DEVELOPMENTAL FRAME OF REFERENCE

                      DEVELOPMENTAL FRAME OF REFERENCE

1.      THEORETICAL BASIS:

·         Human Developmental Frame of Reference, also known as the lifespan development frame of reference (Bruce and Borg 1993; Cole and Tufano 2008)

·         The developmental FOR suggests that development is sequential and behaviors are primarily influenced by the extent to which an individual has mastered and integrated the previous stage.

·         This FOR includes six adaptive skills

Ø  Sensory integration skills

Ø  Cognitive skill

Ø  Dyadic interaction skills

Ø  Group interaction skills

Ø  Self-identify skill

Ø  Sexual identify skill

·         Mastery of skills to an age appropriate level in all areas of development is necessary to achieve satisfactory coping behaviour and adaptive relationship.

·         Occupational therapy prevents developmental of maladaptive behaviour and skills and promote growth and developmental links to close the gap between the expectation and ability through skilled application of activities and relationships.

·         To facilitate the development of particular skills.

2.      THEORY:

·         Erickson jung: psychosocial

·         Freud: psychosexual

·         Piaget: cognitive

·         Kohlberg: moral reasoning

3.      AIMS GOALS:

·         Goals the occupational therapist uses activities and relationships to facilitate growth and development.

·         To increase skills in all areas, with emphasis being placed on the main area of deficit so that the gap is narrowed or closed between expected coping behavior for the individual’s chronological age and actual adaptive ability.

·         To learn the skills needed for the next stage of development.

·         Occupational therapy is also concerned with maintaining health and preventing maladaptation through early detection of problems and early intervention.

·         This allows the individual to continue the growth process with a minimum of disruption or maladaptation.

·         Intervention may be particularly effective in helping people adapt to change at times of transition, such as starting a family or retiring (Cole and Tufano 2008).

4.      ASSUMPTIONS:

·         Basic Assumptions About People People are dynamic, developing organisms whose lives go through predictable stages of growth and decline that necessitate adaptation by the individual.

·         Development can be thought of as a process in which the key elements are the individual, society and the  person’s own activity (Fortmeier and Thanning 2002).

·         Developmental achievements are not necessarily permanent: regression to an earlier level can occur. Although it is possible to identify the average age at which someone might reach a particular developmental stage, there is a wide variation between individuals and across cultures.

·         People develop at different rates, they encounter different environmental opportunities and barriers and their ‘development can be understood only in light of the cultural practices and circumstances of their communities’.

·         Age ranges can be suggested for particular skills to be mastered but these are not absolute and are mainly useful for checking whether development in all skill areas is proceeding at the same pace.

·         Each stage of development can only proceed normally if the preceding stages have been completed successfully and the conditions for further development are in place. Incomplete development in one area of skill, or in one life stage, will influence subsequent development.

·         Early patterns of development influence the personality structure of the adult but growth and development continue into adulthood and middle age.

·         Maladaptive or incomplete development can be remediated at any age by recapitulating earlier developmental stages (Mosey 1968).

5.      HUMAN GROWTH AND DEVELOPMENT:

·         Llorens (1970) model of human growth and development on 10 premises:

1.      A person develops in parallel the areas of neurophysiological, physical, psychosocial and psychodynamic growth, social language, daily living and sociocultural skills

2.      All these areas continue to develop throughout the person’s life

3.      Mastery of skills to an age-appropriate level in all areas of development is necessary to the achievement of satisfactory coping behaviour and adaptive relationships

4.      Such mastery is usually achieved naturally in the course of development

5.      Intrinsic factors and external stimulation received within the family environment interact to promote early growth and development

6.      The later influences of the extended family, community and social groups assist in the growth process

7.      Physical or psychological trauma can interrupt the growth and development process

8.      Such interruption will cause a gap in the developmental cycle resulting in a disparity between expected coping behaviour and the skills necessary to achieve it

9.      Occupational therapy can provide growth and developmental links to assist in closing the gap between expectation and ability through the skilled application of activities and relationships

10.  Occupational therapy can provide growth experiences to prevent the development of maladaptive behaviour and skills related to insufficient nurturance.

