OT Practice Models [Willard & Spackman's OT-12th Edition]

Civil Rights and the ECOLOGICAL OT Practice Models

-Disability groups started equality movements that pushed civil rights for individuals with disabilities and the promotion of their self-determination and empowerment. -The movements made these long-standing issues more visible to the public eye in America (especially in the 1980s and 1990s). -ECOLOGICAL models EMBRACED the values of the disability movement; this is reflected in the emphasis on environment as BOTH a significant BARRIER and FACILITATOR of occupational performance AND the adoption of principles of occupational performance.

Definition of FORMAL THEORY

-Explains observable events or relationships by stating a series of abstract propositions or principles. -Based on SYSTEMATIC RESEARCH with CAREFULLY DEFINED concepts and explanations of relationships between these concepts. *Systematically explains, predicts, or describes phenomena*

Definition of LIFE EXPERIENCES (ECOLOGICAL Models)

-Form a person's HISTORY and PERSONAL NARRATIVE.

Definition of FRAMES OF REFERENCE

-Guide practice by delineating the BELIEFS, ASSUMPTIONS, DEFINTIONS, and CONCEPTS within a SPECIFIC area of practice. -Delineate EVALUATION PROCESSES and INTERVENTION STRATEGIES that are consistent with the theoretical base. *Guide a specific area of practice*

Definition of VALUES & INTERESTS (ECOLOGICAL Models)

-Help to determine what is IMPORTANT, MEANINGFUL, and ENJOYABLE to the person.

Definition of SKILLS & ABILITIES (ECOLOGICAL Models)

-Include COGNITIVE, SOCIAL, EMOTIONAL, and SENSORIMOTOR skills. EX. Reading... Balancing a Checkbook... Public Speaking... Grocery Shopping... Effective Coping Mechanisms...

Definition of ENVIRONMENT (ECOLOGICAL Models)

-Location(s) where occupational performance takes place. -ENVIRONMENT consists of 'physical', 'social', and 'cultural' aspects. -The EHP Model ONLY includes an additional aspect called 'temporal' environment.

Definition of TEMPORAL ENVIRONMENT (EHP Model)

-Made up of TIME-ORIENTED factors. -PERSON's environment, at a SPECIFIC POINT IN TIME that includes his/her present developmental and life stages. ~and~ -The TASK, PRECISELY as it TAKES PLACE, how often, duration, etc. *Occupational Performance CANNOT be understood OUTSIDE of the CONTEXT of the ENVIRONMENT* *EHP MODEL ONLY*

Definition of PHYSICAL ENVIRONMENT (ECOLOGICAL Models)

-Most tangible environmental aspect. -Includes built AND natural features: =LARGE elements, such as buildings or terrain(mountain/lake). =SMALL objects, such as tools. *Occupational Performance CANNOT be understood OUTSIDE of the CONTEXT of the ENVIRONMENT*

Scope of THEORIES

-OT THEORIES tend to be overarching theories which are BROAD IN SCOPE and help translate our understanding of the occupational nature of humans.

Definition of TASK (EHP Model)

-Objective representations of ALL POSSIBLE ACTIVITIES available in the universe.

Definition of FLOW EXPERIENCE (ECOLOGICAL Models)

-Occurs when the person's skills and abilities match the challenges of the activity. -Person is "at one" with the occupation and so completely absorbed that the passage of time goes unnoticed. *Significant because the "goodness-of-fit" aspect of the ECOLOGICAL models are based upon some of these concepts*

PEO-Assumptions

-P, E, & O INTERACT CONTINUALLY ACROSS TIME AND SPACE in ways that increase or diminish their congruence. -Observable qualities of OP can be measured objectively. -Subjective attributes of OP are more appropriately measured by self-report. -Over lifetime, individuals constantly negotiate their view of self and their role(s) as they ascribe meaning to occupation and the environment around them. -Easier to change the environment than the person. -Environment is context that influences, and is influenced, by behavior. -Although attributes can be changed, some characteristics are more responsive to intervention than others.

'Occupation' vs. 'Task' (ECOLOGICAL Models)

-PEO & PEOP use 'OCCUPATION'. -EHP uses 'TASK': *BC the primary purpose of EHP was to FACILITATE INTERDISCIPLINARY COLLABORATION* *It was felt that 'TASK' would be more accessible/understood by other disciplines*

EHP-Year and Authors

*1994* -Dunn -Brown -McGuigan

PEO-Year and Authors

*April 1996* -Law -Cooper -Strong -Stewart -Rigby -Letts

EHP's Primary Focus

*CONTEXT & PERSON ARE INTERACTIONAL* *PERSONS BOTH AFFECT, AND ARE AFFECTED BY, THEIR ENVIRONMENT* -EHP is a framework providing a STRUCTURE FOR THINKING OF CONTEXT AS A KEY VARIABLE IN ASSESSMENT AND INTERVENTION PLANNING. -Simultaneously explains the inherent dangers in examining performance out of context: (misinterpretation>miscommunication) = Set Wrong/Fail to Meet Client's Desired Goals *CONTEXT IS KEY*

PEO facilitates what important shift?

