8 Occupational therapy concepts

Using models in practice 181

Trends in occupational therapy theory 182

A renaissance of occupation 182

Importance of context 183

Conclusion 185

References 186

This chapter discusses how models of practice illustrate the trends in concepts and priorities in occupational therapy over time. Occupational therapy is a profession that exists within the broader context of societies. Consequently, the roles and perspectives of occupational therapy will differ from country to country, place to place, and at different historical times. The models of practice presented in this book largely reflect the perspectives of occupational therapy in Western countries. Other excellent texts such as Occupational Therapy without Borders (Kronenberg et al., 2005) explore the perspectives of occupational therapy from non-Western countries. However, these perspectives have not been specifically included in this book because there have not been many models of practice emanating from non-Western countries.

The only model included here that originated from work done in a non-Western country is the Kawa model (Iwama, 2006). Such models are important as they not only bring a novel and different perspective on occupational therapy, but their emergence from a different worldview also illuminates the cultural features of contemporary occupational therapy thought, theory and practices. Such alternative models reveal the cultural nature of the profession’s core concepts as well as the context of experience through which its ideas of occupation are interpreted. They can highlight how occupational therapy makes sense of and privileges the individual as the central concern through which occupations are interpreted, understands the relationship between individuals and environments, and conceptualizes occupation. Awareness of and reflection upon these revelations can bring to debate how power is constructed and exercised in occupational therapy and is inherent in values and procedures such as client centredness as well as in important processes such as engagement and enablement. It will be interesting to see how this relatively recent acknowledgement of the Western-centric nature of occupational therapy theory plays out in the future. For example, it is already the case that many of the more recent versions of models of practice from Western countries are incorporating into their models consideration of the collective nature of some cultural perspectives and including concepts of cultural safety. We might also see more models of practice originating in non-Western countries in the future.

This book presented a historical approach to models of practice. When understanding and using models in practice, it is important to have a sense of the purpose for which they were developed. Typically, models are developed to fulfil a perceived need. Often this relates to the surrounding context, whereby the model identifies the limitations of the current views and proposes alternative or extended views. Three examples are provided.

The first example is the Model of Human Occupation (MOHO) (Kielhofner, 1985, 1995, 2002, 2008). The first edition of MOHO was produced because of the perceived need to provide a structure that made explicit the relationships between the multitude of concepts generated within the occupational behaviour tradition. Occupational behaviour was developed by Mary Reilly because of her perception of the limitations of a biomedical model of health (mechanistic and reductionist in approach, characteristic of medicine and dominating health in the 1960s and 70s) and of occupational therapy’s alignment with this. As this critique of a mechanical view of persons was central to both occupational behaviour and MOHO, it is not surprising that the limitations of a mechanistic view of humans (upon which biomedicine is based) remained a theme throughout all four editions of MOHO.

Another example is the Kawa model (Iwama, 2006). This was developed because of the perception that a Western-centric understanding pervaded occupational therapy theory and the difficulty occupational therapists in Japan had in understanding many occupational therapy concepts (because of their poor cultural relevance). It also aimed to fill a gap in understanding diversity of cultural perspectives such as collective cultures. Because of its cultural emphasis and critique of Western-centric occupational therapy concepts, it appears that the Kawa model has a broader appeal than just in Japan. Because of this emphasis on culture, it is presented as a model that needs to be changed and adapted as appropriate to the cultural context in which it is being used. This is quite different from many of the other models of practice, which encourage faithfulness to the model as it has been published. The same level of consistency is also important when using assessments requiring validation that were developed from a particular model. Thus, many other models rely on their concepts being used consistently, rather than being changed and adapted for the particular setting in which they are being used. As the issue of cultural specificity of theoretical material (and the assessments that derive from them) becomes more apparent, we may see a fundamental shift in how models are critiqued, constructed and adapted for use across diverse practice contexts.

A third example is the Canadian Model of Occupational Performance and Engagement (CMOP-E) (Townsend & Polatajko, 2007). This model was presented within a text that claimed in its title to be Advancing an occupational therapy vision for health, well-being and justice through occupation. In that text, the model was changed from the original Canadian Model of Occupational Performance (CMOP) model to include engagement because of the claim that the concept of engagement in occupation does not necessarily require performance. In this way, one perceived gap that this model aimed to address was the limitations that the concept of occupational performance placed on an occupational therapy perspective. The model also addresses the concern that some individuals, groups and populations (or subpopulations) do not have equal opportunities for occupational engagement. Consequently, it includes aims and processes that target the enhancement of equity of engagement that promote justice. Certainly, the concept of occupational justice is not explicitly addressed in any of the other models to date.

Local needs were also the impetus for the development of some of the other models covered in this book. In many cases, specific models were created to guide the development and implementation of a specific occupational therapy curriculum. In these cases, particular staff undertook the role of developing the model and they often then remained responsible for its further development. Other models were developed on behalf of national occupational therapy bodies.