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

2. 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
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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.
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4. 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
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5. 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
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6. 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
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7. The Model of Human Occupation—(cont.)
Performance capacity
The physical and mental processes and abilities that underlie performance of an activity
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8. The Model of Human Occupation—(cont.)
Environment
Contexts in which we live
Physical
Social
Cultural
Economic
Political
Environments provide
Opportunities
Resources
Demands
Constraints
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9. The Model of Human Occupation—(cont.)
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10. 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.
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11. 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)
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12. 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
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13. 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).
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14. 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.
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15. Person–Environment–Occupation Models—(cont.)
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16. 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.
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17. 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.
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18. 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
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19. Ecology of Human Performance Model—(cont.)
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20. 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.
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21. 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.
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22. 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.
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23. Occupational Adaptation Model—(cont.)
Therapists facilitate adaptive responses so that performance is
Effective
Efficient
Satisfying
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24. Occupational Adaptation Model—(cont.)
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25. 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
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26. 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.
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27. 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
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