Person-Environment-Occupation

Basics- Canadian Originated from Rogers and Maslow’s theories Authors: Law, Baptiste, Townsend et al McMaster University in Canada 1990’s CAOT (1997). Enabling Occupation: An Occupational Therapy Perspective. Preceded the Practice Framework

Basics- PEOP Influenced by Maslow, Kielhofner & Burke, Reilly, Reed & Sanderson, Law Authors: Christiansen & Baum (2005) Occupational therapy: Performance, participation, and well-being (3rd ed).

Roles of therapist and client OT is enabler, facilitator, coach Client is the expert re performance issues Goal of therapy: empowering client to perform valued activities in context

Six Principles of Client-Centered Client autonomy and choice Respect for diversity Therapeutic partnership and shared responsibility Emphasis on enablement & empowerment Contextual congruency Flexibility

Big picture Occupational performance is the result of the dynamic interaction between the person, environment and the occupation. When one changes, everything else is affected and performance changes. So, performance changes over time.

PEO Through the Lifespan Person Environment Occupational Performance Occupation

Canadian Model of Occupational Performance Institutional Cultural Occupation Self-care Affective Social Spirituality Productivity Person Cognitive Physical Leisure Environment Physical

Definitions

Occupational performance Ability to choose, organize, and satisfactorily perform meaningful occupations that are culturally defined and age appropriate for looking after one’s self (self care), enjoying life (leisure), and contributing to social and economic fabric of community (productivity).

Spirituality The essence of the self . . . Our truest self, and . . . Something which we attempt to express in all our actions Who we were before we added all those conditions of worth

Physical environment Natural and man made surroundings, geographical topography

Institutions Policy and decision-making processes and organization procedures such as religious, judicial, educational, and other practices For example, LSUHSC procedures, dress code, etc.

Cultural environment Beliefs, values, artifacts, tool use, ceremonial practices, ethnic and racial affiliations For example, for someone from New Orleans: Catholicism, Mardi Gras, King cake, crawfish boils, Jazz music

Social environment Family, friends, community associations, networks, work associates, etc

Occupations Everything people do to occupy their time Consisting of actions (discreet actions necessary to complete a task) For example, making lasagna is a task in which grading the cheese is an action. abilities<action< task < occupation<roles

Assumptions

Occupation is . . . Basic human need Determinant of health Source of meaning, self-identity, choice and control, balance and satisfaction Means of organizing time, materials, and space Generating income Therapeutic medium

Spirituality is . . . Innate essence of self Quality of being uniquely and truly human Expression of will, drive and motivation Source of self determination and personal control Guide for expressing choice

The environment . . . Easier to change than the person Constantly changing- requiring person to change Has enabling and constraining effects on performance Should be considered when designing interventions

Occupational therapy process . . . Guides development of collaborative partnerships Integrates theory with practice Flexible and dynamic Action-oriented Leads to client outcomes & guides evaluation of client outcomes Applicable to all clients in diverse environments

CMOP: Occupational Performance Process Model 1. Identify Performance Issues 2. Select Theory 3. Identify task components and environment 7. Evaluate outcome 4. Identify strengths and resources 6. Implement plan using occupation 5. Negotiate goals and plan

Assessments Canadian Occupational Performance Measure (COPM)

Expected outcome Improved fit among PEO which results in optimal occupational performance

Person Environment Occupation loves adventure, sports good upper body strength loss of B LE control & sensation spasticity in LE? intact cognitive skills disrupted role, routines loss of previous leisure Person Occupation Environment occupational performance in role of athelete cold, wet, slippery, visibility? safety risks (snow, temperature, trees) seasonal, time limited due to cold athletic, sports culture social supports, coaches adapted ski chair, poles ski lift clothing negotiate process, trust balance, concentration, strength, motor planning http://www.youtube.com/watch?v=jush8yo8qdE