This essay intends to compare and contrast three occupational therapy models.
The use of the word ‘model’ in O. T. language has not as of yet, had unified definitions. “Authors all acknowledge that there are no fixed definitions and on the whole they appear to have ‘agreed to disagree’” (Hagedorn, 2001, p.21). In this essay, Hagedorn’s definition has been utilised and three of the models that she has pin pointed as ‘O.T. Models’ will be compared and contrasted. Hagedorn also links the ‘O.T. Models’, which are of similar time frame and concept as P.E.O.P. models.
This term she took from Christiansen and Baum’s (1997) title of model (Hagedorn, 2000, p.9). The three models I have chosen are: Person Environment Occupational Performance (P.E.O.P.); Canadian Model of Occupational Performance (C.M.O.P.); and Competent Occupational Performance in the Environment (C.O.P.E.). These models have been developed along the same time-scale and are representative of three different countries’ theories of occupational therapy.
The P.E.O.P. was chosen to represent American theory as it has a clear presentation and can be applied to all age groups and is non-specific to a client group. The model is clearly broken down into its elements and each is individually explained. In this essay, it is intended to give a brief history of evolution, inspiration of the model and the theorists. An explanation of how the model guides therapy will be given.
American theorists Christensen and Baum first published P.E.O.P. model in 1991 and then re-published it in 1997 with some alterations. Christensen and Baum have compared the model to the Ecological Systems Model by Howe and Briggs (1982, cited in Christiansen and Baum, 1997, p.48) and the Self-determination theory of Decit and Ryan (1991, cited in Christiansen and Baum, 1997, p.48) and stated that these models hold some similarities. The P.E.O.P. Model has also been built on previous scientific studies of occupation and rehabilitation (Christiansen and Baum, 1997, p. 49).
The P.E.O.P. model is a conceptual framework that occupational therapists can use to support their practice. It is made up of three major parts in the process: firstly, that allows consideration of the client’s characteristics; secondly, how these support optimal achievement in their activities of daily living and finally, their motivation. The belief is that roles, activities, and tasks should be important to the person. Successful achievement of personal goals and occupational performance shape the person and allows them to reach a sense of self-identity within themselves and the world. It is also believed that intrinsic factors (psychological, cognitive, neurobehavioral, and physiological abilities) and extrinsic factors that involve their environment (physical, cultural, social, and society) are the core to either dysfunction or success of occupational performance.
The PEOP approach to intervention follows a problem-solving model. The process is:
* Identification or referral of case
* Screening + initial assessment
* Determination of needs
* Intervention plan
* Intervention + formative assessment
* Summative assessment
* Termination of treatment
(Christiansen and Baum, 1997, p.63)
During treatment, the therapist is to go back and forth between sections to allow adjustment and refinement. Success is seen as an important element, as it is believed to increase self-esteem and the motivation to accept new challenges. The use of adaptation and resources is a means of measuring success.
As with the P.E.O.P. model the C.M.O.P. will be explained in a similar manner. However, the C.M.O.P. has its own assessment tool and this will be briefly described. This model was chosen to represent Canada due to the uniqueness of its development. Like the P.E.O.P., this model gives a clear process for the application of occupational therapy. In addition, its application can be used with all age groups and likewise to the PEOP is non-specific to client group.
The C.M.O.P. is a theoretical, process-driven basis for occupational therapy as a client-centred practice. The Canadian Association of Occupational Therapy (C.A.O.T.) and the Department of National Health and Welfare jointly developed the model. It was originally based on the work of Reed & Sanderson (1980, cited in Sumsion, 1999, p.6). The model was developed from the guidelines of the Canadian Occupational Performance Measurement. “The CAOT task group found that they had inevitably become engaged in building a conceptual foundation for practice “(Hagedorn, 2001, p.150). The model was previously called ‘Model of Occupational Performance’, but in 1997, ‘Canadian’ prefixed the name along with the addition of “many new concepts” (Sumsion, 1999, p.7).
The model “identifies occupational performance as being in areas of self-care, productivity and leisure” (Warren, 2002, p.516). The beliefs for this model are that, for the client to achieve optimal performance to their full potential, there is a three-way inter-play of environment, occupation, and the person to be considered. A key part to the model is the instinctive sense of self and how the therapist can facilitate this for the client, during the process of therapy.
The model outlines a method of operation for therapy, with use of COPM as the specific standardised assessment tool. This model uses a seven-point stage process for occupational therapy:
* Identifying and prioritising of problems
* Determine the theory and approaches required
* Pinpoint occupational performance and environmental factors
* Evaluate client strengths and assets
* Develop client centred goals and process of achievement
* Use occupation to fulfil selected goals
* Follow a process of occupational measurement
(Hagedorn, 2001, p.151)
COPM is a client-centred assessment tool that works as a semi-structured interview where the client identifies problems in occupational performance areas. The identified performance areas are rated in both performance and satisfaction and areas are prioritised as to importance of activity to the client. The tool also allows outcome-measurement. Although this is a tool specific to the model, other tools can be used along side when required as long as they follow a client centred approach.
The ‘COPE’ is the final model to be explained and is chosen as being representative of the British approach in Hagedorn’s fore-mentioned ‘P.E.O.P. family’. This is the newest of the three models, however it follows a similar concept as the other two. Hagedorn (2000) has used this model to illustrate the occupational therapy core processes and approaches. Although this model is not widely discussed, it was chosen to demonstrate the theory similarities of this time in occupational therapy in a different country.
Rosemary Hagedorn has been developing the COPE model during 1995 to 2000 stating that the influence came from work being carried out on occupational performance by American theorists. C.O.P.E. is a model, which applies theory to the occupational therapy process. Hagedorn describes her model as ‘person centred’ as the client as well as the therapists should be involved in identifying areas requiring intervention.
