Running head: OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile and Intervention Plan

Austin Lepper
Touro University Nevada

OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile
Client
The client is a 48 year old male who is diagnosed with Bipolar disorder. The client is an
alcoholic who has been in and out of rehab for the last ten years. The client is also clinically
diagnosed with depression resulting from his job loss and divorce ten years ago. The client
smokes a pack a day of cigarettes. The client has two children which he claims he has not spoken
to in nearly two years. Prior to his admission to Rawson-Neal Psychiatric Hospital the client
lived with friends in an apartment in North Las Vegas. The client currently lives in the Meadow
House, which is a grant funded halfway house that is both drug and alcohol free. He attends
group counseling sessions Monday-Friday for three hours and one on one counseling sessions for
two hours three times a week. The client is receiving counseling services and caregiver services
at the Community Counseling Center and the Meadow house. The client is not seeking
occupational therapy services at this time and has no plans to do so. The client is motivated to
remain sober and wishes to contact and develop a relationship with his children.
Rationale for Services
The client is seeking services after being discharged from Rawson-Neal two weeks ago.
The client was preapproved for the Meadow House and the Community Counseling Center
program prior to his discharge from Rawson-Neal. The client suffers from depression and has
been abusing alcohol to cope with both his Bipolar disorder and depression. He has been
discharged from Rawson-Neal Hospital and has been attending the outpatient counseling
program. The client has remained sober for two weeks. The client is independent in all of his
Activities of Daily Living (ADLs) as well as the majority of his Instrumental Activities of Daily
Living (IADLs). The client needs services to help him cope with his Bipolar disorder and
depression. Without the care he is receiving from the Meadow House and the Community

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Counseling Center the client will relapse and be back on the streets abusing alcohol and not
treating his symptoms.
The clients main concerns include staying true to his sobriety and developing positive
relationships with his children and family. The client is on multiple different medications and is
concerned about remembering when to take them all. The client has concerns with his sleeping
routine and claims to have severe headaches that keep him awake through the night. The client
can become easily angered secondary to his Bipolar disorder and has come close to having
physical altercations with some of his housemates. The client is concerned that if he gets in a
fight with a housemate that he will get kicked out of the house and relapse once again.
Occupations
Successful occupations. The client is successful in the most all of his occupations
including all of his ADLs and the majority of his IADLs. The client is successful with his
education, play, and social participation. The client is also successful with his leisure activities,
but mentions that during leisure time he sometimes feels the urge to drink.
Problem occupations. The clients biggest problem occupation is rest and sleep. The
client also admits that he has problems with a few IADLs including financial management,
shopping, and safety and emergency maintenance secondary to his Bipolar disorder. Another area
of occupation that is a problem area for the client is work. The client has been unable to maintain
a steady job because of his inability to remain sober. The client has been to prison and claims that
because of his criminal record, he will not be hired.
Aspects supporting engagement. The context and environments that support the client
in his ability to participate in a variety of areas of occupational performance would be primarily
cultural, temporal, and virtual. The cultural environment for the client supports his engagement
because the client was raised by a middle class Christian family, and has been raised with
Christian values. The clients parents are still proactive in his recovery and help him pay for his

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bills. The temporal aspect supports the clients engagement because the client is still able to
understand what stage of life he is in as well as his history and diagnosis. The virtual
environment supports his engagement by allowing him to communicate with his parents. The
client had a cell phone prior to his admittance to Rawson-Neal, but the Meadow House does not
allow cell phones and has a house phone that can be utilized.
Aspects inhibiting engagement. The contexts and environments that inhibit the client in
his overall occupational performance include personal, physical, and social. The clients personal
environment inhibits his engagement because of his socioeconomic status and his inability to
remain employed. He is 48 years old and has been unable to maintain sobriety for the past ten
years. The clients physical environment prior to his admittance into Rawson-Neal was an
apartment in North Las Vegas in which he lived with roommates who also abused alcohol. The
clients physical environment was surrounded by bad influences and left him with nothing but
alcohol to help him cope with his Bipolar disorder and depression. The clients social
environment inhibits his engagement because all of his friends abuse drugs and alcohol. The
client does not have any physical deficits regarding his social participation but the clients social
circle negatively impacts his ability to engage in occupations.
Occupational History
The client was born and raised in Los Angeles, California and moved to Las Vegas after
high school and started working on the strip. He started out as a valet driver and worked his way
up to a management position. He later got married and had two children. The economy started to
falter and he lost his job and soon after lost his marriage. The client then moved to an apartment
in North Las Vegas with friends and started abusing alcohol. The client then began working
different jobs within various casinos and stopped taking his medications. He became more and

