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 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.
This model presents a hierarchy of family-therapist involvement in occupational therapy services, with associated attitudes, specific knowledge, and skills that enable therapists to operate at each level.
The first level, no family involvement, outlines the traditional medical model of intervention. This level focuses on technical skills which are expected of entry-level therapists, with no awareness of the role of the family and client’s social context. It provides the basis for alternative types of family involvement.
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 is symbolized as an infinity symbol, which emphasizes that independence is a continuum without a start or an end. An individual’s independence can exist at any point within this continuum. Inside the symbol, there are two sides representing two themes, they are personal factors and environmental factors. The lighter (left) side of the model represents personal factors, which consists of personal attributes.
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.