Running head: INTERVENTION PLAN

Occupational Profile and Intervention Plan in a Non-Traditional Setting

Marissa Stendel
Touro University Nevada

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Occupational Profile

Mr. Anderson is a 37 year old male who attends Easter Seals adult day services five days
a week. Mr. Anderson has several diagnoses including Autism Spectrum Disorder (ASD), bipolar
disorder, intellectual disability (ID), and hyperlipidemia. He takes medications daily with
supervision to decrease obsessive behaviors, anxiety, and other symptoms as they arise. The
client has recently moved into a group home where he his own bedroom, and shares the common
areas with two roommates and a caretaker. Prior to living in the group home Mr. Anderson lived
with his parents until his mother passed away. At that time, he was then living with his father,
Donald, and cousin, Emma, who both assumed caretaker roles. Mr. Anderson has a younger
brother and sister who visit with him on a monthly basis.
The client is seeking services at Easter Seals to allow for simulated daily life working
skills in order to live a productive and meaningful life. The client has many hobbies and enjoys
the adult day services by expressing that he attends Easter Seals in order to do activities that are
important. The client demonstrated his concern with financial management by discussing his
interest in monetary value and purchasing items when taken to the local grocery store or during
outings at Easter Seals.
Supports and Barriers to Occupation
The client primarily feels successful with his life skills tasks that he is to perform while
at work or attending the adult day services at Easter Seals. He is able to cook small microwave
meals for himself independently, and complete basic home management tasks such as taking out
the trash. The client would like to be able to cook more for himself and choose items at the store
to cook with that fall within his budget however, he is unable to identify those items because he

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has limited knowledge of monetary value. He is also concerned with cleaning his group home
and sharing responsibilities with this roommates. Mr. Anderson finds cleaning to be hard, has
difficulty regulating his emotion, and staying attentive to tasks when asked. Lastly, Mr. Anderson
is able to dress himself with help from his caregiver and would like to know how complete that
activity more independently.
In attending Easter Seals and living in a group home environment, the client experiences
both major supporting and inhibiting factors in his daily social and physical living environments.
While supporting the safety and daily routines of Mr. Anderson is a key component of the
clients caregivers, it could be potentially inhibiting his performance by disallowing him to
attempt to carry out tasks independently.
Occupational History
Mr. Anderson has many hobbies and has partaken in many sports and activities
throughout his life. He explained his interest in dance classes in the past through Opportunity
Village, competing in swimming for the Special Olympics, playing football, and attending
church on Sundays with his family. The client enjoys going on outings with Easter Seals to the
Strip and its casinos, Red Rock Canyon hiking, and to the local grocery store with his caregiver.
He also enjoys sitting on his porch, playing board games, and watching classic TV shows such as
Little House on the Prairie and the Cosby Show on the weekends.
The client values participating in activities at Easter Seals, and receiving services from
his group home. He enjoys counting money, folding towels, and playing at the group home
complex over the weekend with others. Mr. Anderson also enjoys going to the library to pick out
books to look through as he cannot read well, and participating in photography on his outings at

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Easter Seals. He is interested in learning and reinforcing topics such as safety awareness,
purchasing items from the grocery store, scrapbooking, and going into the community utilizing
proper social skills. Mr. Anderson is also interested in dance, church with his family, swimming,
and playing the keyboard. The client takes pride in assisting his caregiver(s) when he is able to
by demonstrating skills he has learned and been rewarded for in the past.
As previously mentioned, Mr. Anderson lives at a group home with a caregiver and two
roommates. He is responsible for keeping his room clean, taking out the trash, assisting with
some of his meals, and attending his workplace or Easter Seals five days a week. He is also a
loving son, brother, and nephew to his close family members that visit with him typically on
Sundays. Mr. Anderson is very close with his father and aunt who have helped to take care of
him since his mothers passing. He takes pride in his daily work tasks at the adult day center and
is eager to help others when he is able to do so.
Patterns of Engagement
As part of his ritualistic patterns of engagement, Mr. Anderson participates in church
services with his family members on Sundays. He has set roles as defined above including being
a good roommate, a hard worker, and a son, nephew, and brother to his close family members.
He prefers strict routine in his daily life and personal space when needed. The client has
supporting and inhibiting habits that affect his everyday life. Though on medication, he often has
outbursts where he becomes agitated and endures in self-stimming behaviors. He also has habits
that including rocking, growling, demanding items from others, and talking to imaginary friends.

