Occupational Therapy in Community-Based Practice Settings 2nd Edition by Marjorie Scaffa, Maggie Reitz

تمرين 1

Antonio
Contributed by Karen Leigh, MS, OTR/L, San Francisco Veterans Administration Homeless Mentally Ill Outreach Program
Antonio is a 63-year-old male who emigrated from Nicaragua at the age of 11 with both parents and an older brother. He reports he developed symptoms of schizophrenia following an automobile accident shortly after high school graduation, and that his symptoms were exacerbated by his service in the U.S. Navy and worsened following a breakup with his girlfriend. Antonio had been hospitalized five times prior to seeking treatment at the Veterans Administration (VA) hospital and was primarily living on the street, in shelters, or in single-room-occupancy hotels. He self-medicated with cocaine, amphetamines, marijuana, and alcohol, and initially presented to the VA for substance abuse treatment in 2001.
Following an acute hospitalization and a 3-year stay in a locked facility, Antonio has been living in a board-and-care home and receiving intensive case management services at an out patient VA clinic for the past 2 years, where he has remained abstinent from all substances and regularly attends AA meetings.
Antonio began attending an outpatient Psychosocial Rehabilitation program where he completed an initial evaluation with the occupational therapist. The evaluation revealed that Antonio's most important goal was "to shave more often," and together he and the occupational therapist determined this would be every other day. He was currently shaving about once a week and typically only when reminded by board-and-care staff. Further evaluation using the Allen Cognitive Level Assessment demonstrated that Antonio's cognitive level of functioning was consistent with the need for striking visual cues to initiate ADLs. An evaluation of his living environment revealed that some shaving supplies were kept in a closed cabinet in his room and others were kept locked up by the board-and-care operator and provided upon request.
Antonio's intervention plan included the purchase of an electric razor that he would be allowed to keep in his room. The occupational therapist and client reviewed use and proper care of the razor, and together determined a place near the sink where the razor would be visible to maximize the likelihood of its use. A can of shaving cream was also placed with the razor. The occupational therapist educated the board-and-care operator on the need for these items to be left where they had been placed in order to maximize their use.
What other types of functional difficulty might Antonio be having?