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Introduction

Cognitive Orientation to daily Occupational Performance (CO-OP) is a specifically tailored, active client-centered approach to intervention that uses cognitive strategies to promote successful performance. The CO-OP approach is based on the premise that cognition plays an important role in the acquisition of occupational skills. The objectives of this approach include skill acquisition, cognitive strategy development, and generalization (Polatajko, 2001).

Focused on enabling success, the CO-OP approach employs collaborative goal setting, dynamic performance analysis, cognitive strategy use, guided discovery, and enabling principles.  These elements are embedded into a structured intervention format and family involvement is highly recommended (Dawson, 2009).

Occupational therapists using the CO-OP approach guide individuals to independently discover and develop cognitive strategies to perform the necessary tasks of everyday living and improve social-emotional skills.

Theory

The Person-Environment-Occupation Model of Occupational Performance describes the theory and clinical application of the interaction between the person, the environment, and the occupation. The model is a framework that guides clinical reasoning in analysis and understanding of the interdependent interaction between these dynamic elements. This model provides a framework for a systematic interactional analysis of: P-E; P-O; E-O. Optimal function or occupational performance results from a good fit between the three components (P-E-O). Maximum fit relates to optimal occupational performance, whereas minimum fit relates to minimum occupational performance, hence dysfunction. Disability can be associated with a minimum or poor person-environment fit rather than the impairment itself (Law et al., 1996).

Evidence

Rodger, Ireland, and Vun (2007) conducted two case studies of children with high functioning autism to address both the use and the potential of CO-OP to promote mastery of social and organisational skills. Two boys, 10 and 12 years old, participated in ten CO-OP sessions. Both boys were evaluated using the Canadian Occupational Performance Measure, the Social Skills Rating Scale and the Performance Quality Rating Scale before and after implementation of the intervention. The post-intervention scores showed that both children improved in social and organisational skills. As well, they were both able to generalize their learning to their home and school environments.

Case Study

Aaron is a 13 ­year ­old boy who was referred to speech therapy because of his stuttering. He started to stutter when he was three years old and that time he also had bedwetting problem. In the early period during his diagnostic process it turned out that he had serious emotional problems. He was often moody and sad without any reason. Sometimes he became irritable and withdrew from social situations. At that time, he lost his interest in school and was thinking about committing suicide. His mother reports that the teacher complains about her son because he also has behavio­ral problems in school. He is not able to control his strong emotions. He is often angry, because his classmates tease him. She describes an incident when random boys attacked her son while he was walking down the street on his way to the video shop. They teased him, got around him and when he tried to run away, they trip­ped him, he stumbled and hurt his knees. This incident shocked him very much, and since then he has become more introverted and started to think about committing suicide. Aaron was referred to a psychologist and occupational therapist for further evaluation.

Intervention Plan

Problem Statement

Aaron has difficulty in social participation secondary to poor social skills.

Long Term Goals

1. Aaron will be able to independently participate in social activities within 12 weeks.
2. Aaron will be able to incorporate CO-OP problem solving strategies independently to an unfamiliar social gathering within 12 weeks.

Short Term Goals

1. Aaron will independently verbalize the CO-OP problem solving process with 100% accuracy within 3 sessions in order to participate in social activities.
2. Aaron will incorporate CO-OP problem solving strategies within a role play session with verbal cues within 2 sessions in order to participate in social activities.
3. Aaron will apply the CO-OP problem solving strategies within a trained task with verbal cues within 4 sessions to in order to participate in social activities.

Intervention Format

Individual

Setting

Outpatient

Supplies

None

Agenda

• Greet Aaron and his mother (3 min)
• Review and discuss goals (7 min)
• Introduce Global Cognitive Strategy: Goal-Plan-Do-Check (5 min)
• Map Goal-Plan-Do-Check to a familiar task (10 min)
• Ask Aaron map Goal-Plan-Do-Check to a familiar task (15 min)
• Discuss application of Goal-Plan-Do-Check at home with Aaron’s mother (15 min)
• Session reflection and feedback (5 min)

Documentation

S: Client expressed anxiety in participating in unfamiliar social settings and lack of skills needed for social participation.

O: Client engaged in a 1 hour CO-OP based session at an outpatient clinic. Client independently applied the Goal, Plan, Do, Check process to engage in role play simulated activity with a peer to help reinforce social skills acquisition needed for social participation. Client required verbal guided instruction 3x to effectively carry out role play activity appropriately. Client showed willingness to learn and identify possible solutions and testing them out in a trial and error approach. Client was able to verbalize why his first attempts weren’t successful.

A: Client demonstrated improvement in his understanding and ability to engage in the CO-OP process. Client’s poor social skills hindered his ability to participate in role play activity without assistance. Client demonstrated good insight by identifying solutions to effectively participate in role play activities. Client would benefit from skilled OT services to improve is CO-OP application to trained and untrained tasks, along with improving his social participation skills.

P: Continue skilled OT services for 10 more sessions in order to increase ability to use CO-OP to trained and untrained tasks.

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

Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23.

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

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? British Journal of Occupational Therapy, 71(1), 23-32. https://doi.org/10.1177/030802260807100105