OTA 102L
Fieldwork Level I – Observational Analysis
1. Name:
Ranz Navarro
2. Facility name and description:
Integrity House of Santa Ana is a clubhouse that is modeled after the
Fountain House in New York City. It is a program that offers support and
opportunities for individuals living with a mental disability. Participants are
called “members” and activities are focused on restoring and encouraging
their strengths and abilities.
There are four different units members can participate in, Administration,
Research, Kitchen, and Maintenance. Administration unit is responsible for
answering phones, filing paper work, greeting visitors, updating member
files, and other administration duties. The Research unit is responsible for
making signs, listing items to sell on the Internet, making posters, and
website maintenance. Kitchen unit cooks lunch everyday for everybody.
Members are in charge of creating a menu, budgeting, grocery shopping and
baking. The Maintenance unit is in charge of doing repairs, painting, cleaning,
and taking care of the clubhouse. They also have a snack bar and garden on
the premise.
Currently there are about 48 male and female active members attending
Integrity House, ranging from white, black, hispanic, and asian. Youngest
member is 22 year old male and the oldest is a 64 years old female.
Members share both ownership and responsibilities for the success of the
clubhouse. Members and staff also work side by side as colleagues. Since this
is not a clinical program, there are no therapists or psychiatrists on staff.
Participations are strictly on a voluntary basis.
3. Clinical Reasoning
3.1 – Member is a 32 year old white female. She has four children who are no
longer in her custody. Her children now reside in Florida with extended
family that formally adopted her children. She has not been in contact with
her children since they moved in 2010. Member was previously married,
however, her husband passed away several years ago. Member also has a
sister that resides in Oregon, but she does not talk to her very much.
Member wants to find a job, earn money, and get custody or visitation rights
back with her children.
3.2 – Member is diagnosed with Schizoaffective Disorder. Characterized by
psychotic symptoms of schizophrenia and severe mood changes, which
include depression, mania, hallucinations, delusions, and disorganized
thinking. This member has had a history of self-destructive and dangerous
behavior, disruptive behavior, emotional outbursts (crying), and thoughts of
suicide. Member also has an incarceration record in 2005 and history of child
neglect. Schizoaffective disorder is not curable, but treatment with
psychotherapy and medication can help minimize symptoms, enabling the
person to improve social and occupational functions.
As a result of her disorder, the member that I observed sometimes have
difficulty completing her assigned tasks at Integrity House. She told me that
she currently does not like to hangout with many friends at this time. She
also states that she is currently feeling depressed and prefers to stay home
often. She limits herself coming to Integrity House to twice a week. Member
takes the Orange County Transit Authority public bus to Integrity House.
Member said that now she’s off probation, she just wants to keep out of
trouble. Member also lives independently at the Integrity House Cottages in
Anaheim. She maintains and pays for her apartment through her Social
Security funds. She is also able to independently take care of herself in terms
of self-care and hygiene. She sees her psychiatrist every 3 months to monitor
her medications.
Due to this disorder, one of the major events that this disorder affected her is
when social service took her children away from her due to child neglect.
Although she is now stable, she still has a lot of work to do. Her progress is
closely being monitored.
3.3 – Areas of strength: She enjoys living on her own and being independent.
She is also able to take care of herself, performing her Activities of Daily
Living independently. At Integrity House, she likes to help out in the research
and kitchen unit. She loves to cook and bake, help with grocery shopping, and
menu planning.
Areas of concern: Although she likes living on her own, she states that it does
get lonely and she feels like she has no one to hangout with. I suggested that
maybe she can look in to community activities at her local park or maybe at
Santa Ana Community College. She also has difficulty managing her finances.
Currently, Integrity House assists her with her budgeting and financial
responsibilities.
4. 3.4 – The member’s personal goals are 1) To try and look at people when
talking to them, 2) To build a relationship with her children, and 3) To try
and speak up for herself.
