The CMOP-E Model

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The CMOP-E Model

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The profession continued to grow and redefine itself in the s. The profession also began to assess the potential for the use of trained assistants in the attempt to address the ongoing shortage of qualified therapists, and educational standards for occupational therapy assistants were implemented in New developments in the areas of neurobehavioral research led to new conceptualizations and new treatment approaches, possibly the most groundbreaking being the sensory integrative approach developed by A. Jean Ayres. The profession has continued to grow and expand its scope and settings of practice.

Occupational science , the study of occupation, was created in as a tool for providing evidence-based research to support and advance the practice of occupational therapy, as well as offer a basic science to study topics surrounding "occupation". In addition, occupational therapy practitioner's roles have expanded to include political advocacy from a grassroots base to higher legislation ; for example, in PL titled the Patient Protection and Affordable Care Act had a habilitation clause that was passed in large part due to AOTA's political efforts as noted in AOTA's Centennial website AOTA, The World Federation of Occupational Therapist's Resource Centre has many position statements on occupational therapy's roles regarding their participation in human rights issues.

The philosophy of occupational therapy has evolved over the history of the profession. The philosophy articulated by the founders owed much to the ideals of romanticism , [13] pragmatism [14] and humanism , which are collectively considered the fundamental ideologies of the past century. One of the most widely cited early papers about the philosophy of occupational therapy was presented by Adolf Meyer , a psychiatrist who had emigrated to the United States from Switzerland in the late 19th century and who was invited to present his views to a gathering of the new Occupational Therapy Society in At the time, Dr.

Meyer was one of the leading psychiatrists in the United States and head of the new psychiatry department and Phipps Clinic at Johns Hopkins University in Baltimore, Maryland. William Rush Dunton , a supporter of the National Society for the Promotion of Occupational Therapy, now the American Occupational Therapy Association, sought to promote the ideas that occupation is a basic human need, and that occupation is therapeutic. From his statements came some of the basic assumptions of occupational therapy, which include:.

These assumptions have been developed over time and are the basis of the values that underpin the Codes of Ethics issued by the national associations. The relevance of occupation to health and well-being remains the central theme. In the s, criticism from medicine and the multitude of disabled World War II veterans resulted in the emergence of a more reductionistic philosophy.

While this approach led to developments in technical knowledge about occupational performance, clinicians became increasingly disillusioned and re-considered these beliefs. Three commonly mentioned philosophical precepts of occupational therapy are that occupation is necessary for health, that its theories are based on holism and that its central components are people, their occupations activities , and the environments in which those activities take place. However, there have been some dissenting voices. Mocellin, in particular, advocated abandoning the notion of health through occupation as he proclaimed it obsolete in the modern world.

As well, he questioned the appropriateness of advocating holism when practice rarely supports it. In recent times occupational therapy practitioners have challenged themselves to think more broadly about the potential scope of the profession, and expanded it to include working with groups experiencing occupational injustice stemming from sources other than disability. An occupational therapist works systematically with a client through a sequence of actions called the occupational therapy process. There are several versions of this process as described by numerous scholars. All practice frameworks include the components of evaluation or assessment , intervention, and outcomes. This process provides a framework through which occupational therapists assist and contribute to promoting health and ensures structure and consistency among therapists.

The OTPF framework is divided into two sections: domain and process. The domain includes environment, client factors, such as the individual's motivation, health status, and status of performing occupational tasks. The domain looks at the contextual picture to help the occupational therapist understand how to diagnose and treat the patient. The process is the actions taken by the therapist to implement a plan and strategy to treat the patient.

A central element of this process model is the focus on identifying both client and therapists strengths and resources prior to developing the outcomes and action plan. The following are examples of such occupations:. According to the Salary and Workforce Survey by the American Occupational Therapy Association, occupational therapists work in a wide-variety of practice settings including: hospitals The broad spectrum of OT practice makes it difficult to categorize the areas of practice, especially considering the differing health care systems globally.

In this section, the categorization from the American Occupational Therapy Association is used. Occupational therapists work with infants, toddlers, children, youth, and their families in a variety of settings, including schools, clinics, homes, hospitals, and the community. In planning treatment, occupational therapists work in collaboration with parents, caregivers, teachers, or the children and teens themselves in order to develop functional goals within a variety of occupations meaningful to the young client.

