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Occupational Therapy Goals & Examples (Adults and Children)

Courtney Gardner, MSW

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What strategies do you have in mind to engage your clients and improve your occupational therapy practice? As an occupational therapist, setting meaningful goals for your clients is essential. However, covering all aspects, such as physical, cognitive, self-care, and work-related goals, can be overwhelming. In this blog, we will provide you with a step-by-step guide on how to set goals, starting with understanding SMART goals and then moving on to setting short- and long-term goals. We will also discuss categorizing these goals and involving your clients in goal-setting.

Also, we will share examples for adults and children to inspire collaboration between you and your clients to achieve their goals. Furthermore, we will teach you how to make the goal-setting process interactive and engaging, allowing your clients to participate actively in their treatment and feel empowered. By following our guidance, you can establish client-centered goals and support your clients in making meaningful progress.

Understanding Occupational Therapy and Its Benefits

Occupational therapy aims to enhance your ability to carry out the daily activities that matter to you. As occupational therapists, we collaborate with clients to establish individualized objectives and offer techniques and resources that enable them to function independently and participate in the activities they require and desire.

Functional Independence

OT helps individuals improve their self-care, productivity, and leisure skills. If someone struggles with daily tasks such as bathing, cooking, or driving due to an injury, disability, or health condition, an occupational therapist can help by providing adaptive techniques and equipment. This will help the individual live independently and safely in their home.

Life Enrichment

OT is not solely focused on accomplishing necessary functions but on enabling individuals to lead fulfilling and enriching lives. As an occupational therapist, you can assist your clients in exploring various hobbies, social activities, and other interests that inspire and satisfy them.

Also, you can help your clients establish objectives to enhance their career or education. The ultimate aim is to empower them to engage in activities that hold personal significance and meaning.

Exploring the Connection Between Occupational Therapy and Mental Health

Occupational therapy is an excellent treatment option for managing the symptoms of various mental health conditions, including anxiety, depression, and PTSD. As an occupational therapist, you can help clients develop effective   coping mechanisms, set healthy boundaries, practice mindfulness, and make lifestyle changes that improve their well-being. Engaging in meaningful activities and achieving small goals can release dopamine, boosting mood and motivation. By setting collaborative yet achievable goals and providing practical strategies, occupational therapists can help people with mental illness regain their sense of control and confidence in their ability to participate in meaningful activities.

OT is a practical and constructive support system for managing mental health conditions and achieving personal goals. Occupational therapists work closely with clients to create personalized treatment plans promoting wellness, independence, and community participation. Regardless of age, everyone can thrive with the proper support and strategies.

Occupational therapists are trained to support clients with mental health conditions in achieving their goals. They do so in several ways:

• Symptom Management Strategies : Occupational therapists can help clients develop routines, prioritize tasks, and pace themselves to minimize triggers exacerbating symptoms.
• Meaningful Activities : Occupational therapists work with clients to identify hobbies, interests, and social activities that can boost motivation and mood.
• Adaptations : Occupational therapists can recommend changes to the environment, tools, equipment, or daily living tasks to make them more accessible and manageable for those struggling with daily tasks.
• Ongoing Monitoring : Occupational therapists regularly evaluate attainment and adjust goals based on a client's changing needs and capabilities.

The Backbone of Occupational Therapy: Setting Collaborative and Meaningful Goals

As an occupational therapist, one of your most important responsibilities is to assist clients in setting and attaining significant objectives. Developing meaningful client-centered goals will significantly impact your clients' progress and outcomes, resulting in increased independence and improved quality of life.

Creating Client-Centered Goals

The most effective approach is to work with your client to establish goals tailored to their unique needs. Discuss their strengths, challenges, and priorities to determine the appropriate short—and long-term goals. Some clients may benefit most from learning coping strategies or establishing a self-care routine , while others may prioritize work-related or social objectives.

Customizing Treatment

Occupational therapy should be customized to meet each client's needs and circumstances. Some clients may only require short-term therapy to develop skills and confidence. However, those with chronic conditions may need ongoing support. The decision to choose short- or long-term treatment should be based on factors such as diagnosis, symptom severity, level of functioning, and client motivation.

Encouraging Independence

OT aims to help clients achieve the highest possible independence and quality of life. We can provide suggestions and adaptations to make everyday tasks more accessible and help clients develop independent living skills. For children, our focus may be on developing skills to support their learning and social participation.

Creating SMART Pediatric and Adult Occupational Therapy Goals

When working with clients to achieve their goals, it can be helpful to use the SMART framework.  SMART stands for Specific, Measurable, Attainable, Relevant, and Time-bound . This framework helps to focus and provide direction, leading to a clear path to success. With SMART goals, objectives are well-defined, progress can be easily tracked, timelines are reasonable, and skills or activities selected are purposeful and relevant to your client's needs. Goals such as "improve mobility" or "increase independence" are too broad and do not provide clear direction. To ensure success, it is essential to define specific objectives. For example, "The client will be able to climb one flight of stairs with minimal assistance within two months." Evaluations and tracking outcomes should be used to measure clients' progress.

Specific goals target a clear outcome.

Instead of "improve handwriting," try "write legibly for 30 minutes."

Measurable goals can be objectively assessed.

"Complete morning routine in 1 hour" is more effective than "improve self-care skills."

Working with children

Involve parents and teachers. What activities do they struggle with? What skills do they want to gain? Set play-based goals, such as "participate in pretend play with peers for 15 minutes." Provide opportunities for children to practice skills in natural environments.

When working with adults

Discuss meaningful activities they want to resume and ask open-ended questions to determine specific barriers are helpful. Set goals to systematically overcome each barrier. If depression reduces motivation, start with "shower and dress daily." As mood improves, build up to "cook a meal once per week" and "call a friend twice weekly."

Setting Achievable Goals for Occupational Therapy: Examples of Short-Term and Long-Term Objectives

Occupational therapy goals should be established for both short-term and long-term periods. Short-term goals can be achieved within three months, while long-term goals can take 6-12 months. Initially, clients should focus on basic skills, and the difficulty level should gradually increase as they improve. Regularly reviewing and revising the goals based on clients' feedback and progress is essential.

Occupational Therapy Short-Term Goals Example

Short-term goals aim to build clients' confidence and motivation by focusing on incremental progress.

• For example, a short-term goal for a client with limited mobility could be improving sitting balance to four seconds with minimal support.

Reaching short-term goals frequently helps clients track their progress and remain engaged in the therapeutic process. Based on the client's progress, these goals should be reviewed and updated every few weeks.

Occupational Therapy Long-Term Goals Example

Long-term goals represent meaningful life changes that provide purpose and direction.

• For example, a long-term goal for a client with a traumatic brain injury could be returning to work as an accountant, independently managing a full-time workload within six to twelve months.

Long-term goals can take months or years to achieve, and it is necessary to modify short-term goals to stay on track. Revisiting long-term goals with the client ensures they remain realistic and meaningful. With hard work and perseverance, long-term goals become life-changing accomplishments.

Enhancing Children's Development and Learning Through School-Based Occupational Therapy

School-based occupational therapy is an effective way to help children with disabilities or learning difficulties participate fully in school activities. It's a collaborative approach in which occupational therapists work directly in schools to observe children in their learning environment and tailor treatment to their needs. The benefits include no missed class time for appointments and children learning skills that directly translate to school routines. To achieve these goals, children, parents, teachers, and therapists work together to understand a child's needs, strengths, and challenges across settings. This collaborative approach ensures that the most meaningful and impactful goals are set to support children's success and participation.

School-Based OT Goals Examples

Examples of school-based occupational therapy goals include:

• Improving handwriting by using specialized grips or paper positioning.
• Developing time-management skills to complete assignments on time.
• Learning coping strategies to handle anxiety, sensory issues, or social difficulties.
• Gaining independence in self-care activities like packing a backpack, opening lunch items, or using the restroom.

Creating Effective ADL Goals: A Guide to Achieving Independence

Occupational therapists are an integral part of the healthcare system. They help individuals with physical or cognitive disabilities and older adults achieve greater independence in their day-to-day activities, known as activities of daily living (ADL) goals. They work closely with their clients to design customized plans incorporating adaptive techniques, specialized equipment, home modifications, and exercises. By assessing the clients' current abilities and challenges, therapists set achievable short-term goals that help build new skills and long-term goals for maximum independence.

• For instance, a short-term goal could be to help a client dress independently within 15 minutes, with a long-term goal of achieving independent dressing within 10 minutes.

Setting achievable ADL goals can have a profound positive impact on clients' overall well-being. By gaining independence in everyday activities like cooking, bathing, and getting ready for bed, clients can experience increased self-esteem and decreased frustration or sadness. Regular re-evaluation of progress is essential to measure success and identify new goals. Some clients may need ongoing therapy to maintain their functionality, while others may be able to achieve complete independence. Graduating from treatment with the right tools and strategies can help clients continue to succeed at home. Ultimately, the goal is to empower clients to live life on their own terms with renewed confidence and a sense of autonomy.

Boost Your Productivity with this Printable Occupational Therapy Goal List

Developing appropriate goals for each client can be challenging as an occupational therapist. To assist you in your work, we have compiled a list of suggested occupational therapy goals you can use as a starting point. We aim to help you brainstorm with your clients and make a personalized treatment plan that caters to their unique requirements. You can modify these goals to develop a customized and effective treatment plan that helps your clients achieve their desired outcomes.

Suggested Occupational Therapy Goals for Adults and Older Adults:

• Enhance upper extremity motor function.
• Improve grip strength.
• Increase the range of motion in the shoulders, elbows, and wrists.
• Enhance dexterity and hand-eye coordination.
• Improve balance and coordination.
• Improve gait and mobility.
• Improve the ability to perform daily living activities independently.
• Improve the ability to use assistive devices effectively.
• Enhance cognitive skills like memory, problem-solving, and attention.
• Improve social skills and the ability to interact with others.
• Reduce pain and improve pain management strategies.
• Increase standing balance to 30 seconds with minimal support.
• Improve hand dexterity to open and close jars independently.
• Improve mobility by walking with a cane for 20 minutes without rest breaks.
• Develop compensatory strategies to manage fatigue and complete daily tasks.
• Increase range of motion in shoulders to allow for dressing and hygiene tasks.
• Build upper body strength to climb two to three stairs with handrail support.
• Improve fine motor control to manipulate buttons and zippers.
• Develop coping skills to manage anxiety and depression that may interfere with therapy progress.

Suggested Occupational Therapy Goals for Children:

• Enhance fine motor skills to manipulate toys independently within 3 to 6 months.
• Improve hand-eye coordination to accurately catch and throw balls or other objects within 6 to 12 months.
• Within 6 to 12 months, client will develop self-care skills like feeding themselves with utensils, dressing with minimal assistance, and independently using the toilet.
• Enhance gross motor skills such as sitting up, crawling, walking, running, and jumping within age-appropriate timeframes.
• Within 6 to 12 months, develop age-appropriate communication and language skills for clients with speech delays through targeted exercises.
• Improve sensory processing and integration to regulate emotions, behaviors, and attention within 6 to 12 months.

The Bottom Line

Occupational therapy can unlock incredible transformations in mental health and quality of life. Occupational therapists can help clients achieve milestones they never thought possible with a client-centered approach to goal-setting and regular communication. Remember, every small step counts, and progress is always within reach. By working together and following the SMART framework, we can set our clients up for long-term success and help them live their best lives.

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FAQs About Setting OT Goals

How do i determine if a client will benefit more from short- or long-term occupational therapy.

Short-term occupational therapy, ranging from a few weeks to 3-6 months, can be effective for conditions that require minor lifestyle adjustments or skills retraining. Long-term occupational therapy, 6-12 months or longer, is better suited for chronic conditions, significant functional limitations, or complex rehabilitation needs.

The answer also depends on several factors, including:

• The client's responsiveness to treatment. If progress is slower, long-term occupational therapy may be needed.
• The client's motivation and support system. Strong motivation and support can help you achieve goals faster.
• The specific goals set. Complex, multi-step goals usually take longer to achieve.

What kind of goals are suitable for occupational therapy?

Occupational therapists can help clients set goals related to improving their ability to perform daily activities and function at a higher level independently. Some common goals include:

• Improving self-care skills like bathing, dressing, feeding and toileting
• Increasing mobility and strength
• Improving dexterity and hand function
• Performing household tasks more easily
• Returning to work or school
• Managing stress and anxiety that impact daily life
• Developing compensatory strategies to overcome challenges

The key is specific, measurable, and achievable goals to evaluate progress throughout therapy .

How do I determine if a client has met their occupational therapy goals?

You'll want to reassess clients regularly throughout therapy to determine if they're making meaningful progress toward their goals. Some signs a client has met their goals include:

• They can independently perform the activity at the level outlined in the goal.
• They report an improved ability to function in daily life due to therapy.
• Standardized tests, assessments, or observations show they've achieved the functional level targeted.

You can also get feedback from family members to confirm the client is applying what they've learned in therapy to their everyday routines at home. Once goals are fully met, you can discharge the client or set new, more advanced goals to continue therapy.

How do I write specific, measurable occupational therapy goals?

Specific, measurable goals use concrete language to outline what the client can do differently after occupational therapy. They include:

• A condition, behavior, or task the client wants to improve
• A defined action the client will be able to perform.
• An amount or frequency that action will be done
• A timeline for achieving the goal

What are some examples of SMART occupational therapy goals?

Examples of SMART goals include:

• Wash and dry hands independently three out of four times within two weeks.
• Stand from a seated position without assistance at least 50% of the time in three months.
• Open childproof medicine bottles independently nine out of ten times in six weeks.
• Walk 20 feet with a walker and only one rest break in one month.

How do I develop client-centered occupational therapy goals? Client-centered goals are made by:

• Asking the client what activities are most important to them
• Discussing the client's values, interests, and needs
• Involving the client in deciding the goal and timeline
• Making the goal meaningful and relevant to the client's daily life
• Revising the goal as needed based on the client's feedback
• Concorde Career College. (2020, September 30).   How Can Occupational Therapy Help with Mental Health?   https://www.concorde.edu/blog/how-can-occupational-therapy-help-mental-health
• Edemekong, P. F., Bomgaars, D. L., Sukumaran, S., & Schoo, C. (2023, June 26).   Activities of Daily Living . National Center for Biotechnology Information.  https://www.ncbi.nlm.nih.gov/books/NBK470404/
• Heffron, C. (2024, February 6).   What is School-Based Occupational Therapy ? The Inspired Treehouse.  https://theinspiredtreehouse.com/school-based-occupational-therapy/
• Henry Ford Health. (2023, August 7).   The Benefits of Occupational Therapy .  https://www.henryford.com/blog/2023/08/the-benefits-of-occupational-therapy
• Kristenson, S. (2024, February 7).   9 Examples of SMART Goals for Occupational Therapy . Develop Good Habits.  https://www.developgoodhabits.com/smart-goals-occupational-therapy/
• Lyon, S. (2023, February 20).   What There is to Know About ADLs and IADLs in a Healthcare Facility . Verywell Health.  https://www.verywellhealth.com/what-are-adls-and-iadls-2510011

All examples of mental health documentation are fictional and for informational purposes only.

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Executive Functioning Occupational Therapy: Enhancing Daily Life Skills

In this post, you will learn: Explore Executive Functioning Occupational Therapy: a comprehensive guide to enhancing daily life skills. Learn targeted strategies and interventions for improved cognitive control and adaptability.

Occupational therapy plays a crucial role in enhancing the quality of life for individuals with executive functioning challenges. Executive functions are a set of cognitive processes that allow us to plan, organize, initiate, and complete tasks. These processes are essential for successful daily living and can significantly impact one's ability to perform various occupations, including school, work, and social activities.

In recent years, the focus on executive functioning within the field of occupational therapy has grown, with practitioners developing targeted interventions and strategies to help individuals struggling with these cognitive processes. Occupational therapists work closely with clients to identify strengths, areas of improvement, and potential barriers to success while tailoring a customized approach to address cognitive needs effectively.

Key Takeaways

• Executive functioning is crucial for daily living, impacting performance in various occupations and activities.
• Occupational therapists play a vital role in helping individuals with executive functioning challenges.
• Personalized strategies and interventions in occupational therapy address cognitive needs effectively and enhance quality of life.

Understanding Executive Functioning

Defining executive function.

Executive function refers to a set of cognitive processes that enable individuals to manage and regulate their thoughts, emotions, and actions. These mental skills encompass problem-solving, self-reflection, and metacognition. In other words, executive functions help us make decisions, plan, organize, and monitor our performance in daily activities. We use these skills constantly, whether we’re at home, work, or school.

Importance of Executive Functioning

Developing strong executive function skills significantly impacts our daily lives and overall well-being. These cognitive abilities help us maintain a positive mindset, increase self-awareness, and adapt to changing situations. In children and youth, strong executive functions are crucial for academic success, social-emotional growth, and self-regulation. Similarly, for adults, these cognitive processes play a vital role in occupational performance, personal relationships, and mental health.

Assessing Executive Function Skills

Evaluating executive function skills can provide valuable insights into an individual's cognitive abilities and help tailor interventions to address specific deficits. In occupational therapy, tests such as the Executive Function Performance Test can help therapists determine the level of support individuals need following a stroke. By assessing and understanding the cognitive deficits of individuals, we can help families and support systems provide the appropriate assistance in daily life.

In summary, understanding executive functioning is essential for ensuring success and well-being in various aspects of life. As occupational therapists, it's our responsibility to develop and apply interventions that enhance executive function skills and promote optimal performance in daily activities.

Related Executive Function Posts You Will Love!

Improving Executive Function: Top Tips for Boosting Brain Power

Executive Function Skills List: A Quick Guide for Success

Occupational Therapy and Executive Functioning

Role of occupational therapy.

In occupational therapy, we aim to assist individuals in developing and maintaining their functional abilities. One aspect we focus on is executive functioning, which involves initiation, self-monitoring, and regulation of behaviors. These are all critical components in a person's daily life, allowing them to successfully navigate various tasks and situations.

We recognize the importance of addressing executive functioning skills in children and youth, as it can significantly impact their overall development and occupational performance. By implementing therapeutic interventions targeting executive functions, we can support our clients in reaching their full potential and increase their participation in meaningful activities.

