The Model of Human Occupation Clearinghouse

Department of Occupational Therapy

College of Applied Health Sciences

A User’s Manual for

MODEL OF HUMAN
OCCUPATION
SCREENING TOOL
(MOHOST)
Sue Parkinson, OT (Version 2.0) Copyright 2004
Kirsty Forsyth, PhD, OTR Version printed January 2006
Gary Kielhofner, DrPH, OTR, FATOA
The Model of Human Occupation Clearinghouse
Department of Occupational Therapy

College of Applied Health Sciences

A User’s Manual for

MODEL OF HUMAN
OCCUPATION
SCREENING TOOL
(MOHOST)
Sue Parkinson, OT (Version 2.0) Copyright 2004
Kirsty Forsyth, PhD, OTR Version printed January 2006
Gary Kielhofner, DrPH, OTR, FATOA
Copyright 2004 by Sue Parkinson, Kirsty Forsyth, and Gary Kielhofner. All rights reserved.

This manual may not be reproduced, adapted, translated or otherwise modified without express permission from the
MOHO Clearinghouse.

Score sheets, summary sheets and other forms which are provided as perforated pages in this manual may be
reproduced, but only by the single individual who purchased the manual and only for use in practice.

These forms may not be reproduced for use by others. Each individual user must purchase a manual to have
permission to use forms.

Some forms from this manual may be available in other languages. For access to any available forms, please visit
www.moho.uic.edu. Any available translated forms will be posted under Additional Resources / MOHO Related
Resources / Translated MOHO Assessments and available for download. The password to access and download
translated forms associated with this manual is: Moho$t73. A therapist must purchase this manual to have access to
this password. Only the purchaser of this English-version manual has permission to download and use translated
forms. Restrictions regarding the use of forms within this manual also apply to use of downloadable, translated forms.

Forms may not be available for all languages. Some full translations of this manual may be available for international
sale or distribution through third parties; details on obtaining these resources may also be found at Additional
Resources / MOHO Related Resources / Translated MOHO Assessments.
The Model of Human Occupation Clearinghouse
Department of Occupational Therapy

For further evidence and resources related to this product, please visit our
Web site at http://www.moho.uic.edu

The MOHO Clearinghouse is a nonprofit organization. All funds generated are used to continue
research and development of these resources. Thank you for your support and interest in the
MOHO Clearinghouse products.
 MOHOST v.2.0:
ACKNOWLEDGEMENTS

We would like to acknowledge the UK Centre for Outcomes Research and Education, for
co-ordinating some of the developments and research work. We also wish to acknowledge
the good will of our managers and the invaluable contribution of so many colleagues, who have
offered their encouragement, contributed their ideas, helped to pilot the assessment, written
translations, offered case studies for the manual and participated in the research. In particular,
we would like to mention:

Dorothee Acker Marie Ahern Carolyn Atkinson Mary Axon

Helen Bailey Andy Barnett Jo Batten Andrew Baxter
Lynn Brownwood Diveena Cooppan John Cooper Debbie Cotgrave
Sarah Cratchley Alison Critchley Simon Curle Anita Desikan
Laura Di Bona Sue Ducker Angela Ross-Gamble Laura Dunphy
Sharon Durose Leigh Dyson Green Dimitra Efstathiou Esther Evans
Sarah Eves Rachael Fayerman Denise Ferrett Rachel Goodman
Adam Graham Margaret Gray Tori Gregory Miriam Hanley
Tanya Harris Ruth Hartwright Emma Haynes Wendy Hill
Kylie Innocente Catherine Jones Layla Jones Aliza Kander
Jessica Keller Denis Lacey Ron Larty Emma Lashbrook
Maggie Lee Julie Leeson Chris Lucas Wendy Lyons
Melissa Mackinnon Sue Marshall Debbie Martin Gina McConnachie
Rosie McConville Paulette McIntosh Louise McMillan Jane Melton
Carole Merriman Rachel Miles Celia Millington Sarah Morris
Laura Moston Liz Newington Theresa O’Neil Michelle Palmer
Civil Parkinson Chet Patel Tejal Patel Gemma Payne
Katrina Reece Judith Rimell Jayne Robinson Angela Ross Gamble
Karen Ruff Joanna Sanday Ezra Schwartz Gemma Scott
Saffron Scott Shelley Seed Daksha Shah Rebecca Shaw
Sarah Skinner Leanne Smith Nicki Snape Becci Thompson
Helen Tilley Carrie Tucker Louise Twigger Laura Wain
Vicky Waud Jonathan Weir Richard Western Karen Wheeler
Mary Williams Fiona Willis Suzie Willis Emma Whelan
Keith Wilshere Katherine Wimpenny Janet Woodhouse

Finally, we are indebted to Central and North West London Mental Health Trust; The State Hospital,
Carstairs; Gloucestershire Partnership NHS Trust; Coventry Teaching Primary Care Trust and
Derbyshire Mental Health Services NHS Trust for supporting the research process.

MOHOST 2.0
 MOHOST v.2.0:
INTRODUCTION

The Model of Human Occupation Screening Tool (MOHOST) has evolved slowly over a pe-
riod of several years. My first attempt was, to say the least, lacking in scientific rigour. Despite this,
it soon proved invaluable to me as a practising clinician. I was able to use it as a basis for sharing
insights with clients and colleagues and for communicating the focus of my work to students and
the wider multidisciplinary team. In fact, I might never have developed it any further if it hadn’t
been for the generosity of Gary Kielhofner who encouraged me to think of the Model of Human
Occupation as “community property”. He put me in touch with Dr. Kirsty Forsyth, and the improved
design of the MOHOST owes as much to her enthusiasm as it does to her research skills. The layout
has changed dramatically since we first started collaborating, but my original vision remains the
same: to create a simple outcome measure covering a broad range of occupational performance.

I work in an Acute Psychiatric setting and it would be fair to say that I meet chaos and
disorder on a daily basis. So I was keen to base any new assessment on a model that could provide
a stable framework and help me to look for clear patterns of behaviour. I turned to the Model of
Human Occupation to provide the inspiration I needed because MOHO seems to me to explain
not just the scope of occupational therapy, but the importance of occupational therapy and how it
brings about change.

I am aware, however, that not everybody shares this enthusiasm, and I know that the
Model of Human Occupation’s terminology has proved a stumbling block for many of my British
colleagues. My hope is that the MOHOST goes some way towards addressing this issue by at-
tempting to use commonly understood terms as much as possible. This hope has been strengthened
by the experience I have had of working with many gifted occupational therapists whose work is
largely intuitive. Many of them would ordinarily view manufactured models and assessments with
a healthy scepticism and yet they have surprised me with their reports of the MOHOST being both
useful and user-friendly.

I would be delighted if the MOHOST proved to be of use to you in your work setting.

MOHOST v.2.0
MOHOST v.2.0:
TABLE OF CONTENTS

1. Theoretical Basis of the MOHOST ....................................................... 4

2. Contextual Issues ................................................................................. 8

3. What Does the MOHOST Measure? .................................................. 12

4. Content and Purpose of the MOHOST .............................................. 15

5. MOHO Terminology and the MOHOST ............................................. 18

6. Administration ................................................................................... 20

7. Links with Other MOHO Assessments ............................................... 25

8. OCAIRS Questions - Getting to Know Your Client ............................. 29

9. Case Studies ....................................................................................... 31

10. Quick Guide to Treatment Planning ................................................... 51

11. Guidelines for Using the Rating Scale ................................................ 54

12. Instructions and Expanded Criteria .................................................... 60

Appendix ........................................................................................... 87

MOHOST 2.0
 Chapter One:
THEORETICAL BASIS OF THE MOHOST: THE MODEL OF HUMAN OCCUPATION

The MOHOST is based on concepts from the model of Components:

human occupation, which addresses motivation, per-
Personal causation: Personal causation refers to what
formance, and organisation of occupational behaviour
persons believe about their effectiveness. It includes: a)
in everyday life. This section provides a brief overview
knowledge of capacity, an awareness of and attitude to-
of the elements of the model that are most relevant to
ward one’s present and potential abilities, and b) a sense
the MOHOST. Those who wish to use the MOHOST are
of efficacy which includes the perception of whether and
also encouraged to refer to the text, A model of human
how one controls one’s own performance and achieves
occupation: Theory and application (Kielhofner, 2002),
desired outcomes of performance.
since the MOHOST presumes that persons who use it are
familiar with the concepts of this model.
Values: What one sees as worth doing, how one
believes one ought to perform, and what goals or
The model is based on the premise that occupational per-
aspirations one holds are all expressions of values.
formance is a central force in health, well being, develop-
Also reflected in one’s values is the common sense
ment and change. The model views humans as dynamic,
that guides the kind of life that persons strive for. Values
self-organising systems always unfolding and changing in
elicit strong emotions concerning how life should be and
time, and ongoing occupational behaviour is regarded
how one should behave.
as underlying this self-organisation. That is, as human
beings engage in work, play and daily living tasks, they
Interests: Interests reflect both natural dispositions and
maintain, reinforce, shape and change their own capaci-
acquired tastes. Interests include: a) the disposition to
ties, beliefs, and dispositions.
enjoy certain occupations or certain aspects of perfor-
mance, referred to as attraction, and b) preference, which
According to the model, a person’s occupational partici-
is the knowledge that one enjoys particular ways of per-
pation emerges out of a co-operation of the person with
forming or particular activities over others.
conditions of the environment.
HABITUATION
The Person
Humans acquire and exhibit recurring patterns of occu-
The person is made up of the following elements: pational performance that make up much of their every-
a) volition, b) habituation, and c) performance capacities day lives. These patterns are regulated by habits and roles.
The process of acquiring and repeating these patterns of
VOLITION occupational performance is referred to as habituation.

The model asserts that a universal need to act is uniquely Components:

expressed in each person’s occupational performance.
The choices that persons make to act are seen as a function
of the volition subsystem. Volition is made up of values,
personal causation, and interests. These pertain to what
one holds as important, how effective one is in acting
on the world, and what one finds enjoyable and satisfy-
ing. Personal causation, values, and interests are interre-
lated and together constitute the content of our feelings,
thoughts, and decisions about engaging in occupations.
Habits: Habits allow occupational performance to
unfold automatically. They preserve ways of doing
things what we have learned and repeated. Habits are
reflected in one’s: a) performance in routine activities, b)
typical uses of time, and c) styles of performance (e.g.,
being slow-paced versus fast-paced).
Roles: Occupational Performance also reflects the roles
one has internalised. People see themselves and behave
as spouses, parents, workers or students when they are in
these roles. The roles one inhabits also create expectations

4 MOHOST v.2.0

for certain kinds of occupational performance, and
competence depends on being able to reasonably meet
those expectations.
Interweaving of Habits and Roles
Habits and roles, together, allow one to recognise
features and situations in the environment and to behave
automatically. Roles guide how one performs within social
positions; habits regulate other aspects of an individual’s
routine and ways of per-forming occupations. Much of
occupational behaviour belongs to a familiar round of
daily life, and adaptive performance means being able
to sustain a pattern which is both satisfying to oneself
and which meets reasonable expectations in one’s
environment. The MOHOST provides an opportunity
to gather information about the roles that a person has
internalised and about how the person carries out those
roles. It also provides an opportunity to examine the
daily routines in a person’s life.
Performance Capacities
The third element of the person makes possible
performance in daily occupations. Performance involves
a complex interplay of musculoskel-etal, neurological,
perceptual, and cognitive phenomena that make up a
mind-brain-body performance subsystem. The underlying
capacities of a person as reflected in their performance
capacities interact with environmental factors to allow
the person to express skill in occupation. The MOHOST
does not directly assess performance capacities.
The Environment
The environment influences occupational participation
by: a) providing opportunities and resources, and b)
creating conditions that constrain and make demands
upon a person.
The environment is conceptualised as having physical
and social dimensions. The physical dimension consists
of spaces and the objects within them. Spaces refer to
both natural and fabricated contexts in which people
behave. Objects also refer to both natural and fabricated
things with which persons may interact.
The social environment includes groupings of persons
and occupational forms that persons perform. Social
Theoretical Basis of the MOHOST
groups provide and define expectations for roles and
constitute a milieu or social space in which those roles
are enacted. The ambience, norms, and climate of a
group give opportunities for and demand certain kinds of
occupational performance.
Occupational forms refer to the “things to do” within a
particular milieu. Occupational forms are recognisable,
coherent, and purposeful aspects of performance that
are sustained in collective knowledge. They generally
are named such as “doing the laundry”, “playing
poker”, “reading a book”, and so on. Consequently,
an occupational form that is part of a group’s typical
performance is something members will recognise and
have language to describe.
The environments in which one performs occupations are
combinations of the physical and social.These occupational
settings are composites of spaces, objects, occupational
forms, and/or social groups that cohere and constitute
a meaningful context for performance. Occupational
settings can include home, school or workplace, and
sites for gathering, recreation, or resources (e.g., theatres,
churches, clubs, libraries, museums, restaurants, and
stores). A person’s occupational behaviour is invited and
shaped by these occupational behaviour settings.
Skills
Within occupational performance we carry out discrete
purposeful actions. For example, making coffee is a
culturally recognisable occupational form in many western
cultures. To do so one engages in such purposeful actions
as gathering together coffee, coffeemaker, and a cup,
handling these materials and objects, and sequencing the
steps necessary to brew and pour the coffee. These actions
that make up occupational performance are referred to as
skills. Skills are goal-directed actions that a person uses
while performing. In contrast to performance capacity
that refers to underlying ability, skill refers to the discrete
functional actions. There are three types of skills: motor
skills, process skills, and communication and interaction
skills. Detailed taxonomies of the skills that make up
each of the three types of skills have been developed as
part of creating assessments of skill (See below for further
information on these assessments). Fisher and colleagues
have developed the taxonomies of motor and process skills
that make up an Assessment of Motor and Process Skills.
Forsyth and her colleagues have developed a taxonomy
MOHOST v.2.0 5
Theoretical Basis of the MOHOST

of communication/interaction skills which make up

the Assessment of Communication/Interaction Skills.

Occupational Performance A teenager’s occupational participation may be:

Occupational performance refers to the completion of an • Personal care

occupational form. For example taking a shower, riding
a bike, going fishing, play cards, bake a cake, shining
shoes, mowing the lawn, and painting a room.
Occupational Participation
Occupational Participation is the engagement in work,
play or activities of daily living that are part of the social
context. Not just occupational performance -- it is
doing things with personal and social significance e.g.,
volunteering, working part time, maintaining one’s living
space or attending college.
• Being a student
• Participating in sports
The teenager’s school attendance is primarily shaped
by societal expectations and social roles assigned to the
teenager.
What kind of sports the teenager plays is influenced by
capacities, interests, and available opportunities in the
environment.

Level of Doing Examples

Socialising
Working as a Maintaining one’s
Occupational Participation Grooming oneself routinely with
nurse apartment
friends
Giving an Vacuuming the
Occupational Performance Brushing teeth Playing scrabble
injection floor

Calibrating Speaking Reaching Reaching

Occupational Skill Reaching Reaching Sequencing Sequencing
Sequencing Sequencing Manipulating Manipulating
Manipulation Manipulating Walking Speaking

6 MOHOST v.2.0

Occupational Identity
Our participation helps to create our identities.
Occupational identity is defined a composite sense of
who one is and wishes to become as an occupational
being generated from one’s history of occupational
participation. Occupational Identity includes:
• One’s sense of capacity and effectiveness for doing,
• What things one finds interesting and satisfying
to do,
• Who one is, as defined by one’s roles and
relationships,
• What one feels obligated to do and holds
as important,
• A sense of the familiar routines of life, and
• Perceptions of ones environment and what it supports
and expects.
These are garnered over time and become part of one’s
identity.
Occupational identity reflects accumulative life
experiences that are organized into an understanding of
who one has been and a sense of desired and possible
directions for one’s future.
Theoretical Basis of the MOHOST
Occupational Competence
Occupational competence is the degree to which one
sustains a pattern of occupational participation that
reflects identity. Competence has to do with putting your
identity into action. Includes:
• Fulfilling the expectations of ones roles and one own
values and standards of performance,
• Maintaining a routine that allows one to discharge
responsibilities,
• Participating in a range of occupations that provide a
sense of ability, control, satisfaction, and fulfillment,
and
• Pursuing one’s values and taking action to achieve
desired life outcomes.
Occupational Adaptation
Occupational adaptation is the construction of
a positive occupational identity and achieving
occupational competence over time in the context of
the environment.
MOHOST v.2.0 7
 Chapter Two:
CONTEXTUAL ISSUES
Integrating outcome measures into our
practice
It has been said of the MOHOST, that it doesn’t tell an
experienced clinician anything more than she or he
knows already. This is, in fact, one of its strengths. It can
reveal fresh insights at times, and has been found to be
especially useful in alerting students and recently quali-
fied occupational therapists to those aspects of a client’s
occupational participation that require most attention.
However, one of its prime functions is to document
the knowledge that we hold clearly and systematically,
providing a format by which we can communicate this
knowledge to others. Moreover, when a group of occupa-
tional therapists adopt the assessment, then the purpose
of occupational therapy is promoted and the concerns
of occupational therapists in the multidisciplinary team
become more prominent.
Integrating any outcome measure into our practice can
be challenging. The better that we know our clients, the
quicker and easier the MOHOST is to use. As with any
new assessments, the MOHOST may take a little while
to become accustomed to, and it may take 40 minutes
to complete a MOHOST form for a client with complex
needs when one is unfamiliar with the concepts involved.
If this seems to be too much time, we might put this in
perspective by asking ourselves as how long a standard
kitchen assessment could take to do, compared with pro-
ducing a standardised assessment of your client’s overall
occupational participation? Or how long do we spend
writing formative assessments without ever producing
a summative report? Notes that are written day by day
are often relative in nature, with clinicians noting that
clients are ‘more spontaneous’ or ‘less preoccupied’ but
without any baseline information to measure this against.
The MOHOST provides us with a format to overcome
this weakness in note-writing, allowing us to be more ac-
countable for our professional judgement.
Of course, one could argue that it would be wrong to at-
tempt to capture our understanding, in all its richness and
depth, in a single assessment. In truth, however, the Mod-
el of Human Occupation has only ever sought to help
8 MOHOST v.2.0
us to manage complexity, never to reduce it (Kielhofner
2002). We ourselves are occupational beings, and we will
always look for order and patterns to help us make sense
of our world. We acknowledge that we can never hope to
fully control our lives or to mould the lives of others and,
“each individual presents with a unique set of problems
that needs to be addressed” (Chesworth et al, 2002, p.30).
At the same time, we believe that we can benefit from a
framework to inform our clinical practice and decision-
making (Payne, 2002), and should be mindful that,
“It is not only directives from central
government that are guiding us towards
evaluating and improving the quality of
our work as practitioners, it is also our own
common sense. As health and social care
professionals, we know it is good practice
to routinely gather information on the results
of intervention so that we can objectively
evaluate our effectiveness and state the benefits
of occupational therapy intervention. We also
know that by finding out about the quality of
our work we can strategically work towards
refining our professional skills and improving
our provision of care. The challenge is upon
us all to find appropriate tools to measure the
quality of our work” (Clarke et al, 2001, p.1).
A theory driven, formal assessment like the MOHOST
can therefore be used to deliver information about the
effectiveness of our services and support us towards
evaluating and improving the quality of our work as
practitioners.
Ensuring client-centred practice
There are some clinicians who have registered their con-
cern about using a therapist-rated assessment due to their
fears that this might mitigate against client-centredness,
and there has also been a great deal published about the
challenge that client-centred practice presents (Hamell
2001). We all now recognise the value of working in
partnership with our clients and know that we should
strive to validate the expert opinions of service-users.
In doing so, however, we sometimes need to remind

ourselves that this “does not negate the importance of
professional expertise” (Kusznir & Scott, 1999, p.81).
After all, client-centred practice includes taking a
comprehensive perspective and providing clients with
sufficient information so that they might make informed
choices about their occupational lives (Law & Mills,
1998). Indeed, the essence of client-centred practice lies
not in the tools that we use but in the approach that we
adopt. It has more to do with therapists being “motivated,
hardworking, fun to work with, appreciative and even
inspiring” and it is threatened when therapists make
“unrealistic recommendations” (Kusznir & Scott, 1999,
p.77). By using tools wisely to systematically analyse our
findings, we are less likely to fall into this trap.
An important aspect of MOHO-based therapeutic
reasoning is its client-centred nature. MOHO is recog-
nised as a model consistent with client-centred practice
(Law & Mills, 1998). MOHO concepts require therapists
to have knowledge of their client’s values, sense of
capacity and efficacy, values, roles, habits, performance
experience, and personal environment. MOHO-
based assessments are designed to gather information
on and provide clients with opportunities to improve
their perspectives on these factors. The client’s unique
characteristics, in combination with the theory, guide
the development of an understanding of the client’s
unique situation. The understanding of the client, in turn,
provides the rationale for therapy. Moreover, since MOHO
conceptualises the client’s own doing, thinking and feeling
as the central dynamic in achieving change, therapy
must support the client’s choice, action, and experience.
MOHO is, therefore, inherently a client-centred model in
two important ways:
• It views each client as a unique individual whose
characteristics determine the rationale for and nature
of the therapy goals and strategies, and
• It views what the client does, thinks, and feels as the
central mechanism of change (Kielhofner 2002).
In particular, the model includes a concept called volition
(Kielhofner, 2002). This is defined as motivation to engage
in occupations and is based on what we perceive to be
interesting (interests) and valuable (values) and what we
believe ourselves capable of doing (personal causation).
This concept is particularly important for client-centred
practice as it asks the therapist to fully understand the
Contextual Issues
occupations that the client values and finds satisfying
and meaningful. Being client-centred cannot only mean
paying attention to clients who can communicate to
us about their unique situation. We have often heard
therapists indicate that they cannot apply the concepts
of volition to their clients whose level of functioning
is too low. This has always perplexed us since clients,
who are least able to self-describe and self-advocate,
most deserve careful assessment of their volition. Client-
centredness should extend to those clients who are
unable to verbalize and/or be active in collaboration.
Within MOHO there are ways to be client-centred and
gather this important information volitional information.
The therapist uses MOHO to understand the client’s view
on the world, what matters to the client, what the client
enjoys, and how the client feels about his or her abilities.
This can be achieved through careful observation of the
client’s volitionally relevant actions.
The MOHOST works well with clients who are unable to
identify their occupational needs, but it is also possible
to share its results with clients who are more articulate,
enabling them to debate or confirm the results of the
assessment and so clarify their occupational goals. The
decision to show the assessment to clients rests entirely
with the therapist. It will be necessary to balance the
right of the client to access their clinical notes with the
understanding that some clients may find it difficult to
respond to the written word. Should the therapist deem
that it would be useful for the client to see the assessment,
then it is hoped that the MOHOST is worded in such a
way as to facilitate this process.
Maintaining our unique focus of
occupational participation
We can sympathise with Perrin, when she asks whether it
would, “be true to say that we have been so preoccupied
with assessment … that we are losing the art (and the heart)
of what it means to use occupations in healing“ (Perrin
2001, p.129). This is particularly true when occupational
therapists turn to psychological and medical assessments
that do not assess occupational participation and also
when they restrict their assessments to those based on the
interview format. The MOHOST, however, can only be
completed if the client is observed engaging in occupation.
Information provided by carers and the multi-disciplinary
team can be used to confirm these observations, but one
cannot assess a client with confidence without direct
MOHOST v.2.0 9
Contextual Issues
contact in an occupational setting. In this way, the
MOHOST encourages occupational therapists to focus
on their core skills.
We agree with Nelson, that “what makes us unique is
not that we document functional outcomes but that
we use occupations as the method to achieve positive
outcomes” (Nelson, 1997, p.22). This is also consistent
with the belief that it is only right that “we should seek
ways of measuring the effectiveness of our interventions
in terms of enhanced engagement in occupation”
(Creek, 2002, p.4). The MOHOST allows us to own an
assessment process that is congruent with our professional
focus. “Clinicians like MOHO because it gives them a
theoretical understanding of occupation and tools for
doing occupationally focussed practice, not just a way of
thinking about occupation” (Forsyth, 2001, p.620), and
10 MOHOST v.2.0
the MOHOST allows clinicians to actively use MOHO
theory in their occupation focused practice.
The importance of this cannot be underestimated at a
time when professionals have been pressured to become
increasingly generic in their roles, leading to inevitable
role-blurring and consequent stress and insecurity,
(Bassett & Lloyd, 2001). Many occupational therapists
are now attempting to reverse the tide of genericism and
we are encouraged to spend “the majority of our time”
using our core skills, (Craik 1998, p.391), but difficulties
remain in explaining our role to others. The beauty of
the Model of Human Occupation and the MOHOST is
that they can provide us with the vocabulary to define
the scope of our work so that we can communicate our
occupational focus clearly and effectively.

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Payne S (2002). Standardised Tests: an Appropriate Way to
Measure the Outcome of Paediatric Occupational
Therapy? British Journal of Occupational Therapy,
65(3), 117-122.
Perrin T (2001). Don’t despise the Fluffy Bunny: a
Reflection from Practice. British Journal of
Occupational Therapy, 64(3), 129-134.
Sweetman M (2001). Outcome oriented treatment
planning in acute inpatient mental health.
Occupational Therapy News, 9/10, 19.
Trombly C (1993). Anticipating the future: assessment
of occupational function. American Journal of
Occupational Therapy, 47(3), 253-257.
MOHOST v.2.0 11
 Chapter Three:
WHAT DOES THE MOHOST MEASURE?

The link with activities of daily living

The MOHOST measures occupational participation of the client. Occupational participation has been defined as self
care, productivity, and leisure. Some department call these activities of daily living (ADL).

Self care, productivity, and leisure

MOHOST ANALYSIS

Motivation for occupation, pattern of occupation, communication &

interaction skills, motor skills, process skills, environment

MOHOST provides a framework for understanding why a client is not engaging in self care, productivity or leisure. The
MOHOST is a theory driven activity analysis that can be used in all areas of practice to understand the client’s engage-
ment in activities of daily living.

? What do ADL issues look like from a MOHOST perspective e.g., appraisal of abilities as part of “motivation
for occupation”?

MOHOST Self care Productivity Leisure

Is the client appropri- Is the client appropri- Is the client appropri-

ately appraising their ately appraising their ately appraising their
own ability in self care own ability in produc- own ability in leisure
skills and abilities? tive skills and abilities? skills and abilities?
Appraisal of abilities
Is the client over/under Is the client over/under Is the client over/under
estimating their ability estimating their ability estimating their abil-
when engaging in self when engaging in ity when engaging in
care activities? productive activities? leisure activities?

? Is it important to consider the full range of issues of self care, productivity and leisure when rating a MOHOST?

Yes, the MOHOST is a measure of OCCUPATIONAL PARTICIPATION and that means it should consider the
areas of……………
Motivation for occupation, Pattern of occupation, Communication and
Interaction skills, Process skills, Motor skills, Environment
…………..in relationship to self care, productivity and leisure – as below

12 MOHOST v.2.0
 What does the MOHOST measure?

How is the client motivated for self care, productivity,

Motivation for occupation
and leisure?

How does the client organise their self care, procuc-

Pattern of occupation
tivity, and leisure?

Communication and Interaction Does the client have adequate social interaction skills
skills to complete their self care, productivity, and leisure?

Can the client organise themselves within their self

Process skills
care, productivity, and leisure?

Can the client move themselves and objects around

Motor skills
during their self care, productivity, and leisure?

Does the client have a supportive social and physical

Environment environment to allow for meaningful self care, pro-
ductivity, and leisure?

? Can I still use group work as an observational setting for the MOHOST?
Yes, many leisure/productivity activities are delivered in group formats within occupational therapy services. This is an
entirely appropriate setting to observe the client engaging in occupation. However, you need to make sure you are also
data gathering in others areas of self care, productivity and leisure as well before completing the MOHOST ratings.

? So if I receive a referral asking for a “functional assessment” I can complete a MOHOST?

Yes, we would encourage you to think through what you mean by “functional assessment” as this has various meanings
within OT. The MOHOST would ask you to assess the person’s occupational participation, i.e. their ability to engage in
self care, productivity, and leisure. This includes considering dressing, grooming, cooking, home maintenance, taking
care of others, paid employment, enjoyable social activities and so on.

? What do I do if I receive a referral that asks for a “kitchen assessment”?

