Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable
copyright law.
2
MODELS OF HEALTH AND WELLNESS
“Striving toward occupational justice is the major ethical dilemma facing
occupational therapists in every corner of the world.”
WILCOCK AND TOWNSEND, 2014, P. 541
This chapter will review the following prevailing systems
of health care and the position of occupational therapy
within them:
 The medical continuum of care
 The biopsychosocial model
 The World Health Organization’s model
 The recovery model in mental health
 Client-centered care
 Public health models
 Wilcock’s occupational perspective of health
These provide a further context for understanding the
changes that are occurring in the occupational therapy
profession both nationally and globally and how they will
affect the theories, models, and frames of reference we
develop and apply now and in the future.
THE MEDICAL APPROACH
TO CONTINUUMS OF CARE
No one can argue that the medically based system of
health care in the United States is in trouble. Consider
the following scenario: Sue, a healthy 75-year-old widow,
fell and injured her knee while walking down the front
steps to her car, which was parked in the driveway. It hurt,
but she got up anyway and continued with her errands. By
4 o’clock in the afternoon, her knee had become swollen
and red, and Sue’s friend, whom she was visiting, told her
to go to the doctor right away. Sue called her primary care
physician, but he couldn’t see her until later in the week.
She refused to go to the city hospital’s emergency room, so
her friend suggested a walk-in clinic at a local strip mall.
There, a physician’s assistant examined her knee, wrote a
prescription, and sent her for an X-ray. By then the radiology center was closed, so after filling her prescription for
an anti-inflammatory medication, she returned home with
instructions to wrap her knee with ice packs and keep her
leg elevated. Sue tried filling plastic bags with ice cubes, but
the bag wouldn’t stay on her knee, and she found the cold
hard to tolerate. The next morning, the pain in her knee
had increased, making it difficult to walk. Sue also worried about her out-of-pocket medical costs. Her Medicare
Advantage insurance plan only covered certain pharmacies
and medical providers, and she found out that neither the
walk-in clinic nor the pharmacy near her friend’s home were
in her network. She drove with difficulty to get her X-ray
and had it sent directly to her primary care physician, with
whom she made an appointment for the next day. Although
the X-ray showed no broken bones, by then her knee had
developed a full-blown infection, for which she was sent
directly to the hospital she was trying so hard to avoid. One
week and several thousand dollars in copays later, while
still in the hospital receiving intravenous antibiotics, Sue
was told that some complications were found on magnetic
resonance imaging (MRI) and she would now need knee
replacement surgery. This entailed some other preparatory
tests, a surgical procedure at the hospital, a stay in a subacute rehabilitation center, and outpatient rehabilitation
29
Cole M. B., Tufano R.
Applied Theories in Occupational Therapy: A Practical Approach, Second Edition (pp 29-53).
© 2020 SLACK Incorporated.
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable
copyright law.
30
Table
2-1
CHAPTER 2
Examples of Medical
Facilities
• Primary care, doctors’ offices, group practices, walkin clinics
• Outpatient treatment centers, diagnostic testing, outpatient surgery, rehabilitation
• Mental health clinics
• Substance abuse recovery residential programs
• Home health care agencies
• Subacute rehabilitation hospitals
• General hospitals
• Skilled nursing facilities, nursing homes
• Hospice programs for terminal illness
over the next 6 months. Sue lived alone, with no family
nearby. So she needed many home care visits to enable her
to remain in her home, a ground-level apartment. If she
had not been able to manage “aging in place,” Sue’s next
residence might easily have been a nursing home.
Stops Along the Continuum of Care
What medical services has Sue used? To summarize,
her medical journey included a walk-in clinic, a pharmacy,
a doctor’s office, a diagnostic imaging center, a hospital,
a subacute rehabilitation inpatient facility, an outpatient
rehabilitation center, multiple visits from a home care
agency, and the possibility of nursing home placement.
These offices, institutions, and agencies represent the current continuum of medical care (Table 2-1).
Learning Activity
Discuss the following questions regarding Sue’s case:
1. To what extent did Sue’s own attempts to self-manage
cause her condition to become worse?
