Matthews Model of Clinical Reasoning A Systematic Guide to
Occupation Based Evaluation and Intervention Planning, 1st
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Matthews Model of Clinical Reasoning
A Systematic Guide to Occupation-Based Evaluation and
Intervention Planning
Edited by Laurie Knis-Matthews
Cover image © Getty Images
First published 2024
by Routledge
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© 2024 selection and editorial matter, Laurie Knis-Matthews; individual chapters, the
contributors
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Library of Congress Cataloging-in-Publication Data
Names: Knis-Matthews, Laurie, editor.
Title: Matthews model of clinical reasoning : a systematic guide to occupation-based evaluation
and intervention planning / edited by Laurie Knis-Matthews.
Other titles: Model of clinical reasoning
Description: New York, NY : Routledge, 2024. | Includes bibliographical references and index.
Identifiers: LCCN 2023019597 (print) | LCCN 2023019598 (ebook) | ISBN 9781032491615
(hbk) | ISBN 9781032491608 (pbk) | ISBN 9781003392408 (ebk)
Subjects: MESH: Occupational Therapy—methods | Clinical Reasoning
Classification: LCC RM735.3 (print) | LCC RM735.3 (ebook) | NLM WB 555 |
DDC 615.8/515—dc23/eng/20230721
LC record available at https://lccn.loc.gov/2023019597
LC ebook record available at https://lccn.loc.gov/2023019598
ISBN: 978-1-032-49161-5 (hbk)
ISBN: 978-1-032-49160-8 (pbk)
ISBN: 978-1-003-39240-8 (ebk)
DOI: 10.4324/9781003392408
Typeset in Times New Roman
by Apex CoVantage, LLC
To my husband, Scott. Our journey started over twenty-five years ago
in the very occupational therapy class this book is based upon. I could
not think of a more perfect person to share in all of my life adventures.
My sons, Michael and Max. You are the pride and joy of my life. I am
so incredibly proud of your accomplishments, and in turn you inspire
me every day.
All of the people who helped formulate the MMCR model for this book.
It took a village to put this book together, and I am incredibly grateful
for your patience, kindness, friendship, perseverance and dedication.
Thank you for encouraging me to present this model to a wider
audience and infuse different views into our profession.
To my students, mentees, colleagues and friends. My ideas for this
model were inspired by all the people I have come into contact with
on this journey. Thank you for challenging my worldviews so I can
continue to grow and learn.
To the people I worked with as an occupational therapist over my
career. I am in constant awe of your strength and courage to keep
moving forward in a world that is not always kind to others. You have
taught me to be compassionate, more empathetic and a better person.
To my former self. Don’t be afraid to step outside of your comfort zone.
Change comes with risk taking and sharing ideas with others. Just
because something has always been done a certain way does not mean it
cannot change or should stay as the status quo.
Contents
About the Author xii
Contributing Authors xiii
Acknowledgements of Contributions xv
Preface xvii
Acknowledgements xxiv
SECTION 1
Clinical Reasoning and Evaluation 1
1 Exploring the Literature Related to Clinical Reasoning 3
ASHLEY N. FUENTES, ERIK M. HORN, SUSAN E. KUSHNER, DARYLL ADRIAN A. HENSON,
JESSICA L. ORTIZ, LYNNE RICHARD, AND LAURIE KNIS-MATTHEWS
2 The MMCR Approach to Evaluation Guided by the Profession’s
Domain of Concern 14
LAURIE KNIS-MATTHEWS AND NANCY R. DOOLEY
3 Compartmentalizing Evaluation Information and Understanding the Person Served 27
LAURIE KNIS-MATTHEWS AND LYNNE RICHARD
4 Compartmentalizing Evaluation Information and Understanding the Six
Facets of the Environment 34
LAURIE KNIS-MATTHEWS AND NANCY R. DOOLEY
5 Compartmentalizing Evaluation Information to Understand How Activities
and Occupations Relate to a Person’s Story 44
LAURIE KNIS-MATTHEWS AND MARGARET SWARBRICK
6 Putting It All Together to Identify Occupational Performance Issue(s) 51
LAURIE KNIS-MATTHEWS AND MARGARET SWARBRICK
x Contents
SECTION 2
