OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

This assignment involves synthesizing the information from OTCH 6120 (Theory), OCTH 6140 (Skills) and OCTH
6160 (Evaluation) on the module we completed on school-aged children. The format for this case study replicates the
occupational therapy process from referral through evaluation and planning intervention.
You are to complete all the questions in the order that they appear. As in the therapy process, you will gain more
information as you go through case. DO NOT change your answers to earlier questions as you gain more
information. It is important for you to reflect on your thinking processes and to identify information you need and want
to obtain as you learn more about the child and his or her family.
You may refer to your notes, textbooks, or use the internet to help you to answer the questions. You may work with a
partner, if you want.
Case Study
Sasha is a 10-year-old girl who attends a regular 5th grade classroom. Her teacher referred her for a
comprehensive evaluation due to concerns about Sashas behavior in the classroom, her difficulty completing
assignments, and her aggressive behavior on the playground. You are the occupational therapist who will do part of
Sashas comprehensive evaluation.
Question 1:
a) What are two possible diagnoses that Sasha may have? (Include diagnostic information and support it with
evidence from the referral).

1. Traumatic Brain Injury (TBI) - According to the Mayo Clinic, children with TBIs may display concentration
problems, mood changes or mood swings, agitation, combativeness or other unusual behavior.
(http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/symptoms/con-20029302)
Sashas behavioral issues could be explained by a TBI. Her difficulty completing assignments could be a
reflection of the concentration problems that can occur following a TBI. These symptoms of a TBI align
with the teachers concerns of Sashas behavior in the classroom, her difficulty completing assignments,
and her aggressive behavior on the playground.
2.

Oppositional Defiance Disorder (ODD) - According to the Mayo Clinic, children with ODD may
display angry and irritable mood; argumentative and defiant behavior; or vindictiveness, occurs with at
least one individual who is not a sibling; causes significant problems at work, school or home; angry and
irritable mood; argumentative and defiant behavior. ODD severity can vary as well from mild where
symptoms occur in only one setting to severe where they appear in three or more settings.
(http://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/basics/symptoms/con20024559). These symptoms of ODD align with the teachers concerns of Sashas behavior in the
classroom, her difficulty completing assignments, and her aggressive behavior on the playground. The
irritable mood, defiant behavior, and vindictive behavior occurring with a peer are consistent with ODD.
Her difficulty completing assignments may have more to do with her viewing the teacher as an authority to

OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

defy resulting in her not doing assignments as opposed to her not being capable of the coursework. Since
ODD may only be present in one setting such as school, it is not surprising that the teacher is making the
referral; they may not be another adult aware of the issues because she doesnt act out around them.

b) Pick one of these diagnoses. Name the diagnosis you selected and identify four specific occupational
performance tasks (areas) that may be affected. Identify three potential contextual and three potential
personal barriers that may limit Sashas participation in everyday activities.
Diagnosis: ODD
1. Education formal education participation

2. Play - play participation

3. Social participation community

4. Social participation peer, friend

List four specific occupational performance tasks (areas) that may be affected for Sasha:

Personal Weaknesses
(Client Factors,
Performance Skills,
Performance Patterns)

Contextual/Environmental
Barriers

Body functions mental

functions, specific mental
functions, global mental
functions
She may have had a TBI
which is resulting in altered
mental functions. Without a
diagnosis, we have a very
small snapshot for what is
occurring and even less
information for why it could
be occurring.

Process skills attends,

sequences, continues,
terminates, organizes,
accommodates, benefits
Her difficulty completing
assignments may be a
reflection of processing
skills. Even if she knows
the information required for
an assignment she may
lack the skills necessary to
carry it out.

Physical Environment Very

little is known about her
physical environment where
he lives, plays, or even the
classroom. She could be in a
noisy apartment building that
disrupts his rest and sleep
leaving her irritable and
quick to aggression. Lack of
sleep could contribute to
difficulty completing
assignments. Too much is
unknown at this point.

Personal context Sasha

is a 10 year girl in a typical
classroom. We dont know
anything else about her
personal context. Is she an
only child so she doesnt
have good models of
behavior and social
interactions? Was she
abused so she is fearful of
being close to someone
and aggression keeps
them distant? Is she in

Social Interaction SkillsApproaches/Starts,

gesticulates, touches,
regulates, expresses
emotions, matches
language
Sasha is currently engaging
with peers and possibly her
teacher inappropriately. Her
lack of social skills are likely
alienating her and with
alienation, her chances of
ever having enough
experience with positive
interactions is dwindling.
Social Environment we
dont know anything about
outside of school and very
little about school itself.
Does she have people
outside of school she
prefers so school behavior is
atypical? Do parents work
so she was never educated
on social interactions? Does
she get the attention she
wants or is acting out filling
that need?

OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

foster care and angry
about how she got there?
They a lot of reasons why
children act out and we
know very little about her
personal context.

