MODELS FROM AN OCCUPATIONAL BEHAVIOR PERSPECTIVE

1. MODELS FROM AN OCCUPATIONAL BEHAVIOR PERSPECTIVE Cole & Tufano, Chapter 6

2. OCCUPATIONAL BEHAVIORREVISITED Mary Reilly (1969) Purpose of occupational behavior was to articulate a general theory of OT “that would explain why occupation was the media & method of the field” Central premise: “…man, through the use of his hands as they are energized by his mind & will, can influence the state of his own health”

3. HISTORICAL CONTEXT Reilly opposed the medical model practice of the times Reilly believed the potential of OT was diminished from originator’s intent “It is the task of medicine to prevent & reduce illness; while the task of OT is to prevent & reduce the incapacities resulting from illness”

4. OCCUPATIONAL BEHAVIOR DEFINED Concepts of occupational behavior are mainly based on ideas from philosophy, psychology, social psychology, sociology & anthropology Occupational behavior - activities that occupy a person’s time, involve achievement, and address the economic realities of life (Reilly, 1962, 1966).

5. Domain of Practice – Focus Areas The occupational behavior model is meant to suit persons of all ages and abilities. Reilly’s proposed focus for practice is to prevent and reduce the disruptions and incapacities in occupational behavior that result from injury and illness (Reed & Sanderson, 1999, p. 244).

6. Basic Assumptions Man has a need to master, alter, and improve his environment. Practice Application: Clients show the capacity for self direction and self actualization. Occupational therapists need to discover what is meaningful and of interest to the client as a way to motivate and initiate treatment.

7. Basic Assumptions, cont. Occupation is intrinsically motivating and people engage in occupation for its own sake to experience learning, control, and mastery that occurs during performance Practice Application: As clients engage in occupational behavior, the process will become self reinforcing and self enriching. The occupational therapist should grade the activities and tasks selection to be meaningful for the client so that he experiences competency and success.

8. Basic Assumptions, cont. Humans have a psychological need for occupation & when they lack occupation they suffer. Occupation is the main way that people a) occupy time b) find meaning and c) establish the ability to contribute productively to society through life roles. Roles are the primary ways that persons express occupational behavior. Practice Application: Clients who experience disruption in occupational behavior and role functioning due to illness, disability, environmental barriers, etc will show signs of distress. Occupational therapists understand that these disruptions in occupational behavior will impact one’s psychological profile and psychosocial attitudes in conjunction with the client’s health condition or stressful events

9. Basic Assumptions, cont. Normal development influences the process of occupational behavior evident in a continuum of play (childhood) to work (adult). In childhood, persons engage in occupations for exploration; this evolves into the desire to learn and gain a sense of competence. Finally, this process culminates in adulthood with the urge to master and achieve in tasks such as work and productive activity. Practice Application: Occupational therapists can learn a lot about their client’s interests, values, desires, etc. in the present by taking a play/leisure history. Patterns of occupational behavior can be understood by reviewing one’s past interests and experiences. Persons who experienced disruption in childhood play experiences are likely to show disruptions in adult occupations.

10. Basic Assumptions, cont. Society and culture highly influence the specific occupations chosen by a person. Practice Application: There is a phenomenological experience to participating in occupations. Clients’ occupational behavior is influenced by many components including one’s cultural beliefs and societal norms. Culture and society are part of the contextual features that occupational therapists assess during an occupational profile.

11. Basic Assumptions, cont. Occupational behavior involves the daily routine of work, play, and rest within a physical, temporal and social environment. Practice Application: Occupations take on many forms in a client’s day. Some are necessary for self maintenance while others are exploratory and by choice. The environment both consciously and unconsciously influences the person’s choice to engage in occupational behaviors.

12. Basic Assumptions, cont. Through participation in occupations, persons learn how to cope and adapt by responding to societal expectations and validating themselves as contributing members of society. As persons are challenged to deal with tasks of everyday life, occupation allows for adaptation to occur. Practice Application: Occupations are instrumental in providing opportunities for a person’s psychological growth and development. The natural challenges of engaging in typical occupations foster one’s ability to cope and adapt in productive ways. Occupational participation requires a certain degree of flexibility and adaptation by its own nature.

13. Basic Assumptions, cont. Health is realized in the rhythm of activity & rest, and includes the need for balance and habits. Balance is achieved by managing the demands of work & play. Habits are the basic structures that give order to daily behavior in time. Practice Application: Persons with healthy occupational behaviors demonstrate a balance of activities that meet the demands of one self and society. Habits provide a healthy structure and sense of order to our lives on a daily basis.

14. Basic Assumptions, cont. Occupational behavior includes both a physical and visible form as well as a subjective and affective experience for the person. Practice Application: Occupational therapists use observation as a means to understand the objective nature of occupational performance and client interviews/self reports to understand the emotional/phenomenological experience of the client.

15. Basic Assumptions, cont. Learning takes place as a person compares external facts and realities to one’s internal, subjective self. A person derives meaning in occupational behavior by exploring one’s internal values in relation to the external environment and its demands. Practice Application: There is a reciprocal nature to developing one’s occupational behavior profile. Clients constantly attempt to integrate feedback from the environment. It is natural to compare and contrast one’s internal perceptions with the external demands. It is possible to experience occupational behaviors that are congruent (matching) with one’s inner core of values and/or incongruent (mismatching). Clients often assign value to occupations that are also appreciated by society.

16. Function/Dysfunction Function is evident within a person when he or she is capable of seeking, undertaking, and adapting occupations that meet one’s personal needs as well as those of society. Dysfunction is evident when a person “suffers” from the lack of occupational fulfillment, competency, and/or achievement. Persons may report or exemplify a lack of self competence and mastery in occupational behavior. Role functioning is likely to be impaired.

17. Change/Motivation Change is a complex process because it often involves personal dynamics that the occupational therapist cannot measure nor observe. According to this model, change can be encouraged by enlisting a person’s intrinsic drive toward mastery, which is assumed to be innate within each one of us. In other words, a person can be motivated to alter his occupational behavior if he finds something rewarding and meaningful about the process. An appropriate way to motivate a client from this model’s perspective is to utilize the person’s internal resources by inquiring about one’s interest.

18. Assessments Mary Reilly did not identify specific assessments for her model. However, assessments such as those designed by Kielhofner et al. for the Model of Human Occupation, Matsasuya’s “Interest Check List”, “Takata’s Play History Questionnaire” and Shannon’s “Inventory of Occupational Choice Skills” are relevant choices for the evaluation process.

19. Interventions Occupational therapy interventions include the use of occupations to promote adaptation and life satisfaction (Bruce & Borg, 2002). Reilly did not identify specific intervention strategies as part of her model. Rather, she described a therapeutic process for enhancing personal life satisfaction. Occupational therapy should prevent and reduce the incapacities in occupational behavior that result from illness.

20. Research Occupational behavior has been criticized as being difficult to apply to practice, mostly because of its general use of concepts. Case methods have been the primary source of exploring its application to occupational therapy practice

21. RELEVANCE OF OCCUPATIONAL BEHAVIOR TO PRACTICE 1. Brought attention to the construct of occupation & away from medical model practice. Noted as the source of our OT paradigm shift 2. Basis for occupational science 3. Foundation for several occupation based models that have attempted to take these concepts & apply for practice

22. Relevance, cont. Historically, occupational behavior has shaped the identity & direction of occupational therapy & has provided the foundations for modern scholarship & practice

23. RELATED THEORIES & MODELS Occupational Science – academic discipline MOHO Occupational Adaptation Ecology of Human Performance Person Environment Occupation

24. Class Activity Use the template & apply to Warren Schmidt