PERSON–ENVIRONMENT–OCCUPATION MODELS

                  PERSON–ENVIRONMENT–OCCUPATION MODELS

1.      HISTORY:

·         Environment – behaviour studies: ideas developed in an interactive frame work

·         Occupational perspective on environment:

Ø  Fitting p into environment (O’reilly,1954)

Ø  Interaction  between living system and environment (kielhofner and burke,1980)

Ø  Describing various properties of environment and how it may provide optimal level of arousal (Barris ,1982)

Ø  Ecological systems model to study relationship between organism and their environment(Howe and Briggs,1982)

Ø  Relationship between challenges of an activity and individual skills (Csikzentmihalyi,1988)

2.      INDRODUCTION:

·         Developed in Canada by Mary Law and colleagues beginning in the 1990s, PEO has much in common with MOHO.

·         It is a person-centered model that focuses on the occupational performance that results from transactions between the person and the environment as the person engages in occupation.

·         PEO views the person in a holistic way, including motivations, performance capacities, and client factors. Performance skills are considered part of the person, as are acquired culture, values, and life experiences.

·         The person is viewed as dynamic and changing through time and experience. Within PEO, the environment includes physical, social, and cultural aspects. Environment is fundamental to occupational performance.

·         Within PEO, occupation represents groups of self-directed functional tasks and activities in which a person engages over the lifespan. Occupations are composed of tasks. Tasks are sets of activities. Activities are the basic unit.

·         Client- centered approach

·         Top-down ,focus on the occupation

3.      TYPES OF PEO MODELS: 

3.1.Person-Environment-Occupation- Performance (PEOP) Model

3.2.Person-Environment-Occupation Model Of Occupational Performance (PEO-MOP)

3.3.Ecology Of Human Performance(EHP)

4.      THEORY:

·         Systems theory

·         Environmental theory

·         Neurobehavioural theory

·         Behavioural psychology

5.      CONCEPTS AND ASSUMPTIONS:

·         Person: personal characteristic of the client

·         Environment: cultural ,social, psychological, organizational, and physical components of the clients surroundings

·         Occupation: self-directed ,functional tasks and activities

·         Occupational performance: outcome of the transactional relationships among child environment and occupation.

·         Person –environment –occupation fit: goal of interventions to promote change in the child ,occupation ,and environment to optimize occupational performance.

6.      COMPONENTS:

·         The person: including physiological, psychological, motor

·         The environment: including cultural ,social support, social determinants, and social capital ,physical and natural environments, health education and public policy ,assistive technology.

·         Characteristic of the activity task or role

7.      BASIC ASSUMPTIONS OF THE PEO MODEL :

·         The person is complex and continually developing.

·         The person’s occupational performance takes place within the context of the environment, which can facilitate or restrict performance.

·         The environment is more easily changed than is the person.

·         Occupations meet basic human needs, and occur in the context of roles and environment.

·         Occupational performance occurs in time and space and is continually changing. Changes occur as a result of transactions between person and environment.

·         The better the fit between person and environment, the better the occupational performance.

8.      EVALUATION AND ANALYSIS OF OCCUPATIONAL PERFORMANCE:

·         Assess potential strengths and weakness by conceptualizing the fit among PEO aspects.

·         Analyze each PEO aspect in relationship to the child and family.

·         Consider the skills, abilities, task and activities that are meaningful to the child and environments where occupational engagement occurs.

9.      USE IN PRACTICE:

·         A family –centered approach.

·         Intervention target changes in occupation and environment.

·         Changes can occur at each level of the environment, include home, neighborhood and community.

·         Assessment and outcome measurement incorporate abroad repertorie of measures.

10.  INTERVENTION:

·         Support a family –centered approach.

·         Recognize the influence of cultural and values in implementing the evaluation process.

·         For evaluation of and intervention with older children support their values and perception as individuals and in the context of family and community.

·         Consider the environment as both an area for evaluation and a change element for intervention.

