Interactive Reasoning Fall 2017 Instructors Dr Guice Professor

Interactive Reasoning Fall 2017 Instructors: Dr. Guice, Professor Reeks, Dr. Steed

Interactive Reasoning August 22 Syllabus Review Fieldwork

Interactive Reasoning • http: //lsustudent. pbworks. com/w/page/19413085/Front. Page • http: //sahp. lsuhscshreveport. edu

Fieldwork--Level 1 Words of Wisdom • “You won’t know everything” • “Be flexible, even when it feels impossible” • “Good walking Shoes (Mizunos)” • “Don’t be so nervous. The therapists know you are level ones and are prepared to work with you. You know more that you think you actually do” • ”Be Confident” • “Never say ‘I don’t know’ when you are asked a question” • “wear good deodorant. You will get sweaty!”

• “Take initiative. Ask questions. Ask to do things. Let them know you want to learn” • “Day 1 -talk about your objectives, intervention, skills checklist, evaluation forms” • “Take any and all opportunities offered” • “be open to feedback from all employees” • “bring mints/gum for after lunch” • “Be aware of the primary population at that particular facility and research about that population

Interactive Reasoning August 30 Level I Processing

So…How was Day 1? • Tell us about you placement. Include the population and the primary diagnoses seen in your setting. Also include your environmental observations. • Tell us about Communicating with Field. Work Educator. • Questions • ****Reminder: Complete the Myers Brigs on-line testing

Interactive Reasoning September 5 Client Centered Practice Systems Theory Therapeutic Use of Self Learning Styles

REMINDER!!!!!! • Don’t forget to bring your Myers Briggs Results to class Thursday

Client Centered • What does this mean to you?

Client-Centered Care • From the OT Practice Framework (OTPF) • Approach to service that incorporates respect for the partnership with clients as active participants in therapy process. This approach emphasizes client’s knowledge and experience, strengths, capacity for choice, and overall autonomy (Boyt Schell et al. , 2014 a, p. 1230

Client-centered Practice • From the LSUHSC Shreveport OT Handbook • One of the core tenets of the occupational therapy profession is the belief that individuals are inherently motivated to participate in meaningful occupations. The role of therapist is seen as a facilitator empowering the client in selfdirected goal attainment. The therapeutic relationship consists of a phenomenological understanding of the client’s world-view, unconditional positive regard for the client as an individual, and a genuine presentation of self in the occupational therapy process (Posthuma, 1999; Rogers, 1961). • The fundamentals of client-centered practice are introduced during the second semester in Interactive Reasoning (OCCT 6519), and Therapeutic Occupations and Activities (OCCT 6535). Reinforcement and mastery of the client-centered practice concept occurs throughout the remainder of the curriculum.

Carl Rogers • https: //www. youtube. com/watch? v=i. Mi 7 u. Y 83 z-U

Therapeutic Use of Self • What does this mean to you?

Therapeutic Use of Self • Willard and Spackman • “Planned use of a practitioner’s personality, insights, perceptions, and judgements as a part of therapeutic process”

Therapeutic Use of Self • Understanding who YOU are • • • Strengths Weaknesses Communication style Personality Conflict style Stress style

Therapeutic Alliance • Patients with higher self-rated alliance had fewer symptoms and higher levels of therapist-rated adaptive functioning. Over time, self-rated alliance scores predicted better outcomes. Patient-rated alliance was more strongly associated with outcome than therapist-rated alliance. • https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3946510/ • https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3742444/

The Intentional Relationship Model Rene Taylor • Client Interpersonal Characteristics • • • Communication style Capacity for trust Need for control Capacity to assert needs Response to change or challenge Affect Predisposition to giving feedback Capacity to receive feedback Response to human diversity Orientation towards relating Preference for touch Capacity for reciprocity

The Six Therapeutic Modes • Advocating • Collaborating • Empathizing • Encouraging • Instructing • Problem Solving

Boundaries • Self-disclosure • Therapist becoming client • Important to maintain good self-care/wellness • Important to have a mentor or consultant

Family Systems Theory • Family systems theory is a body of knowledge that has arisen out of the observations of clinical & counseling psychologists as they work with individuals and their families. • The theory suggests that individuals cannot be understood in isolation from one another—families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system

What does it mean to say a family is a system? • To understand this better, consider the example of a mobile. • When you move any one piece of a mobile, all the other pieces move too! They do not exist in isolation from one another, and “movement” in any one part of the “system” will affect all the rest of the parts of the system.

