Occupational Therapy in Behavioral Health Services
foreign my name is Hannah Brosnan I am the finance and operations coordinator with Mental Health America of Kentucky thank you for joining us for today’s webinar occupational therapy and Behavioral Health Services with an emphasis on coordinated Specialty Care programming this is the fifth session in a Statewide learning series designed to increase Workforce capacity to address early serious mental illness and first episode psychosis this virtual series is made possible by bsea funds through Kentucky Department for Behavioral Health Developmental and intellectual disabilities today’s session will be held for three hours the live training is eligible for certificates of attendance and several types of CEUs so on to our presenters today’s webinar is led by Dr Camille skubig puploski Dr Josh scholar and Tanya newer Dr scuba poplasky currently serves as profession Professor sorry and Capstone director for the Department of Occupational services and occupational therapy at Eastern Kentucky University Dr sculler currently serves as associate professor for our back school of occupational therapy and program director of enabling Technologies and Tech at Spalding University Tanya Newark currently serves as a senior research assistant for OHSU PSU School of Public Health in Bend Oregon so now I will pass it on to our presenters thank you all so much for joining us thank you Hannah can you post our presentation yes I’ll be uploading that right now um I was going to share my screen right sure yes so glad to have everyone here we are very excited to be presenting with you excellent thank you Tanya you bet as Hannah said I am Camille Scooby poplasky and Josh sculler and Tanya newer will be joining will be presenting with me today and we want to thank you for attending this session we are excited to teach you about occupational therapy and Behavioral Health and how occupational therapy practitioners can address the quality of life for kentuckians during the presentation as Hannah mentioned if you would have any questions please post the chat room as Hannah is keeping an eye on that if you would Advance the slide please Tanya so what you’re going to experience today for attending is that we are going to teach you about occupational therapy so that you can define the role especially with individuals experiencing their first episode of psychosis also we want you to be able to identify occupational therapy’s unique contributions to an individual’s ability to perform their occupations daily and we want you to be able to demonstrate the ability to screen and refer individuals For Occupational Therapy Services we know a lot of you provide services through the I hope program and other community-based mental health programs so we want to share with you how the value of occupational therapy and how we can contribute to the quality of life of these individuals uh Advanced Tanya so let me start with asking you what do you know about occupational therapy can you share in the chat what you know about us do you know any occupational therapists or occupational therapy assistants have you received our services have you watched therapy maybe because you had brought someone to therapy do you know the value of Occupational Therapy so if people would Post in the chat just to give us an idea if you have any experience oh interesting Sally did testing for occupational therapists okay so and Christy brought her child in for sensory processing disorder excellent oh okay Lisa no experience well today is your first experience then so we’re so glad to have you and okay so Madeline at the hospital so that’s a really good experience to have you’ll also hopefully grasp that occupational therapy works in many different settings and venues and addresses many issues and we’ll go into that a little more in detail so Jody has worked in pediatric clinic alongside OTS go Jody and Phillips also has some experience with sensory integration so that is very exciting and we are glad that you have some idea of what occupational therapy practitioners do okay Tanya if you’d advance excellent so we’re going to start with telling you the definition of Occupational Therapy first of all we help people participate in life in many different venues the the thing that’s tricky about occupational therapy is we cover a lot of areas that contribute to the quality of life so sometimes you can’t just say we do one thing because we do several things and you’re going to learn more about that today what occupational therapy defines is that we work with people on everything they need to do want to do and are expected to do so if you think about what you did today so far that you were expected to be at this presentation so did you shower hope you can go back and stay where you were Tanya thank you so did you shower did you eat did you pack a lunch thank you sorry it just did it on its own all right that might happen the rest of the time I wonder that we’ll work with it okay so did you pack your lunch and eat quickly just before this started today did you brush your teeth use the bathroom did you drive today or take the bus or ride share did you follow any directions were they new directions Old directions these are all occupations that we would work with you throughout the day so that you can contribute to your community our job is to support kentuckian’s well-being to participate in their roles be in relationships work clean cook manage stress fear and respond appropriately to their environments we work with individuals to promote physical and mental health and their well-being by supporting occupational performance so think about all the things that you did already today and if you were unable to do them you could come see an occupational therapist to work on them to become more satisfied and successful in your life now our profession was established in 1917 so we have been around a long time over a hundred years we did celebrate 100 years in 2017. so Tanya if you would go ahead to the next slide all right so we want to start with asking you to think about a client think about yourself think about what I just defined occupational therapy for you and do you have any challenges that interfere with your ability to complete an occupation let’s start with looking at the environment for example if a lot of people are in a room do you hesitate going into that room my spouse despises shopping at the mall at holidays he will never go into a crowded space so online shopping has been a god-saving godsend for us and and Leanne agrees with me too or with my spouse so looking at environment if we look at the occupation what we have to complete again I use a lot of stories with my husband today my husband does not like if he cannot control the Clank when he empties the dishwasher if I’m emptying the dishwasher and he’s in the room not being able to control when it’s going to clink or make a noise with the dishes silverware glasses it he’ll become over responsive and he struggle with that now if he’s hungry or tired that exacerbates his response so me being a loving partner I will let him empty the dishwasher anytime so then if we look at the person if we look at the person any of you are over responsive to where someone wearing too much perfume or aftershave and it causes a headache or you just don’t like being in a room with a lot of different smells those are all issues regarding the person and we’re going to talk more about this but the client that you’re thinking about I also want to ask does the client have physical issues that interfere with their participation and occupation do they have attentional issues do they have cognitive issues social skills that interfere with their ability to interact since covid we’ve seen a lot of different and changes in behaviors of people some covet have contributed some probably they had these behaviors before and now we’re starting to deal with them now that we’re past covet I think we’re past coven anyway then let’s go to sensory processing which Philip had experience with so sensory processing is looking at the senses such as smell hearing Vision touch taste the vestibular sense or knowing where I’m at in space and movement and also interception which is what my body is doing is my are my muscles Contracting do I know where that I’m sitting right now or standing or am I moving that is interception also mental health and Behavioral Health dealing with emotions and adapting to the stress in our environment the stress around us some of the individuals that we work with have such severe sensory processing deficits that how they adapt to them is not appropriate for their environment so that interferes with them to be successful in their environment so does everybody have someone that they’re thinking about as we continue to talk and give you more ideas of what occupational therapy is and how it works everybody got someone themselves a family member or a client that you work with in mind okay thanks Lisa good okay so we can go to the next slide Tanya please I wanted to review a little bit about the history of occupational therapy and the different movements that we’ve gone through so as I mentioned to you occupational therapy began in 1917 and it was in response to inhumane treatment of people with mental illness that were living in asylums some living in shackles and chains in prison-like conditions so there was a moral treatment which encompasses treating the mind and the body together focusing on using healthy aspects of the individual for treatment and using meaningful occupations and modifying the environment so that is the moral treatment that occupational therapy began to do then you had the mental hygiene movement which followed establishing that it’s the state and the community’s responsibility to also care for individuals with mental health issues someone had to take responsibility so in the early 1900s the benefits of the Arts Movement were embraced as a therapeutic modality and that became the foundation using occupation as an art form for our therapy so Arts with occupations were recognized to provide vocational trainings they gave people meaning value and purpose and this is the beginning of Occupational Therapy because we wanted to work with individuals so they could contribute to their society which isn’t all of your focus helping people contribute and give back to society so Tanya you can switch the next slide please all right so this reiterates a little bit of what I’ve already said it just lays it out a little bit differently and makes it pop in the blue for you so we use the Mind and Body Connection we look at using the environment to influence Mental Health we look at people’s healthy aspects to address their unhealthy aspects we also use meaningful occupations to help people be more effective to engage or distract from unhealthy behaviors we also try to remove stressors use Humane humanity and dignity and we build routines or regimens based on occupation exercise work and Amusements or Leisure if you would like to call it so we work to create a structured regimen using the goal to return to the community which is what an occupational therapy’s Focus would be there are several people’s names in this slide to tell you a little bit about our history and mental health history and panel which I found interesting became known as the father of modern Psychiatry and he came from this perspective so and took who’s also listed here wanted more of them than a medical approach to individuals of mental health so he coined the term gentler methods and that became known as the moral treatment Focus okay Tanya so then we moved to the mental health hygiene and that’s a little bit later and also the Arts and habit training now I mentioned to you earlier talking about the person the environment and the occupation and this is how we look at providing intervention that we try to create Harmony between the architect the designer and the Craftsman or the three components of how an individual interacts with their environment so beers is also on this slide on the left side and beers suffered from depression and paranoia and he was institutionalized several times so therefore then he authored a ma a mind that found itself and which is still in print which is amazing and it highlights the abuse of mentally ill in hospitals and it became the voice of one who had lived the experience to advocate for reforms and he was the founding member of the Mental Health America which I find interesting and many of you have probably worked with this Association he also highlighted the link of social factors to mental health for example reshaping the environment to promote well-being and mental health accessibility so using the person the environment the occupation in which Josh and Tanya will talk about later also we’re looking at using those benefits through educational and Vocational learning opportunities so that we can help people to increase their self-esteem and self-worth having them understand their environment better the occupation they’re trying to perform and themselves personally Hall is another advocate for mental health and they coined the term occupation of hand and mind is a potent factor in maintenance of physical mental moral health of the individual and the community so in the beginning of our profession it was these movements helped us to view occupation as both the way we provide intervention through occupation and what we’re measuring to see if someone is contributing to the community or the end outcome so we use it as our therapy and as the end outcome and it makes us a really powerful profession one of the early founders of Occupational Therapy Slagle believed that occupational balance through habit training was key to mental health and wellness so you’ll see us use habit training and that’s the first occupational therapy model used in our profession with individuals with mental health all right Tanya thank you so now we skip through and look at Trends throughout our lifespan of our profession so it’s interesting to compare 1955 there was one bed for every 300 Americans for mental health issues in 2006 there’s one bed for every 3 000 Americans and that is why we are in a crisis that interventions for mental health issues aren’t as readily available as we would like them to be there are three times as many seriously mental ill persons in jails and prisons as in hospitals and here’s a fact I