Occupation-Focused Practice Models

Occupational Performance

• Primary outcome of ecological models

• Determined by the person, environment, and occupation

• Values and Interests

• Skills and Abilities

• Life Experiences

• Variables of the Person component in the ecological models

• Physical

• Cultural

• Social

• Temporal

• Components of Environment in the ecological models

Activities

• Observable behaviors of the PEO model

Tasks

• purposeful activities of the PEO model

Occupations

• self-directed tasks a person engages in over the life course (PEO model)

Actions

• basic units of tasks (PEOP model)

Tasks

• combination of actions with a common purpose (PEOP model)

Occupations

• goal-directed, meaningful pursuits that typically extend over time (PEOP model)

Task

• the term facilitates interdisciplinary collaboration

• objective representation of all possible activities

• EHP model

Outcome

• confluence of the person, environment, and occupation

• relies on the goodness of fit

Person-Environment-Occupation Model

• goodness of fit increases → occupational performance increases

• The goodness of fit is always fluctuating

• OTs will adjust the factors to promote occupational performance

Person-Envioronment-Occupation-Performance Model

• goodness of fit increases → occupational performance increases

• Person factors = intrinsic, environmental factors = extrinsic

• Performance is a separate factor from Occupation

Ecology of Human Performance Model

• person is within a given context

• includes all possible tasks available for a person, but they can only do those within the performance range

Establish or Restore

• develop and improve skills and abilities

Adapt or Modify

• change environment or tasks to increase performance rate

Alter

• do not change person, task, or environment

• simply design to make a better fit

Prevent

• change the course of events when a negative outcome is predicted

Create

• do not assume that a problem has occured or will occur

• Designed to promote performance in context

1. Relationship between people, environment, and occupations are dynamic and unique, interacting continually across space and time.

2. Environment is a major factor in occupational performance that may facilitate or inhibit it.

3. It is more efficient to change the environment or find better person-environment fit.

4. Occupational performance is determined by confluence of PEO

Assumptions of the Ecological Models

1. Begins by identifying what occupations a person wants or needs using the top-down approach

2. Involves promoting self-determination and inclusion of people with disabilities

   • Service recipient is the primary decision maker

• Assumptions of OT Practice

Client-centered approach

• Overarching value of the Ecological Models

Model of Human Occupations

• Developed in 1980 by Kielhofner and Berg

• Most used occupation-based model in OT

• Occupation-focused, theory-driven, client centered

• how people experience their area of concern/impairment

• Occupational behavior approach by Mary Reilly

• Gary Kielhofner et al. General Systems Theory

• Theoretical antecedents of the MOHO

Occupational Behavior Approach by Mary Reilly

• focused on activities that occupy time, produce achievement, and sustain the individual

• Focused on the disruptions in occupational functioning

• Based on:

  • Developmental theory

  • Achievement theory

  • Role theory

Gary Kielhofner et al. General Systems Theory

• Explain sets of interrelated concepts

• When input is altered, the through-put is different, and produces a different output

• Feedback is given based on the input to operate better the next time

Volition

• Motivation

• Process by which people are motivated toward and choose what activities they do

• It may be because of personal causation, value, or interests

• In the prcocess of:

  1. Thinking of what to do

  2. Choosing which occupation to do

  3. Experiencing occupation

  4. Evaluating the experience

• MOHO

Personal Causation

• Thoughts and feelings about one’s abilities and effectiveness as they do everyday activities

• how they feel doing an occupation

• MOHO

Values

• Beliefs and commitments about what is good, right, and important to do

• meanings ascribed to what they do

• MOHO

Interests

• developed through the experience of pleasure and satisfaction derived from occupational engagement

• MOHO

Habitutation

• people organize actions to patterns and routines

• MOHO

Habits

• involve learned ways of doing things that unfold automatically

• MOHO

Roles

• cultural script for one’s identity

• provide a set of responsibilities and obligations that are associated with that identity

• MOHO

Performance Capacity

• underlying mental and physical abilities or capacities and how they are used and experienced in occupational performance

• MOHO

Environment

• Physical, social, cultural, economic, and political features within a person’s context that influence motivation, organization (habituation), and performance of occupation

