2

Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable

MODELS OF HEALTH AND WELLNESS

“Striving toward occupational justice is the major ethical dilemma facing

occupational therapists in every corner of the world.”
WILCOCK AND TOWNSEND, 2014, P. 541

This chapter will review the following prevailing systems to go to the doctor right away. Sue called her primary care
of health care and the position of occupational therapy physician, but he couldn’t see her until later in the week.
within them: She refused to go to the city hospital’s emergency room, so
 The medical continuum of care her friend suggested a walk-in clinic at a local strip mall.
 The biopsychosocial model There, a physician’s assistant examined her knee, wrote a
prescription, and sent her for an X-ray. By then the radiol-
 The World Health Organization’s model ogy center was closed, so after filling her prescription for
 The recovery model in mental health an anti-inflammatory medication, she returned home with
 Client-centered care instructions to wrap her knee with ice packs and keep her
 Public health models leg elevated. Sue tried filling plastic bags with ice cubes, but
the bag wouldn’t stay on her knee, and she found the cold
 Wilcock’s occupational perspective of health hard to tolerate. The next morning, the pain in her knee
These provide a further context for understanding the had increased, making it difficult to walk. Sue also wor-
changes that are occurring in the occupational therapy ried about her out-of-pocket medical costs. Her Medicare
profession both nationally and globally and how they will Advantage insurance plan only covered certain pharmacies
affect the theories, models, and frames of reference we and medical providers, and she found out that neither the
develop and apply now and in the future. walk-in clinic nor the pharmacy near her friend’s home were
in her network. She drove with difficulty to get her X-ray

THE MEDICAL APPROACH and had it sent directly to her primary care physician, with
whom she made an appointment for the next day. Although
TO CONTINUUMS OF CARE the X-ray showed no broken bones, by then her knee had
developed a full-blown infection, for which she was sent
No one can argue that the medically based system of directly to the hospital she was trying so hard to avoid. One
health care in the United States is in trouble. Consider week and several thousand dollars in copays later, while
the following scenario: Sue, a healthy 75-year-old widow, still in the hospital receiving intravenous antibiotics, Sue
fell and injured her knee while walking down the front was told that some complications were found on magnetic
steps to her car, which was parked in the driveway. It hurt, resonance imaging (MRI) and she would now need knee
but she got up anyway and continued with her errands. By replacement surgery. This entailed some other preparatory
copyright law.

4 o’clock in the afternoon, her knee had become swollen tests, a surgical procedure at the hospital, a stay in a sub-
and red, and Sue’s friend, whom she was visiting, told her acute rehabilitation center, and outpatient rehabilitation
Cole M. B., Tufano R.
Applied Theories in Occupational Therapy: A Practical Approach, Second Edition (pp 29-53).
29 © 2020 SLACK Incorporated.

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
 30 CHAPTER 2
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable