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more agitated and got in numerous physical altercations and was in and out of prison. The client
has been to Alcoholics Anonymous (AA) meetings and other various groups within the
community and has been unable to remain sober. The client has been in and out of Rawson-Neal
Hospital and has been unable to find proper medications to control his Bipolar disorder and
depression.
Roles. The primary role of the client is being a father to his two children. The client also
wants to be able to secure a job and maintain employment by the conclusion of the program. The
program has reintroduced religion back into his life and the client is interested in becoming an
active member within the church congregation. The client is motivated to maintain his sobriety
and thinks that with the addition of his sponsor, and the support he receives from the house that
he can accomplish his goals.
Values. The client shares the values that were instilled in him by his mother and father.
He values his beliefs and religion as well as his family. He is planning to contact his children
after his first month of sobriety. Most importantly, the client still values his life and wants to
make a change for the better and not continue down the same road that he has for the past ten
years.
Interests. As previously mentioned, the client is very interested in keeping and
maintaining employment. The client is interested in determining and adhering to a medication
management routine in order to properly manage his symptoms. The client is interested in
finding his own place to live after the program so that he can stay away from people that will act
as triggers to him relapsing. The client is also interested in losing weight and exercising to
promote a healthy self image.
Previous Patterns of Engagement
Prior to the clients admission to Rawson-Neal he became agitated and aggressive very
easily. The client was independent in all of his areas of occupation, but the Bipolar disorder and
depression coupled with his alcohol addiction was negatively impacting his life and ability to

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engage in meaningful occupations. The client has lost touch with those who have positive
impacts on his life such as family and friends. His social circle revolved around his friends and
coworkers when he had various jobs.
Changes. After discharge from Rawson-Neal and his acceptance into the Community
Counseling Center addiction recovery program and his living situation at the Meadow House he
has reevaluated his life. Rawson-Neal hospital was able to find medications that worked for him
and for the first time in over five years the client stated that he can think clearly. The client has
come to the realization that he needs help and that he has not been engaging in occupations
because of his addictions.
Clients Priorities and Outcomes
The clients priorities are to remain independent in his daily occupations by maintaining
his sobriety. The client wishes to develop a relationship with his children as well and he knows
for that to be possible he must remain sober. He also has a priority to return to work and maintain
employment while moving into his own place so that he will not be tempted to abuse alcohol.
The outcomes for the client are for him to remain sober and get him on the right
medications that work best for him. Another outcome is to find the client a better living situation
and a job to avoid temptations of abusing alcohol again. If the client can become more
independent in his occupations and not let his addictions consume him, then he can then begin
developing a relationship with his children and family.
Occupational Analysis
Context/Setting
The client lives in a halfway house called the Meadow House. The client receives at least
20 hours of counseling every week. The client attends group session for 3 hours everyday to
address addiction recovery and coping strategies. The client also receives 5 to 6 hours per week
of individual counseling. The Meadow House is a drug and alcohol free government funded
house to aid in addiction recovery. The Community Counseling Center is a non profit Counseling
service that is an outpatient setting funded predominately by Medicaid.

