Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Jennifer Unck
Touro Universtiy of Nevada

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile
The Client
Client is a 46 year old male who has always lived with his parents. They live in a two story
home in Summerlin, Nevada. Client lives on lower level and has access to a bathroom. Clients
mother is the primary caregiver. Clients father still works on week days. Client has one brother
and two nieces. Client was diagnosed with intellectual disability at a young but was high
functioning. At age 42 the client acquired sinusitis and received brain surgery which left him
functioning at a lower level and left him with hemiparesis of the right side. Client has been in
and out of the hospital for minor health issues since then, but has made small gains with his right
side. Client comes to the community program at Opportunity Village twice a week with the
assistance of his caregiver. Client speaks mostly with gestures and minimal words.
The Clients Current Concerns
The client and caregiver have many concerns when it comes to the clients occupations. Many
of the occupations that the client used to do he can no longer perform. The client and caregiver
are seeking services to reintegrate the client back into occupations that are meaningful to him.
The caregiver is concerned with his assistance level with activities of daily living (ADL),
functional transfers, and inappropriate behaviors. The caregiver is concerned that the clients
hemiparesis may be interfering with his independence and his engagement in occupations. The
caregiver finds it concerning that the client is not mobile enough to get himself to the bathroom
in the night when she is still asleep. The caregiver is concerned that he is becoming too
dependent on her to do simple tasks that he can already do. The client gets frustrated and will act
out when he does not get to the rest room in time. The caregiver is concerned that her and her
husband are getting older and wont be able to take care of the client due to their old age. Client

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occasionally does inappropriate behaviors like putting hands down his pants and yelling curse
words. Caregiver says client gets concerned when his daily routine goes too far off course. He
becomes agitated and confused and wants to get back to his normal routine.
Clients Success and Barrier Affecting Clients Success
Client is successful in coming to the program twice a week with his caregiver and
caregiver states that client enjoys it because he gets to socialize with friends and engage in
activities that are significant to him. As part of the clients routine, he is successful in putting
together 12 piece puzzles every Monday. On Thursdays he participates in a bowling activity that
is held at a bowling alley in the community. These activities are meaningful to him and bring
him fulfillment. Client is able to socialize with his peers using gestures and some words. The
client exhibiting inappropriate behaviors occasionally impacting his success with relationships.
The caregiver states that the client does need assistance with functional transfers, but once on his
feet he can swerve over to the chair or toilet with less assistance which she sees as a success.
Caregiver states that decrease range of motion (ROM) and hemiparesis limit use of his
right upper extremity (UE) and right lower extremity (LE) are barriers to engaging in
occupations and limits his ability in ADL, IADL, play, and leisure. Client is right hand dominant
but has learned to uses his left hand for most occupations. The caregiver believes that his
inappropriate behaviors have an adverse effect on his success in social skills and feels that he
need to learn to control his behaviors. The caregiver says that his limited mobility is a barrier to
helping him to be more independent in the bathroom and with dressing. The caregiver would like
for him to be independent going to the bathroom alone.

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What Environment/Context Supports or Inhibits Clients Participation

Because the client live at home he has support from his parents at all times. The clients
room is on the lower level of his house with a bathroom close by. This aspect of his physical
environment supports him and his physical limitations, although he still needs assistance with
ADL and functional transfers. The caregivers room is upstairs which could inhibit the clients
participation when he wants to get up but has to wait for his mother. When the client comes to
the community program, he is able to participate in occupations he enjoys and he is supported by
the physical environment in having the building to come to, tables, puzzles and an open room to
move around. On Thursdays he gets to go out into the community to bowl and this supports his
interests and participation. Aspect of the social environment include having friends and staff at
the program to support his needs and wants. Due to the how many participants that are in the
program it can also inhibit participation because it is not one on one with the staff and
individuals.
Clients Occupational History
The clients has had many opportunities throughout his life. When the client was born
they were unsure what his specific diagnosis was. They first thought that it was Cerebral Palsy
(CP) but then quickly ruled it out. They referred him to occupational therapy as a baby because
he was not hitting the developmental milestones. While going to the occupational therapist the
client progressed to where he needed to be with gross motor skills. After a few years the
caregiver realized there was something off with his cognition. They then tentatively diagnosis
him with intellectual disability and the caregiver was never positive if that was what was wrong.
Client has always lived with his parent and was independent in most ADL. He was able
to communicate and socialize with his peers. The client could walk, run and play like most