Importance of Intervention

Intervening early in cases where individuals show difficulty with executive functions is crucial. Providing proper support and guidance can make a huge difference in their ability to navigate daily tasks, succeed in school, and interact with others. By incorporating executive functioning strategies and activities into our occupational therapy sessions, we can foster better self-awareness, problem-solving, and decision-making skills in our clients.

Furthermore, as occupational therapists, we recognize the need for adaptation and flexibility in our approach. We understand that each person comes with a unique set of strengths and areas for improvement. Keeping this in mind, we tailor our interventions to best meet the needs of each individual, continually reevaluating our methods to ensure optimal outcomes.

Measuring Occupational Performance

In order to assess the impact of our interventions on executive functions, we use various tools to measure occupational performance. One such method is the Executive Function Performance Test (EFPT) , which allows us to evaluate higher-level cognitive functions through the use of a structured cueing and scoring system.

In addition to standardized assessments, we also utilize goal setting, informal observations, and feedback from clients, families, and other professionals to gauge progress and guide our interventions. This comprehensive approach enables us to monitor our clients' development and continually adapt our therapy sessions to support their growth in executive functioning skills best.

Practical Approaches in Occupational Therapy

In occupational therapy sessions, we focus on several approaches to support the development of executive functioning skills. These approaches include task management strategies, attention improvement techniques, and fostering organization skills.

Strategies for Task Management

When it comes to task management, we believe in breaking tasks into smaller, achievable steps to facilitate task initiation and completion. Here are a few methods we use in our sessions:

• Chunking : We break down larger tasks into smaller, more manageable parts.
• Visual supports : We utilize visual aids such as checklists and schedules to help clients manage their tasks effectively.
• Timers : We encourage the use of timers to support time management and keep clients on track with their tasks.
• Positive reinforcement : We provide feedback and praise for task initiation and completion to boost motivation and self-confidence.

Techniques for Attention Improvement

To help improve attention, we employ various techniques to keep our clients engaged and focused during occupational therapy sessions. Some of the methods we utilize include:

• Fidget tools : We provide tools like stress balls, fidget spinners, or alternate seating options to help clients channel their excess energy and maintain focus.
• Mindfulness practices : We incorporate mindfulness exercises, such as deep breathing and guided meditation, to help clients center their thoughts and improve their attention.
• Individualized attention strategies : We work with clients to identify personal techniques that help them maintain focus, such as taking short breaks or using white noise.

Approaches for Fostering Organization Skills

Developing organization skills is essential for managing daily tasks effectively. We focus on the following methods to help clients improve their organizing abilities:

• Visual organization aids : We use visual tools like color-coding systems and labels to help clients categorize and arrange items logically.
• Routines and schedules : We assist clients in establishing daily routines and schedules to promote predictability and organization in their lives.
• Goal setting : We work with clients to set realistic and attainable goals related to organization, such as decluttering a specific area or maintaining an organized workspace.

By incorporating these practical approaches in our occupational therapy sessions, we strive to foster the development of essential executive functioning skills, including task management, attention improvement, and organization.

Working with Different Groups

In our occupational therapy practice, we work with various groups of individuals, focusing on their unique needs and challenges. This allows us to tailor our interventions and support to help them achieve their goals and improve their executive functioning skills. In this section, we will discuss three specific groups that we cater to: children, individuals with autism, and people with mental health needs.

Occupational Therapy for Children

We believe that it's essential to address executive functioning challenges early in life, as these skills are crucial for success in school and daily activities. Our approach with children involves using play-based and engaging activities that help them develop and improve their planning, organization, time management, and self-regulation skills. By incorporating fun and enjoyable tasks, we can create a positive environment that fosters growth and development, ultimately supporting their overall well-being.

Supporting Autistic Individuals

A significant portion of our work involves helping autistic individuals, who often face unique challenges related to executive functioning. Autism spectrum disorder has been linked to deficits in motor skills and executive function, impacting their ability to succeed in school, work, and other aspects of life. Our approach in this area is tailored to the specific needs of each individual, using a combination of therapies that address both fine and gross motor skills development, as well as targeted interventions to improve executive functions.

Catering to Mental Health Needs

Lastly, we are dedicated to supporting individuals with mental health needs, as executive function deficits have been associated with various mental health disorders. In fact, improving executive function can be essential for these individuals to succeed in their work, education, and daily living pursuits. We establish a safe and supportive environment for our clients to work on practical problem-solving, emotional regulation, and self-monitoring strategies. By focusing on these elements, we aim to help them overcome the barriers they face due to executive function challenges and enhance their overall quality of life.

Executive Function Coaching

Coaching model.

In our executive function coaching, we focus on helping individuals improve their cognitive abilities related to planning, organizing , and problem-solving. We utilize a personalized coaching model that aims to enhance clients' self-regulation skills, adaptability, and overall executive functioning.

Our coaching model is a blend of one-on-one sessions and group activities. Through individualized coaching sessions, we assess each client's unique strengths and weaknesses and create a specialized plan tailored to their needs. Collaborative group activities allow clients to practice newly acquired executive functioning skills in real-life situations and offer an opportunity for peer feedback and support.

Professional Development

Continuous professional development is vital for the success of our executive function coaching program. Engaging in ongoing training and education ensures that we stay updated on the latest research and methods in occupational therapy. One way we do this is through the use of online training modules. I really enjoyed taking executive function continuing education courses from Sensational Brain. You can check it out here!

Conferences, seminars, and workshops are also an essential part of our professional development. These events provide a venue for our team to learn from leading experts in the field, share their own experiences, and network with other professionals.

Resources for Executive Functioning

Free resources.

As occupational therapists, we understand that finding free resources for executive functioning can be crucial for some families and practitioners. One excellent source for information and support is the American Occupational Therapy Association , which offers various resources, including research articles focused on executive functioning lens for occupational therapy with children and youth .

In addition to professional organizations, various websites and online platforms provide free resources. These may include printable worksheets, activities, and guides to help improve executive functioning skills in children and adolescents.

You can get this free executive function checklist by subscribing to my email list below!

Useful Products

Occupational therapists often recommend specific products to help clients develop and enhance their executive functioning skills. These products may vary from board games that promote planning and problem-solving skills to books that teach time management and organization strategies. Some popular choices include:

• Timer apps for smartphones, which can help clients stay on task and manage their time more effectively
• Color-coded organization systems, such as folders, calendars, and planners, to help clients visually structure their day-to-day activities
• Board games and puzzles that stimulate cognitive skills like planning, attention, and decision-making

Blogs and Popular Topics

As we explore the world of executive functioning and occupational therapy, we often come across informative blogs and websites that discuss popular topics in the field. Some notable blogs might cover innovative therapy techniques, case studies, or trending issues related to executive functioning. For example, the SAGE Journals offers a paper about putting executive performance in a theoretical context, useful for occupational therapists.

Special Topics in Executive Functioning

Inhibition and self-control.

In our practice as occupational therapists, we often encounter individuals with challenges in inhibition and self-control. These aspects of executive functioning play a vital role in regulating behavior and emotions. Inhibition involves the ability to resist impulses and distractions, while self-control focuses on managing emotions and maintaining appropriate behavior.

Working memory is essential for inhibition and self-control as it helps individuals hold and process information to make well-informed decisions. By addressing these executive functioning skills, we can help our clients improve emotional control and behavioral inhibition, leading to better overall functioning in daily life.

Effects on Processing Speed

Processing speed is another crucial aspect of executive functioning that may impact an individual's performance in various tasks. It refers to the rate at which individuals can process and understand information. Executive functioning challenges, such as deficits in working memory or inhibition, can directly affect processing speed.

As occupational therapists, we strive to address these issues by implementing interventions designed to enhance processing speed and overall executive functioning. By doing so, we can help our clients function more effectively in their daily tasks and routines.

Impact of Sensory Factors

Lastly, sensory factors play a significant role in executive functioning as well. Sensory processing refers to the way our brains receive and interpret sensory information from the environment. When sensory processing is compromised, it can impact executive functioning skills, such as working memory, emotional control, and self-regulation.

In our practice, we consider the unique sensory needs of our clients and work on developing sensory executive functioning skills. By addressing sensory factors, we can help our clients better cope with their environment and improve overall executive functioning. This approach enables us to provide comprehensive interventions that cater to the individual needs of each client.ÎÅ

Executive Function and Occupational Therapy

We've explored the importance of executive functioning in occupational therapy and discussed various aspects such as impulse control, flexible thinking, foresight, and hindsight. Executive functioning plays a significant role in our daily lives, and its impact on children and adolescents has been highlighted in occupational therapy literature .

As we've seen, occupational therapy can provide support and interventions for individuals with executive functioning challenges, enabling them to improve their performance in daily tasks and activities. Evidence from studies like this preliminary study demonstrates the value of occupational therapy in addressing executive function-related issues and providing screening and treatment to help individuals achieve better outcomes.

Introducing tools like the impulse control journal and incorporating strategies to develop flexible thinking can be beneficial for both clinicians and clients. By promoting foresight and hindsight, we can help people adapt to situations, learn from past experiences, and plan for the future.

We hope we've highlighted the relevance of executive functioning and occupational therapy. Continued research and awareness of this topic will undoubtedly contribute to developing more effective interventions and improved outcomes for individuals facing executive functioning challenges.

Frequently Asked Questions

What are common activities for enhancing executive function in adults.

There are several activities that can help adults enhance their executive function. Some popular ones include:

• Task management: Encouraging the use of to-do lists, setting priorities, and breaking down tasks into smaller, manageable steps.
• Planning and organization: Providing support in setting goals, identifying resources, and creating timelines to accomplish tasks more efficiently.
• Memory training: Encouraging the use of mnemonic devices and practicing recall strategies.
• Cognitive exercises: Engaging in activities such as crossword puzzles or Sudoku can help improve problem-solving, memory, and attention skills. For more activities, you may refer to the Dream Home Assessment study.

How can an occupational therapist help improve problem-solving?

Occupational therapists can help improve problem-solving skills by:

• Assessing a person's strengths and weaknesses related to problem-solving.
• Developing an individualized intervention plan with specific goals and strategies.
• Collaborating on the creation of practical scenarios to practice problem-solving skills.
• Monitoring progress, adjusting the intervention plan as needed, and providing regular feedback.

What are the key components of a skills checklist for executive functioning?

A skills checklist for executive functioning often includes:

• Response inhibition: The ability to think before acting.
• Working memory: The capacity to hold and manipulate information for short periods.
• Emotional control: The ability to manage and regulate emotions.
• Task initiation and completion: The ability to begin and complete tasks in a timely manner.
• Planning: The skill of organizing information and tasks, then executing a plan.
• Organization of materials: The ability to organize personal belongings and workspace.

At what age do executive function skills typically develop?

Executive function skills develop gradually throughout childhood and adolescence. Some essential executive functioning milestones include:

• Between 2-3 years: Developing basic attention, beginning to control emotions, and early problem-solving skills.
• Between 5-7 years: Increasing working memory capacity, more advanced problem-solving, and the ability to plan and complete simple tasks.
• Between 12-18 years: A substantial development of executive functioning skills, including abstract thinking, reasoning, multitasking, and self-monitoring.

What are some effective games for improving executive functioning?

Fun and engaging games can help improve executive functioning skills. Some examples are:

• Memory games: Classic card-matching games or apps that challenge working memory.
• Board games: Strategy games like chess, checkers, or Settlers of Catan can improve planning and problem-solving skills.
• Puzzles: Jigsaw, Sudoku, and crossword puzzles can help with visual-spatial processing and attention to detail.
• Brain teasers: Riddles, logic puzzles, and lateral thinking challenges can improve critical thinking and cognitive flexibility.

What is the role of occupational therapy in promoting executive function?

Occupational therapists play a crucial role in promoting executive function by:

• Assessing an individual's strengths and weaknesses in executive functioning.
• Developing targeted interventions to address specific skills deficits.
• Collaborating with the client on goal setting and intervention strategies.
• Monitoring and adjusting the intervention plan based on the client's progress.

For more information on occupational therapy and executive functioning, you can refer to this scoping review of the literature .

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Occupational Therapy IEP Goals

Occupational therapists (OTs) in the school setting are instrumental in helping students maximize their potential and participate fully in their educational environment. They develop specialized  Occupational Therapy IEP Goals , keeping in mind the student’s individual needs. Drawing inspiration from the SMART goals structure outlined on  Your Therapy Source , goal writing is an important step for a student’s IEP. 

The Duality of Occupational Therapy IEP Goals

In some districts, occupational therapists (OTs) write collaborative goals in tandem with the entire IEP team, including speech-language pathologists, physical therapists, and the classroom teacher. This strategy ensures a holistic approach to the student’s education program. On the other hand, there are cases where OTs pen stand-alone OT IEP goals, which focus solely on areas directly impacted by occupational therapy. Both methodologies have their merits and are contingent upon the educational environment, the student’s individual needs, and district preferences.

IEP Goals Related to the Common Core for OT/PT

The science behind occupational therapy iep goals.

Writing a measurable goal involves the integration of data collection and the understanding of the student’s strengths, weaknesses, and meaningful progress. Whether you are writing collaborative goals or stand-alone goals, every OT goal should be SMART : Specific, Measurable, Achievable, Relevant, and Time-bound.

Review the Role of Occupational Therapy in the Schools

Occupational therapists (OTs) in school settings play a crucial role in helping students access the school environment and participate to their fullest in educational activities. Here’s a general breakdown of areas that OTs may focus on within the school context:

• Improving hand strength.
• Holding writing utensils.
• Practicing finger dexterity 
• Bilateral coordination (using both sides of the body together).
• Postural control and stability.
• Handwriting
• Visual discrimination (spotting differences and similarities).
• Visual memory (recalling visual information).
• Buttoning and zipping clothes.
• Tying shoes.
• Managing lunchtime tasks like opening food containers.
• Developing sensory diets (specific activities tailored to help the child’s sensory needs).
• Implementing sensory breaks.
• Recommending adaptive equipment, like weighted vests or fidget tools.
• Organizing materials.
• Time management.
• Task initiation and completion.
• Problem-solving.
• Understanding social cues.
• Navigating group dynamics in the playground or classroom.
• Self-regulation and emotional control.
• Software for writing support.
• Adaptive keyboards or mice.
• Communication devices.
• Alternative seating arrangements.
• Soundproofing or creating quiet zones.
• Adjusting lighting.
• Transition Skills : As students approach graduation, OTs support skills related to:
• Job readiness.
• Organizational skills for higher education.
• Life skills like cooking or public transportation navigation.
• Collaboration with School Staff : OTs work closely with teachers, paraprofessionals, and other school staff to:
• Modify curriculum.
• Recommend classroom strategies.
• Adjust students’ routines to best support their success.

Examples of Occupational Therapy IEP Goal

Here are some examples of possible OT IEP goals to provide ideas. Remember each student needs personalized goals for their learning journey.

Fine Motor Skills IEP Goals

OTs enhance fine motor skills that directly impact daily school activities such as writing and using classroom tools.

a)  In six weeks, the student will demonstrate an ability to use a tripod grasp to write their name legibly in 4 out of 5 attempts, with minimal verbal cues.

b)  In two months, using a proper grip, the student will cut simple shapes with smooth edges, achieving success in 90% of classroom activities.

c)  By the semester’s end, the student will assemble a 10-piece puzzle within 10 minutes.

Read more  Fine Motor IEP goals here .

Gross Motor Skill IEP Goals

These are vital for overall school participation, and often overlap with skills that physical therapists focus on.

a)  In eight weeks, the student will catch a ball using both hands in 8 out of 10 gym class attempts.

b)  Throughout the semester, the student will maintain a seated position during story time for at least 30 minutes without leaning or slouching.

c)  In three months, the student will safely navigate classroom transitions, avoiding physical obstacles in 9 out of 10 movements.

Visual-Motor and Visual-Perceptual IEP Goals

These skills directly impact a student’s ability to interpret visual information and coordinate it with motor movements.

a)  By the end of the term, the student will copy a provided sentence with 85% letter accuracy.

b)  Over nine weeks, the student will match similar shapes in classroom activities with 90% accuracy.

c)  In six weeks, the student will reproduce a sequence of five drawn objects in the correct order.

Self-Care or ADLs IEP Goals

An essential aspect of a student’s day, these skills can greatly affect confidence and independence.

a)  Within a month, the student will button their own shirt in under 5 minutes before PE class.

b)  By the end of the first semester, the student will tie their shoes in under 3 minutes before recess.

c)  In two months, the student will independently open their lunch items in 9 out of 10 lunch sessions.

Sensory Processing IEP Goals

OTs utilize sensory strategies to help students with sensory challenges navigate their school environment.

a)  Within six weeks, after utilizing a sensory break, the student will return to class and refocus on the task at hand in under 5 minutes in 80% of instances.

b)  Over a semester, using tools like fidgets, the student will remain seated during instructional periods for 25 continuous minutes in 85% of sessions.

c)  In two months, the student will wear noise-canceling headphones and report a decreased sensory overload in 7 out of 10 noisy environments.

Read more about IEP goals related to sensory processing here.

Sensory Strategies Workbook

Executive functioning skills iep goals.

For more insights on these skills,  this article  is a great resource.

a)  By the end of the quarter, the student will utilize a planner to track and submit 85% of assignments on time.

b)  Within nine weeks, the student will initiate and complete a two-step classroom task in 8 out of 10 instances without prompts.

c)  Over six weeks, the student will raise their hand and wait to be called upon before speaking in 8 out of 10 classroom discussions.

Social-Emotional Skills

Skills that are vital for social interactions and self-regulation. Learn more  here .

a)  In three months, using visual cues or verbal prompts, the student will acknowledge peers’ greetings in 7 out of 10 social interactions.

b)  Over eight weeks, the student will ask for a break using a calm voice in 9 out of 10 overwhelming situations.

c)  Within a semester, the student will participate in group projects and share materials with peers in 4 out of 5 group tasks.

Assistive Technology IEP Goals

This is crucial for students with varied needs to access the curriculum.

a)  By the end of the term, the student will type a one-page assignment using adaptive software with fewer than five errors.

b)  In two months, the student will access and read an e-book, using a screen reader, completing three chapter reviews with 80% comprehension.

c)  Over six weeks, the student will communicate using a speech-generating device in 6 out of 10 classroom discussions.