2. Preparation for Evaluation

You review the referral and learn the following: Sasha received occupational therapy in kindergarten but met
academic expectations and did not qualify for further specialized educational services. She struggled in 2nd and 3rd
grades but successfully met academic expectations. Sasha had difficulty following directions, staying on task,
completing tasks, and participating with peers during recess. She was easily upset in unfamiliar environments, when
people were too close to her, and with changes in schedule. The school psychologist observed her and made
recommendations to her teacher for modifying instructions and giving her more time to complete tasks. With these
accommodations, Sasha completed the earlier grades but continued to require much assistance to learn, to complete
tasks, to complete her work in a timely manner, to remember her belongings and her homework, and to engage in
recreational and gym activities.
Now, in fourth grade, Sasha continues to exhibit problems in the classroom and during recess despite adaptations.
She is in danger of being held back because she does not complete assignments and is not meeting academic
expectations. The team decided to refer Sasha for a comprehensive evaluation. Sashas mother agreed to the
evaluation and expressed concerns about Sashas ongoing difficulties with school, with completing homework, with
getting along with peers, and with her poor coping skills.
a) From the information above, identify three risk factors that may influence Sashas development. (Cite your
information source, identify references from lecture notes.)
Risk Factor
1. Social isolation
Bovey, T., Strain, P. (2003). Promoting Positive Peer
Social Interactions. What Works Briefs. Retrieved
from http://csefel.vanderbilt.edu/briefs/wwb8.pdf

2. mental health issues particularly suicidal

tendencies
Nevada Division of Public and Behavioral Health.
(2014). Risk and protective factors. Retrieved
from
http://suicideprevention.nv.gov/Youth/RiskFactors/

3. overweight

Scientific Reasoning & Evidence

Interacting with peers is an important development for
children to achieve. Social interactions with others help
teach problem solving, collaboration, and build positive
social and emotional development. Because Sasha
doesnt get along with peers she is missing out on the
positive construction that comes from social interactions.
With her aggressive behaviors, peers will likely start
avoid any contact with her and thus she is at risk for
social isolation.
Poor coping skills are a common risk factor of individuals
who attempt or commit suicide. Unless Sasha learns
positive ways of coping with life, her risk will continue
and as pressures of adolescence increase so may her
risk of suicide. Another common risk factors for suicide is
conduct disorder and behavioral factors which are also
obvious in Sasha. If she continues down this path she is
at risk for suicidal tendencies.
Poor school performance has been linked to a higher

OCTH 6140 - Integrative Case Study #3

Kark, M., Hjern, A., Rasmussen, F. (2014). Poor
school performance is associated with a larger
gain in body mass index during puberty. Acta
Paediatrica. 103(2), 207-213.

Name: Melanie Francis

BMI in adolescents. If Sashas school performance
continues to suffer she is at an increased risk of using
food to cope which may lead to being overweight.

b) Pick two of the risk factors you identified above. Next to each risk factor identify
a. How it may affect Sashas occupational performance
b. How it may the affect Sashas school experience.
1.
1.

Risk #1 social isolation

Sashas occupational performance
Social isolation will negatively affect Sashas education, future work performance, play,
and social participation. She will likely be unable or have difficulty making friends which
hinders her social participation with peers which will result in decreased performance in
play as well. Group settings/projects may be difficult which will hinder education and work
performance further.

2.

Impact of occupational performance problems on Sashas school experience

Sasha is already having difficulties completing assignments and any group work will
become even more difficult for her. She may continue to perform poorly because she
cannot interact with peers in a constructive manner. Recess will get worse as well as
peers begin distancing themselves from her to avoid her aggression.
2.

Risk #2 become overweight

1.

Marias occupational performance

If her poor performance in school and other occupations continues she may become
overweight which will ADLs (particularly mobility), IADLs (health management), rest &
sleep, education, work, play, leisure, and social participation more difficult and
occupational performance will decline. Children can be cruel and exclude her because of
her weight. Depending on severity, sitting at a desk with an attached chair could be very
uncomfortable and interfere with her ability to learn. She may not be able to keep up in PE
or at recess with the other children. Even quality sleep is more difficult with excess weight.
Being overweight would certainly change her performance throughout her occupations at
least slightly if not drastically.

2.

Impact of occupational performance problems on Sashas school experience

If she is no longer able to sit at a desk comfortably her attention to what shes learning will
likely decline. If she is unable to keep up educationally or physically (in PE) with the other
children she may be teased and further isolated making school a miserable experience.
c) Domain Analysis: Based on what you know, highlight domains that you think need further investigation
during your initial evaluation to see how they might be impacting the childs occupational performance and
their school and family life.
Occupations

Client Factors

Performance
Skills

Performance
Patterns

Context & Environment

OCTH 6140 - Integrative Case Study #3

ADLs
IADLs

Values
Beliefs
Spirituality

Motor Skills

Habits

Cultural
Personal

Rest & Sleep

Education

Name: Melanie Francis

Routines
Body Functions

Process Skills

Work

Physical
Rituals

Social

Roles

Temporal

Play
Leisure
Social
Participation

Body Structures

Social Interaction
Skills

Virtual

d) Practice Models Guiding Your Evaluation and Assessment

Based on what you know so far (Age, diagnosis, concerns, setting, risk factors, etc.) and all the factors considered
above:
Choose an organizing practice model (PEO, MOHO, OA, EHP, Lifestyle Balance that will help guide you in
the overall evaluation process. Be specific Justify and provide a rationale to support your choice for this
child.
Choose at least 2 (two) complimentary OT models that will help guide you in the overall evaluation process.
Be specific. List only those most pertinent. Justify and provide a rationale for each one to support your
choice for this child.
REMEMBER you want to choose a model that provides a foundation for a COMPREHENSIVE evaluation
plan.
Practice Models

