Occupational Therapy Intervention Plan

Name: Raymond Schuler Age: 7 Gender: M Date of Report: 12/8/17

Primary diagnosis/condition: Autism

Other diagnoses/concerns: No other diagnoses

Precautions/Contraindications: no medications, no allergies, no special diet

Reason for referral: Mom is seeking OT services due to areas of concern especially with self-care,
handwriting is sloppy, and his social skills. Her husband’s business has recently taken off and so they
have financial resources to spend on therapy for him. His behavior also needs to be addressed. He is
receiving school therapy 1x/month and did receive early intervention services previously.

Therapist: Jessica Brauzer, OTS

FINDINGS

Occupational Profile:

 States comprehensive understanding of occ. Hx, experiences, patterns of daily living, interests, values, and needs & reason for
seeking services.
Raymond is a 7 year old male in the 2nd grade who is being homeschooled by his mother. He has a diagnosis
of autism and is not taking any medications or has allergies. His mother is seeking OT services due to areas of
concern in his self-care, his behavior (kids think he is weird) and his handwriting legibility. Raymond currently
lives with his mom, dad and 4 other siblings. They live in the suburbs with a fenced backyard and no pets. He
is currently receiving therapy services through the school 1x/ month. In the past, developmental milestones
have shown that he has done well with self-care tasks and socializing with his siblings. He did receive EI
services and parent reports that “it was helpful, and thought it worked better for the parents then Raymond”.
Raymond’s interests include: playing with the WII, playing with dinosaurs, harry potter, playing with siblings at
home, and engaging in simple games like tag and hide and seek. Raymond’s typical day includes: waking up
with other siblings, mom is busy with toddler so he plays, gets dressed and then moms serves breakfast:
apple, oatmeal, bacon, eggs, depends on the day (he doesn’t have problems with eating, just with
manipulating his utensils, and is using a sippy cup, then he has school lessons at 9 am, play time at 11:30am,
lunch, unstructured play in the afternoon, more school, family time together (when dad gets home), dinner,
story time, puts on pajamas, then sleeping by 9pm (gets around 9 hours of sleep).
 strengths and weaknesses (person) identified
Raymond’s strengths include: wanting to engage in dressing activities just has difficulty manipulating buttons
and fine motor skills, he also likes to eat a variety of foods, and he is able to brush his teeth (just needs some
prompting from mom). He has great functional mobility really good here with jumping, swinging, etc. He also
does a good job cleaning up his toys, responsibility for chores. Per mom’s report he does a good job with
playing with siblings and engaging in family activities, he is strong in quiet recreation activities and he wants to
be engaging with peers in games for social aspect.
Raymond’s weaknesses include: self-care tasks such as: dressing (fine motor abilities), toileting, using utensil/
sippy cup during meals, not independently showering or bathing (doesn’t like it), doesn’t understand the

Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 1
sequencing for showering (puts on shampoo then will be done), brushing teeth same (puts on a lot of
toothpaste, and then think’s that is good enough), community management-can be impulsive, academics: he
has sloppy handwriting and is not reading. Sports: he is not engaged in because mom feels “that is long way
down the road” to get there. Socialization- he tends to change the game and doesn’t understand the correct
rules of the game when with peers

 potential areas of occupation disruption identified

Potential areas of occupations disrupted include: self-care tasks such as toileting, dressing, feeding, brushing
teeth, going out in the community and handling public areas appropriately with behavior, household
management: sometimes needs helps with initiating, he is not engaging in any sports which could affect his
socialization. Also he tends to play with siblings more and is having difficulties understanding games and the
rules, so play is affected and social participation.
 Supports and barriers (context & environment) identified
Supporting contexts and environments for Raymond include: 1) supportive family and socioeconomic status as
father has resources for his therapy, 2) mom’s support for engaging him in therapy and giving him the one on
one attention at home for home schooling, socially: has many siblings to bond with and form relationships.
Inhibiting environments and contexts include: 1) homeschooling could be inhibiting progress as his mom may
have not the resources or knowledge on how to help him academically, 2) family: if dad is working a lot that
could be taking away father son bonding time, 3) socially: he is able to bond with siblings, but doesn’t have
play dates in the neighborhood which is limiting social development.
Parent’s Priorities & concerns for intervention identified
Mom is seeking OT services due to areas of concern especially with self-care, handwriting is sloppy, and his
social skills. The top 5 priorities she would like addressed in therapy include: social skills with games and any
occupations that he engages in, especially with emotional regulation, 2) handwriting: his handwriting is sloppy
and he has trouble reading, 3) feeding: he eats a lot of foods but has trouble with fine motor coordination, 4)
hygiene: she would like brushing teeth, and bathing to be priorities so he is doing this independently without
reminders, 5) dressing (fine motor skills again for button, and with tying laces on shoes, and not wearing Velcro
shoes

