OCCUPATIONAL THERAPY

Treatment Session Plan

Client’s Name: N Supervising Therapist: Marilyn Schneider,

MOT, OTR/L
Student OT Practitioner(s): Kyle Johnson
OT/S
Date: Time Units: Safety Issues/Precautions: N/A
12/03/18 in/out:1600/1700 4
Clients Goals to Address in Session: (DDDM, Step 1, 6, & 8 -Identification of Participation
Challenges, Goals & Measures)
1 Within 6 months, N. will increase VMI as noted Proximal Measures GAS Scale
Date: 11/25/18 (Distal)
through independently forming 26/26 letters of the Letter formation: Date: 11/25/18
alphabet (capitals) with 80% form accuracy over 3 1) min- VC to stay in line with formation Letters: Z, X, Y
2) min VC to follow the curve of letters (-1) min- VC
consecutive testing periods. accuracy was
60%
2 Within 6 months, N. will increase VMI as noted Date: 11/05/18
Letter Sizing:
Date: 11/05/18
(-2) min VC for
through writing 26/26 letters of the alphabet 1) min VC to follow the path of the letters accurate sizing
for correct size in app of letters Q, S,
(capitals) with 80% accuracy for age appropriate 2) mod VC to write correct size of letters U, W, X, Y. Z
sizing, using min Vis Cues over 3 consecutive testing 60% accuracy of
letter sizing
periods.

3 Within 6 months, N. will increase self-regulation Date: 11/25/18

Identification of emotions:
Date: 11/25/18
(-1) improved in
skills as noted through independently identifying his 1) correctly identified emotions from identification of
examples 8/8 w/min VC emotions but
emotional state and at least one coping strategy to Placement of emotion in correct zone: still not
use in that state. 2) correctly placed correct emotion in accurate in
matching zone 7/8 w/max VC identifying them
3) Identified 1 coping strategy (breathing) in himself and
connecting
importance to
the zones
4 Within 6 months, N. will increase self-regulation as Date: 11/25/18
Attention and participation:
Date: 11/25/18
(-1) has
noted through participating in non-preferred and/or 1) (~10 min) writing app task, completed improved self-
half the letters for this session before regulation with
difficult tasks for a minimum of 10 minutes, with needing a break with min-mod VC to stay task. Stayed at
min VC for participation. on task table top for 10
2) Has previously stayed at task for 15 and min ZOR and 6
20 min with min VC to stay on task min
handwriting
Materials:
Clients Occupations to be treated include: (Check all that apply; DDDM, Step 7-Design
Intervention)
ADL’s/Self Care: (bathing, showering, toileting & hygiene, swallowing/eating, feeding, Personal device
care & managing personal belongings, personal organization, functional mobility, personal hygiene and
grooming)
X Instrumental ADLS & Graphic Communication: (Care of others, Care of pets, child rearing,
Communication management, driving & community mobility, financial management, health
management & maintenance, home establishment & management, meal prep & cleanup,
religious/spiritual activities & expression, safety & emergency maintenance/awareness, & shopping &
Handwriting, Keyboarding, Drawing, Coloring, Art, etc).
Rest & Sleep: (Rest, sleep preparation, sleep participation)
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Treatment Session Plan

Work: (Employment interests & pursuits, Employment seeking & acquisition, job performance,
retirement preparation and adjustment, volunteer exploration & participation).
X Play & Social Participation: (Social Awareness, Building/Maintaining Relationships, Turn-taking,
imaginative play, sharing materials, exploring new play ideas/opportunities, play exploration, social
participation in community, family and with peers)
Leisure: (Leisure exploration & participation)
Client Factors & Performance Skills/Patterns addressed: (Write goal number(s) that
this skill will be addressed in; DDDM Step 7-Design Intervention)
Motor/Muscle/Movement Sensory Skills Social Skills
Skills
Core 1 Manipulation Temperatur Pressure Engages/Approaches Others
Stability 2 e
Endurance 1 Coordination Hearing Taste Concludes/Transitions/Takes turns
2
1 Position/Alig 1 Motor 3 Vestibular Smell 3 Communicates (verbal/non-verbal)
2 ns 2 Planning 4 4
Joint Mobility 1 Reaching/gr Tactile Pain 3 Looks/Turns (Makes eye-contact)
2 asp 4
Joint Stability Reflexes Propriocepti Visual Emotional Expression
ve
Tone & 1 Controlled 3 Discriminati Modulati Physical behavior (regulates
Strength 2 Movement 4 on on movement, position, touch)