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others. He went to a school the specialized with children with special needs where he learned to
read and write. The client went to a specialized high school that had a work center for the student
to increase their vocational skills. There the client was able to work at a bowling alley close by,
learn how to fold clothes, further his knowledge in computer classes, and learn other functional
skills needed in the community as well as home. During high school the client joined a
recreational league program where he was able to play sports like, baseball, basketball, and
bowling. It was through this program that the client participated in the Special Olympics. The
client received a silver medal for bowling. The client continued to participate in these programs
until he got older.
When the client was relocated to Las Vegas the caregiver did not find many programs
like she had before. She did find opportunity village, and she took him there so he could
socialize and find meaningful activities for him. The Enables program is a part of opportunity
village that focuses on community skills. The client has been in the program for over 15 years
now. Four years ago the client contracted sinusitis and had his brain operated on. He lost many
occupations that were important to him as well as higher level cognition and behavioral skills.
The caregiver thought it was important to keep bringing the client to progress with his cognition.
The clients cognitive skills have improved since the surgery but he has experienced gallstones
and had had minor surgeries for that. The history of the client is profound but because he
developed himself he learned what he liked to do and what he wanted to do.
Clients Values and Interests
The client values going to the Enables program every week. Caregiver explains the client
will get frustrated if they are unable to go. Family is also important to the client and is evident
when observing his behavior as we talked about his brother and nieces. The client values his

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friends that he has met in the program this is exhibited by him being able to say some of their
names. By observation the client values the role that his mother plays and likes her to be around
him. The caregiver values family and is evident in how she takes care of the client and how she
talks about the family.
Due to the intriguing history of the client, he has been able to develop many interests.
The client likes puzzles that he puts together with help when he comes to the program. The client
is interested in his friends and is very social. He enjoys watching airplanes and trains because he
and his family used to live by an airport when he was younger. Being around his nieces is very
important to him and he expresses that by laughing and smiling when they play. The client likes
music and his favorites are songs from Grease and Pitch Perfect. The client liked to play sports
prior to brain surgery. The client likes watching sports like hockey, basketball, and football but
especially hockey because he likes watching the fights. The most important interest he has is
bowling, this sport has been with him throughout his life and he still continues to play every
Thursday in the program with his friends. These interests and values make up who the client is
and what is meaningful to him.
Clients Daily Life Roles
The client has many daily roles that he takes on that can contribute to what is meaningful
to him. Some of the clients role include being a son, uncle, brother, and friend. The main role
the client plays is son. Due to always living with his parents the client has always been able to
rely on them for support. The caregiver expresses that her and her husband have a meaningful
relationship with their son. Being an uncle is important to the client and the caregiver says he
lights up when his nieces are over. By being an uncle and son this gives the client significance.to
his life.

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The caregiver states one specific role the client has is to get everyone up in the morning.
Since the client always gets up earlier than her and her husband he rings a bell for them,
signaling is time to get up. The caregiver feels that the client feel like he is being helpful and that
is meaningful to him. Another role the caregiver states is when they watch television the client
holds the remote control and with some assistance will change channels if needed. The caregiver
states that this helps him feel important and like he is contributing. These specific roles are small
but the caregiver feels that he enjoys doing them it makes him feel useful.
Clients Patterns of Engagement in Occupations over Time
Throughout the clients life he has had many patterns and routines that have driven his
engagement in occupations and activities. The caregiver exclaims that when he was in
elementary school he developed patterns to get ready for school and go to certain classroom. He
was able to engage in classes and recess with other children with special needs. The client did
not have many physical impairments when he was younger, therefore he could engage in more
activities and have more roles within the classroom and with other students. Some patterns
changed as he went to high school where he got himself ready for school and then at school the
focus was more on learning new skills to help him engage in the community. He engaged in
developed vocational skills and participating in recreational activities. Although the client still
needed some assistance he engaged in as many activities that he could. As he has gotten older his
patterns have shifted into being less independent and more about doing the things he likes to do.
His caregiver says that his routines have been come important to him and he does not like when
they change. The client is unable to get himself ready and dressed in the mornings A typical day
includes waking up eating breakfast, going to the program for a few hours and eating lunch,
coming home and talking a walk, going to the grocery store, watching his mother cook dinner

