EMILIO AGUINALDO COLLEGE

School of Physical, Occupational, and Respiratory Therapy

​ ​ Bachelor of Science in Occupational Therapy

Lecture Activity

1.​ Study each FOR/Model and prepare to fill out the theory analysis template at our next meeting.
2.​ Specific topics to be completed will be in a random order.
3.​ One to two topics for each student will be assigned
4.​ Here are the FORs/Models:
Psychosocial Frames of Reference Occupation-Based Models

Object Relations/Psychodynamic Model of Human Occupation

Behavioral Occupational Adaptation
Cognitive-Behavioral Ecology of Human Performance
Cognitive Disability Person-Environment-Occupational Performance
Movement-Centered Kawa Model
Lifespan Development Canadian Model of Occupational Performance

5.​ Template

Focus

Theorists/Proponents

Function

Dysfunction

Change

Motivation

Assessment/Evaluation Tools

Intervention Guidelines

Psychodynamic FOR

Focus The Psychodynamic FOR emphasizes the role of the

unconscious, emotions, and defense mechanisms in
 shaping human behavior and occupational engagement. It
explores how past experiences and unconscious conflicts
affect present behavior, relationships, and occupational
performance.

Theorists/Proponents Sigmund Freud

Function ●​ A balanced expression of drives that are

self-gratifying and acceptable within the social
environment well functioning ego-self control.
●​ Reality testing is the most important function.
●​ Expressing one’s emotion.

Dysfunction ●​ The presence of neurotic anxiety, fixations and use

of immature defense mechanisms.
●​ Unrealistic view of self, others and/or environment.
●​ Lack of accurate awareness of personal feelings.
●​ Choices in conflict with one's own values.
●​ Problem seeking and gratifying needs satisfactorily.

Change Change occurs through increased self-awareness, insight,

and emotional processing. This is achieved by:

●​ Exploring unconscious thoughts and feelings.

●​ Understanding the emotional meaning of
occupational engagement.
●​ Resolving internal conflicts through therapeutic
interventions.
●​ Engaging in occupation as a means of emotional
expression and regulation.

Motivation Motivation in the psychodynamic FOR stems from the

individual's unconscious desires and needs. Factors
influencing motivation include:

●​ The drive for self-actualization and emotional

healing.
●​ The need to resolve unconscious conflicts.
●​ Engagement in meaningful occupations that
provide emotional expression and insight.
●​ A safe and supportive therapeutic relationship.

Assessment/Evaluation ●​ Draw A Person Test

tools ●​ Azima Battery
●​ Person Symbol Test

Intervention guidelines ●​ The therapist implement the assessment and

treatment by selecting activities that provide the
appropriate level of social interaction through
 activity analysis the therapist can figure out which
activity will be used through its appropriateness.
Activities are chosen to determine the ff:
○​ Ability of the ego to integrate new
information
○​ To organize
○​ To problem solve
●​ The therapist should work closely together with the
patient’s psychiatrist in directing the patient’s
behavior through activities.
●​ An important thing that an occupational therapist
should work closely on is to catch the symptoms
producing unconscious content and then bring it to
the consciousness.
●​ The goal is to resolve the conflict and help the
person learn new, more satisfying behavior within
the conscious insight.

Behavioral FOR

Focus ●​ Clients who might benefit from behavioral

interventions are “people who have difficulty planning
and organizi ng activities, those who have problems
with memory and/or attention, those who have deficits
in sequencing activities, and those who demonstrate
inappropriate social behaviors” (Helfrich, 2014).

(Add. info) - Behavioral principles are generally used whenever

occupational therapists need to create behavioral goals and
objectives or to teach clients new occupational skills through
grading the steps of a task.

Theorists/Proponents Burrhus Frederic Skinner

Function ●​ Acquisition of Adaptive behavior and learning that are

defined by others desirable, or the specific skills the
client wishes to master

Function in the behavioral frame of reference is narrowly

defined by setting behavioral goals and objectives. - (add. info)

Dysfunction
●​ maladaptive Behavior - self injurious or tantrum (eto
lang for cole)
●​ Based kay arjenna na ‘to
○​ Skill deficit - a person lacks the ability needed
 to perform a task or unable to to meet personal
standards in performance
○​ Performance Deficit - a person is able to
perform the desired skill but fails to do so until a
situation that calls for it, if fails to demonstrate
the skill with necessary consistency
○​ Behavior Excess - behavior occurring at too
great frequency, intensity, and duration

Change ●​ Achieved through reinforcement

●​ Extinguish unwanted behaviors
●​ Forming new habits with technology

Motivation External rewards and reinforcement

Assessment/Evaluation ●​ Stress management questionnaire

tools ●​ Antecedent-behavior-consequence (ABC) approach
●​ Parent observation rating scale, such as dunn’s sensory
processing questionnaire
●​ Observational assessment
●​ Checklist that assist clients with identifying areas of
dysfunction and task or role preference

Intervention guidelines Intervention tends to be specific to the target behavior, either

developing new skills or coping strategies or systematically
eliminating unwanted behaviors.

●​ Teaching new skills (new behaviors or the target

behavior)
●​ Behavior contracts
●​ Relaxation training
●​ Systematic desensitization
●​ Exposure and ritual prevention

Cognitive behavioral FOR

Focus ●​ This frame of reference has been identified as the

one most often used in behavioral health settings
because it is especially effective in dealing with
issues of motivation and emotion.
●​ The cognitive behavioral frame of reference offers
useful techniques for self-management that
occupational therapists can use in addressing
thoughts, emotions, and/or behaviors that create
barriers to occupational performance.
●​ Should consider if there are any psychological
barriers to activity engagement.

