Santa Ana College Occupational Therapy Assistant Program OTA 102L Psychosocial Components of Occupation Based on the Occupational

l Therapy Practice rame!or" ield!or" Le#el $ O%ser#ational Analysis

1. 2.

Students name: Maria Carcamo Facility name and description. Briefly describe type of setting, population (age, gender, ethnicity, diagnosis , and physical layout of facility including !" department. #ntegrity $ouse %as founded in 1&&' by a group of people %ith e(isting mental disabilities %ho e(panded the concept of a %ell)*no%n establishment facility in +e% ,or* called, -Fountain Clubhouse.. #ntegrity $ouse e(panded the idea of accepting members not only %ith mental disabilities, but also accepts people %ith diagnosis li*e brain in/uries, de0elopmental impairment, cerebral palsy, and dual diagnosis. "he purpose for this facility is to help members find a meaningful occupation and feel producti0e in a safe en0ironment that simulates acti0ities of a con0entional /ob. "he members conser0e their autonomy and can come and go in the time they decide to do it1 the ma/ority of the members usually come in 2CC3SS, %hich is a bus ser0ice pro0ided by the state, that ser0e people %ith disabilities. #ntegrity clubhouse is di0ided in units such as Clerical (members deal %ith actuali4ation of board, and prepare acti0ities for the clubhouse , Media (members %or* in different acti0ities using the computer, and prepare crafts for acti0ities , 5itchen (members prepare lunch for e0erybody , Maintenance (members *eep the club house organi4ed and clean . "he units %here members %or* are spacious and ha0e the necessary tools such as special chairs and adapti0e e6uipment for complementing tas*s. 3ach unit has a leader and se0eral assistants that only help the members to accomplish each tas* %ithout actually performing the /ob for the member. Members decide in %hich unit they %ant to %or*, and ha0e the option of mo0ing from one unit to another %ithout authori4ation. "he freedom that members ha0e in the clubhouse can be reflected e0ery%here in the facility since there are no doors in units or offices.

Members can mo0e about in the facility and it can be difficult to distinguish bet%een a member, or %ho is part of the staff since they do not %ear special uniforms or name tags and ha0e the same rights and responsibilities. "he floor plan of the clubhouse is a reflection of the necessities of members1 there is a hall%ay that goes in a circular motion that not only ser0es as a sense of freedom, but also helps pre0ent members from getting lost. "his hall%ay starts from the main entrance %here the clerical unit e(ists and goes around through the offices of -2lliances of 2bilities., media unit, *itchen, play room, cafeteria and circles bac* to the main entrance again. 2ll the rooms and offices in the clubhouse ha0e big %indo%s %here members can see in, %hich is in0iting for members to feel %elcome and participate in acti0ities. "he building has %ide frame door and is only one le0el %ith no steps in order to ma*e the access to the facility easier for those %ho ha0e %heelchairs. "he clubhouse has 7 unise( bathrooms located throughout the facility and they are the only rooms in the facility that ha0e doors ) t%o in the front entrance, and the other t%o in the middle of the building. "he doors also in the facility do not ha0e a loc* for safety purposes but are hea0y)duty and the good manners of the members al%ays *noc* on the door before opening, %hich pro0ides /ust enough pri0acy and ensures the safety of e0eryone in the facility. "he population of the clubhouse ser0es appro(imately 89: males and 29: females from the ages bet%een 18 through ;< and from all different ethnicities, %hich include, Caucasian, and =atino that come from !range County and referred by >egional Center.

?.

Clinical &easoning: ?.1. @escribe a patientAclient that you ha0e obser0ed. #nclude age, gender, ethnicity and roles the person has (e.g. father, sibling, friend, co)%or*er, playmate "he member # obser0ed in the #ntegrity $ouse is B.". %ho is a ?1)year)old female $ispanic1 she has a fair s*in comple(ion, bro%n hair, and bro%n eyes. B.". is appro(imately <)? and 299 pounds and %as diagnosed %ith a Mild #ntellectual @isability. She presents herself independently

meaning she is able to communicate, %al*, and dress, %ith no help of others. She is the first child in her family and shares her house %ith ? other siblings, her mother, father and 2 nephe%s. B.". has many friends in the community and has had a romantic relationship %ith a member of the integrity house for last ' months.

