Selected Practice Models for Occupational Therapy in Mental Health

Chapter Objectives

  • Name and describe six practice models used in psychosocial occupational therapy.

  • Identify medical or psychological theories or models that are compatible with each occupational therapy practice model.

  • Recognize concepts associated with each model.

  • Define terms associated with each model.

  • Discuss, in general terms, which practice model might best address the needs of a particular client and situation.

Introduction

  • Overview of theory-based approaches:

    • Benefits:

    • Factors important to the theory are satisfactorily addressed.

    • Drawbacks:

    • Factors not directly applicable to the theory may be overlooked.

    • Emphasis on successful management of the patient as a priority over strict adherence to any single theory.

    • Acknowledgement that major psychiatric theories often do not focus on the relationship of occupation to mental health, but can be applied in occupation-centered intervention.

    • Introduction of eight practice models based on these psychiatric theories.

The Eight Practice Models of Occupational Therapy

  1. Development of adaptive skills

  2. Role acquisition and social skills training

  3. Psychoeducation

  4. Sensory integration (SI)

  5. Sensory processing

  6. Cognitive disabilities

  7. Model of human occupation (MOHO)

  8. Person-environment-occupational model (PEO)

Development of Adaptive Skills

  • Purpose: To help individuals master occupation-supporting skills that they have not yet acquired, in a systematic, developmental manner.

  • Guiding Principles:

    • The therapist must:

    • Provide an environment that facilitates growth.

    • Ensure that subskills are mastered sequentially.

    • Allow addressing subskills from different areas simultaneously, provided they are acquired at the same chronological age.

    • Engage the patient's intrinsic motivation related to mastery of subskills.

  • Areas of Adaptive Skills:

    1. Sensory Integration: Ability to receive, select, combine, and utilize information from the vestibular, tactile, and proprioceptive senses to perform functional activities.

    2. Cognitive Skills: Ability to perceive, represent, and organize sensory information for critical thinking and problem-solving.

    3. Dyadic Interaction: Participation in various relationships involving one other individual.

    4. Group Interaction: Participation as a productive member in diverse group settings.

    5. Self-Identity: Recognition of one's personal assets and limitations leading to a self-perception as worthwhile, self-directed, consistent, and trustworthy.

    6. Sexual Identity: Acceptance of one's sexual nature as natural and pleasurable, alongside the ability to engage in a relatively long-term sexual relationship that considers both partners’ needs.

Role Acquisition and Social Skills Training

Introduction

  • Role Acquisition: The learning process wherein individuals develop necessary life, work, and leisure skills to participate effectively in social and productive roles.

  • Focus:

    • Emphasis on social skills training.

    • Concentration on current, situational behavior.

    • Motivation derived from intrinsic factors.

Role Acquisition Principles

  • Principle 1: Client Participation

    • Involvement of clients in identifying treatment-related problems and goals as well as evaluating their progress.

  • Principle 2: Personalized Goals

    • Goals and activities chosen should reflect the client’s interests, personality, and values shaped by ethnicity and culture.

  • Principle 3: Ability-Based Goals

    • Tenets focus on selecting goals and activities offering a realistic challenge appropriate to the client’s current abilities.

  • Principle 4: Increasing Challenges

    • Gradual addition of challenges and demands correlating with the person's increasing capabilities.

  • Principle 5: Natural Progression

    • Promote the learning of new skills in a natural developmental sequence from simple to complex tasks.

  • Principle 6: Client Knowledge

    • Clients must understand the learning objectives and the reasoning behind new activities.

  • Principle 7: Client Awareness

    • Clients should recognize the effects of their actions; challenges may be faced if self-evaluation is difficult.

  • Principle 8: Practice Makes Perfect

    • Emphasis on repeated practice of skills that encourages future application in varied situations without the necessity of perfection in the learned skills.

  • Principle 9: Parts of the Whole

    • For complex or lengthy tasks, focus on teaching individual components sequentially while showcasing the entire task.

  • Principle 10: Imitation

    • Learning behaviors are often achieved through imitation of others.

Social Skills Training

  • Teaching interpersonal skills necessary for effective interaction with others.

  • Four Groups of Social Skills:

    • Self-expressive

    • Other-enhancing

    • Assertive

    • Communication

Psychoeducation

  • An educational model aimed at enhancing skills for individuals with mental disorders.

  • Regularly employed in the Psychiatric Rehabilitation (PsyR) model—not a dedicated occupational therapy model.

  • The therapist adopts the role of educator; sessions are likened to classroom settings rather than clinical environments.

    • Clients receive syllabi, assignments, and homework and are evaluated on outcomes.

  • Skills are exercised in a structured setting and then contextualized for real-life application.

  • The psychoeducational framework is multidisciplinary.