Two goals that are appropriate for the patient are 1) Member will actively
seek employment in an area she enjoys. She will follow the duties of a job
description and maintain employment to enhance her skills. (Work), 2)
Member will participate in social/recreational activities with friends and
peers at least four times per month. (Social Participation)
3.5 – I would use Occupational Behavior as a frame of reference. With this
frame of reference, it will help me assist and guide my client to intrinsically
motivate and socially engage in occupations. This approach will enhance her
strengths, incorporate her interests, and by using play and leisure to develop
her skills.
3.6 – One activity I observed with this member is in the kitchen unit
preparing lunch for the members. The kitchen unit cooked chili, toasted
garlic bread, and strawberry and banana fruit salad. She loves cooking and
working in the kitchen enhances and strengthens her skills. Everyday is a
different menu and she’s able to follow instructions and complete the task
whenever she’s working in the kitchen unit.
3.7 – Member later told me that she enjoys working in the kitchen unit
whenever she’s at Integrity House. She reports to me that she learned
something new every time she works in the kitchen unit and that maybe she
can find a job as a cook in a restaurant. I suggested if she could volunteer at a
homeless kitchen. She replied that he just might do that and make new
friends as well.
3.8 – What I would change next treatment session would probably be the
complexity of the recipe. Have her cook or bake something from scratch
within a smaller time frame without getting frustrated.
5. Evidence Based Practice:
The member I observed is a 51 year old female diagnosed with Bi-polar
disorder, hyperthyroidism, and diabetes mellitus. She gets very defensive
which results into agitation and verbal aggression, usually about her diet,
controlling her spending, and budgeting her money. She has a hard time
accepting that someone is just trying to help her.
As an intervention plan, I would use a Behavioral Approach System (BAS.)
When my client escalates into an agitated state and becoming verbally
aggressive, reassure her that no one is trying to force her to do anything.
Keep telling her that people are only trying to sincerely help her so she will
not have to suffer the negative consequences of her choices, especially with
her diet that can affect her diabetes. By using Behavioral Approach System
(BAS), it will generate positive emotions and motivations. Reward her by
providing a lot of verbal praise for controlling herself and engaging in calm
appropriate communication and verbal exchange with others.
Nusslock R, Abramson LY, Harmon-Jones E, Alloy LB, Coan JA. Psychosocial
Interventions used for Bipolar Disorder: Perspective from the Behavioral
Approach System (BAS) Dysregulation Theory. Clin Psychol (New York).
2009 Dec 1;16(4):449-469. PubMed PMID: 20161456; PubMed Central
PMCID: PMC2790718.
6. Occupational Profile
5.1 – Client is 56 year old male diagnosed with mild retardation, mild
intermittent asthma, and Chronic Obstructive Pulmonary Disease (COPD) .
He has dark brown eyes and graying hair of Filipino descent. He is 5 foot 5
inches tall and weighs approximately 180 pounds. He is ambulatory but
walks with a slight limp due to knee replacement surgeries on both knees. He
has good verbal skills and is able to express his needs. He is very friendly and
polite in his interactions with others. He actively participates in the research
unit and has painted many murals at Integrity House.
5.2 – Client concern regarding daily life activities. 1) Client participates in
numerous household activities including chores and cooking. He can cook
simple meals such as eggs, pancakes, and chicken independently but relies on
his mother to prepare complex meals. 2) Client enjoys doing yard work, but
allergens can sometimes prevent him from doing so due to his asthma. 3)
Client needs help in keeping track of his medical records. Currently, Integrity
House’s Independent Living Staff (ILS) assists him with filing his medical
records and following up with medical appointments. 4) Client’s mother is
aging. He seeks a service that will allow him to live independently once his
mother passes away.
5.3 – Client has completed several murals at Integrity House. Client likes to
paint and express his creativity. Client also likes to participate in
maintenance activities, such as repairs and renovations at Integrity House.
Two things that inhibit the client from participating in certain activities are
his health conditions; asthma/copd and his knees. He is unable to carry
heavy objects due to his knee surgery and unable to participate in certain
activities that may trigger his asthma.