Terms from Family Systems Theory that you’ll want to understand • Family Roles • Family Rules • Homeostasis/Equilibrium

Terms from Family Systems Theory that you’ll want to understand • Family Roles--what is expected of each family member • The most basic types of roles are “father, ” “mother, ” “aunt, ” “daughter, ” “son, ” “grandmother, ” etc. What is expected from people in each of these roles? • But there also roles beyond this most basic level. For example, one person may be the “clown” of the family. Another person may be the “responsible one. ” One person may be the “emotional one. ” Another role might be “crazy uncle Joe” who everyone knows is going to act odd in his own unique way. There a lot of different roles in families.

Terms (cont. ) FAMILY RULES • Family Rules are rules about how the family operates; these rules are often unspoken. For example… • When people are angry at each other, do they express this or keep it to themselves? • How affectionate or emotional are family members expected or allowed to be with each other? • How do decisions get made in the family? Who has input and who is expected to “just go along”? How is the final decision made? • Are there limits on “how much” or in what ways kids can argue with their parents? • How much are family members “allowed” to talk to people outside the family about family problems? • Families tend to develop patterns about these sorts of things (& other similar types of things). These patterns become “unspoken rules. ” Family members may see these things as “just the way it is, ” but different families do these things differently from one another.

Terms (cont. ) HOMEOSTASIS--EQUILIBRIUM • Systems develop typical ways of being which are reliable and predictable. Family roles & family rules are examples of what I mean by “typical ways of being. ” • Whether these roles & rules are adaptive or not, there is a pull from the system NOT to CHANGE—but to continue functioning as things have always been. • Think of the mobile. If you move one part, the other parts move. But if you let go of that one part, the whole “system” (i. e. , the parts of the mobile) will “pull each other” back to the way they were before that one part moved. • This tendency of systems to keep doing things as they’ve already been done is known as homeostasis or the system’s equilibrium.

Some examples of family patterns: Distancer. Pursuer Dyad • Often the roles that various family members take on are related to one another. For example, consider the distancer -pursuer dyad (a dyad is just a group of two people). • Sometimes in a relationship, there may be one person who seeks out closeness with the other person (the pursuer) while his/her partner (the distancer) wants more space or independence and pulls back from the relationship. • This pattern might occur in the marital relationship but might also occur in the parent-child relationship. Outside the family, you might see this pattern in dating relationships or even in close friendships.

Distancer-Pursuer Dyad & Circular Causality • As you might imagine, as the distancer & pursuer act out their “roles” within the relationship, a cycle can develop. • The pursuer pushes for closeness while the distancer pulls back. • The pursuer then feels “abandoned” and thus feels even more of a need for connection & so pushes even harder for connection. • As a result, the distancer feels “smothered” and pulls away even more… • …and so on & so forth…. . a cycle!

Distancer-Pursuer Dyad & Circular Causality • One might ask: How do they get in the cycle? Who starts it? • Family systems theory sees this question as like the question: “What came first? The chicken or the egg? ” • Just as the “chicken & the egg” question is impossible to answer, it may impossible to say whether the “distancer” or the “pursuer” started it! But in the cycle, BOTH patterns cause the OTHER • Family systems theorists refer to this concept as circular causality.

Distancer-Pursuer Dyad & Circular Causality • Circular causality refers to the fact that in family systems, each family member’s behavior is caused by and causes the other family members’ behaviors. They are each impacting the other, in a circular manner. • A good clue to a “circular” pattern is when people tend to respond in predictable ways to each other, and their responses may become more extreme or even “stubborn” over time.

Homeostasis & Equilibrium • Remember that we talked about how “systems” are resistant to change? • According to systems theory, this is true EVEN IF the change might seem to be a desirable one! • For example, if the “distancer” within a relationship tries to work at taking the initiative to seek out connection within the relationship, the “pursuer” may --in perhaps unintended, subconscious ways---sabotage the distancer’s attempts to change.

