History OT Student Presentation Models, Module 8

What is the Canadian Model of Occupational Performance?

• Conceptual model that can be applied across a wide range of OT practice settings

• Utilizes the Canadian Occupational Performance Measure (COPM) as an assessment tool

• Assumptions:

  • Humans are occupational beings

  • Occupation affects health and well-being

  • Occupation has therapeutic potential

  • Occupations are idiosyncratic

• Principes:

  • Client-centered practice

  • Interdependence between individual, environment, and the occupation

  • Occupational performance

  • Self-perception

• Cultural relevance:

  • Western-centric model emphasizing individualism and person at the center of the model

    • Disregard for collectivist cultures

  • Flexible framework, strong starting point

• Values:

  • OT treatment determined by diagnosis of physical/mental disorders

    • Methods: Occupational engagement and recreation

    • Objectives: Promote recovery, create new habits, prevent deterioration

• Dysfunction: Individuals w/ cognitive disabilities demonstrate poor judgement, inappropriate occupational choices, lack of structure in ADLs, and dysfunction without external support

• Interventions:

  • Holistic, addressing several areas and their interactions, intersectionality

  • Facilitate client lead goals > therapist driven

    • Emphasize autonomy

  • Preserve engagement, not just independence

What is the Model of Human Occupation?

• An occupation-focused, evidence-based theoretical framework that seeks to explain how human occupation is motivated, organized, and performed within an environment

• Volition, habituation, performance

What are the basic assumptions of the Model of Human Occupation?

• Humans are occupational beings

  • Innately motivated to perform occupations and repeat their performance over time (habituation)

  • Each person comprises an inherent physiological and brain-based nervous system that propels one to act, do, and perform

• People shape themselves by doing

  • Each person develops a subjective perception (personal causation) of their own capacity through acts of doing

  • Occupational adaptation derives from occupational identity and occupational competence

• Behavior is dynamic and emergent

  • The process of engagement in occupation results from a dynamic and reciprocal interaction of internal, person-based variables and environmental factors that are physical and social in nature

  • Persons differ in levels of motivation and in the selecting, organizing, and undertaking of occupations

• The environment matters

  • Environmental factors can facilitate occupational participation as well as create barriers

  • The effects of supports vs. barriers

  • Environments consist of an ongoing feedback mechanism between a person and the corresponding environment (reciprocal influence)

What are the principles of the Model of Human Occupation?

• Engagement

  • Personal subsystems + environmental factors

• Environment

  • Influence participation (supportive or restrictive)

• Motivation

  • Volition + personal causation through “doing”

• Motivational differences

  • Differences between individuals

• Identity & Competence

  • Participation’s influence

What is volition in the Model of Human Occupation?

• One’s motivation for occupation

  • Value

  • Interest

  • Personal causation

What are habituations in the Model of Human Occupation?

• Occupational organization into patterns or routines

  • Habits

  • Routines

  • Role Competency

What is performance capacity in the Model of Human Occupation?

• Abilities required for skilled actions and occupational performances

• NOT for observable performance of skills

What is the environment in the Model of Human Occupation?

• Physical and social components

  • Physical

    • Space, sensory, visual, physical objects

  • Social

    • Relationships & Interactions

  • Also includes

    • Occupational, economic, political, cultural components

What are the values of the Model of Human Occupation?

• Interconnectedness

  • Human motivation + behavior + performance → interconnected and unique to each individual

• Empowerment

  • Client-centered

  • Holistic perspective

  • Respecting client’s personal choices + values + self-efficacy

• Occupational participation

  • Occupational identity + competent performance → improved well-being and health

What is the focus of the Model of Human Occupation?

• Offers a systems-based, holistic approach for person’s of varying needs & populations across the lifespan

• Capable of being changed/revised in multiple care settings

• Main focus = doing of occupation

What are the functions and dysfunctions in the Model of Human Occupation?

• Function:

  • When an individual has a sense of order

  • Defined as a status of health and competent performance of daily living, work, and play

  • Individuals display order when they are given full autonomy

• Dysfunction

  • Being in a state of disorder

  • Individuals in a state of disorder are unable to participate successfully in their occupations

What are the developmental stages of change in the Model of Human Occupation?

1. Exploration

   1. Discovering capacity

   2. Self-exploration

2. Competency

   1. Meeting expectations

   2. Building self-efficacy

3. Achievement

   1. Full participation

   2. Occupational identity

What is volition and motivation in the Model of Human Occupation?