Analysis of Occupational Performance:

Information was gather through a semi-structured interview, the COPM which was given to Amy, Raymond’s
mom, and clinical observations were made Raymond engaging in activities in his natural home setting.

Canadian Occupational Performance Measure:

The Canadian Occupational Performance Measure (COPM) was administered to Amy to identify the main
concerns of priorities for Raymond’s intervention. The COPM allows both therapist and interviewee to identify
the top 5 priorities and rank performance and satisfaction in those areas: The top 5 priorities help the therapist
to formulate goals for Raymond’s progress.
Results are as following:

OP Problems Important Performance Satisfaction

Social Participation 10 4 5
(occupations/activities/
games in general)
Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 2
 Handwriting 8 7 5
Feeding (manipulating 8 7 5
utensils well and not
using sippy cup)
Hygiene (bathing and 8 4 5
brushing teeth)
Dressing (difficulties 8 4 5
with buttoning, and
tying shoes)
Total scores 26 25
Average Scores 26/5 25/5=5

Results from the COPM, per mom’s report show that Raymond is having difficulties with the following skills:
fine motor coordination/manipulation, social skills, and processing skills which is correlating to difficulties with
the following occupational areas: self-care especially feeding, showering/bathing, dressing, toileting, brushing
teeth, organizing thoughts on his paper for his handwriting, his overall education, active recreation (sports),
since he has difficulty with social skills this could be impacting ability to engage in sports, and lastly social
participation with peers in neighborhood, during games, etc. Mom reports that the top priorities to be
addressed: include social participation, performance is low at a 4, and satisfaction is a 5, and handwriting
performance is at a 7, but her satisfaction is at a 5 as well. By showing the top priorities she would like
addressed and her overall satisfaction with his performance, will be good to get a reassessment 6 months from
now to see how he progresses.

