Student

Name:

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Courtney McDonald

I. Diagnosis, Referral, Setting, Reimbursement, LOS

Albert is an 18-year-old male who has been diagnosed with schizophrenia

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Referral: Albert's psychiatrist
Hx: no previous medical history provided
Setting: Outpatient
Reimbursement: funding by the state legislature for early psychosis programs in the community
Tx lensth: Zxlwk for 6 weeks

Will

2. Prasmatic Factors to Consider

need to coordinate therapy schedule with the early psychosis program, psychiatrist, and Albert's

schedule

Only have 12 visits with him

Will be consulting with the Early Psychosis team
May need to coordinate therapy around medication schedule
Medications may have severe side effects that impact occupational performance
Reimbursement will pay for communiW outin

4: Top Three Client/Familv Goals and Priorities

Copins with voices durine his dailv routine
Makine new friends at the communitv collese
Focusins during class

5. Diagnosis and Expected Course

6. Scientific Reasoning

Schizophrenia (according to NIMH)

Usually starts between the ages of l8 and 30
Positive symptoms include hallucinations,
delusions, thought disorders, and movement
disorders
Negative symptoms include flat affect, reduced
feelings of pleasure in everyday life, difficulty
beginning and sustaining activities, and reduced
speaking
Cognitive symptoms include poor executive
functioning, trouble focusing or paying attention,

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o

According to the schizophrenia presentation in

Pollie's class:
Research has found that social skills training is

symptoms.

Medication combined with OT helped clients

with treatment-resistant schizophrenia exhibit

& Evidence

effective in teaching persons with

schizophrenia assertiveness skills,
communication skills, and reducing psychiatric

Date: 4l2l/2016

Case: #7-Albert

better interacti ons, reduc e ne gative symptoms

and problems with working memory

Treated with antipsychotics and psychosocial

treatments
The outlook for people with schizophrenia
continues to improve. Treatments that work well
are available, and new ones being developed.
Many people with schizopkenia experience
recovery and lead independent satisfying lives.
Approximately 10% of the population of people
with schizophrenia commit suicide.

and minor psychotic episodes, and stabilize

positive symptoms.
Cognitive-behavioral intervention and
neurocognitive training with skills training
improves social and cognitive performance and

reduces negative symptoms.

Letting the client choose the activity for

therapy produced improvement in positive

symptoms of suspiciousness and hostility.
The combination of executive function
strategies with participation in simulated daily
activities improves actual activity performance
and oarticioation.

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7. Practice Models Guiding

Assessment and

Rationale

Treatment

I.

PEO

2.

CognitiveDisability

3.

Sensory Processing

14.

This is a good practice model to use with Albert because there is obvious
dysfunction between Albert, his environment, and the occupations hewould
like to participate in. For example, Albert will be attending schools and is
nervous about making new friends. His environment could be changed by
having him take classes that have fewer students in them. Changes in Albert
could including telTFng him ways tot@Ewith the voices that he hears so
that they do not interfere with sSffifpEitiEipation. A change in the occupation
could be havine Albert use social scriots when meetins new oeoole.
The Cognitive Disability model focuses on promoting the client's ability to
function and facilitate self-efficacy and success in people with cognitive
impairments. This would be appropriate for Albert because, according to the
cognitive disability screening and the Allen Diagnostic Modules, he is
functioning at a 5.2 cognitive level. Knowing this, occupational therapy
treatments can be altered to begin at an appropriate level of difficulty for his
cognitive level. For example, he may need set-up assist and supervision for
safetv for medication management and using public transoortation.
The overall outcome for this model is to understand how individuals respond
to sensory stimuli and to help the client meet their sensory needs to improve
occupational performance. This is approf?Iffi for albert-EEGilse he scored as
"much more than most people" in sensation avoiding and low registration for
auditory processing. This means that Albert notices auditory stimulation
much less than others but he actively avoids situations where auditory stimuli
mafbe to-o overwhelming for him. b..flutionul therapy treatment can
include compensatory strategies that he can use to help him function irrloud
places, such as a crowdedbus.

Evaluation: What Assessment tools and other means of assessment will you use?

Top Down Assessment: Prioritize one Occupation to observe the client perform
Observed Occuoation
Rationale/flow will vou use this information
o This will provide me with information about
Albert's cognition, cognitive sffategies that he
uses, how interacts with his social environment,
and how he handles situations that can be
stressful and are in a loud environment.

Method/Tool
1. Bay Area Functional Performance

Evaluation-

Social Interaction Scale

2. Beck Depression

Inv$qry/f

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5'

,x.%,qi;ivT4/#'

Nffi4K

Rationale/IVhat is beins Assessed

This assessment will provide me with
information about Albert's social behavior. The
social portion of the assessment will provide me
with information about his response to authority
fi gures, verbal communication, psychomotor
behavior, socially appropriate behavior, and
ability to work with peers. This assessment also
has a self-assessment ofsocial behavior that
provides information about the client's views of
his relationships with others.
This will provide me with information about
whether Albert is experiencing depression and
how severe it is. This is important to assess
because it will affect motivation to participate in

fNfr"o
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occupational therapy and affect his occupational

performance. While the psychiatrist will
diagnose depression if Albert has it, this

inventory will provide me with information

about thoughts that Albert is having that relate to
his self-esteem and can impact his social

particioation.
3. Stress Management Questionnaire

Because Albert's symptoms increase when he

gets stressed, it is important to know what
causes him stress. This will provide me with
infoiiEtlon at-out Albert's symptoms and
problems caused by stress, his stressors in life,
and how he manases andiedues stress.

