The Canadian Model of Occupational Performance - Coursework Example

The Canadian Model of Occupational Performance (CMOP) Introduction This research examines the Canadian Model of Occupational Performance (CMOP). Theresearch recognizes that in critiquing the CMOP it’s necessary to establish the model’s foundational elements. It follows then that this research traces the evolutionary path of the CMOP from its theoretical origins and influences through its developmental stages and adaptations for change. Among the prominent theoretical elements, the research argues that the theoretical work established by Reilly forms the original backbone of occupational therapy. Following this originary contributor the research traces and examines the contributions systems theory, Reed & Sanderson, and flow theory have made to future development stages and revised models. Finally, the consideration of these foundational elements leads to a critical evaluation of how the CMOP is used in practice, including its cultural appropriateness, as well as a variety of limitations and shortcomings. Theoretical Underpinning The CMOP appears to have evolved from various different theories and perspectives. Reilly is considered by many within the Occupational Therapy (OT) profession as the catalyst for the paradigm shift back to occupation (Kielhofner, 1997). Reilly suggested that achieving a balance of occupational behavior in self-care, work and leisure/play was key to an individual’s overall health and well-being. From this belief, Reilly proposed an occupational behavior model, which served as the basis for the development of future occupation-based models (which shall be discussed later in relation to the CMOP). Meaningful occupations shall continue to provide means for an individual to improve a sense of well-being and to build up healthy role functioning (Cole and Tufano, 89). Humanistic theories appear to have further influenced the development of the CMOP as is evident through the significance placed on autonomy and personal growth. Developmental, educational and learning theories are also evident in the CMOP through the emphasis placed on an individual’s development and capacity to learn and adapt skills, occupations and roles. There is also evidence of the biological and social sciences assisting in the formation of the model, regarding the effect of disease on function and person-occupation-environment interactions (Fearing, Law & Clark, 1997). Later in the 1960s, Lunwig Von Bertalanffy founded the science of general systems theory (Von Bertalanffy, 1969). A system view gives the Occupational Therapist an expansive and holistic overview for both health and disability awareness within current practice. Von Bertalanffy protested the concept of reductionism and focused instead on the relations between the parts that combine to form a whole (Von Bertalanffy, 1969) as opposed to the separate components in isolation of each other. One of the primary assumptions of Von Bertalanfly’s theory is that we can only appreciate the whole by regarding the links and interactions between the elements that make up the complete system. Therefore, this theory put forward the concept that an alteration in one component of a system will inevitably change the whole (Rapoport, 1986). This is highly reflective of the CMOP, as it believes that disruption in any area of the model can-lead-to-occupational-dysfunction as, “it is the dynamic interaction between individuals, purposeful occupation and the environment that influences a person’s health and well-being” (Clarke, 2003). The original Model of Occupational Performance was built upon the work of Reed & Sanderson (Law, Baptiste, McColl, 1990). In 1983 Reed & Sanderson put forward a Human Occupation Model which identified the aim of OT as to improve or sustain health through the performance of occupational tasks throughout ones life, and at all stage of health and sickness. Evidently the early Canadian model (the Model of Occupational Performance) drew upon parts of Reed & Sanderson’s work but also put forward other unique elements. The individual was placed at the center of this model. The model supported a holistic view and emphasized the worth of the individual (Townsend, 1998). Issues arose, however, regarding the limitations of the model. The model addressed occupational performance but not occupation; and secondly it was established in an unconventional way, with no practical support offered to explain the underlying assumptions of the original model (McColl and Prager, 1994) To address the aforementioned issues, the model was revisited and the name changed to the Canadian Model of Occupational Performance (CMOP). “CMOP is a social model that places the person in the social/environmental context rather than locating the environment outside of the person” (Sumsion, 1999, p7) The revised model as seen in fig. 1 is now an interactive model showing relationships between persons, environment and occupation (CAOT, 1997). The revised model allows for change and focus on the interaction of the elements. This research recognizes and later explores the further deviance from this model. Figure 1: Canadian Model of Occupational Performance Canadian Journal of Occupational Therapy, 61, p. 32 Enabling Occupation: An Occupational Therapy Perspective, CAOT (2002). A New Era of Occupational Therapy: CMOP-E In understanding the amendments to the original model that resulted in the CMOP-E, this research argues that one of the primary contributing elements was the increasing acceptance of flow theory. Flow, established within the area of psychology, primarily by Mihalyi Csikszentmihalyi (1975), has been defined as a subjective, psychological state that occurs when people become completely absorbed within an activity that they don’t pay attention to anything other then what they are doing (Csikszentmihalyi & Rathunde, 1992) Carlson & Clarke (1990) believe that our understanding of flow allows therapists to select and recommend occupations for their clients that can make an experience of flow likely to occur, thereby improving the clients sense of well-being. In order to achieve flow one could argue that the model used must be client centered to ensure the chosen activity has occupational purpose and meaning for the client. Otherwise flow is highly unlikely to occur as flow can only be achieved through using a client-centered approach. It was suggested that Occupational Therapists may need to pay greater attention to the process of engagement, while carrying out occupations rather than the outcome in order to enable people to accomplish greater levels of well-being (Molineux, 2004). This theory appears to have influenced the next development stage of the CMOP. In 2007 the CAOT published Enabling Occupation II as a counterpart to Enabling Occupation (CAOT, 1997). This document included a revised version of the CMOP known