Model of Human Occupation, Cole & Tuffano (2007)

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com,
based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.
MODEL OF HUMAN
OCCUPATION
Cole & Tufano (2007), Chapter 7

THE BEGINNING…
 (MOHO) is a conceptual model of
practice that evolved from Reilly’s
Occupational Behavior Model and
General System Theory.
 Gary Kielhofner was a student of
Mary Reilly who originally created this
model as a Master’s thesis in 1975.
Within five years, Kielhofner and his
colleagues published MOHO for the
first time

WHAT IS IT?
The Model of Human Occupation is a
conceptual practice model which is
defined as “ …a set of evolving
theoretical arguments that are
translated into a specific technology
for practice and are refined and
tested through research” (Kielhofner,
2002, p. 3).

FOCUS
 Systemic, holistic approach for persons of varying
needs and populations across the lifespan
 Stresses the importance of the mind/body connection
in its depiction of how motivation (internal) and
performance of occupations (external) are
interconnected
 Human occupation is described as the “doing” of
work, play, or activities of daily living within a
temporal, physical, and sociocultural context.
 Interactive nature between the person and his
environment and how this relationship contributes to
one’s source of motivation, patterns of behavior, and
performance.

PERSON – redefined for practice
 Kielhofner’s theoretical view of the person
is very comprehensive.
 Variables include one’s motivation,
behaviors, and performance
 All 3 inter-relate to form a person’s identity.
 Kielhofner has specifically grouped these
variables into 3 subsystems that he calls 1)
volition, 2) habituation, and 3) performance
capacity.

Volition Subsystem
• Volition is the source of motivation for
occupation.

Habituation Subsystem
• Habituation refers to the process by
which occupation is organized into
patterns or routines

Performance Subsystem
• Performance capacity refers to the
physical and mental abilities that
underlie skilled occupational
performance. This subsystem is also
called the mind-brain-body
performance.

Assumptions
 Humans are biologically mandated to be
active. Spontaneous action is the most
fundamental characteristic of all living
things (Boulder, 1968; von Bertalanffy,
1968).
 Practice Application: Persons have a
fundamental and neurologically based need
for action and doing. This innate need is
the dominant source of motivation for
participation in occupation.

Assumptions, cont.
 Thinking, feeling, and doing are influenced by a
dynamic interaction between one’s internal
components and the environment. Situations and
conditions within the environment will influence a
person’s motivation.
 Practice Application: Systems theory helps the
practitioner to understand that there are multiple
factors within the person and the environment that
influence each other. A change (positive or negative)
in any one variable will automatically result in a
change in one’s motivation, behavior, and/or
performance.

Assumptions, cont.
 Man is an open system that can change and develop
through interaction with the environment. The parts
of the open system cycle include input, throughput,
output, and feedback.
 Practice Application: Persons are continuously
impacted by input from one’s environment and
feedback from one’s environment. Clients learn about
themselves by experimenting with behaviors and
receiving feedback about this behavior (output).
Some cycles are positive and some are negative in
outcome.

Assumptions, cont.
 Heterarchy is the principle that the demands of a
context or situation will determine how human
variables will organize themselves to achieve a sense
of order. In a heterarchy, each component contributes
something to the total outcome but the arrangement
or order of these variables is changeable due to the
conditions of the context and/or environment.
 Practice Application: The client’s environment,
context, and/or situation greatly influence how the
person variables identified as volition (motivation),
habituation, (habits and routines) and performance
capacity (mind/body skills) will inter-relate with each
other.

Assumptions, cont.
 Participation in occupations helps to create
our occupational identity, which is formed
by the person’s internal structures defined
by volition, habituation, and performance
capacity. It is a subjective construct.
 Practice Application: Clients develop an
identity over time. It is believed that this
identity begins with self-appraisal and
extends toward more challenging dynamics
such as accepting responsibility for and
knowing what one wants in life.

Assumptions, cont.
 Occupational competence is the degree to
which one sustains a pattern of
occupational participation that represents
one’s occupational identity. Competence is
the ability to put into action what a person
internally regards as meaningful.
 Practice Application: Clients demonstrate
competency when they can organize their
life to meet the basic responsibilities to
themselves and the role obligations of
society in satisfying and meaningful ways.

Assumptions, cont.
 Occupational adaptation is the outcome of a positive
occupational identity and achievement of occupational
competence. It is dynamic and context dependent
(refer to concept of heterarchy). Occupational therapy
can promote change in clients. The parts within the
person (throughput) that include motivation, life
patterns, and performance lead to behaviors in work,
play, and self care.
 Practice Application: The internal parts of the
person are responsible for one’s occupational
performance and adaptation. Occupational therapy
acts as a form of feedback within one’s environment
that can ultimately impact how one changes and
alters behaviors

ORDER
 Kielhofner defined function as order (a
status of health and competent
performance of daily living, work, and
play). A person displays function when he is
able to choose, organize, and perform
occupations that are personally meaningful.
It is a process whereby a person
continuously learns how to balance his own
expectations with those of society. A person
who demonstrates order in daily living,
work, and play experiences a sense of
competence and role fulfillment

DISORDER
 Kielhofner termed dysfunction as disorder
 The inability to perform occupations
 An interruption in role performance
 An inability to meet role responsibilities)
(Barris, Kielhofner, & Watts, 1983).
 A person with dysfunctional behavior
patterns does not experience a basic
quality of life nor can he meet personal and
societal expectations.

