This model aims to facilitate occupational therapists in accessing clients’ mind as an instrumental tool for occupational functioning and adaptation to the environment. It consists of three phases across 10 steps.
Phase 1, belief establishment. This is to clarify beliefs that guide actions and includes the step 1 to 5. Step 1 is the introduction where the client is introduced to the concept of mind as an instrument for adaptation and is described as a tool to achieve his/her desired goals. The purpose of the therapy is to explore how to use the mind to live adaptively in the environment. Step 2 is to assist the client in clarifying perceived purpose in life. A personal mission statement serves as a systemic attractor. Step 3 is to select activities that are consistent with the personal mission statement. By using the Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (AIIIOT), therapists individualize therapeutic activities in a structured manner, and the client is asked to list required activities in achieving the mission statement. Step 4 is to clarify beliefs that guide performance of chosen activities. This includes clarifying the extent to which the beliefs hinder performance and identifying the origins of the beliefs. Step 5 is to challenge these beliefs. This involves challenging through the provision of the questions that give the client insight and require he/her to formulate new beliefs that energize tasks that are consistent with the personal mission.
Phase 2, action. This is to design activities that strengthen appropriate beliefs and to commit to complete the activities. This phase includes the step 6 to 9. Step 6 is to set consistent and concrete goals. The therapist uses activity analysis to assist the client to set goals that are functional, observable, measurable, and achievable within a reasonable time frame. Step 7 is to perform activities in daily lives to strengthen the newly chosen beliefs. This enables the client to engage in occupations that lead to a purposeful and meaningful lifestyle. Step 8 is the evaluation of the cognitive and physical capabilities to perform the chosen activities. Step 9 is the commitment, and these activities must be performed regularly, achieved by establishing a contract.
Phase 3, appraisal of consequences. This is to evaluate if the consequences are expected or desired. Step 10 is the evaluation of progress towards the personal mission. Then a feedback loop back to phase 1, to use the consequences to adjust beliefs. In short term, scores in the AIIIOT may be used to assess progress (performance and satisfaction). In long term, the therapist and client examine the consequences of the client’s activities carefully to determine if the activities are what were expected, therapy continues until the client is confident that s/he can accomplish the mission.
Domain of occupation
Therapeutic interventions using this model begin with belief clarification and establishment because beliefs are the basis of using the mind as a tool for adaptation to the environment.
Ikiugu, M. N. (2004). Instrumentalism in occupational therapy: Guidelines for practice. International Journal of Psychosocial Rehabilitation. 8, 164-177.
This framework aims to guide clinical reasoning with respect to describing, analyzing, and selecting a potential strategy for a client’s unique performance problem. It identifies seven general attributes that can be used to describe and organize cognitive strategies. They are:
The Meaning Perspectives Transformation Model is characterised by three phases: the trigger phase, the changing phase, and the outcome phase. These three phases move the process of meaning perspective transformation in the physical, emotional, cognitive, or spiritual dimensions. Critical self-reflection acts as a catalyst and represents as a moment of “readiness of change”. This allows clients to identify their assumptions, question meaning, and develop alternative ways of performing.
The Partnership for Change (P4C) model emphasizes the therapists’ partnership with the educators and parents to change the life and environment of a child who has motor difficulties (or developmental difficulties). The partnership focuses on the collaboration of building capacities for the teachers and parents in enhancing daily environment for the child. The core activities of occupational therapists under the P4C model are relationship building and knowledge translation with the school and parents. It consists of three steps. The first step is universal design for learning.
The Canadian Practice Process Framework (CPPF) consists of four distinct components, three of which are contextual (including the societal context, practice context, and frame of reference). The forth component is process based and is represented by the eight action points that guide the process of occupational enablement. The eight action points are: (1) from enter/initiated, (2) set the stage, (3) assess/evaluate, (4) agree on objectives plan, (5) implement plan, (6) monitor/modify, (7) evaluate outcomes, and (8) conclude/exit.