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Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan


Sam Mitchell
Touro University Nevada

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile
Elka is a 38 year old woman from Australia. She moved to the United States ten years
ago. She came to the United States as a mail-ordered-bride. However, she is no longer married.
Elka does not have any children and does not have any family in the United States. She does
have two brothers that live in Europe, but she currently is not in contact with them. Prior to being
admitted to the psychiatric hospital, Elka was homeless and living on the streets of Las Vegas.
She was picked up at a local casino by the Las Vegas police department for a complaint that she
was stealing food from peoples plates at the restaurant, and stealing merchandise from the
casino store. When the police found her at Ellis Island Casino, she stated that she was paying
tribute to her mother whose name is Ellis. The police department brought her to the psychiatric
hospital for evaluation. Following her admission, Elka was diagnosed with bipolar disorder. The
physician gave her medication to stabilize her disorder. After her mental state was deemed stable,
Elka was transferred from the main psychiatric hospital to a wing called the difficult placement
unit (DPU). Elka has currently been at the psychiatric hospital for 45 days.
Elka stated in a previous occupational therapy session that she was a victim of the sex
slave industry. She said a prior boyfriend trapped her and sold her as a sex slave. She claimed to
be sold as a sex slave in a forty million dollar business trade. After being sold, Elka said she
lived with an Arabian man that was involved in large businesses. She said she would entertain for
his male business partners. However, Elka was able to escape from the sex slave industry, but has
been working as an exotic dancer for the past couple months.
Prior to being admitted, Elka did not maintain any hobbies. She stated that she enjoys art,
nature, and reading but hasnt been able to participate in those activities for a very long time.
Elka is oriented to person, place, and time. She has been deemed too unstable to reenter the
community. Therefore, she has been placed in the DPU, since she does not have any support in

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

the community. During Elkas therapy session she stated, I do not have any interest in the
outside world. Elka is currently independent in all activities of daily living (ADLs), but has
present deficits in instrumental activities of daily living (IADLs), rest and sleep, play, leisure,
and social participation. Following the doctors referral to occupational therapy services, the
occupational therapist administered the Executive Function Performance Test to assess Elkas
performance in IADLs.
Elka shows avoidance behavior when asked to talk about her past or current feelings. She
shuts down and excuses herself from the discussion or treatment session if topics related to her
past experiences are addressed. Elka does show better participation in environments with
minimal distractions. Elka currently does not show interest in reentering the community. She
spends her time watching television, sitting on the patio, and reading magazines. Elka shows
symptoms of anxiety, avoidance, lack of attention to task, and depression during occupational
therapy sessions.
Occupational Analysis
Elka was observed performing an activity as part of an occupational therapy intervention
session. The intervention session took place in the DPU, in the common area. Elka was initially
located on her unit by the nursing station; however, she agreed to work with the occupational
therapist and student in the common area. The area is semi secluded with tables and chairs, and
with minimal distractions. Elka reported, I feel up, not down today. The session began by
presenting Elka with a self-esteem activity titled, What Do You Believe About Yourself. The
occupational therapist read a short story called, How Baby Elephants Are Trained and then
Elka was asked to complete the, What I Believe worksheet. While the occupational therapist
(OT) was reading the short story, Elka demonstrated increased distractibility by diverting her

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

attention to a National Geographic magazine, wanting to share a poaching story regarding


elephants. Elka was unable to concentrate and maintain her sustained attention to the activity.
When completing the What I Believe worksheet, Elka became tearful when speaking
about positive self-esteem and excused herself from the table. After a two minute break, Elka
returned to the treatment session and began working on a new activity titled, Toot Your Own
Horn. The activity, Toot Your Own Horn is an activity that works on building positive selfesteem, and again Elka was unable to initiate the activity. Elka was unable to take liability of her
emotions and communicate them during the activity. Following her avoidance behavior, the OT
decided to change the course of the session to an art activity. The art activity was titled,
Creating a Safe Haven Through Imagery. Elka required maximum verbal cuing and direct
prompting to write responses on the worksheet. Elka was unable to initiate drawing her identified
safe haven, which she described as a forest in Ireland. Elka requested that she would like to keep
the worksheets and work on them another time. Elka emotionally shut down and self-terminated
the intervention session. Throughout the session, it was observed that Elka continued to
demonstrate avoidance behavior regarding her feelings, refusing to speak about experiences or
process her state of emotions.
Elka has been diagnosed with bipolar disorder. Elka demonstrates the typical depressive
episode, alternating with a distinct period of elevated mood. During her episodes of mania, Elka
shows symptoms of restlessness, low energy, distractibility, emotional inappropriateness,
cognitive inflexibility and a decreased need for sleep. During her depressive phase, Elka shows
symptoms of high fatigue, distractibility, avoidance, low confidence, emotional instability and an
increased need for sleep.
The performance skills affected by Elkas diagnosis include process and social interaction
skills. Elka shows deficits in attending to tasks and refraining from interrupting ongoing tasks

