OT Interventions Made Easy: Using OTPF

 Welcome to Occupational Therapy Month!  This week our podcast episode all about occupational therapy interventions! We'll be discussing practical tips and strategies for success, including how to use the Occupational Therapy Practice Framework (OTPF-4) in your everyday practice. Join us as we break down complex ideas into easy-to-understand concepts, offering simple ways to enhance your OT practice and make intervention planning easier.

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Transcript

Microphone (3- Logitech USB Headset) & Integrated Camera 0:00

Hi, welcome to animals and aquatics. This is April occupational therapy month, and we've been focusing on the occupational therapy practice framework and how we use it. In our practice to guide us and our last session really. Looked at evaluation this episode, I want to take some time to talk about intervention and in some ways, Intervention is the most fun part, right. It's designing what we're going to do and going out and doing it with our clients. Today, we're going to talk about how I use the OTPF to do that. Happy occupational therapy month. Hi, welcome to animals and aquatics and occupational therapy. I'm Gina, your host. And this month is occupational therapy month, and we're excited to think about how the occupational therapy practice framework can be used in everyday practice. From evaluation to interventions, to discharge, planning, to setting up programming and communicating our value to other professionals. This is something that I'm really passionate about when I'm working with my occupational therapy assistant students. When I'm taking fieldwork students. And when I'm creating frameworks around how our practice will work and how we'll communicate our value to others. And one of our goals here with the animals and aquatics podcast is really to support occupational therapy practitioners. In these non-traditional areas. And often when we get a little bit outside the beaten path, sometimes it feels like we're losing our way as far as how do we evaluate or. How do we communicate on document our sessions? And I really think that when we bring it back to the occupational therapy practice framework, we can really see its significance in guiding occupational therapy interventions, even when we're outside of the traditional clinic or hospital or school setting. So this episode, we're going to give some examples in the different areas that we primarily talk about incorporating animals into our practice in the aquatic setting and in the nature based setting. And I think it's really interesting to look at. Occupational therapy in the nature-based setting and thinking about. How that can integrate with the OTPF as well as in our other unique settings. And if you're not familiar with the OTPF well, Definitely. This is a document that you want to be able to refer to so you can find. Free PDF copies online. And I have a really nice spiral bound covered print copy that I took to staples and got done because I do keep it. In my school bag with me. So that way when I'm teaching class, I can pull it out and refer to it. But it really looks at domain process and outcomes of occupational therapy. And it gives us some really standardized language in communicating with other occupational therapy providers, it defines the domain or scope of occupational therapy. Now this is different than how our state defines our scope of occupational therapy. And when we're talking about practice, we really need to follow our state guidelines. As far as what we're allowed to do within our licensure within our state. And it does vary. By state. And I think it's really interesting because we keep considering moving to a new state and we've pretty much looked for him everywhere from Maine to Florida. As far as where might be the right place to relocate to. And so we spend a lot of time looking at the occupational therapy. Licensure laws for supervision requirements for scope of practice. One area of particular interest to us as wellness. And leisure activities. Community-based OT practice. And in some states, wellness is not included. It's not explicitly written into the state practice act. So that's an area that always jumps out to us. It's included. In the domain of occupational therapy within the OTPF, but isn't written into the state licensure laws. So that's something that's really important when you're considering using the OTPF as a guide. It also gives us a process for intervention. So since our main focus today is really intervention. We're going to dive a little bit deeper into that and take a look at how it looks at intervention. And some of the interesting parts of looking at intervention is a lot of times it includes a little bit more than we think. When we're just thinking about providing interventions. So the intervention process is the services provided by the OT practitioner. In collaboration with the clients, looking at various service delivery models, the goals that were going to be used, what tools that we're going to be incorporating in. And. It's interesting to think about, it's not just going out and doing the intervention, that actual link, direct service kind of component. Of it. But it is also the intervention process includes looking at our frame of reference, looking at how we're going to bring in those theoretical principles into the interventions that we're selecting. So some types of occupational therapy interventions could be. Occupations and activities, right? Those are the ones where really familiar with. Interventions to support occupation. So a lot of times this would be what we would have considered like preparatory activities. The. Modalities fall into here. So like our Pam's fall into there. Education and training again, there's a new code that came out with a caregiver education. And we'll be seeing if that's getting paid. What's that getting paid? And that may be an interesting area to explore advocacy group interventions. And in any of our settings, we may be incorporating group interventions and virtual interventions. Again, that's not an area so much typically that we're looking at now, we can take different approaches to our interventions. We can be creating. Promoting. Establishing restoring. Maintaining modifying or prevention. And each of those has its own definition. So typically when I'm writing up my plan of care, I will include which approaches to my interventions. I'm taking. So that way we already know. How I'm looking at the interventions. Am I trying to create something? Am I trying to look at establishing a new skill. Do I want them to maintain a current level of function? Those are all areas that we might be looking at. So when we're thinking about this intervention process, we're thinking about. How we're putting together that intervention plan, then we're thinking about the setting or the service delivery model that we're working into. Our components are, or that. Plan part. The intervention implementation, and then an intervention review. And so with the intervention process, In the