National Occupational Therapy Certification Examination (NOTCE)

Transcription

1 CAOT Exam Services N O TC E National Occupational Therapy Certification Examination (NOTCE) Resource Manual

2 All rights reserved Ottawa, 2006 No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Canadian Association of Occupational Therapists. Revised March, 2010, September, 2012, August 2013 Published by CAOT Publications ACE Ottawa, Ontario Copies are available from: Canadian Association of Occupational Therapists CTTC Building Colonel By Drive Ottawa, ON K1S 5R1 Tel: (613) or (800) Fax: (613) exam@caot.ca Des exemplaires sont également disponibles en français sous le titre: Manuel de ressources Canadian Association of Occupational Therapists, 2006 ISBN: PRINTED IN CANADA

3 Table Titleof Contents The Examination Purpose... 4 Process... 4 Content... 4 Format... 4 New Item Generation... 5 How is current practice reflected in the design of the Certification Exam?... 5 The National Occupational Therapy Certification Examination Blueprint (2008) The Blueprint... 7 The Enabling Occupation Matrix... 7 Blueprint Component Definitions... 8 Sample Cases and Questions Sample Cases and Questions Answers and Clinical Reasoning Applying the Sample Questions to the Blueprint Scantron Answer sheet sample Reference List National Occupational Therapy Certification Examination (NOTCE) Resource Manual 3

4 National Occupational Therapy Certification Examination (NOTCE) Purpose The purpose of the National Occupational Therapy Certification Examination (NOTCE) is to protect public interest by assessing the written application of academic knowledge and professional behaviour of individuals entering the occupational therapy profession in Canada. Successful completion of the National Occupational Therapy Certification Examination allows candidates to meet: a) a criterion of the Canadian Association of Occupational Therapists membership and/or; (membership details: b) a registration requirement for regulatory organization(s). Occupational therapists are regulated health professionals in all Canadian provinces. Each province has a provincial regulatory organization responsible for regulating the practice of occupational therapy. When you apply to become registered to work as an occupational therapist in a specific province, it is important to note that each provincial regulatory organization has its own set of regulatory requirements.please contact the provincial regulatory organization for the province in which you wish to work to obtain its specific requirements. There is no reciprocity amongst countries with regard to certification exams i.e. a successful outcome of the NOTCE will not allow you to practice in the US or elsewhere without meeting their requirements, including their certification exam. Process The NOTCE is developed and regularly monitored by the Certification Examination Committee (CEC) of the Canadian Association of Occupational Therapists (CAOT). Committee members are selected on the basis of expertise. Members represent a diversity of occupational therapy practice including clinical, academic, managerial and consultative experience with clients of all ages in a variety of practice settings. In conjunction with CAOT, the CEC established an item generation process to ensure ongoing development of new examination case studies and questions that reflect national practice. This process draws on the expertise of occupational therapists who practice across the country in a variety of areas and who have been trained in case and item development. Format The National Occupational Therapy Certification Examination (NOTCE) uses a multiple choice format. Current research indicates that use of well designed, in-context multiple choice questions provides a valid measure of a candidate s clinical reasoning and thinking skills. The cases and multiple choice questions on the exam reflect a variety of clinical settings, clients, occupational therapy tasks/activities and roles, in realistic situations. The NOTCE presents a number of cases. Each case is followed by approximately four to seven items (multiple choice questions). The candidate is required to carefully read each case and use the content to assist in answering the associated questions. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 4

5 Each question is followed by four options, of which ONE is the best answer. The examination contains 200 questions (associated with approximately 30 cases) designed to measure entry level knowledge. Sample cases and questions are provided in this manual. New Item Generation Cases and related questions are generated at Item Generation Workshops by participating occupational therapists who are CAOT members and have received training in question writing. Once developed cases and questions are forwarded to and reviewed by the Item Generation Coordinator, they are brought to the CEC for final review and revision before being accepted into the exam bank. All accepted cases and questions are translated into English or French as required. If the CEC does not agree that a case is ready for inclusion in the bank then it is sent back to an Item Generation Workshop for further development. Once material is accepted into the exam bank, it is reviewed for currency each time it is used on an exam, or every two years. All cases and questions are coded according to the Blueprint and referenced. When a question cannot be referenced, CEC must reach consensus about the item. How is current practice reflected in the design of the Certification Exam? The National Occupational Therapy Certification Exam is designed around a Test Blueprint or Table of Specifications. The purpose of the Blueprint is to depict the major content areas of the exam, provide a structural map indicating the relative distribution of desired content and reflect the way in which exam questions are coded. In addition, the Blueprint provides direction to the item generation process, the construction or make-up of each exam and informs candidates and other stakeholders of the primary exam foci. The Blueprint assumes that exam content is at the entry-level of occupational therapy practice in Canada. Since the inception of the Exam, the Blueprint has undergone several revisions. The current blueprint (Figure 1) was newly revised in 2008 through an extensive review process and the assistance of an external facilitator. The purpose of this review was to ensure that the structure, weighting and description of the Exam Blueprint reflected the content of recently published professional documents and current practice. As a result of the 2008 review, the Exam Blueprint was revised to reflect the Profile of Occupational Therapy Practice in Canada (CAOT, 2007), herein called the Profile. The current Blueprint components are built on role descriptors, similar to those outlined in the Profile, that relate to the various roles an occupational therapist enacts during provision of occupational therapy services. Each component of the Blueprint is defined and given a code number. This Blueprint code system is used to code all questions on the exam, and these codes guide selection of questions for any particular exam. Definitions of each Blueprint component are outlined in the following section. Figure 1: Exam Blueprint and Percentage of Exam Questions National Occupational Therapy Certification Examination (NOTCE) Resource Manual 5