ORDER vs DISORDER
 Exploration, competence, and
achievement = ORDER
 Helplessness, incompetence, and
inefficacy = DISORDER

MAN AS AN OPEN SYSTEM
 Input -
 Person -
 Occupational Performance ->
 Environmental Feedback

3 PARTS OF A VOLITIONAL
SUBSYSTEM
 Volitional Subsystem – source of motivation that guides
individuals to anticipate, choose, experience and interpret what
they do; thoughts and feelings about doing occupations that
reflect a sense of mastery, enjoyment and value judgments.
Composed of three smaller parts.
 Personal Causation – refers to one’s sense of competence and
effectiveness; what a person feels capable of; a person’s awareness of
his abilities; includes feelings of self efficacy (perception of control
over one’s own behavior, thoughts, and emotions including a sense of
control in achieving desired outcomes). Example: “I am an intelligent
person who can succeed in occupational therapy”.
 Values – beliefs about what is right, important, and good to do that
influences one’s goals; include personal convictions, principles, and a
sense of obligation. Example: “I value helping others and therefore my
goal is to become an occupational therapist”.
 Interests – what a person finds enjoyable, pleasing, and satisfying.
Example: “I enjoy studying the arts and science that underlie
occupational therapy as a profession.”

2 PARTS OF THE HABITUATION
SUBSYSTEM
 Habituation Subsystem – made up of the
behaviors and roles that help persons to
organize their daily life. Composed of two
smaller parts.
 Habits – automatic and repetitive behaviors that
influence how persons perform routine
activities, use time, and behave on a daily
basis.
 Internalized Roles – a source of identity with
inherent obligations and expectations; also
referred to as scripts or ideas of what is
expected of oneself in a particular situation;
enable individuals to fulfill needs for self and
society.

PARTS OF THE PERFORMANCE CAPACITY
SUBSYTEM
 Mind-Brain-Body Subsystem – composed
of four constituents that represent one’s
capacity for occupational performance;
one’s underlying natural ability
 Musculoskeletal – bones, muscles, joints
comprising one’s biomechanical structure
 Neurological – central and peripheral nervous
systems
 Cardiopulmonary – cardiovascular and
pulmonary systems
 Symbolic – abstract images that guide and give
meaning

Occupational Performance or
Skilled Actions(output)
 Goal directed actions (output) that make
up occupational performance.
 3 categories.
 Motor Skills – used to move one’s self or objects
 Process Skills – thinking and planning actions
used to help one organize and adapt
 Communication and Interaction Skills –
observable operations used to verbalize needs
and intentions that are part of social behaviors

Person + Occupational Performance
 Person constructs (volitional,
habituation, and mind-brain-body
subsystems) plus one’s occupational
performance contribute to the
development of occupational
identity, occupational
competence and occupational
adaptation.

ENVIRONMENT
Physical and social places in which a
person performs occupations
Shaped by culture
Provides opportunities and resources
(positive) as well as demands and
constraints (negative)
A significant source of feedback that can
maintain or extinguish one’s
occupational performance.

CHANGE
 As a person experiments with novel
behaviors and repeats them over time,
these behaviors will become more
automatic and habitual.
 Persons create a sense of occupational
competence when they are capable of
engaging in productive and meaningful
actions
 Sufficient repetition and environmental
feedback is required to assimilate new
performance patterns

MOTIVATION
 Motivation is influenced by a
person’s interests, values, and a
sense of personal causation, all
aspects of the volitional subsystem.
Therefore, the volitional subsystem
becomes a significant focus area for
motivation and change.

EVALUATION PROCESS
 Kielhofner calls this a data gathering
process.
1. Use the data to find out about a client from the
viewpoint of an outsider looking in.
2. Collect and use data to help clients understand
how their personal perceptions and subjective
views lead to occupational performance actions
and patterns.

ASSESSMENTS
 MOHO assessment instruments are both
structured and unstructured. Structured
assessments typically include
observational measures, self report
questionnaires and checklists, and
structured interviews. Unstructured
assessments allow the therapist to be
more informal and spontaneous in
response to a client’s needs

INTERVENTION GUIDELINES
 Interventions should be focused on changing
one’s occupational performance (skilled action
process). Adaptive solutions should be offered
in substitution for maladaptive ones.
 Interventions may be aimed at modifying or
altering one’s environment to promote
opportunities for change.

INTERVENTION GUIDELINES
 Interventions that are aimed at skilled
performance are more efficient than those
aimed at a client’s underlying personal
structure.
 Interventions that take place in one’s natural
environment are more likely to be assimilated
by the client. Therapists should be ready to
alter or modify the client’s environment to
increase occupational performance
 Interventions that relate to one’s volitional
subsystem provide the most meaning and
impact for the client. Occupations must be
relevant to the client to be effective.

RESEARCH
 Since 1980, over 80 studies have
been conducted and published
 Kielhofner and his constituents have
offered major contributions to the
field including a wide variety of
assessments and extensive research
concerning the impact of therapy and
the positive outcomes achieved from
this therapeutic approach.

Model of Human Occupation, Cole & Tuffano (2007)

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