Apied - Lecture notes 1 PDF

Preview

Summary

APIED Information...

Description

APIED Assessment  Collect baseline data on the client’s cognitive, social, physical, spiritual, and psychological behavior and leisure functioning  Summarize the client’s strengths and needs Planning  Develop long term, short term and or discharge goals  Develop outcome measures  Develop content and facilitation techniques  Communicate with the clients, staff and caregivers  Identify precautions and contraindications  Schedule programs and services  Staff and prepare resources  Prepare an evaluation plan Implementation  Begin the program  Monitor and document progress  Adjust client participation Evaluation  Complete a summative evaluation – determine client outcomes  Report evaluation results – documenting efficacy  Revise the plan  Develop a discharge, referral or transition plan 1. Summarize the client’s progress 2. Assess the clients’ functional abilities 3. Recommend transitions 4. Plan follow up

1

Assessment – it is defined as the systematic process of gathering and analyzing selected information about an individual client and using the results for the placement into a program(s) that is designed to reduce or eliminate the individual’s problems or deficits with his/her leisure, and that enhance the individual’s ability to independently function in leisure pursuits.

Individual Client Information – Why? 1. Initial baseline assessment – treatment planning and program placement 2. Monitoring progress – formative information 3. Summarizing progress – summative information Research on program efficacy and effectiveness Communication within and among disciplines Administrative requirements The focus of client assessment within therapeutic recreation services more often than not has been on placement of clients into programs. Assessment Categories Psychosocial Domain – Those aspects of an individual’s life and personal development which encompass the integration of a psychological and social functioning. Independence Frustration Tolerance Self Concept Engagement Affect Social Appropriateness Social Anxiety

2

Cognitive Domain – The aspect of a person’s life and personality development which has to do with the intellectual processes of learning or knowing and is often reflected in beliefs and attitudes Learning Capacity Short Term Memory Long Term Memory Decision Making Follows Directions Concentration and Attention Span Attention to Details Problem Solving

Physical Domain – That aspect of one’s life which relates to the physical functioning in our environment Overall Coordination Activity Level Strength Flexibility Balance Endurance Mobility Physical Health Leisure/Play Domain – The use of free time and/or the skills needed to satisfy leisure needs and interests. Does the individual have the knowledge, attitude and skills needed to make appropriate use of leisure? An assessment of this area requires a qualitative element as well as a quantitative one. Leisure Awareness Motivation to Participate Social Skills Personal Resources available for Leisure/Play Group Interaction Leisure/Play Interests Quality of Past Leisure/Play Involvements Ability to Learn Activity/Play Skills

For TR – Assessment Instruments fall into one of the following categories 3

Leisure Attitudes and Barriers Functional Abilities Leisure Activity Skills Leisure Interests and Participation

Assessing Clients Methods of Gathering Data 1. The chart – read the chart…there is valuable information that is in the chart…you just need to take the time to look. It is recommended that you read the chart before you interview the client. Information you can obtain about the person – via the psychiatrists exam, maybe the nurses evaluation, maybe the social workers evaluation and whatever the ED sent…or a sending hospital sent. 2. The client – as we discovered in Overlook – due to the length of stay clients self report. They use a form that they give the client to fill out and obtain information. Another method would be observation… sometimes watching the client without them realizing you are watching them – you can determine information. The other method would be an interview. Interview is the predominant method of collecting information about the client. Communicating – verbally and non-verbally Believe it or not…Knowing who you are and recognizing your biases do play into the interview. Your views on culture, religion and politics will influence what you hear in the interview. If you have beliefs about AIDS – if you are interviewing someone – it could influence the interview. If you have beliefs about domestic abuse – if you interview someone who has been abused – it could influence the interview. Your preconceptions will affect your ability to focus and listen to what they are saying. If the client feels you are truly listening they might share more.

4

Attending Behaviors Eye Contact – you need to make eye contact without starring – this conveys an interest in what the client is saying and that you are paying attention Body Language – the therapist’s appearance – use of body movements such as hand gestures, head nodding – this indicates interest in and comfort level with a conversation Vocal Qualities – loudness, rate and fluency of the therapist speech patterns – this serves to regulate and control the conversation. Speaking loudly – not always the answer…. The interview environment – try to go to a quiet area…if possible….distractions – should be minimized…Some say the recommended positioning for an interview is 90 degree angle rather than a 180 degree.

Recording Data – note taking…if you are going to be writing things down…explain that to the client. It should not short change the verbal exchange. If you are taking notes and the client wants to look at them…be aware that they have the right…and be careful what you record

Determining Interview Content – need to gather the information systematically. You need to ask the questions that elaborate on the difficulties they are having…so stay away from yes/no type questions. Sometimes clients do not want to engage…this happens…sometimes – you need to get the client to focus or they will ramble. Asking Questions – Closed Questions/Open Questions Closed – single word answers – age – date of birth - etc Open – usually begin with why, what, how…sometimes the questions can appear to be threatening…so get to know the client a little and see where they are and how they can focus…You might need to summarize – or paraphrase – to help the client connect the thoughts. This is often tough… There is not exact method – you will have to determine your own path.

