4. Person – Environment – Occupation
(PEO) Model
Environment
Occupation
Person
Occupational Performance
5. •Person: A unique being who, across time and space,
participates in a variety of roles important to him/her
•Environment: Cultural, institutional, physical, and social
factors outside a person that affect occupational
performance
•Occupation: Any self-directed, functional task or
activity in which a person engages over the life span
PEO Model -Key Terms
6. PEO Model - Key Terms (con’t)
Occupational Performance
• Performing a task related to participation in a major life area
• Shaped by transaction that occurs between person,
occupation, and environment
• Requires ability to balance occupations and views of self and
environment that sometimes conflict – and to encompass
changing priorities
• Best measured by self-report
Central Features
8. Key Terms
• Person –physical, social, and psychological aspects of
the individual
• Environment – physical and social supports and those
things that interfere with the individual’s performance
• Occupation – everyday things people do and find
meaningful
• Performance – the actions of occupations
O&H p. 137)
9. Assessment Procedures
•Identify the intrinsic and extrinsic factors
that support and/or limit the occupations,
activities, or roles of the client.
•Determine the client’s occupational
performance status.
•Consider the environmental context in
which the client typically performs.
•Assess the person’s “assets and deficits.”
Central Features
11. “Perhaps the most
therapeutic action the
occupational therapy
practitioners can do is to
always hold in mind each
person’s hopes, dreams, and
experiences while at the
same time understanding all
the many person and
environmental factors that
affect that person and his or
her occupation.”
(Boyt Schell & Gillen, 2014, p. 747)
13. Occupational Adaptation (OA)
Adaptation is a normative process that is most pronounced in periods of transition.
adaptiveness active participation
in occupations
14. OA: Key Terms
• Occupational Adaptation: specifically to how
occupation and adaptation become integrated
into a single internal phenomenon within client.
• Occupations: activities characterized by three
properties - active participation, meaning to the
person, and a product that is the output of a
process (tangible or intangible)
• Adaptation: a change in functional state of the
person as a result of movement toward relative
mastery over occupational challenges
http://prezi.com/ftpkwsjjb3py/?utm_campaign=share&utm_medium=copy&rc=ex0share
15. OA: Implications for Practice
• Main goal- client’s ability to adapt is used to
maximize effectiveness to adapt
• Client is assisted in choosing occupational roles
and these guide treatment
• Using occupational readiness and occupational
activity
• OT focuses on clients ability to adapt by directing
intervention towards the three subprocesses
• Treatment needs to progress quickly to
meaningful activities
16. Application of OT Theory
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20. Overview
Theory Role of OT Main Points Key Terms Tools Notes
OA
MOHO
CMOP-E COPM
PEO
PEOP
LBM LBI
21. OTPF - Domain & Process
TRUE or FALSE?
• A definition of OT can be found in the preface.
• Several definitions for occupation can be found
within the Framework.
• The OTPF is divided into 3 sections: domain,
process, and outcomes.
• Purposeful activities are described as one type of
intervention within the Framework.
• The OTPF supports a top-down approach to
intervention.
Review
22. References
• Baum, C. M., & Law, M. (1997). Occupational therapy practice: Focusing on
occupational performance. American Journal of Occupational Therapy, 51(4), 277-
288.
• Boyt Schell, B. A., Gillen, G., & Scaffa, M. E. (2013). Willard & Spackman’s
occupational therapy (12th ed.). Baltimore, MD: Lippincott Williams & Wilkins, Inc.
• Christiansen, C., et al. (2005). Occupational therapy: Performance, participation,
and well-being, Slack Thorofare, NJ.)
• Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A
practice approach. Thorofare, NJ: Slack, Inc.
• Law, M. (1991). “The environment: a focus for occupational therapy.” Canadian
Journal of Occupational Therapy 58(4).
• Letts, L., et al. (1994). “Person-Environment Assessments in Occupational Therapy.”
Canadian Journal of Occupational Therapy 48(7).
• Law, M. (1996). “The Person-Environment-Occupation Model: A Transactive
Approach to Occupational Performance.” Canadian Journal of Occupational
Therapy 63(1): 9-23.
• Schkade, J. & Schultz, S. 1992. Occupational Adaptation: Toward a Holistic
Approach for Contemporary Practice, Part 1. American Journal Of Occupational
Therapy. 46 (9) p29 -p37
• Strong, S., et al. (1999). “Application of the Person-Enviornment-Occupation
Model: A practical tool.” Canadian Journal of Occupational Therapy 66(3).
Editor's Notes
Tip – in the front of textbooks, look for supplemental student resources (may need a code) – example quizzes and study guides
In looking at MoP and FoR in this course, focus on linking general themes with the terms and ideas that go with each one. Won’t be expected to recall principles or to apply theories to case studies on midterm. Think in broad strokes –
Prezi on Life Balance Model - http://prezi.com/3webb0yjl_b3/?utm_campaign=share&utm_medium=copy&rc=ex0share
Drives me crazy when I pull the trigger on a bottle of spray cleaner and the tip is closed. Cleaner backs up and drips.