?.2 . @iscuss the diagnosis in terms of signs and symptoms and prognosis. Comment on the impact of disease or in/ury on client factors and ho% these affect your patientAclient functionally. B.". %as diagnosed %ith Mild #ntellectual @isability (M#@ also called mental retardation. M#@ is characteri4ed by belo%)a0erage intelligence or mental ability and a lac* of s*ills necessary for day) to)day li0ing. Ceople %ith intellectual disabilities can, and do learn ne% s*ills, but they learn them more slo%ly. "here are 0arying degrees of intellectual disabilities, from mild to profound (C@C . Dith symptoms similar to those of 0arious learning disabilities, mild intellectual disability (M#@ , is diagnosed according to more than /ust an #E score, although that plays a big role in diagnosis. 2dapti0e beha0iors and functioning s*ills are t%o other areas that must be closely obser0ed in order to properly diagnose mild intellectual disability. 2dapti0e beha0iors refer to those s*ills that allo% a person to function in day)to)day life. Some sings of this disability are: @elay in oral language de0elopment, difficult problem sol0ing techni6ues, Croblems learning and getting along in social situations, Memory problems are also common. Some of the symptoms for M#@ include a lo% #E score (belo% '9 . Coor adapti0e beha0iors li*e conceptual, social, and practical s*ills that are used to get along in life, problem %ith learning, lo% academic, memory problems etc. (FoMentor . Most persons %ith intellectual disability should ha0e a life e(pectancy reaching into adulthood. Ceople li*e B.". %ith #E scores bet%een <9 and '9 generally de0elop the ability to read and perform basic math functions. "hey usually are able to tal*, %al* and communicate basic feelings. "hey typically de0elop independence in toileting, feeding, and dressing and participate in %or* en0ironments (=ip*ing .

For e(ample in the case of B.". she is able to %or* in a retail store %here she stac*s shoes and prepares a simple cold meal, but she is not able to remember things she did t%o days ago or ans%er 6uestions %ith comple( 0ocabulary.

?.?. =ist areas of strength and areas of concern in your clientApatients life. Areas of Strength' )B.". is able to communicate. )She is able to do self)care. )She is Friendly (sociali4e %ith others . )She is able to maintain a /ob. )She is able to orientate herself in a familiar en0ironment. )She is able to %rite and read small sentences. Areas of Concern' )B.". is self)in/urious. )She has beha0ioral problem in her house. )She has emotional outbursts %hen she is frustrated. )She is not able to remember general information from the past. )She is not able to understand comple( 6uestions.

?.7. =ist 2 goals for the patient. Dhich areas of occupation do they addressG Foal 1:"o learn to schedule her o%n appointments %ith doctors and transportation. 2rea of !ccupation: social interaction.

Foal 2: Dor* %ith money management s*ills. 2rea of !ccupation: #nstrumental 2cti0ities of @aily =i0ing.

?.<. Dhich frame(s of reference did your clinical super0isor use or %ould you use to guide you in process of ser0ice deli0ery for this clientApatientG "he frame of reference # %ould use to guide the process of ser0ice deli0ery for this member is the Model of $uman !ccupation %here the person ha0e meaningful acti0ities using their mind and body in an organi4ed form in order to see results in the e0ery day life.

?.;. +ame an acti0ity that you obser0ed. $o% is it related to the one of the goalsG # obser0ed an acti0ity %here B.". %ould dial a phone number for another member %ho %ould then tal* to a different member only to find out %hy he or she did not come to the clubhouse that day or if they needed something H #ntegrity $ouse refers to this as -outreach.. "his acti0ity relates to goals since B.". is learning ho% to dial numbers by herself, at the same time she is listening ho% other people as* 6uestions on the phone. "his %ill help B.". to become familiar using the machine, and %ill help to ha0e an idea of ho% to as* for people o0er the phone so that she can progress to do her o%n calls and schedule future appointments.