Organizing: PEO

Rationale:
Describe the model & Justify the relevance to this child & their family using
postulates of change.
PEO addresses the interactions between person, environment, and occupation. It
recognizes that the environment is easier to change than the person. This model will
acknowledge each member of the familys needs/priorities as well as their
needs/priorities as a whole.
Sasha has to go between multiple environments but primarily home and school.
Under PEO, strategies can be taught to Sasha (P) to help her cope or overcome
issues, the environments (E) can be modified to make them conducive to her needs
for growth & development, the occupations (O) or more likely the occupational
demands can be adjusted to what she needs.
We would want to do evaluations that look at how her environment, in this situation
school in particular, is supporting her behavioral growth and how adjusting
interactions between her and peers/teachers can increase her social participation

OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

appropriately. Postulates of change from the PEO that support this include:

Complimentary #1: Social

Participation

Complimentary #2:
Sensory Processing

1. Barriers to occupational performance can be prevalent in the persons

environment and interventions applied to the environment may enable to
individuals occupational performance in the presence of disability.
2. Change in person, environment, or occupation, or their transaction, can improve
occupational performance
The Social Participation model states that social development is formed in early
childhood and requires certain skills, habits, and routines. Through this model
behavioral and environmental deficits are identified and adapted to allow for effective
communication a social participation opportunities.
Sashas current habits and routines are isolating her peers and social interactions in
the community. By observing Sasha in different environments (classroom, lunch
room, playground), we can better understand her current social skills and behaviors
that are affecting her social participation. This information will highlight areas of
improvement give a template for therapy that will encourage appropriate and positive
social participation. Postulate of change from the Social Participation model that
support this is:
1. If a therapist assists a childs [teacher] to develop strategies to teach a child
habits for social interaction that support the childs participation in daily [school]
routines, then the child will be more available to learning to participate in daily
[school] routines at his or her developmental or functional level.
The Sensory Processing model is used to understand how individuals respond to
sensory stimuli. Individuals responses are organized on a scale that generates a
description of the individual as having a high or low threshold for each stimuli as well
as how they react, actively or passively. Sasha has behavioral issues which may be
due to sensory issues. By giving her a sensory assessment, we can understand how
her body is reacting the stimuli around her and teach her skills to adapt to the stimuli
n a more positive way. Once we know her profile we can design interventions to help
her desensitize to stimuli or adapt her response.
Postulates of change from the Sensory Processing model include:
1.
We can design environments to meet individuals sensory
processing preferences. Interventions require us to match the environmental
features with the sensory processing preferences.
2.
Therapy can focus on the senses of: vision, tactile,
vestibular, proprioceptive, smell, and auditory in order to help the child organize
the environment and themselves better.
3.
Interventions provide the just right challenge

e) Evaluation Plan
Identify at least three assessment tools or strategies (formal or informal) you would use to evaluate Sasha during this
initial one-hour session. Next to each assessment or strategy, briefly describe information you hope to obtain using
this method. Also identify the practice model that guided your choice of this tool with a brief rationale. You may
schedule a return visit to collect additional information. [Remember that, collectively, your assessments and
procedures must only take 1 hour.]

OCTH 6140 - Integrative Case Study #3

Strategy/Assessment
Tool
COPM

School Function
Assessment

Information you would hope to

obtain
Doing the COPM with the mother
would give much more information
about Sasha as a whole rather than
Sasha as a student. While therapy will
be at school, a better understanding
of Sasha will have an effect on
interventions.
I would also ask the teacher for input
on the school specific aspects to get a
better picture of what is typical for
Sasha.

This assessment gives us information

about her participation. Performance,
and supports available in her
classroom. It would give a great
picture of her in the classroom. It will
identify much of the E & O needed to
guide treatment as well as an
understanding of her interactions
within the classroom.

Name: Melanie Francis

Practice Model & Rationale
PEO - COPM will help to identify what is
affecting and how to create an optimal
congruence between the person,
environment, and context for Sasha. Will
also help teacher/parents to become aware
of the interactive nature of everything and
begin thinking about how they are already or
can support Sasha.
We would want to do evaluations that look
at how her environment, in this situation
school in particular, is supporting her
behavioral growth and how adjusting
interactions between her and
peers/teachers can increase her social
participation appropriately. Postulates of
change from the PEO that support this
include:
1. Barriers to occupational performance
can be prevalent in the persons
environment and interventions applied
to the environment may enable to
individuals occupational performance in
the presence of disability.
2. Change in person, environment, or
occupation, or their transaction, can
improve occupational performance
Social Part - Sashas current habits and
routines are isolating her peers and social
interactions in the community. By observing
Sasha in different environments (classroom,
lunch room, playground), we can better
understand her current social skills and
behaviors that are affecting her social
participation. This information will highlight
areas of improvement give a template for
therapy that will encourage appropriate and
positive social participation. Postulate of
change from the Social Participation model
that support this is:
1. If a therapist assists a childs [teacher]
to develop strategies to teach a child
habits for social interaction that support
the childs participation in daily [school]

OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

routines, then the child will be more
available to learning to participate in
daily [school] routines at his or her
developmental or functional level.
PEO - will help to identify what is affecting
and how to create an optimal congruence
between the person, environment, and
context for Sasha. Will also help
teacher/parents to become aware of the
interactive nature of everything and begin
thinking about how they are already or can
support Sasha.
We would want to do evaluations that look
at how her environment, in this situation
school in particular, is supporting her
behavioral growth and how adjusting
interactions between her and
peers/teachers can increase her social
participation appropriately. Postulates of
change from the PEO that support this
include:

Observation in classroom
and recess specifically

Through observation, I would want to

see her typical school day. What is
her current social skill level? What
types of behaviors (appropriate or
inappropriate) are seen? How is
aggression manifested? Is aggression
targeted on a specific peer or is it
whomever is closest? Is there a
common antecedent to the behavior?
What in her environment is supporting
social participation?...learning?