11.  IMPLICATIONS FOR OCCUPATIONAL THERAPY PRACTICE:

·         Intervention to target person ,occupation and environment in different ways

·         Use of multiple avenues for eliciting change

·         Implementation of intervention in context and at different level of environment

·         Outcomes measured in terms of changes in occupational  performance

·         Emphasizes occupation as opposed to performance components

·         Use of wider repertoire of well –validated instruments developed by other disciplines can be used

12.  FUNCTION _DYSFUNCTION:

·         A good fit between components results in optimal function

·         Maximum fit –maximum occupational performance

·         Minimum fit-dysfunction

·         Problems associated with disability could be due to minimum or poor person –environment fit

·         Therefore intervention could be focused on changing the environment to maximize fit

·         Intervention or change in one component affects other components and degree of occupational performance

       2.1. PERSON-ENVIRONMENT-OCCUPATION- PERFORMANCE (PEOP) MODEL

1.      MAIN CONCEPTS:

·         The PEOP model is described as “a client-centred model organized to improve the everyday performance of necessary and valued occupations of individuals, organizations, and populations and their meaningful participation in the world around them” (Baum & Christiansen, 2005, p. 244).

·         This definition demonstrates the importance of two concepts: occupational performance and participation in daily life. While many occupational therapy models explicitly focus on the enhancement of occupational performance as their main goal, this model explicitly identifies enhancing participation as a second primary goal.

·         This model makes explicit that the goal of occupational performance is to enable participation in the social, cultural, financial and political world in which people and organizations exist.

·         A major contribution of the model is its acknowledgement that occupational performance might not be an end in itself but might gain meaning through its role in facilitating participation.

·         The focus of the model is the complex interaction between a person and his or her environment, which influences occupational performance and participation.

·         This interaction forms the basis for occupation, in that intrinsic and extrinsic factors, respectively, form the foundation for what people do. Intrinsic factors (neurobehavioural, physiological, cognitive, psychological and emotional, and spiritual factors) and extrinsic factors (built, natural and cultural environments; societal factors; social interactions and social and economic systems) can “support, enable or restrict” performance by individuals, organizations and communities.

2.      COMPONENTS:

·         Four components of the model are person, environment, occupation and performance.

·         Three dimensions

Ø  Person and environment

Ø  Occupation and performance  

Ø  Occupational performance and participation

2.1.Person and environment

·         Which interact in a mutually influencing way, form the foundation for what people do.

·         The concept of ‘person’ includes the various capacities (neurobehavioural, psychological, etc.) that a person might have, which can influence what a person can and is inclined to do. These are referred to as intrinsic factors.

·         The environment also has features that can affect performance (extrinsic factors). The extrinsic factors include physical, cultural and societal aspects of the context that surrounds them.

2.2.Occupation and performance

·         The model makes clear distinctions between the concepts of occupation, performance and occupational performance, the last located in the third layer.

·         Occupations were defined by Christiansen and Baum (2005) as “human pursuits that       

Ø  Are goal-directed or purposeful

Ø  Are performed in situations or contexts that influence how and with whom they are done

Ø  Can be identified by the doer and others

Ø  Have individual meaning for the doer as well as shared meaning with others

·         Performance refers to the actual doing of them. As Baum and Christiansen (2005) stated, “To be able to do requires that an action or a task be performed. Performance can come from either capacity intrinsic to the individual or by support provided by the environment or a combination of both.

2.3.Occupational performance and participation

·         As Baum and Christiansen (2005) stated, “when occupation and performance are joined in the term occupational performance, it describes the actions that are meaningful to the individual as he or she cares for him- or herself, cares for others, works, plays, and participates fully in home and community life”.

·         As “occupations have a purpose” (Baum & Christiansen, 2005, p. 252), the top three

Ø  Levels on the hierarchy – roles, occupations and tasks – would be conceptualized in the occupation part of the model because they are linked to purpose.

Ø  The next level in the hierarchy – actions – would be attended to in the performance part of the model, because they do not have a separate purpose.

Ø  The lowest level of the hierarchy – abilities – would be considered in the person part of the model, as they lie within the person (as intrinsic factors).

·         All of these occupation-related behaviours occur within a specific context or environment, which can support, enable or restrict the performance of occupations and tasks and, hence, affect participation in everyday life.

3.      FACTORS:

·         Intrinsic factors in the PEOP Model that are central to occupational performance are:         

Ø  Physiological, including strength, endurance, flexibility, inactivity, stress, sleep, nutrition and health 

Ø  Cognitive, including organization, reasoning, attention, awareness, executive function and memory, all necessary for task performance

Ø  Neurobehavioural, including somatosensory, olfactory, gustatory, visual, auditory, proprioceptive and tactile, as well as motor control, motor planning (praxis) and postural control

Ø  Psychological and emotional, including emotional state (affect), selfconcept, self-esteem and sense of identity, self-efficacy and theory of mind (social awareness)

Ø  Spiritual: that which brings meaning.

