A theoretical perspective designed for clinical application and based on fundamental occupational therapy principles is offered. This perspective, the occupational adaptation frame of reference, is presented as an articulation of (a) a normal developmental process leading to competence in occupational functioning; (b) the process through which the benefits of occupational therapy occur; and (c) a perspective that promotes holistic practice. The person is viewed as operating occupationally through an idiosyncratic configuration of sensorimotor, cognitive, and psychosocial systems, all of which are inevitably involved in each occupational response. This occupational functioning is described as occurring through interaction of the person with a work, play and leisure, or selfcare context that has distinctive physical, social, and cultural properties (i.e., the occupational environment). Occupational adaptation is a perspective that can influence practice, education, and research.

This paper introduces a practice model based on the occupational adaptation frame of reference (Schkade & Schultz, 1992). The occupational adaptation practice model emphasizes the creation of a therapeutic climate, the use of occupational activity, and the importance of relative mastery. Practice based on occupational adaptation differs from treatment that focuses on acquisition of functional skills because the practice model directs occupational therapy interventions toward the patient's internal processes and how such processes are facilitated to improve occupational functioning. The occupational adaptation practice model is holistic. The patient's occupational environments (as influenced by physical, social, and cultural properties) are as important as the patient's sensorimotor, cognitive, and psychosocial functioning and the patient's experience of personal limitations and potential is validated. The integration of these concepts drives the treatment process. Through a description of treatment with a variety of patients, this paper presents the model's diversity and illustrates the relationship between the concepts. The occupational adaptation practice model reflects the uniqueness of occupational therapy and integrates the profession's historical practice with contemporary interventions and methods.

Research method considerations (use of participant observation for hypothesis testing) preclude definitive interpretation of a link between skill mastery and self-esteem. Short-term positive effects of the skiing experience reported by questionnaire were present 1 month after the trip. Long-term effects should be studied.

Both groups benefited from occupational therapy intervention. Occupational Adaptation was associated with a more efficient outcome and greater patient satisfaction.

This research addressed the need for a clinically practical and psychometrically sound measure of a central construct of Occupational Adaptation theory. As an indicator of Occupational Adaptation, the Relative Mastery Measurement Scale (RMMS) was developed and evaluated for content and construct validity. The RMMS assesses individuals' perceptions of their effectiveness, efficiency, and satisfaction regarding their responses to occupational challenges. In the first phase, the content validity of the RMMS was statistically evaluated using the ratings of five experts in Occupational Adaptation. Lu's Coefficient of Agreement among the experts for the final 12-item RMMS was an acceptable .95. In phase two, construct validity and reliability were examined using a combination of Rasch analysis and traditional measurement statistics. Participants were 150 rehabilitation clients. Reliability and validity was supported through the unidimensionality of 11 of 12 RMMS items by the ordering of item difficulty, goodness-offit statistics, factor analysis, and point-biserial correlations.