?.'. Dhat %as the outcome of therapeutic use of acti0itiesG Iy the end of the acti0ity the member %as able to recogni4e the places %here numbers are in the phone %ithout loo*ing for a long time. Meaning that by the end of the acti0ity she too* less time to dial phone numbers.

?.8. Dhat %ould you change ne(t treatment session (refer to client factors, acti0ity and conte(t in order to progress to%ard meeting the goalG Some of the client factors, acti0ities, and conte(t # %ill change in ne(t treatment session in order to progress to%ard meeting the goals are:

)B.". should memori4e (client factor: body function phone numbers that are important li*e &11, family phone numbers, doctor and transportation contact, %hich %ill help to ma*e the process of dialing faster. )Dor* in perception of short)term, long)term, and %or*ing memory (client factor: body function , by letting her see part of the phone number, then co0er the number %ith a piece of paper %hile she is dialing the number. )B." should practice scheduling an appointment %ith the therapist using the phone so that the member %ill be able to use correct speech (acti0ity demand %hile practicing %ith someone familiar. )B.". should ha0e an en0ironment %here noises (conte(t from other people do not interrupt the learning and practicing moment. )"he therapist should find a telephone that has big numbers so that the member %ill be able to identify the numbers easier.

7. (#idence Based Practice' Choose any clientApatient that you obser0ed. Iriefly describe the client H age, gender, and diagnosis. Iriefly describe an inter0ention (acti0ity, therapeutic use of self that you %ould use for this client. Cite your source (use a /ournal article from 2J!" and summari4e (2 to ? sentences ho% it supports this inter0ention for this client. S" is a Caucasian male that is 72 years old %ho suffered a dramatic brain in/ury in his /ob 1< years ago. $e is appro(imately 1<< pounds and <)& tall, and is able to communicate %ith others, but does ha0e difficulties doing it, meaning he spea*s less than 12 %ords per minute. $e also has some difficulty %ith the right side of his body since his hand and leg sho%s spasticity1 for e(ample, he fle(es his right hand and *eeps it close to his chest. $is leg is a little rigid, but he is able to control it in order to %al*. $e li0es %ith his family and mo0es in the community %ith the help of 2CC3SS. $e has some cogniti0e problems such as poor /udgment and gets frustrated easily because his short)term memory does not %or* effectible. # feel S.". could benefit from !ccupational therapy and impro0e the 6uality of life by doing meaningful acti0ities %hen he comes to the #ntegrity

$ouse. !ne of the acti0ities he en/oys performing in the clubhouse is typing the calendar acti0ities for the month, but it ta*es him long time to do it because he does not get a lot of time to practice typing. "he acti0ity inter0ention # choose for him %as: to type a different paragraph e0eryday from a daily ne%spaper %hen he comes to the clubhouse in order to get enough practice and reduce the time it ta*es doing the calendar of the month. #t is important to change the paragraph e0ery day so that he is able to retain the practice of typing and not forget the mo0ement needed to find letters. 2ccording to a study published in "he 2merica Journal of !ccupational "herapy people %ho learn things in random order practice is more li*ely to ha0e greater s*ill retention than those %ho ha0e a bloc*ed ordered practice. #n this study half of the sub/ects %ith dramatic brain in/ury perform acti0ities that include typing random articles and numbers %hile the other half of the sub/ects %ith the same diagnose perform typing %ith the same article o0er and o0er. "he study sho%s that those sub/ects %ho change the article %ere able to type more %ords e0ery minute than those %ho repeat the same article o0er and o0er (Fiuffrida .

<.

Occupational Profile' "his is defined in the Cractice Frame%or* as the clients -occupational history and e(periences, patterns of daily li0ing, interests, 0alues, and needs.. Kse formal inter0ie% andAor casual con0ersation (o0er one or more sessions to obtain the information needed for an indi0iduali4ed approach to e0aluation and inter0ention. Client can refer to family, significant others and caregi0ers. #nclude the follo%ing information: <.1. Dho is the clientG Iriefly describe.

