Intro to ot major models PDF

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INTRO TO OT MAJOR MODELS...

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PEO MODEL – PERSON, ENVIRONMENT & OCCUPATION PERSON – Skills, abilities, values, interests, life experiences Factors influencing the person: • Every person is unique • People assume a variety of changing and simultaneous life roles • Life roles vary across time, context and in their importance • The person is viewed holistically as a composite of the mind, body and spirit Skills Motor • Muscle strength, flexibility, agility, reaction time, endurance, speed, acceleration, dexterity, Sensory • Sight, listening, tasting, touch, proprioception, coordination, balance Cognitive • Logic, non-verbal communication, creativity, decision making, reason, interpretation, active listening, ability to communicate, problem solving Intrapersonal • Confidence, self-esteem, initiative, taking responsibility, emotional control, persistence/perseverance, resilience, values, interests, Interpersonal • Communication with others, relationship building, assertiveness, collaboration, counselling, diplomacy, empathy, sympathy, instructing ----------------------------------------------------------------------------------------------------------------------------------------------------------Illness Experience: People have different experiences of illness. The experience of illness is influenced by a person’s: • Perception of what is going on with them • Social and cultural context OT’s in Understanding Illness • Occupational therapists base their understanding of order and disorder on the occupational performance of the person in question Occupational performance may be affected by pathologies or it may diminish due to changes that are part of normal development • Performance occurs in normal life contexts, not just in clinical settings Why do people seek OT’s? • People seek occupational therapy when they are unable to complete the occupations (activities/tasks) that are important to them in their day to day lives. Understanding illness from individual perspective • Explanatory models - People seek to understand the nature and origins of the problem and what can be done about it • Illness and disability narratives - Listen to first person accounts chronicling key events, situations, personalities and factors: People telling the story of illness etc Maximising the fit: • Develop new skills and strategies, for example, Develop new cooking skills using one hand, learn memory strategies to help with weekly shopping •

Restore skills, for example, Increasing range of motion in hand to allow a person to dress them self Prevention, for example, Use of a cushion in a wheelchair to prevent pressure ulcers allowing a person to sit comfortably in their wheelchair while at work all day, use of splint to prevent deformities and manage pain while cooking Assumptions of THE PERSON  a dynamic, motivated and ever-developing being constantly interacting with environment  Constantly interacting with environment, always developing • •

ENVIRONMENT – Physical, social, cultural, socioeconomic, institutional – PEO CONT’D Physical • Built environment with physical layout e.g. home, work, leisure, community environments • Recognised strongly by community, can be a barrier to occupational performance o The observable layout of the environment (What you can see – surroundings) o Most obvious to us in everyday life o Recognised for it’s ability to enable or disable • Physical environment includes: o Home environment: Lighting, distances, surfaces o Work environment: Heights, objects, sound, access (ramps/stairs) o Leisure environment AND Community environment: Accessibility fir wheelchairs/equipment o Availability of modifications or equipment • The importance of Place: o (More than just the obvious) Physical places have meaning to people (home and sense of identity), critical point is the “meaning of home” – Key events, importance/significance to the person (life story / narrative) , safety comfort and freedom Social • People: Family, friends, work colleagues, neighbours, shop keepers, coaches, formal and informal caregivers • Attitudes: Held by people about those with disability – these can restrict people from participating OR promote inclusions • Social practice: Reasons why you would/wouldn’t include someone o Family: Impacts on priorities/vaules/beliefs and are likely to influence clients experience of illness/disability o More than ONE perspective in a family o Family can help shape goals, but can also be a barrier o Roles change, power relations change, daily activities change when Cultural • Customs, beliefs, activity patterns, behaviour standards, social expectations, language • Culture affects performance by prescribing norms for the use of time and space and influencing beliefs regarding the importance of activities, work and play. • It also influences what people do, how they do it and how important it is to them • Culture shapes what people desire to do • Culture drives values Socioeconomic • Financial situation, access • Individuals perception of what occupations they can and can’t participate, can be influenced by SES • Can also impact individuals access to resources Institutional • Policies, bureaucracies, practices, laws and regulations, health care Environments can enable or disable occupational performance Maximising the fit: • Environmental modification • Advocacy • Education Assumptions of the environment:  influences behavior and in turn is influenced by behavior  not static  can have an enabling or constraining effect on occupational performance