find very interesting 500 000 persons with mental health excluding dementia reside in nursing homes on any given day 500 000 people so during our formative years of Occupational therapists many occupational therapists worked in mental health settings just to give you an example up into the 1990s part of our curriculum required that occupational therapists and occupational therapy assistants did Field Works in mental health facilities we had to complete one of our three-month field work rotations in a mental health setting however since mental health settings have decreased in number our profession had to shift and now you can do one of your Field Works in mental health or Capstone in mental health but it is it isn’t required and we can also work more in community-based mental health facilities so in the 1950s you can see that we moved from therapeutic use of occupation and environmental factors and we became more of a medically based approach so but there are occupational therapists that work in mental health settings and they work in community settings prisons nursing homes and among the homeless and we have a few occupational therapists on this call today that work in mental health settings and so we are very active in the settings and we’re looking for more contributions that we can help kentuckians just for an example in 2010 when the patient protection and Affordable Care Act was passed it emphasized the integrated primary care with Behavioral Health Services so that was a really wonderful shift for everybody in the behavioral health Realm so those are things to kind of keep in mind okay if you could thank you okay so we wanted to also review to you to let you know about the occupational therapy Workforce in Kentucky so you don’t have to worry that we’re not available to you so to give you an idea we are either a clinical or a master’s entry level to our profession and there are four occupational therapy programs in the state we have Eastern Kentucky University we have Spalding University Murray University in Paducah and Northern Kentucky University in Florence and eku’s Richmond and Spalding is in Louisville just to give you context for those places too now we also have occupational therapy assistants who enter the profession with an associate’s degree and there are three programs in the state Jefferson Community and Technical College Madisonville Community and Technical College and Ross all have programs so out of all of these seven programs 25 of the curriculum is focused exclusively on behavioral and mental health content and within the rest of our curriculums for the years that we go to school there is woven in all the classes mental and Behavioral Health content that focuses on the ability to engage in occupations and what individuals need to do want to do or expected to do to give you an example of this Josh will talk about a case later but if someone has a spinal cord injury we’re going to address both physical and mental health issues for this individual because they will be experiencing both for them to resume their lifestyle or their occupational performance so we must address with every client we see both psychosocial and physical disabilities with these clients just to let you know there are over 4 000 occupational therapy practitioners currently licensed and ready to provide services to kentuckians so we are a Workforce ready to go we have the knowledge we have the expertise and we want to improve the lifestyle and the quality of life of kentuckians so Tanya you can switch to the next slide so I wanted to review this Wellness model because this Rutgers Wellness model and you all have the link in your handout is a really interesting and informative model and you can go on more and look at it but it encompasses all of these circles or areas of Occupational performance that someone has to perform every day now there are a lot of similarities between all of these circles and occupational therapy the profession as we work with our clients we address anything the client wants to participate in or we see as a deficit for them and especially under the area of Occupational that you see at six o’clock on this circle if there is a deficit in any of these then we it can have an impact on occupational performance and the person cannot contribute to themselves their families their job or their community occupational therapy practitioners address every circle of Wellness while striving to gain balance amongst all the circles for homeostasis Josh and Tanya are going to continue to dig a Little Deeper and for that balance amongst these and they’re going to address circles that we even look at more thoroughly within occupational therapy remember that these circles are areas that occupational therapies therapists address for wellness is what we’re looking at and we’re going to be identifying how to address mental health issues and behavioral health issues in Kentucky and give you more details so I’m going to pass it off to Tanya now no Josh now excuse me all right that’s the next slide please all right fasten your seatbelts everyone we’re going to talk about the OT practice framework so this is pretty much what defines occupational therapy really digs deep into what we do during the day and so um I’m going to be spending actually the next few minutes really talking about this image on the screen so um you’ll usually hear me refer to this just as the framework so instead of saying occupational therapy practice framework and it’s a document of the American Occupational Therapy Association and presents a summary of the integrated constructs that describe occupational therapy practice in order in other words what we do um and the definition of OT per um the OTP after the framework um this this finds occupational therapy as the therapeutic use of everyday life occupations with persons groups or populations for the purpose of enhancing or enabling participation so that’s a mouthful just where we’re working with everyone on what they need to do want to do and have to do every day um and on this graphic you’re going to see that the framework consists of two sections so the domain and the process the domain outlines the purview of our profession of occupational therapy and the areas that of which we have extensive knowledge and expertise and the process describes the actions that we take when providing services to our clients so now I’m going to delve even deeper into what this means so you’re going to see that within the domain we have these these words occupations context performance patterns performance skills and client factors so what does this mean well occupations are what we do on a daily basis every single thing that we do during the day is an occupation so you know a lot of times you know I I tell our students at here at the University that you’re going to spend a lot of time explaining to people that occupational therapy is more than helping people find jobs because people naturally think about the Word occupation that’s what that means but really every single thing that we do during the day and we’re going to talk a little more about that so within occupations we consider the following activities of daily living so this is going to be like you’re grooming your self-care um feeding yourself taking a shower in the morning um waking up in the morning you know those are those are your activities of daily living you also have instrumental activities of daily living taking care of your pets so for example I know when I first get out of bed in the morning I have four dogs yes I own four dogs who are waiting to be fed you know so feeding them making sure they go out um that is instrumental activity of daily living together Josh I accidentally muted you I’m sorry thank you that’s okay I’ve unmute it so but like I said taking care of my pets is an instrumental day um uh activity daily paying my bills budgeting finances going to the bank those are other instrumental um activities of daily living so that’s one example of occupations um Health Management so working out anything that you know anything that’s going to raise your your cardio and or raise your heart rate in a good way you know that’s going to be you know Health Management tending to your medications can also fall under Health Management so really working to manage our our health um rest in sleep so again sleep hygiene preparing yourself for Sleep preparing yourself for bed um get you know the whole process the whole routine of getting ready for bed is an occupation education and education can be either formal or informal so formal would be you know kids going to school preschool through grade 12. students enrolled in college um this right here could be a good example of formal education you all are participating in and in service or continuing ed and then there’s informal education which is more learn learning things for a hobby um you know there’s some adult like here in Louisville we have um you know Louisville learns which is an adult ed program where you can take like art classes or other types of things are going to be a little more informal a little more flexible a little more flexible for the way you want you know the way you want to learn and what your goals are for that um work so again going to work uh participating being you know being able to participate in work um that may be socially that may be productively um play and Leisure so for little kids going to going to play groups playing on the playground at recess etc for um adult Leisure skills so learning how to participate in various leisure activities I like to do yoga every day so that falls under my leisure um and then social participation participating in Social you know social settings social interactions so these are all our occupations um contexts are environmental and personal factors and they help to shape our values so environmental factors are aspects of the physical social and attitudinal surroundings in which people conduct their lives so we consider physical geography population technology for personal use or for employment cultural spiritual activities families friends social norms as a part of as a part of the environment and things that we do within the environment um and then personal factors what make up an individual’s background they’re not part of a health condition so for example I’m a male I’m in my 40s and I was raised with my three siblings in a Jewish household so those would be my personal factors that make up me as a person performance patterns um are our habits so for example many people will say they have to have coffee before anything else in the morning so that’s going to be your habits um our um routine so your morning routine so your morning routine may start with coffee before anything else but then what else do you do in your morning routine before you go to work so most people have a routine that they follow um rolls so you may be a parent a sibling an employee so those are the roles that you participate in and rituals so um and I know that Camille’s husband would not do this but how many of you all for a ritual engaged in shopping on Black Friday right Black Friday shopping it’s a national holiday it’s a ritual that we all follow so that’s going to be so that’s a ritual um performance skills Encompass motor skills but sometimes when people think about OT that’s the first thing we’re going to think about is working on um so Sherry just said thank goodness for online shopping um so with the motor skills when people traditionally think about OTS they sometimes immediately will think about those motor skills so gripping stabilizing manipulating moving an objects from one from point A to point B but we also have process skills so being able to attend to something like being able to attend to a lecture you all are attending to this presentation you all are attending to my presentation about the framework right now um inquiring so asking questions to gain more information um initiation so being able to initiate start to start a task so um some you know sometimes you’re an individual who may have had your traumatic brain injury or they may have intellectual disability or something like that they may have trouble initiating um in a work setting so they may need somebody to cue them that’s time to start working or time to start working doing a task in school or something like that and then sequencing so as I mentioned before um you know I grew I grew up in the you know Jewish household under a Jewish mother I know how to do laundry I know every step it takes to do laundry I know how to sort it I know how to load it into the washer add the detergent Etc and I’ve learned that if you do and I learned from my mother if you do it any other way that’s wrong in her eyes but again sequencing is following those steps to complete a task and then social interaction skills so this may be initiating interaction so thinking about how to appropriately initiate that interaction so maybe in a classroom you’re going to talk quietly to someone to get their attention versus Screaming to them to get their attention but on the same note shouting to get friends attention on the playground may be appropriate um turning towards a social partner when they’re talking to you so knowing that somebody’s talking to you and turning to them to engage them continuing a conversation by replying appropriately um and then taking turns her attainment about order so and then so those are our performance skills and then lastly you have client factors which are your values beliefs and spirituality so being honest to self and others is a value that a lot of us have um body functions fall under this so think about your mental function such as like attention memory perception emotion sense and then sensory functions like Vision hearing but also as Camille mentioned earlier in her reception understanding what’s going on inside of us um and then lastly body structures falling through this and when I say body structure that’s like your skeletal system your nervous system so that’s what we think about so that’s the domain so now within the process we have evaluation intervention and outcomes so this is really kind of what we’re doing as a part of our treatment so the evaluation we screen the client if needed develop the occupational profile which we which we usually will can have all the information about the client in there um it considers the domains I just mentioned analyze the client’s