5.4 – Client is able to complete all activities of daily living without assistance
in the areas of self-care; eating, toileting, personal hygiene, bathing, and
dressing. Areas of occupation that may be a problem or risk for the client is
work. Due to his mental illness and health condition (asthma/copd) he has
been unsuccessful finding work. Community mobility is also an issue due to
his health condition. Client knows how take the public bus, but currently uses
OCTA’s ACCESS service for transportation.
5.5 – Client was born in Hawaii in 1956 and moved to California in 1987.
According to his chart, “his developmental history is mildly abnormal. He
walked late, but was speaking in phrases by the age of 2.” He attended a
special education program in Hawaii. Client has three sisters and a brother
who are all normal.
Client has held a job before as a courtesy clerk at Ralph’s from October 2007
through February 2008. Since 2008, client has participated in the Integrity
House day program. Client attends five days a week for an average of six
hours a day. He is currently a member of the research and maintenance unit.
Client is always willing to help with different tasks such as flyer and poster
projects, drawing art that is eventually converted to digital format for use in
Microsoft Publisher. Client also occasionally helps with various tasks in the
maintenance unit such as cleaning, repairs, and stocking the snack bar.
Client is always happy and ready to participate in most activities each day, as
long as his health allows. He prefers creative activities such as painting and
drawing. He rarely has any issues with other members, staff, or the tasks
assigned to him.
5.6 – Client’s long-term goals: Client will maintain good physical health,
client will improve independent living skills; money management skills and
medical records keeping, and client will seek and acquire a job.
Client’s short-term goals: Client will schedule his own social and recreational
activities, client will learn how to use a computer starting with internet
explorer and Microsoft word, and client will learn how to find a job online
using JobDeveloper.com.
5.7 – Daily Schedule
6:00am – Wake up, get ready, and eat breakfast
7:30am – OCTA ACCCESS bus pickup for transport to Integrity House
8:00am – Arrive at Integrity House, complete assigned daily tasks
12:00pm – Lunch
1:00pm – Continue working on assigned daily tasks
2:30pm – OCTA ACCESS bus pickup for transport to go home
3:00pm – Arrive home, do house chores
6:00pm – Dinner
7:00pm – watch TV
8:00pm – Get ready for bed
7. Therapeutic Use of Self
I casually approached my client because of something we both had in
common, we were both from Hawaii. It became a topic of our conversation
and we were both speaking in a language we both understood, Hawaiian
pidgin. Client was very enthusiastic in speaking with me and sharing his
stories and his life. Client was very open in answering the questions I had for
him. We talked a lot of stories about Hawaii, when we moved here, life on the
mainland, and what we missed most about Hawaii.
Client indicated that his mother’s health has been unstable, she’s getting
older, and she might pass away soon. He’s worried about who’s going to take
care of him and also that he’s going to miss his mother. I empathized with
him and I told him that I understand that we all get old and move on. I also
told him that I know how he feels because I feel the same way with my
mother and father. I also advocated for him to seek help or assistance from
his two sisters who lives locally.
Our interview was successful; we were both comfortable with each other. It
felt like we were neighbors just having a simple conversation. People from
Hawaii just have this common bond, a bond that is hard to break; the bond of
Aloha.
8. Documentation
7.1a – Cerebral palsy/ataxia, 36, male hispanic. Participate in administrative
activity. Created signs for bookshelves using Microsoft Word on a computer
with a printer. Client had difficulty typing due to uncontrolled muscle
movements. Moderate to maximum assist. Member repeatedly presses the
wrong letter on the keyboard, assisted member correcting error with
backspace button. Member completed task.
7.1b – Member required moderate to maximum assistance. I didn’t find this
activity appropriate for the client. Without proper adaptive equipment and
training, it was difficult to accomplish the task independently.
7.2 – SOAP Notes
S – Down syndrome, 32, male Hispanic. Participates in craft activity without
completion
O – Member is unable to complete task due to getting caught pocketing
supplies. Patient denies action and exhibits inappropriate behavior with
others then leaves group.
A – Member is able to perform task and improve social skills with others in
the administration unit.
P – Member will continue to participate in one therapeutic activity of his
choice 1x/week in order to improve social skills.
