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.