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and then watching television. Over time the client has become less active but him and his mother
still find ways to engage in meaningful occupations.
Clients Priorities and Desired Outcomes
The client is unable to express his desired outcomes but his mother stated that using his
right hand in occupations, decreasing inappropriate behaviors, and increasing functional mobility
and functional transfers are the outcomes she would like to see improvement in. The caregiver
expressed that she desires to have the client be more independence with leisure participation to
increase his strengthen in his right UE. Caregiver would like to see the client participate in
puzzles and bowl independently because this was very important to him prior to impairments of
right UE. In doing this he could have better occupational performance and improvement in
independence.
The caregiver would like to decrease the amount on outbursts and inappropriate touching of
himself so that he will have better social interaction skills and proper manners when meeting and
engaging with people. By modifying his emotional regulation and maintaining appropriate social
skills he can have better occupational performance with his peers and family. In functional
mobility, working on wheeling himself into the bathroom and transferring onto the toilet is the
desire that the caregiver prioritized. She believes that this would be beneficial for her as well as
the client so he can have independence and she does not have to continue to do most the work as
she gets older. This could help the client to have a better quality of life and more self-reliance in
ADL. This will also allow him to have role competency in effectively meet the demands of roles
in which the client participates in.
By addressing these desired outcomes the client will have better health and actively engage
in making choices to improve wellness. By becoming more independent in these aspects the

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clients quality of life will be better and his participation in these activities will automatically
increase because they are important to him and his caregiver. This can increase his sense of
belonging and increase occupational performance.
Occupational Analysis
Context/Setting of Occupational Therapy Services
The client participates in a community program for adults with intellectual disabilities.
The client comes on Mondays and Thursdays for a few hours. Within this setting there are three
medium sized rooms where tables are set up for individuals. Each individual has a certain place
and staff that work with them. The client sits at a table with one other individual but is close to
another table with three individuals as well. The client participates in activities at this table as
well as in the cafeteria were he eats lunch. The cafeteria has long tables and benches like
elementary school. Since the client is in a wheelchair he sits at the end of the long tables. These
two areas are where the client and caregiver spend their time when they come to the program.
Description of Activity Observed and Clients Occupational Performance
The activity being observed was eating lunch in the cafeteria with the caregiver. The
caregiver takes the client to the cafeteria earlier than normal lunch time because she does not
have a seat otherwise. The client was eating a tuna fish sandwich with a Twinkie and Gatorade.
The client was able to feed himself but had some hand over hand (HOH) assistance and a few
bites where the caregiver fed him. The client used his left hand mostly and when the caregiver
asked him to use his right hand he did it with more difficulty.
Key Observations from Clients Performance
Through observation of this occupation, it was evident that the client has some learned
helplessness. The caregiver would help the client when he was not feeding himself quickly. This

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may have been due to the time constraint or that it is easily for her. The caregiver setup his meal,
undoing the wrappers and lid. The client ate with his left hand unless cued to use his right hand.
Although the client was able to complete this occupation with assistance, he did not have any
social interaction while eating besides his mother. When the client was finished he started
displaying inappropriate behaviors like pulling up on his shirt and reaching down his pants. The
caregiver stated that she thought he needed to go to the restroom. Throughout this activity, it
took extra time and constant assistance and cueing from the caregiver. A key observation noted
was the height of the tables in the cafeteria. The client has long legs so it was difficult for him to
fit them under the table, this environmental aspect could be impacting his performance in eating.
Clients Diagnosis and the OTPF Domains
Due to the clients intellectual disability he will always need 24 hour care, but he would
benefit from occupational therapy services to increase his independence in the occupations that
are meaningful to him. The clients higher level cognition such as judgement, executive
functions and sequencing are significant when it comes to making engaging in occupations.
Attention skills hinder his ability to perform occupations and complex tasks. Deficits in impulse
control, agreeableness, and self-control negatively affect meaningful occupations that deal with
social interaction. It is difficult to engage and communicate in social settings because of the lack
of production of speech due to the clients disability. Due to the clients physical limitations his
joint mobility and joint stability are hindering his engagement to use his right UE in many
occupations. His functional mobility and transfers are also compromised because of the joint
stability, muscles power, and muscle endurance. The occupations that these deficits impact the
most include: all ADL, communication management, home management, health management,

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safety and emergency maintenance, play exploration, leisure participation, and social
participation.
Problem List
1. Client requires Mod A to complete leisure activities due to hemiparesis of right UE.