@.+. is a 2; year old male %ho is Caucasian and about ;)2, 229 pounds. @.+. has been diagnosed %ith mental retardation. $e has blonde hair and blue eyes and ta*es pride of his physical appearances as one of his best 6ualities. $e is able communicate fluently, %al*s and self )cares independently. $e li0es %ith his mom, stepfather and t%o dogs. $e has a sister %ho li0es in another state and a grandmother %ho he 0isits fre6uently in northern California. @.". has many friends in the clubhouse and a girlfriend %ho he has been dating for the last ' months

<.2. Dhat are the clients concerns about participating in daily life acti0itiesG #s the client see*ing ser0ice and %hyG ("he client may not be see*ing !ccupational "herapy per se but other ser0ices @.". has some concerns about participating in daily life acti0ities because he feels that he does not ha0e the necessary tools for de0eloping in society. For e(ample he has concern because he is not able to read, %rite or understand simple signs on the street. @.". %ill li*e to be more independent in #nstrumental 2cti0ities of @aily =i0ing (#2@= and chose a /ob that %ill help him financially, or a /ob %here he can help his mother %ith the e(penses for the house. "he member %ould li*e to see* more information about his concerns because it %ill help him to %or* to%ard those areas and maybe one day, he %ill be able to be more independent in things that are important to him li*e: li0e by himself and raise a family.

<.?. =ist and briefly describe 2( areas of occupation, 7( performance s*ills or patterns, conte(ts, acti0ity demands or client factors that are impacted by the clients disability or disease. "he areas of occupation that are affected in the life of the member are: 3ducation, %or* and #2@= (financial management . "hese areas are affected because he is not able to learn concepts or retain important information that is fundamental to carry those acti0ities. "here are other areas that are affected by the disability in the life of @.". "hese areas include performance s*ills: for e(ample he has problems %ith Cra(is (it is hard for him to learn no0el acti0ities that include follo%ing se6uencing action through imitation , and cogniti0e s*ills, (he is not able to problem sol0e effectible . "his disability also affects his social en0ironment1 he prefers to restrain himself because he does not %ant to be discriminated against.

<.7 =ist and briefly describe 2( areas of occupation, performance s*ills or patterns, conte(ts, acti0ity demands or client factors that support the clients ability to participate in occupation. "he areas of occupation that support the members ability to participate in occupation are: Cersonal $ygiene, and body structure. "hose t%o areas help the client to participate in acti0ities since people are more li*ely to spend more time %ith him teaching ne% things because he ta*es good care of

himself and he is clean. "he body structure helps the client because he does not ha0e any problems %ith mo0ement and he is able to control his body.

<.< Dhat is the clients occupational history: life e(periences, 0alues, interests, pre0ious patterns of engagement in occupations and daily life acti0ities G @.". has al%ays li0ed %ith his mother since he %as a child, he is able to remember the day his biological father hit him in his face, and that is the reason he does not %ant to see him again. $e mentions that he does not %ant to be a carpenter because that is his fathers occupation. @uring the inter0ie%, he e(plained that he used to go to high school and en/oy playing ping)pong %ith his friends, but since he mo0ed to the clubhouse he prefers to help in the maintenance of the facility. @.". has learned to help his mother clean the house and to be self)sufficient %ith tas*s such as dressing, sho%ering, maintaining hygiene, preparing meals etc. $e %as able to prepare a simple hot and cold meal %hen he %as 1;. $e ta*es care of the familys t%o dogs, including feeding, %al*ing around the bloc* and cleaning after them. $e 0alues spending time %ith his family and ta*ing care of himself. $e thin*s that by ta*ing care of his body he is able to attract the attention of girl. $e %ould li*e to %or* at "aco Iell and be able to dri0e his mothers car.

<.;. Dhat are the clients long term and short term goalsG Long)term goals )"o li0e in a least restricti0e en0ironment of his choice )"o remain mentally stable and participate in a meaningful employment in the community )Manage his money independently in small purchase

Short)term goals )=earn no0el acti0ities li*e riding a bicycle.

