Model of Human Occupation (MOHO)
Theoretical Foundations of OT (OT-TFO)
By: Margot Del Rosario | BSOT 1-3
Brief history of MOHO Focus on MOHO
❖ Developed by Gary Kielhofner & Burke ❖ Occupational Behavior
with Shannon (1970) and Reilly (1962) ➢ An outcome of a dynamic
❖ First published in 1980 process that helps us to shape
and organize ourselves as
MOHO human beings.
❖ Human Occupation
➢ Doing the work, play, or
activities of daily living within a
temporal, physical, and
sociocultural context.
MAJOR FOCUS OF MOHO
❖ The major focus is on the person and
❖ A conceptual practice model
how the environment contributes to
❖ Was the first OT model to
one’s source of motivation, patterns of
conceptualize the interactive and
behavior, and performance
cyclical nature of human interaction
with one’s environment.
THEORETICAL VIEW
❖ Defined as a set of evolving theoretical
arguments that are translated into a ❖ The person reflects on how motivation,
specific technology for practice and are behavior, and performance are
refined and tested through research integrated.
❖ Offers a systematic, holistic approach
for persons of varying needs and COMPONENTS OF THE PERSON
populations across the lifespan ❖ Three interrelated parts exist within
❖ Stresses the importance of the each person:
mind/body connection in its depiction 1. Volition - the process by which
of how motivation (internal) and people are motivated toward
performance occupations (external) and choose what activities
are interconnected they do.
MOHO addresses 2. Habituation - a process
whereby people organize their
1. The motivation for occupation
actions into patterns and
2. The routine pattering of occupations
routines. It aims to give
3. The nature of skilled performance
regularity, character, and order
4. The influence of environment on
to what we do and how we do
occupation
it.
Main conceptual ideas of MOHO
3. Performance Capacity -
1. Embracing the complexity of human
underlying mental and
occupation
physical abilities and how they
2. Components of the person
are used and experienced in
3. Environment
performance.
4. Occupational performance
(mind-brain-body
performance).
COMPONENTS OF THE PERSON ENVIRONMENT
❖ The physical, social, cultural, economic,
VOLITION and political features within a person’s
context that are influenced by
1. Personal Refers to thoughts and motivation, organization, and
causation feelings about our own performance of occupation.
capacities and ➢ Physical Environment
effectiveness that each ■ Natural and
of us have as we do human-made spaces
everyday activities. ➢ Social Environment
■ Groups of persons
2. Values Are beliefs and come together for a
commitments about purpose and have a
what we think is good, major impact on the
right, and important to development of role
do. It shapes our sense behavior.
of what is worth doing, ■ Occupational forms or
how we should act, and conventionalized ways
the right way to do of doing things like
things. manners.
3. Interests Are our feelings of OCCUPATIONAL PERFORMANCE
attraction based on ❖ Performance can be examined at
anticipation of a various levels:
positive experience in ➢ Skills
doing an occupation. ➢ Occupational performance
➢ Occupational participation
HABITUATION
➢ Occupational identity and
competence
1. Habits Learned ways of doing
➢ Occupational adaption
things that unfold
automatically.
Skill discrete purposeful
2. Roles Give people an identity actions that make up
and a sense of the occupational
obligations that go with performance.
that identity. (motor, process,
communication &
PERFORMANCE CAPACITY interaction skills)
1. Body structures Musculoskeletal system, Occupational doing tasks related
Neurological system, Performance to participation in a
Sensory Structures major life area.
2. Body functions Motor, Sensory, Occupational refers to engaging in
Cognitive, and Participation work, play, or
Emotional functions activities of daily
living that are part of
one’s sociocultural
context
and that are desired
❖ A human is an open system that can
and/or necessary to
change and develop through
one’s well-being.
interaction with the environment.
