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MASTER NCTRC EXAM STUDY GUIDE
Foundational Knowledge (Section A) - Correct Answers -Theories and Concepts Erik Erickson's Stages of Human Development - Correct Answers -Erik Erikson (1950,
- proposed a psychoanalytic theory of psychosocial development comprising eight stages from infancy to adulthood. During each stage, the person experiences a psychosocial crisis which could have a positive or negative outcome for personality development. Infancy - Correct Answers -Trust vs. mistrust stage Feeding and other needs are met fully and consistently or not. Years 0- Toddlerhood - Correct Answers -Autonomy vs Shame/Doubt Feelings of personal control and independence with successful toilet-training/other physical skills, OR shame and self doubt with failure Years 2- Reliability - Correct Answers -Estimate of the consistency of measurement Validity - Correct Answers -The extent to which the assessment meets its intended purpose Usability and Practicability - Correct Answers -Involve whether the assessment is "do- able" as far as: -time constraints -ease of use -cost -availability -staff knowledge and ability Availability - Correct Answers -Is this assessment available for use by TR? Preschool - Correct Answers -Initiative vs. Guilt Success exploring and asserting power/control over environment brings sense of purpose OR excessive, destructive power/disapproval brings guilty feelings Years 3- School-Age - Correct Answers -Industry vs Inferiority
Successfully meeting academic and social demands brings a sense of competence OR failure, feelings of inadequacy Years 7- Adolescence - Correct Answers -Identity vs Role Confusion Forging a personal identity and sense of self enables being true to oneself OR failing, a weak sense of self and role unsureness Years 12- Early Adulthood - Correct Answers -Intimacy vs Isolation To lose and find oneself in a another, love, promiscuity, exclusivity Years: 20- Middle Adulthood - Correct Answers -Generatively vs stagnation Successfully nurturing others and providing legacies brings feelings of accomplishment and usefulness OR failure, shallow world involvement Years 30- Later Adulthood - Correct Answers -Ego Integrity vs Despair Satisfying life reviews bring fulfillment and wisdom OR failure, bitterness and regret. Years: 50+ Hierarchy of Needs Theory of Human Behavior - Correct Answers -Albert Maslow We have a hierarchy of needs, visualized in pyramid form. At base are physiological needs: sleep, water, food, and being warm; then needs for safety and security. Psychological needs follow: love friendship and belonging, then esteem needs for feelings of accomplishment and prestige. Above these are self-actualization needs to fulfill one's highest potential Social Learning Theory - Correct Answers -Albert Bandura New behaviors can be acquired by observing and imitating others. Learning is a cognitive process that takes place in a social context and can occur purely through observation or direct instruction, even in the absence of motor reproduction or direct reinforcement. Learning also occurs through the observation of rewards and punishments, a process known as vicarious reinforcement. When a particular behavior is rewarded regularly, it will most likely persist; conversely, if a particular behavior is constantly punished, it will most likely desist. Experiential Learning Model - Correct Answers -David Kolb Learning through experience, and is more specifically defined as "learning through reflection on doing". Hands-on learning, action learning, adventure learning, free-choice learning, cooperative learning, service-learning, and situated learning.
