Canadian model of occupational performance

The Canadian Model of Occupational Performance (CMOP) was developed by the Canadian Association of Occupational Therapists, and describes transactions and mutual influences between the dimensions of occupational performance Law M.L, Cooper BA, Strong S. Stewart D, Rigby P and Letts L (1997). Theoretical contexts for practice of occupational therapy in Christiansen CH and Baum CM (eds.)Occupational Therapy: Enabling function and well-being (2nd Ed) New Jersey, SLACK ] . It is applied by the accompanying Occupational Performance Process Model, which describes the therapeutic process from a client’s perspective Fearing VG, Law M and Clark J (1997). An occupational performance process model: Fostering client and therapist alliances. Canadian Journal of Occupational Therapy, 64(1), 7-15 ] . Stanton S, Thompson–Franson T and Kramer C. (2002). Linking concepts to a process for working with clients. In Townsend E, Stanton S, Law M, Polatajko M, Baptiste S, Thompson-Franson T, Kramer C, Swedlove F, Brintnell S and Campanile L (2002). Enabling occupation, An occupational therapy perspective. Revised edition. Ottawa, CAOT Publications ACE.] . Clarke C (2003). Clinical application of the Canadian Model of Occupational Performance in a forensic rehabilitation hostel. British Journal of Occupational Therapy, 66(4), 171-174 ] . The main model illustrates the relationship between person, occupation and environment. Spirituality is the fourth dimension, placed in the centre of the model to highlight its fundamental importance.

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History

The current CMOP results from developments in occupational therapy spanning thirty years. It was initially inspired by occupational performance frameworks proposed by the American Occupational Therapy Association American Occupational Therapy Association, Inc. (1974). A curriculum guide for occupational therapy educators. Rockville, MD: Author ] and Reed and Sanderson Reed, K. L., & Sanderson, S.R. (1980) Concepts of occupational therapy. Baltimore: Williams & Wilkins ] . However, calls to develop a national quality assurance system lead to its forerunner in 1983 - 'Client-Centred Guidelines for the Practice of Occupational Therapy' Baum CM and Law M (1997). Occupational therapy practice: Focusing on occupational performance. American Journal of Occupational Therapy, 51(4), 277-288 ] Refinements in the model are evident in further guideline statements Canadian Association of Occupational Therapists (1991). Occupational therapy guidelines for client-centred practice. Toronto, CAOT Publications ACE. ] Health Canada and Canadian Association of Occupational Therapists (1993). Occupational therapy guidelines for client-centred mental health practice. Toronto, CAOT Publications ACE. ] and 'Enabling Occupation, A Canadian Occupational Therapy Perspective' Townsend E, Stanton S, Law M, Polatajko M, Baptiste S, Thompson-Franson T, Kramer C, Swedlove F, Brintnell S and Campanile L (2002). Enabling occupation, An occupational therapy perspective. Revised edition. Ottawa, CAOT Publications ACE ] . The model’s national development is a unique feature and so CMOP does not reflect the views of any one individual. However while some assume the model has no cultural bias and adaptation has been encouraged, little research has been conducted into the efficacy of its application in non western societies Awaad T (2003). Culture, cultural competency and occupational therapy: A review of the literature. British Journal of Occupational Therapy, 66(8), 356-362 ] . Cresswell MK and Rugg SA (2003). The Canadian Occupational Performance Measure, Its use with clients with schizophrenia. International Journal of Therapy and Rehabilitation, 10(12), 544-551 ] .

Apart from cultural relevance, Kielhofner Kielhofner G (1997). Conceptual Foundations of Occupational Therapy. 2nd Ed. Philadelphia, F.A.Davis ] identifies four characteristics of well developed models which CMOP possesses to varying degrees,

Interdisciplinary Base

Client centred practice originally evolved in psychology. It combines with systems approach, environmental theory and research into 'flow' by Csikszentmihalyi to provided CMOP with a broad interdisciplinary base of knowledge Stanton S, Thompson–Franson T and Kramer C. (2002). Linking concepts to a process for working with clients. In Townsend E, Stanton S, Law M, Polatajko M, Baptiste S, Thompson-Franson T, Kramer C, Swedlove F, Brintnell S and Campanile L (2002). Enabling occupation, An occupational therapy perspective. Revised edition. Ottawa, CAOT Publications ACE ] .

Theory regarding order, disorder and intervention

In CMOP, occupational order has six perspectives – physical rehabilitative, psycho-emotional, socio-adaptive, neurointegrative, developmental or environmental – in relation to the arbitrary performance areas of self care, leisure and productivity . Quality of function is assessed in terms of both performance and satisfaction Ward GE, Jagger C and Harper WMH (1996). The Canadian Occupational Performance Measure, What do users consider important? British Journal of Therapy and Rehabilitation, 3(8), 448-452 ] . Disorder may occur in the dimensions of person, occupation or environment, or when the momentum of experience is lost due to unresolved issues . Intervention aims to improve transactions between person, occupation and environment, through the process of enablement rather than treatment. Enablement involves working with clients to facilitate autonomy, and does not focus primarily on performance components Kusznir A and Scott E. (1999). The challenges of client centred practice in mental health settings. In T. Sumison. Client Centred practice in occupational therapy. Edinburgh, Churchill Livingstone ] .

