OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

This assignment involves synthesizing or integrating the information from OTCH 6120 (Theory), OCTH
6140 (Skills) and OCTH 6160 (Evaluation) on the module we completed on adolescents. 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 the 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 family.

It is recommended that you use the OTPF as a resource, and youre also allowed to use your notes,
textbooks, or the internet to help you to answer the questions. References must be given on designated
questions.

Case Study #4

1. Referral
Jorge is a 16-year-old boy who recently moved to Salt Lake City from New Mexico. You are a
member of the IEP team who will participate in developing a transitional program with Jorge and his
family. Jorge was attending a general education class and received specialized education services for
about of each school day. He was followed by an OT in New Mexico on a consult basis. You are the
occupational therapist who will do Jorges evaluation.

a) What are two possible diagnoses that Jorge may have? (Include diagnostic information and
support it with evidence from the referral).

1. Down syndrome. Children with Down syndrome often receive specialized education due to the
intellectual disabilities and developmental delays that accompany the diagnosis; however, they
are now being educated alongside their typically developing peers. A section of IDEA focuses on
providing the Least Restrictive Environment for children with special needs in public schools. It
states that children need to be involved in mainstream classrooms as often as possible. Aides
and other services are to be used in order to keep the children among their neurotypical peers.
Removing a child into a special education class room or putting them in a specialized school
should not be the first move of the IEP team.
A Childs Right to a Free & Appropriate Education (2012) Retrieved from
http://www.ndss.org/resources/education/schooling-from-preschool-to-age-21/

2. Autism. Children with ASD are eligible under IDEA to receive special education services and may
have symptoms relating to autism such as intellectual disability, developmental delays, sensory
processing problems, and speech delays. These specialized services are to be unique to the child
and allow them to participate in a general education classroom for as much time as possible.
Some examples of services include and an aide assigned to accompany the child throughout the
day and assist them with their various needs, preferential seating in class, allowing the child
sensory breaks as necessary (using a fidget in class or standing or walking around the room), and
extended deadlines on assignments and tests.

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Your Childs Rights (2016) Retrieved from https://www.autismspeaks.org/what-autism/your-

childs-rights

b) Pick one of these diagnoses. Name the diagnosis you selected and identify four specific
occupations from Table 1 of OTPF (ex: Activities of daily living-dressing) that could be affected if
the child has this diagnosis.

Diagnosis: Down syndrome

List four specific occupations that may be affected for Jorge:

1. Social Participation peer friend

2. Education Formal

3. Work Employment seeking and acquisition

4. IADL Driving and community mobility

c) Based on childhood development, what performance tasks would you typically expect a child of
this age to be doing in each of the following areas of occupation (be specific)? Not all areas may
apply.

Area of Occupation Developmental Expectation

Activities of Daily Living Physical fitness becomes a concern, drawing and

Instrumental Activities of Daily Living
Rest and Sleep
handwriting develops more fully, language and
vocabulary continue to develop, independent with
self care, selects own clothing (style develops), takes
interest in own appearance, may use specific
products (for hair/face/etc)
Knowledge of current events develops, desire
independence, self-reliance develops, develop ability
to understand delayed gratification and compromise,
communicates with friends via phone/text/internet,
may purchase own clothing

Education Academic performance (reading, writing, math)

advances, proficient at reading, abstract reasoning
develops, self-directed learning is utilized, logically
reasoning and ability to think about future plans
develops

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Work More effective ability to work with tools, may join

work force
Play Risk taking behavior occurs more often, participation
in sports may increase or decrease
Leisure Develops more leisure interests
Social Participation Social pragmatics are important, conflict with
parents, influenced by peer group, self-identity
becomes important but may be unclear, hanging
out is considered fun,

2. Preparation for Evaluation

You review Jorges educational record and learn that he has received specialized services since he was 6
years of age when he received an educational diagnosis of mental retardation. At 10 years of age, he
sustained a closed head injury after falling off the 3rd floor balcony at his apartment. He has also
participated in adaptive physical education. Currently, he is with peers for homeroom, study hall, lunch,
health education, art, and assemblies. He is in a specialized education class for academics.

a) From the information above, identify three associated risk factors and/or deficits associated with
any listed diagnoses that may influence Jeremys development (Cite information source).

Risk Factor or Deficit
1. Intellectual Functioning
Discuss the barriers to development/performance that may present
due to this risk factor or deficit (cite information sources).
A diagnosis of intellectual disability indicates an IQ score under 75.
An IQ score is a measure of intellectual functioning which is defined
as the ability to learn, use logic, and problem solve. It is also a way to
judge general cognitive abilities. A low IQ score will make
independent participation in everyday life difficult if there are not
strategies and supports in place for the child to access. Attending
school, acquiring and keeping a job, community mobility, as well as
general household management may be outside the abilities of
people with lowered IQs.

Definition of Intellectual Disability (2013) Retrieved from

2. Adaptive Behavior
http://aaidd.org/intellectual-disability/definition#.WEMmkfkrLD4
Adaptive behavior covers a range of behaviors that are learned
throughout development. They include conceptual skills, social, and
practical skills. Conceptual skills are things learned in school. For
example, telling time, counting and understanding the concept of
money, using and learning about language, and reading. Social skills
are a developmental continuum ranging from turn taking and eye
contact to holding a complete conversation with another person.
They also allow people to maintain their independence and avoid
being conned or tricked. Practical skills can be anything from ADLs,
job skills, personal care, including health and hygiene, safety,
communication, and community management, and travelling.

