This section is intended to provide a brief background on OT models and is appropriate to use when advocating for OT services or communicating with individuals unfamiliar with the theoretical base of occupational therapy.

Occupational therapy (OT) models are an important component of practice, because while the OTPF-4 outlines the domain and practice of occupational therapy; it is not a theory, taxonomy, or model of practice (AOTA, 2020). Generally the OTPF-4 and OT models describe related concepts. For example the PEO model emphasizes the importance of personal and environmental contextual elements within occupational therapy, as does the OTPF-4. However, the difference is that OT models provide a lens through which to view elements of the domain and assist the practitioner in making relevant connections that will best serve the client during the OT process (AOTA, 2020). Thus is the relationship of theory to practice. Yet, this is not the only use for OT models in practice.

OT models of practice also…

• Aid in communication with clients, family members, caregivers/care partners, other healthcare professionals, and leadership teams.

• Assist OT practitioners in expressing their clinical reasoning process to others, such as payors, auditors, and administrators.

• Can help determine what assessments are needed during evaluation and reevaluation.

• Sets OT apart from other fields, only OT uses occupation based models of practice, this enables us to highlight OT’s unique contribution to the health care team.

• Guide development of occupational profile to ensure relevant information is included.

• Supports the clinical reasoning process and synthesis of occupational profile for further assessment and intervention planning.

Ecological OT models of practice are especially useful because they provide a lens to focus on contextual factors relevant to occupational performance in specific settings and explain the relationship between an individual (or group), the environment, and occupation.

Additional key features associated with ecological models include:

• Occupational performance changes over time because people, environments, and occupations lifelong are dynamic.

• The environment as a key factor in predicting (and understanding) successful occupational performance.

• Intervention approaches target the environment, or person-environment fit, rather than changing the individual.

• Use of a “top-down” approach where the client identifies areas of occupational performance that are unsatisfactory, that they have difficulty doing or cannot do.

• Assessment comes after the client identifies areas of dissatisfaction and focuses on identifying supports and barriers within each person, environment, and occupation. (Brown, 2019).

The New Occupational Therapy Paradigm: Implications for Integration of the Psychosocial Core of Occupational Therapy in All Clinical Specialties (Ikiugu, 2010)

Summary: Provides a brief history of OT and OT paradigms, the role of occupational therapists, and suggests objective strategies for supporting opportunities for participation in meaningful activities. A case study of low to medium complexity is included using the PEO as the guiding model of practice.

Key Points:

Ikiugu suggests the following process to thoroughly integrate psychosocial components into intervention:

1. Understand psychosocial issues (strengths and limitations)

2. Select a model of practice (or frame of reference)

3. Use the model of practice (or frame of reference) to guide assessment and intervention to address physical performance limitations.

Strategies of integrating psychosocial interventions strategies into all OT specialties:

1. Choose occupations that are meaningful to the client

2. Wield the therapeutic relationship with skill

   1. Validate and explore feelings and emotions and their meaning

   2. Explore beliefs and their influence on function

   3. Change cognitions that may lead to negative rehabilitation outcomes

To deliberately integrate the “psychosocial core of occupational therapy” in all OT specialties therapists should:

1. Identify psychosocial issues associated with physical condition (including psychosocial strengths and limitations).

2. Find out whether the client believes they have the power to change their life circumstances (perceived self-efficacy).

3. Assess motivation to change present circumstances.

4. Determine what is meaningful to the client.

5. Identify available social support system(s) that could help the client achieve their aspirations.

Application of the Person-Environment-Occupation Model: A practical tool (Strong et al., 1999)

Summary: Summarizes the PEO and emphasizes it’s nature as a suitable model to use in combination with others. Provides in-depth exploration of the utility of the PEO model including three case studies as examples. Illustrates how the PEO can be used to help therapists throughout the OT process and highlights the ways the PEO facilitates communication within and outside the profession of occupational therapy.

Key points:

• Concisely summarizes the OT process through the lens of the PEO via a PEO Application Framework and uses this process in three case study examples.

  • Client identifies occupational performance challenges

  • Client and therapist consider occupational performance challenges by looking at the environment, occupation characteristics/demands, and client’s

  • Synthesis within the transactional framework (consideration of the overlap of person-occupation, environment-occupation, and person-environment relationships)

  • Plan is developed with the client.

  • Plan is evaluated and re-evaluated for changes in occupational performance.

• Emphasizes the overlapping area of the PEO model as areas to target intervention and assessment (person-occupation, environment-occupation, and person-environment relationships)

• Benefits of the PEO model:

  • Flexibility

  • Systematic approach to analyzing occupational performance issues

  • Provides multiple organized ways to consider interventions

  • Facilitates communication with others, both OT professionals, non-OT professionals, and individuals outside of healthcare

  • Supports interprofessional communication (can be used to diffuse situations where issues are brought up through the lens of the PEO rather than on a profession or individual)

  • Easy to understand and not culturally specific

  • Client-centered

Comparing and Using Occupation-Focused Models (Wong et al., 2015)

Summary: Provides information on comparison of occupation-focused models and proposes strategies for selecting and combining models of practice with frames of reference to support OT practice. The distinction between occupation-focused models (those that are rooted on occupation, are client centered, and validate occupational therapists' role as one that targets client engagement and participation in line) and frames of reference (supporting concepts that relate to specific areas of practice) is made and contributes to the overall process described below in Key Points*.

*Note that the models reviewed in this article include the Canadian Model of Occupational Performance and Engagement (CMOP-E), the Model of Human Occupation and the (MoHO), Person-Environment-Occupation-Performance Model; this is an excellent source of for information on the theoretical focus, research, and practice tools associated with those models.

Key Points:

• Reflects the process described by Ikiugu (2009) of using an organizing model of practice supported by complementary models of practice. (See visual representation in Appendix B: Eclectic approach)

• Complimentary models of practices should work in harmony with the organizing model of practice, especially when both are occupation-focused models. For example: Using MoHO as an organizing model of practice and later concluding that environmental factors present barriers to occupation leading to using the PEOP as a complimentary model.

• Using frames of reference as organizing models of practice is discouraged (especially impairment focused ones), as this may lead to a performance skill specific bottom-up approach with occupation being a secondary goal of therapy.

  • If specific frames of reference are needed based on practice setting (such as hand therapy) using an occupation-focused model ensures the therapist starts with a top-down approach.