Occupational Therapy Models

Occupational Therapy (OT) theoretical models are frameworks that guide the assessment and treatment process of OT practice. They provide a structure to understand and explain the complex and multifaceted nature of occupation, the central focus of the profession.

The benefits of using these theoretical models in OT practice include: They provide a conceptual framework that guides the OT's understanding of the individual, their occupations, and the factors affecting their occupational performance and participation. They assist in clinical reasoning and decision-making, helping OTs identify the individual's strengths, challenges, and needs, and plan effective interventions. They support evidence-based practice, linking the OT's practice to theoretical knowledge and research evidence. They promote holistic and person-centred care, considering the individual's physical, psychological, social, and environmental factors in relation to their occupations. They facilitate communication and collaboration among OTs and with other professionals, individuals, and their families, providing a common language and understanding of occupation and OT practice.

Below are some key OT models and a brief description:

KAWA (River) Model (Iwama, 2006)

The name Kawa is derived from the Japanese word for 'river'. This model uses the metaphor of a river to depict a person’s life journey. Various aspects of a person’s life are represented by elements of the natural environment. This includes rocks, driftwood, and spaces in the river. It gives significance to the effect of the social and physical environment on the person's occupational performance.

The Canadian Model of Occupational Performance and Engagement (CMOP-E) (Townsend, & Polatajko, 2007)

The CMOP-E helps occupational therapists to understand and explain the dynamic and complex nature of occupation and its impact on health and well-being.

It provides a framework for understanding the person, their occupations and the context in which they live. The model illustrates how these elements are interrelated and how changes in one can impact the others.

The CMOP-E emphasises the importance of engagement in occupation as a means of promoting health and well-being.

Person-Environment-Occupation-Performance (PEOP) model (Baum, Christiansen, & Bass, 2015)

Person: This refers to the individual's physical, cognitive, and emotional abilities. It's about understanding the person's strengths, weaknesses, interests, and values.

Environment: This is about the physical, social, and cultural surroundings in which the person lives and interacts. It includes their home, workplace, community, and the people around them.

Occupation: This refers to the activities or tasks that the person needs or wants to do. It could be anything from self-care tasks like eating and dressing, to work tasks, leisure activities, or social interactions.

Performance: This is about how well the person can carry out their occupations within their environment. It's about assessing whether they're able to do the things they need or want to do, and if not, understanding what's getting in the way.

The Person-Environment-Occupation (PEO) model (Christiansen & Baum, 2005)

PEO provides a structure for understanding the dynamic relationship between people, their occupations and roles, and the environments in which they live, work, and play.

Person: This refers to the individual's physical, cognitive, and emotional capabilities. It includes personal characteristics, experiences, and expectations.

Environment: This includes the physical, social, cultural, institutional, and virtual conditions and circumstances that surround the person. It can either facilitate or hinder occupational performance.

Occupation: This refers to the everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do.

The PEO model suggests that a good fit between the person, their environment, and their occupation leads to optimal occupational performance and engagement.

To review occupational performance over time using the PEO model, an occupational therapist would: Assess the individual's capabilities and limitations (the 'Person' component) Evaluate the impact of the environment on the person's ability to perform their occupations (the 'Environment' component) Identify the person's occupations and roles, and how these have changed over time (the 'Occupation' component) By regularly reviewing these three components, the therapist can identify changes in the person's occupational performance over time. They can then adjust the therapeutic interventions accordingly to ensure the person can engage in meaningful occupations.

For example, if a person's physical capabilities decrease due to aging, the therapist might suggest modifications to the environment or the way the person performs their occupations to maintain their independence and quality of life.

The Model of Human Occupation (MOHO) (Kielhofner, 2008)

The Model of Human Occupation (MOHO) (Kielhofner, 2008) is based on the belief that occupations (activities) are shaped by three interrelated components: Volition: This refers to the motivation for occupation. It includes personal causation (how effective one feels in carrying out an occupation), values (what one finds important and meaningful), and interests (what one finds enjoyable and satisfying). Habituation: This refers to the patterns and routines that people develop over time. It includes roles (social and societal expectations) and habits (automatic behaviours). Performance Capacity: This refers to the physical and mental abilities that underlie occupational performance. It includes the objective physical and mental components, as well as the subjective experience of these capacities.

the environment is considered a crucial aspect that influences occupational behaviour. It's not explicitly listed as one of the three main components, but it's inherently integrated into the model.

The MOHO model suggests that these three components interact to shape how individuals choose, organise, and perform occupations. It is used by occupational therapists to understand how a person's physical and mental capacities, habits, roles, and personal values and interests affect their engagement in daily activities. This understanding can then be used to guide therapeutic intervention.

The Occupation Performance Model (Australia) (OPM(A)) (Chapparo & Ranka, 1997)

The Occupation Performance Model (Australia) (OPM(A)) (Chapparo & Ranka, 1997) suggests individuals fulfil their occupational roles through participation in routines, tasks, and activities across four areas: self-maintenance, productivity, leisure, and rest. This participation is a response to the demands of their internal and external environments. The model posits that engaging in occupations provides individuals with a sense of competence, autonomy, temporal organisation, and purpose. The model emphasises the activation of the relationship between the person and their environment through participation in occupations. The internal environment comprises the conditions and components within the individual that influence occupational performance, such as core elements of occupational performance. The external environment refers to the structures and conditions outside the individual, including sensory, physical, social, and cultural dimensions that exist in a specific time and space, which influence occupational performance. The foundation of occupational performance roles consists of three dimensions: knowing, doing, and being.

References:

Baum, C., Christiansen, C., & Bass, J.D. (2015). Person-Environment-Occupational Performance (PEOP) Model. In C. Christiansen, C. Baum, J.D. Bass, Occupational Therapy: Performance, Participation, Well-being. (4th ed.). Thorofare, NJ: Slack.

Chapparo, C., & Ranka, J. (1997). The Occupational Performance Model (Australia): A description of constructs and structure. In C. Chapparo & J. Ranka (Eds.), Occupational Performance Model (Australia). Monograph 1. Sydney: Occupational Performance Network.

Christiansen, C.H. and Baum, C.M. (2005) Occupational Therapy: Performance, Participation, and Well-Being. 3rd edn. Thorofare, NJ: SLACK Incorporated.

Iwama, M.K., 2006. The Kawa Model: Culturally Relevant Occupational Therapy. Edinburgh: Churchill Livingstone/Elsevier.

Kielhofner, G. (2008) Model of Human Occupation: Theory and Application. 4th edn. Baltimore: Lippincott Williams & Wilkins.

Townsend, E. and Polatajko, H.J., 2007. Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation. Ottawa: CAOT Publications ACE.