Using Occupational Therapy Models in Practice , 2nd Edition

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Senior Lecturer in Occupational Therapy, School of Health and
Rehabilitation Sciences, The University of Queensland, QLD 4072
Australia

Jenniffer Garcia
Lecturer, School of Occupational Sciences, Universidad del
Desarrollo, Santiago, Chile

Michael K. Iwama
Professor, Department of Orthopedic Surgery, Occupational
Therapy Doctorate Division, School of Medicine, Duke University,
Durham, USA
Table of Contents

Cover image

Title page

Copyright

Preface to 2nd edition

Acknowledgements

Introduction

A historical and contextual approach

Western models of health and systems theory

Historical progression in occupational therapy theory

Using models in practice

Overview of the book

References

1. Theory and practice

What are theory and practice and why do they matter?

Practice is more than theory

Different types of knowledge

 Implications of different types of knowledge

Terminology

Practice as a starting point: Models serving occupational therapy

practice

How models of practice serve practice

Conclusion

References

2. Professional reasoning in context

The context of professional practice

Communities of practice

Occupational therapy professional reasoning

Art, science, and action

A model for professional reasoning in context

Occupational therapy reasoning in action

Occupational therapy professional reasoning and models of

practice

Conclusion

References

3. Occupational performance models and occupational adaptation

Occupational performance model

Occupational Performance Model (Australia)

Occupational adaptation model

 Conclusion

References

4. Ecological models

Person-Environment-Occupation model

Ecology of Human Performance model

Person-Environment-Occupation-Performance model

Conclusion

References

5. Occupational therapy practice framework (OTPF) and

occupational therapy intervention process model (OTIPM)

Occupational therapy practice framework, Fourth Edition

(OTPF-4)

Occupational therapy intervention process model (OTIPM)