Intervention 61
7 MMCR Five-Step Guide to Infusing the Frame of Reference/Practice Model
Into a Person’s Story 63
LAURIE KNIS-MATTHEWS AND LYNNE RICHARD
8 Overview to Intervention Planning: Spiraling Within the Top-Middle-
Bottom Occupational Performance Issues 71
LAURIE KNIS-MATTHEWS AND LYNNE RICHARD
9 Overview to Intervention Planning: Spiraling the Top-Middle-Bottom
Occupational Performance Issues Across the Intervention Plan 81
LAURIE KNIS-MATTHEWS
10 Overview to Intervention Planning: Spiraling the Top-Middle-Bottom
Occupational Performance Issues Across the Intervention Plan Continued 88
LAURIE KNIS-MATTHEWS AND MARGARET SWARBRICK
11 Strategizing the Beginning-Middle-Ending of the Specific Intervention Plan 95
LAURIE KNIS-MATTHEWS AND MARGARET SWARBRICK
12 Strategizing How to Create Change During the Intervention Plan 106
LAURIE KNIS-MATTHEWS AND MARGARET SWARBRICK
SECTION 3
Documentation 117
13 Documentation Overview and the Evaluation Summary 119
LAURIE KNIS-MATTHEWS AND ASHLEY N. FUENTES
14 Documentation Continued: Goal Creation, Progress Notes, and Discharge
Summaries 127
LAURIE KNIS-MATTHEWS AND ASHLEY N. FUENTES
SECTION 4
Case Examples 139
15 Case Example: Using the MMCR in an Outpatient Hand Therapy Clinic
Over 8 Weeks of Intervention 141
PAIGE GARRAMONE, PAULINE GASPARRO, AND SHANIQUA BRADLEY
Contents xi
16 Case Example: Using the MMCR to Guide a Seven-Day Intervention Plan
in an Inpatient Acute Rehab Hospital 164
CHRISTINE A. BODZIOCH, MARLEE MURPHY, SHANIQUA BRADLEY, AND ASHLEY N.
FUENTES
17 Case Example: Using the MMCR to Guide a Six-Month Intervention Plan
for an Adult With an Intellectual and Developmental Disability 188
MAUREEN GRAINGER, THAIS K. PETROCELLI, SHANIQUA BRADLEY, AND ASHLEY N.
FUENTES
18 Case Example: Using the MMCR to Guide a Three-Month Intervention
Plan in a Homecare Setting 214
VALERIE HENGEMUHLE, GERALDINE PAGAOA-CRUZ, SHANIQUA BRADLEY, AND ALLISON
C. INSERRA
MMCR Glossary of Terms 253
Appendix 1A MMCR Guide to Understanding a Person’s Story (Triangle) 260
Appendix 1B Explanation of MMCR Guide to Understanding a Person’s Story (Triangle) 261
Appendix 2A MMCR Five-Step Guide to Infusing a Frame of Reference/
Practice Model Into a Person’s Evaluation Selection and Intervention Plan 262
Appendix 2B MMCR Five-Step Guide to Infusing a Frame of Reference
and/or Practice Model Into a Person’s Evaluation Selection and Intervention
Plan (Explanation) 263
Appendix 3A MMCR Overview Guide to Intervention Planning 264
Appendix 3B MMCR Overview Guide to Intervention Planning (Explanation) 265
Appendix 4A MMCR Planning Guide to Address Specific Sections of the
Overall Intervention Plan 266
Appendix 4B MMCR Planning Guide to Address Specific Sections of the
Overall Intervention Plan (Explanation) 267
Appendix 5A MMCR Guide to Evaluation Summaries 269
Appendix 5B MMCR Guide to Evaluation Summaries (Explanation) 270
Appendix 6A MMCR Guidelines to Formulate a Short-Term Goal 271
Appendix 6B MMCR Guidelines to Formulate a Short-Term Goal (Explanation) 272
Index 273
About the Author
Dr. Laurie Knis-Matthews has been an occupational therapist for almost thirty years. She gradu
ated from Kean College with a bachelor’s of science in 1992 and then earned a master’s degree
(1996) and doctoral degree (2005) in occupational therapy from New York University.
Laurie’s clinical experiences have been primarily focused on the mental health practice area.
She has worked with children, adolescents and adults in diverse settings such as psychiatric inpa
tient units, group homes, day programs, addiction services and shelters.
Laurie is a passionate advocate for the core tenets of authentic occupation for all people and
institutions. She weaves these beliefs into her teaching, research and academic service as well as
within her own community. Laurie utilizes her lifelong devotion to learning as a highly skilled
group leader across all settings, academic and intervention, as she listens intently to each person’s
perspective, clearly rephrasing and moving the discussion or goal process forward.
