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MOHO~Model of Human Occupation

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Danielle Chadwell

on 18 October 2010

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Transcript of MOHO~Model of Human Occupation

MOHO Model of Human Occupation Written by Gary Kielhofner Dr. Gary Kielhofner 1949-2010
Bachelor degree in Psychology from St. Louis University
Master's degree in OT from the University of Southern California
Doctorate from UCLA
Faculty of both Boston University and Virginia Commonwealth University
Joined University of Illinois @ Chicago in 1987 Theoretical development of MOHO MOHO began as Dr. Kielhofner's unpublished doctoral thesis in 1975 MOHO Defined: What types of problems does this Model address? What types of assessments/treatment modalities are used in MOHO? Strengths of MOHO Weaknesses of MOHO Holistic model used for:
Practice
Education
Research MOHO is a very ecclectic model Incorporates views of early occupational therapists and general system theorists Existential and humanistic psychology
Ego psychology
cognitive theory
sociology
biology
social psychology emphasizes the constant interaction between person, task and environment Occupation is innately driven Essential to human maintenance and self-organization The idea of occupation in life and in treatment was first developed by Mary Reilly during the late 60's and 70's This idea developed many of the occupational behavior views that continue to influence occupational therapy today Reilly encouraged the profession to adopt an occupational behavior paradigm Kielhofner defined this paradigm as a broad collection of assumptions or core concepts that give coherence to the profession This paradigm addresses the healthy nature of people as well as the problems and incapacities that result from illness 3 of the most important concepts of MOHO Systems Theory Person-Environment-Occupation Theories of Motivation Humans are an open system People are changed by the environment and, in turn, can cause change in the environment Both the individual's characteristics and the environment influence choices and behaviors Open system is made up of 4 phases: Input (Taking in information) Throughput (Making sense of the information) Output (Action-what people do as a result of the processed information) Feedback (the reaction from the environment after the action) People's inner characteristics and patterns of performance are maintained and changed through occupation Occupation reflects the influence of a person's characteristics and environment Occupational form is analyzed into: work, play, and daily living tasks Human occupation is performed in temporal, physical, and sociocultural environments Interaction between context, occupational form, and human systems result in occupational performance Three subsystems of the "open system" 1. Volition~guides choice of action and motivation Includes; interests, values, and personal causation (thoughts and feelings about personal activities and effectiveness while completing activities) 2. Habituation~habits and roles of a person's daily routine Includes; habits, roles, and routines
There are two types of habituation:
1. Intentional functioning; goal directed behavior which may cause a person to do something he or she has not tried before.
2. Habits; consistent ways of behaving in particular circumstances which are learned through repitition and are not the result of conscious planning. 3. Performance capacity~skills for producing the action Includes; perceptual motor skills, processing skills and communication skills Change in an individual is the direct result of the interaction of the above three subsystems Two types of Motivation Effectance Competence The person's desire to use one's own actions to cause an effect The person's attempt to become competent through one's experiences People desire small amounts of unpredictibility in order to offset boredom However, they try to avoid large amounts of unpredicitibility which could be perceived as threatening Motive is a state of mind aroused by some stimulus situation that signals an imminent change that will be either pleasant or unpleasant This means that people will act either to increase pleasure or to avoid displeasure When the person acts to increase pleasure, they use an approach motive
When the person acts to avoid an unpleasant change, they use an avoidance motive Approach and avoidance motives are referred to as need for achievement or fear of failure Approach motives indicate the anticipation of success and lead to planned task behavior, which can produce effective, efficient outcomes and a sense of satisfaction Avoidance motives usually emphasize the threats in the environment. They can yield ineffective, inefficient or obsessive thoughts and behaviors, passivity, or a sense of threat or dissatisfaction A collection of habits is a trait A trait is a "learned tendency in persons to react as they have reacted more or less successfully in the past in similar situations when similarly motivated." A cluster of traits makes up a role Traits and roles explain habitual functioning motives Motives explain intentional functioning However, one must also take into account the schema The schema is a cognitive unit that symbolizes past experience. Schemata house one's values, ideas, and social roles, and thereby provide a guide for living and boundaries for the possibilities in one's life. Ideas and values concern primarily economic, aesthetic, social, political, religious, and theoretic realms. Social roles, are those related to age, gender, family position, occupation and group membership Being engaged in human occupation means doing culturally
meaningful work, play, or daily living tasks in the stream
of time and in the contexts of one's physical and social world. Kielhofner believed that people are, by nature, occupational~they need to be active More than 20 assessments have been developed for use with this model MOHOST: Model of Human Occupation Screening Tool (An assessment
that addresses the majority of MOHO concepts.
ACIS: Assessments and Communication of Interaction Skills
SCOPE: The Short Child Occupational Profile
COSA: Child Occupational Self Assessment
OCAIRS: The Occupational Circumstances Assessment INterview and Rating Scale
OPHI-II: The Occupational Performance History Intervention-II
OSA: The Occupational Self Assessment
OTPAL: The Occupational Therapy Psychosocial Assessment of Learning
PVQ: The Pediatric Volitional Questionnaire
SSI: The School Setting Interveiw
VQ: The Volitional Questionnaire
WEIS: The Work Environmental Impact Scale
WRI: The Worker Role Interview
Work Environment Impact Scale Videotape