You need to ask “what is my professional position?” Can an OT make sound judgements based on one kitchen
observation? If the OT states that the person is able to function in a kitchen, based on a one-off observation in the
OT kitchen and the person is subsequently found to not cook while at home – what would the consequences be? It
is the OT’s judgement that would be scrutinised, not the referring agent and, therefore, it is the responsibility of the
OT to decide what an assessment should contain. If you are asked for a one-off kitchen assessment – we recommend
that you complete an assessment of the full range of self care, productivity and leisure as there are so many factors to
take into consideration. For instance, if someone has just completed an afternoon (habits) football group with peers
(leisure activity) – they may be more motivated (volition) to cook because they are hungry. If someone takes pride
(values) in their appearance, however, seems reluctant to engage with you in the kitchen (volition) – the reluctance
may be due to them being conscious of their body odour because they weren’t able to wash adequately (self care)
in the morning in the ward due to the lack of shower facilities (physical environment). It may have nothing to do

MOHOST v.2.0 13
with their kitchen skills, and so self care & leisure can influence the person’s ability to prepare food in the kitchen.

To meet the referring agent’s concern, you will need to make a judgement about the client’s ability to feed himself/her-
self. The OT can complete the MOHOST (self care, productivity, and leisure) based on the person’s behaviour in the
hospital environment. You will also need to know what the person’s daily life is like in the community i.e., how they
construct their habits, what responsibilities they hold, how motivated are they to cook even though they have the skill,
do they have enough confidence, skill, capacity to get food into their house, and so on, - how feeding themselves fits
into their occupational participation. For example, if they have no responsibilities and an empty routine, they may lack
motivation to do anything – even though they have the skills to cook in the OT kitchen.

This assessment structure will provide the following information:

Completed MOHOST in hospital

(which may include observations of dressing, kitchen work, group work, discussion with nursing staff)

In addition to....

Community proxy report

Proxy report from someone who knows the client in the community
Note: it may also be appropriate in some circumstances to complete a home visit in a MOHO format.

develop case formulation

Discharge recommendations

The completed MOHOST will document how the person is participating in occupation in the hospital (self care,
productivity, leisure). Meanwhile, a proxy report of the person’s life in the community can be used in order to predict
the likelihood of participation on discharge (which is what the referring agent is probably looking for). So if a person
participates well in their daily life on the ward, but a proxy report states that they don’t participate well at home – then
reasons for this can be explored before discharge. Reflections may include……….is it the structure of the routine that
helps them engage more in occupation in the hospital? … is it the verbal prompting of the environment? … is it the peer
support and friendships formed in the ward that support the persons function? … is it because they have an OT standing
over them! … is it because they are on medication and are medically stable and so on. If there is a major difference
between the hospital MOHOST ratings and the community proxy report of the persons’ community participation prior
to admission then the OT may decide to complete a full MOHOST within the community context of the person’s life
(within a home visit). This allows the persons abilities to be measured within the community before discharge. Note:
this structure is also effective in a day hospital situation when it would be appropriate to complete 2 MOHOST’s – one
in the day hospital and one in the community.

14 MOHOST v.2.0
 Chapter Four:
CONTENT AND PURPOSE OF THE MOHOST
The MOHOST aims to give a broad overview of occupa-
tional participation. It consists of 24 items, four for each
of the following sections:
• Volition (or ‘motivation for occupation’)
• Habituation (or ‘pattern of occupation’)
• Communication and Interaction skills
• Process skills
• Motor skills
• Environment
Most of the sections deal directly with the person’s par-
ticipation in occupation. The last section is slightly dif-
ferent, in that it explores how the environment supports
the person to participate in occupation. The items in all
the other sections are concerned with different aspects
of the person. When it comes to rating the environment,
however, the therapist is not rating the person’s skill to
manage their environment but the resources, opportuni-
ties, constraints and demands of the environment itself.
It must be remembered that occupational participation
is always contingent on the support that we receive from
the environment and the inclusion of the environment
section therefore puts a person’s occupational participa-
tion into context.
Having an equal number of items per section allows the
therapist to compare the person’s relative strengths and to
focus on those areas of occupational participation requir-
ing further assessment or intervention. The MOHOST’s
value lies in its ability to take into account the impact of
volition, habituation and the environment as well. In this
way, it makes plain that the focus of occupational therapy
is more than the treatment of discrete skills and instead
involves looking at the person and how they engage with
the environment in order to complete self care productiv-
ity and leisure activities.
The MOHOST enables occupational therapists to
formalise the knowledge that they build up about the per-
son informally over a period of time, by systematically
documenting their observations/interactions regarding
how the person respond to occupation within a given
therapeutic environment. The observations/interactions
with the person are structured through the conceptual
model of practice.
The MOHOST is the most flexible of the MOHO assess-
ments available to date as it provides a comprehensive
evaluation of the person using a mixed data collection
method. This means that the MOHOST can be used with
a wide ability range of people including those with ver-
bal or non-verbal skills. It thereby allows the therapist to
infuse client-centredness into practice even in challeng-
ing circumstances, acting as a basis for discussion with
the person and the multidisciplinary team, to guide the
aims of therapy and to set occupational goals.
It is intended to be a screening assessment for a broad
range of occupational participation issues that are
articulated by MOHO, by identifying that a person has
a difficulty in any particular aspect of their occupational
participation. The therapist may then decide to complete
further, more specific assessments. The MOHOST may
also be used alone, particularly when the occupational
therapy service is under pressure and a review of the
person’s needs are required and/or when the reasons for
referral to occupational therapy are unclear and clients
need to be assessed and prioritised.
The only limiting factors are that clients need to have
regular contact and sufficient access to meaningful
occupation in order to adequately gauge their level of
performance, and that their performance is consistent
over a period of time. The therapist needs to be confident
of having sufficient information in order to have a real
sense of knowing the person. If the person is verbal and
co-operative it may be possible to collect the information
required in one or two sessions but getting to know a
person often takes longer. For more challenging clients it
can take up to a week (depending on regularity of access
to the client).
MOHOST v.2.0 15
Content and Purpose of the MOHOST
Aims of the MOHOST
• To maintain a perspective that is unique to Occupa-
tional Therapy, using a conceptual model of practice
focused on occupational participation (self-care,
productivity, leisure).
• To identify when further more detailed assessment is
needed and to complement the existing assessments
in the MOHO toolbox.
• To be straightforward and reasonably quick to use,
allowing repeated assessment at regular intervals.
• To use terms that will be understood by the
multidisciplinary team.
• To assess a representative sample of issues relating
to the person and the environment as framed by the
Model of Human Occupation, allowing their relative
strengths to be demonstrated in a person’s profile.
• To analyse a person’s general occupational
participation irrespective of symptoms or diagnosis or
the treatment setting.
Typical uses of the MOHOST
• To be used in situations where accurate self-assessment
may not be possible and lengthy interviews may not
be appropriate (e.g. when the person may be too
confused and lacking insight or too depressed and
lacking concentration, or in settings where there is a
high turnover of clients).
• To aid documentation by enabling occupational
therapists to systematically record both their initial
observations and their subsequent analyses (e.g.
recording baseline assessment and changes in
occupational participation (self-care, productivity,
leisure).
• To aid communication regarding the person’s needs
and to analyse their relative strengths (e.g. prior to
care-planning and treatment reviews).
• To highlight the impact of volition (motivation for
occupation) and habituation (pattern of occupation)
as well as the more commonly assessed aspects of
skills, making it explicit that the focus of occupational
therapy needs to be broader than the teaching of
discrete skills.
16 MOHOST v.2.0
• To help the multidisciplinary team to recognise when
a person with florid symptoms is nevertheless able to
participate in occupation well, or conversely, when
a person with an absence of primary symptoms has
disengaged from occupation.
• To provide the answers to those questions commonly
asked when a clinician is considering how best to
approach a person who may be previously unknown
to them, and thereby enabling any clinician to have
a clearer understanding of the person’s current
occupational participation (e.g. discharge planning,
when a person is referred to another agency).
• To help identify when further more detailed
assessment would be useful (e.g. Volitional
Questionnaire, Assessment of Communication and
Interaction Skills, Assessment of Motor Process
Skills).
• To establish whether occupational therapy services
are necessary, by reinforcing the occupational focus
of occupational therapy.
Purpose of the Ratings
We believe that most therapists who take the time to
complete the MOHOST will find that doing so is a good
investment of time and energy.
• The ratings provide an objective, theory-based, and
succinct assessment of a client. This can contribute
to occupational therapy & interdisciplinary decision
making in treatment, discharge, placement, and
other decisions.
• The rating scale of the MOHOST reflects theory from
the Model of Human Occupation and functions as
a way of relating the information obtained in the
assessment back to the theory.
• The descriptive criteria serve as a visual profile of
strengths and weaknesses of which the therapist
should be cognisant when beginning treatment
planning. The ratings, when completed, provide a
visual profile of the person’s strengths and weaknesses
and can serve as a ready index for quickly identifying
these strengths and weaknesses.
 Content and Purpose of the MOHOST

• The MOHOST provides a method of effective a consistent framework for communicating about
communication. In an era when occupational the needs of a person and recommendations for
therapists are increasingly assuming indirect service services, structure, etc. Moreover, by using the same
roles such as in education, consultation, and framework across clients, therapists can readily point
supervision of direct service providers, clear and out similarities and differences of clients, justifying
consistent means of communication are essential. recommendations or specifications for services.
The MOHOST provides a means of communicating
• The ratings provide a means of measuring the
a range of considerations for the occupational
person’s occupational participation. When one uses
participation of the client. That is, the ratings
a tool capable of measurement, it is possible to
can serve as an effective structure for providing
measure the effectiveness of occupational therapy
consultation, education, and supervision. By
services.
consistently using the ratings, the therapist employs

MOHOST v.2.0 17
 Chapter Five:
MOHO TERMINOLOGY AND THE MOHOST
The words that are selected to describe therapy are very
important and MOHO terms, like those of any other pro-
fessional language, offer benefits and pose challenges.
When the MOHOST was first conceived, the specialist
terminology was not a particular issue. The sole inten-
tion was that it should be relatively quick and simple to
use, so that it could be used on successive occasions to
document progress. However, it soon became apparent
that its simplicity made it an ideal tool for communicat-
ing the focus of occupational therapy to the wider mul-
tidisciplinary team, and for this reason it was decided to
de-code the professional language used by the Model of
Human Occupation. In this way:
• Volition becomes Motivation for
Occupation
• Habituation “ Pattern of
Occupation
• Physicality “ Non-verbal skills
• Temporal “ Timing
Organisation
It is not intended, however, that MOHO terms should
be discounted altogether. Occupational therapists have
always used professional terminology, indeed they have
acquired the professional languages of several disciplines
and theoretical perspectives. The terms, “resuscitation”,
“repression” and “reinforcement” respectively reflect
medical model, object relations, and behavioural con-
cepts. Such specialised terms are designed to support the
flow of communication among practitioners. Complex
conditions or procedures can be conveyed and imme-
diately understood when such professional terminology
is used.
A common example of how a professional term can ef-
ficiently convey complex information and facilitate com-
munication between professionals is medical diagnosis.
The term, “Alzheimer’s dementia” conveys the following,
rather complicated meaning:
18 MOHOST v.2.0
“. . . the development of multiple cognitive
deficits manifested by both a) impaired ability
to learn new information or recall previously
learned information, b) one or more of the
following deficits: i. language disturbance; ii.
impaired ability to carry out motor activities
despite motor function; iii. failure to recog-
nise or identify objects despite intact sensory
function; vi. disturbance in planning orga-
nising, sequencing, and abstracting. These
cognitive deficits cause a significant impair-
ment in social or occupational functioning
and represent a significant decline form a
previous level of functioning. It is charac-
terised by a gradual onset and continuing
cognitive decline. The deficits do not occur
exclusively during the course of delirium”
(DSM VI, 1994).
Using diagnostic terms such as Alzheimers allows those
who know the meaning of terminology to share com-
mon perspectives and to succinctly convey information.
Similarly, MOHO terminology can be used to convey
complex concepts to those who are familiar with the
model. For example, the term, volition, denotes a com-
plex idea about how persons are motivated toward their
occupations. To those who know its meaning, “volition”
will convey several concepts. When someone refers to
a “volitional problem” those who know the terminology
can anticipate that the problem involves clients’ values,
personal causation, and interests. They can further ex-
pect that the problem is manifest in how clients antici-
pate, choose, experience and interpret what they do. In
this way, MOHO terminology can convey a great deal
of information.
The major disadvantage of all professional language is
that everyone needs to have a common set of definitions
for the words to be used to communicate effectively. It
is, therefore, ineffective to use MOHO terms with col-
leagues and/or clients/relatives who will not understand
what the words mean. Some MOHO terms such as “voli-
tion”, “personal causation”, and “roles” have meanings
not readily understood. Other terms such as “interests”
and “values” and “habits” contain meaning beyond but

are still consistent with ordinary usage. Still other terms,
such as skill, have a meaning within the MOHO context
(i.e., a quality of actual occupational performance), that
may be quite different to everyday usage (i.e., underly-
ing capacity). Therefore, therapists do have to be careful
when and how they use MOHO terms, lest they confuse
or mislead clients, lay persons, and other professionals.
There are circumstances in which it is appropriate to use
MOHO terms in communication. These include:
• Circumstances when the primary or exclusive
audience is other occupational therapists,
• Situations when clients are empowered by
learning the MOHO concepts as a means of increasing
understanding and control over their own
circumstances, and
• Settings where other professionals are receptive to
becoming familiar with occupational therapy
terminology.
Certainly, the whole point of MOHO language is to
facilitate communication of ideas between occupational
therapists. This language can be particularly helpful when
therapists are discussing clients, plans for therapy and so
on. While clients ordinarily require that we communicate
to them in everyday language, there are occupational
therapists who encourage their clients to learn basic
MOHO language and concepts. A couple of years ago the
second author visited a private, community occupation-
al therapy program, Reencuentros, Chile. In this setting
clients are educated on the basic language and views of
MOHO as part of their therapy. It was interesting to note
that many of these clients (who have chronic disabilities)
were quite interested to discuss their own “volition” with
this visiting therapist.
The authors have routinely used MOHO language with
other professionals in practice contexts with good results.
Other professionals are often quite willing, within reason,
MOHO Terminology
to acquire a basic understanding of one’s professional
terminology. Therapists have often noted to us that they
have been surprised by how quickly teams pick up
MOHO terms. More often than not, it is the therapist’s
lack of confidence in using the terminology than resis-
tance on the part of other professionals that prevents use
of MOHO terminology in an interdisciplinary context.
Nonetheless, therapists do need to be sensitive to the
demands they put on other professionals for learning
their terminology. It is important to decide which terms
one would like interdisciplinary colleagues to under-
stand and to take the time to explain them.
As this example illustrates, one benefit of using MOHO
language in a multidisciplinary context is that it conveys
the fact that occupational therapy has its own concepts and
approaches. Related to this, using MOHO language
also denotes that the occupational therapist has a
specific domain of interest and expertise. For example, a
psychologist was apparently upset because she felt that
occupational therapists were claiming motivation as their
domain. She felt that motivation was a psychological
term and area of expertise. The second author explained
that occupational therapy’s interest in motivation was
based on the concept, volition, and offered a brief
explanation. Following this, the psychologist realised
that her concerns with motivation and occupational
therapy concerns were actually complementary rather
than competitive or duplicative.
Of course, most therapists will find it necessary to
develop the facility of moving back and forth between
using MOHO terminology and expressing MOHO
concepts in ordinary language. This is not unique to
occupational therapy. All professionals who wish to
be effective in interacting with those who don’t share
their expertise must know how to explain themselves in
everyday language. Our intention is that the MOHOST
will assist in facilitating this process.
MOHOST v.2.0 19
 Chapter Six:
ADMINISTRATION
When should I use the MOHOST and
with whom?
The MOHOST attempts to paint an overall picture of a
person’s occupational participation, irrespective of symp-
toms or diagnosis, as well as the level of support that the
person receives from their environment. It enables occu-
pational therapists to formalise the knowledge that they
build up about people informally over a period of time,
by systematically documenting their observations regard-
ing how they respond to occupation. It can then be used
as a basis for discussion with a person and the multidis-
ciplinary team, to guide the aims of therapy and to agree
occupational goals. As such, it is a valuable tool to use:
• In the initial stages of assessment when planning
treatment,
• To document change when progress is apparent, or
alternatively when a deterioration in occupational
participation is perceived, or
• In discharge-planning, when referring the person to
a new service.
Its objective focus is of particular value when client-
centred practice is most challenged, being ideally suited
for use with clients who are unable to tolerate lengthy
interviews, i.e., clients who may have difficulty evalu-
ating or articulating their own abilities because of lack
of insight, or concentration or verbal skills. Such clients
are also likely to experience a wide range of impaired
performance capacity, and this is another reason to con-
sider using the MOHOST, because of its broad scope and
ability to summarise information succinctly. These same
qualities mean that the MOHOST can also be useful
when the occupational therapy service is under pressure,
when the reasons for referral to occupational therapy are
unclear and clients need to be prioritised. Clients with
medical problems do not necessarily have any occupa-
tional challenges, and once this has been established, it
enables therapists to concentrate their efforts on those
clients who are most in need.
Therapists need to use their own professional judge-
ment as to when to use the MOHOST. In some acute
20 MOHOST v.2.0
settings the MOHOST could well be used to document
the progress of certain clients every two weeks, but to use
the MOHOST any more frequently would be impractical.
In those situations where clients are making daily prog-
ress, it is impossible to know with any certainty that the
changes are going to be maintained, and the MOHOST
can only be used when the therapist can confidently
predict how the person is going to respond. When change
is too rapid, or a person’s occupational participation is
unpredictable then it becomes more difficult to use the
MOHOST, although the first author has frequently used
two assessments to document client’s typical “good” and
“bad” days.
The occupational therapist may have particular difficulty
using the MOHOST if their own observations of a person
are consistent but these are not corroborated by discus-
sion with carers and the multi-disciplinary team. In most
cases it will be possible to reach a consensus as to how
the person participates in occupation and the therapist’s
role is to clarify this in order to provide a consistent treat-
ment approach. However, there may be times when no
agreement is reached and on these occasions the thera-
pist must ask themselves whether or not the occupational
therapy itself is the reason for the person’s changed pre-
sentation. The demands and the support of occupational
therapy may be responsible for the changed presentation,
either because it nurtures enhanced occupational partici-
pation or perhaps because it highlights areas of difficulty
that the person is adept at masking in other settings. The
occupational therapist can still complete the MOHOST
ratings, but needs to make it clear in the MOHOST sum-
mary that the ratings reflect occupational participation as
witnessed in the therapeutic setting and may not reflect
the level of participation seen e.g., on the ward or in the
home environment.
The therapist could then make recommendations that
would support the person’s occupational participation in
other environments.
To summarise, as its name indicates, the MOHOST is es-
sentially a screening tool:

• Assessing for areas of occupational participation
requiring further assessment and intervention, and
• Assessing the person referred to occupational
therapy to determine whether occupational therapy
is essential or not.
It is not an assessment that can be used to screen referrals
before the occupational therapist has begun the process
of getting to know the person.
How is the information gathered?
The MOHOST has been designed to provide a perspec-
tive that is unique to occupational therapy by document-
ing those skills that can only be assessed when a person
is engaged in occupation. It is therefore dependent on
the person having regular contact and sufficient access
to meaningful occupation and assumes that occupational
therapists will not be working in a wholly generic role.
It is also assumed that the occupational therapists will
always have some direct contact with the person and
will be using discussion and case notes to confirm their
professional observations.
Occupational participation is inherently client-centred; it
allows the person to demonstrate their commitment and
involves the possibility of them making long-term occu-
pational choices. Some activities utilised by therapists are
short-term and therapist-led (Quizzes, Anxiety Manage-
ment, Reminiscence, etc.) and by using the MOHOST it
becomes apparent that these activities offer insufficient
opportunities to adequately assess occupational partici-
pation. E.g., it can be difficult to observe a person’s or-
ganisational skills when they attend a discussion-based
group that is organised for them.
Although the MOHOST is primarily an assessment
based on observation, it does allow the therapist to draw
upon a variety of different sources of information, in
order to fully reflect their knowledge of the person. The
criteria is “getting to know your client” and this may be
done through:
• Informal observation in open settings,
• Formal observation in 1:1 and group settings,
• Discussion with clients regarding their motivation,
interests, roles, and routines,
Administration
• Discussion with carers and the multidisciplinary
team regarding their observations,
• Reading case notes, and
• Completing other formal assessments.
Occupational therapists report significant advantages
in completing the MOHOST in conjunction with other
colleagues or carers, or even with the clients themselves.
In doing so, the therapist is able to validate opinions and
build rapport at the same time as educating others about
their focus of intervention and the value of occupation.
However, it should be recognised that the therapist will
have to exercise professional judgement in whether to
share the assessment form with the client or not. The
occupational therapist has a duty to check out their
assessment with the person in the manner which will
be most appropriate. This may involve completing the
assessment with the person, but when their skills are
limited due to reduced volition, or communication and
interaction, or processing abilities, then the therapist may
decide to delay sharing the form and confine themselves
to verbal feedback & dialogue. The therapist therefore
has several options:
• To complete the MOHOST with the person,
• To complete the MOHOST with a carer or another
member of the multi-disciplinary team,
• To complete the MOHOST alone and discuss the
main findings with the person,
• To complete the MOHOST alone and use the findings
to frame future interactions, and
• To complete the MOHOST alone and share the
analysis with the person when appropriate.
How long does it take to gather the
information?
The MOHOST recognises that a therapist’s knowledge of
a person is built up over a period of time, and its scope is
such that it would be almost impossible to gather all the
information in a single therapeutic contact. A period of a
week might provide adequate time in acute settings where
progress is being monitored frequently. In community
settings, however, or when the person’s occupational
participation is more settled, the assessment could be
made over the period of two weeks or more. When
progress has plateaued, as it may have done e.g. with
MOHOST v.2.0 21
Administration

people who have dementia, then longer periods of time How do I decide which form to
may even be possible. The length of time that it takes
to gather the information is perhaps not important, so
complete?
long as the occupational participation observed has been
There are four forms provided in this manual
relatively consistent for the whole period.
1. MOHOST Form
It should take ten to twenty minutes to write up the 2. Multiple MOHOST Form
assessment itself, once the therapist has become familiar 3. MOHOST Data Sheet Single Observation Form
with it through regular use, although the assessment may 4. MOHOST Data Sheet Multiple Observation Form
take 40 minutes to complete if the person’s needs are
complex or unclear. However, all assessments take longer a) MOHOST Form
to complete when first attempted and it may take half a
day to read through the manual before starting to use the This form allows an assessment of all 24 items – 20
assessment. This may cause a degree of dismay to a busy relating to the person and 4 relating to the environment. It
therapist, but if the person’s needs can be articulated and is the MOHOST form that is recommended, enabling the
clarified in the process then the effort is worthwhile. Also, occupational therapist to document the person’s abilities
research has shown that the time taken to complete a within the context of their environment.
MOHOST decreases dramatically after it has been used
for the first 5 times. If the person’s abilities are similar across different
environments then one MOHOST assessment can be
completed. If, however, the person performs differently in

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills _____________

Occupational demands
Expectation of success
Appraisal of ability

Posture & mobility

Physical resources
Vocal expression
Non-verbal skills

Problem-solving

Strengh & effort

Physical space
Responsibility

Co-ordination

Social groups
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

a) Occupational Participation in Day Hospital

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

b) Occupational Participation in Home Environment

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

22 MOHOST v.2.0

different environments the occupational therapist should
complete separate MOHOSTs for each environment.
For example a person’s occupational participation
may be different in the home as opposed to their work
environment, perhaps because the work environment is
more stressful, or perhaps because a parent tends to be
over-protective in the home environment. Or a person’s
occupational participation may be perceived as being
very different in hospital as compared to their home.
2. Multiple MOHOST form
This form is used to document multiple MOHOST
assessments. It is particularly useful if the client is engaged
with services over a long period of time. Their change
of occupational participation can be easily tracked. It is
also helpful to visually track a person who is repeatedly
admitted into a service.
3. MOHOST Data Sheet Single Observation Form
This form has been included in the MOHOST manual
in response to the growing demand from occupational
therapists for a form that would help them to gather
information about their clients in preparation for
completing a MOHOST Form. However, it should be
emphasised that the single observation form is not an
outcome measure on its own and does not have the
advantages of the MOHOST form in being able to
capture the whole of the therapist’s knowledge of a
person. The MOHOST Form provides a summative
assessment of a person’s occupational participation,
summarising the wealth of information that exists,
whereas the single observation form provides a
snapshot/single observation of the person doing an
occupation and as such gives a formative assessment.
Example use of environment section
Space offers stimulus and comfort
Environment
Resources allow safety and independence
Social interaction provides support
Demands of activity match abilities/interests
Administration
It is purely observational and can be completed after a
single intervention, concentrating on individual behav-
iours that are representative of the items assessed in the
MOHOST. For example, it assesses whether the person
‘manipulates tools and materials easily’ instead of assess-
ing the general skill of ‘Co-ordination’. As such, it is ideal
for use by occupational therapy support staff to use in
order to discuss their observations with the occupational
therapist. Occupational therapists should, of course, pro-
vide training in the Model of Human Occupation and
supervise the use of the rating scale until the support
staff become confident in its use. All single observations
completed by support staff need to be countersigned by
qualified staff.
The most common query raised by support staff relates
to the environment section and can be expressed as:
‘Why do I continue to rate the environment when I
usually observe the person in the same situation each
time?’ The occupational therapist will need to explain
that the conditions of the environment can still vary and
the example is given below of how the occupation of
gardening can vary even though the garden remains the
same:
• One day the physical space may be unbearably hot
and so the physical space is not as comfortable,
• There may be sufficient physical resources for
everyone to get involved with the task of pricking out
seedlings, but there are insufficient garden forks for
everyone to use when digging is required,
• The social group may be generally very supportive,
but one day another person may enter the garden
and disturb the others, or
• The person may usually enjoy the occupational
demands but they may prefer certain activities and
may particularly dislike e.g., weeding.
N/S F A I R The garden is bare at the moment
N/S F A I R Kneeling stool was provided
N/S F A I R Needs of others in the group conflicted
N/S F A I R Satisfaction expressed with planting
MOHOST v.2.0 23
 Administration

4. MOHOST Data Sheet Multiple Observation Form

This form allows occupational therapy staff to record

multiple ratings from sigle observations on one form and
is often used to give a snap shot record of progress over
5 days.

