Healthcare Training Institute - Quality Education since 1979

The first and probably most basic Success Therapy® activity is called Caps-in-a-Bowl. This is the most basic because it is a good starting point, when you get a new admission, to get an idea regarding what the resident can and cannot do.

The materials are...
Seven or eight gallon milk bottle caps, and an empty butter dish or plastic bowl. Bowls that hold two to four cups work best. The idea is to drop the milk cap into the butter dish or bowl. Thus, the name is Caps-in-a-Bowl.

Matching Your Resident with this Activity
To determine if this activity is appropriate for your resident, perform the following steps:
• Show the resident the milk bottle cap, look at his/her eyes to assess whether you have achieved eye contact. If your Helen cannot achieve eye contact with you or with the cap when you say something like, “Helen, look at the cap,” she is not a good candidate for this activity. Next…
• Hand your Helen the bottle cap. If she puts the cap into her mouth, she is not a candidate for this activity. She will need one of the activities explained in another Course in this Series related to the use of magazine pictures for discussion or another non-object manipulation activity.
• If the Helen can give you eye contact and does not put the item in her mouth, but is unable to focus her attention on the activity, Caps-in-a-Bowl is still not a good activity for her.
• Some residents make continuous verbalizations. However, even though they have excellent hand movement, they are unable to focus their attention on the activity. This kind of resident would also not be a good candidate for Caps-in-a-Bowl.

In short, you need a resident who is able to have eye contact for at least for 15 to 30 second; does not put inappropriate items in his/her mouth; has an attention span of 15 to 30 seconds; and is able to stop inappropriate verbalization for 15 to 30 second.

How to Introduce Caps-in-a-Bowl
For your lower-functioning Helen that does meet the assessment criteria of eye contact, attention span, agitation level, and energy level, ask something like, “Let’s see if you can drop this cap in the bowl for me. Would you like to do that?” Place the gallon milk bottle cap between their thumb and index finger and gently pull one of their fingers out, if they are unable to do so themselves. Thus, the cap drops into the bowl. For this lower-functioning resident, the starter phrase for your Care Plan Goal would be…

Goal: to drop the cap into the bowl with total physical assistance…
Approach: to move the resident’s thumb or index finger to facilitate their dropping the cap into the bowl…

Some residents may be agitated or uncomfortable...
when you talk to them. Some have a very low energy level and appear too fatigued even to hold the gallon milk bottle cap in their hand. Always be sensitive to your resident’s agitation and energy level. Stop the activity if you sense what you are doing is having a negative impact on your Helen.

Adaptations Based Upon Changing the Materials
If Helen has extremely stiff finger movement, she may have a problem moving her finger out of the cupped part of the gallon milk bottle cap. Therefore, you might glue two caps together using Elmer’s glue. A small vice works nicely to hold the two caps in position until they dry. Since you are applying a water based glue to plastic, the drying process takes several days. Glue guns, of course, provide instant results. However, I have been burnt so many times, I tend to avoid them. J Maybe you will have better luck. The finished product is a larger object, which is easier to hold and requires a less firm grasp.

A second adaptation...
would be to use a different kind of cap; for example a laundry water softener cap, Gatorade lid, juice bottle lid, or liquid laundry detergent lid. A suggestion would be to collect caps from various bottles over the next two weeks. When you evaluate a new admission’s thumb and index finger movement, try several sizes and shapes of caps, to see which affords your resident the most “Success.”

Adaptations Based Upon the Level of Assistance Given
Regarding Caps-in-a-Bowl, if the resident has a little more mental and physical ability, perhaps he or she is able to hold the cap independently. Your Care Plan Goal might start with

Goal: to drop the cap into the bowl upon request…

Thus, you might say to the resident, “Let’s see if you can do this for me.” You demonstrate dropping two or three caps into the bowl slowly, one at a time, usually not speaking. You need to assess if your words are a distraction and then provide the appropriate amount of verbal instruction.

    Approach: to demonstrate Caps-in-a- Bowl using resident’s name…
    Approach: to request resident to do the activity in an encouraging manner…
    Approach: to speak at resident’s eye level…

If the resident has a little more ability, the next level of Care Plan Goal would be

Goal: to drop the cap in the bowl, independently once started…

“Independently once started,” means that you would demonstrate how to drop the cap into the bowl, explain to your resident that this is a hand exercise or a game. He or she would independently continue to pick up caps and drop them into the bowl without further direction or prompting.

The preceding is an example of how you can adapt the difficulty of Caps-in-a-Bowl by varying the level of assistance given to the resident. As a review, the Care Plan Approaches are from lowest to highest functioning:

    Approach: To do xxx with physical assistance…
    Approach: To do xxx with demonstration and instruction…
    Approach: To do xxx independently once started…

Remember SUCCESS...
is your primary purpose. Never lose sight of this. Do you recall the definition stated earlier? What you are really doing is providing a situation, a circumstance, or a task to allow you an opportunity to say sincerely, “Good, great, you did a good job!” Thus, you are providing even the lowest functioning resident with a feeling of accomplishment, self-worth, and...SUCCESS.

Culture Change Implementation: Place Caps-in-a-Bowl in labeled Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.

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