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Introduction

Cognitive orientation to daily occupational performance or CO-OP is a client-centered and performance based therapeutic technique that allows for learning of skills through guided discovery of useful strategies (Polatajko, Mandich, Miller, & Macnab, 2001). The goals of using the CO-OP are to gain skills in client-chosen tasks, development of cognitive strategies, and generalization of skills and strategies attained. The CO-OP uses a goal, plan, do, check procedure when making a plan for a task (Polatajko, et al). First the client chooses a goal they would like to attain, the therapist will then help the client create a plan with specific steps to accomplish the goal. Once the steps have been discussed, the client will perform their plan and lastly the client will check their work to identify if their goal has been met successfully.

Theory

The Person-Environment-Occupation Model (PEO), is used by therapists to use in alliance with clients to elicit engagement in their meaningful occupations in the most natural of environments. (Strong, et al., 1998). It has been suggested that the environment is a critical influence on occupational performance and purpose. Environments that promote opportunities are more conducive to enhancing occupational performance. It has been suggested that the environment has a powerful impact on the individual compared to the length of treatment (Rebeiro, 2001). In many cases, a safe environment that also provides affirmation that the individual will be supported and valued, enables successful occupational performance. The PEO model assists in conceptualizing, analyzing and communicating possible occupational performance intervention (Strong, et al., 1998).

Evidence

Currently, there is no evidence supporting the use of the CO-OP for individuals with eating disorders.

Case Study

Eugene is a 26 year old male professional ballet dancer who has been struggling with Anorexia Nervosa for the past two years. He has been receiving occupational therapy services for three weeks with an emphasis on cognitive remediation therapy. He was initially assessed with the COPM where he identified his personal goals as maintaining friendships, attending work related social events and visiting his doctor annually. He has made great progression using the goal, plan, do check method to initiate health management activities. The goal for Eugene is to generalize the planning skills used with the CO-OP, effectively, to maintain friendships and attend work related social events. Eugene mentions his best friend’s 27th birthday dinner is in the next 3 weeks. Eugene would like to attend his friend’s birthday dinner without feeling uncomfortable and anxious.

Intervention Plan

Problem Statement

Due to lack of problem solving skills, client is unable to attend social events.

Long Term Goals

1- Client will be able to generalize the CO-OP process, previously learned, independently without showing any signs of discomfort in order to participate in his friend’s birthday dinner by discharge.

2- Client will independently complete CO-OP problem solving strategies on an untrained task in order to improve problem solving skills needed for social engagement by discharge.

Short Term Goals

1- Client will be able to verbalize how he will implement the CO-OP process to attend to his friend’s birthday dinner with 2 verbal cues in 1 session.

2- Client will use the CO-OP process, when going out with family, with 3 verbal cues within 2 sessions.

3- Client will use the CO-OP process in a role play session with the therapist, independently, to participate in social events by 2 weeks.

Intervention Format

Individual

Setting

Client will meet with therapist in a clinic setting for 20 sessions.

Supplies

None

Agenda

Client is currently in session 15.

• Reassess client’s goals using the COPM.
• Discuss application of CO-OP process when attending doctor’s appointment from previous week.
  • Identify level of difficulty
• Review and reinforce the CO-OP approach learned from previous sessions
• Have client complete the goal, plan, do, check process for attending best friend’s birthday dinner.
• Summarize and give feedback to client

Documentation

S: “ I may lose my friend if I keep avoiding to participate in social events”

O: Client completed the COPM and goals remained the same from initial evaluation. Client expressed his desire to attend his friend’s birthday party. Client completed a goal, plan, do, and check process for attending his friends birthday party with verbal cues. Eugene explained how he applied the CO-OP when he attended his doctor’s appointment last week and described this as a minimally difficult task. Client was able to attend the doctors appointment, but felt actually carrying out the plan was difficult. Therapist gives the client two different hypothetical scenarios for him to practice and reinforce his skills implementing the CO-OP process. During this activity, the therapist had to guide the client using 1 to 2 verbals cues for each scenario.

A: Client’s ability to effectively implement the CO-OP process when attending his doctors appointment, demonstrates greater ease in incorporating the goal, plan, do, check process. The need to provide verbal cues has decreased, demonstrating improvement in planning and problem solving abilities. Client continues to feel uncomfortable with the Do process of the CO-OP, therefore, client will benefit from further practice and implementation of the CO-OP process through role playing with the therapist and eventually carrying over those skills in occupation based activities.

P: Next session, client and therapist will continue working on the goal, do, check process. Client will continue generalizing the CO-OP, planning, and problem solving skills previously acquired into different life situations.

References

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. doi:10.1080/J006v20n02_06

Rebeiro, K. L. (2001). Enabling occupation: The importance of an affirming environment. Canadian Journal of Occupational Therapy, 68(2), 80-89.

Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., & Cooper, B. (1998). Application of the person-environment-occupation model: A practical tool. Canadian Journal of Occupational Therapy, 66(3), 122.