79

Introduction

We have various approaches and strategies to aid someone with cognitive impairments through compensatory or remediation approaches. Unfortunately, there are situations where one needs the learn the their skills through a compensatory thinking. Metacognitive strategies are a type of approach that can include planning, problem solving, goal managing, monitoring and regulating their approaches to executive functions (Suarez & Fernandez, 2011). Best approach under a type of metacognitive strategies for our case study is using the CO-OP or the Cognitive Orientation to Daily Occupational Performance.

Theory

Metacognitive strategies theorizes that the clients will be able to enhance their personal insights, or be able to be aware of their own thinking and foster independent living (Suarez & Fernandez, 2011). A large amount of research demonstrates support towards how important metacognitive strategies benefit learning in everyday activities (Suarez & Fernandez, 2011). This strategy would aid the population of children in the foster care system.

Evidence

The use of metacognitive strategies in the treatment of cognitive disorders in adolescents is lacking. However, the use of metacognitive strategies as an effective treatment for neuropsychological disorders shows promise in the treatment of depression by positively effecting executive function and attention (Groves et al., 2015). Use of CO-OP specifically has been shown in an RCT to be effective as a client-centered intervention in the treatment of children with Developmental Coordination Disorder (Polatajko, Helene J., Mandich, Angela D., Miller, & Macnab, 2000).

Case Study

James is a 17-year-old male, currently in the foster care system. James is currently in the process of transitioning to the community for independent living. James completed the COPM and reported that he wanted to improve his performance in meal prep. James has met with his residential supervisor who has referred him to an occupational therapist to help his meal preparation skills.

Intervention Plan

Problem Statement

Client has difficulty with meal preparation due to deficits in executive functioning, knowledge and safety awareness

Long Term Goals

• Client will demonstrate independence in meal preparation as evidenced by a self-rated performance score of 10/10 on the COPM within 20 weeks for increased independence in meal preparation.
• Client will implement CO-OP strategies independently on an untrained task within 20 weeks to improve independence in IADLs.

Short Term Goals

• Client will be able to prepare a healthy meal with verbal and gestural cues within 7 weeks for increased independence in meal preparation.
• Client will be able to implement CO-OP independently on a trained task within 5 weeks to improve independence in complex IADLs.
• Client will implement CO-OP strategies with verbal and gestural cues on a trained task within 5 weeks.

Intervention format

Individual

Description of the setting

Client will see the OT in the Residential house/activity room for therapy for 45 minutes at 4:00pm.

Supplies

• Checklist and Pen
• Kitchen
• Kitchen appliances (stove, microwave)
• Kitchen cooking tools and utensils

Agenda/Description

• Set up safe learning environment (5 minutes)
  • Review treatment goals with James
  • Assess client’s readiness to learn
• Implement CO-OP (20 minutes)
  • Help client develop Goal-plan-do-check list
  • Execute meal preparation task
• Evaluate learning outcomes (5 minutes)
  • Discuss domain specific strategies that will help complete meal prep
  • Ask client to review plan and revise checklist for successful execution of meal prep task

SOAP

S: James stated that he wanted to learn how to cook meals independently and repeated it again during his COPM.

O: James engaged in a 1-hour-long session using the CO-OP for meal preparation. This is his 3rd session.  James verbalized which cooking tools should be avoided in microwave and which cooking materials that could burn during cooking. For the session he made Goal-Plan-Do-Check checklist for making Oatmeal in the microwave and on the stove top. He was able to successfully use the CO-OP for microwaving the oatmeal, but he had some difficulty with using the stovetop.

A: James continues to present with difficulty in timing and sequencing, as evidenced by him adding the ingredients for the oatmeal too late. James demonstrated improvement in problem solving abilities, as evidenced by his ability to self-correct of 4 out of 6 tasks. James demonstrated improved safety awareness in regards to proper function of cooking ware, temperature and materials avoided in heating. He also was able to notice that the tupperware was too close to the stove and could have burned so he removed it. He was a able to implement the CO-OP strategies with some verbal cuing. He will continue to benefit from OT services.

P: James will benefit from attending occupational therapy session for meal preparation skills 2wk/1 hr sessions.

References

Groves, S. J., Porter, R. J., Jordan, J., Knight, R., Carter, J. D., McIntosh, V. V. W., . . . Joyce, P. R. (2015). Changes in neuropsychological function after treatment with metacognitive therapy or cognitive behavior therapy for depression. Depression & Anxiety (1091-4269), 32(6), 437-444. doi:10.1002/da.22341

Polatajko, H. J., Mandich, A. D., Miller, L. T., & Macnab, J. J. (2001). Cognitive Orientation to Daily Occupational Performance (CO-OP) Part II The Evidence. Physical & Occupational Therapy in Pediatrics, 20(2-3), 83-106.

Suarez, J. M., & Fernandez, A. P. (2011). A model of how motivational strategies related to the expectative component affect cognitive and metacognitive strategies. Electronic Journal of Research in Educational Psychology, 9(2), 641-658. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ946115&site=eds-live http://www.investigacion-psicopedagogica.org/revista/new/english/ContadorArticulo.php?550