3. Barriers to occupational performance

can be prevalent in the persons
environment and interventions applied
to the environment may enable to
individuals occupational performance in
the presence of disability.
4. Change in person, environment, or
occupation, or their transaction, can
improve occupational performance
Social Part - Sashas current habits and
routines are isolating her peers and social
interactions in the community. By observing
Sasha in different environments (classroom,
lunch room, playground), we can better
understand her current social skills and
behaviors that are affecting her social
participation. This information will highlight
areas of improvement give a template for
therapy that will encourage appropriate and
positive social participation. Postulate of
change from the Social Participation model
that support this is:
2. If a therapist assists a childs [teacher]
to develop strategies to teach a child

OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

habits for social interaction that support
the childs participation in daily [school]
routines, then the child will be more
available to learning to participate in
daily [school] routines at his or her
developmental or functional level.

Sensory Profile Child

(mom)
School Companion
(teacher if it seems she
has different response to
stimuli between school
and home)

What if any issues she has with

sensory? Avoiding or seeking? Types
preferred/organizational for her? Does
she differ between home and school?

1.
Sensory integration its important to find
out what sensory components are inhibiting
her social participation and completion of
work. Given her sensory profile we can
devise interventions to teach her how to
tolerate less than ideal situations or help her
become desensitized to an undesirable
stimuli which will in turn promote
occupational performance.

You contact Sashas teacher so that you can interview her about Sashas performance in the classroom.
3. Evaluation: Occupational Profile
a)

List the three most important questions you would ask Sashas teacher. State the questions in the words
you would use with her teacher.

1. What strategies are you already using to help promote participation and manage behaviors?
2. When does she do her best? Is it at a particular time of day, with a specific person, certain setting?
3. Have you noticed any specific triggers to a behavior?
b) List the three most important questions you would ask Sashas mother. State the questions in the words you
would use with her mother.
1. When do you see aggressive behaviors, if any, at home?
2. Have you noticed any specific triggers to a behavior?
3. What have you done at home to manage difficult behaviors or get through homework?

c) Given her age, list 6 occupational performance tasks that you would like to observe Sasha perform during the
evaluation. Include tasks from at least three settings (home, school, community) in your answers.
1. Social interactions (every setting)
a. Group at school
b. Family
c. Teacher
d. Strangers (appropriate eye contact, greetings, etc.)
2. Attention to tasks (home & school)
a. School work (at school)
b. Homework (at home)
c. Preferred task (at school & home)

OCTH 6140 - Integrative Case Study #3

3.
4.
5.
6.

Name: Melanie Francis

Transitions (every setting)

Fine motor tasks - Handwriting (school & home) to see if that is the difficulty in completing assignments
Create a game or make up a story to see her ideation
Gross motor activity (tag) to see if motor deficits are inhibiting socialization

4. Evaluation: Analysis of Occupational Performance

From your evaluation, you find the following:
Both Sashas teacher and her mother reported that Sasha occasionally strikes out at people when they invade her
space. Sasha often chooses to hang back before and during transitions to activities, and these are particularly
difficult times for her. Her mother reported that these behaviors also occur at home, with more intensity, when there is
a sudden change in plans from the normal routine.
From your interview with Sasha you learn that she gets into trouble because she doesnt get her school work
competed, she doesnt bring in her homework, she forgets her lunch money, and gets in fights with kids at school and
in the neighborhood. You observe that Sasha looks disheveled, often trips on her own feet, and appears clumsy
during recreational activities such as tag, Chinese jump rope, and dodge ball. Sasha has a sense of humor, is
talkative, and enjoys using the suspended equipment in the OT room.
Standardized Tests:
Sensory Profile:
o Low threshold for tactile and auditory input
o Difficulty organizing and executing gross & fine motor movements (praxis and motor planning)
School Function Assessment
1. Participation: Below criterion cut-off score of 100 Notable problems with transitions, in the regular
classroom, on the playground, and during mealtime.
2. Activities:
Physical
Significantly below criterion cutoff for written work and recreational movement.
Cognitive/Behavioral
Significantly below criterion cutoff for task behavior/completion and following
social conventions.
a) From the evaluation information you gathered and information provided above, identify two specific areas of
occupation that are being impacted for Sasha. With these occupations in mind, identify two activity demands, two
client factors, and two possible contextual factors that may limit Sashas participation in the identified occupations.
Occupations

Activity Demands
(related to the 2
occupations stated
above Table 7 OTPF)

Potential Limitations or Barriers

Social Participation
Education

1) Social Demands: SFA shows

significantly below criterion for
following social conventions. Does
Sasha understand how to play with
peers? Does she know what is
appropriate for the activity?