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Desired Outcomes
The clients priorities and desired outcomes including occupational improvement and
enhancement to increase performance in activities of daily living (ADL) and instrumental
activities of daily living (IADL) tasks, increase quality of life, and participation. The clients
overall concern is completing tasks as independently as possible with no behavioral outbursts
which in turn affect his overall performance in engaging in thoughtful and meaningful tasks that
comprise an occupation.
Occupational Analysis
Easter Seals provides a variety of home and community-based services affording adults
and seniors opportunities to live, learn, work and play as a vital part of their own
community living. When working with Mr. Anderson services take place in a small room within
the main building of the organization. The client works alongside others in the same adult day
program attending to tasks designated to them by their caregiver or staff member. The client sits
at a long table with three other clients while working on his life skills tasks. In the room there is
typically some type of music playing on a nearby stereo and a caregiver assisting with his/her
own four designated adults. All tools and materials to complete the work assigned to the clients
is stored in the same room.
During the activity session Mr. Anderson completed a variety of tasks including those on
his To Do life skills list. The client completed small home management tasks such as folding
towels correctly and placing them into the bin, placing the correct monetary change and bills into
the preassigned piles, and completing a small section in his scrapbook. Mr. Anderson was able to
complete folding towels and placing the money in piles according to its physical features with

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supervision for verbal cues. When completing the scrapbooking task, Mr. Anderson required
verbal cuing for each step in the activity. The client was familiar with all tools and materials
required to complete the activity but seemed unsure of the process required to carry out the
activity. The clients motor skills seem intact as he was able to move objects and himself through
the environment effortlessly. The clients processing skills may be affected because of his
demonstrated difficulty in choosing items to use when asked but, he answered accurately shortly
after. Mr. Andersons social interaction skills may also be compromised as observed through lack
of making eye contact, regulating self, expressing emotion, and talking to himself while
completing the task.
Based on observations, Mr. Anderson might have difficulty in a number of domains listed
throughout the Occupational Therapy Practice Framework (OTPF). The primary areas of
occupation that affects Mr. Anderson would likely be social participation and IADLs. The client
is unable to regulate emotional and behavioral outburst during activities with the group. IADLs
specific to the clients functions at work that are likely have an effect on his daily life including
aspects of financial management, home management, and communication. These occupations are
in turn are most important to address in intervention because of their impact on performance at
Easter Seals and likely in the greater community. Alongside deficits in social participation and
IADLs, Mr. Andersons global mental functions are compromised. Observation of the client
demonstrated impairment in these functions that cover the broad spectrum of cognition including
attention, perception, emotion, and temperament. Performance skills are effected mostly by way
of processing skills. The clients inability to initiate, choose, continue, and sequence activities is
bringing about debility in social participation and IADL function during daily routines and
occupations.

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Mr. Anderson also exhibited habits that could be a barrier to his overall performance in
daily activities including behaviors that are not viewed as socially acceptable such as rocking,
and talking to himself. Lastly, Mr. Andersons contexts and environment are affected by his
diagnoses. Although the client has multiple contexts and environments impacting his daily life, it
is likely (through observation in this short time) that his social environment is most at risk for
prohibiting him to engage in occupations. Mr. Andersons diagnoses including both ASD and
bipolar disorder known to have effects on the sensory system and sociality of a person. These
domains are most affected by the clients diagnosis and are likely to contribute to the challenges
he experiences associated with his daily occupations.
Problem List
Below are the functional problem statements associated with Mr. Andersons complex
conditions. The order and statements reflects the needs of the client, the occupational therapy
perspective, and the settings in which they could be fulfilled as goals.
1. Client has decreased ability to engage in social activities at the community level due to
deficits in emotional regulation.
2. Clients deficits in executive functioning limit ability to make independent purchases in
the community.
3. Client requires verbal cues to maintain safety due to decreased judgement.
4. Client requires moderate verbal cuing to complete job related tasks due to impairments in
sustained attention.