2. How might the need for surgery have been prevented?
3. Where did economics enter into the reasoning process?
4. Where might Sue have encountered occupational
therapy on this journey?
5. What could occupational therapists do to help Sue at
each stage of her recovery?
The medical continuum begins with a primary care
setting, the first level of care where the problem is diagnosed and treatment given or recommended. Sue used two
primary care settings: a doctor’s office and a walk-in clinic.
When medical diagnostic testing is required, this may occur
in a different location, such as the radiology center where
Sue got her X-ray. Each medical specialist will likely have
his or her own practice. For example, if Sue’s bone had been
fractured initially, the primary care physician may have sent
her as an outpatient to an orthopedic specialist, and in fact
Sue did eventually have her knee replacement performed
by an orthopedic surgeon in the hospital. For persons with
terminal illness, hospice care might also be considered,
with these services offered at inpatient hospice centers or
as home care programs.
Origins of the Medical Model and
Occupational Therapy in the United
States
Occupational therapy has been associated with the medical model from its beginnings. Early in the 20th century,
humanism influenced the practice of medicine by promoting a holistic approach that encouraged experimentation
with many new and creative treatment methods. Without
this openness, the central role of occupation in the restoration and maintenance of health, which inspired the birth of
our profession, may never have become known. However, by
the 1930s, the scientific movement had gathered sufficient
strength to shape medicine and occupational therapy practice in ways that allowed both to benefit from the rapidly
growing body of scientific research.
The medical model of health care came into existence
because of the conditions of the times. In the 1930s and
1940s, many diseases were on the rise, such as tuberculosis
and polio, for which there was no cure. Scientific research
led to an understanding of how bacteria spreads disease
and what measures could be taken to prevent it. Medicine
applied the scientific method to develop medications and
vaccines to prevent or cure many of the diseases of the
mid-20th century. Occupational therapy struggled to keep
up with the advances in medicine and adopted practice
methods for remediation, adaptation, and compensation.
Remediation involved the use of occupations to restore the
ability to function. For example, in persons with depression
or anxiety disorders, occupational therapy worked side by
side with medicine in order to hasten recovery through a
return to normal daily occupations. Occupational therapists
developed adaptations to the task and environment in order
to enable occupational functioning despite the limitations
brought on by illness or injury. In using compensatory strategies, occupational therapists took over where medicine left
off. For example, splinting, adaptive equipment, and, more
recently, robotics and computer-assisted technology are
used by occupational therapists to enable activities of daily
living (ADL) for persons with partial paralysis from polio, a
stroke, or a spinal cord injury, for which no further improvement could be gained with other medical treatment.
For most of the 20th century, occupational therapists
worked in hospitals, nursing homes, rehabilitation centers,
day hospitals, and outpatient clinics under the auspices of
the medical model. Occupational therapists became a part
of the health care teams that offered a multidisciplinary
approach to the treatment of illness and disease. As such,
occupational therapy often required a doctor’s prescription
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable
copyright law.
MODELS
in order to be paid by Medicare or other health insurance, and this requirement remains written into many
states’ occupational therapy licensure laws today. Because
occupational therapy treatment is categorized as a medical
service, it also falls under the current medical reimbursement system, which remains a major stumbling block for
occupational therapy practitioners. The medical system of
payment has not kept up with current research, which generally supports a more social or community based model of
care. In the 21st century, our profession appears to be in the
midst of a transition, and changes in public policy will be
needed in order to fully adopt a broader paradigm of occupation and to become truly client centered.
Characteristics of the Traditional
Medical Model
The scientific method requires that a research problem
be narrowly defined in order to study it more rigorously. For
example, the action of a muscle is broken down into nerves,
circulation, molecules, cells, and the nutrients such as fat,
protein, and carbohydrates that make up the cells so that
each component can be studied in detail. Much of our scientific knowledge of the physical world has been developed
through careful examination of the relationships among
component parts. Medicine used the scientific method
in the development of biochemistry, anatomy, physiology, genetics, pharmacology, nutrition, and bioengineering
(Kielhofner, 2004). This method of study encouraged the
belief, prevalent in medical practice and research, that the
human body operates like a complex machine. As such, “the
task of medicine was conceived as repairing breakdowns
in the machine” (Capra, 1982; Kielhofner, 2004, p. 231),
thus restoring a state of health, normalcy, and homeostasis.
