Models of OT Midterm-2 PDF

Theory Organization: understand the reasonings on first PPT (interactive, procedural and conditional) Procedural Reasoning– What is the nature of the problem? (includes literature search) How do we expect client to present? (consider OTPF performance skills and client factors)...

Theory Organization: understand the reasonings on first PPT (interactive, procedural and conditional) Procedural Reasoning– What is the nature of the problem? (includes literature search) How do we expect client to present? (consider OTPF performance skills and client factors) What theoretical/practice models & research guide the assessment and intervention process Interactive reasoning– How can we understand our client better? How can we understand the disability from client’s POV? (illness perspective) What is required of a therapist using interactive reasoning processes? Illness perspective: OTs engage in narrative clinical reasoning. - What meaning does disability have for a particular person? - Who are the players in their story? - Within what context does the person’s story play out? Occupational therapists understand the integral role of uniqueness of person’s disability experience. Conditional Reasoning– Elusive in nature → difficult to describe Concerned with broaden social & temporal contexts Requires therapist to think/imagine client premorbidly, currently, & in newly defined self in future. Reflective process looks at clinical interaction → was it success or failure Have an understanding of the use and premise of the Medical model - Patient care - Treatment team - Medical insurance - Medical diagnosis → symptom based - Prescriptions - Scientific evidence= REDUCTIONISTIC & MECHANISTIC OT’s role in medical model… Restoring state of health, normalcy, & homeostasis. Approach developed for treatment of specific disabilities. - Focused on performance components NOT occupation based. Know what Human Agency means– In the PEOP Human agency: person having innate desire to explore their environment and demonstrate mastery within it. Know the CMOP and the main concepts and tenets  - Functional ability between the person, occupation, and environment. - Motivation is considered intrinsic - Facilitate by clients participation in identifying meaningful goals. - Change in any part of system= impact in occupational performance - Therapeutic process is guided by 6 principles of client centered practice. 6 principles of client centered practices 1. Client is capable of choice 2. Flexibility & individualized approach 3. Therapist’s role as enabler (therapist shares power, empowers client) 4. Success measured by attainment of client goals 5. Need for contextual congruence (interventions have to be meaningful to client in their own life setting) 6. Client readiness to use therapist services CMOP focused in all areas of life including self-care, leisure, productivity. CMOP components person environment occupation cognitive Person embedded in Connecting person & environment environment affective social Performed by person in environment Physical Cultural Self care/ leisure Core spirituality: center of Institutional environment productivity person CMOP assumptions Humans are occupational beings Occupation affects health & well being Occupation has therapeutic potential Occupation brings meaning to life through cultural and individual influences KEY tenets of COMP-E - Health is achieved= performance & satisfaction with occupation optimized. - Client centered, social justice, enablement - Emphasis on occupation where person and environment interact - Spirituality Know the difference between top down and bottom up approaches Top down: starts with a bigger picture and then funnels down. Bottom up: starts with a specific issue or topic and works way up or broadens it. PEOP was first then narrowed down to PEO. Understand the purpose of the International Classification of Functioning Model (ICF) Created by the world health organization  - Reflects the shift to a holistic view from a reductionist view. - Provide scientific basis for studying health. - Establish a common language. - Allow comparison across countries, disciplines, & time. Provide systemic coding for purpose of record keeping & research Occupational Based Models: Know the differences between the models (i.e. CMOP, OA, OB, PEOP, MOHO, EHP etc.) and the differences within their subcomponents ***Recommended to understand the key components and words of each model—This will help with differentiating the models and their concepts. Make a note of the key components and language in the Venn diagrams they are presented in –that will help a lot. CMOP– interaction between person, environment, & occupation itself. environment= physical, institutional, cultural, social, physical occupation= self-care, productivity, leisure person= affective, physical, cognitive CORE = SPIRITUALITY Made by= canadian association of occupational therapists Occupational adaptation– Holistic & based on A. Meyer’s philosophy. - Collaborative approach between therapist and client. - Reflects on approach for health promotion, prevention & remediation. Adaptation: normative, lifelong process that is response to internal & external pressures for mastery. 4 main constructs to Occupational adaptation 1. Occupations: 3 priorities a. Actively involve the person b. Meaningful to the person c. Include a process and product that may be tangible/intangible 2. Adaptive capacity: person’s ability to recognize need for change, modification, or refinement in order to achieve relative mastery. a. Occurs when person’s typical response does not meet challenges of occupation so they modify behaviors to achieve competent outcome. 