Technology for application

The Canadian Occupational Performance Measure (COPM) is a semi structured interview developed to apply the model McColl MA and Pollock N (2000). Measuring occupational performance using a client centred perspective. In Law M, Baum C and Dunn W (2000). Measuring occupational performance: Supporting best practice in occupational therapy. New Jersey, SLACK ] Pollock N, McColl MA and Carswell A (1999). The Canadian Occupational Performance Measure. In T. Sumison (1999). Client centred practice in occupational therapy. Edinburgh, Churchill Livingstone ] and is the only prescribed assessment. This allows freedom to choose other supporting assessments but also restrict the methods of application for the model MacRae A, Falk-Kessler J, Julin D, Padillo R and Schultz S (1998). Occupational therapy models In Cara E and MacRae A (1998). Psychosocial occupational therapy: A clinical practice. New York, Delmar ] . Therapists have praised its client centred approach, relatively quick administration, role in promoting occupational therapy in multidisciplinary teams and compatibility with other assessment tools Toomey M, Nicholson D and Carswell A (1995). The clinical utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 62(5), 242-249 ] Dressler J and MacRae A (1998). Advocacy, partnerships and client centred practice in California, Occupational Therapy in Mental Health, 14(1/2), 35-43 ] Fedden T, Green A and Hill T (1999). Out of the woods, the Canadian Occupational Performance Measure from the Manual to Practice. British Journal of Occupational Therapy, 62(7), 318-320 ] Chesworth C, Duffy R, Hodnett J and Knight A (2002). Measuring clinical effectiveness in mental health, Is the Canadian Occupational Performance an appropriate Measure? British Journal of Occupational Therapy, 65(1), 30-34 ] Donnelly C and Carswell A (2002). Individualised outcome measures: A review of the literature. Canadian Journal of Occupational Therapy, 69(4), 84-94 ] Warren A (2002). An evaluation of the Canadian model of Occupational Performance and the Canadian Occupational Performance Measure in mental health practice. British Journal of Occupational Therapy, 65(11), 515-521] . However these properties are compromised by most therapists using COPM without training or knowledge of the model, particularly when the tool is used without implementing the model .

Empirical Base

The majority of related research evidence pertains to the assessment tool rather than the model. Of this research, most has been in institutional settings McColl MA, Paterson M, Davies D, Doubt L and Law M (1999). Validity and community utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 66(2), 22-30 ] , methodologies usually have medium to low levels of credibility Egan M, Dubouloz CJ, Von Zweck C and Vallerand J. (1998). The client centred evidence based practice of occupational therapy. Canadian Journal of Occupational Therapy, 65(6), 136-143 ] , and may are attributed to the same therapists involved in the models formulation. The model is said to be applicable to all ages and diagnoses groups but few studies have explored its practical application.

Further Developments

In July 2007, the Canadian Association of Occupational Therapists launched Canada's 8th landmark occupational therapy practice guidelines entitled "Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation". The new publication is a companion to "Enabling Occupation: An Occupational Therapy Perspective 1997/2002" and reflects the growth and development of the profession’s knowledge in occupation-based, evidence-based and client-centred practice.

"Enabling Occupation II" advances the core concepts of occupation and enablement, and their application in practice with clients, education and research. Drawing on the experience and research of over 60 authors in Canada, "Enabling Occupation II" raises complex sociocultural issues, such as diversity, individualism and collectivism, language, economy and regulation.

Several significant developments are captured in these new guidelines, including a deeper discussion of occupation, clear specification of enablement, the practical characterization of occupation-based enablement, and an emphasis on scholarship, accountability, funding and workforce planning as leadership strategies.

The 2007 publication can be considered the ‘triple model’ guidelines:
*the Canadian Model of Occupational Performance was expanded to include the concept of engagement;
*the Canadian Model of Occupational Performance and Engagement (CMOP-E) portrays an occupational perspective that includes and extends beyond occupational performance; and
*the Canadian Model of Client-Centred Engagement (CMCE) captures the profession’s historical concern for client-centred practice, now linked to the broader concept of enablement.
* and the new Canadian Practice Process Framework (CPPF) portrays eight action points for the process of occupation-based, client-centred enablement.

CAOT encourages readers of "Enabling Occupation: An Occupational Therapy Perspective 1997/2002" to continue to advance their understanding of occupational therapy by reading the companion document "Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation". Readers are strongly encouraged to use the CMOP-E in place of the Canadian Model of Occupational Performance (CMOP); the CPPF in place of the Occupational Performance Process Model (OPPM); and refer to the CMCE to bring client-centred practice to life.

For purchasing information: Visit CAOT's on-line store at http://www.caot.ca

For further information on the Enabling occupation publication visit http://www.caot.ca/default.asp?pageid=1439

Townsend, E.A. & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT ACE

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