9. Role of OT
The overall goal of an occupational therapy practitioner at a clubhouse is to
help members develop the skills and interests and to be independent and
productive. By providing appropriate interventions to improve their quality
of life.
Practitioner: helping a member adapt their environment at home and at
work to promote their occupational function and independence. Provide
goal-oriented activities, stress management activities.
Educator: providing a treatment group or education program where a
member can learn or develop their skills and interests. Help clients identify
what is safe and not safe. Teach members different techniques to manage or
cope with their disability.
Fieldwork Supervisor: help members to seek and acquire employment,
independent living, and community mobility. Monitor members living
independently; help client with finding resources for employment, education,
and assistance programs.
Consultant: help adapt the facility for work simplification and energy
conservation. Provide an ergonomic and safe environment. Preparing an
emergency plan for members.
10. Ethical Issues
There was one incident where one of my colleagues gave one of the members
a physical activity workout in the weight room without knowing the
precautions and condition of the member. The member requested that he
wanted to workout. According to the schedule, physical workouts are only
allowed on Mondays and Tuesdays when a trained professional trainer is
present and can get members in and out of their wheelchairs on to a
machine. The member has cerebral palsy/ataxia. One of the precautions of CP
is no strength training with weights and member is on a wheelchair. I saw
them doing strength training with weights on his wrist and ankles. I pulled
my colleague aside and advised him to stop. Because he may injure him and
he should get permission from the clubhouse supervisor before doing the
activity. I also told him that he should adhere to clubhouse rules and
regulations. In response, he terminated the activity.
According to the AOTA Code of Ethics’ Nonmaleficence, “Principle 2.
Occupational therapy personal shall intentionally refrain from actions that
cause harm.”
American Occupational Therapy Association. (2005). Occupational therapy
code of ethics (2005). American Journal of Occupational Therapy, 59, 639–
642.
11. Time and dates of fieldwork scheduled at facility
12. Attach complete Fieldwork Site Evaluation form
13. Attach completed Student Performance Evaluation
14. Attach Journal
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.16.12
Time of Treatment Session: 10:00am – 12:00pm
Patient Initials: DV Age: 51
Gender: F
Diagnosis: Bipolar I, Manic, Type 1 Diabetes
Activity (briefly describe): Clerical and organizational activities; filing,
categorizing, and inventory.
Goals of Treatment: Member will complete all of her Unit Tasks before lunch.
Tasks include organizing office supplies, filing purchase receipts, and making a list
of office supplies needed.
Treatment Environment and Modifications: Member is currently part of the
research unit, working with computers, filing folders and cabinets. No modifications
Equipment: Filing folders, pen, and envelopes
Precautions: Type 1 diabetes, sharp objects, lifting of heavy boxes
Patient Reponses: Member was very willing to complete two tasks but hesitated
doing one task and needed assistance.
New things I learned and definitions: Changes in mood with bipolar disorder are
not predictable. It is hard to tell whether a patient is coming out of a bipolar phase.
Other activities I observed or participated in:
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Office supplies inventory
Desktop printing
Group cleanup before lunch.
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.18.12
Time of Treatment Session: 10:am – 12:00pm
Patient Initials: SB Age: 32
Gender: F
Diagnosis: Psychotic-Schizoaffective Disorder
Activity (briefly describe): Clerical and administrative duties; checklist, typing a
newsletter
Goals of Treatment: Member will complete tasks before lunch. Make eye contact
with other members while taking attendance. Member will participate in at least
one social and recreational activity.
Treatment Environment and Modifications: Member is currently working in the
Administration Unit. Attendance is taken by walking around and searching for
members. No member sign-in sheet.
Equipment: Clipboard, pen, computer, printer
Precautions:
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Depression
Medication
Moderate hypertension
Patient Reponses: Member enjoys saying hello and good morning to members in
the morning. Member expressed that although she enjoys the company of her peers
at Integrity House, sometimes she feels that she has no one to hangout with.
Suggested to join an activity program or recreational center to meet new people.
