Models of Practice Flashcards
Model of Human Occupation (MOHO)
Regarded as systemic and holistic and promotes the importance of a mind/body connection. It considers the relationship between internal motivation and performance of occupations. This model relies heavily on the human experience and the impact of that experience based on the environment.
What is the most researched model that the field of occupational therapy possesses?
MOHO
Who developed MOHO?
Gary Kielhofner and his colleagues in the late seventies and early eighties.
How does MOHO view the person?
As an open system, always interacting with the environment and adapting to the changes at the environment might pose.
- The environment
- The person
- Engagement in occupation
- Person performance skill + environment= occupational identity, adaption and competence
What are the 3 subsystems that help view the person as occupational being in MOHO?
Volition, habituation, and performance capacity. (in certain texts and literature, the performance capacity system is referred to as the mind-brain-body connection)
Input (MOHO)
The individuals always receiving information from the environment.
Throughput (MOHO)
The information gets processed and changes are made
Output (MOHO)
Once changes have been made, the person will perform an action
Feedback (MOHO)
We are always receiving feedback from the environment as their own actions and as such, we are constantly changing and adapting how we do things
MOHO Concepts
- MOHO is concerned with how people can participate in daily life
- MOHO conceptualizes OT as a process in which practitioners support client engagement in occupations
Volition (MOHO concepts related to person- subsystems)
-Personal causation
-Values
-Interests
(Process includes interpretation anticipation and activity and occupational choices)
Habituation (MOHO concepts related to person- subsystems)
Habits- influences and assists in establishing routines
Roles- part of our identity and who we are.
Performance Capacity (MOHO concepts related to person- subsystems)
The capacity to do things depends on the following 2 factors: Bodily systems, Mental or cognitive abilities
Moho concepts related to environment
- Engagement in occupation
- Environment
- Three levels we can examine what a person does: Occupational participation, Occupational performance, Skills
Occupational identity competence and adaptation (MOHO)
- What people do creates their occupational identity
- Occupational competence
- Occupational adaptation
Process of change and therapy (MOHO)
- All change in OT is driven by the clients occupational engagement
- Occupational engagement
- Therapeutic strategies (Choose/decide, Commit, Explore, Identify, Negotiate, Plan, Practice, Re-examine, Sustain).
6 steps of Therapeutic Reasoning (MOHO)
Gathering- gathering information on and with the client
Using- using the info gathered to create an explanation of the client’s situation
Generating- generating goals and strategies for therapy
Implementing and monitoring- implementing and monitoring therapy
Determining- determining outcomes of therapy
A sample of moho assessments
- Assessment of Communication and Interaction Skills (ACIS)
- Assessment of Occupational Functioning (AOF)
- Model of Human
- Occupation Screening Tool (MOHOST)
- Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS)
- Occupational Performance History Interview-II (OPHI-II)
- Occupational Self-Assessment (OSA)
- Worker Role Interview (WRI)
Values (MOHO)
What one finds important and meaningful
Personal Convictions (MOHO)
Views of life that define what matters
Occupational Performance (MOHO)
Doing an occupational form task
Performance Capacity (MOHO)
Ability to do things provided by the status of underlying objective physical and mental components and corresponding subjective experiences
Human Occupation (MOHO)
The doing of work play or activities of daily living within a temporal physical and socio cultural context that characterizes much of human life
Personal Causation (MOHO)
Sense of capacity and effectiveness
Habits (MOHO)
Tendencies to respond and perform in certain ways in familiar environments or situations
Roles (MOHO)
Incorporation of a socially and or personnel defines status and a related cluster of attitudes and behaviors.
Habituation (MOHO)
Consistent patterns of behavior guided by habits and roles and fitted to the characteristics of routine temporal physical and social environments
Occupational Adaptation (MOHO)
Constructing a positive occupational identity and achieving occupational competence over time in the context of one’s environment
Occupational Competence (MOHO)
Degree to which one is able to sustain a pattern of occupational participation that reflects one’s occupational identity
Occupational Participation (MOHO)
Engagement in work play ADL that are part of ones sociocultural context and that are desires and or necessary to one’s well being
Interests (MOHO)
Ways one finds enjoyable or satisfying to do
Occupational Choices (MOHO)
Deliberate commitments to enter an occupational role acquire a new habit or undertake a personal project
Volition (MOHO)
Pattern of thoughts and feelings about oneself as an actor in ones world which occur as one anticipates chooses experiences and interpret what one does.
Occupational Identity (MOHO)
A composite sense of who one is and wishes to become as an occupational being generated from ones occupational history
Bill, a police officer, is returning to work after a serious injury to his right, dominant hand. He is anxious about being able to safely perform his job duties after returning to work. Bill is struggling with which component of volition?
Personal causation
The model of human occupation is an occupation-focused approach to OT practice that is also all of the following except:
Diagnostic process
In MOHO, ____________ is the process by which people are motivated toward and choose what activities they do.
Volition
Which of the therapeutic strategies identified by MOHO is described this way: “sharing your understanding of the client’s situation or ongoing action”?
Giving feedback
MOHO’s definition, “locate novel information, alternatives for action, and new feelings that provide solutions for and/or give meaning to occupational performance and participation,” applies to which dimension of occupational engagement?
