Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN 1

Occupational Profile and Intervention Plan

Tiffany Poon
Touro University Nevada










OCCUPATIONAL PROFILE AND INTERVENTION PLAN 2

Occupational Profile
Adam is a 37 year old divorced male who has a 7 year old son, but currently, his son lives
with his ex-wife outside of Nevada. Adam currently resides in Las Vegas, Nevada. His parents
and his younger sister also live out of state but are strong supporters of Adam. When Adam was
8 years old, he experienced a traumatic life event where he was sexually abused by a priest. He
has been experiencing post-traumatic stress disorder (PTSD) since the incident and it has been
identified as the underlying cause for his addiction. Since the age of 16, Adam has experienced
and become addicted to alcohol and multiple drugs such as marijuana, methamphetamine,
cocaine, and psilocybin mushrooms. He graduated high school and received two years of
undergraduate education before dropping out of college. He was employed full-time for three
years as a chef, but has been unemployed for the past year due to his drug and alcohol addiction.
He has little motivation to participate in any activities that are not related to drug and alcohol. In
the past, Adam has been unsuccessful in his sobriety and has relapsed a total of five times.
Currently, he is enrolled at Solutions Recovery, a residential treatment program that commits to
providing alcohol and drug treatment to substance dependent adults in a safe, secure, and
peaceful setting. As a client, Adam participates in a minimum of 30 hours per week of
therapeutic activity which includes individual counseling, group counseling, and 12-step
meetings.
Adam is seeking services for his diagnosis of drug and alcohol addiction and PTSD. He
also seeks a supportive environment and a structured facility to aid him in successful treatment
for addiction. Adams current concern is his addiction affecting his ability to live a fully
independent life. He is also concerned about his susceptibility to relapse. The only successful
occupation for Adam is his activities of daily living (ADLs). Unsuccessful areas of occupation
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are instrumental activities of daily living (IADLs), rest and sleep, education, work, leisure, and
social participation. Adams priorities and desired outcomes include treating his addiction and
PTSD. He also desires to prevent any hope for relapse. Other priorities include completing his
college degree, but most importantly becoming employed. Ultimately, these top priorities will
allow Adam live an independent, successful, and sober life.
Occupational Analysis
As stated, the Solutions Recovery, residential treatment program requires clients to
participate in individual and group counseling, as well as 12-step meetings. At Solutions
Recovery, holistic services and amenities are provided, structured interactions are utilized to
enhance interpersonal skills, and a supportive environment is maintained. At this moment,
treatment providers for this program do not include occupational therapists. Providers in this
program include drug and alcohol counselors, marriage and family therapists, and case
managers. However, Adam will benefit from skilled services provided by an occupational
therapist to ensure a more holistic approach, focusing on client-centeredness and meaningful
occupations.
Adam was observed during the group treatment session with six other clients who are
also struggling to overcome drug and alcohol addiction. In group sessions, each client, including
Adam are required to share the everyday obstacles they face in the road to recovery. Adams
observed area of occupation is social participation in group. Adam, during group treatment
session, sporadically participates and shows low levels of attentiveness. Adam is often reminded
to participate in group discussion and to use proper eye contact when speaking directly to
another group member or to the therapist. When Adam does share, he shows a lack of empathy
towards others troubled feelings and thoughts. Adam shows an introvert personality, however,
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he has inappropriate outbursts during group that are distracting to others. Specific mental
functions in Adams occupation of social participation were also observed.
Adam displays some higher-level of cognition despite his years of drug and alcohol
abuse. He shows the inability to judge a situation and may respond inappropriately. He shows
insight only when asked to share his personal experiences relating to a topic of interest. Adam
has low sustained attention. He is often seen dazing off and getting up frequently to use the
bathroom. From observation, Adam shows strong memory skills in short-term, long-term and
working memory. Adam shows awareness of reality by communicating logical and coherent
thoughts when asked to share. At times, Adam seems unaffected by certain topics and other
times he is overly excited and laughing inappropriately, which shows his lack of appropriateness
of emotions.
