Case Study 4: Schizophrenia and Intellectual Disability

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OTA 115 Principles of OT in Mental Health
Case Study: Training in Use of Interventions and Therapeutic Use of Self
Purpose: Provide training in use of interventions, therapeutic use of self, and
ways to vary use of group and other activities as well as the environment to
address psychosocial needs of clients relevant to occupations of daily living
including but not limited to self-care, self-management, health management,
home management, community re-entry, and school or work integration.
Summary of Assignment: This assignment has two parts. 1) Review the assigned
case study from Appendix A of MHC&T by Early 5th Edition, formulate three
additional interventions, provide three supporting scholarly resources, and
develop and write about your client’s treatment plan and interventions. 2)
Provide a short training video that demonstrates the use of your three
interventions.
NOTE: Interventions are the activities or occupations you will use strategically to
help your client achieve established goals. Your interventions should be relevant
to one or more specific areas of occupation categorized and described within the
OTPF-3. E.g., ADLS, IADLs, etc. such as self-care training, self-management and
maintenance, home management, and/or community and work (or school)
integration strategies and interventions you select and document in your APA
paper.
Assignment Objectives (You will accomplish these by the time you complete the
assignment): The following Course Objectives will be addressed by the student:
1) Employ logical, critical analysis, problem solving, and creativity.
2) Analyze task relative to areas of occupation, performance skills,
performance patterns, activity demands, context (s), and client factors to
implement the intervention plan.
3) Use sound judgement in regard to treatment plan choices, safety of self
and others, and adhere to safety regulations throughout the occupational
process.
4) Document treatment plan and OT services in a manner that reflects
applicable regulatory standards and communicates the need and rationale
for occupational therapy services.
Revised 032718_BAP
OTA 115 Principles of OT in Mental Health
Case Study: Training in Use of Interventions and Therapeutic Use of Self
5) Select and provide appropriate occupational therapy interventions and
procedures to enhance safety, wellness, and performance in activities of
daily living (ADL), instrumental activities of daily living (IADL), education,
work, play, leisure, and social participation.
6) Participate in occupational performance and evidence based intervention
planning and implementation, considering the occupational profile, client
factors, performance patterns, contexts, activity demands, performance
skills, and aspects of diversity.
7) Grade and adapt the environment, tools, materials, occupations, and
interventions to reflect the changing needs of the client and the
sociocultural context.
8) Provide therapeutic use of occupation, exercise and activities.
9) Provide training in self-care, self- management, home management, and
community and work integration.
10)
Provide development, remediation, and compensation for physical,
cognitive, perceptual, sensory, neuromuscular, and behavioral skills.
11)
Adapt and modify environment and adapt process to facilitate
occupational performance.
12)
Assess and recommend home and community programming that will
support occupational performance.
13) Demonstrate the ability to problem solve with the OT to determine
effective therapeutic interventions.
14) Make recommendations for referral to internal and external specialist as
needed for complete comprehensive consultation and intervention.
15) Provide proof of collaboration with an OT to make recommendations for
modified interventions, continuation or discontinuation of services, case
management and transition services or discharge planning.
16) Make recommendations for discharge planning based on needs for
resources, environmental adaptations, home programs and other referrals
Revised 032718_BAP
OTA 115 Principles of OT in Mental Health
Case Study: Training in Use of Interventions and Therapeutic Use of Self
Student Instructions for this Assignment 1. Based on the Case study you were assigned from Appendix A pp. 601-619, by the
time you finish this assignment, you will achieve the course objectives listed above.
2. Create a paper that is typed in the APA format, with a cover sheet and all references
cited, and include the following:
A) A narrative Introduction to your Case Study
B) List the personal data of the Client according to the Case Study and
occupational profile: Include medical history, occupational history, education,
work history (if any), leisure habits, self-care habits, social relationships,
cultural background, support system, etc. If information is missing in the case
study in the text, use your imagination and fill in the missing parts so that the
occupational profile is complete.
C) Review Client’s treatment plan as recorded in case study.
D) Develop Client’s treatment plan further than is recorded in the case study.
Use your imagination and critical reasoning and design three additional
interventions for your client and your rationale for each.
E) Describe your role (as an OTA) in the evaluation process.
F) Describe your observation of the Client’s occupational deficits, and related
underlying impairments.
G) Describe how you would work in collaboration with your supervising OT using
clinical reasoning in selecting evaluation tools and interventions during the
initial evaluation for the client.
H) Describe how you in collaboration with your supervising OT would select and
write treatment goals for the client.
I) What other referrals might the client benefit from? Why? Support your
answer.
J) Describe the additional treatment methods and interventions you would use
with the client. Why? Support your answer.
K) What occupational therapy interventions and procedures would you use to
provide training to the client and his or her family in self-care, selfmanagement, health management and maintenance, home management,
community and work or school integration, or any other area of occupation
not listed but you deem important?
Revised 032718_BAP
OTA 115 Principles of OT in Mental Health
Case Study: Training in Use of Interventions and Therapeutic Use of Self
L) What methods would you use to enhance the client’s safety, wellness, and
performance in activities of daily living (ADL), instrumental activities of daily
living (IADL), education, work, play, leisure, and social participation?