Identity
Mary is not able to hold her three-year-old due to decreased strength resulting from a nerve injury to her left arm. According to MOHO, Mary is having difficulty with:
Performance Capacity
The question “What routines does this person participate in, and how do routines influence what he or she does?” is asking about which MOHO concept?
Habituation
You are helping steady your client while she is standing at the sink brushing her teeth. Which therapeutic strategy identified by MOHO are you using?
Providing physical support.
Dr. Frank discussed using a MOHO assessment with her client that provides information about future, present, and past role participation and how much clients value those roles. Which MOHO assessment did she talk about?
Role checklist
You want Susan to try to dress herself today, but she is not feeling up to it. She agrees to put on her pants if you help her with her shirt. You agree so that she can increase her independence with dressing. Which therapeutic strategy are you using according to MOHO?
Negotiating
Who founded the Canadian Model of Occupational Performance and Engagement?
Polatajko, Townsend, and Craik in 2007
-Furhter expansion of COMP founded by CAOT in 1997 (expansion covers occupational engagement following the development of occupational theory in how clients are enabled to choose and perform their meaningful occupation in their environment)
What are the 3 main comments of the Canadian Model of Occupational Performance and Engagement?
- Person
- Environment
- Occupation
Environment (Canadian Model of Occupational Performance and Engagement)
The outermost circle represents the external “environment,” including the physical, social, cultural, and institutional environment of the client. Physical is the built environment, social is the communication with others, cultural is the person’s own cultural context, and institutional is the environment placed upon the person, such as school or the workplace. This model emphasizes that the interaction between the person, environment, and occupation results in occupational performance. The model also emphasizes that there is interplay between the three concepts, so if one element changes, so do the other two. For example, if a person’s physical ability deteriorates, they are unable to access their built environment, which reduces their social environment and limits or changes their occupational engagement. Conversely, if the environment changes, such as ramping to enable access out of their home, their occupations expand, and this improves their mood (affective).
Key assumptions: Spirituality is a central component of a person. Person, environment, and occupation are mutually dependent.
Occupation (Canadian Model of Occupational Performance and Engagement)
The intermediate circle represents “occupation,” which is performed by the person in the environment and includes three domains of self-care, productivity, and leisure. All engagement in occupation, according to this model, can be classified into either self-care, productivity, or leisure. It is important to understand that it is the individual who categories the occupational category. For example, cooking dinner could be categorized as leisure, self-care, or productivity by different people and could also be categorized differently by the same person depending on the context.
Person (Canadian Model of Occupational Performance and Engagement)
The person is situated in the center of the model and correlates with the client-centered focus within occupational theory. The spirituality of the person is in the center. This is not necessarily the religious beliefs of the person but rather their “essence of self.” The spirituality is shaped and expressed through engagement in occupations. The other elements of the person are divided between cognitive, affective (their mood), and physical.
What model is popular and used worldwide because it encapsulates much of occupational therapy philosophy?
Person Environment Occupation Performance Model
What kind of approach does the Person Environment Occupation Performance Model use?
- Top down approach
- Human agency (mastery)-helping to gain mastery of occupations
- Transactional relationship (change one element you change the others Person environment occupation)
- Client-centeredness
Top Down Approach of the Person Environment Occupation Performance Model
Focuses on the occupation first (not symptoms of the person)
-From main occupation to symptemology
Who designed the Ecology of Human Performance Model and why?
Dunn, Brown, and McGuigan 1994 to focus more on the context of a person.
How can one understand the Ecology of Human Performance Model?
Need to understand the meaning of context: in occupational therapy theory is the person’s “place”; therefore, it includes the person’s environment and personal aspects.
- Task vs occupation (mainly refer to task for this model)
- Persons context and environment interact and impact task performance
- Emphasis is on prevention promotion and rehabilitation
Ecology (The Ecology of Human Performance Model)
Transaction between person and construct person and context are combined in reciprocal nature that leads to task performance
Person (The Ecology of Human Performance Model)
Task (The Ecology of Human Performance Model)
Objective set of behaviors that is necessary to accomplish a goal ex meal prep (cooking grocery shopping driving to store and money management).
Context (The Ecology of Human Performance Model)
- Set of interrelated conditions that surrounds a person
- Temporal context is: Chronological age, Developmental stage in life, Stage of life cycle, Health status, Environmental context
Performance (The Ecology of Human Performance Model)
- Process and result of interacting with the context to engage in a task
- Performance range: determined by the interaction between person and the context or ecological performance
- Performance in natural context is better than performance in contrived context
Alter (The Ecology of Human Performance Model)
Change the situation around someone rather than the actual person (ex. having someone else drive the car for them)
Adapt/Modify (The Ecology of Human Performance Model)
Adjust how the person carries out the task (ex. placing adaption on the steering wheel for 1 arm use)
Prevent (The Ecology of Human Performance Model)
Take action against future deterioration of function (ex. Applying fatigue management principles regarding frequency of driving)
Create (The Ecology of Human Performance Model)
Deliver entirely new experiences (ex. Starting to learn to drive)