In the traditional medical model, health is defined as the
absence of disease; norms are based on vast collections of
clinical data (e.g., a normal body temperature of 98.6°) and
homeostasis, or a balance of physical and mental health
(e.g., patient can be discharged from medical care and
resume previous life activities). Likewise, many occupational therapy frames of reference have also been validated
using the scientific method, among them biomechanical,
sensory integration, psychodynamic, neurodevelopmental,
and cognitive disabilities (see Section III).
Reductionism in Medicine
The 10th revision of the International Statistical
Classification of Diseases and Related Health Problems
(ICD-10), published and updated by the World Health
Organization (WHO), lists thousands of diseases, illnesses,
injuries, and syndromes, subsequently described in medical
textbooks and journals, each with a unique name. Medical
diagnosis is the process of analyzing a patient’s signs and
symptoms, and reducing the problem to a specific, narrowly
defined cause. Hence, the medical model is often described
OF
HEALTH
AND
WELLNESS
31
as reductionistic. Once the doctor names the disease—
pneumonia, for example—he or she can then apply what is
known about that illness in order to prescribe a treatment—
for example, antibiotic medication, bed rest, maintenance
of a sterile environment, increased fluid intake, or other
specific instructions leading to a cure. The patient, a passive
recipient of treatment, complies with the doctor’s instructions in order to get well, feel better, and restore health.
This describes the unique terminology of the medical model
as we know it.
Fragmentation in Health Care
In the example of Sue, it becomes evident that the current medical system of service delivery is highly fragmented
and inefficient. A recent study Montenegro et al. (2011)
states that:
… high levels of fragmentation characterize health
systems in the Americas … [which] can lead to difficulties in access to services, delivery of services of
poor technical quality, irrational and inefficient use of
resources, unnecessary increases in production costs,
and low user satisfaction. (p. 5)
Fragmentation means that there are separated parts of the
medical treatment process that are paid for separately (fee
for service) without anyone coordinating them. Although
the primary care physician (PCP) should be overseeing
the different steps, there is no guarantee that will happen.
People hesitate to use their PCP this way because it is too
costly, there is too long a wait time for appointments and
not enough time with the doctor, and there are unclear
recommendations (Freed, Hansberry, & Arrieta, 2013). The
implementation of the Patient Protection and Affordable
Care Act (ACA, 2010), originally designed to reduce costs
and increase accessibility of health care, has thus far only
succeeded in raising costs for most Americans, leaving large
gaps in medical insurance coverage and otherwise complicating health care delivery. Health care reform within the
ACA is just beginning the process of implementation. With
the right fixes, it is hoped that the new system will smooth
out the continuum and solve some of the problems with
accessibility and cost. There are some very positive aspects
of the new health care law that provide for more incentives
and programs for prevention and wellness, in which occupational therapy could offer valuable input, especially at the
level of primary care. More about this will be discussed later
in this chapter.
Inadequate Medical Reimbursement
Systems
The following is a very brief overview of the reimbursement issues for health care in the United States today.
Insurance under the fee-for-service system, for example,
does not pay for wellness and prevention, seldom pays for
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable
copyright law.
32
CHAPTER 2
group interventions, and excludes occupational therapy
from primary care settings where it could make a significant
contribution.
Fee-for-Service System
This system of payment is simple: provide a service and
charge a set fee. Typically, this is the prevailing payment
system for medical care for most of the population. Private
and employee-funded health insurance works this way, paying separately for each medical visit, test, or procedure. As
a system, fee-for-service has been held responsible for the
inflated costs of health care by creating an incentive for
providers to add unnecessary visits, tests, hospital days, or
procedures in order to collect more fees. The profit motive
of providers is compounded by the intervention of thirdparty payers, the health insurance companies, who shield
the patients and clients from paying directly so that most
seek more services without regard or even knowledge of
their true cost. Some have questioned the ethics of such a
system when health care is considered a basic necessity or a
right to which all citizens should be entitled.