Assistive Technology, Classroom Implementation Strategies & Resource Recommendations for Kids Who Struggle to Write

Environmental modifications.

The school environment plays a pivotal role in a student’s ability to learn.

a)  Within three months, using alternative seating, the student will remain on task for 20 continuous minutes in 70% of classroom activities.

b)  Over the semester, in a designated quiet zone, the student will complete independent tasks with 90% accuracy.

c)  By the term’s end, using adjusted lighting, the student will read and answer comprehension questions with 85% accuracy.

Transition Skills

Preparing students for life after school, OTs focus on real-world skills. Dive deeper  here .

a)  By the end of the year, the student will create a resume and successfully participate in two mock interviews.

b)  In six months, the student will organize and manage a personal schedule, attending three different after-school activities on time.

c)  Over nine months, the student will utilize public transportation independently to travel to two different local destinations.

Occupational Therapy IEP Goals & Collaborative Efforts

Data from treatment sessions, teacher reports, and classroom observations collectively help in refining these goals. Collaborative efforts ensure that every goal directly addresses the student’s individual needs, making it relevant and achievable. The IEP team, including the school-based therapist and other relevant school staff, plays a crucial role in this journey.

As you navigate the path of goal writing and data point collection, remember the importance of the student’s overall development. Whether it’s a self-regulation IEP goal or one focusing on fine motor skills, the essence remains: to foster growth, independence, and a joyful learning experience in the school setting.

In essence, OTs in schools work holistically, striving for the comprehensive development of students. By ensuring that the  Occupational Therapy IEP Goals  are relevant, measurable, and tailored, they enable students to thrive in their academic and daily lives.

Your Therapy Source

Email: [email protected] Phone: (800) 507-4958 Fax: (518) 308-0290

BIG List of Sample IEP Goals for School Occupational Therapy

1. Abstract thinking: The student will develop abstract thinking skills to understand and apply concepts or ideas that are not concrete or directly observable. 2. Adaptive equipment and strategies: The student will learn to use adaptive equipment or strategies to accommodate physical or cognitive challenges and maximize independence in daily activities. 3. Assistive technology: The student will learn to utilize assistive technology devices or software to enhance access to educational materials and promote independence in academic tasks. 4. Attention (auditory): The student will actively listen and comprehend verbal instructions or information without getting distracted, such as following a series of multi-step directions. 5. Attention (details): The student will increase accuracy and minimize errors in assignments or tasks that require close observation or precision, such as completing science experiments or art projects with attention to detail. 6. Attention (divided): The student will successfully multitask or shift focus between two or more tasks, such as listening to instructions while organizing materials. 7. Attention (flexibility): The student will adapt to changes in the environment or task demands without becoming overwhelmed or losing focus, such as smoothly transitioning between different subjects during the school day. 8. Attention (groups): The student will actively participate and contribute relevant ideas or responses without being distracted by peers or environmental stimuli, such as actively engaging in a classroom discussion. 9. Attention (selective): The student will effectively filter out irrelevant distractions and maintain focus on a specific task, such as ignoring background noise while working on a writing assignment. 10. Attention (sustained visual): The student will maintain visual focus on written material or visual aids for a specified duration, such as tracking a line of text while reading for 10 minutes. 11. Attention (sustained) : The student will reduce off-task behaviors, such as daydreaming or getting up from their seat without permission, and maintain focus on independent assignments. 12. Attention (task completion): The student will stay focused and persevere through assignments or activities until they are finished, such as completing a math worksheet without getting off task or seeking frequent breaks. 13. Auditory memory: The student will enhance auditory memory skills to retain and recall auditory information, such as following multi-step directions or remembering verbal instructions. 14. Auditory processing: The student will enhance auditory processing skills to accurately process and interpret auditory information, such as following instructions or classroom discussions. 15. Bilateral coordination: The student will enhance bilateral coordination skills to effectively use both hands together during tasks such as cutting with scissors, buttoning, or tying shoelaces. 16. Classroom participation: The student will increase active engagement and participation in classroom activities, including group discussions, collaborative projects, and following classroom routines. 17. Cognitive skills: The student will improve cognitive skills, such as memory, problem-solving, or critical thinking, to support academic learning and problem-solving abilities. 18. Collaborative problem-solving: The student will actively engage in collaborative problem-solving activities with peers, brainstorming solutions, sharing ideas, and working together towards a common goal. 19. Community integration: The student will enhance community integration skills to participate in community outings, field trips, or vocational experiences, promoting functional independence. 20. Community resources: The student will explore and utilize community resources, such as libraries, museums, or recreational facilities, to support learning, social participation, and leisure engagement. 21. Emotional expression: The student will learn appropriate ways to express emotions, such as through verbal communication, art, or journaling, to promote emotional expression and communication. 22. Emotional regulation during peer interactions: The student will develop strategies for emotional regulation specifically during peer interactions to manage frustration, disappointment, or conflict in social situations. 23. Emotional regulation during sensory overload: The student will develop strategies for emotional regulation specifically during sensory overload situations, such as crowded environments or noisy settings. 24. Emotional regulation during test-taking: The student will develop strategies for emotional regulation specifically during test-taking situations to manage test anxiety and optimize performance. 25. Emotional regulation in transitions: The student will develop strategies for emotional regulation specifically during transitions between activities, classes, or environments to manage anxiety or frustration. 26. Emotional regulation: The student will develop emotional regulation strategies to identify and manage emotions appropriately, supporting emotional well-being and social interactions. 27. Emotional resilience: The student will develop emotional resilience skills to bounce back from setbacks, adapt to challenges, and maintain a positive attitude towards learning and personal growth. 28. Environmental adaptations: The student will benefit from environmental adaptations, such as seating modifications, visual schedules, or sensory supports, to optimize their access and participation in the classroom. 29. Environmental organization: The student will benefit from environmental organization strategies to maintain an organized and structured learning environment that supports their attention and productivity. 30. Executive functioning: The student will enhance executive functioning skills, such as organization, time management, and planning, to facilitate successful completion of academic tasks and assignments. 31. Expressive language skills: The student will improve expressive language skills, including sentence formation, vocabulary usage, and storytelling abilities, to enhance communication in academic and social settings. 32. Fine motor coordination for handwriting: The student will improve fine motor coordination specifically for handwriting tasks, including letter formation, spacing, and legibility. 33. Fine motor dexterity: The student will improve fine motor dexterity skills to manipulate small objects, use tools, or engage in activities that require precise hand movements. 34. Fine motor skills: The student will develop finger strength and dexterity to manipulate clothing fasteners, such as buttons, zippers, snaps, or shoelaces, independently in 8 out of 10 dressing tasks. 35. Fine motor skills: The student will develop precision and coordination in using scissors to accurately cut along straight, curved, and zigzag lines, in 9 out of 10 cutting tasks. 36. Fine motor skills: The student will enhance finger isolation and control to manipulate individual small objects or buttons independently, in 7 out of 10 opportunities. 37. Fine motor skills: The student will enhance their ability to manipulate small objects using a pincer grasp, such as picking up and sorting small beads, coins, or buttons, in 9 out of 10 opportunities. 38. Fine motor skills: The student will improve eye-hand coordination and accuracy in activities such as catching and throwing a ball, hitting a target, or playing a tabletop game, in 8 out of 10 opportunities. 39. Fine motor skills: The student will improve fine motor skills to independently manipulate writing tools, such as pencils or pens, and demonstrate improved legibility in written work. 40. Fine motor skills: The student will improve hand strength and dexterity to enhance their ability to manipulate small objects, such as using tweezers or tongs, in 9 out of 10 opportunities. 41. Fine motor skills: The student will improve hand-eye coordination and control while using various art materials, such as drawing, painting, or coloring, to create age-appropriate artwork, in 8 out of 10 artistic tasks. 42. Fine motor skills: The student will refine their grasp and control while using utensils during self-feeding, demonstrating appropriate scooping, cutting, and bringing food to their mouth, in 9 out of 10 meals. 43. Fine motor skills: The student will refine their hand manipulation skills to complete age-appropriate fine motor activities, such as threading beads, building with blocks, or completing puzzles, in 9 out of 10 opportunities. 44. Fine motor skills: The student will refine their pencil grasp and control to write legibly with appropriate letter formation and spacing, in 8 out of 10 writing assignments. 45. Following multi-step directions: The student will improve the ability to follow multi-step directions accurately and independently in various academic and classroom contexts. 46. Graphomotor skills: The student will improve graphomotor skills, such as handwriting or drawing, to enhance legibility, letter formation, and fine motor control. 47. Gross motor skills: The student will develop their ability to kick a ball with control and accuracy, demonstrating improved lower limb strength and coordination, in 9 out of 10 attempts. 48. Gross motor skills: The student will develop their ability to ride a tricycle or bicycle with training wheels, demonstrating improved leg strength, coordination, and balance, in 9 out of 10 opportunities. 49. Gross motor skills: The student will enhance gross motor skills to participate in physical education classes and outdoor activities with improved coordination and balance. 50. Gross motor skills: The student will enhance their ability to jump with both feet off the ground and land with control, demonstrating improved lower limb strength and coordination, in 9 out of 10 attempts. 51. Gross motor skills: The student will enhance their ability to perform age-appropriate gross motor movements, such as hopping, skipping, or galloping, demonstrating improved rhythm, coordination, and balance, in 8 out of 10 attempts. 52. Gross motor skills: The student will enhance their overall endurance and physical fitness by engaging in activities that promote cardiovascular health, such as jogging, dancing, or participating in structured physical education classes, for a specified duration, in 9 out of 10 opportunities. 53. Gross motor skills: The student will enhance their throwing and catching skills, demonstrating improved upper limb strength, coordination, and hand-eye coordination, in 8 out of 10 attempts. 54. Gross motor skills: The student will improve their balance and coordination to walk on a straight line, navigate obstacles, or negotiate stairs independently, in 8 out of 10 opportunities. 55. Gross motor skills: The student will improve their bilateral coordination and upper body strength to engage in activities such as crawling, climbing, or navigating playground equipment, in 9 out of 10 opportunities. 56. Gross motor skills: The student will improve their body awareness and motor planning skills to participate in games or activities that require directional changes, spatial awareness, or following a sequence of movements, in 8 out of 10 opportunities. 57. Gross motor skills: The student will improve their running skills, including speed, endurance, and proper arm swing, to participate in running-based activities or games, in 8 out of 10 opportunities. 58. Hand-eye coordination: The student will enhance hand-eye coordination skills to accurately coordinate hand movements with visual input during activities such as catching or throwing a ball. 59. Handwriting skills: The student will develop letter slant skills to consistently write letters with a slight forward or backward slant, maintaining consistency throughout their written work. 60. Handwriting skills: The student will develop size consistency skills to maintain consistent letter size, both within and between words, ensuring legibility and visual coherence. 61. Handwriting skills: The student will enhance alignment skills to consistently place letters on the baseline, ensuring a neat and organized appearance of written work. 62. Handwriting skills: The student will enhance grip and pencil control skills, promoting a functional grasp and appropriate pressure on the writing utensil for improved letter formation and overall handwriting quality. 63. Handwriting skills: The student will improve letter formation skills to accurately write uppercase and lowercase letters with correct stroke sequence and direction. 64. Handwriting skills: The student will improve overall neatness and legibility of written work, focusing on consistent letter size, spacing, alignment, and clarity of letter formation. 65. Handwriting skills: The student will improve spacing skills to consistently leave appropriate spaces between words, allowing for clarity and ease of reading. 66. Handwriting skills: The student will increase writing speed and fluency, allowing for faster and more efficient written expression without sacrificing legibility or accuracy. 67. Handwriting skills: The student will learn and practice cursive handwriting skills, including connecting letters, forming loops, and maintaining proper flow and rhythm. 68. Handwriting skills: The student will refine handwriting skills to produce written work that is neat, legible, and consistently aligned with age-appropriate standards. 69. Handwriting skills: The student will refine letter shape skills to accurately produce letters with proper proportions, angles, and curves, improving overall letter legibility. 70. Inclusive play: The student will actively participate in inclusive play activities, where they can engage with peers of different abilities, promoting social interaction, empathy, and understanding. 71. Inhibitory control: The student will enhance inhibitory control skills to resist impulsive behaviors, follow rules, and maintain appropriate behavior in the classroom. 72. Motor coordination: The student will enhance motor coordination skills to participate in physical activities, such as sports or recess, with increased accuracy and fluidity of movements. 73. Motor planning: The student will enhance motor planning skills to effectively plan and execute sequential movements, such as putting on clothes, using utensils, or navigating through obstacles. 74. Multisensory learning: The student will engage in multisensory learning activities to enhance learning and retention of information through the integration of visual, auditory, and tactile modalities. 75. Oral motor skills: The student will improve oral motor skills to support speech and language development, articulation, or feeding skills. 76. Oral presentation skills: The student will enhance oral presentation skills, including clear articulation, volume control, and maintaining eye contact, to effectively communicate ideas in front of peers or teachers. 77. Peer collaboration: The student will engage in peer collaboration activities, such as group projects or cooperative learning, to foster teamwork, cooperation, and shared problem-solving skills. 78. Peer conflict resolution: The student will learn and apply strategies for peer conflict resolution, such as active listening, compromise, or negotiation skills, to resolve conflicts peacefully. 79. Peer feedback: The student will actively seek and provide constructive feedback to peers during group projects or collaborative tasks, fostering a supportive learning environment. 80. Peer interactions: The student will enhance peer interaction skills, such as sharing, taking turns, or collaborating, to promote positive social relationships and inclusiveness. 81. Peer mentoring: The student will participate in peer mentoring programs, where they can serve as mentors 82. Peer support: The student will participate in peer support programs, where they can receive support from classmates or serve as a support system for peers with similar challenges. 83. Personal space awareness: The student will develop personal space awareness skills to understand appropriate boundaries and respect personal space of others during social interactions. 84. Perspective-taking: The student will enhance perspective-taking skills to understand and consider the viewpoints and feelings of others, promoting empathy and positive social interactions. 85. Phonics and phonological awareness: The student will develop phonics and phonological awareness skills, including letter-sound recognition, blending, or segmenting, to support reading and spelling abilities. 86. Pragmatic language skills: The student will improve pragmatic language skills, including turn-taking, topic maintenance, and understanding social cues, to enhance social communication in various contexts. 87. Pre-vocational skills: The student will develop pre-vocational skills, such as time management, following workplace routines, or demonstrating appropriate work behavior, to prepare for future employment opportunities. 88. Pre-writing skills: The student will develop pre-writing skills, such as tracing lines, shapes, or patterns, to lay the foundation for letter formation and handwriting. 89. Problem-solving: The student will enhance problem-solving skills to independently identify solutions, make decisions, and overcome challenges encountered in academic and social contexts. 90. Reading comprehension: The student will improve reading comprehension skills, such as identifying main ideas, making inferences, or summarizing information, to enhance understanding of academic content. 91. Reading fluency: The student will improve reading fluency skills, including speed, accuracy, and prosody, to enhance reading comprehension and overall reading abilities. 92. Safety skills: The student will learn safety skills, including road safety, fire safety, or personal safety, to enhance awareness and make safe choices in various environments. 93. Self-advocacy in the classroom: The student will develop self-advocacy skills to communicate their needs, accommodations, or modifications with teachers and actively participate in their educational planning. 94. Self-advocacy skills: The student will develop self-advocacy skills to express their needs, seek assistance when necessary, and actively participate in their educational planning. 95. Self-care skills: The student will develop independence in self-care activities, such as dressing, grooming, and feeding, to promote greater participation and self-sufficiency in daily routines. 96. Self-initiation: The student will enhance self-initiation skills to independently start tasks or activities without constant prompts or reminders from teachers or caregivers. 97. Self-monitoring: The student will develop self-monitoring skills to assess their own performance, identify errors or areas of improvement, and make adjustments accordingly. 98. Self-regulation: The student will develop self-regulation strategies to manage emotions, impulses, and sensory needs to facilitate engagement and appropriate behavior in the classroom. 99. Sensory accommodations: The student will benefit from sensory accommodations in the classroom, such as noise-reducing headphones, visual schedules, or flexible seating options, to optimize their sensory environment. 100. Sensory diet: The student will implement a sensory diet, consisting of tailored sensory activities, to support self-regulation and attention throughout the school day. 101. Sensory discrimination: The student will improve sensory discrimination skills to differentiate and interpret sensory information, such as identifying textures, temperatures, or shapes through touch. 102. Sensory exploration and play skills: The student will actively engage in sensory exploration and play activities to promote sensory integration, creativity, and imaginative play. 103. Sensory modulation during mealtime: The student will improve sensory modulation skills during mealtime to tolerate different textures, tastes, or smells, promoting healthy eating habits and mealtime participation. 104. Sensory modulation: The student will improve sensory modulation skills to effectively respond to and regulate their responses to sensory stimuli in the environment. 105. Sensory processing: The student will improve sensory processing skills to effectively regulate responses to sensory stimuli, resulting in increased attention and engagement in the classroom. 106. Sensory regulation: The student will enhance sensory regulation skills to manage sensory sensitivities or sensory-seeking behaviors that may impact participation and attention in the classroom. 107. Sensory-based strategies: The student will learn and utilize sensory-based strategies, such as deep pressure input or fidget tools, to regulate sensory needs and promote attention and focus in the classroom. 108. Sensory-based transitions: The student will utilize sensory-based strategies to support transitions, such as incorporating movement breaks, deep pressure activities, or sensory fidgets during transitions. 109. Sequencing and organization: The student will improve sequencing and organization skills to arrange information or tasks in a logical order, enhancing problem-solving abilities and task completion. 110. Social participation: The student will increase social participation and engagement with peers during group activities, cooperative play, or structured social interactions. 111. Social problem-solving: The student will develop social problem-solving skills to analyze social situations, identify appropriate responses, and resolve conflicts effectively. 112. Social skills: The student will develop conflict resolution skills by using appropriate strategies, such as compromising, problem-solving, or seeking adult assistance, to resolve conflicts with peers, in 9 out of 10 conflict situations. 113. Social skills: The student will develop social skills, including initiating conversations, maintaining eye contact, or understanding social cues, to foster positive peer interactions and social relationships. 114. Social skills: The student will develop their ability to recognize and interpret social norms and expectations in different situations, demonstrating appropriate behavior and manners in various social settings, in 8 out of 10 opportunities. 115. Social skills: The student will develop turn-taking skills during group activities or games, waiting for their turn and appropriately sharing materials or responsibilities, in 8 out of 10 opportunities. 116. Social skills: The student will enhance their ability to interpret and understand nonverbal cues, such as facial expressions, body language, and tone of voice, to better comprehend and respond to social situations, in 9 out of 10 opportunities. 117. Social skills: The student will enhance their ability to recognize and respect personal space boundaries, demonstrating appropriate physical proximity to peers during interactions or group settings, in 8 out of 10 opportunities. 118. Social skills: The student will enhance their ability to work collaboratively in group settings, demonstrating effective teamwork, sharing responsibilities, and respecting others’ ideas and contributions, in 9 out of 10 group activities. 119. Social skills: The student will improve their ability to demonstrate active listening skills, such as making eye contact, nodding, and providing verbal or nonverbal feedback, in 9 out of 10 listening activities or conversations. 120. Social skills: The student will improve their ability to identify and express their emotions in a socially appropriate manner, using words or appropriate gestures to communicate their feelings, in 8 out of 10 opportunities. 121. Social skills: The student will improve their ability to initiate and engage in play interactions with peers, demonstrating sharing, cooperation, and imaginative play skills, in 9 out of 10 play situations or activities. 122. Social skills: The student will improve their ability to initiate and maintain conversations with peers by appropriately greeting, asking questions, and responding to conversation prompts, in 8 out of 10 opportunities. 123. Social skills: The student will enhance their ability to demonstrate empathy and perspective-taking by recognizing and understanding others’ feelings and experiences, and responding with kindness and support, in 8 out of 10 opportunities. 124. Social-emotional learning: The student will participate in social-emotional learning activities, such as mindfulness exercises, empathy-building activities, or conflict resolution strategies, to enhance emotional intelligence and social skills. 125. Spatial awareness: The student will improve spatial awareness skills to accurately perceive and navigate the physical space, including body awareness and spatial relationships. 126. Study skills: The student will learn effective study skills, such as note-taking, organization of materials, or test preparation strategies, to enhance academic performance and retention of information. 127. Technology skills: The student will develop technology skills, including keyboarding, accessing educational software, or utilizing assistive technology devices, to enhance digital literacy and access to educational resources. 128. Time management for homework completion: The student will enhance time management skills specifically for completing homework assignments, including setting priorities, estimating time, and staying on task. 129. Time management: The student will enhance time management skills to effectively allocate time for different tasks, assignments, and transitions throughout the school day. 130. Transition planning: The student will engage in transition planning activities to develop skills necessary for post-school settings, such as vocational training, higher education, or employment. 131. Transition skills: The student will develop motor planning skills to successfully transition between activities, by practicing specific movement sequences or using visual prompts to guide their actions, in 8 out of 10 opportunities. 132. Transition skills: The student will develop problem-solving skills to overcome challenges during transitions, by using strategies such as asking for help, seeking alternative solutions, or adapting to unexpected changes, in 8 out of 10 opportunities. 133. Transition skills: The student will develop transition skills, including managing changes in routines, transitioning between activities, or adapting to new environments, to promote smooth transitions throughout the school day. 134. Transition skills: The student will enhance executive functioning skills to independently initiate and complete transitions between activities, including gathering necessary materials and moving to the designated area, in 7 out of 10 opportunities. 135. Transition skills: The student will enhance self-regulation abilities to transition between activities calmly and without exhibiting disruptive behaviors, by utilizing deep breathing techniques or sensory self-regulation strategies, in 7 out of 10 opportunities. 136. Transition skills: The student will generalize transition skills across different environments and settings, by successfully transitioning between activities in various contexts, such as the classroom, therapy room, or community spaces, in 8 out of 10 opportunities. 137. Transition skills: The student will improve organizational skills to facilitate smooth transitions between activities, by using visual cues or checklists to plan and prepare for the next task, in 9 out of 10 opportunities. 138. Transition skills: The student will improve social skills during transitions, by appropriately interacting with peers and following social expectations, such as taking turns or waiting patiently, in 9 out of 10 opportunities. 139. Transition skills: The student will improve time management skills during transitions, by accurately estimating the time required for packing up and transitioning to the next activity, in 9 out of 10 opportunities. 140. Transition skills: The student will improve transition skills, including transitioning between activities or locations, to promote independence and successful navigation within the school setting. 141. Transition skills: The student will increase attention span during transitions, by engaging in a designated transition activity or following a transition routine without becoming distracted, for at least 80% of transition instances. 142. Transition skills: The student will independently transition between activities within the classroom setting, including packing up and moving to the next activity, within three minutes, in 8 out of 10 opportunities. 143. Typing skills: The student will demonstrate improved typing fluency by maintaining a consistent rhythm and flow in typing activities. 144. Typing skills: The student will develop finger placement and keyboarding technique to increase efficiency and reduce errors during typing tasks. 145. Typing skills: The student will enhance finger dexterity and coordination to facilitate fluid and smooth typing movements. 146. Typing skills: The student will enhance typing accuracy by reducing errors in typing, including correct spelling and punctuation. 147. Typing skills: The student will improve hand-eye coordination to accurately locate and press keys without visual reliance during typing activities. 148. Typing skills: The student will improve keyboard navigation skills, including locating and using function keys, arrows, and other essential keyboard shortcuts. 149. Typing skills: The student will increase independence in typing tasks by minimizing the need for visual prompts or assistance from others. 150. Typing skills: The student will increase typing speed to a specified words-per-minute (WPM) target, enabling more efficient written expression. 151. Typing skills: The student will learn and practice touch typing techniques to improve accuracy and speed in keyboarding tasks. 152. Typing skills: The student will transfer typing skills to real-life applications, such as word processing, email communication, and online research, for academic and functional purposes. 153. Visual closure skills: The student will improve visual closure skills to recognize and complete visual patterns or missing parts of visual stimuli, enhancing visual perception and problem-solving abilities. 154. Visual memory: The student will enhance visual memory skills to remember and recall visual information, such as spelling words or visual sequences. 155. Visual perception: The student will improve visual perception skills, such as visual discrimination or figure-ground skills, to accurately identify and interpret visual information in academic materials. 156. Visual tracking: The student will enhance visual tracking skills to smoothly and accurately follow lines of text during reading and improve reading fluency. 157. Visual-motor integration: The student will enhance visual-motor integration skills to accurately copy written material from the board or a source text onto their own paper. 158. Visual-spatial perception: The student will enhance visual-spatial perception skills to accurately perceive and interpret spatial relationships, such as understanding maps, graphs, or geometric shapes. 159. Vocabulary development: The student will improve vocabulary development, including understanding and using new words, to enhance communication and comprehension skills. 160. Work habits: The student will develop work habits, including task initiation, persistence, and completion, to improve productivity and follow-through on academic assignments.

