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1980 first published as a series of four articles in the AJOT
3 OT practitioners attempted to articulate concepts that guided their practice.
Many practitioners have added to that |
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| most widely used occupation focused model in OT practice internationally |
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| why 80% of therapists like MOHO |
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supports occupation focused practice
helps prioritize clients' needs
provides a holistic view of clients
offers a client centered approach
affords a strong base for generating treatment goals
supplies a rationale for intervention |
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support practice throughout the world that is occupation focused, client centered, holistic, evidence based and complementary to practice based on other occupational therapy models and interdisciplinary theories
specifically developed to focus theory, research and practice on occupation |
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| can be both an enabler and a barrier |
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| evidence based support for MOHO |
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much research done on MOHO
studies have:
supported the validity of the concepts offered in the model
confirmed the reliability and validity of MOHO assessments
Documented the process and outcomes of interventions based on MOHO |
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to be used with other OT models
rarely addresses all problems faced by a client |
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| 3 broad areas of doing within MOHO |
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| ADLs according to the book |
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| typical life tasks required for self-care and self-maintenance such as grooming, bathing, eating, cleaning the house and doing laundry |
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| Human Occupation according to the book |
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| The doing of work, play or activities of daily living within a temporal, physical and sociocultural context that characterizes much of human life. |
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| play according to the book |
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| activities undertaken for their own sake |
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| work according to the book |
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| activities (both paid and unpaid) that provide services or commodities to others such as ideas, knowledge, help, information sharing, entertainment, utilitarian or artistic objects and protection |
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| within MOHO the environment |
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| volition, habituation or performance is affected by how the environment influences these aspects. The environment is a constant influence on occupation and a persons' occupational circumstances. Nothing is considered without considering the environment in which the person interacts |
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| volitional thoughts involve ... |
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personal capacity and effectiveness
importance or worth attached to what one does
enjoyment or satisfaction one experiences in doing things |
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| all human beings are driven |
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| toward action-they want to do the things that they value, feel competent to do and find satisfying |
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| refers to one's sense of capacity and effectiveness |
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| refer to what one finds important and meaningful to do |
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refer to what one finds enjoyable or satisfying to do.
In everyday life, personal causation, values and interests are interwoven |
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| experience (according to the book) |
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| refers to the immediate thoughts and feelings that emerge in the midst of and in response to performance. |
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how someone reflects on an experience
according to the book it is : recalling and reflecting on performance in terms of its significance for oneself and one's world |
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| anticipation (according to the book) |
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| the process of noticing and reacting to potentials or expectations for action |
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short-term, deliberate decisions to enter and exit occupational activities.
Examples: starting a job, beginning a quilt, starting a garden |
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| Occupational Choices (according to the book) |
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deliberate commitments to enter an occupational role, acquire a new habit or undertake a personal project.
Together activity choices and occupational choices influence what kinds of occupational performance make up our daily lives.
These choices are the function of volition. They reflect our personal causation, our interests and our values.
Look at page 15 in the book |
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| volition again (according to the book) |
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a pattern of thoughts and feelings about oneself as an actor in one's world which occurs as one anticipates, chooses, experiences and interprets what one does.
Volitional thoughts and feelings include personal causation, values and interests |
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| refers to a semiautonomous pattern of behavior in concert with our familiar temporal, physical and social habitats. |
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| defined as incorporation of a socially and/or personally defined status and a related cluster of attitudes and behaviors. |
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| the capacity to do things depends on these factors: |
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musculoskeletal, neurologic, cardiopulmonary and other bodily systems that are used when acting on the world
mental or cognitive abilities such as memory and planning |
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| performance capacity (according to the book) |
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| the ability to do things provided by the status of underlying objective physical and mental components and corresponding subjective experience. |
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| environmental impact (according to the book) |
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| can enable or disable the individual. The environment is often the critical dimension that either supports or interferes with an individual's occupation. |
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the principle that aspects of a person and that person's envioronment are linked into a dynamic whole.
Each component contributes something to a total dynamic
The environment is central here as well |
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is the principle that complex actions thoughts and feelings spontaneously arise out of the interactions of several components.
EX: when faced with SCI new actions will "emerge" to allow for a new life |
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sufficiently changes the total dynamic to result in the emergence of something different.
change in a factor that creates a new dynamic and shifts thought, emotion and/or action.
