Models of Practice and Frames of Reference

Occupational therapy practitioners help clients engage in occupations, by working with clients of all
ages, different cultures, and clients who have a variety of conditions (OBrien & Hussey, 2011, p.135).
Two important practice models used in occupational therapy are model of practice and frame of
reference. A model of practice helps organize ones thinking, whereas a frame of reference is a tool to
guide ones intervention (OBrien & Hussey, 2011, p.135). An important factor of a frame of reference is
that it guides the practitioner on how to intervene with the client and what to do. Evidence-based
practice can be described as choosing the best possible intervention technique.
A theory is a set of ideas that helps explain things and supported or refuted by research (OBrien &
Hussey, 2011, p.136). Concepts and principles are two components of theory. Concepts are ideas
represented in the clients mind. Principles explain the relationship between two or more concepts
(OBrien & Hussey, 2011, p.136). Theory allows for a practitioner to develop effective intervention for
their clients. There are five areas that theory serves a purpose in. Theory validates and guides practice,
justifies reimbursement, clarifies specialization issues, enhances the growth of the profession, and
educates competent practitioners (OBrien & Hussey, 2011, p.136).
A model of practice takes the philosophical base of the profession and organizes the concepts for
practice, which help the occupational therapy practitioners organize their thinking around occupation
(OBrien & Hussey, 2011, p.137). Model of Human Occupation, Canadian Model of Occupational
Performance, the Person-Environment-Occupation-Performance, and Occupational Adaptation are four
different types of models of practice. The first example, the Model of Human Occupation is a model that
views occupational performance in terms of volition, habituation, performance, and environment.
Volition is the clients motivation and belief in skill. Habituation is the clients pattern of behavior or
everyday actions/routines. Performance is the motor, cognitive, and emotional aspects required to act
upon the environment (OBrien & Hussey, 2011, p.137). Lastly, environment is the physical, social, and
societal surroundings in which the person is involved (OBrien & Hussey, 2011, p.137). This model of
practice is also one of the best researched model used in the practice of occupational therapy. The
Canadian Model of Occupational Performance is the model that highly centers around spirituality.
Person, environment, and occupations are also factors included in this model. The Canadian Model of
Occupational Performance emphasizes client-centered care, which refers to understanding the clients
desires and wishes for intervention and outcome (OBrien & Hussey, 2011, p.137). The PersonEnvironment-Occupation-Performance involves are person, environment, occupation, and performance.
This model is defined as the interactive nature of the human being (OBrien & Hussey, 2011, p.137).
Person includes physical and social aspects of the individual. Environment is anything that interferes
with the clients performance. Occupation is the activities the client does on an everyday basis and has
meaning to the client. Lastly performance is the actions of occupation (OBrien & Hussey, 2011, p.137).
Occupational Adaptation includes that the OT practitioner examines how they may change the person,
environment, or task so the client may engage in occupations (OBrien & Hussey, 2011, p.137). The
person, occupational environment, and the interaction are the main aspects that are looked at in this
model.
Frames of reference are produced from the body of knowledge of the profession and address a specific
aspect of the professions domain of concern (OBrien & Hussey, 2011, p.138). Frame of reference
describes the process for change in their client. A frame of reference includes a description of the

population, theory regarding change, function and dysfunction, principles of intervention, role of the
practitioner, and evaluation instruments (OBrien & Hussey, 2011, p.138). A frame of reference includes
six necessary parts: population, continuum of functional/dysfunction, theory regarding change,
principles, role of the practitioner, assessment instruments. The frame of reference identifies the type of
diagnoses or population that would benefit from the intervention (OBrien & Hussey, 2011, p.138). Age
and type of condition are also included in this. Continuum of function and dysfunction defines
characteristics and behaviors. The theory regarding change provides evidence-based intervention.
Another theory, called the theory of brain plasticity, refers to the phenomenon that the brain is capable
of change and through activity one may get improved neurological synapses, improved dendritic growth,
or additional pathways (OBrien & hussy, 2011, p.139). This means that repetition is an important aspect
in improving brain activity. The fourth part of frame of reference is principles. In this part it is important
to notice how an individual is helped in making change and progress. Principles are based on theory and
research. The role of the practitioner is how the practitioner interacts with their client (OBrien &
Hussey, 2011, p.139). An example would be that a practitioner may want to use a behavioral frame of
reference to reward positive behaviors and ignore negative ones (OBrien & Hussey, 2011, p.139). Lastly,
assessment instruments are instruments to operationalize the principles and test the clients functioning.
Some examples of these are the Sensory Integration and Praxis Tests and the Occupation SelfAssessment.
There are many frames of reference that a practitioner can use. Biomechanical frame of reference and
cognitive disability frame of reference are two examples of frames of reference. Biomechanical frame of
reference comes from theories in kinetics and kinematics. It is used with individuals who have deficits in
the peripheral nervous, musculoskeletal, integumentary, or cardiopulmonary system (OBrien & Hussey,
2011, p.140). These deficits cause many problems, including, impairment in range of motion, and
decreased endurance. Many medical conditions also occur. Some examples of medical conditions are
osteoarthritis, hand traumas, and spinal cord injuries. In this frame of reference, the practitioner
evaluates range of motion, and endurance using many different tools. The second common frame of
reference is the cognitive disability frame of reference. It is based on the premise that cognitive
disorders in those with mental health disabilities are caused by neurobiological defects or deficits
related to the biological functioning of the brain (OBrien & Hussey, 2011, p.140).
There are many different frames of reference that can be used to benefit a client. Frames of reference
will be decided after the practitioner has evaluated the client, including setting and principles. Frames of
reference may be combined, while others do not fit well together (OBrien & Hussey, 2011, p.141).
Combining certain frames of reference may alter or result in less progress in the intervention.

Works Cited
OBrien, J.C. & Hussey, S.M. (2012). Introduction to occupational therapy. (4th ed.). Saint Louis, MO.
Elsevier: Mosby.