Clinical Reasoning in Occupational Therapy: A Comprehensive Guide

Clinical reasoning is the backbone of effective decision-making and problem-solving in occupational therapy (OT). It enables therapists to analyze complex situations, gather information, and develop tailored treatment plans for their clients. In this blog post, we will delve into the intricacies of clinical reasoning in occupational therapy, exploring its importance, key components, and practical strategies. Whether you’re a seasoned occupational therapist or a student just starting your journey, this guide will empower you to enhance your clinical reasoning skills and deliver optimal outcomes for your patients.

Important of Clinical Reasoning in OT

The Significance of Clinical Reasoning in Occupational Therapy At the core of occupational therapy lies the process of clinical reasoning. This cognitive process allows therapists to integrate knowledge, clinical expertise, and patient values to make informed decisions. Here’s why clinical reasoning is paramount in occupational therapy:

• Promotes Personalized Treatment: Clinical reasoning enables occupational therapists to individualize treatment plans based on the unique needs and goals of each client. By analyzing client factors, activity demands, and environmental considerations, therapists can tailor interventions to maximize functional outcomes.
• Enhances Problem-Solving Abilities: Occupational therapists face diverse challenges and must navigate complex client situations. Clinical reasoning equips them with the skills to identify problems, explore potential solutions, and make sound judgments that optimize intervention effectiveness.
• Facilitates Evidence-Based Practice: Clinical reasoning guides therapists in critically evaluating research evidence and integrating it with their clinical expertise. This ensures that therapeutic interventions are grounded in the latest scientific knowledge and align with best practices.

Components of Clinical Reasoning in OT

Components of Clinical Reasoning in Occupational Therapy To fully grasp clinical reasoning in occupational therapy, it’s essential to understand its core components. Here are the key elements involved:

Strategy of Clinical Reasoning for OT

Strategies for Enhancing Clinical Reasoning in Occupational Therapy

• Continual Professional Development: Engage in ongoing learning and attend relevant workshops, conferences, and seminars to stay updated with the latest evidence-based practices and research.
• Reflective Practice: Regularly reflect on clinical experiences, seeking to understand the reasoning behind your decisions and analyzing the outcomes. This introspection helps refine your clinical reasoning skills over time.
• Collaborative Approach: Foster open communication and collaboration with colleagues, clients, and other healthcare professionals to gain diverse perspectives and enhance your problem-solving abilities.
• Utilize Clinical Tools: Make use of standardized assessment tools, clinical guidelines, and evidence-based resources to support your clinical reasoning process.

FAQ: Frequently Asked Questions about Clinical Reasoning in Occupational Therapy

Q1: What role does clinical reasoning play in the occupational therapy process?

A1: Clinical reasoning serves as the foundation for decision-making in occupational therapy. It guides therapists in analyzing client information, identifying problems, setting goals, planning interventions, and evaluating outcomes.

Q2: How can I improve my clinical reasoning skills?

A2: Enhancing clinical reasoning skills requires a combination of ongoing learning, reflective practice, collaboration, and utilization of clinical tools. Engaging in professional development activities and

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OT INTERVENTIONS

Play slideshow, occupational therapy interventions.

     Occupational therapists help people participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). At the core of occupational therapy is a belief in health through doing . "Doing" may range from participating in practical and leisure activities to more subtle activities such as cultivating empathy or identifying values.      Psychosocial occupational therapy interventions seek to optimize human functioning using a holistic approach. Interventions may facilitate reaching a youth’s goals surrounding social skills, communication skills, decision-making, problem-solving, emotional regulation, coping strategies, healthy risk-taking, attention span and focus, intrinsic motivation, values identification, positive self-concept, time management, agency and self-efficacy. Interventions are customized to leverage a youth’s interests and strengths, facilitate optimal well-being, and to match a youth’s stage of development. OTTP occupational therapists practice client-centered, trauma-informed care.     For a visual tour representing a small sampling of possible interventions, view our OT slideshow above.

Core Beliefs

• There is a positive relationship between occupation and health (physical/emotional) • ”All people need to...engage in the occupations of their need and choice , to grow through what they do, and to experience independence or interdependenc e , equality, participation, security, health and well being .”  • Occupations structure daily life, are central to our identity and sense of competence, and have particular meaning and value to us. • Health and well being can be affected by environmental barriers to participation. American Occupational Therapy Association (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609-639.

Ot domain / scope of practice.

OT’s Established Body of Knowledge & Expertise

Areas of Occupation

Activities of daily living  instrumental activities of daily living  rest & sleep education work play leisure social participation, client factors, values, beliefs, spirituality body functions body structures ‍, performance skills, sensory/perceptual  motor & praxis emotion regulation cognitive  communication / social ‍, performance patterns, habits routines roles rituals ‍ ‍, context & environment, cultural personal physical social temporal virtual ‍, activity demands, objects/properties space  social  sequencing / timing required actions required body structures & function ‍, american occupational therapy association (2002). occupational therapy practice framework: domain and process. american journal of occupational therapy, 56, 609-639..

10 Best Problem-Solving Therapy Worksheets & Activities

Cognitive science tells us that we regularly face not only well-defined problems but, importantly, many that are ill defined (Eysenck & Keane, 2015).

Sometimes, we find ourselves unable to overcome our daily problems or the inevitable (though hopefully infrequent) life traumas we face.

Problem-Solving Therapy aims to reduce the incidence and impact of mental health disorders and improve wellbeing by helping clients face life’s difficulties (Dobson, 2011).

This article introduces Problem-Solving Therapy and offers techniques, activities, and worksheets that mental health professionals can use with clients.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What is problem-solving therapy, 14 steps for problem-solving therapy, 3 best interventions and techniques, 7 activities and worksheets for your session, fascinating books on the topic, resources from positivepsychology.com, a take-home message.

Problem-Solving Therapy assumes that mental disorders arise in response to ineffective or maladaptive coping. By adopting a more realistic and optimistic view of coping, individuals can understand the role of emotions and develop actions to reduce distress and maintain mental wellbeing (Nezu & Nezu, 2009).

“Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella” (Nezu, Nezu, & D’Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.

Clinical research, counseling, and health psychology have shown PST to be highly effective in clients of all ages, ranging from children to the elderly, across multiple clinical settings, including schizophrenia, stress, and anxiety disorders (Dobson, 2011).

Can it help with depression?

PST appears particularly helpful in treating clients with depression. A recent analysis of 30 studies found that PST was an effective treatment with a similar degree of success as other successful therapies targeting depression (Cuijpers, Wit, Kleiboer, Karyotaki, & Ebert, 2020).

Other studies confirm the value of PST and its effectiveness at treating depression in multiple age groups and its capacity to combine with other therapies, including drug treatments (Dobson, 2011).

The major concepts

Effective coping varies depending on the situation, and treatment typically focuses on improving the environment and reducing emotional distress (Dobson, 2011).

PST is based on two overlapping models:

Social problem-solving model

This model focuses on solving the problem “as it occurs in the natural social environment,” combined with a general coping strategy and a method of self-control (Dobson, 2011, p. 198).

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

The model is a “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (Dobson, 2011, p. 199).

Relational problem-solving model

The theory of PST is underpinned by a relational problem-solving model, whereby stress is viewed in terms of the relationships between three factors:

• Stressful life events
• Emotional distress and wellbeing
• Problem-solving coping

Therefore, when a significant adverse life event occurs, it may require “sweeping readjustments in a person’s life” (Dobson, 2011, p. 202).

• Enhance positive problem orientation
• Decrease negative orientation
• Foster ability to apply rational problem-solving skills
• Reduce the tendency to avoid problem-solving
• Minimize the tendency to be careless and impulsive

D’Zurilla’s and Nezu’s model includes (modified from Dobson, 2011):

• Initial structuring Establish a positive therapeutic relationship that encourages optimism and explains the PST approach.
• Assessment Formally and informally assess areas of stress in the client’s life and their problem-solving strengths and weaknesses.
• Obstacles to effective problem-solving Explore typically human challenges to problem-solving, such as multitasking and the negative impact of stress. Introduce tools that can help, such as making lists, visualization, and breaking complex problems down.
• Problem orientation – fostering self-efficacy Introduce the importance of a positive problem orientation, adopting tools, such as visualization, to promote self-efficacy.
• Problem orientation – recognizing problems Help clients recognize issues as they occur and use problem checklists to ‘normalize’ the experience.
• Problem orientation – seeing problems as challenges Encourage clients to break free of harmful and restricted ways of thinking while learning how to argue from another point of view.
• Problem orientation – use and control emotions Help clients understand the role of emotions in problem-solving, including using feelings to inform the process and managing disruptive emotions (such as cognitive reframing and relaxation exercises).
• Problem orientation – stop and think Teach clients how to reduce impulsive and avoidance tendencies (visualizing a stop sign or traffic light).
• Problem definition and formulation Encourage an understanding of the nature of problems and set realistic goals and objectives.
• Generation of alternatives Work with clients to help them recognize the wide range of potential solutions to each problem (for example, brainstorming).
• Decision-making Encourage better decision-making through an improved understanding of the consequences of decisions and the value and likelihood of different outcomes.
• Solution implementation and verification Foster the client’s ability to carry out a solution plan, monitor its outcome, evaluate its effectiveness, and use self-reinforcement to increase the chance of success.
• Guided practice Encourage the application of problem-solving skills across multiple domains and future stressful problems.
• Rapid problem-solving Teach clients how to apply problem-solving questions and guidelines quickly in any given situation.

Success in PST depends on the effectiveness of its implementation; using the right approach is crucial (Dobson, 2011).

Problem-solving therapy – Baycrest

The following interventions and techniques are helpful when implementing more effective problem-solving approaches in client’s lives.

First, it is essential to consider if PST is the best approach for the client, based on the problems they present.

Is PPT appropriate?

It is vital to consider whether PST is appropriate for the client’s situation. Therapists new to the approach may require additional guidance (Nezu et al., 2013).

Therapists should consider the following questions before beginning PST with a client (modified from Nezu et al., 2013):

• Has PST proven effective in the past for the problem? For example, research has shown success with depression, generalized anxiety, back pain, Alzheimer’s disease, cancer, and supporting caregivers (Nezu et al., 2013).
• Is PST acceptable to the client?
• Is the individual experiencing a significant mental or physical health problem?

All affirmative answers suggest that PST would be a helpful technique to apply in this instance.

Five problem-solving steps

The following five steps are valuable when working with clients to help them cope with and manage their environment (modified from Dobson, 2011).

Ask the client to consider the following points (forming the acronym ADAPT) when confronted by a problem:

• Attitude Aim to adopt a positive, optimistic attitude to the problem and problem-solving process.
• Define Obtain all required facts and details of potential obstacles to define the problem.
• Alternatives Identify various alternative solutions and actions to overcome the obstacle and achieve the problem-solving goal.
• Predict Predict each alternative’s positive and negative outcomes and choose the one most likely to achieve the goal and maximize the benefits.
• Try out Once selected, try out the solution and monitor its effectiveness while engaging in self-reinforcement.

If the client is not satisfied with their solution, they can return to step ‘A’ and find a more appropriate solution.

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Positive self-statements

When dealing with clients facing negative self-beliefs, it can be helpful for them to use positive self-statements.