Interactive Reasoning September 7 Personality

Field. Work Processing • Share a story where you saw client-centered treatment by any member of the team. IF you did not see any client-centered treatment, reflect on why this might not be the

Complete Your Card INFP Elizabeth

Myers-Briggs Type Indicator • Helps you identify your unique gifts • Helps you understand yourself • Motivations • Natural strengths • Potential areas for growth • Helps you understand appreciate people who differ from you • Helps you make the best of your college experience • Helps you begin the career exploration process

MBTI GUIDELINES • A person’s psychological type should be regarded as a working hypothesis. • Everyone uses every preference. We favor, however, one preference over the other on each of the four scales. • MBTI scores should not be over interpreted. High scores do not indicate greater skill, magnitude, or use of a preference. Scores indicate clarity of choice. • Psychological type can explain some human behavior—not all. • Type should not be used as an excuse for doing or not doing something. Avoid stereotyping someone on the basis of his or her type. MBTI Team Building Program

Type Theory • Based on the work of Carl Jung • Researched normal differences between healthy people • Jung concluded that differences in behavior result from inborn tendencies to use your mind in different ways. • As we act on these tendencies, we develop patterns of behavior.

Type helps us to understand… • Where you focus your attention and energy? • How you acquire or gather information? • How you make decisions or judgments? • How you relate to the outer world?

A word of caution…. • Do not assume you know an individuals type. • Understand that many people are “close to center” • One preference is not more desirable than another. All are needed

ACTIVITY Plan the perfect party

EXTRAVERSION INTROVERSION • Direct energy outward toward people and things • Direct energy inward toward ideas and concepts • Orientation – after thinkers • Orientation – fore thinkers • Work Environment • Action-oriented • Prefer to be around others • Many interests • Quiet and concentrated • Prefer to be alone • Interests have depth

Type Differences in Close Relationships (E vs. I) Extraverts Need: Introverts Need: • Sufficient external stimulation • Sufficient “alone time” • Reach decisions by talking them out and getting feedback • Reach decisions by processing them internally and sharing final decision • May experience I’s style as excluding them and robbing them of mutual sharing • May experience E’s style as intrusive and controlling

Introverts and Extroverts • How will your preference potentially impact your work as an occupational therapist • What are some strengths you anticipates • What are some areas that may prove challenging

Activity Describe your object

SENSING INTUITION • Focus on five senses(experience) • Details, practicality, reality • Work Environment • Prefer learned skills • Pay attention to details • Make few factual errors • Focus on the possibilities(sixth sense) • Patterns and expectations • Work Environment • Prefer adding new skills • Looks at the big picture • Patient with complexity

Type Differences in Close Relationships (S vs. N) • Sensing partners with strong grounding in reality can make Intuitive partners feel impractical and unobservant • Intuitive partners with rapid insights can make Sensing partners feel slow and mundane

Sensing and perceiving • How will your preference potentially impact your work as an occupational therapist • What are some strengths you anticipates • What are some areas that may prove challenging

Activity You are hiring someone for a job. One candidate had a perfect resume and interview. The other candidate was not as outstanding as the first, however the second candidate is a single parent and really needs a job. You can only hire one person. Who do you hire and why?

THINKING FEELING • Focus – logic of a situation, truth and principles • Focus – human values and needs, people and harmony • Work Environment – brief and businesslike • Work Environment – friendly and personal • Contributions – intellectual criticism, solutions to problems • Contributions – loyal support, care and concern for others

Type Differences in Close Relationships (T vs. F) • Thinking favors an objective , logical approach to arrive at truth • Feeling favors a subjective, personal approach that arrives at harmony • Can become irritated when Feeling type appears to ignore the logic of a situation • Can feel hurt when Thinking type appears to be cold, uncaring, and hypercritical

Thinking and Feeling • How will your preference potentially impact your work as an occupational therapist • What are some strengths you anticipates • What are some areas that may prove challenging

Activity Plan a summer-long trip to Europe

JUDGING PERCEPTION • Attitude – decisive, planful, selfregimented, purposeful • Attitude – curious, spontaneous, flexible, adaptable, tolerant • Work Environment – focus on completing tasks, makes decisions quickly • Work Environment – focus on starting tasks, postpones decisions

Type Differences in Close Relationships (J vs. P) • Judging partner likely to value order and predictability in his or her surroundings • More likely to value careful planning • Like closure and concrete plans (vacations) • Perceiving partner more likely to value spontaneity and freedom • More likely to value “flying by the seat of their pants” • Like weighing all the options (furniture)

Judging and perceiving • How will your preference potentially impact your work as an occupational therapist • What are some strengths you anticipates • What are some areas that may prove challenging

Interactive Reasoning September 12 Emotional IQ

What is Emotional Intelligence?