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Definition of Intellectual Disability (2013) Retrieved from

3. Behavioral Changes
http://aaidd.org/intellectual-disability/definition#.WEMmkfkrLD4
A traumatic brain injury may have occurred when he had a closed
head injury. These can cause a range of symptoms. Changes in
behavior are very common after a TBI. They include changes with
controlling impulses, having emotional flare-ups, having a difficult
time acting appropriately in a social situation, and a lack of
recognition of ones own skills and self-perception. If the person
with the TBI does not recognize these symptoms within themselves
they may have a hard time controlling them. This can cause many
problems in their daily life if they do not follow through on their
commitments, constantly put themselves in danger, do not regulate
their emotions, and overestimate their abilities.

Traumatic Brain Injury (May 15, 2014) Retrieved from

http://www.mayoclinic.org/diseases-conditions/traumatic-brain-
injury/basics/symptoms/con-20029302

b) Pick two of the risk factors and/or deficits you identified above. Next to each risk factor identify:
a. How it may affect Jorges occupational performance at home
b. How it may the affect Jorges at school

Risk #1 Adaptive Behavior

Impact on Jorges occupational performance at home

A lack of adaptive behaviors will severely effect Jorges performance at home. His lack of practical skills
will require his caregivers to take care of many of his needs. He may be unable to schedule doctor
appointments for himself, properly take care of his own hygiene, and get around his community
independently. A lack of safety awareness will also require his caregivers to remain vigilant while caring
for him which can be tiring and time consuming. They may not feel comfortable leaving him by himself,
especially if he is unable to use communication devices to get a hold of them in case of an emergency.

Impact on Jorges occupational performance at school

Jorge will require specialized education for his academic subjects. He may also need additional help
throughout the school day. This may be in the form of an aide to direct him to his next class, social skills
training to interact with the other children, or help on and off the bus in the morning.

Risk #2 Behavior Changes

Impact on Jorges occupational performance at home

Emotional outbursts can be a difficult thing to deal with in children. When they get to be older the
outbursts can become more dangerous if they dont know their own strength compared to the people
around them. Changes in behavior may also cause people with TBIs to participate in riskier behaviors.

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

This type of behavior coupled with a general lack of safety awareness can be a dangerous combination.
A lack of social appropriateness can also hinder his caregivers ability to take him on outings.

Impact on Jorges occupational performance at school

Acting in a socially appropriate manner is very important in a school setting. The other children often do
not want to associate with people who are not acting in a socially acceptable way which can lead to
social isolation. They will also usually avoid someone who is prone to emotional outbursts which can be
scary to people who dont understand why it is happening. A TBI can also lead to a warped sense of self
as well as an inaccurate picture of ones abilities which could be exacerbated in a school setting.

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 Performance Context &

Skills Patterns Environment

ADLs Values Motor Skills Habits Cultural

Beliefs Personal
IADLs Spirituality
Rest & Sleep Routines

Education Body Functions Process Skills Physical

Social
Work Rituals

Play

Leisure Body Social Roles Temporal

Structures Interaction Virtual
Social Skills
Participation

3. Evaluation Plan

a) Practice Models Guiding your Evaluation & 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 (i.e. PEO, MOHO) that will help guide you in the overall
evaluation process. Be specific and describe how this model would direct your evaluation
process.

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Choose at least 2 (two) complementary OT models that will help guide you in the overall
evaluation process. Be specific and describe how this model would direct your evaluation
process. List only those most pertinent.
REMEMBER you want to choose a model that provides a foundation for a COMPREHENSIVE
evaluation plan.

Practice Models Brief description of the practice model
Organizing: This model looks at how the person,
PEO environment, and occupation interact with
one another. You can affect positive
change in the clients daily life by
determining in which area or areas the
problem is occurring and coming up with
new or modified strategies to overcome or
compensate for the issue.
Complementary The SCOPE-IT model uses occupations
#1: SCOPE-IT to improve occupational performance.
The model focuses on the perfect fit
between the child, the environment,
and the occupation. If any one of those
is out of sync then the child will
experience dysfunction. It has an
emphasis on the main figures in a
childs life bringing about the change. It
also uses motivation as a way to
engage the child in occupations.
Complementary The four quadrant model focuses on
#2: Four scaffolding techniques used to
Quadrant facilitate independence in occupations.
The child may start out needing
maximum assistance within an
occupation, but the therapist can
implement strategies and practice to
move the child through the four
quadrants towards independence.
How this practice model would direct
your evaluation (i.e. what would you
be looking for based on this model)
I would be looking at Jorge, his diagnosis,
and any associated problems and how they
are affecting his performance and
participation. I would look at the specific
occupations in which he is struggling and in
what environments those occur. I would
also want to observe him in his natural
environments like his house or at school.
I would be looking for the breakdown
in the child-environment-occupation
system. For example, if the occupation
of riding public transportation is not
within Jorges realm of function we
would find a means of transportation
that is better suited to his needs.
Finding the areas that Jorge is having
trouble in will also direct our
intervention. This model has a basis in
occupations so observing and finding
out about his various occupations and
his performance within them will be
beneficial for his therapy.
I would want to observe Jorge in his
natural environment while he is doing
his usual occupations. I would also
want to find out where he is on the
assistance continuum for each
occupation in each environment. I
need to find out which quadrant he is
in for each occupation based on the
level of assistance he needs.

b) Obtaining Occupational Profile

List three important questions you would ask Jorge. Phrase your questions as you would if you were
talking with Jorge.

1. What are your favorite things to do at home and at school?

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

2. What do you do during a regular day?

3. What do you want to do when you graduate from high school?

List three questions that would ask Jorges father. Phrase your questions as if you were speaking to his
father.

1. What do you hope to get out of therapy?

2. What are Jorges strengths and weaknesses?

3. What does Jorges daily routine look like?

Given his age and what you know about Jorge so far, what are four occupational performance task that
you would want to observe/analyze during your evaluation?