5

Structure of an Interview Prior to asking any questions or doing anything – introduce yourself to the client and tell your title. Introduction – small talk – education client about confidentiality, purpose of the interview, put the client at ease by establishing genuine interest in the client and treatment process Opening – exploratory – determine the client’s awareness of issues, goals, desires for therapeutic relationship and intervention outcomes Body – information gathering on client’s areas of interest, concerns, abilities and goals Demographic Information - please read the chart first – some of the information may appear…some may not appear…. What brought you to the hospital?  Current  Brief information about previous hospitalizations What is your current living situation? This is more the social workers role…but if it is unclear in the chart you can ask…were they living with parents? Family? Boarding Home? Own apartment? Living with friends? Education History – again this may appear in the chart…but you can ask High School College Feel free to engage in conversation – if they feel comfortable sharing about high school or college Vocational History – again this may appear in the chart…but you can ask Current status – how long – kind of job – do they like it – can you go back – do they know you are hospitalized? History of employment Any work experience –

How do you spend your typical day…. You wake up around ? 6

What do you do? If they work..or go to school? What do they do after work/school? Social/Leisure History Do you have friends? Family? Children? Do they know you are hospitalized? What interests do you have? Sports? Games? Arts/Crafts? Music? Reading? Try and get them to talk about themselves…it might not happen on the first or second attempt…but it might happen while coloring or playing uno or dominoes or doing something… Coping Skills What kinds of situations or events tend to cause you the most stress? Are there any triggers? What do you do when you feel this way? How does it feel – describe it. Then you can explain – what your facility offers….everyplace you work it will be different…so know what is offered and based on what they say they like – or what the team feels they need – will help you make the decisions as to what groups to assign them to or will be offered.

Closing – supportive – reassure client, instill hope, tie up loose ends, clarify expectations for future interactions

7

Planning Interventions Goals and Objectives Goal – is a direction…broad statement…with some intent Client will increase/decrease/articulate/identify/engage/express/demonstrate/explain/ modify/focus Objective – is measurable description of a performance you want the patient/client/resident to demonstrate - how to reach the goal Goal – To reach the top of Pyramid Mountain Objective – Client will walk up Pyramid Mountain’s trail unassisted, from the starting maker to the marker at the top of the mountain. Client will complete the task in 1 hour or less. Terminology Goal – broad statement of intent Objective – measurable description  Performance – what the client is expected to be able to do in very specific terms  Condition – important circumstances or limitations under which the performance is expected to occur  Criterion/Criteria – states qualities that determine if the performance was achieved or how you will know if the performance was accomplished Overt or Doing Words– performance that can be observed directly whether that performance is visible or audible. Such as writing, running, drawing, eating, sewing, identifying, building, sorting and underlying Covert or Being Words – performance that cannot be observed directly – it is mental, invisible, cognitive or internal. Such as appreciating, understanding, knowing, feeling, enthusiastic, being, enjoy

Overt/Covert – which is it? 8

Identify leisure preference Play the piano Demonstrate appropriate social skills Distinguish assertive behavior from passive and aggressive behaviors Recall daily schedule Walk one mile Express feeling Establish goals – Examples of goals To increase functional leisure skills To increase leisure awareness To increase social interaction To increase awareness of relaxation methods To decrease physical aggression To decrease verbal outburst To improve time management skills

What is an Objective Ask yourself 1. What is the main intent of the objective? 2. What does the learner have to do to demonstrate achievement of the objective? 3. What will the learner have to do it with, or to it? What if anything, will the learner have to do without? 4. How will we know when the performance is good enough to be considered acceptable? Goal – To increase assertiveness by two weeks Obj – Pt will attend three classes on assertiveness within one week Performance – Pt will attend – this is what is expected to demonstrate Condition – three classes on assertiveness – circumstances under which the patient must perform Criteria – within one week – the quality of the performance that must be demonstrated in order for the objective to be achieved

Goals and Objectives 9

Goal – Develop assertion skills Obj – During a role play situation, patient will demonstrate appropriate assertiveness skills Performance – Condition – Criteria – Goal – To expand knowledge of available community leisure resources Obj- Pt will possess a thorough comprehension of community leisure resources within one week time frame Performance – Condition – Criteria – Examples of Performance These are words that you can actually see or hear or observe….the overt words…. Action words – walk, run, throw, jump, catch, kick, hike, sing, draw, color, swim, actively participate as evidenced by….. Initiate questions or provide responses

Examples of Criterion Amount of time – used when the probability that the skill will occur by chance is minimal, and the speed with which the skill is performed is important – within 5 minutes Degree of accuracy – used typically with skills requiring accuracy as a criterion for success – throwing horseshoes – within 2 feet of the target Degree of assistance – used when the criteria for performance is based on the amount of assistance the client needs to perform the behavior – with minimal assistance – with moderate assistance – independently Form – when performance of the behavior requires specific form – swimming stroke – as judged by a WSI Number of trials – used to avoid the possibility that the client performed the designated behavior by chance – 4 out of 5 times or 2 out of 5 days Percentages or fractions – used when it is important that the behavior be maintained over extended periods of time – 50% of the time