Occupational generated from ➢ parts of the open system: input,
identity experience, is the throughput, output and
cumulative sense of feedback
who we are and who ❖ Heterarchy
we wish to become ➢ is the principle that parts of any
as occupational system will interact with each
beings according to other in ways that depend on
our history of the situation.
occupational ❖ Participation in occupations
participation. ➢ helps to create our
occupational identity, which is
Occupational the degree to which formed by the person’s internal
Competence we sustain a pattern structures defined by volition,
of doing that enacts habituation, and performance
our individual capacity.
occupational ➢ It is a subjective construct.
identity. ❖ Occupational competence
➢ is the degree to which one
Occupational An organization of sustains a pattern of
Adaptation positive occupational occupational participation that
identity and reaching represents one’s occupational
occupational identity.
competence in ➢ Ability to maintain and fulfill
different contexts of routines & habits
the environment. ❖ Competence
➢ the ability to perform what a
Occupational refers to the client’s person internally regards as
Engagement doing, thinking, and meaningful.
feeling under certain ➢ ability to effectively perform a
environmental task, role, or activity based on
conditions during skills, knowledge, and
therapy or as a experience.
planned ❖ Occupational adaptation
consequence of ➢ Outcome of a positive
therapy. occupational identity and
achievement of occupational
THEORETICAL BASE competence. It is dynamic and
❖ Humans are biologically mandated to context-dependent.
be active. Spontaneous action is the
most fundamental characteristic of all FUNCTION/DYSFUNCTION CONTINUUM
living things. ❖ Function as order
❖ Thinking, feeling, and doing are ➢ A status of health and
influenced by a dynamic interaction competent performance of
between one’s internal components daily living, work and play.
and the environment. ➢ A person displays function
❖ Situations and conditions within the when he or she can choose,
environment will influence a person’s organize, and perform
motivation occupations that are
personally meaningful.
❖ Dysfunction as disorder ❖ The Open System cycle:
➢ The inability to perform ➢ Input: External information that
occupations typically and usually surrounds
➢ Interruption in role performance
us and is taken in by the use of
➢ Inability to meet role
the five senses.
responsibilities
➢ Person: Composed of the 3
❖ Function subsystems. Once the internal
➢ Exploration processing is complete, the
➢ Competence person then takes some form of
➢ Achievement
skilled action.
➢ Skilled action/Occupational
❖ Dysfunction
Performance: Goal-directed
➢ Helplessness
■ Having inadequate action that can be externally
skills witnessed.
■ Few to no interests and ➢ Environment: Physical and
roles social components
➢ Incompetence
■ Lack of routine
EVALUATION PROCESS
■ Poor skill functioning
❖ Two recommended general steps to
■ Decreased interest and
values this data-gathering process:
➢ Inefficacy a. Use the data to find out about
■ Decreased function a client from the viewpoint of
■ Dissatisfaction with an outsider looking in.
one’s performance b. Collect and use data to help
clients understand how their
CONCEPT OF MOHO personal perceptions and
❖ The model begins with the idea that a subjective views lead to
person’s inner characteristics and occupational performance
external environment are linked actions and patterns.
together into a dynamic whole. ❖ Both structured and unstructured
❖ The model asserts that inner capacities, assessment
motives, and patterns of performance ❖ typically include observational
measures, self-report questionnaires
are maintained and change through
and checklists, and structured
engagement in occupations.
interviews AND informal and
❖ OT is a process in which practitioners spontaneous in response to a client’s
support client engagement in needs, respectively.
occupations to shape the client’s
abilities in doing a routine, and their INTERVENTION GUIDELINES
thoughts and feelings. ❖ Interventions aim to enhance the open
system cycle so that it yields
❖ The process of human occupation
competent and adaptive performance.
➢ Man is an open system with 3
interacting subsystems: volition,
habituation, and
mind-brain-body performance
(performance capacity).
KEILHOFNER’S GUIDELINES TO INTERVENTION 14. Interventions should be aimed at
1. Interventions must be client-specific improving one’s functional level
and related to the unique life according to the function/dysfunction
circumstances of the individual. continuum.