1) Social demands: Problems with

transitions. Difficulty following social
conventions. Does she know the
expectations of teachers, peers, parents?
2) Relevance and importance to client: Does
she care about the subject? Does she realize

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OCTH 6140 - Integrative Case Study #3

Personal factors
(Client Factors,
Performance Skills &
Patterns Table 4
OTPF)

Contextual Factors

2) Relevance and importance to client:

Does she feel like shes missing out?
Does she want more friends?
1) Motor Skills: Sensory profile
shows difficulty organizing and
executing gross and fine motor.
Does she have the gross and fine
motor skills necessary to
participate? Can she motor plan
the steps of a game?
2) Social interaction skills: Difficulty
following social conventions. Can
she start a conversation? Stay on
topic? Continue a conversation
1) Cultural: It is expected for Sasha
to follow rules and not have
emotional outbursts during social
interactions. She should listen to
adults. Does she understand
these expectations? Does she
know how to deal with peers,
teachers, and family
appropriately?
2) Social: She is expected to interact
with peers, teachers, family
respectfully. Does she understand
what appropriate behavior is?
Does she know when she is being
appropriate? Does she
understand why her behaviors are
not appropriate

Name: Melanie Francis

its future impact on her?

1) Process skills: Difficulty completing

course work. Can she attend to the task?
Can she sequence the task?
2) Social interaction skills: Difficulty
following social conventions. Can she
ask the questions she needs to? Can
she answer questions? Can she work in
a group as needed?

1) Cultural: students should be at

school to learn and complete
homework at home. Does she
understand these expectations?
2) Social: She is expected to interact
with peers, teachers, family
respectfully. Does she understand
what appropriate behavior is? Does
she know when she is being
appropriate? Does she understand
why her behaviors are not
appropriate

From the evaluation information you gathered and information provided above, identify two specific areas of
occupation that are strengths for Sasha. With these occupations in mind, identify two activity demands, two client
factors, and two possible contextual factors that may promote Sashas participation the identified occupations.
Occupations

Activity Demands
(related to the 2
occupations stated
above Table 7 OTPF)

Potential Strengths or Supports

Functional Mobility
ADLs self-care

1) Required body structures: she has

the necessary limbs to move
about. She may trip and look
clumsy but she is structurally
sound for functional mobility.
2) Relevance and importance to
client; though not stated above,
she likely values being able to

1) Relevance and importance to client:

though not stated above, she likely is
proud of doing these things by herself
instead of having her parents do it all for
her.
2) Objects used and their properties:
though not verified in above information,
in order to accomplish self-care tasks

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OCTH 6140 - Integrative Case Study #3

Personal factors
(Client Factors,
Performance Skills &
Patterns Table 4
OTPF)

1)

2)

Contextual Factors

1)

2)

Name: Melanie Francis

move about on her own rather

than with a wheelchair or her
parents carrying her everywhere.
Body structures: she has all
necessary structures to get
around. She may trip and look
clumsy but she can get where she
wants/needs to go.
Neuromusculoskeletal and
movement-related functions: Joint
mobility- She has mobility of joints
to sit, stand up, and move
throughout her environment.
Cultural: It is culturally expected
that a 10 year old girl with no
physical impairments move about
independently. Her parents likely
encouraged her to learn to walk
and once she learned probably
encouraged her to walk more than
she was carried which culture
dictates as typical.
Social: the kids at school are
walking and running about, to
even attempt to interact she must
be mobile as well.

she would need to understand what a

shirt is and how it is put on, how to use a
toothbrush, etc.
1) Neuromusculoskeletal and movementrelated functions: Joint mobility- She has
mobility of joints to get dressed, groom,
shower.
2) Routines: parents likely started morning
and nighttime routines that she is now
completely with more independence. She
follows through getting, dressed, then
breakfast, then brush teeth.
1) Cultural: It is culturally expected that
Sasha dress, bathe, groom herself. It has
not been addressed in the information
given so I assume she is meeting these
cultural expectations.
2) Personal/Temporal: Sasha is a 10 year
old that likes to be independent instead
of having her parents do everything for
her.

b) Projected Outcomes: Based on the information collected in your evaluation, explain and detail your targeted
outcomes for Sasha (Select at least 2-3 that are being the most directly addressed in your intervention plan).
Occupational
Performance
Through working
with Sasha,
outcomes will be
focused on her
ability to interact
with others. Her
sensory profile
shows her low
threshold for
tactile and
auditory input
which are likely

Prevention

Health & Wellness

Quality of Life

Participation

Well-being

Through
working with
Sasha,
outcomes will
be focused on
her ability to
participate
socially. Her
sensory profile
shows her low
threshold for
tactile and

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OCTH 6140 - Integrative Case Study #3

inhibiting her
performance
socially and in
school in general
(aggressive
behaviors).
School can be a
noisy place and
desks are often
quite close which
may be too
much for Sasha.
By increasing
her tolerance of
these stimuli or
implementing
coping
strategies,
Sasha will be
able to perform
better in
education, social
participation, and
play. These
areas are not
limited only to
her school
environment but
every
environment.
Her motor skills
will also need to
be addressed to
improve overall
occupational
performance.

