OTA I: Lecture 2
MODELS OF OCCUPATION
AND
CLIENT-CENTERED PRACTICE
Danielle N. Naumann, OT Reg (Ont) MSc. OT, PhD Candidate
Overview
Discussion of Readings
Discussion of Activity Log
Review Occupation
Models of Practice in OT
PEO
(Lab Activity #1)
CMOP-E
MOHO
Kawa Model
Client Centered Practice
Analyzing Occupational Performance
Canadian Occupational Performance Measure
Lab Activity #2
Readings
Chapters 1-4 in Early
Text
History of Occupational
Therapy Assistants in
Canada
Discuss:
Questions?
Comments?
Impressions?
Strategies for exam
preparation…
Discuss…
Questions?
Comments?
Impressions?
Activity Logs
Thoughts on the process?
Discuss what you found:
Are you doing the most important work at the right time of day
for you?
How much of your time spent on
Leisure
Productivity
Self-care
Are you wasting time?
Any personal revelations to share?
Key features of Occupation
Occupation is a:
Basic human need
Determinant of health
Source of meaning
Source of purpose
Source of choice and control
Source of balance and satisfaction
Means of organizing time
Means of organizing materials and space
Means of generating income
Descriptor
Therapeutic medium
Occupation and Physical Dysfunction
Occupation is defined as:
The ordinary and familiar things that people do every day.
The ability to pursue and perform a person’s customary
occupations is taken for granted so long as a person is well.
Injury and disease may disrupt occupation temporarily, but
most people seek or are referred for the services of an OT only
when they encounter significant difficulty resuming or
enacting (carrying out) occupations that are important to
them.
Models of Practice in OT
Person Environment Occupation
Performance Model (PEO) (Charles Christiansen &
Carolyn Baum)
Occupational Performance Model (OPM)
Canadian Model of Occupational
Performance and Engagement (CMOP-E)
(CAOT, 1997)
Model of Human Occupation (MOHO)
(Kielhofner)
Kawa (River) Model (Michael Iwama)
Person-Environment-Occupation Model
Dominant Canadian model
Occupational Performance
is the intersection of factors
of the person, environment
and occupation
Person: personal factors
that allow or limit
performance
Environment: factors in the
environment that allow or
limit performance
Occupation: factors in the
task or activity that allow
or limit performance
PEO Model
Person-Environment-Occupation
Person:
Dynamic, motivated, ever-developing, constantly interacting with the
environment
Individual attributes that can change, influence interactions with
environment and approach to occupational performance
Environment:
The context, influences behavior and is influenced, is not static and is
easier to change then the person
Occupation:
Purposeful activities that meet intrinsic needs for self-maintenance,
expression, and fulfillment
Occupational Performance:
Complex, dynamic phenomenon, shaped by PEO factors
Person-Environment-Occupation Fit:
The closer the overlap, the more harmonious the interaction
Greater compatibility= more optimal occupational performance
PEO Model
Source: Law et al. 1996
PEO Model: Implications for Practice
Consideration of interventions that target different
problem areas of the Person, Environment, and
Occupation
Multiple avenues for eliciting change
Use more instruments to elicit change and
understand the context of the occupational
performance issue
Lab Activity 1:
In pairs (and one group of 3):
15 minutes to:
Review materials on a model of occupation
MOHO
CMOP-E
KAWA Model
Answer 4 questions on the model of occupation
Discuss case study in light of this model of occupation
5- minute presentation to the class
key features of the model of occupation
case study
explain the model
Lab Activity 1
What are the key points of the model?
1.
1.
Summarize the model
2. Explain the visual model
1.
Tell us how it works visually
3. How is it different from the PEO model?
4. What does it add to the OT perspective?
1.
Implications for practice
CMOP-E
Canadian Model of Occupational Performance
and Engagement (CMOP-E)
CMOP states that OP is the result of a dynamic
relationship between persons, environment and
occupation over a person’s lifespan.
OP refers to the ability to choose, organize, and
satisfactorily perform meaningful occupations that
are culturally defined and age appropriate for
looking after one’s self, enjoying life and contributing
to the social and economic fabric of a community.
