Canadian model of occupational performance

The Canadian Model of Occupational Performance (CMOP) was developed by the Canadian Association of Occupational Therapists, and describes transactions and mutual influences between the dimensions of occupational performance. It is applied by the accompanying Occupational Performance Process Model, which describes the therapeutic process from a client’s perspective. . . The main model illustrates the relationship between person, occupation and environment. Spirituality is the fourth dimension, placed in the centre of the model to highlight its fundamental importance.

History
The current CMOP results from developments in occupational therapy spanning thirty years. It was initially inspired by occupational performance frameworks proposed by the American Occupational Therapy Association and Reed and Sanderson. However, calls to develop a national quality assurance system lead to its forerunner in 1983 - 'Client-Centred Guidelines for the Practice of Occupational Therapy' Refinements in the model are evident in further guideline statements and 'Enabling Occupation, A Canadian Occupational Therapy Perspective'. The model’s national development is a unique feature and so CMOP does not reflect the views of any one individual. However while some assume the model has no cultural bias and adaptation has been encouraged, little research has been conducted into the efficacy of its application in non western societies. .

Apart from cultural relevance, Kielhofner identifies four characteristics of well developed models which CMOP possesses to varying degrees,

Interdisciplinary Base
Client centred practice originally evolved in psychology. It combines with systems approach, environmental theory and research into 'flow' by Csikszentmihalyi to provided CMOP with a broad interdisciplinary base of knowledge.

Theory regarding order, disorder and intervention
In CMOP, occupational order has six perspectives – physical rehabilitative, psycho-emotional, socio-adaptive, neurointegrative, developmental or environmental – in relation to the arbitrary performance areas of self care, leisure and productivity. Quality of function is assessed in terms of both performance and satisfaction. Disorder may occur in the dimensions of person, occupation or environment, or when the momentum of experience is lost due to unresolved issues. Intervention aims to improve transactions between person, occupation and environment, through the process of enablement rather than treatment. Enablement involves working with clients to facilitate autonomy, and does not focus primarily on performance components.

Technology for application
The Canadian Occupational Performance Measure (COPM) is a semi structured interview developed to apply the model and is the only prescribed assessment. This allows freedom to choose other supporting assessments but also restrict the methods of application for the model. Therapists have praised its client centred approach, relatively quick administration, role in promoting occupational therapy in multidisciplinary teams and compatibility with other assessment tools. However these properties are compromised by most therapists using COPM without training or knowledge of the model, particularly when the tool is used without implementing the model.

Empirical Base
The majority of related research evidence pertains to the assessment tool rather than the model. Of this research, most has been in institutional settings, methodologies usually have medium to low levels of credibility , and may are attributed to the same therapists involved in the models formulation. The model is said to be applicable to all ages and diagnoses groups but few studies have explored its practical application.

Further Developments
In July 2007, the Canadian Association of Occupational Therapists launched Canada's 8th landmark occupational therapy practice guidelines entitled Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation. The new publication is a companion to Enabling Occupation: An Occupational Therapy Perspective 1997/2002 and reflects the growth and development of the profession’s knowledge in occupation-based, evidence-based and client-centred practice.

Enabling Occupation II advances the core concepts of occupation and enablement, and their application in practice with clients, education and research. Drawing on the experience and research of over 60 authors in Canada, Enabling Occupation II raises complex sociocultural issues, such as diversity, individualism and collectivism, language, economy and regulation.

Several significant developments are captured in these new guidelines, including a deeper discussion of occupation, clear specification of enablement, the practical characterization of occupation-based enablement, and an emphasis on scholarship, accountability, funding and workforce planning as leadership strategies.

The 2007 publication can be considered the ‘triple model’ guidelines:
 * the Canadian Model of Occupational Performance was expanded to include the concept of engagement;
 * the Canadian Model of Occupational Performance and Engagement (CMOP-E) portrays an occupational perspective that includes and extends beyond occupational performance; and
 * the Canadian Model of Client-Centred Engagement (CMCE) captures the profession’s historical concern for client-centred practice, now linked to the broader concept of enablement.
 * and the new Canadian Practice Process Framework (CPPF) portrays eight action points for the process of occupation-based, client-centred enablement.

CAOT encourages readers of Enabling Occupation: An Occupational Therapy Perspective 1997/2002 to continue to advance their understanding of occupational therapy by reading the companion document Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation. Readers are strongly encouraged to use the CMOP-E in place of the Canadian Model of Occupational Performance (CMOP); the CPPF in place of the Occupational Performance Process Model (OPPM); and refer to the CMCE to bring client-centred practice to life.

For purchasing information: Visit CAOT's on-line store at http://www.caot.ca

For further information on the Enabling occupation publication visit http://www.caot.ca/default.asp?pageid=1439

Townsend, E.A. & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT ACE