Clinically Oriented Theory for Occupational Therapy Chapter Four: Modern Occupation-Based Approaches

Chapter Outline: Modern Occupation-Based Approaches The Model of Human Occupation Volitional System Habituation System Performance Capacity Environment Person–Environment–Occupation Models Ecology of Human Performance Model Occupational Adaptation Model Comparison and Prevalence of Occupation-Based Models Prevalence in Practice Copyright © 2019 Wolters Kluwer • All Rights Reserved

Copyright © 2019 Wolters Kluwer • All Rights Reserved Learning Objectives Explain what is meant by the term occupation-based model. Identify modern occupation-based approaches. State the key principles of person–environment–occupation models. State the key principles of the ecology of the human performance model. State the key principles of the occupational adaptation model. Determine the prevalence of occupation-based models in clinical practice. Explain why a practice framework was developed by the American Occupational Therapy Association. Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation Gary Kielhofner was primary author Many others contributed over time “3rd generation model” based on Reilly’s occupational behavior This model describes How people choose occupations Develop habits Perform in the environment Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation—(cont.) Volitional System The power to make a choice or decision Motive Intrinsic sense of control Extrinsic sense of control Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation—(cont.) Habituation System The process of becoming used to something or of establishing routines Automatic actions that make up important and meaningful components of daily life Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation—(cont.) Performance capacity The physical and mental processes and abilities that underlie performance of an activity Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation—(cont.) Environment Contexts in which we live Physical Social Cultural Economic Political Environments provide Opportunities Resources Demands Constraints Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation—(cont.) Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Model of Human Occupation—(cont.) Review the case study (James—Part 1) Answer these questions. Describe the nature of the patient–therapist relationship between James and the OT. List the questions the OT would ask as part of assessing assets, liabilities, skills, and influences of the environment . Describe intervention strategies that the OT might use to minimize James’ problems and to achieve occupational goals. Describe the expected outcome of the OT intervention process. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Person–Environment–Occupation Models Several models share these common elements that focus on transactional relationship between these elements. Person Environment Occupation Examples of PEO models PEO (Law et al, 1996) PEOP (Christiansen, Baum, Bass-Haugen, 2005) CMOP-E (Polatajko, Townsend, Craik, 2007) Copyright © 2019 Wolters Kluwer • All Rights Reserved

Person–Environment–Occupation Models—(cont.) Occupational performance The ability to complete a task that is related to self-care, productivity, or leisure participation The terms activities, tasks, and occupations are used to describe human action—there is no consensus definition on these terms Copyright © 2019 Wolters Kluwer • All Rights Reserved

Person-Environment-Occupation Models—(cont.) PEO models share common assumptions Top-down approach to clinical problem solving is recommended. People are unique and should be treated as autonomous agents. People engage in a variety of tasks (occupations). Copyright © 2019 Wolters Kluwer • All Rights Reserved

Person-Environment-Occupation Models—(cont.) PEO models share common assumptions. Environments are complex and should be considered in broad terms. People impact and are impacted by the environment. The transaction between PEO elements dictate competence in occupational performance. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Person–Environment–Occupation Models—(cont.) Copyright © 2019 Wolters Kluwer • All Rights Reserved

Person–Environment–Occupation Models—(cont.) Review the case study (James—Part 2) Answer these questions. Describe the nature of the patient–therapist relationship between James and the OT. List the questions the OT would ask to identify James’s concerns. Describe what data the OT would gather regarding personal and environmental factors. Describe intervention strategies that the OT might use to improve the fit between James’s ability and his preferred occupations, given his current context. Describe the expected outcome of the OT intervention process. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Ecology of Human Performance Model Designed to account for the influence of the environment on human performance “OT is most effective when it is embedded in real life” Occupations are interpreted in light of contextual meaning. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Ecology of Human Performance Model—(cont.) Establish or restore contextually relevant skills/abilities Alter the performance context Adapt contextual features to support performance Prevent negative outcomes Create more adaptable performance in context Copyright © 2019 Wolters Kluwer • All Rights Reserved

Ecology of Human Performance Model—(cont.) Copyright © 2019 Wolters Kluwer • All Rights Reserved

Ecology of Human Performance Model—(cont.) Review the case study (James—Part 3) Answer these questions. Describe the nature of the patient–therapist relationship between James and the OT. List the questions the OT would ask to identify and incorporate James’s life context. Describe intervention strategies that the OT might use. Describe the expected outcome of the OT intervention process. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Occupational Adaptation Model Describes the state and process of occupational adaptation. OA is a normal process that exists in humans to allow us to respond masterfully and adaptively to occupational challenges. Focus of this model is on adaptation itself. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Occupational Adaptation Model—(cont.) People are occupational beings with a desire to master the environment. The environment demands mastery from the person. This transactional relationship is called the “press for mastery.” Normal developmental experiences help to navigate that transaction. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Occupational Adaptation Model—(cont.) Therapists facilitate adaptive responses so that performance is Effective Efficient Satisfying Copyright © 2019 Wolters Kluwer • All Rights Reserved

Occupational Adaptation Model—(cont.) Copyright © 2019 Wolters Kluwer • All Rights Reserved

Occupational Adaptation Model—(cont.) Review the case study (James—Part 4) Answer these questions. Describe the nature of the patient–therapist relationship between James and the OT. List the questions the OT would ask to identify the sources of James’s dysfunction, including occupational environments, role expectations, and the impact of the problem on these systems. Describe intervention strategies that the OT might use to maximize James’s internal adaptation processes and the use of meaningful occupations Describe the expected outcome of the OT intervention process Copyright © 2019 Wolters Kluwer • All Rights Reserved

Comparison and Prevalence of Occupation-Based Models Prevalence in practice In a survey of 503 published works (Lee, 2010) MOHO—86% OA—6% PEO—5% EHP—3% In an NBCOT Practice Analysis (Bent et al, 2005) MOHO is the most commonly used model. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Comparison and Prevalence of Occupation-Based Models—(cont.) The absence of any universal model contributed to development of the OT Practice Framework (OTPF) The OTPF Outlines the occupational therapy process Is not considered a practice model Copyright © 2019 Wolters Kluwer • All Rights Reserved