Name: Melanie Francis

auditory input
which are
likely inhibiting
her
participation
socially which
impacts all of
the areas of
occupation in
which she is
struggling.
School can be
a noisy place
and desks are
often quite
close which
may be too
much for
Sasha. By
increasing her
tolerance of
these stimuli
or
implementing
coping
strategies,
Sasha will be
able to
participate in
education,
social
interactions,
and play
better. These
areas are not
limited only to
her school
environment
but every
environment.
Her motor
skills will also
need to be

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OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

addressed to
improve
overall
occupational
participation.

c) Based on the evaluation information, list three priority intervention/goal areas for Sasha. (Be sure the priorities you
select directly support your outcomes listed above.)
1. Increase tolerance of tactile and auditory stimuli using coping strategies in order to increase occupational
performance and participation in education, social participation, and play.
2. Increase social participation through improved social interaction skills and motor skills in order to prevent
social isolation, increase participation at home and school and improve her overall occupational
performance.
3. Increase fine and gross motor coordination to improve occupational performance and participation.
1. Intervention Process: Develop a Plan
Practice Models need to be selected to guide intervention and activity selection and intervention priorities based on:
Client Goals, values, beliefs & occupational needs
Client health & well-being
Client performance skills & patterns
Collective influence of context/environment, activity demands & client
factors on the child
Context of service deliver in which intervention is provided
Best available evidence
a) From the evaluation information and your chosen priorities:
Review your choice of an organizing practice model (PEO, MOHO, OA, EHP, Lifestyle Balance). Is it still a
good choice to guide intervention for your client? (If not revise your choice) Justify and provide a rationale
for your choice with research/readings support your choice for this child. (see below)
Choose at least 2 (two) complimentary OT models that will help guide you in the overall intervention
process. Be specific. List only those most pertinent. Justify and provide a rationale for each one with
research/readings support your choice for this child. (See below)
REMEMBER you want to choose models that provide a foundation for a COMPREHENSIVE evaluation and
intervention plan.
Scientific Reasoning and Evidence: What researched evidence is available to help you with your evaluation
and/or treatment process? Give references to readings or research
Practice
Models

Organizing: PEO

Rationale:
Describe the model & Justify the relevance to this
child & their family using postulates of change.

PEO addresses the interactions between person,

environment, and occupation. It recognizes that the
environment is easier to change than the person. This

Explain how these models address the priorities and

areas of intervention and overall outcomes you
identified for this child. **Use research articles to
support your rationale.
Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener,
R., Ellner, M. L. (2012). Effect of Classroom
Modification on Attention and Engagement of

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OCTH 6140 - Integrative Case Study #3

model will acknowledge each member of the familys
needs/priorities as well as their needs/priorities as a
whole.
Sasha has to go between multiple environments but
primarily home and school. Under PEO, strategies can
be taught to Sasha (P) to help her cope or overcome
issues, the environments (E) can be modified to make
them conducive to her needs for growth & development,
the occupations (O) or more likely the occupational
demands can be adjusted to what she needs.
We would want to do evaluations that look at how her
environment, in this situation school in particular, is
supporting her behavioral growth and how adjusting
interactions between her and peers/teachers can
increase her social participation appropriately.
Postulates of change from the PEO that support this
include:

Complimentary
#1: Social
Participation

1. Barriers to occupational performance can be

prevalent in the persons environment and
interventions applied to the environment may enable
to individuals occupational performance in the
presence of disability.
2. Change in person, environment, or occupation, or
their transaction, can improve occupational
performance
The Social Participation model states that social
development is formed in early childhood and requires
certain skills, habits, and routines. Through this model
behavioral and environmental deficits are identified and
adapted to allow for effective communication a social
participation opportunities.
Sashas current habits and routines are isolating her
peers and social interactions in the community. By
observing Sasha in different environments (classroom,
lunch room, playground), we can better understand her
current social skills and behaviors that are affecting her
social participation. This information will highlight areas of
improvement give a template for therapy that will
encourage appropriate and positive social participation.
Postulate of change from the Social Participation model
that support this is:
1. If a therapist assists a childs [teacher] to develop
strategies to teach a child habits for social interaction

Name: Melanie Francis

Students With Autism or Dyspraxia. The American
Journal of Occupational Therapy, 66, 511-519.
This article looked at children with auditory sensitivities in
a typical classroom. By altering the classroom, their
environment, they caused a positive change in the
students attention and engagement. This illustrates how
a better congruence was achieved by changing the
environmental factor. Using this idea to construct a quiet
zone within the classroom will provide Sasha with a
relief from the overwhelming auditory stimuli which gets
us closer to achieving our first priority.
Providing Sasha with an environment where she
performs best is one way of using PEO to improving
occupational performance. Another is to change her
through improving her motor skills. With her motor
coordination improves, the assignments and demands of
play will be less difficult for her which is our third priority.

Hollingsworth, L, H., Buysse, V. (2009) Establishing

friendships in early childhood inclusive settings, what
roles do parents and teachers play? Journal of Early
Intervention, 31, 287-307.
This article looked the needs of children with and without
developmental delays in order to make friends. It
illustrates how parents and teachers can facilitate social
inclusion for children by setting up an environment that
promotes and teaches principles of friendship. With this
article in mind, Sashas teacher could make changes to
her teaching method to point out principles of friendship
throughout the day and encourage appropriate
friendships.
This falls directly in line with the social participation
model. If a therapist assists a childs [teacher] to develop
strategies to teach a child habits for social interaction that
support the childs participation in daily [school] routines,
then the child will be more available to learning to

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OCTH 6140 - Integrative Case Study #3