For older Americans, the Medicare system began in
the 1960s in an attempt to provide elders with needed
medical care in their retirement. Medicaid is the health
care payment system that each state can make available
to its citizens who are disabled, too young to be eligible for
Medicare, or too poor to afford private health insurance.
Both Medicare and Medicaid also operate under a fee-forservice system, but with certain reforms and restrictions.
Medicare Reimbursement Restrictions
Medicare, although intended for older adults (age 66
and older), tends to set the standard for private or employerbased insurance plans. Therefore, we will summarize here
some of the payment systems that have been implemented
over the past several decades. In order to contain the everrising health care costs, Medicare has put in place some
prospective payment systems (PPS). These are systems that
limit the length, frequency, and type of health services that
may be reimbursed, in keeping with current evidence about
the different diagnoses or disease categories. Theoretically,
these would work like health maintenance organizations
(HMOs), taking a flat dollar amount (monthly premium)
and giving an incentive to providers to serve the client’s health needs efficiently and without excessive cost.
Different facilities must follow unique prospective payment
systems in order to be reimbursed by Medicare. Some
examples are the following:
 Inpatient acute care hospitals use diagnosis-related
groups (DRGs), with costs and limitations based on
535 primary diagnoses
 Inpatient rehabilitation facilities use case-mix groups
(CMGs), based on patient assessment and impairment categories that consider motor and cognitive
skill levels and age
 Skilled nursing facilities (long-term care) use resource
utilization groups (RUG-III), 58 groups or categories
based on a comprehensive assessment, the Minimum
Data Set (MDS). Each group is paid a specified number of rehabilitation or therapy minutes per week
 Home health agencies use home health resource groups
(HHRGs), 80 categories based on the Outcome and
Assessment Information Set (OASIS) to determine
number and frequency of home services within each
60-day period
 Hospice uses four care levels for each day: (a) routine
home care, (b) continuous home care, (c) inpatient
respite care, and (d) general inpatient care (American
Speech-Language-Hearing Association, n.d.)
Although these cost-containment measures limit costs
generally, they also restrict the choices afforded to Medicare
beneficiaries and often arbitrarily deny needed services, a
downfall of the government bureaucracy that oversees the
payments without regard to individual differences.
Additionally, some see government regulation as actually
increasing costs because of the additional paperwork and
recordkeeping service providers must submit, which slows
the process and benefits no one.
Flat Fee Payment Systems
The logical alternative to fee for services is to pay health
care workers a salary, regardless of the quantity of services
provided. However, this system also presents problems. An
example of the downside of a flat fee payment system is the
government-controlled Veterans Health Administration
hospitals, which offer a full range of services to current
and former members of the country’s armed services. The
service providers in these hospitals are paid salaries that
may be considerably lower than those in the private sector,
thereby decreasing any incentive for services to be delivered
in an efficient or timely manner. Wait lists are often very
long in these facilities, and the staff sometimes must make
do with less than state-of-the-art equipment. It seems that
neither fee-for-service nor flat fee payments have led to
high-quality, cost-effective medical services. Hopefully the
United States Congress and those responsible for implementing the ACA or its replacement will find an ideal
combination of high-quality medical care and a reasonable
cost for consumers.
Reimbursement systems that follow the guidelines of
the medical model have reduced access and limited the
ways clients can use occupational therapy services. Most
occupational therapists are aware that neither Medicare
nor private health insurance will pay for health services
rendered only to maintain function for our clients. Progress
must be continually demonstrated through the use of valid
and reliable assessment tools, mostly products of research
studies using the scientific method. The medical model has
convinced third-party payers that health should be defined
as the absence of disease. In contrast, the client-centered
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable
copyright law.
MODELS
model being adopted by occupational therapy and others
goes further to include well-being, quality of life, and the client’s continued ability to engage in meaningful occupations
and to participate in life (American Occupational Therapy
Association [AOTA], 2014; WHO, 2001).