1. IADL community mobility how does he get to/from school and around the community

2. IADL Safety management I would like to know how safe Jorge is when participating in his
community

3. Education formal education Id like to see how he is in a classroom environment and how he
handles school work

4. Social participation peer, friend I want to see how he interacts with classmates and people his age

c) Assessments/Tools

Identify 1 or 2 appropriate assessment tools you would use to evaluate Jorge during this initial one-hour
session, other than your interview for your occupational profile and observation of performance skills
(these are listed for you in the table). Be sure to consider the practice setting and remember that asking
questions for the occupational profile, observation and analysis of occupational performance, and
assessments should take no longer than one hour collectively. Next to each assessment, 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.

Also, in the Observation row, list the information you would hope to obtain, practice model and
rationale. In the Interview role, identify if your interview would be informal vs structured/standardized
(such as the COPM), what information you would hope to obtain, the practice model, and rationale for
your choice.

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________
Strategy/Assessment Information you would hope to
Tool obtain
I would like to see how Jorge
Observation interacts within his various
environments. I would also like to
see how functional he is at his
occupations and how much
assistance he requires from
caregivers and teachers. I would
like to see how he acts in a
classroom setting and within the
other various environments at
school, such as the cafeteria and
in a crowded hallway between
classes.
Interview- I would like to interview Jorges
Type/Tool: parents. I would like to know
COPM what their needs and wants are
for occupational therapy and
Jorges future in general. I would
also like to get to know about
Jorges daily activities and his
independence in his occupations.
Interviewing his parents will give
me a good idea about what kind
of goals he needs to be working
towards.
The WeeFIM-II is geared toward
Assessment #1: children without disabilities under
Wee FIM-II seven; however, it can be used to
assess the self-care, mobility, and
cognitive abilities of people over
the age of seven who have
disabilities that cause
developmental delays. This
assessment will help me
determine Jorges self-care
abilities, including grooming,
eating, and dressing, his mobility
abilities, including transfers and
walking, and his cognitive
abilities, including his
comprehension, social skills, and
problem solving skills.
Assessment #2: I would like to find the parts of
Activity Analysis the activity that are a struggle for
Jorge. There may be a specific skill
Practice Model & Rationale
PEO. Since PEO is such a broad model I
need a complete picture of my client to
use it appropriately. I need to see how
he interacts with all of his
environments and during his
occupations to see what kind of
assistance he will require to become
more independent in his daily life.
SCOPE-IT. This model has an emphasis
on using meaningful occupations to
teach children how to be more
successful and independent in their
daily lives. Talking with Jorges parents
will give me a good idea of the kinds of
activities in which Jorge enjoys
participating. This model also
emphasizes working with parents to
find the best child-environment-
occupation fit for each child.
SCOPE-IT. In order to determine the
best child-environment-occupation fit
for Jorge I need to find out where he is
developmentally. This assessment will
also help me to judge in which areas
Jorge would benefit the most from
therapeutic intervention. Since the
SCOPE-IT model has such a large
emphasis on using occupation as a
means to achieving more
independence it will be invaluable to
find out in which occupations Jorge
needs the most assistance.
Four-Quadrant. The 4QM has a focus
on varying degrees of help from a
clinician to help a client learn a new
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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

that he lacks that is holding him
back. If that skill is identified then
strategies can be implemented to
allow him to learn that skill and
eventually become independent
in the activity.
skill. First, however, the areas a client is
struggling in must be identified. In
order to find out what those areas are
the environment and activities in which
the client participates must be analyzed
to find the problem area.

4. Evaluation

In addition to previous information provided in the case study, you now know the following pieces of
information:
Jorge readily engaged in conversation with you in English. He often interrupted you and
interpreted what you said literally.
On the COPM, he identified the following goals for himself: riding the bus, getting a job, and
making friends.
His father identified the following goals for Jorge: getting a job, getting up and ready on time,
using public transportation, and getting along with others at home/school/work.
When observing Jorge during lunch and in the classroom, you observe that he frequently tries to
hug peers. Peers respond by pushing him away or walking away. You also noticed Jorge trying to
sit by a particular girl. When you later ask him who she is, he responded Shes my girlfriend.
When you ask the girl how she knows Jorge, she tells you she doesnt know him.
In the classroom, Jorge was able to follow a schedule taped to his desk.
When working on a practical activity on grocery shopping, he was unable to calculate sums but
was able to identify foods to purchase for a meal when looking at a pre-determined checklist of
food items.
Jorge is able to print his name and copy common grocery items.
When leaving school, he requires assistance to determine which bus to take home.

a) With all of this information in mind, write 1-2 brief paragraphs summarizing your occupational
profile and analysis of occupational performance for Jeremy:

Jorge is a 16 year-old boy whose family recently moved from New Mexico to Salt Lake City. He lives
at home with his mother and father. He has a diagnosis of intellectual disability and sustained a closed
head injury six years ago. He has an IEP through the public high school he attends and has received
specialized education for the last 10 years. The IEP requires OT throughout his transition period. His
school in New Mexico had an OT on his case on a consultative basis. His IEP determines that Jorge
receives specialized education for academics and an adaptive physical education course but is in a
general education classroom for homeroom, study hall, lunch, health, art, and assemblies. Jorge and his
father completed the COPM and came up with similar goals. Jorges goals are to ride the bus, get a job
and make friends. His fathers goals for him are to use public transportation, get a job, get along with
others at school/work/home, and get up and get ready on time.

