OTAMent-AS1-CaseStudy-Mark-vCFeb2021 (1)
OTAMent Assignment 1 Case Study A mental health case study is provided at the beginning of this course, with homework questions assigned to complement problem solving related to the daily topics addressed in class. This project is designed to develop the skills of drawing pertinent information from written documentation and applying the student’s knowledge base to occupational therapy intervention with a fictitious client. Part 1 of the case study questions will be submitted to the instructor for grading at the end of the first week, and Part 2 submitted near the beginning of the second week. Each student will submit an individual assignment. However, how you choose to complete the assignment is up to you. In other words, you may choose to work alone, liaise with colleagues, and/or use various resources for completion of the case study. While time is allotted in class for some group discussion related to the case study, this is a homework based written assignment and it is expected that students will have prepared in advance for the group discussions. The criteria for submission of this assignment are as follows: · Case study answers must be typed in 12-point font, double spaced · Each answer must be written below the corresponding question and question number · This assignment is a word document and will be forwarded to each student via e-mail. Answers can be typed directly into the document. · Note: If an editing block presents on the case study document when you open it, please copy and paste the questions into a separate word document for your use. · Ideas must be expressed in a clear, concise, organized manner · Part 1 must be handed in at the beginning of class on Day 5 · Part 2 must be handed in at the beginning of class on Day 7 · An electronic copy of the case study answers in Part 1 and Part 2 must be submitted for grading, unless otherwise specified by the instructor · Handwritten submissions will not be graded This assignment is worth 15% of the final grade. Case Study: Mark Mark is a 30-year-old Korean man with diagnoses of chronic schizophrenia and borderline intellectual disability. He was recently hospitalized due to an acute episode of psychosis, and upon discharge was referred to a community day treatment center. Mark also has asthma, allergies, and a hearing impairment. He needs to wear hearing aids. The referral to the community center was made by the hospital Occupational Therapist who believes that Mark would benefit from a structured day program with a focus on his daily functions and on facilitating community re-integration. History: According to the client’s chart, Mark was diagnosed with schizophrenia at the age of 20 and was known to have intellectual disability at the age of 8. He was born in North Korea and the only child of an agnostic family. His parents divorced soon after he was born. Mark showed some delays in his language, gross motor, and fine motor development in his childhood. However, his mother, who was suffering from chronic depression since her divorce, did not think that those delays were important. Mark and his mother immigrated to Canada when he was 6 years old. Mark’s father stayed in North Korea and did not keep in touch with Mark after they left Korea. His father was also reported to have some mental health issues. Mark has two aunts, one uncle, and 4 cousins in Canada. He has not kept in touch with them, but his mother has and received support and assistance from them when needed. After immigration to Canada Mark started attending school and displayed some challenges in learning English. The school provided some support and he also participated in English as a second language (ESL) classes. Mark’s grades were always below average, which were thought to be caused by his poor English command. Mark considered himself ‘stupid’. Mark had a close friend in elementary school, but they gradually grew apart. He did not make friends with other children in the school. Eventually, a teacher discussed the situation with the Mark’s mother, and he was referred for further consult and assessment by a psychologist. Mark’s IQ score was reported to be 80 and indicative of borderline intellectual disability. An Individual Education Plan (IEP) was developed for Mark and he received support and interventions in school to reach his academic goals. Mark did not complete his high school education and dropped out when he was in grade 9. The client’s mother was unable to spend much time with him at home and Mark spent the majority of the days alone. At the age of 18 Mark started looking and acting in an eccentric way. He stopped eating regularly and taking showers as he believed that he had to purify his body and soul by not eating and showering using chemicals. Mark later started displaying erratic behaviors such as not sleeping at nights, pacing in his room, and listening to loud music saying that he did not want to hear any other noises except for his “inner voice”. The police attended the client’s residence upon receiving complaints from neighbors about the loud music, and after talking to Mark called for an ambulance. Mark was taken to