This is the most important because the caregiver states that the client gets frustrated
when he cant perform occupations due to his right side weakness. The caregiver
finds it important because not using his right side is effecting many ADL and limiting
his independence.

2. Client requires Max VC to decrease inappropriate behavior due to impaired cognitive

functioning.

This is important because the client participates in social interaction daily with many
different people and it is important to the caregiver that the client is socially
appropriate with others to maintain relationships and have good manners in the
community.

3. Client is dependent in functional mobility due to hemiparesis and impaired executive

functioning.

Due to the hemiparesis the client does not walk or wheel his chair. This was selected
because the caregiver expressed that it is important to her to have him be more
independent in getting around so the client can be more self-reliant.

4. Client requires Max A in toilet transfers due to right side hemiparesis.

Because the caregiver is getting older it is important to her that the client be
independent in transfer because she will not always be there to help him. This was
selected because the caregiver mentioned it is important to her and her health.

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5. Client requires Mod A in feeding due to impaired right UE and impaired cognitive
functioning.

The caregiver expressed that feeding independently would be helpful and would
increase the use of his right hand. She believes that this is an important occupations to
do independently.

Justification for Order of Problem Lists

It is necessary to prioritize the hemiparesis of the right side because it is important to the
client and the caregiver to be more independent. This is something that is appropriate for this
setting and can be worked on while the client is at the program. The next problem is significant
to the client because he loves to be social and interact with others. The caregiver thinks it is
imperative to be appropriate to continue to have friendships and have social interactions within
the community. This can be worked on specifically within the program because of the social
interactions there. Functional mobility is the next on the list because the client is dependent on
his caregiver to get him around in the home and community. The caregiver is getting older and
exclaimed she does not want the client to be dependent on her especially because of her age and
physical health. Functional transfers are important as well to the health of the caregiver and
dependence level of the client. It is important to the caregiver that the client learn to be more
functional with toilet transfers so the client can go when he needs to without the help from her.
This can decrease accidents and increase independence. This is lower on the list because it is
more beneficial to help the client with functional mobility first. The last problem was put last
because the other problems mentions were more important to the caregiver and client.

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Intervention Plan and Outcomes

Long Term Goals 1
Client will complete a leisure occupation c Mod I c RUE at the community program
within 4 wks.
Short Term Goals 1a. Client will complete a 30 piece puzzle c Min A c R hand at the
community program within 1 wk.
Intervention. The client will participate in putting a puzzle together using his right UE.
Assistance and verbal cues will be given as needed to place the puzzle pieces into the puzzle.
Encouragement to perform the activity independently will be given if needed as well. Education
will be given to the caregiver on the importance of letting him try on his own before doing it for
him. The client will be given as much time as he needs to complete the activity. If the client
becomes frustrated then giving him a break would be beneficial. It would be important to look at
the clients nonverbal expressions and gestures during the activity to be cognizant of frustration.
Creating the just right challenge for the client will be significant during this activity so the client
does not get overly agitated.
Grading up. This intervention can be graded up by adding environmental distractions.
The client likes music so adding music while trying to complete the puzzle will be more
challenging for him. This will test his attention to task during the activity. Having more puzzle
piece would increase the difficulty of the activity as well. The pieces would be smaller so they
would be harder to grasp and put into place.
Grading down. To grade the activity down, the client can put one puzzle piece in and
then the therapist can put one puzzle piece in. Then gradually increasing the number of puzzle
pieces the client is putting in with his right UE as progress is made. Another way to grade down

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this intervention would be to increase the size of the puzzle pieces making them easier to grasp
and place.
Approach. This intervention would be considered an establish/restore approach due to
trying to restore skills and abilities that have been impaired with the clients right UE. The client
is relearning how to incorporate his right UE into leisure occupations. Many of the clients
leisure occupations have been lost due to the brain surgery that took place leaving him with
impairment so it is imperative to remediate these to get back to the things that are meaningful to
him.
Evidence. Research has shown that participation in meaningful occupations, especially
leisure occupations, has an important and positive influence on health and wellbeing (Law,
2012). In the Occupational Therapy Practice Framework (OTPF) it addresses occupational
therapys overarching goal to achieve health, well-being and participation by actively engaging
in occupations. Leisure participation is describes as planning and participating in activities,
balancing activities with other occupations, and attaining and maintaining appropriate supplies
(American Occupational Therapy Association.[AOTA], 2014).
Outcome. The desired outcomes of this intervention is to increase the quality of life,
health and well-being. By engaging in this meaningful occupations this can increase the clients
life satisfaction. Another outcome would be to improve performance in completing puzzles
because it is meaningful to the client. By engaging in desired occupations it can promote
motivation and increase occupational performance as well.
Short Term Goal 1b. Client will bowl c S c RUE at the community program within 2
wks.