Jorge is not shy but is lacking in some social skills. He is able to hold a conversation in English but
often interrupts the person with whom he is speaking. He also was unable to understand metaphors or
colloquialisms, taking each phrase very literally. He often tries to hugs his peers and is rebuffed by being

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

pushed away or ignored. He stated that a girl in one of his classes next to whom he tried to sit was his
girlfriend. Upon being question she stated she did not know Jorge personally. Jorge is able to
independently follow a schedule that is taped to his desk. Jorge cannot do simple addition but is able to
print his name and copy a list of grocery items. He was able to find certain items at a grocery store when
provided with a list. Jorge cannot determine which bus he is supposed to take home without assistance.
In order to get along better with others Jorge needs to learn age appropriate social skills. He also needs
to become more independent with his ADLs and morning routine. He may need some strategies in place
like a bus/train map/schedule to become more functional at taking the bus home and using public
transportation. Finding an appropriate job for Jorge will require a breakdown of the skills he currently
has and those he can learn before high school graduation.

b) From the evaluation information you gathered, identify two specific areas of occupation that
Jorge is having difficulties with. From those two occupations, identify two client factors, two
performance skills, two performance patterns, two contextual factors, and two activity demands
that may limit Jorges participation in home, school, community, and/or vocationally related
activities. Be specific and relate information provided to you in case study to the categories you
select (i.e. Client factors: Specific mental functions-Child demonstrates decreased attention to
tasks during tabletop activities.)

Potential Limitations or Barriers

Occupations Occupation #1 Occupation #2
IADL Community mobility Social Skills Peer, friend
Jorge is not able to use the public Jorge is not currently
bus system independently which demonstrating an age appropriate
will be his main source of understanding of social skills while
transportation after high school. He interacting with his peers. He
is also unable to independently use needs to gain those skills in order
the school bus system. to become a functioning member
of society and be able to hold a
job.
Client Factors (Table 2 of Body Functions Mental functions Body Functions Mental functions
OTPF) Specific Mental functions Specific Mental functions
Memory Higher Level Cognitive
Jorge is unable to remember which Jorge does not have the ability to
bus he is supposed to use to get judge what is socially appropriate
home. His inability to remember during an interaction. He needs to
one bus will make using public learn social skills to improve his
transportation more difficult if he functional independence in
has to transfer to a second bus or a society. For example, he needs to
train. learn when it is appropriate to hug
another person.
Body Functions Mental functions
Specific Mental functions Body Functions Mental functions
Higher-level cognitive Specific Mental functions
Jorge may have problems adjusting Thought
to a change in route if one of his Jorge was unable to tell the
difference between his own

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OCTH 6140 - Integrative Case Study #4
Performance Skills (Table
3 of OTPF)
Performance Patterns
(Table 4 of OTPF)
Name: ____________________________________________
busses is late, does not show up, or
he misses his tranfer.
Process Skills Chooses
Jorge is unable to do simple sums. If Jorge needs to learn appropriate
he is unable to effectively handle
money he may have problems
paying for the bus with cash or
repurchasing or reloading his bus
pass.
Process Skills Locates
Jorge has trouble locating the
appropriate bus that he needs to
get home. He will also need to
locate the appropriate bus stop
when using public transportation.
Routines
If Jorge is unable to remember the
bus schedule or get access to a bus social habits that people learn
route/schedule he may have
trouble getting places on time and
successfully making transfers.
Roles
Jorge will be unable to fulfill his role skills.
as an independent young adult if he
is not able to independently use
public transportation. He may also
have a hard time in his role as a
employee if he cannot get to work
in a timely manner.
thought and reality. He believed
the girl that he fancied in his class
was actually his girlfriend. He was
acting very familiar with her, but
she did not even know who he
was. He needs to be able to learn
how to interact with people and
be able to tell the difference
between his social fantasies and
the real world.
Social Interaction Skills Touches
social behavior. For example, he
needs to learn when it is
appropriate to hug another
person and when it is not
appropriate. He can learn another
method of showing affection with
touching to replace hugging. For
example, he can give someone a
high five instead of a hug.
Social Interaction Skills Times
Response
Jorge was unable to give his
conversation partner the time to
respond and interrupted them
while they were speaking. He
needs to learn how to hold an
appropriate conversation that
allows both partners the time they
need to respond.
Habit
Social interactions are just a lot of
throughout their lives. Since Jorge
was not able to pick up on
appropriate social habits on his
own throughout his development
he is presenting with poor social
Roles
Jorge will be able to engage more
fully in his role as a friend and as a
student if he learns appropriate
social skills that allow him to
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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

interact more successfully with is

peers.

Contextual/Environmental Virtual Cultural

Factors (Table 5 of OTPF) A lot of public transit information is
available on line or via text
message. If Jorge does not have
access to these devices using public
transportation will prove to be
more difficult for him.
Social
Jorge is lacking in social interaction
skills. He will have to interact with
people while waiting for the bus,
riding on the bus, and getting off
the bus. In order to be successful in
this occupation he needs to be able
to interact appropriately with the
people he meets while participating
in it.
Activity Demands (Table 7 Required actions and performance
of OTPF) skills
Jorge needs to work on various
performance skills before he will be
able to independently use public
transportation. For example, he
may need to improve his
sequencing skills to properly use a
bus system including paying for
passage and making a transfer.
Occupations/ Activities
Being proficient in public
transportation will allow Jorge to
participate independently in his
desired occupations. For example,
he will be able to travel to and from
his job.
The culture that Jorge is in does
not appreciate a lot of physical
contact during social interactions.
For this reason his penchant for
hugging his peers is seen as
socially inappropriate and may
lead to social isolation.
Social
If Jorge does not learn appropriate
social skills he may not be
accepted by his peers. This may
lead to social isolation which will
further allow his skills to
deteriorate.
Required Actions and
Performance Skills
Jorge is lacking certain social
interaction skills that will hinder
his ability to participate
successfully in his social
environment.
Sequencing and Timing
Jorge needs to learn the proper
sequence of social interactions. He
needs to understand how to hold
a proper conversation. He also
needs to learn at what point in the
relationship it is appropriate to
hug other people.

c) From the evaluation information you gathered, identify two specific areas of occupation that are
strengths for Jorge. From those two occupations, identify two client factors, two performance
skills, two performance patterns, two contextual factors and two activity demands that may
support Jorges participation in home, school, community, and/or vocationally related activities.
Be specific and relate information provided to you in case study to the categories you select (i.e.
Client factors: Specific mental functions-Child demonstrates decreased attention to tasks during
tabletop activities.)