6 The percentage of test questions allocated to each component of the exam is depicted in the Blueprint (Figure 1 and Figure 2) along with the code number. It is important to note that these percentages are used as a guideline and it is possible that these percentages may not be attained for all cells of the blueprint on every administration of the examination. Figure 2: Enabling Occupation Matrix Codes and Percentage of Exam Questions National Occupational Therapy Certification Examination (NOTCE) Resource Manual 6

7 The National Occupational Therapy Certification Examination Blueprint (2008) The Blueprint The central focus of the blueprint, like the Profile, is Enabling Occupation. In the blueprint, this core component is defined more explicitly by an embedded matrix (Figure 2) that includes elements of professional knowledge on one axis intersecting with those of a practice process framework on the other. Peripheral to, but closely related with the blueprint core, are the supporting components based on the supporting roles articulated in the Profile including: Practice Management, Communication, Collaboration, Change Agent, Professional Behaviour and Scholarly Practice. The blueprint illustrates that all of these components, core and supporting, exist on a background of occupational therapy related theories, models and frames of reference, which are assimilated and applied in practice. The relationship between these elements is iterative, that is, theory is applied to inform practice, which in turn, may influence theory. This relationship is demonstrated in Figure 1 above. The Enabling Occupation Matrix (Figure 2) As noted above and depicted in Figure 2, the examination blueprint uses a matrix to describe the core Enabling Occupation component. The matrix includes professional knowledge on one axis including knowledge of the client, the environment and occupation. The client is broadly understood as the individual with an occupational performance issue, their family and/or significant others as well as community and society groups, agencies, organizations or populations that may be considered clients. Knowledge related to the client includes understanding the physical, cognitive and affective attributes that affect their occupational performance. Knowledge about community and larger societal groups includes understanding social, cultural, organizational and institutional elements that influence the function of the larger group. Environmental elements include those that influence occupational performance/engagement. These elements include the physical (natural and built environments), social, cultural and institutional. Occupation relates both to our understanding of the different types of occupation, including self-care, productivity, and leisure as well as underlying conceptual ideas such as occupational engagement, performance, justice and deprivation. The second axis of the matrix incorporates the occupational therapy practice process. This process has been modified from that described in the Canadian Practice Process Framework in Enabling Occupation II (Townsend and Polatajko, 2007, p.251). The components of the practice process within the matrix include: Initiating the therapeutic relationship, which includes all those activities in which an occupational therapist engages prior to commencing an assessment with a client, as well as, Assessment, planning, implementation and evaluation. Each of these elements is further defined in the definitions section of this resource manual. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 7