Here is a portion of those assessments MOHO is intended for use with any person experiencing
problems in their occupational life and is designed to be
applicable across the life span. MOHO has been applied with very diverse groups Adults with chronic pain Children with attention deficit hyperactivity disorder People with traumatic brain injury Older persons with dementia Persons living with AIDS Adolescents with mental illness
Performance areas (ADLS such as grooming, dressing
feeding/eating socialization, functional communication
and health maintenance routines. Work and producive
activities such as home management and vocational
activities; as well as play and leisure activities)

MOHO addresses many problems Performance components such as sensory awareness and
processing. Neuromusculoskeletal, which includes ROM
and endurance. Motor skills; gross coordination, fine
coordination and visual motor integration. Cognitive skills
such as orientation, initation of activity, memory and
sequencing. Psychosocial skills are also addressed. MOHO: A CASE STUDY Carl, a 32 year old man with a history of chronic schizophrenia was
admitted into an inpatient facility after discontinuing his meds for
six weeks. Although the Occupational therapist knew his symptoms
of hearing voices would subside once he resumed his meds; she had concerns.
Carl also neglected daily grooming functions. She wondered if he had any interests and experiences
that would suggest a potential life for him. She wanted
to make sure that he had meaningful ways to fill his
time and achieve an identity in life. Carl spent most of his time, prior to admission, watching
television and occasionally going to the park to pick flowers. The OT knew that if Carl had a daily schedule and life roles that
gave him purpose, he would have fewer relapses. After talking to the family and hearing that Carl was very interested
in plants and flowers, the OT invited him to come to the occupational
therapy setting and care for the plants. This made Carl happy. The therapist used Carl's love for plants as a motivator for him to
improve self care. It was agreed between the OT and Carl that he
would only be allowed to care for the plants if he would properly groom
and dress himself. This was the motivation that Carl needed to stop
neglecting these areas. He immediately began following the OT's rules
so that he could do what he loved; caring for the plants. Carl and the OT completed the Interest Checklist and the Role Checklist,
horticulture emerged as the most consistent and strongest of his
interests. He agreed that hobbyist was a life role he wanted to pursue. The remainder of the therapy sessions were used to help him
develop this role. His parents, and the day treatment center where
he would be discharged after his short hospitalization were apprised
of the situation. They all agreed to allow him to care for the plants
and flowers. Carl had found his "life role". ROLE OF THE OCCUPATIONAL THERAPIST WITHIN THE MOHO MODEL Foremost, is the importance of the therapist to "appreciate the
life the individual has lived and might live in the future". Primary responsibility of the therapist is to evaluate clients' or patients'
occupational performance and assist them in making the changes that
they want to make. Because of this, the therapist takes on very specialized roles. Role Model
Teacher
Mentor
Counselor
Supervisor
Environmental Manager
Consultant Kielhofner stresses that the role of the therapist
is to assist or support change while understanding
that the client makes most of the change by their
own efforts. Therefore, the process becomes one of personal engagement, problem solving and
experimentation while continuing to appreciate the impact that disease or trauma
has had in the clients' life and to adapt general intervention guidelines to suit the
clients' life situation. Unlike a medical intervention, the therapist
will not alter the human system directly.
Instead, they will produce change in the clients'
environment. This includes altering the physical setting, providing
assistive devices or technology, providing mentoring
or finding social groups that the client can participate
in. Most of all, the therapist is expected to help the client by
making available to them meaningful occupations. How does the therapist accomplish this? INTERVENTION! Kielhofner's "Principles for Intervention": This list
is not exhaustive or a prescription of what to do.
It merely contains guidelines to help the therapist
understand how volition, habituation, and the
environment contribute to occupational functioning. Therapy is an event that comes into a life in progress, therefore, it must be understood as such The focus for change should be the action/process of the underlying human system. As therapists, we really need to get to know our clients. Assuming that
two patient's who have similar problems require the same treatment
modalities is incorrect. Life situations of client mandate treatment. Occupational therapists have to look at the client's ability to function
or perform in his/her everyday environment, rather than focusing