Complimentary
#2: Sensory
Processing

that support the childs participation in daily [school]

routines, then the child will be more available to
learning to participate in daily [school] routines at his
or her developmental or functional level.
The Sensory Processing model is used to understand
how individuals respond to sensory stimuli. Individuals
responses are organized on a scale that generates a
description of the individual as having a high or low
threshold for each stimuli as well as how they react,
actively or passively. Sasha has behavioral issues which
may be due to sensory issues. By giving her a sensory
assessment, we can understand how her body is reacting
the stimuli around her and teach her skills to adapt to the
stimuli n a more positive way. Once we know her profile
we can design interventions to help her desensitize to
stimuli or adapt her response.
Postulates of change from the Sensory Processing model
include:
1. We can design environments to meet individuals
sensory processing preferences. Interventions
require us to match the environmental features with
the sensory processing preferences.
2. Therapy can focus on the senses of: vision, tactile,
vestibular, proprioceptive, smell, and auditory in
order to help the child organize the environment and
themselves better.
3. Interventions provide the just right challenge

Name: Melanie Francis

participate in daily [school] routines at his or her
developmental or functional level. This intervention/model
will help us accomplish our second priority in particular.
Bagby, M. S., Dickie, V. A., Baranek, G. T. (2012). How
Sensory Experiences of Children With and Without
Autism Affect Family Occupations. The American
Journal of Occupational Therapy, 66, 78-86.
This article shows how children with sensory needs
outside the range of typical affect the family units
occupations. They narrowed it done to three basic ways:
what they chose to do or not do; how they prepare for
occupations; and what extent the occupations are
shared. This is similar to the classroom as well. A teacher
may avoid certain activities to avoid a behavioral issue.
By addressing the sensory needs of Sasha, the goal is to
expand the variety of occupations her family and class
are able to participate in without her having behavioral
issues. As the article above in PEO rationale illustrates,
how we can design environments to meet individuals
sensory processing preferences. Interventions require us
to match the environmental features with the sensory
processing preferences. In order to meet our first priority,
therapy will focus on the senses of tactile and auditory in
order to help the child organize the environment and
themselves better.

b) Goals
Choose one of your priority intervention/goal areas for Sasha.
Write a long-term goal and two related/supporting short-term goals for Jeremy. Be sure your goals are
behavioral, measurable, and functional (SMART format).

Annual Long Term Goal 1: In 1 year, Sasha will (I) engage in appropriate group activity (play,
academics, classroom discussion, etc.) for at least 15 consecutive minutes in 4/5 trials.
o Short Term Goal 1: In 3 months, Sasha will (I) initiate 4 appropriate social interactions per day
with a peer for 4/5 days.
o

Short Term Goal 2: In 4 weeks, Sasha will (I) utilize self-regulation strategies to prevent a
behavioral outburst in 4/5 trials.

c) Service Delivery: What type(s) of services do you anticipate will best meet Sashas needs?
(Direct/Consult/Collaboration/Co-treat, etc.)
Type(s) of service
Consult

Rationale:
I need to consult with her teacher about the classroom environment. I
cannot just go in and change everything and maintain a good relationship

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OCTH 6140 - Integrative Case Study #3

Direct

Name: Melanie Francis

with the teacher and positive environment for Sasha to be in doing it any
other way. I will also need to consult with her mom for similar reasons and
to have an impact at home even with therapy being conducted at school.
Sasha will need direct services to help her understand her sensory
preferences and strategies that can be used to accommodate them. She
will also need help with motor skills which are best addressed directly at
least initially. Direct services will likely be scaled back before consult
services because she will learn how to implement strategies for herself.

What setting(s) will the services take place? School

What is Frequency & Length of Services? Sasha will be seen for 1 year, for 120 minutes per month
then reevaluate to see if continuation of services are needed.

6. Implement the Plan

Treatment Sessions: Choose at least 2 Interventions to do in a 45 minutes session that support one of your
above stated goals.
Intervention #1:
What goal does this Intervention support? Short Term Goal 2: In 4 weeks, Sasha will (I) utilize self-regulation
strategies to prevent a behavioral outburst in 4/5 trials.
Intervention Description: Emotional Bingo
Therapist and Sasha will each have a game board.
1. Therapist will draw a card with an emotion on it and act out the emotion.
2. Sasha will have to guess the emotion and then state an appropriate way to express the emotion and how
to self-regulate in that emotional state.
3. Sasha will draw a card with an emotion on it and act out the emotion.
4. Therapist will have to guess the emotion and then state an appropriate way to express the emotion and
how to self-regulate in that emotional state.
5. Repeat steps 1-4 until one player has blackout (whole board covered) this should provide a wide
range of emotions
6. Sasha losing may cause an aggressive behavior so be aware and prepared to help her self-regulate
To increase the challenge, game can be played in a noisy area requiring Sasha to use her self-regulation
techniques throughout the game. If the noise is too challenging, shorten the game to traditional bingo (5 in a row).
Setting
Activity Demands:
Anticipated outcome
Therapy room at school
Relevance & importance to
Sasha will improve her
client: able to express and
recognition of emotions.
understand emotions to be a
Sasha will improve her
better friend, self-regulate to
understanding of appropriate
prevent aggressive behaviors and
emotional behavior.
hurt peers
Sasha will improve her
Objects used and their
understanding of selfproperties: emotional bingo game
regulation techniques.
board, markers, cards
Sasha will practice selfSpace demands: therapy room,
regulation strategies.
table & chairs
Social demands: attention to