)#nitiate a tas* and finish it. )=earn the 0alue of money. )=earn to %rite and read names.

<.'. @escribe a typical day for your client using a daily schedule format. ':99 a.m. ))))))))))))))))))))) Da*e up ':99 to ':?9 a.m.)))))))))))) Kse the toilet, ta*e a sho%er, brush teeth, brush hair and get dress. ':?9 to 8:?9 a.m.)))))))))))) Crepare brea*fast, eat, %atch "B and %ait for the bus. 8:?9 to &:99 a.m.)))))))))))) "a*e the bus to the #ntegrity $ouse. &:99 a.m. to 12:99 p.m.)))) Dor* at the clubhouse. 12:99 p.m. to 12:?9 p.m.)) $a0e lunch at the clubhouse. 12:?9 p.m. to 7:99 p.m.)))) Dor* at the clubhouse. 7:99 p.m. to 7:?9 p.m.))))) "a*e the bus home. 7:?9 p.m. to <:99 p.m.))))) "a*e a sho%er and prepare a snac*. <:99 p.m. to ;:99 p.m.))))) "a*e care of the dogs. (Dal*, clean, feed them . ;:99 p.m. to ':99 p.m.))))) Datch "B. ':99 p.m. to ':?9 p.m.))))) Call his girlfriend. ':?9 p.m. to &:99 p.m.))))) Datch "B. &:99 p.m. to &:1< p.m.))))) Irush teeth and prepare for bed. &:1< p.m.)))))))))))))))))))))) Fo to sleep.

<. Therapeutic *se of Self' @escribe your approach to conducting this inter0ie%. Dhat strategies did you use to obtain the information you neededG @id you empathi4e, collaborate, problem sol0e, ad0ocate for, encourage andA or educate the clientG Fi0e e(amples. Dhat non)0erbal communication did you use and %as this successfulG Could you ha0e used some other strategyG @id the client say or do anything to ma*e you feel uncomfortableG $o% did you reactG

"he type of approach # used to conduct the inter0ie% %as humanistic: first, # de0eloped a relationship %ith the member %ho %as able to share e(periences %ithout feeling /udged. Second, the member %as able to feel empo%ered of the situation because he only shared information that he felt comfortable %ith. #n other %ords, the member %as able to share information %ith me because # had de0eloped a relationship based on respect, interest and his needs. Some of the strategies # used to obtain the information %ere: Ieginning the inter0ie% %ith building rapport and tal*ing about the %eather, as*ing simple 6uestions such as, age and close ended 6uestions, and ma*ing a smooth transition to start tal*ing about hisAher pri0ate life %hile al%ays paying attention to small details so that # get to as* more 6uestions based on those details (acti0e listening , and ma*e the inter0ie% more li*e a con0ersation %here the member feels comfortable %ithout forgetting about the essential information # %as loo*ing for. @uring the inter0ie% # empathi4e %ith the member in many situations1 For e(ample, # ac*no%ledge the feeling of the member %hen he told me about his physical abuse %hen he %as a child. # also encouraged the client to open up to his family about his interest in finding a /ob in his community. Finally, # educated the client in the process of finding a /ob and e(plained some of the adaptation needs for this /ob in order to fit his disability so he can be successful doing it. # also used non)0erbal communication during the inter0ie% li*e: eye contact, nodding head, sitting at the same le0el as the patient, and not at a table or des* bet%een the member and #. # thin* # could ha0e used other strategies to get more information from the member1 For e(ample, ha0ing silence after the member shared his emotion about a harmful e(perience in his life so that he %ould ha0e felt more comfortable to tal* about the sub/ect in more detail. @uring the inter0ie% the member al%ays beha0ed and %as being respectful and %anted to collaborate %ith me at all moments in the inter0ie%. # ne0er felt uncomfortable around him, instead # felt %elcomed to his %orld and li*ed.

'.

