RHS 303

TRANSITION OF THEORY AND TREATMENT Philosophical Base: Philosophy of

occupational Therapy represent the profession’s view of the nature of existence nature of existence and gives meaning to and guides the action and gives meaning to and guides the action of the profession.

The Philosophical base of Occupational Therapy (adopted in April 1979)

Man is an active being whose development is influenced by the use of purposeful activity. Using their capacity of intrinsic motivation, human being are able to influence their physical and mental health and their social and physical environment through purposeful activity. Human life includes a process of continuous adaptation. Adaptation is a change in function that promotes survival and self actualization. Biological, psychological and environmental process at any time throughout the life cycle. Dysfunction may occur when adaptation is impaired. Purposeful activity facilitates the adaptive process. (cont….)

Occupational Therapy is based on the belief that purposeful activity (occupation), including its interporsonal and environmental components, may be used to prevent and mediate dysfunction, and to elicit maximum adaptation. Activity as used by occupational Therapist includes both and intrinsic and a therapeutic purpose. (resolution 532-79, 1979,p.785)

Theory Base The body of knowledge in Occupational

Therapy and its theoretical base derived from several broad scientific areas including biologic and behavioral sciences, sociology, anthropology and medicine.

Transition of theory to treatment The transition from theory to viable treatment

strategies is not direct. An intermediary mechanism is required.

A diagrammatic presentation: Theories (from the scientific bases)

Academic Discipline (Occupational Sciences)

Occupational Therapy Theory Philosophical base of the Profession

professional Model

Frame of Reference

MODEL

• A model is defined as a theoretical simplification of a complex reality and consists of several explicitly defined concepts.

• In order to improve the theoretical foundation we need to explain the theoretical concepts that underpin their practice.

WHY STUDY MODELS ?1.1. Models provide a link between theory and practice.Models provide a link between theory and practice.

2.2. Model define and focus the area of interest to OT Model define and focus the area of interest to OT

practitioners.practitioners.

3.3. Models provide a framework for assessment, Models provide a framework for assessment,

intervention & evaluation.intervention & evaluation.

4.4. Models contribute to a sound philosophical base Models contribute to a sound philosophical base

for the professionfor the profession..

5. Model provides a common vocabulary to

communicate ideas.

6. Models facilitate professional unity.

7. In OT practice there are common themes present

throughout all the models. Those are- - concern for individual person. - the value of human occupation. - the recognition of each human as a total

entity. - willingness to share professional

knowledge to improve lives of others.

8. Models should be reviewed regularly.

CAUTIONS WHILE FOLLOWING MODELS

• Models are not “cookbooks”. They are guide books

used as helpers in organizing the practice of OT but not

in dictating the practice.

• Is not a solution to every problem.

• Sometimes used to form the boundaries of practice.

• Models should be viewed as inclusive not exclusive.

• A single best model does not exist in occupational

therapy.

Types of Models

• Two types of models present in occupational therapy.

1. Conceptual model 2. Practice model

Two types of models in OT:• 1. Conceptual Models – explain WHY OT works,

validate value of OT but tend to be generic and do not address specific areas of practice.

• 2. Practice Models – explain HOW OT works, gives guidelines for specific types of evaluation and intervention

Mosey's Model:“Occupational Therapy Loop”

PHILOSOPHY

ASSUMPTIONS ETHICS ART SCIENCE

MODEL

RESEARCH FRAMES OF REFERENCE

PRACTICE

DATA

• Conceptual model: It explains about the ideas why the

profession works in a particular way.

• Practice model: It is used to explain how the ideas of

the theoretical model can be implemented into a plan of actions.

An important aspect of Conceptual Model –

Frame of Reference

Frame of reference is based in philosophy.Philosophy is expressed in - view points - beliefs - values & attitudes

Frame of Reference, Defined

“A set of interrelated, internally consistent concepts, definitions, and postulates that provide a systematic description of and prescription for a practitioner's interaction within a particular aspect of a profession's domain of concern.“

Mosey

Frame of Reference• Theoretical base (propositions) - conceptualization of man’s purpose for interacting with the

environment. -areas addressed within our domain of concern of target population.

• Basic Assumptions: -Concepts, constructs, relationships, principles, postulates

• Function/disability continuums: - definition of function -definition of dysfunction -treatment expectations/outcomes -evaluation content/treatment focus (cont….)

• Behavior indicative of function-dysfunction -behavior to be elicited in evaluation -representative evaluation method -behaviors to be changed in treatment -outcome measures -guidelines for analysis of evaluative activities

• Postulates regarding change and intervention -rationale for conceptualizing process of change -sequencing of treatment strategies -representative change techniques -guidelines for activity analysis -short term and long term treatment goals

OCCUPATIONAL THERAPY PROCESS

Occupational Therapy Process

• REFERRAL STAGE• Receive referral• Identify pertinent data from referral• Collect additional data, if needed.• Summarize the referring data.

CONCEPTUAL MODEL SELECTION STAGE

• Review possible occupational therapy conceptual models

• Select a tentative theoretical model

SCREENING EVALUATION STAGE - Select screening instruments consistent with

theoretical model - Interpret data from the instruments

COMPREHENSIVE EVALUATION STAGE- Review list of comprehensive assessment techniques consistent with the conceptual model.- Select the assessment techniques based on the priorities established from the referral and screening stages

OCCUPATIONAL THERAPY DIAGNOSIS STAGE

- List all the problems identified - Group the problems into categories suggested by the conceptual model.

• Occupational therapy diagnosis is

described as complete knowledge to

distinguish occupational role and

performance task problems and

functional levels that occupational

therapists by virtue of their education

and experience are able to treat or

manage.

OCCUPATIONAL THERAPY PRACTICE - MODEL SELECTION STAGE

- Review tentatively selected theoretical model- Considering the occupational therapy diagnosis, select the theoretical model that best address the diagnosis.- Identify possible occupational therapy practice

models based on the theoretical model.- Select a tentative occupational therapy practice model

PLANNING STAGE- Prioritize the list of categories and problems

based on the client (family, referral source) and therapist discussion.- Develop a list of expected changes.- Determine when these changes should be expected.- Based on practice model consider possible intervention strategies.

IMPLEMENTATION STAGE- Begin with first goal statement- Continue with goal list.

Planning process involves selection of media

Major media are-1. Creative arts2. Manual skills3. Educational tasks4. Daily living task5. Functional equipment6. Avocational activities (recreation)7. Prevocational exploration and training tasks8. Use of self9. Exercise

Active participation by individual

REVIEW STAGE- Select an assessment methodology that can detect change in client.

REVISION STAGE- Revision stage- Determine what barriers occurring- Explore which options are reducing the barriers.- Determine if OT services are required to resolve the problem

DISCHARGE STAGE

- Collect data on the progress toward all goal statements- Document the status on goal statement at discharge.- Discharge the client.

FOLLOW-UP STAGE

- Discuss the client the need for follow up- Document arrangements for follow up visit