Table Sue did eventually have her knee replacement performed

2-1 Examples of Medical by an orthopedic surgeon in the hospital. For persons with
Facilities terminal illness, hospice care might also be considered,
with these services offered at inpatient hospice centers or
• Primary care, doctors’ offices, group practices, walk- as home care programs.
in clinics
• Outpatient treatment centers, diagnostic testing, out-
patient surgery, rehabilitation
Origins of the Medical Model and
• Mental health clinics Occupational Therapy in the United
• Substance abuse recovery residential programs
• Home health care agencies States
• Subacute rehabilitation hospitals Occupational therapy has been associated with the med-
• General hospitals
ical model from its beginnings. Early in the 20th century,
• Skilled nursing facilities, nursing homes
• Hospice programs for terminal illness
humanism influenced the practice of medicine by promot-
ing a holistic approach that encouraged experimentation
with many new and creative treatment methods. Without
this openness, the central role of occupation in the restora-
over the next 6 months. Sue lived alone, with no family tion and maintenance of health, which inspired the birth of
nearby. So she needed many home care visits to enable her our profession, may never have become known. However, by
to remain in her home, a ground-level apartment. If she the 1930s, the scientific movement had gathered sufficient
had not been able to manage “aging in place,” Sue’s next strength to shape medicine and occupational therapy prac-
residence might easily have been a nursing home. tice in ways that allowed both to benefit from the rapidly
growing body of scientific research.
Stops Along the Continuum of Care The medical model of health care came into existence
because of the conditions of the times. In the 1930s and
What medical services has Sue used? To summarize,
1940s, many diseases were on the rise, such as tuberculosis
her medical journey included a walk-in clinic, a pharmacy,
and polio, for which there was no cure. Scientific research
a doctor’s office, a diagnostic imaging center, a hospital,
led to an understanding of how bacteria spreads disease
a subacute rehabilitation inpatient facility, an outpatient
and what measures could be taken to prevent it. Medicine
rehabilitation center, multiple visits from a home care
applied the scientific method to develop medications and
agency, and the possibility of nursing home placement.
vaccines to prevent or cure many of the diseases of the
These offices, institutions, and agencies represent the cur-
mid-20th century. Occupational therapy struggled to keep
rent continuum of medical care (Table 2-1).
up with the advances in medicine and adopted practice
methods for remediation, adaptation, and compensation.
Learning Activity Remediation involved the use of occupations to restore the
Discuss the following questions regarding Sue’s case: ability to function. For example, in persons with depression
1. To what extent did Sue’s own attempts to self-manage or anxiety disorders, occupational therapy worked side by
cause her condition to become worse? side with medicine in order to hasten recovery through a
return to normal daily occupations. Occupational therapists
2. How might the need for surgery have been prevented?
developed adaptations to the task and environment in order
3. Where did economics enter into the reasoning pro- to enable occupational functioning despite the limitations
cess? brought on by illness or injury. In using compensatory strate-
4. Where might Sue have encountered occupational gies, occupational therapists took over where medicine left
therapy on this journey? off. For example, splinting, adaptive equipment, and, more
5. What could occupational therapists do to help Sue at recently, robotics and computer-assisted technology are
each stage of her recovery? used by occupational therapists to enable activities of daily
The medical continuum begins with a primary care living (ADL) for persons with partial paralysis from polio, a
setting, the first level of care where the problem is diag- stroke, or a spinal cord injury, for which no further improve-
nosed and treatment given or recommended. Sue used two ment could be gained with other medical treatment.
primary care settings: a doctor’s office and a walk-in clinic. For most of the 20th century, occupational therapists
When medical diagnostic testing is required, this may occur worked in hospitals, nursing homes, rehabilitation centers,
in a different location, such as the radiology center where day hospitals, and outpatient clinics under the auspices of
copyright law.

Sue got her X-ray. Each medical specialist will likely have the medical model. Occupational therapists became a part
his or her own practice. For example, if Sue’s bone had been of the health care teams that offered a multidisciplinary
fractured initially, the primary care physician may have sent approach to the treatment of illness and disease. As such,
her as an outpatient to an orthopedic specialist, and in fact occupational therapy often required a doctor’s prescription

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
 MODELS OF HEALTH AND WELLNESS 31
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable

in order to be paid by Medicare or other health insur- as reductionistic. Once the doctor names the disease—
ance, and this requirement remains written into many pneumonia, for example—he or she can then apply what is
states’ occupational therapy licensure laws today. Because known about that illness in order to prescribe a treatment—
occupational therapy treatment is categorized as a medical for example, antibiotic medication, bed rest, maintenance
service, it also falls under the current medical reimburse- of a sterile environment, increased fluid intake, or other
ment system, which remains a major stumbling block for specific instructions leading to a cure. The patient, a passive
occupational therapy practitioners. The medical system of recipient of treatment, complies with the doctor’s instruc-
payment has not kept up with current research, which gen- tions in order to get well, feel better, and restore health.
erally supports a more social or community based model of This describes the unique terminology of the medical model
care. In the 21st century, our profession appears to be in the as we know it.
midst of a transition, and changes in public policy will be
needed in order to fully adopt a broader paradigm of occupa- Fragmentation in Health Care
tion and to become truly client centered.
In the example of Sue, it becomes evident that the cur-
rent medical system of service delivery is highly fragmented
Characteristics of the Traditional and inefficient. A recent study Montenegro et al. (2011)
Medical Model states that:
The scientific method requires that a research problem … high levels of fragmentation characterize health
be narrowly defined in order to study it more rigorously. For systems in the Americas … [which] can lead to dif-
example, the action of a muscle is broken down into nerves, ficulties in access to services, delivery of services of
circulation, molecules, cells, and the nutrients such as fat, poor technical quality, irrational and inefficient use of
protein, and carbohydrates that make up the cells so that resources, unnecessary increases in production costs,
each component can be studied in detail. Much of our sci- and low user satisfaction. (p. 5)
entific knowledge of the physical world has been developed Fragmentation means that there are separated parts of the
through careful examination of the relationships among medical treatment process that are paid for separately (fee
component parts. Medicine used the scientific method for service) without anyone coordinating them. Although
in the development of biochemistry, anatomy, physiol- the primary care physician (PCP) should be overseeing
ogy, genetics, pharmacology, nutrition, and bioengineering the different steps, there is no guarantee that will happen.
(Kielhofner, 2004). This method of study encouraged the People hesitate to use their PCP this way because it is too
belief, prevalent in medical practice and research, that the costly, there is too long a wait time for appointments and
human body operates like a complex machine. As such, “the not enough time with the doctor, and there are unclear
task of medicine was conceived as repairing breakdowns recommendations (Freed, Hansberry, & Arrieta, 2013). The
in the machine” (Capra, 1982; Kielhofner, 2004, p. 231), implementation of the Patient Protection and Affordable
thus restoring a state of health, normalcy, and homeostasis. Care Act (ACA, 2010), originally designed to reduce costs
In the traditional medical model, health is defined as the and increase accessibility of health care, has thus far only
absence of disease; norms are based on vast collections of succeeded in raising costs for most Americans, leaving large
clinical data (e.g., a normal body temperature of 98.6°) and gaps in medical insurance coverage and otherwise compli-
homeostasis, or a balance of physical and mental health cating health care delivery. Health care reform within the
(e.g., patient can be discharged from medical care and ACA is just beginning the process of implementation. With
resume previous life activities). Likewise, many occupa- the right fixes, it is hoped that the new system will smooth
tional therapy frames of reference have also been validated out the continuum and solve some of the problems with
using the scientific method, among them biomechanical, accessibility and cost. There are some very positive aspects
sensory integration, psychodynamic, neurodevelopmental, of the new health care law that provide for more incentives
and cognitive disabilities (see Section III). and programs for prevention and wellness, in which occu-
pational therapy could offer valuable input, especially at the
Reductionism in Medicine level of primary care. More about this will be discussed later
in this chapter.
The 10th revision of the International Statistical
Classification of Diseases and Related Health Problems
(ICD-10), published and updated by the World Health
Inadequate Medical Reimbursement
Organization (WHO), lists thousands of diseases, illnesses, Systems
injuries, and syndromes, subsequently described in medical
The following is a very brief overview of the reimburse-
copyright law.

textbooks and journals, each with a unique name. Medical

ment issues for health care in the United States today.
diagnosis is the process of analyzing a patient’s signs and
Insurance under the fee-for-service system, for example,
symptoms, and reducing the problem to a specific, narrowly
does not pay for wellness and prevention, seldom pays for
defined cause. Hence, the medical model is often described

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
 32 CHAPTER 2
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable

