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Introduction

Cognitive orientation to daily occupational performance or CO-OP is defined by Polatajko and Mandich (2004) as a  “a client-centred, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.”  CO-OP is an evidence based approach that has been successful for children with developmental coordination disorder (DCD) and 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

Cognitive behavioral therapy (CBT) is based on the theory that our thoughts cause our feelings and behaviors instead of external factors, like people, situations and events. Our thoughts have a direct relation to our feelings and behaviors (“What is Cognitive Behavior Therapy”, n.d.). CBT uses a variety of cognitive and behavioral techniques to help the client become more successful in their occupational performance. CBT techniques fall into three categories: cognitive restructuring, coping skills, and problem solving. The CBT process is a short, structured, process that revolves around the collaborative nature of the client and therapist (Taylor, 2011). Problem solving goes hand in hand with the CO-OP model. The techniques must be practiced in therapy and also lived in real life situations to be the most effective.

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. During Sam’s third session a month ago, he learned how to meal prep and take money to school everyday as an alternative in case he didn’t want to eat his lunch. Because he didn’t use that money, he now has some money saved up and would like to buy tickets to a basketball game. Sam does not know how to manage his money and wants to be able to have a good time.

Intervention Plan

Problem Statement

Client had difficulty managing his money due to poor planning skills.

Long term goals

1- Client will independently complete CO-OP problem solving strategy on an untrained task in order to improve money management skills needed for IADLs within 20 sessions

2- Client will demonstrate independence in money management by rating money management performance skills as 10/10 on the COPM by 20 sessions

Short term goals

1- Sam will be able to apply the CO-OP strategy to a trained task in order to improve independence in money management within 10 sessions

2- Sam will demonstrate understanding of CO-OP strategy in a simulated role play to improve money management skills within 10 sessions

3-Sam will create a Goal-Plan-Do-Check list with verbal guidance for a planned activity of choice to improve planning skills necessary for money management within 5 sessions

Intervention format

Individual

Setting

At the client’ home for a 1 hour session

Supplies

Index card

Pen/ marker

Agenda & description

• OT arrived at Sam’s house and caught up on the last week. He said he would like help managing his money while attending a basketball game with his friends (10 minutes)
• The OT introduced Sam to preparing a goal-plan-do-check for the basketball game (5 minutes)
• The OT guides Sam in identifying what expenses he would have at the basketball game (10 minutes)

• The OT asks how he will go about doing each one of his goals? (20 minutes)
  • Establishing a plan for each purchase
• Sam wrote a cue card, with verbal instructions provided by OT, to use as a visual reminder to use at the basketball game (15 minutes)

Documentation

S- “I want to be able to use my extra money and go to a basketball game with my friends”

O-  Sam participated in an 1-hour one on one session using the CO-OP model to work on money management skills. Sam created a goal, plan, do, checklist with his ultimate goal being able to attend and have fun at a basketball game with his friend. Sam was able to complete a goal, plan, do, checklist, with verbal guidance, to plan how he will spend his money while at the basketball game. During the plan portion of the CO-OP model, Sam was able to identify 5 items he plans to spend his money on while at the game. Sam created a cue card, with verbal instructions provided by OT, as a visual reminder while at the basketball game.

A-  Sam has difficulty with money management due to poor planning skills. Sam demonstrated poor management skills by underestimating how much money he would need for the game and the items he would like to buy during the game. Sam needed numerous verbal guidance through the process of the goal, plan, do checklist because he had difficulty remembering the steps and how to implement them.

P- Sam will continue to attend OT sessions, to focus on using the CO-OP model to gain independence in money management skills. Sam will benefit from using the CO-OP model in two activities throughout the week and will report his success and struggles during the next session. This will help Sam generalize the use of the CO-OP method in his daily life.

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

Taylor, Renee R. (2011). Overview of Cognitive Behavioral Therapy, Cognitive Behavioral Therapy for Chronic Illness and Disability (pp.15-17). Spring Street, New York: Springer Science+Business Media, Inc.

What is Cognitive Behavior Therapy | Beck Institute. (n.d.). Retrieved February 16, 2018, from What is Cognitive Behavioral Therapy (CBT)