Use the following (or add new) self-statements to replace harmful, negative thinking (modified from Dobson, 2011):

• I can solve this problem; I’ve tackled similar ones before.
• I can cope with this.
• I just need to take a breath and relax.
• Once I start, it will be easier.
• It’s okay to look out for myself.
• I can get help if needed.
• Other people feel the same way I do.
• I’ll take one piece of the problem at a time.
• I can keep my fears in check.
• I don’t need to please everyone.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Answering the questions in the Problem-Solving Self-Monitoring Form provides the therapist with necessary information regarding the client’s overall and specific problem-solving approaches and reactions (Dobson, 2011).

Ask the client to complete the following:

• Describe the problem you are facing.
• What is your goal?
• What have you tried so far to solve the problem?
• What was the outcome?

Reactions to Stress

It can be helpful for the client to recognize their own experiences of stress. Do they react angrily, withdraw, or give up (Dobson, 2011)?

The Reactions to Stress worksheet can be given to the client as homework to capture stressful events and their reactions. By recording how they felt, behaved, and thought, they can recognize repeating patterns.

What Are Your Unique Triggers?

Helping clients capture triggers for their stressful reactions can encourage emotional regulation.

When clients can identify triggers that may lead to a negative response, they can stop the experience or slow down their emotional reaction (Dobson, 2011).

The What Are Your Unique Triggers ? worksheet helps the client identify their triggers (e.g., conflict, relationships, physical environment, etc.).

Problem-Solving worksheet

Imagining an existing or potential problem and working through how to resolve it can be a powerful exercise for the client.

Use the Problem-Solving worksheet to state a problem and goal and consider the obstacles in the way. Then explore options for achieving the goal, along with their pros and cons, to assess the best action plan.

Getting the Facts

Clients can become better equipped to tackle problems and choose the right course of action by recognizing facts versus assumptions and gathering all the necessary information (Dobson, 2011).

Use the Getting the Facts worksheet to answer the following questions clearly and unambiguously:

• Who is involved?
• What did or did not happen, and how did it bother you?
• Where did it happen?
• When did it happen?
• Why did it happen?
• How did you respond?

2 Helpful Group Activities

While therapists can use the worksheets above in group situations, the following two interventions work particularly well with more than one person.

Generating Alternative Solutions and Better Decision-Making

A group setting can provide an ideal opportunity to share a problem and identify potential solutions arising from multiple perspectives.

Use the Generating Alternative Solutions and Better Decision-Making worksheet and ask the client to explain the situation or problem to the group and the obstacles in the way.

Once the approaches are captured and reviewed, the individual can share their decision-making process with the group if they want further feedback.

Visualization

Visualization can be performed with individuals or in a group setting to help clients solve problems in multiple ways, including (Dobson, 2011):

• Clarifying the problem by looking at it from multiple perspectives
• Rehearsing a solution in the mind to improve and get more practice
• Visualizing a ‘safe place’ for relaxation, slowing down, and stress management

Guided imagery is particularly valuable for encouraging the group to take a ‘mental vacation’ and let go of stress.

Ask the group to begin with slow, deep breathing that fills the entire diaphragm. Then ask them to visualize a favorite scene (real or imagined) that makes them feel relaxed, perhaps beside a gently flowing river, a summer meadow, or at the beach.

The more the senses are engaged, the more real the experience. Ask the group to think about what they can hear, see, touch, smell, and even taste.

Encourage them to experience the situation as fully as possible, immersing themselves and enjoying their place of safety.

Such feelings of relaxation may be able to help clients fall asleep, relieve stress, and become more ready to solve problems.

We have included three of our favorite books on the subject of Problem-Solving Therapy below.

1. Problem-Solving Therapy: A Treatment Manual – Arthur Nezu, Christine Maguth Nezu, and Thomas D’Zurilla

This is an incredibly valuable book for anyone wishing to understand the principles and practice behind PST.

Written by the co-developers of PST, the manual provides powerful toolkits to overcome cognitive overload, emotional dysregulation, and the barriers to practical problem-solving.

Find the book on Amazon .

2. Emotion-Centered Problem-Solving Therapy: Treatment Guidelines – Arthur Nezu and Christine Maguth Nezu

Another, more recent, book from the creators of PST, this text includes important advances in neuroscience underpinning the role of emotion in behavioral treatment.

Along with clinical examples, the book also includes crucial toolkits that form part of a stepped model for the application of PST.

3. Handbook of Cognitive-Behavioral Therapies – Keith Dobson and David Dozois

This is the fourth edition of a hugely popular guide to Cognitive-Behavioral Therapies and includes a valuable and insightful section on Problem-Solving Therapy.

This is an important book for students and more experienced therapists wishing to form a high-level and in-depth understanding of the tools and techniques available to Cognitive-Behavioral Therapists.

For even more tools to help strengthen your clients’ problem-solving skills, check out the following free worksheets from our blog.

• Case Formulation Worksheet This worksheet presents a four-step framework to help therapists and their clients come to a shared understanding of the client’s presenting problem.
• Understanding Your Default Problem-Solving Approach This worksheet poses a series of questions helping clients reflect on their typical cognitive, emotional, and behavioral responses to problems.
• Social Problem Solving: Step by Step This worksheet presents a streamlined template to help clients define a problem, generate possible courses of action, and evaluate the effectiveness of an implemented solution.

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

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While we are born problem-solvers, facing an incredibly diverse set of challenges daily, we sometimes need support.

Problem-Solving Therapy aims to reduce stress and associated mental health disorders and improve wellbeing by improving our ability to cope. PST is valuable in diverse clinical settings, ranging from depression to schizophrenia, with research suggesting it as a highly effective treatment for teaching coping strategies and reducing emotional distress.

Many PST techniques are available to help improve clients’ positive outlook on obstacles while reducing avoidance of problem situations and the tendency to be careless and impulsive.

The PST model typically assesses the client’s strengths, weaknesses, and coping strategies when facing problems before encouraging a healthy experience of and relationship with problem-solving.

Why not use this article to explore the theory behind PST and try out some of our powerful tools and interventions with your clients to help them with their decision-making, coping, and problem-solving?

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Cuijpers, P., Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. (2020). Problem-solving therapy for adult depression: An updated meta-analysis. European P sychiatry ,  48 (1), 27–37.
• Dobson, K. S. (2011). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Dobson, K. S., & Dozois, D. J. A. (2021). Handbook of cognitive-behavioral therapies  (4th ed.). Guilford Press.
• Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: A student’s handbook . Psychology Press.
• Nezu, A. M., & Nezu, C. M. (2009). Problem-solving therapy DVD . Retrieved September 13, 2021, from https://www.apa.org/pubs/videos/4310852
• Nezu, A. M., & Nezu, C. M. (2018). Emotion-centered problem-solving therapy: Treatment guidelines. Springer.
• Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual . Springer.

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Occupational Therapy Interventions for Adults Living With Serious Mental Illness

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Elizabeth Griffin Lannigan , Susan Noyes; Occupational Therapy Interventions for Adults Living With Serious Mental Illness. Am J Occup Ther September/October 2019, Vol. 73(5), 7305395010p1–7305395010p5. doi: https://doi.org/10.5014/ajot.2019.735001

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Occupational therapy practitioners have education, skills, and knowledge to provide occupational therapy interventions for adults living with serious mental illness. Evidence-based interventions demonstrate that occupational therapy practitioners can enable this population to engage in meaningful occupations, participate in community living, and contribute to society. Systematic review findings for occupational therapy interventions for adults living with serious mental illness were published in the September/October 2018 issue of the American Journal of Occupational Therapy and in the Occupational Therapy Practice Guidelines for Adults Living With Serious Mental Illness. Each article in the Evidence Connection series summarizes evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how research evidence from the reviews can be used to inform and guide clinical decision making. Through a case story, this article illustrates how current evidence is applied for effective occupational therapy intervention with an adult living with serious mental illness.

Rosa is a 42-yr-old woman who was diagnosed with schizophrenia at age 23 yr. She completed her high school education but is currently unemployed. Rosa never married and has no children. Her parents are deceased, and she is close to her sister and brother-in-law, who live several states away. During the first 10-yr period after her initial diagnosis, she had three admissions to the local general hospital’s inpatient unit for acute episodes; the interventions included medication stabilization and discharge referrals to local mental health services. After her first hospitalization, Rosa attempted to live in an independent apartment but was unable to manage her self-care and household responsibilities. For the past 5 yr, Rosa has lived in a supported-housing, one-bedroom apartment, managed by the local community mental health agency.

Rosa currently participates in the Assertive Community Treatment (ACT) program to address her stated wellness and employment goals. Doug is the ACT team occupational therapy practitioner, collaborating with Inez, the occupational therapy assistant, for intervention implementation.

• Occupational Therapy Evaluation and Goal Setting

Doug began the occupational therapy evaluation by administering the Canadian Occupational Performance Measure (COPM; Law et al., 2014 ) to determine Rosa’s strengths and challenges in occupational performance and complete her occupational profile ( American Occupational Therapy Association [AOTA], 2017 ). Doug learned that Rosa’s roles include sister and participant in an ACT program. Rosa reported wishing to live in an independent apartment but acknowledged needing assistance from supported housing staff. She reported not socializing with any other residents. With assistance from local vocational rehabilitation services, she worked briefly in several cleaning jobs. Rosa described leaving these jobs because of difficulty with supervisors and coworkers, but she was unable to be more specific about her work challenges. During the COPM assessment, Rosa shared being very dissatisfied with her social participation and unemployment. Rosa voiced wanting to “have friends to connect with” and find a job that she “could do for many years.”

To gain additional information to support Rosa’s community participation, Doug administered several assessments for the analysis of occupational performance ( AOTA, 2014 ), including the Allen Cognitive Level Screen–5 (ACLS–5; Allen et al., 2007 ) and the Routine Task Inventory–Expanded (RTI–E; Katz, 2006 ). The score of 5.0 on both indicated that Rosa experiences difficulty with abstract thinking and uses trial-and-error problem solving ( Allen et al., 1995 ). Rosa will benefit from visual demonstrations accompanied by verbal explanations. Use of concrete explanations and examples will assist Rosa’s planning ahead for potential problems.

Results of the Weekly Calendar Planning Activity ( Toglia, 2015 ) supported the findings from the ACLS–5 and RTI–E, demonstrating Rosa’s limited ability to monitor her own performance and difficulty in complex thinking for performance. Combined assessment results indicated that Rosa needed assistance to develop strategies for establishing and maintaining daily and weekly routines as well as balancing work, rest, leisure, and social participation. Environmental cues can promote Rosa’s success in her home and future work environments. Structured daily and weekly routines, incorporating work and meaningful social interactions, will support and maintain Rosa’s recovery. A brief summary of assessment results is presented in Table 1 .

On the basis of Rosa’s interests, goals, and assessment results, Doug collaborated with Rosa to develop intervention goals. Rosa willingly participated in occupational therapy interventions with Doug and Inez to address employment and social participation. Goals included securing competitive employment through an Individual Placement and Support (IPS) model of supported employment, achieving independence in self-care and transportation to support employment (activities of daily living and instrumental activities of daily living tasks), and participating in social and leisure activities in the community. Doug reviewed the evidence from the September/October 2018 issue of the American Journal of Occupational Therapy (see D’Amico et al., 2018 ; Noyes et al., 2018 ) and AOTA’s Occupational Therapy Practice Guidelines for Adults Living With Serious Mental Illness ( Noyes & Lannigan, 2019 ), incorporating that evidence into Rosa’s occupational therapy intervention plan.

• Intervention Implementation

On the basis of the strength of the evidence and findings from the systematic reviews, the following interventions were implemented to address Rosa’s goals (Doug’s intervention implementation included two sessions per week for 12 wk):

Doug collaborated with Rosa to facilitate her referral to the IPS program sponsored by the local community mental health agency ( Areberg & Bejerholm, 2013 ; Campbell et al., 2010 , 2011 ; Catty et al., 2008 ; Heslin et al., 2011 ; Kinoshita et al., 2013 ; Kukla & Bond, 2013 ; Michon et al., 2014 ; Modini et al., 2016 ; Twamley et al., 2008 , 2012 ; Wong et al., 2008 ).

Individual sessions with Rosa focused on skill development for effective workplace grooming and dressing and using public transportation to travel to work independently (Lindström et al., 2012 ; Roldán-Merino et al., 2013 ).

Rosa attended occupational therapist–led groups at the ACT program to increase social participation ( Cook et al., 2009 ; Štrkalj-Ivezić et al., 2013 ; Tatsumi et al., 2012 ), with one group intervention using cognitive–behavioral therapy (CBT) to directly address social skills ( Rus-Calafell et al., 2013 ).

Intervention 1

Rosa requested that Doug accompany her on initial appointments with the IPS team to share results of her occupational therapy evaluation. This collaboration addressed making the best possible match between her strengths, skills, and challenges and the requirements of her desired job. Inez visited several potential work settings with Rosa and provided onsite job coaching while Rosa learned the tasks of her chosen retail job.

Intervention 2

During sessions with Inez, Rosa identified workplace requirements for grooming and clothing. Inez accompanied Rosa to visit several secondhand clothing stores, where Rosa purchased appropriate clothing for the retail job. Inez assisted Rosa to create a chart of grooming tasks to be completed daily for her work shifts. Rosa added scheduled times for each task, producing a printed schedule to follow. She posted this chart in her apartment bathroom.

Intervention 3

Inez assisted Rosa in identifying the public transportation route from her apartment to the retail store. Inez accompanied Rosa on a trial run, after which Rosa completed successfully three independent trials of public transportation to the store.

Intervention 4

Doug led occupational therapy social participation groups within the ACT program. Rosa attended six group sessions, participating in the CBT approach to improve her workplace social interactions. She completed role-plays enacting conversations with coworkers and supervisors. Rosa reported feeling more able to engage in workplace conversations and to communicate her needs to the supervised housing staff.

Through use of evidence-based, occupation-focused, and client-centered occupational therapy interventions, Rosa met her goals by the end of her 4-mo intervention plan. Rosa performed her employment responsibilities with decreasing job coaching by Inez. Rosa excitedly reported working at her retail job 2 days per week. She credited Inez with “teaching me all the steps,” stating that she knew how to do all the job tasks now. At 4 mo, Rosa no longer required onsite job coaching but continued to meet weekly with Inez to discuss work performance concerns.

Rosa reported managing communication at her workplace, such as feeling comfortable asking questions of her direct supervisor when needed. She also reported considerable improvement in her use of structured routines to effectively complete self-care activities before going to work, sharing her supervisor’s comment that her appearance at work contributed to her employment success. Rosa also described successfully using public transportation for work. Rosa made plans to meet two peers from the social skills group socially after discharge. She described having “a much easier time knowing what to say” to coworkers at her job, which made her feel more confident.

Doug and Inez met with Rosa at the end of 4 mo for reevaluation of her daily living, social participation, and employment goals. Rosa intended to continue the IPS program as support for maintaining her job. Rosa requested continuing attendance in therapeutic groups to address communication and employment concerns because of her desire to seek employment with greater responsibilities. She reviewed other discharge recommendations and community resources with Doug and Inez. Together, they researched opportunities for increasing social interactions in her community through the local community recreation and adult education centers.

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Note. ACLS–5 = Allen Cognitive Level Screen–5; COPM = Canadian Occupational Performance Measure; RTI–E = Routine Task Inventory–Expanded; WCPA = Weekly Calendar Planning Activity.

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10 Problem Solving IEP Goals for Real Life

Written by:

  Rebekah Pierce

Filed under: IEPs , Executive Functioning , Problem Solving

Published:  April 2, 2022

Last Reviewed: April 11, 2024

READING TIME:  ~ minutes

This article is designed to be utilized with the utmost professional integrity and ethical consideration. It is imperative to acknowledge that directly copying and pasting example goals into student’s IEPs from any external source, including ours, undermines the individualized nature of IEP planning and does not serve the best interests of students.

This resource aims to inspire the development of IEP goals that address executive functioning needs, not a substitute for the detailed, student-centered IEP goal setting process. Educators and IEP teams are urged to use this as a tool for ideation, basing final goals on student assessments and collaborative IEP team insights.

We all have problems – but when it comes to solving problems, how good is your child at solving them?

For many parents and teachers who work with children with executive functioning issues, it quickly becomes clear that problem-solving is essential for succeeding in school and the workplace.

Problem-solving not only requires being able to identify when a problem exists, but also being able to come up with reasonable solutions to fix them.

If you’re planning on writing IEP goals that address problem-solving skills, this post should serve as a helpful starting place.

What is Problem Solving?

Problem-solving is simply our ability to identify and describe a problem and then come up with solutions to resolve it.

What exactly defines “a problem”?” It’s any time you want something and there is something that stands in the way, in essence. When you have good problem-solving skills, you are able to evaluate this problem and figure out possible steps forward.

As is the case with all other executive functioning skills, including task initiation and organization, a child’s ability to problem solve relates closely to other executive functioning skills.

Ask yourself the following questions to figure out whether problem-solving is an area that needs some work in your child:

• Can he or she complete games and puzzles to accomplish a goal?
• Is he or she able to identify all parts of a problem, including where it originated and why?
• Can your child break apart a larger problem into smaller parts? Can the student identify problems in many different contexts, like work versus school versus social contexts?
• Will your child seek guidance from others when looking for help in solving a problem?
• Does the child persist in coming up with new strategies when the original ones are not successful?

Being a good problem solver doesn’t just come down to being able to “figure things out” in real life. A child who struggles with problem-solving skills may also develop problem behaviors. They might talk back, demonstrate aggression, or engage in other self-destructive behaviors when frustrated with a challenging task.

Therefore, coming up with IEP goals that address this “problem” of not being able to solve problems head-on is essential.

Sample IEP Goals for Problem Solving

Here are a few sample IEP goals for problem-solving to give you some inspiration.

Adaptive Goals

• By the end of the school year, when given a written scenario in which a problem needs to be solved, the student will provide two appropriate solutions with 80% accuracy in 4 out of 5 opportunities, according to teacher observation.
• By the end of the school year, the student will practice problem-solving techniques when dealing with personal or school experiences 100% of the time, according to teacher observation.

Social Goals

• By the end of the IEP term, when given pre-taught behavioral strategies to decrease or avoid escalating behaviors, the students will complete at least one activity with positive behavioral results, according to teacher observation.
• By the end of the school year, the student will solve problems by apologizing in conflict situations 90% of the time, based on teacher observation.