occupational performance through the use of standardized non-standardized assessments observation and interviews and we then synthesize the evaluation results and to determine the overall impact of the client’s issues on occupational performance so kind of figuring out like what we need to do then the intervention um we’re going to develop an intervention plan including client goals select a method for Service delivery and framework a theoretical framework which we’re going to talk about personal environment occupation in a minute um and then we’re going to implement and review the intervention to determine the effectiveness and then um after we’re doing the intervention for a while we look at outcomes and the outcomes evaluate change and occupational participation and to determine next steps so are we going to transition them to a new level of care of service or maybe we’re going to discontinue the service so that is so really that nutshells the domain and process of Occupational Therapy when we talk about that the clients of OT are typically typically classifies persons the patient as well as caregivers groups um and then populations so again you have individual you have a group so those of us participating right now would be considered to be a group and that population is kind of like the overall so maybe people who work in mental and Behavioral Health throughout the state of Kentucky would be more of our population so when we think when we want to think about that so and just and just to give some um and then just to give some background for like thinking about how an OT would plan um for that like if we’re thinking about like self-regulation as an intervention and OT could plan um for a person a client they may have a client participate in a fabricated sensory environment or sensory diet um through a movement tactile sense Sensations to promote alertness before engaging in school so that may be at a level for a person a group an OT May instruct a classroom teacher to implement mindfulness techniques um visual imagery rhythmic breathing at the beginning of the day to enhance participation in Student Activities at the population level a practitioner consults with businesses and Community sites to establish sensory friendly environments for people with sensory processing so for example um like things I think about here autism friendly Days at the movie theater where families can watch a movie with the lights on and the sound is turned down so you don’t have that loud sound that’s happening so kids so individuals are on Spectrum can enjoy a movie without it being a very toxic environment for them okay on the next slide we will begin to look at theoretical model known as person environment occupation or you’re going to hear me talk about peo a lot when I say this all right so wow okay got framework framework’s done we understand what OT does now so p o um is a model that was developed by Mary Law and her team um in 1996 they’re actually Canadian occupational therapists um but this works this works really really really well um so it describes the dynamic relationships that occur when people engage in occupations within given environments over time so the person you know it’s considered to be a composite of Mind bodies and spirit the environment is the context where occupational performance takes place so like the classroom kitchen the home grocery store wherever uh and the uh in the occupation is a cluster of tasks and activities in which people engage while carrying out various roles in multiple rooms uh so what you want to do is um look at the look at the Venn diagram um we want to do is look at the Venn diagram on the screen and you’ll notice that this is kind of like a lifespan approach you know the person environment occupation come together to form a Venn diagram making occupational performance and at the um which is the dark blue in the center so and depending on where you are in live your occupational performance may be great which you know looking at the first Venn diagram or it may be related to the second Venn diagram it’s not so great for that person so a way I like to think about this is let’s consider a little guy named John um John is is eight he attends Hebrew school he attends you know after he goes to school after school he tends Hebrew school he also plays on Little League he’s able to participate in all of his occupations so right now at this point in time he would match that first Venn diagram so his occupational performances is going really well now John was diagnosed with leukemia so he’s undergoing chemotherapy which leaves him feeling tired and sick he’s not able to give his full attention to school work due to fatigue and his grades have slipped he also had to stop playing baseball and his attendance at Hebrew school sporadic dude with being late in the afternoons and he needs to rest at this time he also does not have good perception of the cells due to his illness so he’s lost his hair due to the chemotherapy um and he just he just doesn’t feel good you know people going through chemotherapy a lot of times get very sick they just don’t feel good so at this point in time you know his occupational performance would match that second diagram so it’s very poor right right now um so it’s now a year later so let’s go to the third diagram he’s and he’s finished chemotherapy he’s participating better in school and has supports in place to kind of help kind of help you know catch him up um but he still needs to take rest breaks and it and but not as often now the chemotherapy caused him to experience some neuropathy so he kind of has some numbness in his hand so that’s causing some motor issues and he’s a year behind his peers in Hebrew school because he had to redo that year in Hebrew school so his occupational performance has improved at this point but it’s still not where it was re-diagnosis so another another example that we can think about is you know just really quick um I was telling Camille about this the other day uh my AC went out my house so I have a unit that operates my second floor of my home and so it went out so those of you who have houses with the second floor you know that second floor during the summer can get very hot so for four days it took four days for the HVAC crew to get out to my house to fix it so for four days I’m sleeping in a very hot bedroom uh my occupational performance was not great because I have like you know there’s lights coming in from outside I normally have the shades down um I had to have a fan running which was making a lot more noise and it’s just temperature wise so basically it was out of my normal right now so didn’t sleep well for those four days which therefore impacted my occupational performance at work because I was irritable I was Moody I was tired so you know that’s they’re little things like that that can happen to us during the day to cause your occupational performance to be pretty lousy or other things to happen that could be pretty great so I you know I’m happy to say now that that’s been taken care of and you know the second floor my house is 72 degrees you know my occupational performance is great today you know I’m here I’m presenting I’m smiling so we’re doing pretty good so what I’d like for you all to do is think about a time when your occupational performance was fantastic so what oh we we’ve got we’ve got the we’ve got the um we’ve got the goblin by speeding us ahead again um the on the unknown Goblin um that’s what we call them here but anyway so think about your occupational performance what may a fantastic um consider like yourself as a person during this time your environment and your occupational performance like how did they all work together to make it fantastic so and then in contrast think about a time when your occupational performance was not so great so considering those three aspects person environment and occupation what inhibited your occupational performance so if anyone wants to share want to share a time when things were great for them and why and things weren’t so great for them and why you know we can do we can you know we can do that oh all right looks like we are at our first break one more so so one more okay all right perfect oh there we go so lastly and then you can take this into break with you to get to our break um think back to that client you considered a few minutes ago um and using the peo model that I just talked about what might be challenging to your client so what personal aspects might be challenging what environmental aspects may be challenging what occupational aspects may be challenging so for example um as a person maybe your client has ADHD and finds it difficult to attend the tasks maybe it’s schizophrenia and hearing voices um is causing difficulty to engage in appropriate conversation with co-workers um occupation that means maybe you need to be a student and sit for extended periods of time and your if your work requires sustained attention or Focus um you need to be able to read text you need to be able right fluently um the environment uh maybe you need to maybe the person needs to understand Norms or hidden curriculum of the school setting or the work environment uh maybe their settings may be over stimulating so again take a few minutes um to think about your client what might be challenging for them and actually what I think we could do with this um what if let’s go ahead because we are about break time let’s go ahead on to break so think about your client while we’re on break and then when we start back up after break we can take a quick minute to review that and then go and then continue on okay so while we’re on break um and you all were thinking about your client who who wants to give a quick example our quick or a quick thought about client that you were working with by the way I was looking at the chat as well and you all gave a lot of great examples of your own occupational performance when it was great when your occupational performance was slipping so I I read about autoimmune or about medications causing issues autoimmune immune disorder um so what about your clients too who has some thoughts about a client where their occupational performance may be challenging and what might be causing these challenges based on personal environment occupation um yeah this is Angela um I’ll just share again no longer working directly with clients but in in previous work uh as case management in a hospital setting um obviously a lot of times um when you know working with individuals that are um inpatient um I worked with the link to stay individuals so they were very complex individuals so not only did they have some some type of physical condition um but obviously there were barriers to discharge again and challenges for them to get to that next level of care and so it could be you know family it could be finances it could be a number of things and so it’s not really a specific I know client but again you know that often led to mental health issues and barriers and earns too and so again it was a you know very comprehensive challenges and needs that could be addressed absolutely absolutely and Samantha just mentioned depression causing clients not eat shower so again they’re ADLs activities of daily living the depression is causing problems with that um child with parents going through divorce and adjusting to new environments you know absolutely so you know divorce impacts everyone so this is you know could be very very very challenging so the environment may not be a good fit based on the child’s emotional state at that point in time absolutely excellent thanks Jody all right so from here we’re going to move on to Tanya yes um really happy to be here so just a real quick uh history about how where I’m at um and what I’ve done uh as far as the mental health world I’ve been in mental health OT working for the last 15 years with the first episode psychosis program and I was really lucky because when they started in Oregon I was able to when they it started in Central Oregon Bend Oregon where I’m from I was able to uh really like I had a lot of freedom in my role within the team it’s a very interdisciplinary team and through that process was able to take what I learned in school and talk to a couple other mental health OTS and help develop the program which then moved on to now for the last eight years I’ve been working on the state level doing program development policies trainings Field Works and or like uh sorry Fidelity reviews which is kind of like an audit and such so another rule of mine is also being an OT consultant both regionally and Nationwide and I also help businesses incorporate OT into their current business structure so just wanted to mention that um so going into my slides sorry let’s see oops sorry whenever I try to hit admit to the room it does something with other slides um so what I wanted to cover now that you have a lot of the history and a lot of understanding uh you know a dive into our framework where this comes from and why I wanted to start getting more specific about our role within the process of a mental health um clinic and then I’ll move forward and then talk more specifically about on the team so our work is already always collaborative with participants and it’s Guided by their definition of Wellness not what we think it is and so some of our specimens will really highlight that because you know they rate how meaning if they have a certain role they write how meaningful it is for them and what I might perceive as a meaningful task associated with a role it could be very different and so I’ve always you know I’ve had to go okay no problem you know I mean this is about what you want to work on and they’ve actually did a study where this comes up time and time again just in general with all with all treatment providers and mental health there was they did this extensive study and there was a big discrepancy between what the providers thought was wellness and how the participants described wellness and what they were looking for so we know that this is working with the transitional youth or 13 to 27 years old it’s just a huge transitional and identity time and one thing I want to mention about you know the OT work is some of our training within our graduate and doctorate programs it has a lot of generalist ideology that supports the foundation of our skills and we learn a lot about developmental milestone milestones and OT and also and then