Mandy

1. Mandy CBL CASE KATY, CASSIE, LAUREN S., BRANDY, ALANNA, AND MEGAN D.

2. Mandy 35-year-old female Diagnosis: Depression, AIDS, Addiction Currently in a 2-year transitional living facility Five children

3. MOHO • Volition • Client needs help identifying values • Client is able to identify interests such as cooking • Habituation • Client needs to eliminate destructive habits and establish new, healthy ones • Client needs help internalizing and interpreting her roles • Performance Capacity • Client has the musculoskeletal, neurological, cardiopulmonary and symbolic means to perform daily activities and functional tasks

4. Toglia’s Dynamic Interactional • Goal: to restore client’s functional performance and improve cognitive function • Dysfunction Deficiencies • Organizing and structuring incoming information • Anticipating, monitoring, and verifying the accuracy of performance • Flexibly applying knowledge and skills to a variety of situations • Change: cognitive strategies within multiple contexts.

5. Assessments • Occupational Performance History Interview II (OPHI II) • Life history interview using scales and narrative reports. • Cost: $43.50 • Target population: adolescent or adult client who has cognitive and emotional ability to participate in the interview. • Validity: 90% valid

6. OPHI Narrative

7. OPHI Scores • Occupational Identity • Present: Someproblems • Past: Extreme problems • Occupational Environment • Someproblems • Occupational Competence • Present: Some problems • Past: Extreme problems

8. Assessments • Worker Role Interview (WRI) • Semi-structured interview that rates impact of volition, habituation, and perceptions of the environment on readiness to return to work. • Focus on psychosocial readiness. • Cost: $43.50 • Target population: workers with recent injuries/disabilities, chronic disabilities,

9. WRI Summary • Personal Causation: Interferes with function • Values: Interferes with function • Interests: Supports function • Roles: Interferes with function • Habits: Interferes with function

10. Assessments • Occupational Self Assessment (OSA) • Client self-report on 21 daily activities and their importance to the client. Allows client to set priorities for change. • Cost: $43.50 • Target population: adult mental health clients

11. OSA Summary • Myself: • Managing finances • Expressing self to others • Satisfying routine • Accomplishing goals • Environment: • Living arrangements • Resources • Opportunities to participate

12. Assessments • Assessment of Communication and Interaction Skills (ACIS) • Observation tool that gathers information about communication and interaction while engaged in an occupation. • Cost: $40.00

13. ACIS Summary • Physicality • Ineffective • Information Exchange • Ineffective/Questionable • Relations • Ineffective/Questionable

14. Goal 1 • The client will improve self-awareness as measured by identifying three meaningful life goals in three weeks.

15. Intervention 1 • Value Card Sort • Occupational functioning problems. • Help Mandy to identify values according to the OPHI- II. • Assisting in increasing self-awareness of values. • Occupational functioning problems. • Just-right challenge http://www.motivationalinterviewing.org/content/personal-values-card-sort

16. Adaptations • Reduce number of value cards • Give her the option of choosing “very important to me” or “not important to me”. • Eliminating the option of “important to me”.

17. Goal 2 • The client will improve organizational habits and routines according to her previously identified goals as measured by 80% adherence to a daily checklist by the end of four weeks.

18. Intervention 2 • Reusable Checklist • Dry erase board in her room that the therapist can check • Process of organizing occupations into routines

19. Adaptations • Therapist identifies daily routines to be completed • Add pictures to identify task instead of words • Divide up day into times (morning, afternoon, evening)

20. Intervention 3 • Financial Management: creating a weekly budget • Mandy is required to attend courses to educate her on finances and maintaining a budget. • In the occupational profile, Mandy stated she wanted to improve financial management. http://www.docstoc.com/docs/40707030/Weekly-Budget-Planner

21. Adaptations • Reduce the number of categories • Creating a monthly budget instead of weekly • Color code the categories • Changing structure by providing money envelopes for each budget category based on a certain percentage

22. Instructional Approach • Acquisitional • Provide a budget planner which will promote self-evaluation • Focus: modify performance skills • Materials: written directions, budget planner

23. Resources Cole, M, & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack. Custer, V. L., & Wassink, K. E. (1991). Occupational therapy intervention for an adult with depression and suicidal tendencies. American Journal of Occupational Therapy, 45(9), 845-848. doi: 10.5014 Garrett, B. (2011). Brain and behavior (3rd ed.). Thousand Oaks, CA: Sage. Gates, L. B., Akabas, S. H., & Oran-Sabia, V. (1998). Relationship accommodations involving the work group: Improving work prognosis for mental. Psychiatric Rehabilitation Journal, 21(3), 264-272. Retrieved from http://web.a.ebscohost.com Giles, G. M., Radomski, M. V., Champagne, T., Corcoran, M. A., Gillen, G., Kuhaneck, H. M., & Toglia, J. (2013). Cognition, cognitive rehabilitation, and occupational performance.  American Journal of Occupational Therapy, 67(6). doi: 10.5014/ajot.2013.6759

24. Resources Cont. Helfrich, C. A., Chan, D. V., & Sabol, P. (2011). Cognitive predictors of life skill intervention outcomes for adults with mental illness at risk for homelessness. American Journal of Occupational Therapy, 65, 277– 286. doi: 10.5014/ ajot.2011.001321 Kielhofner, G., & Burke, J. P. (1980). A model of human occupation, part 1.  American Journal of Occupational Therapy, 34(9), 572-581. doi:10.5014/ajot.34.9.572 Paul-Ward, A., Kielhofner, G., Braveman, B., Levin, M. (2005). Resident and staff perceptions of barriers to independence and employment in supportive living settings for persons with AIDS. American Journal of Occupational Therapy, 59, 540–545. doi:10.5014/ajot.59.5.540 Schell, B.A.B., Gillen, G., Scaffa, M. E. (2013). Willard and Spackman's occupational therapy (12th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Wagner, C. C., & Sanchez, F. P. (2002). The role of values in motivational - interviewing. Motivational Interviewing: Preparing People for Change, 2, 284-298.