Emotional Intelligence (EQ) • “EQ refers to a set of personal qualities that allow you to understand, control, and manage your own emotions, as well as to recognize the emotions of others in order to see the world through their eyes” • Davis, L. , & Rosee, M. (2015). Occupational therapy student to clinician: making the transition. Thorofare, NJ: SLACK Incorporated.

• According to the article you read…. “most students graduating from an accredited program are skilled and capable at the basic level of expectations. Therefore, it is the emotional competencies rather than the clinical ones that separate average new therapists from exceptional ones. ” High emotional IQ = success in level II fieldwork

Why take the time to assess my emotional intelligence…

Activity Complete the SSEIT

SSEIT • Schutte et al. (1998) suggested that the scale might appropriately be used for research purposes and to assist individuals who are motivated to self-reflect on aspects of their emotional functioning in the context of issues such as career goals or experience of problems that may be related to emotional functioning. As the items on the scale are transparent and respondents may perceive some answers as more socially desirable than others, Schutte et al. (1998) suggested that the scale is not appropriate for use with individuals who have an incentive to present themselves in a socially desirable manner.

Schutte Self-Report Emotional Intelligence Test (SSEIT) • Perception of emotions • Managing emotions in self • Managing others emotions • Utilization of emotion

Emotional Intelligence Schutte Perception of Emotion Managing emotions Self and others Self others Utilizing Emotions

Scoring the SSEIT • Add scores with numbers 5, 27, and 33 reversed. • For example, if you scored question 5 a • • • 1 ----the actual score is 5 2 ----the actual score is 4 3 ---- the actual score is 3 4 ---- the actual score is 2 5 ----the actual score is 1

Scoring • Perception of Emotion (items 5, 9, 15, 18, 19, 22, 25, 29, 32, 33) • Managing Own Emotions (items 2, 3, 10, 12, 14, 21, 23, 28, 31) • Managing Others’ Emotions (items 1, 4, 11, 13, 16, 24, 26, 30) • Utilization of Emotion (items 6, 7, 8, 17, 20, 27)

John is described by his co-workers as “brilliant. ” He has achieved a high degree of success in the field of occupational therapy. He has published in the American Journal of Occupational Therapy several times. He has earned a board certification in Physical Rehabilitation (BCPR) and specialty certification in low vision (SCLV). He was awarded the Texas Association for the Blind Occupational Therapist of the year award. He has been asked to speak all across the united states and internationally.

John In the 20 years that John has been in practice he has worked in 12 different setting; both academic and clinical. In addition to “brilliant”, his coworkers have also labeled him a “know it all” and “mean. ” Supervisors have stated that he is unable to accept any feedback that is not praise. Individuals he has taught or supervised stated that he “speaks down” to others (including clients). John currently owns his own private practice. No administrative staff has stayed more than 9 months. John is twice divorced. Although somewhat successful in accomplishments, it is obvious that John is struggling in the area of emotional intelligence.

Questions for further clarification • Is John aware there is a problem? • If he is aware, is he able to take any ownership of the difficulties? • Can John read social cues? • How is John communication (verbal and non verbal) • Does john desire any type of change

Emotional Intelligence Rosee Emotional Intelligence Skills Your Perceptions Your Actions Personal Competence Self Awareness Self Management Social Competence Social Awareness Relationship Management

Two ways of looking at the same thing… • Schutte • Perceptions of Emotion • Managing own emotions • Managing others emotions • Utilization of emotion • Rosee • • Self Awareness Social Awareness Self Management Relationship Management

Negative Emotion

Your Emotional Intelligence--table 3 -2 • Self Awareness • Self-management • Social Awareness • Relationship Management

ACTIVITY • Utilizing the SSEIT and the table 3 -2 (37) identify one area of potential growth at least 2 areas Develop an action plan for each area of growth

Arica • Arica is in her second level II placement. During her first placement in an adult outpatient clinic, she had no difficulty with emotional regulation. However, she has been experiencing significant panic attacks in her current placement (in-patient pediatrics). Arica called her fieldwork coordinator and reported that she is “losing it. ” When questioned, Arica stated that she becomes short of breath during these episodes and she is unable to talk or move.

