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MOHO: Occupational Adaptation

Adam Cefai, Chaya Greenbaum, Alice Hanna, Ellie Hosking, Breanna Lloyd & Isabella So

Ellie Hosking

on 11 March 2013

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Transcript of MOHO: Occupational Adaptation

MOHO Concept Case Study: Jorge OPHI-II Research Study Experiential Activity Model of Human Occupation Occupational Adaption 'Occupational Performance History Interview-Version 2.
Gathers information about a client's past & present occupational adaptation.
Three-part assessment:
Semi-structured interview
Rating scales (occupational identity, competence & impact of occupational environment)
Life history narrative Aim: to develop more insight into the process of occupational adaptations in people who had sustained a traumatic brain injury (TBI).

7 participants: 6 men and 1 woman
Range of age: 29-45 years
Recruited through referral:the director of a local brain injury association & the director of a program for people with TBI.
4 participants suffered TBI as the result of a motor vehicle accident
2 participants suffered work-related accidents
1 was the victim of a knife attack.
All injuries were sustained from 2 to 16 years prior to the interview.
Only one was employed and also the only participant who was able to return to driving. Adam Cefai, Chaya Greenbaum, Alice Hanna, Ellie Hosking, Breanna Lloyd & Isabella So. The achievement of a positive occupational identity and the maintenance of occupational competence in the context of one’s environment over time (Kielhofner, 2008). Occupational Competence: "the degree to which one sustains a pattern of occupational participation that reflects their identity and puts the personal identity into action" (Kielhofner, 2008, p.107). Occupational Identity: refers to a definition of self, including roles, relationships, values, self-concept, goals and desires’ (Christiansen, 1999; as cited in Kielhofner, 2008). Jorge, a 47-year old with 14 siblings from Puerto Rico, has a limited work history, a long history of substance use and abuse and lives in a small, subsidized apartment provided by an addictions recovery program.

Although he described himself as a “straight-A student”, Jorge dropped out of school and began smoking marijuana at the age of 14. He worked in temporary jobs, painting houses with long breaks in between which he attributed to his drug use. At 22, Jorge moved to Chicago with his mother and sister with plans for the rest of the family to join them. He began “making deliveries” for drug dealers for money to bring his family from Puerto Rico. His drug use escalated. He attributes his HIV infection to heroin use that also led to homelessness and the loss of his family, including his wife and children.

Jorge described intermittent employment for the next 15 years including jobs at gas stations, cleaning jobs or painting, with his longest stretch of continuous employment being at a car dealership for 12 months. Currently, his daily life is spent on tasks that he structures for himself including housework, medical appointments, attending recovery meetings and volunteering at a local center for recovering addicts. He focuses on maintaining a healthy diet and adhering to his medications. He has also increased contact with his family and is proud that they recognise the progress he has made in his recovery. Discussion Questions 1. Keilhofner (2008) states that ‘performance limitations may influence, but need not prevent, occupational participation if a person can make volitional choices and has adequate environmental supports’ (p. 102). How can you apply this statement to Jorge?

2.List three examples of Jorge’s occupational participation in this case study, that he has altered due to his condition.

3.Throughout ones life, an individual can experience threats to occupational adaptation, causing them to rebuild their occupational identity, has this occurred with Jorge? Has his occupational identity been restored?

4.What are some suggestions of things that can be done to further enhance Jorge’s occupational adaptation and deal with the circumstances he faces? Results/Key Findings Themes identified
2. Who I am is intimately and completely intertwined with what I do and how I do it. 5. I am different, thus I must change the environment in which I do things. 4. I am different, thus I must change my doing. 3. Adapting means accepting the new me. 1. I am who I am, but I am not who I was before. Study Design & Method Design Qualitative
Phenomenological Method Data collection: Semi-structured interviews
Lasted 1.5 hours
Audiotaped & Transcribed verbatim
Data analysis: Constant comparative method Strengths & Limitations Strengths Recently published in 2005
Reflective journal in data collection
Analysis continued until data saturation
Themes identified were supported by verbatim quotes
Discussion of themes with a second, expert independent researcher
Member checking
Peer review Limitations Data is not generalisable
Small sample size (7)
Gender imbalance (6 men, 1 woman)
One participant was known to the researcher prior to study.
Participants were drawn from the same population
Two participants: not involved in memberchecking. Elements of Occupational Adaptation Occupational Adaptation The Model of Human Occupation (MOHO) is a theoretical model used by occupational therapists to better facilitate a therapeutic outcome for clients/patients.