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

during the therapy session. She agrees to complete tasks initially, but does not maintain heed
through the activity. Due to avoidance in expressing emotions, she is unable to heed through
many specific activities. Elka shows deficits in concluding discussions and regularly selfterminates treatment sessions by shutting down and being nonresponsive to the activities and the
therapist.
Elkas performance patterns are greatly affected by her physical environment, social
environment, and the state of mental health she is currently in. At this time, Elka has not
established a meaningful routine for daily life. The hospital where she is admitted has a daily
routine list that she does not fully participate in due to lack of motivation and initiative. The daily
routine list includes participation in self-care, room management, chores, therapy sessions, and
leisure activities. Due to her past, Elka does not have any established roles in the community.
Also, she does not have social supports in the community such as friends or family. She has
established friends in the hospital, but is guarded.
Problem List
Problem statements state the areas of occupation that are limited due to certain underlying
factors. It is a list of problems that can be treated by an occupational therapist and provides a
central understanding of the clients problem areas. Elkas functional performance is limited due
to several factors such as depression, anxiety, lack of attention to tasks, and avoidance behaviors.

Problem Statements
Problem statement one. Client is unable to verbally communicate emotions due to
ineffective coping strategies and avoidance behavior.

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Problem statement two. Client is unable to independently perform the hospitals daily
routine list that includes ADLs and IADLs such as grooming and personal hygiene, home
establishment and management, and leisure activities due to difficulty maintaining sustained
attention.
Problem statement three. Client is unable to independently perform IADLs such as health
management and maintenance due to inability to maintain a routine for medication management.
Problem statement four. Client is unable to regulate emotions during therapy session due to
anxiety and fear related to past experiences.
Problem statement five. Client is unable to identify and participate in leisure activities due
to depression.
Elkas problem statements are prioritized by the problems most greatly inhibiting her from
reentering the community. Elkas inability to verbally communicate her emotions due to
avoidance and ineffective coping strategies is hindering her from establishing liability of her own
emotions. This ultimately leads to Elka shutting down emotionally and preventing her from
successfully returning to the community. Elka is also unable to perform required IADLs due to
her inability to maintain attention caused by depression and will not be able to live
independently. By determining these problem areas, the occupational therapist will be able to
focus on the underlying factors and develop long and short term goals to improve Elkas overall
functional performance.
Intervention Plan and Outcomes
When writing goals the occupational therapist must ensure that the goals maintain and
promote function, and prevent dysfunction at all times. Occupational therapy goals are highly
individualized and are based on the clients evident occupational performance problem areas as
well as the concerns and priorities of the client. Elkas goals have been determined by

