88

Introduction

Metacognition strategies allow individuals to learn to understand their own thinking process (“Metacognition Strategies,” 2015). CO-OP is a metacognitive strategy that can assist individuals in creating goals for themselves, setting a plan to accomplish their goals, complete activities that will lead to their goal, and finally check the task once its’ completed. If the plan did not achieve desired outcomes, then alternate solutions are brainstormed and implemented. Occupational therapists can implement CO-OP strategies with clients to promote functional performance in ADL’s and IADL’s needed in their daily lives.

Theory

Cognitive behavioral theory (CBT) implies that an individual’s behavior is mainly influenced by internal and external stimuli, and client is capable of manipulating those stimuli to be able to reach their life goals (Rokke & Rehm, 2001). The three behavior categories of cognitive behavioral therapy include cognitive reconstructing, coping skills and problem-solving. Metacognitive strategies such as the CO-OP fall under the problem-solving category of cbt. This theory was selected because our client is having difficulties with problem solving.

Evidence

A pilot study used the CO-OP approach with adults who had executive function deficits after a traumatic brain injury (TBI) to determine if this strategy is effective in changing behaviors in trained tasks and if person is able to transfer what they learned. The intervention group was compared with a control group who did not receive intervention. CO-OP was provided twice a week for one hour for ten consecutive weeks. The results indicated that individuals receiving CO-OP showed improvement in their performance of trained tasks and ability to transfer to real-world occupations (Dawson, Malcolm, Hunt, Lemsky & Polatajko, 2013). However, the study contained a small sample size and suggests that further research would be beneficial to better support the findings for individuals with a TBI (Dawson, Malcolm, Hunt, Lemsky & Polatajko, 2013).

Case Study

In her initial session, Leslie completed the COPM with the therapist. She identified her three main goals as improving grocery shopping, social leisure activities, and household tasks. She expresses the greatest concern with household chores such as laundry. Leslie is feeling overwhelmed with the amount of tasks she has to complete in her home as well as being able to complete them without errors. She is experiencing frustration and disorganization due to her mild cognitive impairments. This impairment stems from head trauma sustained during her previously abusive relationship. Furthermore, the client is experiencing deficits in planning and problem solving abilities. Based on this information, the therapist has decided to approach Leslie’s treatment with the CO-OP strategy. Leslie is now on session six and is working on the trained task acquisition of completing laundry.

Intervention Plan

Problem Statement –Difficulties with completing household chore of laundry secondary to deficits with executive functioning.

Outcomes – The desired outcome is for Leslie to improve problem solving skills by implementing CO-OP to complete occupations such as laundry.

long term goals

1. Client will be able to complete laundry independently in order to improve household management by discharge.
2. Client will be able to apply CO-OP approach on an untrained household task by discharge to improve IADLS.

short term goals

1. Client will independently use the CO-OP strategy during the trained task of laundry to improve IADLs by 11 weeks.
2. Using verbal and gestural cues, the client will complete laundry task without mistakes to improve IADLs by 6 weeks.
3. Client will independently verbalize all steps of the CO-OP strategy for the trained task of laundry in 2 weeks to increase independence in household management for IADLs.

Intervention format: Individual

Description of the setting: This session was completed in the afternoon at the women’s shelter where Leslie is currently residing. It was located at the facility laundromat where Leslie typically completes her laundry.

Supplies (if any): Leslie’s laundry from the week, laundry basket, detergent, washer and dryer.

Agenda & description

Review previous session (5 min)

Go, Plan, Do, Check review (5 min)

Laundry Task (45 min)

Summary and Review (5 min)

Documentation

SOAP Note

S: Client stated “Last session I had trouble sorting the clothes into whites and colors.”

O: Client participated in a 1 hour session using CO-OP strategies to increase independence in completing laundry. Client was able to independently verbalize all steps of the CO-OP process. However, she needed additional verbal cueing to implement the plan to her specific trained task. During today’s activity, client demonstrated 3 errors. She incorrectly sorted clothing, demonstrated incorrect use of bleach, and unsuccessfully transitioned the clothes from the washer to the dryer in a timely manner. Client required verbal and gestural cues to make corrections to sort clothes into separate piles of whites and colors.

A: Client demonstrated improvements in her understanding of the CO-OP process by correctly verbalizing the CO-OP method. However, her deficits in memory and problem solving are affecting her ability to independently implement the CO-OP method to her laundry tasks. In addition, her difficulties completing the actual task are secondary to impairments in organization and executive function. Therefore, she requires verbal and gestural cues to complete task. Although client still had difficulty with sorting clothes, client demonstrated improvement in committing less error making as compared to last session

P: Use the CO-OP approach to improve memory and organization in laundry tasks. Continue recommended plan of care to improve laundry skills.

References

Metacognitive strategies. (2015, September 3). Retrieved from https://inclusiveschools.org/metacognitive-strategies/

Dawson, D. R., Binns, M. A., Hunt, A., Lemsky, C., & Polatajko, H. J. (2013). Occupation-based strategy training for adults with traumatic brain injury: a pilot study. Archives of physical medicine and rehabilitation, 94(10), 1959-1963.

Rokke, P. D., & Rehm, L. P. (2001). Self-management therapies. In K. S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (2nd ed., pp. 173–210). New York: Guilford Press

Taylor, R. (2006). Cognitive Behavioral Therapy For Chronic Illness And Disability. New York, NY: Springer Science+Business Media, Inc.