31

Introduction

Cognitive Orientation to Daily Occupational Performance (CO-OP) is a method in which daily occupational performance problems can be solved using a cognitive approach.
Having clients self-identify goals that are meaningful to them has been shown to increase the likelihood of goal achievement (Dawson, et al., 2009). In CO-OP, the therapist is simply acting as a “guide”, which allows the client to become self-motivated and be in control of her therapy sessions. In time, this will allow the client to transfer and generalize their skills to other contexts as needed.

Theory

The PEO model looks at the relationship between the person’s abilities, the environment’s characteristics, and the occupation being performed. The model uses each of these areas to develop an intervention plan with the focus being to maximize occupational performance. The person includes their roles, habits, routines, and what motivates them. The environment includes the cultural, social, physical context and how it affects the person and the occupation. Adaptations should be made to increase performance in occupation. The occupation includes tasks and activities that the client finds meaningful to them.

Evidence

Cognitive Orientation to Daily Occupational Performance (CO-OP) is a unique approach in the rehabilitation of executive dysfunction in the patient’s daily life in which the clients set their own personal goals (Dawson, et al., 2009). The stress on goal setting as motivation is a useful way of having clients identify and attain goals (Froude, 2017). In a study conducted by Froude, the CO-OP strategies that were implemented allowed the clients to achieve their goals evidenced by the improvements in their COPM ratings. The “do” portion of the process is paramount since it allows the the client to carry out the action and perfect the task, or similar tasks.

Case Study

Edie is a 26-year-old woman attending medical school. She has been abusing alcohol for over two years, since starting the program, secondary to the intensity of the program and the stress that comes with it. Lately, she has been experiencing excessive distractibility, caused by her drinking, leading to procrastination when attempting to study for upcoming exams. This inability to focus on her studies is not allowing her to reach her fullest potential in her professional development. Edie has become very self conscious about her academic performance and is constantly comparing herself to her classmates. This is preventing her from attending any group study sessions, that would highly benefit her. Edie is currently on academic probation due to her poor study habits which are having a negative impact on her grades. Edie was referred by the school counselor to see an occupational therapist in order to help her reach her goals.

Intervention Plan

Problem Statement:

Edie is having difficulty studying secondary to executive dysfunction.

Short-Term Goals:

• Client will verbalize the CO-OP process with 100% accuracy without assistance in 2 sessions in order to improve academic performance.
• Client will apply the CO-OP problem solving strategy to a known task with verbal cues in 3 sessions to improve academic performance.
• Client will apply the CO-OP problem solving strategy to improve her academic performance without assistance in 8 sessions.

Long-Term Goals:

• Client will independently demonstrate high quality study skills as evidenced by passing her midterm exams in 20 weeks to improve academic performance.
• Client will independently apply her knowledge of the CO-OP process in a social setting (untrained task) in 20 weeks to improve social participation.

Intervention Format:

Individual

Setting:

Edie will meet with the occupational therapist in the university clinic for 1 hour 1x per week for 20 sessions.

Supplies:

• Notebook
• Pencil / Pen

Agenda:

• Therapist meets and builds rapport with Edie (5 min)
• Therapist interviews Edie and conducts initial assessment using the COPM (25 min)
• Therapist identifies problems in performance that Edie is experiencing (5 min)
• Therapist collaborates with Edie to define goals and create a list of three goals (10 min)
• Teach Edie methods of CO-OP using verbal cues (10 min)

• • • Goal
    • Plan
    • Do
    • Check

• Provide a summary of the session and elicit feedback (5 min)

Documentation

S: Client stated that she is having trouble keeping up with the demands of medical school. She stated that she gets distracted often, causing her to procrastinate when she needs to study for exams.

O: Client engaged in a 1-hr CO-OP based session at the university. COPM was utilized to identify three goals: improve study skills, social skills, and decision-making skills when out with friends. Client was educated on CO-OP problem solving strategy using moderate verbal cues. During a task analysis of her goals, the client was able to identify problems that she is having in achieving her goals. However, when presented with soft music in the background, Edie became distracted and began singing along to the music playing.

A: Client demonstrated improvement in her ability to engage in the CO-OP process, but required verbal cues to stay on task when distractors were present in the environment. She demonstrates signs of distractibility and impairments in planning which decreases her ability to engage in the cognitive demands of her education. She also demonstrated good insight to reasons why her studying has not been effective. Based on this session, Edie would benefit from further skilled OT services to improve her ability to apply CO-OP to trained and untrained tasks to improve her overall performance.

P: Client will continue with CO-OP training in order to achieve her goals. She will continue to generalize the skills that she is learning in her school context. Edie’s improvement will be evaluated each session by her ability to achieve each goal. A task analysis will be used to identify problems that Edie is having in her goal achievement. Client is to see OT for 1 hour 1x per week for 20 sessions.

References:

Dawson, D. R., Gaya, A., Hunt, A., Levine, B., Lemsky, C., & Polatajko, H. J. (2009). Using the Cognitive Orientation to Occupational Performance (CO-OP) with Adults with Executive Dysfunction following Traumatic Brain Injury. Canadian Journal of Occupational Therapy, 76(2), 115-127. doi:10.1177/000841740907600209

Froude, E. H. (2017). Cognitive orientation to daily occupational performance (CO-OP): Sylvia Rodgers contributions to the understanding and implementation of this approach. Australian Occupational Therapy Journal, 64, 43-44. doi:10.1111/1440-1630.12390