Other global mental functions observed include consciousness, orientation, temperament
and personality, and energy and drive. During the majority of the group sessions, Adam has a
high level of arousal and high level of consciousness. However, during some sessions when his
physical pain is more intolerable than usual, he shows a lower level of consciousness. He is
aware of his orientation but only shows limited emotional stability. Adam shows motivation to
take on the action phase of recovering from drug and alcohol addiction by being physically
present in group treatment sessions and individual treatment sessions five days a week.
However, his low participation and passive demeanor in group sessions displays his uncertainty
to take full advantage of the Solutions Recovery program.
The performance skills observed during Adams participation in group sessions include
process skills and social interaction skills. Adams decreased self-initiative to participate in
group sessions shows deficits in areas of attending, heeding, and initiation. However, he shows
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good organization and sequencing skills by consistently maintaining his morning activities or
routines to ensure punctual arrival to group. During group sessions, Adam shows low emotional
regulation skills when inappropriately responding to the feelings of other group members by
laughing and making offensive jokes. Only when he is prompted, he can show the appropriate
emotional response. Adam shows poor eye contact, he does not initiate to answer questions;
therefore, not showing any gestures such as raising his hand to speak. However, when he is
asked to speak, he answers with relevant information, usually sharing good insight related to the
topic. He does not acknowledge another members perspective before interjecting with his own
thoughts. Lastly, throughout the group session, he is able to maintain acceptable personal space
with the therapist and other group members.
Performance patterns are difficult to observe in Adam. However, some of the roles that
Adam fills at the residential treatment program are supporter, friend, and encourager of other
members. Most importantly, his role in group treatment session is to be an active participant.
Fulfilling this role allows Adam to fully benefit from a group support system.
Contexts and environments to consider for Adam are personal, physical and social. The
personal environment of the group treatment session is adults recovering from drug and alcohol
addiction. The group members ages range from 27 to 45-years-old. The physical environment
for these group members takes place in the Community Counseling Center of Southern Nevada
(CCC). Group sessions take place in the same room at the CCC five days a week. The room is a
small physical space with chairs placed in a circle and members face each other. There is one
big window that provides natural light into the room. For three hours a day, five days a week,
the same group members share experiences, stories, and advice in this private, secure room. It is
a group treatment session, therefore, the social environment is very important. Members are
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expected to show respect and support to each other. All environments support Adam and his
occupation of social participation. Within these environments, Adam is able to stay accountable
for his journey into a sober lifestyle. However, the main question arises whether or not Adam
will be able to maintain his sobriety outside a supported environment and structured facility.
Problem List
Problem Statement One
Client is unable to maintain sobriety outside of a structured facility due to ineffective coping
strategies.
Problem Statement Two
Client is unable to independently communicate with group members due to his poor social
interaction skills.
Problem Statement Three
Client is unable to become employed due to disinterest in non-drug related activities.
Problem Statement Four
Client is unable to complete instrumental activities of daily living (IADLs) tasks such as
meal preparation due to coarse hand tremors from alcohol withdrawals.
Problem Statement Five
Client is unable to be successful in health management and maintenance due to
overeating when experiencing overwhelming feelings of stress and anxiety.
Adams problem statements are prioritized by the problems most greatly affecting his
ability to live a fully independent and sober life. The biggest area of concern for Adam is his
performance outside of a structured facility. Currently, while Adam is in the residential
treatment program, he has the support of other group members, therapists, and the house
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manager. When he graduates in four weeks, he will not have these supports. The highest
priority for Adam is maintaining his sobriety by applying the appropriate coping strategies when
negative emotions trigger drug and alcohol cravings. Adam also shows the inability to
independently communicate with other group members. This is also an area of high concern
because he will be returning into the community soon. When he returns into the community, he
must have the appropriate social interaction skills to obtain housing, a job, and maintain a
healthy lifestyle. Other problem areas also need to be resolved in order for Adam to live a
successful, independent, and sober life.
