Program Redesign Based on the Model of Human Occupation: Inpatient Services for People Experiencing Acute Mental Illness in the UK

This paper discusses the current context of the UK mental health service system and the resulting need for program change within acute-care inpatient hospitals. The primary focus is to illustrate through practice example what can be done to support the delivery of client treatment packages by using the concepts described by the Model of Human Occupation (MOHO). The paper concentrates on explaining how MOHO has helped to guide program redesign and develop an Occupational Therapy Care Pathway to support occupation-focused services. The example given is of a hospital service in Gloucestershire, England, which provides inpatient care for people experiencing acute mental illness.     

Choice,Knowledge, and Utilization of a Practice Theory: A National Study of Occupational Therapists Who Use the Model of Human Occupation

Objective. To identify how therapists choose and use the Model of Human Occupation (MOHO). Method. A systematic random sample of 1,000 occupational therapists was surveyed as to whether they used MOHO in their practice. Those who were using MOHO were then sent a detailed questionnaire; 259 therapists responded to the survey questionnaire, forming a response rate of 60.2 percent. Results. A total of 80.7% of therapists indicated that they had used MOHO in their practice. A number of factors influenced therapists' choice to use MOHO. The most frequently cited factors were therapists' judgment that MOHO fit their own practice philosophy and their clients' needs. Most therapists used multiple means of learning about MOHO, and the number of means they used was related to both self-reported levels of knowledge and utilization of this model. Many therapists are also actively engaged in sharing their knowledge and utilization of this model. Conclusion. Multiple factors contribute to therapists' choice and use of MOHO. Therapists actively make a decision to use MOHO in practice and put forth substantial efforts to learn and share their knowledge of MOHO.     

Using the Model of Human Occupation to Conceptualize an Occupational Therapy Program for Blind Persons in South Africa

The diversity within South African society encourages innovative occupational therapy practice. This paper illustrates how the Model of Human Occupation (MOHO) was used as a guiding framework for an innovative program for unemployed blind adults. The program allowed these clients to participate in income-generating projects and illustrates how factors related to South Africa's cultural, economic, and social conditions influence the use of MOHO in occupational therapy practice.     

Vocational intervention based on the Model of Human Occupation: a review of evidence

Abstract

Work is a growing concern in disability and rehabilitation fields. Specific evidence related to occupational therapy in the area of vocational rehabilitation is somewhat limited. With increased demands for occupation-focused, evidence-based, and theory-informed practice, this review aims to use clinically relevant questions to organize and synthesize evidence regarding work-related interventions specifically related to an occupation-focused theory, the Model of Human Occupation. A total of 45 published works related to both the MOHO and vocational issues were identified and included in the review. The review demonstrates that there is a range of evidence that supports the use of the MOHO and its tools as a basis for work-based clinical interventions. Evidence supports the conclusion that MOHO-based work assessments have good psychometric properties and are useful in evaluating vocational potential and needs. MOHO-based work programs have been shown to have a positive impact in improving vocational outcomes to a range of clients.     

Occupational Therapy Intervention to Foster Goal Setting Skills for Homeless Mothers

SUMMARY

Occupational therapy intervention was provided to two mothers living in a homeless shelter to foster goal setting skills and the ability to develop a systematic method to meet those goals. The Model of Human Occupation (MOHO) was used as the theoretical framework to guide intervention. Both mothers were able to establish personal goals and work towards meeting those goals but the outcomes varied. The difference in outcomes between the two mothers is described using MOHO with analysis of how occupational therapy services can be used with homeless mothers.     

Using the Model of Human Occupation to Nurture an Occupational Focus in the Clinical Reasoning of Experienced Therapists

Best ooccupational therapy practice requires a commitment to ongoing learning to enhance clinical reasoning. This paper describes a five-step cooperative learning process to advance clinical reasoning based on the Model of Human Occupation (MOHO). During the five-step process the MOHO concepts and assessments provide opportunities for therapists to develop occupation-focused clinical reasoning and deepen their knowledge of the theory and its application in practice.     

Addressing the Needs of Elderly Clients Whose Lives Have Been Compounded by Traumatic Histories

This paper presents a community-based group intervention for elderly women in Israel. The intervention, based on the Model of Human Occupation (MOHO), addresses problems of aging clients whose lives have been compounded by traumatic histories. The unique contribution of MOHO concepts to this population is illustrated and discussed.     

A Process for Translating and Validating Model of Human Occupation Assessments in the Danish Context

The aim of the study was to validate the Danish translation of The Assessment of Communication and Interaction Skills (ACIS) and The Occupational Self-Assessment (OSA). The validation process followed four research steps where pilot versions were tested by occupational therapists in practice, peer-reviewed, and back-translated. The result of the study was two validated assessment tools based on the Model of Human Occupation (MOHO) available for Danish occupational therapy practice, education, and research. Future studies should enlighten how to maintain the validity and reliability of assessments when translations are made into other languages.     