How might this issue be addressed?
Only buy cleaners w/o the locking mechanism Hide the bottle
Put a note on the bottle reminding other people to leave it on unlock Quit using it
Or reminding me to unlock it before pulling trigger Put a towel around it
Hot glue the head of it in the unlock position
How does a person figure out which strategy to use in situations like this?
Motivations/outcome goals Education/training Personality Previous experience (others’ reactions)
Relate this to things that guide an OT in choosing a MoP or FoR –
“Either-or” questions are tricky at this point b/c need more info on diagnoses, prognosis, symptoms, clinical reasoning, etc.
At first exposure (+ a few more), try to absorb the central concept and key terms for each, and then assmt tools and populations
Developed by Canadian Assoc of OT in 1983 – primary author Mary Law
Client centered model that allows OTs to think about the everyday challenges and experiences of their clients.
PEO - Consists of three components: person, environment and occupation.
The product (OUTCOME) of the transaction between the components is occupational performance.
The components are dynamic and continue throughout the lifespan.
The closer the overlap/fit the more harmoniously they are interacting
One benefit of this model is that it helps OTs to communicate the scope of practice and how their practice influences outcomes.
This model compliments the CMOP-E and guides intervention by examining the dynamic relationship between these 3 components on OCC PERF. In other words, this model offers a way to systematically analyze what OTs see and do.
In both models, “person” can refer to an individual, group of clients, or an organization. Occupations are chosen to fulfill a purpose and for the value/meaning attributed to them by individuals. Both can be used in many different practice settings
Theoretical underpinnings - Environmental-Behavioral theories, Developmental theories, Theories of occupation, Clinical practice experience
Assumptions:
Occ performance is the result of the dynamic relationship between the person, their environment, and the occupation – one that changes through the lifespan.
Qualities defining an individual will influence the way he/she interacts with the environment and carries out occupations. Attributes are subject to change (some more so than others)
The environment can serve as a barrier or a support. It’s considered to be more dynamic than the person.
If you improve the fit among person, environment, and occupation then you improve occupational performance.
Occupation is complex and is a necessary function of living.
In intervention – the OT and client work together to identify supports and barriers to occ perf by looking at the environment, to devise a plan to eliminate obstacles and hazards to promote a better way of living. Changing the home environment might allow for a better fit between the person and the environment, for example.
PEO describes occ perf as the transaction (complex interaction) between the person, occupation and environment. The model suggests that successful occupational performance occurs when there is a good fit or interaction between the person, environment and occupation. However, if someone is having difficulties performing an occupation, the OT can analyze the PEO elements to identify where the issues may lie and to then provide the appropriate intervention. The other element I like about the PEO model is it shows how the transaction between the PEO changes over time.
Occupational Performance –
Performing a task related to participation in a major life area
Accomplishing a selected occupation through the dynamic transaction among the client, context and environment, and the activity
A complex, dynamic phenomenon with spatial and temporal considerations
Shaped by transaction that occurs between person, occupation, and environment
Requires ability to balance occupations and views of self and environment that sometimes conflict – and to encompass changing priorities
Best measured by self-report
This model and the next one (PEOP) are based on the science of “ecology” and therefore they consider how the environment shapes our behavior and how our behavior shapes the environment. Or, put another way, how the environment shapes the things we need and want to do and how we adapt our environment to do the things we need and want to do.
Developed by Dr. Charles Christiansen & Dr. Carolyn Baum in 1985 (published in 1991)
The PEOP model is similar to the PEO model but it provides a bit more detail in terms of what we should be considering when analysing the person, environment and occupation. It also illustrates the transaction that occurs during occupational performance in a slightly different way.
Key postulates: People are naturally motivated to explore their world and demonstrate mastery within it.
Settings in which people experience success will promote increased satisfaction and motivation.
Occupational Performance: Abilities, actions, tasks, occupations and roles of the individual as they engage in daily life.
Postulate for Occupational Performance:
Roles influence the nature of occupational performance.
In order to understand performance, it is necessary to consider client factors, context, environment, and desired occupations.
Occupational choices are dependent on the individual’s personal factors, which may include, but are not limited to:
Motivation
Intrinsic theories of motivation
Cognitive theories of motivation
Internality
Self-efficacy
Personality
Values
Meaning
Spiritual Meaning
Assumption/focus: Describes the interactive nature of the human being
Defines each term included in the model in general terms:
Human Agency: person’s innate desire to explore the environment and achieve mastery within it.
General guidelines for assessment, intervention, and anticipated outcomes.
No standardized assessments available, but OT will use a top-down approach.
Recommended assessments: COPM, Occupational Self Assessment, Interest Checklist, etc.
WORD CLOUD - http://www.tagxedo.com
Intervention plan involves collaboration between therapist and client.