Theorists/Proponents Aaron beck

 Function ●​ Function involves the ability to use cognitive
processes to reason, test hypotheses, and develop
accurate self-awareness and realistic perceptions of
others and the environment.
●​ Functional individuals can control and manage
their own thoughts, feelings, and behavior to cope
with stress, manage time, and balance their life
roles and occupations.
●​ Cognitive ability may be conceptualized as a
continuum, which can be measured on many
levels, including intelligence, problem solving,
mental status, appropriateness of social behaviors,
and life satisfaction. In occupational therapy, we
look at how cognitive limitations affect one’s
occupations and identify the specific problems that
cause occupational disruption.

Dysfunction ●​ Dysfunction is not defined by diagnosis or

symptoms of illness but by the presence of
maladaptive behaviors, which are presumed to
have been caused by maladaptive learning.
●​ This frame of reference defines both function and
dysfunction in terms of characteristics of the
person, task, and environment that can be
observed and measured.

Change Change in the Cognitive Behavioral Frame of Reference

(CBT FOR) is driven by reinforcement. Clients change their
behaviors by modifying their maladaptive thoughts and
reinforcing adaptive behaviors. Change occurs when:

●​ Clients identify and challenge irrational beliefs

(e.g., decatastrophizing, challenging absolutes).
●​ They modify automatic thoughts through
techniques such as thought stopping,
self-instruction, and visualization.
●​ The environmental and cognitive reinforcers that
maintain maladaptive behaviors are addressed and
adjusted.
●​ Therapeutic techniques such as relaxation
training, systematic desensitization, and imaginal
exposure help remove barriers to occupational
participation.

Motivation Motivation in CBT FOR is based on reinforcement, both

external and internal:

●​ External reinforcement: Money, privileges, and

social expectations (e.g., fulfilling obligations or
avoiding social sanctions).
●​ Internal reinforcement: The personal satisfaction
 that comes with mastery and achievement of
occupational goals.
●​ Motivation is enhanced when clients recognize and
internalize their ability to control their behaviors
and responses (self-efficacy).
●​ Social and cultural contexts also influence
motivation, sometimes creating barriers to
change (e.g., family disapproval of assertive
behavior).

Assessment/Evaluation tools ●​ Evaluation in the cognitive behavioral frame of

reference focuses on thought processes in relation
to emotions and behavior.
●​ Occupational therapists use self-report checklists,
rating scales, and cognitive assessments to
understand the client’s perceptions, emotions,
abilities, and occupational problems.
●​ Common assessment tools
●​ Self-Report Measures – Role Checklist, Life
Satisfaction Inventories
●​ Cognitive & Mental Status Tests – Folstein’s
Mini-Mental Status Exam, Allen’s Cognitive
Levels Screening
●​ Mood & Anxiety Scales – Beck’s Depression
Inventory, Stress Management
Questionnaire
●​ Occupational & Functional Assessments –
BaFPE (Bay Area Functional Performance
Evaluation), KELS (Kohlman Evaluation of
Living Skills), Barthel Index
●​ MOHO-Based Tools – Occupational
Self-Assessment (OSA)

Intervention guidelines ●​ Four areas for intervention identified by Bruce and

Borg (2002) for the cognitive behavioral frame of
reference are context, thoughts and attitudes,
knowledge, and skills.
●​ Some of the specific occupational therapy
approaches based on this frame of reference will be
reviewed, including psychoeducational groups,
social and life skills programs and groups,
self-regulation programs, and Williamson’s coping
model.

Cognitive disability FOR-l

Focus
The Allen’s Cognitive Levels (ACLs) framework applies to all
 areas of occupation outlined in the Occupational Therapy
Practice Framework (OTPF3), including ADLs, IADLs,
education, work, play, leisure, and social participation, by
focusing on the role of cognition as a process skill, the
influence of habits and routines, the impact of physical and
social contexts, and the analysis of activity demands,
particularly for individuals with dementia, acquired brain
injuries, chronic mental illness, nervous system diseases, and
developmental disabilities, where cognitive limitations create
predictable safety risks and guide decisions regarding
independent living, self-direction, and competence in
managing daily occupations.

Theorists/Proponents Claudia Allen

Function Function:
● Maximizing engagement and
participation is done by
assessing the cognitive
impairment
● Using assistance and
environmental adaptations to
compensate for activity
limitations
● Promoting routines that allows
for continued participation in
daily occupation
● Cognitive Level 6 - Planned
Activities -
●​ Ability to think deductively and anticipate problems
(covert trial and error).
●​ Can follow written instructions and symbolic cues (e.g.,
instructions for a DVD player).
●​ Able to consider past, present, and future when making
decisions.
●​ Full cognitive functioning without disability.
●​ Independent in occupational therapy tasks and can
apply recommendations.