Other Other Other

Processing/Cognitive/Mental functions: Visual Perceptual/Visual Motor Skills
1 Attends Experience of self & Oculomotor Skills Object Perception
2 time
1 Memory 3 Emotional 1 Visual Attention 1 Eye-hand
2 4 regulation 2 2 Coordination
Sequences Tasks 3 Energy & drive 1 Visual Discrimination 1 Copying Shapes
4 2 2
Executive Functions Notices/responds to 1 Visual Motor Speed 1 Spatial Relations
cues 2 2
Chooses/Uses Pacing of activities 1 Visual Memory 1 Form Constancy
materials 2 2
Locates/Gathers Organizes Materials Depth Perception Visual Acuity
materials
Adjusts/Accommodate Navigates Visual Closure Sequential Memory
s Environment
Initiates/Continues/Ter Orientation to self, Figure Ground 1 Visual Closure
minates other, time & place 2
Tasks/Activities
Other Other
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Treatment Session Plan

Intervention: (Briefly describe planned intervention; DDDM, Step 7,9-Design and Conduct
Intervention)
Brief Description of Intervention (DDDM, 7-Design Intervention): Intervention involved using gross motor
sensory regulation breaks as needed. Intervention focused on the use of Zones of Regulation curriculum to
help client identify emotional state and coping strategies to change his state of emotion when dysregulated.
Additionally, that he will improve his ability to participate in non-preferred table top activity.

Identify Desired Outcomes (DDDM, 8-Identify Outcomes):

-Proximal Outcomes: Client will increase tolerance of participation in non-preferred task, improve ability
to cross midline during letter writing, write upper case and lower-case letter.
-Distal Outcomes: Use coping strategy for emotional regulation so as to participate appropriately in
school and home activities and chores. Write letters and improve handwriting for school lessons.

Identify How you will Measure Outcomes and Collect data on Intervention Outcomes: Measure
through number of VC, level of assist, number of regulation breaks, time to complete and time to transition to
next activity. Measure based on accuracy of form of letter that is legible and if letter is within margins for
sizing. Collect data and monitor progress with GAS goals.

Space Intervention Approach: Type: Practice Model: Goal(s)

Establish: Occupation Sensory Processing/sensory addresse
Description & Time preparatory integration, behavioral
attention and d:
task acquisition model
engagement (goal #) 3
activity &4
Gym Warm up: (5 Minutes) Activity Demands: Anticipated Activity
area -Name of activity: As chosen Important to child and is Outcome: Client will
by client Ball Pit, jumping on
tire, etc.
a gross motor activity. engage in gross motor ball to
provide needed
Other sensory regulation proprioceptive and vestibular
breaks as needed throughout input to increase attention
session. and focus during therapy.
-Ways to grade up: N/A
-Ways to grade down: N/A

Materials: items available for

N. to choose from
Seated Activity 1: (15-20 Minutes) Approach: Type: Practice Model: Goal(s)
with establish Occupati sensory address
curtains -Name of activity: Writing
open lower case letters g, h, I, j, k,
on and processing/sensory ed:
e preparat integration, development (goal #)
ory tasks of handwriting skills 1,2,4
Regulation breaks as needed.