·         Extrinsic factors in the PEOP Model that are central to occupational performance are:   

Ø  Social support, practical or instrumental support and informational support

Ø  Societal, including interpersonal relationships (groups), social and economic systems and their receptivity (policies and practices) to supporting participation, laws

Ø  Cultural, including values, beliefs, customs, use of time 

Ø  The built environment, including physical properties, tools, assistive technology, design and the natural environment, covering geography, terrain, climate and air quality.

       2.2. PERSON-ENVIRONMENT-OCCUPATION MODEL OF OCCUPATIONAL PERFORMANCE

1.      CONCEPT  PEO MODEL OF OCCUPATIONAL PERFORMANCE:

·         PEO conceptualizes the relationship between the person and the environment as “transactive” (Law et al., 1996, p. 10) rather than interactive (as with PEOP).

·         The distinction between these two concepts relates to whether person and environment are conceptualized as

Ø  An interactive approach allows behaviour to be predicted and controlled, by influencing change at the level of an individual or environmental characteristic.

Ø  A transactive approach presents the person and environment as interdependent and proposes that a person’s behaviour cannot be separated from the context within which it occurs (including temporal, physical and psychological factors).

·         Therefore, occupational performance is a context-, person- and occupation-specific process. That is, it is the result of particular people doing particular things in particular times and places.

·         The relationship between person and environment is understood to be mutually influencing. As Law et al. (1996) stated, “a person’s contexts are continually shifting and as contexts change, the behaviour necessary to accomplish a goal also changes”

·         This model to understand the distinction made between interactive and transactive approaches to the person–environment relationship between person, environment and occupation which has probably become most associated with this model.

2.      COMPONENTS:

·         Three interconnected components

Ø  Environmental supports and barriers

Ø  Individual skills

Ø  Occupational demands − surrounding occupational performance.

·         Occupational performance is considered to be the “outcome of the transaction of the person, environment and occupation. It is defined as the dynamic experience of a person engaged in purposeful activities and tasks within an environment.”

·         The person is presented as “a dynamic, motivated and ever-developing being, constantly interacting with the environment”

·         The model outlines five aspects of the context surrounding the person − cultural, socioeconomic, institutional, physical and social.

3.      THREE ASPECTS OF HUMAN ACTION:

·         The model considers what people do within their environmental contexts. While this is called occupation in the model’s considered three aspects of human action – activity, task and occupation.

Ø  Activity was defined as “a singular pursuit in which a person engages as part of his/her daily occupational experience” and was considered to be “the basic unit of a task”

Ø  Task was defined as “a set of purposeful activities in which a person engages” and could be represented by “the obligation to write a report”

Ø  Occupation, then, was considered as “groups of self-directed, functional tasks and activities in which a person engages over the lifespan” .defined “occupations” (the plural) as “those clusters of activities and tasks in which the person engages in order to meet his/ her intrinsic needs for self-maintenance, expression and fulfilment”

·         Occupational performance results from the interconnectedness of the person, Occupational performance is the result of a complex process in which people determine the purpose of occupations in their lives; a process that is shaped by their perceptions, goals, responsibilities and desires and the demands of the context in which they live.

·         Occupational performance also changes over time, as represented in the relationship between person, environment and occupation changes through the lifespan and will differ at different times for any particular person.

·         The goal of occupational therapy is to improve occupational performance by facilitating or enhancing the fit between person, environment and occupation.

4.      ADVANDAGE PEO MODEL OF OCCUPATIONAL PERFORMANCE:

·         It enables people to select from and use interventions that are directed at person, occupation and environment in different ways 

·         It provides a framework for using multiple paths (in conjunction) to effect change

·         It draws particular attention to interventions that address different levels of the environment and the importance of selecting and implementing interventions “in context”

·         Taking an ecological approach to the environment, it provides for the “use of a wider repertoire of well validated instruments of measure developed by other disciplines”

                         2.3. ECOLOGY OF HUMAN PERFORMANCE

1.      MAIN CONCEPT:

·         EHP emphasizes the environment as the primary context within which performance needs to be understood.