Dysfunction When there is a need to

measure and monitor a client’s
problem-solving ability and
safety while performing daily
activities.
Cognitive Levels:
Level 1 - Automatic Actions
Level 2 - Postural Actions
Level 3 - Manual Actions
Level 4 - Goal Directed Activities
Level 5 - Exploratory Actions /
Independent Learning through new
activities

Level 1: Automatic Actions

●​ Dysfunction:
○​ Limited or no awareness of the environment.
○​ Inability to follow instructions or engage in purposeful
activity.
○​ Only reflexive responses (e.g., blinking, moaning).
○​ No intentional movements or purposeful actions.
○​ Severe cognitive impairment (often in a coma-like
state).

Level 2: Postural Actions

●​ Dysfunction:
○​ Difficulty with complex or higher-level tasks.
○​ Need for constant physical assistance (e.g., feeding,
moving from one place to another).
○​ Can only approximate movements when imitating tasks
(not exact).
○​ Limited attention span and difficulty with tasks requiring
sitting still for extended periods.
○​ Limited ability to handle unfamiliar tasks, needing
constant guidance.
○​ Cannot perform self-care or household tasks without
guidance.
○​ Clients at this level often require significant physical
support for daily activities.

Level 3: Manual Actions

●​ Dysfunction:
○​ Unable to initiate or complete unfamiliar tasks without
cues.
○​ Difficulty following through with complex tasks without
repeated cues.
○​ Potential for engaging in unsafe or impulsive actions
(e.g., disassembling objects or getting lost).
○​ May require supervision, especially when performing
tasks that involve potential hazards (e.g., leaving doors
open, picking up dangerous items).
○​ Lack of awareness of consequences (e.g.,
disassembling a plugged-in radio).

Level 4: Goal-Directed Actions

●​ Dysfunction:
○​ Difficulty with complex, long-term, or multi-step tasks.
○​ Reduced cognitive capacity to handle a cluttered
 environment, making it hard to focus or select relevant
items.
○​ Can’t think abstractly, leading to misunderstanding of
certain concepts (e.g., mixing up objects with similar
visual appearances).
○​ Can complete familiar tasks with supervision, but needs
to have visual cues and assistance.
○​ At this stage, there is a loss of abstract thinking (e.g.,
confusing a bottle of cleaner with juice).
○​ Safety is a concern (e.g., difficulty distinguishing
harmful items from safe ones).

Level 5: Exploratory Actions

●​ Dysfunction:
○​ Impulsive behavior and trial-and-error learning without
anticipation.
○​ Difficulty planning or making decisions without trying
and failing.
○​ Unsafe behavior (e.g., testing if an iron is hot by
touching it).
○​ Lack of foresight and understanding of consequences,
resulting in accidents or poor judgment.
○​ Struggles with self-control and managing
responsibilities (e.g., financial management problems).
○​ Difficulty organizing and completing tasks without
assistance.

Change
In the Allen Cognitive Levels frame of reference, change refers
to the processes through which a person's cognitive
functioning improves or adapts.

●​ Brain Chemistry, Physiology, and Plasticity: Allen

emphasizes that cognitive changes occur due to brain
chemistry, brain physiology, and brain plasticity (the
brain's ability to reorganize and adapt). These biological
factors play a role in how a person's cognitive abilities
develop or decline over time.
●​ Caregiver Assistance and Environment: Change also
happens through external support, such as caregiver
assistance and adapting the environment.
Occupational therapists play a critical role in helping
clients make cognitive changes by providing
instructions, cues, and hands-on assistance to engage
in activities of daily living (ADLs). The therapist may also
adjust the environment to make tasks easier or more
engaging, promoting learning and skill development.
●​ Monitoring Change: The Allen Cognitive Levels (ACLs)
and modes can help occupational therapists monitor
changes in clients’ abilities over time. By observing how
 clients engage in daily tasks, therapists can assess the
cognitive progress or decline and adjust interventions
accordingly

Motivation
Motivation is key to promoting engagement in occupations,
which in turn drives cognitive development.

●​ Cognitive Engagement and Motivation: As individuals

progress through the ACL levels, their motivation to
engage in tasks changes based on their cognitive
abilities. For example:
○​ At Level 1, the person may be largely
unmotivated by external stimuli, driven only by
basic physiological needs (e.g., hunger, comfort).
○​ At Level 2, there may be some motivation to
engage in simple physical actions like rocking or
shifting position, primarily driven by body
comfort.
○​ At Level 3, motivation may expand to include
manual tasks and activities that involve tactile
interaction, like stringing beads or doing simple
crafts.
○​ At Level 4, motivation can include the desire to
accomplish specific goals and use visual cues to
perform tasks, making the person more
goal-oriented and driven.
○​ At Level 5, motivation shifts towards exploration
and trial-and-error learning, driven by curiosity
and self-direction.
○​ At Level 6, motivation is rooted in abstract
thinking and planning, where the individual can
anticipate consequences and make decisions
based on foresight.
●​ Influence of Therapists: Occupational therapists can
enhance motivation by fostering an environment that
supports cognitive functioning and goal-directed
behavior. By providing effective instructions, clear
cues, and supportive assistance, therapists can guide
the client’s efforts and reinforce task engagement.
●​ Adapting the Environment: Environmental
changes—such as providing visual cues, simplifying
tasks, or offering assistive tools—can also increase
motivation by making tasks more achievable or
rewarding for the client. By setting up the environment
to reduce cognitive load, the therapist can create
opportunities for success, further encouraging the
person to stay motivated.
Assessment/Evaluation ● Allen Cognitive Level Test
tools ● Routine Task Inventory (RTI)
● Cognitive Performance Test (CPT)
● Allen Diagnostic Module (ADM)

Intervention guidelines ● Facilitating: Giving appropriate

sensory cues.
● Probing: Asking focused
questions to encourage problem
solving.
● Observing: How client processes
cues and questions and try new
behaviors.
● Rescuing: Stepping in when client
becomes frustrated or is unable to
perform.
● Modify Environment
● Advise other professionals and
caregivers about the limitations on functional performance that
are
imposed by cognitive disabilities.

