MODEL OF HUMAN OCCUPATION

        

                     MODEL OF HUMAN OCCUPATION

                                 

1.      HISTORY:

·         This was first devised by kielhofner burke and lgi in the late 1970 and early 1980s kielhofner etal 1980and was revised and refined in the the early 1990s.The model of human occupation :theory and application kielhofner 1995

·         MOHO became the first client-centered model by looking beyond impairment to other client-related factors affecting occupational performance

·         The model was originally based on an open systems theory  but later thinking related it more to chaos theory and dynamic system theory those emphasis the dynamic nature of occupation al performance and the role of occupational performance in maintaining a systems organization and achieving changes  

·         Kielhofner also believes that action is central force of  health, wellbeing, development and changes  

2.      THEORY:

·         MOHO is ultimately concerned with individuals’participation and adaptation in life occupations

2.1  Volition

·         Volition is the process by which people are motivated toward and choose the activities they do. It begins with the universal human desire to do things and is shaped by life experiences. Volition consists of thoughts and feelings that occur in a cycle of:       

Ø  Anticipating possibilities for doing 

Ø  Choosing what to do

Ø  Experiencing what one does

Ø  Subsequent interpretation of the experience 

·         The thoughts and feelings that make up volition are referred to as personal causation, values, and interests

Ø  Personal causation refers to the thoughts and feelings about personal capacities and effectiveness that people have as they do everyday activities

Ø   Values are beliefs and commitments about what is good, right, and important to do

Ø   Interests are generated through the experience of pleasure and satisfaction in occupation

·         Volition has a pervasive influence on occupational life.

Ø  How people see the opportunities and challenges in their environment

Ø   What people choose to do

Ø  How they experience and make sense of what they have done

·         Occupational therapy based on MOHO often involves identifying and addressing clients’ volitional problems 

2.2  Habituation

·         Habituation is a process where by people organize their actions into patterns and routines

·         Habits involve learned ways of doing things that unfold automatically

·         Roles give people an identity and a sense of the obligations that go with that identity  Learning a new role involves internalizing an identity, an outlook, and an expected way of behaving 

·         One of the major tasks of therapy is to construct or reconstruct habits and roles so that the person can more readily participate in everyday occupations 

2.3  Performance capacity

·         Performance capacity refers to underlying mental and physical abilities and how they are used and experienced in performance The capacity for performance is affected by the status of musculoskeletal, neurological, cardiopulmonary, and other bodily systems that are called on when a person does things

·         Performance also calls on mental or cognitive abilities such as memory

·         MOHO stresses the importance of also attending to the experience of performance and, in particular, the experience of having limitations in performance

2.4   MOHO Concepts Concerning the Environment

·         MOHO stresses that occupation results from an interaction of the inner characteristics of the person (volition, habituation, and performance capacity) with the environment 

·         The environment includes the particular physical, social, cultural, economic, and political features within a person’s context that influence the motivation, organization, and performance of occupation .The environment includes:

Ø  The objects that people use when they do things

Ø   The spaces within which people do things

Ø   The occupational forms or tasks that are available, expected, and/or required of people in a given context

Ø   The social groups that make up the context

Ø  11 The surrounding culture, political, and economic forces

2.5  Dimensions of Doing

·         MOHO identifies three levels for examining what a person does:

Ø  Occupational participation refers to engaging in work, play, or activities of daily living that are part of one’s sociocultural context and that are desired and/or necessary to one’s well-being

Ø  Occupational performance is the process of doing such occupational forms or tasks

Ø   Occupational skills are the purposeful actions that make up occupational performance. Skills are goal-directed actions that a person uses while performing

Ø  Categories of skills include motor, process, and communication and interaction skills 

2.6  Occupational Identity, Competence, and Adaptation

·         Occupational identity is a person’s cumulative sense of who they are and wish to become as occupational beings The degree to which people are able to sustain a pattern of doing that enacts their occupational identity is referred to as occupational competence

·         Occupational adaptation refers to the process of creating and enacting a positive occupational identity 

·         An occupational narrativeis a person’s story that integrates across time one’s unfolding volition, habituation, performance capacity, and environments and that sums up and assigns meaning to these elements 

·         Research has shown that occupational narratives predict future adaptation of occupational therapy clients

2.7   Change and the Process of Therapy

·         MOHO asserts that all change in occupational therapy is driven by clients’occupational engagement (i.e., clients’doing, thinking, and feeling under certain environmental conditions in the midst of therapy or as a planned consequence of therapy). Each of these aspects of what the client does, thinks, and feels is essential to the process of therapy

3.      PRACTICE RESOURCES:

 

3.1  Therapeutic reasoning

                         Therapeutic reasoning must be client centered

Ø  The process reflects a deep appreciation for the client’s circumstances

Ø  The client is involved in the process to the extent possible Therapists may move back and forth between the steps of therapeutic reasoning

                        Therapeutic reasoning is a process for MOHO concepts and resources to                  understand and address clients’needs. Therapeutic reasoning involves six steps:

1.      Generating questions about the client

·         Therapists must understand their clients before planning therapy

·          This understanding begins with asking questions about each client derived from MOHO concepts