M) Describe how you would engage the client and his or her family in
occupational performance and evidence based intervention planning and
implementation, considering the client’s occupational profile, client factors,
performance patterns, contexts, activity demands, performance skills, and
aspects of diversity.
N) Describe how you would provide therapeutic use of occupation, exercise and
activities as part of the client’s intervention.
O) Explain how you would provide training in self-care, self- management, home
management, and community and work or school integration for the client.
P) Provide development, remediation, and compensation for the client’s
physical, cognitive, perceptual, sensory, neuromuscular, and behavioral skills.
Q) Describe how you would modify the client’s environment and adapt processes
to facilitate his occupational performance.
R) Assess and recommend home and community programming that will support
the client’s occupational performance.
S) Describe when you in collaboration with your supervising OT may reevaluate,
or have the treatment plan revised.
T) Describe how you would collaborate with your supervising OT for discharge
planning. What type of self-care training and/or management referrals
would benefit the client and his family to make discharge transition smooth?
Why? Support your answer.
U) Answer the questions at the end of your assigned Case Study in Appendix A of
the MHC&T text.
V) Use textbooks, scholarly journals and other credible sources to help you
answer the questions, and remember to cite your sources using APA format.
W) Include a Summary of your Case Study, Interventions, and supporting sources.
X) Submit online in Blackboard by due date and time.
Y) Late submissions will not be accepted for this assignment.
Revised 032718_BAP
OTA 115 Principles of OT in Mental Health
Case Study & Professional Literature EBP Decision Making Grading Rubric
Grading Rubric Explained:
Your paper will be graded according to the standards represented on the rubric below.
• There are ten categories that are each worth a maximum of 15 points each.
• The Video of your interventions is worth 50 points maximum
• There are 200 points total possible for this assignment.
• No extra credit is available for this assignment.
• Write the points you would give yourself according the category rubric in the
“Student Checklist” column.
• Turn the rubric in with your written paper, and the instructor will add comments to
the “Instructor’s Comments” section.
Name: _____________________________ Date: __________
Category
Rating for 15
points in
category 1-10
1. Is the case study The case study
and interventions
and supporting
are presented in an articles are
original and
presented in a
engaging manner
typical way and
that explains why
the case study or
the goals and
supporting
interventions of
articles are
the case study are
discussed in a
supported by the
somewhat vague
EBP articles and
way that causes
warrant the
interest to
interest of reader
occasionally
and how the case
wane. EBP
study and
articles seem
supporting articles somewhat
relate to the
relevant and
interventions
connected to the
chosen and course case study or
content; and are
course content
stated clearly in the and are stated in
introduction to the introduction to
paper?
paper
2. Are there clearly There are clearly
stated client goals
stated goals and
and are
are all
interventions
interventions are
presented in a way related to the
Rating for 12.75
points in category 110
The case study and
supporting articles
are presented in a
weak way that
causes the reader to
occasionally have
difficulty following
the content. EBP
articles are loosely
relevant and poorly
connected to the
case study or course
content and are not
stated in the
introduction to
paper. Case Study
and supporting
articles are explained
but relationship to
course content is
stated, but weak.
Rating for 11.5
points in
category 1-10
The case study
and interventions
as well as
supporting EBP
articles are
presented with a
lack of critical
reasoning, and
without linking
them clearly to
one another or
the course
content.
There are stated
goals and
interventions, but
they are not clearly
stated or related to
There are goals
and interventions
stated, but they
are markedly
unclear or have
Student
checklist
Instructor
comments
OTA 115 Principles of OT in Mental Health
Case Study & Professional Literature EBP Decision Making Grading Rubric
Category
Rating for 15
points in
category 1-10
case study and
course content.
Rating for 12.75
points in category 110
course content.
3. Are the EBP
articles reviewed
from a peerreviewed journal?
Yes for all
articles.
No for one article
Yes for two
4. Does the
summary
accurately capture
the meaning and
intent of the case
study, the
interventions, and
the articles
reviewed?
Information is
summarized
without changing
the meaning or
understanding of
the case study’s
mental disorders
and
recommended
interventions;
articles and
referred to in a
clear manner
that is consistent
with information
in the
introduction and
interventions;
summary “flows”
logically.
Information is
accurate; however,
reader must return
to the original case
study, introduction,
or articles twice after
reading to clarify the
summary; relevant
information is
omitted; sequence is
difficult to follow
logically.
5. Does the
summarizing
paragraph explain
how the selected
articles help
answer the case
study questions?
Explanations are
clear and
logically answer
the case study
questions. The
relationships of
selected articles
to the case study
questions are
clear.
Explanations are
related to the case
study questions, but
relationships are not
logically explained on
a consistent basis.
that is related to
the case study and
course content?
Rating for 11.5
points in
category 1-10
important
content related
to the course or
case study
missing.
No for two or
more articles
Information from
the case study or
articles is
inaccurately
represented in 1
or more places;
the reader must
refer back to the
article more than
twice after the
original reading
to clarify
information;
several pieces of
relevant
information are
omitted;
sequence is
poorly organized
and illogically
presented.