Intervention Plan and Outcomes
Long-Term Goal
Client will independently apply coping strategies when emotions elicit cravings of drug
and alcohol, and record the thoughts and the strategies used, in a personal journal, 100% of trials,
within four weeks.
Short-term goal. Client will identify, verbalize and record in a journal three coping
strategies that he finds the most effective during treatment sessions with minimal verbal cues
within two weeks.
Intervention. Utilizing cognitive-behavioral therapy (CBT), Adam will apply coping
strategies to negative emotions. CBT centers on uncovering distorted beliefs and faulty thinking
patterns in clients such as Adam. CBT then requires Adam to practice alternative cognitive and
behavioral patterns (Spangler, 2011, p. 162). For the intervention activity, Adam will write a list
of negative emotions and a list of alternate positive emotions he would prefer to feel instead.
With this list, Adam and the therapist will review the negative emotions together, and apply
emotion-focused coping strategies or problem-focused coping strategies to achieve positive
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emotions. Emotional-focused coping involves trying to reduce the negative emotional responses
that are associated with stress such as fear, anxiety, depression, and frustration. Examples of
emotion-focused strategies include expressing the emotion to other people, looking for guidance
from a higher power, finding distractions to keep the mind off of the thought and suppressing the
thought until it goes away. Problem-focused strategies target the causes of stress in practical
ways which tackles the problem or stressful situation that is causing stress. Examples of
problem-focused strategies include taking control, seeking information, and evaluating the
situations pros and cons. As Adam is exposed to different strategies during treatment session,
he will verbally express three coping strategies that he finds most effective for himself to utilize
when having negative emotions arise.
Grading-up. To grade this activity up, Adam will receive less verbal cuing when
discussing emotion-focused coping strategies and problem-focused coping strategies. Also,
Adam will need to verbalize more than three effective coping strategies and state why it will be
work best for him. For generalization, Adam will need to independently state which coping
strategy may also be applicable in different areas of his life.
Grading-down. The therapist can provide more scaffolding for Adam such as preparing
a list of general negative and positive emotions. Also, the therapist can provide Adam with a
handout of emotion-focused coping strategies and problem-focused strategies. The therapist may
provide increased verbal cuing and guidance when Adam is displaying a difficult time applying
strategies to certain emotions.
Intervention approach. The intervention approach establishes the ability to apply
coping strategies when negative thoughts arise.
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Outcome. The end result or outcome of this intervention is to improve Adams health
and wellness, specifically in mental well-being, to improve his participation in daily life.
Evidence support. The objective in the article written by Klima et al. (2012), was to
assess the effects of psychosocial interventions for problem alcohol users and illicit drug users.
Psychosocial interventions are talking therapies that aim to identify an alcohol problem and
motivate an individual to do something about it (Klima et al., 2012, p. 54). The research
conducted randomized controlled trials comparing four psychosocial interventions: (a) cognitive-
behavioral coping skills training versus 12-step facilitation, (b) brief intervention versus usual
treatment, (c) hepatitis health promotion versus motivational interviewing and (d) motivational
intervention versus assessment only. This research concluded that there is high effectiveness in
all types of psychosocial interventions in alcohol and drug users, but could not conclude which
intervention was most successful (Klima et al., 2012). Although cognitive-behavioral coping
skills training was not specifically determined to be the most successful psychosocial
intervention, this study provided evidence showing that cognitive-behavioral coping skills
training had high effectiveness as a psychosocial intervention for drug and alcohol users.
Short-term goal. Client will identify and develop five written strategies to prevent drug
and alcohol relapse with moderate verbal cues, within three weeks.
