A Model Of Human

Occupation Approach
*MOHO emerged around 1980 as a further
definition of the theory of OCCUPATIONAL
BEHAVIOR developed by Mary Reilly
(1962).
*The central idea of occupational behavior is
that theory engagement in activity or
occupation in itself will produce and maintain
health.
 MOHO view the human as a open system
who interact with the environment and
who maintain and change themselves
through their output
 What does open system means?
 It is composition of interrelated
structure and function organized into a
coherent whole that interact with
environment and change itself
  throughput

input
output

feedback
 Human system composed of 3
subsystems:
-Volitional subsystem: conscious choices
for occupational behavior(personal
causation, value and interest )
-habituation subsystem: trigger and guide
the performance of routine patterns of
behavior
-performance subsystem: skills use in
production of occupational behavior
Type of skills:
-communication skills
-process skills
-perceptual motor skills
Interaction with environment
- There are 4 environmental layers
interact with human system:
- Object
- Task
- Social group
- culture
 Assessment
 Therapeutic reasoning:
 Process for MOHO concepts and resources to understand
and address clients needs.
 Therapeutic reasoning involves six steps:
 1-generating questions about the client
 2-generating information on, from, and with the client
 3-using the information gathered to create an explanation
on the clients situation.
 4-generating goals and strategies for therapy
 5-implementation and monitoring therapy
 6-detarming outcomes of therapy
 Generating questions
 Therapist must understand their clients before
planning therapy
 This understand begins with ask question about
each clients
 Moho concepts provide a framework for
generating these questions
 occupational performance history interview
*occupational identity scale , occupational
competence scale , occupational behavior
sitting scale *
 Gathering information
 Therapist must gather information on, from , and with the
client in order to answer the question to they have
generated about the client
 Information gathering may take advantage of informal
,naturally occurring opportunities.
 Therapist also use structured moho assessment some
these assessment focus on specific factors such as
interest and roles while other capture comprehensive
information on several aspects of the person and the
environment .
 Creating a theory-based
understanding of clients
 Information that therapists gather to answer
question about their clients is used to cerate is
a theory-based understand of those clients
 To this end, therapist use moho theory as
framework for creating a conceptualization or
explanation of each particular clients situation
 As part of creating a conceptualization of
clients circumstance ,therapists identify
problem or challenge to address as well as
strengths that can be built upon in therapy
Generating theory goals and strategies
 The theory-based understanding of clients is
used to:
 Generate therapy goals
 Decide what kinds of occupational engagement
will enable the client to change
 Determine what type of therapist strategies
will be needed to support the client of change
Therapeutic strategies identified
by MOHO
 Identifying: locating and sharing a range of
personal , procedural ,and-or environmental
factor that can facilitate occupational
performance.
 Giving feedback: sharing one understanding of
the clients situation or ongoing action .
 Advising: recommending intervention goals-
strategies.
 Physical support: using one body to provide
support for a client to complete an occupational
from-task.
 Implementation and monitoring
therapy
 Monitoring how the therapy process
unfolds may confirm the therapist
conceptualization of the client situation
or it may require the therapist to rethink
the clients situation .
 The monitoring process may confirm the
utility of the planned client occupation
engagement and therapist strategies
 Collecting information to assess
outcome
 Important finally step in the therapy process
 Typically therapy outcomes are documented by:
 1-examining the extent to which goals have been achieved
 2-readministering structured to determine whether the
clients score have improved
 Both approaches are valuable means of determine
whether positive outcome have been achieved ,they are
sometime used in combination.
 Therapeutic
intervention

The picture of how person cope with and

adapt to disability serve as general frame
work for under standing what therapeutic
intervention we can accomplish.
 Therapeutic strategies identified
by MOHO
1. Validating : attending to and acknowledging the client’s
experience
2. Identifying : locating and sharing a range of personal,
procedural, and\or environmental factors that can facilitate
occupational performance
3. Advising : recommending intervention goals\strategies.
4. Giving feedback : sharing one’s understanding of the client’s
situation or ongoing action
5. Negotiating : engaging in a give-and-take with the client
 6. Structuring : establishing parameters for choice and
performance by offering a client alternatives ,setting
limits, and establishing ground rules
 7. Coaching : instructing, demonstrating, guiding, verbally
and\or physically prompting
 8. Encouraging : providing emotional support and
reassurance in relation to engagement in an occupation
 9. Physical support : using one’s body to provide support
for a client to complete an occupational form\task
 The most recent edition of a model of human
occupation outline a series of therapeutic principles,
these principle are organized into general volitional ,
habituation and performance categories and include
the following general principles:

 1. therapy is an event that comes into a life in

progress and must be understood and undertaken in
that context
 2. the focus for changes should be the action or
process underlying the human system
 3. change does not mean simply more or less it means
different form of organization
 4. change can and should occur in many aspects of
the human system simultaneously
 5. change is often disorderly
 6. therapy should involve experimentation to find the
best solutions
 7. the only tool that therapists have at their disposal
is to change the relevant environment to support or
precipitate change in the human system
 * These principles derived from the
theoretical arguments propose
broad themes about how change
may take place, the therapists
knowledge of each patient is
necessary to know how apply the
principles .
why MOHO is important for
OT??
MOHO is intended as a tool to facilitate
clinical thinking and problem solving ,
these are :
1) Treatment planning
2) Occupational analysis
3) Program development
 Disorder
- Recognition of the Dysfunction

( problems at performing , organizing ,

&\or choosing occupations &
environment )
CASE STUDY
 Carl is 32 years old, single and has a
diagnosis of chronic schizophrenia.