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Potential Strengths or Supports

Occupations Occupation #1 Occupation #2
IADL Shopping Education Formal Education
During a practical activity in a Jorge receives a lot of support
grocery store Jorge was able to from his IEP which is only possible
successful copy a grocery list and through his formal education at a
find the necessary items. There was school. His IEP gives him access to
no mention of payment; however, services that will prepare him for
with appropriate supports Jorge life after graduation.
should be able to successfully
complete that part of the task.
Client Factors (Table 2 of Body Functions Mental Functions Body Functions Mental
OTPF) Specific Mental Functions Functions Specific Mental
Attention Functions Attention
Jorge was able to copy and find the He can learn strategies to help
list of grocery items in its entirety. him become more successful in
He was able to remain focused on maintaining and directing his
the task of shopping even in the attention. Being able to have a
distracting environment of a more sustained attention span will
supermarket. allow him to practice life skills
more effectively.
Body Functions Mental Functions
Specific Mental Functions Body Functions Mental
Memory Functions Specific Mental
Jorge was able to able to keep his Functions Thought
thoughts on the task at hand which Jorge has been learning adaptive
was grocery shopping. He was able strategies to help him become
to remember what he was in the more independent. His formal
store for, to look at the his list for education will continue teaching
direction, and which items he had him how to logically approach a
already retrieved. situation and the skills he needs to
live independently.
Performance Skills (Table Process Skills Heeds Process Skills Benefits
3 of OTPF) Jorge was able to copy the list of Within the special education
items and find all the items on the system Jorge will learn the best
list during the grocery store activity possible way to complete various
thus completing the activity in its tasks and occupations in the most
entirety since the act of paying for effective manner for his own
the item was not mentioned in the abilities.
report.
Process Skills Accommodates
Process Skills Continues Jorges can work with his service
Jorge was able to completely copy providers and teachers to
over the grocery list. He was also continue to improve his
able to find all the items on the list occupational performance. He can
at the store successfully. He get one on one assistance from
them so that he is able to

13
OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________
completed all the steps in the tasks
before stopping.
Performance Patterns Roles
(Table 4 of OTPF) Successfully shopping for groceries
is an important step in becoming a
functionally independent adult.
Jorge is not completely in that role
yet, but he is preparing for it by
practicing these skills.
Routine
Grocery shopping is an important
skill to have. It is also important to
have a routine in place for weekly
shopping trips. Jorge needs to
implement a weekly routine of
making a list of what you need at
the store then going to the store to
buy the items.
Contextual/Environmental Physical
Factors (Table 5 of OTPF) Jorge was able to navigate the
grocery store in search of the items
on his list. Supermarkets can be
busy, poorly organized, and
intimidating. Being able to
successfully traverse a grocery
store is an important skill to have.
Temporal
Jorges success will make it easier
to shop even when the store gets
more crowded. He may have to go
to the store after 6pm at which
time supermarkets tend to have
more people. Since Jorge has the
basic skill of shopping down he
should be able to succeed even in
that challenging environment.
Activity Demands (Table 7 Relevance and Importance to Client
of OTPF) Being able to make a list, buy the
corresponding items, prepare a
meal, and clean up the area are
very important parts of being an
independent adult. Jorge has
shown is well on his way to
complete tasks as independently
and as successfully as possible.
Routines
Having a routine during school will
allow Jorge to become more
independent within the school
system. It will also teach him how
to successfully use and follow a
schedule, like the one taped to his
desk in one of his classes.
Roles
Jorges IEP allows him to fulfill his
roles as a student and a peer by
giving him the assistance he needs
to keep up with the other
children. He will also receive
support for his future role as an
independent young adult through
his formal education.
Cultural
Jorge is living within a cultural that
values the education of each of its
members regardless of persona
abilities. The special education
system and his IEP will help Jorge
to achieve success in his future
endeavors.
Temporal
The routine of the school day will
allow Jorge to become more
familiar with keeping a schedule
and learn how to keep track of the
day on his own. This skill will be
vital once he procures a job after
high school.
Required Actions and
Performance Skills
Jorges participation in his formal
education will help him gain many
important processing and social
interaction skills that he will need
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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

achieving this type of to become a functionally

independence by successfully
shopping for his groceries.
Objects used and their properties
Jorge was able to copy a grocery list
successfully. He was also able to
use a grocery list to fine the
designated items at the store. This
type of adaptive strategy will keep
him organized and on task while at
the store.
independent adult.
Relevance and Importance to
Client
Jorges formal education and
specialized services will be
invaluable to him as he transitions
out of high school into the
workplace. The skills and
strategies he learns at school will
be relevant to his post high school
life.

d) Projected Outcomes
Identify and describe appropriate projected outcomes (Table 9) based on familys priorities,
occupational profile, evaluation, and analysis of occupational performance. Only identify those
pertinent to the case.

Occupational Prevention Health & Wellness Quality of Life Participation Well-being

Performance

Jorge needs to Giving Jorge Giving Jorge

learn some the tools to be the basic
basic skills, like more skills he
social skills and independent needs to
math skills, to will allow him perform well
increase his to have a will allow
function and greater quality him to
occupational of life in the participate
performance. long run. more fully in
occupations
in which he is
interested.