Reading Goals

• By the end of the IEP term, when presented with text at his instructional level, the student will use context clues to determine the meaning of unknown words with 80% accuracy, as measured by written work samples.
• By the end of the school year, the students will read a short story and answer who, what, where, why, and how questions with 90% accuracy in four out of five recorded opportunities, based on teacher observation.
• By the end of the IEP term, when given a word problem, the student will independently determine which operation is to be used with 100% accuracy on 4 out of 5 trials, measured quarterly by teacher observation.
• By the end of the school year, the student will independently solve two-step word problems (mixed addition and subtraction) with 100% accuracy on 4 out of 5 trials based on teacher observation.

Writing Goals

• By the end of the school year, when given a writing assignment, the student will independently create a keyword outline that includes the main topic and three supporting points as a basis for the essay, based on a rubric, 90% of the time.
• By the end of the IEP term, the student will create five-paragraph essays with proper essay structure that clearly address a question in an assignment, based on a rubric, 100% of the time.

Tips on Setting Goals for Problem Solving

Here are a few tips to help you come up with effective goals that work toward better problem-solving skills.

Do a Behavioral Observation

Behavioral observations can be useful for identifying all kinds of skills deficits, but particularly in the area of problem-solving. Take the time to sit down and observe the child at work.

What do they do when they encounter a problem? What are their strengths and weaknesses? What are they able to solve independently – and in what areas do they consistently require support?

A skills assessment can also be helpful. The Real Life Executive Functioning Skills Assessment is a great place to start, since it will help you see where your child is struggling in particular.

Get the Whole Team Involved

Writing problem-solving goals should not be an independent process. It should involve all members of your child’s care team, including family members, coaches, teachers, and other professionals. You’ll need their input to see if the child is struggling with problem-solving across the board, or just in one or two isolated areas.

Play to Their Interests

Motivation plays a major role in teaching new executive functioning skills so do your best to make sure your student stays motivated! Incorporate their favorite activities into learning and have conversations about your child’s favorite movie character, sports figure, or other celebrities. What sorts of problems have they encountered? How did the person solve these problems successfully?

Try Role Playing

Give your child the opportunity to practice his new problem-solving skills in every walk of life. Using role-play cards that prompt your child to solve problems in certain situations (like when you have a large homework assignment due tomorrow or even something as simple as you don’t know what to eat) is highly effective. You can find templates and helpful examples for how to get started with these scenarios in the Real Life Executive Functioning Workbook (coupon code LSA20 for 20% off at checkout).

Try the IDEAL Method

The IDEAL Method is one strategy you can use to help your child become a better problem solver. This method can be used while you are working toward any of the sample goals listed above (or any that you come up with on your own). You can learn more about it here and in the Real Life Executive Functioning Workbook .

Know When to Ask For Help

None of us is an island. We all need help from time to time. Knowing when – and who – to ask for help is essential. Encourage your child to brainstorm a list of people who can help in a pinch and be sure to try the Phone a Friend exercise in the Real Life Executive Functioning Workbook.

How to Address Each Goal

When working on problem-solving skills, the most important thing to remember is that you need to be focused on other areas in which your child struggles, too.

Problem-solving is often viewed as a collection of executive functioning skills rather than one individual skill. To help your child become better at solving problems, he needs to develop other executive functioning skills as well.

Problem-solving requires the ability to evaluate and outline different strategies – aka, planning. They need to be able to take action – task initiation. They might also need to use attentional control, organization, and time management skills. A holistic approach to addressing these problem-solving goals is essential.

Our Executive Functioning Assessment is a great place to start. It will show you where your child is at and what they need in order to improve. This assessment isn’t just for teachers – it’s also a helpful resource for parents, administrators, and even the student himself or herself.

Problem Solved! Here’s How to Write the Best Problem-Solving IEP Goals

If you find the process of writing IEP goals for problem-solving to be…well, a major problem, then you need to consider these tips. If you aren’t sure where to start, get organized! Start by giving your student the Executive Functioning Assessment and use the Real Life Executive Functioning Workbook as a guide to help point you in the direction of what skills to target.

Start by writing down what you want them to be able to do. Be as specific as possible, and use terms that your student can understand.

Once you have a good list of goals, work on breaking them down into smaller steps that will help your student reach their ultimate goal.

Remember to make sure these steps are achievable, measurable, and time-based so you can track your student’s progress and give them the support they need along the way.

Problem solved!

Looking For More Executive Functioning IEP Goal Ideas?

Visit our EF IEP Goal Resource Hub or check out our other skill-specific IEP goal articles:

• 8 Impulse Control IEP Goals
• 8 Attentional Control IEP Goals
• 8 Self-Monitoring IEP Goals
• 10 Problem Solving IEP Goals
• 10 Working Memory IEP Goals
• 9 Emotional Control IEP Goals
• 7 Cognitive Flexibility IEP Goals
• 10 Organization IEP Goals
• 12 Task Initiation IEP Goals
• 10 Time Management IEP Goals
• 15 Planning IEP Goals

Further Reading

• Amy Sippl: Executive Functioning Skills 101: Problem-Solving
• Amy Sippl: Teaching the IDEAL Problem-Solving Method to Diverse Learners
• Amy Sippl: Problem-Solving: Long-Term Strategies & Supports For Diverse Learners

About The Author

Rebekah pierce.

Rebekah is a New York writer and teacher who specializes in writing in the education, gardening, health, and natural food niches. In addition to teaching and writing, she also owns a farm and is the author of the blog J&R Pierce Family Farm .

Related Posts

Understanding the adhd iceberg: a comprehensive guide for parents and educators, 7 cognitive flexibility iep goals for real life, how to track the effectiveness of a new routine, 5 time management mistakes & how to avoid them in the new year, building flexibility: activities to teach diverse learners how to adapt to change, how to make your living spaces executive function friendly.

Life Skills Advocate is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Some of the links in this post may be Amazon.com affiliate links, which means if you make a purchase, Life Skills Advocate will earn a commission. However, we only promote products we actually use or those which have been vetted by the greater community of families and professionals who support individuals with diverse learning needs.

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Interventions Within the Scope of Occupational Therapy Practice to Improve Performance of Daily Activities for Older Adults With Low Vision: A Systematic Review

Chiung-ju liu.

Chiung-ju Liu, PhD, OTR/L, FGSA, was Associate Professor, School of Human and Health Sciences, Indiana University, Indianapolis, at the time of the study. She is now Associate Professor, College of Public Health and Health Professions, University of Florida, Gainesville; [email protected]

Megan C. Chang

Megan C. Chang, PhD, OTR/L, is Associate Professor, College of Health and Human Sciences, San Jose State University, San Jose, CA.

Importance: The prevalence of low vision increases with age. Low vision has detrimental effects on older adults’ independence.

Objective: To identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities for older adults with low vision.

Data Sources: Literature published between 2010 and 2017 was searched in CINAHL, Cochrane Databases, MEDLINE, OTseeker, and PsycINFO.

Study Selection and Data Collection: The authors screened and appraised studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies were eligible if the participants’ mean age was 55 yr or older, the level of evidence was Level III or higher, the intervention was within the scope of occupational therapy practice, and the outcome measures assessed the performance of daily activities.

Findings: Fourteen studies met the review criteria. Three intervention themes were identified: low vision rehabilitation services ( n = 6), self-management approach ( n = 6), and tango ( n = 2). Moderate evidence was found for low vision rehabilitation services. Low evidence was found for using the self-management approach or adding the self-management approach to existing low vision rehabilitation services. Low evidence was found for tango.

Conclusion and Relevance: This systematic review supports the use of low vision rehabilitation services as an effective approach. Occupational therapy practitioners are encouraged to be part of multidisciplinary teams that offer comprehensive low vision evaluations and multicomponent services.

What This Article Adds: Low vision rehabilitation that offers multidisciplinary services, including occupational therapy, is effective in promoting independence among older adults with low vision.

Vision loss caused by age-related macular degeneration, diabetic retinopathy, and glaucoma is progressive and irreversible and often leads to low vision. Low vision refers to vision loss that results in difficulty in everyday life activities even with regular glasses, contact lenses, medicine, or surgery ( National Eye Institute, 2018a ). The prevalence of low vision increases drastically with age, from 1% of people in their late 60s to 17% of people in their 80s and older ( National Eye Institute, 2018b ). The adverse effects of low vision on older adults’ independence and emotional health have been well documented ( Brown et al., 2014 ; Kempen et al., 2012 ; Popescu et al., 2011 ; Taylor et al., 2016 ; van der Aa et al., 2015 ).

The top functional complaints among people with vision loss include difficulty reading, driving, recognizing faces, and performing in-home activities ( Brown et al., 2014 ). Activities such as functional mobility, shopping, meal preparation, cleaning, and self-care are negatively affected ( Taylor et al., 2016 ). Older adults with low vision report not only poorer performance in activities in daily living (ADLs) but also higher levels of depression and anxiety compared with older adults in the general population and with chronic conditions ( Kempen et al., 2012 ). A population-based study showed that community-dwelling Medicare beneficiaries with vision impairment were more likely to be hospitalized than those without vision impairment ( Bal et al., 2017 ). Clearly, the impact of vision loss on older adults’ independence and quality of life is profound. Although the pathological process of low vision cannot be reversed by current surgical or medical procedures, the functional decline associated with low vision may be attenuated through nonsurgical intervention provided by occupational therapy practitioners.

A prior systematic review that examined the effectiveness of occupational therapy interventions in improving ADLs and instrumental activities of daily living (IADLs) in older adults with low vision identified a positive effect of using multicomponent approaches to increase knowledge and build skills to overcome the disablement process ( Liu et al., 2013 ). The review also suggested that multiple sessions of training in the use of low vision devices and eccentric viewing are necessary to have a positive effect on clients’ daily activity performance. One of the national vision health objectives in Healthy People 2020 is to increase vision rehabilitation services and comprehensive vision health services ( U.S. Department of Health and Human Services, 2018 ). The demand for occupational therapy services for older adults with low vision will increase in parallel with the increased availability of vision rehabilitation and health services.

The purpose of this systematic review was to update the prior review and provide the most current empirical evidence to support occupational therapy practice in low vision rehabilitation. The question for the updated systematic review was, What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in ADLs and IADLs for older adults with low vision?

This systematic review is one of three updated reviews supported by the American Occupational Therapy Association (AOTA) as part of the Evidence-Based Practice (EBP) Project (see also Nastasi, 2020 , and Smallfield & Kaldenberg, 2020 , in this issue). The methods for the review were specified in advance and documented in a protocol followed by the authors.

Literature Search

The search terms were the same as those used in the last review ( Liu et al., 2013 ; Table 1 ). These search terms were developed by the methodology consultant to the EBP Project and AOTA staff, in consultation with review authors and an advisory group. An experienced medical research librarian conducted the literature search in CINAHL, Cochrane Databases, MEDLINE, OTseeker, and PsycINFO. The search duration for published articles was set at January 2010 to January 2017, and the publication language was limited to English.

Search Terms for Daily Activity Performance for Older Adults With Low Vision

Suggested citation: Liu, C.-j., & Chang, M. C. (2020). Interventions within the scope of occupational therapy to improve performance of daily activities for older adults with low vision: A systematic review ( Table 1 ). American Journal of Occupational Therapy, 74, 7401185010. https://doi.org/10.5014/ajot.2019.038372

Literature Screening

The EBP Project methodology consultant reviewed the article titles and removed articles that were not relevant to the review before passing the search results to the authors. The two authors then individually screened each article title and abstract to determine eligibility. An article was included for further review if the average age of study participants was >55; the level of evidence provided was Level I (randomized controlled trials [RCTs], systematic reviews, or meta-analyses), Level II (nonrandomized studies with two or more groups), or Level III (one-group pretest–posttest studies); participants had low vision; the intervention was within the scope of occupational therapy practice; and the outcome measures assessed ADL or IADL performance. Articles were excluded if the publication format was a dissertation, thesis, or conference presentation or proceeding; the research design was not an intervention study; the intervention content was outside the scope of occupational therapy practice; or the publication language was not English. If the title and abstract did not provide sufficient information, the full text was retrieved for screening. Articles cited in the systematic reviews and meta-analyses included in the search results were also screened for eligibility.

Articles that passed the initial screening were retained for full-text screening. The two authors used the same eligibility criteria for the full-text screening. Any discord in eligibility decisions was resolved through discussion between the authors.

Risk-of-Bias Assessment, Data Extraction, and Synthesis of Intervention Themes

The two authors independently rated the risk of bias of each eligible study using the Cochrane risk-of-bias guidelines ( Higgins et al., 2011 ). The risk of selection bias, performance bias, detection bias, attrition bias, and reporting bias was rated as high, low, or unclear ( Table 2 , at the end of this article). The authors discussed any discord in bias rating until they reached a consensus.

Risk-of-Bias Table

Note . Categories for risk of bias are as follows: + = low risk of bias; ? = unclear risk of bias; – = high risk of bias. N/A = not applicable because no objective outcome measures were used. Risk-of-bias table format adapted from “Assessing Risk of Bias in Included Studies,” by J. P. T. Higgins, D. G. Altman, and J. A. C. Sterne , in Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0), by J. P. T. Higgins and S. Green (Eds.), 2011 , London: Cochrane Collaboration. Retrieved from http://handbook-5-1.cochrane.org . Copyright © 2011 by The Cochrane Collaboration.

Suggested citation: Liu, C.-j., & Chang, M. C. (2020). Interventions within the scope of occupational therapy to improve performance of daily activities for older adults with low vision: A systematic review ( Table 2 ). American Journal of Occupational Therapy, 74, 7401185010. https://doi.org/10.5014/ajot.2019.038372

After the risk-of-bias rating, the authors extracted and summarized study information, including level of evidence, research design, participant characteristics, intervention, outcome measures, and results, in an evidence table ( Table 3 , at the end of this article). One author extracted and entered the information, and the other checked the accuracy of the entered information.

Evidence Table for Daily Activity Performance for Older Adults With Low Vision

Note . AMD = age-related macular degeneration; IADLs = instrumental activities of daily living; M = mean; Mdn = median; NEI VFQ–25 = National Eye Institute Visual Function Questionnaire–25; NR = not reported; RCT = randomized controlled trial.

Suggested citation: Liu, C.-j., & Chang, M. C. (2020). Interventions within the scope of occupational therapy to improve performance of daily activities for older adults with low vision: A systematic review ( Table 3 ). American Journal of Occupational Therapy, 74, 7401185010. https://doi.org/10.5014/ajot.2019.038372

The authors worked together to identify intervention themes in included studies. The strength of evidence in each intervention theme was rated as high, moderate, or low according to the grade definitions by the U.S. Preventive Services Task Force (2014) . High strength of evidence indicates that the available evidence includes consistent results from well-designed, well-conducted studies and is unlikely to be strongly affected by the results of future studies. Moderate strength of evidence indicates that the available evidence is sufficient to determine the effects; however, confidence in the evidence is constrained by factors such as the number, size, or quality of individual studies; lack of coherence in the chain of evidence; or limited generalizability, and the magnitude or direction of the observed effect could change when more information becomes available. Low strength of evidence indicates that the available evidence is insufficient to assess effects because of the limited number of studies, significant flaws in study design or methods, inconsistency of findings across studies, or limited generalizability.

The database searches identified 10,549 records. After removing irrelevant articles and duplicates, the authors reviewed 469 titles and abstracts and excluded 433 articles. The authors then reviewed the full text of the remaining 36 articles. Fourteen articles met the inclusion criteria and were included in the final review. Figure 1 shows the flow of the articles through the literature screening and selection process.

Flow of articles through the selection process.

Note. Figure format from “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement,” by D. Moher, A. Liberati, J. Tetzlaff, & D. G. Altman; The PRISMA Group, 2009, PLoS Medicine, 6 (7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Suggested citation: Liu, C.-j., & Chang, M. C. (2020). Interventions within the scope of occupational therapy to improve performance of daily activities for older adults with low vision: A systematic review ( Figure 1 ). American Journal of Occupational Therapy, 74, 7401185010. https://doi.org/10.5014/ajot.2019.038372

The 14 articles include 6 Level I RCTs ( Hackney et al., 2015 ; Pearce et al., 2011 ; Rees et al., 2015 ; Rovner et al., 2013 , 2014 ; Stelmack et al., 2012 ) and 8 Level III studies ( Alma et al., 2012 ; Coulmont et al., 2013 ; Goldstein et al., 2015 ; Hackney et al., 2013 ; Renieri et al., 2013 ; Ryan et al., 2013 ; Tay et al., 2014 ; Whitson et al., 2013 ). All trials included participants of both genders, and participants’ mean age was in the 80s in 8 studies ( Coulmont et al., 2013 ; Hackney et al., 2013 , 2015 ; Rees et al., 2015 ; Rovner et al., 2013 , 2014 ; Ryan et al., 2013 ; Whitson et al., 2013 ), in the 70s in 5 studies ( Alma et al., 2012 ; Goldstein et al., 2015 ; Pearce et al., 2011 ; Renieri et al., 2013 ; Stelmack et al., 2012 ), and in the 60s in 1 study ( Tay et al., 2014 ). Four studies specified a low vision condition (i.e., age-related macular degeneration) as an inclusion criterion ( Rovner et al., 2013 , 2014 ; Stelmack et al., 2012 ; Whitson et al., 2013 ). The rest of the studies did not specify a low vision condition and recruited participants who attended low vision service clinics, met a specific visual acuity criterion, or had any visual impairment.

Intervention approaches were categorized into three themes: (1) low vision rehabilitation services (6 studies, 1,130 participants), (2) self-management approach (6 studies, 603 participants), and (3) tango (2 studies, 45 participants). Outcome measures that assessed ADLs or IADLs were almost exclusively self-reported. The National Eye Institute Visual Function Questionnaire 25-item version (NEI VFQ–25; Mangione et al., 2001 ) was the most frequently used outcome measure. Key findings are presented by intervention theme in the sections that follow.

Low Vision Rehabilitation Services

Studies that evaluated outcomes of low vision rehabilitation services provided in clinics include 2 Level I studies ( Pearce et al., 2011 ; Stelmack et al., 2012 ) and 4 Level III studies ( Coulmont et al., 2013 ; Goldstein et al., 2015 ; Renieri et al., 2013 ; Ryan et al., 2013 ). All studies were high in risk of selection bias, performance bias, and detection bias.

