Acute Care Hospitals

This setting offers perhaps the greatest diversity. Therapists treat hospitalized clients with traumatic conditions, including heart attack, stroke, hip replacement, brain injury, burns, spinal cord injury and premature birth, and such progressive neurological diseases as Guillian Barre and multiple sclerosis. Medical management and stability have the highest priority. Clients are moved to less costly settings as soon as possible. The primary contributions of occupational therapy may be to prevent functional loss and restore clients’ confidence in their ability to regain function.

Because patients are being stabilized in terms of their medical condition, treatment is for short periods of time, possibly at several times during the day. Students will see a variety of patients, but usually only in the acute phase of the illness; usually up to 7 days.

Subacute Centers

Offer more intense treatment than traditional nursing facilities; bridge the gap between acute care hospital and home. Treatment might be 30 minutes to 1 and a half hours; up to 10 to 35 days. A rehabilitation team is usually involved, including nursing, PT, OT and speech therapy. This might take place in a nursing home setting, or connected with an acute care hospital. Likely to provide services to a variety of neurological and orthopedic disorders.

The overriding goal is to design services to enable clients to assume and maintain their functional skills such that they can return home or to a less restrictive living unit in a nursing home setting.

Rehabilitation Centers

Offer intensive restorative services with a comprehensive team of rehab professionals. Treatment provided 1-2 hours per day, 5-7 days a week, usually anywhere from 1 to 6 weeks, depending on diagnosis. The emphasis here is primarily on restoration of independence in self-care shills. Activities of daily living, such as personal hygiene, eating and grooming, serve as the most common vehicles to help clients regain their life roles. Therapists are frequently involved in assisting clients to assist their living arrangements, incorporate safer techniques in their routine, and learn compensatory methods to complete tasks, either by modifying their approach or using assistive devices. Rehabilitation may occur on either and in - or outpatient basis.

Home Health

Services are provided for patients in their home setting. Might be provided as follow-up to inpatient care and usually are meant to ease the transition to home. Duration of treatment might be 1-6 months, 1-3 visits per week. The focus of treatment sessions might be assessing living arrangements, incorporating safer techniques in their familiar routines, learning compensatory methods to complete tasks, and monitoring and facilitating independent living skills. In the home setting, therapists often relinquish treatment modalities and techniques associated with clinic-based therapy and provide interventions that incorporate personal values, activities, and objects meaningful to the client.

Outpatient Settings

These might be departments of inpatient facilities, they might be free-standing rehabilitation facilities, or private practice clinics. These programs typically address patients who have enough functional mobility to participate and who have deficits that interfere with full participation in community and vocational activities.

Hand Therapy Centers

Many hand therapists are hospital-based, but an increasing number are associated with surgeons with specialized hand practices. The complexity of conditions presented by these clients often requires therapists to design and fabricate totally individualized splints for each client, as well as to prescribe a regime of exercise and activity that will facilitate the healing process.

Industrial Rehabilitation

The concept of work hardening involves using specific tasks to prepare an individual for return to work. Work-related therapy is typically provided in outpatient clinics. Therapists also offer interventions at the work site: conducting assessment of the employment setting and tasks, and offering recommendations to prevent work-related injury, as well as to enhance performance.

Psychiatric Fieldwork Settings

General Hospital Psychiatric Unit

There are usually 15-25 bed psychiatric units housed within a general hospital. Usually they house patients while in the acute phase of psychiatric illness; hospital stays may range from 24 hours up to 7 days. Diversity in diagnosis is the norm. The priorities in treatment are to assess, manage the illness medically, and to stabilize the presenting problems. Occupational therapy is involved in assessing the client for potential return to independent living, as well as teaching short-term skills and working with the team in crises intervention.

State Hospital Setting

Usually a large hospital system with several buildings and several psychiatric units ranging from acute care to long term maintenance, and possible forensic programs. Length of stay might vary, but the average is from 30 days to 6 months. Much diversity is evident in terms of diagnoses and severity of illness; individuals with serious mental illness (chronic) are more likely to utilize this setting, although most state hospitals also have an acute unit as well for short-term stays.

Clients in the long-term programs who are coping with chronic mental illness might have occupational deficits in establishing short and long-term goals, such as following a regular routine; spending money effectively; acquiring and demonstrating effective work performance; achieving a healthful balance of work, rest and leisure; interacting with other people in the daily environment; and making appropriate use of community resources.

Veterans Administration Hospitals

Very similar to state hospital systems in terms of size and scope of services. These hospital systems are reserved for veterans and their dependants, so tend to run toward male population, but in more urban settings might have a large variety in caseload. Because it is a government hospital, the paperwork and documentation differs from a private hospital, and is usually less demanding.

Community Mental Health Settings

Often these settings are associated with Mental Health Centers and provide outpatient services to eligible clients within an identified region. The focus of services is usually toward independent living skills training, and providing ongoing resources and skills necessary to live independently in the community: Usually utilized by those with long term or serious mental illness; often these are individuals who have been hospitalized in the acute phase of their illness in a state hospital setting.

Hospital Based Psychiatric Outpatient Programs

Individuals utilizing these services live at home and come back to the hospital for day treatment programs which assist them in returning to their daily routine. Bridges the gap for patients in acute crises. Common diagnoses include chemical dependency, eating disorders, depression and other mood/anxiety disorders. This program is usually not designed for those with long-term and serious mental illness.