Rhonda

1. Rhonda Morgan Brewton, Sarah Durham, Chris Matzye, Hillary Olivier, Becca Price, & Lauren Tumey

2. RHONDA • 46 year old Caucasian woman living in Denver • Only child and lives at home with her parents (ages 73) • PhD in comparative literature and has taught at several universities • Referred to local hospital for 90 days outpatient treatment (Psychiatric Day Treatment Program) to include OT services 3x a week. • Rhonda is on SSI disability, and the hospital does not take her Medicaid insurance; her parents are paying out of pocket

3. Rhonda's HISTORY • First became ill when a graduate student at Stanford, age 22 • Spent 3 months in mental hospital where she was diagnosed with depression • After leaving hospital, Rhonda had difficulty holding down a job • She hit a period of drug and alcohol abuse( “the alcohol temporarily killing the depression”) • After being pulled over for drinking and driving, Rhonda joined AA and has been sober for 10 years now. • A few years later Rhonda began having additional symptoms • Hallucinations and delusions • “Visualized dogs and cats that had been run over but not yet dead, and I had to work my way through them with my car” • “ I was certain I was being watched”

4. Rhonda's HISTORY • When symptoms continued, Rhonda saw a psychiatrist where she was put on thiothexine • Symptoms gradually resided • After finishing PhD,she went to teach at a university in South Dakota, but results were disastrous • Symptoms, paranoia and delusions, returned after teaching one year • She was put into local hospital for 5 weeks • “grateful that I no longer had to stand in front of the students who terrified me” • Rhonda withdrew from her job and returned to Denver to live at home with her parents.

5. Current Status • Medication: Clozapine • Main side effects: Weight gain, dizziness • Questions strange thoughts • Unable to hold intricate conversations • Doesn’t seem to care about anything • Anxiety triggers confusion • Insight: “I know the voices are wrong; I am not evil and I am not to blame for my illness, but I still feel guilty and depressed anyway.” • Rhonda would like to live on her own, but cannot afford it.

6. Occupational competence scale • Section of the OPHI assessment • Rhonda scored a 2 on all items of occupational competence scale • 2= some occupational dysfunction • Additional evaluator notes • “client has difficulty adjusting to stress” • “client has been persistent over time, but has difficulty sustaining effort” • “client states depression and cognitive issues have hindered her ability to participate in leisure activities” • “client has difficulty maintaining work routine, however she has been sober for 10 years and has adapted several adaptive coping strategies”

7. Results of leisure checklist • Her top 5 activities were: • AA meetings, 12 step work; editing newsletter maybe • Needlework • Get a cat • Garden • Writing(although this is also work) • 5 activities she would like to do in near future: • Go to a fair • Make a friend • Teach part-time( not leisure, but I want to work) • Cant think of anything else

8. OBM: occupational Adaptation(oa) • Rhonda is hyperstable • Rhonda uses existing mode • Rhonda uses primary energy • Our goal is for Rhonda to become more adaptive in her social skills and stress management • As Rhonda becomes more adaptive, she will become more functional • Focus on Rhonda’s barriers to adaptation

9. OBM: occupational Adaptation(oa)

10. Frame of Reference: CBT • Cognitive Behavioral Therapy • CBT is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. • By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping. • Client is encouraged to challenge irrational beliefs and thoughts (delusions).

11. Rhonda's GOALS • In order to improve productivity, client will learn stress management techniques in OT and report having used them at least once a week by the end of the 90 days/discharge.

12. Diaphragmatic Breathing & Yoga • Stress can be a major trigger for people with schizophrenia, which can lead to relapse and rehospitalization. • Rhonda’s anxiety and stress keep her from performing meaningful occupations of teaching and forming friendships. • Incorporating stress management techniques into therapy and having the client determine ways to use them during different situations can help the client be able to generate adaptive responses to stressful situations in order to function more independently. • If she is unable to generate times or situations where she can use these techniques, we will help her create a schedule and give her possible ideas. • We will also give her resources for additional yoga classes and encourage her to use her strategies to attend these classes and socialize with others.

13. Diaphragmatic breathing & Yoga • Questions to ask during treatment (Motivational interviewing and CBT): • When can you use diaphragmatic breathing? • What time of day can you use yoga to decrease your stress? • What situations would you find these strategies most effective? • How can yoga direct you away from irrational thoughts (delusions)? • What are the benefits of implementing diaphragmatic breathing or yoga into your daily routine? • What are the costs of implementing diaphragmatic breathing or yoga into your daily routine?

14. nEEDLEWORK • To encourage rhythmic, repetitive motion to decrease stress. • Questions to ask during activity: • How has your stress level changed during this activity? • Where can you use this activity? • How could you use this activity to interact with others?

15. Needlework • Behavioral Activation Worksheet • Record keeping and journaling depression, pleasure, and achievement levels before and after performing needle working activities.

16. Rhonda’s Goal • In order to improve social participation, client will have meaningful and personal interactions with friend for at least 10 minutes 3 times a week by the end of 90 days/discharge.

17. Role playing • Skill- starting conversation with new person • Introduce self to person, “HI” • Chose topic to talk about or ask question • Judge whether the other person is listening or wants to talk • Know when is the appropriate time and place to begin conversation • Scenario examples: sitting at lunch with another person, volunteering with new person, meeting someone new at AA) • How to know if a person is interested in conversation: • Interpret tone of voice • Affect • Gestures

18. Role playing • Strategy to enhance role play=REBT self help form • Questions to ask during activity: • Think about a situation or conversation where you felt overwhelmed. How could you have used these skills to better handle the situation? • How will you use these skills to initiate a conversation? • How do you feel these skills will help you form friendships? • What will be the most difficult part of interacting with others?

19. NAMI • The nation’s largest non profit grass roots mental health education advocacy and support organization dedicated to mental illness • There are discussion groups and message boards for all 50 states • Information about specific mental illnesses • State chapters • Peer-to-Peer Support Groups • https://www.nami.org

20. HUD Housing Program • U.S. Department of Housing and Urban Development • Establishes to provide decent and safe rental housing for eligible low-income families, elderly, and person’s with disabilities • Eligibility: • Annual gross income • U.S. citizen or eligible immigration status • If meeting these requirements, public housing would then check references to make sure you will be a good tenant • Rhonda would benefit from HUD housing because it is a cheaper alternative for her to live independently