Within this model, humans are conceptualized as being made up of volition, habituation and performance capacity, and to understand human occupation, the physical and social environments also must be understood. Relevance to Occupational Therapy practice Relevance to Jorge •Involved selecting participants and giving them an impairment (e.g, blindfolding or tying up hand)

•Participants were then asked to draw a picture on the board in a certain amount of time (the time limit was to add to the demands of the environment) with their impairment •Participants then repeated the same activity but in a longer space of time Semi-structured Interview Rating Scales (3) Life History Narrative OPHI-II
Data Summary Sheet Interviews are structured around the
following themes:
'Activity & occupational choices
Critical life events
Daily routine
Occupational roles
Occupational settings (environment)' (Kielhofner, 2008, p.266). Occupational Competence Scale (9 items)
Occupational Identity Scale (11 items)
Occupational Settings Scale (9 items) Therapist describes items & asks client to rate them on a scale: -1 Extreme occupational functioning problems
-2 Some occupational functioning problems
-3 Appropriate satisfactory occupational functioning
-4 Exceptionally competent occupational function OT asks client to fill out a Life History form.
The form requests a time line representing the client’s life and a brief narrative of the client’s life history.
Patients have reported finding the form helpful to motivate them to adapt to their life situation. Study adds to the body of research indicating the benefits of OA.
Adds to the perception that being an active person; a 'doer' is positive for adaptation and overall health.
Shows there is greater depth to OA; internalised acceptance of situation along with physical adaptation.
Suggested more research to be investigated for other disabilities
How does OA occur in other populations? References Braveman, B., & Helfrich, C. A. (2001). Occupational Identity: Exploring the Narratives of Three Men Living with AIDS, Journal of Occupational Science, 8(2), 25-31.
Kielhofner, G. (2008). Dimensions of Doing. In G. Kielhofner (Ed.), Model of Human Occupation: Theory and application (4th ed., pp.101-109). Baltimore: Lippincott Williams and Wilkins.
Kielhofner G., & Burke, J. P. (1985). Components and determinants of human occupation. In G. Kielhofner (Eel.), A model of human occupation. pp. 12-36. Baltimore: Williams & Wilkins.
Klinger, L. (2005). Occupational Adaptation: Perspectives of People with Traumatic Brain Injury. Journal of Occupational Science, 12(1), 9-16.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry.Newbury Park, CA: Sage.
Llorens, L A. (1976). Application of developmental theory for health and rehabilitation. Rockville, MD: American Occupational Therapy Association.
Mosey, A. C. (1973). Activities therapy. New York: Raven. Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage.
Neistadt, M.E. (2000).Occupational Therapy Evaluation for Adults: A Pocket Guide. Baltimore, MD : Lippincott Williams & Wilkins.

Pasek, P, B. & Schkade, J, K. (1995).Effects of a Skiing Experience on Adolescents with Limb Deficiencies: An Occupational Adaptation Perspective. The American Journal of Occupational Therapy, 50(1), pp. 24-31. Denton, Texas.

Schkade, J.K., & McClung, M. (2001). Occupational Adaptation in Practice: Concept and Cases. NJ, USA. Slack Incorporated
Schkade, J., & Schultz, S. (1992). Occupational Adaptation: Toward a Holistic Approach for Contemporary Practice, Part 1. The American Journal of Occupational Therapy, 46(9), p.829-837., Texas Woman’s University, Denton, Texas
Schultz, S. & Schkade, J.K. (1992). Occupational Adaption: Towards a Holistic Approach for Contemporary Practice, Part 1, Am J Occ Ther, 46, 829-837
Schultz, S. (2009.) Theory of Occupational Adaptation. In Crepeau, E.B, Cohn, E.S. & Schell. B.A. (2009). Willard's & Spackman's Occupational Therapy (11th ed.) Philadelphia: Lippincott Williams & Wilkins. Images from Kielhofner, 2008 (pp. 101-109). Themes identified from research study can apply to Jorge:
Eventual willingness to change
Accepted 'the new me'; new occupational identity
Developed some form of occupational competence
Altered environment to better adapt
Recognises that his identity is inextricably linked with what he does & how he does it. Question 2 Question 3 Question 4 Question 1 Our Answers -Jorge has become much healthier

-Stable job and values health

-Created a positive environment at home, completing housework and attending a recovery program for drug addicts.
-Volitional choices and environmental supports (including his family) have prevented an adverse problem.
-Recognises his limitations but does not allow them to prevent him from participating in occupations he desires and values. - Lifestyle/health: Jorge now takes into consideration that preserving a healthy diet and adhering to his medications has a positive influence on his health and reflects his commitment and values relating to maintaining his sober state.

- Family/relationships: The support of his family and recognition of his progress is immensely significant in Jorge’s recovery and he is working to mend the relationships that were impacted by his previous actions.

- Work: Despite acknowledging his “poor” work history and limitations such as fatigue, Jorge is optimistic and determined to succeed in the workplace and hopefully maintain a job for more than 12 months. -In the context of Occupational Adaptation, it is clear that Jorge has undergone a range of positive changes in his life, particularly as a result of his diagnosis with HIV AIDs.

-Recognises acquiring AIDS as a critical turning point in his life that has provided him with a second opportunity

-Adapted to a desired occupational lifestyle that includes goals for work and becoming self-sufficient, and is actively working to achieve these aspirations.

-Achieved a positive occupational identity and is continuously working to maintain his occupational competence and overall health and wellbeing. - Focus on getting his own place rather than living at small-subsidized apartment provided by the addictions recovery program

- Regular contact with his family

- Continue attending recovery meetings

- Continue working to maintain a job for a longer period of time, possibly in different fields rather than his usual painting, or car dealership types
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