Referral Criteria
Referral criteria include the patient’s functional decline and “gridlock” in progress or non-compliance due to signs or symptoms in excess of the norm and which prolong the length of stay, such as:
- Depression
- Fear/panic
- Anger
- Hostility
- Apathy
- Suicidal behavior
- Denial
- Resignation
- Feelings of worthlessness, shame or guilt
- Staff "splitting"
- Refusal to do activities of daily living or comply with physical or occupational therapy
- Dependency
When to refer a patient to Psychiatric OT:
Patients should be referred whose daily living skills are impaired, due to:
- Treatment non-compliance or resistance
- Severe lack of motivation or investment
- Depressive symptoms: anhedonia, apathy, isolation, social avoidance, indifference, vegetative state, crying
- Adjustment reaction: depression, ruminating, reaction out of character for patient or out of proportion to physical insult, anger, hostility, blaming, treatment refusal
- Anxiety prohibiting function
- Cognitive impairment due to psychosis
- Chronic pain/behavioral maladaptation
Medical diagnoses with potential for psychological sequelae include:
- Leukemia
- Carcinoma
- COPD
- Transplant
- Colorectal dysfunction
- Amputation
- Cardiac disorders
- AIDS
- Inflammatory disorders
- Post-concussion syndrome
- ESRD
How to Make a Referral to Psychiatric OT
A physician referral is necessary for Psychiatric OT (Doctor’s order needed: “Psychiatric OT: Evaluation and Treatment”). Place the order on LastWord, Occupational Therapy Screen, “Psychiatric OT.” Direct orders may be called in at ext. 45615 or 45607, but LastWord ordering is still mandatory.
Psychiatric Occupational Therapy Treatment
Psychiatric OT bases its treatment on the secondary psychiatric diagnosis, and not the initial medical diagnosis. Thus, Physical Rehabilitative OT might treat hemiplegia S/P CVA, and Psychiatric OT would treat related depression or adjustment disorder. Diagnostically based documentation is essential, not only for the patient’s care, but for reimbursement.
Psychiatric diagnoses commonly treated by the Psychiatric OT are:
- Depression
- Atypical depression
- Dissociative Disorder
- Conversion reaction
- Adjustment disorder
- Atypical psychosis
- Schizophrenia
- Early onset dementia
- Borderline personality disorder
- Obsessive compulsive disorder
- Panic disorder/anxiety
Treatment is usually provided at the patient’s bedside or an assigned hospital room, or, if feasible, in a group therapy setting. If the patient is able to leave his or her hospital room, Psychiatric OT may be offered in the P Building, on the seventh floor in the OT treatment room. The patient would be brought to the P building by Patient Transportation.
Psychiatric Occupational Therapy Treatment Team
Psychiatric OT works closely with Nursing to maintain excellent, prompt communication related to patient care. A unified approach is also created whenever possible, by also liaising with Social Services, Nutrition Therapy and Pastoral Care. The MD Consult Team from Psychiatry also refers patients to Psychiatric OT. Likewise, if a patient is identified as having either a psychiatric history, or a new onset of symptoms, Psychiatric OT will encourage the attending physician to refer the patient to the Psychiatric Consult MD Team for diagnostic evaluation, counseling and psychopharmacological treatment.
Psychiatric OT Personnel
- Carol A. Leslie, Manager
- Maggie Maloney, Occupational Therapist
- Laura Pomonis, Occupational Therapy Assistant
- Heather Foos, Occupational Therapist
- Jeanne Milicic, Occupational Therapy Assistant
- Christa Zalar, Occupational Therapist