Use compensatory adaptations to overcome barriers.
Barriers can occur in the domains of perf skills, patterns, and/or client factors
Develop social networks.
Educate client & families.
Intervention is based on the client’s roles & personality.
Outcome goal:
Increased competence and improved occupational performance.
Development of “life performance skills”.
Improved health & well-being.
Research - Similar to the PEO, however there are more studies that use the PEOP model to guide the research design.
Publication in peer-reviewed sources since 1990 and the newest article was published in 2010.
As a busy community OT I often wondered whether theoretical models were really that relevant to my everyday practice. However, since starting my PhD journey I’ve had the good fortune of going back to the literature and exploring the rich theoretical base we have as a profession and I’ve come to the realisation that yes, theories are relevant to our everyday practice. For me, theoretical models give us the language to explain and explore what we do; it’s just a case of finding a theoretical model that helps you to do this.
HANDOUT from Anna on OA
Students: make notes on these aspects of OA as we go:
Role of the OT
Main point(s)
Key terms – marking any unfamiliar ones
Tools for assessment/intervention used with this theory
Notes - Population and/or other theories associated with it
OA –examines the relationship between 3 elements of occ adaptation: person, environment, and their interaction
Each element is dynamic and fluid – change in one elements influences the other two.
Proposes that OTs look at how change can be effected on the person, environment, or task so that client may engage in occupations.
OT assists client in choosing occ roles and these guide treatment
Primary goal: for the client to achieve mastery over the environment (even if that requires using compensatory techniques)
Originally a frame of reference, but later further developed into a broader theory aimed at describing th elink between to fundamental constructs of OT: occupation and adaptation
OA – articulated by Schkade and Schultz
Proposes that OTs look at how change can be effected on the person, environment, or task so that client may engage in occupations.
Originally a frame of reference, but further developed into a theory
Distinction between other interventions is the focus on improving adaptiveness versus functional skills
Core belief of OA: an increase in one’s ability to adapt results in increased active participation in life
When disruption in the normative OA process occurs, a person’s adaptive responses are often inadequate. Ex. Cognitive decline limits participation, if OA does not occur – depression or injury may result
Core Therapeutic Tools in OA
Therapeutic use of self
Use of occupation to promote adaptiveness
Client is the agent of change
Client – internal factors related to occupational performance, including sensorimotor, cognitive, and psychosocial abilities
Environment – external factors in the occ adaptation process that impact the client
Person: a being made up of three systems - sensorimotor, cognitive and psychosocial
Each client will have their own unique pattern of adaptation.
Sensorimotor, psychosocial, or cognitive factors can have an effect on a person’s adaptive capacity.
Occupational environments: contexts of work, play and leisure, and self-maintenance with physical, social, and cultural influences
Occupational Challenge: Demands that are internal or external to the client.
Adaptive Response Evaluation: Individual assesses quality of occupational response.
Measured by efficiency, effectiveness, satisfaction of self, and satisfaction to society.
Interventions: Individual generates a new adaptive response to better reach desired level of mastery
Research: Multiple articles that compare the Biomechanical model and Developmental models with OA.
OT educators have started to use the OA Model with students to effectively improve professional development.
Therapeutic use of occupation as a tool to promote adaptive capacity of clients
To improve adaptiveness, intervention is focused on improving and activating client’s internal adaptive response
OT manages the occupational environment to promote the client’s ability to adapt
Client is agent of own change.
Distinction between other interventions is the focus on improving adaptiveness versus functional skills
Similarities to models such as spatio-temporal adaptation, model of adaptation through occupation, MOHO, the model of occupation.
Assumptions:
Competence in occupation is a lifelong process of adaptation to demands to perform.
Demands to perform occur naturally as part of person- occupational environment interactions.
When demand for performance exceeds person’s ability to adapt, dysfunction occurs.
Adaptive capacity can be overwhelmed by disability, impairment and stress.
The greater the level of dysfunction, the greater the demand for change in adaptive process.
Sufficient mastery + ability to adapt= success in occupational performance.
For a case study comparing MoP – See p. 137 in O&H
Ironman N’nal Championship – annually around Oct. 10, lots of very inspiring stories of people like this man
MoP or FoR – OA
Role of OT
Assist client in choosing occupational roles that guide treatment.
Manage the occupational environment to promote client’s ability to adapt
Main Point
-Occupation is viewed as the primary means to achieve adaptation.
-When demand for performance exceeds one’s ability to adapt, dysfunction occurs.
-Sufficient mastery + ability to adapt = success in occupational performance
Key Terms
-Adaptation
-Occupational environments
-Adaptive response
-Occupational challenge
Tools
-Therapeutic use of occupations to promote adaptive capacity of client
-Compensatory techniques (if necessary)
Notes
Has been compared to MOHO and Biomechanical and Develop-mental FoR. Can be applied to improve prof. development.
Each pair to come to a consensus on each of these and then answers will be shared in class.