Inclusion - Correct Answers -Provides opportunities to choose to be with peers in regular settings. Provides supports/accommodations to ensure personally satisfying/valued participation. Social integration—core dimension that contributes to quality of life. Social integration and quality of life—highly complex, personally variable, and socially constructed notions that defy precise definition. Group Dynanmics - Correct Answers -Forming Storming Norming Performing Adjourning Forming - Correct Answers -Acceptance of risk Dependency on leader Forming assumptions and identity Storming - Correct Answers -Conflict Personal agendas revealed Group power and influences surface Norming - Correct Answers -New social tolerance Increased cooperation Team identity Group purpose "We" instead of "me" Performing - Correct Answers -Tasks accomplished Productive outcomes Group strength & weaknesses Roles less rigid Adjourning - Correct Answers -Adjournment anxiety Group support Transition of skills to "real world" Autocratic Leadership - Correct Answers -Has superior knowledge and expertise They make all decisions and expects obedience from others All authority and all responsibility remain with the leader Autocratic leaders allow minimal group participation Never any questions as to who is in charge Democratic Leadership - Correct Answers -Involves others in decision making The leader draws in group members for ideas Sense that participation is important
Laissez-Faire Leadership - Correct Answers -Open and permissive approach Leader does not exercise authority Minimal control is used so that participants may take on responsibility for decision making Participate and client-centered ADA (Americans with Disabilities Act) - Correct Answers -A civil rights law that prohibits discrimination based on disability. 1990 Title I - Employment Title IIA - Government Services Title IIB - Public Transit Title III - Public Accomidations Title IV- Telecommunications Individuals with Disabilities Education Act - Correct Answers -A four-part (A-D) piece of American legislation that ensures students with a disability are provided with Free Appropriate Public Education (FAPE) that is tailored to their individual needs. Free appropriate education/special education and related services, available to children/youth. Rights of children and youth with disabilities and their parents or guardians are protected. Assess/assure effectiveness of special education at all levels of government. Assist state/local govts. to provide full education to all with disabilities using federal funds. Joint Comission - Correct Answers -A United States-based nonprofit tax-exempt 501(c) organization that accredits more than 21,000 US health care organizations and programs. The international branch accredits medical services from around the world. A majority of US state governments recognize Joint Commission accreditation as a condition of licensure for the receipt of Medicaid and Medicare reimbursements. CARF (Commission on Accreditation of Rehabilitation Facilities) - Correct Answers -An international, non-profit organization. For some institutions, it represents an alternative to Joint Commission certification. Revenue sources include contributions from the International Advisory Council, which comprises entities being accredited. Accreditation in Canada - Correct Answers -Laws at three levels: federal, provincial, and local. 1962, Parliament passed Vocational Rehabilitation for Disabled Persons Act (VRDP). VRDP framework revised in the early 1990s.
Schools Home Heath Care Standards of Practice - Correct Answers -The 12 standards reflect levels of service provision for recreational therapy professionals to implement in a variety of settings. The Standards will assist the recreational therapy professional in assuring the systematic provision of quality recreational therapy services. Assessment Treatment Planning Plan Implementation Re-Assessment and Evaluation Discharge/Transition Planning Prevention, Safety, Risk Management Ethical Conduct Written Plan of Operation Staff Qualifications/Competency Quality Improvment Resource Management Program Evaluation and Research http://www.atra-online.com/page/SOP Code of Ethics - Correct Answers -BENEFICENCE/NON-MALEFICENCE AUTONOMY JUSTICE FIDELITY VERACITY/INFORMED CONSENT CONFIDENTIALITY AND PRIVACY COMPETENCE COMPLIANCE WITH LAWS AND REGULATIONS https://www.recreationtherapy.com/history/atra.htm Certification - Correct Answers -A voluntary process Demonstrate competency You choose to be certified to show your competence. CTRS stamp. Get a title. Who provides? NCTRC. Individual credentials. Licensure - Correct Answers -Required by law in Utah, New Hampshire, NC, DC Oklahoma. Provided by DOL. Individual credentials. State licensure exam. Registration - Correct Answers -List control Sometimes required, not always.