6.      KNOWLEDGE BASE:

·         The developmental frame of reference is based on theories of human development covering all skill areas:

Ø  Physical

Ø  Sensorimotor

Ø  Intellectual

Ø  Language

Ø  Psychosocial

Ø  Psychosexual

Ø  Moral and spiritual development

7.      EVALUATION:

·         Assessment tools used with in frame of reference include the meaning of objectives interview  and observation of relationship in group

·         The therapeutic elements:

Ø  Action of the clients

Ø  Objectives used in or result from action

Ø  Human and non-human environment

Ø  Interpersonal relationship

·         Four levels, in interaction with the environment (Fortmeier and Thanning 2002):              

Ø  Functions are the motor and sensory requisites for action, such as muscle tone, perception and sensory-motor coordination. 

Ø  Operations are the procedures through which functions are translated into action. The more operations a person can perform, the greater will be their range of occupational choices.

Ø  Activity includes: general abilities, such as setting goals; theoretical abilities, such as having knowledge and skills in a particular subject, and social abilities, such as collaborating with others.

Ø  Consciousness of the world and of one’s own place in it enables people to develop a sense of identity and gives them the capacity to assume responsibility for their own lives.

8.      ASSESSMENT:

·         Appropriate assessment methods include interviews, observation, review of records, projective techniques, tests and collaboration with care givers.

9.      INTERVENTION:

·         It is necessary to meet an individual’s needs at their present developmental level if further development is to take place, so intervention takes the person’s present level of development as the starting point (Llorens 1970).

·         Activity theory

Ø  Activity theory (Fortmeier and Thanning 2002) tells us that each person has an actual developmental level, which determines what can be performed independently, and a potential developmental level, which is the area in which further learning can take place.

Ø  The distance between the actual and potential developmental levels is called the zone of proximal development (ZDP). A person can perform tasks in the ZDP with support from others.

Ø  Skills are developed most effectively through performing activities (Fortmeier and Thanning 2002) so that basic functions, such as attention and listening, become integrated in performance.

Ø  It is important for the occupational therapist to take the individual’s ZDP as the starting point for selecting therapeutic activities in order to present demands that slightly exceed the person’s abilities.

·         Intervention continues until the individual has attained an age-appropriate level of adaptive skill in all areas, or has attained sufficient skill to be able to function adequately in their expected environment, or has reached what seems to be their highest possible level of achievement.

·         Intervention techniques include activities, relationships and environments.   

Ø  Activities are analysed and selected for their potential to facilitate the development of particular skills and combined with a suitable type and level of interpersonal interaction to achieve the maximum benefit.

Ø  The person’s human and nonhuman environments are organized, as far as possible, to provide the appropriate stimulation and support for learning.

10.  FUNCTION –DYSFUNCTION:

·         Function

Ø  A functioning individual is one who achieves satisfactory coping behaviour and adaptive relationships by developing appropriate skills, abilities and relationships throughout the lifespan.

Ø  These adaptive behaviours allow the individual to adjust to both internal needs and external demands.

Ø  Growth and development can be disrupted or delayed by congenital or acquired disease or injury, or if the conditions for normal growth and development are absent.

·         Dysfunction

Ø  Dysfunction occurs when the developmental level of the individual, in any area, is unequal to the age-related demands made on them.

Ø  Some of these expectations are for skills common to all people, such as walking by a certain age, while others are culturally determined, such as social skills.

Ø  Dysfunction can also occur when the person fails ‘to resolve the dilemmas, conflicts, or polarities appropriate for one’s stage of life’ (Cole and Tufano 2008).

Ø  Trauma at any age can interrupt the developmental process and inhibit the development of adaptive skills or cause regression to an earlier developmental level.

Ø  A major disruption in any one skill area affects all other areas, and the longer the disruption continues the more gaps there will be in the developmental process.

Ø  People may complete a delayed developmental stage at a later time, when the conditions are right, or may compensate for developmental delay by learning certain higher-level skills without the underpinning of more basic ones (Mosey 1986).