5. Intervention Process: Developing the Treatment Plan

a) Based on evaluation information, list three priority intervention/goal areas for Jorge.
1. Social Skills

2. Public Transportation

3. Job Skills

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 OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

b) Selecting one of your priority intervention/goal areas for Jorge listed above, write one long term
goal and two supporting short term goals for Jorge. Be sure goals are in SMART/COAST format.

Annual Long Term Goal 1: In 1 year, using adaptive strategies client will be able to
independently use a public bus to reach destination on a familiar route used 5 or more
times on 4/5 opportunities.

o Short Term Goal 1: In 6 months, with less than five verbal cues to utilize adaptive
strategies client will successfully transfer from one bus to another 80% of the time
on 4/5 opportunities.

o Short Term Goal 2: In 3 months client will be able to independently locate correct
school bus to get home within 10 minutes on 4/5 school days using adaptive
strategies.

c) Identify the practice models that you will utilize to guide intervention and activity selection in
order to accomplish your established goals. These may or may not be the same as the practice
models you selected to guide your evaluation
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) complementary 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)
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 Rationale:
Models Briefly describe the practice model and postulates
for change. Describe how postulates of change
are relevant to child/family.
Organizing: OA is all about relative mastery and adaptation.
OA People may not reach the same level of mastery as
everyone else. The important thing is that the
reach their optimum level of mastery of a
particular skill. An important aspect of this process
is an adaptive response. Adaptive responses are
needed throughout ones life in various contexts
and situations. People with intellectual disabilities
often have delayed adaptive responses or lack
them all together. Jorge needs to first learn some
adaptive strategies then how and when to apply
them in his daily life.
Explain how these models address the goals and
overall outcomes you identified for this child.
**Use research articles to support your rationale.
Jorges goals revolve around him successfully using
the public and school bus systems. In order to do
this in a functional manner he needs to be able to
independently navigate the whole process. The OA
model will allow us to look at his performance of
the occupation. We can then break down the
internal system of occupational adaptation and
locate the area in the process in which Jorge is
struggling. This area is most likely his adaptive
response which is a process within itself. It involves
many steps that include the mode, gestalt,
behaviors, and evaluation of the chose response. A

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 OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________
Complementary The Four-Quadrant Model of Facilitated Learning is
#1: Four a frame of reference to guide the facilitators and
Quadrant Model clients involvement in the occupation. At the
beginning of treatment the client may be in the
first quadrant requiring a lot of assistance and
information from the facilitator. As the
intervention progresses the facilitator will stop
having such a prominent role and allow the client
to be more independent throughout the activity.
At this time, Jorge needs a lot of assistance to
successfully ride the school bus and use public
transportation. The therapist will be very involved
throughout the first few treatments and will slowly
back off and let Jorge take the lead as he becomes
more confident and capable.
Complementary The CO-OP model focuses on using guided
#2: CO-OP discovery and cognitive strategies use to attain
client set goals in therapy. Allowing the client to
make discoveries about the occupational and
adaptive responses will allow them to fully
understand the activity and process. Working
toward a goal that is meaningful to the client will
also motivate them to succeed. The use of
cognitive strategies is a way of helping the person
transition towards independence. Jorge will
benefit from using guided discovery and
implementing cognitive strategies that are
individualized to his needs to obtain the goal he set
of using public transportation.
delay in this area of the system can be remedied by
implementing adaptive strategies that Jorge can
learn to use on his own. This will lead to a more
functional adaptive response to the environmental
stimuli.
Bouteloup, Z. & Beltran, R. (2007). Application of the
occupational adaptation framework in child and
adolescent occupational therapy practice. A case study.
Australian Occupational Therapy Journal, 54(3), 228-
238. doi: 10.1111/j.1440-1630.2007.00620.x
The Four-Quadrant Model of Facilitated Learning is
a frame of reference based in helping clients
obtain their goals and their independence. It uses a
type of scaffolding that slowly decreases as the
client becomes more independent in the activity.
There are many different types of instructions that
a facilitator can use to help a client learn the
necessary steps of an occupation. This ensures that
there is a type of instruction that will work for each
client and allows the intervention to be very
individualized. Jorge will benefit from having a lot
of instruction in this occupation at the beginning of
treatment. This approach will allow him to take
small steps toward his goal of independently riding
public transportation.
Greber, C., Ziviani, J., & Rodger, S. (2007). The four
quadrant model of facilitated learning: A clinically based
action research project. Australian Occupational
Therapy Journal, 54(2), 149-152. doi: 10.1111/j.1440-
1630.2006.00558.x
The CO-OP model is based around guided
discovery. This allows the clients to fully
understand what they need to do to successfully
participate in the desired occupation. Guided
discovery is found in many different types of
treatments. It most often occurs during the
specified occupation through problem solving
issues that come up due to poor occupational
performance or environmental factors. Clients
learn various adaptive strategies that can
implement on their own. Jorge will benefit from
this type of learning as well as the strategies that
he will be able to utilize after treatment.
Polatajko, H., Mandich, A., Missiuma, C., Miller, L.,
Macnab, J., Malloy-Miller, T., Kinsella, E. (2001).
Cognitive orientation to daily occupational performance
(CO-OP): Part III The protocol in brief. Physical &
17
OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Occupational Therapy in Pediatrics, 20(2-3), 107-123.

DOI: 10.1080/J006v20n02_07

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

Type(s) of service Rationale:

Direct Intervention I will teach Jorge strategies to use when navigating public
transportation as well as taking him on public transportation to
practice.
Consult I will act in a consultative role for Jorges teachers and parents to
help him gain functional and vocational skills he can use after
graduating from high school.