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The Community Counseling Centers have a wide variety of programs for individuals with
physical and mental illnesses. The Center has an HIV/AIDS support group and has many groups
for coping with anxiety and depression. The Community Counseling Center is predominately
funded by Medicaid or out of pocket payments. The client attends an addiction recovery support
group which is mandatory for his stay at the Meadow House.
The Community Counseling Center staff has discussed the need to have an occupational
therapist on staff. An occupational therapist could be very beneficial for this setting and could
address client need throughout the transition process and ensure that the clients are receiving the
proper home modifications and techniques to avoid triggers that would increases the chances of
relapse.
Within the Community Counseling Center there were numerous rooms and offices. Each
of the rooms that held group sessions had chairs that were in a circle and also a table that had
cups and water. There was a dry erase board that the group leader could utilize and the group
sessions had a classroom type feel to them.
Observed Activity
The group leader led the client and group through multiple group sessions to address
coping strategies and emotional regulation. During every group meeting the client is to report to
the group leader how they are feeling that day, whether they are suicidal or homicidal, and if they
are taking their medications as prescribed. The client stated that he was tired and that his
medications give him headaches making it hard for him to sleep. The client stated that he was not
suicidal or homicidal and that he was doing just fine other than feeling tired.
After the group has shared their feelings they then participate in a group activity led by
the group leader. The client has been observed through various craft activities as well as taking
turns reading handouts of success stories from current recovering alcoholics. The client is able to

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engage in these activities independently, but sometimes the group leader will have to cue the
client because he is not paying attention.
Performance Observations
While the client was completing the reading activity the client seemed disengaged so the
group leader asked if he would read out loud to the group. The client was able to read and he
commented on and related to the reading which was about shutting people out of ones life
because of addictions. The client shared stories about is two children and how they have not
spoken to him in years. The client stated that he believed his depression stemmed from his
divorce and unemployment but that has become unmanageable because his kids refuse talk to
him.
The client is seeking counseling services and staying at the Meadow House in order to
regain control of his life by recovering from alcohol addiction and managing his Bipolar disorder
and depression.
OTPF Domains Impacted
There are many domains of the Occupational Therapy Practice Framework (OTPF) that
are impacted by the clients diagnosis. The areas of occupation that have been impacted were
previously addressed in the above sections. However, with proper treatment the client will be
able to address and increase his areas of occupation.
In regards to client factors, the areas that are most impacted for the client is body
functions and body structures. The clients body functions that are impacted are mental functions,
specific mental functions, and global mental functions secondary to his Bipolar disorder and
alcohol abuse. The clients emotional regulation is impacted in large part by his Bipolar disorder
and not taking the right medication to control it. The body structures that are impacted most
include cardiovascular, immunological, and respiratory systems. The client is a heavy drinker
and smokes a pack of cigarettes a day which has resulted in negative impacts for his some of his
body structures.

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The performance skills that are impacted include the clients process skills as well as
social interaction skills. The clients process skills are impacted because of his prolonged use of
alcohol. The social interaction skills have been impacted because he has not talked to his
children for over two years and struggles to behave appropriately while interacting with people.
The performance patterns that are impacted include the clients habits, routines, and roles.
The clients habits have been affected because of his alcohol abuse and instead of participating in
healthy habits the client would drink alcohol. The clients routines have been impacted by not
being able to control his actions when he drinks and not developing a routine for his daily life
and occupations. The clients roles were impacted because he lost touch with his children and
could not maintain employment (American Occupational Therapy Association, 2014).
Problem List
1. Client is unable to control his temperament in social interactions due to inability to
manage his medications.
Rationale. This problem statement is prioritized at number one because it is
meaningful to the client as well as a necessity. The client must be able to manage his
medications properly so that he can control his Bipolar and depression symptoms. It is
important that the client find the right medications because not only will it control his
psychological issues it will also help to enable him to refrain from abusing alcohol.
2. Client is unable to have restful sleep due to migraines and withdrawals from alcohol.
Rationale. This problem statement is prioritized second because it is a
contributing factor to the clients mood and overall health and well being. When the client
does not get enough sleep he becomes agitated and depressed and it initiates triggers to
abuse alcohol. The client has admitted to abusing alcohol so that he could sleep better and
has conditioned his body in that way. It is very important that sleep be addressed for this
client early on in the intervention process.