24 MOHOST v.2.0
 Chapter Seven:
LINKS WITH OTHER MOHO ASSESSMENTS
Other Assessments that Cover Similar
Areas
The MOHOST is similar in content area to the OCAIRS,
OPHI-II & OSA and so one might suppose that they would
not normally be used in conjunction with the MOHOST.
However, if the client is conversational, or perhaps pro-
gresses to being so, then these assessments create invalu-
able opportunities for dialogue with the client in which
to fully explore their motivation for therapeutic goals.
This would make them the assessments of first choice in
many instances. Being based on the interview process,
however, they may be less easy to administer regularly
at repeat intervals. The MOHOST offers greater flexibility
and the chance to use a single assessment with mixed
ability clients.
Occupational Circumstances Assessment Interview and
Rating Scale (OCAIRS)
The OCAIRS is a semi-structured interview that provides
a structure for gathering, analysing, and reporting data
on the extent and nature of an individual’s occupational
participation. It can be used with a wide range of cli-
ents, and would be appropriate for any adolescent or
adult client who has the cognitive and emotional ability
to participate in a short interview. The OCAIRS provides
a structured and theoretically based means of developing
interview skills in evaluation and treatment.
Occupational Performance History Interview-Second
Version (OPHI-II)
As a historical interview, the Occupational Performance
History Interview-Second Version (OPHI-II) gathers
information about a client’s past and present occupa-
tional adaptation. The OPHI-II is a three-part assessment
that includes:
• A semi-structured interview that explores a client’s
occupational life history,
• Rating scales that provide a measure of the
client’s occupational identity, occupational compe-
tence, and the impact of the client’s occupational
behaviour settings, and
• A life history narrative designed to capture salient
qualitative features of the occupational life history.
It is designed to give the interviewer a means of under-
standing the way a client perceives her or his life to be
unfolding. The OPHI-II can be used with adolescents and
adults who have a range of impairments.
Occupational Self Assessment (OSA)
The Occupational Self Assessment (OSA) is designed to
capture clients’ perceptions of their own occupational
competence. It also allows clients to indicate personal
values and to set priorities for change. As such, the OSA
is designed to give voice to the client’s perspective and
to give the client a role in determining the goals and
strategies of therapy.
Having gained a broad overview of the client’s abilities
using the MOHOST, the therapist may decide to ex-
amine specific aspects of occupational performance in
greater detail. The MOHOST would more commonly be
used in conjunction with the following MOHO assess-
ments, which include b) Observational Assessments, c)
Self Report Assessments, and d) Occupation Focused
Interviews.
Observational Assessments
Assessment of Communication and Interaction Skills
(ACIS)
The Assessment of Communication and Interaction Skills
(ACIS) is a formal observational tool designed to mea-
sure an individual’s performance in an occupational form
and/or within a social group of which the person is a
part. The instrument aims to assist occupational thera-
pists in determining a client’s ability in discourse and
social exchange in the course of daily occupations. The
ACIS has been developed for use in a wide range of set-
tings. Observations are carried out in contexts that are
meaningful and relevant to the client’s lives. The occu-
pational therapist then completes a 20-item rating form.
MOHOST v.2.0 25
Links with Other MOHO Assessments
Data can be combined with observations from other
settings to give a more complete picture of the client’s
skills in communication and interaction.
Assessment of Motor and Process Skills (AMPS)
The Assessment of Motor and Process Skills (AMPS)
(Fisher, 1994) represents a fundamental and substantive
re-conceptualisation in the development of occupational
therapy functional assessments. The AMPS is a structured,
observational evaluation. The AMPS is used to evaluate
the quality or effectiveness of the actions of performance
(motor and process skills) as they unfold over time when
a person performs daily life tasks. The daily life tasks
included in the AMPS are both personal & domestic
activities of daily living. The tasks included in the AMPS
manual vary in difficulty from simple to complex, with
the easiest tasks being less difficult than many self-care
tasks, including dressing and toileting.
Volitional Questionnaire
Traditionally, it has been difficult to assess volition in
clients who have communication and cognitive limita-
tions due to the complex language requirements of most
assessments of volition. The Volitional Questionnaire is
an attempt to recognise that while such clients have dif-
ficulty formulating goals or expressing their interests and
values verbally, they are often able to communicate them
through actions. The client is observed in a number of oc-
cupational behaviour settings so that a picture of the per-
son’s volition and the environmental supports required to
support the expression can be identified.
Self Report Assessments
Interest Checklist
Although the Interest Checklist was developed prior to
the introduction of the Model of Human Occupation,
both the instrument and the theory have strong ties to the
occupational behaviour tradition. The Interest Checklist
has been modified and utilised extensively over the years
in studies based in the Model of Human Occupation be-
cause of this tool’s utility in identifying clients’ past and
present interests and the degree of attraction clients ex-
press towards those interests.
26 MOHOST v.2.0
The National Institutes of Health Activity Record
(ACTRE)
The NIH Activity Record (ACTRE) was developed
as an outcome measure for a study of patients with
rheumatoid arthritis. This instrument provides a 24-hour
log of a patient’s activities and is an adaptation of the
Occupational Questionnaire (described later in this
appendix). The ACTRE aims to provide details on the
impact of symptoms on task performance, individual
perceptions of interest and significance of daily activities,
and daily habit patterns. Specific information gathered
covers frequency and/or percentage of time spent in
role activity and resting, frequency of rest periods
during activity, frequency and/or percentage of time
with pain and fatigue and time of day or activity with
which it occurs. It also covers volitional concerns such
as interests, meaning, enjoyment, and perception of
personal effectiveness.
The Occupational Questionnaire (OQ)
The Occupational Questionnaire (OQ) is a pen and
paper, self-report instrument which asks the individual to
provide a description of typical use of time and utilises
Likert-type ratings of competence, importance, and
enjoyment during activities. The OQ asks the client to
complete the instrument in two parts. First, he or she
completes a list of the activities he or she performs each
half-hour on a typical weekday. After listing the activities,
the client is asked to answer four questions for each
activity. The questions ask the client to rate whether he or
she considers the activity to be work, daily living tasks,
recreation, or rest, and to consider how well he or she
does the activities, how important they are to him or her,
and how much he or she enjoys doing them.
Role Checklist
The Role Checklist is a self-report checklist that can
be used to obtain information about the types of roles
people engage in and which organise their daily lives.
This checklist provides data on an individual’s perception
of his or her roles over the course of their life and also the
degree of value, i.e., the significance and importance that
they place on those roles. The Role Checklist can be used
with adolescents, adult, or geriatric populations.

Occupation Focused Interviews
Worker Role Interview
The Worker Role Interview (WRI), is a semi-structured
interview designed to be used as the psychosocial/
environmental component of the initial rehabilitation
assessment process for the injured worker. The interview
is designed to have the client discuss various aspects of his
or her life and job settings that have been associated with
past work experiences. The WRI combines information
from an interview with observations made during the
physical and behavioural assessment procedure of a
physical and/or work capacity assessment. The intent is
to identify the psychosocial and environmental variables
that may influence the ability of the injured worker to
return to work.
Links with Other MOHO Assessments
Work Environment Impact Scale (WEIS)
The Work Environment Impact Scale (WEIS) is a semi-
structured interview designed to gather information
about how individuals with disabilities experience and
perceive their work settings. The focus of the interview is
the impact of the work setting on a person’s performance,
satisfaction and well-being. An important concept
underlying this scale is that workers are most productive
and satisfied when there is a “fit” or “match” between
the worker’s environment and the needs and skills of the
worker. Hence, the same work environment may have a
different impact on different workers. It is important to
remember that the WEIS does not assess the environment.
Rather, it assesses how the work environment impacts a
given worker.
MOHOST v.2.0 27
 Links with Other MOHO Assessments

The MOHOST covers all the major concepts in MOHO and as such it may be useful when
a) The client group is non verbal or has a range of abilities,
b) It is your first contact with the client and/or,
c) It is unclear where the source of the difficulty is, and/or
d) There is a need to understand how a specific difficulty affects a range of occupational issues.
Having completed the MOHOST, the therapist may then decide to assess specific aspects of performance in
more depth.

Communication
Motivation for Pattern of
and Interaction Process Skills Motor Skills Environment
Occupation Occupation
Skills

VQ AMPS
ACIS
Observational Observational
Observation
assessment assessment that
assessment that
that focuses on NIH Activity focused on motor
focuses on com-
volition Record and process skills
munication and
Identifies habitual
interaction skills
routines in
Interest Checklist relationship to
Useful to pain and fatigue WEIS
identify interests
Interview about
the work
OQ OQ environment
Identifies routine Identifies routine
in relationship in relationship
to volition to volition

Role Checklist Role Checklist

Identifies past, Identifies past,
present and present and
future roles in future roles in
connection with connection with
importance importance

WRI WRI WRI

Interview about Interview about Interview about
the worker role the worker role the worker role

OTPAL OTPAL OTPAL

Observation Observation Observation
and interview for and interview for and interview for
student role student role student role

SSI SSI SSI

Interview for Interview for NB: Several tools cover more than one Interview for
student role student role area of occupational functioning student role

28 MOHOST v.2.0
 Chapter Eight:
OCAIRS QUESTIONS - GETTING TO KNOW YOUR CLIENT
Although the MOHOST is primarily an assessment based
on observation, it does allow the therapist to draw upon
a variety of different sources of information, in order to
fully reflect their knowledge of the client. The criteria
is simply “getting to know your client” and this may be
done through:
• Informal observation in open settings,
• Formal observation in 1:1 and group settings,
• Discussion with clients regarding their motivation,
interests, roles, and routines,
• Discussion with careers and the multidisciplinary
team regarding their observations,
• Reading case notes, and
• Completing other formal assessments.
It is assumed that the occupational therapists will always
have some direct contact with the clients and will be using
discussion and case notes to confirm their professional
opinion.
If the occupational therapist reasons that it is appropriate
to ask questions as part of the data gathering method it is
recommended that the questions in this chapter be used.
Originally there were no recommended questions within
the MOHOST, as we preferred the therapist to use the
questions that were most comfortable to the situation and
the client. We discovered, however, that occupational
therapists were looking for guidance regarding
occupational interviewing and we have, therefore,
provided the following recommended questions. It should
be stated though that these are only recommended
questions and can be changed in how they are phrased
as long as they elicit similar kinds of information from
the clients. The questions in this chapter are the same
questions used within the OCAIRS interview. The benefit
of using these questions are that at the end of the interview
the OT will be able to rate both the MOHOST and the
OCAIRS. The following are guidelines regarding when to
use the OCAIRS and the MOHOST:
✓ Use the OCAIRS if all your clients are
conversational:
If all your clients are verbal and can all comply with
an interview format it is more appropriate to use the
OCAIRS and NOT the MOHOST, unless outcome
measuresare required at frequent intervals.
✓ Use the MOHOST and the OCAIRS in a service if the
service has clients of mixed ability:
If you have a client group who have mixed abilities it
may be more appropriate to use both assessments.
✓ With clients who are more non verbal then a
MOHOST can be used and the method of data
gathering is observational and proxy report.
✓ If the clients are not conversational but will give
you some verbal information then a MOHOST
is appropriate and information is gathered by
observation, proxy report. The OCAIRS questions
in this chapter can also be used to support the
MOHOST data gathering method for clients who
can respond to questions in part.
✓ Use the MOHOST in a service if the service has
clients who do not have verbal skills:
If your clients cannot give you information about
themselves verbally through conversation it is
recommended that you use the MOHOST and gather
information by observation and proxy report and NOT
use the OCAIRS questions in this chapter.
Recommended Questions – See
Appendices
I. OCAIRS QUESTIONS – Mental health settings
II. OCAIRS QUESTIONS – Forensic settings
III. OCAIRS QUESTIONS – Physical settings/Older Adult
Mental Health
It should be noted that these are recommended questions
and SHOULD be adapted and rephrased to communicate
effectively with the client as long as they are eliciting the
same information.
MOHOST v.2.0 29
OCAIRS Questions

It should also be noted that it is often easier to start with

questions regarding the client’s pattern of occupation and
proceed gradually to questions regarding motivation for
occupation.

There are three different formats that can be used and

the choice is made through personal preference.

30 MOHOST v.2.0
 Chapter Nine:
CASE STUDIES
Case Study 1: Joy
with thanks to Leigh Dyson Green
Joy is in her early twenties. She was diagnosed with bi-
polar disorder at the age of 16 having become acutely
ill while taking some exams. Joy’s parents were divorced
when she was 10 years old. Her mother has schizophre-
nia and used to have frequent admissions to hospital and
consequently Joy spent most of her early childhood living
with her grand parents. They both died when she was a
teenager and she went on to spend the weekdays living
with her father and his new family, and the weekends
with her mother and her older brother who is also known
to the mental health services.
The occupational therapist has been involved with Joy
for 12 months, and first met Joy when she was elated
in mood and had been admitted on a voluntary basis to
hospital. The local hospital had no beds available and so
Joy had been transferred to a nearby town, which was an
unsettling experience in an already extremely unsettled
life. The one point of stability in Joy’s life was her clerical
work. She had worked full-time with the same firm since
leaving school. While Joy was in hospital, however, the
company went through a restructuring process, which
meant that Joy would no longer be working with the same
team. She felt unable to face the changes and although
the occupational therapist liased with the company to fa-
cilitate part time work, it soon became apparent that Joy
was unable to cope with the transition or manage finan-
cially on her reduced income. The occupational therapist
worked to help Joy to explore alternatives to work and
also supported Joy in her decision to live independent-
ly. Joy coped remarkably well with the changes and the
MOHOST was used to document Joy’s progress.
Motivation for Occupation
When unwell Joy tends to overestimate her capabilities
but in general Joy has low expectations of herself. She re-
tains hopes for the future but requires reassurance regard-
ing her skills. She has had few interests beyond drinking
socially with friends and meeting young men, but has
recently joined a gym and she has started to have driving
lessons and has requested further support to develop new
interests. Given support, Joy stays engaged and listens to
advice, but she also experiences conflicting values. For
instance, she knows drinking alcohol is likely to have a
detrimental effect on her mental health, but she wants
to have what she sees as a “normal young person’s life-
style”. This involves going back to full time employment,
as she believes that by keeping busy she can maintain her
mental health. She views her current unemployment as a
chance for her to plan her future, and has enrolled on a
vocational course.
Pattern of Occupation
Joy copes well with a structured routine and has initiated
three different jobs through the volunteer bureau, dem-
onstrating loyalty and commitment. If anything, she tends
to be overactive, and the occupational therapist frequent-
ly has discussions with Joy about the need to maintain a
regular sleep pattern. Joy continues to find that adapting
to change is a little anxiety provoking, and requires en-
couragement, but is generally very responsible and can
be relied upon to carry out planned tasks. She derives
a lot of pleasure from her voluntary work and role as a
friend and she keeps regular contact with her family.
Communication and Interaction Skills
Joy has no assessed deficits with communication skills.
She worries about when to disclose her illness and what
to say, but she discusses this appropriately with her thera-
pist. She is also able to assert her own needs, and when
a friend moved in to stay with her on a temporary basis
Joy was able to clearly state the terms on which this ar-
rangement was made. She has also been very supportive
and has shown considerable maturity towards a friend
who was having problems, and she enjoys the social
nature of her voluntary work.
Process Skills
When last employed, Joy had been distractible and had
required continual supervision, but her process skills are
now much improved. She is able to seek out and retain
relevant information, and shows a level of general aware
MOHOST v.2.0 31
Case Studies

ness that is within the norms of her peer group. Once independently in a rented flat. Initially Joy found that
she has a plan, she is able to sustain her concentration her sudden independence was a lonely experience.
and to follow the plan through independently. She is also Gradually, however, she has become used to living alone
organised and neat, e.g., after a discussion on how best and has learnt to appreciate her new found freedom.
to maintain her correspondence she organised it into a She now says she could not go back to living with either
file. Joy continues to have difficulty problem solving, parent. She is financially secure, having been awarded a
however, and she seeks out reassurance and advice from Disability Living Allowance and receives some practical
family, friends and mental health workers. support from her father. Her family relationships
continue, however, to be a source of stress, - the family
Motor Skills dynamics were the main reason for Joy wanting to live
independently. Not only is Joy’s mother frequently unwell
Joy has no deficits with her motor skills, which are within but her father can also be somewhat over protective and
the norm for her age. controlling. Joy is coming to terms with her relationships
with her parents and looks to her friendships for support
Environment instead. Unfortunately, she can be easily influenced
by peer pressure. She does, however, find satisfaction
With practical help and support from the occupational in her chosen activities which are now all within her
therapist, Joy has moved out of her mother’s home to live capabilities.

MOHOST Analysis of Strengths & Limitations

Joy’s main strength is her determination. She has proved to be responsible and has
carried through agreed plans. She is also prepared to work at being more adapt-
able, and she is able to change and learn new skills. She is caring and sensitive to
the needs of others, but can sometimes be overwhelmed by the views of others and
she finds problem solving difficult. She needs to seek reassurance and advice over
basic decisions, and finds it difficult to see the future in the long term. Her main
focus is on the here and now.

Summary of Ratings

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills Community

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

32 MOHOST v.2.0

The assessment tool was helpful in three ways. Firstly,
it showed that Joy has made good progress towards an
independent and balanced lifestyle; that her process
skills and communication & interaction skills are
much improved and that she has the willingness and
perseverance necessary for success. Secondly, it clearly
identified those areas of occupational competence
requiring further work, e.g., developing interests and
independent problem-solving strategies. Thirdly, it
reinforced the importance of the occupational therapists
role in providing an alternative source of support
and encouragement to explore more stimulating and
appropriate alternatives for her future employment. With
the intervention of her occupational therapist Joy’s mental
health has gradually became stronger and stable. Joy will,
however, require ongoing support to enable her to realise
her long-term goals.
Case Study 2: Jessie
with thanks to Sarah Morris
Jessie is in her nineties and still lives in her own house.
She is well known in her neighbourhood, having worked
with her husband to teach generations of children to swim
at the local swimming pool. Her husband died a number
of years ago and so she lives alone now, receiving some
support from a niece who lives just around the corner.
Her two daughters are also supportive and one lives fairly
close but the other is further afield. She has no statutory
support.
Jessie was referred to the Day Hospital following
concerns expressed by her family that she was throwing
food away and wandering around the local area looking
for her mother’s house. The doctor who visited her
at home found that her house was in good order and
immaculately tidy. Jessie herself was neat and clean, but
it was clear from the looseness of her clothes that she had
lost a considerable amount of weight. Alzheimers disease
was diagnosed and the occupational therapist became
involved in order to assess Jessie’s ability to manage
independently. Jessie proved able to bath, wash, dress
and make a hot drink without any problems but these
achievements needed to be seen in the wider context and
so the occupational therapist used the Model of Human
Occupation Screening Tool (MOHOST) to summarise her
observations. These are detailed below.
Case Studies
Motivation for Occupation
Jessie is often overly confident about her abilities, without
being aware of her limitations. She is a lively character,
has a strong belief in her own abilities, and generally
anticipates successful outcomes. She participates in
most activities at the day hospital with enthusiasm and is
generally willing to try anything. She likes to keep active
and obviously values social company, and she has always
been house-proud so her domestic responsibilities give
her a clear sense of purpose. Unfortunately, she tends to
lack realism when she sets out to do things, so sometimes
makes inappropriate choices.
Pattern of Occupation
Jessie is on the go all the time and she rarely sits down
when on her own. She has maintained a daily routine of
getting up, bathing, and dressing, but without support she
neglects preparing or eating regular meals. For this reason,
a home help service was arranged to assist and prompt
with cooking and Jessie had difficulty accepting this
initially, as she believed herself to be perfectly capable.
Eventually she adjusted to the new routine and became
more accepting of help. She also adapted well to the Day
Hospital environment. She remains keen to maintain her
domestic role and most of her time is spent in domestic
activity. There are times, however, when she still believes
her mother to be alive and adopts inappropriate role
behaviour because of this.
Communication and Interaction Skills
Overall, Jessie has good communication and interaction
skills. Her non-verbal interactions are always appropriate
and she can put on a good social front even when
disoriented to time and place. She chats readily and is
mostly appropriate, but she may jump from one topic
to another. She can also confabulate at times and her
conversation can be repetitive. Moreover, the pace of her
conversation is very fast and when she becomes agitated
or distressed she tends to speak quite loudly. She has
been known to make derogatory comments about other
clients but these are infrequent and for the most part she
is very friendly and sociable. She has even made a new
friendship since she started to attend the Day Hospital.
MOHOST v.2.0 33
Case Studies

Process Skills able to make a hot drink safely and dress herself
independently. Her energy levels are more questionable
Jessie relies heavily on her previous knowledge of activities as she clearly finds relaxing difficult and enjoys always
and she is clearly disoriented and confused at times. being on the go, but her daughter reports that she has
Although she is well oriented to her home environment always been very active and so her energy levels now are
she often believes that she does not live there. She then only congruent with her past.
wants to return to her mother’s and has difficulty retaining
information given to reorient her. Her concentration Environment
is also quite poor and she becomes easily distracted,
making it difficult to complete tasks independently. Her The risks that Jessie faces by staying in the same
organisational skills are better, (as demonstrated by her environment need continuing assessment. Jessie values
ability to keep tidy), but she sometimes has difficulty the freedom of living independently and her home is
finding objects and has a history of losing money. She comfortably furnished. She is mostly disoriented to time
also has difficulty thinking through problems and without and person rather to place, and benefits from being in
firm direction she sometimes make rash decisions. familiar surroundings. She is also financially secure and
has no unmet needs that would be remedied by further
Motor Skills resources. As to social support, her daughters and niece
continue to provide what help they can. They are unable
Jessie is a highly independent lady. She has good posture to be with her 24 hours a day but Jessie is well known
and mobility and can, as she says, “walk for miles”. Her in the local community and when she wanders, people
co-ordination and strength are equally good, and she is have always brought her home. Finally, although Jessie

MOHOST Analysis of Strengths & Limitations

Jesse is highly motivated to be occupied but her pattern of activity is repetitive and
she requires assistance to organise her routine. She is a good communicator
despite being confused and her motor skills are excellent. Continuing assessment
is required to assess the risks of staying in her own home and to ensure that her
occupational needs are met.

Summary of Ratings

Motivation for Pattern of Communication & Environment:

Process Skills Motor skills
Occupation Occupation Interaction Skills Community

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F
A A A A A A A A A A A A A A A A A A A A A A A A
I I I I I I I I I I I I I I I I I I I I I I I I
R R R R R R R R R R R R R R R R R R R R R R R R

34 MOHOST v.2.0

enjoys her domestic responsibilities, they clearly do not
meet all her social, leisure and relaxation needs. The Day
Hospital remains a crucial factor in supporting Jessie.
Completing the MOHOST enabled the occupational
therapist to see where Jessie’s strengths and weaknesses
were. This in turn had an impact in the planning of
Jessie’s therapy, ensuring that the occupations she carries
out help to hold her concentration and maintain her
remaining problem-solving skills in addition to meeting
her social needs. The MOHOST was also used to provide
evidence that Jessie can sustain relationships and adapt
her routine with help, and that she is able to function in a
new environment and orient herself to the Day Hospital.
This gave the team hope that she would be able to adapt
to new accommodation should this become necessary in
the future. However, the decision was made that Jessie
should be supported at home with a large care package
as she so obviously values her domestic responsibilities
and feels positive about staying in her own home with the
support of her local community.
Case Study 3: Brendan
with thanks to Kylie Innocente
Brendan is a 36 year old Afro-Caribbean male who was
diagnosed as having Schizophrenia when he was 19. He
has had multiple admissions to secure and acute wards,
averaging an admission every year for the last 15 years.
He lives in supported housing with three other residents.
He reportedly has a good relationship with his parents.
His mother is on an Older Persons mental health ward
and his father lives at home. He also has a 26 year old
brother and a 41 year old sister with whom there is no
apparent contact. It has been noted that his maternal
Aunt is in a psychiatric hospital in Jamaica and has been
resident there for ‘some years’.
His most recent admission was precipitated by a rapid
deterioration in his mental state. He was running up and
down the stairs of his house, holding his head and yelling,
“I want to kill myself”. He was observed looking into the
mirror and grimacing throughout the day and staring at
pictures of Christ. There was reported enuresis and he
was urinating and vomiting on the floor and in drawers
of his room. Brendan described experiencing command
hallucinations to kill himself, and evidence of thought
insertion and withdrawl were noted. In addition, he was
Case Studies
experiencing visual hallucinations stating that he could
see the Devil and “all things evil”. Admission was at his
request and Brendan stated that he did not want to return
to his home as someone was bothering him. His care
manager denied any conflicts with other residents.
A risk assessment revealed that he was at risk to himself
and others. Risk behaviour has ranged from personal
neglect and reports that he wanted to kill himself in
addition to stabbing patients and strangers with cutlery.
Brendan was given an atypical anti-psychotic medication
and the MOHOST was used to assess his progress over
a period of time. It was chosen because it could be used
in collaboration with the multi-disciplinary team and
could be based on observations only, with no invasive
questioning being required at a time when Brendan was
acutely mentally unwell. Brendan was observed both on
the ward and also in the Therapy Centre that served his
ward and two others in the hospital.
a) The first MOHOST was completed when Brendan
was floridly psychotic before any medication was
prescribed.
b) Two months later, a second MOHOST was
completed. By this time Brendan was consenting
to take the maximum dose of anti-psychotic
medication and was consistently attending his
selected group programme.
c) The third MOHOST was completed after another
two months when Brendan was close to being
discharged from the hospital.
Motivation for Occupation
Appraisal of ability
a) Brendan wanted to be admitted because he
recognised that he felt unable to cope, but could
not identify the skills that he needed to work on.
[R]
b) He would often say, “I am no good”, and was unable
to see positive achievements. [R]
c) Verbal prompting from clinicians was still required
to maintain his confidence about the efficacy of his
skills. [I]
MOHOST v.2.0 35
Case Studies
Expectation of success
a) Brendan did not express his feelings. [R]
b) Brendan wanted to make some achievements but
was ambivalent about whether he would be able
to cope. [I]
c) Brendan was positive about his decision to move
into supported accommodation. [F]
Interest
a) Brendan could only tolerate therapy sessions for five
minutes at a time. There was no other evidence that
he was engaging in any other activity apart from
smoking cigarettes and making coffee. [R]
b) Brendan was able to express his interests but did
not always engage in them, e.g. Brendan identified
being interested in sports and relationships with
women. [I]
c) The nursing team reported that he was consistently
talking about his achievements and expressing
pleasure in the tasks he was engaging in. [F]
Choices
a) Brendan appeared unable to act on choices
regarding routine activities of daily living and was
dependent on nursing staff for self-care including
dressing. [R]
b) Brendan became involved in selecting the groups
he wanted to attend at the Therapy Centre. He also
planned to buy some new clothes but did not do so
despite offers of help [I]
c) Brendan had set the goal of wanting to move into
supported accommodation, and he was motivated to
engage in relevant groups. Some verbal prompting
was still required in order to achieve goals. [A]
Pattern of Occupation
Routine
a) All of his daily routine was structured by the acute
admissions ward e.g. breakfast, medications, lunch
and evening meal. All engagement in routine was
through verbal prompting from nursing staff. [R]
36 MOHOST v.2.0
b) Less prompting was required to attend to the routine
on the ward and at the Therapy Centre. [I]
c) Brendan adapted fully to the ward routine, and
attempted groups without prompting although
he still expressed some uncertainty about the
timings. [A]
Adaptability
a) Brendan was unable to tolerate conflicts between
other patients on the ward. He would become
agitated, screaming and then urinating in his
bedside cabinet and crying. [R]
b) Brendan was able to adapt to the changes in his
therapy programme and became less disturbed by
changes on the ward environment. [I]
c) Brendan appeared more able to tolerate change
but a visit to his new accommodation highlighted
a residual difficulty. It took a further visit and
encouragement from staff, for him to feel
comfortable. [A]
Roles
a) Brendan’s only role was that of being a patient. [R]
b) As before. [R]
c) Brendan demonstrated a strong sense of belonging in
the hospital and valued being known and belonging
to the Therapy Centre, but prompting was required
to enable him to take on new roles. [I]
Responsibility
a) Brendan was unable to take responsibility. He had
been evicted from his home but did not want to
retrieve any of his belongings. All decisions were
made by professionals involved in his care. [R]
b) He continued to avoid responsibility by stating he
was tired. It was clear to the occupational therapist
he was adopting the patient role. [R]
c) He began to take on extra responsibilities and would
clear up after himself, and make tea for others.
However, if someone else would offer to do these
tasks, he would relinquish the responsibility. [A]
 Case Studies

Communication and Interaction Skills operative) behaviour to other clients, offering his
cigarettes and making cups of tea on occasion for
Non-verbal skills female clients. [I]
b) Brendan developed a friendship with another client
a) Brendan’s affect was frequently observed to be
who had cooked a meal for him and they wentout
incongruent with the environment. e.g. laughing
walking together in the local area. He was also
tohimself and hyper posturing. [R]
observed to be supportive to female clients. [A]
b) Brendan still had difficulty controlling his body
c) It became apparent that the people initiating
language. Unusual posturing was attributed to
friendships with Brendan were requesting money,
Tardive Dyskinesia and incongruent laughter was
tobacco and clothing from him. Brendan’s lack of
still observed but to a lesser extent. [I]
assertiveness led to him being vulnerable. [I]
c) The incongruent laughter stopped and the dyskinesia
was controlled. However, he would shake one’s Process Skills
hand in greeting too hard and for too long and kiss
female staff two or three times on the cheek which Knowledge
was not his usual behaviour. [A]
a) Brendan was observed to have difficulties handling
Conversation objects that were not familiar to him, e.g. in an art
class he was utilising the felt tip pen the wrong way
a) Brendan would occasionally respond to a greeting around. [R]
with a monosyllabic answer but otherwise only
b) Brendan was still observed to be confused when
expressed distress, e.g., screaming at the auditory
engaged in an activity and verbal prompting and
hallucinations he was experiencing. [R]
modelling of tools for the task were required in
b) Brendan was now able to engage in a limited and order for tasks to be completed. [R]
basic conversation if questions were put to him
c) Prompting was still required to complete tasks, e.g.
by others. Prompting was still required to keep a
in baking, Brendan would know how to prepare the
dialogue. [I]
ingredients but would help to follow the recipe. [I]
c) He became able to initiate conversation, discussing
current affairs and world events. However, there Timing
were times when he would self isolate and ignore
any attempts to engage in conversation. [A] a) Brendan was not orientated to time or place. Verbal
prompting was required for all tasks other than
Vocal expression making a cup of coffee. [R]
b) Brendan began to enquire about his Therapy
a) Brendan was able to express himself when upset.
Programme in advance, e.g. he asked questions of
However, his verbal expression was loud, pressured
whether he needed to bring certain items with him
and mumbled. [I]
on a community visit. [A]
b) Despite his conversation having improved, Brendan
c) It was observed that Brendan continued to have
was still observed to be mumbling with pressured
difficulties with forward planning more than a few
speech. [I]
steps at a time but this had a minimal impact on his
c) His pressure of speech and volume had decreased. occupational functioning. [A]
Mumbling continued due to Tardive Dyskinesia,
but conversation could be followed. [A] Organisation