Explanations are
unrelated or
loosely related to
one or more of
the question,
illogical, or
absent.
Student
checklist
Instructor
comments
OTA 115 Principles of OT in Mental Health
Case Study & Professional Literature EBP Decision Making Grading Rubric
6. Are Research
Citations are in
APA format?
Articles are
correctly cited in
APA format in
reference list and
in-text. May have
one error.
7. Paper follows All areas as stated
assignment
in the “Assignment
guidelines?
Guidelines” section
of the assignment
are followed.
8. Paper
Paper is
Presentation
significantly less
Length – not
than 2 pages in
counting Cover length or
Sheet or
significantly more
Reference List? than 3 pages in
length. Paper
meets guidelines as
stated in the OTA
Student Handbook.
9. Does the final Final paragraph
paragraph
describes in detail
summarize how how the article
the articles
answers the
answered the
questions.
clinical
Reasoning is clear
questions posed and the relationship
at the end of
between the
the case study? questions and
articles’ content is
clearly stated.
10. Are there
Error free or no
spelling,
more than one
grammar,
error.
punctuation, or
capitalization
errors?
Quality
Original with
Interventions’
accurate and
Video
creative content
Submitted?
submitted. 50 pts
TOTAL
Article is cited intext and in
reference list in APA
format with no
more than 2 errors.
Not cited in APA format,
or if attempted, multiple
mistakes
One area as stated
in the “Assignment
Guidelines” section
of the assignment is
not followed.
One area of
assignment
instructions not
followed as
directed.
More than one area as
stated in the
“Assignment Guidelines”
section of the assignment
is not followed.
Two or more areas of
assignment instructions
are not followed as
directed.
The final paragraph
addresses how the
articles answer the
questions; however,
reasoning and the
relationship to the
questions is unclear.
The final paragraph
addresses how the
articles answer the
questions; however,
reasoning and the
relationship to the
questions is not stated.
Two to three errors
in one or more
categories.
Several errors in one or
more categories
Video submitted;
original but lacks
creativity, or has
one error. 42.5 pts
Video submitted but
lacks originality,
creativity, and has
multiple errors. 38.5 pts
Case 4: A 22-Year-Old Man with Schizophrenia and Intellectual Disability
This 22-year-old Hispanic man with a diagnosis of schizophrenia (295.90) and mild
intellectual disability was referred to a community day treatment center in a large East Coast
city. The referral originated at another mental health clinic in a different part of the city. He had
been attending that clinic for medication, and the staff there believed he could benefit from a
structured day program and family therapy.
Mr. Velasquez was born in Columbia, South America. His parents were teenagers when
he was born and have subsequently divorced (the father is reported to have been a drug addict
and alcoholic). The client, who has four younger sisters and a younger brother, lived with his
maternal grandparents in Columbia while his mother emigrated to the United States when he was
10. The rest of the family emigrated 6 years ago. Immediately after the move, the client became
ill but was never hospitalized. He was followed at an outpatient clinic and stabilized on
haloperidol (Haldol) and benztropine (Cogentin). Mr. Velasquez dropped out of school at age
16, without completing his high school education.
On admission, the social worker obtained the following information from the family.
The mother is employed in a factory job. Mr. Velasquez, who speaks no English, stays home
and masturbated all day. He sees no one but family members and has not been able to care for
his own hygiene. His 14-year-old sister has been washing and dressing him. He appears to be
hallucinating, says he is in the space shuttle, and has frequent loud outbursts of inappropriate
laughter. Mr. Velasquez was also seen by a psychiatrist, who changed his medication to
Risperdal.
The occupational therapy evaluation was performed 3 days later by an occupational
therapy student under the supervision of the therapist. Evaluation instrument used were the
Occupational Role History Interview and the Allen Cognitive Level Screening test. Result were
as follows.
Interview
Mr. Velasquez appeared for the interview neatly dressed but with the back of his hair
uncombed and his pants unzipped. He closed the zipper at the student’s reminder to do so.
Occupational Role History Interview
In the Occupational Role History Interview, Mr. Velasquez often gave tangential and
irrelevant replies to questions asked by the student. He spoke of violent events, such as being
beaten by a man with a club in school and having been accused by a classmate of killing her
grandmother. When asked about school, he stated that he was food at drawing but bad at biology
and physics. Mr. Velasquez said emphatically that he had no friends and could think of no one
whom he had looked up to in the past as a role model.
Mr. Velasquez attended school in Columbia but had no further schooling since his family
moved to this country when he was 16. He has never had a job. He has very limited
understanding of English; the interview was conducted in Spanish.
Allen Cognitive Level Screening Test
In the Allen Cognitive Level Screening test, the client was able to complete two
running stitches and then two whip stitches. He was unable to complete the single cordovan
stich, and he recognized that he had made errors but did not attempt to correct them. The student
repeated the instructions (the client did not request this), and Mr. Velasquez was not able to
complete the stitch on his second attempt. This performance was scored at cognitive level 4.

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