Occupation-centred, occupation-based, occupation-focused: Same, same or different?

Abstract

Background: Since the beginning of the occupational therapy profession, engagement in occupation has been valued as the primary therapeutic agent as well as the goal of intervention. While there are few today who would not support this idea, occupational therapists continue to struggle with implementing their beliefs through “what we do” and “how we do it”. Contributing to this problem is their failure to use terminology in a manner that clearly defines what and how occupational therapists do what they do in occupational therapy research, education, and practice. Methods: The author will, therefore, first discuss some key occupational therapy terms and propose that they represent an occupation-related taxonomy that can be used to more clearly define and describe for occupational therapists and others what they do and how they do what they do as occupational therapists. Then, with a goal of fostering critical self-reflection among occupational scientists and occupational therapy researchers, educators, and practitioners, the author will go through the stages of the occupational therapy process outlined in the Occupational Therapy Intervention Process Model (OTIPM) and demonstrate how a more precise use of this occupation-related taxonomy can facilitate maximizing the power of occupation in practice.

Key words::

• evaluation
• intervention
• occupational science
• occupational therapy
• occupational therapy theory
• professional reasoning

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

Notes

1. While there might be a tendency to equate the term occupation-based with the term occupation-as-means, the term occupation-as-means includes the use of preparatory techniques (e.g. ultrasound, stretching) and the practice of decontextualized subskills, provided their use supports the ultimate emergence of the client's goals in relation to occupational performance (20,21). In addition, occupation-as-means has been used only to refer the use of occupation as a form of intervention [cf. (16,22,23)]; whereas, the term occupation-based applies to the use of a person's engagement in occupation as both an intervention and an evaluation method.

2. Just as the term occupation-based should not be equated with the term occupation-as-means, the term occupation-focused should not be equated with the term occupation-as-end. First, occupation-as-end also includes intervention outcomes where occupation is not the immediate or proximal goal (16). Second, occupation-focused, unlike occupation-as-end, also includes occupation-focused evaluation, not just occupation-focused intervention methods.

3. While I will focus on occupational therapy practice, I believe that the examples I use can be generalized to research and education.

4. Up to now, I have use the term person in a general sense, to refer to a human being. I will now use the term client, but in so doing, it is important to stress that the client may be a person, a client constellation, or a client group. A person is commonly the person who has been referred to occupational therapy. A client constellation pertains to the person who has been referred to occupational therapy as well as others who are close to that person and whose occupational performances have been impacted by the person and his or her occupational challenges (e.g. a man who has had a stroke and his wife who now needs to care for him, a student in a classroom and the teacher who will need to implement accommodations or modifications). A client group pertains to a group of persons who have no other special relationship outside the fact that they may experience similar occupational challenges or concerns (e.g. a group of persons with dementia and their carers, a population of well older persons living in the community who may be at risk for developing occupational challenges, a governmental agency desiring advice on how to develop occupational opportunities for youth). Thus, clients can be individuals, groups, agencies, companies, communities, or populations (19).

5. In fact, a major focus of MOHO is the conceptualization of doing (occupational participation, occupational performance, and occupational skills) and adaptation emerging from a transaction among (a) the person's volitional characteristics, internalized routines, and underlying performance capacity; (b) the physical and social environment; and (c) an occupational form (i.e. task) (7).

6. While MOHO (7) supports an occupation-centred perspective, a major focus of intervention is on volition (i.e. motivated choice: values, interests, and personal causation) and habituation (i.e. internalized routines: habits and role scripts). Volition and habituation are internal body functions and persons factors, not occupational performance. Thus, the proximal focus of intervention is volition and habituation; enhanced doing (i.e. occupational skills, occupational performance, and occupational participation), as well as occupational adaptation (identity and competence), are not proximal.