The Person Environment Occupation (PEO) Model of Occupational Therapy

The PEO Model of Occupational Therapy
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  CANADIAN JOURNAL OF OCCUPATIONAL THERAPY VOLUME 63 ã NO 1 KEY WORDS Client-centred practice Environment, physical Human activities and occupations Models, theoretical Environment, social MARY LAW ã BARBARA COOPER ã SUSAN STRONG ã DEBRA STEWART ã PATRICIA RIGBY ã LORI LETTS The Person-Environment- Occupation Modei: transactive cpproach to occupational parformance Mary Law, Ph.D., OT(C), is Associate Professor in the School of Occupational Therapy and Physio- therapy and the Department of Cinical Epidemology and Bio-statis-tics, McMaster University, and Research Associate, Occupational Therapy, Chedoke-McMaster Nos- pitals,OT/PT Bldg., T-16, 1280 Main Street West, Hamilton, ON. L8S 4K1. Barbara A. Cooper, Ph.D., OT(C), is Associate Professor, Associate Dean of Health Sciences, and Director of the School of Occupational Therapy and Physiotherapy, McMaster University, Hamilton, ON. Susan Strong, M.Sc., OT(C), is an Occupational Therapist, Program Evaluation/Qualiiy Assurance, Hamil- ton Psychiatric Hospital, Hamilton, ON. Debra Stewart, B.Sc., OT(C), is an Occupational Therapist at Erinoak, and an Occupational Therapy Consul-tant in Paediatrics, Mississauga, ON. Patty Rigby, M.HSc., OT(C), is a Lecturer, Department of Occupational Therapy, University of Toronto, and an Occupational Therapist, Hugh MacMillan Rehabilitation Centre, Toronto, ON. Lori Letts, M.A., OT(C), is Assistant Professor in the School of Occupational Therapy and Physio- therapy, McMaster University, Hamlton, ON. ABSTRACT ccupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work and play. There have, however, been few models of practice in the occupational therapy literature which discuss the theoretical and clinical applications of person-environment interaction. This paper proposes a Person-Environment-Occupation Model of occupa- tional performance which builds on concepts from the Occupational Therapy Guidelines for Client Centered Practice and from environment- behaviour theories. The model describes interactions between person, occupation and environment, outlines major concepts and assumptions, and is applied to a practice situation. RÉSUMÉ a théorie, la pratique et la recherche en ergothérapie met- tent de plus en plus l'accent sur la relation transactionnelle entre la per-sonne, son environnement et son occupation. Le rendement occupation- nel se traduit par la relation dynamique entre les gens, leurs occupations, leurs rôles et les environnements dans lesquels ils vivent, travaillent et se détendent. Par ailleurs, peu de modèles, dans les publications sur la pra-tique en ergothérapie, font état des applications théoriques et cliniques de l'interaction entre la personne et son environnement. Cet exposé décrit le rendement occupationnel dans un Modèle relationnel personne-environ- nement-occupation a. partir des concepts élaborés dans les Lignes directri- ces pour une pratique de l'ergothérapie centrée sur le client et des théories sur l'environnement et le comportement. Le Modèle décrit les interactions entre la personne, son occupation et son environnement, souligne les princi-paux concepts en cause et est appliqué dans le cadre d'une situation pratique. APRIL 1996 ã 9  M. Law et a . The early history of occupational therapy recog- nized that the relationship between persons and their environments. For example, Crane (1919) discussed how occupational therapy can bolster morale in the hospital environment and recom- mended the establishment of healthy hospital environments. While these ideas were present early on in occupational therapy, they were not emphasized in occupational therapy literature during the 1940s to 1960s. During the past 20 years, views on the relationship between occupa- tion and the environment have altered. Occupational therapy theory, research and prac- tice have moved from a biomedical model based on principles of cause and effect, to a transactive model of occupational performance. The latter recognizes that occupational performance may be better described as the product of a dynamic, interwoven relationship that exists among peo- ple, their occupations and roles, and the environ- ments in which they live, work and play (Canadian Association of Occupational Therapists (CAOT), 1991; Christiansen & Baum, 1991; Law, Cooper et al., 1994; Polatajko, 1994). These changes indicate that, on a broad scale, people now consider the environment from a more complex transactive view rather than from an interactive perspective. The interactive ap- proach assumes that characteristics of the person and characteristics of the environment exist