Relationships a) Brendan would always look for assistance for any

task before attempting independently. [R]
a) Brendan was observed to demonstrate friendly (co-

MOHOST v.2.0 37
Case Studies
b) Brendan was observed having difficulty searching
for objects, e.g. in an art group, he was observed to
knock items over and he became quickly frustrated
when he could not find a paintbrush. [I]
c) Brendan maintained his improvement. [I]
Problem-solving
a) Brendan would disengage from a task before a
problem arose. Instead of turning some music
down, he once put his hand to his ears and sat there
until another patient turned it down. [R]
b) Brendan was now engaged in tasks long enough to
encounter problems or difficulties. He reported that
he found it useful to talk with a staff member about
his concerns before his blood tests. [I]
c) It was clear that some deficits remained in all of his
executive functions. [I]
Motor Skills
Posture and mobility
a) Brendan always walked head down with his hands
in his pockets, and was reluctant to take his hands
out of his pockets even to make a coffee. [I]
b) Brendan began to walk with his hands out of his
pockets and his head upright, but this behaviour
fluctuated throughout the day. [A]
c) Brendan exhibited fluid and agile movements. [F]
Co-ordination
a) Brendan was able to co-ordinate and manipulate
movements but not without substantial difficulties.
Tardive Dyskinesia made his movements gross,
rigid and tremulous and when making a coffee,
there would be milk, coffee and water spilt on the
tabletop. [I]
b) As before. [I]
c) Brendan demonstrated excellent bilateral co-
ordination and reactive reflexes. [F]
Strength and Effort
a) Brendan was able to grasp, move and transport
38 MOHOST v.2.0
objects but consistently used too much force to
open doors and they would swing around into the
wall, on one occasion hitting another client. [I]
b) As before. [I]
c) Brendan improved but remained inconsistent in
how he moved and transported objects. [A]
Energy
a) Brendan had difficulty maintaining energy. He was
observed to fall asleep in groups and would say ‘tired’.
This was linked to the sedative effects of medication. [I]
b) Brendan was consistently reporting to be tired and
would disengage from activities as a result. This
information was fed back to the medical team and
his medication was decreased as a result. [I]
c) Brendan no longer reported feeling tired and
demonstrated an ability to engage in tasks for up to
two hours. [F]
Environment
Physical space
a) Brendan’s environment (acute admissions ward
and the Therapy Centre) provided the structure and
support that he required at this time. [A]
b) As before. [A]
c) Brendan began to explore his local community. He
personalised his bedroom space and reported to be
feeling safe. However the ward would not be able
to meet his needs for much longer. [A]
Physical resources
a) Brendan often threw away the possessions he
had. [R]
b) Brendan began to utilise more resources and was
given time to leave the ward environment. [I]
c) Brendan was living off a daily budget that was
meeting his needs and was independent in transport
use. He had stopped throwing away his possessions
and was keeping the ones he had. [F]
 Case Studies

Social groups a) Brendan sought only to perform habitual tasks such

as smoking cigarettes and making coffee,
a) Brendan was unable to engage in groups. [R] which were not affected by his reduced
ability. However, his personal care needs
b) Brendan occasionally received the support of his
were overwhelming and he was unable to
peers. One client volunteered to teach him to cook,
attend to them without physical assistance. [R]
and Brendan accepted. [I]
b) Brendan still found activity tiring and was reluctant
c) Brendan continues to have some social support from
to become independent of staff. [I]
fellow clients but very little from his family. [I]
c) The groups and activities offered to Brendan
Occupational demands appeared to meet his interests and needs. [F]

a)
Motivation for Pattern of Communication & Environment:
Process Skills Motor Skills
Occupation Occupation Interaction Skills Hospital

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

b)
F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I
R R R R R R R R R R R R R R R R R R R R R R R R

c)
Motivation for Pattern of Communication & Environment:
Process Skills Motor Skills
Occupation Occupation Interaction Skills Community

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A
I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

MOHOST v.2.0 39
Case Studies
It is clear that Brendan made significant gains. However,
he continued to lack confidence in his own abilities
and was thought likely to have initial difficulties coping
with change in the future. It was noted that his process
skills did not improve at the same rate as other skills and
in this respect the MOHOST reflects the chronicity of
Brendan’s condition. ‘Relationships’ was the only item
to receive a reduced rating and this perhaps reflects the
increasing awareness of his vulnerability by the multi-
disciplinary team. The ratings for the environment might
also have decreased if Brendan had not been discharged,
as they would have been unable to keep pace with his
increased ability to utilise resources. The median rating
of ‘A’ suggests that Brendan requires supervision, albeit
verbal prompting, to engage and sustain commitment to
tasks and activity. He was referred to 24-hour residential
home for people with long and enduring mental health
problems, where it was hoped that he would be able to
improve his ability to form relationships and build a more
supportive social network.
Case Study 4: Mark
with thanks to Katrina Reece
Mark is in his early 40s. He had his first psychotic episode
in his late teens leading to three admissions to hospital
in quick succession and a diagnosis of schizophrenia.
He met his wife in hospital and the marriage lasted for
5 years. During this time they had a son, but Mark no
longer has any contact with them due to having had an
injunction taken out against him, the circumstances of
which are not known. After he split up with his wife, he
had a period of living independently but states that this
was not successful. He therefore returned to living with
his parents, and gradually lost contact with the mental
health services.
When his parents divorced, Mark moved to live in staffed
accommodation in a different part of the country. Since
this time he has had three further admissions to hospital
when he has been detained involuntarily. During his
last admission he was preoccupied with delusions of a
religious nature and had difficulty interacting with others.
He did not believe that he should have been brought into
hospital, but was nevertheless very co-operative and
willing to engage. One of the reasons he gave for attending
occupational therapy was to increase his confidence in
managing activities of daily living. He attended a varied
40 MOHOST v.2.0
programme of activities including lunch and breakfast
cookery, baking, computing, wood sculpture, art, pottery,
quizzes and bowling games. The MOHOST was used to
evaluate his skills prior to discharge and used as a basis
for discussing the possibilities for independent living in
the future.
Motivation for Occupation
Prior to discharge, Mark was more aware of his strengths
and limitations. He was able to maintain a positive
attitude and belief in his ability to live independently
and he was also realistic in recognising that he would
require support. He consistently set goals for himself in
occupational therapy that were appropriate for his level
of ability and then worked methodically to complete
them. Within the hospital environment, he was always
keen to try new activities and he reported finding them
invaluable in helping him to recover. Ordinarily, however,
his interests had always been solitary and consisted
largely of computing, walking, doing jigsaw puzzles, and
writing music.
Pattern of Occupation
On the ward, Mark followed a routine that was balanced
and structured, but without occupational therapy
intervention he would have continued to have difficulty
in organising his routine to meet any responsibilities.
The change in his pattern of occupation demonstrated
his adaptability and this was also evident in his ability to
accommodate changes to group times and appointments.
However, the drawback to this relaxed attitude manifested
itself in a lack of commitment to any major roles. He had
no employment role, very little contact with his family
and a poor sense of belonging. He could demonstrate
responsibility for set tasks in therapeutic groups, but he
found it difficult to exercise responsibility in the group
home, where much was done for him.
Communication & Interaction Skills
Mark’s communication and interaction skills were
partially intact. He was able to sustain conversation with
staff but he was generally self-isolating and was rarely
observed initiating conversation. Once approached,
however, he was assertive and articulate. Indeed, his
relaxed manner sometimes seemed incongruous with the
situation and his eye contact could be so full as to make
 Case Studies

situation and his eye contact could be so full as to make Motor Skills
him appear to be overly familiar at times. Yet he did not
pursue relationships, and in many ways seemed to lack Mark had no problems with motor skills other than
interest in other people and to be entirely satisfied with becoming short of breath on exertion. He walked fluidly,
his own company. had a good range of movement and no evident problems
with strength and effort. It was also encouraging that he
Process Skills was willing to incorporate more physical exercise into
his routine.
Mark was able to obtain and retain information and select
tools appropriately. He could plan ahead, sustain intense Environment
concentration and was very methodical, preferring
to complete one job before moving on to another. He Mark’s progress needs to be seen within the context
needed assistance organising himself in order to carry out of a relatively supportive hospital environment where
multiple tasks, (e.g., necessary for cooking and baking), Mark can readily access the facilities he needs and is
and he demonstrated some difficulties in making decisions reasonably comfortable. The nurses support him to take
if problems arose. In general, although he recognised that his medication as prescribed and Mark appears to enjoy
he needed help, he was not sufficiently reflective enough the opportunities that he has for social interaction. He
particularly enjoys the activities available in occupational
to predict what it was that he needed help with.
therapy and sets projects for himself on the computer.

Analysis of Strengths & Limitations

Mark has been well-motivated to attend occupational therapy and would like to
work towards living independently.

At present, he has very limited roles and although living independently might
inevitable fill this gap, he would need some assistance in organising his respon-
sibilities and making decisions. There would also be a risk of him being isolated
without structured support.

Summary of Ratings

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills Hospital

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

MOHOST v.2.0 41
Case Studies

The MOHOST provided a useful structure to help the However, the occupational therapist was aware that Mark
occupational therapist analyse Mark’s abilities. Using the had not been functioning as well when he was living in the
MOHOST required the whole occupational therapy team community, so she completed another MOHOST based
to gather the information, including technical instructors on proxy reports of his functioning prior to admission.
and assistants, and once completed it ensured that the This highlighted that Mark’s functioning was markedly
team focussed on those aspects of functioning requiring different prior to admission, as even though he had
the most attention. This was particularly helpful for a been living in staffed accommodation the environment
student on placement with the occupational therapist. was not as conducive to his good mental health. The
accommodation was some distance away from a town
When Mark was first assessed, he had seemed so willing and there were no shops or community facilities nearby.
to engage and so able to express himself, that other The staff were not able to monitor Mark’s medication and
assessments had been used, including self assessments so it was likely that his health would rapidly deteriorate
and interview formats. However, it soon became clear if he returned to live there. Nor were they able to
that although Mark had sufficient insight to set himself influence his budgeting, with the result that Mark had
long-term goals, he was less able to identify the specific experienced financial difficulties and could no longer
objectives necessary for success. The MOHOST lent afford to use the internet on his computer. Over the years,
objectivity to this task and also led to the consideration the relationships with other residents had also become
of further therapist-rated assessments: the Assessment of more acrimonious so the whole environment was
Communication and Interaction Skills, (ACIS), and the affecting Mark’s mental health in a negative way.
Assessment of Motor Process Skills, (AMPS).

Summary of Ratings

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills Group Home

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F
A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

So the MOHOST allowed the occupational therapist concerned that independent living would not provide
to present her findings in a convenient report format him with the structure he needed. Mark decided to
for the multidisciplinary team and to the staff at Mark’s return to live in familiar surroundings for the time being
accommodation, and to gather her thoughts to give clear and a community psychiatric nurse was also appointed
feedback to Mark. to support Mark in taking his medication. A community
occupational therapist was allocated to give him extra
Mark was soon ready to be discharged and no alternative support to meet his goal of living independently. She
accommodation was forthcoming in the short-term. He planned to use the MOHOST on a repeat basis in order
accepted that the structure of the hospital had made a to review Mark’s progress in the future.
significant impact on his recovery and the team remained

42 MOHOST v.2.0

Case Study 5: Sophie
Sophie was referred to a community team via her GP. An
initial assessment was completed and was written up in
two formats a) a narrative home visit report, b) a MOHOST
Form. The narrative home visit report provides a detailed
account of Sophie’s needs and is complemented by the
MOHOST form which gives a brief summary.
Homevisit Narrative Report
Referral & Reason for Assessment:
The referral was received from Sophie’s GP Dr. Smith.
The referral stated that Sophie was now reporting
“difficulties with coping and mobility”. It also stated that
Sophie has early dementia and has a previous medical
history of osteoarthritis and congestive heart failure.
The reason for the assessment, therefore, was to assess
Sophie’s engagement with everyday activity and make
recommendations to support Sophie to feel like she can
“cope and manage her mobility” issues and support
with other potential unidentified difficulties engaging
in activity.
Sources of Information for Report:
This report is a compilation of information gathered on a
home visit (Sophie, Sophie husband & OT present) and a
telephone contact with Sophie’s Daughter.
Evidence based assessment used to gather data:
Parkinson S, Forsyth K, Kielhofner G (2005) The Model of
Human Occupation Screening tool (MOHOST), version
2.0, Model of Human Occupation Clearinghouse,
Department of Occupational Therapy, College of Applied
Health Sciences, University of Illinois at Chicago.
________________________________________________
History of Activity:
Information from Sophie:
She was previously a very active person. She worked
behind the bar of a local pub for 20 years before her
retirement five years ago. She enjoyed the social aspect
of her job and felt that a lot of the “regulars” at the pub
were like friends. Since retirement she has felt isolated.
She is extremely house proud, always had high standards
of cleaning and ran the household very efficiently. It was
Case Studies
important for Sophie to always present herself well. She
took great care of her appearance, liked to be “well
turned out” and had her hair set once a week. She
enjoyed spending time with her daughter and family. She
was particularly close to her granddaughter and they had
previously spent time together every Saturday out in the
community. She also enjoyed board games and knitting.
She used to volunteer at a local sheltered housing
complex where she made soup and meals and she was
involved in church events; running charity events for the
woman’s guild.
Information from Sophie’s husband and daughter:
They both confirmed the above information from Sophie
and so it could be concluded Sophie is an accurate
historian. They stated that Sophie’s activity levels fell
when she retired five years ago. There has been a gradual
deterioration over a 12 month period. She has been
sitting in her chair all day doing very little since her
recent hospital admission 6 months ago. This admission
was to review Sophie’s mental state – at this time she was
diagnosed with dementia.
________________________________________________
Current Mental/Physical Health:
A: Current Mental Health
On the visit Sophie was observed to be responsive and
co-operative; she reported that her mood has been low
for 6 months and that she no longer took any interest in
activities that were once meaningful. Sophie identified
the source of her low mood to include a) her inability to
mobilise out of doors, b) her recent hospital admission
(6 months ago), c) a flood incident in the flat above.
She states she is not coping with any activities that were
previously meaningful to her.
Sophie’s daughter feels her current low mood is due to
social isolation since retiring and having reduced mobility
ascending/descending stairs due to painful and swollen
feet. There is a podiatrist involved which has improved
the situation, however, Sophie still reports pain. Sophie’s
social isolation has worsened recently because Sophie
is not taking as much care of her physical appearance
and now would not want anyone to see her in an
unkempt state.
MOHOST v.2.0 43
Case Studies
B: Current Physical Health
Sophie needs a zimmer frame to mobilise around her
environment. She was observed to mobilise in her flat
independently and safely using this frame. She has not
gone outside for the past 12 months due to inability to
ascend/descend stairs. She was observed to have swollen
feet, with hyper-extended big toes which Sophie stated
were painful. Podiatrist and Physical Therapist are
involved. She wears glasses, although states she is able to
read without them. She reports deteriorated eyesight since
cataract operation. She stated has hearing aids which
she was not wearing on the visit. She was answering
questions appropriately and followed the conversations
so could hear people talking adequately.
________________________________________________
Current Engagement in Activity:
A: Physical Environment
Sophie was observed to live in a 2 bedroom, first floor flat.
External access is by 2 steps (no rails) into building, 100
yards paved corridor then 16 steps broken half way with
a landing (with rail right side ascending). The physical
condition of the flat was well maintained. It is centrally
heated and connected by a telephone.
B: Social Environment
Sophie states she has had a Home carer for the last 3
months who attends 3 times per day, seven days a week.
Sophie states she has not been enjoying the company of
her granddaughter recently.
Sophie lives with her husband and he states he is in good
health. He states he is frustrated with his wife’s lack of
engagement in activities and her perception that he isn’t
completing tasks to her standards.
Sophie’s daughter states she and her husband live close
by. They both work full time but Sophie’s daughter attends
every evening to support. She has 2 teenage children a
son and a daughter who now only attend sporadically.
Sophie has asked friends to no longer come round. She
states she doesn’t want them to see her unkempt.
44 MOHOST v.2.0
C: Daily Routine
Sophie’s husband states Sophie rises at 9am when
the home care assistant attends. She goes through her
morning routine then has breakfast at 9.30am. She sits
in the lounge chair watching TV all day and evening. The
homecare assistant attends at 1pm to carry out domestic
tasks. She then attends at 10pm to support Sophie with
her night routine. Sophie states she is not happy with this
routine but can’t “be bothered to do anything”.
D: Roles
i) Self Care
Sophie’s self care routine happens entirely within her
bedroom. Sophie does not a) strip wash at the bathroom
sink, b) use shower, or c) use perch stool due to lack
of confidence in her balance. Sophie states to wash
herself she has an established routine and sits on the
bedside commode. The care assistant (arranges needed
objects to support lack of mobility) and provides verbal
encouragement (to support lack of confidence). Sophie
and her daughter both state she has the skills to dress
herself independently on the commode. Grooming
herself is very important to Sophie and she states she is
currently unable to set her hair and no longer has access
to the hairdresser.
Sophie was observed on the visit to:
• Independently transfer on/off 16” high commode
using zimmer frame with a safe technique.
• Independently transfer on/off 16” high toilet, using
2” raised toilet seat & right wall grab rail, with a
safe technique.
• Bed transfer not observed.
• Sophie did not want to attempt shower transfer as
she is not currently using shower and is comfortable
with her current arrangement of strip washing
at bedside.
ii) Productivity
Cooking:
The kitchen was observed to have a gas cooker with
overhead grill, microwave, electric kettle, continuous
surfaces and a table and chairs.

Although she stated she previously enjoyed cooking for
the sheltered housing volunteer position, her husband
now does all the cooking and hot drinks. She states
she has “no interest” in cooking now although does
occasionally help prepare meals with her husband.
She feels she can’t do this now and feels she won’t
be able to do this independently. They have a diet
of toast in the morning, banana and bread for lunch
and a cooked meal in the evening. Sophie states she
doesn’t eat the vegetables because her husband doesn’t
prepare them well enough. Sophie’s husband feels that
Sophie still has the skill, supportive environment and
previous habits to cook but she is not motivated to do
so. He is frustrated by his wife’s lack of engagement
with cooking.
Task on Visit: Hot Drink
Sophie stated she wouldn’t be able to manage to complete
the activity. She did, however, managed to make the hot
drink independently with the following skill level,
Motor Skills: She was unsteady at time and slow,
however, physically managed without intervention. She
demonstrated some stiffness and reduction in strength.
She appeared to lack energy & sat at regular intervals
during the activity.
Process Skills: Sophie managed to use knowledge, plan
and organise the activity. She did, however, have difficulty
problem solving.
Laundry/Cleaning, Shopping: These activities are complet-
ed by the home carer and Sophie’s husband. They are
happy to continue to support, however, Sophie feels these
activities are not completed to “her standards”.
Volunteer Job: Sophie has not been involved with her
volunteer job for 3 years. She states she misses the social
contact and the feeling of “being useful”.
iii) Leisure
Sophie could identify interests that she engaged in in the
past. She specifically identified the social aspect of these
interests as being enjoyable and satisfying.
Sophie now appears to have reduced leisure opportun-
ities. She could identify specific TV programmes that she
enjoys watching. She receives a weekly visit at home
from the church. She could not identify anything else that
she does that brings her enjoyment.
Case Studies
Sophie’s daughter is particularly concerned that Sophie
is not engaging with previously leisure activities. Her
daughter states she feels that this is the key for supporting
her mother to “re-engaging life again”.
E: Goals
Sophie was unable to identify any goals for the future.
Sophie feels very pessimistic about her ability to return
to a meaningful life. She states she feels “hopeless” about
the future.
F: Readiness for change
Sophie’s current situation is not supportive of her mental
or physical health. The following are issues which indicate
that although Sophie wants to change her circumstances,
she is not ready to independently change and therefore
requires further extended occupational therapy input.
• Sophie lacks motivation to engage in doing activities
that were meaningful to her and cannot identify any
goals, develop plans and follow them through.
• Although socially isolated by not being able to
ascend/descend external stairs, Sophie stated that
she is not prepared to consider moving to alternative
accommodation on the ground floor. They have been
buying their council flat and moving would be too
large an upheaval.
• Now has carer support and developed strong habits
and dependence on this support.
G: Occupational Therapy View (see MOHOST Ratings)
Sophie gives the impression of a person who has given
up on life. Sophie has previously been an active woman.
She has had a reduction in activity in the past 5 years
since retiring and this has further reduced in the past 12
months and was accelerated within the last 6 months
following a hospital admission. This situation was brought
about primarily by a difficult transition from working to
retirement, physical limitations and pain when mobilising.
This has been compounded by the identification of the
start of a dementia process.
Motivation for Activity
Currently Sophie lacks motivation to engage in previously
held meaningful activity. Specifically, she has difficulty
MOHOST v.2.0 45
Case Studies

appraising her own abilities leading to being dependent Environment

on others. She doesn’t expect success in the future,
which leads to fear of failing and not meeting her high Sophie’s physical environment is problematic as her flat is
standards. She cannot identify any activities that bring her accessed by stairs and she cannot ascend/descend them.
enjoyment and is unable to set goals for the future. These This will not be easily resolved. Her social environment
characteristics create a situation where Sophie doesn’t is very supportive, however, carers are not supporting the
make choices to do activity apart from basic self care. development of Sophie’s engagement.

Pattern of Activity H: OVERALL RECOMMENDATION

Sophie has had substantial role loss over the last five Sophie’s current situation is not supportive of her mental
years, which has lead to an empty routine, a poor sense of or physical health. Although Sophie wants to change her
belonging and avoidance of previously held responsibility. circumstances, she is not ready to independently change
She demonstrates an unwillingness to agree to changes in and therefore requires further extended occupational
her current routines and ways of doing activities. therapy input.

Skill for Activity

NAME: Kirsty Forsyth
Sophie has adequate communication and interaction GRADE: Senior I
skills, however is now having challenges maintaining LOCATION: Edinburgh Community Rehabilitation Team
relationships. She has physical difficulties with balance,
stiffness, strength and energy. She has adequate processing cc. GP, PT
skills but has difficulty with problem solving.

Summary of MOHOST Ratings

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills Home

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

46 MOHOST v.2.0
 Case Studies

Case Study 6: Grace once a week and otherwise has a strip wash at the sink.
Grace feels it s very important to be clean and “not
The single observation MOHOST can be used by the smell”. She particularly likes to have her jewellery and
occupational therapist and/or support staff to document her make up on when visitors come to see her. She has
observations of one occupation – that leads up to the a hairdresser who visits her flat once a week (Saturday
completion of a MOHOST. The following case study of afternoon ready for the dance at night). Grace was very
Graces illustrates this. keen to get home “asap” as she hates hospitals and feels
it puts a burden on her son to visit.
Grace, a 79 year old woman, was admitted to an acute
care hospital following a chest infection. She was Proxy report (Information from Grace’ son about Grace’s
unable to cope at home and couldn’t complete any of home life)
her activities of daily living. The occupational therapist
received a referral once Grace was medically stable Contact was made with her son via telephone. Her son
– three days after admission. The occupational therapist states prior to admission Grace was not able to complete
completed a “functional assessment” which included her morning routine of dressing and getting breakfast due
a) Community occupational participation (discussion with to chest infection. She had also missed her tea dance the
Grace; discussion with Graces’ son) b) Ward occupational Saturday before admission – which is very unlike her.
participation (information from multi disciplinary Her son confirmed the above information and is keen his
team; personal care assessment; kitchen assessment). mother is discharged soon. He states she is like a “fish out
This allowed for a triangulation of information - OT of water” in hospital. He states his mother’s home help is
observation; information from client; information from a very supportive and praised the warden of the sheltered
community source. This enabled the OT to have multiple housing complex who apparently makes regular contact
perspectives on the client’s (ward and community) with all residents.
occupational participation and, therefore, strengthened
the likelihood of being able to develop a professional B) Ward Occupational Participation (used in MOHOST
judgement around the client’s safe discharged into the ratings)
community. Information from multi disciplinary team about how
Grace is performing in ward
A) Community Occupational Participation
Physiotherapists state that Grace can walk independently
Information from Grace about her home life using a stick. The stick is not used for support, however,
but gives Grace the confidence to walk. Nursing staff
Grace was orientated and keen to engage in conversation. states her medical condition has stabilised.
She was smartly dressed. Grace stated she lives in a
sheltered housing complex with a 24 hour warden for 6
years, that she is very settled there and has many good
friends. There is bingo on Wednesday nights and tea
dancing on Saturday nights in the lounge area and Grace
regularly attends these events. She has a wide circle of
friends and usually has visitors every day to her flat. This
is important because Grace hasn’t been outside in 5 years
and is reliant on the social life within the complex and
friends visiting her. Grace states her “legs are poor” but
she can manage with a stick. She has to make breakfast
for herself (tea and toast) and a sandwich for her evening
meal. A home help visits everyday to make a main meal
for her at lunchtime and also does her laundry, shopping
and cleaning. Grace is appreciative of this help but doesn’t
feel her home help cleans as thoroughly as she did. Grace
is helped in and out of the bath by her daughter in law

MOHOST v.2.0 47
Case Studies

C) Single observation form to document personal care assessment:

Client: Grace Assessment environment: Ward bedside

Date of birth: 79 yrs old Occupation being assessed: Dressing/personal hygiene
Hospital number: 9999999999 Date of assessment: 24th April 2005
F Facilitates participation in occupation Name of Assessor: K Forsyth
A Allows participation in occupation
I Inhibits participation in occupation
Designation: Occupational Therapist x
R Restricts participation in occupation
OT Support Staff o
N/S Not Seen Signature of Occupational Therapist:
Area to Evaluate Rating Comments
Shows awareness of strengths & limitations N/S F A I R Accurately assesses abilities
Motivation

Shows pride/seeks challenges N/S F A I R Mostly pleased with progress

Shows curiosity and demonstrates interest N/S F A I R Requires encouragement at times
Chooses clothes, wants to dress for son’s
Identifies preferences/is goal-oriented N/S F A I R
visit
Maintains routine habits (ADL) N/S F A I R Underlying habits are evident
Occupation
Pattern of

Some frustration because she is out of

Remains settled/copes with disruption/change N/S F A I R
home routine
Becomes actively involved with task/group N/S F A I R Absorbed in activity until completion
Fulfils responsibilities in the session N/S F A I R Very willing
Occasionally appeared unhappy with
Communication

Uses appropriate non-verbal expression N/S F A I R

& Interaction

progress
Initiates and sustains appropriate communication N/S F A I R Talked about plans for discharge
Uses appropriate vocal expression N/S F A I R Occasionally slow to respond
Relates to and co-operates with others N/S F A I R Always respectful and sociable
Chooses/uses equipment appropriately N/S F A I R No problems identified
Process Skills

Maintains focus throughout task/sequence N/S F A I R Mostly able to maintain focus

Works in an orderly fashion N/S F A I R Benefits from some minor prompts
Modifies actions to overcome problems N/S F A I R Beginning to anticipate difficulties
Mobilises independently N/S F A I R Managing transfers more easily
Motor Skills

Manipulates tools and materials easily N/S F A I R Some difficulty managing buttons
Uses appropriate strength and effort N/S F A I R Mostly able to grip items securely
Maintains energy and appropriate pace N/S F A I R Tires after five minutes
Space offers stimulus and comfort N/S F A I R Ward area was noisy and distracting
Environment

Resources allow safety and independence N/S F A I R Chair a bit too high
Social interaction provides support N/S F A I R Appreciative of small support provided
Demands of activity match abilities/interests N/S F A I R Able to dress in the way she wanted to

Summary [written in contemporaneous notes]
Grace has high standards of personal hygiene and personal
appearance. It is important to her that she wears makeup,
jewellery and has her hair set regularly. Grace managed
to wash and dress herself without support. She displayed
adequate motivation, routines, process skills within the
ward environment. Only areas of concern included
managing her buttons and ensuring she could take regular
rests due to fatigue.

