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The Model of Human Occupation or (MOHO) as most occupational therapists call it, was the first model made as a guide for occupational therapy. It is an evidence-based, occupation-based, occupation-focused, holistic, theory-driven and client-centered approach to occupational therapy. This model focuses on how humans participate in their daily occupations and how occupational practitioners should treat their clients. The model looks at “the motivation for occupation, the routine patterning of occupations, the nature of skilled performance, and the influence of the environment on occupation” (Forsyth, Taylor, Kramer, Prior, Richie, Whitehead, Owen, & Melton, 2014, p. 506). The model was developed by Dr. Gary Kielhofner. Dr. Kielhofner, who was a student of Mary Riley’s at the time, developed the model as a master’s thesis in 1975. After five years of collaboration and development, the model was published in 1980. While reading the model, one may notice some similarities to Mary Riley’s work. This is because MOHO was inspired by Mary Riley’s occupational behavior model and general systems theory. Mary Riley was also one of the contributors to the model of human occupation, along with a few other colleagues of Dr. Kielhofner’s. This was also the first time a model was developed for occupational therapy that was looking holistically at the person. It was made because occupational therapy did not have its own model and was trying to fit into models of other professions, such as medical models; however, such models were not looking at the client holistically.
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The model of human occupation has three core concepts, which are; volition, habituation, and performance capacity. Volition is the client’s interests, beliefs and values. These are the things that motivate clients and gives them reason to carry out tasks. Volition must be looked at first because without it the other components of human occupation will not be carried out by the client of enjoyed. As seen in the schematic in Appendix A, volition is at the top of the human open system. As a therapist, you want your clients to be interested in the occupation in order to be successful in it. Habituation is the client’s habits, roles, routines, and patterns. Performance capacity is client’s physical and mental ability to carry out certain tasks. This model also incorporates the impact of the environment on the client and how the environment can support or suppress these concepts.
As stated above, volition is understanding the client’s interests, beliefs and values. It is ones “source of motivation that guides individuals to anticipate, choose, experience, and interpret what they do; thoughts and feelings about doing occupations that reflect a sense of mastery, enjoyment, and value judgments” (Cole and Tufano, 2008, p. 98). This element is considered to be most important because if the client is not motivated or interested then it will be difficult to keep the client engaged in the occupation during therapy. Both Forsyth et al. (2014) and Cole and Tufano (2008), breakdown volition into three subcategories; Personal causation, values, and Interests.
Personal causation is “One’s sense of competence and effectiveness; what a person feels capable of; a person’s awareness of his or her abilities; includes feelings of self-efficacy” (Cole and Tufano, 2008, p. 98). Values are “beliefs about what is right, important, and good to do that influences one’s goals; includes personal convictions, principles, and a sense of obligation” (Cole and Tufano, 2008, p. 98). Interests are “what a person finds enjoyable, pleasing, and satisfying” (Cole and Tufano, 2008, p. 98). These three subsystems come together in the component of volition to influence our choices in daily occupations.
This is the client’s role, routines, habits and patterns. According to Cole and Tufano (2008), habituation is “made up of the behaviors and roles that help persons to organize their daily lives” (p. 98). Like volition, habituation has two subsystems of habit and roles. A client’s habits are “automatic and repetitive behaviors that influence how persons perform routine activities, use time, and behave on a daily basis” (Cole and Tufano, 2008, p. 98). Their roles are “a source of identity with inherent obligations and expectations; also called scripts or ideas of what is expected of oneself in a particular situation; these enable individuals to fulfill needs for self and society” (Cole and Tufano, 2008, p. 98).
Performance capacity, “refers to a person’s underlying mental and physical abilities and how those abilities are used and experienced in occupational performance” (Forsyth et al., 2014, p. 508).
According to Cole and Tufano (2008), the environment is not just your physical surrounding but entails a social component also (p. 97). Environment plays a big role in this model because one’s environment can help or hinder their occupations. The client’s behavior can also be impacted by the environment.
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The model of human occupation can be used in practice in many ways. It was not made specifically for one population but for everyone that is an occupational being, which is everyone in the world. This model helps clients gain and regain their independence as occupational beings. It is used to treat the whole person and not just a disability. For instance, when an occupational therapist is treating a man with a shoulder injury, they are treating a complex person. They are not just treating a shoulder, they are treating a man with a shoulder injury, who may have a family, who may be depressed, who has to get back to work soon or else he may lose his job, he might lose his house, etc. It is important to understand how complex the person can be. I’ll use myself as an example of the client. I’m a track athlete and running is an occupation I like to do on a regular basis.
A few years ago, I was told I have patella chondromalacia or “runner’s knee”, which is the softening and deterioration of the cartilage in my kneecaps (patella). After an accident at practice I injured my left knee even worse than it was already. I was told that I couldn’t run on it for a few months. I was determined to get back to running soon and knew that I had the mental and physical ability to do it. In occupational therapy, volition influences how I chose this occupation of running because it is something that I value. I’m interested in running and I believe running improves my health. Running also makes me feel as though I accomplished something important, so it helps with my personal causation of self-efficacy. With this information, the occupational therapist may want to slowly ease me into running again by walking a lap or two around the track during our sessions then grading up to jogging eventually. By making this a habit and repeating it, I will be able to strengthen my knees over time. My role here is an athlete. I was told that the chondromalacia is worsened when I run on the concrete because the impact is too harsh for my knees. My occupational therapist would suggest that I stop running on the road and change the environment by running on a treadmill because it is softer on my knees and can help with the impact.
Overall, the model of human occupation focuses on what can be done to help every aspect of the client. It is evident that volition is most important because a person needs to be motivated and interested in order to succeed in therapy. Since volition is the top element of the model of human occupation, it resembles the Self-Efficacy Theory. This theory was developed by Albert Bandura. He believed that a person’s outcome to a goal all depends on the person’s belief of if they can carry out the task or not and if they will do it well. According to Helfrich (2014), the self-efficacy theory of learning is the “person’s individual beliefs about how effective he or she is or will be at learning or completing a new skill or behavior” (p. 597). He also believes that a person’s outcome can be determined by how strongly the person feels about the task and how interested they are. Though there are many similarities between these two theories, they have one difference. They differ in that the model of human occupation believes that the environment has a strong impact on the client, whereas the self-efficacy theory does not focus much on environmental impacts.
The model of human occupation is different from all other models because all other theories do not have this hierarchy of what element is more important and what element is not. All other theories take every element into consideration and believe they all play an equally important part in the success of the client. Lastly, I feel as though I align most with the self-efficacy theory because if I do not feel as though I can do a task or do not feel motivated to do it and my self-esteem is low then my success level will be low. This is why as a future occupational therapist, it is important for me to pay attention to what motivates my client, try to be a huge encourager to them, and make sure they believe in themselves in order to help them improve as occupational beings.
This Schematic shows how Kielhofner saw humans as an open system, how we receive information from the environment and how it is processed. It is seen as a never-ending cycle and is a part of the throughput process. The throughput process is where information is received from the environment (input), processed through the subsystems of volition, habituation, and performance, outputted in the form of our actions and behaviors, feedback is given, then we start the cycle all over again.
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