Did you know that the Canadian Model of Occupational Performance has reached its 30th birthday? You may not realize it, but this approach revolutionized OT in the U.S. and has been influential in the development of contemporary professional language and philosophy, as articulated in the Occupational Therapy Practice Framework. This blog is my tribute and thanks to the brilliant minds who have formed and developed such an elegant, practical and durable model for OT practice.
The Canadian Model, or “P-E-O” (Performance, Environment, Occupation) as many call it, is the culmination of efforts by a small group of Canadian scholar-therapists who were called upon to help develop their national healthcare system. They drew from ideals and concepts that had been described in the literature of various professions, and articulated ways to translate these ideas into practice.
As an OT practitioner, I love the way the following model structures my thinking about key aspects of each client’s situation and helps me to be both holistically and occupationally focused:
• Person: Who they are, what they care about, how they see their strengths and problems, what they most want help with, what is their diagnosis and prognosis, what they believe will help.
• Environment: Where they live and work, the important people in their lives, their financial and social resources, how accessible and safe their communities are.
• Occupation: Their life roles, how they spend their time, what they want to be doing, what they dislike doing, what may be impeding their occupational performance.
As an OT educator, I have seen how analyzing clinical scenarios through a P-E-O lens facilitates students’ rapid development of clinical reasoning. It is easy to learn and gives them a solid basis for reasoning ways to evaluate and intervene. Simple, yet so effective.
Perhaps the most universally beloved aspect of P-E-O is its emphasis on client-centered practice. When I initially heard the term “client-centered” about 25 years ago, I was puzzled as to why everyone was so excited about it. After all, aren’t all healthcare professionals working in our patients’ best interests? As I learned more, I discovered that to be client-centered was much more than just trying to help. It meant asking, listening fully and striving to design interventions that would fit within each client’s paradigm. It meant using my expertise but giving up the role of expert in order to follow my client’s lead. This model honors each client’s uniqueness and complexity and demands patience and open-mindedness on the part of the practitioner. It can be quite challenging to achieve in today’s hurried and systems-driven practice arenas, but in my experience it is an essential ingredient for successful outcomes in OT.
I admire the Canadian Model of Occupational Performance’s simplicity, which is exemplified in the evaluation process. The Canadian Occupational Performance Measure is the assessment developed with reference to the P-E-O model, and it has been shown to be a valid and reliable way to generate well-rounded, client-centered information. The COPM is an interview tool that, with a little study and practice, can be correctly administered by even novice therapists. However, with the therapist’s practice and experience, the COPM can serve as a highly sophisticated means of gathering a great deal of relevant, personal information for planning comprehensive evaluation and intervention.
The data generated from the COPM can direct the therapist toward selecting effective frames of reference and observation-based assessments that will further aid in clarifying how to best approach intervention. So, happy 30th birthday, Canadian Model of Occupational Performance! Congratulations and many thanks to the OT scholars and practitioners who have contributed to conceptualizing, developing, testing and refining this useful and elegant theory.
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