A Model Of Human Occupation Approach

*MOHO emerged around 1980 as a further definition of the theory of OCCUPATIONAL BEHAVIOR developed by Mary Reilly (1962).

*The central idea of occupational behavior is that theory engagement in activity or occupation in itself will produce and maintain health.

MOHO view the human as a open system who interact with the environment and who maintain and change themselves through their output

What does open system means?

It is composition of interrelated structure and function organized into a coherent whole that interact with environment and change itself

throughput

output

feedback

input

Human system composed of 3 subsystems:

-Volitional subsystem: conscious choices for occupational behavior(personal causation, value and interest )

-habituation subsystem: trigger and guide the performance of routine patterns of behavior

-performance subsystem: skills use in production of occupational behavior

Type of skills:-communication skills-process skills-perceptual motor skills

Interaction with environment- There are 4 environmental layers

interact with human system:- Object- Task- Social group- culture

Assessment Therapeutic reasoning: Process for MOHO concepts and resources to

understand and address clients needs. Therapeutic reasoning involves six steps: 1-generating questions about the client 2-generating information on, from, and with the client 3-using the information gathered to create an

explanation on the clients situation. 4-generating goals and strategies for therapy 5-implementation and monitoring therapy 6-detarming outcomes of therapy

Generating questions Therapist must understand their clients

before planning therapy This understand begins with ask question

about each clients Moho concepts provide a framework for

generating these questions occupational performance history interview

*occupational identity scale , occupational competence scale , occupational behavior sitting scale *

Gathering information Therapist must gather information on, from , and with

the client in order to answer the question to they have generated about the client

Information gathering may take advantage of informal ,naturally occurring opportunities.

Therapist also use structured moho assessment some these assessment focus on specific factors such as interest and roles while other capture comprehensive information on several aspects of the person and the

environment .

Creating a theory-based understanding of clients

Information that therapists gather to answer question about their clients is used to cerate is a theory-based understand of those clients

To this end, therapist use moho theory as framework for creating a conceptualization or explanation of each particular clients situation

As part of creating a conceptualization of clients circumstance ,therapists identify problem or challenge to address as well as strengths that can be built upon in therapy

Generating theory goals and strategies The theory-based understanding of clients

is used to:is used to: Generate therapy goals Generate therapy goals Decide what kinds of occupational Decide what kinds of occupational

engagement will enable the client to engagement will enable the client to changechange

Determine what type of therapist strategies Determine what type of therapist strategies will be needed to support the client of will be needed to support the client of changechange

Therapeutic strategies identified by MOHO

Identifying: locating and sharing a range of personal , procedural ,and-or environmental factor that can facilitate occupational performance.

Giving feedback: sharing one understanding of the clients situation or ongoing action .

Advising: recommending intervention goals-strategies.

Physical support: using one body to provide support for a client to complete an occupational from-task.

Implementation and monitoring therapy

Monitoring how the therapy process unfolds may confirm the therapist conceptualization of the client situation or it may require the therapist to rethink the clients situation .

The monitoring process may confirm the utility of the planned client occupation engagement and therapist strategies

Collecting information to assess outcome

Important finally step in the therapy process Typically therapy outcomes are documented by: 1-examining the extent to which goals have been

achieved 2-readministering structured to determine whether

the clients score have improved Both approaches are valuable means of determine

whether positive outcome have been achieved ,they are sometime used in combination.

The picture of how person cope with and adapt to disability serve as general frame work for under

standing what therapeutic intervention we can accomplish.

Therapeutic intervention

Therapeutic strategies identified

by MOHO 1. Validating : attending to and acknowledging the client’s experience2. Identifying : locating and sharing a range of personal, procedural, and\or environmental factors that can facilitate occupational performance3. Advising : recommending intervention goals\strategies. 4. Giving feedback : sharing one’s understanding of the client’s situation or ongoing action 5. Negotiating : engaging in a give-and-take with the client

6. Structuring : establishing parameters for choice and performance by offering a client alternatives ,setting limits, and establishing ground rules

7. Coaching : instructing, demonstrating, guiding, verbally and\or physically prompting

8. Encouraging : providing emotional support and reassurance in relation to engagement in an occupation

9. Physical support : using one’s body to provide support for a client to complete an occupational form\task

The most recent edition of a model of human occupation outline a series of therapeutic principles, these principle are organized into general volitional , habituation and performance categories and include the following general principles:

1. therapy is an event that comes into a life in progress and must be understood and undertaken in that context

2. the focus for changes should be the action or process underlying the human system

3. change does not mean simply more or less it means different form of organization

4. change can and should occur in many aspects of the human system simultaneously

5. change is often disorderly 6. therapy should involve experimentation to find

the best solutions 7. the only tool that therapists have at their

disposal is to change the relevant environment to support or precipitate change in the human system

* These principles derived from the theoretical arguments propose broad themes about how change may take place, the therapists knowledge of each patient is necessary to know how apply the principles .

why MOHO is important for OT??

MOHO is intended as a tool to facilitate clinical thinking and problem solving , these are :

1) Treatment planning 2) Occupational analysis 3) Program development

Disorder - Recognition of the Dysfunction

( problems at performing , organizing , &\or choosing occupations & environment )

CASE STUDY Carl is 32 years old, single and

has a diagnosis of chronic schizophrenia.

He has an eighth grade education and has always lived with his parents and older brother in a two bed room apartment in a low income in a major city.

