INTERVENTION PLAN FOR COMMUNITY CLIENT

Jessica Smith, OTS

Tx Plan: 3/3/18
Client – B.D.

What went well with your treatment (2/23)? Did things go as you planned or not? Explain. What will you do differently with this next treatment
plan?
- The client had to cancel our last session d/t inclement weather (winter decided to show up). We called B and confirmed that our next meeting with him
will be in his home and in the community (we are planning to ride a UTA bus). – D/t missing last session, we are going to see B for 90 minutes rather
than just 60 minutes during this week’s session; this will allow for more time to address medication management, public transportation and community
access.

Long-Term Goal: In 6 weeks, client will independently organize his weekly medications using visual
reminders.

Short-Term Goal: In 4 weeks, client will independently organize all medications for one day, using a visual
reminder to read instructions.

OCCUPATIONAL
PERFORMANCE PROBLEM
Specifically identify only the client
factors and/or performance skills
that are barriers to the
achievement of this goal. This
should not be a bullet list, rather
you should describe how the client
factor impacts this client’s
performance of the occupation in
the goal.
OPM and CPM TREATMENT SESSION DESCRIPTION GRADING THE ACTIVITY
AND RATIONALE Provide details of how you will set up the Choose one client factor or
Identify your OPM and all activity and how your intervention addresses performance skill that you address
relevant CPM’s that best the performance problem. Your description in your treatment session. Describe
addresses the should detail how the activity will be set up to one way (only one) that you can
performance problem and make it therapeutic. grade the activity up and one way
describe how each will be (only one) to grade the activity down
used to design treatment based on that one factor or skill.
for this client’s specific
problems. Factor/Skill: MEMORY

Client sustained TBI when he fell
down the stairs, hitting rock
fireplace with the anterior aspect of
his skull, resulting in Frontal Lobe
damage.
Client has difficulty in several
areas of mental functioning
I will be using MOHO as At the beginning and end of each activity in Tx
my organizing practice Jenna and I will be implementing a modified
model, and Cognitive protocol to help improve client’s self-
Adaptation Training (CAT) awareness to performance abilities on tasks.
as my complementary - We will begin by (1) describing the task to
practice model. be completed to client (B). and (2) Have
client predict performance (self-report
using performance Likert scale –
Grading Activity Up:
I would grade this activity up, by
increasing the demand on his
memory. I would do this by
decreasing the prompting I provide
during both scanning (reading label)
and organization tasks. This will
 including HIGHER-LEVEL
COGNITION (has poor judgement,
decreased insight of his abilities
post-TBI); MEMORY (has impaired
short-term memory and working
memory – occasionally requires
cuing to stay on task).
Client has decreased VISUAL
ACUITY (he requires reading
glasses for small print); and
decreased visual AWARENESS of
his environment.
MOHO can be used to
help increase client’s
understanding of strengths
and weaknesses through
focusing on his volition of - Upon Completion of task, (1) have client
wanting to self-manage
his medications, and by
beginning to incorporate
the task as a habit and
role (habituation). – i.e.
practicing new skills and
learning new habits.
w/pictures representing levels of difficulty-
scale attached at the bottom of
document) – if possible, also have client
predict any errors he may have with task.
complete a posttest with their self-
perceived performance of tasks (same
Likert scale), and (2) have OTS discuss
with client how his perceived performance
compared with OTS observation of his
actual performance.
_____________________________
provide client with opportunity to
problem-solve independently and
attempt to remember the steps
needed to accurately organize
medications (i.e. remembering the
importance of reading instructions
prior to organizing).
Grading Activity Down:

