Occupation-Centred Assessment with Children (OCAC) framework
The Occupation-Centred Assessment with Children (OCAC) framework is a top-down, family-centered, ad ecological assessment approach that provides a holistic view of children and their occupational performance within their naturalistic contexts. OCAC focuses on occupational performance issues most relevant and important to a child and his/her family. These may include leisure/play, productivity/school, self-care/activities of daily living, as well as time use, roles, habits, identity, and activity patterns. This framework assists therapists to address more realistic and critical occupational issues by evaluating a child’s valued occupations in naturalistic environments. Ecological assessment of different layers of the daily environments such as the child, home, school, community and society is also emphasized in the framework. To implement OCAC in clinical practice, the first step is that therapists need to understand the clients as occupational beings with unique values, interests, habits, routines, and roles that form their occupational identity (i.e., understanding the meaning of the client’s occupations). In the second step, any problems of the clients’ occupations should be identified in relation to the function of the occupations (i.e., the purpose, importance, and contribution made to the client’s own and other’s lifestyles). In the third step, therapists need to address the observable characteristics of the occupations that are problematic. For example, therapists could conduct assessments in order to obtain information about where, when, and how frequently the occupations can be observed; what actions or resources are needed for the individual to complete the occupation successfully; and whether the environment facilitates or hinders the performance of the occupation. Finally, if the clients’ occupational dysfunction is not evident and needs to be known for its causes, therapists may consider the assessment of the clients’ performance components.
Domain of occupation
The framework has a specific focus on top-down, family-centered, and ecological assessments with children.
Brown, T., & Chien, C. W. (2010). Occupation-centred assessment with children. In S. Rodger (Ed.), Occupation-centred practice with children: A practical guide for occupational therapists (pp. 135-159). Oxford, UK: Wiley-Blackwell.
The Ecology of Human Performance framework (EHP) focuses on the relationship between several important constructs in occupational therapy; they are person, context, task, performance, and therapeutic intervention, in order to get a throughout understand of human occupation. The person construct is one’s experience and his/her sensorimotor, cognitive, and psychological skills and abilities. Then the person construct is surrounded by a circle symbolizing this person’s context (including temporal, physical, social, and cultural contexts).
The Children’s Hand Skills Framework (CHSF) is used as a conceptual guide to analyze and describe children’s hand skills in the assessment and intervention process. The CHSF divides children’s hand skill use into six major categories, based on the extent to which the hands contact objects/parts of the body or not. The first two categories are manual gesture and body contact hand skills that do not contact specific objects.
The Client-centred Strategies Framework (CSF) aims to help clinicians in creating environments and contexts that facilitate client-centered practice. This framework consists of five categories; personal reflection, client-centered process, practice settings, community organizing, and coalition advocacy and political action. Each category provides strategies that can be used by clinicians in facilitating client-centered practice. The personal reflections category is the clinician’s process of gaining insight from clinical and individual experiences.
Data Driven Decision Making (DDDM) is a framework for therapists to implement clinical reasoning within occupational therapy process and has a focus on the use of observation, testing and intervention results to guide and measure outcomes. This framework consists of 11 steps. Step 1, the therapists have to identify the participation challenges and goals. In step 2, therapists need to describe the level of the client’s functioning in each part of the body or the brain.
The Acquisitional frame of reference emphasizes the use of teaching-learning process and activities analysis, to achieve the goal which is the acquisition of specific skills or appropriate behaviors required for optimal performance within an environment. It also emphasizes on the context of the environment, functional behaviors, and learned skills. Behaviors are viewed as a response to the environment. People learn new skills during interactions with the environment and therefore, the role of environment in eliciting adaptive response is the main reinforcer in this frame of reference.