OCCUPATION– Self-care/Maintenance, Productivity and Leisure - PEO CONT’D Occupations are: person directed daily life activities that match, support or address identified participation goals Self Care/Maintenance • Showering/bathing, washing clothes/dishes, cooking, dressing yourself, Productivity • Working, studying, volunteering, playing (child - learning through play) Leisure • Based on the individual - examples include gardening, reading, sports etc. Hierarchy of occupations: Positions in society having expected responsibilities and privileges Roles:  A set of behaviours that have socially agreed upon function and for which there is accepted norms  Shaped by culture and society  Role identification occurs when we see ourselves as students, parents, workers etc.  We recognise that we have certain statuses or positions  This is reinforced when other people recognise and respond to us as having these positions Occupations: Client-directed daily life activities that match and support or address identified participation goals. • Laundry • Shopping • Cleaning Activities:

Actions designed and selected to support the development of performance skills and performance patterns to enhance occupational engagement. Activities often are components of occupations and always hold meaning, relevance, and perceived utility for clients at their level of interest and motivation.  a set of purposeful actions/behaviours that contribute to the overall performance of the occupation  combinations of actions that share a common purpose  are recognised by the performer  supported by skills/proficiencies Actions Observable behaviours that are recognisable • Scrubbing • Reaching

Life Role: Mother Occupation: Cleaning Activities / Tasks: Picking up clothes, Washing clothes, hanging clothes up Actions: Reaching for clothes, Bending, Reaching to hang clothes up Occupation and Health: • Health is a recourse that people create in their everyday lives, using either physical capabilities and personal resources • Health referred to as the ability to engage in activities, fulfil life roles and meet demands of daily life Occupation and well-being: • Well – being = a persons subjective perception about their mental, physical, social and spiritual health • Arising from things that provide meaning, fulfilment, and purpose • OT’s believe people achieve a sense of well-being through engagement in occupation Maximising the Fit: Adapt/modify activities, tasks and habits • Change in usual technique eg. Poach eggs in microwave instead of on the stove top • Choose easiest technique eg. Tying shoe laces • Modify the occupation eg. computer for notetaking instead of handwriting, gardening in a raised garden bed Simplification of tasks • Reduce task steps/ rest breaks Education • Teach clients how to do tasks

Processes that guide PEO MODEL Occupation Centred Practice: Occupation-based practice addresses the occupational needs of clients: • Self Care • Productivity • Leisure Person Centred Practice: “We focus on what the individual needs, wants and is expected to do” • This means that they identify their own goals and collaborate in making decisions • Key to helping people is to understand from their perspective what is important to them • Person-First Language: Language used reflects the client as a person first and the condition second (E.g. NOT “asthmatic” but instead “person with asthma”) • Choices: The person is offered choices and is supported in directing the process • Access to intervention: Intervention is provided in a flexible and accessible manner How to be person centred? • Environment: the person in the context of their family, friends, socioeconomic status, culture etc. • Person: the person’s identity that is bound up in the enactment of their life roles eg. student, worker, mother, soccer player •

Occupations: the activities people need, want and are expected to do Life story: The client’s past, present and future story