Self Awareness Assessment Triggers What is a behavior Arica is concerned about? What situations may cause these behaviors? Emotional audit: what might she be thinking and feeling? What should she want to do differently? What steps might help her control the concerning behavior

Self Assessment---- Self Awareness Triggers What is a behavior you are concerned about? What situations cause these behaviors? Emotional audit: what are you thinking and feeling? What do you want to do differently? What steps can help you in controlling the concerning behavior

Putting it all together… • How can an understanding of who you are impact your role as an occupational therapist. Consider your personality type and your emotional IQ • Client centered • Therapeutic alliance/therapeutic use of self • Supervisor (COTA)

Interactive Reasoning September 14 The Occupational Profile

The Occupational Profile • The Occupational Therapy Practice Framework: Domain and Process (3 rd ed. , American Occupational Therapy Association [AOTA], 2014) states that every occupational therapy evaluation includes (1) the occupational profile and (2) the analysis of occupational performance. As the first step in the evaluation process,

AOTA • the occupational profile provides. . . an understanding of a client’s perspective and background. . . During the process of collecting this information, the client, with the assistance of the occupational therapy practitioner, identifies priorities and desired targeted outcomes that will lead to the client’s engagement in occupations that support participation in life. Only clients can identify the occupations that give meaning to their lives and select the goals and priorities that are important to them. By valuing and respecting clients’ input, practitioners. . . can more efficiently guide interventions. (AOTA, 2014, p. S 13, italics added)

The Occupational Profile • Who is the client? • Why is the client seeking services? • What occupations and activities are successful or are problematic for the client? • How do context and environments influence engagement in occupations and desired outcomes? • What is the clients occupational history? • What are the clients priorities and targeted outcomes?

OCAIRS (MOHO) • Semi-structured • 20 -30 minutes • Instrument guides you to rate 12 defined areas-identify strengths and weaknesses • Adolescents to adults • Can be used with psychiatric and physical disabilities

MOHO (W&S Ch. 39) • Volition • Habituation • Performance Capacity

Rating Scale • F: Facilitates occupational participation • A: Allows occupational participation • I: Inhibits occupational participation • R: Restricts occupational participation

MOHO • http: //www. cade. uic. edu/moho/resources/a bout. aspx

OCAIRS • Be familiar with MOHO • Be familiar with manual • practice

COPM (PE 0) • Identify problem areas in occupational performance • Provide a rating of the client’s priorities in occupational performance • Evaluate a performance and satisfaction related to those problem areas and • Measure changes in a clients perception of his occupational performance over the course of occupational therapy intervention

COPM • Standardized instrument • Not normed reference • Children and adults (5 and up) • 15 -30 minutes (may take longer 1 st time)

COPM • Complete cover page • Step 1: problem definition • Step 2: Rating Importance • Step 3: Scoring • Step 4: reassessment (2 pt difference significant)

COPM • http: //www. thecopm. ca/learn/

SCOPE (MOHO) • Birth to 21 years of age • Non-standardized • 10 -20 minutes • Observation and interview

Purpose • Initial evaluation and/or outcome measure • Broad overview of child’s occupational participation • Identify occupational strengths and areas to address • Guide occupation-based goals and interventions

SCOPE • If selected: • Summary form pg. 127 • Instrument pg. 128 -134 • Possible teacher/therapist interview

Options for information gathering • Parent interview • Teacher interview

Domains (Sub-domains) - Volition (exploration, expression of enjoyment, showing preferences/making choices, response to challenge) - Habituation (daily activities, response to transitions, routines, roles) - Communication and Interaction Skills (non-verbal communication, verbal/vocal expression, conversation, relationships) - Process Skills (Understands and uses objects, orientation to environment, plan and make decisions, problem solving) - Motor Skills (posture and mobility, coordination, strength, energy/endurance) - Environment (how the environment affects the child, physical space, physical resources)

Procedures • observations • interview with the child • Interview with the parents, teachers, multidisciplinary team • Reading case notes

AOTA Occupational Profile • https: //www. aota. org/~/media/Corporate/Files/Practice/Manage /Documentation/AOTA-Occupational-Profile-Template. pdf

Interactive Reasoning September 14 Conflict Resolution Compassion Fatigue Self-Care/Wellness

Occupational Profile • Questions? ? ? • Concerns? ?