-None of the family members is employed –each received supplemental social security.

-Both parents have a history of mental illness.

-Carl has along history of psychiatric hospitalization dating back to when he was 16 years old.

*Carl stopped taking his medications approximately 6 weeks prior to this acute care hospital admission and, according to his parents, his behavior has gradually deteriorated.

At the time of his referral to occupational therapy, he demonstrated occupational dysfunction at the level of helplessness.

-He was disoriented and reported hearing voices. He often wandered into other patients’ rooms taking their plants and flowers into his room.

*He was extremely withdrawn, was not responsive to verbal approaches, and required staff assistance for personal hygiene, grooming and eating.

-He was unable to articulate his interests or his goals and preferred to stay in his room in the dark.

Assessment *At admission, Carl’s occupational

behavior was too disorganized for him to participate in a formal assessment battery.

-Data were therefore gathered from observation and from talking with Carl’s parents.

-They related that Carl had never worked nor had friends, and spent the majority of his time at home watching television.

-Occasionally, he would ride the bus to the local park where he would pick flowers and bring them home.

-When his illness was in remission, he was able to attend to his self – care and help around the house.

The short term goal was to encourage Carl to interact with the environment and to develop adaptive habits.

-Plants seemed to be the only thing that evoked Carl’s interest. Since there were several plants in the occupational therapy room, Carl was invited to care for them during therapy.

*His behavior became more organized and he started performing personal hygiene and dressing without staff intervention.

-He preferred to work alone, remaining on the fringes of the group with little interaction with others.

As Carl became increasingly organized, he was administered the Interest Checklist, the Role Checklist, and an activity configuration.

Interest Checklist

*He reported strong interest in gardening/ yard work, macrame (which he had never performed), and listening to the radio, some interest in woodworking, television, ceramics (never done before), house cleaning, laundry, and home repairs.

-All other activities were of no interest.

Role Checklist

*He has no continuous roles, but indicates past and future role.

VALUES

not at some

Role Past Present future all what very

Student× ×

Worker×

Volunteer×

Caregiver×

Home maintainer× × ×

Friend× ×

Family member×

Religious participant×

Hobbyist× × ×

Participant in×

organization

Simplified occupational Questionnaire

*Typical day.

-The same as described by his parents ( at home watching T.V.)

Treatment Plan

*The long term goal of occupational therapy was to engage Carl in an occupational role which was meaningful to him, which matched his level of skill, and which would serve organize his daily life.

-Carl was encouraged to pursue the role of hobbyist.

*The hobbyist role was built around his interest in plants and flowers.

-In occupational therapy, Carl participated in increasingly complex projects. He learned to make wooden hangers for his plants. He also learned to macrame plant hangers, and to make ceramic pots.

*He seemed very pleased with his accomplishments and received positive feed back from the patients and staff.

Occupational status goals and intervention

Volition

PERSONAL CAUSATION

Lack of successful opportunity to attempt interesting ,

experiences realistic activities with a high

probability of success. Activities

should match his level of skill and

be of an appropriate level of arousal.

Identification of past successes

which can serve as a source of future action.

VALUES

-Deficient future orientation assist in goal formation with

-Sense of meaningfulness identification of behaviors

need to attain goals. use

occupations which have

meaning for him.

INTERESTS

-Decrease potency of interests Priority to explore and generate

-Primary area in interest is new interests. To maintain past

Plants and flowers. Interest in plants. Interests

-has a motivation to doing pursue should be congruent with

Macrame, ceramics. His economic status and

-woodworking in past potential priorities beyond

Hospitalization. Hospitalization.

Habituation

ROLES

-Lack for major occupational Encourage participation in role. Alternatives roles in

-Lack access to traditional hobbyist, home

Roles. maintainer

HABITS

-maladaptive habit patterns. Opportunity to develop

-skills not organized into and maintain habits and skills which support

occupational rule.

Habits

Performance

SKILLS

-perceptual- motor skills intact. Opportunity to practice

-process skills impaired. Problem solving and

-deficient communication skills. Motor planning includes

in groups to assist in

development of increase

interpersonal skills.

Outcomes

*Carl will attend psychiatric day treatment center 5 days a week.

-It also suggested that Carl be assigned task to perform over the week end and related to his interests.

*In the week end he will go to the park with a friend from center to collect flowers and plants to take to the center on Monday.

Conclusion

component of the model of human occupation

Internal

Volitional subsystem

Habituation subsystem

Performance capacity

External

Social

occupational form

group

Physical

object

spaces

ReferencesReferences

-A MODEL OF HUMAN OCCUPATION THEORY A MODEL OF HUMAN OCCUPATION THEORY AND APPLICATION (BY GARY KIELHOFNER )AND APPLICATION (BY GARY KIELHOFNER )

- PERSPECTIVE IN HUMAN PERSPECTIVE IN HUMAN OCCUPATION .PARTICIPATION IN LIFE ( PAULA OCCUPATION .PARTICIPATION IN LIFE ( PAULA KRAMAR , JIM HINOJOSA, CHARLOTTE BRASIC KRAMAR , JIM HINOJOSA, CHARLOTTE BRASIC ROYEEN )ROYEEN )

- OCCUPATIONAL FOUNDATIONS OF OCCUPATIONAL FOUNDATIONS OF OCCUPATIONAL THERAPY ( GARY KIELHOFNER OCCUPATIONAL THERAPY ( GARY KIELHOFNER ))

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