8 Blueprint Component Definitions The National Occupational Therapy Certification Examination Blueprint (2008) is intended to represent current occupational therapy entry level knowledge and practice as described in the Profile of Occupational Therapy Practice in Canada (2007) (CAOT, 2007), Enabling Occupation: An occupational therapy perspective (CAOT, 1997), and Enabling Occupation II (Townsend & Polatajko, 2007). Consequently, where possible, the definitions listed below are those presented in these documents or are versions which have been minimally modified. General Definitions Application: Transference of theoretical and conceptual knowledge and assimilating (i.e., adopting and using the knowledge as appropriate) that knowledge into professional practice. Theory: Conceptual systems or frameworks used to organize knowledge. (Whiteford and Wright-St. Clair, 2005, p. 52) CORE Component Enabling Occupation: Enabling Occupation refers to the processes of facilitating, guiding, coaching, educating, prompting, listening, reflecting, encouraging, or otherwise collaborating with people (the client) so that they may choose, organize, and perform those occupations which they find useful and meaningful in their environment (CAOT, 1997, 2002). Definitions of the two major components and related subcomponents of the Enabling Occupation matrix include: Practice Process Axis: Practice process forms the y-axis of the Enabling Occupation matrix. This axis reflects and describes the steps or process in which an occupational therapist engages with the client (individual or groups) during the course of enabling occupation of the client. The subcomponents of the practice process are derived and modified from the Canadian Practice Process Framework, Townsend and Polatajko (2007, p. 251) and include the following: Initiating the therapeutic relationship: This element includes the first two stages of the Canadian Practice Process Enter/initiate and Set the stage, and includes activities such as: Call to action: create positive first point of contact with client based on a referral, contract request, or the occupational therapist s recognition of real or potential occupational challenges with individual, family, group, community, organization, or population clients; Consult to decide whether to continue or not with the practice process; Educate and collaborate to establish and document consent; Engage client to clarify values, beliefs, assumptions, expectations, or desires; Collaborate to mediate/negotiate common ground or agree not to continue; Adapt ground rules to the situation, build rapport, foster client readiness to proceed; Explicate mutual expectations and document the stage set Collaborate to identify priority occupational issues and possible occupational goals Assessment: This element includes activities to identify needs or issues of the client (individuals, families, groups, communities, organizations or populations). It includes such as: Assess/evaluate occupational status, aspirations, and potential for change; Consult with the client and others as required to determine status Use specialized skills to assess/evaluate and analyze spirituality, person, and environmental influences on occupations; Coordinate analysis of data and consider all perspectives to interpret findings; National Occupational Therapy Certification Examination (NOTCE) Resource Manual 8

9 Formulate and document possible recommendations based on best explanations. Planning: Planning follows the assessment/evaluation and re-evaluation stages of client interaction(s), and is considered the thinking and development stage of the process. Planning occurs when the therapist, often in collaboration with the client, plans and determines the objectives and the focus/ approach of the intervention or actions to follow. Planning includes agreeing on objectives and follows the planning process from the Canadian Practice Process Framework. It includes activities such as: Collaborate to identify priority occupational issues for agreement in light of assessment/evaluation; Design/build plan, negotiate agreement on occupational goal, objectives, and plan within time, space and resource boundaries, and within contexts, using requisite elements Implementation: Implementation is the doing phase or the carrying out of the plan. In the implementation phase the occupational therapist will: Engage the client in the therapeutic process to enable occupational engagement; Use occupation as a means or an end to enable participation and client s occupational engagement Use frames of reference, models, theoretical approaches as appropriate to effect or prevent change Evaluate Outcomes: Includes the elements of monitor and modify and evaluate outcome from the Canadian Practice Process Framework. Evaluation includes those activities that are conducted to determine whether occupational therapy involvement with a client (individual or group, etc) has been effective. These elements include: Consult, collaborate, advocate, educate, and engage client and others to enable success; Monitor and modify client progress; involves reassessment, adaptation and re-design of plan Use of formative evaluation Re-assess/evaluate occupational challenges and compare with initial findings; Document and disseminate findings and recommendations for next steps Professional Knowledge Axis: Professional knowledge forms the x-axis of the Enabling Occupational matrix. Professional knowledge is information derived from theories, models of practice, research and clinical experience that form the foundation of occupational therapy practice. In particular this includes knowledge related to the client, whether this is an individual person where knowledge encompasses an understanding of the physical, cognitive and affective attributes that affect occupational performance; or a family, community or larger societal group where knowledge includes an understanding of social, cultural, organizational and institutional elements that influence the function of the larger group. Professional knowledge includes understanding of environment, its impact on occupation, occupational performance and occupational engagement and knowledge of occupation itself. Definitions of these three main components are outlined below. Client: The client includes individuals, families, groups, communities, organizations, or populations who participate in occupational therapy services by direct referral or contract or by other service and funding arrangements with a team, group, or agency that includes occupational therapy. Professional knowledge of the individual (person) includes any component of the person, such as physical, cognitive, affective components, and cultural or social experiences. Note that cultural experience includes beliefs, attitudes and values. Social experiences include organized interactions with family, friends and community. Knowledge of family, community or larger societal group includes an understanding of group process and functioning as well as of social, cultural, organizational and institutional elements that influence the function of the larger group. Environment: The environment refers to the contexts and situations that occur outside of an individual and elicit responses from them (Law, 1991). It is the context within which occupational performance National Occupational Therapy Certification Examination (NOTCE) Resource Manual 9

