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The Adults Doing Life Skills clinic serves adults who have diagnoses such as mild, moderate, and severe intellectual impairments, cerebral palsy, brain injury, epilepsy, autism and other developmental disorders. The main referral source is the Center for Disability Services. The focus of the clinic is to provide meaningful occupations for adult consumers, while maintaining and increasing functional skills. Many of the consumers are in wheelchairs, are nonverbal, have limited functional movement, and/or are incontinent. Individual evaluation and treatment includes mobility, feeding and swallowing assessment and treatment, sensory modulation, range of motion, attention, and activities of daily living. Through evaluation, the clinic helps to determine functional independence levels. Intervention is designed to promote independence in activities of daily living, independent living skills, improve sitting and standing balance, increase PROM and AROM, improve independent feeding skills, fine and gross motor skills, decrease drooling, develop sensory diets for sensory modulation, increase communication, and promote leisure skills.

The role of the occupational therapy fieldwork students, under the supervision of a licensed occupational therapist, includes in-depth evaluation and designing client-centered intervention directed toward engagement in meaningful occupations and improvement of functional skills. Interns utilize therapeutic use of self to develop rapport and therapeutic relationships with their consumers. Interns also become proficient in administration of assessments during evaluation, writing and carrying out of treatment plans, including development of long and short term goals, using the goal attainment scale model, documentation of daily as well as semester progress, reporting on and providing evidence-based practice as it relates to their consumers, reporting at clinical care team meetings, and providing treatment throughout the semester. Interns are expected to communicate with caregivers and staff, in the clinic as well as through home visits.

Client evaluation process

The evaluation is scheduled over two to three treatment sessions and consists of standardized assessments, screenings, and observations in the clinic, and home visits as appropriate. Students also contact caregivers and family members to obtain evaluation information.

Consumers are seen individually and evaluated by the primary student and a partner. Each student has two primary and two secondary consumers.

Specific areas covered in the evaluation include: occupational profile, cognition, orientation, attention, memory, safety awareness, topographical orientation, communication, vision, visual perception, UE and LE AROM and PROM, MMT, grip and pinch strength, muscle tone, sensation, functional use of UE, fine motor, gross motor, praxis, motor planning, calibration, balance, transfers and mobility, protective reactions, posture, endurance, functional transfers, bed mobility, ADLs, IADLs, vocation, leisure, living situation, and psychosocial status.

Standardized assessments may include any of the following: comprehensive assessment, beckman oral motor assessment, routing task inventory, sensory profile, dysphagia screening and the Beery VMI.

Client intervention process

Intervention is scheduled for one to two times a week for the duration of the semester. Intervention is designed to improve engagement in meaningful occupations and increase functioning in every day skills. Goals for intervention are developed in collaboration with the staff, supervisors at CDS and the caregivers. Students report at team meetings with the staff and supervisors one to two times per semester.

Intervention is scheduled for 2.5 hours, twice weekly and is designed to improve independent living skills, communication and interaction skills, and vocational skills through participation in therapeutic social and task groups as well as individually to target specific skill areas for the individual. An individualized intervention plan is developed in collaboration with the consumer, and any individuals identified as “significant” by the consumer. Consumers are seen individually as well as in groups developed by the students, based on goal areas. Frames of references utilized include: MOHO, biomechanical, motor control, rehabilitation, sensory integration, behavioral and cognitive-behavioral.

By the end of the semester it is expected that students will have developed the following basic competencies regarding working with adults with intellectual disabilities, brain injuries, cerebral palsy, epilepsy, autism, and developmental disorders:

• Evaluation and intervention process

• Building therapeutic relationship and therapeutic use of self

• Developing client-centered and occupation-based intervention plan supported by appropriate theoretical approaches and empirical evidence

• Providing intervention directed toward improving engagement in meaningful occupations and increasing functional skills

• Implementing 1:1 and group intervention