4. PASS (Meal preparation and light housework)

This will provide me with information about

Albert's safety_awAreness. This will also provide
me with information about Albert's praxis skills.
It will provide me with another opporfunity to
observe and assess whether Albert is having any
motor symptoms of Schizophrenia. This will
help me to assess if Albert will be able to
eventually live independently.
This will provide me with information about
what areas Albert is experiencing cognitive
deficits in. This instrument assesses attention
span, memory/orientation, following directions,
immediate memory, temporal awareness,
foresight and planning, safety and judgement,
concrete problem solving, and abstract

5. Cognitive Assessment of Minnesota

reasoninq.

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6. Home and School Eval

Evaluating Albert's home and school will

provide me with information about any
environmental factors that may impact his
occupational performance. It will help me to
discern which se4!.ry_strqtggies are going to be
the most helpful for Albert to function in his
typical environments. I will be able to provide
Albert and his familv sussestions on
modifi cations thmEnG'frade to decrease
Albert's symptoms and stress levels.

16. Resources and Team Members

Psychiatrist
Other people on the Early Psychosis Team

His siblings
His parents
Teachers at school
Referral to a social skills group
Referral to familv for

for familv members of those with schizoohrenia.

17. Intervention Plan

Barriers

Paranoia

Supports
a

His familv

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Delusions

History of drug and alcohol issues

Behavioral issues
Hears voices when stressed

Has difficulty concenhating

Crowds overwhelm him

Feels like a failure
A "little freaked' by the diagnosis

of

schizophrenia

The Early Psychosis program and team

Medications are working

Has good goals
Wants to continue his education
Is motivated by drawing and graphic design
He has a desire to make new friends at the
community college
Wants to be more independent

Hassensoryprocessingdysfunction
Has cosnitive imoairments
Practice Model for each

1. LTG:
In 6 weeks, Albert will independently respond to social cues and
idtie*e an appropriate interaction with a group of unfamiliar peers
for 15 minutes.
STG:

In 3 visits, Albert will demonstrate appropriate social behaviors

while engaging in a group setting with no more thanZ verbal
STG:
In 7 visits, Albert
an

unfamiliar

will initiate

and hold a 5-minute conversation with

with fewer than 3 verbal

2. LTG:
In 6 weeks, Albert will independently plan a route and ride public
ftansit without an i[crease in his stress level above baseline.
STG: -fOKqil.* 9 /qt4fion
In 5 visits, Albert will implement sensory strategies for stress
management while riding public transit with fewer than 3 verbal
prompts.
" ^.+N

PEO, Sensory Processing

Sengory Processing

r*tttY

.t@ tr'

STG:

In 8 visits, Albert will independently plan a rort.f.r+if$public transit

that has at least one bus or train ohe+ge*P*lts4e{
3. LTG:
In 6 weeks, Albert will independently attendto a 30-minute WM
ffi#Fdr and take organized notes with no more than I rest break.

Cognitive Disability

,MW

STG:

In 5 visits, Albert will use coggjli+e#ratogips to concentratgon a. t

(h
task for 20 minutes with no {ore than I b;e;h z -.t flA

\----'-s-'--

STG:

;YlWffi%h/rh";rr*

fu-AA0<W

Cognitive Disability
In 8 visits, Albert will te&e+md use his notes to correctly answer 5g;;*,.
ouestions immediatelv followine a lO-minute idoe,
^/n, buo
18. Treatment Sessions: Plan
1. What

will you

for first two 45 minute treatment sessions:

do?

Watch a TEDTalk
- Albert will watch a 20-minute TEDTalk
- During the talk, the therapist will have Albert take
notes about important points.

Page 4 of 5

Identify

Based on which goal(s)?

Approaches
Establish/ restore

Revised l/7/13

,il

lro
-

If Albert

6t,

does not initiate taking notes during the talk,

the therapist may point out important informati on at
first or give him a set number of notes to take.

The therapist will have ple-galce{the video and

generated nygguesEgfqs to ask Albert after the video.
Albert will be encouraged to use his notes to answer
the questions.
Ifthe notes are disorganized or do not have enough
information in them to answer the questions, the
therapist will provide suggestions and strategies. For
example, use abbreviations to take notes faster or
underline key words or phrases to make them easier to
Establish/ restore

find.
Preparing to ride the bus
The therapist will introduce Albert to the Utah Transit
Authority webpage and walk him through the steps of

how to use the route finder.

Albert will then use the route finder to figure out how
to get to his school from his home.
The therapist will have Albert prg,blem solye what time
he needs to leave his house in order to gefto school on
time and what he would do if he missed the bus, missed
his connection, or got on the wrong bus.
Albert will then find another route to his school from
the clinic. This will be in preparation for the next
treatment session,

2. What

will you

Identify

do?

Approaches
Establish/ restore

fuding the bus

The therapist and Albert will follow through on the

plan that Albert created last time.
The therapist and Albert will meet at the clinic and talk
about selggry strategies to keep his stress levels low.
For examplqTlEeffuuuld wear noise reducing
headplolres so that the noise does not increase his
stress but he can still hear the announcements about
where the bus is stopping.
The therapist and Albert will then ride the bus to his
school and back to the clinic.
Albert will be in charge of when to get off the bus and
switch buses if necessary.
The therapist will provide cueing and help when
needed.
While at the school, Albert and the therapist will find
his classroom and prq!lg{n_!9lye where the best place
for himETit would 6f ro tt ut t can pay attention to
the professor and that meets his "sensory needs. The
therapist and Albert will locate areas around the school
that Albert can go to whenlelsTtiessed so that he can

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Based on which goal(s

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