Applying the MoHO in a Hospice Day Therapy Service

Transcription

1 Applying the MoHO in a Hospice Day Therapy Service Lucy Clarke AHP Day Therapy Lead, St Kentigern Hospice, North Wales HOPC conference 9th November

2 The Model of Human Occupation (MOHO) Gary Kielhofner An International Conceptual Practice Model 2

3 What Is a Model? Conceptual practice models are bodies of knowledge developed in a therapy for its practice. They aim to: Generate and test theory about some phenomena of concern to the profession. Develop and test related strategies, tools, and techniques for use in therapy. 3

4 A model must provide some insight into the nature and workings of some phenomena The technology aids therapists to make the link between theory and practice by providing specific tools, procedures and examples. Over the years the attempts of many occupational therapists to apply MOHO in practice have provided invaluable feedback, leading to changes in the theory. The dialectic between theory and practice is important for development of better theory and more effective practice. 4

5 The Model of Human Occupation Seeks To: Provide an explanation of human occupation as it is manifest in individual lives. Explain how Occupation is ordinarily motivated, patterned and performed. Conceptualise what happens when problems arise, and what sorts of problems are associated with disability. Provide theoretical explanations of how therapy enables people to engage in occupations that provide meaning and satisfaction and support their physical and emotional well being. 5

6 30 Years of MOHO The 4th Edition of Model of human Occupation- Theory and application is now in print. 3 rd edition has 54 contributors from 17 countries world wide. Attempts to apply and test MOHO in different cultures and under different national conditions have provided feedback about how its theoretical arguments and technology for application can be developed to transcend cultural differences. There is now established a UK MOHO centre for research and education. 6

7 Dynamics of Human Occupation The principle of interactive solutions- holds that important aspects of any thought, emotion, or action are worked out in the actual dynamics of the person interacting with the environment. Heterarchy- that parts of any system will interact with each other in ways that depend on the situation. In a heterarchy, each component contributes something to the total dynamic. Emergence-this is the spontaneous occurrence of complex actions coming out of the interaction of several components without the benefit of a central controller. 7

8 Emergence Dynamics of reaching as an emergent behaviour arising out of conditions to which different components make contributions Emergent reaching and grasping behaviour Arrangement of musculoskeletal components Nervous system information contributes activation of muscle groups related to strategies Dynamic conditions Object contributes characteristics Intention contributes selection of movement stategies 8

9 What is Human Occupation? Human Occupation refers to the doing of work, play, or related activities of daily living within a temporal, physical and sociocultural context that characterises much of human life. The kinds of things we do, why and how we do them, and what we think and feel about them all derive from the intersecting conditions and influences of time, space, society and culture. The uniquely human occupation, which characterises our species, is a function of these conditions and influences. 9

10 THE MODEL OF HUMAN OCCUPATION Occupational Adaptation Occupational Identity Occupational competence Physical Social Environment Interests Personal Causation Opportunities Occupational Participation Occupational Performance Occupational Skills PERSONAL CHARACTERISTICS Cultural (occupational forms) Volition Performance Capacity Habituation Values Resources Demands Constraints Temporal Subjective experience of the Lived Body Habits Roles Objective Physical & Mental components 10

11 Personal Characteristics: Volition: Pattern of thoughts and feelings about oneself as an actor in one s world which occur as one anticipates, chooses, experiences, and interprets what one does. Performance capacity: Ability for doing things provided by the status of underlying objective physical and mental components and corresponding subjective experience. Habituation: Internalised readiness to exhibit consistent patterns of behaviour guided by our habits and roles and fitted to the characteristics of routine temporal, physical, and social environments. 11

12 Components of Volition Personal causation: Sense of competence and effectiveness. (Appraisal of abilities, expectation of success) Values: What one finds important and meaningful to do. Interests: What one finds enjoyable or satisfying to do. 12

13 Components of performance Capacity OBJECTIVE Sensory motor capacity Cognitive and process capacity Communication, interaction capacity SUBJECTIVE The Lived body: The experience of being and knowing the world through a particular body. 13

14 Components of Habituation Habits: Acquired tendencies to respond and perform in certain consistent ways in familiar environments or situations. Internalised role: Incorporation of a socially and/or personally defined status and a related cluster of attitudes and behaviours. 14

15 Environment Environment: Particular physical and social features of the specific context in which one does something that impacts upon what one does, and how it is done. Components of the Environment Opportunities and resources. Demands and constraints. Physical- space, objects Social Groups Culture and sub cultures. Occupational Forms: Conventionalised sequences of action that are at once coherent, oriented to a purpose, sustained in collective knowledge, culturally recognizable, and named. 15

16 Environmental Impact Environmental impact: Actual influence (in the form of opportunity, support, demand, or constraint) that the physical and social aspects of the environment have on a particular individual. Whether these are noticed or felt, and whether they influence behaviour depends on each persons current values,interests, personal causation, roles, habits, and performance capacities. 16

17 Volition, habituation, perfomance capacity and the environment always resonate together, creating conditions out of which our thoughts, feelings and doing emerge 17