Conclusion

References

6. The model of human occupation (MOHO)

Main concepts and definitions of terms

Dimensions of doing

A narrative aproach to the lifespan

Pathways of change in MOHO

Use of the model in practice

Historical description of the model’s development

 Memory aid

Conclusion

References

7. The Canadian model of occupational participation (CanMOP)

The Canadian model of occupational participation: Major

concepts and definitions

Collaborative relationship-focused occupational therapy: Major

concepts and definitions

Canadian occupational therapy interrelational practice process

framework: Major concepts and definitions

Historical description of the Canadian guidelines’ development

Memory aid

Major works

Summary

References

8. Kawa model

Main concepts and definitions of terms

Elements of the river

The river metaphor

Historical description of the model’s development

Japanese cultural context

Development of the model

 Use of the model in practice

Memory aid

Major works

Conclusion

References

9. Reflections on occupational therapy concepts

Using models in practice

Trends in occupational therapy theory

Conclusion

References

Index
Copyright

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Preface to 2nd edition

As occupational therapy forges ahead into its second century, the

time seemed right to take stock of its current approach to theory and
practice. Over the last century, much has changed in this great
profession in terms of its ideas and practices. The industrialized
world has moved from a period of modernity that favoured singular,
positivist explanations of human phenomena and truth, to a post-
modern condition marked by plural and relative views of truth and
the world around us. The primacy and meanings of ‘doing’ in
contemporary occupational therapy interpreted through the lens of
the rational individual is being challenged and expanded to include
the possibilities that come with diverse views of truth and collective
experience. What was once a biomedically dominated body of theory
and knowledge is expanding into the realms of critical social science
and social justice. Many of these alterations have been prompted by
changes in the greater contexts within which occupational therapy
ideas and practices have existed. The evolution of our ideas and
theory attest to the enduring occupational therapy belief that
humans carry enormous capacity to adapt to diverse environments
and their varying circumstances.
As much as these changes present enormous challenges for the
occupational therapy scholar and theorist who must find a way to
explain the phenomena and shared experiences around ‘doing’, the
challenges for occupational therapy students and practitioners to
comprehend and navigate the occupational therapy theory-to-
practice continuum across a landscape of diverse contexts of daily
life and practice has to be an even more daunting one. Thus, the
authors, who have practised and taught occupational therapy theory
for almost a century combined, saw the need for a different kind of
textbook on occupational therapy models.
 When planning the first edition, we felt that what was needed was
a textbook that presented a uniform overview of the more popular
models of the profession, and one that was written from the
perspectives of practice and the practitioner . We heard and
empathized with many practising occupational therapists around the
world who were feeling inadequately prepared to use theories and
imperatives for practice that were thought up and theorized in
locations far removed from the proving grounds of practice. What
was really needed in occupational therapy education and practice
was a useful resource that students and practitioners could take into
and use within varying contexts of the occupational therapy practice
arena; one that would help them make the necessary connection
between theory and what actually takes place in that crucial dynamic
uniting client and therapist. The need to support our colleagues in
the field to use theory to help their clients solve the challenges of day
to day living led to the infusion of clinical (professional) reasoning
into the material.
The authors of the first edition recognized a need for a book on
occupational therapy theory that would consider the emerging
challenge that culture presented to occupational therapy practice in a
global world. In the first edition, we stated:
Instead of merely conveying instructions on how a particular
model should be applied, a new kind of theory resource that would
aim to empower and enable the therapist to critically understand
models and how to judiciously select and apply them, was required.
With such ideas and tensions in mind, and while the authors
contemplated their various needs in occupational therapy theory
classes in Australia, North America, the UK and Europe, Asia, South
America, and Africa, the basic framework and content of this book
you are now examining was born.
Since that edition, awareness has been increasing of the
embeddedness of many long-held occupational therapy ideas in a
Western/Global North perspective. No longer does the profession
assume that models can simply be plucked from their countries of
origin and planted without modification in another country. The
need for cultural sensitivity, reflexivity and appropriateness is widely
acknowledged. The profession has come a long way from the first
decade of the twenty-first century when the Kawa model was a lone
voice lamenting lack of cultural appropriateness. In contemporary
models and editions in this second edition, many Western,
traditional taken-for-granted concepts in occupational therapy
theory born of individualism, such as independence and client-
centredness, have been replaced with relationship-oriented ideas.
Structural issues of power intertwined in the client, therapist and
institution dynamic, affecting how practitioners reconcile what they
want to do, and how they will do it, with their clients are also
acknowledged in some models.
This second edition includes a memory aide for each model to
assist occupational therapists to use the models in practice, as in the
first edition. A new feature of this edition is the inclusion of case
illustrations. Because the authors are culturally connected to
different countries, we hope that the case studies resonate with
occupational therapists in different places in the world.
While not claiming to be a historical document, this book places
those theoretical frameworks that aim to guide practice into a
broader historical and situational context. Ideas and practices are
located in time and space. They exist within a historical context in
which they follow on from what has come before and they pave the
way for what might come in the future. They also sprout from the
fertile soil of other ideas and practices that surround them, both
locally and more broadly. As a profession where theory and practice
are intimately linked, occupational therapy has a rich tradition of
developing conceptual models that aim to guide practice. However,
these models of practice also form part of a century-old development
of ideas and practices. We believe that no single model is adequate
and universally applicable in all occupational therapy situations.
Each model is profoundly complex and represents a constellation of
conditions, truisms, ideals, cultural norms and values that preceded
and now surround them. A similar dance between a model and the
contexts of conditions and ideas that contributed to its current form
occurs between the model and the unique experiences and
circumstances of daily life of the client. The reasoning occupational
therapist is the mediator who strives to bring the best and safest fit
between the client and what occupational therapy can offer.
This book provides a small window into the progress of theory and
practice over the four decades from the 1980s by presenting eleven
current occupational therapy models and a review of their historical
development. In a rapidly changing world, it is easy to lose sight of
what had led up to the current situation and to only look towards the
future. However, in doing so, we risk losing important ideas that
might have temporarily been put aside in favour of ones that meet
current challenges. We hope that this book will assist occupational
therapists to review some of the ideas that have been important over
the past three decades and to ‘dust them off’, look at them anew and
determine their utility in the current context.
[Merrill] The writing of this book also has its own history. The
seeds of the first edition grew out of an invitation from the Division
of Occupational Therapy at The University of Queensland to
Professor Michael Iwama to become an adjunct professor. His
acceptance of this position provided the opportunity for the forging
of many important professional relationships for occupational
therapy staff members at The University of Queensland. The first
edition of this book is the result of one such association (but only one
of many). Five years after the first edition was published, Jenniffer
Garcia came to Australia from South America to undertake a
research higher degree at the Division of Occupational Therapy at
The University of Queensland. While my eyes to culture had been
opened earlier by Professor Iwama, close collaboration for many
years with Dr Garcia has left me with a wide-eyed cultural lens.
When it came time for a second edition, it was clear to me that
inviting Dr Garcia to be an author would bring even more cultural
richness to the text. I wish to thank both Jenniffer and Michael for
sharing their wisdom with me, for schooling me in true cultural
diversity, and for their passion and breadth of vision for occupational
therapy.
[Michael] I remember how blessed and fortunate I felt when I
arrived at The University of Queensland in 2003 to begin this
wonderful association with the occupational therapists of Australia. I
was stunned & impressed by the highly experienced, learned and
capable academic team there. I was most impressed in particular by
an emerging light in our profession by the name of Merrill Turpin.
Though I was initially invited to share ideas about culture and theory
in OT with my Australian colleagues, I ended up being schooled by
Dr Turpin on these subjects. As you read through this text, you will
readily appreciate that the majority of content is Merrill Turpin’s. It
has been a privilege to ‘piggy-back’ on Dr Turpin’s ideas and work, to
be inspired and to be allowed to partner with her in bringing this
resource to the classrooms and practice arenas of our great
profession. Theory construction, testing, application and evolution
are dynamic, fluid processes that necessarily require multiple critical
lenses and varying spheres of experience. This edition is
strengthened and enriched by co-author Jenniffer Garcia of South
America, who broadens even further the critical, cross-cultural lens
required to extend justice and inclusion to occupational therapy’s
diverse, world-wide clientele.
[Jenniffer] For the last eight years I have had the true honour of
working with and learning from Dr. Turpin, who has been my
mentor, advisor and friend. I graduated as an occupational therapist
in Chile 20 years ago, but I moved to Australia because of the lack of
disciplinary postgraduate studies in my country. Language barriers,
lack of awareness of the resources available, and limited knowledge
locally created in the Spanish language, limited the quality of my
practice with clients. My journey as MPhil and PhD student at The
University of Queensland allowed me to have access to a wide body
of knowledge that was not available to me before. I learned about
models of practice and theories, frameworks to guide clinical
reasoning, and a big range of information that supports research,
education and practice of occupational therapists in Anglophone
countries. It is a huge privilege for me to be a co-author of this book
with Dr. Turpin, who has shared with me her wisdom and deep
understanding of the principles of our profession, and the
singularities of each model. She has increased my capacity to think
critically and be culturally sensitive, we combined our experiences to
share examples that could be meaningful and clear for students and
occupational therapists in different parts of the world. I am also
honoured to work with Professor Iwama, who was a pioneer in
publishing a model that emerged from non-western countries. His
work is an inspiration for me. I hope this book can be a window to
observe the progress of occupational therapy globally, to assist
reasoning in practice, which can someday be translated into other
languages for colleagues in each corner of the world.
We hope that this book will ultimately be the useful resource to
students, practitioners and educators that we envisioned. And if
knowledge is indeed power, we would like to see that power,
customarily ceded to theoretical side of the continuum, transferred
to and vetted in the crucible of occupational therapy practice. We
hope that in turn, over time, therapists will once again be regarded as
the holders of the essence and potential power of occupational
therapy. Occupational therapy models should be interpreted and
understood through the lens of practice and in the daily life
experiences of our clients. Models should ultimately be evaluated by
their usefulness in exacting positive change and benefit to its clients
and service recipients. Therefore, we hope that the practising
occupational therapist will utilize this book in a different way than
they might have with previous theory books. We hope that the
student and therapist will bring the book into their places of study
and work where it can be handily and conveniently referred to,
within the domain of occupational therapy practice.
Acknowledgements

