Step 2: Determining the Relevance and Importance — Comprehensive Study Notes

Step 2: Determining the Relevance and Importance

  • Purpose: Assess how relevant an activity is to the client and how important it is in the client’s life and sense of self.
  • Core idea: Relevance and importance help define what the client needs to do, what it means to them, and how it contributes to their identity.
  • Asked questions (Hocking, 2001):
    • In what ways is this activity important to you?
    • How does engaging in this activity make you feel?
    • In what ways do you need to engage in this activity?
    • Tell me about the experiences you have when engaged in this activity.
    • How has limited ability to engage in this activity affected your life? Your roles? Your relationships?
    • How does this activity define who you are?

Defining the Occupation in an Occupational Analysis

  • First best step to understanding how a client defines the occupation: have the client define the occupation they want or need to do.
  • Ask: how and where do they typically perform this occupation?
  • Determine the category of occupation (see Chapter 2) under OTPF-4 that this occupation falls into.
  • Identify what defines successful participation for the client.
  • Explore how this occupation plays a part in the client’s life.

Perceived Utility

  • Occupations define who we are (occupational identity).
  • Activities fulfill roles.
  • Considering occupations as part of a person’s identity helps analyst assess the demands of the activity.

The Occupational Profile

  • Purpose: gain understanding of how a client defines:
    • An occupation
    • The meaning and utility of an occupation
    • The client’s values, beliefs, and spirituality
    • The form in which the occupation takes place
  • Gained through an occupational profile.
  • The occupational profile is part of the evaluation process.
  • The profile is conducted through an interview.

Questions Asked in the Occupational Profile (Overview)

  • Why is the client receiving services — what are their concerns with daily life activities?
  • Which occupations are they having trouble with and which have been successful?
  • Which aspects of the client’s environment or contexts support or inhibit participation in the occupations?
  • What occupations has the client participated in in the past, what do they currently engage in, and what are desired future occupations?
  • What are the client’s values and interests?
  • What roles does the client fulfill?
  • What aspects of the client’s contexts either support or hinder engagement in their occupations?
  • What are the client’s patterns of daily activities — how have these patterns changed?
  • What client factors do they feel are supporting or inhibiting engagement in occupations?
  • What are the client’s priorities — what are their desired outcomes?

Contexts and Environments

  • Environmental Factors: Aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives.
  • Personal Factors: The particular background of a person’s life, consisting of unique features not part of a health condition or health state.

Environmental Contexts (Categories and Subcategories)

  • Natural environment and human-made changes to the environment:
    • Physical geography
    • Population
    • Flora and fauna
    • Climate
    • Natural events
    • Human-caused events
    • Light
    • Time-related changes
    • Sound and vibration
    • Air quality
  • Products and technology:
    • Food, drugs, and other products for personal consumption
    • General products and technology for personal use in daily living (including assistive technology and products)
    • Personal indoor and outdoor mobility and transportation equipment used by people in activities requiring movement inside and outside of buildings
    • Communication
    • Education
    • Employment
    • Cultural, recreational, and sporting activities
    • Practice of religion and spirituality
    • Indoor and outdoor human-made environments designed for public and private use
    • Assets for economic exchange (money, goods, property, etc.)
    • Virtual environments (simulated, real-time, near-time, absent of physical contact)
  • Support and relationships:
    • Immediate and extended family
    • Friends, acquaintances, peers, colleagues, neighbors, community members
    • People in positions of authority and those in subordinate positions
    • Personal care providers and personal assistants
    • Domesticated animals
  • Attitudes:
    • Individual attitudes of family, friends, peers, neighbors, authorities, professionals
    • Societal attitudes (including discriminatory practices)
    • Social norms, practices, ideologies that marginalize populations
  • Services, systems, and policies:
    • Services designed to meet the needs of persons, groups, and populations
    • Governmental or recognized systems at local, regional, national, and international levels
    • Policies, rules, regulations, conventions, and standards

Personal Factors

  • Age (chronological)
  • Sexual orientation
  • Gender identity
  • Race and ethnicity
  • Cultural identification and cultural attitudes
  • Social background, social status, and socioeconomic status
  • Upbringing and life experiences
  • Habits and past and current behavioral patterns
  • Individual psychological assets (temperament, character, coping styles) for handling responsibilities, stress, crises, and psychological demands
  • Education
  • Profession and professional identity
  • Lifestyle
  • Other health conditions and fitness

Learning Activities

  • Environmental Factors exercise:

    • Question: What are your environmental factors? How do they support or hinder your ability to study?
    • Components to consider: Natural environment and human-made changes; Products and technology; Support and relationships; Attitudes; Services, systems, and policies.

