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Application of the Ecology of Human Performance Model

Jacquelyn Bonneville, Katelyn Brooks, David Burzynski, Louisa Chan, Danielle Kandel-Lieberman, Farah Mohamad, Amanda Smith

Assumptions of the Ecological Models

  • PEO constantly interacting; dynamic

  • Environment is facilitator or inhibitor of occupational performance

  • Client is primary decision maker

Before Intervening...

  • Identify the person's needs
  • Conduct task analysis
  • Observe performance of individual in tasks, in context
  • Consider how to make the best fit

(Schell, Gillen &Scaffa, 2013)

Intervention Strategies for EHP

Learning Objectives

Prevent

Evidence

Establish/Restore

• Foresee a negative outcome and attempt to avoid it

• Can use any of the other intervention strategies before problem develops

  • E.g., provide education on back safety techniques to prevent future back problems

Adapt/Modify

• Person is the target

• “Aimed at developing and

improving skills and abilities so

person can perform tasks

(occupations) in context” (p. 497)

• E.g., ROM

Efficacy Studies

Studies supporting a relationship between Environment and Person/Occupation

(Schell, Gillen &Scaffa, 2013)

  • To distinguish between main concepts in ecological models

  • To recognize how context is significant in OT practice

  • To learn how to apply the 5 intervention strategies specific to the EHP

(Schell, Gillen &Scaffa, 2013, p. 497)

• Target context or task

• Important to consider social and

cultural environment, not just

physical

  • E.g., use of elastic shoelaces

(Schell, Gillen &Scaffa, 2013)

Alter

  • Effect of contextual barriers children in transition

(Law et al., 1999 as cited in Schell, Gillen &Scaffa, 2013)

  • Social support as a factor for overcoming environmental inaccessibility

(Lund & Nygard, 2004 as cited in Schell, Gillen & Scaffa, 2013)

  • Effect of context on eating habits in African American women

(Hargreaves et al., 2002)

  • Institutional context as a barrier to persons with AIDS

(Paul-Ward, Kielhofner, Braveman, & Levin, 2005)

  • Impact of contextual factors on persons with psychiatric disabilities

(Chamberlin, 1990; Deegan, 1993 as cited in Schell, Gillen &Scaffa, 2013)

  • CarFit Assessment study of older adults and driving

(Stav, 2010)

  • Grocery shopping intervention for persons with schizophrenia

(Brown, Rempfer, & Hamera, 2002)

  • Environmental Skill Building Program for persons with dementia and caregivers

(Schell, Gillen & Scaffa, 2013)

  • Studies of home modification interventions to reduce number of falls in older adults

(Gillespie, Robertson, Gillespie, Lamb, Gates,

Cumming & Rowe, 2008)

Create

• Improve fit

  • Do not attempt to change person, task, or context
  • Take advantage of existing person, task and context factors
  • E.g., finding a job that matches client’s current skills

  • Develop opportunities to support occupational performance in context
  • No problem has occurred or is expected to occur
  • Can use establish/restore, adapt or alter intervention
  • E.g., optimal study area

(Pendleton & Schultz-Krohn, 2013); (Schell, Gillen &Scaffa, 2013)

(Schell, Gillen &Scaffa, 2013)

Castaway Applied!

Person

Context

Tasks

A Brief Introduction

Strengths and Limitations

Why the need for an ecological model?

Case Study

• 1990’s ==> Creation of three models

emphasizing the environment

• Ecology of Human Performance Model (EHP)

• Person-Environment-Occupational-

Performance Model (PEOP)

• Person-Environment-Occupation Model (PEO)

  • Inclusion of assessments and interventions focused on environment (context)
  • Account for all aspects of the PEO
  • To appreciate every situation as unique

(Schell, Gillen &Scaffa, 2013)

Background:

"Ms. Tario is a 75-year-old who has had a right hemisphere stroke. She has some problems walking and getting a hold of objects around her house. She lives with her son Steven and daughter-in-law and their two grandchildren Mike and Matt."

All three models:

• Are dynamic

• Are primarily concerned with occupational

performance

• Consider person, environment (context) and

occupation (task) as determinants of OP

• Are based on goodness of fit

History of the Ecological Models

Based on:

• Social science theory

• Earlier models of occupational therapy

• Disability Movement

(Schell, Gillen &Scaffa, 2013)

(Dunn et al., 1994, p. 605)

Important Definitions

Why EHP?