New things I learned and definitions: Self-management techniques, including
participating in internet forums, are sometimes used by individuals with
schizoaffective disorder.
Other activities I observed or participated in:


Cleanup
Data entry

Serving lunch
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.23.12
Time of Treatment Session: 1:00pm – 2:00pm
Patient Initials: DB Age: 56
Gender: M
Diagnosis: Developmentally disabled, Mild retardation
Activity (briefly describe): Create thrift store signs, print, cut, and laminate. These
signs will be put up on the thrift store windows.
Goals of Treatment: Member will create window signs allowing him to use his
creativity by using the computer and desktop publishing software.
Treatment Environment and Modifications: Research Unit. Use of computers and
laminating machine
Equipment: Computer, paper slicer/cutter, laminating machine, printer
Precautions:
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Member had a history of burning or melting laminating covers with the
laminating machine.
Assist using the paper cutter/slicer when trimming edges of laminated sign
Patient Reponses:
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Member was excited designing the sign.
Had a lot of input.
Needed assistance trimming sign’s edges evenly
Needed assistance using the computer
Asked if I can pick up the prints down the hall
New things I learned and definitions: We have to give them as much opportunity
as possible to participate to develop their skills and interests.
Other activities I observed or participated in:
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
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Cleanup
Making a piñata
Greeting card workshop
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.23.12
Time of Treatment Session: 9:00am – 12:00pm
Patient Initials: JG Age: 34
Gender: M
Diagnosis: Down syndrome
Activity (briefly describe): Cooking group. Preparing lunch for all members and
staff. Served pesto pasta, strawberries, cucumber salad, and toasted bread.
Goals of Treatment:
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
Member will be able to work with other group members and be respectful.
Member will complete task before lunch
Treatment Environment and Modifications: Kitchen unit
Equipment: Knife, cutting board, large bowl, latex gloves, stove, apron
Precautions:
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Member has a history of aggressive and disrespectful behavior.
Using a knife or sharp object when cutting vegetables and fruits
Patient Reponses:
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
Member was rude telling staff and other members “you’re fired!”
Did not complete 2 out of 3 tasks given
New things I learned and definitions: a major precaution I learned is knowing
about the member’s behavioral history. It can give you a heads up of how a member
with down syndrome will react to an activity.
Other activities I observed or participated in:
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Carrying boxes of canned goods being delivered from the food bank
Showed another member how to properly stir pasta in the pot after he
complained his shoulder were hurting
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.25.12
Time of Treatment Session: 9:00am – 12:00 pm
Patient Initials: RS Age: 42
Gender: F
Diagnosis: Cerebral Palsy, Ataxia
Activity (briefly describe): Laundry; washing rags, aprons, and towels used in the
kitchen. Using laundry detergent, bleach, and fabric softener. Drying washed items
in the dryer.
Goals of Treatment: Member will wash and sanitize rags, towels, and aprons for
use in the kitchen. Member will demonstrate ability to perform daily task as job
training.
Treatment Environment and Modifications: Washer and dryer are located in a
closet along the main hallway. Member pushes his wheelchair with him all the time
and when doing his laundry task, wheelchair blocks part of the hallway.
Equipment: Washer and dryer, laundry detergent, bleach, fabric softener, rags,
towels, aprons.
Precautions: Member uses a wheelchair as a walker, use of laundry detergent and
bleach; task is performed in a hallway with high traffic.
Patient Reponses: Member enjoys doing laundry everyday, except for the folding
part.
New things I learned and definitions: the average lifetime cost for someone with
CP is over 1 million dollars.
Other activities I observed or participated in:

Folding rags, towels, and aprons for use in the kitchen.
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.25.12
Time of Treatment Session: 1:00pm – 2:30pm
Patient Initials: SN Age: 56
Gender: M
Diagnosis: Mild mental retardation
Activity (briefly describe): Halloween decoration. Putting up props.
Goals of Treatment: Member will be given the opportunity to creatively decorate
the activity hall with Halloween decoration with the group.
