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Stephanie Mockus

on 19 April 2013

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Emily Freeman,
Emily Hershkowitz,
and Stephanie Mockus Occupation Environment
(extrinsic factors) Performance Person (intrinsic factors) Physiological- related to health and fitness Cognitive- learning, communicating, moving, observing, language comprehension and production, task organization, reasoning, attention, and memory Occupational Performance and Participation 1990s: PEO, EHP, and PEOP were developed by 3 independent groups of OTs
3 Models are considered models in occupational therapy
Ecological models highlight the importance of considering the environment and are based on the idea of "goodess of fit"
Share many similarities
Distinctions are apparent in the definitions, components, and structures of the models History Quality of Life Well-Being PEOP was developed by Charles Christiansen and Carolyn Baum in 1985
Published in 1991, updated in 1997
Though described as an ecological model, it is described by Turpin and Iwama (2010) as "a bridge between the Occupational Performance (OP) model and the ecological models" (p. 90)
> analyzes individual capacities (OP)
> also analyzes the environment in similar detail (ecological)
PEOP conceptualizes relationship between person, environment, and occupation differently Ecological ~ “the complex interaction between a person and his or her environment, which influences occupational performance and participation” (Turpin & Iwama 2010).

Appropriate for individuals, poplations, and communities

Domain- selected by client, who identifies important occupational performance issues within
personal care
home maintenance
There are four constructs for which PEOP stands for. Thinking of these constructs in three dimensions makes it easier to understand the way the model was conceptualized. The Focus of PEOP Conceptualization:
Person and Environment are INTERCONNECTED through Occupation
PEOP is an INTERACTIVE model that uses a top-down structure Neurobehavioral- sensory & motor systems Spiritual- signs, symbols, and events that provide personal meaning Psychological- personality traits, motivational issues, and internal processes Built- physical properties developed people, including technology Natural- geographical features, including terrain, hours of sunlight, climate, air quality Cultural- values, beliefs, customs, and behavior passed from one generation to the next Societal- social acceptance and relationships that influence personal development Social Interaction- the experience of social support Social and Economic Systems- access to health care, the laws, monetary resources what persons want or need to do in their daily lives the actual act of doing of occupations Why?
How? This is the culmination of the model

The successful outcome of person, environment, and occupation

Complex phenomenon

Meaningful, purposeful participation in a broad societal context Basic Properties Abilities- traits and characteristics that lead to occupational performance (including intrinsic factors)

Actions- observable behaviors that can be used to complete many different things

Tasks- combination of actions for common purpose

Occupations- tasks that have a distinct purpose that include social dimension

Social/Occupational Roles- positions that define status in society and include expectations for behavior Human Agency:



Occupational Performance:

Transactional Relationship: Theoretical Base Application to the Case Study~ Morrison People are innately driven to explore and master the environment. Competence is achieved when there is fit. Challenges of daily living are met through use of resources is driven from mastery and sense of self-identity from participation in meaningful occupations influenced by many factors including the person, their environment, and the occupations that make up thier life roles

comprised of 2 components Each of the four constructs is interdependent and directly impacts occupational performance OTs assess competence level and personal, social, and material environment. OTs recognize that the environment changes. Clients are viewed as adpative when they can meet the changing environmental demands. Performance is complex and comprised of many variables. OTs recognize that disruption of any component can have a negative outcome. It is complex and representative of the uniqueness of their clients. Clients gain self-confidence through success, which creates motivation for further challenges. OTs will ask the client about thier needs, and they will respect thier uniqueness. Clients are influenced by their health condition and environmental demands. The focus is ALWAYS person-first. Application to the Case Study- Morrison Function Client expresses competency in the ability to master occupations
Engages in meaningful activities
Personal and environmental demands are balanced
Shows adaptation
Healthy role patterns that meet personal and societal expectations Disability Client's occupational performance is limited or restricted
Competency is not achieved
Lack of goal attainment and participation
Dysfunction in role responsibilities
Due to: health conditions, restrictive barriers, or lack of resources in the environment Application to the Case Study- Morrison Change and Motivation Human agency must be activated to enhance motivation
Self fulfillment comes from mastery of occupations and a sense of self-identity develops from participating in them
Clients persists through change and stay motivated when they feel their occupational performance is competent and meaningful (top-down, client-centered approach)
Practitioner looks for the "just the right challenge"
MATCH INTRINSIC FACTORS WITH INTERVENTION Application to the Case Study- Morrison Assessments Top-down approach:
OT should assess the client's perception of the problem within occupational performance and analyze the client's issues within their performance Ex: -COPM
-Activity Card Sort
-Occupational Self-Assessment
-Interest Checklist
-Role Checklist
-Occupational Performance History Interview II
-Standardized and Observational Screenings
-Task Analysis Intervention Process Goals:
Increase competency in occupational performance
Develop life-long skillls
Increase health and well-being Guidelines: Appreciate occupational performance as restorative and as a way to enhance personal abilities to:
control movement, modulate sensory info, coordinate/integrate sensory info, compensate for sensorimotor deficits, and make modifications through behavior
maintenance of health and fitness
maintenance of cognition
increase motivation, develop identity, and enhance occupational identity and sense of self-efficacy
enhance personal and collective meanings Recognize how the environment affects health and participation in meaningful activities, tasks, and life roles by:
using occupation-enabling resources (assistive technology)
learning how to adapt to natural environment
respecting culture
incorporate societal acceptance
foster social skills/networks
promote client rights to economic support and health care Structure intervention for meaningful participation and competent mastery by adapting/modifying tasks to match client abilities, teach compensatory strategies, and foster adaptation Enhance roles through skill development through understanding ways to balance multiple roles, and clarifying role expectations Application to the Case Study References Please take a few moments to fill out the chart with your group mates and then we will discuss it! 6. Garrett has started teaching classes to children and “sees himself as a role model,”- especially to D.J, his first student with Down syndrome. His father said that, “it’s the first time that he’s made a friend of somebody else with special needs.” According to the PEOP intervention process, there has been improvement in Garrett’s _________ factors by fostering healthy interpersonal skills.