• Includes objects, spaces, tasks, social groups

• MOHO

Volition, Habituation, Performance Capacity

• Person factors of the MOHO

Particiopation, Performance, Skills

• Dimensions of doing of MOHO

Occupational Participation

• Engaging in occupations that are part of one’s sociocultural context and that are desired or necessary to well being

• MOHO

Occupational Performance

• Doing a task related to participation in a major life area

• MOHO

Skills

• Goal-directed actions a person uses while performing

• Motor, process, communication and interaction

• MOHO

Occupational Identity, Competene, and Adaptation

• Output of MOHO

Occupational Identity

• sense of who people are and who they wish to become as occupational beings

• generated from experience

• MOHO

Occupational Competence

• Degree to which poeple are able to sustain a pattern of doing that enacts their occupational identity

• MOHO

Occupational Adaptation

• creation of occupational identity and ability to enact this in various circumstances

• MOHO

1. Generating questions

2. Gathering information

3. Theory-based explanation

4. Generating goaks and strategies

5. Implementing and monitoring

6. Determining outcomes

• Therapeutic reasoning of MOHO

Theory of Occupational Adaptation

• basis for a doctoral program in OT at the Texas Women’s University

• Describes occupation and adaptation

Adaptation through occupation

• occupation could be adaptive, maladaptive or non-adaptive

• Spiraling process of development

• Influences within and outside of the person interact to promote occupation and thereby to achieve adaptation

Theory of spatio-temporal adaptation

• Spiraling process of development

• skills are learned in response to stimuli in the environment

Dynamic Model of Occupation

• external demands, occupational performance, and adaptation formed a continuous interactive loop

• Adaptation as a development process that responds to environmental challenges constantly evolving skills and aptitudes

• Adaptation through occupation

• Theory of spatio-temporal adaptation

• Model of Human Occupation

• Dynamic Model of Occupation

Theoretical Antecedents of TOA

• More adaptive = more functional

• Competence in occupation is a lifelong process to internal and external demands

• Demands to perform naturally occur

• Dysfunction occurs becauyse the person’s ability to adapt has been challenged

• The person’s adaptive capacity can be overwhelmed by impairment

• Greater dysfunction = greater demand for changes

• Success in occupational performance = ability to adapt with sufficient mastery

• Theoretical assumptions of TOA

Desire for mastery

• innate within the human condition to master the environment

• Person factor

• TOA

Demand for mastery

• expectations from the environment

• impact and is impacted by the person

• Occupational Factor

• TOA

Press for Mastery

• interaction of internal and external factors

• TOA

Occupational Role expectations

• response to the unique occupational challenge experienced by the individual

• TOA

Occupational response

• action done by the individual in response to the occupational challenge

• TOA

Generation

• Individuals assess existing repertoire of adaptive if there is a suitable response available, if existing response can be modified, or if a new response must be learned

• TOA

Hyperstable

• same solution

• adaptive response behavior

• TOA

Hypermobile

• move solutions with no result

• adaptive response behavior

• TOA

Blended

• greater opportunity for positive outcome

• adaptive response

Adaptation Gestalt

• Individual configures their person systems to carry out a plan

• Drawn from individual’s experiences

• TOA

Evaluation

• activated to evaluate the chosen response option in terms of effectiveness, efficiency, satisfaction to self, satisfaction to society

• TOA

Relative Mastery

• desired outcome of therapy

• how the client feels when they were able to adapt to their contexts

• TOA

Integration

• Integrates and stores positively evaluated response options for future use

• Discards negatively rated response options

• Built and refined through feedback

• TOA

• Canadian Model of Occupational Performance

• Carl Rogers in 1940

• Social Learning theory

• Adaptation and human's quest for mastery within the environment

• Maslow’s hierarchy of needs

• theoretical antecedents of CMOPE

Canadian Model of Occupational Performance

• Occupation through Adaptation model by Reed and Sanderson (1980)

• Individual interaction through the medium of occupation with the environment

• Health is achieved when both performance and satisfaction with occupation are optimized