If you make a mistake, the agency will back you up and cover you in court. Who provides? NCTRC. Individual credentials. Accreditation - Correct Answers -Certification for agencies. Don't need to do in order to stay in order and get paid. Meet certain standards as an agency. External body will help agency demonstrate their competency. Cultural Competencies - Correct Answers -Person-centered approach Quality of Life is foundational Normalization: you act right when making available to persons with intellectual and other impairments or disabilities patterns of life and conditions of everyday living which are as close as possible to or indeed the same as the regular circumstances and ways of life of their communities. Self-determination=meaningful life choices Inclusion Foundational Knowledge (Section C) - Correct Answers -Diagnostic Groupings Cognitive/Developmental Disorders - Correct Answers -Defined as a condition that results in intellectual functioning significantly below average and is associated with concurrent deficits in adaptive behavior that require special education and related services. E.g. Demential, TBI, Intellectual Disabilities Physical/Medical Disorders - Correct Answers -A physical disability is a limitation on a person's physical functioning, mobility, dexterity or stamina. Other physical disabilities include impairments which limit other facets of daily living. E.g. Diabetes, MS, Muscular Dystrophy, Spinal Cord Injury, Sensory Impairments Psychiatric Disorders - Correct Answers -A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. E.g. Addictions, PTSD Assessment Process (Section A) - Correct Answers -. Selection and Implementation of Assessment Comprehensive Evaluation in Recreation Therapy-Psych (CERT-Psych) - Correct Answers -To identify, define, and evaluate behaviors relevant to a person's ability to successfully integrate into society using his/her social skills Assesses 3 performance areas:
- General
- Individual
- Group
TRS=useful for establishing that an individual's needs for leisure are being met by the existing programs and for finding areas where interventions may increase the individual's level of satisfaction with leisure. Leisure Barriers Inventory (LBI) - Correct Answers -Examines the barriers to leisure in 8 different categories. Different barriers include: money, transportation, time, etc Client responds to 48 items on a 3 point scale (agree, don't know, disagree) Function Independence Measure (FIM) - Correct Answers -Measures a clients level of functional ability. Score indicates degree of disability and how much care is required. 18 items (13 motor , 5 cognitive related tasks) 2 highest level = independence 5 lowest levels=greater assistance Leisure Satisfaction Scale - Correct Answers -Leisure attitudes & barriers Self reported Population= moderate -> no cognitive impairments Interprofessional Assessment Instruments - Correct Answers --FIM (Functional Independence Measure) -ASIA ( American Spinal Injury Association Scale) -Rancho Los Amigos Scale of Cognitive Functioning -Glasgow Coma Scale -Children's Coma Scale -IRF-PAI-(Inpatient Rehabilitation Facility-Patient Assessment Instrument) (used for Medicare reimbursement) -GDS (Global Deterioration Scale) (used in long term care facilities) -Mini-Mental State Examination -MDS (Minimum Data Set for Resident Assessment and Care Screening) (used for Medicare reimbursement) -Multiaxial Assessment System (psychiatric) -GAF (Global Assessment of Functioning (psychiatric) Secondary Sources of Assessment Data - Correct Answers --Medical records -Education records -Interviews with family and friends -Other members of treatment team Criteria for selection &/or development of assessment - Correct Answers -Needed to select most appropriate assessment tool: -reliability -validity -usability/practicability -availability
Implementation of Assessment - Correct Answers -To ensure reliability, TRS needs to completely understand the assessment tool and is able to administer it with ease following the directions TRS must have 3 competencies
- Observation skills
- Interviewing skills
- Functional skills testing 7 Step Process for Assessment Implementation - Correct Answers -1. Reviewing the assessment protocol
- Preparing for assessment
- Administering assessment to the patient
- Analyzing or scoring the assessment results
- Interpreting results fro placement into programs
- Documenting results of assessment
- Reassessing the patient as necessary / monitoring progress Behavioral Observation - Correct Answers -Standardizes tools used for observation: *identifying the targeted behavior *developing specific recording techniques for the observation of targeted behavior *scoring and interpreting the observation Observation Recording Methods - Correct Answers --checklists -rating scales -anecdotal records -frequency / tally methods -interval and instantaneous time sampling techniques Interview techniques for Assessment - Correct Answers --Purpose of assessment is to gather info about client -Directive Approach *involves a series of questions targeted for a specific end result -use open-ended or closed-ended questions -questions should directly relate to purpose of interview/assessment -interview should have: *opening *body of interview *closing -TR departments should have protocol for giving assessments Functional Skills testing for Assessments - Correct Answers -TRS should be able to use mechanical measurement tools (stop watches, measuring tapes...) to provide standardized info Assessment Process (Section B) - Correct Answers -Assessment Domains
