Mental Health Models & FOR

Question 1

Model of Human Occupation (MOHO)

Answer 1

• Occupation-based model
• DIMENSIONS OF DOING (occupational participation, performance & skill)
• The classic model of occupational therapy practice describes the effect of the following on engagement in occupations:
  1. VOLITION
  2. PERFORMANCE
  3. HABITUATION
• Evaluation: i.e. Role Checklist
• Interventions: Focus on the client engaging in occupational performance through doing, thinking, and feeling within the therapeutic environment. Strategies include feedback, coaching, structuring, and encouraging; however direct teaching and mastery of a task are NOT included/essential.

Question 2

Person-Environment-Occupation-Performance (PEOP)

Answer 2

• Occupation-based model
• Emphasizes the essential interaction among the person; performance of a desired, meaningful occupation; and the context in which the person engages in the occupation.
• It is a key model of occupational therapy practice that describes the experiences of individuals and populations and explains the effect of the key components of the model on health, wellness, and quality of life.

Question 3

Canadian Model of Occupational Performance and Engagement (CMOP-E)

Answer 3

• Occupation-based model
  INSIDE
• Human spirit is the central organizing structure of the person.
• Physical, cognitive, and affective factors are also found within the person in the CMOP.
  OUTSIDE
• Occupations surround the person and emphasize self-care, productivity, and leisure.
• The environment surrounds both the person and the occupations to include physical, institutional, cultural, and social components.
• Occupations that are essential to the person’s spirituality are critical in producing client-centered practice.

Question 4

Intentional Relationship Model (IRM)

Answer 4

• Occupation-based model
• IRM is about the therapeutic use of self and the effect the therapist-client relationship has on improving function.
• The model describes a triad among client, occupational therapy practitioner, and occupation.
• It also includes the following principles:
  1. Critical self-awareness and interpersonal self-discipline are fundamental to the intentional use of self.
  2. Practitioners must keep “head before heart.”
  3. Practitioners must practice “mindful empathy.”
  4. The client defines a successful relationship.
  5. Practitioners must balance a focus on activities with a focus on the interpersonal.

Question 5

Allen’s Cognitive Disabilities Model

Answer 5

• Frame of Reference (FOR)
• Allen’s uses a hierarchical continuum of cognitive ability (derived from Piaget’s developmental theory) called Allen’s Cognitive Levels
• Functional abilities improve as cognitive levels increase

Question 6

Behavioral Approaches to Learning

Answer 6

• Frame of Reference (FOR)
• The behavioral framework and behavior modification theory is based on operant conditioning. (Behavior is shaped by connecting a positive or negative reinforcement to a behavioral response.)
• Particularly beneficial with social skills training; however, use of rewards to shape behaviors is controversial (especially with adult mental health clients) as it implies a passive response by the client and little cognitive processing
• Reinforcement:
  1. Positive = A favorable outcome that occurs after the desired behavior (e.g., a “reward” such as praise, increased privileges, or a high-five). Are more effective than negative reinforcement, especially when used intermittently vs. continuously.
  2. Negative = Removal of an unfavorable outcome to produce the desired outcome (e.g., a person calls in sick because a report is not finished yet, thereby avoiding difficult questions from the boss and reducing anxiety in the short-term).

Question 7

Cognitive-Behavioral Therapy (CBT)

Answer 7

• CBT has at its foundation the idea that distorted thinking leads to behavioral and emotional problems related to mental illness.
• The focus of therapy is to increase awareness of (and eventually change) cognitive distortions to ultimately alter behavior and the emotional impact on function.
• Intervention strategies include goal setting, homework, mindfulness, and restructuring cognitive thoughts.

Question 8

Kawa Model

Answer 8

• The Kawa Model serves as an example of how culture has an effect on mental health intervention in occupational therapy practice.
• Developed by Japanese OTs, the Kawa Model presents the concept of cultural safety as a key component of the model.
• The notion that healing must come from within a safe cultural context is emphasize as the foundation for practice with clients with mental illness.

Question 9

Psychoanalytic & Psychodynamic Theory

Answer 9

• Used primarily in contemporary mental health interventions and within OT as a mechanism for improving self-identity and interpersonal relationships.
• The concepts from psychoanalytic-psychodynamic theory are the cornerstone of mental health practice, from which many other theoretical principles and models have derived.
• They are especially useful for exploring underlying, deep-seated origins of human emotion and motivations.
• Although many concepts of the theory have been refuted, they continue to have a strong historical value and application to understanding group dynamics, relationships, and feelings.
• Interventions that emphasize expression in OT include creative and expressive media, and journaling for reflection.

Question 10

Occupational Adaptation

Answer 10

• Three basic elements:
  1. Person = INNATE DESIRE FOR MASTERY in occupation
  2. Environment = where occupation occurs
  3. Interaction between person and occupational environment = creates a press for mastery
• Occupational adaption is a normative process that is prominent in periods of transition

Question 11

Ecology of Human Performance Model

Answer 11

• Intervention approaches:
  1. Create, promote = focused on populations
  2. Establish, restore = focused on the child’s skills and abilities
  3. Alter = focused on context & identifying needs
  4. Modify = focused on context or task, and adjusting demands as needed
  5. Prevent = focused on problem anticipation
• Main concepts:
  1. The PERSON is composed of sensorimotor, cognitive, and psychosocial skills
  2. The demands of a TASK determine which specific behaviors the person will need to participate successfully
  3. The CONTEXT includes the temporal, physical, social and cultural aspects of the environment
  4. PERFORMANCE range is the number and type of tasks available to the person
• INDEPENDENCE occurs when the client’s wants and needs are satisfied