10 takes place and includes the dimensions of physical, social, cultural and institutional environments (CAOT, 2002). Definitions of environment subcomponents include: Physical environment refers to that part of the environment that can be perceived directly through the senses. The physical environment includes observable space, objects and their arrangement, light, noise and other ambient characteristics that can be objectively determined (Christiansen & Baum, p. 601). It includes both natural and built environments. Social environment refers to those social systems or networks within which a given person operates, the collective human relationships of an individual, whether familial, community or organizational in nature (Christiansen & Baum, 1997, p. 604). Cultural environment refers to a shared system of meanings that involve ideas, concepts and knowledge and include the beliefs, values and norms that shape standards and rules of behaviour as people go about their everyday lives (Townsend & Polatajko, 2007). Institutional environment refers to economic, legal and political influences on the person and their occupation (CAOT, 2002), e.g., government legislation and policies for the accessibility of buildings. Occupations: are groups of activities and tasks of everyday life, named, organized and given value and meaning by individuals and a culture; occupation is everything people do to occupy themselves, including looking after themselves (self care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy (CAOT, 1997), (CAOT, 2002, p. 181). SUPPORTING ROLE Components Change Agent: Overall being a change agent encompasses responsible use of occupational therapy expertise and influence to advance occupation, occupational performance, and occupational engagement. Being a change agent may involve the following activities: (refer to CAOT, 2007, pages 6, 30) Occupational therapists advocate on behalf of, and with clients, working toward positive change to improve programs, services, and society, within health and other systems. Practitioners work for population and community change in the funding, management, policy, and other systems that impact occupations in daily life. Occupational therapists collaborate with those inside and outside the system, and draw on strategies to enable the empowerment of populations. One example might be advocating for and realizing the implementation of a community living skills program for clients with mental health issues. Collaboration: Collaboration includes working effectively with clients, teams and the broader community to enable participation in occupations by using and promoting shared decision-making approaches. The client is considered to be an equal member of the team. Occupational therapists collaborate, both in an interprofessional and intraprofessional environment, sometimes leading, and sometimes sharing with team members including professionals and other members of the community. Teams work closely together at one site or are extended groups working across multiple settings and in the broader community. Collaboration includes understanding the role that various team members contribute to the team. Collaboration may include conflict management, prevention and resolution. (CAOT, 2007) Communication: Communication includes oral, written, non-verbal, and electronic interaction or exchanges with the client (individual or group) and other relevant stakeholders or team members (CAOT, 2007). Occupational therapists communicate about occupations, occupational performance, and daily life, as well as about occupational therapy services. Communication approaches vary widely and require a high level of expertise that is adapted and changed in each different practice setting. Examples of communication may include: Building rapport, trust, and ethics in the occupational therapy client relationship National Occupational Therapy Certification Examination (NOTCE) Resource Manual 10

11 Appropriate display of empathy, compassion, trustworthiness, integrity Inclusion of the client voice in planning, decision-making, and evaluation Supporting diversity in communication Ensuring mechanisms for informed consent and decision-making (this is about the process of communicating rather than the practice standard or ethical expectation of consent), Effective listening Use of verbal and non-verbal communication Adapt communication approach to ensure that barriers to communication (e.g., language, hearing loss, vision loss, inability to communicate verbally, cognitive loss) do not impact the client s ability to direct their own care process Eliciting and synthesizing information for client service Conveying effective oral and written information/documentation for client service Flexibility in application of communication and critical thinking skills (CAOT, 2007, p. 6, 28) Practice Management: Includes activities such as time management, prioritization and management of effective and efficient practice (CAOT, p. 6). Broader concepts include appropriate assigning of services and sharing of client information. Elements of practice management may include: Setting priorities in day-to-day work activities, Managing caseloads Running effective meetings and/or participating effectively in committees Participating in quality assurance and improvement (CAOT, 2007, p. 6, 29) Professional Behaviour and Responsibility: This element encompasses ethical practice and high personal standards of behaviour. Professional behaviour includes concepts relating to the understanding of how the practice environment can impact on the scope of practice, and conversely, how scope of practice impacts the practice setting. It also includes concepts such as: Accountability for one s own behaviour Application of ethical principles Commitment to excellence in clinical practice Integrity and honest Disclosure of conflict of interest, Knowing limits of professional expertise and clinical competence Responsibility to society and public protection Ensuring the practice of informed consent is in place and that informed consent is attained prior to service provision (CAOT, 2007, p. 6, 30-1) Scholarly Practice: An occupational therapist engages in scholarly practice through the incorporation of critical thinking, reflection, and quality improvement in everyday practice and through a process of lifelong learning. The scholarly practitioner demonstrates a commitment to engaging in evidenced-informed practice. As educators occupational therapists facilitate learning with clients, team members, and other learners. The scholarly practitioner seeks out research that supports practice and in so doing is able to interpret, understand National Occupational Therapy Certification Examination (NOTCE) Resource Manual 11

12 and incorporate relevant research to inform practice. More specific scholarly activities might include: Reflection before, during, and after practice Self-assessment Identifying gaps in knowledge, skills, and attitudes Asking effective learning questions Accessing information to improve practice and service Moral and professional obligation to maintain competence and be accountable Critical appraisal of evidence Translating evidence and knowledge into practice Enhancing personal, professional competence Using a variety of learning methodologies Assessing learners and providing feedback Teacher-student ethics, power issues, confidentiality, boundaries Research ethics, disclosure, conflicts of interest, human subjects, and industry relations (CAOT, 2007, p. 6, 30) National Occupational Therapy Certification Examination (NOTCE) Resource Manual 12