3. Relative mastery: person’s self assessment of occupational response a. Efficiency defined by use of time, energy, & resources b. Effectiveness defined by successful achievement of one’s goal c. Satisfaction defined by one’s self perceptions (internal) & societal norms (external) 4. Occupational adaptation process: when person is faced with occupational challenge & takes place in one’s environment and within one’s role capacity. Components of occupational adaptation a. Person b. Occupational environment c. Interaction between person & environment Primary goal = achieve mastery over the environment. 6 main assumptions…  Competence in occupation: competence is lifelong process of adaption to internal & external demands. Demands to perform: person’s desire for mastery coupled with environment demands for competency produce occupational “press” Adaptive capacity: adaptation emerges from interaction between person & environment. ○ This is compromised during transition and stress. Demand for changes: occupational challenges occur when person performs roles. Expectation or demands on person are determined from external & internal resources. Success in occupational performance: inherent drive for mastery. Person believed to be influenced by sensorimotor, cognitive, & psychosocial factors. Dysfunction: person’s ability to adapt has been challenged where demands for performance are not met. Motivation: desire for mastery, demand for mastery, press for mastery. Goal of intervention= focus on client’s “role” selection as they attempt to adapt. Occupational behavior– Mary Reilly 1969 Concepts of occupational behavior mainly based on ideas from philosophy, psychology, social psychology, sociology, anthropology. - Activities that occupy a person’s time, involve achievement, & address economic realities of life. Clinical reasoning for practitioner reflected on reductionist approach. Treatment included modalities & techniques to fix the problem. Mary Reilly stated… “purpose of OTs is to prevent and reduce incapacities resulting from illness.” TODAY= OTs recognize importance of promoting health through meaningful occupational behavior and intervening when client experiences a disruption in functioning due to illness/disability. Emphasis on significance of adaptation, intrinsic motivation, development & society & culture. Change & motivation is intrinsic motivation. Work-play approach to OT approach. Balance & well being= balance in occupation behavior in self-care, work and play/leisure. Theoretical assumptions: Occupational behavior is developed according to developmental continuum & includes child’s need to - Explore - Achieve - competency Man has a need to master, alter, and improve his environment. PEOP– developed in 1985 Model is interactive NOT transactive. Main goal= enhancement of occupational performance Secondary goal= enhancement of participation Occupational performance is emphasized!! Client sets goals & participates in creating plan to PROMOTE OCCUPATIONAL PERFORMANCE. Goals & intentions influence occupational performance. Success → well being. PEOP is associated with human agency. Occupational performance in PEOP: describes actions meaningful to individual as they self manage, care for others. (separated into 2 components occupation and performance) 4 constructs of occupational performance 1. Person: made up intrinsic factors compose one’s set of abilities. 2. Environment: participation impacted by extrinsic characteristics of environment. 3. Occupations: activities person does in managing their daily lives, grouped in some meaningful way so that person carries out life-roles. 4. Occupational performance & participation: culmination of doing occupations. a. Interaction of intrinsic and extrinsic * occupation= occupational performance & participation Adaptation= person confronts challenges of daily living & able to use resources to master demands. PEO– related to human ecology Developed by Mary Law Provides framework for delivery services with client centered approach. 3 components: person, environment, occupation Transactive relationship between person, environment, occupation. PEO highlights= complexity of person-occupation-environment relations EQUALS occupational performance Concepts of PEO model… Person: unique & assumes variant of roles simultaneously Roles- dynamic Seen as holistic in mid body and spiritual qualities Environment: equal importance to cultural, socioeconomic, intuitional, physical and social considerations of environment. Activity, task & occupation… Activity: basic unit of task. Person engages in daily occupation Task: set of purposeful activities Occupation: group of self-directed functional tasks Concepts of PEO Tasks that are done to meet intrinsic need for self maintenance, expression, & fulfillment. - Time patterns & rhythms that encompass occupational routines of individuals. - Temporal aspects = lifespan of person MOHO– evolved from occupational behavior. - Attempts to explain how occupation is motivated (volition), patterned (habituation), & perform (performance). Volition→ why are individuals motivated? (interest, values, personal causation) Person causation– how capable & effective one feels. Values– what one holds important & meaningful Interests– what one finds enjoyable & satisfying habituation→how is this behavior organized/structured (habits, routines) Habits– learned ways of doing that occur automatically & takes into account context. Roles– gives people identity & a sense of these obligations that go along with that identity. Performance→ how well can a person do the things they are motivated to do? Capacity for performance affected by status of musculoskeletal, neurological, cardiopulmonary, & other body systems. MOHO TERMS volition participation habituation Environment Performance capacity Occupational identity skill Occupational adaptation performance Occupational competence Occupational participation= work, play, activities of daily living that are part of one’s sociocultural context and that are desired or necessary for one’s well-being. Occupational performance= process of doing the occupational tasks related to participation. Occupational skill= discrete actions that constitute occupational performance. Motor Process Communication & interaction Occupational identity= formed by person’s internal structures defined by volition, habituation, performance capacity. Occupational competence= one sustains a pattern of occupational participation that represents one’s occupational identity. Occupational adaptation= outcome of positive occupational identity & achievement of occupational competence. DYNAMIC & CONTEXT DEPENDENT. Order vs. disorder order= exploration, competence, achievement disorder= helplessness, incompetence, inefficacy Evaluation process= data gathering process. EHP: interaction between person and environment  - Ecology affects human behavior and task performance. - Emphasizes preventive & health promotional attitude. Task performance= ADL, work, productive activities, education, leisure/play, social participation Targeted area= context! 