Early intervention is an extremely important aspect of the daily functioning of a child between the ages of birth-3 years old. This area of practice sets the tone or standard for therapy in the school setting. OT's who practice in early intervention develop a family's ability to care for their child with special needs and promote his or her function and participation in the most natural environment as possible. It's possible for an OT to serve as the family's service coordinator and facilitate the team process for creating an IFSP for each eligible child.

Objectives that an occupational therapist addresses with children and youth may take a variety of forms. In the United States, pediatric occupational therapists work in the school setting as a "related service" for children with an Individual Education Plan IEP. Department of Education, As a related service, occupational therapists work with children with varying disabilities to address those skills needed to access the special education program and support academic achievement and social participation throughout the school day AOTA, n. Occupational therapists have specific knowledge to increase participation in school routines throughout the day, including:. Other settings, such as homes, hospitals, and the community are important environments where occupational therapists work with children and teens to promote their independence in meaningful, daily activities.

This therapy, provided by experienced and knowledgeable pediatric occupational therapists, was originally developed by A. Jean Ayres, an occupational therapist. Recognition of occupational therapy programs and services for children and youth is increasing worldwide. As of , there are over , occupational therapists working worldwide many of whom work with children and academic institutions providing occupational therapy instruction. According to the American Occupational Therapy Association's AOTA Occupational Therapy Practice Framework , 3rd Edition, the domain of occupational therapy is described as "Achieving health, well-being, and participation in life through engagement in occupation". By examining an individual's roles, routines, environment, and occupations, occupational therapists can identify the barriers in achieving overall health, well-being and participation.

Occupational therapy practitioners can intervene at primary, secondary and tertiary levels of intervention to promote health and wellness. It can be addressed in all practice settings to prevent disease and injuries, and adapt healthy lifestyle practices for those with chronic diseases. Occupational therapy interventions for health and wellness vary in each setting: [55]. Occupational therapy practitioners target school-wide advocacy for health and wellness including: bullying prevention , backpack awareness, recess promotion, school lunches, and PE inclusion.

They also heavily work with students with learning disabilities such as those on the autism spectrum. A study conducted in Switzerland showed that a large majority of occupational therapists collaborate with schools, half of them providing direct services within mainstream school settings. The results also show that services were mainly provided to children with medical diagnoses, focusing on the school environment rather than the child's disability.

Occupational therapy practitioners conduct treatment sessions, group interventions and promote hospital-wide programs targeting: self-care activities, neurocognitive assessment and intervention, pain management techniques, physical activity and mobility, leisure, social engagement, stress management, diet and lifestyle recommendations, and medication management. Occupational therapy practitioners develop and implement community wide programs to assist in prevention of diseases and encourage healthy lifestyles by: conducting education classes for prevention, facilitating gardening, offering ergonomic assessments, and offering pleasurable leisure and physical activity programs.

The occupational therapy profession believes that the health of an individual is fostered through active engagement in one's occupations AOTA, When a person is experiencing any mental health need, his or her ability to actively participate in occupations may be hindered. For example, if a person has depression or anxiety, he or she may experience interruptions in sleep, difficulty completing self-care tasks, decreased motivation to participate in leisure activities, decreased concentration for school or job related work, and avoidance of social interactions. Occupational therapy practitioners possess the educational knowledge base in mental health and can contribute to the efforts in mental health promotion, prevention, and intervention.

Occupational therapy practitioners can work directly with clients, provide professional development for staff, and work in collaboration with other team members and families. For instance, occupational therapists are specifically skilled at understanding the relationship between the demands of a task and the person's abilities. With this knowledge, practitioners are able to devise an intervention plan to facilitate successful participation in meaningful occupations. Occupational therapy utilizes the public health approach to mental health WHO, which emphasizes the promotion of mental health as well as the prevention of, and intervention for, mental illness. This model highlights the distinct value of occupational therapists in mental health promotion, prevention, and intensive interventions across the lifespan Miles et al.

Below are the three major levels of service:. Intensive interventions are provided for individuals with identified mental, emotional, or behavioral disorders that limit daily functioning, interpersonal relationships, feelings of emotional well-being, and the ability to cope with challenges in daily life. Targeted services are designed to prevent mental health problems in persons who are at risk of developing mental health challenges, such as those who have emotional experiences e. Occupational therapy practitioners are committed to early identification of and intervention for mental health challenges in all settings.

