Model of Human Occupation Approach Occupation Based Models

Model of Human Occupation Approach

Occupation Based Models MOHO EHP OA PEO KAWA

Model Of Human Occupation Concerne d with: Motivation for occupation Patterning of occupational behavior into routines and lifestyles Nature of skilled performance Influence of environment on occupational behavior

Structure of the Model Basic Assumptions • Humans as Open Systems • Volition • Habituation • Mind-Body Performance • Environment Cyclic al Proces s • Person gives OUTPUT to the environment • FEEDBACK comes in as INPUT from the environment • Experiences THROUGHPUT, a process of change & adaptation of the person, from the feedback given

Throughput & The Three Internal Subsystems Volition, habituation & performance are interdependent Volition: Personal Causation, Values, Interests, guide our choices for Occupation Habituation: Habits, Roles Performance Capacity: Mind, Brain, Body Abilities (intrinsic/extrinsic) Three subsystems work together to maintain balance of work, play, &self-care activities

Interaction with the Environment �Output, Feedback and Input define the subsystem’s interaction with the environment �Influences of the environment on behavior ◦ Opportunities/ Resources ◦ Demands/ Constraints �Environments afford opportunities and press for behavior �Described in physical and social contexts �Occupational-Behavior Settings (home, church, school)

Occupational Adaptation �Develops from repeated interactions with the environment �Consists of 2 Elements ◦ Occupational Identity- sense of who we are and who we wish to become as occupational beings (Kielhofner et al. 2003) ◦ Occupational Competence- established by sustained levels of occupational performance ◦ Both develop as a result of feedback from environment

Function and Dysfunction Function Open system is functioning and order exists within the system Order produces and maintains a state of health Competently performing everyday life tasks in a routine and satisfying way 3 Levels of function Dysfunction Problems performing, organizing and/or choosing occupations and when one’s environment fails to support and expect adaptive behavior Causes can include both intrinsic and extrinsic contributors

3 Levels of Function “Levels of Arousal and Accomplishment” Exploration Level: requires a failsafe and nurturing environment to express & develop basic skillssense of self & potential Competence Level: being adequate to the demands of task/environment- organize skills into habits Achievement Level: fullest mastery over self & environment- performance of roles

Exploration Level Client Behavior ◦ Lacks ability and/or awareness ◦ Minimal habits ◦ No productive role ◦ Lacks basic skills ◦ Extremes of personal causation (extremely depressed or grandiose in belief of abilities) Tx Interventions ◦ Activate desire to explore environment ◦ Therapist defines major goals of tx, provides occupations, defines choices, supports learning ◦ Tx setting provides firm boundaries yet encourages exploration

Competence Level Client Behavior ◦ Vague or unrealistic goals, accurate self-report ◦ Identifies but has few interests ◦ Needs to add skills to repertoire ◦ Lacks everyday habit pattern that integrates skills with goals & interests ◦ Needs to ID and develop environmental supports Tx Interventions ◦ Identify and integrate valued goals and skills into habit pattern ◦ Therapist provides support to reinforce learning; engage in collaboration ◦ Facilitate establishment of routines and normal standards of performance through a schedule of varied activities

Achievement Level Client Behavior ◦ Identifies valued goals and interests ◦ Adequate skills for most valued activities ◦ Assumes responsibility to choose and implement daily routines; competent in these routines ◦ Main problem is integrating skills and routines into an occupational role which is productive and satisfying Tx Interventions ◦ Help client acquire successful and flexible role behavior ◦ Develop awareness of occupational behavior system ◦ Identify community sources of demand reinforcement ◦ Teach processes underlying successful role behavior and role flexibility

Change ◦ Restoring order in the person’s internal and external life structure ◦ Maintaining a satisfying and productive life through activity and occupational choices ◦ Organizing life to routinely function to one’s own and other’s satisfaction ◦ Employing intact skills to compensate for deficits and maximize success in occupations ◦ Environmental accommodations Motivation ◦ Innate urge to explore and master the environment Change & Motivation