What does person centred practice involve? The Person: • Life roles, priorities, capabilities – physiological, cognitive, and psychological The Occupation: • Steps involved, activities and tasks associated with this occupation, time each task/activity takes, cognitive, physical, psychological demands of the occupation Environment: • Elements of context that impact on occupations E.g. social, cultural and physical demands Evidence based practice: OT’s engaging in research to further promote the development and knowledge base of occupational therapy. Therapists need to: • Access • Evaluate • Interpret relevant research • Implement EBP throughout all stages of the OT process Stages of the OT Process: • Evaluation • Intervention • Re-evaluation Types of narratives: • Restitution: Client tells a story from a resolved perspective, where their experience with medicine helped them to return to good health. It is often a positive story linked to western medicine. • Chaos: these stories maybe difficult to listen to, as they are out of control with issues unresolved. The client may still be involved in the experience, they've not had an opportunity to reflect and extract positive outcomes from the experience. • Quest: Usually provide the transformation of a persons experience, where the client confronts serious illness or disability. In turn finds themselves empowered by embracing their ability to engage in activities they have control over and their interaction with their community is positive.

OT History (Week 2 Content) How the wars impacted OT? • WW1 (Post) : Decline and closure of training schools, INCREASE for OT’s in hospitals – TB and deconditioning, general medical patients, benefits of OT seen in war now applied to paediatric care, Mental illness. Overall lead to a steady growth in profession • WW2: Overall expansion of the profession, Not enough OT’s, Occupational therapy developed in Australia o OT became reductionist :rehabilitation VS occupations • WW2 Large impact: War survivors had long stays in hospital and required more rehabilitation (less craft ore job related occupations), the change in medical technology led to many wounded survivors . Reductionist approach and what it means? • The view that a system can be fully understood in terms of its isolated parts • Moving away from a humanistic / holistic understanding of health and well-being • People are viewed as machines with parts that go wrong Humane movement? • Moral treatment Mental Health treatment? • Moral Treatment (Samuel Tuke) : Was the advocacy for the humane treatment of the mentally ill. E.G. clothing to be worn, daily habits encouraged, participation in work and exercise. Australia’s participation in OT History: • During WW2 OT was developed in Australia • By 1939 there were already 3 OT’s in AUS • Sylvia Docker: A physio trained in England returned to AUS in 1938 established training centres in 1942, and eventually the OT club, and later founded the Australian Association of Occupational Therapists 1948.

CMOP-E – CANADIAN MODEL OF OCCUPATIONAL PERFORMANCE AND ENGAGEMENT Features • • •

Client centred Focus on enablement Champions occupational engagement

Process • • • •

OT requires both enablement and client-centred practice Client centred Focus’s on client goals in relation to occupational performance Is collaborative in relationship to enable engagement in everyday life

Performance VS Engagement • • • •

Performance has a dynamic interaction with the person, occupation and environment CMOP-E was expanded to include engagement Engagement is broader in context to engagement Engagement includes what we do to occupy time, involve our self in occupation, and participate

Developmental perspective • • •

Acknowledges the changes over a lifespan E.g. birth, infancy, childhood, adolescence, adulthood and old age Experience over lifetime is cumulative Compensation and adaption are important concepts over time

Order and Disorder • • •

Order and disorder is evaluated in terms of performance and satisfaction Disorder may occur in the person, environment, or occupation Disorder may occur when the momentum of experience is lost

Example of CMOP-E used to analyse performance issue Issue: Unable to shop for groceries • • • •

Lacks strength to carry bags Cannot remember grocery items No delivery service from local shop Gear of shopping alone

Performance components in CMOP-E Physical and cognitive performance: Strength and memory Affective: Fear Physical environment: Large heavy bags Social environment: No delivery Occupation: Occupation is the bridge Purposes of Occupation • •

Leisure: Occupations for enjoyment o Socialising, creative expressions, outdoor activities, games and sports Productivity: Occupations that make a social or economic contribution, provide economic substance

Play in infancy and childhood, school work, employment, homemaking, parenting, community volunteering Self care: Occupations for looking after self o Personal care, personal responsibilities, functional mobility, and organisation of space and time o

• Person:

Spirituality • • • • •

Innate sense of self Quality of being uniquely and truly human Expression of will, drive and motivation Source of self-determination and personal control Guide for expressing choice