13 Sample Cases and Questions For each questions, you are to use the information within the case to select the correct response. The other responses will be plausible but not correct. As much as possible, questions are written using a client centered occupational performance model of practice. All cases will have associated questions drawn from the blueprint component areas. The following sample cases are not meant to be a practice examination booklet. They are meant to illustrate the format only. Case for questions 1 to 5 Client: Mrs. C is a 66 year old woman. Case: She is recently divorced. She lives alone in a seniors apartment She has decreased functioning as a result of a degenerative neurological disorder She was getting home-making services in her apartment She was going to a geriatric day hospital to receive treatment related to physical problems Her physical problems include unstable gait, decreased balance, potential risks for falls, decreased vision and general safety She has been admitted to an in-patient geriatric unit due to increasing depression On admission to the in-patient geriatric unit, she is withdrawn, irritable, expressed vague suicidal ideation, and has stopped doing previous leisure activities Her previous leisure activities included music and sewing She has few close friends who are of the same age nearby She has one daughter who lives several hundred kilometers away Question 1: What should the occupational therapist do FIRST to address Mrs. C s depression? 1. Arrange a visit from her friends. 2. Challenge her with new activities. 3. Engage her in short term, familiar activities. 4. Suggest she attend the unit s Friday evening social event. Enabling Occupation Role: Client and Implementation Question 2: Mrs. C. tells the occupational therapist that she is upset that her decreased vision means that she is no longer able to sew. Using a client-centred perspective, what should the therapist do FIRST? National Occupational Therapy Certification Examination (NOTCE) Resource Manual 13

14 1. Suggest other leisure activities using the Interest Check List 2. Explore low vision aids and techniques that could allow Mrs. C. to sew 3. Encourage Mrs. C. to join activities at her local Senior s Center 4. Assist Mrs. C. to find a volunteer to help her do her leisure activities Enabling Occupation Role: Occupation and Implementation Question 3: At discharge, the occupational therapist will recommend that Mrs. C. attend an activity at her local Seniors Centre. Which activity would be MOST appropriate for the therapist to suggest? 1. Music enjoyment group. 2. Recreational dancing. 3. Playing cards. 4. Recreational swimming. Enabling Occupation Role: Occupation and Planning Question 4: Mrs. C. is often impulsive and is not following safety guidelines when walking with her walker. What should the occupational therapist do? 1. Set up a behaviour modification program for Mrs. C. 2. Continue teaching walker use, providing only 1 to 2 step instructions. 3. Further assess Mrs. C s comprehension and ability to remember information. 4. Encourage Mrs. C. to regain internal locus of control and take responsibility for her safety. Enabling Occupation Role: Client and Assessment Question 5: The multidisciplinary team is not confident that Mrs. C. has the functional ability needed to return to her apartment. Mrs. C. strongly states that she wishes to return to her apartment. What should the occupational therapist do? 1. Have a discussion with Mrs. C. about safety and her ability to manage at home. 2. Arrange for increased home care services. 3. Investigate the potential for repeated hospitalizations. 4. Provide legal documentation of Mrs. C. s incompetence. Supporting Role: 2 - Collaboration END OF SERIES Case for questions 6 to 11 Client: Mrs. H is a 39 year old female Case: Married, living with her husband and three children Two of her children are teenagers Her youngest child is five This is Mrs. H. s first contact with a mental health centre. During the initial occupational therapy interview, she is pleasant, cooperative, and able to talk about herself. She states she is seeking help at this time because she is experiencing increased fear. She reports this help will not be needed once her children leave home. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 14

15 She describes an inability to ask for attention and support in a direct manner, feeling at times that her husband and children do not appreciate her. Her self-esteem is low. She can never find time to complete her home-based work as a seamstress. All major decisions in the family are made by her husband. She reports always feeling lonely, like an outsider, and now has very few friends. She describes her marriage as comfortable, but adds that her husband is boring, and not able to address her emotional needs. Question 6: One of Mrs. H s goals is to improve time management. What time management principle will the occupational therapist stress as most important for Mrs. H.? 1. Work on the easier tasks first to ensure success 2. Rate tasks in order of priority 3. Create a list of appointments 4. Take responsibility for all tasks Enabling Occupation: 9.4 Occupation and Implementation Question 7: Mrs. H identifies a problem in her communication style. She tries to avoid conflict. What is the MOST appropriate intervention strategy for the occupational therapist use when assisting Mrs. H. to overcome this problem? 1. Family therapy 2. Assertiveness training 3. Behaviour therapy 4. Cognitive therapy Enabling Occupation: 7.3 Client and Planning Question 8: What activity would be MOST appropriate to assist Mrs. H explore self-esteem and self-image issues? 1. Role playing 2. Refuting irrational beliefs 3. Self-hypnosis 4. Use of projective techniques Enabling Occupation: 7.3 Client and Planning Question 9: Mrs. H has agreed to a referral for a group for women who are considering returning to work. What is the MOST important benefit that Mrs. H would gain from attending this group? 1. Support and encouragement from other woman 2. Techniques for re-entering the work force 3. New community contacts 4. Assertiveness strategies Enabling Occupation: 9.3 Occupation and Planning Question 10: Mrs. H s husband calls the occupational therapist and is very upset because his wife is late returning home. He asks about Mrs. H s treatment program. What should the therapist do? National Occupational Therapy Certification Examination (NOTCE) Resource Manual 15