48 MOHOST v.2.0
 Case Studies

C) Single observation form to document kitchen assessment:

Client: Grace Assessment environment: OT kitchen

Date of birth: 79 yrs old Occupation being assessed: Cup of tea and toast
Hospital number: 9999999999 Date of assessment: 24th April 2005
F Facilitates participation in occupation Name of Assessor: K Forsyth
A Allows participation in occupation
I Inhibits participation in occupation
Designation: Occupational Therapist x
R Restricts participation in occupation
OT Support Staff o
N/S Not Seen Signature of Occupational Therapist:
Area to Evaluate Rating Comments
Shows awareness of strengths & limitations N/S F A I R Kept within the boundaries of her ability
Motivation

Shows pride/seeks challenges N/S F A I R Very excited she completed task

Shows curiosity and demonstrates interest N/S F A I R Keen to find out if she could manage
Identifies preferences/is goal-oriented N/S F A I R Strong preference re task progression
Maintains routine habits (ADL) N/S F A I R Strong habits evident with task
Occupation
Pattern of

Remains settled/copes with disruption/change N/S F A I R Frustrated she was not in own kitchen
Becomes actively involved with task/group N/S F A I R Engaged in activity until completion
Fulfils responsibilities in the session N/S F A I R Understood expectation and fulfilled this

Uses appropriate non-verbal expression N/S F A I R Appeared tired throughout

Communication
& Interaction

Initiates and sustains appropriate communication N/S F A I R Appropriate communication

Uses appropriate vocal expression N/S F A I R Clear expression

Relates to and co-operates with others N/S F A I R Negotiated task appropriately

Chooses/uses equipment appropriately N/S F A I R Appropriate

Process Skills

Maintains focus throughout task/sequence N/S F A I R Remained focused

Works in an orderly fashion N/S F A I R Very precise organising tools
Modifies actions to overcome problems N/S F A I R Very active in overcoming challenges
Mobilises independently N/S F A I R Stick got in the way several times
Motor Skills

Manipulates tools and materials easily N/S F A I R Some difficulty manipulating knife
Uses appropriate strength and effort N/S F A I R Appropriate
Maintains energy and appropriate pace N/S F A I R Needed regular rests throughout
Space offers stimulus and comfort N/S F A I R Adequate maneuvering space
Environment

Resources allow safety and independence N/S F A I R Chair available for rests
Social interaction provides support N/S F A I R Rapport established
Demands of activity match abilities/interests N/S F A I R Pleased to have time off the ward

Summary [written in contemporaneous notes]
Grace is very particular about her routine around making
breakfast. She is very precise and organised within
the tasks. She doesn’t like clutter or messiness and
cleared her tools regularly. Grace was able to make tea
and toast independently. The main concern is that
she needs regular rests throughout the activity. She
did, however, realise this limitation and initiated
regular rests herself. Grace states she has a table
and chair in her kitchen to allow her to have rests.

MOHOST v.2.0 49
Case Studies

Prior to discharge, the standard MOHOST form was used to summarise the information above:

Summary of MOHOST Ratings

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills Ward

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

Grace is able to take care of her basic needs within the and her son is supportive of this. The occupational
ward environment. This level of occupational participation therapist recommended discharge when her home help
in the ward (see MOHOST ratings) is consistent with the could be reinstated. The OT also contacted her son and
ability she needs to have in order to be discharged to warden of sheltered housing complex to inform them of
her home environment (see report of home abilities from Grace’s fatigue.
Grace and her son). She is keen to return home quickly

50 MOHOST v.2.0

CONCEPTS O.T. AIMS
• To provide opportu-
Appraisal of Ability nities to experience
success
• To encourage self-
Expectation of Success appraisal and
awareness
• To facilitate the
Interest stimulation of new
and previously held
interests
Choices • To promote choice
within accepted values
• To provide a structure
Routine
capable of supporting
productivity
• To encourage tolerance
Adaptability
and acceptance
• To promote the impor-
tance of commitment
Roles
and involvement
• To facilitate
opportunities for taking
Responsibility responsibility
• To provide clear feed-
Non-Verbal Skills
back and positive role
modelling
• To encourage assertive
Conversation
behaviour and
communication
• To facilitate appropriate
Vocal Expression self-expression
MOHOST v.2.0
• To promote co-opera-
tion and the value of
Relationships social interaction
51
OCCUPATIONAL
CLIENT’S AIMS STRATEGIES
FORMS
• Occupations that offer
a high degree of
tangible success • Give verbal encourage-
• Graded activity that ment and feedback
To be confident and
motivated to set challenges perceived • Agree contracts and
occupational goals, ability document these clearly
to have interests and • Occupations that
• Offer reinterpretation
Chapter Ten:
be able to maintain reflect social and envi-
ronmental constraints of events and opportu-
worthwhile occupations
nities for reflection and
• Occupations that are for testing out reality
valued by the person/
provide satisfaction
• Balance between
work and leisure • Negotiate balanced
occupations activity schedules
To have a productive Give reminders and
• Occupations that simu- •
routine and clear coping prompts
late previous interests
strategies, to be able to take
offering either novelty • Encourage self-
responsibility and
or familiarity monitoring and
be actively engaged in
occupational roles • Occupations that can self-evaluation
QUICK GUIDE TO TREATMENT PLANNING
be graded according to • Explore barriers to
time and the responsi- developing new roles
bility required
• Offer cues for
• Occupations that allow interaction
To possess communication self-expression
• Facilitate
& interaction skills • Tasks requiring sharing communication using
necessary for occupational
and teamwork open questions
performance, to be self-
aware & assertive, able to • Occupations that offer • Offer opportunities
express self and have graded opportunities for self-reflection and
for social contact mental rehearsal
positive relationships
with others
• Activities requiring • Set clear boundaries
healthy competition and agree ground-rules
for groups
52
CONCEPTS O.T. AIMS
Knowledge
• To provide clear and
relevant information
• To encourage and offer
Timing
appropriate prompts
MOHOST v.2.0
throughout
• To facilitate effective
Organisation
organisation
• To promote indepen-
dent problem-solving
Problem-solving
• To provide appropriate
Posture & Mobility aids, equipment and
education
• To encourage
Co-ordination adaptation and energy
conservation
• To facilitate graded
Strength & Effort activity, especially daily
living activities
• To promote relaxation
Energy and strategies to
increase fitness
• To provide a safe &
Physical Space
appropriately stimulat-
ing environment
• To encourage
Physical Resources
exploration of resources
• To facilitate communi-
cation with significant
Social Groups
others
• To promote occupation-
al and environmental
Occupational Demands
analysis
CLIENT’S AIMS
To have the knowledge,
planning and organisational
skills to be able to
complete occupations
effectively and efficiently,
and to be able to cope with
problems independently
To have the mobility,
strength and co-ordina-
tion to carry out activities
of daily living safely and
independently and be able
to pace self efficiently
To live in an environment
that is safe, comfortable and •
appropriately stimulating,
with adequate resources and
support to allow occupa-
tional goals to be met easily
and independently
• Occupations in mean-
OCCUPATIONAL
STRATEGIES
FORMS
• Practical and creative
activity
• Develop risk
• Occupations that offer management strategies
Treatment Planning
graded opportunities for
• Deconstruct activities
decision-making
into component tasks
• Occupations that orient
• Use repetition
the person in time and
space • Focus on solutions and
problem-solving
• Occupations that build
on previous knowledge
• Set realistic goals
• Occupations that offer
within the constraints
graded opportunities
of performance and the
for physical exercise
environment
including general
mobility and transfers • Teach proven tech-
niques in the context
• Personal and domestic
of practising occupa-
activities of daily living
tional behaviours
• Occupations that are
• Involve careers to rein-
perceived to be relaxing
force techniques
• Give feedback regard-
• Occupations in alterna-
ing the effect of the
tive environments
environment and oc-
Occupations which cupational forms on oc-
maximise use of cupational functioning
resources and match
• Facilitate graded
interests, energy and
exposure to new
time available
environments
• Be clear about social
ingful social settings
and cultural dynamics
 Treatment Planning

The preceding chart gives a brief outline of the role that
the MOHOST and the Model of Human Occupation can
play in treatment planning; giving examples of how the
general aims of an occupational therapist and a client
will be influenced according to the particular skill
deficits identified. It is intended to be of particular use for
students and those therapists who are unfamiliar with the
Model of Human Occupation.
The example aims, goals, occupational forms, and
strategies are not intended to be comprehensive and
neither are they meant to be prescriptive. Wherever
possible, aims should be re-worded as specific objectives
in order to serve as measurable targets. These will state
clear timeframes, behaviours and contexts, including the
degree of support required and any conditions that need
to be observed.
The connections between skill items and strategies
becomes even more indistinct, in that it is quite plain that
the first strategy, i.e., ‘giving verbal encouragement and
feedback’, is fundamental to all good therapy, irrespective
of the underlying issues that require treatment. The chart,
however, may still be useful in helping a whole team to
focus in on the essential processes that we need to consider
for clients with particular skill deficits. This would help
to ensure that a consistent approach is maintained, and
provide a clear focus for therapy.
Ultimately, we must remember that,
“Good therapy never substitutes generalised
principles for detailed knowledge of the individual’s
situation. Rather, knowledge of each client should
infuse any general principles with local meaning”,

It is recognised, however, that occupational therapists (Kielhofner & Forsyth, 1997, p.109).
may not always be working in settings that afford them
the degree of control requisite for preparing specific Reference
objectives. Given that time is often at a premium in these
settings, the chart may provide a useful aid to highlighting Kielhofner G, Forsyth K. (1997) The Model of human
those aims that require the most attention depending on the Occupation: an Overview of Current Concepts. The
type of deficit experienced. For instance, although every British Journal of Occupational Therapy, 60(3), 103-110.
client undoubtedly needs the opportunity to experience
success, (this being at the heart of what occupational
therapy is about), it becomes meaningless in treatment
planning if it is written indiscriminately for every client.
Also, if a client’s main deficits affect their motivation for
occupation (volition), then it makes little sense to work
on those aims related to performance issues until their
motivation is addressed.

As to recording the client’s goals, the occupational

therapist needs to discuss this with the individual in order
to gain a clear understanding of how they relate to the
MOHO framework. Once agreement is reached then
the best course of practice is generally to record these
goals using the client’s exact words, in order to retain the
client’s understanding and commitment.

Similarly, there can be no standard formula for deciding

on the most appropriate occupation to use in therapy.
Certain occupations might appear to be more suitable
than others, but a therapist must primarily be guided by
the client’s interests and values.

MOHOST v.2.0 53
 Chapter Eleven:
GUIDELINES FOR USING THE RATING SCALE
Deciding which rating to assign is a professional
judgement, informed by the data gathered by the
occupational therapist
The MOHOST uses a 4-point rating scale. Assigning
a rating requires the therapist to use the information
gathered to make a professional judgement about the item
that is being rated. This professional judgement requires
that the therapist to clearly understand the item being
rated, the rating system, and the information gathered.
(See page 23 regarding how to handle conflicting data.)
Rating system
The 4-point rating system:
• F - Facilitates occupational participation
• A - Allows occupational participation
• I - Inhibits occupational participation
• R - Restricts occupational participation
For each item, the therapist is required to assign a rating of
F, A, I, or R as an indication of how the client participates
in occupation and how well the environment supports
the client. The first twenty items refer to aspects of the
client’s occupational participation and the last four to
aspects of the environment that underpin occupational
participation. As such, the environment section is slightly
different, in that it refers not to occupational participation
per se, but to the level of support that the environment
affords, according to the opportunities and resources that
are available, the constraints and the demands. However,
the meaning of each the rating scale is the same across all
items. That is, a rating of “F” is an indication of appropriate,
satisfactory occupational participation, where the
person’s occupational participation reflects acceptable
functioning in his or her culture/context. A rating of “A”
indicates that there are times when the client continues
to have a few difficulties participating in occupation due
to a noticeable albeit small remaining awkwardness, or
that occupational participation is put at risk and that the
client remains vulnerable due to the effect of this item.
A rating of “I” indicates that the client is experiencing
difficulties in this area and that this has a major impact
54 MOHOST v.2.0
on his or her occupational participation. In addition, a
rating of “I” indicates that the person has a significant
difficulty meeting the requirements or demands of his or
her culture/context. A rating of “R” reflects an aspect of
the person or the environment that restricts occupational
participation.
If in doubt about how to remember the value of ratings
scale, one may find it helpful to think about how
much therapeutic intervention is required to sustain
occupational participation.
• F - No outside support required
• A - May benefit from occasional support
• I - Requires support and/or encouragement
• R - Unable to manage despite support
Finally, it is important to bear in mind that the MOHOST
is designed to measure a broad range of occupational
participation with a wide range of individuals. In
particular, it is designed for clients who have challenges
engaging in their occupations. Therefore, “F” does not
represent excellence and it is quite possible that an
average person who is functioning adequately in his or
her life will receive mainly ratings of “F” with perhaps
a few “A” ratings. A client who received such a ratings
profile would not be expected to require the services
of an occupational therapist, whatever their diagnosis
might be. On the other hand, there are some clients who
experience problems with occupational participation
to such a degree that they are likely to receive “R” for
most items, with the odd “I” or even “A”. It is extremely
important that the therapist use the rating scale with this
in mind. This continuum includes the most chronically
disorganised, decompensated individuals to the client
who has many strengths and who could generally be
described as a good all-rounder, - no more than this.
Criteria Statements
The meanings of the ratings F, A, I and R are constant
across all items. Assigning these ratings require clinical
judgements that are complex and may involve different
considerations depending on the content of a given item.
 Guidelines for Rating Scale

To make this process easier, broad criteria are written
next to each item that the therapist should consider
in assigning ratings as well as a page-to-view list of
behavioural criteria in the manual. Therapists should not
spend long periods of time pouring over the criteria. The
important decision to make is whether to assign a rating
of F, A, I, or R. The criteria exist to aid this decision. A
therapist who has become familiar with the assessment
would not be expected to be frequently returning to the
manual to refer to the meanings of ratings for individual
items. A single criteria statement has been included
directly on the assessment in order to simplify the process
of assigning ratings, but therapists should be clear about
the differences between the ratings and the criteria
statements. Criteria statements are provided to clarify for
therapists the typical way in which a rating of F, A, I, or R
is typically manifested for any given item. For example,
for the Motivation for Occupation item ‘Expectation of
Success’, a rating of “I”, is typically or most likely to
be seen when an individual has difficulty sustaining
confidence about overcoming obstacles or alternatively,
is overly confident. On the other hand, for the Pattern of
Occupation item ‘Routine’, a rating of “I”, is typically or
most likely to be seen when an individual has difficulty
organising routines to meet occupational responsibilities
without support. For both items, a rating of “I” means that
the item allows participation in occupation. The criteria
may not be all-encompassing and it is quite possible
that a therapist may recognise some uniquely different
characteristics in their client that still warrant a rating
of “I”. The criteria statements are provided to assist the
therapist in narrowing down the options as to which
rating to assign, but above all else the therapist needs to
pay attention to the fundamental meaning of the rating
scale.
When making a rating, the therapist should begin by
looking in the criteria column. The therapist may decide
to underline aspects of the criteria statement on the
assessment that best describe the factors influencing
their client’s occupational participation. This may act as
a handy indicator of the most appropriate rating. More
than one part of a criterion statement can be underlined
for any item.
Once the appropriate descriptive criteria have been
underlined, the therapist can look to the rating scale
points, F, A, I, or R to assign a rating. The underlined
statements provide help to identify the appropriate rating
for a client. In the example below, two parts of a criteria
statement have been underlined next to the rating of “I”. A
therapist would circle the rating “I” after having checked
these descriptive statements.

Posture & Mobility F Stable, upright, independent, flexible, good range of movement
(possibly agile)
A Generally able to maintain posture and mobility in occupation,
independently or with aids
stability walking I Unsteady at times despite any aids, slow or manages with difficulty
alignment reaching
positioning bending R Extremely unstable, unable to reach and bend or unable to walk
balance transfers
Comments:

If the specific criteria on the assessment do not entirely from top to bottom, one can locate the statements thatbest
match the client, then a therapist who is unfamiliar with describe the client. For the example below, the therapist
the MOHOST may wish to check the expanded set of mentally places a tick against those criteria that describe
criteria in the manual for further assistance. By scanning the client and thus confirms a “I” rating.

MOHOST v.2.0 55
Guidelines for Rating Scale

Posture & Mobility

F = Facilitates occupational participation

Stable, upright, independent, flexible, good range of movement (possibly agile)
• good rotation and flexion of the spine
• maintains balance with ease, keeping the body stable without support
• positions self in relation to objects so that movements are most effective
• reaches safely in all directions

A = Allows occupational participation

Generally able to maintain posture and mobility in occupation, independently or with aids
• movements are awkward at times
• moves slowly or hesitantly at times
• reaching objects requires effort
• slight stoop or leaning, awkward gait

I = Inhibits occupational participation

Unsteady at times despite any aids, slow or manages with difficulty
• may need some help with domestic activities of daily living ✓
• some unsteadines, shuffling or lurching ✓
• stooped or leaning posture leads to some instability ✓
• uses aids for support or furniture to prop self upright, may use wheelchair effectively
• uses excessive movements or has difficulty bending and reaching

R = Restricts occupational participation

Unstable, unable to reach or bend, unable to walk
• dependent on others to help with domestic activities of daily living due to lack of posture/mobility
• moving results in unacceptable delay or effort
• poor trunk control, risks falling or other danger due to poor stability or positioning
• unable to mobilise independently or reach objects independently

When more than one rating has criteria statements that
describe the client
However, as in the next example, it may be possible
for the criteria statements to suggest a rating of either
“A” or “I” because the therapist identifies some criteria
statements that allow occupational participation and
also some criteria statements that inhibit occupational
participation. If the therapist is confident that a particular
rating truly represents the client’s functioning then this
rating should be made irrespective of any criteria that
match. For example, the therapist may decide that even
though several statements that could indicate a “A” rating
are applicable, the person’s occupational participation
remains inhibited and so the person should still be given
a “I”. It is especially important to refer back to the ratings
system rather than simply circling the rating next to the
one with the most statements that match, because the
number of criteria statements is not the same for each
rating. (The therapist may have identified more matching
statements next to the “A” rating simply because there are
more statements next to “A” than there are against the “I”).
Remember, criteria statements are simply typical instances
of a particular rating for a given item that have been
identified by the developers and other expert clinicians
who have been part of the development process. No
attempt has been made to make the criteria for the ratings
symmetrical. The aim is to identify criteria statements
that were likely to be used regularly by therapists in
assigning a rating. Therapists should remember that it is
not the number of criteria statements that match beside
a particular rating which determines a rating, rather
the impact on the person’s occupational participation.
Therapists should remember that it is not the number

56 MOHOST v.2.0
 Guidelines for Rating Scale

of criteria statements that match beside a particular truly undecided, the lower of the two ratings should
rating which determines a rating, rather the impact on always be circled in order to assist planning treatment
the person’s occupational participation. If the therapist is goals.

Posture & Mobility

F = Facilitates occupational participation

Stable, upright, independent, flexible, good range of movement (possibly agile)
• good rotation and flexion of the spine
• maintains balance with ease, keeping the body stable without support
• positions self in relation to objects so that movements are most effective
• reaches safely in all directions

A = Allows occupational participation

Generally able to maintain posture and mobility in occupation, independently or with aids
• movements are awkward at times
• moves slowly or hesitantly at times ✓
• reaching objects requires effort
• slight stoop or leaning, awkward gait ✓

I = Inhibits occupational participation

Unsteady at times despite any aids, slow or manages with difficulty ✓
• may need some help with domestic activities of daily living ✓
• some unsteadines, shuffling or lurching ✓
• stooped or leaning posture leads to some instability
• uses aids for support or furniture to prop self upright, may use wheelchair effectively
• uses excessive movements or has difficulty bending and reaching

R = Restricts occupational participation

Unstable, unable to reach or bend, unable to walk
• dependent on others to help with domestic activities of daily living due to lack of posture/mobility
• moving results in unacceptable delay or effort
• poor trunk control, risks falling or other danger due to poor stability or positioning
• unable to mobilise independently or reach objects independently

When several ratings have criteria statements that
describe the person
It may not always be the case that the descriptive criteria
cluster neatly around the rating. This most commonly
happens when a client’s occupational participation is
inconsistent, or when their occupational participation
varies according to the environment or the amount of
support available. If the criteria statements that match
arerepresentative of ratings F, A, and I, the therapist
should recall the meaning of the 4-point scale previously
discussed. A rating of “F” should be given if the item
facilitates occupational participation, a rating of “A”
if it allows occupational participation, an “I” indicates
that occupational participation is inhibited, and “R” if
occupational participation is restricted. The rating given is
likely to be the visual average of the criteria statements.
If the criteria that match are spread across ratings of F, A,
and I then a rating of “A” may well be the most appropriate
rating. However, in making a professional judgement, the
therapist must weigh how important each of the criteria
statements are in assessing the occupational participation
of a particular client.

MOHOST v.2.0 57
Guidelines for Rating Scale
When there is not a criteria statement to describe the
client, the therapist should write down the observation
that they have used to justify the rating in the space
reserved for ‘comments’. The criteria statements are
designed to capture the more common patterns of
occupational participation in occupational therapy
clients. Simply assign the appropriate rating and write
in the comment section why such a rating was made,
always referring back to the general meanings of F, A, I or
R to assist in making the rating. Similarly, if the therapist
has selected one or more descriptive criteria, but feels
strongly that an additional factor (not listed as one of the
criteria) is considered important to making the rating,
the therapist should briefly write down this additional
criterion in the comments section.
Important Principles to Guide Ratings
• Making ratings is a professional judgement, informed
by the data gained by the therapist.
• The intent of the criteria statement is to act as a handy
reference for selecting the appropriate rating.
• Underline the criteria statements that best describe
the client’s level of occupational participation.
• Therapists are not expected to spend a great deal of
time selecting the appropriate criteria statements.
• Focus on making appropriate ratings of F, A, I, or R.
Use the criteria statements to focus this process.
• When there are not descriptive criteria that
characterise the client (or when important aspects of
the client are not captured by the criteria), therapists
should write in descriptive criteria in the comments
column.
Finally, make ratings in terms of the cultural context
in which the client lives. A final and important issue
in making a rating for any item is to consider what is
functional in the individual’s culture and context. The
format of the MOHOST requires that the user be able
to make judgements about what is adaptive within
the culture and other relevant contexts to which the
individual belongs. In taking culture and context into
consideration, therapists should always recall that
occupational participation is reflected in two factors: a)
maintaining and enhancing the individual’s well-being
and b) satisfying or meeting the reasonable expectations
or norms of one’s occupational behaviour settings.
58 MOHOST v.2.0
The most important issue surrounding sensitivity to
culture and context is to avoid imposing therapist’s
individual cultural views when making ratings. This is
probably best illustrated by example. Western cultures
generally emphasise such values as mastery over one’s
context, achievement, keeping busy, and independence.
Eastern cultures place higher values on harmony with
one’s context, belonging, reflection and interdependence.
An older individual in the West who experiences a
disability will tend to strive for maintaining activity and
independence and his or her family will similarly expect
and wish for this. However, an older individual from the
East may feel dishonoured if her or his family does not
readily accommodate to the disability and will feel less
need to struggle for independence and physical activity.
That family, in turn, considers it their honour-bound duty to
take care of the elder with a disability, thereby minimising
his/her need to struggle against functional limitations.
Both options represent different and culturally relevant
ways of adjusting to a disability while maintaining an
occupational life that satisfies self and others. In the case
above therapists should be aware of their own cultural
background and, thereby, avoid imposing criteria from
one cultural perspective upon an individual from another.
Sensitivity to cultural differences does not begin when the
therapist is completing the rating scale. Rather, it begins
with how the data is gathered. The therapist should gain
an appreciation of the cultural perspectives that influence
an individual’s views about their lives.
Decision-Rules for Assigning a Rating on the 4-Point
Scale
• Always remember the scale rating meanings and use
the scale accordingly (i.e., F = facilitates occupational
participation, A = allows occupational participation,
I = inhibits occupational participation, R = restricts
occupational participation).
• Criterion statements will usually give an indication of
the appropriate rating, however, the therapist needs
to make a judgement of what rating best describes
the client.
• When it is not clear which of two ratings to use
choose the lower of the two possible ratings.
 Guidelines for Rating Scale

• When the client’s lifestyle or occupational

participation means criteria statements are
inappropriate, use the meanings of the 4-point
rating scale to assign a rating and write in the
commentssection to explain the rating.
• Do not impose a specific cultural value when making
the ratings; make the ratings in terms of the context in
which the person lives.

MOHOST v.2.0 59
 Chapter Twelve:
INSTRUCTIONS AND EXPANDED CRITERIA

1. Fill in the client’s details and the details of the assessor

Client: _____________________________________ Assessor: __________________________________

Age: _______ Date of birth: _____/_____/_____
Gender: Male o Female o
Identification code: __________________________
Ethnicity: White o Black o Asian o
Other: __________________________
Health condition: ___________________________
Designation: _______________________________
Signature: __________________________________
Date of first contact: _____/_____/_____
Date of assessment: ______/_____/_____
Treatment settings: __________________________
___________________________________________

Designation

This is likely to be Occupational Therapist. Any worker who is familiar with the Model of Human Occupation could
complete the assessment. However, previous research has shown that a lack of knowledge of the model may affect the
reliability of an assessment.

Treatment settings

Include any relevant information including e.g., therapeutic groups, home visit, ward environment. In particular, use
this opportunity to clarify whether the ratings reflect the client’s occupational participation across a range of settings,
or whether they correspond purely to the client’s engagement in occupational therapy.

2. Ensure familiarity with the ratings key

All ratings will refer back to these fundamental definitions, (see chapter twelve).

F Facilitates occupational participation

A Assists occupatioinal participation
Rating Scale
I Inhibits occupational participation
R Restricts occupational participation

3. Rate each item at a time

Each item has a number of key concepts listed below it, which might help you to define the skill. Your task is to circle
the number that most clearly corresponds with your perception of your client for each skill item. If you are unsure
how to rate a client, then you can refer to the expanded set of descriptive criteria in the manual. These should help to
distinguish related items, as well as giving examples of the factors that may justify each rating. However, the criteria
are meant to offer guidance only and cannot be expected to describe the precise behaviour of each individual. The
therapist’s responsibility is to constantly refer back to original ratings key in order to maintain an objective perspective.
We should not avoid reporting a deficit on the grounds that the person assessed is doing “very well in spite of their

60 MOHOST v.2.0
 Expanded Criteria

difficulties”. Only by acknowledging the problems that our clients face can we truly recognise their strengths in
overcoming them and plan treatment strategies together.

Item Rating Specific criteria

Appraisal of ability F Accurately assesses own capacity, recognises strengths, aware of limitations

Understanding of cur- A Reasonable tendency to under/over estimate own abilities, recognises

rent strengths & limita-
tions, accurate belief
in skill, awareness of
competence, awareness
of capacity
some limitations
I Difficulty understanding strengths and limitations without support
R Does not reflect skills, fails to realistically estimate own abilities
Comments: David tends to overestimate how much he can
achieve

Key concepts

4. Record an item as ‘not assessed’ if unsure how to rate

There may be occasions when the occupational therapist completes a MOHOST within a set time, e.g., to prepare
for a review of a person’s progress with the multi-disciplinary team, but finds that it is not possible to rate one or two
items. Given that the ratings do not lead to a total score, it is possible to leave these ratings as blank rather defer the
assessment, e.g:

Timing F Sustains concentration, starts sequences and completes occupation at

appropriate times
Initiation A Generally able to concentrate, start, sequence and complete occupations
Completion
Sequencing I Fluctuating concentration or distractible, difficulty initiating, sequencing
Concentration & completing
R Unable to concentrate, unable to initiate, sequence or complete
occupations

Comments: Not yet assessed

5. Record items as ‘improving’ if the item continues to warrant a particular rating but improvement has been noticed

Responsibility F Reliably completes activities and meets the expectations related to role
obligations
Role competence A Copes with most responsibilities, meets most expectations, able to fulfil
Meeting expectations most role obligations
Fulfilling obligations I Difficulty being able to fulfil expectations and meet role obligations
Delivering without support
responsibilities R Limited ability to meet demands of activities or obligations, unable to
complete role activities

Comments: Some improvement in recent days

MOHOST v.2.0 61
Expanded Criteria

6. Document the environment in which the skills have been assessed

The environment will always influence a person’s performance and we often behave very differently depending on
whether we are with our family, or our friends, or are work colleagues, as we will hold different roles in the different
environments. So an occupational therapist needs to be clear about the context in which a person’s skills have been
assessed. For example, the person may have been assessed only in the occupational therapy department or only in a
day hospital or only in their own home. Or, if their presentation is consistent across a broader range of environments,
the assessment may cover their occupational participation in wider contexts, such as the hospital as a whole, or the
community. However, it will often be necessary to complete two or more MOHOST assessments to analyse the impact
of different environments, especially when the facilities, resources, social groups and occupational demands offer
different levels of support.

Motivation for Pattern of Communication & Environment:

Process Skills Motor Skills
Occupation Occupation Interaction Skills Day Hospital

ENVIRONMENT Primary Environment assessed: Day hospital

7. Complete the summary sheet

Write a summary of your comments, highlighting the main points, e.g.:

David remains moderately overconfident given his current inability to maintain

a balanced routine. All his performance skills are relatively intact. He is capable
of good planning and organisation skills and his communication and interac-
tion skills are much improved. He continues to have difficulty with problem-solv-
ing and tends to be very impulsive with the result that he has few occupational
demands that fit his needs and interests.

