Paradigm Shift: From the Medical Model
to the Community Model
Public Health, Community Health, and
Occupational Therapy
By Hui-Fen Mao
2012/9/20
1. What is paradigm?
• Conceptual framework that allows for
explanation and investigation of phenomena.
• “ universally recognized scientific
achievements that for a time provide model
problems and solutions to a community of
practitioners” (Tomas S. Kuhn, 1970, in “ The Structure of
Scientific Revolutions”)
1. What is paradigm?
• “ consensus-determined matrix of the most
fundamental beliefs or assumptions of a field”
• “ cultural core of the discipline” and “provides
professional identity”
• Two essential characteristics: 1) a sufficiently
unprecedented scientific achievement that draws a
large number of constituents from competing areas
of inquiry, 2) adequately open ended enough to allow
for the exploration of solutions to a variety of
problems.
2. What can discipline-specific paradigm
determine for a profession?
• How professionals view their phenomenon of
interest？
• What puzzles, problems, or questions
practitioners will seek out in their work？
• What solution will emerge？
• What goals will be set for the direction of the
profession？
3. Describe the positive and negative aspects
of having a well-developed paradigm
• “paradigm effect”: paradigm act as filters of
perception
• When utilized appropriately, it distributes or provides
information into meaningful and useful guidelines for
practice
• The danger is that their potential for limiting problem
solving and innovation by constraining thinking and
perception
4. There are 4 stages of paradigm shifts.
5. Do you think there are paradigm
shifts occurring in occupational therapy?
• Paradigm Shifts in OT
1) 18th and 19th centuries: moral treatment
2) 1900~1940--Paradigm of Occupation
3) 1960s—Mechanistic Paradigm: more
scientific, reductionism
4) 1980-1990s—Emerging paradigm, to
understand the complexity of human
behavior-- system’s perceptive
6. What are the characteristics of the
emerging (顯現) paradigm in OT?
• Occupational performance results from the dynamic
interaction between the person, the environmental context,
and the occupations in which the person engages.
• All systems and components of systems are organized by
levels and operate according to the laws of hierarchy (rather
than cause-and-effect relationship)=> Dynamical systems
theory: self-organizing processes
• Input (Open system)=> Throughput=> Output, the interaction
of the system with it environment is refined and guided by the
feedback process
7. The definition of public health
• Green and Anderson, 1982
• The science and art of preventing disease, prolonging life,
and promoting health and well-being through organized
community effort for the sanitation （衛生設備） of
the environment, the control of communicable
infections, the organization of medical and nursing
services for the early diagnosis and prevention of
disease, the education of the individual in personal
health, and the development of the social machinery
to assure everyone a standard of living adequate for the
maintenance or improvement of health.
8. Five phases of the “modern era” of
public health
1) Miasma（毒氣、沼氣） phase (1850-1880)
2) Disease control or health protection phase (18801920)
3) Health resources or medical phase (1920-1960)
4) Social engineering phase (1960-1975)
5) Health promotion phase (1975-present)
9. Health-Care Delivery for Persons with
Disabilities
1) Institutionalization
2) Deinstitutionalization and community
develop (1975~to late 1980)
3) The era of community membership
Dysfunction is a dynamic interplay between an
individual’s limitations and resources and the
demands and constraints of the environment.
(Systems approach: Social and environmental
constraints than inherent in the physical disability)
10. The Vocational Rehabilitation
(1980~)—2 models of practice
1) Clinical model of vocational rehabilitation:
PWD are unemployed, need to be assessed,
counseled,, and treated to make him or her more
employable/ to modify or restructure the psychological
and vocational skills and behaviors
2) Ecological or environmental model of
vocational rehabilitation:
numerous environmental, social,, and economic
forces affect the PWD/ to modify all aspects of
environment (physical, social,, and political)
11. Compare and contrast the
paradigm shifts in OT with those of
public health and vocational
rehabilitation
12. What are the basic components and/ or
characteristics of a community practice
paradigm in OT?
1) Broader perspectives:
Client (vs. Patient), Intervention (vs. Treatment),
Funding (vs. reimbursement)
2) “Client”-centered approach to practice:
promote participation, exchange information, client
decision-making, and respect for choice, focus on the
issues which are most important to the person or
family
3) The collaborative process to enable the client to
identify occupational performance problems, engage in
problem solving
12. What are the basic components and/ or
characteristics of a community practice
paradigm in OT?
• * OT’s role—facilitator, educator, and
mentor in the process
(* Table 2-1: Contrasting Paradigms)
13. Discuss the usefulness of system
theory to community practice
• How to assess the client in the community?
(Box 2-1)
Public Health, Community Health, and
Occupational Therapy
1. What is “Public Health”?
• “The process of mobilizing local, state, national,
and international resources to ensure the
conditions in which people can be health.”
• 4 strategies:
1) Promoting health and preventing disease
2) Improving medical care
3) Promoting health-enhancing behaviors
4) Controlling the environment
• * defined in terms of aims and goals, rather than
grounded in a specific of knowledge=> many
disciplines involved
2. Terms in Epidemiology
• * Epidemiology – the study of the distribution,
frequencies, and determinants of disease,
injury, and disability./ use health statistics,
including measures of incidence and
prevalence, to estimate disease, injury, and
disability in a variety of population groups;
analyze the health trends; plan and evaluate
public health initiatives; and make informed
health policy decisions
2. Terms in Epidemiology
• Public health intervention
– To decrease “risk factors”
– To increase “resiliency (反彈) factors”
•
•
•
•
•
“Health Promotion”
“Prevention”
“Primary prevention”
“Secondary prevention”
“ Tertiary prevention”
3. Describe the differences between
public health and medical approaches to
health and disease. Discuss the
implications of these two approaches
with respect to OT practice
4. What is “community health”?
• *”Community”
– Noninstitutional aggregations of people linked together for
common goals or other purposes
• * “Health”
– the blending of a person’s physical, emotional, social,
intellectual, and spiritual resources so that he or she can
master the developmental tasks necessary to enjoy a
satisfying and productive life.
• * “ Community Health”— the physical, emotional,
social, intellectual, and spiritual well-being of a group of
people who are linked together in some way
5. What are included in “community-based
approach” to enhance “ community health”?
1) Educational intervention
2) Social intervention (economic, political, legal,
organization change)
3) Environmental supports
4) The health behavior of a community: actions
of any person who may influence health
behaviors,, resources or services ( police maker,
ill persons, professionals,, employers,…..)
6. Describe the history of the development of national
health goals and objectives and potential roles for OT
practitioners within the Healthy People framework
1) “Healthy People” proposed by the
Department of Health, Education and Welfare
(Now the Dep. of Health and Human Services)
in 1979.
* Five major health goals according to life span (infants,
children, adolescents and young adults, adults, and
older adults)
6. Describe the history of the development of national
health goals and objectives and potential roles for OT
practitioners within the Healthy People framework
2) In 1980, “ Objectives for the Nation”
3) “ Healthy People 2000” in 1990
Focus is to improve the QOL, and people’s sense of wellbeing (rather than just reduction of mortality rate)
4) “ Healthy People 2010” in 2000
due to advances in preventive therapies, vaccines and
pharmaceuticals, assistive technologies, and computerized
systems.
5) “ Healthy People 2020”