The Model of Human Occupation

Chapter 34 Williard and Spackman's OT 14th edition

MOHO

is an approach to occupational therapy practice that is occupation focused, theory driven, client centered, and evidence based.

Volition

refers to the process by which people are motivated toward and choose occupations.

Values

what one holds as important.

Are beliefs and commitments about what is good, right, and important to do.

Interest

what one finds enjoyable and satisfying.

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

Personal causation

refers to thoughts and feelings about activities that are worth doing, beliefs about the proper way to complete those activities, and the meaning that are ascribed to the things one does.

Habituation

refers to a process whereby people organize their actions into patterns and routines.

Roles

provide a cultural script for one's identity and provide a set of responsibilities and obligations that are associated with that identity.

Performance capacity

refers to a person's underlying mental and physical abilities an how those abilities are used and experienced in occupational performance.

Environment

can be defined as the particular physical, social, cultural, economic, and political features within a person's context that influence the motivation, organization, and performance of occupation.

Culture

shapes the formation of ideas about how one should perform and what is worth doing.

Occupational participation

refers to engaging in work, play, or activities of daily living (ADLs) that are part of one's sociocultural environment and that are desired and/or necessary to one's well-being.

Doing a task related to participation in a major life are.

Skills

are goal-directed actions within an occupational performance, such as reaching or sequencing.

Occupational competence

The degree to which people are able to sustain a pattern of doing that enacts their occupational identity.

Occupational engagement

refers to clients’ doing, thinking, and feeling under certain environmental conditions in the midst of therapy or as a planned consequence of therapy.

Choose/decide

Dimensions of Occupational Engagement

Anticipate and select from alternatives for action.

Commit

Dimensions of Occupational Engagement

Decide to undertake a course of action to accomplish a goal or personal project, fulfill a role, or establish a new habit.

Explore

Dimensions of Occupational Engagement

Investigate new objects, spaces, social groups, and/or occupational forms/tasks; do things with altered performance capacity; try out new ways of doing things; and examine possibilities for occupational participation in one's context.

Negotiate

Engage in a give-and-take approach with others that creates mutually agreed-upon perspectives and/or finds a middle group between different expectations, plans, or desires.

Plan

Dimensions of Occupational Engagement

Establish an action agenda for performance or participation.

Practice

Dimensions of Occupational Engagement

Repeat a certain performance or consistently participate in an occupation with the intent of increasing skill, ease, and effectivenes of performance.

Reexamine

Dimensions of Occupational Engagement

Critically appraise and consider aternatives to previously held beliefs, attitudes, feelings, habits, or roles.

Sustain

Dimensions of Occupational Engagement

Persist in occupational performance or participation despite uncertainty or difficulty.

Therapeutic reasoning

refers specifically to the use of MOHO concepts in thinking about clients’ needs throughout the OT process.

Occupational identity

MOHO Concept

• What is the person's sense of who he or she has been, is, and wishes to become in relation to family life, school, friendships, hobbies, and interests?

• What is the family's sense of who this person has been, is, and what do they wish him or her to become? How does this affect the person's occupational identity?

Occupational competence

MOHO Concept

• To what extent has this person sustained a pattern of satisfying occupational participation over time?

• Does this person feel that he or she can do things he or she needs to do in school, with friends, and in the community?

• To what extent has this person's life sustained patterns of occupational participation over time that reflect his or her occupational identity?

Participation

MOHO Concept

• Does the person currently engage in work, play, and ADLs that are part of his or her sociocultural context and that are desired and/or necessary for his or her well-being?

Performance

MOHO Concept

• Can this person do the occupations that are part of the work, play, and ADLs that make up, or should make up, his or her life?

• Can the person do the occupations that are expected of his o her roles?

Skill

MOHO Concept

• Does the person exhibit the necessary communication/interaction, motor, and process skills to perform what he or she need and wants to do?

Environment

MOHO Concept

• Does the family support the person in developing the necessary volition, habituation, and communication/interaction, motor, and process skills needed for participation?

• What impact do the opportunities, resources, constraints, and demands (or lack of demands) of the environment have on how this person thinks, feels, and acts?

• How do the opprtunities, resources, constraints, or demands provided by spaces, objects, occupations/tasks, and social groups affect the person's skill, performance, and participation?

Volition

MOHO Concept

• What is this person's view of his or her personal capacity and effectiveness?

• What does this person think is important?

• What are this person's interests? What does this person enjoy doing?

Habituation

MOHO Concept

• What routines does this person participate in, and how do routines influence what he or she does?

• What are the roles with which this person identifies with, and how do they influence what he or she routinely does?

Validating

Strategies Identified by the MOHO

Attending to and acknowledging the client's experience.

Identifying

Strategies Identified by the MOHO

Locating and sharing a range of personal, procedural, and/or environmental factors that can facilitate occupational performance.

Giving feedback

Strategies Identified by the MOHO

Sharing your understanding of the client's situation or ongoing action.

Advising

Strategies Identified by the MOHO

Recommending intervention goals/strategies.

Negotiating

Strategies Identified by the MOHO

Engaging in a give-and-take approach with the client.

Structuring

Strategies Identified by the MOHO

Establishing parameters for choice and performance by offering client alternatives, setting limits, establishing ground rules.

Coaching

Strategies Identified by the MOHO

Instructing, demonstrating, guiding, verbally and/or physically prompting.

Encouraging

Strategies Identified by the MOHO

Providing emotional support and reassurance in relation to engagement in an occupation.

Providing physical support

Strategies Identified by the MOHO

Using one's body to provide support fo a client to complete an occupational form/task.