16 1. Tell the husband to attend the next session 2. Refer him to his wife s doctor 3. Ask the husband the reason for his distress 4. Encourage the husband to discuss his wife s program with her Supporting Role: 5 Professional Behaviour and Responsibility Question 11: At discharge, the occupational therapist wants to know if therapy has been effective for Mrs. H. What approach should the occupational therapist use if applying a scientific and systematic method to determine client outcomes? 1. Standardized, valid and reliable measurement approaches 2. Feedback from the client and family about function 3. Family reporting and client observation 4. Both subjective and objective measures Supporting Role: 6 Scholarly Practice END OF SERIES Case for questions 12 to 18 Client: Justin is a 4 yr old male Case: Justin has a diagnosis of autism spectrum disorder. He has an uneven scatter in his developmental skills. His difficulties in occupational performance include: - Delayed language - Over-responds to environmental stimuli and changes in routine He attends an integrated preschool program with typically developing children. This program has enough staff to provide attention to all the children. Occupational therapy is provided in the program. Question 12: Justin presents with hyperactivity, decreased attention span and limited eye contact. What occupational therapy intervention plan is MOST appropriate within a sensorimotor framework? 1. improve overall social-emotional functioning 2. reduce demands made upon Justin, allowing him success experiences in his play 3. decrease arousal through inhibitory methods 4. decrease inappropriate behaviours through behavioural management Enabling Occupation: 7.3 Client and Planning Question 13: Considering Justin s diagnosis of autism spectrum disorder, which of the following specific characteristics is he most likely to display? 1. Deviations in rate of development, perceptual disturbances, echolalia, and inflexible behaviour. 2. Sensory processing difficulties, tonal abnormalities, unusual facial features. 3. Speech and language disorders, fine motor and perceptual skills at an age appropriate level. 4. Emotional instability, increased sensitivity to postural adjustment, inability to relate to others. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 16

17 Enabling Occupation: 7.2 Client and Assessment Question 14: Justin was seen to seek tactile stimulation quite aggressively. Which of the following would BEST illustrates this behaviour? 1. Rubbing and twirling objects. 2. Demonstrating peculiar hand movements. 3. Forming attachments to odd objects. 4. Cuddling with his peers. Enabling Occupation: 7.2 Client and Assessment Question 15: Which activity would provide the MOST tactile stimulation for Justin in the pre-school setting? 1. Water play at a standing table. 2. Rolling in a furry blanket. 3. Spinning in alternate directions on a swing. 4. Playing video games with peers. Enabling Occupation: 9.3 Occupation and Planning Question 16: The pre-school staff has difficulty calming Justin after active group sessions. Using a Sensory Integration approach, what should the occupational therapist recommend? 1. Justin rock in a rocking chair during the quieter activities. 2. Having Justin jump on a trampoline. 3. Doing a finger painting activity with Justin. 4. Having Justin do somersaults on a floor mat. Enabling Occupation: 9.4 Occupation and Implementation Question 17: Justin s father shows the occupational therapist an article on the use of music in the treatment of children with autism. What should the therapist do before the considering use of this intervention with Justin? 1. Review the current literature and professional publications on the topic 2. Tell Justin s father that this form of treatment is not part of the service protocol. 3. Read the article and gradually implement some of the principles. 4. Suggest to the father that he implement this treatment in the home environment first. Supporting Role: 6 Scholarly Practice Question 18: What would be the MOST appropriate way for the occupational therapist to demonstrate the efficacy of the occupational therapy service provided to Justin? 1. Review the documented changes in Justin s behaviour in his home environment. 2. Reassess Justin s behaviours and compare with baseline behaviours in the classroom. 3. Measure his behaviour at home as a result of having a new teacher. 4. Implement a satisfaction survey with the staff and parents. Enabling Occupation: 9.5 Occupation and Evaluation END OF SERIES National Occupational Therapy Certification Examination (NOTCE) Resource Manual 17

