting. Education, physical agent modalities, and resources are used at this level. Examples include:
      • A customized exercise pamphlet with stretches and strengthening exercise that the client can do at home 1-2 times every day
      • Providing electrotherapeutic agents to improve muscle strength, modulate pain, and relax targeted muscles with other physical agent modalities
      • Educating the client on ways to prevent pain by including exercise, diet, sleep, and stress avoidance into their daily life
      • Teaching relaxation, breathing, mediation, and coping techniques
      • Providing the client with community resources, workshops, and associations so the client can have access to a support system
      • Verifying whether the client was provided with the right wheelchair for the right purpose
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