• Volition

  • Internal motivation

  • Personal causation (I believe that I can do something)

  • Interests (I like doing something)

  • Values (I see the meaning in doing something)

• External influences

  • Environmental feedback can shape perspective

  • Individualized motivators: Tangible, intangible, privilege-based, or activity-based

• Sustaining motivation

  • Repeating new behaviors can make them more rewarding and habitual

  • OTs should consider volition and environmental factors collectively

What are key factors of the Ecology of Human Performance Model?

• Person

  • Abilities, interests, and experience

• Context

  • Physical, social, cultural, and temporal

• Task

  • Actions needed to reach a goal

• Performance

  • Person, context, and task working together

What are guiding values of the Ecology of Human Performance Model?

• Client-centered care

• Choice and self-determination

• Strengths-based program

• Inclusion and social justice

• Meaningful participation

• Changing the context or task can support participation

What is the target population and emphasis of the Ecology of Human Performance Model?

• Target population

  • Various individuals across the lifespan

• Emphasis

  • Inclusive approach that focuses on preventative, health-promotional, and rehabilitative intervention

• Unique targeted focus on analysis

  • Analyzes the situation itself

  • Context influences the person completing a task

  • i.e. interaction between person, task, and context influences human performance

What are the four main components of the Ecology of Human Performance Model?

• Person

  • Varying sensorimotor, cognitive, and psychosocial abilities

  • Meaning and purpose influence motivation

  • Person and context is constantly evolving

• Tasks

  • Behaviors needed to accomplish a goal

    • ADLs, IADLs, work, education, play, leisure, sleep/rest, and social participation

• Context

  • Temporal

    • Age, developmental stage, life cycle, health status, and duration

  • Environmental

    • Physical

    • Social

    • Cultural

• Performance

  • Determined by person, context, task transaction

    • An individual who does a task within their unique context results in human performance

What are the functions and dysfunctions in the Ecology of Human Performance Model?

• Function

  • High performance range

    • Participating in many occupations that match roles/preferences and meet environmental demands

  • Relative independence

    • Use assistance and support to meet goals

  • Competency

    • Meeting task demands and adapting to fulfill life roles

• Dysfunction

  • Disruption among person, context, task transaction

    • Person: Health conditions, barriers, and individual vulnerabilities

    • Context: Physical environmental, systemic, cultural barriers

    • Task demand mismatc

What is the role of motivation and change in the Ecology of Human Performance Model?

• Role of motivation is directly impacting the change process

  • To be established by asking a person directly

    • Want?

    • Need

    • Interest or value

  • Client = agent of change

• Change:

  • Practitioners believe changing any variables can change outcomes

What are assumptions of the Ecology of Human Performance Model?

• Holistic systems view

• Individualized skill application

• Subjectivity of meaning

• Dynamic internal and contextual

• Tasks as building blocks

What are theoretical principles of the Ecology of Human Performance Model?

• Establish and restore

  • Personal abilities

  • Motor, cognitive skills

• Alter

  • Focus is context

  • Target is finding the best suitable environment

• Adapt (focus on external modification)

  • Changes are made to the task and/or context

• Prevent

  • Think of risks that may impede progress

• Create

  • Create more opportunities to build skills/confidence

What are the basic assumptions of the Person-Environment-Occupational-Performance Model (PEOP)?

• Person, environment, and occupations are interconnected

• Occupational performance (doing) enables participation (engagement in everyday life) that contributes to well-being (health and quality of life)

• People and their environments influence each other

• Biopsychosocial factors influence occupational performance

• Can be used in a variety of settings

What are they main principles and values of the PEOP Model?

• Interaction between the person, the environment, and the occupation

• Engagement in meaningful occupations can promote well-being and participation in daily tasks or activities

• Client-centered: Respecting the client’s choices and what matters to them

• Recognize that social and environmental barriers can influence occupational access and engagement

What are functions and dysfunctions of the PEOP?

• Function:

  • Able to participate in meaningful occupations and meet the occupational demands

  • The environment matches the individuals needs, abilities, and preferences

  • Participation contributes to satisfaction and quality of life

• Dysfunction:

  • Limited occupational performance due to internal or external barriers

  • Person-related barriers: Cognitive, physical, or psychological barriers

  • Environmental barriers: Inaccessible spaces or inadequate resources

• Disability: Imbalance between an individual’s abilities and the environmental demands

What is the process of the PEOP?

1. Top-down and client-centered:

   1. Driven by the client’s view of occupational disruption

2. Perspective drives goals:

   1. Meaningful change needs to be set by the client’s priorities

3. Success builds competency:

   1. Repetition and self-satisfaction come from successful engagement

How is the cycle sustained in the PEOP?