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5. Client requires supervision for dressing due to sensory defensiveness in multisensory

processing.
In order to create goals and facilitate occupational therapy interventions with Mr.
Anderson, the therapist must be cognizant of the many factors at play. Although the client is
an adult male with ASD, bipolar disorder, and ID, he does have the capacity to remediate and
adapt his life to allow for increased independence. Based on Haertls (2011) discussion in
strategies for adults with developmental disabilities, working with such clients involves
emphasis on enhancing participation and maximizing personal meaning and occupational
engagement to positively influence quality of life. Using a client centered and occupation
based approach considers the clients views, attributes, and environmental contexts that are a
reflection of occupational needs. The therapist should explore goals that enhance personal
choice, meaning, and quality of life (Haertl, 2011). Thus in order to prioritize and justify
reasoning for the problem list order, one must consider strategies that promote an increase in
quality of life for the client.
The first problem addresses the clients inability to successfully socially participate in his
community due to deficits in emotional regulation such as restlessness, speaking loud and in
a different voice, and rocking in response to an inner tension. In order to increase the clients
social participation and limit social isolation it is crucial to address problem behaviors and
tension that impact the clients daily life roles and activities. The second problem listed
reflects Mr. Andersons desires of becoming financially independent. Although complete
financial independence is not likely to occur, basic money management skills and real world
simulation of purchasing items can be addressed to fulfill Mr. Andersons personal goals for
himself in something that he finds to be particularly meaningful. Dowrick (2014), also

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considered this to be one of the most important outcome areas for people with disabilities to
avoid exploitation and foster various levels of independence.
The third problem statement addresses the clients inability to achieve independence in
safety. Understandably so, safety is key to the well-being of the client and should not be
taken lightly when working with this population. However, the reason it is not addressed as
one of the top two priorities is attributed to the fact that Mr. Anderson is always surrounded
by a caregiver or staff member and he does understand basic concepts of safety when
verbally cued. Mr. Anderson is well aware of concepts such as stranger danger and looking
both ways before crossing as long as he is prompted to do so. Since the client has knowledge
and understanding of safety concepts, is at a supervision level of assistance, and is typically
always with someone to ensure his safety, this problem could be addressed secondarily to the
others because it is not immediately impacting his daily outcomes.
The final two problem statements address attentional skills and sensory defensiveness.
Mr. Anderson requires verbal cuing to stay on task while working and often throughout the
process of an activity. Increasing attention to the task could prove to be very important in
completing daily occupations however, the client is fairly capable of doing so on his own
with extra time allotted for his attentional deficits and distractibility. Mr. Anderson likes
routine and understands the tasks he needs to accomplish while at work and does not exhibit
outbursts when asked to stay on task. To improve his attention and decrease verbal cues from
his caretakers, behavioral strategies used in other interventions could carry over to improve
these areas as well.

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Lastly, addressing ADL skills such as dressing, would likely involve the occupational
therapist (OT) going to the clients home for intervention. Due to the setting and context that
the client is likely to be receiving services in, dressing takes the final spot on the functional
problem list. Mr. Anderson has a full time caretaker at his group home that helps him daily
with dressing activities therefore, his needs are technically met at this time. However, due to
the environmental constraints and need to address social participation and IADL goals in this
particular context (Easter Seals), it is still important to understand the underlying problems
this client is having and how it may translate into other occupations. Mr. Anderson exhibits
sensory processing issues to do with touch and self-stimming behaviors. It is possible to
address these same processing problems while addressing the restlessness, anxiety, and
rocking as stated in the first problem statement justification. In doing so, the client could
potentially carry over more positive behaviors with sensory integrative and behavioral
approaches utilized during other intervention practices.
Intervention Plan and Outcomes
Long Term Goal #1
Client will complete a short group activity SUP for emotional outbursts within 6 wks.
Short Term Goal #1
Client will maintain a 5 minute conversation during lunch a staff member of Easter
Seals Min (A) within 3 wks.
Intervention. The final area of occupation found within the domains of the Occupational
Therapy Practice Framework (OTPF) is social participation (American Occupational Therapy

