OCCT 657A: Case

Study
Tiffany Poon
Touro University Nevada

Who is Eric R.?

He is a 5 year & 4 month

old boy.
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He is an older brother in a family that

consists of a mom, dad & younger
brother.
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He is a kindergarten student at Louis

Wiener Jr. Elementary School in Las
Vegas, Nevada.

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He is a classmate & friend to the students

in Mrs. As kindergarten class.

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His interests include Spiderman &

Disneyland.

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q=disneyland&espv=2&biw=1366&bih=643&source=lnms&tbm=isch&sa
=X&ei=szTeVKS6CMGuggTh3YGABQ&ved=0CAcQ_AUoAg#imgdii=

When he grows up, he wants to be

a firefighter or a soccer player.

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School-Based Occupational
Therapy
Setting: L.W. Jr. Elementary school
General education kindergarten class

Eligibility category: Speech and language impairment

Developmental delay

Diagnosis: Speech/language delay

Receives direct Occupational Therapy 120 minutes per
month due to
Poor fine motor skills
Poor visual attention/focus to task
Poor motor planning

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PEOP Model - PERSON

Psychological

Determined
Fun, silly
Energetic
Easy-going
Learned
helplessness

Physiological
Within normal limits
Optic nerve disorder
(wears glasses/farsighted)

Cognitive
Developmental delay
Speech & language
impairment
Decreased attention span
Decreased planning &
organization

Neurobehavioral
Motor planning deficits

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(Cole & Tufano, 2008)

PEOP Model ENVIRONMENT

Built environment

Societal factors

Public elementary school Parents

Teachers
Classroom
Desks & chairs
Related services
Smart board
Peers
Materials, toys, games along
Social
perimeter of classroom

Playground
Hallways

Cultural & values

Education
Student academic
success

experience

Team support

Social & economic

systems
Middle class American
family
Public school

(Cole & Tufano, 2008)

PEOP Model ENVIRONMENT

Environmental impact
Supporting
Interdisciplinary team nurse,
principal, general education
teacher, resource teacher,
speech therapist, occupational
therapist, parents, local
educational agency (LEA)
representative, psychologist
Staff meetings
Individualized Education Plan
Culture of promoting students
to be as successful as they can
be
Resource support time
Supporting related services
occupational therapy & speech
therapy

Inhibiting
Desk & chairs too
tall for students
physical build
Smart board
distance too far for
student to visually
attend to
Parents not
following through
to take student to
get a neurological
test

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PEOP Model OCCUPATIONS

Abilities
Reads at
appropriate age
level
Some hand
strength to grasp
writing utensil
Gross motor skills
within functional
level
Follows directions
Social awareness

Actions
Produces illegible
handwriting/fine motor tasks
Requires maximum
assistance during fine motor
tasks
Requires frequent redirection
Utilizes less efficient
handwriting grasp
Transitions within school
environment, but falls behind
Desires to socialize
Follows the classroom
routine independently

(Cole & Tufano, 2008)

PEOP Model OCCUPATIONS

Tasks
Utilizing more efficient writing
grasp; tripod grasp
Maintaining good sitting posture
Consistently stabilizing hand on
paper
Far-point copying
Grasping scissors;
snipping/cutting; holding,
turning paper
Manipulating small toys, items,
etc.
Buttoning pants during toileting
routine
Zipping up jacket
Communication of wants &
needs to peers & teacher

Occupations
Kindergarten student
Formal education
participation
Play
exploration/participation
Social participation
Self-care/self-help

Social &
Occupational Roles
Student
Peer

(Cole & Tufano, 2008,

& American Occupational Therapy Association
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[AOTA], 2014)

PEOP Model PERFORMANCE

Able to access his educational environment

independently
Not at appropriate kindergarten level
Requires 1:1 assistance for activities that require fine
motor skills in the classroom, lunchroom, & bathroom
Produces unacceptable/illegible work
Requires constant redirection to complete task
Low social participation/communication of wants and
needs due to poor communication skills
Unable to keep up with peers during transitions

Influence of PEOP
Evaluation
Review of confidential files to obtain students
health history, precautions, etc.
Interview of teachers, parents for any concerns
Observation of student in classroom, lunchroom,
playground, transitions
1:1 assessment for students current performance
level in school
CCSD Educational Assessment
Occupational profile
Gross motor, visual motor, visual perceptual, fine motor,
sensory processing, feeding/eating, self-help skills

Vision teacher evaluation

Task analysis

Influence of PEOP
Goals per speech therapist supported by occupational
therapist
By annual review date, in a classroom setting, Eric will
develop writing skills achieving a criteria of 4/5 trials
By annual review date, in a classroom setting, Eric will use
scissors to cut paper achieving a criteria of 4/5 trials

