Models of Occupation

1
OTA I Lecture 2

• Models of Occupation
• and
• Client-Centered Practice

Danielle N. Naumann, OT Reg (Ont) MSc. OT, PhD
Candidate
2
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

3
Readings

• Chapters 1-4 in Early Text
• Discuss
• Questions?
• Comments?
• Impressions?
• Strategies for exam preparation

• History of Occupational Therapy Assistants in
  Canada
• Discuss
• Questions?
• Comments?
• Impressions?

4
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?

5
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

6
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 persons
  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.

7
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)

8
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

9
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

10
PEO Model
Source Law et al. 1996
11
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

12
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

13
Lab Activity 1

• What are the key points of the model?
• Summarize the model
• Explain the visual model
• Tell us how it works visually
• How is it different from the PEO model?
• What does it add to the OT perspective?
• Implications for practice

14
CMOP-E
15
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 persons lifespan.
• OP refers to the ability to choose, organize, and
  satisfactorily perform meaningful occupations
  that are culturally defined and age appropriate
  for looking after ones self, enjoying life and
  contributing to the social and economic fabric of
  a community.

16
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.

17
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

18
Diagram of the MOHO
19
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.

20
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 individuals 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.

21
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.

22
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.

23
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)

24
Kawa (River) Model
25
Break!

• See you all back at 1230

26
Client Centred Practice

• Client as expert
• Family vs. client centred care
• Client centred goal setting
• Why is this important?

27
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.

28
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

29
Canadian Occupational Performance Measure (COPM)

• Interview based assessment
• Structured interview format
• Allows practitioner to cover all necessary areas
• Rating system provides score for reassessment

30
Lab Activity 2

• COPM interview
• Interview your partner
• Partner can assume a personality/condition
• Go through rating scheme together