MODEL OF HUMAN OCCUPATION (MOHO)

THE BEGINNING… (MOHO) is a conceptual model of practice that evolved from Reilly’s Occupational Behavior Model and General System Theory. Gary Kielhofner was a student of Mary Reilly who originally created this model as a Master’s thesis in 1975. Within five years, Kielhofner and his colleagues published MOHO for the first time

MOHO was first published in 1980 as a series of 4 articles. The first edition of the book: A Model of Human Occupation: Theory and Application was published in 1985.

MOHO – Brief Overview MOHO is a conceptual model of practice that evolved in middle of 1970s. Subsequently designed & developed into practice model to provide theory along with practical tools and strategies for occupational therapy and related rehabilitation practice.

Definition MOHO is defined as “ …a set of evolving theoretical arguments that are translated into a specific technology for practice and are refined and tested through research” (Kielhofner, 2002, p. 3).

Focus (domains of concern) Basic Assumptions: Concepts, constructs, relationships, principles, postulates Function/disability continuums: application to individual clients (deductive) Postulates of change: how change occurs provides basis for intervention planning, also includes motivation Evaluations, Interventions Research (evidence, outcomes)

FOCUS Systemic, holistic approach for persons of varying needs and populations across the lifespan Stresses the importance of the mind/body connection in its depiction of how motivation (internal) and performance of occupations (external) are interconnected Human occupation is described as the “doing” of work, play, or activities of daily living within a temporal, physical, and sociocultural context. Interactive nature between the person and his environment and how this relationship contributes to one’s source of motivation, patterns of behavior, and performance.

PERSON – redefined for practice Kielhofner’s theoretical view of the person is very comprehensive. Variables include one’s motivation, behaviors, and performance All 3 inter-relate to form a person’s identity. Kielhofner has specifically grouped these variables into 3 subsystems that he calls 1) volition, 2) habituation, and 3) performance capacity.

HUMAN AS AN OPEN SYSTEM Input  Person  Occupational Performance -> Environmental Feedback

Model of Human Occupation Human Open system Input Output Throughput Subsystem Volition Habituation Performance Feedback

MOHO CONCEPTS Volition Values & interests Performance Subjective Experience Habituation Roles & habits

MOHO – Concepts MOHO addresses how occupation is motivated, patterned, and performed. Humans in this model are conceptualized as being comprised of three interrelated components: volition, habituation, and performance capacity. Volition refers to the motivation for occupation, Habituation refers to the process by which occupation is organized into patterns or routines, and Performance capacity refers to the physical and mental abilities that underlie skilled occupational performance.

MOHO – Four Concepts Since MOHO emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place, the model looks at occupation and problems of occupation that occur in terms of its four primary concepts of volition, habituation, performance capacity and environmental context.

Volition Subsystem Volition is the source of motivation for occupation.

Habituation Subsystem Habituation refers to the process by which occupation is organized into patterns or routines

Performance Subsystem Performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. This subsystem is also called the mind-brain-body performance.

Assumptions Humans are biologically mandated to be active. Spontaneous action is the most fundamental characteristic of all living things (Boulder, 1968; von Bertalanffy, 1968). Practice Application: Persons have a fundamental and neurologically based need for action and doing. This innate need is the dominant source of motivation for participation in occupation.

Assumptions, cont. Thinking, feeling, and doing are influenced by a dynamic interaction between one’s internal components and the environment. Situations and conditions within the environment will influence a person’s motivation. Practice Application: Systems theory helps the practitioner to understand that there are multiple factors within the person and the environment that influence each other. A change (positive or negative) in any one variable will automatically result in a change in one’s motivation, behavior, and/or performance.

Assumptions, cont. Man is an open system that can change and develop through interaction with the environment. The parts of the open system cycle include input, throughput, output, and feedback. Practice Application: Persons are continuously impacted by input from one’s environment and feedback from one’s environment. Clients learn about themselves by experimenting with behaviors and receiving feedback about this behavior (output). Some cycles are positive and some are negative in outcome.

Assumptions, cont. Heterarchy is the principle that the demands of a context or situation will determine how human variables will organize themselves to achieve a sense of order. In a heterarchy, each component contributes something to the total outcome but the arrangement or order of these variables is changeable due to the conditions of the context and/or environment. Practice Application: The client’s environment, context, and/or situation greatly influence how the person variables identified as volition (motivation), habituation, (habits and routines) and performance capacity (mind/body skills) will inter-relate with each other.

Assumptions, cont. Participation in occupations helps to create our occupational identity, which is formed by the person’s internal structures defined by volition, habituation, and performance capacity. It is a subjective construct. Practice Application: Clients develop an identity over time. It is believed that this identity begins with self-appraisal and extends toward more challenging dynamics such as accepting responsibility for and knowing what one wants in life.

Assumptions, cont. Occupational competence is the degree to which one sustains a pattern of occupational participation that represents one’s occupational identity. Competence is the ability to put into action what a person internally regards as meaningful. Practice Application: Clients demonstrate competency when they can organize their life to meet the basic responsibilities to themselves and the role obligations of society in satisfying and meaningful ways.

Assumptions, cont. Occupational adaptation is the outcome of a positive occupational identity and achievement of occupational competence. It is dynamic and context dependent (refer to concept of heterarchy). Occupational therapy can promote change in clients. The parts within the person (throughput) that include motivation, life patterns, and performance lead to behaviors in work, play, and self care. Practice Application: The internal parts of the person are responsible for one’s occupational performance and adaptation. Occupational therapy acts as a form of feedback within one’s environment that can ultimately impact how one changes and alters behaviors

ORDER Kielhofner defined function as order (a status of health and competent performance of daily living, work, and play). A person displays function when he is able to choose, organize, and perform occupations that are personally meaningful. It is a process whereby a person continuously learns how to balance his own expectations with those of society. A person who demonstrates order in daily living, work, and play experiences a sense of competence and role fulfillment

DISORDER Kielhofner termed dysfunction as disorder The inability to perform occupations An interruption in role performance An inability to meet role responsibilities. A person with dysfunctional behavior patterns does not experience a basic quality of life nor can he meet personal and societal expectations.

