OT Models

Occupational Therapy Models

Within the Occupational Therapy profession, models are utilised to support all aspects of the therapy process including assessment, goal setting, intervention and evaluation. Models provide a framework to support a therapist in organising, interpreting and utilising data in a holistic manner. Our therapist utilise a wide range of models (some are briefly described below) as tools to support their clinical judgements.

OPMA 

Occupational Performance Model of Australia

This model was developed by Chris Chapparo and Judy Ranka to “to illustrate the complex network of factors involved in human occupational performance, and the domain of concern of occupational therapy”.

It supports therapists in framing their therapy to achieve occupational performance e.g. “how are leisure activities being impacted by interpersonal factors?”. The complexity of these factors and their interactions are illustrated within the model by interlocking lines (see image).

MOHO

Model of Human Occupation

The MOHO was developed to support therapists in addressing factors beyond motor, cognitive and sensory domains e.g. physical and social environments, sense of meaning in occupations etc. On a personal level it considers

• Volition: observes motivation for occupation

• Habituation: observes the process of organising actions into habits and roles

• Performance capacity: observes underlying physical and mental abilities in relation to the task

From an environmental perspective, the MOHO considers not only physical space, but includes aspects of culture, political and economic features.

In considering these factors, the MOHO provides insight into occupational challenges through the lens of volition, habituation, performance capacity and the environment in, which occupation occurs.

 

THE KAWA Model

This model offers a client-centered model, where client is the supported to determine what is meaningful across four domains through the metaphor of a river as “life’s journey”:

1.  life and overall occupations (river)

2.  environments / contexts, social and physical (river banks)

3. circumstances that block life flow and create challenges (rocks)

4. personal resources that can be barriers or facilitators (driftwood)

From this perspective, Occupational Therapists, serve to support clients in uncovering what is important to their lives and how they can work together to achieve their goals.

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Further reading

OPMA: http://www.occupationalperformance.com/

MOHO: https://www.moho.uic.edu/default.aspx

KAWA: http://www.kawamodel.com/v1/

Your OT Pathway - ReBOOT

Early Links work under a newly defined REBOOT Framework for clinical reasoning and interdisciplinary practice. The aim of this framework is to provide a process for health professional to communicate their knowledge with clients and other key personnel, outside of a health profession. By presenting the models of practice and academic influences that the Early Links Team use to guide their decision making, we aim to increase your understanding of how Occupational Therapy can make daily life easier.

There's no doubt; we all have a different story and different experiences to share which influence the challenges we have, but this framework and additional models for practice allow our Occupational Therapists to find the gaps in learning, development, abilities and supports which can be improved to achieve more meaningful participation in activities you enjoy or need to do.

Domains of Ability

• Sensory

• Motor Patterns

• Self-Awareness

• Self-Regulation

• Emotional Regulation

• Cognition

• Motor Planning

• Social

• Community Awareness

• Executive Function

REBOOT PATHWAY

The REBOOT Framework has a training package which Occupational Therapists complete to strengthen their clinical reasoning and artful use of intervention techniques. 

The REBOOT Framework can provide a snapshot of any situation, while also supporting discussion about therapeutic planning and goals setting.

More information about the academic content is due for release in late-January, including outlines for how various models and frames of reference have influenced the development of the REBOOT framework. 

Click here to be informed when this is released

Clinical Reasoning

"STEP-SI" CLINICAL REASONING MODEL

The STEP-SI model is utilised by our Occupational therapists to support holistic service delivery. It was developed as a tool by Stackhouse, Trunnell and Wilbarger for facilitation of clinical reasoning between occupational therapists, parents and other health professionals.

The approach is divided into 6 dimensions for therapists to consider:

1. Sensation

2. Task

3. Environment

4. Predictability

5. Self-monitoring

6. Interactions

Our therapists utilise STEP-SI to provide scaffolding on multiple levels of the therapy process including: assessment, goal setting, direct intervention and home/community programs. As each client we see is unique, the STEP-SI enables our therapists to reason deeply for provision of individualised and effective therapy.   

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Research

Bundy, A. C., Murray, E. A., Lane, S., & Fisher, A. G. (2002). Sensory integration: Theory and practice (2nd ed.). Philadelphia: F.A. Davis.