Psychometric evaluation of the Finnish translation of the assessment of communication and interaction skills (ACIS-FI)

Abstract

Background: The Model of Human Occupation (MOHO) is a widely used conceptual practice model in Finland. Therefore, Finnish translations of valid and reliable MOHO assessments are needed.

Objective: The primary objective of this study was to examine the psychometric properties of the Finnish translation of the Assessment of Communication and Interaction Skills (ACIS-FI) using the many-facet Rasch model approach.

Methods and Materials: Twenty-eight occupational therapists completed an in-person training workshop on the ACIS-FI and participated as raters in this study. One hundred and forty-eight clients were rated using the ACIS-FI. Rating scale functioning, unidimensionality, person validity and rater severity, item targeting, and item and person separation statistics were examined.

Results: The rating scales demonstrated adequate functioning; the rating category ‘deficit’ was infrequently adopted by the raters. The ACIS-FI had satisfactory construct validity, as confirmed by all items exhibiting unidimensionality within a single construct (i.e. communication and interaction skills), and appropriate item fit. Validity was further confirmed through low person misfit (6%) and low rater misfit (3.6%). No ceiling or floor effects were found. The ACIS-FI was able to separate clients into four levels of communication and interaction skills.

Conclusions: This study offers evidence for the validity of the ACIS-FI as a measure of communication and interaction skills in occupational therapy.

Significance: The ACIS-FI offers Finnish practitioners and researchers a valid tool to measure communication and interactions skills that is theoretically grounded in the MOHO.     

International Efforts to Disseminate and Develop the Model of Human Occupation

This paper documents efforts in Canada, France, Finland, Germany, Hispanoamerica, Israel, Japan, The Netherlands, and Taiwan to disseminate the Model of Human Occupation (MOHO). We aim to characterize the challenges involved, the strategies used, and the impact of these efforts in diverse cultural and social conditions.     

Psychosocial Programming in Ireland Based on the Model of Human Occupation: A Program Evaluation Study

The Model of Human Occupation (MOHO) is frequently used to guide mental health psychosocial programs. However, the benefits of these programs are not fully understood. This study explores the impact of a program that addresses the volition, habituation, and skill challenges reported by those with mental health problems. Follow-up data were collected 32 weeks and 1 year after initial assessment. Based on follow-up data for 28 participants, improvements in the areas targeted by the intervention were found at both time periods.     

A Conceptual-Practice Model for Occupational Therapy to Facilitate Return to Work in Breast Cancer Patients

Purpose Improved therapies and early detection have significantly increased the number of breast cancers survivors, leading to increasing needs regarding return to work (RTW). Occupational therapy (OT) interventions provide successful RTW assistance for other conditions, but are not validated in breast cancer. This paper aims to identify a theoretical framework for OT intervention by questioning how OT models can be used in OT interventions in RTW of breast cancer patients; criteria to be used to select these models and adaptations that would be necessary to match the OT model(s) to breast cancer patients’ needs? Methods Using research specific criteria derived from OT literature (conceptual OT-model, multidisciplinary, referring to the International Classification of functioning (ICF), RTW in breast cancer) a search in 9 electronic databases was conducted to select articles that describe conceptual OT models. A content analysis of those models complying to at least two of the selection criteria was realised. Checking for breast cancer specific issues, results were matched with literature of care-models regarding RTW in breast cancer. Results From the nine models initially identified, three [Canadian Model of Occupational Performance, Model of Human Occupation (MOHO), Person–Environment–Occupation–Performance model] were selected based on the selection criteria. The MOHO had the highest compliance rate with the criteria. To enhance usability in breast cancer, some adaptations are needed. Conclusion No OT model to facilitate RTW in breast cancer could be identified, indicating a need to fill this gap. Individual and societal needs of breast cancer patients can be answered by using a MOHO-based OT model, extended with indications for better treatment, work-outcomes and longitudinal process factors.     

Construct Validity and Factor Structure of the Persian Occupational Self-Assessment (OSA) With Iranian Students

This study aimed to investigate construct validity and factor structure of the Persian Occupational Self-Assessment (OSA; ) based on the model of human occupation (MOHO). Three hundred and thirty-six (179 male and 157 female) Iranian junior high students were measured using the OSA. The data were analyzed using a Confirmatory Factor Analysis (CFA) and the Rasch Rating Scale Model (RSM). In combination, the CFA and RSM results provided strong evidence for the construct validity of the Persian version. The CFA indicated that the hypothesized second-order model could explain the relationship of the OSA items to the latent variables of occupational competence and value for occupations. However, RSM item hierarchies did not replicate those found in previous international studies.     