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Association [AOTA], 2014). This category includes activities associated with behaviors that are
expected of an individual interacting with others within a given social system (AOTA, 2008).
Social participation can be found at the community level and is a result of community-based
activities that help to fulfill required or desired roles (Christiansen, 2011). With deficits in
emotional regulation, the clients social participation is compromised and therefore causing a
decline in successful community based activities with others. Opportunities to take on new roles
through the modeling of others and benefits of creating ones own social identity are hindered
such as in Mr. Andersons case. Christiansen (1999), found that social identity is primarily
achieved through activities, and expression of self. Through a multitude of approaches and
therapeutic interventions and techniques, emotional regulation can be addressed to positively
affect such occupations as social participation.
Sensory processing and sensory integrative approaches positively affect the central
nervous system by organizing sensory input (Ayres, 1972). Several techniques explored under
Jean Ayres approach can directly affect the negative emotions and behaviors that arise during
outbursts. Such interventions include decreasing sensory defensiveness by creating an
environment that is comfortable for the client to work in which can be achieved via
environmental modifications and adaptations. Likewise, implementation of improved adaptive
responses to increase daily function by integrating programs such as ALERT to teach Mr.
Anderson and his caregivers techniques to facilitate neurological readiness to participate in skill
training and therapy can be done (Haertl, 2011; Williams & Shellenberger, 1994). These sensory
approaches used to address emotional regulation deficits can be utilized in a variety of ways
depending on which sensory experiences the client finds to be most helpful in alleviating the
stressors that arise during social encounters. Thus, creating an environment that is safe,

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positively stimulating, and calming can help the client to maintain conversations with staff and
others at Easter Seals with minimal cues and assistance for redirection for instances of outburst.
The primary approach for this intervention is modification. Under the current context,
small modifications can be made to support the performance of the client. By providing
compensatory strategies, cuing, and features that the client finds distracting and off putting the
clients regulation can be improved thus providing more positive experiences during social
interaction and participation. Outcomes identified by the OT and client for this intervention are
to increase participation by improving the occupational performance over time (AOTA, 2014).
Short Term Goal #2
Client will participate in a 4 in a row board game a partner Min (A) within 3 wks.
Intervention. Under the basis of dialectical behavioral therapy is a subcategory of
intervention called opposite action where new behavioral gestures are learned in response to
emotion (Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006). The concept is to facilitate more
positive emotions through the opposite facial expressions, postures, movements and even
thoughts (Lynch et al., 2006). Self-perception theory states self- perception of expressive
behavior and interpretations of proprioceptive sensations influence subjective emotional
experience therefore opposite action may further alter the experience of emotion by changing the
clients perception of his emotional response (Lynch et al., 2006). To provide an example and put
this theory into context we can consider social phobias. To address a social phobia one can
purposefully sign up to give a speech and in that process stand up straight, make eye contact with
the audience, slow his or her speaking, talking in a clear and confident tone, and making hand or
arm gestures to emphasize certain points (Lynch et al., 2006). Therefore, when Mr. Anderson

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immerses himself in social situations and in simple games with others the client is reinforced for
social participation behavior, and the clients repertoire of behavioral responses to anxiety
broadens to other avenues. Modeling of this technique and playing different games with the
client will help the client complete this short term goal.
The approach utilized in this intervention is the establish/restore approach. Applying this
approach would be appropriate because the client is learning a new skill to counteract his
emotional regulation deficits. The outcome targeted with this intervention would be to prevent
and or reduce the incidence of unhealthy conditions or outbursts that affect his ability to
participate in social activities (AOTA, 2014).
Long Term Goal #2
Client will identify, choose, & purchase 5 items worth $20 at the grocery store MOD (I)
for time within 6 wks.
Short Term Goal #1
Client will demonstrate basic money management skills by identifying, counting, &
making change for $20 SUP within 3 wks.
Intervention. The goal of this intervention is to primarily address the basics of financial
management. When addressing executive functioning problems for a client it is important to
establish a baseline of the clients abilities for a particular activity. Mr. Anderson is able to
understand the common qualities and relationships amongst objects such as money thus, using
further techniques to establish and partially remediate skills outlined in Haertls (2011) text can
be used to thoroughly address this intervention. To ensure that Mr. Anderson understands the

