CBL CASE KATY, CASSIE, LAUREN S., BRANDY, ALANNA, AND

MEGAN D.

Mandy

Mandy

35-year-old female

Diagnosis: Depression, AIDS, Addiction

Currently in a 2-year transitional living facility

Five children

MOHO

Volition Client needs help identifying values Client is able to identify interests such as cooking

Habituation Client needs to eliminate destructive habits and

establish new, healthy ones Client needs help internalizing and interpreting her

roles

Performance Capacity Client has the musculoskeletal, neurological,

cardiopulmonary and symbolic means to perform daily activities and functional tasks

Toglia’s Dynamic Interactional

Goal: to restore client’s functional performance and improve cognitive function

Dysfunction Deficiencies Organizing and structuring incoming information Anticipating, monitoring, and verifying the accuracy

of performance Flexibly applying knowledge and skills to a variety of

situations

Change: cognitive strategies within multiple contexts.

Assessments

Occupational Performance History Interview II (OPHI II) Life history interview using scales and narrative

reports. Cost: $43.50 Target population: adolescent or adult client who has

cognitive and emotional ability to participate in the interview.

Validity: 90% valid

OPHI Narrative

OPHI Scores

Occupational Identity Present: Some problems Past: Extreme problems

Occupational Environment Some problems

Occupational Competence Present: Some problems Past: Extreme problems

Assessments

Worker Role Interview (WRI) Semi-structured interview that rates impact of

volition, habituation, and perceptions of the environment on readiness to return to work.

Focus on psychosocial readiness. Cost: $43.50 Target population: workers with recent

injuries/disabilities, chronic disabilities,

WRI Summary

Personal Causation: Interferes with functionValues: Interferes with functionInterests: Supports functionRoles: Interferes with functionHabits: Interferes with function

Assessments

Occupational Self Assessment (OSA) Client self-report on 21 daily activities and their

importance to the client. Allows client to set priorities for change.

Cost: $43.50 Target population: adult mental health clients

OSA Summary

Myself: Managing finances Expressing self to

others Satisfying routine Accomplishing goals

Environment: Living arrangements Resources Opportunities to

participate

Assessments

Assessment of Communication and Interaction Skills (ACIS) Observation tool that gathers information about

communication and interaction while engaged in an occupation.

Cost: $40.00

ACIS Summary

Physicality Ineffective

Information Exchange Ineffective/Questionable

Relations Ineffective/Questionable

Goal 1

The client will improve self-awareness as measured by identifying three meaningful life goals in three weeks.

Intervention 1

Value Card Sort Occupational functioning

problems. Help Mandy to identify

values according to the OPHI- II.

Assisting in increasing self-awareness of values.

Occupational functioning problems.

Just-right challenge

http://www.motivationalinterviewing.org/content/personal-values-card-sort

Adaptations

Reduce number of value cards Give her the option of choosing “very

important to me” or “not important to me”. Eliminating the option of “important to me”.

Goal 2

The client will improve organizational habits and routines according to her previously identified goals as measured by 80% adherence to a daily checklist by the end of four weeks.

Intervention 2

Reusable Checklist Dry erase board in her room that the therapist

can check Process of organizing occupations into routines

Mandy’s Daily Routine (TEMPLATE)

Things to Do Sunday MondayTuesda

yWednesda

yThursda

yFriday

Saturday

Make Bed            Personal Hygiene            

Get Dressed            Make Breakfast            Update Budget              

Job Search              Write in my Journal            

                                                                                                         

Go to Bed              TOTALS 5/15 /15 /15 /15 /15 /15 /15

PERCENTAGE 33%            

Adaptations

Therapist identifies daily routines to be completed

Add pictures to identify task instead of wordsDivide up day into times (morning, afternoon,

evening)

Intervention 3

Financial Management: creating a weekly budget Mandy is required to

attend courses to educate her on finances and maintaining a budget.

In the occupational profile, Mandy stated she wanted to improve financial management.

http://www.docstoc.com/docs/40707030/Weekly-Budget-Planner

Adaptations

Reduce the number of categoriesCreating a monthly budget instead of weekly Color code the categories Changing structure by providing money

envelopes for each budget category based on a certain percentage

Instructional Approach

Acquisitional Provide a budget planner which will promote self-

evaluation Focus: modify performance skills Materials: written directions, budget planner

Resources

Cole, M, & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack.

Custer, V. L., & Wassink, K. E. (1991). Occupational therapy intervention for an adult with depression and suicidal tendencies. American Journal of Occupational Therapy, 45(9), 845-848. doi: 10.5014

Garrett, B. (2011). Brain and behavior (3rd ed.). Thousand Oaks, CA: Sage.

Gates, L. B., Akabas, S. H., & Oran-Sabia, V. (1998). Relationship accommodations involving the work group: Improving work prognosis for mental. Psychiatric Rehabilitation Journal, 21(3), 264-272. Retrieved from http://web.a.ebscohost.com

Giles, G. M., Radomski, M. V., Champagne, T., Corcoran, M. A., Gillen, G., Kuhaneck, H. M., & Toglia, J. (2013). Cognition, cognitive rehabilitation, and occupational performance.  American Journal of Occupational Therapy, 67(6). doi: 10.5014/ajot.2013.6759

Resources Cont.

Helfrich, C. A., Chan, D. V., & Sabol, P. (2011). Cognitive predictors of life skill intervention outcomes for adults with mental illness at risk for homelessness. American Journal of Occupational Therapy, 65, 277– 286. doi: 10.5014/ ajot.2011.001321

Kielhofner, G., & Burke, J. P. (1980). A model of human occupation, part 1.  American Journal of Occupational Therapy, 34(9), 572-581. doi:10.5014/ajot.34.9.572

Paul-Ward, A., Kielhofner, G., Braveman, B., Levin, M. (2005). Resident and staff perceptions of barriers to independence and employment in supportive living settings for persons with AIDS. American Journal of Occupational Therapy, 59, 540–545. doi:10.5014/ajot.59.5.540

Schell, B.A.B., Gillen, G., Scaffa, M. E. (2013). Willard and Spackman's occupational therapy (12th ed.). Philadelphia: Lippincott, Williams, & Wilkins.

Wagner, C. C., & Sanchez, F. P. (2002). The role of values in motivational -interviewing. Motivational Interviewing: Preparing People for Change, 2, 284-298.