Interpretation of Assessment - Correct Answers -*When documenting the assessment results, the TRS summarizes the assessment information. It is importantent to include info about the patient's strengths, weaknesses, the process used to collect the assessment information, and mutually agreed upon treatment goals and interventions. *Each problem and strength needs to be written in measureable terminology: diagnostic lables (eg. depressed) must NOT be used as a problem statemnt. *Narrative: assessment data is written in paragraph format. *Problem-Oriented Medical Records: assessment data is written in list format. *Placement of the assessment: 1: Source-oriented records: assessment information would be entered in the therapeutic recreation section of the chart. 2: Problem-oriented records: the assessment information will be entered in the assessment or data base section of the chart. Documentation - Correct Answers --need to document:
- assessment results
- progress / functional status
- discharge / transition plan Individualized Intervention Plan - Correct Answers -Individualized plan of care or intervention for person served by a qualified RT professional based on assessed strengths and needs, ad includes goals, objectives and intervention strategies aimed at fostering desirable and necessary outcomes. Measurable goals - Correct Answers --A broad general statement of direction & purpose -proposed changes in the individual or their environment; a broad statement of a desired behavior that the participant will demonstrate. -Set in a positive term; a sense of direction. Behavioral Objectives - Correct Answers --states what the participant will do -a statement that describes an outcome -a course of action to meet goal -clear and descriptive of observable behavior -written in terms of participant's behavior Contains three parts:
- Behavior: -a specific behavior to be demonstrated by participant
- Condition: -When & where the behavior will occur; a "given" or a "restriction."
- Criteria: -the measurable outcome; how well must it be done, correctness, time span, percentage, what is acceptable or successful performance.
Ex:: after x# of lessons (condition) the participant will swim (behavior) one length of the pool (criteria). Progress Notes - Correct Answers --record the results of interventions/client progress. -progress notes using SOAP, FIM, DARP SOAP - Correct Answers --mostly used in Hospital Setting Subjective data: -direct quote from patient -gathered from client; -example: stated feelings. Objective data: -data gathered by observation of patient's actions or behaviors -based on observation & other sources; -example: engaged in activity for 40 minutes. Analysis: -interpretations made by CTRS from subjective and objective data -conclusions based on data review; -example: anxiety level is slowly decreasing & there appears to be an inability to express feelings. Plan: -recommendation based on previous information -plan believed to resolve the problem; -continue plan as outlined in initial plans. FIM - Correct Answers -FIM - Functional Independence Measure-Assessment -An assessment of the severity of patient disability. -a basic indicator of patient disability. -FIM™ is used to track the changes in the functional ability of a patient during an episode of hospital rehabilitation care. DARP - Correct Answers -Data, Assessment (and Response), and Plan. Data, in this format, includes both subjective and objective data about the client as well as the therapist's observations and all content and process notes from the session. The Assessment and Response includes your clinical impressions, hunches, hypotheses, and rationale for your professional judgment. Progress is also noted here. Plan refers to your original treatment plan and any response / revisions needed based on your most recent interactions with your client.
3: provide for professional accountability 4: Comply with administrative requirements 5: provide data for quality improvement and efficacy research *The type of documentaiton required is set by the agency. Accrediting agencies like JCAHO and CARF have standards that impact documentation. *The Centers for Medicare and Medicaid Services (CMS) require documentation to indicate that services were necessary. The CMS require that the staff complete the Minimum Data Set for Resident Assessment and Care Screening (MDS) which includes a section on activity pursuit patterns. *Third party payers are interested in documentation because it is from this info that they will make decisions about reimbursement. Implementation - Correct Answers -See 'Implementation' set Administration of RT Services - Correct Answers -See 'Organizing and Managing Services' set Advancement of the Profession - Correct Answers -See 'Advancement of the Profession' set
