Clinical reasoning process underlying teaching transfer skills: An integrative framework
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 CR process consists of eight non-linear, circular stages, and each in relation to the influence of internal and external factors. The eight stages are organized into three phases. Phase 1 (development of the teaching plan) includes gathering information, picturing the teaching situation, and matching to the generic profile and the teaching plan. Therapists first gather information about the external facts during observations and/or home visit. This stage is largely determined by the internal factor like the therapists’ knowledge on clients. Then the therapists develop a general picture of teaching situation from the information, linking it to the generic profile that the therapists have on mind (depends on the therapists’ experience). Phase 2 (finalization of the choice of teaching plan) includes assessing the plan and choosing to use (or not to use) the plan. The therapists assess the plan by considering own availability, the tool’s readiness, the anticipated efficacy of the plan, and the therapeutic relationship. Phase 3 (adaptation in action of the teaching plan) includes setting the plan in motion, checking information, and pursuing or modifying the plan. The therapists consider the clients’ reaction (availability, social environment, result, etc.) to assess whether to continue or modify the plan until the objective is met. During all three stages, the clients are the one who makes choices and decisions and the therapists take the role in facilitating their performance.
Domain of occupation
Throughout the stages, CR evolves from a generic mode (focuses on internal factors), to a personalized mode (focuses on external factors).
Carrier, A., Levasseur, M., Bedard, D., & Desrosiers, J. (2012). Clinical reasoning process underlying choice of teaching strategies: A framework to improve occupational therapists' transfer skill interventions. Australian Occupational Therapy Journal, 59, 355-366.
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.
This model includes two basic concepts, adaptation (i.e. adjustment to the environment) and occupation (i.e., action or behavior of a member in the group). Through individual member’s actions within the group, adaptation occurs. The model is action-orientated and promotes adaptation through action. By participating in purposeful activities, the members in the group adapt, exhibit goal-oriented behaviors, and experience feelings of personal satisfaction.
The four-quadrant model of facilitated learning (4QM) is used by teachers and practitioners in selecting effective learning strategies based on changing needs of the learners during acquisition of new skills. When occupational therapists use skill acquisition as intervention strategy, the 4QM provides a way of understanding, planning, and organizing the use of learning strategies. Through acquiring occupational performance components, the goal is for improve performance in the targeted occupation.
This model focuses on resilience in daily occupations of the mothers of children with autism spectrum disorder, which consists of four categories: (1) creating and re-creating accepting conditions, (2) finding solutions, (3) striving for balance among daily occupations, and (4) thinking about her child’s future. Resilience serves to help the clients in finding solutions to problems and strive for balance among daily occupations. First, creating and re-creating accepting conditions forms a solid base for the client’s resilience in daily occupations.
This model aims to describe the symbiotic relationship between occupation and the brain, as a chaotic, self-organized, and complex system. It assumes that changes in human condition do not follow a linear path. The model views occupational therapy as a complex intervention and a result of dynamic integration of several factors and unpredictable outcomes. The concept of neuro-occupation is complex and holistic, and aims to help occupational therapists to apply the non-linearity principles.