a. Environmental
b. Person
c. Occupational factors
d. All of the above 5. At the end of the tournament, Garrett felt happy. His father said he “doesn’t expect that to be his last fight,” and that now Garrett would have motivation for further boxing tournaments. According to the theoretical base of the PEOP, this occurrence displays the concept of __________.

a. Human agency
b. Function
c. Independence
d. Self-fulfillment 4. All of the following are extrinsic factors which affect Garrett’s occupational performance EXCEPT ___________.

a. Having parents who do not put limits on him
b. Having a trainer like Rodrigo Ramos who makes him work hard
c. Having motivation to succeed beyond others dreams for him
d. Having Interaction with the former MMA fighter Stephan Bonner 3. Garrett would like to use the boxing training from his classes in a real match. According to the theoretical base of the PEOP, Garrett would be termed as _________because he can meet the ongoing challenge and demands over time with an adequate repertoire of resources.

a. Adaptive
b. Self-fulfilled
c. Dysfunctional
d. All of the above 2. Garrett chose boxing as an activity which he wished to participate in although, “few understood what led him here." Instead of others choosing an activity which they deemed appropriate for Garrett, incorporates all of the following aspects of the PEOP model EXCEPT_______________.

a. Client centered practice
b. Bottom up approach
c. Top down approach
d. Assisting a client to change and be motivated by participating in something that is meaningful to him or her 1. Garrett was driven to explore and master boxing because it made him feel happy and good. According to the theoretical base of the PEOP, this occurrence displays the concept of ___________.

a. Self-fulfillment
b. Motivation
c. Human agency
d. Occupational performance http://youtu.be/b6fnP1j7uFE

http://www.garrettsfight.org/ While watching the following video please try to keep in mind the components of PEOP to fill out the chart afterward. PEOP
Activity Morrison’s biggest occupational issue is that he is depressed.
Due to his depression he is on medical leave and unable to work.
Also, Morrison’s diabetic and visually impaired father relies on him for home care and errands. His depression is interfering with his attention and short-term memory making these tasks impossible.
33 year old male
Depression- too depressed to do the dishes, read the mail, pay bills, balance the checkbook; just sat on a stool at work, leaving his work undone
meticulous worker
interested in science
Cognitive: Problems with attention; Deficits in working memory (Ex: gets lost when driving just two blocks from home)
Spiritual: Irish Catholic, attends church every Sunday
Physiological: Was once an athlete, and is now 15 years post-head injury. Against the odds, he is able to walk.
Neurobehavioral: problems with balance Person Environment Social Support: mother died suddenly, lives and cares for diabetic and visually impaired father, boss, church ladies, single, siblings
*rarely socializes
Social and Economic Systems: Currently on medical leave from work
Cultural: Irish Catholic
Built: large home he shares with his diabetic and visually impaired father is in disarray, television, computer, washer/dryer, car, quad cane to balance (buildings, technology)
Natural: unknown Occupation Self-care: is able to maintain hygiene and dress himself
Meal Preparation: him and his father are currently receiving daily hot meals from church ladies
Home maintenance: laundry has been piling up and kitchen is not cleaned up
Leisure: he enjoys watching sports on TV
Work: He is currently on medical leave from work due to his depression
Care for Others: father relies on him to compensate for poor vision The specific occupational performance domains that Morrison, his father and the therapist would identify if completing an occupational profile include;
•Performance areas such as work, ADLS and IADLS
•Performance patterns such as habits, routines and roles
•Performance skills that would be assessed include motor skills, processing and communication/interaction skills
•Client factors include his mobility issues Performance According to the basic assumptions of PEOP a practitioner would view Morrison as having intrinsic factors (depression) that are temporarily inhibiting his ability to engage in meaningful occupation.