Movement centered FOR-l

Focus Add info: (chatgpt) focuses on how the body moves and
how movement can help with sensory processing,
emotional regulation, and improving one's body image. It is
used mainly in occupational therapy to help people with
movement difficulties, sensory issues, and neurological
conditions.

Focus

●​ Perception, Organization, and Adaptation: The

main idea is that the way people move affects their
ability to sense, organize, and adapt to the world
around them. By using body movements (both big
and small), they can integrate sensory information
(like touch, balance, and body position) in a way that
helps them function better.
●​ Purposeful Movement: This framework emphasizes
using purposeful body movements to help
individuals process sensations and adjust to their
environment, enhancing their physical and
emotional well-being.
Theorists/Proponents Lorna Jean King, Mildred Ross, Donna Burdick

Function Ability of the person to perceive, organize, adapt, and

interpret sensations

Utilizing purposeful body movements (fine and gross

motor) to integrate sensations

Dysfunction ●​ An impairment in the ability for successful

adaptation
●​ A person who has an inadequate function for
adaptation is one who has neurological or CNS
deficit
●​ Mood disorders
●​ Poor social and communication skills
●​ Dislike of movement or need to increased
movement
●​ Inability to sustain interest or attention
●​ Rigid or flexed posture
●​ Can't avoid unpleasant stimuli
●​ Poor body image
●​ Low self-esteem

Change chatgpt:Change happens when a person’s movement

improves, helping them integrate sensations and adapt to
their surroundings. By participating in movement-based
activities, individuals can enhance their physical and
emotional responses.

Motivation Chatgpt: Motivation is encouraged by creating fun and

enjoyable activities that don’t require too much thought or
attention. This could include movement-based activities
that help with emotional regulation, like music or dance. As
individuals improve their motor skills, they also build
confidence and a more positive view of themselves.

Assessment/Evaluation ●​ Southern California Sensory Integration Tests (SCSIT)

tools ●​ Sensory Integration and Praxis Test (SIPT)
●​ Schroeder - Block Campbell Adult Psychiatric
Sensory Integration Evaluation Parachek Geriatric
Behavior Rating Scale
●​ Smaga and Ross Integrated Battery

Intervention guidelines Aim: Processing sensation and moving with more

confidence to improve feelings about self

Goals:
 ● Normalize tone
● Improve motor planning
● Activities that would involve full body movement
● Includes therapeutic activities that expect a cognitive
response
● Alerting and Calming through music and movement
● Therapeutic activities should not require much thought or
attention and should be pleasurable
● Activities chosen that normalize movement patterns,
strengthen upper trunk stability, and increase flexibility
● Believed that the motor changes would improve body
image and self-confidence, improve attentional and social
response

Lifespan development FOR-l

Focus
chatgpt
●​ Developmental Tasks: The focus is on
achieving the tasks or milestones expected for
a person’s current stage of life. These tasks
vary by age and culture, so what is expected of
someone at 5 years old may be different from
someone at 50 years old.
●​ Cultural Influence: Developmental research
considers the norms and expectations of
different cultural groups. This means that
people from different cultures may have
different expectations for the same age group.
●​ Life Stages: Key events (called "pivotal
happenings") in life are important markers
that signal significant changes in
development. These events could include
things like starting school, becoming a parent,
or retiring.

Theorists/Proponents Lawrence Kohlberg, Erik Erikson, Daniel Levinson, Robert

Havighurst

Function Function:
● Based on achieving the appropriate or expected
developmental task for the
 current age/stage of the individual

● Developmental research is traditionally embedded in the

norms within specific cultural groups.
● Maker events in life stages - pivotal happenings in life
stages.

Dysfunction Dysfunction:
● Dysfunction may occur when client’s growth and
development falls below that expected for their age.

● Dysfunction can be observed from multiple

developmental perspectives but most importantly from
the client’s own viewpoint.

● Illness or trauma may cause regression to an earlier

developmental stage: Down Syndrome, Intellectual
Disability
(ID), Failure to thrive (FTT),
Cerebral Palsy (CP), Pervasive
Developmental Disorder (PDD)

Change Change happens as individuals grow and develop

through the stages of life

Motivation Motivation comes from the person’s desire to reach their

developmental goals.

Assessment/Evaluation ● Life Performance Profile

tools ● Adolescent Role Assessment (ARA)
● Role Checklist
● Occupational Performance History Interview - 2nd
Edition (OPH1-11)

Intervention guidelines ● The Occupational Therapist arranges a

growth-facilitating environment for the stimulation of
age-appropriate behavior and skill learning

● Mastery of skills and success experiences are important

treatment concepts.

● The focus of activities depends on the specific theorist.

Model of human occupation

Focus Key Focus: Promotes occupational engagement and

 participation rather than just addressing impairments.
Core components
●​ Volition: Motivation for occupation.

●​ Habituation: Organization of occupations into

routines/patterns.