 He has an eighth grade education and

has always lived with his parents and
older brother in a two bed room
apartment in a low income in a major
city.
 -None of the family members is employed –
each received supplemental social security.
 -Both parents have a history of mental
illness.

 -Carl has along history of psychiatric

hospitalization dating back to when he was
16 years old.
 *Carl stopped taking his medications
approximately 6 weeks prior to this
acute care hospital admission and,
according to his parents, his behavior
has gradually deteriorated.
 At the time of his referral to occupational
therapy, he demonstrated occupational
dysfunction at the level of helplessness.

 -He was disoriented and reported hearing

voices. He often wandered into other
patients’ rooms taking their plants and
flowers into his room.
 *He was extremely withdrawn, was not
responsive to verbal approaches, and
required staff assistance for personal
hygiene, grooming and eating.

 -He was unable to articulate his

interests or his goals and preferred to
stay in his room in the dark.
Assessment
 *At admission, Carl’s occupational
behavior was too disorganized for him
to participate in a formal assessment
battery.

 -Data were therefore gathered from

observation and from talking with
Carl’s parents.
 -They related that Carl had never
worked nor had friends, and spent the
majority of his time at home watching
television.

 -Occasionally, he would ride the bus to

the local park where he would pick
flowers and bring them home.
 -When his illness was in remission, he
was able to attend to his self – care
and help around the house.

 The short term goal was to encourage

Carl to interact with the environment
and to develop adaptive habits.
 -Plants seemed to be the only thing
that evoked Carl’s interest. Since
there were several plants in the
occupational therapy room, Carl was
invited to care for them during
therapy.
 *His behavior became more organized
and he started performing personal
hygiene and dressing without staff
intervention.

 -He preferred to work alone,

remaining on the fringes of the group
with little interaction with others.
 As Carl became increasingly organized,
he was administered the Interest
Checklist, the Role Checklist, and an
activity configuration.
 Interest Checklist

He reported strong interest in gardening/*

yard work, macrame (which he had never
performed), and listening to the radio, some
interest in woodworking, television, ceramics
(never done before), house cleaning, laundry,
.and home repairs
.All other activities were of no interest-
 Role Checklist

He has no continuous roles, but indicates*

.past and future role
 VALUES
not at some
Role Past Present future all what very

× × Student
× Worker
× Volunteer
× Caregiver
× × × Home maintainer
× × Friend
× Family member
× Religious participant
× × × Hobbyist
× Participant in
organization
 Simplified occupational
Questionnaire

.Typical day*
The same as described by his parents ( at-
home watching T.V.)
 Treatment Plan

The long term goal of occupational therapy*

was to engage Carl in an occupational role
which was meaningful to him, which matched
his level of skill, and which would serve
.organize his daily life

Carl was encouraged to pursue the role of-

.hobbyist
The hobbyist role was built around his interest*
.in plants and flowers
In occupational therapy, Carl participated in-
increasingly complex projects. He learned to
make wooden hangers for his plants. He also
learned to macrame plant hangers, and to
.make ceramic pots
He seemed very pleased with his*
accomplishments and received positive feed
.back from the patients and staff
 Occupational status goals and intervention

Volition

PERSONAL CAUSATION
,Lack of successful opportunity to attempt interesting
experiences realistic activities with a high
probability of success. Activities
should match his level of skill and
.be of an appropriate level of arousal
Identification of past successes
which can serve as a source of
.future action
VALUES
Deficient future orientation assist in goal formation with-
Sense of meaningfulness identification of behaviors-
need to attain goals. use
occupations which have
.meaning for him
INTERESTS
Decrease potency of interests
Primary area in interest is
Plants and flowers.
has a motivation to doing
Macrame, ceramics.
woodworking in past
.Hospitalization.
Priority to explore and generate -
new interests. To maintain past -
Interest in plants. Interests
pursue should be congruent with -
His economic status and
potential priorities beyond -
Hospitalization
 Habituation

ROLES
Lack for major occupational Encourage participation-
in role. Alternatives roles
in
Lack access to traditional hobbyist, home-
Roles. maintainer
HABITS
maladaptive habit patterns. Opportunity to develop-
skills not organized into and maintain habits and-
skills which support
.occupational rule
Habits
 Performance

SKILLS
perceptual- motor skills intact. Opportunity to practice -
process skills impaired. Problem solving and -
deficient communication skills. Motor planning includes -
in groups to assist in
development of increase
.interpersonal skills
 Outcomes

Carl will attend psychiatric day treatment*

.center 5 days a week

It also suggested that Carl be assigned task-

to perform over the week end and related to
.his interests
In the week end he will go to the park with*
a friend from center to collect flowers and
.plants to take to the center on Monday
Conclusion
component of the model of human occupation

Internal External
Volitional subsystem Social
Habituation subsystem occupational form
Performance capacity group
Physical
object
spaces
 References

-A MODEL OF HUMAN OCCUPATION THEORY AND

APPLICATION (BY GARY KIELHOFNER )

- PERSPECTIVE IN HUMAN OCCUPATION

.PARTICIPATION IN LIFE ( PAULA KRAMAR , JIM
HINOJOSA, CHARLOTTE BRASIC ROYEEN )

- OCCUPATIONAL FOUNDATIONS OF
OCCUPATIONAL THERAPY ( GARY KIELHOFNER )
THE END