Environment/Context

According to all three models:

  • The WHERE
  • Consists of
  • Physical components
  • Cultural components
  • Social components

Diagram of the EHP Model

Social Component

Temporal Component of the EHP

Cultural Component

Physical Component

  • Many layers
  • Includes:
  • Close interpersonal relationships
  • Work groups
  • Social organizations
  • Political and economic systems

  • EHP includes a temporal component (unlike other ecological models)
  • Time-oriented factors related to:
  • Person
  • Task

  • "...based on shared experiences that determine values, beliefs, and customs." (p. 496)
  • "...includes, but is not limited to, ethnicity, religion, and national identity." (p. 496)

  • Tangible
  • Includes:
  • Built features
  • Natural features
  • Large elements
  • Small objects

(Schell, Gillen &Scaffa, 2013)

• Person

• Environment/ Context

• Occupation/Tasks

References

Depiction of Dysfunction

Comparing Definitions of Task/Occupation

"Establish/Restore: The therapist decides to work on functional range of motion for reaching and stepping using facilitation techniques."

"Alter: The therapist and Ms. T discuss her need to socialize and Ms. T expresses concern over her usual socializing in the quilting club, which expects a certain level of performance, The therapist suggests Sunday school as a place to socialize that doesn't require the fine motor control."

"Adapt: The therapist brings clamps to help her with her stitching so that she could still do some stitching, The therapist brings her a stocking darner and Velcro to attach to key items in the bathroom when she expressed desire to dress and complete personal hygiene."

"Prevent: The therapist helps Ms. T to establish a daily routine to prevent joint, muscle, and skin breakdowns."

"Create: The therapist helps her plan regular times to play with her grandchildren as part of the family routine."

(Schell, Gillen &Scaffa, 2013, p. 498)

(Dunn, Brown, & McGuigan 1994)

Crepeau, E. B., Cohn, E. S., & Schell, B. A. (2013). Willard & Spackman's Occupational Therapy (12th ed.). Baltimore, MD: Lippincott, William & Wilkins.

Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of human performance:

A framework for considering the effect of context. The American Journal of Occupational Therapy, 48(7), 595-607.

Gitlin, L. N., Winter, L., Corcoran, M., Dennis, M. P., Schinfeld, S., & Hauck, W. W. (2003). Effects of the home environmental skill-building program on the caregiver–care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative. The Gerontologist, 43(4), 532-546.

Hargreaves, M., Schlundt, D., & Buchowski, M. (2002). Contextual factors influencing the eating behaviours of African American women: a focus group investigation. Ethnicity & Health, 7(3), 133-147.

Lund, M. L., & Nygård, L. (2004). Occupational life in the home environment: the experiences of people with disabilities. Canadian journal of occupational therapy. Revue canadienne d'ergothérapie, 71(4), 243.

Paul-Ward, A., Kielhofner, G., Braveman, B., & Levin, M. (2005). Resident and staff perceptions of barriers to independence and employment in supportive living settings for persons with AIDS. American Journal Of Occupational Therapy, 59(5), 540-545

Schell, B., Gillen, G., & Scaffa, M.(Eds.) Willard & Spackman’s Occupational Therapy, 12th edition (pp 364-381). Baltimore, MD: Lippincott Williams & Wilkins.

Stav, W. (2010). CarFit: an evaluation of behaviour change and impact. The British Journal of Occupational Therapy, 73(12), 589-597.

Schultz-Krohn, W., & McHugh Pendleton, H. (2012). Pedretti’s occupational therapy: Practice skills for physical dysfunction. Elsevier.

Teel C. Dunn W. Jackson ST. Duncan P. (1997). The role of the environment in fostering independence: conceptual and methodological issues in developing an instrument. Topics in Stroke Rehabilitation, 4(1):28-40, 1997.

(Schell, Gillen &Scaffa, 2013, p. 496)

What does the EHP do?

  • Provides a framework in practice in occupational therapy

Focus:

  • Considers the environment as extensively as the person

Values:

  • Client-Centered Approach

Goal:

  • To bring in specific practice models to guide assessments and later interventions and support policies that endorses full participation in community life.

Person

All three models:

  • Have a holistic view:
  • Mind
  • Body
  • Spirit

  • Values and interests
  • "...help to determine what is important, meaningful, and enjoyable to the person" (p. 495)
  • Skills and abilities
  • "...include cognitive, social, emotional, sensorimotor skills..." (p. 495)
  • Life experiences
  • "...form the person’s history and personal narrative" (p. 496)

  • Bidirectional relationship between person and environment

Depiction of Function

(Schell, Gillen &Scaffa, 2013)

(Dunn et al., 1994, p. 605)

(Schell, Gillen &Scaffa, 2013)

(Dunn, Brown, & McGuigan 1994)

(Schell, Gillen &Scaffa, 2013)

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