What setting(s) will the services take place?

o At school
o At a bus stop/ on a bus

What is frequency & length of services?

o 30 minutes, once a week, one year
o At one year we will reevaluate Jorges IEP and goals to see if he has met his goals
and if his parents feel he has reached his functional limit. If he has he will be
discharged from OT, if not we will decide on new goals to work toward for the next
year.

6. Intervention Process: Implementation

a) Treatment Sessions: Plan your first two treatment sessions.

Treatment Session #1:

What goal are you addressing?
In 3 months client will be able to independently locate correct school bus to get home within 10 minutes on 4/5
school days using adaptive strategies.

Intervention Description (Be very specific. Indicate that you understand how the postulates of
change from your chosen practice models will bring about change in the client during your session,
as well as what your role as the OT is during the session. In other words, how is this a skilled
service?):

I will schedule our first appointment for 20 minutes before school ends.

First Activity (10 minutes): I will spend the first ten minutes of our session talking to Jorge about his
goals. I want to discuss why he wants to learn to ride the bus in more detail. I will also explain what
we are going to be doing in therapy. I will tell him we are going to practice finding the right school bus
before we start learning how to use public transportation. At this point I will introduce a piece of
paper with the words Goal Plan Do Check on it. We will fill this out and discuss it throughout the

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

session. First we will write down the goal we are working towards and the plan we have come up with
to attain that goal.

Second Activity (10 minutes): For the second activity we will be doing the plan we have made by
making a card that has the bus number, the location, and the time Jorges school bus leaves in the
afternoon. If he does not know all of this information we will go to the office and ask for the
information there. We will then write the information down on two separate cards and laminate
them. I will ask Jorge where in his back pack he wants to keep one of the cards and remind him leave
it in there. Next we will take the second card to his locker and secure it to the door with a magnet.

Third Activity (10 minutes): The last activity for the day would be utilizing his new strategy. School will
just be getting out so we can head toward the bus pick up location with the other school kids. Jorge
will show me where the busses pick the kids up. Then I will ask him which bus he needs to get on. If
he says he does not know I will cue him to use the laminated card in his back pack. Once he gets the
card out of his back pack and finds out which number his bus is we can find his bus together. I will ask
him where the numbers are on the busses so we can tell them apart. We will then read each bus
number until we find the right one. At this point, I will cue Jorge to put his card away and ask how he
thought our plan worked. We will put a check mark next to check on our piece of paper, then I
will help him get on the bus.
Setting Activity Demands Anticipated outcome
(what skill you expect to
observe change in based
on your session):
School/ Increased occupational
school bus Relevance and Jorge needs to be able to learn strategies performance: Jorge will
pick up importance to for using the school bus before he learns be able to use this
client how to use public transportation. strategy to
Objects used A laminated card Jorge can keep in his
backpack with the information he needs
independently get on the
to get on the correct bus. right bus home.
Space demands Room to write the information on the
cards.
Social demands Jorge needs to interact with the therapist,
the people in the office, the other kids
getting out of class and on the bus, and
the bus driver.
Sequencing and Jorge needs to learn the proper sequence
timing of getting the card out of his backpack,
finding the right bus, putting his card
back in his back pack, and finally getting
on the bus.
Required actions Jorge needs to be able to get him and his
and performance backpack to and on the bus, attend to and
skills heed the task of getting on the bus,
choose and locate the correct bus, use his
strategies to find the right bus, keep his
back pack organized and his information
card handy.
Required body Jorge needs to be able to get the card
functions and from its pocket using his arms and
structures hands, he needs to be able to see the

19
OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

information on the card, and he needs to

be able to get to the bus and on the bus.
Intervention Approach (Table 8 of OTPF): Modify Intervention Type (Table 6 of OTPF):
Occupations/ Activities
Practice Model(s): OA, Four-Quadrant Model, CO-OP
Rationale & evidentiary support for use of interventions/activities:
The purpose of this first session is to find out where the problems in Jorges adaptive response
process are and to implement the appropriate cognitive strategies to counteract these delays. Jorge
has a problem remembering which bus he needs to get on so making a physical copy of the
appropriate bus number, location, time the bus leave will allow him to be more independent in this
occupation instead of having to ask for assistance every day. Since we have just started treatment I
will give Jorge a lot of cues and assistance while still giving him time to discover the answers to his
questions for himself. Using the Goal Plan Do Check format from the CO-OP model will allow
Jorge to visually see the process of each session and know what the plan is once we get started.

Bouteloup, Z. & Beltran, R. (2007). Application of the occupational adaptation framework in child and
adolescent occupational therapy practice. A case study. Australian Occupational Therapy Journal, 54(3), 228-
238. doi: 10.1111/j.1440-1630.2007.00620.x

Greber, C., Ziviani, J., & Rodger, S. (2007). The four quadrant model of facilitated learning: A clinically based
action research project. Australian Occupational Therapy Journal, 54(2), 149-152. doi: 10.1111/j.1440-
1630.2006.00558.x

Polatajko, H., Mandich, A., Missiuma, C., Miller, L., Macnab, J., Malloy-Miller, T., Kinsella, E. (2001).
Cognitive orientation to daily occupational performance (CO-OP): Part III The protocol in brief. Physical &
Occupational Therapy in Pediatrics, 20(2-3), 107-123. DOI: 10.1080/J006v20n02_07

Rodger, S. & Liu, S. (2008). Cognitive orientation to (daily) occupation performance: Changes in strategy and
session time use over the course of intervention. OTJR: Occupation, Participation and Health, 28(4), 168-179.
doi: 10.3928/15394492-20080901-03

Treatment Session #2:

What goal are you addressing?
Annual Long Term Goal 1: In 1 year, using adaptive strategies client will be able to independently
use a public bus to reach destination on a familiar route used 5 or more times on 4/5 opportunities.

o Short Term Goal 1: In 6 months, with less than five verbal cues to utilize adaptive
strategies client will successfully transfer from one bus to another 80% of the time on 4/5
opportunities.
Intervention Description (Be very specific. Indicate that you understand how the postulates of
change from your practice models will bring about change in the client during your session, as well
as what your role as the OT is during the session. In other words, how is this a skilled service?):

Activity 1 (5 minutes): I will talk to Jorge about how finding the bus after school has been going. If it is
going well we will move on. If there has been an issue, however, we will problem solve a solution
together. We will also fill out part of our Goal Plan Do Check paper at this point. Our goal will be
to plan a trip for next week.