Copy out the ratings. This provides a record that can be compared at a glance with previous or subsequent
assessments.

Motivation for Pattern of Communication & Environment:

Process Skills Motor skills
Occupation Occupation Interaction Skills Hospital

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A
I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

62 MOHOST v.2.0
 Expanded Criteria

Motivation for Occupation

APPRAISAL OF ABILITY

Key concepts Accurately assesses personal strengths & limitations

Accurate belief in skill &
Accurate awareness of capacity
inc. Awareness of physical, intellectual and social abilities
N.B.* Confidence in ability to utilise skills effectively is asserted in CHOICES
Confidence in social situations is assessed in RELATIONSHIPS
Ability to take credit or criticism is assessed in RESPONSIBILITY
Ability to think rationally is assessed in PROBLEM-SOLVING

F = Facilitates occupational participation

Accurately assessed own capacity, recognises strengths, aware of limitations

• recognises impact of medical conditions on skills and abilities

• recognises own progress or lack of progress, accurately reflecting on past performance
• accepts that skills are not perfect
• recognises the impact and consequences of limitations
• accurately predicts own performance

A = Allows occupational participation

Reasonable tendency to over/under estimate own abilities, recognises some limitations
• finds self-appraisal difficult and/or painful but acknowledges strengths and limitations
• is beginning to discover changes in personal capacity
• may not fully appreciate the impact or all the consequences of limitations
• mostly able to predict own performance

I = Inhibits occupational participation

Difficulty understanding strengths and limitations without support

• usually under or overestimates own abilities

• overestimates limitations, possibly in order to maintain secondary gains
• overestimates strengths leading to inappropriate occupations that exacerbate symptoms
• unduly self-critical at times
• has difficulty defining particular strengths and limitations

R = Restricts occupational participation

Does not reflect on skills, fails to realistically estimate own abilities
• does not recognise limitations or failures or greatly under or overestimates own abilities
• dwells on negative comparisons to abilities of others or to previous abilities
• believes that own abilities are unique, either the best or the worst possible
• expects abilities to be perfect or dwells on mistakes and failures
• blames limitations on external causes
• overestimates strengths leading to risk of injury or failure
*N.B., used throughout, means “note carefully”

MOHOST v.2.0 63
Expanded Criteria

EXPECTATION OF SUCCESS

Key concepts Self-efficacy, mastery

Sense of control over the environment
Optimism, hope
also Expectation of achieving agreed goals
Strength of will
N.B. Awareness of own capacity is assessed in APPRAISAL OF ABILITY
Realism or accuracy is assessed in APPRAISAL OF ABILITY
Realism or appropriateness of actions is assessed in CHOICES

A person’s motivation for occupation may be driven by sheer

strength of will, so realism is not assessed in this item

F = Facilitates occupational participation

Anticipates success and seeks challenges, optimistic about overcoming obstacles

• accepts occupational circumstances beyond control without discouragement

• feels in control of where life is heading and accepts risks
• looks forward to occupational challenges, shows pride in achievements
• maintains a positive outlook about engaging in occupations
• strong belief in personal effectiveness

A = Allows occupational participation

Has some hope for success, adequate self-belief but has some doubts, may need encouraging

• may be cynical or self-critical but continues to build on occupational success

• expects success in some aspects of occupation, may be apprehensive in new situations
• positive most of the time about ability to engage in occupation
• slight uncertainty about ability to influence future events

I = Inhibits occupational participation

Requires support to sustain optimism about overcoming obstacles, poor self-efficacy

• doubts ability to control/face obstacles/limitations/failures within their occupational life

• easily discouraged when faced with occupational challenges and requires support to continue to engage in
occupation
• feels uncertain about prospects for success within their occupational life
• minimises the risks involved in occupations
• fear of failure inhibits willingness to take positive risks

R = Restricts occupational participation

Pessimistic, feels hopeless, gives up in the face of obstacles, lacks sense of control

• believes that circumstances are stacked against success or that others conspire against self
• feels helpless and unable to control self or influence occupational outcomes despite support
• negative perception of own potential to engage in occupations despite feedback and support
• consistently avoids situations that challenge self-efficacy

64 MOHOST v.2.0
 Expanded Criteria

INTEREST

Key concepts Expressed enjoyment

Satisfaction
Curiosity
Participation

also Passive or active interest in available occupation

Expressed or demonstrated pleasure in occupation
Curiosity and sustained interest
Level of engagement in surroundings

N.B. Pursuit of occupations is assessed in COMMITMENT

F = Facilitates occupational participation

Keen, curious, lively, tries new occupations, expresses pleasure, perseveres, appears content

• actively engages in own interests independent of structured occupations

• expresses enjoyment and may have clear dislikes
• expresses interest and curiosity in surroundings
• follows occupations to completion due to high level of enjoyment
• fully engages in occupations of interest
• may be enthusiastic at times while engaging in occupations

A = Allows occupational participation

Has adequate interests that guide choices, has some opportunities to pursue interests

• appears reasonably but not highly satisfied when engaging in occupations

• compliant — may be engaging only to please those in authority — requires some encouragement
• holds no clear opinion about occupations despite readily participating in activities available
• may require encouragement at times to engage but then sustains interest
• reliant on social support — external rather than internal motivation
• beginning to identify interests independently
• has adequate interests but is not pursuing all of them at present

I = Inhibits occupational participation

Difficulty identifying interests, interest is short-lived, ambivalent about choice of occupations

• changeable, variable response according to occupation, unreliable, infrequent participation

• easily gives up, requires much encouragement or support to maintain interest
• expresses interest but does not engage or does not sustain interest
• expresses vicarious interest in lives of others
• interested in selected activities but generally lacks curiosity
• may be attracted by novelty but does not pursue interests
• requires support to sustain engagement in a stated interest

R = Restricts occupational participation

Easily bored, unable to identify interests, apathetic, lacks curiosity even with support

• does not engage in interests even with support

• may engage in passive activities e.g., watching T.V. but without enjoyment
• no spontaneous interest expressed, no pursuit of interests
• not interested in any occupation and actively resists engaging, refuses all suggestions

MOHOST v.2.0 65
Expanded Criteria

CHOICES

Key concepts Appropriate commitment

Readiness for Change
Sense of value & meaning
Preferences & goals

also Drive, initiative and persistence to work towards appropriate goals

Ability to take appropriate action
Being aware of what needs doing and being able to prioritise
Spontaneity of action
Reactive to the environment and able to put plans into action

N.B. Level of activity is assessed in ROUTINE

Action is assessed in ENERGY

F = Facilitates occupational participation

Clear preferences and sense of what is important, motivated to work towards occupational goals

• consistent and logical, identifies chosen lifestyle and has clear direction
• has clear priorities and personal standards that match societal values
• persists in activities and tries to problem-solve, taking positive risks
• seeks challenges, engages in complex activities and sets projects requiring effort
• selects activities that support socially acceptable values, pursues meaningful occupations

A = Allows occupational participation

Mostly able to make choices, may need encouragement to set and work towards goals

• appears to be holding certain values in order to please others

• attaches some importance to chosen occupations and lifestyle
• may be slightly impulsive at times or may be a little cautious at times
• usually makes choices that fit in with their sense of what is important

I = Inhibits occupational participation

Difficulties identifying what is important or setting and working towards goals, inconsistent

• able to make choices that fit long-term goals if given support

• difficulty choosing activities that have value and meaning to life
• uncertain about purpose of life or holds conflicting values
• initiative is restricted to activities of daily living or structured situations
• often impulsive or easily led, regretting actions later
• somewhat dependent, tents to ‘drift’ aimlessly without support

R = Restricts occupational participation

Cannot set goals, impulsive, chaotic, goals are unattainable or based on anti-social values

• dependent on others, needs prompts to manage personal activities of daily living

• highly suggestible or placid, cannot identify valued occupations
• impulse-led — may take action to meed own needs regardless of needs of others
• lacks commitment or feels alienated by society or cannot identify with societal needs
• unable to make goal choices even with support other than to meet basic needs
• choices lead to unacceptable risks

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Pattern of Occupation
ROUTINE

Key concepts Balance

Organisation of habits
Structure
Productivity

also Balance between work and leisure, social and personal, physical and creative
Daily schedule
Sleep pattern
Amount of activity

N.B. Level of Social Activity is assessed in RELATIONSHIPS

Energy levels are assessed in ENERGY

F = Facilitates occupational participation

Able to arrange a balance organised and productive routine of daily activities

• able to organise daily routine in order to keep appointments

• follows well-organised and productive daily schedule
• maintains appropriate activity levels to support role responsibilities and goals
• routine is adaptive and facilitates meeting role responsibilities and/or goals

A = Allows occupational participation

Generally able to follow an organised and productive daily schedule

• beginning to improve organisation of daily activities but improvement is still only recent
• engages with activity best when a structure exists and there are clear appointments
• may arrive early for events or slightly late for appointments
• needs encouragement to utilise time effectively to meet goals and responsibilities
• time is filled but balance of activities may not always meet responsibilities and goals
• usual routine is temporarily affected by current environment

I = Inhibits occupational participation

Difficulty organising balanced, productive routines of daily activities without support

• engages solely in sedentary activities that don’t support goals or meet responsibilities
• has difficulty getting up in the morning
• looks to others to provide structure for the day
• participates in limited number of activities, some imbalance evident considering goals
• poor sleep pattern affects daytime routine
• requires support and reminders to make appointments, tends to be late

R = Restricts occupational participation

Chaotic or empty routine, unable to support responsibilities/goals, erratic routine

• completely reliant on others to provide daily organisation

• does not utilise time productively despite support
• erratic routine that doesn’t support goals or responsibilities
• may be unaware of day-to-day routines/sleep pattern may be reversed

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Expanded Criteria

ADAPTABILITY

Key concepts Anticipation of change

Habitual response to change
Tolerance of change

also Response to changes in routine

Willingness to adapt
Reaction to adversity/obstacles

N.B. Feelings related to change are assessed in EXPECTATION OF SUCCESS

F = Facilitates occupational participation

Anticipates change, alters actions or routine to meet demands (flexible/accommodating)

• able to make the best of things even if expectations aren’t fulfilled

• accommodating, understanding, responds appro-priately to changes in routine or activity
• adjusts and compensates to cope with changed circumstances/the unexpected
• changes routine to meet changing responsibilities
• copes with disappointment within activity
• copes with suggestions and change to routine or activity

A = Allows occupational participation

Generally able to modify behaviour, may need time to adjust, hesitant

• copes well but is somewhat unquestioning, laissez-faire

• improving ability to modify behaviour within activity when necessary, possibly with encouragement
• may express disappointment, but accepts situations and can adapt appropriately
• unsettled by change but alters actions appropriately despite expressed emotion
• some impulsivity

I = Inhibits occupational participation

Difficulty adapting to change, reluctant, passive or habitually overreacts to change

• may bottle feelings and be prone to outbursts, anxious or irritable or impatient

• may resort to manipulation in order to resist change
• passive — may not voice frustration and therefore not get needs met
• reluctant to change, usually responds to firm boundaries and support
• unpredictable response — may be governed by mood rather than logic

R = Restricts occupational participation

Rigid, unable to adapt routines or tolerate change

• desires immediate satisfaction — lacks patience despite all attempts to support change
• may be extremely anxious or fearful, avoidant of change
• poor response to boundaries or pushes boundaries causing distress to others
• resists suggestions, intolerant, reacts inappropriately to change
• volatile, explosive, aggressive, physically violent or verbally abusive in relationship to change

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ROLES

Key concepts Role identity

Role variety
Belonging
Involvement

also Social acceptability

i.e., Student, worker, volunteer career, home maintainer, friend, family member, religious participant,
participant in hobbies or organisations, health maintainer roles

N.B. Ability to relate to others is assessed in RELATIONSHIPS

Role competence is assessed in RESPONSIBILITY
Practical and emotional support from others is assessed in SOCIAL GROUPS

F = Facilitates occupational participation

Identifies with a variety of roles, has a sense of identity/belonging that comes from roles

• able to include others and support others in occupations

• able to maintain roles without support, fits in well
• able to take on a variety of roles and balance multiple role demands
• recognises obligations and has productive/constructive roles
• able to maintain self-care, leisure and productive roles

A = Allows occupational participation

Generally identifies with one or more roles and has some sense of belonging in these roles

• at risk of role overload or roles are reduced

• has clear roles and sense of belonging but may require encouragement to meet obligations
• major role is vulnerable to change in the near future
• OT questions strategies used to maintain roles
• puts considerable effort into the valid role of ‘health maintainer’, but holds no other roles

I = Inhibits occupational participation

Limited identification of roles, role overload or conflict, poor sense of belonging

• can become over-involved in the lives of others

• has clear roles but poor sense of belonging
• has limited access to long-term roles but shows role behaviour in structured environments
• limited role behaviour, playing e.g. the joker, or e.g. mother figure, but little else
• requires support to meet expectations and obligations

R = Restricts occupational participation

Does not identify with any role, negligible role demands, no sense of belonging

• has withdrawn from all previous roles

• unable to maintain self-care, leisure or productive roles despite support

MOHOST v.2.0 69
Expanded Criteria

RESPONSIBILITY

Key concepts Role competence

Meeting expectations
Fulfilling obligations
Delivering responsibilities
also Willingness/readiness to acknowledge/accept role obligations and assigned tasks

N.B. Reasoning skills are assessed in PROBLEM SOLVING

Role variety is assessed in ROLES

F = Facilitates occupational participation

Reliability completes activities and meets the expectations related to role obligations

• accepts reasonable responsibility for personal actions and is aware of their effect upon others
• readily accepts designated tasks and takes on responsibilities without being asked
• recognises and fulfils most occupational responsibilities without support
• seeks feedback in order to take on responsibilities and meets expectations

A = Allows occupational participation

Copes with most responsibilities, meets most expectations, able to fulfill most role obligations

• accepts feedback or appropriate advice and, with encouragement, is beginning to make changes in order to meet
responsibilities
• may apologise unnecessarily at times, slight reluctance to take on new responsibilities
• may question responsibility occasionally, but soon acknowledges responsibility
• recent improvement/developing awareness of occupational responsibility
• requires feedback to be direct, not always aware of the impact of their actions on others

I = Inhibits occupational participation

Difficulty being able to fulfil expectations and meet role obligations without support

• may be aware of some responsibilities but not others

• needs support to accept occupational responsibility, tends to blame others or general circumstances
• requires support to acknowledge impact of actions upon others
• some guilt feelings expressed about responsibility
• wants to take responsibility but does not show awareness of full occupational implications

R = Restricts occupational participation

Limited ability to meet demands of activities or obligations, unable to complete role activities

• consistently hostile or highly defensive when required to face responsibilities

• denies or disputes feedback, refuses to accept feedback or takes no responsibility
• difficulty disassociating self from other people’s problems, despite support
• lacks awareness — seems unaware of how failure to handle responsibilities affects others
• may attribute actions solely to illness or external situations and doesn’t take responsibility
• not aware of impact on others even with support
• overwhelming guilt feelings expressed about responsibility
• unpredictable acceptance of responsibilities

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Communication & Interaction Skills

NON-VERBAL SKILLS
Key concepts Eye contact
Gestures
Orientation
Proximity

also Facial expression and gaze

Proximity
Responsiveness or spontaneity

N.B. Liveliness is assessed in ENERGY

F = Facilitates occupational participation

Appropriate (possibly spontaneous) body language given culture and circumstances

• able to convey mood and make needs known with non-verbal behaviour
• non-verbal behaviour is congruent with verbal communication
• non-verbal behaviour is fully appropriate in cultural context
• reactive and spontaneous non-verbal behaviour
• uses gestures and eye contact appropriate to the occupational situation

A = Allows occupational participation

Generally able to display or control appropriate body language

• animated, gestures appear somewhat exaggerated, or may be too formal for occupational situation
• certain mannerisms may be distracting or repetitive and don’t support completion of occupation
• use of physical contact and awareness of personal space are questioned

I = Inhibits occupational participation

Difficulty controlling/displaying appropriate body language (delayed/limited/disinhibited)

• benefits from encouragement and feedback to use non-verbal expression effectively

• fidgety, may appear nervous or distracted within the occupational context
• has limited use of gestures, variable eye-contact
• may give inappropriate non-verbal signals, and delay completion of occupation
• may invade personal space or be disinhibited at times
• non-verbal behaviour is incongruent with verbal communication and mood

R = Restricts occupational participation

Unable to display appropriate body language (absent/incongruent/unsafe/aggressive)

• blank, mask-like, or lacks eye contact and does not respond to encouragement
• grossly disinhibited, incongruent or fixed non-verbal behaviour
• non-verbal behaviour is overactive and distracting despite feedback
• uses inappropriate gaze or invades personal space/may cause offence to others

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Expanded Criteria

CONVERSATION

Key concepts Disclosure

Initiating & sustaining communications
Speech content
Language

also Appropriate content of what is said

Ability to share information either verbally or through signing
Able to communicate needs and wants and to negotiate accordingly
Word-finding abilities
Clarity, meaning
Vocabulary and grammar

N.B. Intonation and articulation are assessed in VOCAL EXPRESSION

Readiness to communicate is assessed in RELATIONSHIPS

F = Facilitates occupational participation

Appropriately initiates, discloses and sustains conver-sation (clear/direct/open)

• chooses words or signs appropriately

• communicates openly clearly and concisely
• is able to effectively convey subtle and complex meanings
• makes appropriate requests

A = Allows occupational participation

Generally able to use language/signing to effectively exchange information

• hesitant or superficially initially, or copes best 1:1

• may not attend to verbal cues, may give too much or too little information at times
• mostly clear, may have slight word-finding difficulty
• responds appropriately and engages in conversation when approached
• slight difficulties in sustaining conversation that may be attributed to sensory impairment

I = Inhibits occupational participation

Difficulty initiating, disclosing or sustaining conver-sation (hesitation/abrupt/limited/irrelevant)

• can be difficult to understand at times or requires support to be understood

• communication is not always direct
• can understand communication with the help of signing or symbols
• limited — may have difficulty expressing feelings, have limited vocabulary or use of signs
• may disclose information appropriately at times
• may use non-words repetitively, e.g. “you see,” “sort of,” “like,” “um,” “er,” “yeah”
• meaning is unclear, puzzling
• some dysphasia
• speech impediment or sensory impairment interferes with communication

R = Restricts occupational participation

Uncommunicative, disjointed, bizarre or inappropriate disclosure of information

• bizarre or incomprehensible communication, despite therapeutic interventions

• dysphasic or fragmented communication
• has not reached developmental level that supports effective verbal communication
• monosyllabic or mute/refuses to give information
• unable to convey information using spoken language or signing

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VOCAL EXPRESSION

Key concepts Assertion

Intonation
Articulation
Volume
Pace

also Pitch and modulation (may be affected by ability to hear)

N.B. Language is assessed in CONVERSATION

Liveliness is assessed in ENERGY

F = Facilitates occupational participation

Assertive, articulate, uses appropriate tone, volume and pace

• firm and able to confidently refuse requests, with or without language

• uses vocal expression effectively to communicate needs
• vocally expressive

A = Allows occupational participation

Vocal expression is generally appropriate in tone, volume and pace

• volume of speech may cause slight difficulties

• possible incongruent infection
• mostly able to indicate needs, with or without recourse to language

I = Inhibits occupational participation

Difficulty with expressing self (unclear/pressured speech/monotone)

• accent interferes with communicating within an occupation

• limited range of affect, blunted expression
• overly talkative, or has some pressure of speech
• requires encouragement and feedback to utilise vocal expression effectively
• vocal expression is distracting leading to ineffective communication
• volume may be incongruous with social context at times

R = Restricts occupational participation

Unable to express self (incomprehensible, too quiet or loud, too fast)

• extremely pressured, unintelligible, despite feedback

• mute
• overbearing or frequently shouts, screams
• speaks in monotone
• whispers or is barely audible

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Expanded Criteria

RELATIONSHIPS

Key concepts Co-operation

Collaboration
Rapport
Respect

also Helpfulness
Ability to relate
Dyadic and group interaction
Sociability

N.B. Pattern of co-operation is assessed in ROLES

Continuing support from others irrespective of ability to form relationships is assessed in SOCIAL GROUPS

F = Facilitates occupational participation

Sociable, supportive, aware of others, sustains engagement, friendly, relates well to others

• attentive and able to accommodate behaviour to include others in occupation

• demonstrates awareness of other’s needs, gives constructive criticism to support completion of occupation
• shares and assists appropriately within occupation
• willing to help and get along with others within an occupation

A = Allows occupational participation

Generally able to relate to others and mostly demonstrates awareness of others’ needs

• able to ‘put on a front’ in social situations

• friendly, polite and courteous and seeks interaction but does not easily form relationships
• naturally reserved — may keep self to themselves at times but otherwise appears comfortable in social
situations — self-contained

I = Inhibits occupational participation

Difficulty without co-operation or makes few positive relationships

• appears vulnerable to being manipulated by others

• communicates with certain others but not everybody involved in occupational situation
• complies with direct requests but does not actively collaborate
• difficulty coping with strangers or large groups of people, interacts with selected others
• tendency to be self-oriented or unaware of the needs of others but responds to feedback
• tends to place self on the edge of social groups — degree of discomfort evident

R = Restricts occupational participation

Unable to co-operate with others or make positive relationships

• does not get involved, unresponsive, does not display concern for others
• extremely withdrawn or isolative, may ignore others
• hostile or suspicious, may sabotage interventions or otherwise be destructive
• inattentive, appears to be out of touch with occupational situation
• intolerant of others, possibly malicious or provocative
• obstructive, demanding, interfering within occupational situations
• offensive, may provoke disgust in others
• unaware of boundaries, extremely vulnerable despite support

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Process Skills
KNOWLEDGE

Key concepts Seeking and retaining information

Knowing what to do in an activity
Knowing how to use objects

also Uses tools appropriately

Heeds instruction
Oriented to time, place and person

N.B. Awareness of responsibility is assessed in RESPONSIBILITY

Ability to follow instruction is assessed in ORGANISATION
Knowledge refers to practical knowledge of occupations, not general knowledge or IQ

F = Facilitates occupational participation

Seeks and retains information, knows how to use tools appropriately

• diligently retains information

• seeks out information and probably checks out feedback
• shows awareness of surroundings
• uses tools methodically and accurately, chooses tools logically

A = Allows occupational participation

Generally able to seek and retain information and know how to use tools

• fully oriented but occasionally forgetful or may doubt own memory

• may be slow to ask for clarification, occasionally requires encouragement
• may use common aids (e.g. diaries and lists) effectively
• use of tools is idiosyncratic but effective, does not impact performance
• slight difficulty noticed in applying previous knowledge to a new task

I = Inhibits occupational participation

Difficulty knowing how to use tools, difficulty in asking for help or retaining information

• chooses inappropriate tools resulting in disruption of task performance

• clearly remembers detailed facts and figures which may be inconsequential, but does not always retain practical
information
• dependent on aids to jog memory and the support of others
• does not retain information fully, regularly requires reminders
• highly selective, may retain valued information only or manipulate information received
• may ask for irrelevant information or makes ineffective inquiries

R = Restricts occupational participation

Unable to use knowledge/tools, does not retain information, asks repeatedly for same information

• confused, disoriented, may confabulate, poor long or short-term memory

• frequently misinterprets feedback/makes no changes despite repeated feedback
• illogical in choice of tools, end products are dramatically affected
• insight may be fleeting or lacking
• may use tools without regard for hygiene or safety

MOHOST v.2.0 75
Expanded Criteria

TIMING

Key concepts Initiation

Completion
Sequencing
Concentration

also Attentiveness, ability to focus and sustain concentration

Ability to cope with distractions and variable stimulation
Ability to prioritise and sequence activities
Awareness of time

N.B. Planning goals is assessed in COMMITMENT in the MOTIVATION FOR OCCUPATION SECTION
Planning in this PROCESS SKILLS section refers exclusively to planning within an occupation

F = Facilitates occupational participation

Sustains concentration, starts sequences and completes occupation at appropriate times

• able to become absorbed in activity and cope with distractions

• manages all tasks from beginning to end with minimum fuss
• may be capable of intense concentration or be able to think quickly
• proactive, able to prioritise, forward-thinking

A = Allows occupational participation

Generally able to concentrate, start sequence and complete occupations

• concentrates sufficiently for most day-to-day tasks

• may repeat some steps of a task without apparent disruption
• occasionally preoccupied but is able to refocus with minimal encouragement
• reactive, does not plan far ahead, but times activities adequately
• some variability according to task and situation but has definite ability

I = Inhibits occupational participation

Fluctuating concentration or distractible, difficulty initiating, sequencing and completing

• can become preoccupied or distracted and lose focus after a while

• continues activity unnecessarily
• does not always prioritise effectively and benefits from the support of others
• hesitant, requires prompts, activity is interrupted
• regularly overruns time limits

R = Restricts occupational participation

Unable to concentrate, unable to initiate, sequence or complete occupations

• does not get going or starts tasks but does not return to them
• does not prioritise despite support and encourage-ment to do so
• loses track of time or unaware of time
• poor sequencing ability, gets muddled

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ORGANISATION

Key concepts Arranging space and objects

Neatness
Preparation
Gathering objects

also Quality of work carried out (including activities of daily living)

Ability to search for, locate and gather tools systematically

N.B. Understanding instructions is assessed in KNOWLEDGE

Organisation of routines is assessed in ROUTINE in the PATTERN OF OCCUPATION section
Organisation in this PROCESS SKILLS section refers exclusively to organisation within an operation

F = Facilitates occupational participation

Efficiently searches for, gathers and restores tools/objects needed in occupation (neat)

• accurate and methodical, efficient

• organises space and objects thoroughly and systematically
• produces careful work, arranges objects effectively
• uses tools safely

A = Allows occupational participation

Generally able to search, gather and restore needed tools/objects

• may have a specific disability that impacts on organisation but generally manages well
• works safely and is mostly efficient

I = Inhibits occupational participation

Difficulty searching for, gathering and restoring tools/objects, appears disorganised/untidy

• disorganised, rushed and/or messy, may want immediate results

• does not always tidy up after self
• ineffective or random in search for tools
• may appear vague at times or lose track of what needs doing
• overly fussy
• requires assistance and may make some errors
• requires plenty of time, or firm encouragement

R = Restricts occupational participation

Unable to search for, gather and restore tools and objects

• haphazard, chaotic, extremely messy

• lacks awareness of what needs doing, requires repeated instruction each time
• often does not act upon instruction or makes frequent mistakes despite instruction
• unsafe or at risk due to poor organisational skills

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Expanded Criteria

PROBLEM-SOLVING

Key concepts Judgement

Adaptation
Decision-making
Responsiveness

also Objectivity — ability to distance self

Concrete v. abstract thinking
Ability to generate workable solutions
Ability to learn from mistakes and benefit from instructions

N.B. Motivation to seek solutions is assessed in GOALS

Ability to identify problems and response to feedback are assessed in RESPONSIBILITY

F = Facilitates occupational participation

Shows good judgement, anticipates difficulties and generates workable solutions

• able to make decisions quickly and objectively

• clear, independent, appropriate
• notices what needs doing and responds, modifying actions to prevent problems

A = Allows occupational participation

Generally able to make decisions based on difficulties that arise

• often intuitive (uses ‘gut reaction’) but unable to substantiate choices

• seeks reassurance or advice occasionally when in difficulty
• slow to respond to environmental cues

I = Inhibits occupational participation

Difficulty anticipating and adapting to difficulties that arise, seeks assurance

• does not notice or respond to problems that arise, resulting in unacceptable outcomes
• may not avoid or delay making some decisions, but responds to feedback
• may seek feedback inappropriately, frequently requesting reassurance or ‘fishing for compliments’
• tends to base decisions on emotion rather than logic

R = Restricts occupational participation

Unable to anticipate and adapt to difficulties that arise and makes inappropriate decisions

• avoidant, does not seek information and fails to respond to feedback

• fails to overcome problems or to make appropriate changes
• frequently resorts to inappropriate or anti-social coping strategies
• highly dependent/reliant on others, extremely vulnerable
• irrational, makes random or inappropriate decisions, unamenable to reason
• makes unsuccessful attempts to solve problems

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 Expanded Criteria

Motor Skills
POSTURE & MOBILITY

Key concepts Stability Walking

Alignment Reaching
Positioning Bending
Balance Transfers

also Standing and sitting balance

Range of movement
Gait

N.B. Moving and transporting objects is assessed in STRENGTH & EFFORT

F = Facilitates occupational participation

Stable, upright, independent, flexible, good range of movement (possible agile)

