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Instrumentalism in OT

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Jennie Hofmann

on 30 April 2013

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Transcript of Instrumentalism in OT

Instrumentalism in
Occupational Therapy Kayla Coady, Olivia DeCanio, Jennie Hofmann,
Allison Merlo, and Christina Tripodi To present and inform participants on:

An overview of the Instrumentalism in Occupational Therapy (IOT) conceptual practice model

The Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (AIIIOT)

A case study utilizing the IOT model

An interactive activity based on this model

The relation of IOT to the Occupational Therapy's Centennial Vision

An evaluation of the effectiveness of this panel presentation Objectives The concept of the human as an instrument that fashions the environment for individual and collective survival.
Human mind = an extension of nature & a tool for adaptation

The mind becomes a natural instrument to be used as the human interacts with his or her environment. What is Instrumentalism? Initial Development of IOT model:

Author: Moses N. Ikiugu, Ph.D., OTR/L

To assist adolescents with emotional and behavioral issues; establish personal philosophy to influence occupational performance Instrumentalism in Occupational Therapy's (IOT) Focus Philosophy of pragmatism

Practice guidelines of this model based upon John Dewey's construct of instrumentalism.

Human mind is an extension of nature
tool used to assist in adaptation to environment
Intelligence also viewed as a tool
Behavior as an instrumental action Instrumentalism in Occupational Therapy's (IOT) Focus Instrumentalism in Occupational Therapy's (IOT) Focus cont. Human being:
Complex, dynamical, adaptive system, interacting adaptively in environment

Role of OT:
assist client to become optimally adaptive systems
teach to use the mind to adapt to environment

It is consistent with the profession's roots in mental health! IOT draws on various theoretical concepts:
Moral treatment movement
American philosophy of pragmatism
Chaos theory/Dynamical systems theory Theoretical Constructs Moral treatment movement
occupation was used as therapy to treat individuals with mental illness

Philosophy of pragmatism
helping individuals interact with and control their environment
John Dewey's pragmatic construct of instrumentalism
the idea that human mind is a tool individuals use to help them adapt to environments Theoretical Constructs Not a comprehensive theory, rather a collection of ideas pertaining to the behavior of complex, non-linear systems

These systems have common characteristics that include:
order underlying chaos or a chaotic exterior
sensitivity to initial conditions
self-organization, emergence, and adaptation Chaos theory/Dynamical systems theory Human is seen as a complex, dynamic, adaptive system, interacting with environment through occupational performance
interaction leads to increased self-organization

This develops more adaptive occupational behavior.

Occupational life consists of a course of many occupations that form a self-similar pattern of performance.

Intervention focuses on finding adaptive directions for the disruptions that interfere with an individual's course of occupational life. Chaos Theory Constructs Visualization Activity
Motivation plays a large role in meeting the internal needs and environmental challenges of the individual.

Cognition plays a large role in determining human behavior.

Motivation is the primary focus of therapy with IOT and is used to frame problems and challenges that the individual is facing.
Motivation to engage the body and mind

Framing Problems and Challenges Frame of References Used:

Occupational Adaptation
Model of Human Occupation
Cognitive Disability Frame of Reference
Lifestyle performance model
Cognitive Behavioral Frame of reference (closest model to IOT)
Framing Problems and Challeneges Use the mind as an instrument to performance!

Our neural system changes as we engage in occupations and interact with the environment.
changes occur that enable us to adapt
response to changes and survive

Beliefs action consequences beliefs Link between Theory & Practice Main goal: Develop adaptive patterns of occupational performance and ensure adaptability of the person.
examine beliefs of abilities/performance
ID maladaptive beliefs and educate client
ID adaptive beliefs
find belief promoting activities
set goals Intervention Focus 3 Phase Process with 10 Steps

Phase 1: Belief Establishment

Phase 2: Action

Phase 3: Evaluation/Appraisal
of Consequences Intervention Phases Intervention Diagram Introduce to the concept of mind as a tool

Develop a personal mission statement
attractors - sense of purpose for life
use of eulogy activity
4 areas: family, socialization/friends, work/professional life, religious/community organizations

Determine desired occupations - 2 in each of the 4 areas Phase One: Belief Establishment Introduce to the concept of mind as a tool.

Develop a personal mission statement.
attractors - sense of purpose for life
use of eulogy activity
4 areas to examine:
1. family
2. socialization/friends
3. work/professional life
4. religious/community organizations

Determine desired occupations - 2 in each of the 4 areas. Phase One: Belief Establishment Develop goals consistent with mission.

Choose activities to participate in regularly.
strengthen positive beliefs
eliminate negative beliefs
aim to support purposeful life Phase Two: Action Activities rated by the client in terms of adequacy, frequency, satisfaction, and belief of ability.