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Activity 2 (10 minutes): I will talk to Jorge about paying for his fare on the bus. We will look up bus
passes and write information down for him to take home to his parents. We will also look up the cost
for an individual fare and talk about using money to pay for his fare. We will practice making the right
amount of change using various types of currency. I will help him count out the amount he is looking
for and give him verbal cues and assistance throughout the activity. If he gets frustrated we will not
spend too much time on this task.

Activity 3 (15 minutes): This is the part of the treatment session in which we plan how we will reach
our goal. I will introduce Jorge to Google Maps which has a route finder for using public
transportation. We will practice using this route find and talk about its various aspects. For example,
bus lines are in blue and Trax lines are in red. You can change the date and time of your trip to plan
ahead. We will practice planning the bus trip we will take during our next session.
I will give Jorge the option of going to Temple Square, the Salt Lake Public Library, or the City Creek
Mall, and we will begin working on our do section. I will also explain that we will not be visiting the
location just practicing getting to and from their using the bus. Once he has picked a destination we
will set the correct date and time and find the appropriate route. Once we have finished we will
check our plan by writing down all the relevant information we have found and make sure nothing
is missing. The information we will make a note of will include the bus number, the time, the location
of both bus stops, and the destination. We will then discuss how well we did in following our plan and
what we learned in the session. I will keep the paper until our next session when we use it to take the
bus across town. I will independently check the updated information before my next session with
Jorge since bus schedule usually change by a few minutes every day.
Setting Activity Demands: Anticipated outcome
(what skill you expect to
observe change in based
on your session):
School Relevance and Jorge needs to learn how to plan the routes he I will expect Jorge to
importance to client is going to take and find out when and where become familiar with
the bus will be leaving from. using technology to
Objects used Computer, Google Maps, pen, paper
obtain the proper route
Space demands Place for the computer to sit
Social demands Interacting with the therapist information for any trips
Sequencing and Jorge needs to learn how to plan a route using public
timing before he will be able to use the public transportation that he
transportation system effectively. He needs to plans to take. I will also
learn how to pick a route, find the bus stop, expect him to be able to
get on the bus, pay for his fare, and get off at pay for his fare once he
the correct stop.
Required actions Jorge needs to be able to get him and his
gets on the bus.
and performance backpack to and on the bus, attend to and
skills heed the task of getting on the bus, choose
and locate the correct bus, use his strategies
to find the right bus, pay for his fare, and get
off at the right stop.
Required body He needs to be able to pay for his fare, get to
functions and and onto the bus, use a computer.
structures
Intervention Approach (Table 8 of OTPF): Intervention Type (Table 9 of OTPF):
Establish/ Restore Occupations/ Activities
Practice Model(s): OA, 4QM, CO-OP

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OCTH 6140 - Integrative Case Study #4 Name: ____________________________________________

Rationale & evidentiary Support:

The best way to learn how to do an occupation is participate in it with facilitated assistance. Before
Jorge can independently use the public transit system he needs to learn strategies to plan his routes. I
will walk him through the process of using Google Maps and ask him easy open ended questions that
will guide his learning. He also needs to learn how to pay for his fare. I dont know his skill level in
using money, so I will give him the needed assistance while still allowing him to make the connections
on his own. If Jorge struggles too much with the money I will talk to his parents about getting him a
bus pass to practice using during therapy and at home. Using the Goal Plan Do Check format
from the CO-OP model will allow Jorge to visually see the process of each session and know what the
plan is once we get started.

Bouteloup, Z. & Beltran, R. (2007). Application of the occupational adaptation framework in child and
adolescent occupational therapy practice. A case study. Australian Occupational Therapy Journal, 54(3), 228-
238. doi: 10.1111/j.1440-1630.2007.00620.x

Greber, C., Ziviani, J., & Rodger, S. (2007). The four quadrant model of facilitated learning: A clinically based
action research project. Australian Occupational Therapy Journal, 54(2), 149-152. doi: 10.1111/j.1440-
1630.2006.00558.x

Polatajko, H., Mandich, A., Missiuma, C., Miller, L., Macnab, J., Malloy-Miller, T., Kinsella, E. (2001).
Cognitive orientation to daily occupational performance (CO-OP): Part III The protocol in brief. Physical &
Occupational Therapy in Pediatrics, 20(2-3), 107-123. DOI: 10.1080/J006v20n02_07

Rodger, S. & Liu, S. (2008). Cognitive orientation to (daily) occupation performance: Changes in strategy and
session time use over the course of intervention. OTJR: Occupation, Participation and Health, 28(4), 168-179.
doi: 10.3928/15394492-20080901-03

b) 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
I will reevaluate Jorges goals either when he reaches them or during
his next IEP meeting.
We will modify the plan if he reaches his goals we can either talk to
him and his parents about setting new goals to work toward or, if
they feel he is functionally ready to participate in all his occupations,
we can discharge Jorge from OT. We can also modify the plan if his
goals need to be changed for another reason such as parental
concern.
Jorge will continue to be eligible for services until he graduates from
high school. He can stop services when him and his parents feel he is
ready, and he can feel he is functionally ready to participate in all his
occupations,

22