2.       Gathering information on, from, and with the client

·         Therapists must gather information on, from, and with the client in order to answer the questions they have generated about the client

·          Such information gathering may take advantage of informal, naturally occurring opportunities

·          Therapists also use structured MOHO assessments:

-          Assessment of Communication and Interaction Skills (ACIS)

-          Assessment of Motor and Process Skills (AMPS)

-          Assessment of Occupational Functioning- Collaborative Version (AOF-CV)

-          Child Occupational Self Client  Assessment (COSA)

-          Interest Checklist

-          Model of Human Occupational Observation, Screening Tool (MOHOST)

-          NIH Activity Record

-          Occupational Circumstances Assessment-Interview and Rating Scale (OCAIRS)

-          Occupational Performance History Interview-II (OPHI-II)

-          Occupational Questionnaire (OQ)

-          Occupational Self-Assessment (OSA)

-          Pediatric Interest Profiles (PIP)

-          Pediatric Volitional Questionnaire (PVQ)

-          Role Checklist

-          Short Child Occupational  Profile (SCOPE)

-          School Setting Interview (SSI)

-          Volitional Questionnaire (VQ)

-          Worker Role Interview (WRI)

-          Work Environment Impact Scale (WEIS)  

3.      Using the information gathered to create an explanation of the client’s situation

·         Information that therapists gather to answer questions about their clients is used to create a theory-based understanding of those client

·         As part of creating a conceptualization of clients’circumstances, therapists identify problems or challenges to address as well as strengths that can be built upon in therapy

4.      Generating goals and strategies for therapy

·         The theory-based understanding of clients is used to generate therapy goals, decide what kinds of occupational engagement will enable the client to change, and determine what kind of therapeutic strategies will be needed to support the client to change

·         Change is required when the client’s characteristics and/or environment are contributing to occupational problems or challenges

·          The next element in this step is to identify how the goals will be achieved

5.       Implementing and monitoring therapy

·         Monitoring how the therapy process unfolds may confirm the therapist’s conceptualization of the client’s situation or it may require the therapist to rethink the client’s situation

·         The monitoring process may confirm the utility of the planned client occupational engagement and therapist strategies or it may require the therapist to change the therapy plan

·         When things do not turn out as expected, the therapist returns to earlier steps of generating questions, selecting methods to gather information, conceptualizing the client’s situation, setting goals, and establishing plans.

6.      Determining outcomes of therapy

·         Typically, therapy outcomes are documented by examining the extent to which goals have been achieved and readministering structured assessments to determine whether the client’s scores have improved

4.      INTERVENTION:

·         A large number of MOHO-based programs and standardized protocols for intervention have been developed and published 

·         The Remotivation Process is a standardized intervention developed for clients of any diagnosis who have significant volitional problems 

·         The Remotivation Process involves three levels of intervention (exploration, competence, and achievement); the level that one begins with depends on the severity of the volitional problem

Modules	Goals	Stages and (Strategies)
Exploration	Facilitate a client’s basic sense of capacity Facilitate a sense of security with the environment Facilitate the client a of personal significance	Validation (significant greeting; introduction of meaningful elements into the individual’s personal space; participation in activities of interest to the individual; generating interaction) Environmental exploration (introduce change to allow for exploration; keep a familiar routine for sense of security amid novelty) Choice-making (increase novelty [new settings, people, etc.]; increase invitations for participation) Pleasure and efficacy in action (facilitate participation in collaborative projects; incorporate feedback; facilitate a sense of life story)
Competency	Increase emerging sense of efficacy  Begin looking at experiences as they relate to meeting goals Develop a sense of responsibility with personal and collective projects	Internalized sense of self-efficacy (provide physical or emotional “accompaniment” in new and challenging situations; facilitate skill learning when appropriate; introduce the counseling process and use of feedback ) Living and telling one’s story (allow for “moments of reflection” or disorder in change process; continue counseling process to further insight through more in-depth analysis and questions)
Achievement	Autonomy in a variety of settings Striving for personal goals; making occupational choices Seeking new challenges in relevant occupational environments Continued learning of critical skills and new strategies/tools for seeking and confronting challenges	(Advise client; give feedback; provide information and resources; step back)

·          A manual details how to undertake this intervention protocol; it includes specific assessment guidelines, explanations and examples of the stages, steps and strategies of the intervention, and case examples of clients receiving Remotivation services

·          The Enabling Self-Determination Program was developed to enhance productivity and participation in persons facing substantial personal and environmental challenges 

·         The program helps clients examine their own volition, lifestyle, and skills and begin a process of identifying personal goals for enhanced productivity

·          Because the therapeutic reasoning process is individualized, therapists can benefit from case examples that illustrate the process

·         Kielhofner and forsyth also identified nine therapeutic strategies fo enabling changes:

Ø  Validating clients experience ,perspective and efforts

Ø  Identifying factors that could facilitate change

Ø  Giving feedback

Ø  Providing advice

Ø  Negotiating with clients

Ø  Structuring clients occupational engagement

Ø  Coaching which includes instructing demonstrating ,guiding and providing verbal and or physical prompt

Ø  Encourage clients to explore  practice and persist in their efforts

Ø  Providing physical support