EX: change in employment status can cause a change in the habits involved with going to work in the morning.
Systems theory term- a change in one of the factors creates a new dynamic and shifts thought emotion and/or action. |
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| a change in any aspect of volition, habituation, performance capacity, and/or the environment can result in a change in... |
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| the thoughts, feelings and doing that make up one's occupation. |
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| a person with chronic mental illness will be motivated and choose to enter the worker role will be influenced by factors such as: |
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The extent to which the person feels capable of doing work based on past experiences
Whether and what kinds of work tasks the person has enjoyed in the past
how important work, and other factors either positively or negatively associated with work, are to the person
The kinds of jobs available to the person and whether they match the felt capacity, interests and values of the person
The other factors in the environment that are affected by working
The extent to which others in the environment expect and want the person to work |
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| The quality of a person's performance in doing the task will be influenced by these interactions: |
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The person's underlying capacity for the performance
The complexity and demands of the task itself
The kinds of objects present in the environment for engaging in the task |
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| elements involved in people maintaining a certain constancy in who they are and what they do |
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| Our existing volition, habituation and performance capacity provide certain resources, limitations and tendencies for emoting, thinking and behaving |
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| implications for therapy based on the systems therapy (what therapy should entail because you are encompassing the whole system). |
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indicate that assessment requires consideration of how volition, habituation, performance capacity and environmental factors contribute to the client's circumstance.
since many factors contribute to the emergence of occupational behaviors, thoughts and feelings, it is important to consider multiple possibilities for addressing a client's problems and challenges.
Therapy should, to the extent possible, consider and address all of the factors contributing to the client's occupational dynamic.
because the aim of hterapy is always to achieve a new and positive pattern of occupational life, it requires sustained occupational engagement in a supportive environment. must support client in new ways of doing, thinking and feeling. |
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| aspects of volitional cycle-what happens to make someone do what they do |
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anticipating
choosing
experiencing
interpreting
this is repeated, it maintains or reshapes one's values, personal causation and interests.
feeling successful about something done is very rewarding and therefore reinforces that and it continues. |
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affects how people think about personal effectiveness and what is significant to do.
Culture plays a part in determining what is important based on the cultures values. |
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| personal traits and volition |
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| each person has unique volition based on personality, the lived body, etc. Thrill seeking people and those requiring lots of tactile stimulation will have different volition then those who are naturally shy or require very little stimulation. Personal experiences and capabilities also play a large part in each person's volition. |
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personal causation
values
interests |
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over time one sees
*what one is capable of doing
*what kinds of effects one's doing can produce |
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| two dimensions of personal causation |
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sense of one's personal capacity
knowledge of one's self-efficacy in the world.
people who feel capable and effective seek out opportunities, use feedback to correct performance and persevere to achieve goals. |
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| experienced as difficulty doing the things that matter in one's life |
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| one's sense of capacity does what in the volitional process? |
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the sense of capacity readies one to anticipate, choose, experience and interpret behavior.
Those who see themselves to be capable are disposed to act and generate further evidence of their capacity. |
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includes one's PERCEPTION of
self-control
How much one is able to bring about what one wants. |
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| strong sense of efficacy is impossible if one believes that one is at the mercy of overwhelming emotions or uncontrollable thoughts |
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| personal causation and impact of efforts |
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concerns whether one's efforts are sufficient to accomplish desired ends.
feeling helpless is concomitant with many forms of mental illness.
Those with mental illness often lack a sense of control over life outcomes-especially those with depression. |
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values guide a person to do what is right or wrong. This drives volition to do those things that are considered good by the values.
If these are not adhered to there is guilt |
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| strongly held views of life that define what matters |
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| strong emotional disposition to follow perceived right ways to act |
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| when one experiences extreme pleasure from an activity one continues to choose that as an interest and then can experience flow while participating in it |
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we do not engage in all occupations with equal pleasure or satisfaction
interest pattern is the unique configuration of preferred things to do that one has accumulated from experience. |
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personal causation
values
interests |
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physical
temporal
sociocultural ecologies |
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| they free up conscious attention for other purposes. You don't have to think about every detail of brushing your teeth so you can think about other things while brushing your teeth. |
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habits shared by a group of people consititute social customs.