The focus of targeted services small groups, consultation, accommodations, education is engagement in occupations to promote mental health and diminish early symptoms; small, therapeutic groups Olson, ; environmental modifications to enhance participation e. Occupational therapy services focus on mental health promotion and prevention for all: encouraging participation in health-promoting occupations e. Occupational therapy practitioners develop universal programs and embed strategies to promote mental health and well-being in a variety of settings, from schools to the workplace. Occupational therapists work with older adults to maintain independence, participate in meaningful activities, and live fulfilling lives.

Some examples of areas that occupational therapists address with older adults are driving, aging in place , low vision , and dementia or Alzheimer's disease AD. To enable independence of older adults at home, occupational therapists perform falls risk assessments, assess clients functioning in their homes, and recommend specific home modifications. When addressing low vision, occupational therapists modify tasks and the environment. Occupational therapists address all aspects of aging from health promotion to treatment of various disease processes. The goal of occupational therapy for older adults is to ensure that older adults can maintain independence and reduce health care costs associated with hospitalization and institutionalization.

In the community, occupational therapists can assess an older adults ability to drive and if they are safe to do so. If it is found that an individual is not safe to drive the occupational therapist can assist with finding alternate transit options. Occupational therapists also work with older adults in their home as part of home care. In the home, an occupational therapist can work on such things as fall prevention, maximizing independence with activities of daily living, ensuring safety and being able to stay in the home for as long as the person wants. An occupational therapist can also recommend home modifications to ensure safety in the home.

Many older adults suffer from chronic conditions such as diabetes, arthritis, and cardiopulmonary conditions. Occupational therapists can help manage these conditions by offering education on energy conservation strategies or coping strategies. Not only do occupational therapists work with older adults in their homes, they also work with older adults in hospitals, nursing homes and post-acute rehabilitation. In nursing homes, the role of the occupational therapist is to work with clients and caregivers on education for safe care, modifying the environment, positioning needs and enhancing IADL skills to name a few. In post-acute rehabilitation, occupational therapists work with clients to get them back home and to their prior level of function after a hospitalization for an illness or accident.

Occupational therapists also play a unique role for those with dementia. The therapist may assist with modifying the environment to ensure safety as the disease progresses along with caregiver education to prevent burnout. Occupational therapists also play a role in palliative and hospice care. The goal at this stage of life is to ensure that the roles and occupations that the individual finds meaningful continue to be meaningful. If the person is no longer able to perform these activities, the occupational therapist can offer new ways to complete these tasks while taking into consideration the environment along with psychosocial and physical needs.

Not only do occupational therapists work with older adults in traditional settings, they also work in senior centre's and ALFs. Visual impairment is one of the top 10 disabilities among American adults. Populations that may benefit from occupational therapy includes older adults, persons with traumatic brain injury, adults with potential to return to driving, and children with visual impairments. Visual impairments addressed by occupational therapists may be characterized into 2 types including low vision or a neurological visual impairment. Occupational therapy for older adults with low vision includes task analysis, environmental evaluation, and modification of tasks or the environment as needed. Many occupational therapy practitioners work closely with optometrists and ophthalmologists to address visual deficits in acuity, visual field, and eye movement in people with traumatic brain injury, including providing education on compensatory strategies to complete daily tasks safely and efficiently.

Adults with a stable visual impairment may benefit from occupational therapy for the provision of a driving assessment and an evaluation of the potential to return to driving. Lastly, occupational therapy practitioners enable children with visual impairments to complete self care tasks and participate in classroom activities using compensatory strategies. Occupational therapists address the need for rehabilitation following an injury or impairment.

When planning treatment, occupational therapists address the physical, cognitive, psychosocial, and environmental needs involved in adult populations across a variety of settings. Occupational therapy practitioners, or occupational therapists OTs , are uniquely poised to educate, recommend, and promote the use of assistive technology to improve the quality of life for their clients.

OTs are able to understand the unique needs of the individual in regards to occupational performance and have a strong background in activity analysis to focus on helping clients achieve goals. Thus, the use of varied and diverse assistive technology is strongly supported within occupational therapy practice models. Because of the rising need for occupational therapy practitioners in the U. Assignments can range from 8 weeks to 9 months, but typically last 13—26 weeks in length. This theory brings attention to the relationship between occupations, health, well-being, and quality of life.

Occupational justice can be approached individually and collectively. The individual path includes disease, disability, and functional restrictions. The collective way consists of public health, gender and sexual identity, social inclusion, migration, and environment. The skills of occupational therapy practitioners enable them to serve as advocates for systemic change, impacting institutions, policy, individuals, communities, and entire populations. For example, the role of an occupational therapist working to promote occupational justice may include:.