ID origins of stated beliefs.
negative vs. positive beliefs
for activities stated as unable to complete, discuss why and how those negative beliefs came to be

Determine new beliefs that match mission statement. Phase One continued Evaluate physical and cognitive abilities.
if any deficits, perform intervention/training
Biomechanical model for strength/endurance
if untreatable/unadaptable, redefine beliefs for more realistic goals

contract with therapist
perform activities in and outside of therapy Phase Two continued Reassess ratings in the 4 areas each week.

Discuss consequences of activities.
are desired outcomes of actions?
will they lead to the fulfillment of the personal mission statement?
have the goals been achieved?

If yes - terminate therapy.
If not - re-evaluate goals & determine new actions. Phase 3: Evaluation Pilot Study #2
Significant change in participation in occupations perceived by self and others as important- COPM

This change did not correspond with AIIIOT measurements

The criterion validity of IOT is put into question

IOT has some usefulness with helping participants visualize their DAL more clearly and engage in
activities that would help them achieve that in life Research Pilot Study # 2: Assisting adolescents experiencing emotional
and behavioral difficulties (EBD) transition to adulthood
Purpose: to test the effectiveness of IOT as a guide to help adolescents with EBD transition into adulthood
Participants: 15 adolescents with EBD (13-19 yr)
pre-test (DOI, ACLS)
IOT intervention (group format)- AIIIOT
interview Pilot Study #1: Understanding the occupational human being as a complex, dynamical, adaptive system
Purpose: Can the occupational human being be conceptualized as a complex, dynamical, adaptive system interacting with the environment through occupational performance?
Participants: 9 UofS students
Dairy method- Daily Occupational Inventory (DOI)
Frequency of occupations- Occupational Performance Calculation Guide (OPCG)
Results: the constructs from the chaos theory may be used to understand the occupational human being Research Research Paper: Cost effectiveness of the instrumentalism in occupational therapy (IOT) conceptual model as a guide for intervention with adolescents with emotional and behavioral disorders (EBD).

The cost of intervention per teenager was $162.88 Research Assessment Construct validity studies needed to identify that the assessment measures what it is designed to measure

Concurrent validity studies with sufficient samples comparing the assessment with other established measures are essential

Reliability studies need to be conducted

Use DOI and OPCG in conjunction with assessment tool

More research will allow this instrument to become a valid tool to measure and enable occupational performance. Recommendations for Future Research on AIIIOT Weaknesses
Very limited amount of research has been done to validate
accuracy of the data collected cannot be determined due to the individual-centered tool
information is provided by the client; subjective information
takes about 45 minutes to 1 hour to administer Strengths
Grounded on a strong conceptual foundation with defined philosophical and theoretical constructs
increases construct validity
Yields numerical scores
track occupational performance over time
used to facilitate change Strengths & Weaknesses of AIIIOT Use the evaluation portion of the assessment to re-evaluate beliefs and abilities at the end of therapy each week.

Mark these new scores in the second line for week 2 and sum total each column.

Progress is calculated by subtracting week 2-week 1. AIIIOT for Evaluation Phase Likert scale evaluation - scale of 1-4.
For example: 1 = unable/unhappy/do not belief capable and 4 = frequently perform/happy/can perform adequately and independently

Sum total scores for columns to get a total frequency score, total adequacy score, total satisfaction score, and total belief score.
A satisfaction score below 4 indicates a need to examine a more purposeful life. These occupations become the focus of intervention. AIIIOT continued Complete eulogy activity. Develop mission statement from key elements identified in the eulogy activity.

Identify 2 activities in each of the 4 areas to be performed regularly.

Evaluate each of the activities in terms of:
frequency of participation
adequacy of participation
satisfaction of participation
belief of ability to participate AIIIOT continued A number of pilot studies have been conducted to test the validity and reliability of the assessments (Ikiugu, 2007).
type II basic and applied scientific inquiry

Low test-retest reliability, due to a very small sample (Ikiugu, Anderson, & Manas, 2008).

Adequacy, satisfaction, and belief scores were found to be good predictors of the frequency of engagement in occupations perceived to be important. Research on AIIIOT AIIIOT - administer in quiet room with little distraction. Need ~45-60 minutes.

Contraindicated for the following populations:
those who may decompensate/emotionally reactive
immature children
those with delusions
terminally ill

Alternate visualization activity: Imagine coming home to a large group talking about you. Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy LTGs & STGs In 3 months, Angelica will...
Community LTG #4: Engage in 2 extracurricular activities at school.