plan part, we're integrating information from the evaluation. So if you want to hear more about that, certainly go back and episode. And listen to. The OTPF and evaluation because we're incorporating our theory. Our frames of reference in there. Any research evidence we have on those interventions and especially how that's going to support occupation or occupational performance. And that's going to guide that intervention planning. Now the intervention plan is really where we're looking at. What are the goals? And what is the context of the service delivery? What client performance skills or performance patterns are we trying to address? What evidence is there available? And we develop the plan to select what measure or measurements that we're going to have, how we're going to deliver our services. And of course our intervention approaches then. And I've always looked at this as right from the beginning. We're going to look at. Discharge needs. And then if we need to make any referrals, Now intervention implementation. That's the part we think about the most, right. And that is putting that intervention plan into action. It's where we are out and working with the clients were bringing in a variety of different interventions or intervention steps we might be bringing in the education piece. We might be doing occupation-based interventions or activity-based. So thinking about how we're. Delivering that intervention. And what tools strategies are we actually including there? And our intervention review is an ongoing continuous process to see if that intervention plan is working. If we're moving us towards our goals. So we really are looking at, do we need to continue services, discontinue services refer, modify that, modify the plan. There's a lot of components as we're working on that intervention review. So what are, what about some actual interventions that we might be doing now? If we're incorporating the OTPF in the intervention process, we can use it as a framework for designing, implementing, and then evaluating are nature-based interventions, interventions with animals or aquatics. To see if we are moving towards those goals, promoting clients, health wellbeing. Or a participation, right? Those are all areas that we're looking at. So let's take motor skills as an example, rain. So if we're looking at performance skills and then motor skills, Some areas that we might be focusing on that we've identified in the evaluation phase would be obtaining and holding objects and moving self and objects. So some interventions that we might do is an activity like leaf rubbing. The clients might be collecting different leaves from the environment using crayons or pencils to create a leaf rubbing. This requires pretty precise hand movements and coordination, both hands of the body. It requires them to pick up the items, bring them to a central location, requires them to stabilize them. In order to capture the details of the leaves. So this is a very kind of popular nature based intervention activity. And it does require a lot of those performance motor skills that we would be looking at. Another one would be something like planting seeds. So this might be more of a gardening type of activity. This can also be a really nice take-home activity so we can look at. Planting the seeds or transferring seedlings. We can look at the fine motor skills we got grasping pinching, manipulating the small objects, hand, eye coordination, finger dexterity. And when we think about obtaining and holding objects as the motor skill component. There are again, a number of pieces to this. If we have to go get the objects, choose the correct ones. Hold them, bring them back. We have to move ourselves or move the objects. So when we're looking from that OTPF side of things, we have a variety of different skills that we might be looking at within that area. And incorporating those in. When we're looking at again, that documentation piece, we already have that set up for us. If we're looking at it through this OTPF lens. We can also look at other nature inspired crafts. So even if you are in a indoor setting and you want to start to incorporate some nature-based interventions into your OT, You can look at some nature inspired crafts. So that's crafting with natural materials, and I'm always scouting out things that I see. Things like pine cones, twigs stones. Maybe that brings nature and it also encourages the clients to. Use those fine motor skills to work. In a way that they have to stabilize the task object, they have to position themselves or their body. In an effective distance from the task object, they have to be able to grip effectively pinching. They should be able to manipulate the object. They need to be able to lift and carry the test object. There's a lot of components and language from the OTPF. That can help guide the way we might set up those interventions. Now, if we wanted to look at client factors instead, and we wanted to look at body functions, we could look at neuromuscular and movement related functions, and these look a lot more like a lot of our gross motor activities. So something like a hiking or a nature walk. We're going to be addressing a lot more of those body functions component. And when we look at those, we can look at body functions in that neuromuscular and movement related functions. Some of those would be control of voluntary movement, gait pattern. May, and we think about joint mobility or joint stability and the functions of joint and bones. Right? There's a lot of different components when we start to break it down into that body structure and function. So these are body functions that we're looking at. Under client factors. Other outdoor sports and games that we might be setting up might be another way that we can address that area. We can also look at client factors in the body functions under sensory functions. So there's an area looking specifically at sensory functions and within that, it could be visual functions. So quality of vision, visual acuity, visual stability, visual field functions, visual awareness of the environment and various distances for functioning. So when we think about being out in nature, right, we have a lot of opportunities to work on a lot of different visual areas. And we can do this by Color's by monoculars with nature, sketching or journaling. So we can integrate that visual perceptual piece with what they're seeing in the environment. With hand movement, spatial awareness, we can do some nature, scavenger hunts, and have them visually scan the environment to see if they can find. What is on their list. And then things like an outdoor obstacle course is not only going to incorporate the visual function, but also the vestibular function. Right. For position balance, secure movement against gravity. As well as the proprioceptive function of the awareness of the body position and the body in space. So there's a whole variety of sensory functions that we might be incorporating in there. When you're incorporating nature based activities into your occupational therapy interventions, we can