Earlier in her academic career, Laurie began as an adjunct professor for both of the occupational
therapy programs at Kean University and New York University. In 1999, she accepted a full-time
tenure-track position as an assistant professor at Kean University. Soon after earning tenure, Lau
rie served as chairperson of the department from 2007 to 2017. She was awarded the ranking of
professor in 2012. As a professor at Kean University she teaches both the master’s- and doctoral-
level courses such as psychosocial seminar, theoretical guides to practice, research methods and
doctoral proposal courses.
During her experiences in the doctoral program, Laurie established herself as a qualitative
researcher. She is most interested in pursuing scholarly work that gives voice to people with differ
ent viewpoints and life experiences. Her doctoral work focused on the experiences of parents who
were substance dependent and participating in a year-long drug treatment program. In 2010, this
research was later published as a special issue in Occupational Therapy in Mental Health. In 2017,
her first article, relating to the Matthews Model of Clinical Reasoning (MMCR), was published in
Occupational Therapy in Mental Health.
In collaboration with Kean University occupational therapy students, Laurie has continued
focus on her scholarly agenda utilizing qualitative methods to investigate and publish research
related to such topics as the cultural lens of mental illness, high school transition for female young
adults diagnosed with autism and the meaning of higher education for individuals diagnosed with
a mental illness. She has also presented many of these scholarly activities at national, regional and
local conferences. Laurie has been an ongoing reviewer for such journals as Occupational Therapy
in Mental Health, American Journal of Occupational Therapy, International Journal of Occupa
tional Therapy, and Canadian Journal of Occupational Therapy.
Laurie has a loving husband, Scott, who is also an occupational therapist and founder of Inten
sive Therapeutics pediatric center in West Caldwell, New Jersey. Scott and Laurie have two teen
age boys, Michael and Max. Laurie is a proud swim, band, art and volleyball mom. She enjoys
gardening, writing, watching Marvel movies and spending time with her friends.
Contributing Authors
Christine A. Bodzioch, MS, OTR/L, CBIS, Maureen Grainger, MS, OTR/L
CSRS Occupational Therapist
Adjunct Professor Centura Health
Department of Occupational Therapy Denver, Colorado
Kean University
Union, New Jersey Valerie Hengemuhle, MS, OTR/L
Occupational Therapist
Shaniqua Bradley, PhD, LCSW Holy City Pediatric Therapy
Assistant Professor Charleston, South Carolina
Department of Social Work and Child Advocacy
Montclair State University Daryll Adrian A. Henson, OTD, OTR/L,
Montclair, New Jersey CEAS I
Occupational Therapist
Nancy R. Dooley, PhD, OTR/L Holsman Healthcare
Associate Professor and Program Director Jersey City, New Jersey
Occupational Therapy Doctorate Program *Doctoral student from Kean University, New
Johnson & Wales University Jersey, while working on the book
Providence, Rhode Island
Erik M. Horn, ATC, OTD
Ashley N. Fuentes, OTD, OTR/L Occupational Therapist
Occupational Therapist *Doctoral student from Kean University, New
Kessler Institute for Rehabilitation Jersey, while working on the book
West Orange, New Jersey
*Doctoral student from Kean University, New Allison C. Inserra, OTD, OTR/L
Jersey, while working on the book Occupational Therapist
Kean OT Community Cares Clinic
Paige Garramone, MS, OTR/L Hillside, New Jersey
Occupational Therapist Overlook Medical Center
Kean University Occupational Therapy Com Summit, New Jersey
munity Cares Clinic *Doctoral student from Kean University, New
Hillside, New Jersey Jersey, while working on the book
Pauline Gasparro, OTR/L, CHT Susan E. Kushner, OTD
Certified Hand Therapist Occupational Therapist
Ivy Rehab Physical Therapy *Doctoral student from Kean University, New
Randolph, New Jersey Jersey, while working on the book
xiv Contributing Authors
Marlee Murphy, MS, OTR/L Lynne Richard, PhD, OT/L
Occupational Therapist Associate Professor
The Rehab Center at St. Joseph’s Hospital Department of Occupational Therapy
Savannah, Georgia Florida International University
Miami, Florida
Jessica L. Ortiz, OTD, OTR
