Week 4 W&S Chapter 18: Patterns of Occupations

Occupational Patterns

• Habits, routines, roles, and rituals used in the process of engaging in occupations or activities

Occupational Roles

• Normative models for behavior shaped by culture and society

• Are dynamic throughout the life course since new ones are learned and old ones are replaced

• Can be disrupted, altered, or ended by the presence of a disability

• Do not easily translate from culture to culture and may limit us singular or normative expectations of behavior and meaning

• Ex:

  • Student

  • Friend

  • Worker

  • Mother

Caregiving and Roles

• Can disrupt valued roles

• Can influence how and which roles are performed by their children or family members with disabilities

• The increased demands can result in altered social roles, underemployment, and low levels of well-being

Common Role Assessments

• Role Checklist

• The Adolescent Role Assessment

• The Role Activity Performance Scale

• The Role Change Assessment

• Worker Role Interview (WRI)

Role Checklist

• Purpose:

  • To assess a person’s perception of participation in 10 major life roles and the value placed on these roles

• Method:

  • The client identifies and rates the roles that he or she has done in the past and is currently engaged in as well as roles that he or she would like to have

• Comment:

  • It is a relatively easy and quick way to assess how someone feels about the roles that he or she holds and to see changes in role patterns over time

The Adolescent Role Assessment

• Purpose:

  • To assess four domains: developing aspirations, developing interpersonal competencies, developing self-efficacy, and developing autonomy

• Method:

  • A semistructured interview that provides both narrative and quantitative information regarding worker role development

• Comment:

  • Based on the idea that during adolescence, one explores interests, assumes increased responsibility, and develops values and goals that influence occupational choice and work attitudes necessary for entering an occupation

The Role Activity Performance Scale

• Purpose:

  • To assess a person’s role in performance in 12 major roles over a period of 18 months

  • The role activities assessed include work, education, home management, family of origin relationships, extended family relationships, partner/spouse relationship, social relationships, leisure, self-management, hygiene and appearance, and health care

• Method:

  • Interview process that allows for information to be collected from the client as well as other sources including family, medical record, and the health care team

• Comment:

  • It is used in mental health settings and is designed to guide intervention planning as well as be used as a research tool to measure intervention outcomes

The Role Change Assessment

• Purpose:

  • To assess the level of engagement and satisfaction experienced in these roles and how they have changed over time

• Method:

  • A semistructured interview format to examine 48 roles in family and social, vocational, self-care, organizational, leisure, and health care categories for older adults

• Comment:

  • The interview format allows the OT practitioner to assess both role stability as well as change

Worker Role Interview (WRI)

• Purpose:

  • To assess psychosocial capacity in injured workers for readiness to return to work

  • To address both psychosocial and environmental factors that impact return to work

• Method:

  • Semistructured interview formats for recently injured workers and persons who are chronically disabled

• Comment:

  • The information gathered complements other work/physical capacity assessments to ensure a well-rounded picture of the client and his or her needs that should be addressed to ensure return to work

Habits

• Specific, automatic behaviors that are performed repeatedly, relatively automatically, and with little variation

• Since they can be performed in different contexts, they are not necessarily performed in exactly the same way each time

• Can be useful, dominating, or impoverished and can be difficult to break

• Ones that are simple and useful may be developed to mange time and reduce the stress that interferes with daily performance

Impoverished Habits

• When people have difficulty learning new useful habits because of a dysfunctional internal state

• The OT will consult with the caregivers of clients for ways to modify the environment or the activity for optimal performance

• People with Alzheimer’s disease, depression, or ADHD may not be able to develop new useful habits that help them adjust to their disability

Dominating Habits

• Those that are consistently performed even if they interfere with optimal performance

• Over time, some habits can become addicting and affect one’s health, such as the need to smoke a cigarette when driving or consuming snacks when watching TV

• Occupational therapy intervention may assist individuals to identify and practice alternative habits that are less harmful

• Other types of these habits can create stress or anxiety if they cannot be performed, such as needing to wash hands after touching anything

Habit Domination

• Can occur with obsessive-compulsive disorder (OCD), autism, or other mental health disorders

• These can be very difficult to change and are sometimes managed with medication

Assessments of Habits or Routines

• The Assessment of Life Habits (LIFE-H)

• The Model of Human Occupation Screening Tool (MOHOST)

• The Family Routines Inventory

• The Scale of Older Adults’ Routine (SOAR)

