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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
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
List four specific occupational performance tasks (areas) that may be affected for Sasha:
Personal Weaknesses
(Client Factors,
Performance Skills,
Performance Patterns)
Contextual/Environmental
Barriers
3. 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.
2.
1.
2.
Client Factors
Performance
Skills
Performance
Patterns
ADLs
IADLs
Values
Beliefs
Spirituality
Motor Skills
Habits
Cultural
Personal
Routines
Body Functions
Process Skills
Work
Physical
Rituals
Social
Roles
Temporal
Play
Leisure
Social
Participation
Body Structures
Social Interaction
Skills
Virtual
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
appropriately. Postulates of change from the PEO that support this include:
Complimentary #2:
Sensory Processing
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.]
School Function
Assessment
Observation in classroom
and recess specifically
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)
Activity Demands
(related to the 2
occupations stated
above Table 7 OTPF)
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Personal factors
(Client Factors,
Performance Skills &
Patterns Table 4
OTPF)
Contextual Factors
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)
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Personal factors
(Client Factors,
Performance Skills &
Patterns Table 4
OTPF)
1)
2)
Contextual Factors
1)
2)
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
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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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.
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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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.
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Complimentary
#1: Social
Participation
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Complimentary
#2: Sensory
Processing
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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Direct
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 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.
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Intervention #2:
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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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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.
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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