Models, Frames of Reference, and Theories

This section is a work in progress as of August 2023.

Models

Canadian Model of Occupational Performance and Engagement

The Canadian Model of Occupational Performance and Engagement (CMOP-E) Model was derived from the Canadian Model of Occupational Performance (CMOP) and is similar to the PEO model in that it includes person, environment, and occupation domains.

At its core is the person and their spirituality, surrounded by their affect (personality, emotions), physical, and cognitive abilities. Outside the person is their capacity for occupation—their productivity, self-care, and leisure. Lastly, the environment includes physical, cultural, social, socioeconomic, and institutional contexts.

Occupational performance is the result of the dynamic relationship between these three domains. The difference between CMOP and CMOP-E is that CMOP-E includes occupational engagement. This edition empowers a person toward the choice of and performance of meaningful occupations.

In addition, it affords an assessment tool, The Canadian Occupational Performance Measure (COPM) which identifies the level of difficulty in the client’s occupational performance, and allows the person to score satisfaction of performance in various occupations. This is crucial for intervention development and treatment and encourages collaboration between the therapist and client to create interventions that are meaningful and motivating for the client, increasing compliance.

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: All

Year published: 2007

Developed by: Elizabeth Townsend and Helene Polatajko

Reference:

Townsend, E. A., & Polatajko, H. J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa: CAOT Publications ACE.

Cognitive Disabilities Model (CDM)

The Cognitive Disabilities Model (CDM) focuses on incorporating one’s cognitive functional ability and the level of activities they are able and willing to perform.

Cognitive disability is described by 6 functional levels:

  1. Automatic actions

  2. Postural actions

  3. Manual actions

  4. Goal-directed actions

  5. Exploratory actions

  6. Planned actions

Assessments on functional history evaluate the person’s functional levels in activities of daily living. in order to suggest the level of cognitive abilities and task performance of specific client.

Interventions using this model rely on task analysis and activity analysis to match the demands to the cognitive level of each client during the intervention. The overall goal is to maintain existing skills and develop new coping strategies.

  1. Short-term goals are based on the current mode of performance.

  2. Long-term goals are based on anticipation of change in performance.

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: Behavioral Health

Year published: 1992

Developed by: Claudia Allen

Reference:

Allen, C. K. (1992). Cognitive disabilities. In N. Katz (Ed.), Cognitive rehabilitation: Models for intervention in occupational therapy (pp. 1-21). Stoneham: Butterworth-Heinemann.

Dynamic Interactional Model of Cognitive Rehabilitation

The Dynamic Interactional Model of Cognitive Rehabilitation is a model that stresses cognition as an interaction between the person, task, and environment.

The person’s factors include:

  • Structural capacity including physical limitations (if any)

  • Strategies including routines, approaches, and tactics

  • Metacognitive processes including knowledge, regulation of cognitive processes, and capacities

  • Learner characteristics: motivation and knowledge

These factors interact during information processing (input, elaborating, output) and learning. Each aspect of information processing requires specific cognitive skills, with executive function and metacognitive having overarching influence.

The environmental context (e.g., social, cultural, physical) also has an influence on information processing. It can adapt to the demands by mediating processing between the task and the person.

The task mainly involves surface characteristics (e.g., number of items, type of stimuli, active postural requirement) and conceptual characteristics (e.g., underlying skills and strategies used to perform the task, underlying meaning of task).

Within this dynamic interactional model of cognitive rehabilitation, assessments are divided into two types. Static assessments are used to identify and quantify cognitive deficits.

Dynamic assessments are used to identify and specify the conditions that have the greatest influence on performance. They are also used to identify learning potential (awareness, responsiveness, etc.).

For intervention, this model suggests that a functional approach is more appropriate for client with poor learning potential, and a multiple-context approach is more appropriate for patients with potential for learning.

Type: Model

Population: Adult

Disability: All

Year published: 1992

Developed by: Joan P. Toglia

Reference:

Toglia, J. P. (1992). A dynamic interactional approach to cognitive rehabilitation. In N. Katz (Ed.), Cognitive rehabilitation: Models for intervention in occupational therapy (pp. 104-140). Boston: Andover Medical Publishers.

Functional Model of Cognitive Rehabilitation

Coming Soon.

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: Behavioral Health

Year published: 2001

Developed by: Shirley Lee

Reference:

Lee, S. S., Powell, N. J., & Esdaile, S. (2001). A functional model of cognitive rehabilitation in occupational therapy. Canadian Journal of Occupational Therapy, 68, 41-50.

Kawa Model

The Kawa Model is an ecological approach that uses the metaphor of a river and its components to demonstrate the aspects of a person’s life: the person, their contexts, and their environment. The components of the river include:

  • Water: The person’s life flow

  • River walls and bottom: The person’s contexts (e.g., physical, social); these are inseparable from the water flow (i.e., life slow)

  • Rocks: The person’s challenges, problems, and difficult situations that inhibit or hinder the river flow (i.e., life flow)

  • Driftwood: The person’s attributes and resources

  • Space between obstructions: The current obstacles in the flow of the person’s life; this is where occupational therapists should focus their treatment

The Kawa Model is a reflection of Eastern and collective cultures, focusing on whole systems rather than the independent self. Specific emphasis is placed on the harmony between the person and the factors within the environment as it is believed this harmony is what established well-being.