Clinical observations were made of Raymond participating in 3 separate activities: dressing, fine motor activity
of cutting, and playing with grandma outside to set up a hose.
Observations of Raymond engaging in the dressing activity of putting on his coat outside, he took a while to
orient the coat, and understand putting it on over his head. He did not require any verbal prompting for this
activity. Second activity involved Raymond putting on his shoes and then tying them. Raymond is in the hall
way sitting down and asking mom for help on putting on shoes. She is attending to the other siblings, and so
he decides to figure out on his own, looks inside the shoe, and it says “yes”, so this gives him the cue to put it
on left foot. He has trouble doing this and takes a while. The mother comes over and provides minimal
assistance and verbal prompting on how to get started. She tells him “open big mouth” and is providing a lot of
encouragement and positive reinforcement. The shoes are tied tightly and Raymond struggles to manipulate
the ties, figure out how to pull up the tongue and cannot loosen the shoelaces. After mom provides him with
moderate assistance and shows him how to pull up tongue and loosen shoe laces, after 4 min or so, he is able
to get shoes on. He stands up and pushes foot into the shoe to have it fitting better. Raymond is requiring
many verbal prompts and help with sequencing throughout the task. The next activity involves Raymond
engaging in a fine motor skill of cutting out a star and a heart. Raymond hold the scissors in his right hand, with
thumbs up approach, and with left hand holds the paper well (good fine motor abilities here) and does not
require any verbal prompting throughout this activity. I observe that Raymond is steadily focused on the task at
hand and not engaging in any social or play interaction with brother. In the last activity, Raymond is outside
with grandma and figuring out how to connect a hose to a water sprinkler. Raymond is attending well to the
activity and is doing a good job with sequencing here. He knows to grab the hose, bring it to the sprinkler and
then connect hose to the water line (however he can’t figure out how to connect the hose on the last part). He
is verbally communicating needs minimally to his grandma, has some difficulty expressing thoughts, and
mainly trouble with figuring out how to connect hose to water.
 Performance analyzed & identified priorities supported
Results from the COPM and the clinical observations that were made allow me to conclude that he is having
trouble with the following skills. Fine motor skills, processing skills, emotional regulation and social skills.
Raymond demonstrates difficulty with processing skills (which is the ability to comprehend information and
carry out actions and steps, and modify performance if there is a problem). This is demonstrated by his
difficulties with dressing (per mom’s report and through the observations in the video of him putting on his
shoes). This supports why Raymond is having difficulties with sequencing the steps in dressing, and with other
self-care tasks such as brushing teeth and showering (he usually puts in shampoo and then is done).
Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 3
Raymond demonstrates difficulties with fine motor skills which is the ability to manipulate objects and use
smaller muscles. This is demonstrated by difficulties with feeding and handwriting (per mom’s report), and per
observation with dressing as he is having difficulties loosening the laces of his shoes and can’t pull the tongue
up. I did not see fine motor skill difficulties with cutting activity. Raymond is having difficulties with social skills
which is the ability to communicate with peers and other individuals in an effective manner, which is identified
per mom’s report in the interview, and was observed when he was engaging in cutting activity and using the
hose activity with grandma and this will show that he had difficulties with social participation, play games, and
being able to communicate needs in an appropriate manner. Raymond demonstrates difficulty with emotional
regulation which is the ability to regulate emotions well. This is demonstrated by mom’s report that he may act
out impulsively in the community or he doesn’t know how to act around kids (she states that they think he acts
weird). Per observation I saw that he easily got upset and frustrated when he could not get his shoes. I did not
observe any emotional meltdowns in the videos.
 Identified targeted outcomes
With therapy the following skills will be addressed: processing skills (sequencing, and initiating activity without
mom’s help), fine motor (handwriting and using utensils for feeding, using tooth brush correctly), social skills
(knowing how to play games correctly) and emotional regulation (handling emotions well with peers and
siblings and not getting easily upset if can’t do something correctly-not being so hard on himself) to address
the following occupations: self-care tasks such as dressing, toileting, feeding (using utensils), and personal
hygiene (bathing, brushing teeth), handling emotions out in the community-not being impulsive, academically
with class assignments and handwriting, and social participation and play to improve the following targeted
outcomes: occupational performance in self-care, social participation, role competence and quality of life.

Problems prioritized: #1 ______Social Participation (having the appropriate social skills to effectively
communicate to parents, peers, about needs and know how to interact with them without being
“weird” per mom report and having the social skills to play games with same aged
peers)____________________________________________
#2 _______Handwriting (addressing his fine motor skills which transfers over to
legibility with penmanship and making sure he has the academic skills to progress well as a 7 year old
child)___________________________________________
#3 ________Feeding (addressing his fine motor skills to be able to manipulate
and hold utensils correctly and use a regular drinking cup for a 7 year
old)__________________________________________

Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 4
Supports/Strengths and Barriers/Limitations (identify two supports/strengths and two barriers/Limitations
for each category Personal, Environmental, Occupation)