we practice how to view occupation from a health wellness and illness standpoint incorporating the developmental piece within that in fact many schools they have uh you know we do these rotations for on-the-job skill building and I can’t say all but many um because I don’t know for sure all but most of them that I know do a rotation in a school-based practice that is also on the job experience with working with things like IEPs and 504s helping support the school team to make accommodations and really trying to get the environment to feel more comfortable because what happens often when there is a you know a change in the how the sensory process is processing the world or a change with you know psychosis with the hallucinations delusions and you know um thinking a little bit differently is that there’s uh you know there’s just a lot that also is then added on to the fact that they’re in a very you know big transitional identity phase so we also prioritize prioritize what their roles are and what they’re interested in and or have to do and that could be anything from like Leisure Recreations spirituality volunteering caregiving education Community participation work so the way we move through this is we’ll start with an evaluation where we’ll do an occupational profile and an analysis of performance a lot of our assessments are very Hands-On and you know experiential and then also we do have the assessment format and clinical observation as we hold the discussion then we have the intervention the assessments implementation and then we will re-evaluate every three to six months depending on what the assessment is to make sure that we’re staying with the skills that are we need to build on and then of course there’s the outcomes and we have outcome measures evidence-based practice and our reflections so I just want to say again it’s whatever means Wellness to the participants and the family members that we work with I wanted to give a visual example I am now looking at the right and it looks so blurry to me but luckily I’ve typed it all the different categories on the left but this is a visual understanding of uh General OT process of Service delivery and the mental health context we start with a screening tool and it’s our first step to narrowing down what we’re working on and what I’ll have is I’ll have individuals rate if they have concerns maybe they have lots of satisfactory and strengths and that’s really important information to have let’s say there’s three in concerns then I’ll say if you can and you don’t need to be able to do you don’t need to do this but if you can is there an order of priority for you which is uh what is a bigger concern and what is a lesser concern and you know if they have three or five that really also helps me prioritize what their priorities are and so looking at all of these I do want to mention too this screening tool in our programs is used where either the screener the person doing the very initial assessment anyone on the team but this for the teams I work with here in Oregon this happens right away and it takes about five minutes you can either read it or you can hand it over depending on where the participant is at and we look at all of these through OT lens so it’s not just what it says necessarily sots these areas that we’ve brought up like for example thinking skills were assessing thinking skills from a perspective of it is there something cognitively going on is there something sensory going on or even percepts perhaps there’s something going on where this individual experience trauma and overwhelm and so their systems being overly overloaded step will also incorporating the clinical observation lots of past medical history client Family Support interviews and the assessments we then narrow it down even further so we utilize many different assessments as OTS this is just a brief introduction but our our assessments cover anything from life skills sensory processing of course anxiety stress how they influence the nervous system which then influences the sensory system and vice versa and then we also look at Praxis which would be deciding what your body has to do then doing it so it’s like a conceptualize what needs to be done a plan and then organizing like our motor functions that we call sensory motor and then visual perception ability to visually interpret the sounding or sounding surrounding environment which is why you’ll find OT sometimes doing drivers assessments for uh programs whether it’s physical health or Behavioral Health to figure out if we have these visual perceptual assessments that we do and on the job driving with training where you can see the safety of where someone’s at so you may be wondering um possibly so then when we gather all this information where does it go and it goes into what is the mental health OT assessment um I and this has all of the factors that any mental health any mental health assessment would have um in addition to the integration of the OT perspective so I wanted to give you a quick visual of what this looks like so you know we get some personal information here I’m gonna kind of go slow so you’re not struggling to read this these are just this is just a start you know we have different assistants we do also but I wanted to give love you know this this is for if we do these we can easily check it or we write it in if we’ve done something else and then we go down to what our recommendations are overall are we doing console only or individual therapy um I actually developed this it’s the mental status exam but I did it through uh uh OT lens um and it goes through what you know some of you might be familiar with but then there’s some additions in there that are definitely specific to OTs and by the way you have access to this if um in the PowerPoint if you wanted to take a closer look if I’m moving too quickly I don’t want to do that and happily please just let me know if I need to slow down um so then we bring in some of the collateral information if there was another behavioral assessment completed by the um the the you know like social work or you know the counselor we look at occupational functioning so these areas that we’ve discussed a little bit Josh did uh you know intro uh definition of all of these performance patterns is very big for us looking at habitual behaviors creating routine building things like Keystone habits taking the cognition out of it so that we set the home up for Success there’s a lot of environmental adaptations we do to make sure that you know just generally a lot of the folks we work with are feeling some sort of overwhelm generally and so the most we can do to help support routine in a way that it’s not feeling like Reinventing the wheel every day that it’s a process really helps quite a bit and then we have the assessment summary results where we would like type up a big report we definitely dive into the family systems review and a lot of this also lets us know and discern now are the sensory changes is it from trauma where or is it from you know it helps us figure out their Pathway to care you know and with psychosis the duration of untreated psychosis dup we are there in you know our work hopefully to identify folks as quickly as possible so the dop is less but if this gives information too about their Pathway to care sometimes that can be really challenging and they can be really lost or have negative experiences before they find us um looking at community life and then recommendations and plan um any referrals and there you have it um yeah both that all happened yeah so anyone anyone have any questions I don’t see any questions okay I’m going to move forward then okay okay go here yeah okay so now you know I kind of talked about mental health generally but now as an OT within the clinical team we support in a multitude of ways um of course we’re doing the individual therapy then we are a part of group facilitation whether it’s a multi-family group like family psycho education group or we’re doing groups that have to do with uh you know maybe trauma-informed yoga hiking art I noticed in the chat there was a recommendation of a book um and I just want to bring that up your brain on Art I’m thank you for that I’m really curious to to look at that you know we have to keep in mind that we all learn very differently and so also OTS with everything we do we offer it with different media whether we’re doing it verbal and actually I usually do it all I I offer it to a verbal written if we write it down I make a copy for myself and then sometimes with colors teaching how to use colors so that the information pops or even pictures depending again on where someone is at in their recovery with Family Support I’m you know working with families we might you know helping the families understand maybe some accommodations that need to take place in the home to help that environment feel more relaxing you know OTS really work with the nervous system quite a bit because of the overlay between we’ve got the sensory system which is the peripheral nervous system coming into the central nervous system and then we also have the autonomic nervous system which is like our fight flight and freeze they are very different but they influence each other so we’re always looking at how to create more Harmony and relaxation in a body and another piece is Consulting and collaborating with the OT areas to support the current treatment goals and this is making sure that we work with teams to help make sure that the OT elements of things like cognition what it might be impacting the social skills it’s not just about being comfortable with two people and then become becoming comfortable with four you know there’s it could be cognition it could be sensory issues and you know so we part of what we do with our assessments is to Zer to discern what’s what and with healing we also look at we can help support goals I’ve done it all the time where someone comes to me and says here are my goals what was there anything you would change or tweak and I would say oh okay yeah I have you checked on this and then we can make the goals to be even a better match and more reachable um so that we’re helping you know small successes are big successes right and you know I don’t even know maybe there’s another word for it um so you know small no every success is important so then you know collaborating with other systems there’s so much of that you know there’s so many other support Networks you know I mentioned the schools we do we do a lot I sit in I’ve sat in a lot of IEP 504 meetings and even in the classroom when it’s okay with a participant to sort of take a look at the room oh okay they’re kind of by the air fan and they have difficulties with verbal memory and that isn’t helping or the UV lights making a strange Buzz or they’re in the back and you know changing it to the front or they don’t like having people behind them so we move it to the back you know there’s all sorts of possibilities in a classroom you know other systems of course Juvenile Justice homeless youth you know other community agents and medical facilities and other Mental Health Systems of care the following diagram what you really could do here is draw a star um that points intersectionally to all of these for this presentation in particular because um we only have actually really a limit of my amount of time together today but you know I say a star because they all influence each other and you know again like I mentioned that’s what we’re here for to figure out what it is that’s influencing you know ADLs or ADLs and so social skills it could be not just about the sensory recognition part of it it could be about the formatter of the task or the task characteristics we take a deep look at that so these next slides are going to cover those four areas that I just had up up on that and this I’ll dive in a little bit more about assessment and intervention more specific to these areas and with intervention a lot of our treatment focuses on through doing so it’s occupation-based interventions so this first domain is adl’s idl’s just quick summary again ADLs or personal self-care you know getting ready for the day or sleeping at night intermixed with things during the day the idls are more of a complex set of skills to live independently you know as you can see preparing meals shopping taking medication safety accessing Community race resources finances so we make adjustments to the goals you know for level level of difficulty and then we also carry a role on teams to support discharge planning so I um had a youth that I worked with once and he wanted so badly to move out of his family’s home and get his own apartment well you know said okay but let’s take a look at what we you know what are some steps so that when you do do that you’re set up for success so we did an assessment that highlights these different ideal areas and it rates it to level of difficulty you know meets the needs of this skill or you know it kind of showed him what uh where some of his lagging skills were and his original goal is six months and on his own as we started to work through the different skills that he needed he readjusted it to 12 months and it was great for him and he did do it at 12 months but there was some there was so much knowledge and learning that he had through that process of things that he hadn’t thought about so I’m really grateful that we did that because otherwise he would have been possibly floundering in his own you know and it might have been unsafe and we’re also building supportive strategies from this informational this information that we gather here to not only enable um you know building in routines and uh you know kind of Habitual patterns but also how to sustain that and you know I kind of mentioned Keystone habits it’s it in reminding folks that like any new skill at first you have to use a lot of cognitive load and then you move towards where it’s more automatic we try to do that as much as possible with that daily routine and building in their goals of what they want to fit into that I really like this diagram because I so often and we all might have experienced this where we just don’t it’s like oh I’m man they want so badly to you know turn in these applications for school or start exercise whatever it is and we just is it lack of motivation is it a negative symptom of psychosis or depression or what’s going on and so in light of this this is a really