In the Level I study by Pearce et al. (2011 ), participants who received low vision rehabilitation services completed a low vision assessment (the modified Massof Activity Inventory, on which they rated their difficulty performing daily activities) and then visited an optician to review low vision devices and discuss problems noted at home and available services. An attention control group completed the same low vision assessment, but instead of visiting the optician, they visited a nurse who measured biometrics. Although both groups showed improvement on the selected outcome, there was no difference between the groups.

In the Level I study by Stelmack et al. (2012 ), participants received five weekly low vision rehabilitation therapy sessions and a home visit from a visual therapist who taught strategies for using remaining vision and low vision devices. Participants also completed 5 hr of homework each week. Intervention participants showed significantly higher visual ability as measured by the 48-item Veterans Affairs Low-Vision Visual Functioning Questionnaire at 4 and 12 mo than did wait-list control participants.

Two Level III studies examined low vision rehabilitation services provided by a multidisciplinary team that included an occupational therapist ( Coulmont et al., 2013 ; Goldstein et al., 2015 ). Coulmont et al. (2013 ) found that the improvement on the Functional Global Profile was positively correlated with the number of direct service hours. Goldstein et al. (2015 ) found that half of participants showed a clinically meaningful difference as measured by the Activity Inventory and that the effect size of overall visual ability was large (Cohen’s d = 0.87).

Two Level III studies ( Renieri et al., 2013 ; Ryan et al., 2013 ) examined comprehensive low vision rehabilitation services that included some combination of vision assessment and education, fitting and training for magnifying devices and vision aids, advice about lighting and other methods of enhancing vision, suggestions for managing daily activities, and referral to additional services, reassessment, and follow-up. Both studies reported positive outcomes on the NEI VFQ–25.

Although 5 of the 6 studies in this theme showed positive outcomes for daily activity performance, the strength of evidence is weakened by the poor methodological quality of the studies. Thus, moderate strength of evidence supports using a multidisciplinary low vision rehabilitation team and a comprehensive low vision rehabilitation program to improve ADL or IADL performance.

Self-Management Approach

Three Level I studies ( Rees et al., 2015 ; Rovner et al., 2013 , 2014 ) and 3 Level III studies ( Alma et al., 2012 ; Tay et al., 2014 ; Whitson et al., 2013 ) examined interventions using the self-management approach. The Level I studies had low risk of bias in all categories, and the Level III studies had high risk of selection bias, performance bias, and detection bias.

Interventions in this theme shared the common feature of teaching study participants specific knowledge or a set of specific skills to manage problems related to vision loss as the problems arise. The interventions were not part of the usual low vision rehabilitation services participants received. Some interventions were multicomponent ( Alma et al., 2012 ; Rees et al., 2015 ; Rovner et al., 2014 ; Tay et al., 2014 ; Whitson et al., 2013 ), and one had a single component ( Rovner et al., 2013 ). Common intervention components across these studies included problem-solving skills ( Alma et al., 2012 ; Rees et al., 2015 ; Rovner et al., 2013 ), goal-setting or goal-planning skills ( Alma et al., 2012 ; Rees et al., 2015 ; Whitson et al., 2013 ), and encouragement of social connection ( Alma et al., 2012 ; Rovner et al., 2014 ; Tay et al., 2014 ). These components were delivered weekly in a program format ranging in duration from 6 wk ( Tay et al., 2014 ) to 20 wk ( Alma et al., 2012 ). The interventions were delivered in a group ( Alma et al., 2012 ; Rees et al., 2015 ; Rovner et al., 2013 ; Tay et al., 2014 ), individually in a one-on-one format ( Rovner et al., 2014 ), or individually with the involvement of a friend or family member ( Whitson et al., 2013 ).

Two Level I studies compared a self-management program combined with usual low vision rehabilitation services to usual low vision rehabilitation services alone ( Rees et al., 2015 ; Rovner et al., 2014 ). Rees et al. (2015 ) examined an 8-wk self-management program focused on problem-solving skills training and goal planning added to usual low vision rehabilitation services, which offered an initial assessment by a multidisciplinary team member, an optometric assessment and prescription of optical aids, and further intervention by the multidisciplinary team. Rovner et al. (2014 ) evaluated outcomes from six in-home weekly occupational therapy sessions focused on behavior activation, which emphasizes the relationships among action, mood, and mastery and promotes self-efficacy and social connection as means to improve mood and function, added to usual low vision rehabilitation services, which offered assessments of vision function, prescription of devices, and device education. The combined intervention in both studies did not show significantly greater effects on the Impact of Vision Impairment Questionnaire ( Rees et al., 2015 ) or on the Activities Inventory and the NEI VFQ–25 ( Rovner et al., 2014 ), compared with those of usual low vision rehabilitation services alone.

In the other Level I study, Rovner et al. (2013 ) compared problem-solving therapy to supportive therapy, an attention control condition. The study did not detect a difference between the intervention group and the control group on the Targeted Vision Function or the NEI VFQ–25.

In a Level III study, Alma et al. (2012 ) evaluated an intervention delivered over 20 wk by a multidisciplinary group that included two occupational therapists. The intervention focused on four components: (1) practical skills training; (2) education, social interaction, counseling, and training in problem-solving skills; (3) individual and group goal setting; and (4) a home-based exercise program. In another Level III study, by Tay et al. (2014 ), an occupational therapist delivered a 6-wk intervention focused on understanding vision loss; maximizing remaining vision and using other senses; staying in touch with others; managing personal care, medication, money, and household; participating in daily activities and hobbies; and maintaining safety and mobility. Neither study found a significant improvement in ADL-related outcomes, measured by the Utrecht Scale for Evaluation of Rehabilitation–Participation ( Alma et al., 2012 ) or the Low Vision Quality of Life Questionnaire ( Tay et al., 2014 ), after program completion.

In another Level III study, Whitson et al. (2013 ) evaluated an intervention program that was modified to enable older adults with cognitive deficits to benefit from low vision rehabilitation. The modifications included offering frequent and repetitive training sessions, simplifying the training experience, and involving a friend or family member, and the intervention was delivered by an occupational therapist over 6 wk. The study identified a positive outcome on the NEI VFQ–25—satisfaction with the ability to perform IADLS—and timed activity performance measures after intervention.

In summary, the strength of evidence to support interventions using the self-management approach is low. These studies did not show benefits of the self-management approach, alone or combined with usual low vision rehabilitation services, in improving ADLs or IADLs in older adults with low vision.

One Level I study and 1 Level III study from the same research team examined the effectiveness of an adapted tango intervention in improving balance and reducing falls in older adults with visual impairments ( Hackney et al., 2013 , 2015 ). The adapted tango program consisted of 20 1.5-hr lessons over 12 wk in which participants were paired with partners without vision loss. Both studies had high risk of selection bias, performance bias, and detection bias. In the Level III study, a feasibility study, participants showed significant improvement on the NEI VFQ–25 after the program ( Hackney et al., 2013 ). The Level I study compared the adapted tango program to a standard fall prevention exercise program ( Hackney et al., 2015 ). Although participants in both programs showed a significant improvement on the NEI VFQ–25, the Level I study did not show a superior effect of the adapted tango program relative to that of the standard fall prevention exercise program.

In summary, the strength of evidence to support the use of a tango intervention to improve ADLs and IADLs in older adults with low vision is low. The strength of evidence is weakened by the limited number of studies and poor methodological quality.

The purpose of this systematic review was to identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve ADLs and IADLs for older adults with low vision. Fourteen studies were appraised, and three intervention themes were identified: low vision rehabilitation services, self-management approach, and tango. Moderate evidence was found in support of low vision rehabilitation services. Low evidence was found in support of the self-management approach and tango.

The themes of low vision rehabilitation services and the self-management approach overlap with the themes of multicomponent intervention, single-component intervention, and multidisciplinary intervention identified in the prior review ( Liu et al., 2013 ). Low vision rehabilitation often involves a multidisciplinary team who offer comprehensive evaluations and multicomponent services. The self-management approach can entail a single-component intervention to equip clients with one specific skill or a multicomponent intervention to provide clients with various knowledge and skills. The prior review reported robust evidence in the multicomponent intervention and single-component intervention themes, particularly for interventions delivered over multiple training sessions. The prior review also reported moderate evidence in the multidisciplinary intervention theme.

The results of the current review are consistent with those of the prior review for the multidisciplinary intervention theme and support the positive effect of low vision rehabilitation services. However, the results of the current review for the self-management approach are not as positive as those of the prior review for the multicomponent or single-component intervention themes. The discrepancy may reflect the expansion of study population age and visual impairment conditions, and lack of sensitivity of the outcome measures used in the studies included in the current review.

A wide array of low vision rehabilitation services are available, ranging from simple provision of optical and nonoptical aids to more holistic and comprehensive approaches (e.g., integrated multidisciplinary services) and from one-time service visits to multiple service visits. Prior systematic reviews have shown robust effects of low vision rehabilitation services on vision-related daily task performance regardless of service model or content ( Binns et al., 2012 ; Liu et al., 2013 ). For clients with mild visual impairments, basic low vision services, such as the prescription and provision of low vision devices, and comprehensive low vision rehabilitation services, such as low vision devices plus training in device use or eccentric viewing and environmental modifications, have been found to yield equivalent ADL outcomes ( Stelmack et al., 2017 ). For clients with more severe vision loss in the better-seeing eye, however, comprehensive low vision rehabilitation services have proved more beneficial than basic low vision services ( Stelmack et al., 2017 ). Thus, providing basic low vision services to older adults with mild vision loss is fundamental to promote ADL independence, even when the service content is simple, whereas for clients with more severe vision loss, expansion of service content and involved disciplines is necessary. One caveat of research findings on low vision rehabilitation services in general is that most studies lacked a control group, which weakens the strength of evidence.

Earlier research has shown that self-management skill training improves ADL performance in older adults with age-related vision loss, specifically vision loss caused by macular degeneration ( Eklund et al., 2004 , 2008 ; Girdler et al., 2010 ; Lee et al., 2008 ; Packer et al., 2009 ). Common components of such programs include education about age-related macular degeneration, training in the use of low vision devices, training in problem-solving skills, and provision of low vision information and resources. The self-management studies included in this review expanded the inclusion criteria from older adults with age-related macular degeneration to those with any visual impairment ( Alma et al., 2012 ; Rees et al., 2015 ; Tay et al., 2014 ). The self-management interventions thus were not tailored to participants’ low vision condition, which may have weakened the interventions’ effects ( Rees et al., 2015 ). For example, a client with central vision loss may benefit from training in face recognition, whereas a client with peripheral vision loss may not. In addition, the expansion of the visual impairment conditions addressed also resulted in samples with a wider age range. For example, in two studies ( Alma et al., 2012 ; Tay et al., 2014 ) that met the mean age inclusion criterion for this review, the lower value of the age range was in the 50s; adults in their 50s have different learning capabilities and require different self-management skills relative to adults in their 60s and older ( Tay et al., 2014 ). The effect of the self-management interventions might have been stronger if needs and learning capabilities of different age groups were taken into consideration. In short, the low evidence identified for the self-management approach might reflect the researchers’ interest in expanding the inclusion criteria to include participants with other visual impairment conditions, resulting in a heterogeneous sample who required self-management skill training tailored to each participant’s vision condition and learning capacity.

Another reason for the low strength of evidence for the self-management approach is the lack of sensitivity of the outcome measure used ( Alma et al., 2012 ; Rovner et al., 2014 ). Most studies used assessments of quality of life that include items addressing vision-related functional tasks, such as the NEI VFQ–25 ( Mangione et al., 2001 ). Strictly speaking, vision-related quality of life assessments are not functional assessments ( Ehrlich et al., 2017 ; Stelmack et al., 2002 ). Lack of sensitivity to detect change manifests through nonsignificant findings at the grand total score level but not at the item level ( Alma et al., 2012 ; Rovner et al., 2014 ; Stelmack et al., 2002 ). For example, Rovner et al. (2014) found a significant change only in NEI VFQ–25 items assessing near vision activities. Moreover, setting individualized goals and working to achieve these goals are part of the self-management programs included in the review ( Alma et al., 2012 ; Rees et al., 2015 ; Whitson et al., 2013 ), and the grand total score of a quality of life assessment might not be sufficiently sensitive to reflect improvements in these individualized goals.

Four studies that examined the self-management approach also reported high refusal rates of >40% by eligible participants ( Rees et al., 2015 ; Rovner et al., 2013 , 2014 ; Whitson et al., 2013 ). The high refusal rates are concerning because self-management is a new paradigm in health care to empower clients to be in charge of their own health. Rees et al. (2007 ) suggested that adults with low vision have low interest in participating in a self-management program because of time commitments, travel requirements, negative expectations, or perceived lack of need. The high refusal rate in Rovner et al.’s (2014) study might relate to the inclusion criterion of subthreshold depressive symptoms. Although self-management programs address emotional or psychosocial aspects of low vision and therefore may be more beneficial than low vision rehabilitation services alone ( Rovner et al., 2014 ), lack of accessibility to such programs means that low vision rehabilitation services are the frontline treatment option for older adults with vision loss. Future research should focus on increasing the accessibility and acceptability of self-management programs to older adults with low vision.

Although vision loss is a significant contributing factor to late-life disability, age-related decline in other body functions can accelerate the disablement process. Older adults with low vision also experience reduced endurance, mobility problems, and cognitive impairments ( Goldstein et al., 2015 ). Vision loss, cognitive and physical decline, and participation restrictions create a vicious circle in which relinquishing valued activities because of low vision increases the risk of cognitive decline and falls, leading to further activity limitations ( Lamoureux et al., 2010 ; Rovner et al., 2009 ). This review shows that researchers examining interventions for older adults with low vision have started to address cognitive and physical decline. Whitson et al. (2013) targeted people with low vision who also had cognitive deficits and included frequent and repetitive sessions, simplified training experience, and involvement of a companion in their self-management program. Alma et al. (2012) included home-based exercise in their self-management program, and Hackney et al. (2013 , 2015 ) examined the effect of tango on balance and mobility. Still, few studies have targeted multiple declines in older adults with low vision, and future studies are needed that focus on a multifaceted approach addressing physical and cognitive decline in addition to vision loss to reduce functional decline in older adults with low vision.

Our review findings are partially consistent with a recent scoping review that identified effective interventions to facilitate the occupational engagement of older adults with age-related vision loss ( McGrath et al., 2017 ). These interventions include self-management programs, compensatory interventions such as assistive device use, and social support. The differences in intervention themes and outcomes between the scoping review and this systematic review may be attributed to the different literature search period (2002–2015 vs. 2010–2017) and age cutoff (≥65 vs. ≥55). Our review indicates that the provision of assistive devices is often part of low vision rehabilitation services ( Pearce et al., 2011 ; Renieri et al., 2013 ; Ryan et al., 2013 ; Stelmack et al., 2012 ) and that increasing social networks is often part of self-management programs ( Alma et al., 2012 ; Rovner et al., 2014 ; Tay et al., 2014 ; Whitson et al., 2013 ).

Limitations

This systematic review has a few limitations. Given the wider age range we applied, participants in some studies may not have had age-related vision loss. In addition, although driving is an important IADL, we did not include any driving studies in this review because the samples in the located studies either were young adults or had conditions not limited to low vision.

Implications for Occupational Therapy Practice, Education, and Research

The findings of this review have the following implications for occupational therapy practice, education, and research:

• Basic low vision rehabilitation services, such as the provision of low vision devices, are effective to improve ADL performance in older adults with mild vision loss. Occupational therapy practitioners who are not low vision specialists can provide general services, such as home assessments, problem-solving training, or home exercise programs, to promote ADL performance in older adults with vision loss.
• Comprehensive low vision rehabilitation services are often provided by a multidisciplinary team. Occupational therapy education programs housed close to other vision care professional programs, such as optometry or ophthalmology, could initiate interprofessional education and practice collaboration. Such initiatives would build occupational therapy students’ capacity to work with other low vision care professionals ( Lucas Molitor & Mayou, 2018 ). Additionally, the curriculum could cover knowledge about how to apply general occupational therapy skills to better serve older adults with low vision.
• Performance-based vision-related occupational performance assessments that are sensitive to change are needed. An example is the Revised Self-Report Assessment of Functional Visual Performance ( Snow et al., 2018 ; Zemina et al., 2018 ), which includes a performance component. Performance-based assessments offer complementary information for evaluating intervention outcomes. Researchers in low vision are encouraged to include ADL and IADL measures or occupation-based performance assessments as functional outcome measures.
• Future research needs to continue examining the effectiveness of self-management programs for older adults with low vision. Specifically, the research focus could be shifted to what components to include to improve effectiveness and how to increase the accessibility and acceptability of such programs.

Low vision has detrimental effects on older adults’ independence in ADLs and IADLs. This systematic review supports the use of low vision rehabilitation services as the primary mean to promote independence in older adults with low vision. Occupational therapy services should continue to be part of low vision rehabilitation services, which provide comprehensive low vision evaluations and intervention. Although low evidence was identified for the self-management approach alone or combined with low vision rehabilitation services, increasing access to self-management programs for older adults with more severe vision loss could increase the impact of such programs. This review also shows an emerging trend of expansion of low vision intervention content by considering cognitive decline and physical decline in addition to vision loss. This expansion includes developing effective modes of intervention delivery to older adults with low vision who also experience cognitive deficits, as well as adding a physical component, such as exercise or tango, to address physical decline in older adults with low vision.

Acknowledgments

We thank Deborah Lieberman and Elizabeth Hunter for their guidance and support of this review.

* Indicates articles included in the systematic review.

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Strengthening problem-solving skills through occupational therapy to improve older adults' occupational performance - A systematic review

Affiliations.

