Canadian Model of Client-Centered Enablement (CMCE)
The Canadian Model of Client-Centered Enablement (CMCE) is a model using visual metaphor to show the therapist-client relationship and client-centered enablement. According to the model, enablement is the core of occupational therapy, which helps guide reasoning and choices in the therapy. It is made up of two lines and a series of “enablement skills”. The two lines in the model represent clients, who may be individuals, groups, communities, organizations, or populations, and therapists, respectively. The lines are intertwined, representing that the client and therapist are working together; and sometimes there can be a series of intertwining lines, indicating that the relationship may start and finish again. The “enablement skills” includes adapting, advocating, coaching, collaborating, consulting, coordinating, designing/building, educating, engaging, and specializing. These skills are used by occupational therapists to engage the clients in shared decision-making. It is an interactive and collaborative process that involves at least two parties (i.e., usually clients and practitioners) to share their thoughts and decide treatment options together. Clients should have the right to make choices, and also take the risks according to their choices, and communicate and respond to the therapists to find out the best decision. On the other hand, the role of occupational therapists would be supporting the clients with their professional knowledge and consultation, helping clients see the possibilities for change, and ensuring that the clients know their right in shared decision-making.
Domain of occupation
The decision-making process can be affected by the client-therapist relationship and the type of decision to be made.
Townsend, E. A., & Polatajko, H. J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, Ontario: CAOT Publications ACE.
The Canadian Model of Occupational Performance and Engagement (CMOP-E) is an occupational performance model, which is evolved from the Canadian Model of Occupational Performance (CMOP). The CMOP-E includes three main components: person, environment, and occupation. In this model, the inner part represents “Person”, and its center is the spirituality of a person. The other components surrounding a person’s spirituality are affective, physical, and cognitive abilities.
This model aims to guide occupational therapists in decision-making with the elderly who have cognitive impairment to continued community living. Client-defined decision-making processes are suitable for non-cognitively impaired, non-dependent people, while negotiated decision-making processes are suitable for clients with cognitive impairment, dependent on others/putting others at risk.
The Framework of Occupational Justice (FOJ) offers an occupational perspective of justice or injustice on everyday occupations. This framework emphasizes on the inclusion of every individual in an occupationally just word (i.e., the environment, such as community and government, in which the individuals can do what they decide to be the most meaningful and useful to themselves, family, communities and nations). It illustrates how the inter-relationships of structural factors and contextual factors support or restrict occupational outcomes and occupational rights.
This integrative framework mainly consists of two elements: (1) the factors influencing clinical reasoning (CR), and (2) the evolving CR process underlying the choice of teaching strategies. First, both internal factors (relate to occupational therapists, such as knowledge and experience, personal habits) and external factors (relate to client, environment, task, and interaction of them, such as emotional/cognitive/physical availability, previous knowledge) influence CR of therapists.
The Model of Playfulness suggests that playfulness can be determined within any transaction of the evaluation of three elements, each of which can be represented as a continuum. The three elements are (1) source of motivation (from intrinsic to extrinsic), (2) perception of control (from internal to external), and (3) the suspension of reality (from free to not free). Intrinsic motivation, such as mastery or pure sensation of movement, is the aspect(s) of activity itself that provides motivation for the individual to involve in an activity.