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Introduction

Cognitive orientation to daily occupational performance, also known as CO-OP, is defined by Polatajko and Mandich as a  “a client-centred, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery (2004).”  CO-OP is an evidence based approach that has been successful for children autism spectrum disorder (Rodger & Brandenburg, 2008). According to Missiuna et al. (2001), the main objectives of CO-OP are: skill acquisition, development of cognitive strategies, and generalization and transfer of learned skills and strategies. An occupational therapist can provide an individual with Autism the skills needed to generalize learned skills into their daily environment.

Theory

The Ecology of Human Performance (EHP) was developed to investigate the interrelationship of humans and their environment and its effect on task performance. EHP postulates that the person’s environment affects their behavior and performance, and that performance cannot be understood outside of the environment. The person includes one’s experiences, skills and abilities. The person’s context is the physical, social, temporal and cultural features of the environment. The task in EHP is defined as sets of behaviors necessary to accomplish a goal. The person, context and environment interact with and are affected by each other.  The goal of EHP is for the individual to be able to perform by improving their abilities/skills or altering the context to decrease occupational barriers and increase occupational performance (Dunn, Brown, & McGuigan, 1994).

Evidence

A study done by Rodger, et. al. (2008), had two boys, ages 10 and 12, on the Autism Spectrum participate in 10 sessions utilizing CO-OP interventions that focused on social and organizational skills. The Canadian Occupational Performance Measure (COPM), Social Skills Rating Scale, and the Performance Quality Rating Scale were all used to measure the outcomes of the interventions. Measures taken post- intervention showed that both children improved in social and organizational skills. They were able to generalize and transfer their learning to their home and school environments. CO-OP allowed these children to master their social and organizational goals through this problem- solving framework. The CO-OP guides the children in their thinking so they can concentrate on what their goal is the how to achieve it (Rodger, et. al., 2008).

Case Study

Sam is an 18-year-old boy who is diagnosed with autism spectrum disorder. He lives at home with mom, dad, and sister. He is a freshman at a local college studying marine biology. Sam is independent with all of his ADLs and is mostly independent in his IADLs. Sam’s mom is a homemaker who has always made lunch and dinner for all members of the family, but Sam does not always like what his mom makes.

Intervention Plan

Problem Statement

Sam is having difficulty in meal preparation due to poor problem solving skills.

Long term goals

1-Sam will be able to able to make himself lunch for school 5 out of the 5 days of the week in 1 month.

2- Sam will be able to independently grocery shop with a premade list for meal preparation in 1 month.

Short term goals

1- Sam will list 3 possible meals that he would like to prepare independently in one treatment session.

2- Sam will identify items needed to prepare his lunch independently from his pre chosen meals in two treatment sessions.

3- Sam will accurately follow a goal-plan-do-check protocol for meal preparation in one week.

Intervention format

Individual

Setting

The treatment sessions will take place in the client’s home and in the community at the local grocery store for 45 minute sessions.

Supplies

None

Agenda & description

• OT arrived at Sam’s house and asked him for a tour of his kitchen. The OT asked Sam what his role was in making his own lunches. (10 minutes)
• The OT introduced Sam to the goal-plan-do-check approach that could help him with problem solving abilities in regards to preparing meals. (5 minutes)
• The OT asks Sam what his goals are to be more independent in meal preparation? (5 minutes)
• The OT asks how will you go about doing each one of his goals? (20 minutes)
  • Establishing a plan A, B and C for each goal.
• The OT will give a written copy of the Goal-plan-do-check protocol to attempt implementing until the next session. (5 minutes)

Documentation

S- Sam reports feeling unhappy with the meals his mom makes him for lunch and that he would like to be able to plan and prepare his own meals.

O- Sam participated in a one on one session using the COOP model to work on meal preparation. Sam identified three goals related to meal preparation which were chose meals based on ingredients at home, grocery shop independently, and prepare own meal. Sam listed one plan for meal preparation. When asked what he could do if his plan A did not work, Sam did not identify an alternative plan. OT provided guidance to Sam to identify two alternative plans.

A- Sam shows could potential to becoming independent in meal preparation since he was able to identify his three goals. The fact that he required guidance to identify alternative plans shows a deficit in problem solving skills. Sam would benefit from practicing using the goal-plan-do-check protocol to increase his cognitive skills.

P- Sam will continue with OT for the next 3 weeks to work on planning and problem solving strategies needed for meal preparation. Sam will practice his goal-plan-do-check protocol for meal preparation over the next week so that he can bring up any problems encountered to the OT at the next session.

References 

Dunn, W., Brown, C., & McGuigan, A. (1994). The Ecology of Human Performance: A Framework for Considering the Effect of Context. The American Journal of Occupational Therapy, 48, 595-607. doi:10.5014/ajot.48.7.595

Missiuna, C., Mandich, A., Polatajko, H. & Malloy-Miller, T. (2001). Cognitive orientation to daily occupational performance (CO-OP): Part I — Theoretical foundations. Physical and Occupational Therapy in Pediatrics, 20, 69–81.

Polatajko, H. & Mandich, A. (2004). Enabling occupation in children: The cognitive orientation to daily occupational performance (CO-OP) approach. Ottawa, ON: CAOT Publications.

Rodger, S., Ireland, S., & Vun, M. (2008). Can cognitive orientation to daily occupational performance (CO-OP) help children with asperger’s syndrome to master social and organisational goals? The British Journal of Occupational Therapy, 71(1), 23-32. http://dx.doi.org.ezproxy.fiu.edu/10.1177/030802260807100105