These cognitive and visual skill
deficits may impact client’s
ability to read, comprehend, and
respond/problem solve how to
perform medication organization
and sorting task, as well as will
impact his ability to read the
instructions on the pill bottles.
Client has hand tremors that
occasionally flare up when
concentrating on a task.
Client has difficulty in several
areas of Motor Skills including:
COORDINATES, FLOWS and
CALIBRATES (d/t hand tremors).
Processing Skills including:
NOTICES/RESPONDS (difficulty
likely d/t decreased insight); and
ADJUSTS d/t poor attention.
Client’s motor deficits related to
possible decreased arm
use/function, and hand tremors
may impact client’s ability to
manipulate, open pill bottle, and
get pills out of bottle without
spilling.
Additionally, client’s ANOMIA
(word-finding difficulty) may impact
As client has several cognitive deficits, I would I would grade activity down by
I will use the Cognitive help facilitate learning through using the decreasing the demand on his
Adaptation Training model hierarchy of cuing to provide the appropriate memory by providing him with a
(CAT) to help improve his amount of assistance throughout task. checklist of information to find prior
executive functioning to organizing a daily medication into
deficits through providing This session will take place at client’s pill organizer. While this is already
additional environmental home and in the community (we will be part of my intervention plan, I would
cues (verbal cues or riding a UTA bus from a stop near his keep this as a possible strategy to
simplified instructions for house, as well as the return route). use when organizing actual
medications/pill bottles), medication (to decrease the task
modify task D/t missing the session from last week, I demands).
demands/environment to will be keeping all aspects of the
allow for possibility of medication management tasks from the Additionally, I would increase my
establishing new roles and previous plan. prompting to provide more direct
participating in goal-based VCs, and intervene prior to client
tasks. I will be providing reminders and cuing (to making a mistake, rather than letting
account for his STM deficits), providing words them spend extensive time trying to
when becoming frustrated by anomia, and will problem-solve.
also assist him with motor controlled
movements (by helping him problem solve
ways of maintaining proximal stability – such
as placing elbow on stationary surface – to
allow for distal mobility and hopefully,
decreased hand tremors)
1. I will begin by having client read the
entire medication label on a novel,
complex pill bottle (with as little
prompting as possible) out-loud. This is to
allow OTS to observe if he is reading all of
the information on the bottle and possibly
having difficulty with comprehension and/or
client’s ability to ask for assistance,
ask clarifying questions, or
possibly with comprehension.
initiation skills, or is he having trouble
locating information d/t scanning deficits. I
will provide assistance and prompting
as needed after client’s initial attempt(s)
– i.e. reminding client of strategy of
using left hand label as a guide.

2. Depending how performance reading

task goes, I may stop and move onto
having client locate items on a pill label
based on a checklist of information.
Client will have to check off (preferably
in order) Information to be found on the
pill bottle.
(checklist is attached at bottom of Tx plan)

D/t client’s difficulty stopping to read

instructions prior to organizing pills during last
week’s session, I have made “fake”
medications/pill administration instructions for
his medications.
(attached at the bottom of this Tx plan)

3. Therefore, I will provide initial prompt

asking client to read 1 “fake”
medication bottle information fully
BEFORE trying to accurately fill one day
of medication into his pill box. Prior to
initial prompt, I will try to limit my prompting
to gesturing or minimal indirect VCs.
(time permitting, I would continue this
activity of organizing “fake” medications for
3 additional medications)

4. Practice using client’s medications:

Client is currently taking 4 medications,

each of which have their own instructions
and varying quantities to take each day.

With time permitting, I would like to

incorporate medication management
strategies for client to remember to READ the
instructions PRIOR to putting medications into
weekly organizer. I would have him practice
successful strategies (learned in above tasks)
into a weekly organization of one (or possibly
more) of his actual medications.

The following are some steps I will be taking

with each of the 4 medications the client is
currently taking.

First, I would have client READ the

instructions (for “fake” medication) and
identify (on a weekly calendar) what days/
time of day that medication is meant to be
taken.

Next, I would ask client to remove lid from

pill bottle, and get out appropriate number
of pills.

Then, I would have client put appropriate

number of pills on today’s day on the
weekly calendar.

I will have checklist ready to incorporate if

appropriate/useful to client in previous
tasks.

REPEAT STEPS FOR EACH OF CLIENT’S

MEDICATIONS. (begin by doing each
medication for one day, and then expanding
for one week. THEN begin combining two
medications for one day, and then for the
entire week... adding additional medications
as appropriate)