-Ways to grade up: add
additional letters, extend the
length between breaks.
-Ways to grade down: Use
letter writing app prior to
letter writing Have child use
finger to trace, have lines
prepared to trace, use vis
cues on writing paper,
provide rewards after each
letter, provide breaks
Materials: pencil, lined raised
bottom border paper
Desk Activity 2: (15-20min)
and -Name of activity: Zones of
chair, Regulation with videos
side - Match emotions of others to
room with levels of energy and
zone. Match coping
OCCUPATIONAL THERAPY
Treatment Session Plan
Activity Demands Anticipated Activity
(OTPF table 7) Outcome: Improvement in
Relevance to Client:
core stability while writing.
important to mother and
skills needed for school
Improved ability to cross
Objects: markers, laminated midline during using pencil to
baseball diamond write letters. Increase
Required Actions: place dice participation and attention in
in hands, roll dice onto table,
non-preferred VMI task,
process score based on
number on the dice, plan increased accuracy in lower
movement of runner from case letter form and sizing
base to base, correctly draw
running path of the player
Required Body functions:
Core strength to stabilize
body, ND hand strength and
awareness to stabilize paper,
D hand strength and mobility
to grip pencil apply pressure
and write, cognitive function
and visual motor planning
needed to copy letters and
follow rules of the game and
interpret results of dice and
relate back to game.
Approach: Type: Practice Model: Goal(s)
Establish Occupati behavioral acquisition address
model, 4 quadrant
on and ed:
model, PEO
preparat (goal#)3,4
ory tasks

strategies to do with each
zone. Identify characters
emotions and support
characters reaction to
different emotions. Discuss
how the main characters can
regulate emotions and get to
the green zone. What
strategy can they use? How
does that make the other
character feel? Tie it back to
N. What can you do when
you are frustrated? What can
you do to get to the green
zone? Ask reflective
questions and provide cueing
as need for answers
-Ways to grade down: provide
visible cues to identify
emotions, provide additional
cuing for placement into
zones.
-Ways to grade up take away
pictures and visual cues,
have him come up with
alternate coping strategies
Materials: videos, zone chart,
emotion pictures, coping tool
pictures.
Gym Wrap up/Cool Down: (5
area minutes)
-Name of activity: self-
selected gross motor activity
-Ways to grade up:
-Ways to grade down:
Materials: as chosen by child
what is available in the room
Home Program/Homework (DDDM, 11): Practice zones, feelings, and coping strategies,
identifying when he is in the zone and what he can do in that state. Use questioning and
cueing to identify what he feels after he does the coping strategy, etc. Use questions to
OCCUPATIONAL THERAPY
Treatment Session Plan
Activity Demands Anticipated Activity
(OTPF table 7) Outcome: Improvement of
Relevance to Client:
identification of emotions
important to mother and
ability to self-regulate and
with energy levels and
identify feelings and coping strategies.
emotions Internalization if emotions
Objects: video, emotion and coping strategies
pictures, zone chart, coping
Increased tolerance of table
tools pictures,
Required Actions: staying top activity and response to
regulated during activity, adult directed task.
identifying emotions, Identification of emotions in
connecting emotion to zone others
of regulation and energy
level, identification of coping
strategy.
Required Body functions:
Core strength to stabilization
of body, cognitive function
and visual motor planning
identify emotion and then
state correct emotion with
energy and coping strategy,
listening and attending to
cues when emotion is called
out.
Approach: Type: Practice Model: Goal(s)
Establish, establish sensory address
restore: processing/sensor ed:
emotional
y integration, (goal #)
regulation and 1,2
preparation for
transition to
going home
Activity Demands Anticipated Activity
(OTPF table 7) Outcome: improvement in
Cognitive awareness of transition to going home and
choice and regulation of
emotions, gross motor skills
self-regulation.
as need for activity
Relevance to client:
Important to him and
participation in difficult
activities.
 OCCUPATIONAL THERAPY
Treatment Session Plan

guide. With each zone discussed ask how others might feel and behave in response to that
emotion. Use video of when he is in compromised emotional state and then review when he
is regulated. Practice writing letters and teaching younger brother to write letter e. Use of
emotion tool cards to identify emotions and zones at home while he is in the zone. Practice
and use bunny breathing.

Student Therapist Signature: Date:

Supervising Therapist Signature: Date: