OT & Jesse: Early Occupational Therapy Intervention for a Preadolescent

Jesse was a 12-year-old boy with a history of hospitalizations for mood and behavioural problems including threats to harm himself and others. He had multiple school suspensions because of aggressive behaviour as well as theft, and he stopped attending school altogether. He has committed chargeable offences and is at high risk of entering the justice system. He has made allegations of familial abuse, and his parents are separated. He does not like himself and feels unloved and unwanted by family and peers.

Jesse was highly resistant towards therapy or interventions of any kind but was very keen to take part in work-based sessions with an occupational therapist. The idea of having a job was very appealing, given his age, and it made him feel very mature. The opportunity to engage in a task that gave him some independence, responsibility, and respect was what he needed to move on with his life. As a result of work-based therapy, he learned it is important to: follow rules, take care of your appearance, communicate appropriately, be responsible, get along well with others, and to put forward your best effort. By learning to do these things, he also learned that he had skills and abilities of which he could be proud, and his self esteem grew. He also learned that he could control his environment and his life in a positive way. Jesse was able to transition into adolescence using his thirst for independence and productivity and did not become a statistic in the justice or health systems.

OT & Michelle: Early Identification and Intervention for an Adolescent with a Serious Mental Illness

Michelle was a 16 year old girl being assessed in a residential mental health facility as a result of escalating behavioural issues including aggression, falling grades, and substance abuse. She was diagnosed as having a Conduct Disorder at the age of 12 and has a history in the justice system. Discharge plans were complicated by the fact that her foster family was not willing to take her, she preferred to live independently, and she was of an age to make such decisions on her own. She had been taking part in occupational therapy assessments related to independent living and cognitive capacity. She had refused to take part in formal or standardized assessments, therefore the occupational therapist utilized leisure-based and work-based sessions with which Michelle was more comfortable. During the sessions, there was gathering evidence that Michelle may have been in the early stages of developing a psychotic disorder. This was later confirmed by a psychiatrist where she was eventually diagnosed with schizophrenia.

The occupational therapist was able to assist Michelle through the process of gaining an understanding and acceptance of her illness. The occupational therapist was also instrumental in helping Michelle to prepare for her transition as a young adult to the community to live as independently as possible, and to explore appropriate school programs, volunteer and paid work, and leisure occupations to create balanced daily routines. Michelle was able to make decisions about her school and work goals that were more realistic and learned that taking care of herself, such as addressing her addictions issue, was important in managing her illness.