nice visual um look at it’s like a structured guide really to look at some of these variables that go in occupational performance and we have both internal characteristics and external characteristics so what we you know our goal is to fill you know there’s unfortunately a lot of the folks when they come to us they might have had if you have a success bucket and you have a failure bucket like oh I didn’t do it again you know they might have been working with other providers that didn’t really know how to look at this or so the goals were too lofty or even for themselves to learn you know what it’s not that easy actually these are different things and I’ll walk through this chart with participants and say it’s a lot you know and in some of this is relearning it if you feel like uh you know you’ve maybe forgotten some of the tasks and you know some of the steps because it’s such an overwhelming time already and so it’s easy to be forgetful or kind of have challenges with your short-term memory make moving into long-term memory so this is about doing the best we can to set goals as close as possible to just a slight increment forward so that we fill that success bucket and filling a success bucket means that it’s there’s that I for whoever’s familiar internal um control uh internal locus of control versus external locus of control and research shows that if someone is feeling depressed or some of these other illnesses including any type of psychosis that they’re they’re more out in the external locus of control meaning what is sort of happening to them right this builds internal low focus of control and that leads to yourself you know confidence self efficacy which then the more you believe you can do it the more like you you are to take a risk and try something new and not only that do what you’re hoping to do so just briefly in case there’s any like huh I wonder what that is energy alertness is a responsiveness to the environment that can vary throughout the day so we’ll do a we’ll we’ll do diagrams where we help them map out the day where their Peak is capitalize on the peak and then where the lows are and what other tasks and skills would feel fit best there you know we’ve got cognition there’s you know the executive functioning cells and so an example of that is if someone has response inhibition which is the suppression of actions that are inappropriate in a given to context that interfere with goal-directed behavior so like if you have two kids working on something and one has very low response inhibition and one does not one might have trouble finishing the test and they’re distracted very easily and loses focus and then other may not have any trouble with focus at all and so you know in that case like we would work with how to help with that and and it’s nice when we do like our executive functioning assessments instead of someone going I just can’t do it I don’t know why and I don’t know why everybody around me can we can go it’s not just it’s not just all of it isn’t working now we can really narrow it down to this one thing we can work on that and it all of a sudden becomes really manageable then you’ve got you know emotion of course and then metacognition it’s awareness and understanding about one’s own thoughts so thinking about thinking thinking about our thinking motivation memory task characteristics could be like verbal versus written activity format could be number of steps versus like Hands-On you know fixing things um really works you know there’s some kids I have a dear friend who works in the design he does the elective design and he has so many kids that do really well in his class and then are known unfortunately as like Troublemaker so they don’t listen or they’re disruptive in the just hearing class but the Hands-On classes like art and Hands-On I mean we might even in this group have those feelings like oh yeah I am way better learning when I can when I use my hands and I’m more engaged so there’s that and then role requirements you know just certain roles require different ass different role requirements for Teacher different role requirements for uh maybe someone like a grandmother or a grandfather any questions about this chart okay so moving into cognition it’s come up a couple times as I’ve been speaking so I want to get a little bit more specific so we measure cognitive skills for everyday function you know again occupational performance and yes indeed it’s integral to all of our activities and our participation so we work with how we utilize and integrate you know our thinking and processing skills to bring that in to what we need to do or want to do and then we try to look at you know how are these accessed um and then these cognitive assessments and observation of function-based cognitive assessments give us gives us a lot of information so there’s a um I was doing some you know research study which I just love I love research it’s but it was out of Stanford and they put together some statistics about cognitive functioning in first episode psychosis programs so they found just to kind of explain this through 82 percent of individuals with schizophrenia 52 with affect psychosis they scored below 84 of healthy controls when starting the first episode psychosis treatment another study even showed 91 to 98 of the general populations scored higher than individuals starting a first episode um program now the added layer to this is then they looked at Insight is are you sensing you know what type of um you know change you’re experiencing and of that 82 percent 40 percent they didn’t have um whoops hi hi oh my goodness sorry they didn’t have the insight to understand it it was they really underestimated you know where they were at and that is something important for us to consider because that could lead to you know decreased safety or you know also it gives us a lot of information about what support might be needed and so that’s why you know cognitive assessments are really important for this population and of course there’s also uh you know it’s not just there’s different statistics that also go along with different other mental health illnesses so just to give an example of you know what I mean or you know a way that we can kind of work in a team a clinical environment with each other is I would perhaps work with the nurse on medication management and so I loved working on an interdisciplinary team and it’s really wonder if you can actually have an OT on the team because you’ll see through this presentation there’s so much that comes together with our other team members and helping to support the goals that they have as well as us and how that overlaps with each other so that the client feels like they’re really moving forward and it’s like uh you know it’s very strength based right towards wellness and recovery so we have an assessment called The Ellen cognitive and they give numbers which will show you where someone is at and there’s OT programs in my state where it is just procedure that the OT before an individual discharges they do a cognitive assessment sometimes the ACLS to make sure that they’re making an informed the decision of for the discharge planning and so I would work with a nursing on a team and so let’s say they got a 4.6 the numbers are like very specific 4.6 4.8 5.0 5.2 but 4.6 and we’re just like man you know we’ve got this pill reminder and you know here she is just not taking the medication regularly well we do this and we find out okay so actually they shouldn’t just only have weekly pill boxes you really also want them to have caregiver supervision or um you can hire in some Community as someone who just makes sure that the pills are taken daily and hopefully you have that in your communities but yes so that says they need caregiver supervision they can’t just go with once a week the other piece the 4.6 shows us is that they need ongoing support for psycho education for them and their families and um yeah and so we then you know we’ll take this this perspective to then our treatment ideas and it’s going to be number one we’re going to declutter uh the bathroom um from distractions we’ll work on building those Keystone habits so it’s less of a willpower and cognitive need that it’s like put the toothbrush you know you might have the sticky notes on the mirror take medication then you’ll have the toothbrush next to the med box side by side and then maybe one step further if their goal is also to walk around the block the shoes are right there by the sink so it’s just like oh yeah that’s right oh okay I’m gonna take my Med and oh my gosh yes of course and you’re more you know I’m going I’m that’s I’m gonna walk around the block so you um just keep practicing the patterns and the new lower supervision as you’re able to um you know looking at there’s generally about 12 General domains specific to first episode psychosis the most commonly observed deficits are with verbal memory so that’s if you’re sitting in a glass and the teacher says well everyone’s packing up their bags oh and by the way I want you to read pages four to twenty four for the next thing and write up a paragraph about it so when a combination would be that the teacher will then write it on a piece of paper and hand it to the participant as they leave the room processing speed again sometimes teacher stock really fast right at the end because they’re getting it in I’m saying teachers but you know it’s anything it’s talking to someone who you know people speak to each other with different rates of speed so we might have to slow it down and have a lot of breaks right then we look at executive functioning working memory and attention I there have been so many times that individuals have come into our mental health programs where they have a into in our Network where they come in with a misdiagnosis of ADHD when it is actually uh it’s cognitive or it’s sensory and so when we are seeing ADHD as a diagnoses will definitely look a little deeper at that and just try to see you know what level of where the nervous system is being overwhelmed and what what is causing that so the OTS in essence are you know we’re considering the area of personal factors of the individual um and I’m referring to what you saw with that peo model um the framework that we work um in our earlier discussion group that we work with so it’s about what we want is to smoothly progress occupational performance and that’s why it’s really important to know specifically which domain and what within that domain and also how it’s being influenced perhaps by these other domains so the next part is you know and I’m thinking about some of the comments in the chat is there are a few of you if not more um that have some experience with looking at sensory processing and modulation and sensory processing you know we just we wouldn’t you know I mean without it we wouldn’t know where we were in space or what we were doing I can’t even imagine you know I just don’t think I don’t know I mean there’s no I don’t you wouldn’t know what’s going on if you didn’t have sensory processing so it’s important for how we interpret and you know what we feel from the environment and what that does when it comes into our bodies and that will present both internally and also behaviorally so youth or young adults will get labeled saying oh they’re not paying attention but that individual is working so hard to pay attention and finish that test or listen to you in a crowded supermarket but there’s just so much that is happening that it’s it’s so so much of a struggle and they’re actually I don’t have this here but there are you can go on YouTube to uh you know you know saying visual or auditory sensitivity and put it on and when I have a longer time I actually have people try to hold conversations while this is in their ear and it’s so hard visual sensitivity as well so um so yeah what we you know our assessments we look at more specifically on like our Tendencies of what’s going on and then we will teach strategies that are both about um our self-regulation so how we regulate our nervous system and the homeostasis and Harmony in our bodies ourselves but also co-regulation how we do that with other people and not everybody’s the same and a huge mistake is people think that stress reduction strategies are the same as sensory and they’re very much not they the fibers overlap so again you’ve got the sensory fibers coming in all our you know our nerves into the central nervous system and up to our brains and so if someone is over regulating to anything sensory wise of these eight senses then um they’re over regulating so it’s like the gaps up here are really wide apart and too much information is coming through uh under regulating would be there’s lots of lots of little slaps and not enough information is getting through it’s kind of a nice visual of how that would look and just in case there’s any confusion um vestibular proprioceptive and interoceptive uh I know he you know we mentioned it earlier but just a little bit more vestibular is knowing like where your Center is in space um proprioception is your general body and space so I would like to just ask everyone just for a moment to close your eyes and so you really have to have your eyes closed for this so I hope it you don’t have to do it but I encourage it um but to do it right so close your eyes and then what you do is you raise your thumb up towards the ceiling or down towards the ground and you can even raise your hands up towards the ceiling down to the ground and then you can open your eyes was there anyone that didn’t know where their body was in space with their eyes closed that they didn’t know if their thumb was up or down or their arms were up or down if you didn’t feel that that would mean that proprioception would be an area then an OT could help support and work with you on but sometimes when there is changes um within our body with mental illness and psychosis and sensory processing that can get thrown off and with oh breaking five no problem um and then what we also have is the interoceptive sense and just a little bit deeper on that too is hungry or not you know your body knows when to um when it’s hot or cold or that’s not always the case actually and actually some of the medications can interfere a little bit with that interoceptive internal sense of what’s going on in our body it’s like a lot of those natural systems but yeah what’s going on in our body so following that we want