Student

Name: Alissa Atisme Case: Troy Date: 4.25.2020

1. Diagnosis, Referral, Setting, Reimbursement, LOS

Diagnosis: Multiple R CVA - ABI
Referral: By request from client’s mother
Setting: Home health/community
Reimbursement: Grant from a non-profit organization
LOS: 2x/week for 6 weeks

7. Practice Models Guiding Assessment and Rationale

Treatment
1 PEO Using the PEO model will work towards
. improving the congruence between Troy, his
occupations, and his environment to increase his
ability to independently participate in daily
occupations. For example, if Troy’s difficulty
with following through with tasks is caused by
being distracted by things around his home,
decreasing the distractions would help improve
his ability to follow through with tasks, thus
improving his occupational performance.
2 Cognitive Orientation of Daily Occupational Using CO-OP would help Troy to improve his
. Performance (CO-OP) problem-solving abilities in order to improve his
occupational performance. Since there are many
areas of occupational performance that are
currently suffering, using this model will
promote the generalization of strategies in order
to transfer them to other tasks.
3 Dynamic Interactional Model Using DIM will help to improve his insight
. about his current abilities. Using this model
promotes independent problem solving and
collaborating the therapist to come up with
strategies to better his performance in
meaningful occupations. Using this model
promotes the use of strategies, increasing self-
awareness, altering the activity demands, and
even the environment as a means to promote
better occupational performance for the client.
Overall, Troy will better understand his areas of
deficit and develop strategies for improving
performance.
14. Evaluation: What Assessment tools and other means of assessment will you use?
Methods/Tools Rationale/What is being Assessed

Page 1 of 4 Revised 1/7/13

 MET
 PASS – money management
 Weekly calendar planning activity
From his background information, we know that
Troy has difficulty with finishing tasks. Doing
the MET with Troy would provide the therapist
information about his executive functioning and
problem-solving abilities. It will also provide an
opportunity for the therapist to see what it is that
causes him to stop in the middle of tasks and fail
to return to them. With the instructions being
written, it will help the therapist determine if
written lists and instructions are useful materials
for task completion.
Since one of the areas Troy is having difficulty
with is paying his bills, I would complete the
Money Management PASS assessment to better
understand some of the difficulties he is having
with this task. It will let me know specifically
how his cognitive deficits are impacting his
ability to complete this critical IADL.
This assessment will look at Troy’s ability to
plan and organize a weekly schedule. Because
we know that his deficits include keeping up
with the less obvious parts of household
management, completing this assessment will
provide the therapist information about his
abilities to plan out tasks, which will later lead to
assessing his ability to follow through with
planned tasks.

Goals Practice Model for each goal

1. LTG:
In 6 weeks, client will independently manage all household CO-OP, DIM
tasks with modified independence.
STG:
In 5 weeks, client will independently implement a memory CO-OP, PEO
aide as a reminder to change his sheets bi-weekly.
STG:
In 4 weeks, client will independently clean his bathroom from CO-OP, PEO
start to finish with the use of environmental modification
strategies to prevent distraction.

2. LTG:
In 6 weeks, client will complete child care tasks with min A CO-OP, PEO. DIM
from his mother.
STG:

Page 2 of 4 Revised 1/7/13

By the third session, client will independently identify CO-OP, DIM
required tasks of caring for his son.

STG:
In 3 weeks and with min A, client will follow a diaper DIM, CO-OP
changing schedule with the use of a memory aide.

1. Treatment Sessions: Plan for first two 45-minute treatment sessions

Problem Area(s):
Attention, insight, initiation

Approach:
Direct Intervention: task/habit training

Needed Materials/Equipment:
Paper calendar, pencil, smart phone.

Specific Set-up requirements/Directions:

The first session will be all about working to implement some strategies to help the client better
manage the chores necessary for maintaining a livable household. To set up the task, the therapist
should set out a paper calendar, a pen or pencil, and the client’s smartphone (if they have one). The
therapist should facilitate a conversation and opportunity for the client to reflect on what tasks are
necessary to maintain a clean and livable household. The therapist should allow the client the
opportunity to answer the question before adding in additional tasks that they may end up missing.
After a list of things is established and written down (by either the therapist or the client), the
therapist will facilitate selecting a method of creating a schedule or reminders through either the
smart phone or the paper calendar. The client has the option to choose whichever one they think will
be most effective for them. Once selected, the therapist and client will discuss the best way possible
to complete each of the tasks, whether that be via doing them all in one day or spreading them out
over the week (the choice will be made by the client). Once they have decided the best way to plan
and schedule, the client and the therapist will work through scheduling each of the planning activities
for the upcoming week. Finally, for independent application, the therapist will ask the client to select
2 household management tasks to schedule to complete the for the following week independently.

Therapist Role:
The role of the therapist is for education and introduction of strategies. The therapist is there to walk
him through a specific strategy that they believe will work well for him and that can later be
transferred to other occupations and tasks.

One suggestion for Grading task up:

Require Troy to plan 3 or more household tasks at the end of the session to be completed in the
future.

One suggestion for Grading task down:

Reduce the number of tasks required of Troy to independently plan to complete in the future to 1.

2. Treatment Sessions: Plan for first two 45-minute treatment sessions

Problem Area(s):

Page 3 of 4 Revised 1/7/13

Insight and awareness – Troy lacks the insight and awareness taking care of his child includes more
than just playing with him

Approach:
Direct Intervention: task/habit training; Educational

Needed Materials/Equipment:
Pen/pencil, paper, multiple scenarios printed out

Specific Set-up requirements/Directions:

In order to get the client more independent with caring for his child and relying less on his mother
(which will be essential since he wants to move soon and will not be as close to her anymore),
increasing his awareness of all that goes into childcare aside from playing with his son and
occasionally feeding him will be essential. Because the client lacks awareness about all of the aspects
of child care, this therapy session will work to educate him on these things. I would ask the client’s
mother to join in on this session. To begin, the therapist will ask the client about all of the things he is
currently doing to take care of his son. Then the therapist will ask if he thinks this is everything that
goes into caring for a child or if there is more that goes into it. The therapist will then ask his mother
to discuss her role in caring for the child to give him an idea of all that goes into it. As things are
bring listed off from both the client and his mother, either the client or the therapist will write down
what is being said so he has something tangible to later refer to. From there, the therapist will ask the
client what strategies can be put into place in order to make sure the child is receiving all of the care
that he needs. The mother will then be asked to share some of the strategies she currently uses. The
therapist will ask the client if he thinks any of the strategies his mother is using would be useful for
him to implement.
Once all possibilities are discussed, the client and therapist will work through 5 scenarios about
caring for a child. The client will be responsible for coming up with the best way possible to meet the
needs of the child while implementing the best strategy possible to do so. Examples of the strategies
include: what to do first thing when the child wakes up, how often to change the child’s diaper (and
how to know/keep track of this), how often the child needs to be fed (and how to know/keep track of
this), and the sleep/napping schedule of the child.

Therapist Role:
The role of the therapist for this session would be to educate the client and increase their insight
about all that goes into child care. They will be there to offer up ideas for strategy use through each
of the scenarios and to discuss how each strategy is beneficial in making sure the child is being well
taken care of.

One suggestion for Grading task up:

Require the client to plan out a 4-hour schedule for caring for the child for the following day using
the knowledge he already has about caring for his child as well as the information he gains from his
mother.

One suggestion for Grading task down:

Decrease the number of scenarios the client has to work through for the first session on this topic.

Page 4 of 4 Revised 1/7/13