  • Evaluation focuses on identifying deficient areas and establishing client-specific goals.

Sensory Integration

  • Defined as the collaborative functioning of senses providing crucial information for accurate perception and motor action.

  • Five primary senses:

    • Sight

    • Hearing

    • Taste

    • Touch

    • Smell

    • Additional considerations: proprioception and vestibular awareness.

  • Goal of SI Programs: Direct efforts to improve

    • Balance

    • Posture

    • Range of motion

    • Spontaneity of movement

    • Correction of abnormal shoulder and hip positions.

Sensory Processing

  • Refers to the coordinated activities of sensory receptors and neurological centers involved in:

    • Receiving and conducting sensory input.

    • Registering sensory input.

    • Recognizing sensory input.

    • Discriminating between different sensory inputs.

    • Modulating responses to sensory input.

  • Distinct Focus: Unlike sensory integration, the emphasis lies on sensory sensitivity and behavioral responses to sensory stimuli.

  • Designed to enhance awareness and cultivate effective behaviors in response to sensations.

Cognitive Disabilities

  • Centers on the implications of cognitive impairments on task performance:

    • Cognitive disabilities hinder voluntary motor actions and impede societal integration.

  • A 6-Level Cognitive Scale is utilized, ranging from 1 to 6, where:

    • Level 1: Severely disabled

    • Level 6: No disability

  • Individuals scoring between levels 1-4 face challenges in independent community living, necessitating varying degrees of assistance.

Nine Propositions (Assertions) About Cognitive Disabilities

  1. The routine task behaviors of disabled individuals differ significantly from those of nondisabled individuals.

  2. Task behavior limitations can be hierarchically classified using cognitive levels.

  3. The choice of tasks is influenced by the individual's diagnosis and associated disabilities.

  4. Task environments can positively or negatively affect a patient’s behavioral regulation.

  5. Individuals with cognitive disabilities will focus on elements of the task environment within their capability.

  6. Therapists can adapt tasks to align them with a client’s cognitive abilities through task analysis.

  7. Successful task performance accompanied by a pleasant experience reflects effective occupational therapy services.

  8. Steps in task procedures exceeding an individual’s cognitive capacity may be ignored.

  9. Assessment of cognitive levels can aid in evaluating competency legally.

Model of Human Occupation (MOHO)

  • Humans have an inherent drive towards exploration and mastery of their environment, thus engaging in occupations.

  • The manipulation of environmental elements contributes to an individual’s structure and maintenance in their world.

  • Concept of Human Occupation: Understands the process of engaging in exploration, creation, and control of the environment as fundamental to human occupation.

  • Open System Perspective:

    • The individual is viewed as an open system affected by and affecting their surroundings.

    • Any change within a part affects the entirety of the system.

  • Occupational Behavior: The result of the interplay between the individual, the occupational task, and the surrounding environment.

Subsystems of MOHO

  1. Volition:

    • Similar to motivation, consists of:

    • Personal causation

    • Values

    • Interests

  2. Habituation:

    • Encompasses behaviors performed automatically in familiar scenarios, expressed through established habits and internalized roles.

  3. Performance Capacity:

    • Refers to the abilities related to task completion and the individual's perspective on their performance capability.

    • Lived Body: Understanding the world through the unique experiences of one's body.

Interaction Among Components in MOHO

  • Any of the three components – volition, habituation, or performance capacity – can dominate or influence the others.

  • The interaction reflects an individual's experience and capacity for performance based on their self-perception.

Environmental Impact

  • Environmental alterations, even minor, can significantly sway human occupation.

  • The environment should ideally furnish a "just-right" level of stimulation conducive to engagement.

Person-Environment-Occupation Model (PEO)

Introduction

  • Described as an occupational performance model.

  • A person-centered framework concentrating on the interaction between the person and their environment as they partake in occupations.

  • Three core components:

    • Person: Includes motivations, performance capacities, and client factors.

    • Environment: Encompasses physical, social, and cultural dimensions.

    • Occupation: Defined as "groups of self-directed functional tasks and activities a person engages in throughout their lifespan."

  • Occupational Performance: Formed at the intersection of the person, environment, and occupation.

  • The PEO model emphasizes person-environment fit.

Basic Assumptions of the PEO Model

  1. The individual is complex and constantly evolving.

  2. Occupational performance occurs within a context influenced by the environment, which can either aid or obstruct participation.

  3. Environmental transformations occur more easily than modifications in a person's characteristics.

  4. Occupations fulfill basic human necessities and are contextually framed by roles and environments.

  5. Occupational performance is temporally and spatially contingent, continually evolving through person-environment transactions.

  6. Enhanced fit between person and environment correlates with optimized occupational performance.