Limited Access to Medical Services
and Occupational Therapy
By the 1990s, the medical model had backed occupational therapy into a proverbial corner, limiting its scope
to only those practices that directly affected “symptoms”
or restricted independent functioning in ADL. When I
(M. Cole) consulted for a large state mental health facility
about 10 years ago, I found very few occupational therapists
on staff, and those who remained focused exclusively on
ADL skill building for clients who would soon be relocated
to community settings. My role as a consultant was to educate the staff concerning standardized assessment tools that
could be used to measure progress in self-care and social
skills and to help them determine client readiness for community placement. Soon after my consultancy ended, the
entire facility was closed, leaving many severely disabled
clients without needed health services.
This experience demonstrates how the reductionistic
pressures of the scientific method, fueled by the costreduction measures for all medical services during the
1990s, have rendered the medical model grossly inadequate
to meet the needs of clients with ongoing mental or physical health conditions. Everywhere in society, signs of this
inadequacy abound. Many formerly institutionalized mental
health clients now live among the homeless or have entered
our already overcrowded prison system. Working people
are either losing their health insurance or facing higher
prices for far less coverage. Prescription drugs, advertised as
cures for everything from arthritis and high blood pressure
to insomnia and depression, appear to have replaced the
need for hands-on therapy, at least in the eyes of today’s
television-watching population.
Benefits of Medicine: What We Still
Need From the Medical Model Going
Forward
Although the medical system of health care has its
problems, the scientific research generated by medicine has
served occupational therapy well in the past and will continue to do so in the future. Without the medical model,
many of the scientific advances of the 20th century would
not have been possible. Under the guidance of the medical
model, occupational therapy was able to take advantage of
the knowledge developed in the areas of psychiatry, biomechanics, behaviorism, and neurophysiology in the earlier
years, which led to some of the most widely used applied
theories in occupational therapy today. Examples are sen-
OF
HEALTH
AND
WELLNESS
33
sory integration, neurodevelopmental therapy (NDT),
biomechanical rehabilitation, motor learning, dynamic
interactional, and cognitive behavioral approaches. The
scientific method was used in designing research studies
to test these applied theories and to develop reliable and
valid assessment tools. Assessments also serve as evidence
for administrators or managers of health service agencies,
rehabilitation centers, and school-based services that the
methods occupational therapists use have been and continue to be effective. Furthermore, despite the profession’s
move away from the medical model, many occupational
therapists still practice in medical-based settings.
Another advantage of the medical model is the prestige
it has brought to occupational therapy over the years as an
allied health profession. Educational programs for occupational therapy were jointly accredited by the American
Medical Association (AMA) from the days of Eleanor
Clarke Slagle until quite recently, requiring occupational
therapy students to take classes in anatomy, physiology,
neurology, and physical and mental health conditions. This
medical preparation has influenced public recognition for
occupational therapy professionals as equals with other
professions such as physical therapy and encouraged our
continued national certification and state licensure, setting
us apart from less “scientific” professions.
Furthermore, the medical model gives us a common
language with which to communicate with other professionals as more occupational therapists collaborate with
treatment teams when providing health care services. Until
the sociopolitical systems catch up with the paradigm shift
to client-centered practice, occupational therapists will
need to maintain relationships with members of the current
system of health care delivery, which still relies heavily on
the medical model.
THE BIOPSYCHOSOCIAL MODEL
The biopsychosocial (BPS) model was originally proposed by Engel in 1977 as a needed expansion of the medical
model. In the 1980s, medical providers made some attempts
to broaden their viewpoint of clinical conditions by considering psychological and social components of illness.
The model assumes that all three aspects must be handled
together, thus requiring more information to be gathered
in initial consultation. The BPS model has been applied in
primary care in the United Kingdom and other European
countries, as well as the U.S. Veterans Administration
through the use of integrated medical teams comprising
physicians, nurses, occupational therapists, psychologists,
social workers, and other specialists (multidisciplinary
teams). As a model, the medical community recognized
that certain health conditions, such as cardiovascular disease and type 2 diabetes, require this broader perspective
because environmental and lifestyle factors greatly influence treatment behaviors and outcomes. However, critics
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable
copyright law.