+ocumentation' you need to ha0e a total of 2 different notes to complete the re6uirements. '.1. a. @ocument a client participating in an acti0ity. "he note must be logical and contain only essential information. Ie ob/ecti0e and precise in your description. #nclude the type and amount

of support that the client re6uired and e6uipment or adapti0e de0ices used. "he note must be signed and dated. #ntegrity $ouse S!2C +otes 19)&)291? Catient: @+ S: "he member seems 0igilant and al%ays cooperati0e. $e said, -# %ant to learn to %rite my name,. and as*s the therapist for a piece of paper and told her, -teach me ho% to %rite my name because # %ant to find a /ob.. "he member loo*s attenti0e, and %anted to repeat letter by letter after he %rote his first name. "hen after a fe% trials the member got up and ran to his girlfriends side and told her, -loo* Bictoria, # %rote my nameL.))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) !: "he member %as able to concentrate and *eep his attention for 1< to 29 minutes during the acti0ity1 the member %rote his full name three times %ith the help of the therapist %ho helped spell the members name letter by letter. "hen the member %rote his full name t%ice %ith no help but during the first trial the surname %as spelled %rong, ho%e0er the second time the member %rote his full name successfully.))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) 2: "he interest of the member in learning to %rite his name is a reflection of his determination to find a /ob and occupational necessities. Iased on the demonstration of the members interest, the therapist recogni4ed that there is an actual potential for learning basic acti0ities that %ill gi0e the member more independence in his life. ))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) C: Continue %riting the members name each session and add more personal information li*e, address, age, gender, etc. "his information should be functional in order for the member to use in a different en0ironment.)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) Maria Carcamo

'.1. b. Dhat is your interpretation of the clients performanceG Dhat do you thin* are li*ely reasons for the %ay the client participated in the acti0ityG # belie0e the member performed 0ery %ell during the acti0ity, $e engaged in the tas*, and %as able to pay attention for enough time that he could accomplish an important part of his short)term goals. "he client has different reasons that gi0e him moti0ation in learning to %rite his name. !ne of the

main moti0ations is to be able to find a /ob and be independent in the future. $e understands that if he is able to learn to %rite his o%n name and personal information he %ill be able to fill out an application in order to find a /ob. 2nother important moti0ation is his girlfriend %ho al%ays greets him %ith a smile or *iss if he reaches one of his goals in the clubhouse.

'.2. Ksing the documentation format used by the facility, document one different treatment session that you obser0ed. #f the facility does not ha0e a format, then document the additional treatment session you obser0ed in the S!2C note format. #ntegrity $ouse S!2C +otes

19)11)291? Catient: >D !: "he member %as alert %hile performing the tas*. She came in the session as*ing, -Dhat am # going to do today CG. She %as moti0ated to finish her acti0ity and told the therapist, -=ets get this done, because # ha0e a date after.. 2fter some time she finished the session by stating to the therapist: -#t is late # ha0e to go.. )))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) S: @uring the 7<)minute therapy session the member %as able to cutout 8 letters from a se0eral pieces of paper that other members had dra%n on. She cut around the letters, but only about '<: %ere done %ell, %hile the others she needed help cutting the corners of the letters since she made the corners sharp %hen they should be more rounded. "he client %as able to decorate < letters %ith glitter and glue, ho%e0er did not %ant to the complete the rest.)))))))))))))))))))))))))))))))))))))))))))))))) 2: "he member %as %or*ing fast and %anted to finish her %or*, ho%e0er she %as not able to pay attention to the detail of the acti0ity. She rushed through the tas* and %as performing it sloppy. She demonstrated that its difficult for her to follo% directions in ho% to cut the letters and did not %ant to complete the tas* other times.)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))) C: Follo% the current treatment and Cro0ide clues to the member to pay attention to detail in each tas*.))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))

Maria Carcamo

8. &ole of the OT' Iriefly describe all possi%le roles of the !" practitioner at the facility H practitioner, educator, field%or*Aclinical super0isor, super0isor, consultant, program director, researcher, administrator, entrepreneur.