on particular impairments such as physical/cognitive. Change should occur in a number of human systems simultaneously Let's use an example of an adolescent who is injured and unable to walk.
Not only are the child's legs affected but so are the child's roles of play
and leisure. Helping the child to regain mobility will instantly
aid her in returning to the roles she previously occupied. So, adaptation, if necessary, to help them perform ADL's and IADL's with minimal assistance. In other words, adaptations may be the focus rather than restoration
of previous functions. Change does not mean simply more or less; it means
different organization So, any change in the human system will affect the whole.
Occupational therapists have to assist people who acquire
disabilities to alter the way they do things in their
environment. Change is often disorderly Therapy should involve experimentation to find best solutions The only tool that therapists have at their disposal
is to change the relevant environment to support or
precipitate a change in the human system Change in skill should be the primary target of therapy Change in performance can involve learning to call upon different configurations of skills Occupational forms have a powerful
influence on changes in skill Habits and roles are naturally resistant
to change because their basic function
is to preserve patterns of behavior Habituation organizes behavior for
specific ecologies; new habits must
often be learned in new ecologies The loss of role and habits requires swift replacement Acquiring a new role script and related habits
is a process of socialization and negotiation Volitional anticipation, experience, interpretation, and choice are at the core of what is referred to as meaning in therapy Volitional change means finding a direction for one's personal narratives Therapeutic programs should include occupations
that are relevant to the client and allow the client
to interact at his or her level of function Occupational therapy prorams should provide social
and physical environments that offer consistent and
relevant expectations and opportunities for performance Progress is often uneven and can include both periods of stability and instability.
The therapeutic setting is often a place for the client to "re-group" The therapist is expected to be a problem-solver This includes all environments; home, school, workplaces, or other settings Making the tasks meaningful rather than repetitive provides purpose for
the rehabilitation process These provide clients with a
source of security, familiarity
and identity. Therapists need to stay in close contact with the client
so that they have a sense of what the client is
experiencing through the process and so the client
can make choices about therapeutic goals So new behaviors need to be practiced by the client continually
which requires the therapist to find opportunities outside
of the therapeutic setting It's best to have clients learn
new habits in the environment
they will be using Clients will have to learn to live with a disability
while still finding meaning and quality in life Creation of patterns of behavior (habits and roles) is essential to the clients well being Currently, MOHO is one of the
most widely used models in use
throughout the world MOHO is the occupation-based model
most frequently used by practitioners Strongly Researched Model Used in a variety of contexts Hospitals, outpatient clinics, residential facilities, nursing homes, rehabilitation programs, work programs, prisons and correctional settings, and community based organizations Provides a framework for addressing problematic role and habitual behavior which occur in mental illness, as well as, disability, chronic disease, and traumatic events. The latest edition addresses previous weaknesses such as
inconsistencies in language and how theoretical concepts
tied together. Now theoretical constructs are clearly defined. Many assessment instruments have been developed in support of the model. Dependent on a client-centered practice approach Applicable with all age groups Limited Intervention Guidance Therapists have to give careful thought to objectives for third-party payers Unclear Application for Prevention Model Addresses both function and dysfunction but focuses more on dysfunction. Therefore, the model might be better served as a preventative model rather than an intervention one. Multiple Definitions of Terms Terms remain unclear at times despite the attention
that was given to them in the updated issue References Borg, B., & Bruce, M. (2002) Psychosocial Frames of Reference, 3rd ed. Slack Incorporated.
Thorofare, NJ. Kates, J. (Sept. 7, 2010) Dr. Gary Kielhofner. Chicago Tribune Kielhofner, G., & Henry, A.D. (1988). Development and investigation of the occupational
performance history interview. AJOT 42, 489. Pendleton, H.M., & Schultz-Krohn, W. (2006). Pedretti's Occupational Therapy. Mosby
Elsevier. St. Louis. 375-376. MOHO Clearinghouse. Retrieved on October 17th, 2010 from www.moho.uic.edu/assessments.
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