the hospital ER where he was admitted to the psychiatric ward immediately. Mark was evaluated and diagnosed with schizophrenia. After 4 weeks, Mark was discharged from the hospital and started receiving psychiatric treatments in the community provided by a psychiatrist. Over time, Mark was hospitalized on numerous occasions and received in home follow ups from outreach team members affiliated with the hospital, including an Occupational Therapist, a Behavioral Therapist, and a Social Worker. He was eventually connected to the mentioned day program. Currently, Mark lives with his mother. He has never worked or lived by himself. Mark’s residence is a two-bedroom condominium close to subway lines and public transportation in the Greater Toronto Area. The grocery stores and shopping centers are just a few short blocks from his building and are very accessible to Mark. During one of his acute episodes, Mark ran away from home (later said because neighbors had threatened his life) and police found him accidently when he was walking on the street and loudly yelling at someone who was staring at him. Mark had forcefully thrown his water bottle to the ground and yelled at the person: “What are you looking at?” Through police follow up it was found that Mark was reported to be missing. Mark’s neighbors are afraid of him and some have complained about him to the management, asking them to have him move out. Mark was also arrested once due to trespassing on someone’s property late at night. ADLs/IADLs: In terms of daily life functions, Mark has always received some assistance or supervision from his mother regarding his financial management (also receives allowance from his mother), and housekeeping activities such as grocery shopping, cleaning the floors, doing the laundry, and clothing care. He can complete the majority of his personal care independently receiving prompts from his mother, although he does make some mistakes. Mark has not been following his medication regimen properly and has forgotten to take his medications at times. He is not eating healthy food on a regular basis and mainly consumes energy drinks. He is usually sent to the barber by his mother for regular grooming tasks (i.e. shaving and haircuts). Mark never obtained his driver’s license and always uses the public transportation (e.g., bus) for traveling in town, only going to familiar places. He enjoys spending time on his computer playing games and watching movies the entire day. He does not have any close friends. Mark’s mother has decided that she is no longer able to provide care for him and he needs to do more or move out. She recently stopped reminding him of doing his personal care or take his medications as she is going through another episode of depression. She is, however, willing to provide some financial support if needed but has stated that she can no longer live with Mark unless he starts doing more. Mark noted that he believes in karma, family values, and cares for his mother a lot, which gives him motivation to try and become as independent as possible. Treatment: In terms of current treatments and interventions, Mark is following up with Dr. Yong, Psychiatrist, every 3 months and is taking the following medications: Olanzapine (Zyprexa) 10 mg q.d.; Doxepin (Sinequan) 100 mg t.i.d., Docusate (Colace) 100 mg q.d.; and multi vitamins. He continues to receive in-home follow-ups by the community outreach team. Assessment: After screening and initial admission to the Community Day Treatment Center, the evaluations were completed using the following instruments: Occupational Roles section of the Occupational Performance History Interview, Version 2.0 (OPHI-II), Routine Task Inventory- Expanded (RTI-E), and the Allen Cognitive Level Screening (ACLS). The tests and interviews were conducted by the Occupational Therapy team, including Lana the OT and Joan the OTA. Additional information was provided by the client’s mother who was also present during the initial interview. After the evaluation was completed and the information interpreted, the treatment plan was designed accordingly. Mark agreed to participate. INITIAL DATA COLLECTION The initial data was collected by the following: Occupational Roles interview (from OPHI-II): During the interview Mark gave short replies to the questions. He was wearing old baggy clothes and looked underweight. Mark displayed overall good hygiene, but his nails were observed to be long. His hair was combed only at the front. He made poor eye contact and spoke with a low volume in a monotone manner. Mark’s affect was noted to be flat. He reported that he does not enjoy life. Mark explained that he was hospitalized as he was hearing voices that belonged to aliens because he was special and had powers. He, however, no longer hears the voices. Mark stated that he does not have any friends or girlfriends and grew up without a male figure in his life. He noted that he had no one to count on except for his mother who had recently asked him to move out. Mark advised that he never had a job but wanted to have one to help his mother. He explained that he does not have the skills and intelligence required to have a