typical behaviors are depended upon by others. If you get to places on time all the time then others expect that of you and if you are always late this is true as well. |
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| 3 influences of habits in daily occupations |
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temporal
physical
social habitat
*habits impact how routine activity is performed
* habits regulate how time is typically used
* habits generate styles of behavior that characterize a range of occupational performances. |
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new habits must be formed in order to accomplish the same tasks as before
The transformation of habits is a necessary pathway through which persons find their way back to the participation in everyday activities of daily living, work, and leisure |
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incorporation of a socially and/or personally defined status and a related cluster of attitudes and actions
these give us the necessary social bearings to act effectively
internalized role may be any role; tennis player, student, mother, etc.
identifying with any role means internalizing both what attributes society assigns to the role and one's personal interpretation of that role
one student sees role as intellectual
other sees it as a means to an end only
that is how it is internalized |
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| roles organize action in 3 ways |
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manner and content of our action
what kinds of things we do
how our daily and weekly cycles are partitioned |
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| the process of communicating role expectations |
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| having too few roles is even more likely to be detrimental to psychosocial well-being than having too many role demands. |
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philosopher Merleau-Ponty
he emphasized a phenomenological approach that considered subjective experience as fundamental to understanding human perception, cognition and action
Leder said it was the experience of being and knowing the world through a particular body |
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| philosopher who aimed to separate mind and body and this was adopted in Western cultures. This is contrary to the lived body and is referred to as Dualism. |
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| refers to the opportunity, support, demand and constraint that the environment has on a particular individual. |
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| physical contexts that are bounded and arranged in ways that influence what people do within them. |
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composite of spaces, objects, occupational forms/tasks and social groups that cohere and constitute a meaningful context for performance.
EX: home, work, resource sites, churches |
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occupational participation
occupational performance
occupational skill |
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| occupational participation |
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| referes to engaging in work, play or activities of daily living that are part of one's socio-cultural context and that are desired and/or necessary to one's well-being. |
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| a composite sense of who one is and wishes to become as a occupational being generated from one's history of occupational participation |
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| degree to which one sustains a pattern of occupational participation that reflects one's occupational identity. |
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| construction of a positive occupational identity and achieving occupational competence over time in the context of one's environment |
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| narratives two component parts |
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| how people think and talk when they use stories. I is the intersection between the progression of time and the direction that life takes. The shape of events over time as they get better or worse. |
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the use of a familiar object or phenomenon to stand in the place of the less well understood event or situation. They characterize complex or emotionally difficult circumstances by evoking something familiar or readily understood to stand in the place of that which is difficult to grasp and/or face.
EX: the disease is thought of as "threatening" and something that must be fought. |
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| story (both told and enacted) that integrates across time one's unfolding volition, habituation, performance capacity and environments through plots and metaphors that sum up and assign meaning to these elements. |
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| coherent and meaningful set of occupational forms that cohere and evoke deep feeling, a sense of duty, commitment and perseverance leading to regular involvement over time in relation to a community of people who share the engaging occupation. |
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| 3 elements involved in permanent change |
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alteration of some internal or external component contributes something new to the total dynamic, out of which new thoughts, feelings, and actions emerge
when these conditions are repeated sufficiently, volition, habituation , and/or performance capacity coalesce toward a new internal organization
ongoing interaction of the new internal organization with consistent environmental conditions maintains a new stable pattern of thinking |
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| transformational and catastrophic change |
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| continuum of change that people progress theough in levels of function when they move into new roles, encounter new environments, make lifestyle changes or reorganize their lives in response to major disruptive circumstance or event. |
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exploration is the first stage when you try out new things and learn about your capacities and preferences and values
competency is the stage of change when people begin to solidify new ways of doing that which was discovered through exploration
achievement is the stage of change when persons have sufficient skills and habits that allow them to participate fully in some new work, leisure activity or ADL |
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| two tasks faced during each stage of development |
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constructing an occupational identity by which we know ourselves and our lives
establishing occupational competence in our patterns of doing. |
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| the stage of change when persons have sufficient skills and habits that allow them to participate fully in some new work, leisure activity or activity of daily living |
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| stage of change when persons begin to solidify new ways of doing that were discovered through exploration |
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| first stage of change in which persons try out new things and consequently learn about their own capacities, preferences and values |
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change that occurs when one fundamentally or qualitatively alters an established pattern of thinking, feeling and doing.
ex: SCI |
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| gradual alteration such as a change in amount, intensity or degree. |
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