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Intervention. The client likes to bowl but this intervention will take place in the gym playing a
game with peers to throwing a big and small balls to others to increase the clients strength,
ROM, and endurance to participate independently in bowling. This will focus on ROM of right
UE and increasing gross motor skills. This intervention will be an occupation as a means to help
with the underlying cause of why the client is unable to bowl independently. The client bowls
with assistance now but lacks the strength to hold the ball and swing. By having an intervention
that focuses on ROM of the right UE and throwing the different weighted balls the client will use
the muscles and joints that would be working while bowling. This will facilitate the same
movements and promote use in the right UE.
Approach. The approach used is establish/restore due to the fact that the client wants to
gain back the prior functions that he once had. Bowling was a big part of the individuals life and
continues to be an occupation that is meaningful to him. By restoring the abilities and
movements that are performed during bowling the client can perform in other gross motor leisure
activities that he finds interesting as well. This intervention aims to restore muscle power and
joint endurance to participate in bowling and other desired leisure occupations. The caregiver
and client would like to restore these abilities to be able to achieve desired outcomes and goals.
Evidence. There has been evidence to suggest that using occupations as a mean can be
beneficial when working with a client. According to Gray (1998), using occupation as a means
can help guide treatment planning. It is also necessary to enhance underlying components that
may interfere with occupation but that are not the specific occupation. When looking at an
intervention as a means, the occupation should pertain to the clients sense of self, personally
meaningful, culturally relevant, and goal-directed. By using similar components of bowling the

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client that are meaningful and relevant the client will benefit from this intervention approach and
increase occupational performance in leisure participation.
Outcome. Some outcome desires according to the OTPF would be improving
occupational performance, participation, and quality of life (AOTA, 2014). Improving
independence in gross motor activities will improve occupational performance in bowling as
well. By engaging in this gross motor activity, the same techniques can be transferred over when
bowling. Participation would be other desired because engagement in meaningful occupation is
satisfying to the client. Quality of life would be desired so the client has life satisfaction with the
leisure activities he is performing, this can bring him hope and a good self-concept about
himself.
Long Term Goal 2
Client will demonstrate outbursts & inappropriate touching c Min VC within the
community program within 4 wks.
Short Term Goal 2a. Client will demonstrate yelling C Mod VC at the community
program within 2 wks.
Intervention. This intervention would consist of positive reinforcements for the client
when he does not yell. This would consist of letting him listen to music that he likes and letting
him play his favorite game on the IPad. Assessing why the client might be yelling would be
important to understand what may be causing this behavior. Testing to see what sensory
stimulations might calm the client would be important. Then incorporating these sensory
stimulation so the clients behaviors can be decreased when agitated. This intervention will be to
help find relaxation techniques to decrease behaviors.

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Approach. This intervention would be an establish/restore approach. The client would

need to establish the new skill of decreasing his yelling behaviors. This would be considered
restore as well, to restore proper social interactions skills with peers. By incorporating the
establish and restore approaches the client will learn and remediate skills that will impact
performance.
Evidence. Evidence suggests to be weary when using positive reinforcements for
individuals that have challenging behaviors. Positive reinforcement can be used appropriately
when it is determined what the client finds pleasant and when multiple reinforcements are used
and alternated to determine their effectiveness. Another approach to challenging behaviors is
relaxation training. This training consists of sensory integration and relaxing techniques to
decrease behaviors (Maston, Neal, & Kozlowski, 2012).
Outcome. When looking at the OTPF, desired outcomes would be to improve
occupational performance, improve quality of life, and increase participation (AOTA, 2014). The
client likes to socialize and be around others which but is gets frustrated easily. Improvement in
performance with socially appropriate behaviors will improve his quality of life. This would
include improving social interactions skills as well. The outcome desired would be to participate
with peers in an appropriate way that brings satisfaction to his life.
Short Term Goal 2b. Client will demonstrate inappropriate touching c S during the
community program within 3 wks.
Intervention. The intervention would be to play a card game with the client, caregiver
and friends in the program. This is usually when most of the inappropriate behavior happens
because he is around more people. The caregiver is usually the one to stop the behaviors so it
would be important to educate her on token system, positive reinforcement and ignoring negative

