Treatment Session #1:

What goal are you addressing?

In 4 months Sasha will independently utilize 2 self-regulation strategies when faced with negative emotions
towards peers in 2/3 observation periods
Intervention Description (Be very specific. Indicate that you understand how the postulates of change from
your chosen practice models will bring about change in the client during your session, as well as what your
role as the OT is during the session. In other words, how is this a skilled service?):

Activity 1) Gross motor warm-up

Sasha will begin the session by performing a gross motor warm-up to help her transition into the therapy
session. This will consist of a short obstacle course to help provide vestibular and proprioceptive sensory input
to increase her arousal and allow her to become more engaged in therapy. Postulates from the SI frame of
reference state that “An optimal state of arousal is a prerequisite for adaptive responses to occur.” The
therapist will design the course to ensure that it includes activities that will provide this optimal state of arousal
to help prepare Sasha for the treatment session.

Activity 2) Zones of regulation introduction

Sasha will be introduced to the zones of regulation to help her understand the different states of emotional
behavior. We will talk about what they mean and have client identify particular emotions that fall under each
zone. We will use visuals of the zones with laminated cards that have emotions written on them along with
facial expressions that matches that emotion. Sasha will have to place those cards under the appropriate zone.
This type of scaffolding lies within the 2nd quadrant of the 4QL frame of reference. Postulates from this
reference state that “If the therapist encourages the child to engage in learner-initiated strategies such as
priming, mnemonics, verbal self-instruction visual cues, and kinesthetic self-prompting, then the child will be
able to recall key points essential to task performance”. This will be employed in addition to facilitator initiated
task specification approaches in quadrant 1 (instruction, demonstration, and low order questions) seeing as how
the postulates also state that “it is useful to employ intermediate strategies that straddle two quadrants

Activity 3): Sand box sensory break: Drawing from the same principles and postulates explained above in the
gross motor warm-up, we will provide a short sensory break in between activities to allow for regulation in
preparation for our last activity. This time we will focus more on tactile sensory input by playing in the sand box
instead of vestibular which was targeted earlier in the warm-up

Activity 4: Zones of regulation bingo: This activity will build on the principles and techniques employed in
activity one but will add an element of fun to learning about the different zones of regulation. The therapist and
Sasha will play bingo with the facial expression cards from the zones of regulation manual. As Sasha finds
matches on her bingo board she will have to identify what zone that emotion falls under in order to place it on
her card. The therapist will begin by giving clear instructions, demonstrating, and physical patterning. This is
explained in the 4QM postulate that states “If the therapist employs facilitator-initiated methods such as
explicit instruction explanation, physical patterning, and lower order questions, then the child will be able to
understand the characteristics of the task and/or the performance required.” Once again, a visual prompt that
lays out the task components using pictures will be given to help guide Sasha’s completion of the task. When
Sasha correctly identifies the zones, the therapist will provide positive reinforcement. These techniques draw
upon the same principles and postulates as mentioned in activity two. This will provide a base knowledge of the
zones of regulation for Sasha in which she can then use to identify self-regulating strategies in future therapy
sessions.
Setting Activity Demands
School-based therapy Relevance and importance to
client: Sasha enjoys playing on
the playground so our obstacle
course warm-up will cater to
those interests.
Objects: obstacle course
materials. Zones of regulation
printouts and bingo card
Anticipated outcome (what skills
you expect to observe change in
based on your session):
We hope that Sasha will participate
in the zones of regulation activity in
order to develop an understanding
of the different zones and what
they mean. She can later use this
information to help identify
strategies to use when she finds
herself in difficult situations and is
in zones other than the green.

Space Demands: open gross

motor gym to complete obstacle
course. Quiet place with table for
zones lesson

Sequencing and timing: Sasha will

need to be able to correctly
sequence the steps in the
obstacle course and complete the
correct sequences in our bingo
game.

Required actions and

performance Skills: Attends to
our zones discussion, sequences,
notices and responds to
questions, expresses emotions
appropriately

Required Functions: Higher level

cognitive ability to answer
questions, temperament and
personality, attention and
memory

Required Structures: structures

related to movement and
structures of the nervous system

Intervention Approach (Table 8 of OTPF): Establish Intervention Type (Table 6 of OTPF):

Preparatory tasks and activities
Practice Model(s): 4QL, OT-SI

Rationale & evidentiary support for use of interventions/activities:

Warm-up and activity 3: These two activities are based off of the sensory integration model and their
associating postulates are listed above in the treatment plan. There is also OT related research that supports the
use of these techniques. In a recent article published in AJOT a case study investigated the use of sensory
techniques similar to the ones described in this treatment plan and their effect on participation in activities for a
child with autism. They stated that the employment of these SI techniques increased their participation in
home, school, and family activities (Schaaf, 2012).

Activity 2 and 4: As explained above in the layout of our treatment plan the rationale for these activities lie
within the 4QM model of facilitated learning. the postulates are refer to learning that occurs in the 1st and 2nd
Quadrants. These are: 1) If the therapist employs facilitator-initiated methods such as explicit instruction
explanation, physical patterning, and lower order questions, then the child will be able to understand the
characteristics of the task and/or the performance required. 2) If the therapist encourages the child to engage in
learner-initiated strategies such as priming, mnemonics, verbal self-instruction visual cues, and kinesthetic self-
prompting, then the child will be able to recall key points essential to task performance. 3)To enable a child to
progress through the stages of skill acquisition, and hence advance through the quadrants, it is useful to employ
intermediate strategies that straddle two quadrants. These strategies will be employed with The zones of
regulation program which is a widely practiced program that helps children who are struggling with emotional
regulation issues. This lesson will help Sasha categorize her emotions in a simple way that will help her identify
when she is in an undesirable state of emotion. A recent article published in AJOT examined the effectiveness of
the zones of regulation in a group of children with FASD (Anderson et al., 2017) . They found that the majority of
the children who took part in the program had positive behavior outcomes and scored higher on the BRIEF
assessment than when they began. Sasha does not have FASD, but the principles from this study can be applied
to her situation and give solid evidence that it is a worthwhile approach in improving behavior regulation.