18 Case for Questions Client: Mr. S. is a 45 year old male Case: Mr. S. has a diagnosis of a left cerebrovascular accident (CVA) He lives in the city with his wife At the time of his CVA, he worked as a travel agent He has been referred to an outpatient Occupational Therapy service and will be seen two times a week for 30 minute sessions During initial assessment his outstanding physical problem was impaired right hand function He is right hand dominant He is beginning to develop finger and thumb prehension but is still not able to voluntarily extend his fingers Question 19: The occupational therapist notes that although the tone in Mr. S s right upper extremity varies from session to session, he frequently exhibits high tone in this arm during visits. Which one of the following factors is MOST likely to contribute to this increased tone? 1. Anxiety about attending intervention sessions. 2. Calm environment in the occupational therapy department. 3. Outdoor temperature of 230 C. 4. Positioning of arm in a sling. Enabling Occupation: 7.2 Client and Assessment Question 20: Mr. S would like to return to work part time in the near future. Which task would be the MOST difficult for him to manage? 1. Filing folders 2. Filling out forms 3. Using the telephone 4. Using the calculator Enabling Occupation: 9.2 Occupation and Assessment Question 21: In discussing Mr. S s occupational goals which of the following should the occupational therapist address FIRST? 1. Driving 2. Writing with the right hand 3. Walking with a normal gait pattern 4. Reading travel brochures Enabling Occupation: 9.3 Occupation and Planning Question 22: As Mr.S. has had a left hemisphere lesion, it is MOST important that the occupational therapist assess for the presence of which of the following impairments? 1. Neglect of the affected side 2. Spatial orientation difficulties 3. Body scheme disturbances National Occupational Therapy Certification Examination (NOTCE) Resource Manual 18

19 4. Varying degrees of aphasia Enabling Occupation: 7.3 Client and Planning Question 23: Mr. S s employer phones the occupational therapist to request details regarding Mr. S s ability to return to work. The employer has not discussed this with Mr. S. Which is the MOST appropriate action for the therapist? 1. Inform the employer that he does not need to know this information 2. Obtain Mr. S s permission to discussion this information with the employer 3. Discuss return to work with Mr S. and obtain permission before discussions with the employer 4. Invite the employer to meet with the therapist and Mr. S Supporting Role: 5- Professional Responsibility and Behaviour Question 24: Which would be the MOST difficult self-care activity for Mr. S?: 1. Washing his hair 2. Washing the dishes 3. Shaving with a disposable razor 4. Putting on a sweater Enabling Occupation: 9.2 Occupation and Assessment END OF SERIES Answers and Clinical Reasoning Clinical Reasoning Answers to questions: Item Answer Item Answer Item Answer Questions 1-5: Question 1 The answer is option 3: engaging Mrs. C. in short-term familiar activities is likely to provide successful and positive experiences. The OT would not select activities which provide new challenges, because new challenges will increase the probability of stress, failure and anxiety, and will overemphasize Mrs. C s declining physical ability. It is not the role of the therapist to arrange for Mrs. C. s friends to visit her at the unit. Mrs. C. may not feel confident enough in herself yet to join a large group of patients at a social evening. Question 2 The answer is 2, because it allows Mrs. C to resume activities meaningful to her, and builds on her strengths and interests. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 19

20 Although the other options are possible approaches, only answer 2 specifically addresses possible solutions to regain independence in the identified meaningful activity. Question 3 The answer is 1, because the activity draws on past experience. The other options are not ideal. Playing cards is not a good option, because of low vision. Swimming is not a social activity. Recreational dancing is inappropriate because of her balance issue. Question 4 The answer is 3, because the correct procedure is to assess before providing intervention. The other choices provided are all interventions. Mrs. C s impulsivity and non-compliance may be a result of cognitive decline. There are two possible indicators of potential cognitive decline a degenerative neurological condition and possible symptoms of early dementia. Early dementia and depression have similar presentations; therefore it is important to differentiate what is happening. The intervention for each would be different. Question 5 The answer is 1, because occupational therapists provide client centered practice. For this to happen, Mrs. C s perspective needs to be considered as it pertains to the issues and possible solutions. Answer 1 also allows Mrs. C to make an informed decision. Option 2 and 4 require further assessment before determining these as appropriate actions. Option 3 does not reflect the role of the OT and regardless of the findings would not impact whether or not Mrs. C can be permitted to return home at this time. Mrs. C has not been deemed incompetent, and therefore Option 4 is not a valid response. Questions 6 to 11: Question 6 The answer is 2, because to develop good time management skills one needs to prioritize. Prioritizing facilitates planning and decision making, which is necessary for Mrs. H to determine how she will spend her time effectively. The other options do not stand alone as an effective plan. Option 1 is not correct because the goal is not success in activities but management of time. Option 3 is a possible option because making a list is a beginning, but prioritizing that list (Option 2) is more correct because it is the prioritizing that permits better time management. Option 3 indicates Mrs. H is only having difficulty managing her appointments. There is nothing in the case study to suggest this. Option 4 will not lead to better time management, because taking responsibility for all tasks does not mean you can manage getting things done in a timely fashion. Question 7 The answer is 2, because in order to manage conflict one needs to learn to be assertive. Assertiveness training is about feeling comfortable expressing opinion and managing conflict, as opposed to avoiding conflict. The other three options do not necessarily address the client s ability to deal with conflict as well as assertiveness training. Question 8 The answer is 4, because it is a safe technique used within a safe environment. Projective techniques are about exploring beliefs, values, and emotions in a safe way. The option of role playing is not ideal, because role playing involves exploring behaviour in a particular situation rather than generally exploring feelings around self-esteem/image. Self-hypnosis is not an OT role. Refuting irrational beliefs is an intervention not a method of exploring. Question 9 The answer is 1 because this group allows her to have support and encouragement from others to promote her self-esteem, without having to ask for it. It facilitates her developing a support system outside of her family system so that she is not as dependent on them for all of her psycho-social needs. Options 2, 3, and 4 are potential secondary benefits from attending the group. Question 10 The answer is 4 because of confidentiality and privacy rules. The other three options do not support client centered practice. Mrs. H is the OT s client; the husband is not. Question 11 The answer is 1, because you need a reliable, valid, and standardized tool in order to apply scientific and systematic methods. The other options are good outcomes too, but they are not scientific or systematic in their approach. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 20