4 main constructs of EHP Person: unique & dynamic. Task: objective set of behaviors necessary to accomplish goal. ○ Shapes person’s task ○ Task becomes occupations when transactional relationships exist between person, task, context. Context: temporal and environmental aspects ○ Temporal: chronological age; developmental stage; life cycle; disability states ○ Environmental: physical, social, cultural Social: norms, role expectations, social routines Cultural: customs, beliefs, activity patterns Person-task-context transaction: major variable ○ ecology= relationship between person and environment affecting task performance. ○ Task performance affects person, contextec & person-context transaction. ○ interaction= human performance, ecology= affect task performance which then impacts person, context, and person-context relationship. Performance Range= person-context match most apparent performance. Performance range is fluid Healthy function = HIGH performance range of tasks. Intervention… 1. Establish restore person's ability to perform in context 2. Alter context in which people perform 3. Modify contextual features so that they support performance IN context. 4. Prevent occurrence of performance problems Person’s performance= transaction between person & context. Purpose of the OT practice framework→ client centered History: Know the paradigm shifts and the years they occurred : Moral treatment (18th and 19th century) paradigm of occupation (consensus 1900’s-1940’s) crisis (1940-1950’s “occupation questioned) medical model paradigm (begin with great depression) crisis (1970’s) community paradigm (current). Know the key persons involved in development of OT theories 1600’s Thomas Willis – treatment of insanity - Advocated involving patients in occupations that promoted cheerfulness & joy. Herbert Hall: “work cure.” - Occupational engagement to treat nervous illness. - Avoiding useless self analysis Therapeutic readjustment: “many people are suffering in mind and body due to attempt accomplish too much, or from idleness which isn’t necessary. NSPOT– Susan johnson, George Barton, Elanor Slagle, William Dunton, Isabelle Newton, Thomas Besell Kidner - Occupation could play important role in healing & health. George Barton– named profession. Therapy→ medical treatment of disease - Promoted use of medical language Closely allied with medical profession. (prescription & medical supervision) Adolph Meyer– psychobiologist 1922: philosophy of occupational therapy Fundamental activities of human life = work and play and rest and sleep Remains to be critical components of OT thought & practice. Elanor slagle– 1922 - Developed educational standard - Proposed 12 month course of training A. jean Ayres– 1960s-1970s Neurobehavioral research - Sensory integrative approach → how sensory experiences influence adaptive behavior. Elizabeth Yerxa– “goal of practice is to provide authentic occupational therapy.” in achieving this goal, sincere involvement in their healing experience while establishing meaningful relationship with our clients during recovery process.” - Occupational science Gary Kielhofner– developed MOHO Ann Mosey– frame of reference. - She states one theory does NOT work for our profession. Frame of reference: set of interrelated, internally consistent concepts, definitions, and postulates that provide a systemic description of and prescription for practitioner’s interaction within a particular aspect of profession’s domain of concern. Mary Reilly– founder of occupational behavior (theoretical frame of reference) Central premise: “man through the use of his hands as they are energized by his mind & will, can influence the state of his own health.” Know the difference between reductionism, holistic and medical model Reductionism: simplifying or breaking down. Holistic: looking at one as a whole Medical model: focusing on diagnosis and treatment based on biological factors. Is viewed as systemic and reductionist in perspective. Know about the Moral treatment and treatment for the “insane” Treatment for insanity– 1600’s Thomas Willis. - Advocated involving patients in occupations that promoted “cheerfulness & joy.” Treatment weakened and controlled patients. - Bloodletting, nausea treatment, whipping, beating Moral treatment: early 1800’s Asylum = refugee & protection → human treatment of insanity Medical treatment was psychiatry. (new discipline for curing mental disorders) Kindness & occupation replaced brutality & idleness. Occupations: agriculture, tailoring, sewing, community labor, religious worship. Client centered practice: Understand Client-centered practice (hint some questions same as quiz). Emphasized collaboration with client, respecting their values & goals. - Empowers client to actively participate in their care and make informed decisions. - Foster therapeutic relationship built on trust, empathy, & mutual respect. - Therapist may need to adapt their approaches to meet individual client’s needs. Understand Contextual Congruence in client centered practice - contextual congruence (interventions have to be meaningful to client in their own life setting)