Carl Rogers in 1940

• Client-centered therapy is a non-directive approach

Canadian Model of Occupational Performance and Engagement

• focused on occupational performance

• individual interaction through medium of occupation with the environment

• occupation is the central interests

• vision of health, well-being, and justice through occupation, not just occupational performance

• Humans are occupational beings

• Occupation has therapeutic potential

• Occupation affects health and well-being

• Occupation organizes time and bring structures

• Occupation brings meaning to life through culture and individual meaning

• Occupations are idiosyncratic

• assumptions of CMOPE

Occupation

• Groups of activities and tasks for everyday life, named, organized, and given value and meaning by individuals and the culture

• core domain of concern

• bridge that connects people and environment

• CMOPE

client-centered practice

• client controls the therapeutic agenda

• CMOPE

Occupation, Client-centered practice, spirituality

• Cardinal concepts of CMOPE

Person

• component, affective, physical

• spiritual component at its core

• within the environment

• CMOPE

Environment

• where occupations occur

• affords occupational possibilities

• CMOPE

• specifies domain of concern

• client-centered is the most constructive way

• no spirituality = no meaningful occupation

• motivation associated with context, roles, and innate desire for mastery

• psycho-educational approach requires understanding of teaching-learning process

• Implications of CMOPE

Occupational Performance Model - Australia

• occupational performance as its central concept

• takes a more biopsychosocial approach to occupatonal performance

• occupation as the interaction between the person and the environment

• holistic, client-centered

• driven by intrinsic and extrinsic drivers

Lifelong personal-environment relationship through occupation

• primary focus of OPM

• People as holistic beings with mind, body, spirit

• occupation provides a sense of reality, mastery, competence, autonomy, and temporal organization

• Health is competence and satisfaction in occupational performance

• Humans are active in creating their occupational being or identity

• Occupational being ideates and actualizes engagement in occupational roles

• assumptions about human occupations - OPM

• performance is >doing

• performance as how someone reacts under certain conditions or fulfills a purpose

• Incorporates “knowing“ and “being“

• assumptions about human performance - OPM

• humans → self-organizing systems = produce patterns of behavior arising from the cooperative interaction of many elements

• humans = complex multidimensional subsystems

• no one subsystem has logical priority

• assumptions about self-organizing systems - OPM

Occupational performance

• ability to perceive, desire, recall, plan, and carry out roles, routines, tasks, and subtasks for the purpose of self-maintenance, productivity, leisure, and rest in response to demands of the internal and/or external environment.

• OPM

Occupational Performance Roles

• Patterns of occupational behaviour are composed of configurations of self-maintenance, productivity, leisure, and rest occupations.

• Roles are determined by individual person environment-performance relationships

• They are established through need and/or choice

• Modified with age, ability, experience, circumstance, and time

• OPM

Body, Mind, Spirit

• Core elements of OPM

Body

• tangible physical components of human structure

• OPM

Mind

• core of our conscious and unconscious intellect

• OPM

Spirit

• Seeks a sense of harmony within self and between self, nature, others

• OPM

Kawa Model

• beyond western-based cultural contexts and assumptions

• question OT privileging of individualism, independence, ableism

• has cultural relevance and safety

Culture

• Shared experiences and common spheres of meaning

• Collective social processes by which distinctions, meanings, categorizations of objects, and phenomena are created and maintained

• Kawa

Kawa (River)

• Represents life

• Complex profound journey that flows through time and space

• optimal = strong, deep, unimpeded flow

Mizu (Water)

• Life energy or flow

• lives are bound and shaped by their surroundings, people, and circumstances

• weakened = disharmony or unwell

• stops = end of life

Kawa Zoko (River side-walls and bottom)

• environment

• most important determinant of life flow

• its aspect affect overall flow

• harmonious realtionship enable and complement life flow

Iwa (Rocks)

• impediments to life flow

• problematic and difficult to remove

Ryuboku (Driftwood)

• Personal attributes and resources

• Transient in nature

• Can be inconsequential or obstructive

• Can collide with other structures

Sukima (spaces between obstructions)

• promise of OT

• potential channels of flow

• can erode rocks and rivers for larger conduits for life flow

Harmony

central point of reference of Kawa model

Harmony

• state of individual or collective being in which the subject is in balance with the context that it is a part of

• Kawa model