to then we create a sensory profile and there’s specific assessments for this as well and it will let you know someone’s more like seeking the sensory stuff that they’re under regulating so they’re not getting enough and maybe that means that it’s hard to get once you sit on the couch it’s really you start circling the drain it’s really hard to get up you need more external accountability um avoiding is like oh that that’s bothersome and then sensory sensitivity is that’s bothersome but really triggering like you know um we talked about the dishwasher with the dishes uh but there’s just so many examples of what that would be so to help calm the system perhaps in a classroom we might add you know weight into a backpack that they just have on their lab so it just sort of looks like no big deal but that can really help have a direct response through the proprioceptive system to bring that they’re coming down and when I mentioned that the trauma you know trauma also influences our sensory system you really have to understand what’s going on for an individual with that by through the past medical history because you can actually do damage by not knowing that so if someone is tactile defensive and you’re approaching it only through a sensory processing lens and it’s from trauma then you’re going to do harm so they’re different right and that’s that’s where we come in to figure out what’s what and the next slide is a diagram that I would always bring to the schools to the IEP 504 meetings and we move we do have a bottom-up approach it’s not cognitive skills down it’s this is the foundation and you know the sensory processing is the foundation to shaping function and behavior and Learning and Development without that feeling comfortable or you know if you’re in discomfort or overwhelm that will move up the ladder all the way up to social skills and that individual will have less capacity for the cognitive skills that they might need for the daily living academic you know tasks so yeah it’s just you know it’s really important um and that can also affect balance you might have clients that need to you know run their fingers along the wall so that they don’t feel wobbly going pretty faster I ask I you know or gait changes a little bit so this is a really neat bottom up diagram to show how important the sensory Foundation is um for feeling you know peace and Harmony in your body and being able to do the things that you want to do and just one last piece that I’ll there’s one last slide that I’ll cover and then we’re going to take a break short break is this is a study that was done and that I have to look up This Acronym real quick it is the sensory motor arousal Treatment Institute and what they have here is yes indeed with a strategic program uh program uh for the participants that they worked with working on the sensory processing piece that individual was better able to identify basic needs that interceptive piece which also helps identify emotions where they’re feeling that in their body um better organization ability to express feelings even awareness like putting yourself in other people’s shoes which carries over into like what where someone else is at and kind of those non-verbal cues and and whatnot and empathy and also observing self right you know not being so confused and then the communication got better being able to express self problem solving being feeling engaged and not distracted and then also um just overall less stress distress there’s two studies I just want to mention quickly there’s one attachment in schizophrenia where they found that with schizophrenia the there’s the attachment Styles where you have avoidant attachment secure attachment or anxious attachment and the avoidant they found that more people with schizophrenia had predominantly avoidant attachment there’s another study called adult attachment sensory processing and distress and that showed that if someone had avoidant attachment by doing the sensory processing you can help them move more towards a secure attachment and also if you’re doing sensory strategies before and after your talk therapy there’s big benefits to this because they’re able to feel more comfortable inside so then internally so then they’re able to then open up more um feel less avoidant about opening up then and then there’s more carryover of the learning that happens um because of less fuzzy thinking and more of that cognitive organization so there’s more carryover over of learning from the sessions so when we’re working with our clients you know of course social social interaction skills would be important and this is again an area mentioned um it’s one of the domain in the domains um of the practice framework so things we need to think about with our clients or like their verbal skills so you know expressive communication so how appropriately we express to each other so not only would this be you know kind of the language that we use or considering the context where we are um with the you know the language that’s being used um for example you know my nephew you know hit my sister realized that you know he’s going to speak very politely to her at home but when he’s with his friends um at school walking the hallways at school he is just a very different language but um also just like how or expressive communication is so I mentioned earlier you know speak you know in classroom or like in a or in a building or somewhere like that you’re going to speak to someone you know a normal tone of voice and gain their attention where two kids on the playground May yell to get each other’s attention so how we’re using our expressive communication receptive is also important especially when dealing with some of our clients who you know they may have a lot going on I may go over and say you know hi Joe how are you doing today and the fees do you know currently um and get you know engaging with internal stimuli I.E he’s hearing voices or something like that he may not notice me right right away so I may have to provide some wait time to give him some time to process oh I just heard that somebody said somebody else said hi to me and realized oh there’s somebody standing in front of me or you know saying with you know an individual who’s on the Spectrum sometimes you know you need to give them some wait time you may also want to give them written instructions rather than verbal instructions because written instructions will stand still in time um so you know we sometimes need that to help support the receptive communication non-verbal you know communication is important as well so again I like to talk you know my nephew who is a teenager um we you know we can read them like a book because like most teenagers we know and he’s not happy with us you know based on his posture uh he’s tried he’s tried flipping the bird before that didn’t go over very well um you know with like a gesture but also like understanding a person’s like physical distance like so someone who’s very avoid and very anxious may have like keep a pretty far distance from you but somebody who um is bipolar and they’re experiencing manic episode they may get in your face so they make it very close to you so understanding like physical distance and boundaries are they making eye contact you know negative symptoms you’re not going to see a lot of eye contact um why does their facial expression like so you again these are just all things that you want to consider when working with um with your client and also the context so where are we so are you talking to a friend so again my nephew is going his his language is going to be a lot different when he’s talking to friends than when he’s maybe talking to myself his uncle or his my sister his parent a teacher somewhere at the store so that so that’s just kind of in a nutshell things that we’re going to consider when looking at those interaction skills um next slide and with these social interaction skills we’re going to look at the social participation so um you know as OT practitioners we ask you know what aspects of psychosis influence social functioning so again cognition um how does the cut how do their issues with cognition interfere with that everyday functioning sensory processing and Tanya did a great job talking about sensation to you all and we’re actually going to do a little activity with that in a few minutes but like what is what Sensations drive us to do what it is that we’re doing versus what what kind of put what do we push away because we don’t like as well um motor function and you know for example some individuals who may have been taking a lot of medication you know they may have dystonia or dystonic movements from their medication that may cause problems with their motor function um self and situational awareness so again just what’s going on with themselves so we’ve talked about their habits roles and routines already um but also like they’re positive and negative symptoms so again negative symptoms you’re not going to get as much response out of that person where positive symptoms if they’re having a delusion um or yeah other types of psychosis you know may cause issues as well and that’s going to cause it that could cause issues like the negative symptoms can cause problems with ADLs your hygiene or feeding yourselves you know where a person who is having a delusion um or they may and they may be in the manic episode they may drain their bank account which is going to cause problems with their instrumental activities of daily living what does improved social skills mean for an OT practitioner what does this mean for us well it means um so you know it means that you know we want to manage Stress and Anxiety we want to increase their ability to voluntarily do activities um we want them to engage in Recreation work school um so and we really we want to help them develop their overall competence in daily life okay so let’s go on to the next slide and one other one thing that we’re really skilled at is occupational therapists is um activity analysis so we’re really good at breaking down all of the activities that individual does to help them become functional so with this you know we’re going to look at you know what we need how we’re going to instruct this so do we need to give verbal instructions pictures Etc level of cues needed for successful performance so do you need verbal cues do you need gestural cues again you need picture cubes something like that sequencing so following those steps and how long it takes to follow those steps so putting on a t-shirt should take about a minute at the most not an hour so for someone who’s trying to figure out how to put that on um the physical properties that’s being used um so for you know thinking about like the you know the environment so like sitting at it sitting with a laptop typing at a table versus sitting on a couch typing on a laptop um you’re the so we’re going to look at the motor skills such as strength and manipulation and then lastly adaptations for the task so upgrading and downgrading OT has this great term the just right Challenge and we want to make sure that our client is engaged in the just right challenge so we’re going to adapt the tasks to fit therapy okay all right so I have an activity that we’re going to take a couple minutes to do in your hand in your packet you’re going to see um some sensory diet sheets and as as I mentioned before um and Tanya had mentioned as well the sensory activities that we do drive you know they drive us throughout the day so what I want you all to do is go into these sheets um and take at the most about two minutes so we’re going we’re going we’re going to speed date the sensory processing um activity so take about two minutes and look through here and kind of just check for yourself what do what are things that you like to do what you know what are things that are good like for example um you know under different types of touch or temperature I’ll be the first to say I do not like hot beverages I don’t like you know hot coffee I don’t like hot chocolate I prefer a cold energy drink so that’s like a sensory thing that’s important to me so think about what are things that you prefer so take about two minutes and then share some things and then we’ll take some a minute to share some time to um that stick out to you all right we got the drink hot coffee in the AM what else drives us heavy blankets to sleep and watch movies I love these responses are from two OTS already petting my fur babies bass at night after gardening all day heavy working crunching food so we’re getting all the OTs hahaha what else are a rowing machine that’s a lot of heavy work farming working with animals fidget toys okay so again these are all things that we do to help keep ourselves organized throughout the day so you all can go ahead you can keep these for your own reference um one thing that I do want to point out with these sheets though um while while Tanya’s okay with sharing her document these are sheets that probably should not be shared with your clients unless you’re directly connected with an OT you can kind of help guide this so so these sheets are you being used more for the purpose of today the educational activities that we’re doing today all right and next slide all right so we’ve got case study that I will quickly work through just to move on and because of time so we’re thinking about and we’re thinking about peo and we’re thinking about individuals who are experiencing like a fir you know first psychosis or for you know or like a mental health type issue so a lot of times when people think about OT they tend to think about you know physical issues so here’s something though that’s kind of combines your physical issues with um with the mental health so we have Joe he’s 25 years old he’s a college graduate and Prides himself on being very healthy he works out daily and he’s running around his bicycle he’s completed an ironing um one morning while he was out on a bike ride he was hit by a car when the driver fell asleep behind the wheel he now has a complete spinal cord injury at the C5 level so the C5 level basically what that means is he really he has head neck movement and he can shrug his shoulders he doesn’t have much movement below that maybe some bicep movement but otherwise that’s about it so he does not have a lot of movement left he’s an inpatient Rehabilitation and he presents with flat affect he avoids all activity so we’ve got we’ve got