theory knowledge + concepts Flashcards
Paradigm of Occupation
(1900-1940s)
Mechanistic Paradigm
(1950s-1970s)
New Emerging Paradigm
(1980s-2000)
What is a paradigm shift?
when a discipline abandons one view of the world for another; a revolution; a drastic conceptual restructuring
4 stages within the development of a paradigm
Pre-paradigm phase
various thinking approaches emerge to solve the same problem
Paradigm
“winner”; use of one school of thought
Crisis
not all problems can be solved this way
Resolution
reorganization of the old PLUS new thinking
Paradigm of Occupation (1900-1940s), advocating for what?
Moral treatment (advocating for persons with mental illness by participating in occupations that “normalized” behavior
was the central phenomenon of interest referring to balance of work, play, self-care, & rest; holistic view
Occupation
Paradigm of Occupation (1900-1940s) originates from
Consolation House (1914, NY) a convalescent home founded by George Barton & Eleanor Clark Slagle; Hull House (1915, Chicago) a work program for persons with physical & mental disabilities
The Paradigm Shift (1940s-1950s) is what era?
Crisis Era
The profession comes under pressure from medicine to provide scientific evidence for its practice
Mechanistic Paradigm (1950s-1970s)
Medical model (reductionistic) replaces “occupations” of moral treatment
OTs seek to gain professional respect as a scientific discipline by focusing on disease
Specialization is a popular trend
Loss – commitment to occupational performance
Gain – new assistive devices, technology, techniques; SI; NDT
Paradigm Shift of the 1970s
Crisis Era
Reductionism was inadequate for treating chronically disabled
OTs express dissatisfaction over a loss of professional identity & unity
Emerging Paradigm (1980s & on)
Recommitment to holistic view and the occupational nature of humans
Client centered practice including active engagement & empowerment
Balance of the art & science of practice
MODELS OF HEALTH CARE is a context of?
… a context for understanding the changes occurring in the OT profession, both nationally and globally.
The following models of health care impact the OT profession on both a national & global level by providing a further context for understanding practice in the millenium
Medical model
World Health Organization model (WHO, 2001)
Client-centered practice
American Occupational Therapy Practice Framework (AOTA, 2014).
MEDICAL MODEL
Patient Care Treatment Team Medical Insurance Medical Diagnosis – symptom based Prescriptions Scientific Evidence – reductionistic & mechanistic in perspective
OT’s Role in the Medical Model
Restoring a state of health, normalcy, and homeostasis
Treatment approaches were developed
Client-Centered Practice emerged when?
Emerged in 1960s & Deinstitutionalization
Client Centered Model (OT) founded by
What is it?
founded by the Canadian Occupational Therapy Association (CAOT, 1997)
It is the basic therapy model for the AOTA Practice Framework (2014)
CLIENT-CENTEREDPRACTICE is what?
Resembles Carl Roger’s “person-centered” therapy approach
A client seeks the advice of a professional for life management
Intended to be holistic & global
Collaborative partnership
ASSUMPTIONS OF CLIENT-CENTERED PRACTICE
Clients know what they want & need from therapy
Ultimate relevance of the client’s perspective on problems
Professional dominance is counter-therapeutic
Therapist cannot be the instrument of change, only the facilitator
6 Principles of Client-Centered Practice
Client Autonomy & Choice Respect for Diversity Therapeutic Partnership & Shared Responsibility Enablement & Empowerment Contextual Congruence Accessibility & Flexibility
ICFInternational Classification of Functioning was created by and reflects?
Created by the World Health Organization
Reflects the shift to a holistic and systems perspective of global health care from a reductionistic view.
Purpose of ICF
Scientific basis for study
Common language
To allow comparison
To provide systematic coding
new definations for ICF
Handicap
Disability
Impairment
ICF general points
2001 revision broadens the horizons
“There is a widely held misunderstanding that ICF is only about people with disability; in fact, it is about all people” (WHO, 2001, p. 7)
AOTA OT Practice Framework consists of
Consists of two parts: Domain and Process The categories include occupations (8) performance skills (3) performance patterns (4) contexts (6) client factors (3)
framework general points
The Framework Collaborative Process Model illustrates the way occupational therapists deliver services in collaboration with clients.
The client–practitioner relationship determines the flow of evaluation, intervention, and outcome.
What is Theory?
A description
An explanation
A prediction
Relationships
Kathlyn Reed: two models
Conceptual Models & Practice Models
Conceptual Models explain…
Two types of models in OT:
1. Conceptual Models – explain WHY OT works, validate value of OT but tend to be generic and do not address specific areas of practice (Occupation Based Models)
Practice Models explain…
- Practice Models – explain HOW OT works, gives guidelines for specific types of evaluation and intervention (Frames of Reference)
Mosey’s Model
“Occupational Therapy Loop”
OT theory organization
paradigm –> occupation-based model –> frames of references
a set of interrelated, internally consistent concepts, definitions, and postulates that provide a systematic description of and prescription for a practitioner’s interaction within a particular aspect of a profession’s domain of concern.”
Mosey’s definition of a frame of reference
How a Frame of Reference is organized:
Focus Basic Assumptions Function-Disability Continuums Postulates of change Example
Frame Organization, cont.
Evaluation
Each frame of reference has specific tools for evaluating the extent of function/dysfunction.
Interventions
Each frame of reference has specific strategies for intervention which have been developed and researched
What are we doing NOW?
Integration!
Occupation based models – guiding principles
Frames of Reference – tools to strengthen our approach
Theories Guide Our
Professional Reasoning
They help practitioners reason about: what to assess; how to understand occupational performance problems; how to intervene; and what to expect from the intervention
The Vocabulary of Theory
Assumptions beliefs that are accepted without question Constructs The elements of a model or theory Principles The relationships between the constructs
Theories Vary in Specificity
Broad theories provide an overarching model or framework
Serve to organize
Do not provide precise information
Discrete theories describe specific causal relationships
Propose the specific causes
Guide specific actions
Key Points
Whenever you make a decision in practice you are acting on theory, although that theory may be implicit rather than explicit.
In order to examine whether the evidence supports the validity of your theory, you need to make the key assumptions explicit.
As evidence accumulates, theory should evolve. If key assumptions of the theory are not supported by current evidence, the theory needs to be discarded.
