Applying the model of human occupation* to pediatric practice

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Applying the model of human occupation* to pediatric practice


JESSICA M. KRAMER and PATRICIA BOWYER



Chapter objectives


After studying this chapter, the reader will be able to accomplish the following:


• Describe the meaning of MOHO concepts of volition, habituation, performance capacity, the environment, and skill


• Identify ways to address a client’s volition, habituation, performance capacity, environment, and skill in therapy through the use of therapeutic strategies


• Practice using MOHO concepts to describe and analyze a clinical scenario


*Dr. Gary Kielhofner crafted the MOHO over 30 years ago. He inspired and supported researchers and practioners to use these concepts to enhance practice in order to help clients engage in daily occupations. His vision and scholarship has made a difference in the lives of children and their families. The authors acknowledge Dr. Kielhofner’s work and contributions to the occupational therapy profession and are grateful for his role in mentoring them.



Key terms



Shaun, an 11-year-old boy, has cerebral palsy. His handwriting did not improve this year, and he does not try very hard during his biweekly therapy sessions, so he continues to fall behind his classmates. Maria is a 2-year old girl receiving early intervention services after a medically complicated birth. She is just beginning to learn how to dress herself, and giggles with delight after her mother helps her put on her princess costume. Lizzy, a young woman with autism, is beginning vocational training as part of her transition plan and needs to identify the type of job that will enable her to be successful, given her interests, abilities, and support needs. Sessions with a client—whether an infant, child, or adolescent—can either represent a challenge or be an opportunity to make progress toward the achievement of an intervention goal.


As an occupational therapy assistant (OTA), you have the opportunity to create a therapeutic environment that is individualized to each client’s preferences and challenges and as a result, more likely to enable young clients to reach their occupational therapy goals. So how do you motivate Shaun to practice handwriting so that he does not have to struggle in class? How do you ensure that Maria will learn to successfully perform self-care activities? While working with Lizzy on prevocational skills, what can you do to help her identify the employment setting that is most appropriate for her? The Model of Human Occupation (MOHO) is one way to systematically analyze clients’ current occupational situations, understand their strengths and challenges, and identify the optimal therapeutic environment that enables children and adolescents to achieve their goals.




What is the model of human occupation?


Dr. Gary Kielhofner crafted the MOHO over 30 years ago and inspired others to develop concepts in practice. Dr. Kielhofner was passionate about scholarship and dedicated to making a difference in clients’ lives. The MOHO is an occupation focused, evidence-based, and client-centered way of thinking about your practice with children and youth. MOHO is concerned with a child’s or adolescent’s motivation for engaging in occupations, the pattern and organization of occupations, the ability to perform occupations, and the influence of the environment on occupations. The main concepts in MOHO are volition, habituation, performance capacity, and environment. We will define and explain these concepts later in this chapter. When first learning about these concepts, all the different definitions can sometimes be overwhelming. Rather than worrying about memorizing these definitions, it is helpful to keep in mind that the purpose of the concepts is to enable you to think, in a systematic way, about your clients, their strengths, and the challenges they encounter when participatng in occupations. As you practice using these concepts to analyze your clients’ occupational participation, you will find that it will become easier to remember the different MOHO concepts and their meanings.


MOHO is occupation focused because its concepts are focused on understanding the extent to which children or adolescents are able to participate in the occupations of taking care of self, playing, learning, and working. Further, MOHO does not just focus on children’s or adolescent’s impairments such as lack of strength or poor visual-motor integration, but the model also considers what motivates them to participate in occupations, how their participation in different occupations is organized and patterned on a daily basis, and how the environment supports or interferes with participation in occupations.


MOHO is also evidence based, and the associated concepts and tools have undergone almost 30 years of research and development. At the time this chapter was written, more than 250 MOHO-related publications of studies, case examples, and theoretical discussions were available to support practice. This research and development has occurred through the collaboration of a network of international researchers and OT practitioners. Today, MOHO has become the most widely used occupation-focused model in occupational therapy.1,3,4 This large body of evidence cannot be incorporated into one chapter; the most recent evidence for practice can be easily accessed at the model of human occupation Web site at www.moho.uic.edu. The most recent text on MOHO, Model of Human Occupation: Theory and application (4th edition) also includes a chapter reviewing the evidence supporting the use of MOHO in practice.2


Finally, MOHO is client centered because the concepts are focused on identifying the unique occupational strengths and needs of each client. While these concepts can be applied to children of any age and with a range of abilities, the understanding gained about each child or adolescent will be unique and will enable you to individualize your OT interventions. MOHO also stresses the importance of incorporating the client’s perspective into the therapy process. When working with children and adolescents, the family’s perspective is also included. Some of the therapeutic strategies introduced in this chapter require the OT practitioner to first obtain the perspective of the child or adolescent and the family. Observations, informal interviews, and review of records and assessments are just some ways of obtaining information about the perspectives of the child or adolescent and the family. For more information, refer to the previously mentioned text, which includes several chapters on gathering information from children, adolescents, and families using observations, interviews, and self reports.2


The remainder of the chapter will introduce you to MOHO concepts and illustrate ways of systematically using these concepts to enhance OT interventions. As you practice applying these concepts, remember that MOHO is an occupation-focused, evidence-based, and client-centered way of thinking, in a systematic way, about the clients you encounter in therapy.



