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Introduction

Life skills training is widely used with clients with mental health problems who experience difficulties and obstacles in all areas of life such as shopping, communicating with other people, grooming, cleaning the house, managing money, and being independent in many other areas of life. Having a mental health problem, combined with the side effects of many antipsychotic medications, limits people’s ability to look after themselves, socialise with other people, take part in education or career development (Tungpunkom, Maayan, & Soares‐Weiser, 2012).

Occupational therapists use skill training to remedy some of these difficulties by using different strategies to help the client learn new skills or relearn the forgotten skills. During a skill training intervention, occupational therapists teach clients how to complete life skills and enhance quality of life.

Theory

The Model of Human Occupation (MOHO) theory is the cycle of how the person interacts with their environment and the effect on occupation. The cycle includes four phases consisting of information entering the system (input), the intake and adaptation of information (throughput), the action exerted externally in reaction to the process of input and throughput (output), and the modification of the process (feedback). The throughput process includes subsystems, consisting of volition/ motivation, habituation, and performance. MOHO is relevant to skills training with mood disorders in that the person needs to have the motivation and habituation to relearn forgotten skills or having the ability to learn new skills, whether it is in a new environment or their natural environment (Pawar & Says, 2017).

Evidence

The review included occupation- and activity-based interventions and interventions addressing performance skills and performance patterns, aspects of context and environment, activity demands, and client factors. The evidence for the effectiveness of life skills and instrumental activities of daily living (IADLs) training to improve performance is moderate, as is the evidence for neurocognitive training paired with skills training in the areas of work, social participation, and IADLs (Gibson et al., 2011).

Case Study

Linda, 62-year-old divorced retiree, has been experiencing neuralgia, migraine, lethargy, hypersomnia, weight gain, dislike of housework, fatigue, irritability, constant worrying, and unreasonable sadness without any real cause. Linda’s doctor noticed that this depression happened mainly in the winter months. He diagnosed her with Seasonal Affective Disorder and prescribed an antidepressant. Linda hated the dark winter months.  The antidepressants may have helped a little, but they didn’t lift her spirits very high.  She didn’t feel back to normal until the month of May.

Linda lives by herself and doesn’t have many friends. Her grown-up son recently moved to another state and visits her once a year. Linda’s typical day consists of watching TV, reading magazines, taking naps, and doing basic house work. She feels socially withdrawn and rarely leaves the house especially during winter months. She reports feeling tired most of the time and spends a lot of time worrying about her son.

During the initial occupational therapy session, the COPM assessment was administered and results indicated dissatisfaction with leisure area. The client mentioned that she would like to explore her interests and learn a new activity that can become her hobby.

Intervention Plan

Problem Statement

Linda is experiencing feelings of sadness secondary to her lack of engagement in meaningful leisure and recreation during the winter months.

Long Term Goals

1. Linda will be able to incorporate a newly learned recreational activity in her daily schedule by keeping a time log showing the amount of time she spent performing the activity by d/c.
2. Linda will have a change in satisfaction of her performance in recreation for leisure as reflected in an eight point increase for said client’s goal on the COPM by d/c.

Short Term Goals

1. Linda will identify a recreational activity of interest that she would like to incorporate in her leisure within a week.
2. Linda will verbalize the steps of the learned activity with minimal verbal cues after watching instructional video during her OT session in one week.
3. Linda will demonstrate  performance of the chosen recreational activity independently during a therapy session in two weeks.

Intervention Format

Individual

Setting

Linda will meet with the occupational therapist at the outpatient clinic for 1 hour sessions twice a week.

Supplies

TBD (based on the recreational activity of choice).

Agenda

• Greet Linda (3 min)
• Review and discuss goals (7 min)
• Assist Linda to identify the recreational activity that she would like to learn (10 min)
• Demonstration of skill (10 min)
• Practice of skill (20 min)
• Session reflection and feedback (10 mins)

Documentation

S: Client reports not feeling well today, “I’m very tired”. Client states that she has been experiencing neuralgia, migraine, lethargy, hypersomnia, weight gain, fatigue, irritability, constant worrying, and unreasonable sadness without any real cause. Client also expressed worry about her current mental state and verbalized her fears that there is something seriously wrong with her.

O: Client participated in a 60 minute OT session focused on identifying a recreational activity of interest and finding strategies to incorporate it in her leisure time. After considering several options, client indicated that she wanted to learn how to knit. After watching a 10 minute demonstration video, client was able able to verbalize the steps of the learned activity with min verbal cues. Client was receptive of therapist’s feedback and indicated that she would be  bringing the knitting supplies for next session in order to practice the newly obtained skills.

A: Client continues to present with symptoms of depression and limitations in coping strategies in productivity. Client’s interest in new recreational activity and willinging to learn new skills indicate motivation and high potential for improvement. Progress towards the stated goals is indicated.

P: Client will benefit from continuing 60 minute therapy sessions twice a week for 3 weeks with the main focus placed on learning the new activity and incorporating it into her daily routine in order to decrease her symptoms secondary to Seasonal Affective Disorder .

References

Tungpunkom P, Maayan N, Soares‐Weiser K. (2012). Life skills programmes for chronic mental illnesses. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD000381. DOI: 10.1002/14651858.CD000381.pub3

Gibson, R. W., D’Amico, M., Jaffe, L., & Arbesman, M. (2011). Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness: A systematic review. American Journal of Occupational Therapy, 65(3), 247-256. http://dx.doi.org.ezproxy.fiu.edu/10.5014/ajot.2011.001297

Pawar, O. P., & Says, J. H. (2017, July 13). Model of Human Occupation (MOHO) Frame of Reference. Retrieved January 24, 2018, from https://occupationaltherapyot.com/model-of-human-occupation-moho-frame-of-reference/