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: All

Year published: 2009

Developed by: Michael K. Iawama, Nicole A. Thomson, and Rona M. Macdonald

Reference:

Iwama, M. K., Thomson, N. A., & Macdonald, R. M. (2009). The Kawa model: The power of culturally responsive occupational therapy. Disability and Rehabilitation, 31, 1125-1135.

Model of Human Occupation

The Model of Human Occupations (MOHO) describes how people establish and modify their occupations in relation to the environment contributing to a dynamic system:

  • External contributions to the system: Feedback from the environment as a byproduct of performed actions + the information from the environment

  • Internal contributions to the system:

    • Volition: This subsystem consists of three parts.

      • Personal causation is a person’s motivation to act, sense of effectiveness, and confidence to perform an action.

      • A person’s interest, or pleasure-seeking intentions toward certain actions, events, or objects.

      • Values/goals are outcomes based on a person’s occupational behavior.

    • Habituation: This subsystem relates to a person’s daily routines and patterns related to activity and task performance. There are two components to habituation

      • Internalized roles are a person’s automatic routines that meet the demands of their environment and satisfy their volition.

      • Habits (in this context) that are built through the conscious decision to repeatedly participate in specific occupations.

    • Performance: This subsystem is a catalyst for action. The interaction between each subsystem creates output which provides feedback to the system and becomes new input. The whole system will make adjustments according to the feedback and modify the action at the end. This model can be applied to understanding clients’ formation of action during assessment and modifying clients’ actions through the subsystems and input during the intervention

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: All

Year published: 1980

Developed by: Gary Kielhofner

Reference:

Kielhofner, G., & Burke, J. P. (1980). A model of human occupation, part 1. Conceptual framework and content. American Journal of Occupational Therapy, 34, 572-581.

Model of Playfulness

Coming Soon.

Type: Model

Population: Pediatrics

Disability: All

Year published: 1997

Developed by: Anita Bundy

Reference:

Bundy, A. C. (1997). Play and playfulness: What to look for. In L. D. Parham & L. S. Fazio (Eds.), Play in occupational therapy for children (pp. 52-66). St. Louis, MO: Mosby-Year Book Inc.

PLISSIT Model

Coming Soon.

Type: Model

Population: Adults, Older Adults

Disability: All

Year published: 1976

Developed by: Jack S. Annon

Reference:

Annon, J.S. (1976). The PLISSIT Model: A Proposed Conceptual Scheme for the Behavioral Treatment of Sexual Problems. Journal of Sex Education and Therapy, 2, 1-15.

Person, Environment, Occupation

The Person, Environment, Occupation (PEO) Model is based on occupational performance-based and is influenced by the dynamics between the person, environment, and occupation.

  • The person domain includes their self-concept, roles, culture, personality, health, cognition, physical performance, and sensory capabilities.

  • The environmental domain includes physical, cultural, social, socioeconomic, and institutional contexts.

  • The occupation domain includes all the activities, tasks, and duties a person performs and engages in that meet their self-maintenance needs, self-expression, and fulfillment.

The “overlapping” of these domains is what configures a person’s occupational performance and the congruency of the overlapping demonstrates the quality of performance.

PEO assumes a lifespan perspective so it will change as the person develops through their life. As such, the PEO model can be used:

  1. As an assessment tool as well to both understand and analyze how occupational performance might be affected;

  2. An intervention tool whereby the occupational therapist can collaborate with the person to improve occupational performance by increasing the congruence between the three domains.

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: Behavioral Health

Year published: 1993

Developed by: William A. Anthony

Reference:

Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23. https://doi.org/10.1037/h0095655

Transtheoretical Model (TTM)

Coming Soon.

Type: Model

Population: Pediatrics, Adults, Older Adults

Disability: All

Year published: 1997

Developed by: James O. Prochaska and Wayne F. Velicer

Reference:

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American journal of health promotion : AJHP, 12(1), 38–48. https://doi.org/10.4278/0890-1171-12.1.38

Frames of Reference

Cognitive Behavioral

The Cognitive Behavioral Frame of Reference focuses on five factors of a person’s life experience: thoughts, behaviors, emotions/mood, physiological responses, and the surrounding environment. These factors have a dynamic relationship. Each factor affects one another, and each is affected by the social and physical environment.

One significant component of this frame of reference is its hierarchal perspective of cognition.

  • Automatic thoughts are easily accessible, immediate thoughts; they can be “welcome” or “unwelcome” thoughts.

  • Beliefs are conditional statements or thoughts we hold about ourselves.