MOHO therapeutic strategies


Therapeutic strategies are specific actions that can facilitate client change by influencing the way a child or an adolescent feels, thinks, or does something in the context of therapy. OT practitioners use therapeutic strategies to engage a child or adolescent in therapy and to help create an optimal therapeutic environment. Nine therapeutic strategies have been listed in Table 25-1. Each therapeutic strategy can be applied in several different ways to address a range of client needs or therapeutic challenges. This chapter will demonstrate how OT practitioners use specific therapeutic strategies to address a particular aspect of a child’s or adolescent’s volition, habituation, skill, or his or her environment.



TABLE 25-1


Therapeutic Strategies and Definitions


































THERAPEUTIC STRATEGY DEFINITION
Advise Recommend intervention goals and strategies to the child, adolescent, and family.
Coach Instruct, demonstrate, guide, verbally prompt, and/or physically assist the child or adolescent while he or she is performing an occupation.
Encourage Provide emotional support and reassurance to the child or adolescent during or after an activity.
Give feedback Share an overall conceptualization of the child’s or adolescent’s situation or an understanding of the ongoing participation in occupations.
Identify Locate and share a range of personal, procedural, and/or environmental factors that can facilitate the child’s or adolescent’s occupational participation.
Negotiate Engage in give-and-take with the child or adolescent, parents, and other professionals to achieve a common perspective or agreement about something that the child or adolescent will or should do in the future.
Physical support Have the child or adolescent use the body to support the completion of an occupational task when he or she cannot or will not use motor skills.
Structure Establish parameters for choice and performance by offering alternatives to the child or adolescent, setting limits, and establishing ground rules.
Validate Convey respect for the experience or perspective of the child or adolescent and the parents.

Adapted from Kielhofner G: (2008). Model of human occupation: Theory and application, ed 4, Baltimore, MD, 2008, Lippincott Williams and Wilkins.



MOHO concepts: client factors


Each child or adolescent brings a unique set of personal factors that influence his or her engagement in occupations. The MOHO concepts that help us to think about these personal factors, or client factors, are volition, habituation, and performance capacity.



Volition


Volition, or a child’s or adolescent’s motivation for occupations, is influenced by (1) those activities that the child or adolescent finds most enjoyable (interests), (2) his or her beliefs about what is important (values), and (3) beliefs about his or her ability to effectively perform occupations (personal causation). In combination, these three aspects of volition create a unique pattern of thoughts and feelings that influence how a child or adolescent anticipates, chooses, experiences, and interprets what he or she does.


Consider Shaun’s lack of interest in practicing handwriting. Perhaps Shaun does not find handwriting activities fun and so is not interested in practicing with his OTA. It is also possible that Shaun considers it more important to conserve his energy to perform fine motor tasks other than handwriting, such as eating or using a computer. Another possibility is that Shaun is frustrated by his poor handwriting and believes that further practice will not improve his handwriting, and so he stops trying. By gathering more information, the OT practitioner can determine which of these aspects of volition is influencing Shaun’s participation in therapy. The OT practitioner will then be better able to provide an individualized therapeutic environment that is based on Shaun’s interests, values, and personal causation.



Interests

Interests are things that a child or an adolescent finds enjoyable and satisfying to do. Usually, children and adolescents are interested in activities in which they are most likely to be successful and engage without possibility of failure, pain, or difficulty. Therefore, interests are inherently motivating and thus are quite likely to encourage participation in specific activities; children usually feel good about themselves when engaging in a preferred activity. Often, a child or an adolescent may have a pattern of interests that represents a primary interest in one area such as sports, arts and crafts, or animals. OT practitioners can incorporate a child’s or adolescent’s interests into therapy activities as a means to facilitate desired change.



CLINICAL Pearl


The therapeutic strategy of “encouraging” can be enhanced when it is incorporated along with a child’s or adolescent’s interests. If a child or adolescent is unsure, worried, or scared, the impact of encouragement strategies such as verbal assurance (“You can do it”) can be strengthened by referring to his or her interests.

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Related posts:

  1. Scope of practice
  2. Medical system
  3. Development of occupational performance skills
  4. Functional task at school: handwriting

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Jul 24, 2016 | Posted by in PEDIATRICS | Comments Off on Applying the model of human occupation* to pediatric practice

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