Performance components of a person • •

•

Affective: (feeling) the domain that comprises all social and emotional functions and includes both interpersonal and intrapersonal factors Cognitive: (thinking) the domain that comprises all mental functions both cognitive and intellectual, and includes, among other things, perception, concentration, memory, comprehension, judgement and reasoning Physical: (doing) the domain that comprises all sensory, motor and sensorimotor functions

Environment Elements of an environment • • • •

Cultural: Ethnic, racial, ceremonial and routine practices, based on ethos and value system of particular groups Institutional: Societal institutions and practices, including policies, decision-making processes, procedures, accessibility and other organizational practices. Includes economic, legal and political components Physical: natural and built surroundings that consist of buildings, roads, gardens, vehicles for transportation, technology, weather, and other materials Social: social priorities about all elements of the environment, patterns of relationships of people living in an organized community, social groupings based on common interests, values, attitudes and beliefs

PEOP – PERSON, ENVIRONMENT, OCCUPATION PERFORMANCE MODEL • • • •

Supports client-centred practice The narrative helps synthesise and interpret data from the client to interpret needs, choices and goals ‘Top down’ approach for problem identification and problem solving Model is a tool for therapists to organise knowledge, and plan interventions

Assumptions • • • •

People are naturally motivated to explore their world and demonstrate mastery within it People set and achieve goals that contribute to their development throughout life Settings in which people experience success help them feel good about themselves o this motivates them to face new challenges Through occupations, people develop: Sense of identity and fulfilment

Person Component Physiological Cognition Spirituality Sensory

Psychological Motor

Examples Physical health and fitness Attention, memory, decision making Meaning in everyday occupations Sensing and perceiving

Personality traits, self esteem, motivation Motor control, motor planning, posture

Comparison to other models Similar to biomechanical in OPMA aspect of physical in CMOP-E Same in others Same in others Separated sub-system in this model, included in sensory motor In OPMA Similar to intra/interpersonal in OPMA affective in CMOP-E Separated sub-system in this model, included in sensory motor in OPMA

Environment Component Culture Social determinants and social support and social capital Education and policy Physical and Natural Assistive technology

Example Values, beliefs, customs, rituals, time use Social support, practical support, relationships, networks, includes societal attitudes, and formal laws Access to and availability of societal resources Built environment and it’s accessibility; natural environment eg. Terrain, climate, air quality Tools and assistive technologies eg. Shower chair

Occupation • • •

Occur when people act with intention within environments Goal-directed pursuits that typically extend over time, have meaning to the performer and involve multiple tasks Includes activities, tasks and role

Occupational Performance •

Occupational performance supports participation and well-being

Participation • •

Interaction of capacity (person), environment and chosen occupation lead to performance and participation Participation = engagement in society

Link to the World Health Organisation International Classification of Functioning (WHO ICF) model concept of participation and its relationship to health Hierarchy of Occupational Behaviours Term Roles

Occupations

Tasks

Actions Abilities

Meaning Positions in society having expected responsibilities and privileges Goal-directed pursuits that typical extend over time, have meaning to the person and involve multiple tasks Combinations of actions sharing a common purpose recognised by the person Observable behaviours that are recognisable General traits or individual characteristics that support occupational performance

Example Parent, homemaker

Shopping

Making a grocery list

Lifting, Carrying Attention, motor control, communication

OPMA – OCCUPATIONAL PERFORMANCE MODEL AUSTRALIA • • • •

Illustrates the complexities of occupational performance Framework for OT education Scope of practice Relationship is activated through occupation

Assumptions of OPM-A • Assumptions about human occupations o View people from a holistic perspective (mind, body and spirit) o Engagement in occupation: provides a sense of reality, mastery, competence and autonomy, and involves interaction between people and environment] o Health not merely absence of disease but competence and satisfaction in performance of occupational roles, routines and tasks o Humans are active in cre...