Group Case

Due to budget cuts and the need to enhance the service component of the mission statement of the
occupational therapy dept. Corbett Clinic has agreed to take on contracts from various health care
facilities.

Manpower will consist of instructors who are also OTs and 3rd and 4th year students.

The U of A hospital has approached “Corbett Clinic” to develop some sort of program for a group of
chronic psychiatric patients who don’t fit in to any of their treatment programs.

These patients are all functioning at about a level 3-4 (Allen’s cognitive levels).
They would be able to function at or just below a project level (Mosey). The number of patients varies
depending on admissions and bed availability.

There is usually an average of 8 patients to a maximum of 10. Deficits may include all or some of the
following: - decreased ADL functioning - poor performance skills - decreased life skills - decreased
motivation - poor social interaction skill

CLIENT PROFILES

John

Age: 45

Diagnosis: Paranoia Clinical

Features & Behaviours: Sullen on approach, noncompliance with treatment, great reluctance to
participate. Referred with a long history of admissions to acute psychiatry. Has reported hearing voices
which advise him to stop taking medications. Almost all of his delusions involve the theme of a
conspiracy to harass him. Has limited insight and is almost totally socially isolated. Affect is blunted.
John has been unable to work for the past 3 years. Has a very supportive case worker who has set up
most of the resources John needs. She is not part of his delusional system.

Aaron

Age: 75

Diagnosis: Admitted for assessment

Clinical Features & Behaviours: Low frustration tolerance (especially with others), self-muttering,
isolating behaviours. Lives in a senior’s complex but grumbles about the administration trying to get him
out.

Aaron was a successful building contractor until age 70.

Sons report that he is becoming more forgetful and is very hard to get along with in the last few years.
Loves to do wood working and has made hundreds of wooden toys for underprivileged children.

Alice

Age: 30

Diagnosis: Schizophrenia

Clinical Features & Behaviours: Accountant, meticulous, stubborn, few positive symptoms but negative
symptoms appear to be increasing. Continues to work sporadically from home but currently has
reported poor concentration. She is a perfectionist who likes to control what is going on in the group.
Has been admitted 4 times in the past year and is currently on Clozaril which makes her very tired in the
mornings but has improved his overall functioning.

Mary

Age: 45

Diagnosis: Anxiety Disorder

Clinical Features & Behaviours: Fearful, withdrawn from group, nervous, easily intimidated. Has two
children at home and she worries about them and her own parents who have some health concerns.
Although she recognizes that many of her worries are unfounded she can’t stop worrying.

Mary seems tense and unable to relax and has previously attended a relaxation group which she reports
“did nothing”. Husband is a GP who seems to be quite supportive.

Eric

Age: 68

Diagnosis: Admitted for assessment

Clinical Features & Behaviours: Poor concentration, confused, easily distracted. Eric is keen to figure out
what is going on but thinks the hospital should be doing more medical tests. He’s not really sure what he
can get out of going to a group. He has a very supportive wife who reports that Eric has been very
focused on caring for his elderly mother who recently passed away. Likes to keep busy.

Andrea Age: 50

Diagnosis: Mood Disorder

Clinical Features & Behaviours: Manic, limited sitting tolerance, flight of ideas, controllable with
direction. Andrea has recently cashed in all of her RRSPs and spent the money on clothing and
entertainment. She has some insight and wants to get focused on her life. Currently unemployed but
worked recently as a salesperson at a ladies clothing boutique. Has lots of ideas and likes to contribute
them.

Joshua Age: 20

Diagnosis: Substance Abuse

Clinical Features & Behaviours: Inability to follow 2 step instruction, signs of organic impairment, easily
confused. Drug-induced psychosis diagnosed 3 years ago; currently reports occasional cannabis and
alcohol use. Frequently disoriented with increased psychomotor activity. Living in a group home prior to
his admission. Can be quite disruptive.

1) What unique contribution can you make as an occupational therapist facilitating this group?
- As an occupational Therapist, I can contribute by mainly on increasing the task tolerance of
every individual. Measuring tolerance to a certain task is important for us to identify and
provide specific targets as well as activities to every individual.
- In order to progress on creating suitable programs for every member of the group, I suggest
to conduct simple drills that encourages socialization skill and organizational skills such as
"taking turns in building blocks, throw and catch a ball self introduction, or even table
setting.
- In these activities, everyone has a task to accomplish as a group effort and also individual
capacity is measured.
2) Identify Occupational Performance Issues for each individual group member as well as the group
as a whole.
- John is having trouble in participation.
noncompliance with treatment, great reluctance to participate.

- Aaron has low frustration tolerance and isolating behaviours.

- Alice meticulous, stubborn
- Mary is fearful, withdrawn from group, nervous, easily intimidated.
- Eric has poor concentration, and, easily distracted
- Andrea has limited sitting tolerance.

- Joshua has the inability to follow 2 step instruction, signs of organic impairment, easily
confused.

- As a group OPI, it was shown that all the participants lacks the ability to perform well with other
individual or can easily be distracted disoriented due internal inability or external factors such as
when joined to a group.

3) What are the areas you will want to assess to determine if the clients would benefit from the
group?
- I would like to asses the following areas: Activities of daily living, IADLs (including selection
and supervision of caregivers), Health Management, Work participation, and social
participation.
- Also i would have a data assessment on the frequency of task avoidance and escape
behaviors they show in every activities. Tallying this will enable us to group the participants
who are those that have high tolerance and low tolerance behavior working in a group.
4) What type of information do you hope to uncover with the assessments you have selected?
- I hope to unveil simple steps of effort to every individual such as letting themselves open up
to other participant as well as allowing others to enter their personal space.
- Using a socialization skill activity, i hope i could make every individual feel comfortable of
themselves as who they are and what they are with no personal judments from anyone.
5) What targeted outcomes, goals and action plans in order of priority.
-In the next 4 months, the target outcomes will focus on simple socialization and task
completion with compliance to ADL.
-After 4 months, there will be assessment if the indivual targets are found satisfactory or needs
improvement.
-When all results showed great improvement, we gradually group them into bigger number like
a group of 3 or 4 participant and the same set of activities in order to maintain task completion.
Since they are confident of completing the task, the challenge that will arise is only on adapting
on a bigger number in a group. Before they are working as pair now a 3 or 4 individuals.
-Reassesment will follow after 4 months and they will be joined to a bigger group when they
achieve satisfactory results.
-The routine will be continued until all 7 participants are in the group and results must should a
plausible outcome.
6) Choose one activity that you would give this group? And Why?
- i highly suggest to start with a pair activities or a small group activities. In order to assess
their behavior when they are paired with someone on a task completion, a specific activity
introduced to a pair that would gain their capability of acknowledging the presence of other
individual and create a sense of friendly and relaxed state idea of group task. I believe if we
group them all together and present an activity, all the individual OPI will be triggered and
will not be taken action all at once.
- On of the activity I have in mind is having a bowl of questions and taking turns in answering.
This activity requires two participants. One will pick a question in the bowl and ask the other
participant.
- There will be no personal judgment on every answer. It is just a simple get to know activity
that enables them to open up their outer shell to other people.