Occupational therapists, known for their ability to coach others through difficult changes, now find themselves in changing environments that include clients' desire for participation in service delivery, and the need for evidence of the outcome of occupational therapy intervention. This paper proposes a process model that is based on core concepts of occupation and client-centred practice, that incorporates theoretical approaches, and can be applied to all clients. The process model coaches the occupational therapist through a client-centred problemsolving process. It represents a description or plan for occupational therapy assessment and intervention that leads to a collaborative approach to client-identified occupational performance issues. Examples of the application of the process to occupational therapy practice are included. This model helps to articulate core concepts and values, and provides guidance for occupational therapy practice within changing environments and expectations. RÉSUMÉReconnus pour leur habileté à guider les autres à travers des changements difficiles, les ergothérapeutes sont confrontés aujourd'hui à de nouvelles situations, dont la volonté des clients de participer à la prestation des services ainsi que la nécessité de mettre en évidence les résultats de l'intervention ergothérapique. Cet article propose un modèle de processus qui s'appuie sur les concepts de base de l'occupation et sur la pratique centrée sur le client. Ce modèle, qui incorpore des approches théoriques, peut être appliqué à toutes les clientèles. Le modèle de processus fournit un cadre à l'ergothérapeute pour la résolution de problèmes centrée sur le client. Il constitue un plan d'évaluation et d'intervention en ergothérapie, favorisant une approche coopérative de problèmes liés au rendement occupationnel, identifiés par le client. L'article présente des exemples d'application du processus en ergothérapie. Ce modèle permet de relier des valeurs et des concepts fondamentaux tout en fournissant des directives pour la pratique de l'ergothérapie en fonction des nouvelles réalités et attentes. KEYWORDS Client-centred practice, occupational therapy Human activities and occupations Models of practice Occupational performance
Best practice recommendations are made based on this review.
The absence of clear and practical guidelines for documenting on the health record often makes charting a disorganized and unsatisfying experience for occupational therapists. Like the health record, the occupational therapy process is structured to reflect a problem solving process that promotes clinical reasoning. The model described in this paper was developed to reflect the occupational therapy process as identified in the Occupational Therapy Guidelines for Client-centred Practice and proposes an additional section on problem naming. It is viewed as an open loop through which the client may move one or more times while learning to cope with change until enough momentum is gathered to move into adaptation. Emphasis is placed on naming and validating each problem with the client, and negotiating responsibilities and expected outcomes. This feedback loop summarizes the steps required to practice occupational therapy from a client-centred stance. Occupational therapists who develop competence in using this model, chart in an organized, client-centred, and therefore more satisfying manner.
The third wave, information, began in the mid 1950's when people began to be valued for their brains, and for the first time, more than half of the workforce consisted of white collar workers (Harris, 1998). The fourth wave, that of knowledge, has already arrived. Weiner and Brown (1997) describe their perception of the coming economy as the 'emotile economy' .The word emotile is a combination of emotional, that is, heightened concern for personal well-being, and motile described as fast-moving, portable, and non-fixed. In an attempt to help us think about and understand our changing world and prepare for the future, many people have written in a variety of ways about these changing eras (Harris, 1998; Picard-Greffe, 1994; Wacker & Taylor, 2000; Weiner & Brown, 1997) which are occurring more and more rapidly. We are a product, not of individual waves, but of the complex result of the impact of each succeeding wave on the others. The wave analogy is a good one. We can visualize in some cases being lifted off our feet and slammed, stunned, onto shore, wondering what hit us, and in other cases riding the crest of the wave with exhilaration. Chilton (1995) exhorted us to "wade in deep and risk riding the waves of change to unknown lands…". We are, she said ". .well equipped to ride these waves" (p. 184). Some of us seek waves; some of us try to avoid them and, of course, some of us make waves. Whether sought or not, we know that the waves of change Copyright of articles published in the Canadian Journal of Occupational Therapy (CJOT) is held by the Canadian Association of Occupational Therapists. Permission must be obtained in writing from CAOT to photocopy, reprint, reproduce (in print or electronic format) any material published in CJOT.There is a per page, per table or figure charge for commercial use.When referencing this article, please us APA style, citing both the date retrieved from our web site and the URL.
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