NEXT WOULD BE THE TIME ALLOTED TO

LEARNING TO RIDE and NAVIGATE
WHILE ON THE UTA BUS

D/t the schedule between bus stops, I will

keep this time therapeutic by going into the
grocery store by the bus stop and working on
 some basic scanning and orientation skills
with the client. (Scanning and orienting self is
being addressed within the medication
management treatments, but the client has
expressed difficulty with similar skills while
shopping (i.e. he sometimes has difficulty
locating items on shelves – sister reports that
he often forgets to look at aisle signs to read
what he should find in which isle.)
The following is a short plan for the grocery Tx
plan:
1. Ask client to orient themselves to store
upon entrance (I want to see if he can tell
me some of the general areas of the store
… i.e. freezer items are here, produce is
here, bathrooms are here, checkout is
here, etc.)
2. I will (hopefully) be able to provide client
with an aisle “map” Not all stores are
equipped with them, but for those that are,
the maps can be a useful tool – I will teach
client who they may be able to ask to
retrieve a “map”.
- If we do have a pre-fabricated map from
the store, I will provide client with verbal
cuing and assistance as needed – I will
have a 3 to 5 item grocery list that I will
ask the client to locate.
- If we don’t have a map, then we will use
general observation and discussion to
assist client in re-building a mental image
and his own “map” of the store with
expectations for the different foods in the
different areas.
3. As client is attempting to locate the 3-5
specific items on the list, I will be
providing him possible strategies to
categorize or problem solve about what
types of items may be expected in which
areas of the store. (i.e. if an item is cold or
needs to be refrigerated, what type of
shelf/area would this item likely be
Home Program:
Client will be provided with
checklists, a reminder calendar and
worksheets as his Home Program
over the next few weeks.
The medication management
portion of the home program will
have him utilize a checklist as a
visual reminder while filling his
medications into his weekly
organizer. He will also be provided
with a calendar that he is to use to
mark off the days of the week – this
is a strategy to both help him remain
oriented to the present date, while
also help him to recognize on what
day he should replenish his weekly
pill container. The checklist is a
visual reminder meant to help
facilitate performance at each step
of the task (with the emphasis on
reading the bottle and
instructions before filling up
weekly schedule based on
familiarity alone). The last step on
the checklist is that he MUST have
the medications he organized be
verified by a competent family
member – we have mentioned this
to his sister in previous weeks she
seemed to think the idea was
realistic and achievable. The most
important part of the medication
management plan, is to maintain
safety and good health.
For the public transportation
component of the home program,
the client will be given 9 worksheets
to work on over the next few weeks.
These worksheets will be
 associated with? – produce/freezer door
section, etc.)
4. Although I will not have client actually
purchase the items found, I would like him
to pay attention to price of each item and
be aware of how much he is able to buy –
based on the hypothetical money he is
using.
addressing similar concepts that
have been introduced and practiced
in therapy. The intent of these
worksheets is to help client become
more familiar and efficient when
looking at/through public
transportation documentation, which
would likely be important for his
future mobility. Client will be asked
to complete 3 of these worksheets
each week.

Date: ________ Task: _______________________________________ • Pre-Assessment • Post-Assessment

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Date: ________ Task: _______________________________________ • Pre-Assessment • Post-Assessment

1 2 3 4
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Date: ________ Task: _______________________________________ • Pre-Assessment • Post-Assessment

 1 2 3 4
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Date: ________ Task: _______________________________________ • Pre-Assessment • Post-Assessment

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 University of Utah Pharmacy University of Utah Pharmacy
123 University Way
SLC, UT 84117 123 University Way
SLC, UT 84117

RX# 654321 Dr. Smithson

RX# 234567 Dr. Smithson
Dyson, Brad Dyson, Brad
TAKE 2 CAPSULES BY MOUTH
TAKE 1 CAPSULES BY MOUTH
TWICE A DAY (2 after Breakfast, and
THREE TIME A DAY
2 after Dinner)
FLUOXETINE 20MG CAPSULE
DIVALAPROEX 500MG CAPSULE Discard after 4/13/2019
Discard after 4/13/2019

University of Utah Pharmacy University of Utah Pharmacy

123 University Way 123 University Way
SLC, UT 84117 SLC, UT 84117

RX# 789234 Dr. Smithson RX# 432178 Dr. Smithson

Dyson, Brad Dyson, Brad

TAKE 2 CAPSULES BY MOUTH AT TAKE 3 CAPSULES BY MOUTH 5
BEDTIME DAYS A WEEK

TRAZADONE 100MG CAPSULE VITAMIN B12 1000MG CAPSULE

Discard after 4/13/2019 Discard after 4/13/2019
Medication Checklist –

1. READ entire pill bottle. Find the following information:

a. Patient’s name
b. Pharmacy name
c. Medication name
d. Administration information

2. Open pill bottle (lid)

a. Retrieve appropriate number of pills based on
instructions

3. Double-check instructions on pill bottle to ensure which

medications to sort.

4. Place those pills onto corresponding time of day/day of week

on the pill organizer (for 1 day)

5. Close pill bottle (lid)

6. Continue with this process as moving on to additional

medication bottles.

When weekly medication organizers are finished being filled,

HAVE a family member DOUBLE CHECK YOUR WORK! – this
is VERY important – we do NOT want mediations errors for
SAFETY CONCERNS.
Possible Questions (for my own purposes):
- What time is it/what time of the day? (morning, afternoon, evening)
- Orient to calendar (what is today’s date – day, month, day of the week) – provide assistance prn
- Orient to medication bottles (child safety lid and easy off lid) – what kind does he have?
- Orient to label on pills (name on pills, pharmacy name, medication name, instructions, dosage, expiration
date, etc.)
- What do those things mean?
- Example with Brad’s name on it (and medications he uses?)
- List of Brad’s medications – what they are used for – dosages – etc.
- Simplified instructions:
o Put 1 pill on the morning, and 2 pills on the bedtime section of today’s day on the
calendar/organizer
o Take 2 of the red pills, and put them on the “morning” position on calendar for Monday through
Friday
o Read this bottle label and do what it says..