Conflict Resolution---Activity • Think of a recent conflict that you have experienced with a friend, family member, even a stranger. • Did you avoid the conflict…or face it “head on? ” • During the conflict, did you tend to argue from a place of emotion or from a place of cognition?

Myers Briggs • Log into your MBTI profile • Look under “need some advice tab” • Click on Dealing with Disagreement • With a partner discuss your recent conflict with reflection on your MBTI advice…

Types of conflict • Organizational Conflict • Personal Conflict

Sources of Conflict • Unarticulated assumptions • Unmet expectations • Perceived lack of respect • Playing the blame game • Arguing with superiors

What is your “fight style” • Competition • Accommodation • Avoidance • Compromising • Collaboration

Emotional Awareness during Conflict • Theory of mind • Insight • Verbal and nonverbal communication

Resolution 1. Analyze the situation 2. Review the impact the conflict is having on your ability to meet your goals 3. Identify any broader impact of the conflict 4. Describe the benefits of resolving the conflict 5. Brainstorm possible solutions 6. Negotiate a solution.

Conflict Resolution • Thinking about the earlier identified conflict…. consider MBTI information, the steps to conflict resolution, and your conflict style (pg 82). • What might you have done differently?

Compassion Fatigue The cost of Caring

Self-Care and Wellness • Covered IN DEPTH in OPB-II • Things that derail our self-care • • • Stress Grief Busy schedules Lack of resources ________________

Stress • Log on to your MBTI • Click on Stress • Explore signs of stress, stressors, and solutions

Stress Test

Stress Activity • One a scale of 1 -10 with 1 being no stress and 10 being extremely stressed…. rate where you are right now. • Are you satisfied with this score? • If yes, how do you plan on maintaining this state during the week? • If no, what are you going to do to improve your score?

I’m not happy with my score…. But I don’t have the time or energy to address it! • What are the consequences of inadequate self care? • • Dissatisfaction in school Social/ peer isolation Increased substance use or dependence Relationship conflict Unprofessional behaviors Ethical violations Stress-related illnesses Mental health issues

Wellness • Preventative---- the things we do to keep ourselves at the optimal level of performance

Basic Skills Motivational Interviewing September 26, 2017

• What does it mean to “read” others?

What is communication

Communication discrepancy • Disconnect between verbal and non-verbal communication

Motivational Interviewing MI Spirit OARS • MI I MI Principals Change Talk

Readiness to Change • Ambivalence about change is normal. Change is very difficult often because of ambivalence. NOT because of lack of information, laziness, denial, or being oppositional. • Ambivalence is wanting and not wanting change at the same time or wanting things that are incompatible. • Ambivalence is uncomfortable, causes anxiety, and often leads to procrastination. This is not the same thing as resistance. • Change is nonlinear

Principles of MI • R---resist the righting reflex • resistance MI Spirit • U---Understand your client’s motivation • Where it is derived • L---Listen to your client Chang e Talk OARS • Safe place for exploration • E---empower your clients • Self-efficacy MI Principals

Group Activity • Participant 1: Think about a behavior you would like to change. • Participant 2: respond by telling participant one • all the reasons to change • the importance of changing • how to go about change • Participant 3: jot down notes pertaining to what you saw and heard. How was empathy expressed and how was self-efficacy supported. How much discussion took place? Note did the non verbal communication as well

• Repeat activity, but this time, participant 2 asks: • • why you want to make this change what your three best reasons are to change how important it is for you to change how you might go about it to succeed