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monetary value and in that master the core elements of money management the therapist would
scaffold the tasks of basic counting and making change tasks until the client can do it
independently up to a $20 value. To create occupation as a means for the client, the OT can use
techniques such as role play and experiential practice sessions with the client using board games
such as Pay Day to provide assertive behaviors for not only identifying items worth a particular
amount of money but also provide social responsibility to the client by avoiding financial
vulnerability when making a purchase (Haertl, 2011).
Utilizing these methods during intervention could lead a variety of positive outcomes for
Mr. Anderson. Within this intervention it is hopeful that the clients outcome will be to actively
engage and participate in desired occupations in ways that are personally satisfying to him. The
clients ability to learn and use monetary systems to promote occupations that are important such
as financial independence allow for greater participation outside the home (AOTA, 2014).
Short Term Goal #2
Client will correctly identify & choose 5 items in the grocery store within a $20 budget <2 VC
within 3 wks.
Intervention. Through the use of metacognitive strategy training, executive functioning
can be addressed by having the client interact with complex environments and use skills that are
often generated under changing circumstances of everyday environments (Bottari, Lam Wai
Shun, Le Dorze, Gosselin, & Dawson, 2014). In order to be successful in the performance of
novel situations, an individual must be able to utilize executive functioning skills and create
strategic behaviors that reflect the circumstances of their environment (Bottari et al., 2014). For
Mr. Anderson, the task is not completely novelty, in that he has been to the grocery store before,

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however identifying, choosing, and purchasing items within his budget are novel. To facilitate
learning of common items within his budget, Mr. Anderson can use strategies to enhance his
performance using both self-generated external strategy (SGES) and self-generated internal
strategy (SGIS) to attain his long term goal of purchasing any five items within a $20.00 budget.
Bottari, Lam Wai Shun, Le Dorze, Gosselin, & Dawsons (2014) study found that clients
who had sustained a traumatic brain injury (TBI) used both SGES and SGIS cues to complete
their grocery shopping tasks in a novel situation. The link to Mr. Anderson is that like the clients
with a TBI, his executive functioning is impaired. Utilizing some of the same approaches that
Bottari et al. (2014) used with TBI clients, Mr. Andersons intervention would take place out in
the community at a local grocer where he can practice identifying, and choosing items that he
enjoys to fulfill his long term goal. Throughout the process of identifying items to buy, the OT
can also use remedial strategies to teach the client the value of common items to promote wise
spending in the community (Haertl, 2011).
Mr. Anderson and the OT can work through this novel, client centered and occupation
based activity in order to achieve a real world money management scenario where the client
could be deemed more independent. The OT is establishing skills to increase executive
functioning by allowing the client to rely on SGIS from himself and SGES from the therapist to
identify and choose items of a certain value that fall within his budget. Using an establish/restore
approach the client will learn how to identify and make purchases at the grocery store and a
possible outcome of this intervention would be the increase in occupational performance. In the
act of an activity such as grocery shopping to improve his financial management skills, Mr.
Anderson is increasing his ability to engage in occupations he finds meaningful (AOTA, 2014).

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Precautions and Contraindications

When working with a client that has comorbidities such as ASD, bipolar disorder, and an
ID, it is important to take precautionary efforts in a variety of ways. Precautions should be taken
in accordance with the clients temperament. The client is currently taking medication to help
alleviate anxieties that can cause major tantrums thus assurance that the client is consistently
taking medications is essential. It is also important to take precautionary efforts to assist the
client in areas of safety. Mr. Anderson understands safety concepts but does not necessarily act in
emergency situations therefore verbal cuing and prompts may be needed to keep the client safe.
Typically, the client is surrounded by competent adults that can care for him and deescalate a
situation if it arises. Contraindications for this particular client might be involved in medication
management however, those are usually tightly controlled by doctors prescription and should
not affect the client on a daily basis.
Frequency and Duration of Treatment
The frequency and duration of occupational therapy treatment for this client will vary
depending on the goals set for the client. Goals set for the client by their family or caregivers in
conjunction with Easter Seals range from six months to one year. For the purposes of skilled OT
services in this context, two, one hour sessions per week for six weeks. The frequency and
duration of treatment can vary considerably for each client in this setting because each persons
needs are different. However, working with Mr. Anderson on the two identified problems and
associated goals over the span of six weeks should be enough time to yield improvement in the
clients emotional regulation, social participation, and financial management.