Occupational Therapist Victoria P. Schindler, PhD, OTR, BCMH,
*Doctoral student from Kean University, New FAOTA
Jersey, while working on the book Professor Emeritus
Master of Science in Occupational Therapy
Geraldine Pagaoa-Cruz, MS OTR/L Program
Director of Rehabilitation Stockton University
Dignity Health Rehabilitation Hospital Galloway, New Jersey
Henderson, Nevada Co-editor, Occupational Therapy in Mental
Health
Thais K. Petrocelli, OTD, MHA, OTR/L
Assistant Professor/Doctoral Capstone Coordi Margaret Swarbrick, PhD, FAOTA
nator Professor and Associate Director
Department of Occupational Therapy Rutgers Center of Alcohol and Substance Use
University of St. Augustine Studies, Graduate School of Applied and
St. Augustine, Florida Professional Psychology
Wellness Institute Collaborative Support Pro
grams of New Jersey
Freehold, New Jersey
Acknowledgements of Contributions
Teresita Cruz Department of Family Science and Human
Henderson, Nevada Development
Montclair State University
Ignacio Cruz Montclair, New Jersey
Henderson, Nevada
Juana Guglielmino, MS, OTR/L
Sergio DeAlmeida, MS, OTR/L Kean University, Class of 2020
Professional Therapy Associates, LLC Hillside, New Jersey
Brick, New Jersey
Elvis Gyan, MA, MDiv, PhD Student, Doc-
Dennis DuBois, BA toral Assistant
High School Athletic Coach Department of Family Science and Human
BA in Liberal Studies Development
Thomas Edison State University Montclair State University
Trenton, New Jersey Montclair, New Jersey
Lydia W. Eskander Brielle Hassa, MS, OTR/L
Member of the Lebanese community Intensive Therapeutics
West Caldwell, New Jersey
Mary Falzarano, PhD, OT
Kean University, Assistant Professor, Retired Orah Jooyandeh, MS, OTR/L
Hillside, New Jersey Dr. L. Hanes and Associates
Newark, New Jersey
Melissa Farkas, OTR/L
Children’s Specialized Hospital Daniel Kim, RPh, MBA
Hamilton, New Jersey Director of Pharmacy
Dignity Health Rehabilitation Hospital
C. Shane Flaviano, MD, FAAPMR Henderson, Nevada
Medical Director
Dignity Health Rehabilitation Hospital Nicole Kiseli, MS, OTR/L
Henderson, Nevada Kean University OT Community Cares Clinic
Hillside, New Jersey
Marline Francois, LCSW
CEO and Clinical Director Meagan Koch, OTR/L
Hearts Empowerment Counseling Center Cranial Technologies
PhD Student Morristown, New Jersey
xvi Acknowledgements of Contributions
Theresa Lapinski Alivia Nufrio, OTR/L
South Plainfield, New Jersey FOX Rehabilitation
Bridgewater, New Jersey
Tammy L. Lewis, BS
Parent/Special Education Advocate, Youth Adelaida Pagaoa
Director, Youth Mentor for Girls Ages 7–13 Jacksonville, Florida
BS in Early Childhood Education
Kean University Thomas Pagaoa
Union, New Jersey Jacksonville, Florida
Inti Marazita, MS, OTR/L Noelle Rayment-Cruz
Assistant Professor Architecture Student
University of St. Augustine Bethesda, Maryland
St. Augustine, Florida
Della Spratt, MOTR/L
Danielle Minetti, MS, OTR MUSC Health Florence
Occupational Therapist Florence, South Carolina
North Valley Regional School District
Norwood, New Jersey Emily Thomas, MS, OTR/L
The Children’s Hospital of Philadelphia
Randee Myers, MS, OTR/L Philadelphia, Pennsylvania
Kean University, Class of 2021
Union, New Jersey Katheryne Wall, OTR/L
Holmdel Public Schools
Daniella Nath, MS OTR/L Holmdel, New Jersey
Bayonne Visiting Nurse Association
Bayonne, New Jersey
Cynthia Nead, COTA
Inpatient SCI & TBI
Kessler Institute for Rehabilitation
West Orange, New Jersey
The profession of occupational therapy is the land of the gray so that is why clinical reasoning
is so important and hard. I think that Laurie’s book could make it easier by using something that is
sound and strategic. It is based on the fact that everyone’s life story is different, because that’s the
beauty of clinical reasoning (Jackie).
Preface
In Brief: What Is the Matthews Model of Clinical Reasoning?
The Matthews Model of Clinical Reasoning (MMCR) provides occupational therapy practitioners
a systematic approach to develop their clinical reasoning skills during the evaluation and interven
tion process when collaborating with persons served across multiple practice locations. The three
core constructs of person, environment and occupation lay the foundation for practitioners to com
partmentalize information from selected evaluations, determine relevant intervention priorities,
implement occupation-based intervention plans and interpret successful outcomes.