·         The term ecology refers to the “interrelationships of organisms and their environments” (Dunn et al., 1994, p. 595) and the model emphasizes the inter relatedness of person, context, task and performance.

·         The primary theoretical postulate fundamental to the EHP framework is that ecology, or the interaction between person and the environment, affects human behaviour and performance, and that performance cannot be understood outside of context.

·         In this model (Dunn, 2007) there are three important constructs

Ø  Person

Ø  Task 

Ø  Context (initially called environment)

·         The environment has two aspects that need to be considered in more depth.

Ø  That the environment includes more than just the physical environment

Ø  That the environment has the capacity to shape task performance.

1.1.The environment

·         They stated that the concept of the environment should be expanded to include, “physical, temporal, social, and cultural elements” (Dunn et al., 1994, ). By expanding the definition of environment in this way, Dunn et al. emphasized the contribution that occupational therapists can make to an understanding of the interdependent relationship between the person and environment.

1.2.The influence of the environment

·         The influence of the environment on human performance has long been acknowledged in occupational therapy, the EHP model emphasizes that the environment also shapes both the person and the tasks in which the person engages. These included:

Ø  Jerome Bruner (1989), who conceptualized the environment as providing a context for the construction of the self

Ø  Lawton (1982), who applied Murray’s (1938) concept of environmental press, emphasizing that the demands of the environment influence a person’s perceptions of his or her own competence

Ø  Gibson’s (1986) phenomenological approach to perception, whereby people’s perceptions of objects in the environment are influenced by the opportunities that the environment affords them.

1.3. The construct is task.

·         However, personal and environmental variables influence the tasks that form part of an individual’s actual repertoire of tasks.

·         Personal variables such as interests, values, perceptions and experience as well as sensorimotor, cognitive and psychosocial skills and abilities influence the selection of tasks in which the person participates.

·         Environmental variables also influence task selection and performance.

·         This set of tasks is referred to as the performance range and people select from the available range of tasks.

·         The performance range is influenced by a person’s skills and abilities and the supports and barriers created by the particular context. As people and contexts change, so too do their performance ranges.

1.4.The model is human performance

·         This is the result of the interaction between person, context and task.

2.      FOCUS OF EHP MODEL:

·         As the focus of the model is the relationship between person and environment, the second construct that we will discuss here is person.

·         Dunn et al (2003) stated that “the Ecology of Human Performance is an individually focused, client-centred framework.

·         Individuals are seen as unique and complex”

·         Personal variables contribute to the uniqueness of individuals.

·         These are listed in the model as values, interests and experiences, as well as sensorimotor, cognitive and psychosocial skills.

·         These personal variables influence both the selection of tasks and the quality of task performance.

3.      INTERVENTIONS:

·         EHP also addresses five categories of interventions. These are establish/restore, alter, adapt, prevent and create.

·         These five alternatives for intervention relate variously to person, context and task.

3.1. Therapeutic interventions  

·         Aim to establish or restore an individual’s skills and abilities.

·         This intervention refers to either establishing skills that people haven’t had previously or restoring skills and abilities that have been lost, usually through acquiring a medical condition, injury or disability.

·         Dunn et al. (1994) made the point that restorative interventions are very common among occupational therapists working within a biomedical model, with its corrective emphasis. While these interventions target the individual’s skills and abilities.

3.2. Intervention is to alter or change

·         To alter or change the actual environment, that is, to select a different environment in which the person is able to perform the task.

·         This intervention aims to create the best match between the person and his or her environment and focuses on selecting a different environment rather than adapting the current environment (i.e. not to be confused with altering or making changes to the current environment).

3.3.Intervention alternative is to adapt the contextual features and/or task demands

·         Regarding contextual features, these could be enhanced or minimized to match better the person’s abilities.

·         Similarly, aspects of the task such as the sequence of steps, the tools used, the position required of the person and the skills required of the person can be adapted to enable the person to participate in the task.

3.4. Intervention alternative is to prevent

·         To “prevent the occurrence or evolution of maladaptive performance in context” (Dunn et al., 1994, )

·         This intervention strategy aims to prevent difficulties arising. To do this, occupational therapists might address person, context and/or task.

3.5.Intervention option is called create

·         Intervention option is called create and was described by Dunn et al. as “creating circumstances that promote more adaptable or complex performance in context”.

·         The authors stressed that this intervention does not assume the presence of a disability or that there is a problem that will interfere with performance.