Ecological Model - Readings PDF

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Schell Chap 43 pg 622-632 - Ariana Chap 44 pg 633-642 Christina Cole Chap 8 pg 107-115: Sam Chap 9 pg 117-124 Emily Chapter 43: Ecological Models in Occupational Therapy Pg 622-632 Introduction  Four Models o The Ecology of Human Performance (EHP) o The Person Environment Occupational Performance (PEOP) o The Person Environment Occupation (PEO) o The Canadian Model of Occupational Performance (CMOP/ CMOP-E) Intellectual Heritage - each of the ecological models draws heavily on social science ftheories that describe person-environment interactions (MOHO and Occupational Adaptation)  Health care practice is dominated by a focus on impairment in the person and interventions that are designed to fix that impairment - individuals with disabilities have challenged this perspective  People in the independent living movement pointed out that environmental barriers are typically the greatest impediment to a successful and satisfying life  The ecological models embrace the values of the disability movement - reflected in both the emphasis on the environment as a significant barrier and facilitator of occupational performance and the adoption of principles of client-centered practice Definitions  Person o The holistic view of the person acknowledges the mind, body and spirit  Values and interests - help to determine what is important and meaningful and enjoyable to the person  Skills and abilities - includes cognitive, social, emotional and sensorimotor skills as well as abilities such as reading  Life experiences - from the person's history and personal narrative  Environment - where occupational performance takes place and consists of physical, cultural and social components o Ecology of Human Performance model (EHP) - includes the temporal environment (made up of time-oriented factors associated with the person; developmental and life stages; and the task; when its takes place/how often/for how long) o Canadian Model of Occupational Performance model (CMOP-E) - includes the institutional environment o The physical environment is the most tangible - it includes built and natural features

The cultural environment is based on shared experiences that determine values, beliefs and customs o The social environment has many layers  Interpersonal relationships - family and friends  Work groups/ social organizations  Political and economic systems o Occupational performance cannot be understood outside of the context or environment - the environment can both create barriers to performance and enhance it Occupation or Task o Occupation used by the Person Environment Occupational Performance (PEOP), the Person Environment Occupation (PEO) and the Canadian Model of Occupational Performance (CMOP-E) o Tasks used by Ecology of Human Performance (EHP) - because the primary purpose of the model was to facilitate interdisciplinary collaboration - defined as objective representations of all possible activities available in the o

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Occupational Performance is the outcome that is associated with the confluence of person, environment and occupation factors

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The Person Environment Occupation Model (PEO) - Venn diagram is used to illustrate the meeting of person, environment, and occupational variables

The space in which the three circles come together is occupational performance o The Person Environment Occupational Performance Model (PEOP) - uses four circles instead of three - person and environment touch but do not overlap  Occupation and performance are two separate circles that overlap person and environment - these circles come together to form occupational performance and participation 

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The Ecology of Human Performance (EHP) - the person is embedded inside the context; with tasks floating all around

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The Canadian Model of Occupational Performance (CMOP-E) - occupation connects the person and environment with occupation as our core domain of interest Intervention Strategies o

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The performance range includes the tasks that are available to the person because of the existing environment supports and his or her own skills, abilities and experiences

Establish and Restore Interventions - targets the person and are aimed at developing and improving skills and abilities so that the person can perform tasks (occupations)  Ex. ROM exercises o Adapt and Modify Interventions - change the environment or task to increase the individual's performance range - involves change in social/physical environment  Ex. assistive devices o Alter Interventions - do not change the person, tasl or environment but are designed to make a better fit  OTs may overlook alter interventions because it does not appear that they are “doing” anything - however; alter interventions can be very effective because they take advantage of what is already naturally occuring o Prevent Interventions - are implemented to change the course of events when a negative outcome is predicted  Uses interventions that change the person (establish/restore), change the environment (adapt/modify) or make a better match (alter), but these occur before the problem develops o Create Interventions - do not assume that a problem has occurred or will occur but are designed to promote and enrich performance in context Assumptions of the Ecological Models  The relationships between people, environments and occupations are dynamic and unique - they interact continually and across time and space  The environment is a major factor in the prediction of successful and satisfying occupational performance - can either facilitate or inhibit  People, environments and occupations are constantly changing, and as these factors change, so does occupational performance  OT practice begins by identifying what occupations the person wants or needs to perform  OT practuce involves promoting self-determination and the inclusion of people with disabilities in all environments Application to Practice  Using an ecological model requires an intentional effort on the part of the OT to consider the environment as extensively as he or she considers the person  The person and OT collaborate throughout all stages of the OT process, and the process begins by identifying what the person wants or needs to do in her or her life  Once the person identifies the relevant area(s) of occupational performance, the evaluation process determines what features of the person, environment and occupation support or interfere with occupational performance o

Chap 44: Theory of Occupational Adaptation Page 633-642 Core Principle 1: Occupational Adaptation as an Internal Normative Process  Occupational Adaptation: a product of engagement and participation in occupations; a transaction with the environment; a manner of responding to change, altered situations, and life transitions; and a manner of forming identity