inde- pendently of one another, so that they can be separated for study. The relationship between these characteristics is considered to occur in a linear direction and assumes cause and effect between characteristics. These characteristics are considered to be discrete and easier to measure. An interactive approach allows behaviour to be predicted and controlled, by influencing change at the level of an individual or environmental characteristic. On the other hand, a transactional approach assumes an interdependence of person and environment. In this approach, it is acknowl- edged that behaviour is influenced and cannot be separated from contextual influences, temporal factors, and physical and psychological character- istics. Using a transactional approach, it is recog- nized that a person's contexts are continually shifting and as contexts change, the behaviour necessary to accomplish a goal also changes (Dunn, Brown & McGuigan, 1994). The unit of measurement studied using a transactional approach is an event and the meaning of that event to participants. As well, disability advocates stress that problems with disability stem primarily from the association between the individual and the envi- ronment (Hahn, 1984; Jongbloed Crichton, 1990). Environments may foster dependency and frequently offer poor solutions to the prob- lems of disability. Proponents of this view emphasize the ecological nature of disability and recognize that problems related to disability may be caused by the relationship between a person with a disability and the environment, rather than by the disability itself. Therefore, rather than focus change on the person, they recom- mend that social policy and health intervention be used to change environmental conditions to ones that foster the participation of people with disabilities in our communities (Funk, 1987; Law, 1991). While the importance of person-environ- ment relations has been generally recognized, there is a lack of occupational therapy literature describing the theoretical and clinical applica- tions of person-environment interaction as these pertain to occupational therapy. The purpose of this paper, therefore, is to discuss a Person-Envi- ronment-Occupation Model of occupational performance which can form the basis of a clini- cal model of practice for occupational therapists. LITE TU RE REVI EW ENVIRONMENT The study of human ecology is concerned with human beings and their relationship with their environment. The term environment is defined as those contexts and situations which occur out- side individuals and elicit responses from them (Law, 1991). It includes the personal, social and physical environment. A concept prevalent in the AVRIL 1996 10 EVUE CANADIENNE D ERGOTHÉRAPIE VOLUME 63 NO 1  M.Law et al. environmental literature and more recently in health, is person-environment congruence or environmental fit (Knapper, Lerner, & Bunting, 1986; Michelson, 1976; Shalinsky, 1986). Person-environment congruence suggests the coexistence of human beings and the environ- ment, with neither dominating the other. Several taxonomies of the environment have been created to assist in studying the inter- action between individuals and the environment. Shalinsky (1986) describes environmental factors as physical (the built and natural environments), and psychosocial, (the psychological and social factors such as attitudes, family, and govern- ment). This classification is similar to others in which environments have been described as inan-imate (physical) and animate (social) (Knapper et al., 1986). The Occupational Therapy Guide- lines for Client-Centred Practice (CAOT, 1991) classify environmental factors as cultural, eco- nomic, legal, political, physical and/or social. It has also been proposed that environmental char- acteristics are influential at various levels, includ-ing the person, home, neighbourhood, commu- nity, province and country (Law, 1991). THEORETICAL ORIGINS Considerable multidisciplinary interest has been generated about the study of persons and envi- ronments, resulting in a separate area of environ- ment-behaviour studies. Much of the research in this area has roots in the writings of Lewin (1933) on environmental press theory and of Murray (1938) on need-press theory of human behaviour. The ideas of the leading theoreticians are described briefly and summarized in Table 1 to demonstrate the similarities and differences of their beliefs and the diversity of their disciplinary preparation. In the field of gerontology, Lawton (1977) and Kahana (1982) have focused on seniors and the fit between the person and the environment as people age. Kahana, a sociologist, believes that the characteristics of the individual and the characteristics of the