●​ Performance Capacity: Physical and mental abilities

underlying skilled actions.

Environmental Impact: Both physical/social features and

intangible contexts (cultural, personal, temporal, virtual)
influence occupational participation.

Therapeutic Benefits:
●​ Promotes occupation-focused practice.
●​ Client-centered, prioritizing individual needs.
●​ Provides a theoretical base for goal construction and
intervention rationale.

Interaction of Components: Volition, habituation, and

performance capacity interact with the environment,
impacting motivation, behavior, and performance.

Environmental & Contextual Influence: Environment

(physical and social) and context (cultural, personal, temporal,
virtual) are key to understanding and supporting
occupational participation.

Occupational Therapy Goal: Enhance well-being through

meaningful activity participation, focusing on both internal
and external factors.

Theorists/Proponents kirsty forsyth and gary kielhofner

Function ●​ Based on exploration competence, and achievements.

●​ Healthy and competent occupational performance.
●​ A functional person can choose organize and perform
meaningful occupations.
●​ Requires a balance between the expectations of self

Dysfunction Based on inefficiency, incompetence, and helplessness.

●​ Inefficiency : this may cause due to dissatisfaction
with performance after applying meaningful activity.
●​ Incompetency : may occur due to major loss or
limitation of skills. An individual may experience
feelings of failure or dissatisfaction.
●​ Helplessness : characterized by a total or near total
disturbance in occupational roles and performance
this because of extreme feelings of ineffectiveness,
anxiety, depression, or all three.
 Change Therapeutic Change Process:
●​ Change is a dynamic process influenced by the
interaction of volition, habituation, performance
capacity, and the environment.
●​ Change can result in shifts in thoughts, feelings, and
actions that make up one’s occupation.
●​ Dynamic Systems Theory: Change happens due to
biological and mental factors adapting through an
ongoing process.
●​ Dissonance: Change is triggered when individuals
experience discomfort or disequilibrium (e.g., pain
post-surgery) and strive to restore balance.
●​ Stages of Change (MOHO):
1.​ Exploration: Trying new activities, learning
about capacities and preferences.
2.​ Competency: Meeting performance standards,
developing personal causation and habits.
3.​ Achievement: Fully participating in
occupations, reinforcing occupational identity.
●​ Feedback and Change: Environmental feedback
impacts the change process, both positive and
negative feedback can alter one's perceptions and
actions.
●​ Key Assumptions about Change: Repeated actions
and thoughts (in a supportive environment) create
lasting changes in volition, habituation, and
performance capacity.

Motivation Dissonance and Motivation:

●​ Dissonance (discomfort) creates a need to push
through discomfort in order to reach a new state of
well-being.
●​ Perturbation: Changes in equilibrium motivate
individuals to strive for a new balance or state of
health.
●​ Therapeutic Approach: Motivation is influenced by
both internal (beliefs, values) and external (feedback
from the environment) factors.
●​ Intrinsic Motivation: Internal factors such as
self-efficacy, personal values, and interests are more
sustaining and within one's control.
●​ External Motivation: Feedback, rewards, and
recognition from the environment also play a role in
motivating change.
●​ Internal vs. External Motivation: Motivation is a
combination of internal drives and external feedback.
Internal motivations (volition subsystem) are more
lasting, while external feedback is crucial for shaping
perceptions and encouraging actions.

Assessment/Evaluation ●​ Assessment of Communication and Interaction Skills

tools (ACIS)
 ●​ Assessment of Communication Motor and Process
Skills (AMPS)
●​ Assessment of Occupational Functioning
Collaborative Version (AOF-CV)
●​ Child Occupational Self-Assessment (COSA)
●​ Interview Checklist
●​ Model of Human Occupation Screening Tool
(MOHOST)
●​ NIH Activity Record

Intervention guidelines 6 steps of therapeutic reasoning :

1.​ Generating questions about the client.
2.​ Gathering information on and with the client.
3.​ Using the information gathered to create an
explanation gathered of the client’s situation.
4.​ Generating goals and strategies for therapy.
5.​ Implementing and monitoring therapy.
6.​ Determining outcomes OT

Occupational adaptation FOR

Focus ●​ Occupational adaptation is applicable to populations

across the developmental lifespan.
●​ focuses on the
○​ (a) interactive process between a person and his
or her environment and
○​ (b) internal adaptive process that occurs when
we engage in occupations (Schultz, 2014).
●​ Use OA if there is demand, a desire, and a press for
mastery

Theorists/Proponents JANET SCHKADE & SALLY SCHULTZ

Function Relative mastery and adaptive, and

functional activities.

Dysfunction ●​ Imbalance between desire and demands.

●​ Inability to generate or produce an adaptive response
due to any disruption of the occupational adaptation
process

Change Occupational therapists assess therapeutic change by three

indicators:
1.​ Client’s report of improved relative mastery.
2.​ Observation of spontaneous adaptation to new
situations.
3.​ Client’s initiation of new adaptations not previously
suggested.

Adaptation is an internal process driven by the desire to

 become more functional.
In occupational adaptation, increased adaptability leads to
greater functionality (Schultz, 2014).

Motivation Core assumption: Every person has an innate desire to master

their environment (Reilly, 1962).

Motivation is influenced by three processes:

1.​ Desire for mastery.
2.​ Demand for mastery.
3.​ Press for mastery.