34
CHAPTER 2
say that the BPS model does not fit the definition of a
scientific model, has not been adequately tested as a theory,
and has not worked to inform medical practice (Ghaemi,
2009; McLaren, 1998). In the United States, the BPS model
“seems to have been pushed into the shadows by a return to
medicine and the re-ascendancy of the biomedical model”
(Pilgrim, 2002).
Globally, the International Classification of Functioning,
Disability, and Health (ICF) claims to reflect an integration
of the medical and social models by using a BPS approach
(WHO, 2001). The medical model views disability as a
problem of the person created by disease or trauma and
requiring the services of a health care professional, such as
medication, surgery, or rehabilitation. In the social view,
disability is a socially created problem, and its management
requires some form of social action. By combining aspects of
both, ICF remains neutral regarding the required responses
to problems that it classifies. WHO’s ICD-10 identifies
health trends and statistics globally and represents the
international standard for reporting diseases and health
conditions for both diagnostic and research purposes. This
comprehensive listing, although coming mainly from a biomedical perspective, also tracks resource allocation trends,
safety, and quality guidelines, including factors that influence health status and external causes of disease (WHO,
2010).
For occupational therapy, the BPS model has kept its
appeal because it is holistic, addressing the proverbial whole
person. The roots of our profession were seeded in a holistic
view that included the biological, psychological, and social
aspects of human life. Dr. Adolph Meyer (1921) was the first
psychiatrist to propose that mental illness could be based
on emotional factors and result from interdependent factors
pertaining to both the mind and body. Dr. Meyer’s protégé,
Eleanor Clarke Slagle, based her treatment protocols on
this innovative theoretical perspective. Slagle modeled a
therapeutic process that emphasized the importance of
occupations in helping those with physical, psychological,
and social challenges to maintain a positive life orientation.
Today, this foundational premise remains unchanged. As
stated in AOTA’s Occupational Therapy Practice Framework,
3rd edition (OTPF3), “ … occupational therapy practitioners
recognize the importance and impact of the mind-bodyspirit connection as the client participates in daily life”
(AOTA, 2014, p. S4).
A GLOBAL PERSPECTIVE:
THE WORLD HEALTH
ORGANIZATION’S MODEL
The WHO made significant revisions to its classification system in 2001 that reflect the shift to a holistic and
systems perspective of global health care. ICF encompasses
all aspects of human health and some health-relevant components of well-being. It is intended as a companion for the
ICD-10, which classifies all known diseases, both mental
and physical. The stated purposes of ICF are as follows:
 To provide a scientific basis for studying health and
health determinants
 To establish a common language
 To allow comparison across countries, disciplines,
and time
 To provide systematic coding for purposes of record
keeping and research
In its 2001 revision, WHO seeks to broaden the horizons
of health-related research, service provision, and policy
making beyond the constraints of the medical model. It
states, “There is a widely held misunderstanding that ICF
is only about people with disability; in fact, it is about all
people” (WHO, 2001, p. 7).
Holistic and Systems Oriented
ICF perceives a person’s functioning and/or disability as
a “dynamic interaction” between a health condition and
contextual factors. Contextual factors are those external
factors, “features of the physical, social, and attitudinal
world,” which facilitate or hinder participation (WHO,
2001, p. 8). Accordingly, ICF is divided into two parts.
The first lists the components of human functioning and
disability, including body systems and structures as well as
activities and participation, denoting both an individual
and a societal perspective. The systems of the human body
and the activities represented closely resemble occupational
therapy’s domain of concern according to OTPF3 (AOTA,
2014).
The second half of ICF lists and classifies contexts in the
following categories:
 Products and technology: includes foods, consumable
goods, money, and the systems for distributing these,
as well as objects and tools for other systems such as
education, sports and recreation, and the practice of
religion
 Natural and human-made environments: includes land
and water, climate, population, light, noise, vibration,
natural events such as an earthquake or tsunami,
human-made events such as war, and time-related
changes such as seasons
 Support and relationships: includes immediate and
extended family, friends, acquaintances, authority
figures, subordinates, care providers, domesticated
animals, strangers, health care providers, and other
professionals
 Attitudes: includes individual and societal views,
biases, and stigmas as well as norms, practices, and
ideologies
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066