  • Core schemas are the absolute beliefs we hold about ourselves. These are the foundations of thought processes and can be difficult to shift or change.

Assessments are continuous/ongoing with the Cognitive Behavioral Frame of Reference. These include interviews, questionnaires, and clinical observations.

These are integrated into occupational therapy by way of anxiety or depression management (e.g., breathing techniques, activity diary), phobia management (e.g., desensitization), and fatigue management (e.g., grading activities, scheduling).

Type: Frame of Reference

Population: Pediatric, Adult, Older Adults

Disability: All

Year published: 2011

Developed by: Edward Duncan

Reference:

Duncan, E. A. S. (2011). The cognitive behavioural frame of reference. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (5th ed., pp. 153-164). Edinburgh: Churchill Livingstone.

Cognitive Remediation

The Cognitive Remediation Frame of Reference is founded on the science of neuroplasticity and uses a restorative approach to cognitive skills such as attention, memory, problem-solving, and other areas of executive function. As the person’s performance changes (i.e., improving), the intervention is graded appropriately (i.e., graded up/more difficult).

While widely studied as an effective approach and intervention for schizophrenia, cognitive remediation has also been studied for mood disorders and eating disorders.

Type: Frame of Reference

Population: Adults, Older Adults

Disability: Behavioral Health

Year published: 1993

Developed by: Ann Delahunty and Rodney Morice

Reference:

Duncan, E. A. S. (2011). The cognitive behavioural frame of reference. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (5th ed., pp. 153-164). Edinburgh: Churchill Livingstone.

Ecology of Human Performance

The Ecology of Human Performance (EHP) Framework has several constructs similar to PEO and CMOP-E:

  • The person construct is the human experience; this is the person’s cognitive, psychological, and sensorimotor abilities.

  • Context is the surrounding construct related to the physical, social, temporal, and cultural environments that a person lives within.

  • Within a person’s context are many tasks. These tasks are available to the person based on their skill set, abilities, and the surrounding context.

  • The performance range is the interaction between the person’s abilities and context and considers the person’s life roles for each of the tasks available to them.

  • Therapeutic intervention is used when a person is unable to meet the demands of their roles, has limited skills or abilities, or is unable to understand the cues of their environment. There are 5 intervention strategies under EHP:

    • Establish/restore: focused on improving strength or teaching skills

    • Adapt/modify: changing or modifying the environment

    • Alter: not about changing the environment; rather, they are about making “goodness of fit” choices

    • Prevent: Taking measures to avoid harm/injury or reinjury

    • Create: facilitating performance for ease and satisfaction

Type: Framework

Population: Pediatrics, Adults, Older Adults

Disability: All

Year published: 1994

Developed by: Winnie Dunn, Catana Brown, and Ann McGuigan

Reference:

Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 48, 595-607.

Psychiatric Rehabilitation

The Psychiatric Rehabilitation Frame of Reference proposes the following assumptions:

  1. Recovery is a product of the person, and professional intervention is not always required.

  2. A supportive network is essential to recovery.

  3. The cause of illness has no effect on recovery. In other words, recovery may occur whether or not a person believes the cause of their illness is biological, environmental, or a combination.

  4. Recovery is still possible even if symptoms persist. Episodic illnesses do not prohibit recovery.

  5. As a person recovers, the symptom frequency and duration change. Symptoms that interfere with functioning occur less frequently and more briefly.

  6. Recovery is not linear.

  7. Recovery from the illness can be easier than recovery from its consequences. In other words, recovery from the impairment may be easier than recovering from the result of dysfunction, disability, or disadvantage.

  8. Recovery from mental illness does not invalidate a person’s lived experience with mental illness or negate the illness.

Type: Frame of Reference

Population: Pediatrics, Adults, Older Adults

Disability: Behavioral Health

Year published: 1993

Developed by: William A. Anthony

Reference:

Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23. https://doi.org/10.1037/h0095655

Role Acquisition

The Role Acquisition Frame of Reference uses activity analysis and the teaching-learning process to acquire the necessary skills or functional behaviors for occupational performance within a specific context and environment (natural environment encouraged).

Extrinsic reinforcement can positively or negatively impact the child’s participation depending on the strength of the child and components with difficulty. Intrinsic reinforcement is generated from the mastery of learning a new skill or behavior and motivates the child to generalize said skill or behavior.

ADLs and self-care are the target occupations for this population and frame of reference. he mastery of skill will provide intrinsic reinforcement in motivating the child to generalize the learned skill or behavior.

Type: Frame of Reference

Population: Pediatrics

Disability: All

Year published: 2010

Developed by: Aimee J. Luebben and Charlotte B. Royeen

Reference:

Luebben, A. J., & Royeen, C. B. (2010). An acquisitional frame of reference. In P. Kramer & J. Hinojosa (Eds.), Frames of reference for pediatric occupational therapy (3rd ed., pp. 461-488). Philadelphia: Lippincott Williams & Wilkins.