21 Questions 12 to 18: Question 12 The answer is 3, because decreasing arousal level through the use of inhibitory methods can facilitate attention to tasks, reduce activity level, and allow participation. In addition, this intervention utilizes the sensorimotor framework. The other answer options are not interventions associated with the sensorimotor framework. Question 13 The answer is 1, because some of the primary characteristics of autism are listed in answer 1. Children with autism generally have difficulties with communication, social interaction, including play, and tend to demonstrate rigid behaviours and repetitive movements. They may also have ADL difficulties rooted in poor sensory processing. Options 2 and 3 include features that are not consistent with autism. While you may see the behaviours noted in option 4, they are not the primary characteristics. Question 14 The answer is 1, because receptors are being continuously stimulated. This is the best answer. Option 2 is more related to visual stimulation. Option 3 is not correct because it can demonstrate a rigidity of behaviour rather than a need for tactile stimulation. Answer 4 is not correct, because children with autism have difficulties with social attachment. Question 15 The answer is 2, because a furry blanket would provide full body tactile input. Option 1 involves tactile input to the hands only. Option 3 provides vestibular rather than tactile stimulation. Option 4 is a visually stimulating activity and does not encourage tactile stimulation. Question 16 - The answer is 1, because linear rocking facilitates calming. It is in keeping with the Sensory Integration principle of the child being an active participant. It is also a socially appropriate activity for circle time, reading, etc. Options 2 and 4 are alerting rather than calming activities. Option 3 is more likely to be alerting than calming. Question 17 The answer is 1, because it is important for OT s to be knowledgeable about different approaches through critical evaluation of information from reputable sources. OT s need to use evidence-based practice to direct treatment planning. OT s also need to be open to ideas from parents, and respond to them in an appropriate way. The other options do not provide the best approach. Option 2 dismisses the father s idea for treatment without knowing whether or not it might be a valid approach. Options 3 and 4 imply that the OT would implement this intervention, or encourage the father to implement, without investigating more broadly the evidence of its effectiveness. Question 18 The answer is 2, because it measures efficacy in the setting where the service was provided and intended to have the most effect, i.e. on Justin s behaviour and ability to manage in the classroom. Option 1 is not correct, because the OT service is not provided at home. Option 3 is not relevant because it does not relate to OT intervention. Option 4 evaluates how service was provided, but does not necessarily look at client outcome. Questions 19 to 24: Question 19 The answer is 1. Anxiety is more likely to increase tone than any of the other options listed. Warm temperature and calm environments are more likely to reduce tone as they have a calming effect and use of a sling is not likely to increase his tone. Question 20 The answer is 2, due to the degree of fine motor control required, which is affected by the stroke. The other options require less fine motor skills, can be achieved using gross motor movements, or can be done more easily with the left non-dominant hand. Question 21 The answer is 2, because he is beginning to get return of function of the right hand with some apprehension. It is too early to set driving as a goal. There is no indication in the case study that he has difficulty with walking. The issue of walking with a normal gait pattern is often a physiotherapy role. There is no indication that he has any difficulty reading. Question 22 The answer is 4. From a neuroanatomical knowledge base, it is known that the language center is generally located in the left hemisphere of the brain. Therefore damage to this area is likely to result in varying degrees of aphasia. National Occupational Therapy Certification Examination (NOTCE) Resource Manual 21