A person will be more motivated to change if:

1.​ The occupation is meaningful and desired.
2.​ The demands of the occupation are manageable and
within the person’s adaptive nature.
3.​ The environmental pressures align with the person’s
ability to adapt and perform.

Personal attraction to an activity increases the likelihood of

adaptation when facing challenges (Schultz, 2014; Schkade &
Schultz, 2003).

Assessment/Evaluation
tools 1.​ Guide to Practice (Schultz & Schkade, 1992).
2.​ Occupational Adaptation Clinical and Professional
Reasoning Process (Schultz, 2014).

Practitioners use these tools to assess the client’s adaptive

capacity, considering factors like person variables,
environmental context, and role expectations

Intervention guidelines ●​ Achieve mastery over the environment.

●​ Client will be able to cope with the challenges by
guiding him through occupational adaptation process
and meaningful occupation.
●​ Promote satisfaction, occupational environment in
relation to any condition.
●​ Emphasize occupational readiness

Ecology of human performance FOR

Focus Aimed at individuals across various ages and needs

throughout the lifespan. Emphasizes preventive,
health-promotional, and rehabilitative approaches. Uses
task performance as a key concept, which applies to various
professional disciplines. Tasks include ADLs, IADLs, work,
education, leisure, sleep/rest, and social participation. Focus is
on the situation/context and its impact on task performance.
 Context variables: cultural, temporal, physical, and social
environments (expanded to include personal and virtual
contexts in current OTPF).

Four Main Components of EHP:

1.​ Person:
○​ An individual with unique skills in sensorimotor,
cognitive, and psychosocial domains.
○​ Meaning and motivation come from
engagement in tasks within specific contexts.
○​ The person-context relationship is dynamic and
ever-changing.
2.​ Tasks:
○​ A set of behaviors necessary to accomplish a
goal.
○​ Tasks are influenced by internal (person’s traits)
and external (social norms) factors.
○​ Tasks are building blocks of occupations and
roles, shaping role and occupational
performance.
3.​ Context:
○​ The interdependent conditions that define a
person’s surroundings.
○​ Temporal aspects: age, developmental stage,
life cycle, health status, and time-related task
factors.
○​ Environmental aspects:
■​ Physical: non-human aspects (earth,
buildings, tools).
■​ Social: norms, role expectations, and
relationships.
■​ Cultural: customs, beliefs, activity
patterns, political, and social systems.
4.​ Performance (Person–Context–Task Transaction):
○​ Reflects how a person engages in tasks within
their context, resulting in performance.
○​ The relationship is interdependent, where task
performance influences and is influenced by the
person and context.
○​ Performance range is determined by the
interaction of these variables.

Theorists/Proponents Winnie Beatrice Dunn, Chris Warburton Brown, Amanda

McGuigan

Function Healthy functioning is indicative of a person’s high

performance range to complete tasks.
 Dysfunction Restriction in performance range is evident when a disruption
occurs in the transaction among the person, the context, and
the tasks.

Change An important aspect of this model is to empower the client as

the agent of change and respect his or her role as the primary
decision maker of his or her lifestyle.

Motivation Motivation is elicited by directly asking a person what he or

she wants and needs relative to occupational performance.
Persons are likely to engage in tasks if they have an interest or
value its meaningfulness. It is very important to seek a client’s
perceptions about his or her role functioning and task
performance, even if the practitioner has a different viewpoint.

Assessment/Evaluation ●​ Activity analysis

tools ●​ Environmental assessment-Functional assessments

Intervention guidelines 1.​ Restore/ Establish: Develop and improve skills or

abilities
2.​ Adapt/ Modify: Physical(like assistive devices) and
social(like education, social support, change schedule)
3.​ Alter: No changes, designed to make a better fit
(activity analysis, environmental assessment)
4.​ Prevent: Change before a negative outcome occurs
5.​ Create: Design to promote and enrich occupational
performance

Person-environment-occupational performance FOR-l

Focus
The focus of the
Person-Environment-Occupation-Performance (PEOP)
model, as described, is on understanding the complex
interaction between person factors, environment,
occupation, and performance. This model emphasizes:

1.​ Occupational performance: The central focus is how

individuals carry out meaningful activities, tasks, and
roles through their interactions with the environment.
Occupational performance contributes to participation
and well-being.
2.​ Person factors: Intrinsic factors like physiological,
psychological, neurobehavioral, cognitive, and spiritual
elements that support or limit an individual's
occupational performance.
3.​ Environment: Extrinsic factors like culture, social
support, policy, physical environment, and assistive
 technology that either enhance or limit occupational
performance.
4.​ Occupation: The activities, tasks, and roles individuals
need or want to engage in to support their participation
and well-being.
5.​ Narrative: subjective data about a person, population,
or organization that provides a realistic perception of
the current situation and the desired goals for
intervention. Based on this story or background, an
occupational therapist determines if there is a relevant
match for services that meet the profession’s scope of
practice (Bass et al., 2015)

In this model, client-centered care begins with the client’s

narrative, helping the therapist understand the client’s
personal context, which includes their goals, challenges, and
environment. This holistic approach guides clinical reasoning,
helping to create interventions that address both internal
(person) and external (environment and occupation) influences
on occupational performance.

Theorists/Proponents Carolyn Baum, Charles Christiansen, Julie Bass

Function a person demonstrates healthy functioning when they can

effectively meet the demands of their desired occupations and
roles, leading to positive participation, well-being, and life
satisfaction.