group interventions, and excludes occupational therapy  Skilled nursing facilities (long-term care) use resource
from primary care settings where it could make a significant utilization groups (RUG-III), 58 groups or categories
contribution. based on a comprehensive assessment, the Minimum
Data Set (MDS). Each group is paid a specified num-
Fee-for-Service System ber of rehabilitation or therapy minutes per week
This system of payment is simple: provide a service and  Home health agencies use home health resource groups
charge a set fee. Typically, this is the prevailing payment (HHRGs), 80 categories based on the Outcome and
system for medical care for most of the population. Private Assessment Information Set (OASIS) to determine
and employee-funded health insurance works this way, pay- number and frequency of home services within each
ing separately for each medical visit, test, or procedure. As 60-day period
a system, fee-for-service has been held responsible for the
 Hospice uses four care levels for each day: (a) routine
inflated costs of health care by creating an incentive for
home care, (b) continuous home care, (c) inpatient
providers to add unnecessary visits, tests, hospital days, or
respite care, and (d) general inpatient care (American
procedures in order to collect more fees. The profit motive
Speech-Language-Hearing Association, n.d.)
of providers is compounded by the intervention of third-
party payers, the health insurance companies, who shield Although these cost-containment measures limit costs
the patients and clients from paying directly so that most generally, they also restrict the choices afforded to Medicare
seek more services without regard or even knowledge of beneficiaries and often arbitrarily deny needed services, a
their true cost. Some have questioned the ethics of such a downfall of the government bureaucracy that oversees the
system when health care is considered a basic necessity or a payments without regard to individual differences.
right to which all citizens should be entitled. Additionally, some see government regulation as actually
For older Americans, the Medicare system began in increasing costs because of the additional paperwork and
the 1960s in an attempt to provide elders with needed recordkeeping service providers must submit, which slows
medical care in their retirement. Medicaid is the health the process and benefits no one.
care payment system that each state can make available
to its citizens who are disabled, too young to be eligible for
Flat Fee Payment Systems
Medicare, or too poor to afford private health insurance. The logical alternative to fee for services is to pay health
Both Medicare and Medicaid also operate under a fee-for- care workers a salary, regardless of the quantity of services
service system, but with certain reforms and restrictions. provided. However, this system also presents problems. An
example of the downside of a flat fee payment system is the
Medicare Reimbursement Restrictions government-controlled Veterans Health Administration
Medicare, although intended for older adults (age 66 hospitals, which offer a full range of services to current
and older), tends to set the standard for private or employer- and former members of the country’s armed services. The
based insurance plans. Therefore, we will summarize here service providers in these hospitals are paid salaries that
some of the payment systems that have been implemented may be considerably lower than those in the private sector,
over the past several decades. In order to contain the ever- thereby decreasing any incentive for services to be delivered
rising health care costs, Medicare has put in place some in an efficient or timely manner. Wait lists are often very
prospective payment systems (PPS). These are systems that long in these facilities, and the staff sometimes must make
limit the length, frequency, and type of health services that do with less than state-of-the-art equipment. It seems that
may be reimbursed, in keeping with current evidence about neither fee-for-service nor flat fee payments have led to
the different diagnoses or disease categories. Theoretically, high-quality, cost-effective medical services. Hopefully the
these would work like health maintenance organizations United States Congress and those responsible for imple-
(HMOs), taking a flat dollar amount (monthly premium) menting the ACA or its replacement will find an ideal
and giving an incentive to providers to serve the cli- combination of high-quality medical care and a reasonable
ent’s health needs efficiently and without excessive cost. cost for consumers.
Different facilities must follow unique prospective payment Reimbursement systems that follow the guidelines of
systems in order to be reimbursed by Medicare. Some the medical model have reduced access and limited the
examples are the following: ways clients can use occupational therapy services. Most
occupational therapists are aware that neither Medicare
 Inpatient acute care hospitals use diagnosis-related
nor private health insurance will pay for health services
groups (DRGs), with costs and limitations based on
rendered only to maintain function for our clients. Progress
535 primary diagnoses
must be continually demonstrated through the use of valid
 Inpatient rehabilitation facilities use case-mix groups
copyright law.

and reliable assessment tools, mostly products of research

(CMGs), based on patient assessment and impair- studies using the scientific method. The medical model has
ment categories that consider motor and cognitive convinced third-party payers that health should be defined
skill levels and age as the absence of disease. In contrast, the client-centered

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
 MODELS OF HEALTH AND WELLNESS 33
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable

model being adopted by occupational therapy and others sory integration, neurodevelopmental therapy (NDT),
goes further to include well-being, quality of life, and the cli- biomechanical rehabilitation, motor learning, dynamic
ent’s continued ability to engage in meaningful occupations interactional, and cognitive behavioral approaches. The
and to participate in life (American Occupational Therapy scientific method was used in designing research studies
Association [AOTA], 2014; WHO, 2001). to test these applied theories and to develop reliable and
valid assessment tools. Assessments also serve as evidence
Limited Access to Medical Services for administrators or managers of health service agencies,
rehabilitation centers, and school-based services that the
and Occupational Therapy methods occupational therapists use have been and con-
By the 1990s, the medical model had backed occupa- tinue to be effective. Furthermore, despite the profession’s
tional therapy into a proverbial corner, limiting its scope move away from the medical model, many occupational
to only those practices that directly affected “symptoms” therapists still practice in medical-based settings.
or restricted independent functioning in ADL. When I Another advantage of the medical model is the prestige
(M. Cole) consulted for a large state mental health facility it has brought to occupational therapy over the years as an
about 10 years ago, I found very few occupational therapists allied health profession. Educational programs for occu-
on staff, and those who remained focused exclusively on pational therapy were jointly accredited by the American
ADL skill building for clients who would soon be relocated Medical Association (AMA) from the days of Eleanor
to community settings. My role as a consultant was to edu- Clarke Slagle until quite recently, requiring occupational
cate the staff concerning standardized assessment tools that therapy students to take classes in anatomy, physiology,
could be used to measure progress in self-care and social neurology, and physical and mental health conditions. This
skills and to help them determine client readiness for com- medical preparation has influenced public recognition for
munity placement. Soon after my consultancy ended, the occupational therapy professionals as equals with other
entire facility was closed, leaving many severely disabled professions such as physical therapy and encouraged our
clients without needed health services. continued national certification and state licensure, setting
This experience demonstrates how the reductionistic us apart from less “scientific” professions.
pressures of the scientific method, fueled by the cost- Furthermore, the medical model gives us a common
reduction measures for all medical services during the language with which to communicate with other profes-
1990s, have rendered the medical model grossly inadequate sionals as more occupational therapists collaborate with
to meet the needs of clients with ongoing mental or physi- treatment teams when providing health care services. Until
cal health conditions. Everywhere in society, signs of this the sociopolitical systems catch up with the paradigm shift
inadequacy abound. Many formerly institutionalized mental to client-centered practice, occupational therapists will
health clients now live among the homeless or have entered need to maintain relationships with members of the current
our already overcrowded prison system. Working people system of health care delivery, which still relies heavily on
are either losing their health insurance or facing higher the medical model.
prices for far less coverage. Prescription drugs, advertised as
cures for everything from arthritis and high blood pressure
to insomnia and depression, appear to have replaced the THE BIOPSYCHOSOCIAL MODEL
need for hands-on therapy, at least in the eyes of today’s
television-watching population. The biopsychosocial (BPS) model was originally pro-
posed by Engel in 1977 as a needed expansion of the medical
model. In the 1980s, medical providers made some attempts
Benefits of Medicine: What We Still to broaden their viewpoint of clinical conditions by con-
Need From the Medical Model Going sidering psychological and social components of illness.
Forward The model assumes that all three aspects must be handled
together, thus requiring more information to be gathered
Although the medical system of health care has its in initial consultation. The BPS model has been applied in
problems, the scientific research generated by medicine has primary care in the United Kingdom and other European
served occupational therapy well in the past and will con- countries, as well as the U.S. Veterans Administration
tinue to do so in the future. Without the medical model, through the use of integrated medical teams comprising
many of the scientific advances of the 20th century would physicians, nurses, occupational therapists, psychologists,
not have been possible. Under the guidance of the medical social workers, and other specialists (multidisciplinary
model, occupational therapy was able to take advantage of teams). As a model, the medical community recognized
copyright law.

the knowledge developed in the areas of psychiatry, biome- that certain health conditions, such as cardiovascular dis-
chanics, behaviorism, and neurophysiology in the earlier ease and type 2 diabetes, require this broader perspective
years, which led to some of the most widely used applied because environmental and lifestyle factors greatly influ-
theories in occupational therapy today. Examples are sen- ence treatment behaviors and outcomes. However, critics