Thomas Gordon’s Roadblocks to Communication • Ordering, directing, commanding • Agreeing, approving, praising • Warning or threatening • Shaming, ridiculing, name calling • Giving advice or providing solutions • Interpreting, analyzing • Persuading with logic, arguing, lecturing • Reassuring, sympathizing, consoling • Moralizing, preaching • Judging, criticizing, blaming • Questioning, probing • Withdrawing, distracting, humoring, changing the subject

Spirit of Motivational Interviewing • Collaboration MI Spirit • Evocation • Autonomy Chang e Talk OARS MI Principals

Motivational Interviewing • Assist clients in organizing their experiences • Used for people who are struggling

OARS • Open-ended questions MI Spirit • Affirmations • Reflective listening • summaries Chang e Talk OARS MI Principals

Open-Ended Questions • Should be used—in balance with closed questions • Should be purposeful…not small talk • In motivational interviewing, open questions are a hybrid of reflection and a question • There is a “preamble” which is a non judgmental statement about what you know and your attitude towards the encounter.

Activity • Are you doing ok today? • Are you married? • Do you exercise every day?

Affirmations • For some clients, they have “failed” to make needed change, so they have come to a professional for “help. ” this may lead to demoralization • Affirmation instill hope • Note the clients strengths and resources • There is a difference between and affirmation and a complement • Affirmations are tricky—must be authentic. Do not want client to feel judged or patronized. • Focus on specific behaviors-not attitudes, decisions, or goals • Avoid using I statements

Motivational Interviewing September 28, 2017

Reflective Listening • There should be more reflective listening than questions (2: 1) • In MI, it is the PRIMARY SKILL • It is the mechanism through which practitioners express interest, empathy, and understanding of the client • Starts with showing respect for the clients wisdom • We strive to understand the client---hypothesis testing • Involves making statements, not asking questions • You are enjoying being in graduate school?

Reflective Listening B The speaker says what he wanted to say A The speaker has something in mind he wants to say… C Listener hears and takes in the statement D The listener perceives the meaning of what the speaker is saying.

Reflective listening prompts • So you feel… • It sounds like you… • Your wondering if… • You… • Be Careful!!!

Reflective Listening • Simple • Paraphrase • Complex • Amplified • Double sided • Metaphor • Affective

• https: //www. youtube. com/watch? v=4 VOub. VB 4 CTU&list=PLUd. F f 9_Bmn. Kgu. DYh. TTXH 47 s 3 f. KXLWAjqs

Activity

Summaries • Assist clients in organizing their experiences • Therapist makes a decision about what to include and exclude and how information is presented • Best are succinct---client may get lost in a monologues • Include information that will aid the client in moving forward • Helps therapist with retention and understanding

Types of Summaries • Collective • Linking • transition

Activity

Traps to avoid • The Question/answer trap • The premature focus trap • The confrontation trap • The blaming trap • The expert trap • The labeling trap

Activity • Client, therapist, and observer • Client and therapist: Discuss a change that the client would like to make • Therapist: use open-ended questions, reflections, affirmations and summaries • Observer: Note the balance of questions and reflections (Q A R R) and the use of affirmations and summaries

Motivational interviewing • Change Talk • Managing resistance • Negotiating a treatment plan

Elements of Change talk • Change talk represents statements about change • Statements are linked to a specific behavior or set of behaviors • Statements come from the client • Typically phrased in present tense

Preparatory Language • Desire • Ability • Reason • need

Mobilizing Language • Statements of commitment • Contain action words • Description of steps taken to elicit change

How to elicit change talk • OARS • Elaboration • Using extremes • Looking back • Looking forward • Exploring goals

Resistance • Desire for the status quo • Inability to change • Benefits of the current situation • A need for the status quo

Arguing—changing the subject • https: //www. youtube. com/watch? v=a. FYs. JYPye 94&list=PLYOa. H TQf. Vp. Zbu. Gky 3 F 0 pu 2 Qc. Uix 5 a 4 b. Je

Managing Resistance • Simple reflections • Amplified reactions • Double sided reflection • Shift focus • Siding with the negative • reframe

Treatment Plan • Set Goals • Sort options • Arrive at a realistic and manageable plan • Reaffirm commitment

Activity

Behavioral Theory • Terminal Behavior • Baseline • Reinforcement • Continuous schedules • Intermittent schedules • Shaping • Chaining • Forward chaining • Backward chaining • Systematic desensitization