Exploration, competence, and achievement = ORDER ORDER vs DISORDER Exploration, competence, and achievement = ORDER Helplessness, incompetence, and inefficacy = DISORDER

3 PARTS OF A VOLITIONAL SUBSYSTEM Volitional Subsystem – source of motivation that guides individuals to anticipate, choose, experience and interpret what they do; thoughts and feelings about doing occupations that reflect a sense of mastery, enjoyment and value judgments. Composed of three smaller parts. Personal Causation – refers to one’s sense of competence and effectiveness; what a person feels capable of; a person’s awareness of his abilities; includes feelings of self efficacy (perception of control over one’s own behavior, thoughts, and emotions including a sense of control in achieving desired outcomes). Example: “I am an intelligent person who can succeed in occupational therapy”. Values – beliefs about what is right, important, and good to do that influences one’s goals; include personal convictions, principles, and a sense of obligation. Example: “I value helping others and therefore my goal is to become an occupational therapist”. Interests – what a person finds enjoyable, pleasing, and satisfying. Example: “I enjoy studying the arts and science that underlie occupational therapy as a profession.”

2 PARTS OF THE HABITUATION SUBSYSTEM Habituation Subsystem – made up of the behaviors and roles that help persons to organize their daily life. Composed of two smaller parts. Habits – automatic and repetitive behaviors that influence how persons perform routine activities, use time, and behave on a daily basis. Internalized Roles – a source of identity with inherent obligations and expectations; also referred to as scripts or ideas of what is expected of oneself in a particular situation; enable individuals to fulfill needs for self and society.

PARTS OF THE PERFORMANCE CAPACITY SUBSYTEM Mind-Brain-Body Subsystem – composed of four constituents that represent one’s capacity for occupational performance; one’s underlying natural ability Musculoskeletal – bones, muscles, joints comprising one’s biomechanical structure Neurological – central and peripheral nervous systems Cardiopulmonary – cardiovascular and pulmonary systems Symbolic – abstract images that guide and give meaning

Occupational Performance or Skilled Actions(output) Goal directed actions (output) that make up occupational performance. 3 categories. Motor Skills – used to move one’s self or objects Process Skills – thinking and planning actions used to help one organize and adapt Communication and Interaction Skills – observable operations used to verbalize needs and intentions that are part of social behaviors

Person + Occupational Performance Person constructs (volitional, habituation, and mind-brain-body subsystems) plus one’s occupational performance contribute to the development of occupational identity, occupational competence and occupational adaptation.

ENVIRONMENT Physical and social places in which a person performs occupations Shaped by culture Provides opportunities and resources (positive) as well as demands and constraints (negative) A significant source of feedback that can maintain or extinguish one’s occupational performance.

CHANGE As a person experiments with novel behaviors and repeats them over time, these behaviors will become more automatic and habitual. Persons create a sense of occupational competence when they are capable of engaging in productive and meaningful actions Sufficient repetition and environmental feedback is required to assimilate new performance patterns

MOTIVATION Motivation is influenced by a person’s interests, values, and a sense of personal causation, all aspects of the volitional subsystem. Therefore, the volitional subsystem becomes a significant focus area for motivation and change.

EVALUATION PROCESS Kielhofner calls this a data gathering process. 1. Use the data to find out about a client from the viewpoint of an outsider looking in. 2. Collect and use data to help clients understand how their personal perceptions and subjective views lead to occupational performance actions and patterns.

ASSESSMENTS MOHO assessment instruments are both structured and unstructured. Structured assessments typically include observational measures, self report questionnaires and checklists, and structured interviews. Unstructured assessments allow the therapist to be more informal and spontaneous in response to a client’s needs.

INTERVENTION GUIDELINES Interventions should be focused on changing one’s occupational performance (skilled action process). Adaptive solutions should be offered in substitution for maladaptive ones. Interventions may be aimed at modifying or altering one’s environment to promote opportunities for change.

INTERVENTION GUIDELINES (cont..) Interventions that are aimed at skilled performance are more efficient than those aimed at a client’s underlying personal structure. Interventions that take place in one’s natural environment are more likely to be assimilated by the client. Therapists should be ready to alter or modify the client’s environment to increase occupational performance Interventions that relate to one’s volitional subsystem provide the most meaning and impact for the client. Occupations must be relevant to the client to be effective.

Model of Human Occupation Advantages: Widely applicable & may be particularly useful for unraveling complex problems. Motivation is regarded as crucial Makes strong links between individuals, tasks & environment. Standardized assessments can be used

For whom and where is MOHO applied in practice? MOHO is intended for use with any person experiencing problems in their occupational life and is designed to be applicable across the life span. For example, MOHO has been applied with such diverse groups as adults with chronic pain, children with attention deficit hyperactivity disorder, persons with traumatic brain injury, older persons with dementia, persons living with AIDS, and adolescents with mental illness. It has also been applied in situations dealing with children and adults who are homeless, with battle-fatigued soldiers, and with victims of war and social injustice.  MOHO is also used in a variety of contexts. For example, it has been applied in hospitals, outpatient clinics, residential facilities, nursing homes, rehabilitation programs, work programs, prisons and correctional settings, and community based organizations.