OC TH 6140

Fall 2016

Community Client Treatment Plan Assignment

The purpose of this assignment is to provide students with an opportunity to plan and implement an
intervention session for a pediatric client under the supervision of an occupational therapist or
occupational therapy assistant. Students integrate knowledge from theory, evaluation, and intervention
courses to develop evidence-based treatment activities for weekly occupational therapy sessions with a
client in the community. The treatment session assignment will be submitted to the supervising
occupational therapist at least two days before the clients scheduled appointment in order to allow time
for the therapist to provide the student with benefit.

Clients Name: Supervising Therapist:

Student Therapist:
Date of session: Time:
Clients Goals:

Clients Occupations to be treated include: (check all that apply)

ADLs/Self Care: (bathing, showering, toileting & hygiene, swallowing/eating, feeding, Personal device care & managing
personal belongings, personal organization ,functional mobility, personal hygiene and grooming)
Instrumental ADLS & Graphic Communication: (Care of others, Care of pets, child rearing, Communication management,
driving & community mobility, financial management, health management & maintenance, home establishment & management,
meal prep & cleanup, religious/spiritual activities & expression, safety & emergency maintenance/awareness, & shopping &
Handwriting, Keyboarding, Drawing, Coloring, Art, etc).
Rest & Sleep: (Rest, sleep preparation, sleep participation)
Education: Formal Education- Participating in academic (e.g., math, reading, degree coursework), nonacademic (e.g.,recess,
lunchroom, hallway), extracurricular (e.g., sports, band, cheerleading, dances), and vocational (prevocational and vocational)
educational activities.
Informal Education- (beyond formal education e.g. Identifying topics and methods for obtaining topic-related information or
skills).
Informal personal education participation- Participating in informal classes, programs, and activities that provide instruction
or training in identified areas of interest.
Work: (Employment interests & pursuits, Employment seeking & acquisition, job performance, retirement preparation and
adjustment, volunteer exploration & participation).
Play & Social Participation: (Social Awareness, Building/Maintaining Relationships, Turn-taking, imaginative play, sharing
materials, exploring new play ideas/opportunities, play exploration, social participation in community, family and with peers)
 Leisure: (Leisure exploration & participation)

Client Factors & Performance Skills/Patterns addressed: (check all that apply)
Motor/Muscle/Movement Skills Sensory Skills Social Skills
Core Stability Manipulation Temperature Pressure Engages/Approaches Others
Endurance Coordination Hearing Taste Concludes/Transitions/Takes turns
Position/Aligns Motor Vestibular Smell Communicates (verbal/non-verbal)
Planning
Joint Mobility Reaching/gra Tactile Pain Looks/Turns (Makes eye-contact)
sp
Joint Stability Reflexes Proprioceptiv Visual Emotional Expression
e
Tone & Strength Controlled Discriminatio Modulatio Physical behavior (regulates movement,
Movement n n position, touch)

Other: Other: Other:

Processing/Cognitive/Mental functions: Visual Perceptual/Visual Motor Skills

Attends Experience of self & time Oculomotor Skills Object Perception
Memory Emotional regulation Visual Attention Eye-hand Coordination
Sequences Tasks Energy & drive Visual Discrimination Copying Shapes
Executive Functions Notices/responds to cues Visual Motor Speed Spatial Relations
Chooses/Uses materials Pacing of activities Visual Memory Form Constancy
Locates/Gathers materials Organizes Materials Depth Perception Visual Acuity
Adjusts/Accommodates Navigates Environment Visual Closure Sequential Memory
Initiates/Continues/Terminat Orientation to self, other, Figure Ground Visual Closure
es Tasks/Activities time & place
Other: Other:

Materials:

Intervention Description & Time Approach: Type: Practice Goal(s)

-Accurately described & analyzed CORRELATE with
stated Practice model(s)
Model: addresse
-Described step by step in enough detail so that if
Create/Promote Occupations/ d:
Establish, Activities
another therapist had to take over the session they
would know what to do Restore Preparatory/
- Describe what SKILLED adaptations to make for that (remediation) methods &
individual client to each activity). HINT: if done well Maintain tasks
you can copy/ paste into SOAP note, make minor Education/
adjustments to actually reflect what happened in the Modify
training
(adaptation,
session and this will save you A LOT of time!) compensation) Group
Prevent Intervention

Warm up (5-10 Minutes): Activity Demands: Purpose & Targeted

(OTPF table 7) Skill Development:
Relevance: (This NEEDS to correlate with the
Objects: stated Practice model)
Space demands:
Social demands:
Sequencing/Timing:
Skills:
Body Function/Structures:

Activity 1 ( minutes): Approach: Practice Practice Goal(s)
Model(s): Model: addresse
Create/Promote d:
Establish,
Restore
(remediation)
Maintain
Modify
(adaptation,
compensation)
Prevent
Activity Demands: Purpose & Targeted
(OTPF table 7) Skill Development:
Relevance: (This NEEDS to correlate with the
Objects: stated Practice model(s)
Space demands:
Social demands:
Sequencing/Timing:
Skills:
Body Function/Structures:

Activity 2 ( minutes): Approach: Practice Practice Goal(s)
Model(s): Model: addresse
Create/Promote d:
Establish,
Restore
 (remediation)
Maintain
Modify
(adaptation,
compensation)
Prevent
Activity Demands: Purpose & Targeted
(OTPF table 7) Skill Development:
Relevance: (This NEEDS to correlate with the
Objects: stated Practice model(s)
Space demands:
Social demands:
Sequencing/Timing:
Skills:
Body Function/Structures:

Activity 3 ( minutes): Approach: Practice Practice Goal(s)
Model(s): Model: addresse
Create/Promote d:
Establish,
Restore
(remediation)
Maintain
Modify
(adaptation,
compensation)
Prevent
Activity Demands: Purpose & Targeted
(OTPF table 7) Skill Development:
Relevance: (This NEEDS to correlate with the
Objects: stated Practice model(s)
Space demands:
Social demands:
Sequencing/Timing:
Skills:
Body Function/Structures:

Cool Down (5 minutes): Approach: Type: Practice Goal(s)
Model(s): addresse
 Create/Promote Occupations/ d:
Establish, Activities

Restore Preparatory/
(remediation) methods &
Maintain tasks
Education/
Modify
training
(adaptation,
compensation) Group
Prevent Intervention

Activity Demands: Purpose & Targeted

(OTPF table 7) Skill Development:
Relevance: (This NEEDS to correlate with the
Objects: stated Practice model(s)
Space demands:
Social demands:
Sequencing/Timing:
Skills:
Body Function/Structures:

Home Program/Homework:

Educational Materials (as applicable AT LEAST MONTHLY): See Attached

Student Therapist Signature: Date:

Supervising Therapist Signature: Date: