Model of Human Occupation The Basics Gary Kielhofner

Model of Human Occupation

The Basics Gary Kielhofner & Janice Burke, 1980 Most popular worldwide Most research & assessments

Characteristics Practice oriented Focus on person & environment Considers cognition and motivation behind behavior Evidence based Use with other frameworks

The Person Volition Values Interests Personal Causation Habituation Habits Roles Performance Capacity

Volition (Motivation) Personal causation (self-efficacy) Values Interests

Habituation Habits Internalized Role – what client sees are their role in society, includes scripts: self-talk re role

Performance Capacity Client factors Also known as Mind-brain-body or Lived Body *Not to be confused with traditional sense of mind/body connection!

Consequences of Doing Occ ID Occ Perform Input Person Repeated cycles Adaptation Competency

Occupational Identity Self-concept View of environment (supports & barriers)

Occupational Competence Actual ability to fulfill occupational identity

Occupational Adaptation Construction of a positive occupational identity and achieving occupational competence over time in the context of one’s environment Identity = competence

Occupational Engagement doing, thinking and feeling under certain environmental conditions

Levels of Occupational Engagement Occupational Participation (ADL, work, play) Occupational Performance (task related to ADL, work, play) Occupational Skill (process, motor, communication & interaction)

Dimensions of Engagement Practice Plan Re-examine Identify Commit Explore Negotiate Decide Sustain PRIC ENDS

Stages of Change Exploration try new things 2. Competency gain new skills 3. Achievement mastery of occupations, refine occupational identity 1. Can be in response to injury or in normal development

OT evaluation 1. 2. 3. 4. 5. 6. Use questions to guide reasoning (p. 511) Gather data on client Create picture of client strengths and challenges Id goals and plans Implement plan and review Assess outcomes

Principles of MOHO

Change Real change occurs when the underlying process in the client is changed. For example, the client learns to get dressed using a new technique, or a child begins to believe he can learn to read 1.

Experiment! 2. Therapy should involve experimentation to find the best solution. This may involve disorder in the way the client functions at first. Therapy sometimes looks chaotic.

Role of OT 3. Therapeutic use of self and the environment is the only thing OT can do.

Focus of OT 4. Therapy should focus on development of skill not on the underlying capacity. (that would be PT’s job!)

Practice creates habits 5. People are usually resistant to changing the way they do things. Often changing habits and ways of doing things is needed in order to become competent after an injury. This takes a lot of practice!

Habits 5. It is important to replace lost roles and habits quickly after an injury. (People don’t like being without habits and routines and will develop something fast!)

Meaning 6. The whole cycle of experience, interpretation, anticipation, and choices determines how the client finds meaning - they will need help to find a new positive meaning in their new life.

Some assessments OCAIRS-II Occupational Performance Hx Inv-II Assessment Motor Process Skills Modified Interest Checklist Occupational Self Assessment SCOPE Adolescent Role Survey

Some translations Volition = motivation Habituation = habits and roles Personal causation = self-efficacy Ecologies = settings, contexts