Towards a model: Stage Four (1992-1994)

This section is reprinted from: Chapparo, C., & Ranka, J. (1997). Towards a model of occupational performance: Model development. In C. Chapparo & J. Ranka (Eds). Occupational Performance Model (Australia): Monograph 1(pp. 24-45). Total Print Control: Sydney [now out of print].

STAGE FOUR (1992-1994):

Purpose:

The purpose of Stage Four was 1) to continue field testing the established constructs in practice specific settings, such as paediatrics, psychiatry, spinal cord injury, community services and community-based practice, and 2) to explore the application of the model to the administration of various occupational therapy practice environments,

Methods:

To fulfil the first purpose of Stage Four a series of seminars, group discussions and workshops were conducted at four major multi-service medical facilities in Sydney. Each of these facilities provided a variety of services ranging from acute care to community outreach and placement. The scope of specialty practice areas included school-based therapy, acute medicine, trauma, orthopaedics, psychiatry, transitional living units, nursing home and domiciliary care facilities and community-based therapy. Each series began with an initial presentation of the Stage Three model and definitions of the constructs. Participants were asked to discuss the relevance of the model to intervention in their specific area. Subsequent sessions explored this further through case-based scenarios that were generated by the participants. Through the discussions about these scenarios, participants described how the constructs applied to the process of occupational therapy. Field notes from these discussions were generated by participants, observers and facilitators and subsequently examined to determine whether there were aspects of occupational therapy practice that the model failed to address.

Methods used to achieve the second purpose of Stage Four involved individual and group sessions with occupational therapists in management positions in these multipurpose facilities. Sessions were initiated by managers themselves who sought to determine how occupational performance related to the administration of occupational therapy services. The focus of discussions that occurred within these sessions was determined by the managers and varied between facilities.

Findings:

1.	There was confirmation from all areas of practice of the centrality and relevance of the previously established constructs of occupational performance, including occupational roles, occupational areas, occupational performance components, core elements and environment.
2.	There was confirmation about the presence of some hierarchy of these constructs.
3.	There was strong support for the addition of two new constructs, Space and Time, particularly from community and institutional based practice. Notions of space and time were highly idiosyncratic and appeared to be linked to other constructs within the Model. For example, when talking about case scenarios many therapists talked about performance relative to the time it took people to carry our their roles, activities and tasks. At the component level, many therapists were concerned not only about the form of the response that was observed but also the timing of physical, cognitive and psychosocial responses. Therapists who worked with the elderly remarked on the importance of time when describing the place of reminiscence and life storytelling in intervention. Time, as interpreted in client histories, was a major feature of intervention described by all therapists. Time, as described by notions of development, was emphasised by therapists working with children.
4.	There was support for modifying the structure of ‘occupational performance areas’ by the addition of another area, Rest. Therapists working in both mental health and long term facilities identified aspects of their intervention that focussed on the purposeful pursuit of rest and sleep that did not ‘fit’ with their perceptions of self-maintenance or leisure.
5.	Descriptions of client problems and interventions from therapists in the practice area of psychiatry supported the notion of separating the single psychosocial component area into two distinct components, Interpersonal component and Intrapersonal component.
6.	Therapists managing a number of diverse practice areas were able to successfully construct an overall description of occupational therapy services in their facility using occupational performance (Colyer, 1994). In some cases this was used to develop mission statements, delineate occupational therapy from other services and to structure the content of material used to promote occupational therapy both in the facility and in the wider community.
7.	Therapists used occupational performance constructs to establish hierarchies of performance indicators that were expressed as predictable outcomes of therapy (Barnett, & Hummell, 1993).
8.	Therapists constructed formats for documentation and billing of occupational therapy services based on constructs of the model (Adams, & Shepherd, 1994, Hanrahan, Jackson, Neuss & Walking, 1993).

Outcome:

As a result of this Stage, the model of Occupational Performance was revised to incorporate the constructs of Space and Time. The three occupational performance areas were expanded to include Rest. The psychosocial component was separated into two components: Intrapersonal and Interpersonal component function.

This Model at this Stage of model development incorporates eight constructs: occupational performance; occupational roles; occupational performance areas (self-maintenance, productivity/school, leisure/play, rest); components of occupational performance; core elements of occupational performance; environment; space, and time, and represents the current structure of the Model (Figure 4). The final structure has undergone several revisions from 1992-1994. Selected examples of these versions are in Appendix 1.

At this point in its development, this model is viewed as an explanatory model. It explains dimensions of human occupations that are inherent in occupational therapy practice. As yet, the conceptual links between the constructs are only hypotheses. However, academics, researchers and clinicians are currently working to validate these hypotheses and to further extend notions of how this model can be used in occupational therapy in Australia.