Reason for Services
What is Sam’s current Rancho level?
Level VII: Automatic–Appropriate.
What pre-injury role remains central to Sam’s identity?
Working as an auto mechanic.
Who continues to be Sam’s main caregiver/support?
His wife, Ingrid.
How has Sam’s memory improved at Level VII?
Consistent recall of daily routines; struggles with remembering new complex information.
What self-care goal is realistic now?
Complete all ADLs and basic IADLs independently with occasional checks.
How is Sam’s daily routine affected at this stage?
He can complete daily routines automatically but has limited insight for problem-solving in novel situations.
How could leisure activities be expanded in therapy at this stage?
Encourage independent planning of walks, meals, or attending church events.
How can Ingrid best support Sam’s independence now?
Providing gentle supervision while encouraging self-initiated problem-solving.
What executive functioning challenges remain?
Difficulty anticipating future consequences and adapting to new problems.
What community mobility goal is appropriate?
Navigate familiar community settings safely with standby supervision.
What supervision level does Sam typically require?
Minimal supervision for routine tasks; standby for safety in unfamiliar situations.
What previous strength can Sam now use more actively in therapy?
Social engagement and enjoyment of structured routines like cooking with his wife.
What environmental adjustment may still be needed at home?
Adaptations for higher-level safety (e.g., medication management systems).
How is Sam’s attention now?
Able to attend to highly structured tasks without distraction for longer periods.
What work-related goal could be introduced?
Trial light work tasks or volunteer activities with support
What new therapy focus emerges strongly at Level VII?
Community re-entry and increasing independence in IADLs.
How can Sam’s past work habits be used for executive functioning goals?
Simulating job tasks such as tool organization or simple repairs in structured settings.
How can Sam’s church community support his reentry?
Providing structured, familiar activities that foster safe socialization.
How might Sam behave in new, unstructured environments?
May behave impulsively or require external supervision for judgment.
How can therapy address Sam’s need for improved executive functioning?
Use of problem-solving tasks, safety simulations, and strategy training.
Why must safety training still be emphasized for Sam?
His impaired judgment and slow processing may compromise safety in new environments.
Why is revisiting past successful occupations important for Sam now?
It builds confidence and supports emotional resilience during recovery.
What life role transitions may Sam be preparing for now?
Return to modified work roles or structured volunteering opportunities.
Why is community navigation training important now?
To build real-world safety and independence with increasing complexity.
What emotional adjustment goal remains critical?
Support emotional acceptance of limitations while focusing on strengths.