Occupational Competency: The individual has the ability to

successfully perform and master occupations that align with
their personal goals, values, and life roles.
Balance of Demands: There is a balance between the person's
abilities (physical, cognitive, emotional) and the demands of
the environment and occupations.
Satisfaction and Adaptability: Individuals can self-manage,
care for others, participate in community life, and adapt to
challenges. This adaptability and engagement lead to personal
satisfaction and fulfillment of societal and personal
expectations.
Well-Being and Happiness: Optimal functioning results in life
satisfaction, happiness, and well-being, as the person feels
aligned with their identity, capacities, and the environment.

Dysfunction Dysfunction occurs when an individual's occupational

performance is restricted or limited, resulting in failure to
achieve occupational competency and goal attainment.

Occupational Performance Dysfunction: A lack of success in

performing meaningful activities due to personal,
environmental, or occupational factors. This might result in the
 inability to meet role expectations or personal goals.
Person-Based Deficits: Impairments related to a health
condition, such as physical, cognitive, or emotional limitations,
that hinder occupational performance.
Environmental Barriers: Environmental constraints, such as a
lack of accessibility, social support, or available resources,
contribute to dysfunction.
Role Conflict: Sociocultural factors, such as conflicting
demands of multiple life roles or unclear role expectations, can
lead to stress and unsatisfactory occupational performance.
Negative Impact on Participation: The individual experiences
reduced participation, inability to achieve goals, and lack of
engagement in meaningful activities, leading to frustration,
dissatisfaction, and reduced well-being.

Change Client’s perception and priorities: Change begins by

understanding the client's perspective of a problem during the
narrative phase. The process is top-down, meaning it starts
from the client’s view and experiences, and it emphasizes
identifying what the client finds important and rewarding.
Change is driven by the client’s personal goals and the sense of
mastery or accomplishment they seek through occupational
engagement.

Match intrinsic factors with activities: For change to be

effective, it’s important that the therapist matches the client's
intrinsic motivation and other psychological factors
(self-esteem, self-concept, etc.) with the demands of the
chosen activity or intervention. Achieving success in these tasks
leads to a positive cycle of change, reinforcing the client’s sense
of accomplishment.

Motivation Intrinsic factors: Motivation is based on the intrinsic desire to

master the environment and demonstrate competence in
occupations. Motivation is influenced by internal factors like
self-concept, self-efficacy, identity, and emotional states. The
model emphasizes that these factors play a major role in a
person’s engagement in tasks and the persistence they show
when facing challenges.

Meaning and value: Clients are more motivated when the

tasks they engage in are meaningful and of personal value to
them. If the activities lead to feelings of self-satisfaction and
competency, the client is more likely to persist in them and feel
motivated to continue.

Successful experiences: Motivation is also reinforced when

clients experience success during the intervention process.
Success fosters a sense of accomplishment, which in turn
motivates them to engage in the activity again, building a
 positive cycle of motivation.

Assessment/Evaluation
tool; Intervention 1. Narrative Phase
guidelines
●​ Top-down approach: The process starts by assessing the
client’s own perception of their strengths and problems in
occupational performance.
●​ Eliciting the personal story: The occupational therapist (OT)
gathers the client’s personal story and experiences during this
phase, similar to an occupational profile.
●​ Goal setting: The client describes both short-term and
long-term goals they wish to achieve.
●​ Determining relevance of OT services: Based on the client’s
narrative, the OT decides if and how occupational therapy
services are a good fit for the client's needs.

2. Assessment and Evaluation Phase

●​ Use of evidence-based assessments: The OT selects and

uses assessments grounded in evidence to collect baseline
data about the client’s occupational performance.
●​ Integration of data: The OT evaluates data gathered from
assessment tools that examine the three core components:
occupation, person, and environment.
●​ Identifying strengths and challenges: The evaluation
identifies both the client’s strengths (enablers) and areas of
difficulty (barriers) in relation to occupation, person, and
environment.

3. Intervention Phase

●​ Collaboration with the client: The OT works with the client to

develop a personalized action plan based on the client's
values, priorities, and goals.
●​ Designing an intervention: The plan reflects areas of
concern, ensuring that the intervention is aligned with the
client’s desires and needs.

4. Outcomes Phase

●​ Explaining potential outcomes: The OT discusses the

possible results of the intervention with the client, helping them
understand the expected benefits.
●​ Client involvement in decision-making: Clients are informed
about the potential outcomes and are given a say in the types
of therapy services they wish to pursue.
●​ Measuring effectiveness: The PEOP model emphasizes the
importance of measuring outcomes, not only for individuals but
also for populations and organizations, to ensure that the
therapy process is effective.
●​ Key outcomes: The focus of outcomes is on performance,
 participation, and well-being—all of which are crucial to the
success of the intervention.

KAWA FOR-l

Focus (Book) The focus of this information is on how the Kawa Model is
applied in Western occupational therapy practice, particularly in
working with people from Eastern cultures. The Kawa Model uses a
river metaphor to explain the interconnectedness of individuals with
their social groups, as well as the relationship between occupations
and their natural and spiritual contexts.