The model outlines occupational performance in a hierarchy of levels: organisational, effective, and developmental. Hagedorn also states “competent, adaptive occupational performance depends on a fit between the performance demand generated by the task and the environment and ability of the person to respond to this”(Hagedorn, 2000, p.12). Only after identification of problems and the process of change, the goals and needs can be specified.
The next stage in the COPE outline process is for the theorist to select approaches. The belief is that activity and task performance require a person to adapt, respond, and learn. Hagedorn (2000) states the core processes of intervention are: Therapeutic use of self, Assessment of individual ability potential and needs, analysis and adaptation of environments. The COPE model uses the POET triangle to direct the therapist in the process of therapy. The POET triangle comprises of three areas that are part of competent performance: person, occupation, and environment. The therapist is placed in the centre of the triangle.
The intention of the essay is to compare / contrast and therefore it is intended that the following sections will demonstrate the similarities and differences these models hold to each other. Identification of the theoretical approaches used within the framework will first be presented. Following this, where the appropriate use of the models is i.e. client and age group and the tools that can be used with the models. Finally, the possible benefits and limitations of the models will be explained.
All 3 of the models discussed follow the client-centred approach. However, the P.E.O.P. model can be applied by the ‘family-centred’ approach (‘family’ can be substituted for ‘client’) when the client “does not have the capacity for independent decision making” (Christiansen and Baum, 1997, p. 63). The C.O.P.E. model is the most flexible to implement since its focus can change from “being relatively directive to being totally client-centred, according to the situation and in response to clients progress (Hagedorn, 2001, p.55).
The models can be applied to all client groups. However, in the case where the client has deficits that prevent independent decision-making, the application of the P.E.O.P. and C.M.O.P. is more complex due to the client-centred nature of the approaches. The C.O.P.M. is the standardised assessment tool, which has already been discussed as beings specific to the C.M.O.P. This is the only standardised assessment tool to be specific to a model out of the models discussed so far. The P.E.O.P. supports the use of both non-standardised and standardised assessments that are client-centred and appropriate to the client group. The C.O.P.E follows a similar philosophy that “any client-centred, well validated tool can be used initially and subsequent assessment can be drawn from the selected frame of reference” (Hagedorn, 2001, p.155).
The C.M.O.P. provides a clear, jargon free process for a client-centred approach to therapy intervention. It places the person “in a social-environmental context rather than locating the environment outside the person “(Sumsion, 1999, p7). Unlike the other two models discussed, this model was developed by a national occupational therapy Association rather than being based solely on the work of one or two individuals. Hagedorn (2000, p11) describes the model to be both clear in presentation and application. This model out of the chosen three has had the most research & evaluation. As mentioned earlier this model is also different in having its own assessment tool. This model also has been well researched and has the widest range of information available.
Christiansen and Baum (1997) state that their PEOP model has been based on accepted information and research, however the model as of yet, has had little independent extensive testing. The PEOP model gives a framework to evaluate human behaviour that “combines knowledge about the impairments that impede performance, the environments that support performance and the individual needs, preferences, styles and goals (Christiansen and Baum, 1997, p.48). The limitation “that has been identified is that of the occupational therapy process which accompanies the Person Environment Occupational Performance Model appears quite linear in its focus” (Christiansen and Baum, 1997, p. 86). In this sense, it does not have the flexibility of approach found in the COPE model.
The COPE model has been described by Hagedorn as a contribution to theory which has evolved from and reflects, British practice and ideas “(Hagedorn, 2000, p.11). This model has not been used widely and Hagedorn states the reason for this is due to the model being relatively new. The model has also “not been independently evaluated or researched ” (Hagedorn, 2001, p.155). However, it does have the most flexible approach compared to the others that have been discussed (C.M.O.P. and P.E.O.P.). Hagedorn also states that the model is based on tried and accepted hypotheses and assumptions.
The P.E.O.P., C.M.O.P. and C.O.P.E. models show a close resemblance to one another, with often only different terms used to explain a similar idea. They focus on client-centred practice, where the client is actively involved with the therapist to identify the areas of dysfunction and the process of problem solving. This process empowers the client and therefore provides a better chance of success in the therapy process. The similarities in concept between the models allows a greater solidarity in occupational therapy theory and “strengthens validity of the concept “(Hagedorn, 2001, p.10).
The occupational therapy process identified in all three models, once the person is within the service, dictates that data should be gathered, problems identified, a plan of action devised with a set of goals that are meaningful to and involve the client and an evaluation of how the outcomes identified in the process are being achieved. Each model has a slightly different angle on how to approach this process. The PEOP takes a linear approach while the C.M.O.P. sees the client as central, with the therapist working alongside.
The COPE model places the therapist central in the intervention process. However, the models are all aiming for therapy to provide facilitation of optimal occupational performance, health, and well-being. The models all believe when viewing a person a consideration of both personal factors (Neurobehavioral, cognitive, physiological, psychological and emotional) and environmental factors (physical, societal, social and cultural) are necessary as they play a central role in occupational performance. The models view each new client as an individual and consider ‘occupations’ as having a specific meaning in terms of the needs of that person.
In conclusion all three of the models discussed, provide a clear structure for the process of occupational therapy. An understanding of these models will provide the therapist with the knowledge to view a person as an individual and guide the therapist clinical reasoning. The models are not identified with a specific client group; however, the C.M.O.P. would suit a situation where client-centred approach is required. The C.O.P.E. Model with it’s flexible approach will support the therapist reasoning in situations where clients are unable to problem solve or the therapist requires to be more directive. The models all follow a common line of thinking and this gives reinforcement to the theories. The choice of model used to support practice will ultimately depend on the therapist’s knowledge and are comfortable with it.
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