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3. Client is unable to maintain relationships with his children and family due to his
alcoholism and emotional regulation issues.
Rationale. This problem statement is listed at number three because it is very
meaningful to the client. The client believes that many of his depressive symptoms are
stemming from his inability to maintain relationships with family. This problem
statement is not listed higher because the above two problems need to be addressed
before the client can maintain healthy relationships.
4. Client is unable to maintain steady employment because of his inability to remain sober.
Rationale. This problem statement is listed at number four because the client is
very concerned about returning to work. The reason it is not higher is because the above
problem statements need to be addressed before the client can return to work. The client
needs to develop relationships with his family to avoid depression and then he will be
able to maintain employment.
5. Client is unable to manage his finances due to his inability to maintain his sobriety.
Rationale. This is problem statement number five because the client has admitted
his concerns regarding financial management. However, the above problem statements
need to be first addressed before he will be able to work towards managing finances.
Once the client can manage his symptoms, develop relationships, and return to work he
will then be ready to work towards managing his finances.
Intervention Plan & Outcomes
Long-term Goal
Client will control his temperament in all social interactions (I) using proper medications
& coping strategies by the end of 8 wks.
Short-term goal. Client will take prescribed medications (I) using medication
management strategies by the end of 4 wks.
Intervention. The initial step for intervention would be for the occupational
therapist (OT) to educate the client on different medication management strategies. This

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involves the therapist introducing various techniques such as alarms, calendars, and
weekly pill holders. The client will fill out a daily log of medications and the times in
which the medications were taken in order to develop a routine and find out what
strategies work best for the client. The client will have all of his medications in front of
him and place them in a weekly pill holder and verbalize the times he will take each pill.
The client is not allowed to have a phone while staying at the Meadow House so the
therapist will utilize an alarm clock and show the client strategies to use the alarm clock
as a reminder to take his medications. The therapist will conclude the intervention session
by discussing with the client his preferred medication management strategies and quiz the
client on his comprehension and understanding of his medications and the importance of
taking them.
The intervention approach for this intervention is establish, restore. The therapist
and client will collaborate together to establish a medication management program that is
both appropriate and beneficial for the client.
Literature review. Boltaev, Deryabina, Kusainov, and Howard (2012) evaluated
the quality and effectiveness of medication-assisted therapy (MAT) and reviewed
implementation context and related challenges. The research was conducted using
qualitative and quantitative research methods including a systematic review of relevant
documents, and semi structured interviews with staff members involved in the provision
of medication-assisted therapies. The study included 93 participants interviewed to assess
their perceptions of various MAT programs and its impact on their health. The results
showed that participation in MAT for at least three months resulted in a statistically
significant reduction in the inappropriate use of prescribed medications.
Outcomes for intervention. The outcome that is hoped to be achieved through
this intervention is improvement. The clients routine in adhering to a medication

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management program. The client will be introduced to various medication management

strategies and be able to choose the strategies that he believes he will benefit from the
most. The clients overall health and well being are addressed through this intervention
by allowing the client to take his medications to help cope with his psychosocial issues.
Short-term goal. Client will have 0 emotional outbursts or mood swings using coping
strategies (I) by the end of 4 wks.
Intervention. The occupational therapist will first educate the client on various
coping strategies for when the client experiences symptoms of his Bipolar disorder. The
client and therapist will discuss how the emotions of the client can either positively or
negatively impact situations. The therapist will provide strategies such as counting to ten
or taking a deep breath before reacting when the client becomes agitated. The therapist
will also provide motivational quotes and readings for the client to look at each morning
or carry with him to help him in a positive way when his symptoms arise. In concluding
the treatment session the therapist will present the client with scenarios of possible
altercations with people and ask the client the best way to resolve the issue.
The intervention approach that would be most useful for this intervention is the
create/promote approach. This intervention is promoting the client to act appropriately in
social interactions as well as having a positive impact during altercations and arguments.
The therapist is creating scenarios for the client and asking the client to respond in a
positive way in each scenario.
Literature review. Lauder et al., (2013) developed an online intervention for
bipolar disorder called the MoodSwings program. The MoodSwings program was
adapted as an internet intervention from a validated face-to-face, group-based
psychosocial intervention. The website is available at no cost to registered participants.
The article states that many people with bipolar disorder are accepting of the internet as a