It is recommended to the clinicians to consider occupational justice in their everyday practice to promote the intention of helping people participate in tasks that they want and need to do. In contrast, occupational injustice relates to conditions wherein people are deprived, excluded or denied of opportunities that are meaningful to them. Within occupational therapy practice, injustice may ensue in situations wherein professional dominance, standardized treatments, laws and political conditions create a negative impact on the occupational engagement of our clients. Community-based practice allows for OTs to work with clients and other stakeholders such as families, schools, employers, agencies, service providers, stores, day treatment and day care and others who may influence the degree of success the client will have in participating.

It also allows the therapist to see what is actually happening in the context and design interventions relevant to what might support the client in participating and what is impeding her or him from participating. The role of the OT also may vary, from advocate to consultant, direct care provider to program designer, adjunctive services to therapeutic leader. Worldwide, there is a range of qualifications required to practice as an occupational therapist or occupational therapy assistant. Both occupational therapist and occupational therapy assistant roles exist internationally.

For OT, that is entry-level Master's or entry-level Doctorate. For OTA, that is associate degree or bachelor's degree. All of the educational programs around the world need to meet these minimum standards. These standards are subsumed by and can be supplemented with academic standards set by a country's national accreditation organization. As part of the minimum standards, all programs must have a curriculum that includes practice placements fieldwork. Examples of fieldwork settings include: acute care, inpatient hospital, outpatient hospital, skilled nursing facilities, schools, group homes, early intervention, home health, and community settings.

The profession of occupational therapy is based on a wide theoretical and evidence based background. The OT curriculum focuses on the theoretical basis of occupation through multiple facets of science, including occupational science, anatomy, physiology, biomechanics, and neurology. In addition, this scientific foundation is integrated with knowledge from psychology, sociology and more. In the United States, Canada, and other countries around the world, there is a licensure requirement.

In order to obtain an OT or OTA license, one must graduate from an accredited program, complete fieldwork requirements, and pass a national certification examination. A distinguishing facet of occupational therapy is that therapists often espouse the use theoretical frameworks to frame their practice. Many have argued that the use of theory complicates everyday clinical care and is not necessary to provide patient-driven care.

Note that terminology differs between scholars. An incomplete list of theoretical bases for framing a human and their occupations include the following:. Generic models are the overarching title given to a collation of compatible knowledge, research and theories that form conceptual practice. Frames of reference are an additional knowledge base for the occupational therapist to develop their treatment or assessment of a patient or client group.

Though there are conceptual models listed above that allow the therapist to conceptualise the occupational roles of the patient, it is often important to use further reference to embed clinical reasoning. Therefore, many occupational therapists will use additional frames of reference to both assess and then develop therapy goals for their patients or service users. The International Classification of Functioning, Disability and Health ICF is a framework to measure health and ability by illustrating how these components impact one's function.

This relates very closely to the Occupational Therapy Practice Framework, as it is stated that "the profession's core beliefs are in the positive relationship between occupation and health and its view of people as occupational beings". The ICF also includes contextual factors environmental and personal factors that relate to the framework's context. In addition, body functions and structures classified within the ICF help describe the client factors described in the Occupational Therapy Practice Framework.

It is noted in the literature that occupational therapists should use specific occupational therapy vocabulary along with the ICF in order to ensure correct communication about specific concepts. It also may not be possible to exactly match the connotations of the ICF categories to occupational therapy terms. The ICF is not an assessment and specialized occupational therapy terminology should not be replaced with ICF terminology. Occupational therapy is practiced around the world and can be translated in practice to many different cultures and environments. Een ergotherapeut baseert zich op de wetenschappen van de ergotherapie en hanteert het principe van evidence-based practice.

Bij de behandeling is het paradigma van de ergotherapie leidend. Tevens werken ergotherapeuten in de eerstelijn, hierbij komt de ergotherapeut aan huis om complexe zorgvragen op te lossen. Ergotherapie aan huis wordt vergoed vanuit de basisverzekering. Een ergotherapeut e verantwoordt zijn handelen en visie met behulp van modellen. Met behulp van deze modellen wordt de graad van zelfredzaamheid en eigen kunnen, het welbevinden, karaktereigenschappen, invloed en interactie met de omgeving, participatie in de maatschappij en alledaagse activiteiten, enz.

Ergotherapeuten worden opgeleid in het hoger onderwijs.

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