address a wide range of motor skills and client factors that are outlined in the OTPF. While engaging clients in a very meaningful and enjoyable experience for us, the process. Is as much important as the outcome or the product. Another example would be if we want to look at process skills. So these are more of our cognitive skills and let's use hippotherapy, as our example here. So we could look at attention and focus. So with process skills, we could look at their ability to sustain their performance. So the movement from the horse in a very natural setting is going to require the client to attend. I hate because there's going to be a variety of sensory stimulus. There's going to be changes in movement. There's going to be environmental sounds. There's going to be social interactions, right? So their ability to sustain their attention of focus would be a process skill that could be addressed. We can also look at organizing and timing from the OTPF. So following instructions from the therapist, coordinating movements with the horses, movement sequencing and planning actions, those are all ways that we could work on the process skills, helping them to execute tasks in a logical sequence. Now, if we wanted to look at client factors, again, that body functions, we could look at mental functions of sequencing, complex movements. Yes. That is a category. And responding to unexpected changes in the horse's movement or direction. Challenges that client to problem solve in real time. So we're fostering adaptive thinking decision-making skills. And again, that's another way that we could use. Equine movement. We could also look at client factors, body functions for specific mental functions in emotional regulation. And we can use equine movement and hippotherapy, as an intervention to support emotional regulation, because we can have that co-regulation. With the horses nervous system that can be a very calm and nurturing environment for the client can help them reduce stress and anxiety levels. It promotes emotional wellbeing. A lot of times we see that our clients are much well more well-regulated. After being in the equine environment and experiencing well regulated equine movement. So it's really important that equine movement is cadenced for what the client needs. And we can also look at the way that the client can express emotions, cope with emotions that they're feeling. And part of that can be a bond between the client, the therapy team and the horse. That's a real safe space for the client to express motions, process emotions, and facilitate that emotional expression, coping skill development. Knowing again that they have those co-regulating partners. So when we address process skills within the interventions, when we incorporate hippotherapy,, we really can support clients, physical, cognitive, and emotional wellbeing. In a really, again, engaging setting. If we wanted to look at aquatic therapy. Let's look at the process skills for or the performance skills for social interaction skills. And we're going to break it down for some specific ones. So turns towards, and in a OT session in the aquatic environment, if we're looking at children, we could have a small group interaction. They could be playing with floating toys or participating in a water relay race. And in this case, we have to turn right, turn our bodies towards one another face each other while passing toys, coordinating movements during a relay race. And. And by engaging these activities, the children can learn. Both from their peers. And by modeling from the therapist to attend to others, make eye contact, communicate effectively to foster social interactions in this environment. And we can look at that in the context of being able to turn towards someone when we're engaging with them. We can look at. The social interaction, skill of looks, which we think typically think of is making eye contact. So we can do a water tag game where the children are taking turns, chasing us I'm in the pool and the children have to make eye contact with us, or they're going to make eye contact with us to signal their intention that they are going to give us a splash for a water tag. And that's a way to, to encourage that while remaining regulated and another. Social interaction skill would be placing self. So places, self that's positions at an appropriate distance. And this could be in a group setting or in a one-on-one setting. And we can be working. If we're in a group setting, like in a circle and the therapist is really gonna guide that client to position themselves at an appropriate distance for passing a beach ball around the circle, or we can do some imitation or synchronize movements in which we need to have enough space. I had a client that was really interested in synchronized swimming and synchronized. Like water dance. And so this was a really good one because if you're too close together, you will hit one another. If you're trying to do like a flip underwater. You don't want to kick the other person. So in this way, the client practices, spatial awareness, social proximity in the water where they're getting additional sensory input. And they're learning to navigate some of those social interactions and respecting personal boundaries either with the therapist or with their peers. So in these examples, the aquatic occupational therapy is really looking at that dynamic environment for children to develop those social interaction skills. But it's still fun and meaningful for them. The buoyancy in support of the water can encourage the children in those interactions, in that spatial awareness. And developing a greater ability to focus and sustain those social interaction skills. And then we have the ability to generalize those outside of the aquatic setting. And that's really what we're looking for, right? Whether we're in a nature based setting, incorporating hippotherapy, or in the aquatic setting, we're looking at that ability to generalize outside of our unique treatment environment into their everyday life. So as we went through our interventions and how we can incorporate components from the occupational therapy practice framework today. We looked at different categories that the occupational therapy practice framework provides us such as performance skills or client factors. And how in our evaluation phase, we may have identified areas. That we wanted to work on. And then we can design interventions around those areas and the OTPF can be a way to guide our thinking and help us select activities. We can also kind of backwards plan and where we choose the activity and then refer back to the OTPF and check it off, say yes, it's this is required. Yes. This is required. Heeds is required. Chooses is required. Paces is required. And then we know how, when we get to our documentation, to set everything up. So I hope if you've enjoyed this episode, you'll go ahead and share rate and like the podcast, we hope that you will reach out to us, send us a DM or an email. Let us know what you would like to hear for future podcast topics. And we'll talk to you next week.