depression anxiety here he attempts to refuse Therapy Services and states that he wishes he does not survive the accident so using po um person environment occupation you know we want to consider uh emotional regulation for him acceptance of his new body because he has a new body you know his body is not working the way it used to education on work Leisure and what that’s going to look like for him education on routine surrounding new um ADL so new activities of daily living and care for his wheelchair and also he’s he’s got a lot of new members of his team now they may not have had before so building relationships with the new members of this team so again he’s had preferred occupations and they’ve changed because he can’t complete Ironman competition so ultimately you know he’s not having a good fit between person environment occupation which is leading to his occupational issues with occupational performance right now so again you know we really want to work on the acceptance of his new body and appreciating like developing new leisure activities and new and new work skills so that’s where we kind of go from the physical component to the more social emotional mental health type component here too um so okay so all right so that’s pretty much like again a physical disability uh case that we would work through at this point in time all right next slide all right that’s me and I’m just gonna briefly talk about Malia because this is a homelessness case and just for you to be aware that Melia presents with anxiety she shall she isolates socially isolates she has difficulty processing sensory information and so that she can successfully respond and Tanya and Josh have both gone over situations like this so we would work on sensory and emotional regulations developing roles and routines that support her occupational success building those trusting relationships so that in every environment she’s at she can trust because she has been under trauma and so we would use a trauma-informed care approach with Malia and address those issues to help her be more successful so I’m wondering if some of your clients present like Malia all right you can switch to the next slide thanks Camille thanks Josh so for sake of time because we want to make sure that we have enough time at the end to answer questions and um just even talk through anything that comes to mind this won’t be a group activity today but I do want to sorry I’m trying to find oh where is Jonathan oh here down here okay so can you see Jonathan on my page only the slide group activity let’s get to know Jonathan but they have Jonathan their handouts there we go so this case study here is gives a little bit of discussion about what um you know if we were to meet somebody and um what are the different things we’re thinking about and so the the group exercise would have been like doing a breakout and then going through and writing uh what you think is it cognitive what do you think is a sensory a social skill or ADL IDL and so if you were looking at this I’ll be real quick but um you know him presenting in the same hooded sweatshirt and sweatpants could be um not brushing his teeth could be tactile sensitivity or taste sensitivity and that’s why it’s not changing and that’s what he likes if he is now um you know gets upset really easily again uh blows up that could be sensory and we do that with parents just to also let them know what their profile is and how it’s different from their kids another or supports another thing is he needs is he needs his appointments written down you know where that’s the cognitive part of it and also you know the changes in his social structure so um you know and you’ll see in here misinterpreting instructions that could be executive functioning so for fun since we’re not going to do this all as a group I highly recommend if you could just take a moment and read through it just to kind of integrate the information we gave today we certainly don’t want to keep anyone late of just like little C or an S for social or uh you know SP you know for um sensory processing and idl’s ADLs just to just to see how all of this comes together in the diagrams that we’ve been working on all right all right so this comes back to me so for interventions that occupational therapy practitioners would use the choosing wisely is a evidence-based intervention approach so we’re suggesting that occupational therapy practitioners use evidence strong evidence to make choices to have the best outcomes Tanya’s talked to you about sensory processing and Tanya and Josh have given you ideas about environmental adaptations that we would be making to decrease the effort on the part of the individual so they can be more successful so those are things that we want to consider all right if you can go to the next slide please so when we think about making occupational therapy work for you Tanya showed you an occupational screening tool and we suggest strongly that you identify individuals screen them and then decide who needs the next step who could benefit and where are their occupations that that are interfered with what do they need to do want to do and are expected to do and when can they not do that if you feel that one of your clients is not participating for any reason please screen and refer having someone as an occupational therapy practitioner in your program directly connected would allow you to discuss individual clients and program needs and Tanya talked about this some already you could request staff client caregiver education there may be opportunities to have group therapy as Tanya talked about that are beneficial to the clients sometimes role modeling teaches stronger if a peer does something than a therapist or an adult telling them to do things overall occupational therapies have clients best interests as their focus and we will work with them to ensure a successful engagement in their occupations and as Tanya spoke about we have to work as a team as this slide projects that as a team we will have more success so we need to be able to talk about what our clients need how can they benefit from the services that we can provide an occupational therapists can help the whole team understand their role and what we can contribute so those are things to consider okay Tanya so if we go back to the client that you originally thought about two hours ago and we look at how do you think that client could benefit from a skilled occupational therapy service we can combine the Rutgers Wellness model on the bottom right here with the specific occupational therapy focused circles on the left that Tanya talked about and we’re looking at addressing iadl sensory processing ADLs cognition and social skills I hope you have a much better idea of how much cognition is the foundation and the base for individuals understanding how to be successful in contributing to their communities and being successful in life so and also I want you to imagine on the top right the peo model that Josh talked about so as occupational therapists and you also look at the person in the environment and the occupation how we can help so the client is more successful in participating okay go ahead Josh you’re still muted oh whoops so gang um OT is here to help as you’ve learned you know just from us today we want to help we want to be there with you all so we’re a very collaborative profession and we want to help you achieve your clients goals so there’s multiple ways that we can work together um one ways to do a consultation model in this type of model and OT would be available to you to answer questions and to help you problem solve through a challenging scenario and help you achieve the best possible outcome for your client for some individuals with milder needs a couple of consultation sessions can meet their can meet their needs for clients who have more persistent needs direct OT Services is the way to go by utilizing an OT in this capacity the OT becomes a part of the team and works with the client on a consistent basis helping them to engage in your life activities and Reporting the progress back to the treatment team a client may work with both types of Occupational Therapy practitioners for example in OT an occupational therapist May conduct the initial evaluation however they may then work some of their interventions with an occupational therapy assistant who works under the supervision of the occupational therapist regardless both individual we’ll see occupational therapist in the occupational therapy assistant our licensed professionals skilled in promoting participation in life um so I want to also we want to talk about like seat really Hill and CPT codes just really fast so for CPT codes you know we would use like OT evaluation for like low complexity moderate complexity and high complexity um therapeutic activities that focus on cognitive functioning so direct ones direct 101 um uh patient you know direct 101 service therapeutic activities um you know group therapy self-care and home management training um this is kind of what you would see here in Kentucky but there are 18 states that have explicit regulatory language identifying OT practitioners as a part of the behavioral health Team and so there are several codes I’m not you know it’s a bunch of numbers I’d be reading off but basically there are several codes that they can use related to psychotherapy that’s a part of this as well when they’re billing so which kind of gets more Behavioral Health side of things also um and as mentioned before after an occupational therapist completes an evaluation on the client which also includes construction of the occupational profile collaborative goals are created then embedded into the client’s intervention plan the intervention plan will take all aspects of the client’s environment and daily occupations um into consideration create outcomes that allow them to be successful for example a client who becomes overwhelmed when they experience too much sensory input may also have the goal of independently shopping for groceries rather than relying on assistance of the family this intervention plan may include desensitive desensitization strategies such as depressure coping strategies such as pausing to take a couple deep breaths and positive self-talk and also working with the client to identify times of the day that would be easier to grocery shop for example nine nine o’clock in the morning on a Wednesday might be easier to do grocery shopping versus going at two o’clock in the afternoon on Sunday um I’ll be the first to admit I avoid the grocery store on Sundays Sundays are a little crazy at the grocery store um in addition the client in the OT may work together to map out the grocery store so the client can learn how to navigate and access their items in a more timely manner the otn client may also role play to you know how to interact with the cashier for example greeting making small talk Etc and the and it’s also important to note that the intervention plan is fluid and um evolves based on the client’s needs which would again help too after all this is said done help to promote the occupational performance which you see by the peo diagram being Revisited all right so as you see on this slide these are the eight set I hope centers in Kentucky that you’re all very well aware of in the blue are the contact person and in the red is the occupational therapist that has been identified as the contact person for that facility you can see at the bottom Cumberland River and New Vista do not have an occupational therapist contact or that’s already been identified to assist in their program so Allison Paul Perry and I are meeting with Cumberland River and New Vista to help them connect to an occupational therapy practitioner we’re also going to be working on billing and working to help you secure Occupational Therapy Services or answer your questions and I know that several of you have made contact with OTS but might not be offering the service to your clients yet so we are here to assist you with that process to help you understand what needs to be done and how to do it so that you can be successful and your clients ultimately are able to perform their occupations and contribute to the community and feel good about themselves to increase that self-esteem and self-worth which is really key so if you’d go to the next slide Tanya so when we started today we had several different objectives for you I am hoping that you understand the role of occupational therapy and especially with first episode psychosis so if you want to put in the chat what you learned about the role of Occupational Therapy we’d love to see it what’s your plan to work with an occupational therapist to help practitioner to help your clients be successful in occupational performance and what will you do to refer to occupational therapy what areas are you going to refer for and as Sally’s commenting I’m seeing that yes in Oregon for example Tanya can build under Psychotherapy codes because she is identified as a qualified mental health professional we are working on that in Kentucky right now we’re not able to provide the Behavioral Health billing codes but we can build underneath physical disability code so as Josh mentioned therapeutic activities self-care weak sensory processing we can build underneath all of those services to provide Occupational Therapy Services to your clients foreign does anybody have any ideas how they’re going to work with their occupational therapist now that you have more information about what we can offer your team and your clients Catherine another question not to you what do you think about sensory processing can you pick some of your clients that have sensory processing issues that become overwhelmed and overly responsive and shut down just like Malia did I like that Christy put OTS cover more life areas than I realized yes so I hope that you have us work with your clients on instrumental and basic ADLs Sherry says more assessments now having access to these tools Josh says yes Christy we look at the entire lifespan absolutely and the entire life what as Joshua Tanya said everything we do throughout the day is an occupation so can the clients participate in that we’re also available for questions the rest of this period is for questions to see what you need how can we provide more services to Allison Paul Perry so that we can assist you to secure OT I know we provided a lot of information for you