Group Intervention �Suggested using group programs with activities designed at the levels of exploration, competence, and achievement �Exploratory “Directive Group” structured into 4 stages: ◦ ◦ Orientation and introductions Warm-Up activities Selected activities Wrap-up �Group goals are to restore order and performance of normal daily occupations

Role of Therapist �Advisor, collaborator �Goal= restore order in daily functioning (internal & external)

Examples of Activities �Clients can be placed in groups based upon anticipated social roles (caregiver, homemaker, worker, student, etc) ◦ All suggest cluster of skills and tasks that may be suggested for group activities ◦ Groups designed around specific roles can incorporate specific tasks or skills that need to be practiced or adapted �Environment important in providing feedback and challenging further exploration

Group Leadership �Intro: ◦ greetings/description done thoroughly and at start of each activity ◦ Warm-up optional, can be used to set mood ◦ Time frame varies with activity �Activity ◦ Task choices should be similar if grouped by social roles ◦ Should move patient toward meaningful role in their own social environment

Group Leadership �Generalizing: ◦ Done after the activity is completed ◦ Focuses on how activity relates to life roles ◦ Similarities/differences are de-emphasized ◦ Discussion leads directly into application �Application ◦ May focus on individual application of skills �Summary: ◦ Review purpose and goal of group and what was accomplished ◦ Skills learned may be general and their application should be reinforced in summary

Ecology of Human Performance Model �Primary focus is on context �Ecology- defined as transactions between people & their context �Attaching meaning to tasks within specific environments

4 Basic Constructs Person- skills, abilities interests Tasks- objective sets of behavior : how we organize tasks leads to performance & enactment of roles Context- 6 from framework Performance- Person-Context- task transaction, determines level of participation

Ecology of Human Performance

Assumptions �Dynamic relationship between client & context ◦ Participation is focus NOT disability �Contrived & Natural environments are DIFFERENT �OT promotes self-determination & full inclusion �Independence occurs when wants/needs are satisfied

EHP Function/Dysfunction Function- determined by range of tasks being performed • High functioning can perform numerous occupations & roles that match personal variables & natural contexts Dysfunction- mismatch between person, context and tasks Change- occurs with collaboration b/t client & therapist to identify areas of change (ex: child wants to play)

Group Intervention �Client centered assessment �Evaluation◦ ID clients’ wants/needs ◦ Task analysis ◦ Observe ◦ ID /evaluate clients’ present capacities ◦ ID/analyze desired contexts ◦ Assess personal variables ◦ Assess person/task/context match

Group Structure �Groups of clients with similar interests, needs, situations, contexts �Client and peers within natural context �Client & groups of caregivers/professionals �Populations wishing to maintain health/well-being when faced with occupational challenges

Group Goals 1 - establish/restore task performance 2 - alter context 3 - adapt or modify tasks or contexts 4 - prevention of disability Creation of task opportunities/enhancements

Occupational Adaptation �Encompasses all areas of occupation, performance skills & patterns, client factors, activity demands, contexts & environment �Holistic , client centered approach �Therapeutic use of self is critical �Assumption – People can function when they have the ability to adapt

Elements of Adaptation �Adaptation involves interaction of ◦ Person, environment & interaction of the two �Innate human desire for master of environment �Each person brings unique factors that contribute in varying ways to occupation �Occupational environments are made up of occupational roles regarding areas of occupation, and contexts

Person-Occupation Environment Interaction- Levels Press for mastery presents occupational challenge Interacts with occupational role expectations Yields and occupational response

Sub processes of Occupational Adaptation � 1 - Adaptive Response generation � 2 - Adaptive Response evaluation � 3 - Adaptive Response Integration ◦ Anticipates necessary components of an adaptive response ◦ Evaluates the quality of the occupational response ◦ Activated when person’s judgment of relative mastery is unsatisfactory- prompting trial of new/different responses to same challenge � 4 -Evaluation of Response Outcome ◦ Environmental feedback

OA Function/Dysfunction Continuum Occupational Dysadaptatio n Homeostasis Occupational Adaptation