environment should predict functional performance. Lawton, a psy- chologist, believes that both adaptive or mal- adaptive behaviours can result from the person- environment relationship. Moos (1980), a clinical psychologist, developed the Social Ecology Model on the basis of his observation that environmental character-istics influenced the behaviour of patients in a psychiatric setting. Rather than focus on the indi- vidual person, Moos studied the effects of demo- graphic characteristics, self-concept and health on the function of groups of elderly or psychiatric residents. Kaplan (1983), an environmental psy- chologist, developed the Model of Person- Environment Compatibility, to conceptualize the relationship between the internal environment of the individual and the opportunities and choices offered by the external environment. In his view, informational processes such as perception, attention and planning have a significant influ- ence on function. In contrast, Lawton looks at a diverse collection of abilities, such as, cognition, general physical health, motor, sensory and per-ceptual skills, and their determination of an indi- vidual's level of competence. Baker and Intagliata (1982) were con- cerned with quality of life issues for persons with persistent mental illness, acknowledging the interplay between the individual's perception of the environment and the real characteristics of the environment. Kaplan (1983) and Baker and Intagliata (1982) emphasized the internal envi- ronment of the individual and how this deter- mines the relationship between the individual and the external world. For example, memories of past experiences are often used to evaluate cur- rent and future performance options. Bronfenbrenner (1977), with a back- ground in human development, conceived the Ecological Systems Model that centres on the social development of the individual over his or her life span. This stresses the interdependence of the social environmental systems of home, fami- ly, school, work, community and country. Weisman (1981), an architect and psychologist, described how the physical environment of an organization can be designed to influence the CANADIAN JOURNAL OF OCCUPATIONAL THERAPY ã VOLUME 63 * NO PRIL 1996 11  Baker Intagliata (1982) persons with persistent mental illness two components: actual environment individual's perception of the environment M.Law et al. Table 1 Important Environmental Behavioural Theorists Target population efinition of environment Key assumptions easurement focus Bronfenbrenner ndividuals/families/ social cultural 0 interdependence of social systems ocial structures (1977) ocial groups tructures individuals create meaning in the limate in groups environment nd institutions 0 individuals actively engage to achieve fit between themselves and perceived environment satisfaction dependent on degree of person-environment fit 0 communities need to focus on participation, equity sustainable development O need to change environments, rather than changing persons to fit the environment ã a close fit between environmental characteristics and individual preferences contributes to a sense of well being Oa person s cognitive processes, including memories of past events, influence their perceptions of environ- ment and subsequent actions supportive environments increase personal adaptation ã environmental press consists of forces in the environment that evoke a response as personal competence decreases, vulnerability to environmental influences increases Oenvironmental factors interact with personal characteristics to influence behaviour et, behaviour and environment can be changed D structure and characteristics of physical space influence work performance O organizational goals can be achieved by altering the physical environment Healthy ommunity iological, physical, Communities ultural, social and (Berlin, 1989) conomc components Kahana ersons who are ocial structures (1982) ging nfluencing behaviour Kaplan ndividuals nvironment has internal (1983) within person) and external characteristics Lawton ersons who are s stressors or (1986) ging esources influencing competence Moos roups in institutional hysical, policy, (1980) ettings; e.g., work uprapersonal social environments, school, components residences Weisman mployees and work individual, organiza- (1981) rganizations ional and physical subsystems self-reported quality of life community indicators of health and well-being person-environment fit self-reported quality of life individual competence characteristics of residential, work and school environments physical environment social behaviour patterns AVRIL 1996 12 EVUE CANADIENNE D ERGOTHÉRAPIE VOLUME 63 NO 1
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