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Mandy. CBL CASE KATY, CASSIE, LAUREN S., BRANDY, ALANNA, AND MEGAN D. Mandy. 35-year-old female Diagnosis: Depression, AIDS, Addiction Currently in a 2-year transitional living facility Five children. MOHO. Volition Client needs help identifying values

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35-year-old female

Diagnosis: Depression, AIDS, Addiction

Currently in a 2-year transitional living facility

Five children

  • Volition
    • Client needs help identifying values
    • Client is able to identify interests such as cooking
  • Habituation
    • Client needs to eliminate destructive habits and establish new, healthy ones
    • Client needs help internalizing and interpreting her roles
  • Performance Capacity
    • Client has the musculoskeletal, neurological, cardiopulmonary and symbolic means to perform daily activities and functional tasks
toglia s dynamic interactional
Toglia’s Dynamic Interactional
  • Goal: to restore client’s functional performance and improve cognitive function
  • Dysfunction Deficiencies
    • Organizing and structuring incoming information
    • Anticipating, monitoring, and verifying the accuracy of performance
    • Flexibly applying knowledge and skills to a variety of situations
  • Change: cognitive strategies within multiple contexts.
  • Occupational Performance History Interview II (OPHI II)
    • Life history interview using scales and narrative reports.
    • Cost: $43.50
    • Target population: adolescent or adult client who has cognitive and emotional ability to participate in the interview.
    • Validity: 90% valid
ophi scores
OPHI Scores
  • Occupational Identity
    • Present: Someproblems
    • Past: Extreme problems
  • Occupational Environment
    • Someproblems
  • Occupational Competence
    • Present: Some problems
    • Past: Extreme problems
  • Worker Role Interview (WRI)
    • Semi-structured interview that rates impact of volition, habituation, and perceptions of the environment on readiness to return to work.
    • Focus on psychosocial readiness.
    • Cost: $43.50
    • Target population: workers with recent injuries/disabilities, chronic disabilities,
wri summary
WRI Summary
  • Personal Causation: Interferes with function
  • Values: Interferes with function
  • Interests: Supports function
  • Roles: Interferes with function
  • Habits: Interferes with function
  • Occupational Self Assessment (OSA)
    • Client self-report on 21 daily activities and their importance to the client. Allows client to set priorities for change.
    • Cost: $43.50
    • Target population: adult mental health clients
osa summary
OSA Summary
  • Myself:
    • Managing finances
    • Expressing self to others
    • Satisfying routine
    • Accomplishing goals
  • Environment:
    • Living arrangements
    • Resources
    • Opportunities to participate
  • Assessment of Communication and Interaction Skills (ACIS)
    • Observation tool that gathers information about communication and interaction while engaged in an occupation.
    • Cost: $40.00
acis summary
ACIS Summary
  • Physicality
    • Ineffective
  • Information Exchange
    • Ineffective/Questionable
  • Relations
    • Ineffective/Questionable
goal 1
Goal 1
  • The client will improve self-awareness as measured by identifying three meaningful life goals in three weeks.
intervention 1
Intervention 1
  • Value Card Sort
    • Occupational functioning problems.
    • Help Mandy to identify values according to the OPHI- II.
    • Assisting in increasing self-awareness of values.
    • Occupational functioning problems.
    • Just-right challenge

  • Reduce number of value cards
  • Give her the option of choosing “very important to me” or “not important to me”.
    • Eliminating the option of “important to me”.
goal 2
Goal 2
  • The client will improve organizational habits and routines according to her previously identified goals as measured by 80% adherence to a daily checklist by the end of four weeks.
intervention 2
Intervention 2
  • Reusable Checklist
    • Dry erase board in her room that the therapist can check
    • Process of organizing occupations into routines
  • Therapist identifies daily routines to be completed
  • Add pictures to identify task instead of words
  • Divide up day into times (morning, afternoon, evening)
intervention 3
Intervention 3
  • Financial Management: creating a weekly budget
    • Mandy is required to attend courses to educate her on finances and maintaining a budget.
    • In the occupational profile, Mandy stated she wanted to improve financial management.

  • Reduce the number of categories
  • Creating a monthly budget instead of weekly
  • Color code the categories
  • Changing structure by providing money envelopes for each budget category based on a certain percentage
instructional approach
Instructional Approach
  • Acquisitional
    • Provide a budget planner which will promote self-evaluation
    • Focus: modify performance skills
    • Materials: written directions, budget planner

Cole, M, & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack.

Custer, V. L., & Wassink, K. E. (1991). Occupational therapy intervention for an adult with depression and suicidal tendencies. American Journal of Occupational Therapy, 45(9), 845-848. doi: 10.5014

Garrett, B. (2011). Brain and behavior (3rd ed.). Thousand Oaks, CA: Sage.

Gates, L. B., Akabas, S. H., & Oran-Sabia, V. (1998). Relationship accommodations involving the work group: Improving work prognosis for mental. Psychiatric Rehabilitation Journal, 21(3), 264-272. Retrieved from

Giles, G. M., Radomski, M. V., Champagne, T., Corcoran, M. A., Gillen, G., Kuhaneck, H. M., & Toglia, J. (2013). Cognition, cognitive rehabilitation, and occupational performance.  American Journal of Occupational Therapy, 67(6). doi: 10.5014/ajot.2013.6759

resources cont
Resources Cont.

Helfrich, C. A., Chan, D. V., & Sabol, P. (2011). Cognitive predictors of life skill intervention outcomes for adults with mental illness at risk for homelessness. American Journal of Occupational Therapy, 65, 277– 286. doi: 10.5014/ ajot.2011.001321

Kielhofner, G., & Burke, J. P. (1980). A model of human occupation, part 1.  American Journal of Occupational Therapy, 34(9), 572-581. doi:10.5014/ajot.34.9.572

Paul-Ward, A., Kielhofner, G., Braveman, B., Levin, M. (2005). Resident and staff perceptions of barriers to independence and employment in supportive living settings for persons with AIDS. American Journal of Occupational Therapy, 59, 540–545. doi:10.5014/ajot.59.5.540

Schell, B.A.B., Gillen, G., Scaffa, M. E. (2013). Willard and Spackman's occupational therapy (12th ed.). Philadelphia: Lippincott, Williams, & Wilkins.

Wagner, C. C., & Sanchez, F. P. (2002). The role of values in motivational - interviewing. Motivational Interviewing: Preparing People for Change, 2, 284-298.