#n this facility there is not an !ccupational "herapist %ho de0elops the treatment for members, instead there are leader units %ho %or* %ith member to do meaningful acti0ities. "he possible roles !ccupation "herapist can perform in this facility should be based on the client center approach. 5no%ing this approach an !ccupational "herapist should de0elop the role of the facilitator and it %ill allo% the member to reach their ma(imal capacity in each tas*. Some of the roles an !" may ha0e in the Facility is: Cractitioner since heAshe %ill be able to carry out assessments and actual treatment that %ill help the member in the clubhouse. "he therapist may ha0e a role of a clinical super0isor %ho organi4es different professionals that collaborate %ith the treatment of the member li*e !ccupational "herapist 2ssistant, Csychologist, Speech "herapist, (if they had it in the club) house or the leader units. "he !" may ha0e a role of a consultant for the clubhouse, and by doing this, the members %ould be able to recei0e treatment that %or* specifically to%ard hisAher diagnoses based on the assessment and the *no%ledge of the professional. "he !" could be an educator %ho teaches members about independent li0ing, safety dri0ing, medication management etc. "he !" could also be an entrepreneur since heAshe could manage their o%n facility that has the same model of the #ntegrity Clubhouse and securing a contract %ith a >egional Center %ho refers members to these types of programs.

&, (thical $ssue' #dentify and describe a situationAincident %here there %as or may ha0e been an ethical concern. @escribe ho% the situation %as handled and criti6ue the approach, effect, and outcome. Cite the 2!"2s Code of 3thics, %hich relates to the situation. "here ha0e been some ethical concerns in the #ntegrity $ouse, one of them being the principle 1: Ieneficence of member. 2ccording to the 2!"2s code of 3thics, practitioners should al%ays contribute to the good health and %elfare of the member, and in some instances this facility may ha0e 0iolated this principle. For e(ample, the first day that # came in the facility, # %as loo*ing for a par*ing space in the bac* of the clubhouse, suddenly %hen # %as bac*ing up, one of the members

came running to%ards the bac* of my car %ithout paying attention, and # almost ran him o0er, %hich %as a scary moment for me since none of the staff for the facility %ere around. "he only people %ho %itnessed this %ere members, %hich made me thin* that nobody too* care about the safety of the members %hen they lea0e the clubhouse. Dhen # as*ed one of the staff days later %hy there %as nobody ta*ing care of the entrance or e(its of the facility, he told me that the people there are members, not clients, or patients of this facility and they can e(plore %here0er they %ant as long as they do not brea* any social rules of the clubhouse. "his approach (Client center reflects the freedom members ha0e in this program, but it ma*es me concerned that the type of mental illness that these members ha0e are characteri4ed by poor /udgment in safety situations. 2n e(ample of this %ould be those members %ho had a dramatic brain in/ury and need help crossing the street because he or she may not be a%are to loo* both %ays %hen crossing the street first. #f a tragedy did occur it could be disastrous since families may fear it could happen to there lo0ed one and potentially send them to a different program, %hich could result in less members for the facility, less funding by the state, state contract cancellation, or e0en closing the clubhouse.

Works Cited CDC. "Children's Health." Intellectual Disability (Mental Retardation): Causes, Symptoms, and Treatments. Webmed, 16 Mar. 2013. Web. 18 No . 2013.

!i"##rida, Clare !., $ason %. Demer&, 'isa (. (e&es, )rian *. 'ebo+it,, and (obert -. Halon. "."n/tional 0kill 'earnin1 in Men +ith 2ra"mati/ )rain 3n4"r&." The America Journal o !ccupational Therapy 5th ser. 63.678 82009:; 3987506. Web. !oMentor. "Mild 3ntelle/t"al Disabilit&." " #oMentor$com. !oMentor, 2010. Web. 20 No . 2013. 'i<kin1, =a"l H., $%M3- $. =err&, and Mar& >. 'e<<ert. "3ntelle/t"al Disabilit& 7 =ro1nosis and Com<li/ations." Intellectual Disability " %ro&nosis and Complications. Medmerits, 2011. Web. 20 No . 2013.