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066
 34 CHAPTER 2
Copyright © 2020. SLACK Incorporated. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable

say that the BPS model does not fit the definition of a all aspects of human health and some health-relevant com-
scientific model, has not been adequately tested as a theory, ponents of well-being. It is intended as a companion for the
and has not worked to inform medical practice (Ghaemi, ICD-10, which classifies all known diseases, both mental
2009; McLaren, 1998). In the United States, the BPS model and physical. The stated purposes of ICF are as follows:
“seems to have been pushed into the shadows by a return to  To provide a scientific basis for studying health and
medicine and the re-ascendancy of the biomedical model” health determinants
(Pilgrim, 2002).  To establish a common language
Globally, the International Classification of Functioning,
 To allow comparison across countries, disciplines,
Disability, and Health (ICF) claims to reflect an integration
and time
of the medical and social models by using a BPS approach
(WHO, 2001). The medical model views disability as a  To provide systematic coding for purposes of record
problem of the person created by disease or trauma and keeping and research
requiring the services of a health care professional, such as In its 2001 revision, WHO seeks to broaden the horizons
medication, surgery, or rehabilitation. In the social view, of health-related research, service provision, and policy
disability is a socially created problem, and its management making beyond the constraints of the medical model. It
requires some form of social action. By combining aspects of states, “There is a widely held misunderstanding that ICF
both, ICF remains neutral regarding the required responses is only about people with disability; in fact, it is about all
to problems that it classifies. WHO’s ICD-10 identifies people” (WHO, 2001, p. 7).
health trends and statistics globally and represents the
international standard for reporting diseases and health Holistic and Systems Oriented
conditions for both diagnostic and research purposes. This
comprehensive listing, although coming mainly from a bio- ICF perceives a person’s functioning and/or disability as
medical perspective, also tracks resource allocation trends, a “dynamic interaction” between a health condition and
safety, and quality guidelines, including factors that influ- contextual factors. Contextual factors are those external
ence health status and external causes of disease (WHO, factors, “features of the physical, social, and attitudinal
2010). world,” which facilitate or hinder participation (WHO,
For occupational therapy, the BPS model has kept its 2001, p. 8). Accordingly, ICF is divided into two parts.
appeal because it is holistic, addressing the proverbial whole The first lists the components of human functioning and
person. The roots of our profession were seeded in a holistic disability, including body systems and structures as well as
view that included the biological, psychological, and social activities and participation, denoting both an individual
aspects of human life. Dr. Adolph Meyer (1921) was the first and a societal perspective. The systems of the human body
psychiatrist to propose that mental illness could be based and the activities represented closely resemble occupational
on emotional factors and result from interdependent factors therapy’s domain of concern according to OTPF3 (AOTA,
pertaining to both the mind and body. Dr. Meyer’s protégé, 2014).
Eleanor Clarke Slagle, based her treatment protocols on The second half of ICF lists and classifies contexts in the
this innovative theoretical perspective. Slagle modeled a following categories:
therapeutic process that emphasized the importance of  Products and technology: includes foods, consumable
occupations in helping those with physical, psychological, goods, money, and the systems for distributing these,
and social challenges to maintain a positive life orientation. as well as objects and tools for other systems such as
Today, this foundational premise remains unchanged. As education, sports and recreation, and the practice of
stated in AOTA’s Occupational Therapy Practice Framework, religion
3rd edition (OTPF3), “ … occupational therapy practitioners  Natural and human-made environments: includes land
recognize the importance and impact of the mind-body- and water, climate, population, light, noise, vibration,
spirit connection as the client participates in daily life” natural events such as an earthquake or tsunami,
(AOTA, 2014, p. S4). human-made events such as war, and time-related
changes such as seasons
 Support and relationships: includes immediate and
A GLOBAL PERSPECTIVE: extended family, friends, acquaintances, authority
THE WORLD HEALTH figures, subordinates, care providers, domesticated
animals, strangers, health care providers, and other
ORGANIZATION’S MODEL professionals
 Attitudes: includes individual and societal views,
copyright law.

The WHO made significant revisions to its classifica- biases, and stigmas as well as norms, practices, and
tion system in 2001 that reflect the shift to a holistic and ideologies
systems perspective of global health care. ICF encompasses

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 5/15/2023 6:23 PM via CAL STATE UNIVERSITY DOMINGUEZ HILLS
AN: 2373291 ; Marilyn B. Cole, Roseanna Tufano.; Applied Theories in Occupational Therapy : A Practical Approach, Second Edition
Account: s7451066