Personal
Environmental &
(Client Factors, Performance Activity Demands
Contextual Factors
Skills & Patterns)
Processing skills: Personal: appears to Objects and
(attends)Raymond has be of higher SES as properties:
a strength here as he family has financial Raymond’s family
is able to attend to an resources to receive has the means and
activity for desired therapy services and the financial
amount of time (he has obtain necessary resources to be able
good focusing skills equipment ( if need to get objects for
when he is engaging in be) him to succeed in
fine motor activities) self-care activities
Physical: Raymond and with
Supports/Strengths Motor Skills: lives in the suburbs, handwriting.
Raymond’s gross in a safe
motor functional neighborhood with a Relevance and
mobility are great (can fence and is importance to client:
swing and jump) homeschooled which Raymond wants to
allows him the one on engage with peers
one attention from his and play simple
mom games with them, he
just doesn’t have the
social skills to know
how to effectively
play.
Global mental Social: Raymond is
functions: higher level homeschooled which Space demands:
cognitive skills – he is may be inhibiting his Raymond may be
struggling ability to limited in his
academically, as academically succeed academic
handwriting is sloppy with same aged peers experiences since he
and he is unable to and he is not is just receiving
read participating in any academic guidance
organized sports in one setting and is
Processing skills: which may be making not going to different
sequencing: Raymond him feel weak and not rooms for different
has difficulty with have the confidence subjects, etc.
sequencing the steps to approach peers
Barriers/Weaknesses
of tying his shoes and Sequencing and
knowing how to put Physical: since he is timing: Raymond
them on, also has homeschooled, he is has trouble
trouble with the steps getting one on one sequencing the
in brush teeth and attention however he steps in dressing
showering. may not be advancing and with playing
well academically games
with how the
environment at home
is set up.

Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 5
Areas of occupation to be addressed: (highlight or bold 3-4 most relevant)

 Activities of daily living  Instrumental activities of daily living

 Education  Work (voc or prevoc)
 Leisure/play  Social participation
 Rest & Sleep

Long-term goal: #1 ______By 6 months, Raymond will independently write 6, 4-5 word sentences with
80% handwriting accuracy (line adherence, spacing, sizing) within 10 minutes, within 4/5 trials.
______________________________________________________

#2 ___________By 6 months, Raymond will independently interact one on one with a

peer as demonstrated by 10 reciprocal one on one social interactions, in a 5 minute period, within 4/5
trials. _________________________________________________

1. List practice model with rationale

Short-term objectives for Problem #1
By 3 months, Raymond will improve
grip strength in order to write
sentences as demonstrated by
engaging in fine motor strengthening
activities (Theraputty) with minimal
assistance with 60% accuracy for 4/
5 trials.
By 3 months, Raymond will improve
attention to non-preferred activity in
order to write sentences
2. List Intervention approach(es)
3. List Intervention Type(s)
Practice Model(s)/Frames of Reference(s):
Biomechanical FOR is
Intervention Approach(es): Establish/restore
Intervention Type(s): Occupation
Practice Model(s)/Frames of Reference(s):
Intervention Approach(es): Esatablish/ restore
Intervention Type(s): Occupation/Activity

1. List practice model with rationale

Short-term objectives for Problem #2
By 3 months, Raymond will improve
initiating skills in order to interact one
on one with a peer by initiating a
conversation and maintain a
conversation with a peer for 3
minutes, with less than 2 verbal
prompts, for 4/5 trials
By 3 months, Raymond will improve
emotional regulation skills in order to
interact one on one with a peer by
having less than 2 emotional
outbursts in a game setting (tag or
hide and seek) for a 10 minute period
2. List Intervention approach(es)
List Intervention Type(s)
Practice Model(s)/Frames of Reference(s):
Intervention Approach(es):
Intervention Type(s):
Practice Model(s)/Frames of Reference(s): The Social
Participation model helps me to frame my intervention
process as it targets emotional regulation and peer
interactions.
Intervention Approach(es): Establish/restore
Intervention Type(s):

Service delivery mechanisms:

Service provider (s): Jessica Brauzer,OTS

Location: U of U Outpatient Pediatric Clinic Frequency and duration of services:

Raymond will receive therapy services 1/ week for 1 hour sessions for 6 months.
Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 6
Plan for discharge (criteria and follow-up)______Raymond will be assessed at 6 months in order to assess
progress being made, if goals have been met, how long insurance allows him to attend therapy and ____if
parents decide to terminate services. A GAS scale will be implemented to assess
progress_____________________________________________
________________________________________________________________________________________

Outcome measures (highlight or bold at least three that are most directly addressed in your
intervention plan).

1. Occupational Performance 2. Prevention 3. Health & wellness

4. Quality of Life 5. Participation 6. Role Competence
7. Well – being 8. Occupational Justice

Name and position of person developing plan: ________Jessica Brauzer,

OTS________________________________________

Date plan developed: _________________12/8/17___________________

Date plan modified or reviewed: ___________6/8/18_________________________

Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 7