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Grading of Intervention

The interventions completed with Mr. Anderson can be graded up or down in order to
better assist the clients needs. Grading and adapting interventions addressed in the clients
second long term goal could be easily graded up or down to challenge or support the client.
Specifically the second intervention addressing grocery shopping where the client is to identify,
and choose items to purchase can be graded up or down in a variety of ways. To grade up this
intervention the client could be given a time constraint to attain items, or a higher number of
items to choose within the same $20.00 budget. The client could also be graded up in having to
rely on internal cues to promote higher executive functioning and to use external cues from the
environment such as signs or pictures without the verbal cue from the OT to help him locate
items. To grade down this intervention, the OT could apply task simplification techniques such as
creating a list of items for the client to retrieve. This would give the client predetermination of
items that he would like to identify and choose, and ultimately help the client with the selection
and purchasing process if he becomes disoriented or flustered.
Framework for Interventions
According to Law and Baums (1997) research, Occupational therapy practitioners
should be seen as experts in applying effective intervention strategies that contribute to optimal
occupational function [or performance], including self-sufficiency, social integration, improved
health status, and employment, in persons with chronic disease and disability (p. 280).
The application of the person, environment, occupation, and performance model (PEOP)
stems from the clients concerns and how they view on their own problems in their occupational
performance in any particular occupation (Baum & Christiansen, 2005). Utilizing the person or

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clients motivation, or intrinsic factors, to participate in an occupation they find meaningful in an

environment that is conducive to their learning style, or extrinsic factors, will in turn create an
increase in occupational performance. The increase in function occurs when a client is able to
fully participate and show a certain level of mastery or competency in an occupation simulated
through adaptations, modifications, or the just right challenge.
The PEOP model helped to guide goals and interventions for Mr. Anderson by looking at
the client holistically. Focus on increasing appropriate participation through bettering emotional
regulation can help Mr. Anderson to form stronger bonds with those in his daily social contexts
and increase quality of life. Similarly, applying the PEOP model as a guide for financial
management interventions allows the OT to again take into consideration all components of the
clients needs, and in this case his ambitions. Mr. Anderson explicitly expressed the desire to
become more independent in basic money management skills and shopping with his caregiver.
Addressing the clients wants outside of sincere need is exemplified within the models name
itselfthe clients internal aspiration to increase performance in such occupations as financial
management in multiple environments is in fact the essence of the PEOP model.
Caregiver Training and Education
Caregiver training and education will be provided to Mr. Andersons family members and
caregivers at both his group home and at Easter Seals. In order for the client to reach his goals,
reinforcement of behaviors taught and skills learned will need to be in place by all parties. Mr.
Andersons daily caregivers will primarily be involved in the upkeep and promotion of the
clients occupational performance in these activities. Education for the family and caregivers will
be provided by the occupational therapist in areas of cognitive behavioral therapy and oversight

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of Mr. Andersons finances within his new self-sustained budgeting system he has worked to
attain. Education will derive from handouts for Mr. Anderson to take home, informal
communication with the staff directly overseeing Mr. Anderson at Easter Seals, and in notes
provided to the caregiver at the group home and family in Mr. Andersons journal that is utilized
as a communication source for staff and family discussing the clients behaviors and progression
towards goals. Through education and training, the client, his caregivers and the occupational
therapist can promote independence in the areas that Mr. Anderson finds most meaningful.
Client Progress
The clients progression in goal attainment and enhancement in occupational performance
will be identified and assessed based on several mechanisms. Based on the PEOP model and
research previously provided, several assessment tools could be utilized in order to establish a
baseline and ceiling effect in the clients progression towards his goals. When addressing Mr.
Andersons goals towards independence in basic financial management skills, the IADL Profile
grocery shopping task can be utilized to interpret the behaviors and functioning of the client
while at the grocery store (Bottari et al., 2014). Another assessment, the Social Participation
Profile can be utilized to address cooperation and social participation skills of the client during
interactions with peers across the assessments three main topics of activity participation, social
interaction and group membership/roles (Donohue, 2014). Formal documentation of the clients
progress will be completed at the conclusion of every treatment session over the course of six
weeks. Overall, the progression of the clients abilities to fully participate and exemplify
improvements in his goals will be observed, assessed, monitored, and reevaluated by the
occupational therapist through formal assessments and interviewing processes.

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References

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