Stance: How My Personal Experiences as a Student, Occupational Therapist and
Academician Contributed to the Reasons for Writing This Book
In 1992, I earned my bachelor’s degree in occupational therapy from Kean College in New Jersey.
During my education preparation, the medical model was the gold standard of care in the profes
sion, and many practitioners primarily worked in hospital systems. Although it was emphasized
in school, the construct of occupation was not fully immersed into the curriculum and often was
nonexistent in practice. I recall learning about manual muscle and range of motion testing in class
but not fully understanding how this information connected to a person’s story. Characteristics of
the medical model (practitioner as expert, focus on the diagnosis and separation of the mind/body
connection) guided intervention approaches.
During this time, there was increased pressure to fix peoples’ problem areas, leading to the
selection of preparatory methods and activities during intervention. At this time, practitioners
often used predetermined activities for all people on their caseload despite the person’s life story,
identified goals or suggested discharge plan. Following a one-size-fits-all approach, popular craft
activities and therapeutic exercises such as tile trivets, making doormats, cones and resistance band
exercises were common.
Early in my career I attended a conference and the main speaker emphasized the importance
of client-centeredness and occupation-based treatment. The conference speaker told a story of a
practitioner hiding the “cones” from the closet in a rehabilitation unit for one week. Throughout
the week, practitioners had different reactions to the missing, cones as some searched for the
cones, others were visibly upset the cones were misplaced and some colleagues tried to immedi
ately purchase new ones. Toward the end of the week, some of the practitioners started to become
less reliant on those cones and more interested in other activities that a person might actually
find meaningful. This “experiment” served as the catalyst to begin talking about occupation. Ah,
success!
xviii Preface
This one short but powerful story told during a conference ignited my earliest ideas for the
MMCR. Creating a ripple effect, this and similar stories took me on a twenty-year journey to create
a systematic approach to clinical reasoning when developing an evaluation and intervention plan
for each person served. I soon returned to school to earn both an advanced master’s and doctoral
degree in occupational therapy at New York University. This positive experience solidified my
interest in lifelong learning and mentoring others in the profession.
Eventually the culmination of these experiences and skills became stepping stones to enter
into the field of academia. As a professor in the occupational therapy program at Kean University,
I have taught a specific psychosocial seminar course twice a year for over the last twenty years.
During this course, my students use clinical reasoning skills to think deeply about the constructs of
person-environment-occupation factors to create occupation-based intervention plans applicable
to any practice setting.
As part of this seminar course, my students also actively participate in level one fieldwork
experiences. Students often come back from their clinical fieldwork experiences very frustrated
and confused as they may ask a seasoned practitioner questions about the reasons for selecting an
evaluation or creating goals related to a person’s story. At times, the seasoned practitioner may not
be able to answer that question directly, but hints that clinical reasoning emerges from experiences
or is more just second nature. From a student perspective, it often appears this process naturally
develops with time and experience. I propose that clinical reasoning is a much more complicated
process. Occupational therapy practitioners must strategically think about each person’s evaluation
and intervention plan in a systematic way to ensure measured success. There are no cookie-cutter
approaches, as intervention plans differ depending on the person served, the constraints of the
practice location and numerous other factors.
As an educator, my questions became: How do I teach clinical reasoning skills? How do novice
practitioners learn to think in a systematic way, emphasizing client-centered principles and occu
pation-based treatment applicable to multiple populations and settings? To address these ongoing
student frustrations related to clinical reasoning, I began developing a systematic approach on how
to think about evaluation and intervention. Over my teaching career, I had numerous opportunities
to formulate and evolve my thoughts about how clinical reasoning is integrated within the occu
pational therapy profession. I have been able to deconstruct the clinical reasoning process and “try
out” various learning activities to help students apply this process for multiple settings. This book
is intended to create a “spark” and subsequent ripple effect to the readers of this book. Perhaps it
is time to “hide the cones” in your practice location and embrace the true client-centered journey.
Style and Unique Features of This Book
Following the MMCR, several unique features are incorporated throughout this book to assist
practitioners to learn how this potentially abstract clinically reasoning model can be applied to
daily practice over any practice location.
Progression of Learning and Tone of the Book
From my experiences as an occupational therapy educator, my priority is to teach the next genera
tion of practitioners at a level that is understandable, non-threatening, interesting and dare I say
. . . fun? The progression of learning and tone of this book will often mirror how I introduce new
learning concepts to my students in the classroom. Each chapter builds on the next to solidify those
foundation skills with more complexity and depth over time.