• The Social Rhythm Metric (SRM-5)

The Assessment of Life Habits (LIFE-H)

• Purpose:

  • To evaluate social participation of people with disabilities, regardless of the type of underlying impairment

  • To measure level of difficulty and type of assistance needed

• Method:

  • Self- or therapist-administered

  • Ratings for 12 life habit categories (nutrition, fitness, personal care, communication, housing, mobility, responsibility, interpersonal relationships, community, education, employment, and recreation)

• Comment:

  • Fits well in the International Classification of Functioning, Disability and Health (ICF) participation domains

  • Measuring a person’s involvement in a life situation

The Model of Human Occupation Screening Tool (MOHOST)

• Purpose:

  • To measure the Model of Human Occupation (MOHO) concepts of volition, habituation, communication/ interaction skills, motor skills, process skills, and the environment

• Method:

  • One of the six subscales measures performance patterns related to routines, adaptability, roles, and responsibility

  • Scoring reflects whether the individual’s performance patterns facilitate, allow, inhibit, or restrict optimal performance

• Comment:

  • The MOHOST has initial validity evidence for use as an overview of occupational performance and for use of the six subscales representing the MOHO concepts

The Family Routines Inventory

• Purpose:

  • To measure the predictability of routine in the daily life of a family

  • It measures 28 positive, strength-promoting family routines and has demonstrated validity and reliability

• Method:

  • Scoring is based on the number of routines endorsed by the family (they do the routine), frequency of adherence to the routine (how often they do it), and how important the routine is to them

• Comment:

  • Examples of items include “family eats at the same time each night,” “each child has some time each day for playing alone,” “family regularly visits with the relatives,” and “parents and children play together some time each day”

The Scale of Older Adults’ Routine (SOAR)

• Purpose:

  • To measure stability in activities on a daily and weekly basis for older adults

  • Provides information about the stability or disruption of routine

• Method:

  • It is administered by in-person interview and includes 42 routine activities in five domains (basic, instrumental, leisure, social, and rest) measured on four dimensions (frequency, timing, duration, and sequence)

• Comment:

  • This assessment may be useful for occupational therapists in exploring altered routines during transitions such as from home to a retirement community, independent living to assisted living, or a nursing home

The Social Rhythm Metric (SRM-5)

• Purpose:

  • To quantify daily lifestyle regularity (routines) with respect to event timing

• Method:

  • Diary-like tool where participants record the timing of five daily events over the course of 1 week:

    • When they get out of bed

    • Have first contact with a person

    • Start of work

    • School

    • Volunteer or family care

    • Have dinner

    • Go to bed

• Comment:

  • This measure was developed from the theory that social rhythms (i.e., eating and sleeping schedules) are important for structuring individuals’ days and for maintaining circadian rhythms, and alterations in these rhythms lead to disentrainment and poor health

Routines

• A type of higher-order habit that involves sequencing and combining processes, procedures, steps, or occupations and provide a structure for daily life

• The loss of this can be disruptive

• Can be a very important component of managing one’s overall health but can also be damaging

• Sometimes, people with chronic diseases avoid making future plans and limit social engagements to minimize potential discomfort

• This pattern of avoidance leads to a vicious cycle of less positive social engagements

Fatigue

• Is often unpredictable and severe, making it difficult to follow desired routines or to make future plans

• People who experience this type of fatigue are forced to make choices about how they are going to expend their limited energy and make reductions in the number and type of activities in which they participate

Common Energy Conservation Strategies Include

• Analyzing and modifying activities to reduce energy expenditures

• Balancing work and rest

• Delegating some activities

• Examining and modifying standards and priorities

• Using the body efficiently

• Organizing workspaces

• Using assistive technologies to conserve energy

Family Routines

• Are important to address because they have been shown to be important in individual and family well-being

• Are observable and repetitive patterns involving family members that occur with predictable regularity in family life

• Can help family members arrange everyday life in a way that helps them cope with illness or stress

• When families are stressed, interventions are most effective when the new health routines are aligned with family values, meaningful, and applicable to family needs and when resources were available

Rituals

• Are different from routines in that they include strong elements of symbolism

• Often are a reflection or enactment of one’s culture

• A strong sense of meaning and identity is experienced when a person feels engaged and included in this

• Are often associated with religious activities such as a baptism, bar mitzvah, pilgrimage to Mecca, or other religious ceremony

• Can also be secular such as a holiday parade, high school graduation, or initiation into a group of people (gang, sorority, fraternity, etc.)