• good rotation and flexion of the spine

• maintains balance with ease, keeping the body stable without support
• positions self in relation to objects so that movements are most effective
• reaches safely in all directions
• walks freely, manages stairs and uneven surfaces

A = Allows occupational participation

Generally able to maintain posture and mobility in occupation, independently or with aids

• movements are awkward at times

• moves slowly or hesitantly at times but completes tasks
• reaching objects requires effort
• slight stoop or leaning, awkward gait

I = Inhibits occupational participation

Unsteady at times despite any aids, slow or manages with difficulty

• may need some help with domestic activities of daily living

• some unsteadiness, shuffling or lurching
• stooped or leaning posture leads to some instability
• uses aids for support or furniture to prop self upright, may use wheelchair effectively
• uses excessive movements or has difficulty bending and reaching

R = Restricts occupational participation

Unstable, unable to reach or bend, unable to walk

• dependent on others to help with domestic activities of daily living due to lack of posture/mobility
• moving results in unacceptable delay or effort
• poor trunk control, risks falling or other danger due to poor stability or positioning
• unable to mobilise independently or reach objects independently

MOHOST v.2.0 79
Expanded Criteria

CO-ORDINATION

Key concepts Manipulation

Ease of movement
Fluidity
Fine motor skills

also Hand-eye co-ordination — vision, perception

Dexterity
Sensation

N.B. Range of movement is assessed in POSTURE & MOBILITY

Grip is assessed in STRENGTH & EFFORT

F = Facilitates occupational participation

Co-ordinates body parts with each other, uses smooth fluid movements (possibly dextrous)

• able to manipulate tools easily and quickly

• well-co-ordinated, uses the whole body

A = Allows occupational participation

Some awkwardness or stiffness causing minor interruptions to occupations

• may be slow, but manages all tasks, activity is not disrupted

• may have sensory impairment but manages all tasks independently

I = Inhibits occupational participation

Difficulty co-ordinating movements (clumsy/tremulous/awkward/stiff)

• difficulty manipulating objects causing activity to be delayed or interrupted

• increased tone or ataxia impacts on speed of performance or leads to increased effort
• may need help in some personal activities of daily living because of difficulty with co-ordination
• poor grip, difficulty stabilising objects

R = Restricts occupational participation

Unable to co-ordinate, manipulate and use fluid movements

• coarse tremor or weak grip, risks breaking or dropping objects

• dependent on help with personal activities of daily living because of lack of co-ordination
• severe tremor or rigidity leads to unacceptable delay with risk of damage
• unable to manage tasks requiring co-ordination

80 MOHOST v.2.0
 Expanded Criteria

STRENGTH & EFFORT

Key concepts Grip

Handling and lifting
Moving and transporting
Calibration

also Force

N.B. Ease of movement is assessed in CO-ORDINATION

F = Facilitates occupational participation

Grasps, moves & transports objects securely with adequate force and speed (possibly wrong)

• able to carry appropriately and even pressure and to regulate speed of actions
• able to carry objects easily and safely
• able to grasp objects securely with adequate grip to open fastenings and containers
• able to lift objects smoothly, with appropriate effort

A = Allows occupational participation

Strength and effort are generally sufficient for most tasks

• may adjust strength and effort as task progresses

• possibly hesitant or slow but manages independently
• task performance may be slightly delayed due to weakness

I = Inhibits occupational participation

Has difficulty with grasping, moving, or transporting objects with adequate force & speed

• difficulty carrying more than one item without help

• has difficulty with grasping handles, opening fasteners or containers or removing coverings
• lacks adequate control and may appear clumsy
• may use both hands to life objects that typically need only one
• objects are liable to slip due to poor grasp
• uses coping strategies (e.g. sliding, pushing or pulling objects) to complete activity
• weak or over forceful with objects

R = Restricts occupational participation

Unable to grasp, move, transport objects with appropriate force and speed

• frail, dependent on help or intervention of others to complete tasks

• risks breaking objects or danger to self

MOHOST v.2.0 81
Expanded Criteria

ENERGY

Key concepts Endurance

Pace
Attention
Stamina

also Fitness
Tempo

N.B. Activity level is assessed in ROUTINE

F = Facilitates occupational participation

Maintains appropriate energy levels, able to maintain tempo throughout occupation

• able to increase activity to meet deadlines and relax appropriately

• good stamina, able to maintain focus
• maintains a consistent rate of task performance
• possibly lively, probably engages in physical exercise

A = Allows occupational participation

Energy may be slightly low or high at times, able to pace self for most tasks

• completes tasks slowly but steadily

• poor sleep, but manages to cope during the day
• sedentary, but this is normal given their lifestyle
• tires quickly but soon recovers
• describes changes in energy levels but manages tasks effectively
•
I = Inhibits occupational participation
Difficulty maintaining energy levels (tires easily/evidence of fatigue/distractible/restless)

• becomes short of breath

• generally lacking energy — sufficiently active to achieve bare minimum
• may engage in physical activity but without exerting self
• may keep busy but have difficulty relaxing, may be fidgety
• performance is restricted or slow
• quality of performance is affected, movements may be rushed
• restless, moderately overactive, but able to settle with encouragement
• variable — may have bursts of activity followed by exhaustion

R = Restricts occupational participation

Unable to maintain energy, lacks focus, lethargic, inactive, or highly overactive

• continually restless/pacing or extremely lethargic and inactive

• difficulty settling, overactive, may not sleep adequately
• needs to rest frequently, unable to complete tasks
• swings from one extreme to the other
• works too fast, resulting in risk or danger despite encouragement to pace self

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 Expanded Criteria

Environment
PHYSICAL SPACE

Key concepts Self-care productivity and leisure facilities

Privacy and accessibility
Stimulation and comfort

i.e., Accommodation
Buildings
Nearby shops and amenities
Local surroundings
Natural and fabricated contexts in which people behave

A person’s skills need to be seen within the context of the environment

in which they are assessed, whether this be an occupational therapy department,
a day hospital or the hospital as a whole, their home or the wider community

F = Facilitates occupational participation

Space affords a range of opportunities, supports and stimulates valued occupations

• environment is identified as a good place to be

• facilities are available for work, relaxation and recreation
• environment is familiar
• no unmet needs identified

A = Allows occupational participation

Space is mostly adequate, allows daily occupations to be pursued

• contains apparent risks but is still the best option given the circumstances
• individual may express satisfaction despite apparent unmet needs

I = Inhibits occupational participation

Affords a limited range of opportunities and curtails performance of valued occupations

• individual is disadvantaged by some aspects of the physical environment

• some unmet needs identified

R = Restricts occupational participation

Space restricts opportunities and prevents perfor-mance of valued occupations

• facilities are unsuitable

• lacks opportunities for work, relaxation or recreation
• major unmet needs identified
• architectural barriers impose severe restrictions

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Expanded Criteria

PHYSICAL RESOURCES

Key concepts Finance

Equipment and tools
Possessions and transport
Safety and independence

i.e., Clothing and furnishings

Aids and adaptations
Technology
Natural and fabricated things with which people interact

F = Facilitates occupational participation

Allows occupational goals to be achieved with ease, equipment and tools are appropriate

• physical resources meet needs for safety and for self-expression within the environment
• resources are meaningful and valued

A = Allows occupational participation

Generally allows occupational goals to be achieved, may present some obstacles

• individual may express satisfaction despite apparent unmet needs

• physical resources meet all basic needs but without any luxuries
• resources have been restricted recently but remain adequate
• aids and adaptations are acceptable

I = Inhibits occupational participation

Impede ability to achieve occupational goals safely, equipment and tools are adequate

• individual may be handicapped due to lack of some resources

• lack of appropriate resources or funding leads to major inconvenience/personal discomfort
• resources appear to be inappropriate
• resources are adequate in the short-term but are not sustainable
• resources limit personal freedom
• aids and adaptations engender ambivalent feelings

R = Restricts occupational participation

Have major impact on ability to achieve occupational goals, lack of tools lead to high risk

• individual is unable to make ends meet

• major handicap results from lack of appropriate resources, including loss of freedom or safety
• aids and adaptations are not accepted

84 MOHOST v.2.0
 Expanded Criteria

SOCIAL GROUPS

Key concepts Family dynamics

Friends and social support
Work climate
Expectations and involvement

i.e., Cultural groups

Religious organisation
Fellow students
Membership of clubs or societies
Expressed emotion
Emotional atmosphere

N.B. Ability to relate to social groups is assessed in RELATIONSHIPS

Ability to take on roles in social groups is assessed in ROLES

F = Facilitates occupational participation

Social groups offer practical support, values and attitudes support optimal functioning

• active participation
• clear opportunities exist for social interaction and collaboration
• functioning is enhanced by support of social groups
• members get along well
• others can be relied upon to lend a hand
• praise is given for skills, contributions, efforts

A = Allows occupational participation

Generally able to offer support but may be some under or over involvement

• functioning is generally supported

• influence of social groups on functioning is unclear
• opportunities exist for necessary interaction and communication
• skills, contributions and efforts are acknowledged

I = Inhibits occupational participation

Offer reduced support or detracts from participation, some groups support but not others

• belongs to few social groups

• emotional or practical climate detracts from functioning, make things difficult at times
• has some difficulties getting along with colleagues or family
• skills, contributions and efforts are not recognised
• support is unreliable/under or over involvement limits functioning
• expectations (high or low) may induce stress

R = Restricts occupational participation

Do not support participation due to lack of interest or inappropriate involvement

• emotional or practical climate contributes to maladaptive functioning

• has major difficulties getting along with colleagues or family
• interaction or collaboration is non-existent or impossibly demanding/conflicting
• skills, contributions or efforts are ignored or devalued

MOHOST v.2.0 85
Expanded Criteria

OCCUPATIONAL DEMANDS

Key concepts Activity demands (self-care, productivity and leisure)

Cultural conventions
Construction of activities

i.e., Occupational forms

Activities associated with major roles
“Things to do” within a particular occupation
Recognisable, coherent and purposeful behaviours

F = Facilitates occupational participation

Demands of activities match well with abilities, interests, energy and time available

• afford satisfaction and enjoyment

• challenging and stimulating
• provide a range of opportunities for balanced routine, including self-care, productivity and leisure
• offer opportunities for success

A = Allows occupational participation

Generally consistent with abilities, interest, energy or time available, may present challenges

• individual may express satisfaction despite apparent inconsistencies or imbalance

• demands are limited at present but are normally appropriate

I = Inhibits occupational participation

Some clear inconsistencies with abilities and interests, or energy and time available

• activities may match either abilities, interests, energy or time but not all
• some mismatch between demands of tasks and current personal capacity
• opportunities for involvement in either leisure, domestic or work activities are limited
• social or cultural responsibilities are a source of stress

R = Restricts occupational participation

Mostly inconsistent with abilities, construction of activity is under or over demanding

• poorly suited
• result in over or under stimulation, excessive stress or boredom
• self-care activities severely challenge personal capacity

86 MOHOST v.2.0
MOHOST v.2.0:
APPENDIX

I. OCAIRS Questions — Mental health settings..................................... 88

II. OCAIRS Questions — Forensic settings ............................................. 90

III. OCAIRS Questions — Physical settings/Older Adult Mental Health .. 92

UK English Forms
IV. MOHOST Rating Form (UK English) .................................................. 96

V. Multiple Summaries MOHOST Form (UK English) ........................... 100

VI. MOHOST Data Sheet Single Observation Form (UK English) .......... 102

VII. MOHOST Data Sheet Multiple Observation Form (UK English) ...... 103

USA English Forms

VIII. MOHOST Rating Form (USA English) .............................................. 104

IX. Multiple Summaries MOHOST Form (USA English) ......................... 108

X. MOHOST Data Sheet Single Observation Form (USA English) ........ 110

XI. MOHOST Data Sheet Multiple Observation Form (USA English) .... 111

MOHOST 2.0 87
Appendix
I. Recommended OCAIRS Questions in
Mental Health Setting
PATTERN OF OCCUPATION
N.B.: Focus questioning on current status.
Encourage client to consider all daily activities, being sure
to include self-care and activities of daily living. If the
client identifies having a health maintainer (patient)
role, it is to be considered as a valid role. Successful
performance of the role of health maintainer requires
considerable effort and may be (or become) a source of
pride.
• Describe a typical weekday (before you began
treatment/this programme/were hospitalised).
• Describe a typical weekend day (before you began
treatment/this programme/were hospitalised).
• Does your daily schedule let you do the things you
need and want to do?
• Has your daily routine changed (over the last 6
months/since your accident/since your divorce etc.—
pick some pivotal event if possible)? How?
• Are you satisfied with your current daily routine?
• What do you do? What are your major responsibilities?
(Parent? Spouse? Worker? Student? Homemaker?)
• Do you belong to any groups?
• (For each role mentioned) How important is ______
to you? Do you enjoy ______?
• How well are you able to_______(for each role
mentioned)?
• What else do you do? What other roles do you fill?
SKILLS: COMMUNICATION & INTERACTION SKILLS,
PROCESS SKILLS, MOTOR SKILLS
Note: If unsure of self-report reliability, ask for examples
of performance of each skill in questions.
• Are you able to do the things you want or need to do?
(If no) What limits your ability to do things?
• Are you able to concentrate, problem-solve, and
make decisions to get things done?
• Do you have the physical ability to accomplish what
you need and want to do?
88 MOHOST v.2.0
• Are you able to over come these limitations and
barriers?
• Do you prefer to work alone or with others? How
well do you work with others?
ENVIRONMENT
• Where do you live? (location, house, apartment?) Is it
easy to get around and get things done?
• In the area where you live, are there things to do/
places to go that interest you?
• Is there someplace you go to on a regular basis (e.g.
work, school, church, the park, the doctor’s office)?
Is it easy to get to from your home?
• Are there any physical barriers at _______(from
above) or at home that prevent you from getting
things done?
• In terms of activities you would like to participate
in, places you would like to go, what if anything
prevents you from doing so? (money, transportation,
safety concerns, physical barriers)
• Are there resources available to help you overcome
barriers to getting things done?
• Do you spend a lot of time alone? Who do you spend
most of your time with?
• Who are the most important people in your life right
now?
• Does what they expect from you match what you like
or would like to do?
• Would you describe your (work, school, community)
setting as supportive?
• Do the people or situations in your life place limits
on you?
• If you need help/support, can you count on family/
friends/community?
MOTIVATION FOR OCCUPATION
• What things in your life do you feel you do well, or
are proud of?
• What are some things that have been difficult for
you? How did you handle it?
• What is the biggest challenge you are currently
facing?
 Appendix

• How successful do you think you will be over the

next six months?

• Is your major occupational role such as worker,

student, volunteer, caretaker something you enjoy?
What about it interests or satisfies you?
• What do you like to do with your time outside of
work or major occupational role?
• Do you have any other interests or hobbies?
• (For interests mentioned) How often do you _______?
Are you satisfied with the amount of time you are
able to spend ________?

• What do you value most in your life? (What is most

important to you?)

• What are other things or ideals that you value (are

important to you)?
• How important are these to you?
• Are you able to live life in ways that fit with the values
you think you should have or try to live up to?
• Is there anything about your life that you feel goes
against your values?

• Do you ever set goals for yourself/make plans for the

future? Have you followed through on any of them?
• What goals do you have for the next week? The next
month?
• What are you doing to accomplish that?
• Do you have any long-term goals (1 year, 5-10
years)?
• How will you accomplish those?

MOHOST v.2.0 89
Appendix
II. Recommended OCAIRS Questions in
Forensic Settings
ROLES
• Do you have any family responsibilities? Are you
managing to keep up with these?
• How much contact do you have with your family or
friends? How often do they telephone/visit/write?
• Are you studying now or have any other responsibilities
here?
• What are your needs relating to your culture or
religion?
• How well are you able to ________ (for each role
mentioned)?
• (For each role mentioned) How important is _______
___ to you? Do you enjoy_______?
• What else do you do? What other roles do you fill?
HABITS
• What would you like your routine to be like?
• How is your sleep pattern just now?
• Describe a typical weekday (before you were
admitted here)
• Were your weekends any different?
• What is your routine now? Are you able to do what
you want to do?
• Has your routine changed (since your index offense/
admission here)? If so, how?
• Are you satisfied with your current routine?
PERSONAL CAUSATION
• How well do you think you understand your own
abilities?
• What things do you feel you do well, or are
proud of?
• What things have been difficult for you? Can
you give me an example of something you have
found difficult to cope with recently? How did you
handle it?
• What is the most difficult thing for you at the
moment?
90 MOHOST v.2.0
• How successful do you think you will be over the
next six months?
• How do you think you will achieve this?
• Is there anything you thought you may be able to do,
but have problems achieving?
VALUES
• What do you value most in your life? (Who or what
is most important to you?)
• Are you able to live by your values or ideals at
present? If not, why not?
• Are there any other things that are important
to you?
• Why are these things important?
READINESS FOR CHANGE
• Tell me about a time when you experienced a big
change in your life (around the time of your index
offense/change in mental state). What did you do,
did things become better or worse?
• How do you cope when your expected daily routine
changes? (e.g. when a session/community leave
is cancelled at the last minute/ moving to a secure
unit). Is it difficult for you to adjust?
• How do you react when someone criticises you
or challenges you about an issue (e.g. about your
behaviour on the ward/in a session)? Do you get
angry with them? What kinds of things do you do
when you are angry? Do you feel sad? What kind of
things do you do when you feel sad? Etc.
INTERESTS
• What interests or hobbies do you have? Is there
anything that stops you currently participating?
• (For each interest mentioned) How often do you
________? Are you satisfied with the amount of time
you are able to ___________?
• Are there any activities here that you would like to do
in this environment?
• (If applicable) Do you have an interest in a criminal
lifestyle? (e.g., drugs/alcohol/theft)? What is good or
bad about the criminal lifestyle? Would you like to
live like this?

• What would you like to do with your time when you
leave hospital?
SKILLS
• Are you able to concentrate, problem-solve, and
make decisions to get things done?
• Do you have any physical complaints which limit
what you do during the day?
• Are you able to overcome any problems you have?
• Do you complete tasks to your satisfaction (e.g., too
fast, too slow)?
• Do you prefer to work alone or with others? How well
do you work with others? Do you feel comfortable in
a group situation?
GOALS
• Do you ever set goals for yourself/make plans for
the future? Have you followed through with any of
them?
• What goals do you have for the next week? The next
month?
• How are you going to achieve them?
• Do you have any long-term goals (1 year, 5-10
years)?
• How will you accomplish them?
• Do you feel able to set goals at present?
INTERPRETATION OF PAST EXPERIENCES
• When you think about your life so far, do you think
you have had a good deal or a bad deal?
• What was happening to you around the time of your
index offense?
• Have you even taken drugs or alcohol? If so, how
has your life been influenced by your drug taking/
alcohol problems?
• Give an example of the best period of your life.
• Give an example of the worst period of your life.
• Thinking about your life so far, when you had to make
an important choice about something (say a new job
or choosing friends), were you able to do this freely,
or were there things that got in the way?
• What effect do you think your past has had on your
current situation?
Appendix
PHYSICAL ENVIRONMENT
• How do you feel about your physical environment
here? How could it be improved?
• Is it better or worse than where you were living
before? Why?
• How do you feel about being in a locked environment?
What effect does this have on your being able to
move around the hospital?
• Are there places that you would like to go that you
are currently not able to access?
• Are there resources that you can use on the ward to
compensate for your limited access to other parts of
the building?
• Do you manage to get things done that are important
to you?
• Are you able to keep your possessions accessible?
• Does your environment afford enough privacy?
• Do you feel the physical environment has an effect
on your behaviour?
SOCIAL ENVIRONMENT
• How do you find the other patients on the ward?
• Do you spend a lot of time alone? Who do you spend
most of your time with? Do you have any friends
here/outwith at the hospital?
• Who are the most important people in your life right
now?
• Do you hear from them/see them as often as you
would like to?
• Where do you feel most vulnerable or at risk?
• If you need help or support, who do you turm to?
Can you talk to your family/friends/staff?
• Are you able to form trusting relationships?
MOHOST v.2.0 91
Appendix

II. Recommended OCAIRS Questions in
Physical Settings/Older Adult Mental
Health Settings
SOCIAL ENVIRONMENT
Firstly, I would like to look at how things are for you at
home in regards to family or homecare support and how
this helps you with your daily life.
• In your local area, are there places you go to regularly
(i.e. church, bingo, drs, visit family etc), do you
manage to get there ok?
We have looked at what social support you have at home,
I would like to move on to look at your actual house and
local community to find out what equipment and support
you have from that.
PHYSICAL ENVIRONMENT

• Do you live alone?
• Do you have friends/ family/neighbours who visit
you regularly?
• Do you have any home helps?
• Are you happy with the help they (family/ home
helps) provide you with at the moment? (Restricted/
more support/ more independence)
• If you needed help or support do you feel you could
count on your friends/ family/ home helps?
• Are you able to keep in touch with family/friends?
• What type of house is it? How many rooms do you
have?
• Who owns your property?
• How do you manage the stairs at home? (Banisters)
• What is the layout of the house?
• At your front/ back door do you have steps? (Rails)
• Do you use a walking aid?
We have looked at your home situation I would now like
to find out a bit more about your daily routine.

MORNING SELF-CARE ROUTINE

I’d like you to talk me through your morning routine. (NB: As each activity is discussed a range of questions are asked
for each activity.)

Activity For each activity ask

Bed Transfer Do you feel confident doing this activity? (PC)
Toileting Do you find this activity enjoyable/satisfying? (I)
Bathing/Washing How important is this activity for you? (V)
Dressing Can you physically do the activity? (MS)
Chair Transfer Do you have enough concentration to complete the activity? (PS)
Do you have the full responsibility for doing the activity? (R)
Does someone help you? (SE)
Where do you carry out this activity? Do you have any equipment to help you?
(PE)
Do you have a routine when doing this activity? (H)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your morning self-care routine? (H)

92 MOHOST v.2.0
 Appendix

BREAKFAST
I’d like you to talk me through your breakfast routine.

Activity For each activity ask

Making Breakfast
Do you make you own breakfast? (R)
What do you have for breakfast? , Do you have a routine when
making your breakfast?, When do you have breakfast? (H)
Do you feel confident with this activity? (PC)
Do you find this activity enjoyable/ satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Does someone help you? (SE)
Where do you have your breakfast? (PE)
Do you use any equipment to help you make your breakfast? (PE)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your breakfast routine? (H)

MORNING
How do you typically spend your mornings?

Activity For each activity ask

Do you go out?
Attend any clubs/day centres?
Meet friends?
Do you go out to work?
Do you have responsibilities?
Do you feel confident doing this activity (PC)
Do you find this activity enjoyable/satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Do you have the full responsibility for doing activity? (R)
Does someone help you? (SE)
Where do you carryout this activity? Do you have any equipment to help you? (PE)
Do you have a routine when doing this activity? (H)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your morning routine? (H)

LUNCH
I’d like you to talk me through your lunch routine.

Activity For each activity ask

Making lunch Do you make you own Lunch? (R)
What do you have for lunch? , Do you have a routine when making your lunch? ,
When do you have lunch? (H)
Do you feel confident with this activity? (PC)
Do you find this activity enjoyable/ satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Does someone help you? (SE)
Where do you have your lunch? (PE)
Do you use any equipment to help you make your lunch? (PE)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your lunch routine? (H)

MOHOST v.2.0 93
Appendix

AFTERNOON
How do you spend your afternoons?

Activity For each activity ask

Do you go out?
Attend any clubs/day centres?
Meet friends?
Do you go out to work?
Do you have responsibilities?
Do you feel confident doing this activity (PC)
Do you find this activity enjoyable/satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Do you have the full responsibility for doing activity? (R)
Does someone help you? (SE)
Where do you carry out this activity? Do you have any equipment to help you?
(PE)
Do you have a routine when doing this activity? (H)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your afternoon routine?

EVENING MEAL
I’d like you to talk me through your evening meal routine.

Activity For each activity ask

Evening meal Do you make you own evening meal? (R)
What do you have for evening meal? , Do you have a routine when making your
evening meal? , When do you have evening meal? (H)
Do you feel confident with this activity? (PC)
Do you find this activity enjoyable/ satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Does someone help you? (SE)
Where do you have your evening meal? (PE)
Do you use any equipment to help you make you evening meal? (PE)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your evening meal routine (H)

EVENINGS
How do you typically spend your evenings?

Activity For each activity ask

Do you go out?
Attend any clubs/day centres?
Meet friends?
Do you go out to work?
Do you have responsibilities?
Do you feel confident doing this activity (PC)
Do you find this activity enjoyable/satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Do you have the full responsibility for doing activity? (R)
Does someone help you? (SE)
Where do you carry out this activity? Do you have any equipment to help you?
(PE)
Do you have a routine when doing this activity? (H)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your evening routine?

94 MOHOST v.2.0
 Appendix

NIGHT

Activity For each activity ask

Undressing/self care
Bed transfers
Do you have to get up to the
toilet overnight?
Do you have responsibility for
supporting a partner to get up
during the night?
Do you feel confident doing this activity (PC)
Do you find this activity enjoyable/satisfying? (I)
How important is this activity for you? (V)
Can you physically do the activity? (MS)
Do you have enough concentration to complete activity? (PS)
Do you have the full responsibility for doing activity? (R)
Does someone help you? (SE)
Where do you carry out this activity? Do you have any equipment to help you?
(PE)
Do you have a routine when doing this activity? (H)
Have you had difficult past experiences doing this activity? (PstE)

Are you satisfied with your over-night routine?

GOALS • You said you have had a better/ worse/normal life; can
you identify a good time in your life? And a bad?
• What things do you want to be able to do that you
• How did these ups and downs affect you?
are currently unable?
• What things are important for you to be able to get Often how we have managed in the past helps us manage
back to do at home? in the future, at the moment you have XXXX and that is
why you are in hospital. This may mean things may be
• Do you ever set realistic plans for the future? Do
different for you when you are discharged from hospital.
you feel you have managed to achieve any of these
plans?
READINESS FOR CHANGE
• Do you have any plans for the next week?
• You described XXX as a good/bad time that must
• How do you feel you will manage to accomplish
have been a big event, how did you adjust to this
that?
change?
• Do you have any longer term plans for the foreseeable
• Our daily routines change overtime do you feel you
future?
cope with changes to your routines?
• What do you think you will do to achieve these
• If someone gives you advice or feedback about your
goals?
life, how does it make you feel, how do you react to
this?
We often set goals and sometimes looking back over
past experiences helps us figure out how we will achieve
We have looked at many things within you life and all this
future goals.
information helps us together to plan your occupational
therapy treatment while you are in hospital you said you
INTERPRETATION OF PAST EXPERIENCES
are worried/ concerned/ not managing XXX. Are these
things you would like to look at while you are in hospital
• Overall in your life do you feel you have had the
to help you when you are discharged???
typical ups and downs?
• Do you feel your life has been better or worse than
normal?