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behaviors. The game is consists of laying cards down and the highest card wins. When the
inappropriate touching occurs it is important to be cognizant of what may be causing this
behavior and decrease that stimuli. It is important to know that client and be aware of personal
motivations to use to decrease behaviors. The Motivation Assessment Scale (MAS) can be used
to observe the client to understand what may be the cause of the behavior that is exhibited.
Approach. This intervention would follow the establish/restore approach. According to
the OTPF, this remediation would be done to restore skills and abilities that the client once
possessed but have since been impaired (AOTA, 2014). By understanding the motivation behind
the behaviors, the therapist can incorporate this intervention to increase positive reinforcement
and decrease the negative behavior in social settings. By taking this approach to the intervention
appropriate behaviors will be restored and inappropriate touching can be redirected if frustration
occurs. Restoring the clients behaviors while in social settings can increase occupational
performance.
Evidence. Evidence suggests that behavioral approaches are commonly used with
individuals that have intellectual disabilities. It is important to be client-centered and consider all
possible causes for maladaptive behaviors (Haertl, 2011). There may be many factors that
influence why the client participates in the inappropriate behaviors. According to Kearney,
Cook, and Chapman (2006) the more clearly defined the maladaptive behavior is the better the
MAS can distinguish the possible motivation to perform the behavior.
Outcome. In looking at the OTPF, the desired outcomes for this intervention would be
role competency, participation, quality of life, and well-being. These outcomes will be met by
incorporating social participation and engaging with peers to have a sense of belonging,
satisfaction with self, and being able to meet the demands of roles in which the client engages in

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(AOTA, 2014). Due to the importance of social interaction of the client and caregiver this
outcomes are significant to being in the community and meeting new individuals.
Precautions/Contraindications
It is important to take into consideration the precautions and contraindications when
working with this client. A precaution to take is to consider the clients safety around peers that
may have similar maladaptive behaviors. Contraindications to performing the interventions
would include pain, edema, and redness in the right UE. If the client exhibits any of these then it
would be important to not discontinue using the right UE until the extremity is further assessed
by a doctor.
Frequency and Duration
The intervention frequency and durations would be once a week for 60 minutes. Because
the client only comes twice a week and on one day he goes out into the community this would be
appropriate amount of time to work on this intervention goal. The client will be reassessed
during treatment sessions to be aware of the progress or declines made. Reevaluation will be
done to address progress or additional time for goals.
Primary framework
The model that guided this intervention is the Model of Human Occupation (MOHO).
This model incorporates a holistic approach that looks at motivation and occupational
performance. The MOHO looks at the mind-body connection and the internal motivation along
with the occupational performance which is the external component (Kielhofner, Forsyth,
Kramer, Melton, & Dobson, (2009). Goals were made by looking at the client volition,
habituation, and performance capacity. The client likes puzzles and is motivated to complete
them. By doing the puzzles the client can restore role and routines that once were meaningful to

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him. Therefore, this goal can increases performance capacity and increase quality of life. Social
participation is another motivation for the client and can increase mind-body performance and
quality of life as well.
Client/Caregiver training and education
Due to the clients diagnosis and 24 hour care from his caregiver it is important to have
the educate the caregiver as well as his family on what the therapist is working towards and why
it is important. It would be beneficial to educate them on the importance of letting the client do
as much as he can independently. It would be necessary to educate on using the right UE more
and to practice using the intervention techniques to decrease inappropriate behaviors.
Clients response to the intervention
The clients response to the interventions will be monitored by talking with him and his
caregiver and keeping the intervention client-centered. Documentation would be done to justify
services so the client can continue to participate in interventions. Talking with the caregiver and
the client about concerns and improvements made will be beneficial to achieving goals. It would
be important to talk with the client and caregiver about the just right challenge and how to grade
up and down for interventions. It would be important to reevaluate goals and desired outcomes
frequently with them to have a collaborative relationship and to keep the client and caregiver in
the intervention process.

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References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
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Haertl, K. (2011). Strategies for adults with developmental disabilities. In C.H Christiansen & K.
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Janicki, M. P. (2011). Quality outcomes in group home dementia care for adults with intellectual
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10.1111/j.1365-2788.2011.01424.x
Kearney, C. A., Cook, L. C., Chapman, G., & Bensaheb, A. (2006). Exploratory and
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