18 3 Levels of doing Occupational skills: Observable, goal-directed actions that a person uses while performing. Occupational performance: Doing an occupational form. Occupational participation: Engagement in work, play, or activities of daily living that are part of one s socio-cultural context and that are desired and/or necessary to one s well-being. 18

19 Consequences of doing Occupational identity: Composite sense of who one is and wishes to become as an occupational being generated from one s history of occupational participation. Occupational competence: Degree to which one is able to sustain a pattern of occupational participation that reflects one s occupational identity. Occupational adaptation: Constructing a positive occupational identity and achieving occupational competence over time in the context of one s environment. 19

20 Re-motivational process EXPLORATION Tries new things Identifies preferences ACHIEVEMENT Tries to solve problems Stays engaged Shows pride COMPETENCY Seeks challenges Pursues activity to completion 20

21 Activity and Occupation are determined and motivated by experience (Volition) Occupation is a biological disposition to find pleasure and satisfaction in doing CHOICE OF ACTIVITY INTERPRETATION Reflection ANTICIPATION Ability / effectiveness EXPERIENCE Pleasure/satisfaction 21

22 Occupational Narratives The Process of Occupational adaption is facilitated through the creation of an Occupational Narrative......we conduct and draw meaning from life by locating ourselves in unfolding narratives that integrate our past, present and future selves, these have both a plot that tends to be consistent over time, and metaphors that provide ways of summing up and understanding what is happening. 22

23 Occupational Narratives -stories (both told and enacted) that integrate across time our unfolding volition, habituation, performance capacity, and environments through plots and metaphors that sum up and assign meaning to these elements. Both our identity and our competence are reflected and enacted in the stories in which we make sense of and go about doing our occupational lives. In the end, our adaption, or lack thereof, is reflected in how we tell and enact our occupational narratives. 23

24 Engaging Occupations Engaging occupations evoke a depth of passion or feeling and become a central feature in a narrative. Constructing a positive life story requires a person to find and participate in an engaging occupation( Jonsson, Josephsson,&keilhofner) Adaption is often about coping with the loss of, the challenge of maintaining, or the need to replace an engaging occupation. 24

25 MOHO assessment tools Priority checklist- a tool for directing and facilitating information gathering from the referrer. OCAIRS-Occupational Circumstances Assessment-Interview Rating Scale. MOHOST-Model of Human Occupation Screening Tool. Assessed through observation. OSA-Occupational Self Assessment. Can be a self report or a semi structured interview. OPHI-2-Occupational Performance History Interview-Second Version Role checklist-self report. Interest checklist-self Report. Occupational Questionnaire- Self Report.(assessment of daily habits and activities ) 25

26 MoHO assessment tools assist in hearing a persons narrative, in trying to uncover core aspects of identify, and where there is a mismatch with competence. By trying to identify what is important and enjoyable and why, and how occupations are currently patterned and performed, leads to an understanding of how best to support the person to adapt. 26

27 Hospice Day Therapy Interventions Education and support with activity rescheduling and goal setting to develop strategies and routines to cope with reduced capacity and symptoms such as fatigue. Education and support to develop coping skills for managing mood and anxiety. Support to maximise performance capacity via physical rehabilitation. Support to identify new ways of enacting important roles using problem solving and goal setting. 27

28 Support to find new ways of pursuing valued interests within capacity via adapting the activity, equipment, pacing, selecting key elements of activity and transferring to another activity. Use a re motivational model of exploration, achievement and competence to help identify an Engaging Occupation via access to a range or opportunities for participation Increase Occupational Participation through addressing social, environmental and physical barriers and identifying ways to participate within the Community. Support to identify supportive metaphors and to foster resilience. Support to reflect on life story and to use the occupational narrative to facilitate an amended identity to match competence (acceptance), via discussion, art, reminiscence sessions. 28

29 Case Study?? Aged Man with??? Presenting as low in mood, not getting out of bed, couldn t see the point. Peripheral neuropathy greatly affecting mobility and confidence. Identified an important role as Granddad to 2 boys of? And?. Interests were to be physically capable and active loving going out for walks in country side with his grandchildren, or playing football with them. Intervention included physical rehabilitation to improve strength, stamina and confidence with in and outdoor mobility. Home exercises, walking aids and goal setting used to develop performance and confidence at home. Education with strategies for managing mood and fatigue including relaxation and Cognitive Behavioural Techniques. 29

30 Case study continued Support to find ways of enacting role as granddad within his capacity using exploration of interests at Day Therapy and goal setting to try new activities with grandsons at home. Creating opportunities to narrate important aspects of life story and identifying previous resilience, encouraging a vision of current ways of using the same resilience. On discharge was able to go for short walks with grandchildren, play games with them at home, tell them about his childhood and life with pride. He named himself as being someone who has always coped and found ways to use positive self talk and distract himself with crosswords and reading if he felt his mood becoming low. He became able to establish a routine that was manageable, taking his time to get up and dressed and having regular rest breaks when doing his exercises or daily short walk. 30