Key elements of the focus include:

1.​ Collective Approach: Clients are seen as part of a collective

(family, community, or group), and therapy includes
collaboration with the whole group, not just the individual. The
goal is to address occupational challenges that arise from
internal (client factors) or external (contextual or
environmental) barriers, which interfere with the group’s
functioning.
2.​ Harmony and Inclusion: Especially for Japanese clients, the
focus is not solely on individual occupational performance or
engagement, but rather on inclusion within the group and
 maintaining harmony with others and nature. This highlights
the cultural difference in focusing on collective well-being over
individual achievement.
3.​ Barriers to Flow: Occupational therapists aim to remove or
modify barriers (whether social expectations or environmental
factors) to ensure that the river of life, symbolizing the group’s
collective journey, flows freely, allowing the community to
move towards its spiritual or collective goal.

(Arj) Group of Japanese occupational therapists embarked on a

project that aimed to develop an alternative approach that would
transform their occupational therapy and bring it more in line with
their client’s day-to-day realities and experiences of disablement.

Kawa Model follow the more ‘primitive’ ontological view of

people and nature,
drawing no clear distinctions or separations between selves
and their context of reality.
● “Kawa” means river and this model uses it as a metaphor for
life flow.

Structure and Components:

- River (kawa): fluid and integrative image to represent the
complexity and harmony of the client’s occupational life flow.

- Water (Mizu): symbolizes their life journey, flowing through

time and space.

- Rocks (Iwa): problematic life circumstances that are difficult

to remove

- River side walls (Kawa no soku-heki)

and bottom (kawa no zoko): environmental
issues affective the flow of the river and determining
boundaries, shape, and flow of river.

- Driftwood (Ryboku): personal assets such

as material or immaterial resources
(liabilities).
- Space between the
obstruction in the
river (Sukima): Occupation, Opportunities to problem-solve

Theorists/Proponents Michael K. Iwama, Kee Hean Lim

Function ● Illuminates the transactional

quality of human-environment dynamics and the importance
of inter-relations of self and others through the metaphor of a
river's flow
● Used to understanding of illness, health and disability

Dysfunction Unless these (universal) models are applied to a socially and

 culturally homogenous clientele who abide more and less in
the same socio-cultural contexts of daily life, the practice forms
that follow may exclude and even disadvantage the culturally
diverse person with disability. Such clients may
in many cases be compelled to adopt
unfamiliar ideas, concepts and normative imperatives that
resunate marginally with their own spheres of day-to-day
experiences.

Change
In the Kawa model, change is seen as something that occurs
not just at the individual level but also within the context of the
social group. Occupational therapy is thus not only about
helping an individual client, but it also acknowledges the
group dynamic as part of the solution. Occupations (the
activities people engage in) can be the means to facilitate
change by helping individuals restore their sense of belonging
within the group, contributing positively to it, or harmonizing
their actions with nature. This change is driven by the collective
nature of the environment.

Motivation
Motivation in the Kawa model arises from the desire to
maintain or restore harmony within social structures. People
are motivated by social status and a sense of equality with
others in their group. Rather than being driven by personal
achievements or individualistic goals, motivation often stems
from the need to meet social expectations and fulfill roles
within the community. Achieving equality within a group, or
obtaining something perceived as a right based on one's social
status, can be a powerful motivator. Therefore, occupations that
contribute to status equality or social harmony are highly
motivating.

Assessment/Evaluation Drawing their kawa is an implied method of evalua- tion.

tools Occupational therapists help clients to identify their current
status through drawing their kawa and identifying those
elements that have caused the water to cease flow-ing. In a
group evaluation, the occupational therapist may ask clients to
“draw the rocks that prevent your life from
flowing”—these are the barriers to participation through
occupational engagement. The clients’ personal and group
perspectives are revealed through the drawings.

Intervention guidelines
The intervention described here is a client-centered approach
 using the Kawa model, which involves understanding the
client's unique experiences and perspectives, particularly
through the use of the river metaphor. In this model:

●​ The river (Kawa) represents the client's life journey,

where different elements (water, rocks, riverbanks)
symbolize aspects of their personal and social
environment, challenges, and supports.
●​ The therapist encourages the client to narrate their own
experiences and views of their circumstances, rather
than imposing a fixed set of external principles or
standardized assessments.
●​ By respecting the client's cultural and personal context,
the therapist selects tools and methods that are
appropriate for further exploring and addressing the
client's rehabilitation needs.

The intervention thus involves collaborative exploration of the

client's life, strengths, and barriers, allowing the therapist to
develop a tailored and culturally responsive rehabilitation plan.

Canadian model of occupational performance FOR-l

Focus ●​ To guide occupational therapists in evaluating and

addressing barriers to an individual’s occupational
performance.
●​ It emphasizes the holistic view of a person, considering
not only physical or cognitive aspects but also their
emotional and spiritual well-being.

Theorists/Proponents Definition

Function Individual’s ability to engage in meaningful occupations. This

performance is shaped by the interaction between the person,
their environment, and the occupations.

Dysfunction ●​ Barriers arise in the interaction between these

components, such as physical, cognitive, emotional, or
spiritual challenges.
●​ These barriers can limit a person’s ability to engage in
daily activities and affect their quality of life

Change ●​ Improving occupational performance through

environmental and personal adjustments

Motivation ●​ When their occupations hold personal meaning and

 align with their values
●​ The therapist’s role is to support this motivation by
ensuring that the environment and tasks are conducive
to the person’s interests and goals.

Assessment/Evaluation COPM – Canadian Occupational Performance Measure

tools

Intervention guidelines Client-centered, environmental modifications