We all have families whose love and support have sustained us

through the long but enjoyable time of writing the manuscript. I
[Merrill] would like to thank my husband Iain Renton for the
kindness and compassion that pervades his very being. I would also
like to thank him for adding his graphic design skills to the book and
drawing some of the figures. I [Michael] would like to thank my wife
Sharon for her enduing patience with my obsession for my
profession. I [Jenniffer] would like to thank my husband Orlando
and my children Catalina and Vicente for being my strength and
inspiration every day. We would also like to thank Trinity Hutton,
the development editor of the book, for developing and negotiating
the proposal for a second edition and for her professionalism and
patience.

Merrill Turpin
Jenniffer Garcia
Michael Iwama
Brisbane, Australia; Santiago, Chile; and Vancouver, Canada &
Durham, USA; 2023
List of Illustrations

Fig. 2.1 Model of Context-specific Professional Reasoning.

Fig. 3.1 Occupational Performance Model (as presented by Pedretti
and Early 1996, 2001).
Fig. 3.2 Occupational Performance Model (Australia).
Fig. 3.3 Occupational Adaptation Model.
Fig. 4.1 Person-Environment-Occupation atom diagram.
Fig. 4.2 Person-Environment-Occupation lifespan diagram.
Fig. 4.3 Ecology of Human Performance based on Dunn, Brown &
McQuigan, 1994.
Fig. 4.4 Person-Environment-Occupation-Performance model.
Fig. 4.5 The PEOP occupational therapy process.
Fig. 5.1 Occupational therapy domain and process.
Fig. 5.2 Comparison of approaches.
Fig 7.1 Components of the CanMOP.
Fig. 8.1 The river.
Fig. 8.2 Elements of the river.
Fig. 8.3 Elements constricting water flow.