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

information from her medical records, occupational profile, occupational analysis, and her
functional problem statements.
Occupation Therapy Long-term Goal
Elka will independently verbally express her emotions with no more than one verbal
prompt and apply appropriate coping strategies, to improve liability of emotions within five
weeks.
Short-term goal. Elka will verbally contribute one current feeling or emotion during the
treatment session with no more than three verbal prompts, within three weeks.
Intervention. The approach for this intervention is establish and restore. The
intervention will establish and restore Elkas ability to verbally communicate the feelings she is
experiencing intrinsically. Encouraging Elka to express her feelings and emotions, while also
identifying triggers that cause these emotions, will restore her ability to maintain and regulate her
emotions. It is unhealthy to keep emotions and feelings bottled up inside. Once strategies are
established to cope and express ones emotions, communication with others, as well as within
oneself becomes easier. It's not always easy to express feelings, but it is rewarding to release the
emotions that have been bottled up. In this intervention activity, Elka will write down a list of
emotions, such as anger, delight, sadness, and fear. She will then be asked to think about each
feeling and determine a time when she has experienced these emotions. After she identifies a
time, she will note how she felt. For example, when she is sad, her eyes begin to tear up. This
will help her identify the emotion when it happens to her.
At the beginning of every OT treatment session Elka will refer back to the list of different
emotions to help her to determine her feeling of the day. It can be very difficult to articulate
emotions in the moment, but having a list will help her sort her feelings out. She will be educated
to communicate her feelings by stating, "I feel..." statements, rather than "He made me feel..."

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

This will promote liability of emotions and the understanding that it is ones own self who makes
you feel something. Once she identifies her feeling of the day, she will then identify the thoughts
that trigger her current feeling. If she identifies a negative feeling, the therapist will discuss and
help her to replace them with more adaptive thoughts. Nevid & Greene (2001) stated,
Depressed people tend to focus on how they are feeling rather than on the thoughts that may
underlie their feeling states (p. 244). Aaron Becks form of psychotherapy, called cognitive
behavioral therapy, challenges the distorted thought patterns that give rise to or exacerbate
clients problems (Nevid & Greene, 2001). Cognitive therapist uses a combination of behavioral
and cognitive techniques to help clients identify and change dysfunctional thoughts, and develop
more adaptive behaviors. The text states an example: the client says, I am all alone in the
world, the therapist then responds by helping the client to determine an adaptive response to
say, It may feel like I am all alone, but there are some people who care about me (Nevid &
Greene, 2001). The main outcome for this intervention strategy is health and wellness. Elkas
ability to express and acknowledge her emotions and behaviors, and embrace the need for
change, will promote her mental well-being. By addressing and treating this area of Elkas life, it
will provide her with the awareness to make choices toward a more successful existence (Hettler,
1984).
Grading up and grading down. This intervention activity can be graded up by requiring
Elka to monitor her negative emotions throughout the day in a thought diary. This invention
activity can be graded down by requiring Elka to share one single emotion or feeling, rather than
identifying the triggers and rational responses required in the initial intervention plan.
Short-term goal. Elka will identify and verbalize two positive coping mechanisms that
she finds most effective when managing her symptoms of depression with no more than three
verbal prompts, within four weeks.

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Intervention. The specific approach for this intervention is establish and restore. A good
mantra to follow is, it is not the situation, but it is the response to the situation that causes
problems. Personal experiences are influenced by ones own thoughts and perceptions, which
means that emotional reactions come from within. People suffering from depression must
establish coping strategies to regulate their response to their emotions. In this intervention
activity, Elka and the therapist will explore one particular coping strategy. They will explore
mindfulness based cognitive therapy (MBCT) as a coping mechanism for Elka to manage her
symptoms of depression. The OT must be trained in mindfulness based cognitive therapy to
administer this type of therapy to the client.
In MBCT, clients gain the skills to be able to realign themselves away
from their thoughts and feelings and focus instead on the occurring changes
in their body and mind. This can be done with yoga, breathing,
and meditation (Williams et al., 2013). During this activity the therapist will
focus on mindfulness through meditation. The therapist will use a CD-ROM
by Kabat-Zinn, Williams, Teasdale, and Zindel (2007) titled, The Mindful Way
Through Depression: Freeing Yourself From Chronic Unhappiness. The
meditation CD provides a gentle and encouraging narrative of guided
meditation. While undergoing this form of therapy, the client is instructed to
recognize their sense of being and to view themselves as separate from their
thoughts and moods (Williams et al., 2013). Williams et al. (2013) describes
that this disconnect will allow the client to become liberated from obsessive
thought patterns that replay the same negative messages over and over. By
providing Elka the awareness to the strategy, it will allow her the opportunity
to heal herself by thinking positive thoughts and responses to the negative