• 1 Department of Occupational Therapy, VIA University College, Aarhus, Denmark.
• 2 Programme for rehabilitation, Research Centre for Health and Welfare Technology, VIA University College, Aarhus, Denmark.
• PMID: 35995214
• DOI: 10.1080/11038128.2022.2112281

Background: Evidence supports the role of occupational therapy (OT) for older adults, and therapeutic use of problem solving may provide a way to improve older adult's occupational performance. Aim: To assess the effectiveness and describe the contents of OT interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills. Material and Methods: This systematic review followed the phases recommended by the Cochrane Collaboration. The following databases were searched for clinical trials on OT for populations 65+ years: CINAHL, EMBASE, MEDLINE and PsycINFO. The Cochrane risk-of-bias tool (RoB-2) and the GRADE approach were used to assess the quality of the evidence. Results were presented in tables and by narrative syntheses. Results: Five studies were included comprising a total of 685 participants. In four studies, OT with a problem-solving approach outperformed control conditions post intervention. The interventions involved problem identification, analysis, strategy development and implementation. Although no serious risk of bias was detected in the individual studies, the quality of evidence was deemed low due to inconsistent and imprecise results. Conclusions: Low-quality evidence suggests that strengthening older adults' problem-solving skills may improve their occupational performance. Significance: Further investigation is required before firm practice recommendations can be prepared.

Keywords: ADL; Activities of daily living; cognitive strategies; elderly; functioning; occupation; problem solving; rehabilitation.

Publication types

• Systematic Review
• Occupational Therapy* / methods
• Problem Solving

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03/08/2021 by Jessica Szklut. Hi, I am an occupational therapist at South Shore Therapies. I specialize in pediatirc brain injury and stroke, but love working with all families to help kids reach their optimal potential. Our mission with SST's social media platform is to empower, educate and inspire families to take on life’s challenges while promoting an optimistic outlook and a brighter future. If you want to read more about us, visit www.southshoretherapies.com 0 Comments

Executive Functioning in Kids: Here’s How We Can Help (From Your Occupational Therapist)

Executive function is a set of mental skills that our kids use every day to actively engage in daily like skills, learn, and play. Executive function is responsible for your child’s ability to sustain attention, organize and plan, initiate and complete, problem solve, and regulate emotions. There are many different ways to address breakdowns with executive functioning skills. Your therapy team works together to address ‘the whole child’ so they can perform at their best. Check out some ways in which occupational therapy can focus on improving your child’s executive functioning skills. 

Think of executive function as the CEO of the brain, controlling all the skills required to plan, execute, and complete tasks and projects. These skills can be divided into the broad areas of working memory, flexible thinking, and inhibitory control. When executive function is impaired, children may display difficulty with initiating tasks, memory, organization, planning, time management, emotional control, understanding the perspectives of others, and paying attention.

Many kids tend to be disorganized and distracted at times, but those who are struggling with executive function may take a very long time to get dressed, pack a bag for school, and perform simple chores. Executive function disorder is common among children who are diagnosed with attention-deficit/hyperactivity disorder (ADHD).

Occupational and Speech Therapy can help your child whom is struggling with executive functioning deficits. 

5 ways occupational therapy Addresses executive functioning skills:

1.     Motor planning/sequencing:

• Motor planning – or praxis - refers to the ability to ideate, plan, and execute a novel motor action/sequence while simultaneously making the necessary adjustments for safety and efficiency. We use motor planning for all physical activities – everything from every day tasks like brushing teeth or hand washing, to moving around your environment or playing with peers. Kids who struggle with motor planning often take longer to learn new tasks, have difficulties sequencing and completing everyday tasks, and often are unable to recall from previous experiences in order to execute a task more effectively.
• How does OT address motor planning deficits? Well through play! Providing a multisensory environment that encourages a child to engage with a variety of equipment/activities in novel ways helps foundationally allow the child to build praxis skills. Through play we promote development of initiation and refinement of sequencing skills and with repetition can encourage motor tasks to become more automatic for the child. We love to make obstacle courses and other movement challenges with multi-steps, engaging in multistep crafts/art projects, learning new games, and cooking/baking activities.
• Learn more about motor planning HERE : 

2.      Problem Solving:

• A natural adaptive skill we often take for granted is our ability to draw from past experiences, in combination with our assessment of current situation, in order to determine the best way to approach a task in order to be successful - this is called problem solving . The age old quote “If at first you don’t succeed, try try again” is great for those children whom have foundational motor planning and problem solving skills, but can be quite difficult for kids with breakdowns in these areas - because for these kids, trying again will result in the same failure over and over unless due to difficulties with feedforward and feedback needed to problem solve and adapt their approach. 
• How can OT assist with development of problem solving skills? Using the suspension equipment and various swings allows your kids to naturally find themselves in situations where problem solving is required- how do I climb on this swing? How can I throw at this target without falling? Activities like the floor is lava is often a fan favorite – having your child setup equipment to get from point A to B without touching the floor. In addition, playing games and activities can also promote development of problem solving skills. Games like Rush Hour,  Suduku, Tangrams are great ways to promote critical thinking, planning and problem solving. Using the just right challenge in a controlled environment allows us to teach your child how to objectively assess the situation, actually change their approach, and ultimately be successful with the task at hand. In turn, we can help promote and develop self esteem and confidence for your child to carry with them each and every day! 

3.     Emotional Regulation and Interception:

• We feel emotions – both negative and positive – every single day. It is important that children learn how to manage, express and cope with these emotions in a healthy way – this is called emotional regulation . Interception is a sense that provides information about the internal condition of our body – how our body is feeling on the inside  - Awareness of these body sensations allow us to experience essential emotions – everything from hunger or pain to sadness or anger. However development of interception and foundational emotional regulation  can be an area of challenge for many of our kids. Tantrums or meltdowns may be a common occurrence at home for kid with difficulties with emotional regulation.
• How can OT can help with emotional regulation? OT can help with your child’s ability to identify emotions, teach and support proper responses in situation of heightened emotions, help your child answer the question ‘how do I feel?” and most importantly teach strategies that your child can use to manage these emotions. Using programs like Zones of Regulation and The Alert Program take a cognitive approach to teaching emotional regulation. Role playing can help simulate and prepare for real time scenarios. And of course, using equipment, games and activities allow for opportunities to learn about different emotions, build interception and body awareness, and develop strategies to manage emotions.

4.     Organization:

• Organization is the thinking skills that helps you put things into order, find your stuff, , gather supplies to start a tasks and complete everyday tasks efficiently and effectively. Getting organized can help make life easier and help kids with learning and thinking. Does your child have a hard time remembering where they put their toys? Do they have a hard time finding things in their backpack? Does your child struggle to get ready in the morning? Does your child always push back when it comes to writing assignments? This can be as a result of disorganization. 
• How can OT help with organization? We can help your child develop strategies, implement systems and create aides (visual schedules, check lists, etc) to promote independence and success across environments. 
• Learn more about organization HERE : 

5.     Memory:

• Working memory is a cognitive process that is important for reasoning and plays a direct role in decision making and behavior. Visual memory is the ability to remember or recall visual input – such as words or images. Deficits with memory can impact yourchild’s ability to sustain attention follow multistep directions, independently engage in daily life skills, and can impact reading and writing skills.
• How does OT address difficulties with memory?  Through different games, visual perceptual activities and challenges. Choosing games such as Let's Go To The Market, Clue, Memory Match and other board games require working memory for success. Activities like Take a Picture with your Mind, Burgermania, or Pancake Pile Up promote development of visual perceptual and visual memory skills. Teaching strategies for improved memory and recall is another way OT can help your kids be more successful. 

If your child is showing signs of executive function disorder, we are here to help.

Remember, just because your child may be struggling it does not mean they are incapable of accomplishing anything they put their mind. Through education, practice, and strategies, you can support your child to meet their optimal potential.

We hope you found this post helpful. Click HERE to learn more about what services and supports South Shore Therapies has to offer . Results that make a difference.

Have a question for us or topic you want to learn more about? Send us an email at [email protected]. 

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Occupational Therapy Interventions for Dementia

Whether you work as an occupational therapist or COTA in home health, outpatient, acute care, rehab, or in a long term care facility, you will certainly encounter patients with a dementia diagnosis or co-morbidity. If you work primarily with older adults, this might even be a large percentage of your patients.

In this article, I want to share meaningful and functional occupational therapy interventions for your patients affected by dementia. I was initially inspired to write this post as new grad, after seeing the occasional occupational therapist simply standing their patients with dementia and instructing them to put pegs in a foam board with no functional goal in mind.

Unfortunately this type of intervention can be all too common, which is a disservice to the patient and to our profession. That being said, I hope this post gives you more ideas than the arm bike or peg board! Using functional interventions will also make treatments much more interesting for you as well!

For more on why occupation-based treatments are so great, be sure to check out 10 Reasons Why OTs Should Be Using Occupation-Based Interventions.

This post is organized by the stages of dementia:

• Early Stages of Dementia
• Middle Stage Dementia
• Late Stage Dementia

For more in-depth information on the stages of Alzheimer’s (the most common form of dementia), check out the Alzheimer’s Association website. I also want to note that there are many other forms of dementia, (currently over 100!) according to Alzheimer’s Disease International. To read more about the other most common forms, you can also check out their helpful resource here . 

Challenges to Keep in Mind

While working with people with dementia is very rewarding and humbling, working with this diagnosis can sometimes be more difficult than working with younger adults.

Your patients with dementia may not always recognize you, or understand why you’re trying to do therapy with them.

Patients may become agitated, aggressive, or refuse working with you. It can take you a good amount of time to build a good therapeutic rapport with them.

Once you get to know what works best for them, you can improve the outcome of your session.

One of the hardest parts about treating dementia is that you may not get the same carryover from your interventions that you would get with your patients that do not have dementia.

For example, a patient who is cognitively intact will usually understand and remember much more of what you teach them about ADL retraining.

An individual with a cognitive impairment, however, may not remember what you did in your session or carry-over the information. Even though there are challenges, you can still provide tremendous value to your patients and their families. The key to treating dementia successfully is to keep your interventions  functional  and  meaningful  to the patient.

Interventions for Early Stages of Dementia

An important fact to remember when working with any stage of dementia:

While occupational therapists can’t “fix” a person’s dementia and cognitive performance, we can help improve function through remediation or compensatory strategies.

How do we do this?

For starters, you can interview your patient with measures like the  COPM  to determine the most meaningful activities for them.

When you’re preparing your patient’s plan of care, you will also want to consider preferences, interests and life histories in order to create meaningful activity plans (Kolanowski  et al. , 2005).

In the early stages of dementia, your patients will generally still be able to function in daily life pretty well. They may start noticing that they forget simple things like appointments, where they placed their keys, or if they’ve taken their medication.

In this stage,  memory aids like calendars, journals, medication reminders, and daily routine schedules can help maintain the person’s independence with higher level ADLs.

To further increase effectiveness of memory aids, evidence shows that combining these aids with caregiver education further improves patient independence outcomes and reduces caregiver stress (Dooley and Hinojosa, 2004).

Your patients or their family members might also notice the individual beginning to need reminders to bathe or eat.

Don’t be afraid to focus your interventions on these less complex tasks if you notice your patient having trouble even though they might appear completely intact cognitively.

Interventions for Middle Stage Dementia

With middle stage dementia, the individual will have even more of a decline in memory and high level cognition.

At this stage, most people begin needing assistance with basic self care tasks like getting to the bathroom in time. They may show decreased sequencing ability and motor planning of basic ADLs.

At this stage, the patient’s caregivers might start jumping in and doing  everything for them.  With cues and prompting, however, the patient can still physically assist with this, and they should be encouraged to do so.

As OTs, family or caregivers jumping in and doing too much can be one of our biggest frustrations, as it does not allow the patient to continue their routine and may lead to a loss of basic self-care skills.

This may be due a legitimate lack of time or simply a lack of education of the caregivers.

After taking a MedBridge online continuing ed course on ADL’s and dementia (taught by the amazing OT Teepa Snow ), I was shocked to learn that once caregivers step in and start doing everything for the patient, the patient loses that automatic skill. The saying, “If you don’t use it, you lose it” really does apply in this case.

Because of this, I focus most of my time working on ADL retraining with the patient (along with  balance retraining and functional mobility). I also explain to all caregivers of the benefits of working with the patient to do their own self care as much as possible.

Even if it’s managing clothing and hygiene during toileting, I’ve found this really helps to gain some of that function back. This is a win-win for the patient and caregivers since it reduces the amount of work caregivers have to jump in and do.

Performing basic ADL retraining (toileting, dressing, self-feeding, for example) with your patient will also certainly be more meaningful than giving them a puzzle or clothespin task.

When providing ADL retraining with your patients with dementia, you can include increased verbal or visual cues, demonstration, physical guidance, partial physical assistance and problem solving to improve the outcome (Beck et al., 1997).

Repeating your ADL retraining using the same activity, same sequence, same time, and same place can also help to increase retention.

Completing self-care tasks in your patient’s own personal living area is also more beneficial than doing simulated activities in the gym, when possible.

The more “true to life,” the better!

Interventions for Late Stage Dementia

With late-stage dementia, individuals will be at their final stage of the disease process.

In this stage, they will likely not be oriented to person, place, or time, and are often dependent in all or most self care, including feeding. They will have a severe loss of motor control, and will likely be wheelchair-bound because of this.

Because of the decreased ability to physically perform self-care tasks, you can switch your focus to educating caregivers on safe transfers , contracture management through home exercise programs, proper positioning to avoid skin breakdown and increase comfort, and providing enjoyable sensory stimulation ( AOTA ).

Caregivers may be experiencing increased stress, depression, and exhaustion with this stage. Support groups (either online or in-person) can really help to have others that are going through the same life stresses.

_______________

Caregiver Education For All Stages of Dementia

Along with working with the patient, occupational therapists also provide caregiver education to family members. Educating your patient’s family members on your interventions to increase carryover is just as important as what you’re doing with the patient.

It’s also important to teach family members how they can reduce their own stress. Family members will benefit from resources and support group information if their loved one is newly diagnosed.

In my experience, I’ve also found that collaborating with the family and staff as a cohesive team makes a big difference. Talking “at” the family making them feel like you think you know more than them will not be as beneficial as taking the collaborative approach.

In reality, caregivers can help you a great deal with providing the best outcomes for your patients since they often know more about the patient than you do, and they can carry over interventions during non-therapy time.

Special Considerations From Personal Experience

While keeping your interventions functional and meaningful, also keep in mind what is most beneficial for that individual client.

If your patient is a male and never did homemaking tasks, asking him to fold clothes or do meal prep won’t be the best intervention.

If your patient refuses to work with you or appears agitated, assess the environment.

• Is there excess stimuli?
• Is it late afternoon and they’re exhausted?

Check in with caregivers about the best times of day to work with the individual. In my experience, the time of day can make a HUGE difference in participation levels.

Also, look at how you’re providing the intervention.

Giving one-step, simple directions is much easier for someone with middle stage dementia to follow. Providing multi-step, complicated instructions is very difficult to follow and can lead to frustration.

If your patient is sexually inappropriate or aggressive, this is almost always due to the disease progression. It’s not because they’re a bad person.

If you’re feeling uncomfortable, I recommend asking someone to accompany you in the room when you’re treating to play it safe. Or, you can treat them in public areas if no one is available.

In Conclusion

To wrap this post up, I just want to finish with a big “Thank you!” to all of you working with this population. It’s not always easy but just know that you’re making a big difference in their lives and in their caregivers’ lives.

If you get overwhelmed on what to do, just remember that providing support, education, and functional, meaningful interventions that are client-centered and focus on the person’s strengths will ensure a successful occupational therapy intervention (Schaber & Lieberman, 2010).

I hope this post helps you get a beginning grasp on how to successfully work with patients with dementia.

To learn more about dementia and the role of occupational therapy, check out the resources below for even more useful information.

And as always, please share in the comments below any great tips and tricks that help you when treating individuals with dementia.

This post was originally published on 6/26/2016 and updated on 1/4/2020 and October 21, 2022.

Additional Resources and References

For more occupational therapy intervention ideas for working with clients with dementia, consider joining the OT Flourish Learning Lab online OT membership (you can get 10% off using our code MYOTSPOT:122)

Dementia and the Role of OT (AOTA)

The Power Of OT Applied To Dementia (Fox Rehab)

Therapeutic Interventions for People With Dementia (National Center for Biotechnology Information)

Three Ways Occupational Therapists Support Dementia Care (AMN Healthcare)

Beck, C., Heacock, P., Mercer S.O., et al. (1997). Improving dressing behaviour in cognitively impaired nursing home residents. Nursing Research. 46:126–132.

Dooley, N.R., Hinojosa, J. (2004). Improving quality of life for persons with Alzheimer’s disease and their family caregivers: brief occupational therapy intervention. The American Journal of Occupational Therapy. 58:561–569

Kolanowski, A.M., Litaker, M., Buettner, L. (2005). Efficacy of theory-based activities for behavioral symptoms of dementia. Nursing Research. 2005;54:219–228

Schaber, P., & Lieberman, D. (2010). Occupational therapy practice guidelines for adults with Alzheimer’s disease and related disorders . Bethesda, MD: AOTA Press.

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The Role of the Occupational Therapist in Dementia Care (Exeter PDF) link does not work.

Thanks for letting me know! I removed the link and updated the article with more helpful resources.

Thanks for the useful information. I have a question. If I have a patient on caseload as an OT with dementia and I am spending time to give education to the caregiver and train the caregiver. Is that time billable? Does the patient have to be present for it to be billable? At time is more appropriate to give education to the caregiver without the patient present due to the patient possibly getting agitated or anxious because they are unaware of their cognitive deficit. Thank you!

Hi Bethany! Great question; unfortunately as every facility/job is different I can’t give you a solid answer but would definitely say to ask your manager what their thoughts are. I personally am able to bill for caregiver education where I work but again, every facility seems to differ in what they allow for billing purposes. It never hurts to ask! 🙂

Hi Sarah, Thanks for this insightful information. I am a student OT, just six months into it. Please can you offer some insight as to how I would write the outcome when using music therapy as an intervention for clients with dementia? What outcome measure would you suggest? I am having difficulty understanding outcome and outcome measures.

Thanks in advance and I look forward to hearing from you soon.

I’ve actually never used a music therapy assessment scale when working with clients (I’m more of “self-care assessor” typically), but I did just find this interesting research article about this Music in Dementia Assessment Scale (MiDAS) . This would be a good article/assessment to bring to a professor or clinical instructor to brainstorm with on how to best implement it into OT goals. I hope this helps!

Great information. I found sensory activities particularly helpful when working through mood swings and other behavior issues.

Thanks so much for this information, I can across it in the right time I needed it.

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