Function/Dysfunction �Dysfunction occurs when the person’s ability to adapt has been challenged to the point at which the demands for performance are not met satisfactorily �Person’s adaptive capacity can be overwhelmed by disability and stressful life events �Greater the level of dysfunction, the greater the demand for changes in adaptive process

Change �Mastery evaluated through observation of client problem solving doing tasks that are personally meaningful �OT practitioner is agent of environment, selects activities, materials, features, etc �OT incorporates principles of therapeutic use of self �OT uses occupation to promote adaptiveness �Client becomes agent of change by activating internal adaptive response sub -process

Group Intervention �Evaluation and intervention occur within context of group (occupational performance) �Focus of intervention is on occupational roles ◦ Clients may be grouped by meaningful life roles �Leader acts as facilitator �Group Activity- ex: families caring for child with Autism

Person-Environment-Occupation Model �Focus on interaction of personenvironment & occupation �COPM was developed as a tool for assessment and intervention with the PEO model �Intervention may address one, two or all three components �Main goal is to maximize fit between person, environment and occupation to enable best occupational performance

Basic Assumptions � Person ◦ Physical, emotional, cognitive & spiritual characteristics �Use skills and capacities to perform occupations connected with roles � Environment ◦ Contexts and situations occurring outside individuals that elicit responses � Occupation ◦ Groups of tasks and activities in which a person engages over life � Occupational Performance ◦ Transaction between person, occupation and environment

PEO Function/Dysfunction �Dysfunction= poor fit between person, environment and occupation �Small overlap in intersection �Functioning increases when person afforded greater opportunity, better environmental support, and higher level of competence for occupational engagement �Change- OT has goal of creating better fit between person, occupation and environment to create optimal occupational performance

PEO Groups �Members may have common roles or occupations �Leadership style varies upon group abilities �Goals- chosen in collaboration with members whenever possible �Activity Examples ◦ Group program for caregivers of clients with Alzheimers

The KAWA Model �Kawa means “river” in Japanese �Metaphor for relationships of variables of occupation in Japanese life and process of OT intervention (Iwama, 2006). �Japanese OTs built this theory considering core beliefs and principles of Japanese society

Framework Focus Inseparable nature of people from their collective social groups Inseparable quality of occupations from their natural and spiritual contexts other members of the collective Occupational challenge occurs when internal or external barriers interfere with working of group and prevent the river of life from flowing freely Clients= individual and

Basic Assumptions �One person’s occupation is viewed as collective. Families and groups have combined identities �Reasoning and reality are situational. Social status of those involved has a profound effect upon problem solving, decision making strategies �Perceptions, thoughts, opinions, feelings communicated are heard, accepted or rejected by others according to the status or seniority of the person speaking.

Grounded Theory Building 5 Elements identified • Life flow and health • Environmental factors, social & physical barriers and “ba” (features of social structure) • Life circumstances and problems • Personal assets and liabilities • OT Interventions

Life Flow & Health Personal Assets & Liabilites Life Circumstances & Problems Environmental Factors, Social & Physical Barriers, Ba

Elements Water-life flow & health Rocks- life circumstances & problems Driftwood- personal assets & liabilities River Bottom & Sidesexternal environmental factors, effect of social factors & relationships Spaces between elements – opportunities for OT intervention

Function & Dysfunction �Disability is a collective experience �Existence of disability in one individual does not, in itself, create disability �Function= greater flow of water, greater speed and volume may represent greater health & well-being

Change & Motivation �People motivated to be accepted and belong �This takes priority over goals of mastery, independence or occupational performance �Occupation can be a “means for flow” in that a persons occupations can define his/her contributions to and status within society �Japanese people have heightened sensitivity to social status

Group Intervention �OT’s help clients identify status by drawing their “kawa” and identifying elements that have caused to water to cease flowing �OT role is to find opportunities for intervention and to use occupation to impact those elements

Group Structure �Few ways to structure groups implied in the model ◦ Working with selected members of a collective- one of whom might be an identified client ◦ Forming group of individuals within a population ◦ Issues of social structure will need to be carefully considered when choosing members of a group

Group Goals �Increasing flow �Learn and practice social skills �Occupations involving communication & social interaction �Groups might be organized around life transitions