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Introduction

Skills training is an intervention that involves the acquisition of skills to increase an individual’s ability to further participate in life via activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s) (Brown, Stuffel, & Munoz, 2010). The administration of skills training has been found to increase role functioning, self efficacy, quality of life, and the ability to participate more fully in community living. Skills training may benefit individuals with obesity by increasing better health and wellness, as well as, increasing weight loss behaviors, through incorporating skills in nutrition and physical activity, such as:  meal preparation, grocery shopping, and fitness routines (Brown, Stuffel, & Munoz, 2010).

Theory

Skills training follows learning theory principles of behaviorism and social learning (Kitzman-ulrich et al., 2010), but the development of performance skills and consideration of client factors allows occupational therapists to practice in these areas (OCCUPATIONAL THERAPY PRACTICE FRAMEWORK: Domain & Process 3rd edition, 2014).

Case Study

Rosa is a 52-year-old woman with type II diabetes who weighs 265 lbs (Cypress, 1999). She describes difficulty losing weight, and does not know what to do about it. The client reports feeling fatigued for the most part of the day, especially in the afternoons. Rosa also reports that she has gained a lot of weight in the last 5 years and that she has never been this overweight before. Rosa and her primary doctor are concerned about her health decline and encourage her to to lose some weight to improve her health. Her sugar levels are high and she reports that she was never formally taught how to calculate her daily sugar intake for her diabetes. On a daily basis, she eats mcdonalds, krispy kreme donuts, soda, pan cubano, cafe con leche, candy, chicharrones, and cuatro leches. Her goals include losing weight and getting her cholesterol and sugar levels back under control (Cypress, 1999).

Evidence

A lack or improper use of skills can affect social competence, and low social competence has been shown to increase the chances of developing obesity as early as the third grade (Jackson, & Cunningham, 2015). Skills training then is a path to increase social competence, and in certain groups within a mental health setting, has been shown to improve health and physical fitness outcomes (May, Gazda, & Powell, 1985).

Intervention Plan

Problem Statement

• Client has difficulty losing weight secondary to poor health management skills.

Long Term Goals

• Client will be able to interpret food nutrition labels when grocery shopping to improve her health literacy skills by discharge.

• Client will be able to calculate her carbohydrate intake for each meal to manage her blood glucose levels to improve her health management skills by discharge.

Short Term Goals

• Client will be able to identify portion size, carbohydrate, protein, sugar, and calories on a packaged food item to improve health management skills by 1 week.

• Client will design one healthy meal per day using food pyramid guidelines, for health management in 1 week.

• Client will identify 3 sugar free snacks to incorporate into her daily diet to improve her health management skills in 1 week.

Intervention format:

• Individual

Setting

• Outpatient clinic

Supplies

• Clipboard
• Pen
• Highlighter
• Loose leaf paper
• Scissor
• USDA myPlate guideline

Agenda

• Greet client and build rapport (5 min)
• Identify what current eating habits are like through open-ended questions (5 min)
  • “What do you typically eat during your day?”
  • “What are your favorite snacks?”
  • “How often do you have snacks?”
  • “Do you make your own meals or eat meals prepared for you?”
• Designed a dinner plate using cutouts from her grocery store magazine while referencing USDA myPlate guidelines (15 min)
• Educate client on proper portions for each meal (8 min)
  • Provide guidance on locating USDA resources online
• Summarize session (2 min)

Documentation

S: Client stated that she, “is tired of being fat and sick.” She said that she, “wants to lose weight to go out and party with the girls.”

O: Client participated in a meal preparation activity where she designed a dinner plate using cutouts from her grocery store magazine on a 4-way partitioned plate, while referencing the USDA myPlate during therapy. Client required 6 verbal cues to identify the correct amount of carbohydrates for her meal. She was independent in identifying proper portions of vegetable and fruit servings per meal. Client required 4 verbal cues to identify the correct serving of fats and protein for her meal. Client was able to identify 50 percent of the proper portion sizes for her meal. Client presented with ambivalence about creating a healthy meal at the start of the session, but ended the session motivated about creating healthy meals.

A: Client’s continued difficulty in identifying the correct amount of fats and protein per day shows a need for client-focused education in preparing healthy meals. Clients increased ability to identify the correct amount of vegetables and fruits per day shows increased insight into healthy food preparation. Client’s ability to identify food servings during the activities shows increased potential for learning how to prepare healthy meals to lead a more healthy lifestyle to control cholesterol and sugar levels to facilitate weight loss.

P: Client will resume therapy 3 times a week for 30 minutes a session. Sessions will be focused on skill development within health management and cognitive strategies to suit behavior change and maintenance. Client will be referred to a nutritionist to pursue additional health supports. Client will be given an assignment to craft a meal at home using the USDA Food Pyramid guidelines and take a photo on her phone to bring to the next session.

References:

Brown, Catana, et al. Occupational Therapy in Mental Health : A Vision for Participation, F. A. Davis, 2010. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/fiu/detail.action?docID=3009641.

Cypress, M. (1999). Case study: A 52-year-old woman with obesity, poorly controlled type 2 diabetes, and symptoms of depression. Clinical Diabetes, 17(3), 143.

Jackson, S. L., & Cunningham, S. A. (2015). Social competence and obesity in elementary school. American Journal of Public Health, 105(1), 153-158. Retrieved from            http://ezproxy.fiu.edu/login?url=https://search-proquest-com.ezproxy.fiu.edu/docview/1644296840?accountid=10901

Kitzman-ulrich, H., Wilson, D. K., St George, S.,M., Lawman, H., Segal, M., & Fairchild, A.    (2010). The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs. Clinical Child and Family Psychology Review, 13(3), 231-53. http://dx.doi.org.ezproxy.fiu.edu/10.1007/s10567-010-0073-0

May, H. J., Gazda, G. M., & Powell, M. (1985). Life skill training: psychoeducational training as mental health treatment. Journal Of Clinical Psychology, 41359-367. doi:10.1002/1097-4679(198505)41:3<359::AID-JCLP2270410308>3.0.CO;2-U

OCCUPATIONAL THERAPY PRACTICE FRAMEWORK: Domain & process 3rd edition. (2014). The American Journal of Occupational Therapy, 68, S1-S48. Retrieved from http://ezproxy.fiu.edu/login?url=https://search-proquest-com.ezproxy.fiu.edu /docview/1510287948?accountid=10901