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OCCT 752: Occupations, Adaptations & Technology III
Wakeford, Spring 2007
Fieldwork I Assignment #2
(March 5-9 or 12-16, 2007)
Purpose and Background
This assignment is designed as both an exercise in clinical reasoning and an opportunity to continue
to engage in the treatment planning process based on the Occupational Performance Process Model.
Clinical reasoning is the process that allows the therapist to design intervention that is both
meaningful to the client and effective in meeting the client’s goals. It co-exists with the knowledge of
theoretical approaches, human development, illness/disability issues, philosophical and ethical
considerations, and the “institutional” workings of the clinical setting. The practice of occupational
therapy requires the blending of knowledge with engagement in the reasoning process; that is the art
and science of therapy. In order to move toward the synthesis of those two components of practice,
the clinician must have opportunities to observe, analyze, perform, consider, discuss, question,
construct and reconstruct the actual practice of therapy. This assignment is intended to offer one of
those opportunities. The clinical reasoning component of the assignment asks you to look at
treatment design and implementation, based on the types of reasoning outlined by Mattingly and
Fleming (1994) and referenced in Neistadt, Wight and Mulligan (1998). Working definitions of these
types of clinical reasoning are as follows:
Narrative reasoning: reasoning in which the client’s “life story” (past, present, anticipated future,
roles, activities) provides the basis for the development and structuring of therapeutic intervention.
Disability is not seen as a medical or physiological issue, but as an experience with person meaning
to the client, necessitating that therapy is meaningfully connected to the client’s life process, rather
than an isolated or unrelated series of events. (Mattingly and Fleming, 1994)
Procedural reasoning: “…the type of reasoning therapists used when they tried to identify their
patients’ functional problems and to select the procedures that might be employed to help people
reduce the effects of those problems.” (Mattingly and Fleming, 1994, p. 137)
Interactive reasoning: “monitoring and interpretation of one’s own and one’s client’s behavior”
(Mattingly and Fleming, 1994, p.196) in an effort to develop the collaborative relationship between
therapist and client (including caregivers) that provides the motivation and joint problem solving
necessary for goal attainment.
Conditional reasoning: used in “attempts to understand the “whole person” in the context of the lifeworld, given the influence the disability may have on the person’s future…a kind of reasoning that
makes meaning…requires imagination and an excellent ability to understand.” (Mattingly and
Fleming, 1994, p. 197)
Pragmatic reasoning: “considers the treatment environment and the possibilities of treatment with a
given setting, as well as the therapist’s level of skill and experience” (Neistadt, et al., 1998, p. 126)
The Occupational Performance Process Model (OPPM) (Fearing, et al., 1997) is overlaid on this
assignment, in that questions in Part I address the first four stages of stages of treatment planning:
 Name, validate and prioritize occupational performance issues
 Select theoretical/conceptual approaches
 Identify occupational performance components and environmental conditions
 Identify strengths and resources
Stage 5, negotiating targeted outcomes and developing action plans, will have primarily been
addressed already by the treating therapist, but will likely emerge in the content of student discussion
with the CI.
Stage 6, implementing plans through occupation, is addressed in Part II of the assignment. This
portion of the assignment allows the student to think about the relationship between the goals and
types of intervention, the client's response to the intervention and the clinical reasoning involved in
decision-making. This portion also exposes the student to specific intervention strategies, as they
return to class to focus on those and other strategies in more detail.
References:
Mattingly, C., Fleming, M.H. (1994). Clinical reasoning: Forms of inquiry in a therapeutic practice
FA Davis: Philadelphia
Neistadt, M.E., Wight, J., Mulligan, S.E. (1998). Clinical Reasoning Case Studies as Teaching Tools,
American Journal of Occupational Therapy 52, 125-132
Fearing, V.G., Law, M., & Clark, M. (1997). An occupational performance process model: Fostering client and
therapist alliances. Canadian Journal of Occupational Therapy, 64, 7-15.
Townsend, E. (Editor) (1997). Enabling occupation: An occupational therapy perspective. Ottawa: CAOT
Publications ACE (Canadian Association of Occupational Therapists).
Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy,
56, 609-639.
Assignment
There are two parts to this assignment, with questions to answer for each part. This will be completed through
interaction with your fieldwork supervisor, independent information gathering (chart review, interactions with
child/family/teachers, etc.), and observation of a treatment session.
Part I (Narrative, Procedural, Conditional and Pragmatic reasoning):
1. Who is this child?
2. What are the primary occupational performance issues that are identified in child’s record (evaluation
reports, IEP, IFSP, treatment plan, etc.)? Are there others that are not documented? Please list evaluation
methods/tools.
3. What frames of reference and/or treatment approaches are being used currently by the occupational
therapist? Why were these approaches chosen?
4. Identify problems in the following areas:
 Performance skills
 Performance patterns
 Client factors
How do these issues interfere with occupational performance?
5. What contextual considerations are there in this case which impact performance, intervention, or both?
6. What are the strengths/resources of the child, family, other caregivers?
7. How is the family involved in intervention? Are there unusual or specific family issues that need
consideration?
8. How are other caregivers (teachers, daycare providers, etc.) involved?
9. What is the role of the OT with the team as a whole?
10. What is the level of service being provided to this child? On what basis was this decision made?
11. What is the overall caseload of the treating therapist?
12. What are reimbursement/payment issues for this child’s therapy?
13. What other issues of “reality” impact service provision in this case? Is this situation typical for this setting?
Part II: (Procedural and Interactive Reasoning)
Observe carefully, take notes, etc. during a treatment session with this child, attending particularly to the
middle ten (10) minutes of the session. *Based on your observation of the middle 10 minutes answer the
following questions:
1. What is the intervention activity? Using language from the OTPF, talk about what type or types of
intervention this activity encompasses. What kind of therapeutic approach(es) does this activity imply?
2. How does this activity relate to a) the stated treatment goals and b) occupations of the child?
3. What are the child’s responses to the intervention activity?
Motor
Process
Communicative/Social
4. Given the intervention used, are the child’s responses those that you expect? Why or why not?
5. What is this child’s interactional style?
6. How does the therapist interact with the child? Does the therapist’s interactional style achieve the desired
results? (Also, think about your own preferred interactional style, and whether you would need to adapt it
in some way to interact effectively with this child…)
* Please jot down your own notes and observations first, to answer the questions above, then process with
your fieldwork supervisor to get his/her impressions of that same 10 minutes.
7. Did the intervention go as planned by the therapist? Were there things he/she would have done differently
or will keep in mind for next time?
To turn in…
1. Case Study Report:
 Please type your case study (font size no smaller than 10, double spaced).
 You do not need to re-state the questions, but please organize your work the way it is ordered on
the question pages, and identify your answers by Part and Number (e.g., list “Part I” then under it,
answers 1-12).
 Please attach a cover page to your work, labeling it as “Fieldwork I Assignment #2” and listing your
PID, the dates of your fieldwork, and your fieldwork site.
 Sign the Pledge on the cover sheet
 Attach the grading criteria sheet to the back (as with the last assignment, leave your name off the
grading sheet).
***This assignment is due no later than 5 p.m. on Tuesday, March 27, 2007, in the course instructor's box in
the Occupational Science Division office. ***