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emotions in order to defuse them. Following Elkas participation in the guided


meditation exercise, she will discuss her feelings and emotions regarding
present and future use of this coping mechanism. The main outcome for this
intervention strategy is health and wellness. By aiding Elka in establishing
coping mechanisms to manage her depression, she will be able to restore
good mental health balance and stability in her daily life.
Occupational Therapy Long-term Goal
Elka will independently complete the hospitals daily routine list to improve engagement
and performance in grooming and personal hygiene, home establishment and management, and
leisure activities within five weeks.
Short-term goal. Elka will complete room management activities including making her
bed, organizing personal possessions, and laundering her clothes with no more than two verbal
prompts, within three weeks.
Intervention. The specific approach for this intervention is establish and restore. When
a person experiences a depressive disorder, IADL impairments will be most apparent in activities
requiring processing and communication and interaction skills (Christiansen & Matuska, 2011,
p. 411). IADLs such as financial management, meal planning and preparation, home
establishment and management, and shopping are all activities that require energy, initiation,
motivation, and organization. Elkas symptoms of distractibility, loss of interest, and avoidance
are inhibiting her in completing many IADLs required in her daily life. In this intervention
activity, Elka will plan and perform one of the aspects in room management, such as laundering
her clothes. The therapist will verbally discuss the process of laundering her clothing with Elka
including gathering all dirty laundry, sorting the laundry by color, washing the laundry and all
aspects, drying the laundry and all aspects, folding, and putting away the clothing in the

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appropriate area. Elka will then perform the entire laundering process. Once the clothes are
placed in the washing machine, Elka will set a timer to remind herself that her clothes are in the
washer. While the clothes are washing, Elka will verbally discuss with the therapist the
importance of maintaining clean and presentable clothing. Once the timer notifies Elka that her
clothes are done in the washer, she will then place the clothes in the dryer and set the timer again.
While the clothes are drying, Elka and the therapist will evaluate Elkas closet and drawers to
discuss the best way to organize her closet. Once the clothes are done drying, Elka will fold her
laundry. Once her laundry is folded, she will put her clothes away according to the organization
plan that the therapist and Elka agreed upon. By first educating and then checking Elkas
understanding of the process, it will ensure the therapist that she is retaining the information
presented.
Dilk and Bond (1996) completed a meta-analysis of 68 studies of skills training to
establish its effectiveness as an intervention for people with chronic mental illness. The skills
training programs included either cognitive or cognitive behavioral therapy. Regardless of
approach, skills training demonstrated a positive, moderate effect across studies and was found to
be moderately to strongly effective in teaching inpatients interpersonal and assertiveness skills
and reducing psychiatric symptoms (Gibson, DAmico, Jaffe, & Arbesman, 2011, p. 251).
Several of the studies evaluated showed evidence that participants receiving skills training
integrated more quickly and more successfully into the community. The intervention outcome is
occupational performance, improvement. Establishing and restoring Elkas ability to perform in
room management will better prepare her for when she has to reenter the community and manage
her own home.

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Short-term goal. Elka will establish and perform a meaningful written schedule to
improve structure in daily activities including grooming and personal hygiene, room
management, and leisure activities with no more than one verbal prompts within four weeks.
Intervention. The specific approach for this intervention is modify. Established routines
give individuals a sense of security and mastery in handling their lives. As this sense of mastery
is strengthened, they can tackle larger challenges that take place in their lives. Goodwin and
Jamison (1990) suggest that instability is the fundamental dysfunction in manic depressive
illness. Therefore, in this intervention activity, Elka will establish a weekly schedule of ADLs
and IADLs. Elka will determine fifteen meaningful daily activities she will participate in each
week. Elka will choose five personal hygiene and grooming tasks, five home establishment and
management tasks, and five leisure activities. Elka can choose activities from the hospitals daily
routine list or she can determine her own activities as she sees fit. Once Elka has determined the
activities in which she wishes to participate in, she will organize the activities by personal
significance. Once her list is established, she will create a schedule using a calendar including
the day of the week, activity, and location of where the activity will take place. She will also
have a place on her calendar to mark off the completion of each activity. This intervention
activity will create a schedule for Elka in the upcoming week. Elka will be expected to work on
the following weeks schedule in between therapy sessions. At the end of each therapy session,
Elka will discuss the completion of her scheduled items and the therapist will review the next
weeks schedule to ensure completion and adherence. Velligan et al. (2000) showed good
evidence of the effectiveness of using environmental supports through cognitive adaptation
training. The environmental supports included the use of client and task specific signs, checklist,
and supplies.

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Another study done by Patterson et al. (2003) showed significant improvements in


everyday living skills after administering functional adaptation skills training. Frank, Gonzalez,
and Fagiolini (2006) research group developed an intervention aimed at prevention of recurrence
of bipolar disorder called interpersonal and social rhythm therapy. The researchers used a
behavioral approach aimed at providing a consistent daily routine, especially timing of going to
bed, rising, work, meals, and social contact. Once the routines were established, they worked
with the patient to help them make the routines more regular in their timing. The research
groups interest was in determining the relationship of the circadian system to the reoccurrence
of mood disorders. The intervention outcome is occupational performance, improvement.
Establishing and restoring structure to Elkas daily routine will aid in improving her ADL and
IADL functional performance.
Frequency and Duration of Intervention
Elka will participate in occupational therapy services two days a week for one hour a day.
She will receive skilled OT services for a total of five weeks.
Precautions and Contraindications
One of the crucial precautions related to Elkas treatment is activity flexibility. When
working with Elka, she demonstrates self-termination and shuts down if she does not feel
comfortable participating in the activity. Therefore, determining multiple intervention activities
prior to treatment sessions would be beneficial. Also the therapist must refrain from pressuring
Elka to persist through an activity when she shows and expresses feelings of disinterest. If she is
pressured to perform, she becomes irritable and will remove herself from the activity. Also
during these interventions, Elka will express personal feelings, emotions, and information;
therefore, the therapist must protect all information gathered during the treatment session. The

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therapist must be aware of suicide discussion and report any signs or statements made by Elka,
regarding harming ones self or others.
Primary Theory
The primary framework used to guide this intervention plan is the cognitive behavioral
theory. Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps
clients to understand the thoughts and feelings that influence their behaviors. It is a problemoriented approach that works to improve emotional states by changing distorted thinking
(Reinecke, Ryan, & Dubois, 1998). CBT is commonly used to treat a wide range of disorders
including phobias, addiction, depression, and anxiety (Nevid & Greene, 2001).
For the purpose of this intervention plan, using CBT would be beneficial because it was
developed to focus on changing negative thinking. Elkas main concern is her inability to express
her negative emotions and feelings due to ineffective coping strategies and avoidance behaviors.
There is strong support for the efficacy of CBT for reducing depressive symptoms and that it is
equally effective when compared to medication (Tsang, Siu, & Lloyd, 2011, p. 64). Cognitive
therapists use a combination of behavioral and cognitive techniques to help clients identify and
change dysfunctional thoughts, and develop more adaptive behaviors. Elkas problems are a
result of her cognitive and environmental processes. Modifications to these processes can be
done by educating her on adaptive cognitive and behavior skills (Tsang, Siu, & Lloyd, 2011).
Client Training and Education
The intervention activities discussed above include educating and training Elka in
emotional expression, coping strategies, and home establishment and management skills. It
would also be beneficial to educate Elka in specific intervention activities she participates in.
Providing her with reasoning and meaning to the activity will promote her participation and
understanding of the activity. Elka must be aware of the expectation of her full participation

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during therapy. Elka must also demonstrate a respectable and safe demeanor throughout the
therapy session. Also, it is important to train Elka to generalize the learned skills into her daily
life.
Clients Response to the Interventions
The occupational therapist will monitor and assess Elkas progress in achieving her goals
by assessing the occupational therapy daily progress notes and by performing a reassessment.
The occupational therapist will review daily progress notes regarding Elkas functional
performance. Using clinical reasoning the OT will then determine Elkas response to the
intervention and reassess goals and intervention strategies as necessary. Upon initial evaluation,
Elka was given the Executive Function Performance Test. Her scores reflected poor performance
in all areas including: communication management, financial management, health management
and maintenance, and meal preparation. Theses scores reflected her performance regarding
organization, sequencing, safety and judgment in these specific IADLs. Therefore, she will be
reassessed one week prior to discharge to determine her progress in these particular areas.

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References
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