as the Canadian Model of Occupational Performance and Engagement (CMOP-E). This adapted model placed greater importance on the concept of engagement, signified by the ‘E’. This is achieved through the inclusion of a transverse section (fig. 2) that presents occupation as ‘our core domain of interest’ (Townsend & Polatajko 2007, 24). The CMOP-E is defined as ‘An extension of the 1997/2002 conceptual framework that describes occupational therapy’s view of the dynamic, interwoven relationship between persons environments and occupations; engagement signals occupational therapy interests that include and extend beyond occupational performance over a person’s lifespan and in diverse environments’ (Enabling Occupation II, pg. 364). The CMOP-E goes further than occupational performance to encompass the process of engagement. As a result, the model extents interest to not only performing occupations, but having them as well. In Enabling Occupation II, the focus the CMOP had on performance alone is critiques as only part of our concern. Occupational engagement captures the expansive aspects of occupations, encompassing all that we do in order to become occupied. Today, OT concerns are harmonious with the broad meaning of occupational engagement (Townsend & Polatajko, 2007, p.24). Fig. 2 below demonstrates the Canadian Model of Occupational Performance and Engagement. Fig. 2 Figure 2. Canadian Model of Occupational Performance and Engagement Duncan, E.A.S. and Townsend, E., (2011). Foundations for practice in occupational therapy. The CMOP is versatile enough to allow the use of other assessment tools with it, although the Canadian Occupational Performance Measure (COPM) was established as the tool to be used with this model. It allows the Occupational Therapist and client to work collaboratively on the perceived challenges in the individual’s occupational performance areas of self-care, productivity and leisure. The measure directs attention to the three areas of occupational performance that emerge from the model and directs the individual to determine perceived challenges in these areas. Therefore, occupational performance is being recognized by the person and in turn evaluated indirectly by them (Duncan, 2011). Limitations/Critiques Although there is a considerable amount of information on the CMOP from Canada, there appears to be little information on its clinical and cultural appropriateness in the UK (Clarke, 2003). In Canada, where the model originated, spirituality is well defined and understood (Udell and Chandler, 2000). Conversely, in the UK it is not so definitive, emphasizing the need to establish the model’s relevance. ‘Spirituality’ has strong associations with religion, which in turn can limit its use where clients and some professionals are unfamiliar with the broader concept. For example, in a study carried out by Clarke (2003), the confusion around the concept of spirituality and because of the connotations spirituality has with religion within that cultural setting, the term ‘sense of self’ was used when discussing the model instead. This would lead one to question whether this model can be used across a wide range of cultures and if so why did ‘spirituality’ have to be substituted for a different term in order for it to ‘work’? As stated by the CMOP, meaning is given to occupation through spirituality (CAOT, 2002). However, the general concept of spirituality in the CMOP has provoked disputes about its definition (Hammell 2001, McColl 2000, 2003) as well as controversy about the appropriateness of spirituality being the central element for the model (Hammell, 2001). The Canadian Association of Occupational Therapists illustrated spirituality as being an innate component of a person. People experience things such as an ‘innate essence of self’ and the feeling of being uniquely and wholly human (CAOT, 2002, p45). Two alternative central concepts have been proposed to address these issues: 1. Hammell (2001) put forward the word ‘intrinsicality’ as a more suitable term for the central concept of the CMOP as it affiliates meaning with dimensions, philosophies and choices within a person’s life. Hammell suggested that not all people experience a penetrative life force, so by incorporating such a transpersonal dimension into the model could be viewed as enforcing such ideology’s on to others. 2. ‘Occupational Identity’ has also been proposed for the central element of the CMOP, with spirituality going back to its original position as one of the three aspects of an individual. Expanding on the work of Christiansen (1999), the alteration recommended by Unruh at al. (2002) would emphasise the focus on occupation as oppose to spirituality, within the profession. In relation to appreciating the connection between spirituality, occupation and meaning, the existing literary work presents an abstruse and often contradictory picture (CAOT, 1994, 2002, Christiansen, 1999). As already stated, spirituality is considered key to giving meaning to occupation within the CMOP (CAOT, 2002). However, In a study carried out that explored both meaningful occupations and the definition of spirituality from the perspective of community-dwelling older adults (Griffith, Caron, Desrosiers and Thibeault, 2007) it was found that although spirituality is a dimension of the process, it is not central to the process of giving meaning to occupation. In this study, identity was found to be central to a person’s engagement in life through meaningful occupation. This study raised an interesting point, however due to the small number of participants the research is based on, this may limit the credibility of the study. Some may argue that the results of the research may have been very different if they had a larger number of participants. Nonetheless, it may be necessary to address the confusion between spirituality and religion. Culturally these concepts are often viewed as equal by the client and often times the therapist too, limiting its use. And questions have been raised about the wisdom of keeping spirituality as the central element of the CMOP. Conclusion To conclude, this paper has examined the CMOP in relation to its theoretical underpinnings, how and why it has undergone adaptations and changes over the past 30 years, and has presented a critical examination of how it is used in practice. The research has argued that the prominent changes and adaptations occurred generally as a direct response to theoretical developments. For instance, the emergence of flow theory is situated as making the pivotal contribution of the progression of the CMOP model to the CMOP-E. Finally, the research has examined the limitations and critiques of the CMOP. Within this context of investigation the cultural appropriateness of the model is highlighted, notably in terms of potential religious influences. 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