Morrison will be motivated to change when the intervention matches his intrinsic challenge.
To enhance motivation, human agency must be triggered.
He will gain self- fulfillment by mastering occupations. By participating in these occupations he will develop a sense of identity through mastery.
A top-down and client-centered approach will be taken and the just right challenge will be found. Function:
Before Morrison’s depression hit, he was a meticulous worker and had no trouble finding a job
He worked hard to overcome the short-term memory problems and inattentiveness caused by his brain injury 15 years prior
Through perseverance he was able to regain his ability to walk using the aid of a quad cane for balance
*demonstrates adaptation Disability:
Morrison is having problems with attention and memory
After two years of rehabilitation Morrison could read and understand spoken language but rarely initiates conversation
Morrison is unable to prepare meals and manage his home
Morrison cannot help his father (driving, getting groceries, finances)
*mostly due to his depression Morrison has a strong interest in science. Although it took him 10 years, he attended a community college and earned a degree in medical technology. Morrison found employment in a lab, but he is currently on medical leave.
He enjoys reading and watching sports on television (he played sports in high school prior to the car accident that caused his brain injury)
Morrison cares for his dad and takes pride in helping him around the house Overall Assessment-Morrison
Canadian Occupational Performance Measure


The Person-Environment Fit Scale
http://ajot.aotapress.net/content/48/7/608.full.pdf+html Reference: Letts, et al. 1994, Mulligan 2003. Validated assessment tool for measuring the fit between person and environment
Consists of a self-report questionnaire measuring person-environment fit through examination of physical, social, and cultural contexts Person-Environment Fit Scale Reference: Rehabilitation Institute of Chicago, 2010. Standardized assessment tool for measuring disparities between a person’s abilities and the demands of a task, leading to functional impairment
Detects changes in a client’s self-perception of occupational performance over time Canadian Occupational Performance Measure (COPM) Top-down approach
Use semi-structured interview (such as COPM) and a self-questionnaire (such as Person-Environment Fit Scales) to pinpoint deficits that are affecting Morrison’s quality of life
Results from these assessments will yield information essential to planning an effective client-centered intervention
Modify and adapt tasks to match Morrison’s abilities and improve Morrison’s self-worth
Explore opportunities for leisure activities that appeal to Morrison
Maximize fit between person, environment, and occupation
Use direct observation in addition to the COPM and Person-Environment Fit Scales Overall Assessment: Morrison Reference: Rehabilitation Institute of Chicago, 2010. COPM consists of:
A 5-step process embedded within a semi-structured interview conducted by the occupational therapist:
Step 1: Identification of occupational performance issues
Step 1A: Self-care
Step 1B: Productivity
Step 1C: Leisure
Step 2: Rating Importance
Step 3 & 4: Scoring-initial assessment and reassessment
Step 5: Therapist and client collaborate to create goals for therapeutic intervention
The interview identifies the activities within each performance domain the client wants, needs, or is expected to perform in.
For Morrison, instrumental activities of daily living (IADLs), leisure
Interview may need to be supplemented with direct observation or an assessment of the client’s environment Canadian Occupational Performance Measure (COPM) Application to the Case Study- Morrison Identified needs:
Currently unable to pay bills, run errands, prepare meals, clean house
Unable to go to work 1) Propose a household chore chart to clarify individual roles of Morrison and his father in regards to duties around the house.
2) Introduce use of a GPS so that Morrison can navigate to destinations necessary to run errands.
*make use of the "favorites" application
3) Identify achievable tasks for Morrison to increase self-efficacy and confidence to return to work.
4) Encourage Morrison to develop his social network at his church outside of mass on Sundays to develop healthy interpersonal skills.
5) Encourage Morrison to attend a support group to address his grieving process over his mother.
6) Identify leisure activities that Morrison may be interested in.
7) Participate in leisure activities such as puzzles/games to maintain cognitive skills and physical health
8) Observe and analyze Morrison's financial management skills and develop remediation strategies including alternate methods of financial transactions and planning
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