Medicine:Canadian model of occupational performance and engagement

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The Canadian Model of Occupational Performance and Engagement (CMOP-E) was developed by the Canadian Association of Occupational Therapists in 1997, and describes transactions and mutual influences between the dimensions of occupational performance [1] It is applied by the accompanying Occupational Performance Process Model, which describes the therapeutic process from a client’s perspective [2][3][4] The main model illustrates the relationship between person, occupation and environment. Spirituality is the fourth dimension, placed in the centre of the model to highlight its fundamental importance.

History

The current CMOP-E results from developments in occupational therapy spanning thirty years. It was initially inspired by occupational performance frameworks proposed by the American Occupational Therapy Association[5] and Reed and Sanderson.[6] However, calls to develop a national quality assurance system lead to its forerunner in 1983 - 'Client-Centred Guidelines for the Practice of Occupational Therapy'.[7] Refinements in the model are evident in further guideline statements [8][9] and 'Enabling Occupation, A Canadian Occupational Therapy Perspective'.[10] The model’s national development is a unique feature and so CMOP does not reflect the views of any one individual. However while some assume the model has no cultural bias and adaptation has been encouraged, little research has been conducted into the efficacy of its application in non western societies.[10][11][12]

Apart from cultural relevance, Kielhofner [13] identifies four characteristics of well developed models which CMOP possesses to varying degrees,

Interdisciplinary Base

Client centred practice originally evolved in psychology. It combines with systems approach, environmental theory and research into 'flow' by Csikszentmihalyi to provide CMOP with a broad interdisciplinary base of knowledge.[1][3][4]

Theory regarding order, disorder and intervention

In CMOP-E, occupational order has six perspectives – physical rehabilitative, psycho-emotional, socio-adaptive, neurointegrative, developmental or environmental – in relation to the arbitrary performance areas of self care, leisure and productivity.[2][12] Quality of function is assessed in terms of both performance and satisfaction [14] Disorder may occur in the dimensions of person, occupation or environment, or when the momentum of experience is lost due to unresolved issues.[2] Intervention aims to improve transactions between person, occupation and environment, through the process of enablement rather than treatment. Enablement involves working with clients to facilitate autonomy, and does not focus primarily on performance components [2][15]

Technology for application

The Canadian Occupational Performance Measure (COPM) [1] is a semi structured interview developed to apply the model [16][17] and is the only prescribed assessment. This allows freedom to choose other supporting assessments but also restrict the methods of application for the model.[18] Therapists have praised its client centred approach, relatively quick administration, role in promoting occupational therapy in multidisciplinary teams and compatibility with other assessment tools.[4][19][20][21][22][23][24] However these properties are compromised by most therapists using COPM without training or knowledge of the model, particularly when the tool is used without implementing the model.

Empirical Base

The majority of related research evidence pertains to the assessment tool rather than the model. Of this research, most has been in institutional settings,[25] methodologies usually have medium to low levels of credibility,[26] and may are attributed to the same therapists involved in the model's formulation. The model is said to be applicable to all ages and diagnoses groups [12] but few studies have explored its practical application.