Intervention. Education is an insightful occupational therapy intervention. Adam will
benefit from education in health and well-being to acquire healthy new behaviors and habits
(American Occupational Therapy Association, 2014). In this intervention activity, Adam will be
educated in ways that are efficient in preventing relapse such as the positive effects of joining a
support group after his graduation of Solutions Recovery. Benefits of joining a support group
include interaction on a regular basis with other people who are able to recognize issues and
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offer moral support, gain assistance, and reduce stress or depression through appropriate social
interactions. Support groups also help to develop positive friendships and ways to empower
oneself. Also, Adam will be educated in the importance of being able to understand the warning
signs of relapse. Some specific situations that can lead to relapse include loss of a loved one,
major financial change, social pressures or conflicts, boredom in life, and health issues.
Educating Adam in the warning signs of relapse will allow Adam to be aware when such
situations occur. Also, it will be beneficial to educate Adam in the importance of having a list of
supportive friends, family members, their phone numbers, and numbers of certain hotlines to use
when in need. The therapist will also educate Adam in the importance of determining leisure
and or physical activities to engage in. This will help Adam to stay occupied and find enjoyment
in non-drug related activities.
Concluding this intervention, Adam will have a written strategy plan that will aid in the
prevention of relapse. Items that could be included in Adams list of prevention strategies are:
the name of the support group, meeting place and time, a list of possible warning signs of
relapse, the name and number of his sponsor, names and phone numbers of family members,
friends, and hotlines. Other items on the list could include leisure activities he likes to
participate in and the location of recreational areas that support those activities. These relapse
prevention strategies give Adam immediate options for support when cravings for alcohol and
drugs become unbearable.
Intervention approach. The intervention approach is maintaining by providing the
supports Adam needs to keep a life of sobriety.
Outcome. By implementing strategies of relapse prevention, the outcome of this
intervention is prevention, quality of life, and health and wellness.
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Evidence support. Working within a supportive patient-physician relationship, the
primary care physician can help recovering patients decrease their susceptibility to relapse,
recognize and manage high-risk situations, and use available self-help, pharmacological, and
specialty resources (Friedmann, Saitz, & Samet, 1998, p. 1227). Although this article focuses
on the care of patients through primary care physicians, it is also applicable to practicing
occupational therapists. According to Friedmann et al. (1998), the patient and physician should
negotiate an individualized plan to manage warning signs of possible relapse. Ideally, if the
patients sponsor is unavailable, the patient should have other supporters accessible if a crisis
should arise. The article also states in the article that primary care physicians should have the
important role of supporting, monitoring and maintaining a patients recovery from alcohol or
other drug problems. This is very applicable to any health professions such as occupational
therapy. Occupational therapists who are working with recovering alcohol and drug addicts also
have the important role of maintaining a patients recovery from addiction.
Long-Term Goal
Client will demonstrate improved social interaction skills by showing appropriate
initiation of conversation, maintaining eye contact, and verbally contributing to relevant topics
for the full duration of the group session, five out of five days, within four weeks.
Short-term goal. Client will make at least three appropriate verbal contributions to the
group discussion with minimal verbal cues, three out of five days, within four weeks.
Intervention. Social skills training will be utilized in this intervention. Social skills
training will facilitate concrete skills that will meet specific goals in a real-life, applied situation
(AOTA, 2014). In this intervention activity, Adam and the therapist will role-play several
scenarios that will practice effective communication skills such as listening skills, reading
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nonverbal communication, delivering nonverbal communication, managing stress, and being
emotionally aware of certain feelings before communicating. Educating Adam in these areas of
effective communication will increase appropriate verbal contributions specifically in group, but
also outside of group. Effective listening skills presented to Adam will focus on the speaker,
showing interest, avoiding interruption, and avoiding judgmental behaviors. Skills for reading
nonverbal communication include observing the person who is speaking and being aware of
individual differences. Skills on how to deliver nonverbal communication, consists of educating
the use of nonverbal signals including appropriate body language. Skills in managing stress and
being emotionally aware of feelings before communicating them is a crucial life skill that Adam
needs improvement in. These skills include recognizing when he needs to take a moment to calm
down before speaking and when it is an appropriate time to agree to disagree. Being emotionally
aware allows Adam to empathize with others, communicate effectively, and build strong,
trusting relationships with others.