In 4-6 weeks, Angelica will...
STG #1: Identify two sports that she would like to try out for.
STG #2: Engage in one after school club once per week. LTGs & STGs In 3 months, Angelica will...
Socialization/Friends LTG #2: Engage in healthy activities with friends demonstrated by volunteering at a local organization and weekly movie night.
In 4-6 weeks, Angelica will...
STG #1: Volunteer at the local dog shelter with 2 friends 1 time per week.
STG #2: Organize and participate in a weekly movie night with 3 friends and supervision from a parent. LTGs & STGs In 3 months, Angelica will...
Family LTG #1: Establish a positive relationship with her parents demonstrated by following the rules of the house, obeying curfew, and spending time with her parents.

In 4-6 weeks, Angelica will...
STG #1: Demonstrate understanding of the house rules by obeying curfew 5/7 days of the week
STG #2: Demonstrate understanding of house chores by completing 5 chores per week. Long Term & Short Term Goals "Angelica was a good daughter who helped around the house whenever asked. She blamed herself for her parents' divorce and regrets fighting with them. Angelica was a good friend and loved to have movie nights with her best friends. Angelica also loved to work with animals on the weekends. She played softball for her high school and was president of the Fashion Club. She was also very dedicated to her work and loved her job."

Personal mission statement: "I commit myself to working hard at school and at work. I promise to help my parents and be a good friend. I look to become more involved in school and in my community." Abbreviated Eulogy & Personal Mission Statement IOT was originally developed for adolescents with behavioral and emotional disturbances.
population is well served by this model as seen in pilot study #2.

Angelica's current life trajectory would not enable her to adapt to adult life. This model can enable her to develop a vision for a desired life during this time of development and transition. Rationale for selection Name: Angelica
Age:15 yr
Diagnosis: emotional and behavioral issues
Angelica's parents were divorced when she was 10
She spends the weekdays with her mom and the weekends with her father
She doesn't have a good relationship with her father
She drinks, smokes, and makes bad decisions
She does not consider her future Case Study Video Case Study Activity Time! Write one statement for each area of what you'd like people to say about you...
Work/professional life
Religious/community organizations Develop your eulogy... The IOT model can be directly related to the Occupational Therapy Practice Framework (OTPF).
occupation-based intervention
client-centered treatment
evidenced-based treatment
Research supporting the IOT model in practice adds to the field of OT.
Promote this client-centered and evidence-based treatment into practice in order to meet the occupational needs of society. Contribution to the OT Profession "We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs" (AOTA, 2006)

Accepting IOT into OTs identity
More research needs to be conducted in order to promote its effectiveness as an occupation-based model Connection to the Centennial Vision
This vision cannot be achieved without all of your support!

Educate others about this client-centered model that can be put into practice in order to meet society's occupational needs.

Develop a knowledge of theory and advocate for theory focused practice! What You Can Do! Ikiugu, M.N. (2004) Instrumentalism in occupational therapy: An argument for a pragmatic
conceptual model of practice. International Journal of Psychosocial Rehabilitation. 8, 109-117

Ikiugu, M.N. (2004). Instrumentalism in occupational therapy: A theoretical core for the pragmatic conceptual model of practice. International Journal of Psychosocial Rehabilitation. 8, 151-163.

Ikiugu, M.N. (2004). Instrumentalism in occupational therapy: Guidelines for practice. International Journal of Psychosocial Rehabilitation. 8, 165-179.

Ikiugu, M. N. (2007). Instrumentalism in occupational therapy. In Psychosocial conceptual practice models in occupational therapy: Building adaptive capability. (pp. 151-164). St. Louis, MO: Elsevier/Mosby.

Ikiugu, M. (2007). Measuring occupational performance: A pragmatic and dynamical systems perspective, Journal of Occupational Science, 14(3), 123-135.

Ikiugu, M. N., & Anderson, L. (2007). Cost effectiveness of the instrumentalism in occupational therapy (IOT) conceptual model as a guide for intervention with adolescents with emotional and behavioral disorders (EBD). International Journal of Behavioral and Consultation Therapy, 3(1), 53-76.

Ikiugu, M., & Ciaravino, E.A. (2006). Assisting adolescents experiencing emotional and behavioral difficulties (EBD) transition to adulthood. International Journal of Psychosocial Rehabilitation, 10 (2), 57-78.

Ikiugu, M. N., & Rosso, H. M. (2005). Understanding the occupational human being as a complex, dynamical, adaptive system. Occupational Therapy in Health Care,19(4), 43- 65. References In 3 months, Angelica will...
Work/Professional LTG #4: Apply for one part-time job to participate in three days a week.

In 4-6 weeks, Angelica will...
STG #1: Identify two possible job sites.
STG #2: Develop a resume for the application process with minimal assistance. Intervention To meet LTG #1 for her family relationships, collaborating with Angelica, her mother and her father to establish chore charts and household rules for each household will be one session of therapy.

Consequences for breaking rules or refusing to do chores will also be discussed. Hey Moses!

His AOTA presentation this year was on the lack of theory used in practice. As therapists, we can advocate for use of theory, such as with this model!
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