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a) Service delivery models 

Service delivery models refers to the variety of ways in which occupational therapy services can be provided. The location of services can include hospitals, skilled nursing facilities, outpatient clinics, homes, communities, workplaces, and schools. The recipient of services may be the client, caregiver, family, employer, government agency, etc. Services may be provided 1) individually or in a group, 2) in person or via telehealth systems, and 3) directly to the client or indirectly via consultation or advocacy efforts.

RELATED ICE VIDEOS

Search the ICE Video Library for the titles below, or for keywords such as: Intensive Care Unit (ICU), Acute Care, Skilled Nursing, Outpatient, Home, and Community.

• ICU, Co-treatment, Parts 1-5

• Self-Care: Bedside Grooming & Hygiene in Acute Care

• Femur Fracture, 5 Weeks Post Surgery: Safety During Meal Preparation, Parts 1-3

• Rotator Cuff Repair, Parts 1-7

• Peds Assessment: Administration of the Test of Visual Motor Skills

QUESTIONS 

Ask these questions when watching the related videos.

1. In what ways are occupational therapy services different across settings and in what ways are they the same (e.g., patient goals, level of activity, activity choice, etc)?

2. What are the strengths and limitations of each setting?

3. Many therapists in the acute care spend a majority of their time on making appropriate discharge recommendations. Why is this so important in acute care?

b) Clinical reasoning 

Clinical reasoning involves the thoughtful integration of theoretical principles, evidence-based methods, and awareness of the client’s condition and occupational profile in order to develop a treatment plan that maximizes participation. Clinical reasoning should be utilized during each patient encounter so that adjustments can be made as the patient progresses.

RELATED ICE VIDEOS

Search the ICE Video Library for the titles below, or for related keywords.

• IADLs: Sweeping the Sidewalk

• Radial Fracture, Patient Education 2: Improving Soft Tissue Elasticity with Heat

• Total Knee Replacement, 7 days post: Lymphatic Drainage, 1-2

• Self-Care: Dressing in Acute Care

• Outpatient Assessment, Part 5: Edema of the Hand

QUESTIONS

Ask these questions when watching the related videos.

1. How does clinical reasoning help the therapist develop a greater understanding of the interrelationship between client factors, performance skills, and contexts and environments?

2. How does clinical reasoning help the therapist identify the meaning of the task and the activity requirements to complete the task.

3. Describe how the therapist maximizes treatment outcomes by finding the just right challenge for the client’s level of skill and participation.

c) Therapeutic use of self 

Therapeutic use of self is one of the greatest tools a therapist can use and requires the “planned use of his or her personality, insights, perceptions, and judgments as part of the therapeutic process” as well as an empathetic, collaborative, and client-centered approach. (Punwar & Peloquin, 2000, p. 285).

RELATED ICE VIDEOS

Search the ICE Video Library for the titles below, or for keywords such as: therapeutic use of self, interview, evaluation, and treatment.

• Interview with Dick

• Peds, Mat Activity: Intervention Begins

• Self-Care, Part 2: Washing at the Sink in Acute Care

• Ventilator Part 1: Breathing and Suctioning with Respiratory Therapy

• Family Considerations

QUESTIONS

Ask these questions when watching the related videos.

1. How does the therapist connect with the patient on an emotional level? Notice how different patients may benefit from different approaches.

2. How does the respiratory therapist involve the patient in his care? In what other ways could he involve the patient?

3. What do you notice about the therapist’s body language, facial expressions, and touch communication that facilitate the patient’s participation in treatment?

4. How can the therapist involve the family in the therapy process?

d) Activity Analysis

Activity analysis is a process that helps determines what skills are necessary to complete the task based on the activity demands of the task. Activity demands refer to components of activities that either support or inhibit participation, such as:

1. "Relevance and importance to the client,

2. Objects used and their properties,

3. Space demands,

4. Social demands,

5. Sequencing and timing,

6. Required actions and performance skills, and

7. Required underlying body functions and body structures” (AOTA, 2014, S32).

RELATED ICE VIDEOS

Search the ICE Video Library for the titles below, or for keywords such as: function, task, ADL, and occupation.

• Spinal Stenosis 3 months post surgery: ADLs during breakfast

• Dementia Part 1: Grooming and Hygiene

• Multiple Sclerosis, Problems observed in the home

• Peds, fine motor: letter formation with playdough

QUESTIONS

Ask these questions when watching the related videos.

1. What are the components of each activity in the videos? Which components are promoting participating and which are inhibiting participation?

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Download a sample ICE Lesson Plan

Amanda K. Giles, OTD, OTR/L
Assistant Professor
Division of Occupational Therapy
College of Health Professions
Medical University of South Carolina