OTA IL ecture 2 1g0r9ld

							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         History of Occupational
 Text                           Therapy Assistants in
                                Canada
    Discuss:
      Questions?                   Discuss…
      Comments?                      Questions?
      Impressions?                   Comments?
                                      Impressions?

 Strategies for exam
 preparation…
                         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           PEO 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
          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

1.        What are the key points of the model?
     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