-PEO facilitates the SHIFT TO AN EMPHASIS ON OCCUPATION from an emphasis on performance components. -This shift may cause the need for ongoing monitoring of interventions as opposed to a time-limited case approach.

DIFFERENCES between the 3 ECOLOGICAL OT Practice Models

-PRIMARILY found in their: Definitions Components Structures

Definition of PERSONAL THEORY

-PRIVATE understandings based on EXPERIENCE. *Helps individuals articulate their experience*

ECOLOGICAL Models and Application to OT Practice

-Provide FRAMEWORK FOR THINKING about OT practice but DO NOT delineate specific assessments or techniques. -Occupational therapy practice involves promoting self-determination and the inclusion of people with disabilities in all environments.

Assumptions of the ECOLOGICAL OT Practice Models

-Relationships between PEOPLE, ENVIRONMENTS, and OCCUPATIONS are dynamic and unique. -ENVIRONMENT is a MAJOR factor in the prediction of successful and satisfying occupational performance. -Rather than exclusively using interventions that change the person, often more efficient and effective to CHANGE THE ENVIRONMENT or FIND A PERSON-ENVIRONMENT MATCH. -Based on the idea of GOODNESS OF FIT. -OCCUPATIONAL PERFORMANCE is OPTIMAL when the environment and PERSON'S SKILLS and ABILITIES match the DEMANDS of the occupation (TASK). -Disruption in any AREA, PERSON, ENVIRONMENT, or OCCUPATION will interfere with performance.

Definition of CULTURAL ENVIRONMENT (ECOLOGICAL Models)

-Shared experiences that determine values, beliefs, and customs. -Includes ETHNICITY, RELIGION, and NATIONAL identity. *Occupational Performance CANNOT be understood OUTSIDE of the CONTEXT of the ENVIRONMENT*

PEO-Implications for OT Practice

-Specifies targets for intervention. -Multiple avenues for eliciting change. -Keeps intervention in context. -Well-validated assessments available.

Why view THEORIES as Evolving Knowledge?

-THEORY is NOT a fixed, objective truth. -It needs CONSTANT EXAMINATION and TESTING. -It is essential for a profession to have a base of knowledge grounded in well-articulated and specified theories that, in turn, provide SCIENTIFIC SUPPORT FOR PRACTICE and CONTINUALLY TEST EFFECTIVENESS of OT INTERVENTIONS *(especially as new information/knowledge/treatments become available).

Definition of OCCUPATIONAL PERFORMANCE (ECOLOGICAL Models)

-The OUTCOME that is associated with the confluence of the PERSON, ENVIRONMENT, and OCCUPATION factors. -The degree to which occupational performance is possible depends on the GOODNESS OF FIT of these factors.

SIMILARITIES of the 3 ECOLOGICAL Models

*OCCUPATIONAL PERFORMANCE as the PRIMARY OUTCOME of interest to OTs* -All 3 models indicate that OCCUPATIONAL PERFORMANCE is determined by the PERSON, ENVIRONMENT (CONTEXT), and OCCUPATION (TASK). -The ENVIRONMENT is SIGNIFICANT. -All draw heavily on SOCIAL SCIENCE theories describing person-environment interactions. -Provide FRAMEWORK FOR THINKING about OT practice but DO NOT delineate specific assessments or techniques.

Definition of CONTEXT (EHP Model)

*We DO NOT exist in a vacuum* -'Lens from which persons view their world'. -Interrelationship of a person and context determines which tasks fall within the person's performance range. -Facts that operate external to the person are identified as CONTEXT. -Every person's CONTEXT is unique, although many elements are shared among persons. *CONTEXT IS KEY*

Definition of THEORY

-A set of ideas or concepts that people use to guide their actions. -Reflects an image or explanation of WHY or HOW a phenomenon OCCURS and HOW that phenomenon can be CONTROLLED. -When fully developed, a THEORY DEFINES CONCEPTS and STATES RELATIONSHIPS BETWEEN THEM. *Organizes observations and understanding for easier use*

Definition of PERSON (ECOLOGICAL Models)

-All 3 have similar definitions of PERSON. -A unique and holistic view of the PERSON acknowledges the MIND, BODY, and SPIRIT. -Differences between the 3 models lie in: 1. VALUES & INTERESTS 2. SKILLS & ABILITIES 3. LIFE EXPERIENCES

Theory and New OT Graduates

-As a new OT graduate, theory may be particularly important to draw upon due to lack of experience. -Theory can be seen as a "borrowed experience", "thinking frame", or "metaphor" to guide new practitioners in their professional reasoning.