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1. Person: an occupational being with an inherent desire to master occupations through transactions with the environment 1. Enable the person to perform to and participate in occupations: cognitive, sensorimotor, and psychosocial systems b. Occupational Environment: includes settings and contexts that influence occupational performance and participation 1. Includes the physical and social environments and the temporal, virtual and cultural contexts 2. Asserts a demand for mastery from the person b. Occupational Participation: the mechanism for OA as an internal, normative process to manifest 1. Leads to increased adaptation which leads to improved occupational participation 2. Occupations have 3 important properties: 1. They require active engagement 2. They have meaning to the individual 3. They are goal oriented b. Press for Mastery: when the person and the occupational environment transact during occupational participation, the press for mastery is manifested 1. When the person perceives the level of demand of mastery , analysez the skill demands for the occupation, and assesses his or her desire for mastery of the occupation 2. Manifests as a series of simultaneously or concurrently occurring process, dependent on the features of the occupation and factors within the person and occupational environment 1. Occupational Roles: person defined set of behaviors based on expectations of society and are heavily influenced by culture and context 2. Occupational Challenges: based on the person’s current abilities, desire for mastery of the occupation and environment, and the assessment of the level of demand for mastery from the environment, certain occupational challenges may surface 3. Role Demands or Expectations: a combination of internal( those perceived by the person)/external(asserted by the occupational environment role demands 4. Occupational Responses: the person evaluates the level of occupational challenge, roles expected by society or assumed by the person and role demands 1. Adaptation gestalt: allows the person to assess how to respond and what responses to produce to achieve mastery and competence in occupational participation Adaptive and Dysadaptive Responses: o Adaptive Response Subprocesses: iterative process of identifying, producing evaluating, and modifying occupational responses to various occupational challenges to allow the person to participate in occupations with mastery and competence

Adaptive: overcome or help manage the occupational challenge and promote mastery and competence in the occupation o Dysadaptive: do not overcome the occupational challenge and may make the person feel “stuck” and unable to perform occupations and transact with the occupational environment with mastery and competence  Relative Mastery and Adaptive Capacity: Assessing Occupational Adaptation: o Relative Mastery: 1. Effective Participation: assessed based on how well people achieve their set of goals of occupational engagement and participation 2. Efficiency is a person’s good and appropriate use of available personal resources and resources in the occupational environment 3. Satisfaction: the extent to which people are content with their occupational performance and the congruence between occupational participation and performance expectations Core Principle 2: Occupational Adaptation as an Intervention Process:  Element 1: A Historic Approach and Participation Approach to Assessment: o Not only measure static outcomes but also assess the impact of intervention on the client’s engagement and personally meaningful life roles  Element 2: Reestablish Important Occupational Roles focuses on improving a client’s occupational adaptiveness based on important roles, the client is better able to participate in occupations and use and improve performance skills  Element 3: The Client is the Agent of Change o OA-guided intervention focuses on making the client the agent change in the therapeutic process.They must use therapeutic relationship to help facilitate the OA process within the client  Learning when to push and when to hold back  Facilitating the use of occupations  Facilitating the occupational environment  Element 4: Occupations are Central in Eliciting Adaptive Responses o Occupational Readiness: preparatory activities or performance skill-building approaches o Occupational Activities: facilitating client’s participation in actual occupations  Element 5: Increase Relative Mastery and Adaptive Capacity o OA guided therapy consistently assesses the client’s relative mastery and adaptive capacity during the therapeutic process Cole: Chap 9 pg 117-124- Emily  Ecology of Human Performance  Role of a person’s context and how these features from the environment impact a person and his or her task performance.  Ecology is defined as the transaction between people and their context o Focus  Varying ages and needs across the life span  Influence the theoretical assumptions of Ecology of Human Performance Model o

Person- unique and complex skills that fall within sensorimotor, cognitive, and psychosocial domains  Tasks- demands, and roles  Context- interdependent conditions that are within a persons’ surroundings  Temporal Aspects- chronological age  Environmental Aspects- physical (nonhuman aspects), social (norms, role expectations), cultural (customs and beliefs)  Personal- context-task- transaction o Theoretical Bases  Ecology  Practice application- relates to the environment  Human behavior or performance  Person, context, and task  Performance  Uses skills and abilities to “look through” the context and select the preferred tasks  Each person- is their own individual  Desire to seek tasks  Person’s performance range- transaction between the person and the context  Variables- continually changing  Contexts- are dynamic  Can shape or alter the context to fit their needs.  Transactional Relationship- occupations and roles  Own interpretation of what tasks are important to someone and how they fit into their lives as a part of role functioning  Performance in natural contexts- assessment and intervention shows natural performance enhanced in vito  Observe client doing the same task in different contexts to complete assessment.  OT- client- centered, empowering individuals by enhancing selfdetermination and include disabilities in all contexts  Advocating for the client  Independence- contextual supports to meet a person’s wants and needs  Reframe a clients problems and modify environment Function and Disability  High performance range of tasks  Numerous occupations and roles that match their person variables and natural contexts  Incongruency emerges  Unbalanced relationship Change and Motivation  Directly asking the person what he or she wants and needs 

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Perceptions and role functioning Agent of change- having the capacity to be the primary decision maker  Adapting the tasks or the environment o Evaluation Process  Summary list of guidelines during eval process includes:  Identify wants and needs and task priorities  Do a task analysis  Observe and evaluate functional degree of performance  Identify the desired contexts naturally  Analyze client’s perspective and evaluate external demands  Look at physical, social, cultural and temporal variables  Assess the person variables- sensorimotor, cognitive, and psychosocial functioning  Assess a person/ task/ context, goals and intervention strategies o Interventions Establish and Restore  Teaching skills not previously learned or restoring a lost skills. Alter  Context that allows the client to perform tasks with his current skills and abilities Adapt/ Modify  Modify the context or task for successful performance  Compensatory techniques Prevent  Minimize risks and avoid the development of performance problems Create  Promote enriching and complex performances in one’s context  

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