A realistic approach to the evaluation of the quality management movement in health care systems: a comparison between European and African contexts based on Mintzberg's organizational models

The quality movement is gaining momentum worldwide in the field of health care. Initiated in industrialized countries, it steadily grows in Africa. However, there is no evidence that approaches designed to address issues in a given organizational context have the same effect in another one where issues present differently. Along the epistemological paradigm of realistic evaluation proposed by Pawson and Tilley, we use Mintzberg's organizational models to compare the configurations of European and African health care organizations and the trends followed by the quality management movement in both contexts. We illustrate how European health systems traditionally emphasize professional autonomy while African health systems are structured as command and control hierarchical systems. We illustrate how the quality movement in Europe emphasizes standardization of procedures, a characteristic of a mechanistic organization, while excessive standardization is part of the quality problem in Africa. We suggest that instilling professionalism may be a way forward for the quality movement in Africa to improve patient focus and responsiveness of responsible professionals. We also suggest that our interpretation of broad trends and contrasts may be used as a useful departure point to study the wide contextual diversity of the African experience with quality management.     

On the assessment of adverse drug reactions from spontaneous reporting systems: the influence of under-reporting on odds ratios

A well-known problem in spontaneous reporting systems (SRSs) for adverse drug reactions (ADRs) is under-reporting, that is, the problem that not all occurrences of ADRs are reported to the SRS. We look at the question of how to draw statistical conclusions from analyses of SRS data using reporting odds ratios. We will show that certain under-reporting problems play no role in assessing ADRs from SRSs: the results from the analyses turn out to be biased by some specific under-reporting problems, but not by others. SRS data can be particularly useful for the assessment of drug-drug interactions. If the assumption holds that there is an under-reporting problem for a first drug, and an under-reporting problem for a second drug, but that these two under-reporting problems do not influence each other, then reporting odds ratios estimated from SRSs are useful for signalling drug-drug interactions in the ADR-experiencing population. Similar results hold for covariate-drug interactions. We illustrate our results using two examples.     

Teaching: the role of active manipulation of three-dimensional scatter plots in understanding the concept of confounding

In teaching epidemiology, confounding is a difficult topic. The authors designed active learning objects (LO) based on manipulable three-dimensional (3D) plots to facilitate understanding of confounding. The 3D LOs help illustrate of how confounding can occur, how it generates bias and how to adjust for it. For the development of the LOs, guidelines were formulated based on epidemiology and theories of instructional design. These included integrating the conceptual and empirical aspects: the causal relationships believed to be operating in the study population (conceptual aspect) and data-oriented associations (empirical aspect). Other guidelines based on theories of instructional design included: actively engage the students, use visual methods when possible, and motivate the students about the importance of the topic. Students gave the method strong positive evaluations. Experts in epidemiology agreed that the 3D LOs apply generally accepted scientific views on confounding. Based on their experiences, the authors think that the 3D plots can be useful addition in the teaching of confounding. The article includes links and a downloadable file that provide a demonstration of the 3D LO-based teaching materials.     

Missing data and sensitivity analysis for binary data with implications for sample size and power of randomized clinical trials

Despite our best efforts, missing outcomes are common in randomized controlled clinical trials. The National Research Council's Committee on National Statistics panel report titled The Prevention and Treatment of Missing Data in Clinical Trials noted that further research is required to assess the impact of missing data on the power of clinical trials and how to set useful target rates and acceptable rates of missing data in clinical trials. In this article, using binary responses for illustration, we establish that conclusions based on statistical analyses that include only complete cases can be seriously misleading, and that the adverse impact of missing data grows not only with increasing rates of missingness but also with increasing sample size. We illustrate how principled sensitivity analysis can be used to assess the robustness of the conclusions. Finally, we illustrate how sample sizes can be adjusted to account for expected rates of missingness. We find that when sensitivity analyses are considered as part of the primary analysis, the required adjustments to the sample size are dramatically larger than those that are traditionally used. Furthermore, in some cases, especially in large trials with small target effect sizes, it is impossible to achieve the desired power.     

'Listen to my madness': understanding the experiences of people with serious mental illness

This article explores the salience of disability theory for understanding the experiences of people with serious mental illness. Drawing on data from a focus group study, we suggest that users experience both impairment (as embodied irrationality) which can, in itself, be oppressive, and also have to manage their lives within a largely disabling society. We outline some of the strategies adopted by users to manage their situation and ensure they access and receive health services, and illustrate how these are a result of the complex relationship between disability and impairment. We suggest that using a framework of the social model of disability provides a useful way of understanding and making sense of the experience of users with serious mental illness.