Treatment Environment and Modifications: Large hall used for activities and
lunchroom for all members. Chairs were put aside against the wall; tables were
folded and put away.
Equipment: Hammer, scissor, ladder, stapler, Halloween props, tape.
Precautions: climbing ladder, sharp objects, carrying heavy objects, disruptive
behavior.
Patient Reponses: Member was able to finish two tasks; making a poster and
putting up Halloween props. Had one disruptive behavior; taking away another
member’s material without permission resulting in an argument.
New things I learned and definitions: the members I observed had a high level of
function when putting their creativity to work. They just run away with it and go
wild with the decorations and props.
Other activities I observed or participated in: Helped other members putting up
their decoration, creating a Halloween poster, and taking down the bingo machine.
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.26.12
Time of Treatment Session: 10:00am – 12:00pm
Patient Initials: KF Age: 32
Gender: F
Diagnosis: Traumatic Brain Injury (TBI), MVA
Activity (briefly describe): Listing items for sale on craigslist.com. Using a
computer to list an ad on the internet.
Goals of Treatment: Member will demonstrate that she can follow instructions
how to list an ad on the internet using a computer.
Treatment Environment and Modifications: Research unit; a small computer lab
and printer.
Equipment: Computer, printer
Precautions: Headaches, easily distracted away from task
Patient Reponses: Member gets frustrated; frequent 3 to 5 minute breaks
New things I learned and definitions: I learned today that working with TBI
requires more patience than I expected. Very repetitive when giving instructions.
Other activities I observed or participated in:
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Helped other members with their task
Editing pictures on the computer
Formatting font sizes and color
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 10.30.12
Time of Treatment Session: 10:00am – 12:00pm
Patient Initials: LM Age: 38
Gender: M
Diagnosis: Down syndrome
Activity (briefly describe): Preparing and cleaning lunchroom for lunchtime.
Setup tables and chairs, arranged tables and chairs for lunch. Swept floor, wipe
down tables with damp cloth and Windex.
Goals of Treatment: Member will clean and arrange lunchroom as instructed
before lunch is served at 12pm.
Treatment Environment and Modifications: Large hall used for activities and
lunchroom for all members. Chairs and tables were rearranged for members to sit
and eat their lunch.
Equipment: Broom, dustpan, damp rag, Windex, chairs, tables.
Precautions: Disruptive behavior towards other members and staff.
Patient Reponses: Member was able to finish task, but he disappeared for 15
minutes after he told me he was going to the bathroom. Later found him in the
recreation room playing foosball.
New things I learned and definitions: I must keep track of my client at all times,
never let them out of my sight, make sure they go where they are going and follow
them.
Other activities I observed or participated in:
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Helping members serve other member’s lunch.
Cleaning up the lunchroom after lunch.
Handing out plates and utensils
SANTA ANA COLLEGE
OTA 102L FIELDWORK – JOURNAL FORMAT
Student’s Name: Ranz Navarro
Facility: Integrity House
Date: 11.2.12
Time of Treatment Session: 9:30am – 11:30am
Patient Initials: GH Age: 56
Gender: M
Diagnosis: Mild mental retardation, Asthma
Activity (briefly describe): Printing and editing pictures for the Research Unit
Member board poster/sign. Print member portrait with white border.
Goals of Treatment: Member will learn how to print pictures using a computer
following a five-step instruction.
Treatment Environment and Modifications: Research unit, a small computer lab
with tables, office chairs, and computers. Simulates an office work environment.
Equipment: Computer, photo printer, scissors, tape.
Precautions: Use of sharp objects, member has asthma; watch out for asthma
triggers such as allergens, dust, and stressing member out.
Patient Reponses: Member was enthusiastic and sharing who’s who. Member also
enjoyed using the computer and looking through pictures. Although, member
required constant cuing on the next step to print or search for pictures.
New things I learned and definitions: They use water-based paint so it doesn’t
irritate or trigger any respiratory problems.
Other activities I observed or participated in:
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Helping other members with their computer project.
Going through job search engines on the Internet.
Use of Microsoft Word and creating documents.
Formatting of documents such as font size and color.