so that there’s a lot going on in this presentation but you can see what the role in these word wall is right here of what occupational therapists can provide for your clients we also included the references and the question is what is your next step what will you do at your facility you have a half hour an hour left of today you have all day tomorrow what’s your action plan does anybody want to share okay so they’re asking Bertrand is asking about Aba we all have opinions of Aba and I think it depends on what the client needs ABA does not always take into consideration sensory processing needs of the individual and it’s much more a reinforcement for a behavior or an action so it depends what your client presents with if they would benefit from ABA or would they benefit differently from occupational therapy as we’re going to work on what Tanya presented that triangle and to looking at sensory processing as a foundation and addressing sensory processing so they can have higher level skills because ABA is coming in at a cognitive level and falling directions and again producing a behavior so it depends what your client is presenting and I don’t know if Tanya or Josh you want to add anything to that um part of one of the things I did in the state of Oregon was work with all the different Mental Health clinics in helping the cross system care delivery between intellectual developmental disabilities and first episode psychosis so this question it really applies because um what you know there could be um collaboration if someone is doing ABA of also understanding that different symptoms are recognized as Behavior I mean behavior is communication and unfortunately for our youth I see another comment about you know a child with sensory processing difficulties and another professional saying they’re non-compliant that happens a lot you know all that sort of um the the language terminology like non-compliant resistant to therapy lazy um uh confrontational all of these things if you know what we have really is a behavior showing up to communicate that something isn’t right and honestly that they need help and so yes ABA is great also you know if I’m working with someone and they might have some sort of you know developmental disability that’s in my program I then use a lot of Behavioral analysis to understand what the symptoms are um in being expressed that way so I once you start looking through like that like sensory like what we’re actually really asking like that skilled performance diagram and you start breaking that down with a youth who is being told by other professionals that they’re um they’re yeah that they’re not compliant or resistant all that then you start to actually figure out then you have a lot more compassion and empathy for wow they’re really struggling and us as providers aren’t getting it so we need to take that take the responsibility within us to do better ask different questions re-go back to the drawing board use your team for support and oh yeah so I hope that that answered the question and I want to add to what Tanya said just quickly tell you that I have never found many non-compliant individuals what we do is work to figure out what’s meaningful and purposeful to them and that’s how we approach the interventions so when they feel that they’re valued the client and we’re using things that they enjoy we tend to find much better performance and engagement than possibly again doing a behavior with a behavioral analysis and I know Sally asked about the APA not including sensory processing in the DSM there’s there’s a lot of evidence that has studied sensory processing and is found to be effective as an intervention to address sensory needs so APA often wants a certain level of evidence and they want randomized control trials and many health issues where not uh the randomized control trials systematic reviews do not lend themselves to research well so we run into a little bit of a problem but funding agencies do reimburse for sensory processing issues we have got to do a better job of describing them so that we can get reimbursement and service our clients sorry Tanya you were going to say something no I mean you know I look at the DSM-5 and they’re forget what the diagnosis is it’s one that people use all the time with sensory processing because it is a huge area of intervention for Pediatrics for adults um adult you know sensory processing adolescent sensory pressing I would hope that the next DSM is going to change you know a few things actually like even the definition of trauma in the DSM sort of lists what should be considered traumatic but they’ve completely left out the whole fact that if you what you experience s trauma is trauma it’s the experience whether or not you can you know figure out the why it happened or why someone behave that way the trauma is the experience and so I’m really hoping that they um they you know instead of just broadening definitions that they really go back and understand that um these exist they didn’t even they turned down even like developmental trauma um in their last review so I’m hoping for greater changes in the next one and there’s just enough research out there quite honestly that you would absolutely it would absolutely support a sensory processing DSM number I agree there’s a question also about an organizational level and I need to clarify that because um Christy do you mean from what Tanya offers to organizations or because Josh and I represent the Kentucky Occupational Therapy Association as an organization so it depends what you’re asking for to follow up to talk about more of the organizational level oh there you go Tanya she’s saying yes she wants it from your perspective uh and specifically the from the organizational what’s the what’s the question you said that you you do this work I don’t know if you said for workplaces um I I just heard like an organizational level so I wasn’t sure what that looked like yes yes so I bill in my state I bill all the behavioral health codes so I’m billing mental health assessment individual Psychotherapy group therapy virtual therapy you know all of the ones that are in Behavioral Health and there it just is you know in like 18 states it just is the way and Kentucky is taking big steps to move into that direction that’s why sometimes they the ccos um and other organizations will then they’ll make exceptions because they know OTS need to be in Behavioral Health and they will allow the physical health code for example of OT assessment or OT therapeutic activity you know some of those other ones um self-care you know 97535 they’ll allow that um on the grand uh it what else could I add to that about the organizational level well I know that you consult with the I hope program so Allison Paul Perry can also connect you with each of the centers as my guest correct yes yes and I do a lot of trainings uh like I said working with a number of different states that they they’re they know the change is going to happen where their state is moving towards becoming a qmhp and so they actually have me already helping to train OTS that are out of school that want to do the first episode work or you know maybe work in a trauma facility Eating Disorders um OTS you know really they do a lot like even pelvic floor therapy OTS because of the training we have I mean we do Anatomy physiology all we do all the site classes like half of my training the other half is like science and learning the body systems I mean you know literally like Anatomy um you know and and so it’s the nervous system how cells interact you know synapses so we have that neurologically based understanding of the body the physical health the physical movement based understanding as well as the emotional um the behavioral health piece and for example my Inpatient Rehab Department here at the call at the um Hospital the psychiatrist just for the psychologist just left and they’re hiring um they’ve got a their uh the position description they’re looking for an OT because the OT can then work in Inpatient Rehab for people who just who had an injury but then they’re going to be there for the mental health piece of recovering after an injury and the impact on life roles habits routines um in you know daily living and all of that so thank you Tanya I was going to ask people what would help you use your occupational therapy practitioner more effectively what would you still like to learn more that we can provide to Allison so you have those resources this is Christy again um so Allison is is the liaison to the first episode cycle uh um psychosis um staff at the cmhcs I’m the liaison to to the crisis staff at the cmhc so I’m thinking about this from you know the perspective of you know individuals in crisis and and trying to make those connections of how OT um so I guess any guidance around that um could be appreciated thanks all right Christy we can occupational therapist Ken Bill and cmhcs so there’s no reason that we couldn’t connect you clearly to an occupational therapy or a practice in your area and if you want to let I I will put my email in the chat if anybody wants to contact me and then I will work on finding an OT or connection for you or if there’s another topic that you want but I think connecting you to people in your community would really helpful to start also um I can uh speak a little bit to Angela’s question um Psychotherapy is defined in OT so yes it’s it’s not the role of Behavioral Health therapists we’re considered a mental health OT because we have a different lens to approach we’re looking at different things like sensory processing cognition they it above and beyond I mean sensory processing we gave a few slides is a huge area to study and learn huge and so um and so we’re just known as Mental Health Occupational therapists on teams when they have trouble filling positions or whatnot or they just are seeking the the position descriptions in a lot of our Mental Health Net Network they sometimes OTS will step in and be in the screening role sometimes they will be the supervisor of the program I know a couple OT is doing that now and sometimes they um and then they bill all the behavioral health codes like a behavioral health counselor therapist but we’re doing it through our lens so an example is looking at the model of human occupation when I’m writing about the cognitive behavioral therapy that I did in session and it’s referred to the framework of what my profession has taught me you know I I just love it because it brings in the possibility of it so much more of a bottom-up approach oftentimes sometimes we can work with folks with more of a talk therapy lens and but that’s asking for that’s asking for top down so we sort of already incorporate like the somatic um cognitive you know uh and also with that interceptive piece understanding really helping to figure out when someone says I just feel anxious all the time and actually finding out when we do a lot of the sensory set oh you’re feeling anxiousness really at the same place is excited and then we start going through the areas where where someone might feel anxious and they realize it’s anxious and excited or it’s actually more excited you know and those subtleties that are happening within the body and we’re incredibly effective with um working with the I do a lot of trauma focused therapy and we’re incredibly effective with that because we can we work so much with like the you know polyvagal Theory and how that overlaps with the sensory processing of the body like polyvagal you know you’ve got the Vegas that’s more the parasympathetic and then you’ve got the um the system that connects and then gives messages up to the brain of what’s happening and that also helps participants understand a little bit more what’s perceived reality and what’s real actual reality right did I answer the question it does yes thank you and I guess again uh you know thinking through the lens does that again does the the role of the occupational therapist then help that individual understand um kind of what might trigger those feelings in different situations different scenarios outside of again that present situation so you know how do they cope and deal with that you know moving forward yes yes I always do a relapse prevention plan Wellness Plan stress reduction plan crisis plan um risk assessment all those are are part of my core documents thank you thank you Tanya I wanted to also answer Sally’s question about cognitive assessments and as Tanya talked about it earlier that we look at cognition and how it supports or interferes with occupational performance so Tanya mentioned the Allen cognitive levels which identifies a specific level of where the client can perform and how they can be successful based on their cognitive skills so how many step directions do they understand do they are they able to do new learning so there are several cognitive assessments it also depends on what was the cause that which one we would pick it was neurological if it was developmental we might have a different approach so we’d be glad to talk about a little bit more with you maybe through email or other things it depends on what the clientele is presenting as to you all had a wealth of questions and thank you Tanya put her email in also in the chat so you have that you’re welcome to follow up with me at least following this if you have more questions or if you want more assistance and as Christy pointed out there’s more programs than just I hope here so please let us know if we can assist you Josh and I volunteer for the Kentucky Occupational Therapy Association so we want you to understand more about occupational therapy and how it can benefit your clients and your workers too if you have a happy client you’ll have more likely have happy workers because the job is more satisfying too well thank you all so much for this amazing informative presentation we appreciate you thank you all so much [Music]
Dr. Camille Skubik-Peplaski, Dr. Josh Skuller & Tania Kneuer discuss the role of Occupational Therapy in Behavioral Health Services with an Emphasis on Coordinated Specialty Care Programming. This is the fifth video in our series of webinars on Early Interventions for First Episode Psychosis. This webinar series is a cooperative effort between the Kentucky Department of Behavioral Health, Intellectual and Developmental Disabilities, iHOPE, TAYLRD and MHA Kentucky.
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