10

Specific subskills – used in those circumstances when it makes sense to identify subskills – as evidenced by: initiating a conversation or responding to a request or speaking in a cordial voice tone Therapist judgment – used with less obvious performance, as in displaying concern for others or experiencing emotion. The behavior can only be evaluated in the context of the total intervention program and in comparison to previous displays of attitudes and affect – as judged by the CTRS Examples of Conditional Phrases Upon request Given the necessary supplies When asked After 2 weeks With visual cues With verbal prompts During treatment sessions Given a list of resources Following group discussion

To summarize – the objective is what the client will do to achieve the goal The method is what the staff will do to assist the client in meeting the goals

11

Goal – Develop assertion skills Obj – During a role play situation, patient will demonstrate appropriate assertiveness skills Performance – Condition – Criteria – Goal – To expand knowledge of available community leisure resources Obj- Pt will possess a thorough comprehension of community leisure resources within one week time frame Performance – Condition – Criteria – Goal – Pt will interact with peers Obj – Pt will sit in the day room with others for 30 minutes daily. Performance – Condition Criteria – Goal – Pt will participate in therapies without becoming frustrated Obj – Pt will complete assigned tasks in 3 of 5 groups without verbalizing frustration Performance – Condition – Criteria Goal – Pt will be motivated to engage in leisure activities Obj – Pt will be able to identify 5 reasons why leisure is important in a person’s day to day living by (date). Performance – Condition – Criteria -

12

Goal – Pt will be able to identify free of charge leisure activities Obj – When asked by therapist, pt will be able to plan an entire Saturday engaging in activities that are free of charge by (date). Performance – Condition – Criteria –

Goal – Pt will acknowledge compliments Obj – Pt will respond “thank you” to praise given by peers in group setting 75% of the time. Performance – Condition – Criteria -

13

Interventions Intervention/modality/facilitation techniques – all the same word They could include: mind body health focus, physical activity and fitness, creative expression, self discovery/self expression, social skills, nature based, games, education based

Some examples: Mind Body Health Aromatherapy, Breathing Techniques, Guided Imagery, Meditation, Massage, Relaxation Training, Tai Chi, Yoga, Chair Yoga Physical Activity Aquatics, Exercise, Walking, Sports Creative Expressive Arts and Crafts, Music, Dance and Movement, Drama Self Discovery/Self Expression Adventure Therapy, Bibliotherapy, Journaling, Life Review, Values Clarification Social Skills Assertiveness Training, Anger Management, Coping Skills, Socialization, Current Events, Discussion Groups Nature Based Animal Assisted Therapy, Horticulture, Gardening Education Based Assistive Technology, Computers, Community Reintegration, Leisure Education

So when you have all this information – you need to select/choose which groups/interventions/modalities are for which patient. Not every single patient should receive the same exact treatment. Treatment needs to be individualized. I know this doesn’t always happen – but it should happen and it needs to happen.

14

\

Implementation The group Before the group – gather materials and supplies needed for the session determine if there needs to be any adaptations to accommodate the patients/program prepare the physical space – sitting in a circle, tables and chairs, lighting Introduction – greet the individuals warmly and enthusiastically introduce everyone – including yourself consider who is present – who is missing observe clients moods, energy levels and readiness to participate ask a returning participate to tell the group what the group has been doing could use a warm up or ice breaker also to get a positive vibe going Content – the actual task Introduce the session with simple- step by step explanations and directions Use handouts or poster board Use visual examples and demonstrate as needed Use activities that engage participants visually, auditorily and kinesthetically Use activities that involve everyone Have a back up plan in case your planned activity needs to change Process If at all possible really try hard an process the session – this is a difficult part but really try and do it Simple questions to ask Tell me one thing you feel you’ve accomplished in today’s session Which of the following best describes how you are feeling about what you did today How did today’s activity relate to what we have done in the past If a friend/relative observed you today doing this activity, what would they have noticed How would you evaluate yourself today

15

Can anyone tell me they learned today – about someone else in the group or about the activity Closing Bring the session to a close by summarizing what has occurred in the session Provide reinforcement – thank everyone for attending and sharing If appropriate – assign homework Talk about the next session

When processing – it’s not just about the group or the specific activity – it’s also about the patients and their behaviors. Keep them focused on the task

In reality – every group must have a beginning, a middle and an end The leadership of the group matters.

Running Effective Groups using the R.O.P.E.S. Framework – Anthony Salerno, PhD Beginning R - Review Review of important points from previous lesson  Last time we talked about __________________  What were some of the main points you learned?  The goal is to help he person apply what they learned in their lives)  That was a great answer – anyone else? Review of Action Step  Did anyone decide to take an action step?  Review of participants’ knowledge and experience of the current topic  Today we are going to talk about _____________________  Does anyone know about ______________ or anyone have experience with ________________  Fantastic….validate their knowledge

16

Review of participants’ understanding of the importance of the current topic O – Overview  Why is it important that we talk about ______________ Overview of the current group agenda Let me give you an idea of what we are going to talk about today  Today were are going to talk about _____________  First let’s take a look and understand ____________  Then, address why it is important to prevent or have _______________  Then, w...