Scenarios during role playing will consist of past experiences that have occurred in group
where Adam inappropriately communicated to other group members. Scenarios will also consist
of possible future situations that may occur in group or outside of group. After role playing the
scenario with the therapist, Adam will critique his response independently. The therapist will
interject with positive reinforcement and provide advice and correction where it is necessary.
Intervention approach. This intervention establishes and restores Adams social
interaction skills through role-playing.
Outcomes. The end result of this intervention is to increase Adams participation in
group treatment sessions as well as increase social participation outside of group sessions.
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Evidence support. An article by Walter & Blatner (2014) illustrates how role-playing is
a method of simulation used to commonly teach communication skills. In this study, it used
specific role-playing methods that used techniques such as warm-ups, role-creation, doubling,
and role reversal. The purposes of role-playing are to prepare learners to take on the role of
others, to develop an insight into unspoken attitudes, thoughts, and feelings, and to enhance
communication skills through participation. Also, by role-playing unfamiliar or difficult
situations, will allow the exploration of how others are likely to respond to different approaches.
Role-playing builds experience and self-confidence when handling a situation in real-life and can
help develop quick and instinctively correct reactions to situations (Walter & Blatner, 2014).
Short-term goal. At the end of group treatment session, client will use appropriate social
interaction skills to ask a group member to participate in a leisure activity that does not involve
alcohol or drug consumption, with minimal verbal cues, three out of five days, within three
weeks.
Intervention. This type of occupational therapy intervention involves continued social
skills training as well as involvement in group intervention. Adams participation in the group
treatment session allows him to explore and develop skills for participation. Also, group
sessions allow Adam to build basic social interaction skills, tools for self-regulation, goal
setting, and positive choice making (AOTA, 2014, p. S31). For this intervention activity, it is
important to re-emphasize the social interaction skills that have been previously been taught to
Adam and the importance of participating in leisure activities. Social interaction skills are
important when approaching another member and also during the participation of an activity
with the other group member. The therapist may suggest to Adam an activity that involves
cooking. However, other leisure activities can include going bowling, tossing the football
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around in the backyard, or going for a swim in the pool. The activity of cooking can be
motivation for Adam because it was an area of previous interest as evidenced by his employment
as a chef. The therapist may further suggest to Adam to cook a favorite dish or prepare a dish for
the house. This will promote social interaction between Adam and other housemates. To
achieve the secondary goal of Adam asking a group member to participate in a leisure activity
with him, the therapist can use the previous approach of role-playing and train Adam in
appropriate social interaction skills. Working on social interaction skills will aid Adam in
preparing for his future to live independently, become employed, and participate in the
community.
Intervention approach. This intervention establishes social interaction skills to improve
participation in the natural environment. This intervention also creates opportunities to promote a
healthier lifestyle by engagement in non-related drug activities such as leisure activities.
Outcomes. The end result is an increase in social participation and also participation in
leisure activities, which is correlated with the enhancement of quality of life.
Evidence support. Guhne, Weinmann, Arnold, Becker & Riedal-Hellers (2014) main
objective was to report several approaches of social skills training and to evaluate the efficacy
and key success factors in severely mentally ill adults. This study systematically reviewed
randomized controlled trials and assessed all the evidence. The results showed that social skills
training increases social competence in severely mentally ill adults. The study concluded that
social skills training should be offered as a targeted treatment. Additional considerations include
the patients characteristics, impairments and needs. The study also concluded that social skills
training should be comprehensive, combining other elements that will aid in the generalization
into the community setting (Guhne, Weinmann, Arnold, Becker, & Riedal-Heller, 2014).