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source of treatment and, once engaged, show acceptable retention rates. The internet
appears to be a viable means of delivering psychosocial self-help strategies. The study
utilized a small pilot group of 12 participants who all had a diagnosis of Bipolar disorder.
Ten of the twelve participants utilized the website. The study concluded that they believe
that they have established a program that meets an unmet treatment need and which has
good engagement and retention of patients with bipolar disorder.
Outcomes for intervention. The outcome that is hoped to be achieved through
this intervention is prevention. In conclusion to this intervention the client should be able
to control his temperament and emotional outbursts during social interactions and
altercations. The intervention is providing the client with strategies that he can utilize
when he becomes agitated or is faced with an altercation.
Long-term Goal
Client will develop sleeping routine & have 0 sleep disturbances from withdrawals or
migraines by the end of 8 wks.
Short-term goal. Client will have 8 hours of sleep each night 1 or less sleep
disturbances by the end of 4 wks.
Intervention. The occupational therapist will instruct the client to keep a sleep
diary and record when he falls asleep and the total hours of sleep he receives each night.
The diary will also consist of the amount of times that the client wakes up in the middle
of the night. The therapist will also discuss with the client strategies to develop a routine
before he goes to sleep such as reading a book, avoiding smoking in the evening, or
having and creating a good comfortable sleeping environment. The sleeping environment
can be modified in many ways such as: the thermostat can be changed for the temperature
in the room; noise perception can be altered with ear plugs if his housemates are keeping
him awake, and also proper amount of blankets and pillows for temperature control.

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The intervention approach that would be most useful for this intervention is the
establish/restore approach. The intervention is attempting to establish a sleeping routine
for the client and decrease the amount of sleep disturbances for the client.
Literature review. Brooks, Krumlauf, Whiting, Clark, and Wallen (2012)
compared subjective and objective measures of sleep quality and duration. The study
describes the prevalence of baseline sleep disturbances in an inpatient population of
alcoholics undergoing their first week of detoxification. This article is a great resource to
use in correlation with this client because of the sleep disturbances the client is
experiencing as well as the relevance of the article to the client. There were 22
participants that were admitted to an inpatient behavioral health hospital and enrolled in
the National Institute of Alcohol Abuse and Alcoholism (NIAAA). Participants were
asked to complete daily sleep diaries assessing sleep quality and duration, which have
been shown to correlate with sleep scales. The results indicate that the sample of inpatient
alcohol treatment patients reported experiencing poor sleep efficiency and significant
sleep disturbances during the month before entering treatment. These results suggest that
self-reported measures may not be sufficient to determine sleep quality and duration in
this population. However, the study mentioned that having a larger sample size may
provide evidence to support subjective and objective sleep measures as valuable clinical
assessment tools for informing the development of interventions designed to improve
sleep quality in a similar future sample of patients receiving inpatient alcohol treatment.
Outcomes for intervention. The outcome utilized for this intervention is health
and wellness. The therapist is establishing a sleeping routine by utilizing a sleep diary.
The therapist will then look over the diary with the client and work towards positive
outcomes by implementing sleeping strategies that worked according to the diary.