1. Matching demands:

   1. Intrinsic factors should align with activity demands

2. Value equals persistence:

   1. Personally valuable outcomes increase a client’s passion to overcome challanges

3. Reinforcing cycle:

   1. Intrinsic and extrinsic rewards help fuel accomplishment

What are motivations in the PEOP?

• Core assumption

  • Individuals have a built-in urge to gain success in their environment

• Observing human agency

  • We measure motivation by observing how a client wants to explore and engage with their world

• Roles and self identity

  • Engaging in meaningful life roles supplies self-satisfaction, leading to lasting competence and personal identity

• Influencing factors:

  • Internal (psychological state drives or restricts their passion to perform)

  • Enablers and barriers (Motivation can be blocked by internal states such as self-concept, self-efficacy, identity, and emotional well-being)

  • The power of narratives (Using a client’s personal story uncovers their intrinsic factors, which can help with the start up of their motivation)

What is the intervention process of the PEOP?

1. Narrative phase

   1. Explore client’s personal story

   2. Strengths, challenges, and values

   3. Short and long term goals

   4. Similar to an occupational profile

   5. Person, occupation, and environment’s role in performance

   6. Are OT services relevant?

2. Assessment and evaluation phase

   1. Evidence-based assessments

   2. Identifies capabilities and enablers that support participation

   3. Examines factors across the occupation, person, and environment

   4. Involves occupational categories:

      1. ADLs, IADLs, work, education, rest and sleep, leisure, and social participation

      2. Integrates and interprets data from assessment areas

      3. Purpose is to identify strengths, enablers, and factors

      4. Guides intervention planning

3. Intervention phase

   1. Client collaboration

   2. Designing action plans

   3. Priorities, values, and goals

   4. Relate to theoretical principles

   5. Restorative benefits to enhance abilities

   6. Recognize environment’s influence on health, participation, and roles

   7. Enhance occupational performance and role functioning

4. Outcomes phase

   1. Practitioners explain results/outcomes

   2. Allows OTs to involve clients in decision making about services

   3. Aiming to improve:

      1. Occupational performance

      2. Participation

      3. Overall well-being

What are limitations of the PEOP?

• Too detailed and comprehensive for fast-paced, short-term settings

• More effective for long-term goals

• Lack of guidance

• Not intuitive to apply to groups, communities, populations

• Does not include it’s own assessment tool

  • Synthesize different assessment tools across occupation, person, and environment elements

• Inconsistent application

• Measuring outcomes

• No guidance on evaluating the balance of person and environment factors

• Social determinants equated with other environmental factors

What is the Occupational Adaptation Model?

• Describe the process and/or outcome of the interaction between the person, occupation, and environment response to occupational challenge

What are the basic assumptions of the Occupational Adaptation Model?

1. Issues with adaptation require readjustment

   1. Identity

   2. Competency

   3. Participation

2. Quality of life linked to occupational engagement

3. Involves an internal process

   1. Ability to adapt to challenges

What are key concepts of the Occupational Adaptation Model?

• OA is both:

  • An internal process that happens during occupational participation

  • An outcome that results from improved or renewed participation

• Therapists can only facilitate adaptation

  • OT role = to create opportunities that support the client’s own adaptive process

• Adaptation is self-initiated and occurs via engagement in occupation

• Intervention aims to improve the person’s ability to adapt to both current and future occupational challanges

What are motivations in the Occupational Adaptation Model?

• Meaningful occupations encourage engagement

• Adaptation is a source of both meaning and motivation

• Motivation is tied to matery

• Relative mastery is how well a person responds to an occupational challenge in terms of:

  • Efficiency: How time and energy are used

  • Effectiveness: Whether the desired result is achieved

  • Satisfaction: The person’s internal and external sense of satisfaction with performance

What are functions and dysfunctions in the Occupational Adaptation Model?

• Function:

  • “A person responding masterfully and adaptively in the face of occupational challenge, to enable competence in the occupations associated with an individual’s life roles”

• Overcoming challenges

• Being effective and efficient

• Positive occupational identity

• Generalize responses

• Dysfunction:

  • Inability to overcome obstacles creating barriers to one’s ability to fulfill life roles and engage in meaningful occupations

How can the Occupational Adaptation Model be applied to practice?

• Adaptive response generalization

  • Person generates response using internal capabilities

  • A mix of client's sensorimotor, psychosocial, and cognitive skills

• Adaptive response evaluation

  • The client evaluates their response in relation to the call to mastery (relative mastery)

• Adaptive response integration

  • The client decides whether this internal adaptation framework was effective and generalizable to other tasks

What are motivations and assumptions in the Occupational Adaptation Model?

• Core assumption = every person has an innate desire to master their environment

• Motivation is impacted by three processes:

  • The person’s desire

  • the demand

  • the press for mastery