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Precautions and Contraindications
A crucial precaution is Adams physical and mental state. Adam must be both physically
and mentally stable from addiction prior to implementing any part of the intervention plan. It
will be helpful to assess his state prior to beginning each treatment session. This can be done by
having Adam simply verbalize how he feels physically and mentally that day. Another
precaution is Adams emotional instability. Overwhelming Adam may increase emotions
relating to addiction, or trigger a desire to use. However, reinforcing to Adam that he may
excuse himself for a five minute break whenever he feels overwhelmed is acceptable. For
Adam, trust is a big issue. For therapy to be most effective, Adam must feel safe and secure in
the therapy environment. This will allow him to be open and honest with the therapist. Lastly,
in the addiction recovery population, therapists must always be aware of any suicidal, homicidal,
and relapsing behaviors. Thus the therapist must always be cautious of Adams behaviors and
verbal statements that may show signs of suicide or relapse.
Frequency and Duration
Client will participate in occupational therapy (OT) services five days a week, for one
hour a day. He will receive skilled OT services for a total of four weeks.
Framework
The Transtheoretical Model (TTM), also called the Stages of Change, focuses on the
decision-making of an individual and is a model of intentional change (Sells, Stoffel, & Plach,
2011). This model guides the intervention plan for Adam. It focuses on the assumption that
people do not change their behaviors quickly, but rather, change in habitual behavior occurs
continuously through a cyclical process (Sells et al., 2011). The TTM postulates that individuals
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move through six stages of change: pre-contemplation, contemplation, preparation, action,
maintenance, and termination.
Currently, Adam is in the fourth stage, the action stage. This stage is defined as people
who have recently changed their behavior within the last six months and intend to keep moving
forward with their behavior change (Sells et al., 2011). Adam currently displays a strong desire
for change and is strongly committed to this stage. In this stage, interventions that are most
helpful are modifying behaviors, or acquiring new healthy behaviors. Other interventions
include guidance through problem solving, facilitating social support and also providing positive
reinforcement (Sells et al., 2011).
The next stage Adam will be in is maintenance. This will occur six months after the
action stage. For everyone, this will be the hardest stage and this has strongly proved true for
Adam. Adam has relapsed several times, making this an important consideration for intervention
planning. Because Adam has experienced relapse, it is important to educate Adam in coping
strategies that may cause triggers; triggers such as negative emotions, high stress, and being
socially isolated. For Adam, reviewing the incidences of past relapse is also important. With the
therapist, Adam can develop specific relapse prevention strategies.
Client Training and Education
There are several areas that Adam should be educated in to make sure the intervention is
as successful as it can be. First, Adam must be educated in being present, both physically and
mentally, in the treatment session. This implies arriving on time, participating, and also being
mentally focused. As Adam is educated in certain coping strategies and ways to modify certain
behaviors, it is crucial that he applies these adaptions outside of treatment. Reporting back if he
was successful or unsuccessful in independently applying these strategies will allow the therapist
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to make certain changes in the intervention. This is also possible if Adam is educated in the
importance of completing his personal journal. Lastly, specific to Adam, education regarding
support systems outside of his recovery program will be useful in further success in his sobriety.
Clients Response
Adams responsiveness will be monitored and assessed throughout each treatment
session. The therapist will document all cues and behavioral redirection and complete a daily
progress note at the end of each session. These progress notes will be used to assess Adams
progress towards his goal. If there are discrepancies in Adams progress, the therapists can make
changes to the intervention as necessary. This can include grading up or down an activity, or
modifying a long-term or short-term goal. The progress notes will include both Adams
behavior in group sessions and individual sessions. Because Adam is close to graduating
Solutions Recovery program, and will be released into a life of independency, the therapist must
evaluate the clients response outside of treatment session as best as possible. This can be done
by having Adam complete his personal journal on his own time. It will also be useful to use a pre
and post assessment tool such as the Canadian Occupational Performance Measure (COPM) to
identify Adams issues of personal importance as well as to detect changes in his self-perfection
of occupational performance over time.
Evaluating Adams responsiveness throughout each session, and the intervention plan as
a whole, will ensure the most efficient and client-centered treatment approach. Success in the
intervention is Adams ability to cope with negative emotions, apply learned social interaction
skills and follow-through with the relapse prevention strategies. This will provide Adam a
successful, independent life of health and wellness, and most importantly, a life of sobriety.

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