EHP-Shifting Contexts

-As contexts shift, the behaviors necessary to accomplish a goal also change.

Definition of SOCIAL ENVIRONMENT (ECOLOGICAL Models)

-Close interpersonal relationships -Family and friends -Social groups such as: Work groups(managers/teams/clients) Social groups (church/extracurricular) *Made up of large political and economic systems as well (government/rules/laws-local/state/federal)* *Occupational Performance CANNOT be understood OUTSIDE of the CONTEXT of the ENVIRONMENT*

Definition of PROFESSIONAL PARADIGM

-Conceptual structure for understanding the WORLD. -A PROFESSIONAL PARADIGM provides an ACCEPTED ORIENTING STRUCTURE for the profession, its VALUES, BELIEFS, and KNOWLEDGE.

THEORY in OT Practice

-Concerned with OCCUPATION and HOW OCCUPATION INFLUENCES HEALTH and WELL-BEING -Also concerned with HOW OCCUPATION can be USED THERAPEUTICALLY to enable CLIENTS to engage in those occupations CLIENTS value most.

Definition of PROFESSIONAL MODEL

-Delineates and defines the SCOPE or AREA OF CONCERN for a profession. -Articulates the OVERALL BELIEFS and KNOWLEDGE of the profession. -It is DERIVED FROM the PROFESSION'S PARADIGM. *Defines the scope of practice*

What are the 3 Elements that are integrated into a PROFESSIONAL PARADIGM?

1. OT practitioner's underlying BELIEFS, VALUES, and COMMITMENTS. 2. OT practitioner's KNOWLEDGE, ABILITIES, and SKILLS (including theories, evaluation, and intervention strategies). 3. OT practitioner's PROFESSIONAL VALUES as expressed in a commitment to the field and to their clients.

Why does clinical experience matter?

Experience leads to: -More highly developed professional paradigms. -Provide a greater resource for practitioners to reflect about their practice AND the problems encountered by their clients.

Definition of PRESS

In the ECOLOGICAL OT Models... -Described as the DEMANDS of the ENVIRONMENT.

Definition of POOR FIT

In the ECOLOGICAL OT Models... -Occurs when the person CANNOT meet the DEMANDS of the ENVIRONMENT.

Definition of GOOD FIT

In the ECOLOGICAL OT Models... -Occurs when the person's ADAPTIVE BEHAVIOR and AFFECT match the environmental PRESS.

Name the 3 ECOLOGICAL OT Practice Models

The 3 ECOLOGICAL OT MODELS ARE... 1. Ecology of Human Performance Model(EHP) 2. Person-Environment-Occupational-Performance Model (PEOP) 3. Person-Environment-Occupation Model(PEO)

PEO-Major Concepts

-The Person: 'Unique being who assumes a variety of roles simultaneously' Mind Body Spirit Attributes Skills -The Environment: Physical Social Cultural Institutional Person Family Neighbor Community State/Province Country World -Occupations: GROUPS of self-directed, functional tasks and/or activities in which we engage over a lifetime. CLUSTERS of activities and/or tasks in which the person engages in order to meet his/her intrinsic needs for self-maintenance, expression, and fulfillment. NECESSARY function of living. EX: A MANAGER WHO frequently writes reports. -Activity: Recognizable and observable behavior. Basic unit of a task, a singular pursuit. EX: THE ACT of writing. -Task: A set of purposeful activities recognized by the task performer. EX: TO WRITE a report. -Occupational Performance -Temporal Aspects: Time, patterns, & rhythms that encompass occupational routines. Extended to their fullest, these represent the life span of a person.

Why are THEORIES important to OT Practice?

-Theoretical knowledge or ideas, when combined with the practitioners' personal and professional experiences, form the basis for professional ACTION.

Theory and Experienced OT Clinicians

-Theory assists experienced OTs' REFLECTIVE practice as they work to ARTICULATE the reasons for their actions, and EVALUATE THE EFFECTIVENESS of these actions against EXISTING theory and the responses of their clients.