  • Personal Context exercise:

    • Question: What are your personal contexts? What makes up who you are as a person?
    • Factors include: Age, Sexual orientation, Gender identity, Race/ethnicity, Cultural identification, Social background/status, Upbringing, Habits, Psychological assets, Education, Profession, Lifestyle, Other health conditions and fitness.

Performance Patterns

  • Patterns of behavior that are habitual or routine.
  • Habits: Automatic, repeated, relatively automatic behaviors with little variation; can be healthy or unhealthy, efficient or inefficient, supportive or harmful.
  • Routines: Observable, regular, repetitive activities that provide structure; can be satisfying, promoting, or damaging; require delimited time and are embedded in cultural/ecological contexts.
  • Roles: Aspects of identity shaped by culture and context; can be defined by the client and by the activities/occupations they engage in.
  • Rituals: Symbolic actions with spiritual, cultural, or social meaning; contribute to identity and reinforce values/beliefs; have an affective component and consist of a collection of events.
  • Source: (AOTA, 2020, p. 41)

Learning Activity: Impact of Performance Patterns on Studying

  • Which performance patterns are supportive or harmful for your study ability?
    • Supportive: Habits, Routines, Roles, Rituals
    • Harmful: Habits, Routines, Roles, Rituals

Discussion Questions

  • Why is it important to understand our client’s performance patterns?
  • How can we gather information about our client’s performance patterns?
  • How does understanding our client’s roles impact occupational therapy intervention?

Case Example: Ryan

  • Background: Ryan is a 1717-year-old male who was involved in a motor vehicle accident 66 months ago.
  • Injuries: Severe head injury; coma for 22 months; now able to use his left upper and lower extremities; right-hand dominant prior to the accident.
  • Communication: Expressively aphasic; only able to nod yes/no.
  • Cognitive: Difficulty sustaining attention; limited to following simple directions.
  • Physical: Uses a wheelchair; difficulty maintaining upright position when leaning forward or reaching to the sides.
  • Frustration: Often frustrated with people, especially in noisy environments; may hit or push people away.
  • Prior to injury: High school student; enjoyed talking on the phone with friends/girlfriends; loved classic cars; worked on a 1967 Cadillac with his dad; loves rock and roll music; snowboarded and skateboarded; very involved in church; parents live an hour away but visit weekly; family lives in a two-story cabin in the mountains; bathroom upstairs with a walk-in shower; has 4 younger siblings.
  • Family perspective: Parents want him to be as independent as possible and to return to “normal”; mom tends to rush to help when he struggles.

Case Questions (Context, Performance Patterns, and Outcomes)

  • What contexts or environments inhibit Ryan’s ability to engage in his daily occupations?
  • Which contexts or environments support Ryan’s ability to engage in his daily occupations?
  • What performance patterns does Ryan exhibit? Which are supportive and which are harmful?

Conclusion

  • An occupational or activity analysis involves understanding how the occupation/activity is defined.
  • Consider the multiple environments and contexts surrounding the client.
  • Understand the client’s meaning and purpose for engaging in the occupation.
  • Recognize how performance patterns influence engagement.
  • Acknowledge that environment and contexts can support or hinder participation.
  • Gather this information through the occupational profile interview.

References (Selected)

  • American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). Am J Occup Ther, 74(Suppl. 2), S1-S87.
  • Fiese, B. H. (2007). Routines and rituals: Opportunities for participation in family health. OTJR: Occupation, Participation and Health, 27(Suppl. 1), 41S-49S.
  • Fiese, B. H., Tomcho, T. J., Douglas, M., Josephs, K., Poltrock, S., & Baker, T. (2002). A review of 50 years of research on naturally occurring family routines and rituals: Cause for celebration. Journal of Family Psychology, 16, 381–390.
  • Hocking, C. (2001). The issue is: Implementing occupation-based assessment. Am J Occup Ther, 55(4), 463-469.
  • Kielhofner, G. (2008). The Model of Human Occupation: Theory and application (4th ed.). Lippincott Williams & Wilkins.
  • Matuska, K., & Barrett, K. (2019). Patterns of occupations. In B. A. Schell & G. Gillen (Eds.), Willard and Spackman’s occupational therapy (13th ed., pp. 212–220). Wolters Kluwer.
  • Segal, R. (2004). Family routines and rituals: A context for occupational therapy interventions. Am J Occup Ther, 58, 499-508.