• Often signify to a community of people a transition from one state of being to another, such as from child to adult, single to married, or student to graduate

• Can also exist in the context of families

• Offer individuals and groups of people an opportunity to carry

  out identified roles and to feel a sense of belonging and meaning

Family Rituals

• Contain symbolic and affective components that serve to construct and affirm family identity

• May occur daily (kissing one another hello), weekly (family dinner), annually (reunion), or only once in a lifetime (bar mitzvah)

Lifestyles

• Are unique patterns of everyday occupations including roles, habits, routines, and rituals and can lead to an overall life balance or imbalance with long-term consequences on health, well-being, and quality of life

Occupational Balance

• Refers to a perception that one’s patterns of everyday occupations are satisfactory and include a range of meaningful occupations

Life Balance

• Is similar to occupational balance but uses words more commonly understood outside of the OT profession

• Is defined as a satisfying pattern of daily activity that is healthful, meaningful, and sustainable to an individual within the context of his or her current life circumstances

• Requires the skill to create a match between how much time one desires to engage in activities and actually engages in the activities that meet important needs

Life Balance Model

• Depicts the relationships between occupational patterns, life outcomes, and the environment

• Life balance has associated positive outcomes such as lower perceived stress, higher personal well-being, and need satisfaction

• On the other hand, if people are dissatisfied with the amount of time spent in activities or they are not meeting all four need areas, then the model depicts this situation as life imbalance with associated negative health consequences

• The model is surrounded by a large oval representing the environment and its influence on life balance

Life Balance Inventory (LBI)

• Was created to measure life balance as conceptualized in the Life Balance Model

• The 53-item assessment measures perceived balance across the four need-based dimensions in the Life Balance Model (health, relationships, challenge, identity) and was designed to allow unique configurations of daily occupations for each person within each of those dimensions

• The scoring is based on the idea that imbalance could result from spending too little or too much time in any activity

• Has demonstrated acceptable internal consistency and content validity as a measure for life balance

Daily Activity Logs

• Another method of examining occupational patterns

• The purpose is to have an accurate record of what occurs in peoples’ lives by recording activities at regular intervals

• The length of the intervals and what is recorded varies

• Help the person to be more aware of how time is spent and can be a first step in making healthy lifestyle changes

Life Imbalance

• Is when patterns of daily occupations are perceived to be unsatisfactory (there is not a good match between desired and actual engagement in valued activities), increasing the risk for physical and mental health problems

• Means that occupational patterns limit or compromise participation in valued relationships; are incongruent for establishing or maintaining physiological health and a satisfactory identity; or are mundane, uninteresting, or unchallenging

• People who have disabilities experience this when they cannot participate in valued occupations because of physical or environmental barriers

• People who do not have disabilities also experience this, and addressing this problem is an emerging role for OT practitioners

Spoon Theory

• Is a metaphor for living with a chronic illness

• Spoons= energy and effort

• Every task and every decision is based on the number of spoons, or the amount of energy, required to complete it

  • Not every task is weighted equally

• Each illness is different and each person is different, and there is no one size fits all spoon equation

• People do not know how many spoons they will get each day

  • External factors: not sleeping well, bad weather

  • Gamble day-to-day on how many spoons they start out with

• Living the “spoony” life means constantly calculating opportunity costs

  • Choosing some activities may mean excluding others

  • It’s often impossible to do everything a person wants to do when they want to do it

Spoon Theory: Running Out of Spoons

• Is costly

• Results in mental fatigue where the person feels like they are in a fog, can’t think clearly, can’t make decisions, and find it hard to remember the most basic information

• The most disruptive and most common result is complete and utter physical fatigue

  • Not simply being tired

  • It’s being completely debilitated

  • All of the willpower and motivation in the world can’t get someone up those stairs, even if it is to go to bed

  • This feeling is not something someone can get over quickly

  • Can last for days, weeks, or even longer

  • Can cause a flare up of the disease

  • Person wakes up with less spoons, and it takes double the effort to complete the same activities

• Hard to process new information

• Being anxious or depressed costs more spoons, setting the person back even further

Chronic Disease: CDC

• 6 in 10 adults in the US have a chronic disease

• 4 in 10 adult in the US have 2 or more