Stackhouse. T. M., Trunnel. S. L., & Wilbarger. J. L. (1997). Treating sensory modulation disorder: The STEP-SI: A tool for effective clinical reasoning. Denver: The Children’s Hospital

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The importance of clinical reasoning within a registered health profession.
The benefits of seeing a health professional to help ccordinator care and overall achievement

Other models and theories

S-PaCe Goal Setting Method

S-PaCe Goal Setting

In 2013, a systematic review of goal setting processes in Occupational Therapy was undertaken by researchers, who suggested there was no one gold-standard in goal setting in allied health. However, there were three key attributes of goal setting which were common among frequently used tools, and which accounted for best-practice in goal setting - 

• Specific information related to the achievement in written format

• Easily accessible format which encouraged client-participation and considered client confidence, including indications for client perceptions of their current skills

• Rating scales which accounted for health professionals knowledge

SMARTS

Long-term and overall goal of attending Occupational Therapy.

Specific

Who will achieve?
What does it look like, feel like, sound like when achieved?
How does this achievement make daily life easier?

Measurable

Who will give feedback relating to current performance?
What will they observe within their feedback?
How can these observations be tracked - objectively & subjectively?

Achievable

What resources or equipment are required?
Who else needs to be involved in this partnership?

Realistic

What has been achieved in the past to make the SMART realistic?
Why now? 

Timeframe

This is a predicted time when the SMART goal will be reviewed, to account for any limitations which may have been discovered through assessment or therapy progression, also to account for changes in the client's consideration of meaningful, purposeful achievement. Check-in times are also written into the SMART goal for the short-term PaCe goals.

Signed

To provide additional accountability and inspiration to achieve the SMART goal, clients are encouraged to have additional members of their support network and healthcare team sign the S-PaCe Goal Setting form.

Multiple short-term goals are set throughout the achievement timeline of the SMARTS goal and the "PaCe" component is repeated until the SMARTS goal has been achieved. The CAPITAL letters represent a client-lead component of the method, while the lower-case letters represent a therapist-contribution to the knowledge required to inform goal setting

Perception of skills

Clients will know best where the most challenging times of their day are, and most of the time they realise where the greatest amount of improvement is required to progress towards their goals. The "how" is the tricky part.

By choosing one (or maybe two) observable skills which can serve as monitoring points for achievement and progression towards the SMARTS goals, the client can review their progress. Tracking their perception of skills within this activity serves as measure of how much daily life is becoming easier, and allows for the measurement of change which has been generalised to daily life, outside of behaviours or skills which have been directly practiced during therapy sessions of home program exercises. 

abilities required

The Occupational Therapist will use clinical reasoning to decide which underlying abilities are likely to have the most significant positive impact on achieving the PaCe goal once their assessment and reflection process is completed. The clinical reasoning process is a highly developed skill, in which the Occupational Therapist weights up, judges, analyses, and chooses the most appropriate next steps after considering information from all of the following categories - personal history, culture, social, virtual experience, physical environment, roles, activities of daily living, skills, supports, expectations, medical health, body structures, internal functions, development of; sensory, emotions, self-regulation, movement patterns, motor co-ordination, cognition, social, self-awareness, community awareness, executive functions, and finally the here/now of your situation... it's an exhaustive list of considerations, but that's why Occupational Therapists study these thinking patterns for four(4) years at University!

Confidence

Once the Occupational Therapist has clinically reasoned which abilities are likely to have the most positive impact on achieving the PaCe goals, the client is asked to "rate [their] confidence in achieving the PaCe goals given the abilities within the plan/program the OT shared with [them]" - using a 0 - 10 scale, where zero is no confidence, and 10 is highly confident. This score is used to guide the level of education, review, and coping strategies that are required within the therapy program.

evaluation

A scale score of between 0 - 10 is applied to each of the abilities the Occupational Therapist has recorded as the primary contributors to achieving the goal. There is no set-scale for the observations at each scale level (although perhaps in the future there will be a comprehensive list...), these scores represent the clinical reasoning from the health professional relating to the impact the chosen abilities have on the continuing achievement of the PaCe goal.