MOHOST v.2.0 95
Appendix

Model of Human Occupation Screening Tool (MOHOST) Rating Form (UK English)

Client: _____________________________________ Assessor: _________________________________

Age: _______ Date of birth: _____/_____/_____ Designation: ______________________________
Gender: Male o Female o Signature: _________________________________
Identification code: __________________________ Date of first contact: _____/_____/_____
Ethnicity: White o Black o Asian o Date of assessment: _____/_____/_____
Other: _________________________ Treatment settings: _________________________
Health condition: ____________________________ __________________________________________

F Facilitates occupational participation

A Allows occupational participation
Rating Scale
I Inhibits occupational participation
R Restricts occupational participation

Analysis of Strengths & Limitations

_______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Summary of Ratings

Motivation for Pattern of Communication Environment:

Process Skills Motor skills
Occupation Occupation & Interaction Skills ____________

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

96 MOHOST v.2.0

Appraisal of Ability
Understanding of current
strengths & limitations
Accurate belief in skill,
accurate view of competence
Awareness of capacity
Expectation of Success
Optimism & hope
Self-efficacy, sense of control &
self-identity
Interest
Expressed enjoyment
Satisfaction
Curiosity
Participation
Choices
Appropriate commitment
Readiness for change
Sense of value and meaning
Preferences and goals
Routine
Balance
Organisation of habits
Structure
Productivity
Adaptability
Anticipation of change
Habitual response to change
Tolerance of change
Roles
Role identity
Role variety
Belonging
Involvement
Responsibility
Role competence
Meeting expectations
Fulfilling obligations
Delivering responsibilities
Appendix
MOTIVATION FOR OCCUPATION
F Accurately assesses own capacity, recognises strengths, aware of limitations
A Reasonable tendency to over/under estimate own abilities, recognises some limitations
I Difficulty understanding strengths and limitations without support
R Does not reflect on skills, fails to realistically estimate own abilities
Comments:
F Anticipates success and seeks challenges, optimistic about overcoming obstacles
A Has some hope for success, adequate self-belief but has some doubts, may need encouraging
I Requires support to sustain optimism about overcoming obstacles, poor self-efficacy
R Pessimistic, feels hopeless, gives up in the face of obstacles, lacks sense of control
Comments:
F Keen, curious, lively, tries new occupations, expresses pleasure, perseveres, appears content
A Has adequate interests that guide choices, has some opportunities to pursue interests
I Difficulty identifying interests, short-lived, ambivalent about choice of occupations
R Easily bored, unable to identify interests, apathetic, lacks curiosity even with support
Comments:
F Clear preferences & sense of what is important, motivated to work towards occupational goals
A Mostly able to make choices, may need encouragement to set and work towards goals
I Difficulties identifying what is important or setting and working towards goals, inconsistent
R Cannot set goals, impulsive, chaotic, goals are unattainable or based on anti-social values
Comments:
PATTERN OF OCCUPATION
F Able to arrange a balanced, organised and productive routine of daily activities
A Generally able to maintain or follow an organised and productive daily schedule
I Difficulty organising balanced, productive routines of daily activities without support
R Chaotic or empty routine, unable to support responsibilities and goals, erratic routine
Comments:
F Anticipates change, alters actions or routine to meet demand, (flexible/accommodating)
A Generally able to modify behaviour, may need time to adjust, hesitant
I Difficulty adapting to change, reluctant, passive or habitually overreacts to change
R Rigid, unable to adapt routines or tolerate change
Comments:
F Identifies with a variety of roles, has a sense of identity/belonging that comes from roles
A Generally identifies with one or more roles and has some sense of belonging from these roles
I Limited identification of roles, role overload or conflict, poor sense of belonging
R Does not identify with any role, negligible role demands, no sense of belonging
Comments:
F Reliably completes activities and meets the expectations related to role obligations
A Copes with most responsibilities, meets most expectations, able to fulfil most role obligations
I Difficulty being able to fulfil expectations and meet role obligations without support
R Limited ability to meet demands of activities or obligations, unable to complete role activities
Comments:
MOHOST v.2.0 97
Appendix

COMMUNICATION AND INTERACTION SKILLS

Non-verbal skills F Appropriate (possibly spontaneous) body language given culture and circumstances
A Generally able to display or control appropriate body language
Eye contact
I Difficulty controlling/displaying appropriate body language (delayed/limited/disinhibited)
Gestures
R Unable to display appropriate body language (absent/incongruent/unsafe/aggressive)
Orientation
Proximity Comments:
Conversation F Appropriately initiates, discloses and sustains conversation (clear/direct/open)
A Generally able to use language or signing to effectively exchange information
Disclosing
I Difficulty initiating, disclosing or sustaining conversation (hesitant/abrupt/limited/irrelevant)
Initiating & sustaining
R Uncommunicative, disjointed, bizarre or inappropriate disclosure of information
Speech content
Language Comments:

Vocal expression F Assertive, articulate, uses appropriate tone, volume and pace
A Vocal expression is generally appropriate in tone, volume and pace
Intonation
I Difficulty with expressing self (mumbling/pressured speech/monotone)
Articulation
R Unable to express self (unclear/too quiet or loud/too fast or too passive)
Volume
Pace Comments:
Relationships F Sociable, supportive, aware of others, sustains engagement, friendly, relates well to others
A Generally able to relate to others and mostly demonstrates awareness of others’ needs
Co-operation
I Difficulty with co-operation or makes few positive relationships
Collaboration
R Unable to co-operate with others or make positive relationships
Rapport
Respect Comments:

PROCESS SKILLS
Knowledge F Seeks and retains relevant information, know how to use tools appropriately
A Generally able to seek and retain information and know how to use tools
Seeking & retaining information
I Difficulty knowing how to use tools, difficulty in asking for or retaining information
Knowing what to do in an
R Unable to use knowledge/tools, does not retain information, asks repeatedly for same info
activity
Knowing how to use objects Comments:
Timing F Sustains concentration, starts, sequences and completes occupation at appropriate times
A Generally able to concentrate, start, sequence and complete occupations
Initiation
I Fluctuating concentration or distractible, difficulty initiating, sequencing & completing
Completion
R Unable to concentrate, unable to initiate, sequence or complete occupations
Sequencing
Concentration Comments:
Organisation F Efficiently searches for, gathers & restores tools/objects needed in occupation (neat)
A Generally able to search, gather and restore needed tools/objects
Arranging space and objects
I Difficulty searching for, gathering and restoring tools/objects, appears disorganised/untidy
Neatness
R Unable to search for, gather and restore tools and objects (chaotic, messy)
Preparation
Gathering objects Comments:
Problem-solving F Shows good judgement, anticipates difficulties and generates workable solutions (rational)
A Generally able to make decisions based on difficulties that arise
Judgement
I Difficulty anticipating and adapting to difficulties that arise, seeks reassurance
Adaptation
R Unable to anticipate and adapt to difficulties that arise and makes inappropriate decisions
Decision-making
Responsiveness Comments:

98 MOHOST v.2.0
 Appendix

MOTOR SKILLS
Posture & Mobility F Stable, upright, independent, flexible, good range of movement (possibly agile)
A Generally able to maintain posture and mobility in occupation, independently or with aids
Stability Walking
I Unsteady at times despite any aids, slow or manages with difficulty
Alignment Reaching
R Extremely unstable, unable to reach and bend or unable to walk
Positioning Bending
Balance Transfers Comments:
Co-ordination F Co-ordinates body parts with each other, uses smooth fluid movements (possibly dextrous)
A Some awkwardness or stiffness causing minor interruptions to occupations
Manipulation
I Difficulty co-ordinating movements (clumsy/tremulous/awkward/stiff)
Ease of movement
R Unable to co-ordinate, manipulate and use fluid movements
Fluidity
Fine motor skills Comments:
Strength & Effort F Grasps, moves & transports objects securely with adequate force/speed (possibly strong)
A Strength and effort are generally sufficient for most tasks
Grip Lifting
I Has difficulty with grasping, moving, transporting objects with adequate force and speed
Handling Transporting
R Unable to grasp, move, transport objects with appropriate force and speed (weak/frail)
Moving Calibrating
Comments:
Energy F Maintains appropriate energy levels, able to maintain tempo throughout occupation
A Energy may be slightly low or high at times, able to pace self for most tasks
Endurance
I Difficulty maintaining energy (tires easily/evidence of fatigue/distractible/restless)
Pace
R Unable to maintain energy, lacks focus, lethargic, inactive or highly overactive
Attention
Stamina Comments:

ENVIRONMENT Environment in which skills have been assessed: __________________________________

Physical space
Self-care, productivity and
leisure facilities
Privacy & accessibility
Stimulation & comfort
Physical resources
Finance
Equipment & tools
Possessions & transport
Safety & independence
Social groups
Family dynamics
Friends & social support
Work climate
Expectations & involvement
Occupational demands
Activity demands (self-care,
productivity and leisure)
Cultural conventions
Construction of activities
F Space affords a range of opportunities, supports & stimulates valued occupations
A Space is mostly adequate, allows daily occupations to be pursued
I Affords a limited range of opportunities and curtails performance of valued occupations
R Space restricts opportunities and prevents performance of valued occupations
Comments:
F Enable occupational goals to be achieved with ease, equipment and tools are appropriate
A Generally allow occupational goals to be achieved, may present some obstacles
I Impede ability to achieve occupational goals safely, equipment and tools are inadequate
R Have major impact on ability to achieve occupational goals, lack of tools lead to high risks
Comments:
F Social groups offer practical support, values and attitudes support optimal functioning
A Generally able to offer support but may be some under or over involvement
I Offer reduced support, or detracts from participation, some groups support but not others
R Do not support participation due to lack of interest or inappropriate involvement
Comments:
F Demands of activities match well with abilities, interests, energy and time available
A Generally consistent with abilities, interest, energy or time available, may present challenges
I Some clear inconsistencies with abilities and interest, or energy and time available
R Mostly inconsistent with abilities, construction of activity is under or over-demanding
Comments:

MOHOST v.2.0 99
Appendix

Multiple Summaries Model of Human Occupation Screnning Tool (MOHOST) (UK English)

Client: _______________________________ Assessor: _____________________________

F Facilitates occupation participation
A Allows occupation participation
Date of birth: ________/________/________ Designation: _________________________
I Inhibits occupation participation
R Restricts occupation participation
ID: __________________________________ Signature: ____________________________

Date of Assessment: _______/_______/_______ Environment: ______________________________________

Motivation for Pattern of Communication
Process Skills Motor skills Environment
Occupation Occupation & Interaction Skills

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

Date of Assessment: ________/________/________ Environment: ______________________________________

Motivation for Pattern of Communication
Process Skills Motor skills Environment
Occupation Occupation & Interaction Skills

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

Date of Assessment: ________/________/________ Environment: ______________________________________

Motivation for Pattern of Communication
Process Skills Motor skills Environment
Occupation Occupation & Interaction Skills
Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Co-ordination
Relationships
Conversation

Organisation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

100 MOHOST v.2.0

 Appendix

Multiple Summaries
Model of Human Occupation Screening Tool (MOHOST) (UK English)

Client: ____________________________________ Assessor: __________________________________

Date of birth: ________/________/________ Designation: _______________________________
ID: _______________________________________ Signature: _________________________________

ANALYSIS OF STRENGTHS & LIMITATIONS

Date of Assessment: _____/_____/_____ Environment: _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

ANALYSIS OF STRENGTHS & LIMITATIONS

Date of Assessment: _____/_____/_____ Environment: _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

ANALYSIS OF STRENGTHS & LIMITATIONS

Date of Assessment: _____/_____/_____ Environment: _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

MOHOST v.2.0 101

 Model of Human Occupation Screening Tool Data Sheet (Single Observation) (UK English)
Client: Assessment environment:

Date of birth: Occupation being assessed:

Appendix

ID code: Date of assessment:

F Facilitates occupational participation Name of assessor:

A Allows occupational participation Designation: Occupational Therapist o
Rating
I Inhibits occupational participation OT Support staff
Scale: o
R Restricts occupational participation
N/S Not seen

102 MOHOST v.2.0

Signature of Occupational Therapist:

Area to Evaluate Rating Comments

Shows awareness of strengths & limitations N/S F A I R

Shows pride/seeks challenges N/S F A I R

Shows curiosity and demonstrates interest N/S F A I R

Motivation
Identifies preferences/is goal-oriented N/S F A I R

Maintains routine habits (ADL) N/S F A I R

Remains settled/copes with disruption/change N/S F A I R

Becomes actively involved with task/group N/S F A I R

Pattern of
Occupation
Fulfils responsibilities in the session N/S F A I R

Uses appropriate non-verbal expression N/S F A I R

Initiates and sustains appropriate conversation N/S F A I R

Uses appropriate vocal expression N/S F A I R

Comm. &
Interaction Skills
Relates to and co-operates with others N/S F A I R

Chooses/uses equipment appropriately N/S F A I R

Maintains focus throughout task/sequence N/S F A I R

Skills
Process
Works in an orderly fashion N/S F A I R

Modifies actions to overcome problems N/S F A I R

Mobilises independently N/S F A I R

Manipulates tools and materials easily N/S F A I R

Skills
Motor
Uses appropriate strength and effort N/S F A I R

Maintains energy and appropriate pace N/S F A I R

Space offers stimulus and comfort N/S F A I R

Resources allow safety and independence N/S F A I R

Social interaction provides support N/S F A I R

Environment
Demands of activity match abilities/interests N/S F A I R
This is a formative assessment for the summative MOHOST Form and should only be used in conjunction with the MOHOST Form
 Model of Human Occupation Screening Tool Data Sheet (Multiple Observation) (UK English)
Client: Name of Assessor: F Facilitates occupational participation
Date of birth: Designation: Occupational Therapist o A Allows occupational participation
OT Support staff o I Inhibits occupational participation
ID code: R Restricts occupational participation
Signature of OT: N/S Not seen

Date of assessment:
Assessment environment:
Occupation being assessed:
Shows awareness of strengths & limitations N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Shows pride/seeks challenges N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Shows curiosity and demonstrates interest N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Motivation
Identifies preferences/is goal-oriented N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Maintains routine habits (ADL) N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Remains settled/copes with disruption/change N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Becomes actively involved with task/group N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Pattern of
Occupation
Fulfils responsibilities in the session N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Uses appropriate non-verbal expression N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Initiates and sustains appropriate conversation N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Uses appropriate vocal expression N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

action Skills
Comm. & Inter-
Relates to and co-operates with others N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Chooses/uses equipment appropriately N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Maintains focus throughout task/sequence N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Skills
Process
Works in an orderly fashion N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Modifies actions to overcome problems N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Mobilises independently N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Manipulates tools and materials easily N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Skills
Motor
Uses appropriate strength and effort N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Maintains energy and appropriate pace N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Space offers stimulus and comfort N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Resources allow safety and independence N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Social interaction provides support N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Environment
Demands of activity match abilities/interests N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

MOHOST v.2.0 103

Appendix

This is a formative assessment for the summative MOHOST Form and should only be used in conjunction with the MOHOST Form
Appendix

Model of Human Occupation Screening Tool (MOHOST) Rating Form (USA English)

Client: _____________________________________ Assessor: _________________________________

Age: _______ Date of birth: _____/_____/_____ Designation: ______________________________
Gender: Male o Female o Signature: _________________________________
Identification code: __________________________ Date of first contact: _____/_____/_____
Ethnicity: Caucasian o African American o Date of assessment: _____/_____/_____
Asian o Hispainc/Latino o Other: ___________ Treatment settings: _________________________
Health condition: ____________________________ __________________________________________

F Facilitates occupational participation

A Allows occupational participation
Rating Scale
I Inhibits occupational participation
R Restricts occupational participation

Analysis of Strengths & Limitations

_______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Summary of Ratings

Motivation for Pattern of Communication Environment:

Process Skills Motor skills
Occupation Occupation & Interaction Skills ____________

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Relationships

Coordination
Organization
Conversation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

104 MOHOST v.2.0


Appraisal of Ability
Understanding of current
strengths & limitations
Accurate belief in skill,
accurate view of competence
Awareness of capacity
Expectation of Success
Optimism & hope
Self-efficacy, sense of control &
self-identity
Interest
Expressed enjoyment
Satisfaction
Curiosity
Participation
Choices
Appropriate commitment
Readiness for change
Sense of value and meaning
Preferences and goals
Routine
Balance
Organization of habits
Structure
Productivity
Adaptability
Anticipation of change
Habitual response to change
Tolerance of change
Roles
Role identity
Role variety
Belonging
Involvement
Responsibility
Role competence
Meeting expectations
Fulfilling obligations
Delivering responsibilities
Appendix
MOTIVATION FOR OCCUPATION
F Accurately assesses own capacity, recognizes strengths, aware of limitations
A Reasonable tendency to over/under estimate own abilities, recognizes some limitations
I Difficulty understanding strengths and limitations without support
R Does not reflect on skills, fails to realistically estimate own abilities
Comments:
F Anticipates success and seeks challenges, optimistic about overcoming obstacles
A Has some hope for success, adequate self-belief but has some doubts, may need encouraging
I Requires support to sustain optimism about overcoming obstacles, poor self-efficacy
R Pessimistic, feels hopeless, gives up in the face of obstacles, lacks sense of control
Comments:
F Keen, curious, lively, tries new occupations, expresses pleasure, perseveres, appears content
A Has adequate interests that guide choices, has some opportunities to pursue interests
I Difficulty identifying interests, short-lived, ambivalent about choice of occupations
R Easily bored, unable to identify interests, apathetic, lacks curiosity even with support
Comments:
F Clear preferences & sense of what is important, motivated to work towards occupational goals
A Mostly able to make choices, may need encouragement to set and work towards goals
I Difficulties identifying what is important or setting and working towards goals, inconsistent
R Cannot set goals, impulsive, chaotic, goals are unattainable or based on anti-social values
Comments:
PATTERN OF OCCUPATION
F Able to arrange a balanced, organized and productive routine of daily activities
A Generally able to maintain or follow and organized and productive daily schedule
I Difficulty organizing balanced, productive routines of daily activities without support
R Chaotic or empty routine, unable to support responsibilities and goals, erratic routine
Comments:
F Anticipates change, alters actions or routine to meet demand, (flexible/accommodating)
A Generally able to modify behavior, may need time to adjust, hesitant
I Difficulty adapting to change, reluctant, passive or habitually overreacts to change
R Rigid, unable to adapt routines or tolerate change
Comments:
F Identifies with a variety of roles, has a sense of identity/belonging that comes from roles
A Generally identifies with one or more roles and has some sense of belonging from these roles
I Limited identification of roles, role overload or conflict, poor sense of belonging
R Does not identify with any role, negligible role demands, no sense of belonging
Comments:
F Reliably completes activities and meets the expectations related to role obligations
A Copes with most responsibilities, meets most expectations, able to fulfil most role obligations
I Difficulty being able to fulfil expectations and meet role obligations without support
R Limited ability to meet demands of activities or obligations, unable to complete role activities
Comments:
MOHOST v.2.0 105
Appendix

COMMUNICATION AND INTERACTION SKILLS

Non-verbal skills F Appropriate (possibly spontaneous) body language given culture and circumstances
A Generally able to display or control appropriate body language
Eye contact
I Difficulty controlling/displaying appropriate body language (delayed/limited/disinhibited)
Gestures
R Unable to display appropriate body language (absent/incongruent/unsafe/aggressive)
Orientation
Proximity Comments:
Conversation F Appropriately initiates, discloses and sustains conversation (clear/direct/open)
A Generally able to use language or signing to effectively exchange information
Disclosing
I Difficulty initiating, disclosing or sustaining conversation (hesitant/abrupt/limited/irrelevant)
Initiating & sustaining
R Uncommunicative, disjointed, bizarre or inappropriate disclosure of information
Speech content
Language Comments:

Vocal expression F Assertive, articulate, uses appropriate tone, volume and pace
A Vocal expression is generally appropriate in tone, volume and pace
Intonation
I Difficulty with expressing self (mumbling/pressured speech/monotone)
Articulation
R Unable to express self (unclear/too quiet or loud/too fast or too passive)
Volume
Pace Comments:
Relationships F Sociable, supportive, aware of others, sustains engagement, friendly, relates well to others
A Generally able to relate to others and mostly demonstrates awareness of others’ needs
Cooperation
I Difficulty with cooperation or makes few positive relationships
Collaboration
R Unable to cooperate with others or make positive relationships
Rapport
Respect Comments:

PROCESS SKILLS
Knowledge F Seeks and retains relevant information, know how to use tools appropriately
A Generally able to seek and retain information and know how to use tools
Seeking & retaining information
I Difficulty knowing how to use tools, difficulty in asking for or retaining information
Knowing what to do in an
R Unable to use knowledge/tools, does not retain information, asks repeatedly for same info
activity
Knowing how to use objects Comments:
Timing F Sustains concentration, starts, sequences and completes occupation at appropriate times
A Generally able to concentrate, start, sequence and complete occupations
Initiation
I Fluctuating concentration or distractible, difficulty initiating, sequencing & completing
Completion
R Unable to concentrate, unable to initiate, sequence or complete occupations
Sequencing
Concentration Comments:
Organization F Efficiently searches for, gathers & restores tools/objects needed in occupation (neat)
A Generally able to search, gather and restore needed tools/objects
Arranging space and objects
I Difficulty searching for, gathering and restoring tools/objects, appears disorganized/untidy
Neatness
R Unable to search for, gather and restore tools and objects (chaotic, messy)
Preparation
Gathering objects Comments:
Problem-solving F Shows good judgement, anticipates difficulties and generates workable solutions (rational)
A Generally able to make decisions based on difficulties that arise
Judgement
I Difficulty anticipating and adapting to difficulties that arise, seeks reassurance
Adaptation
R Unable to anticipate and adapt to difficulties that arise and makes inappropriate decisions
Decision-making
Responsiveness Comments:

106 MOHOST v.2.0

 Appendix

MOTOR SKILLS
Posture & Mobility F Stable, upright, independent, flexible, good range of movement (possibly agile)
A Generally able to maintain posture and mobility in occupation, independently or with aids
Stability Walking
I Unsteady at times despite any aids, slow or manages with difficulty
Alignment Reaching
R Extremely unstable, unable to reach and bend or unable to walk
Positioning Bending
Balance Transfers Comments:
Coordination F Coordinates body parts with each other, uses smooth fluid movements (possibly dextrous)
A Some awkwardness or stiffness causing minor interruptions to occupations
Manipulation
I Difficulty coordinating movements (clumsy/tremulous/awkward/stiff)
Ease of movement
R Unable to coordinate, manipulate and use fluid movements
Fluidity
Fine motor skills Comments:
Strength & Effort F Grasps, moves & transports objects securely with adequate force/speed (possibly strong)
A Strength and effort are generally sufficient for most tasks
Grip Lifting
I Has difficulty with grasping, moving, transporting objects with adequate force and speed
Handling Transporting
R Unable to grasp, move, transport objects with appropriate force and speed (weak/frail)
Moving Calibrating
Comments:
Energy F Maintains appropriate energy levels, able to maintain tempo throughout occupation
A Energy may be slightly low or high at times, able to pace self for most tasks
Endurance
I Difficulty maintaining energy (tires easily/evidence of fatigue/distractable/restless)
Pace
R Unable to maintain energy, lacks focus, lethargic, inactive or highly overactive
Attention
Stamina Comments:

ENVIRONMENT Environment in which skills have been assessed: __________________________________

Physical space
Self-care, productivity and
leisure facilities
Privacy & accessibility
Stimulation & comfort
Physical resources
Finance
Equipment & tools
Possessions & transport
Safety & independence
Social groups
Family dynamics
Friends & social support
Work climate
Expectations & involvement
Occupational demands
Activity demands (self-care,
productivity and leisure)
Cultural conventions
Construction of activities
F Space affords a range of opportunities, supports & stimulates valued occupations
A Space is mostly adequate, allows daily occupations to be pursued
I Affords a limited range of opportunities and curtails performance of valued occupations
R Space restricts opportunities and prevents performance of valued occupations
Comments:
F Enable occupational goals to be achieved with ease, equipment and tools are appropriate
A Generally allow occupational goals to be achieved, may present some obstacles
I Impede ability to achieve occupational goals safely, equipment and tools are inadequate
R Have major impact on ability to achieve occupational goals, lack of tools lead to high risks
Comments:
F Social groups offer practical support, values and attitudes support optimal functioning
A Generally able to offer support but may be some under or over involvement
I Offer reduced support, or detracts from participation, some groups support but not others
R Do not support participation due to lack of interest or inappropriate involvement
Comments:
F Demands of activities match well with abilities, interests, energy and time available
A Generally consistent with abilities, interest, energy or time available, may present challenges
I Some clear inconsistencies with abilities and interest, or energy and time available
R Mostly inconsistent with abilities, construction of activity is under or over-demanding
Comments:

MOHOST v.2.0 107

Appendix

Multiple Summaries Model of Human Occupation Screnning Tool (MOHOST) (USA English)

Client: _______________________________ Assessor: _____________________________

F Facilitates occupation participation
A Allows occupation participation
Date of birth: ________/________/________ Designation: _________________________
I Inhibits occupation participation
R Restricts occupation participation
ID: __________________________________ Signature: ____________________________

Date of Assessment: _______/_______/_______ Environment: ______________________________________

Motivation for Pattern of Communication
Process Skills Motor skills Environment
Occupation Occupation & Interaction Skills

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Relationships

Coordination
Organization
Conversation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

Date of Assessment: ________/________/________ Environment: ______________________________________

Motivation for Pattern of Communication
Process Skills Motor skills Environment
Occupation Occupation & Interaction Skills

Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Relationships

Coordination
Organization
Conversation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

Date of Assessment: ________/________/________ Environment: ______________________________________

Motivation for Pattern of Communication
Process Skills Motor skills Environment
Occupation Occupation & Interaction Skills
Occupational Demands
Expectation of Success
Appraisal of Ability

Physical Resources
Posture & Mobility
Non-verbal Skills

Vocal Expression

Problem-solving

Strength & Effort

Physical Space

Social Groups
Responsibility

Relationships

Coordination
Organization
Conversation
Adaptability

Knowledge
Choices

Routine
Interest

Timing

Energy
Roles

F F F F F F F F F F F F F F F F F F F F F F F F

A A A A A A A A A A A A A A A A A A A A A A A A

I I I I I I I I I I I I I I I I I I I I I I I I

R R R R R R R R R R R R R R R R R R R R R R R R

108 MOHOST v.2.0

 Appendix

Multiple Summaries
Model of Human Occupation Screening Tool (MOHOST) (USA English)

Client: ____________________________________ Assessor: __________________________________

Date of birth: ________/________/________ Designation: _______________________________
ID: _______________________________________ Signature: _________________________________

ANALYSIS OF STRENGTHS & LIMITATIONS

Date of Assessment: _____/_____/_____ Environment: _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

ANALYSIS OF STRENGTHS & LIMITATIONS

Date of Assessment: _____/_____/_____ Environment: _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

ANALYSIS OF STRENGTHS & LIMITATIONS

Date of Assessment: _____/_____/_____ Environment: _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

MOHOST v.2.0 109

 Model of Human Occupation Screening Tool Data Sheet (Single Observation) (USA English)
Client: Assessment environment:

Date of birth: Occupation being assessed:

Appendix

ID code: Date of assessment:

F Facilitates occupational participation Name of assessor:

A Allows occupational participation Designation: Occupational Therapist o
Rating
I Inhibits occupational participation OT Support staff
Scale: o
R Restricts occupational participation
N/S Not seen

110 MOHOST v.2.0

Signature of Occupational Therapist:

Area to Evaluate Rating Comments

Shows awareness of strengths & limitations N/S F A I R

Shows pride/seeks challenges N/S F A I R

Shows curiosity and demonstrates interest N/S F A I R

Motivation
Identifies preferences/is goal-oriented N/S F A I R

Maintains routine habits (ADL) N/S F A I R

Remains settled/copes with disruption/change N/S F A I R

Becomes actively involved with task/group N/S F A I R

Pattern of
Occupation
Fulfils responsibilities in the session N/S F A I R

Uses appropriate non-verbal expression N/S F A I R

Initiates and sustains appropriate conversation N/S F A I R

Uses appropriate vocal expression N/S F A I R

Comm. &
Interaction Skills
Relates to and cooperates with others N/S F A I R

Chooses/uses equipment appropriately N/S F A I R

Maintains focus throughout task/sequence N/S F A I R

Skills
Process
Works in an orderly fashion N/S F A I R

Modifies actions to overcome problems N/S F A I R

Mobilizes independently N/S F A I R

Manipulates tools and materials easily N/S F A I R

Skills
Motor
Uses appropriate strength and effort N/S F A I R

Maintains energy and appropriate pace N/S F A I R

Space offers stimulus and comfort N/S F A I R

Resources allow safety and independence N/S F A I R

Social interaction provides support N/S F A I R

Environment
Demands of activity match abilities/interests N/S F A I R
This is a formative assessment for the summative MOHOST Form and should only be used in conjunction with the MOHOST Form
 Model of Human Occupation Screening Tool Data Sheet (Multiple Observation) (USA English)
Client: Name of Assessor: F Facilitates occupational participation
Date of birth: Designation: Occupational Therapist o A Allows occupational participation
OT Support staff o I Inhibits occupational participation
ID code: R Restricts occupational participation
Signature of OT: N/S Not seen

Date of assessment:
Assessment environment:
Occupation being assessed:
Shows awareness of strengths & limitations N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Shows pride/seeks challenges N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Shows curiosity and demonstrates interest N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Motivation
Identifies preferences/is goal-oriented N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Maintains routine habits (ADL) N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Remains settled/copes with disruption/change N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Becomes actively involved with task/group N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Pattern of
Occupation
Fulfils responsibilities in the session N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Uses appropriate non-verbal expression N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Initiates and sustains appropriate conversation N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Uses appropriate vocal expression N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

action Skills
Comm. & Inter-
Relates to and cooperates with others N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Chooses/uses equipment appropriately N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Maintains focus throughout task/sequence N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Skills
Process
Works in an orderly fashion N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Modifies actions to overcome problems N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Mobilizes independently N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Manipulates tools and materials easily N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Skills
Motor
Uses appropriate strength and effort N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Maintains energy and appropriate pace N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Space offers stimulus and comfort N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Resources allow safety and independence N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R
Social interaction provides support N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

Environment
Demands of activity match abilities/interests N/S F A I R N/S F A I R N/S F A I R N/S F A I R N/S F A I R

MOHOST v.2.0 111

Appendix

This is a formative assessment for the summative MOHOST Form and should only be used in conjunction with the MOHOST Form