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Short-term goal. Client will develop a sleeping routine using a preferred sleep
intervention by the end of 4 wks.
Intervention. The occupational therapist will educate the client on various sleep
interventions to utilize in developing a sleeping routine. The therapist will implement
music-assisted relaxation into the clients sleeping routine based on supporting evidence
based literature. The therapist will provide the client with different relaxing tapes that the
client can choose from to find what sounds help him improve the quality of his sleep. The
client will be asked to verbalize which sounds are most soothing to him and if they
should be included into his sleeping routine.
The intervention approach that is most appropriate for this intervention is the
establish/restore approach. The therapist is promoting a sleeping routine using musicassisted relaxation in order to improve the quality of sleep for the client.
Literature review. Niet, Tiemens, Achterberg, and Hutschemaekers (2011)
explored the applicability of two brief evidence-based interventions to improve sleep
quality in inpatient psychiatry. The research question for this study is What conditions
are needed to introduce and apply an evidence-based intervention for sleep problems in
practice? (Niet et al., 2011, p.320). The study involved three comparable admission
wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and
music-assisted relaxation at the second. At the third ward, no intervention was
introduced. The results of the study reported that music-assisted relaxation is applicable
in inpatient psychiatry. The study concluded by stating that sleep interventions are needed
as alternative methods or in conjunction with sleep medication.
Outcomes for intervention. The outcome for this intervention is quality of life.
The outcomes that are hoped to be achieved through this intervention are to develop a
positive sleeping routine for the client using evidence based literature to increase his

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quality of life.. The client and caregiver in collaboration together will work towards
implementing strategies and interventions that will help the client get the sleep that he
needs.
Precautions. The interventions utilized with this client do have certain
precautions to take into account. It is important in the psychosocial setting that the client
and therapist is being discrete and keeping the information obtained confidential. The
client will be asked to open up and share personal information and it is important for the
therapist to be empathetic for the client while still keeping the client engaged on the goals
for the interventions.
Frequency and duration. The client will be seen at the Community Counseling
Center for group interventions for three hours, five times a week. The individual
interventions will take place for one hour, two times a week.
Grading up and down. This intervention could be graded up and down in many
different ways while the client is participating in various interventions. The sleeping
interventions can be graded up by having the client document more tasks within the sleep
diary. The sleeping interventions can be graded down by having the client only try one
different sleeping strategy before each session.
Framework. The primary framework utilized when determining this intervention
plan is the Person Environment Occupational Performance Model (PEOP). The PEOP
model is ideal for this client because it is imperative that the client's personal
characteristics be taken into consideration as well as his environment and how well he
performs in these occupations in relation to both of these factors. For this particular
client, this model would allow for the intervention to be the most client-centered and
effective framework for developing interventions.
Client/Caregiver training. The training required for the client for the intervention
is the education that is required to learn the different strategies for medication

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management and sleep routines. The caregivers of the Meadow House should be educated
on the importance of the environmental factors for the client and assist him with
modifications.
Responses monitored. The therapist will monitor the clients diary and listen to
the client as he implements various strategies. The therapist will assess the clients
responses towards the progress of goals and educate the client on which strategies are
working for him and which strategies should be implemented on the client.

References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1).
S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006
Boltaev, A. A., Deryabina, A. P., Kusainov, A., & Howard, A. A. (2012). Evaluation of a Pilot
Medication-Assisted Therapy Program in Kazakhstan: Successes, Challenges, and
Opportunities for Scaleup. Advances in Preventive Medicine, 1-13.
doi:10.1155/2012/308793
Brooks, A. T., Krumlauf, M. C., Whiting, B. P., Clark, R. J., & Wallen, G. R. (2012). Are you
Sleeping? Pilot Comparison of Self-Reported and Objective Measures of Sleep Quality
and Duration in an Inpatient Alcoholism Treatment Program. Substance Abuse: Research
& Treatment, (6), 135-139. doi:10.4137/SART.S10385
Lauder, S., Piterman, L., Castle, D., Chester, A., Berk, M., White, C., et al. (2013). Development
of an online intervention for bipolar disorder. www.moodswings.net.au. Psychology,
Health & Medicine, 18(2), 155-165. doi:10.1080/13548506.2012.689840

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Niet, G. D., Tiemens, B., Achterberg, T. V., & Hutschemaekers, G. (2011). Applicability of two
brief evidence-based interventions to improve sleep quality in inpatient mental health
care. International Journal of Mental Health Nursing, 20(5), 319-327.