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Name: Melanie Francis

task, follow simple directions,

interaction with therapist, turn
taking
Sequencing and timing:
sequencing directions, turn taking
Required actions and
performance skills: UB and core
strength, positions, coordinates,
moves, lifts, flows, endures,
paces, attends, notices/responds
Required body functions:
-Mental functions: Attention,
perception, emotional,
temperament and personality,
energy and drive
-Sensory functions: visual,
hearing, vestibular, proprioceptive,
touch
-neuromusculoskeletal and
movement related functions: joint
mobility and stability (particularly
UE)
-muscle functions: muscle tone,
muscle endurance, muscle power
Required body structures:
-structures related to cognition
-structures of the eyes, ears,
mouth
-structures related to movement
-skin and related structures
-structures of the nervous system
Intervention Approach: create, promote
Intervention Type: occupations & activities
Practice Model(s): PEO, Social Participation, Sensory Processing (depending on demands in place)
Rationale & evidentiary support:
Fox, L., Lentini, R. H. (2006). Teaching Children a Vocabulary for Emotions. National Association for the
Education of Young Children. Retrieved from
https://www.naeyc.org/files/yc/file/200611/BTJFoxSupplementalActivities.pdf
This shows how teaching children about emotions, how to express emotions, and recognize emotions
helps them avoid behavioral outbursts. By teaching Sasha about emotions we are changing her as a
person (PEO) to better equip her for occupational performance. Playing a game with the therapist is
innately practicing social participation and although it is not with a peer, Sasha can still learn important
social interaction skills (turn taking, initiate, continue, etc.). If this game is held in an area that challenges
her sensory system then sensory processing would be utilized as well to manage the stimuli input.

Intervention #2:

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OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

What goal does this Intervention support? Short Term Goal 1: In 3 months, Sasha will (I) initiate 4 appropriate
social interactions per day with a peer for 4/5 days.
Intervention Description:
Would you rather? (kid edition)
Class will be split into groups and each group will have their own game of would you rather going on. Sasha will
be in charge of the game in her group to practice her initiation of social interactions.
1. Sasha will choose a classmate and ask them a question from the would you rather deck
2. Sasha will have an appropriate response to the peer indicating she was listening.
3. Sasha will then choose the next peer to read a card.
4. Game continues for 15 minutes or until all cards are used.
Setting
Activity Demands:
Anticipated outcome
in classroom during flex time
Relevance and importance to
Sasha will increase comfort
client: safe environment
initiating social interactions
supported by therapist in which to Sasha will increase attention
get to know peers and find
to social interactions
commonalities
Sasha will increase social
Objects used and their
interaction skills
properties: would you rather
Sasha will practice using selfgame cards
regulation skills to prevent
Space demands: classroom,
behavioral outbursts
desk, chairs
Social demands: attention to
task, follow simple directions,
interaction with therapist & peers
Sequencing and timing:
sequencing directions given,
waiting until peer is done
answering
Required actions and
performance skills: UB and LB
strength, positions, coordinates,
moves, lifts, flows, endures,
paces, attends, notices/responds
Required body functions:
-Mental functions: Attention,
perception, emotional,
temperament and personality,
energy and drive
-Sensory functions: visual,
hearing, vestibular, proprioceptive,
touch
-neuromusculoskeletal and
movement related functions: joint
mobility and stability
Required body structures:
-structures related to cognition
-structures of the eyes, ears,

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OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

mouth
-structures related to movement
-skin and related structures
-structures of the nervous system
Intervention Approach: create, promote
Intervention Type: occupations & activities
Practice Model(s): Social Participation, Sensory Processing (depending on demands in place)
Rationale & evidentiary support:
Hollingsworth, L, H., Buysse, V. (2009) Establishing friendships in early childhood inclusive settings, what roles do
parents and teachers play? Journal of Early Intervention, 31, 287-307.
This article looked the needs of children with and without developmental delays in order to make friends. It
illustrates how parents and teachers can facilitate social inclusion for children by setting up an environment that
promotes and teaches principles of friendship. With this article in mind, Sashas teacher could make changes to
her teaching method to point out principles of friendship throughout the day and encourage appropriate
friendships.
By letting the students play a social interaction/get to know each other game during flex time, Sashas
teacher is providing an inclusive environment that promotes friendship. This opportunity will increase
Sashas comfort level with her peers. According to the social participation model, positive social
experiences can lead to more social interactions because of the prior success. This is an opportunity for
Sasha to have a positive experience which will encourage future interactions.
If this game is held in an area that challenges her sensory system then sensory processing would be
utilized as well to manage the stimuli input.
7. Review the Plan
a. Explain how & when you will
review/re-evaluate your plan.

b. Modifications to plan (Are

they needed? How do you
implement them?)
c. Continuation/DC from
Services

Plan will be reviewed in 6 months or as goals are met. Upon review, the
frequency and efficacy of services will be reevaluated and adjusted according
to need. Ideally, Sasha will need less therapy time per month with the review
because of progress. During reevaluation, the SFA and the COPM will be readministered to indicate progress.
Any modifications needed will be made at the 6 month review or sooner as
they are made known and if needed. Teacher and parent will be made aware
of any changes to therapy before they occur and changes will only occur if
teacher and parents agree to them.
At the end of the school year, Sasha will be reevaluated to determine
continuation or DC from services. Reevaluation will include classroom
observations, SFA, Sensory Profile for Children, and COPM interview with
caregivers. If goals have been met, this re-eval may illuminate new areas to
be addressed or her performance compared to her performance at the
beginning of the school year will show no further need for services at that time
which will mean DC.

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OCTH 6140 - Integrative Case Study #3

Name: Melanie Francis

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