Intervention Planning/Intervention
Classroom modifications to increase students participation and
academic success (i.e. sit closer to teacher for increased assistance)
Teacher education; consult with teacher on specific fine motor
strategies
Hand strengthening activities age appropriate, fun, engaging
Multisensory approach to increase fine motor skills (focus on writing)
Gross motor; to increase body awareness, motor planning, coordination
Sensory motor; to increase attention & focus

Influence of PEOP
Outcomes (OTPF)
Occupational performance
Improvement
Enhancement

Participation
Role competence

Check in weekly with teacher

for improvements observable
in class, or for other concerns
Data collection per week

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(AOTA, 2014)

Occupational Adaptation
(OA)

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Occupational Adaptation
Theoretical base: Driven by the fact that if clients
become more adaptive they will be more functional
Focus of OA
Person: internal factors that occur with the person
(cognitive, sensorimotor, psychosocial systems); desire
for mastery
Environment: external factors that affect the person
(physical, social, cultural); demand for mastery
Interaction: the person and environment are
continuously interacting through engagement in
occupation; press for mastery
Occupational challenge
Role expectation
Demand for adaptation occurs (internal occupational
response)

(Schultz, 2014)

Application of Theory
Eric R.
Person Desire for mastery

Realizes he is falling behind his classmates

Lacks good communication skills
Is able to read/recognize letters and words correctly
Knows his writing is not legible/understandable

Environment Demand for mastery

School
Classroom
Educational culture

Interaction Press for mastery

Faces an occupational challenge due to lack of fine motor
skills, cognitive skills, and communication skills
His role expectation of a successful student is not
appropriately showcased, it is not fulfilling
Demand for adaptation
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Application of Theory
Demand for adaptation
Eric R. notices his hard work is not receptive
How can he adapt his situations or have his situations
be adapted?
Activities that are not of educational focus should be
disregarded or adapted for Erics skill level
Make sure the activity focuses on the academics
EX: A color, cut, paste, & writing activity for sight words

For testing purposes, have Eric point to or verbalize

answers
Introduce adaptive equipment or strategies for Eric
iPad
Correctly click & drag the correct word to picture

Typing instead of handwriting

Alternative ways of communication

Influence of OA
Evaluation
No specific tools related to OA
In CCSD setting, would refer student to A/T
department who implements a formal evaluation to
provide appropriate materials; OT will support
Determine strengths & weaknesses that comprise
the student in the areas of sensorimotor, cognitive,
psychosocial functioning
Evaluate a students capacity to perform activities
within the expected role

Intervention
Therapist must act as a guide and allow the student
to act as a problem-solver/decision-maker
Encourage student to know his role expectations

(Schultz, 2014)

Influence of OA
Outcomes
Occupational
performance
Improvement
Enhancement
Participation
(AOTA, 2014)
Role competence

Determine if intervention is
affecting students
occupational adaptation
process by observation and
consultation with teacher
Is it overall positive?
What changes can be made?

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Conclusion
PEOP model allowed for a rich identification of the many
variables that affected Erics occupational performance
A complete picture of interaction between the individual,
environment, and occupations
Although we support the given goals, the PEOP allowed a
deeper investigation of Eric as a whole picture

OA model focused on how Eric perceived his student

role
His personal history of success or unsuccessful experiences
correlates to his response to occupational challenges and his
own expectations of being a student
With this model, we provided Eric & his team strategies for
him to better adapt to his school environment in order to be
successful when facing occupational challenges as a
kindergartener. This in the long run, will be more effective in
the many years he has left of school.

Questions

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References
American Occupational Therapy Association. (2014). Occupational
therapy practice framework. (3rd ed.). American Journal of
Occupational Therapy, 68 (Suppl. 1),
S1-S48.
http://dx.doi.org/10.5014/ajot.2014.682006
Cole, M.B., & Tufano, R. (2008). The Person-Environment-Occupation
Performance Model. In Applied theories in occupational therapy: A
practical approach. (pp. 127-133). Thorofare, NJ: Slack Inc.
Law, M., Cooper, B., Strong, S., Steward, D., Rigby, P., & Lori, L. (1996).
The person environment-occupation model: A transactive approach to
occupational performance. Canadian Journal of Occupational Therapy,
63(1), 9-23. doi:10.1177/000841749606300103
Lee, Jenica. (2010). Achieve best practice: A review of evidence linked
to occupation
focused practice models. Occupation Therapy in
Health Care, 24(3), 206-222. doi: 10.3109/07380577.2010.483270
Schkade, J., & Schultz, S. (1991). Occupational adaptation: Toward a
holistic approach
for contemporary practice, part 1. American
Journal of Occupational Therapy,
46, 829-837. doi:
10.5014/ajot.46.9.829
Schultz, S. (2014). Theory of occupational adaptation. In Crepeau, E.S.,
Cohn,
E.C., & Schell, B.A.B. (Eds.), Willard and spackman's
occupational therapy (12th ed.). (pp.527-540). Philadelphia:
Lippincott, Williams & Wilkins.