Occupational Performance Process Model

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					    Occupational Performance
    Process Model
Source material for lecture:
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P.,
Letts, L. (1996). The person-environment-occupation
model: A transactive approach to occupational
performance, Canadian J Occup Ther, 63 (1) p.9-23

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                  Developed by

Virginia G. Fearing, B.Sc. O.T., OT(C)
– Head Occupational Therapist at Vancouver Hospital and
  Health Sciences Centre in British Columbia, Canada

Mary Law, Ph.D., OT(C)
– Associate Professor at McMaster University, Hamilton,
  Ontario, Canada

Jo Clark, B.Sc. O.T., OT(C)
– Section head in Psychiatry at Vancouver Hospital and Health
  Sciences Centre in British Columbia, Canada


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    Corollary of Move Toward
    Client Centered Practice
Traditionally
– Clients had little say in how therapy was
  carried out
– Therapist established the priorities for tx
– Followed the traditionally paternalistic
  practices of medicine



                                                3
     Client Centered Practice

Clients are the experts in identifying the
problems that face them in adapting to
life and should decide whether or not
they want assistance in understanding
and addressing these problems
Therapist forms an alliance with the
client to use their combined skills and
strengths to work towards client goals
                                             4
        Theory Background

Occupational performance is the
product of a dynamic relationship
between the person, their occupations
and roles, and the environments in
which they live, work and play.
– In a nutshell-individuals and problems don’t
  exist in a vacuum


                                             5
  Our lives are very complex…
Each day we deal with a variety of factors
– We play many different roles
– We operate in a variety of environments and
  contexts
We bring to each role/activity a unique
perspective which is a product of
– Upbringing
   •   Cultural roots
   •   Cultural values of community and family
   •   Place within our family
   •   Place within our community
                                                 6
– Our education
– Our place in society
– Our experiences
All adaptation has a temporal component
– Roles change throughout the day
   • Assume each for a period of time
– Viewpoints/perspectives change over time as
  result of experiences


                                                7
Our ability to engage successfully in
occupations results from a combination of
personal attributes and environmental
attributes
Our behavior (and that of our clients) is
influenced and cannot be separated from
contextual influences, temporal factors and
physical and psychological characteristics


                                              8
Context continually changes requiring
behavior to change to adapt
– Nothing is forever; change is the only
  constant




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OPPM




       10
           Operating Definitions
Activity
– The single unit-singular pursuit in which a person
  engages as part of his/her daily occupation
    • Act of slicing cheese
Task
– A set of purposeful activities
    • Making a cheese sandwich
Occupation
– Groups of self-directed functional tasks and
  activities that a person engages in over the
  lifespan
    • Role of being the family cook
    • A job as a chef                                  11
       Definitions continued…
Occupations
– Clusters of activities completed over time
– Completed to meet intrinsic needs for self-
  maintenance, expression and fulfillment
– Carried out within the context of individual roles
  and multiple environments
Temporal
– Time patterns incorporated into the activities
   • Extended to their fullest-represent the life span of the
     person


                                                                12
  Major Components of OPPM
Occupational performance is the outcome of
the transaction between the person,
environment, and occupation
– The dynamic experience of a person engaged in
  purposeful activities and tasks within an
  environment
– Key dimensions of occupational performance
   • Person
   • Environment
   • Occupation


                                                  13
                     Person

Key component in the process of adaptation
Unique being who assumes a variety of roles
simultaneously
– Roles are dynamic
– Vary across time in duration
– Vary in significance
Person has three dimensions: mind, body
and spirit

                                          14
               Person continued…
Person brings a set of attributes
(performance components) and life
experiences to bear on occupational
performance
–   Self concept
–   Cultural background
–   Personality style
–   Personal competencies
     •   Motor performance
     •   Sensory capability
     •   Cognitive capability
     •   Social skills
     •   General health               15
        Person continued…

Some aspects of the person are
changeable and some are not
– Person’s cultural roots cannot be altered
– But person’s cultural views can be altered
  • By a move to another culture
  • By self determination




                                               16
                Environment
Context in which the activity takes place
Includes
–   Personal
–   Social
–   Physical
–   Cultural
–   Economic
–   Legal
–   Political

                                            17
    Environment continued…

Influences person on several levels
– Home
– Neighborhood
– Community
– State
– Country



                                      18
               Environment…
Influences the behavior and in turn is
influenced by the behavior of the person
– Not static
– Can have an enabling or constraining effect on
  occupational performance
   • Problems with disability stem primarily from the
     association between the individual and the environment
   • Environments can foster independence or dependence
From a treatment perspective, environments
are more amenable to change than persons

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                Occupations

Meet the person’s intrinsic needs for
self maintenance, expression, and
fulfillment within the context of his/her
personal roles and environment
Includes activities and tasks done to
accomplish a purpose
– Can be simple or complex
   • Brushing teeth to driving a car in rush hour
     traffic
                                                    20
         Assumptions Made
           by the Model
Person is a dynamic motivated and ever
developing being constantly interacting with
the environment
The qualities defining the person will
influence the way in which the person
interacts with the environment and carries out
his/her occupational performance
Some qualities are more amenable to change
than others
                                             21
    Occupational Performance
A complex, dynamic process
Has both spatial and temporal aspects
Shaped by the transaction that occurs among
the person, environment and the occupation
in which the person engages
Requires the ability to balance occupation
and views of self and environment
– Sometimes conflict
– Person must encompass changing priorities
Over a lifetime, individuals are constantly
renegotiating their view of self and their roles22
        Treatment Intervention
           Using the OPPM
Goal is to achieve optimum
person/environment fit
 – Person, environment, occupation interact
   with one another across time and space
   • Interaction may increase or diminish their
     congruence
– Closer person, environment, occupation overlap
  one another and fit-the better the occupational
  performance


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     Treatment intervention….
Treatment intervention can be targeted at
– Environment
   • Change environment to improve participation
– Person
   • Change person to improve participation
– Occupation
   • Change the requirements of the occupation to get a
     better person/occupation fit and improve performance
OT clients are not just individuals but also
may be groups/systems such as families,
caregivers, businesses, organizations,
communities and governments                                 24
              In Designing Tx
              Interventions…
Person must be considered in multiple
contexts
–   As an individual
–   As part of a family
–   As a member of a community,
–   As a member of a state
–   As member of a region
–   As member of a community


                                        25
            Treatment cont….

Treatment must be client centered and client
driven
– When problems occur, individuals usually draw on
  their own experiences and environmental supports
  to solve these problems satisfactorily
– When a person can’t solve the problem on their
  own, they start to lose momentum
   • They seek the assistance of an outside expert (OT)




                                                          26
            Treatment cont…
Role of the OT is to assist the client to
problem solve so that lost momentum can be
redirected to a continuing satisfactory
experience
– Requires a complex combination of knowledge
  and skills to enable a client to move through the
  stages required to complete problem resolution
– First step is to assess the client, environment and
  occupation to determine how each can be
  modified to provide a better fit

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        The 7-Stages of the Occupational
          Performance Process Model
1. Name, validate, and prioritize occupational performance
problems/issues
2. Select Potential Intervention Models
3. Identify Occupational Performance Components and Environmental
Conditions
4. Identify Strengths and Resources
5. Negotiate Targeted Outcomes and Develop Action Plans
6. Implement Plans through occupation
7. Evaluate Occupational performance Outcomes


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Treatment is successful when a
maximal fit between person,
environment and occupation is achieved




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