Cognitive Behavioral Therapy • https: //www. youtube. com/watch? v=ZZt-Q 1 DR 3 Ds • https: //www. youtube. com/watch? v=07 Jqkt. JGyy. A

Cognitive Behavioral Therapy • Aaron Beck • Short-term/goal-oriented • Goal is to change patterns of thinking and behavior associated with difficulties---leads to a change in feelings • change attitudes and behaviors by focusing on the thoughts, images, beliefs and even attitudes that are held (an individuals cognitive processes)

CBT • Some difficulties have maladaptive patterns of thinking • What we think (internal dialogue) determines how we act! • Cognitive distortions • Self-efficacy • Automatic thoughts • Links precipitating event to your thoughts about the event and then to the feelings about the event

CBT

Interactive Reasoning October 5, 2017

Cognitive Assessment

Assessment • As occupational therapist, it is important to fully assess and individual before you begin developing goals and planning interventions. • • Individuals perception of issues Values and beliefs Support system Time in treatment • Individuals capacity

Cognitive assessments • Cognition is the ability to perceive, represent and organize objects, events and their relationship to one another in an appropriate way; mental processes that allow us to recognize, learn, remember and attend to changing information around us. • Danger of over-estimating capacity • Danger of under-estimating capacity

Information gathering • What do you already know about your population (or client)? • Where can you go to find more information?

Field. Work • Complete Occupational Profile • Cognition screen • Activity analysis (TOA) • Provide Intervention (client education) • discharge

Mo. CA • Initially designed as a brief screening tool for mild cognitive impairment • Evaluates multiple domains of cognitive functioning • Available free of charge and takes 10 mins to administer • Short-term memory, visuospatial, executive, attention, concentration and working memory, language and orientation • A cut-off of 25 and below indicates cognitive impairment

Mo. CA • https: //www. youtube. com/watch? v=ryf 8 SG 0 NQLQ

Mo. CA • https: //www. youtube. com/watch? v=y 0 KFQ 7 Lgf-w

ACTIVITY • Administer the Mo. CA

Ages and Stages • The Ages & Stages Questionnaires® pinpoints developmental progress in children between the ages of one month to 5 ½ years. Its success lies in its parent-centric approach and inherent ease-of-use—a combination that has made it the most widely used developmental screener across the globe. • Evidence shows that the earlier development is assessed—the greater the chance a child has to reach his or her potential.

ASQ • Areas of development screened include • • • Communication Gross motor Fine motor Problem solving Personal-social

Activity • Score the ASQ

Now what? • How can cognitive assessment results impact goal development and intervention?

Interactive Reasoning October 10

Standardized Patient Lab • OCAIRS • Paper: • Discuss (in 5 -8 sentences) one aspect of the patient evaluation process that went well. • What steps did you take to prepare for this evaluation? • Elaborate on something that did not go well. What steps will you take in the future to improve on this aspect of your evaluation? • What is one thing you learned from watching the video that you did not realize while performing the evaluation? • How will you apply these experiences to your fieldwork level one rotations (or your next interactions with clients)? • What grade would you give yourself on the Standardized Patient Evaluation?

SPL Basics • Entering the room • OT definition • Orient patient • Limits of confidentiality

Activity • Practice SPL skills

FW Activity Analysis • See documentation on WIKI (2017 important documents) • Purpose: information to assist in client education/intervention

MOHOST • Occupation-focused screen that determines the extent to which client factors (values, personal causation, interests, roles, habits and skills) and environmental factors (social and physical) facilitate or restrict an individuals participation in daily life. Based on the Model of Human Occupation (MOHO) • 6 sections: Motivation for occupation (volition), patterns of occupation (habituation), communication and interactive skills, process skills, motor skills, and the environment • Not a screen for OT services.

MOHOST • Primarily based on observation—focused on occupational participation • Discussion with client regarding motivation, interests, roles, and routines. • Works best on collaboration with others on a multi-disciplinary team. • Client MUST have regular and sufficient access to meaningful occupation. Performance should also be consistent

Uses of MOHOST • Good for non-verbal clients • Aids is documentation • Identify needs and strengths • Highlight volition and habituation • Identify where further assessment may be needed

Roles and Interest • WIKI • AOTA • MOHO Web