References

  1. 1.0 1.1 1.2 Law M.L, Cooper BA, Strong S. Stewart D, Rigby P and Letts L (1997). Theoretical contexts for practice of occupational therapy in Christiansen CH and Baum CM (eds.)Occupational Therapy: Enabling function and well-being (2nd Ed) New Jersey, SLACK
  2. 2.0 2.1 2.2 2.3 Fearing VG, Law M and Clark J (1997). An occupational performance process model: Fostering client and therapist alliances. Canadian Journal of Occupational Therapy, 64(1), 7-15
  3. 3.0 3.1 Stanton S, Thompson–Franson T and Kramer C. (2002). Linking concepts to a process for working with clients. In Townsend E, Stanton S, Law M, Polatajko M, Baptiste S, Thompson-Franson T, Kramer C, Swedlove F, Brintnell S and Campanile L (2002). Enabling occupation, An occupational therapy perspective. Revised edition. Ottawa, CAOT Publications ACE.
  4. 4.0 4.1 4.2 Clarke C (2003). Clinical application of the Canadian Model of Occupational Performance in a forensic rehabilitation hostel. British Journal of Occupational Therapy, 66(4), 171-174
  5. American Occupational Therapy Association, Inc. (1974). A curriculum guide for occupational therapy educators. Rockville, MD: Author
  6. Reed, K. L., & Sanderson, S.R. (1980) Concepts of occupational therapy. Baltimore: Williams & Wilkins
  7. Baum CM and Law M (1997). Occupational therapy practice: Focusing on occupational performance. American Journal of Occupational Therapy, 51(4), 277-288
  8. Canadian Association of Occupational Therapists (1991). Occupational therapy guidelines for client-centred practice. Toronto, CAOT Publications ACE.
  9. Health Canada and Canadian Association of Occupational Therapists (1993). Occupational therapy guidelines for client-centred mental health practice. Toronto, CAOT Publications ACE.
  10. 10.0 10.1 Townsend E, Stanton S, Law M, Polatajko M, Baptiste S, Thompson-Franson T, Kramer C, Swedlove F, Brintnell S and Campanile L (2002). Enabling occupation, An occupational therapy perspective. Revised edition. Ottawa, CAOT Publications ACE
  11. Awaad T (2003). Culture, cultural competency and occupational therapy: A review of the literature. British Journal of Occupational Therapy, 66(8), 356-362
  12. 12.0 12.1 12.2 Cresswell MK and Rugg SA (2003). The Canadian Occupational Performance Measure, Its use with clients with schizophrenia. International Journal of Therapy and Rehabilitation, 10(12), 544-551
  13. Kielhofner G (1997). Conceptual Foundations of Occupational Therapy. 2nd Ed. Philadelphia, F.A.Davis
  14. Ward GE, Jagger C and Harper WMH (1996). The Canadian Occupational Performance Measure, What do users consider important? British Journal of Therapy and Rehabilitation, 3(8), 448-452
  15. Kusznir A and Scott E. (1999). The challenges of client centred practice in mental health settings. In T. Sumison. Client Centred practice in occupational therapy. Edinburgh, Churchill Livingstone
  16. McColl MA and Pollock N (2000). Measuring occupational performance using a client centred perspective. In Law M, Baum C and Dunn W (2000). Measuring occupational performance: Supporting best practice in occupational therapy. New Jersey, SLACK
  17. Pollock N, McColl MA and Carswell A (1999). The Canadian Occupational Performance Measure. In T. Sumison (1999). Client centred practice in occupational therapy. Edinburgh, Churchill Livingstone
  18. MacRae A, Falk-Kessler J, Julin D, Padillo R and Schultz S (1998). Occupational therapy models In Cara E and MacRae A (1998). Psychosocial occupational therapy: A clinical practice. New York, Delmar
  19. Toomey M, Nicholson D and Carswell A (1995). The clinical utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 62(5), 242-249
  20. Dressler J and MacRae A (1998). Advocacy, partnerships and client centred practice in California, Occupational Therapy in Mental Health, 14(1/2), 35-43
  21. Fedden T, Green A and Hill T (1999). Out of the woods, the Canadian Occupational Performance Measure from the Manual to Practice. British Journal of Occupational Therapy, 62(7), 318-320
  22. Chesworth C, Duffy R, Hodnett J and Knight A (2002). Measuring clinical effectiveness in mental health, Is the Canadian Occupational Performance an appropriate Measure? British Journal of Occupational Therapy, 65(1), 30-34
  23. Donnelly C and Carswell A (2002). Individualised outcome measures: A review of the literature. Canadian Journal of Occupational Therapy, 69(4), 84-94
  24. Warren A (2002). An evaluation of the Canadian model of Occupational Performance and Engagement and the Canadian Occupational Performance Measure in mental health practice. British Journal of Occupational Therapy, 65(11), 515-521
  25. McColl MA, Paterson M, Davies D, Doubt L and Law M (1999). Validity and community utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 66(2), 22-30
  26. Egan M, Dubouloz CJ, Von Zweck C and Vallerand J. (1998). The client centred evidence based practice of occupational therapy. Canadian Journal of Occupational Therapy, 65(6), 136-143

Further reading

  • Townsend, E.A. & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT ACE