CMOP-E
OT theory, research and practice showed that OP
performance is not static as the circle implied.
Therefore recently added Engagement to the model
OP is the result of an interdependent and changing
person-environment-occupation relationship
This dynamic interaction occurs among people, their
occupations and roles, and the environment in which
they live, work, and play over the lifespan
CMOP-E provides a framework for enabling
occupations for all persons.
CMOP-E
Change in any aspect of the model would affect all
other aspects
CMOP highlights the focus on occupation
Spirituality is embedded as a core in all parts of
person-environment-occupation interactions.
Spirituality resides in the persons, is shaped by the
environment, and gives meaning to occupations.
Conveys client-centered perspective
Diagram of the MOHO
Model of Human Occupation
Gary Kielhofner
Based upon different areas of knowledge
Systems theory
Cognitive psychology
Developmental psychology
Humanistic psychology
Social psychology
OT roots of the model stem from Mary Reilly
“Man, through the use of his hands as they are energized by
mind and will, can influence the state of his own health.”
Key Assumptions of MOHO
Human organism is an open system
Occupations are central to human experience, survival and
satisfaction.
Occupational areas of work, self-care, and play evolve and change
throughout the lifespan.
People seek to explore and master their environments.
Environment affords opportunities and presses for performance.
The individual’s perceptions of feedback from the environment
are crucial in directing further output of adaptive occupational
performance.
OP results from interaction of 3-subsystems:
Volition (will) – the mechanisms whereby we choose what to do
Habituation (roles and rules) – the basic cognitive structures with which we
organize our lives.
Mind-body-brain interactions (skills) – the means by which we carry out
occupational behaviour.
Ways in which the human system is able to
change adaptively:
New behaviour established by repetition
Change can be produced by alterations within the
organization of the internal system or by changes
that occur outside the system.
Change can be dramatic
Small changes are important
Human system continually changes and adapts: “the
organization at any point in time is a reflection of the
dynamic process of life.”
Influence of Environment on the individual:
“Press” is the demands the environment places on an
individual for appropriate occupational behaviours
Environment contains things which are capable of arousing us
and promoting action (objects, tasks, social groups, cultural
pressures)
Novelty and stimulation to a degree is pleasurable and
promotes exploration and master. People generally perform
well in such conditions.
Too much “press” can result in stress, anxiety, uncertainty,
helplessness, frustration, anger or inability to cope. People
generally fail to perform in such environments.
Too little “press” results in apathy, withdrawal and
disinterest, in which circumstance people also fail to perform
well.
MOHO applies to all aspects of OP
Not just the physical
Altering environment to elicit a change in OP is a key
principle of MOHO.
Purposeful alteration of the physical setting (ex. Adding a
ramp)
Providing a new object (reacher to grasp objects)
Providing or facilitating a change in social groups (ex.
Training a caregiver to break down and cue a sequence such
as brushing teeth)
Arranging the client to experience new occupations (ex. Using
a computer to access the internet for a client who has always
handwritten letters)
Kawa (River) Model
Break!
See you all back at 12:30
Client Centred Practice
Client as expert
Family vs. client centred care
Client centred goal setting
Why is this important?
Analyzing Occupational Performance
When physical
generally obvious deficits in performance components
Important to continue to focus on the occupation as
a whole not focus only on specific deficits.
Therapist is required to look at the bigger picture of
occupational functioning;
the specific and highly individual functioning desired /required for
that individual in his or her chosen and valued occupations.
Obtaining Information about OP
Assessed by: self-report, family/caregiver report and
skilled observation
Client asked to identify problems, needs and priorities
Information gained through clinical interview skills and
use of therapeutic rapport.
Two examples of assessments to gain information about
OP:
Interview-based assessments (ex. COPM)
Performance-based assessments
Direct observation of the client performing activities that are difficult
for them and that they have identified that they want to be able to do
again
Canadian Occupational Performance Measure
(COPM)
Interview based assessment
Structured interview format
Allows practitioner to cover all necessary areas
Rating system provides score for reassessment
Lab Activity #2
COPM interview
Interview your partner
Partner can assume a personality/condition
Go through rating scheme together
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