2. Intervention should be focused on
changing one’s occupational ASSESSMENT TOOLS (3)
performance. 1. OBSERVATIONAL ASSESSMENTS
3. Interventions that impact one aspect of ❖ Assessment of communication and
the overall human performance cycle Interaction Skills (ACIS)
(subsystem) will result in a ❖ Assessment of Motor and Process Skills
reorganization of the entire process. (AMPS)
4. Interventions typically occur during 2. SELF-REPORT ASSESSMENTS
periods of chaos or crises for clients. ❖ Modified Interest Checklist
5. Interventions may be aimed at ➢ Modified by Scaffa & again by
modifying or altering one’s Kielhofner & Neville
environment to promote opportunities ➢ Designed for adult psychiatric
for change. inpatients
6. Interventions that are aimed at skilled ➢ Used to assess interests
performance are more efficient than ❖ Role Checklist
those aimed at a client’s underlying ➢ Developed by Oakley, Kielhofner
personal structure. and Barris
7. Interventions may be aimed at skill ➢ Used to assess the habituation
development and skill substitution and volitional components
when lacking. ➢ Used to obtain info on client’s
8. Interventions that incorporate a perceptions of their
client’s typical occupational forms will participation in occupational
have a more meaningful impact than roles and the value they place
rote learning or mere repetitious on those roles
behavior. ➢ Consists of (3) three parts:
9. Interventions directed at changing ■ Semi-structured
one’s habits and roles are challenging ■ Rating Scale
due to their basic function of preserving ■ Life History Narrative
patterns for the person. ■ Qualitative Data
10. Interventions that take place in one’s 3. INTERVIEW-BASED ASSESSMENTS
natural environment are more likely to ❖ Occupational Performance History
be assimilated by the client. Interview, Version 2 (OPHI-II)
11. Interventions that are aimed at ➢ Published by Kielhofner,
habituation will need to be applied Mallinson, Crawford, Nowak,
swiftly to secure one’s occupational Rigby, Henry and Walens
identity. ➢ Used to assess general
12. Interventions aimed at acquiring new occupation adaption
role scripts and related habits should
be practiced in natural and appropriate ❖ Occupational Circumstances
environments where feedback is Assessment-Interview and Rating
typically generated. Scale (OCAIRS)
13. Interventions that relate to one’s ➢ Assess a client’s occupational
volitional subsystem provide the most participation and
meaning and impact for the client. environmental influences.
❖ Worker Role Interview 5. Negotiate
➢ Developed by Velozo and ○ Engage in a give-and-take
Kielhofner with others that creates a
➢ Used as the psychosocial or mutually agreed-upon
environmental component of perspective.
the initial rehabilitation
assessment process 6. Plan
○ Establish an action agenda for
❖ The theoretical concept in MOHO and performance or participation
responding Work Role Interview (WRI)
items: 7. Practice
○ Repeat a certain performance
○ Consistently participate in an
occupation with the intent of
increasing skills, ease, and
effectiveness of performance
8. Reexamine
○ Critically appraise and
consider alternatives to
previously held beliefs,
attitudes, feelings, habits, or
roles
9. Sustain
○ Persists in occupational
performance or participation
despite uncertainty or difficulty
DIMENSIONS OF CLIENT OCCUPATION
ENGAGEMENT
STEPS OF THERAPEUTIC REASONING
1. Choose/Decide
1. Generating questions about the client
○ Anticipate and select from
2. Gathering information on and with the
alternatives for action
client
2. Commit
3. Using information gathered to create
○ To pursue something
an explanation of the client’s situation.
○ Decision to undertake a course
4. Generating goals and strategies for
of action to accomplish a goal
therapy
3. Explore
5. Implementing and monitoring therapy
○ Trying out new things
6. Determining outcomes of therapy
○ Investigate new objects,
spaces, social groups,
THERAPEUTIC STRATEGIES (MOHO)
occupational forms/tasks
1. Validating
○ Do things with altered
○ attending to and
performance capacity
acknowledging the client’s
○ Examine possibilities for
experience.
occupational participation
4. Identify
2. Identifying
○ Locate novel information,
○ locating and sharing a range
alternatives, for action, and new
of personal, procedural
feelings that provide solutions
environmental factors that can
for and/or give meaning to
facilitate occupational
occupational performance and
performance.
participation.
3. Giving feedback
○ sharing your (as an OT)
understanding of the client’s
situation or ongoing action.
4. Advising
○ recommending intervention
goals/strategies.
5. Negotiating
○ Engaging in a give-and-take
with the client.
6. Structuring
○ Establishing parameters for
choice and performance by
offering a client alternative,
setting limits, and establishing
ground rules.
7. Coaching
○ Instructing, demonstrating,
guiding verbally and/or
physically prompting.
8. Physical support
○ Using one’s body to provide
support for a client to complete
an occupational form/task.
