Occupational Therapy Models for Intervention with Children

and Families 1st Edition

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Library of Congress Cataloging-in-Publication Data

Dunbar, Sandra Barker

Occupational therapy models for intervention with children and families / Sandra Barker Dunbar.
p. ; cm.
Includes bibliographical references.
1. Occupational therapy for children. 2. Occupational therapy services. I. Dunbar, Sandra Barker
[DNLM: 1. Occupational Therapy--methods. 2. Child. 3. Family. WS 368 O156 2007]

RJ53.O25O235 2007
618.92’89165--dc22

2007001927

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 Dedication

Dedicated to the memory of my mother, Matilda (Syd) Nowell Barker,

PhD, and my son, Jaden.
 Contents

Cover
Title Page
Copyright

Dedication
Acknowledgments
About the Author
Contributing Authors
Foreword—Susan H. Knox, PhD, OTR/L, FAOTA
Introduction

Chapter 1: Theory, Frame of Reference, and Model: A

Differentiation for Practice Considerations
Sandra Barker Dunbar, DPA, OTR/L
Chapter 2: Sensory Integration and Neurodevelopmental Treatment
as Frames of Reference in the Context of Occupational
Science
Erna Imperatore Blanche, PhD, OTR/L, FAOTA and
Dominique Blanche Kiefer, OTD, OTR/L
Chapter 3: Person-Environment-Occupation Model
Mary Law, PhD, OT(C) and Sandra Barker Dunbar,
DPA, OTR/L
Chapter 4: Application of the Model of Human Occupation to
Children and Family Interventions
Jessica M. Kramer, MS, OTR/L and Patricia Bowyer,
EdD, OTR/L, BCN
Chapter 5: The Occupational Adaptation Model: Application to
Child and Family Interventions
Beth Werner DeGrace, PhD, OTR/L
Chapter 6: Ecology of Human Performance Model
Winnie Dunn, PhD, OTR, FAOTA
Chapter 7: Using Occupation by Design to Synthesize Across
Multiple Models for Services to Children and Families
Christine Teeters Myers, MHS, OTR/L; Shirley O’Brien,
MS, OTR/L, FAOTA; Doris Pierce, PhD, OTR/L, FAOTA;
and Mary Ellen Thompson, MS, OTR/L
 Acknowledgments

Many thanks to all of the occupational therapists, occupational scientists,

and occupational therapy students for their contributions to this text. Thanks
also to the numerous families who permitted their stories to be told in the
form of case examples throughout the chapters.
 About the Author

Sandra (Sandee) Barker Dunbar, DPA, OTR/L, has practiced

occupational therapy with children and families for more than 20 years. She
received her Bachelor of Science degree in Occupational Therapy from
Loma Linda University, her Master of Arts degree in Occupational Therapy
from New York University, and her Doctor of Public Administration degree
from Nova Southeastern University.
Sandee’s initial occupational therapy work was in early intervention,
neonatal intensive care, and community-based intervention. Sandee has
enjoyed developing a variety of innovative programs for families, including
a primary care approach to early identification of developmental issues in
collaboration with a pediatrician, Dr. Rose Joseph.
Currently, Sandee is Chair and Professor in the Occupational Therapy
Program at Nova Southeastern University. Since 1995, Sandee has
contributed to student learning at NSU while maintaining a link to clinical
and community settings that are geared toward helping children and
families. This includes supervising students in on-campus pre-service
learning at the Baudhuin School of the Mailman Segal Institute, which
serves hundreds of children with autism each year.
Sandee continues to be committed to creatively finding ways to better
meet family needs for children with and without disabilities. She is grateful
for the support of family, co-workers, and friends for their shared vision of
making life better for those in need.
 Contributing Authors

Erna Imperatore Blanche, PhD, OTR/L,

FAOTA
Associate Professor of Clinical Practice
Department of Occupational Science and
Therapy
University of Southern California
Co-Director Therapy West
Los Angeles, California

Patricia Bowyer, EdD, OTR/L, BCN

Post-Doctoral Research Associate
University of Illinois at Chicago
Chicago, Illinois

Beth Werner DeGrace, PhD, OTR/L

Assistant Professor
Department of Rehabilitation Science
College of Allied Health
University of Oklahoma Health Sciences
Center
Oklahoma City, Oklahoma

Winnie Dunn, PhD, OTR, FAOTA

Professor and Chair
Department of Occupational Therapy
Education
School of Allied Health
University of Kansas Medical Center
Kansas City, Kansas
Dominique Blanche Kiefer, OTD, OTR/L
Independent Contractor
Philadelphia, Pennsylvania

Jessica M. Kramer, MS, OTR/L

Head Research Assistant MOHO
Clearinghouse
PhD Student, Disability Studies
University of Illinois at Chicago
Chicago, Illinois

Mary Law, PhD, OT(C)

Professor and Associate Dean (Health
Sciences) Rehabilitation Science
Co-Director, CanChild Centre for
Childhood Disability Research
McMaster University
Hamilton, Ontario, Canada

Christine Teeters Myers, MHS, OTR/L

Visiting Assistant Professor
Department of Occupational Therapy
Eastern Kentucky University
Richmond, Kentucky

Shirley O’Brien, MS, OTR/L, FAOTA

Associate Professor
Department of Occupational Therapy
Eastern Kentucky University
Richmond, Kentucky

Doris Pierce, PhD, OTR/L, FAOTA

Endowed Chair in Occupational Therapy
Eastern Kentucky University
Richmond, Kentucky

Mary Ellen Thompson, MS, OTR/L

Assistant Professor
Department of Occupational Therapy
Midwestern University
Glendale, Arizona
 Foreword

In the mid-1960s, Mary Reilly proposed that the uniqueness of

occupational therapy should be its emphasis on occupation and that
engagement in meaningful occupation was the key to recovery from illness.
In the classic statement from her Eleanor Clark Slagle address, “Man,
through the use of his hands, as they are energized by mind and will, can
influence the state of his own health” (Reilly, 1962, p. 2), she urged the
profession to return to the founding principle of occupational therapy, that
being a balance of work, play, and rest. She described “a theory, specific for
occupational therapy, which proposes the play-work continuum called
occupational behavior as the theoretical framework for practice and
education” (Reilly, 1969, p. 299). She further designed the curriculum at the
University of Southern California around occupational behavior, and many
of her students researched various aspects of occupational behavior.
Over the years, former students of Dr. Reilly and others embraced and
further refined the concepts of occupation and purposeful activity as frames
within which to evaluate and treat clients, and they developed other models
of practice. In 2002, the American Occupational Therapy Association firmly
positioned occupation as the core of our practice with the adoption of the
Occupational Therapy Practice Framework. In addition, the current
demands of health care, the legislative initiatives, and the expansion of
occupational therapy into nontraditional areas of practice have emphasized
the need for holistic models to guide clinical reasoning and treatment of
children and their families.
With this background, it is exciting to read this book which compiles the
most recent and most utilized models of practice for occupational therapists
dealing with children, youth, and their families and to see that all these
models view children as occupational beings within the context of their
families and society.
 The first chapter defines and differentiates between theory, frame of
reference, and model and puts the models into perspective within the
demands of society today. Subsequent chapters describe the models and
their development, describe assessment tools and intervention methods, and
apply the models through extensive case studies. Chapter 2 utilizes
occupational science as a context within which to apply the frames of
reference of Sensory Integration and Neurodevelopmental Treatment. The
concept of Lifestyle Redesign is applied to address the family and lifestyle
issues of children with sensory integrative or neurodevelopmental
problems. In Chapter 3, the Person-Environment-Occupation model is used
to analyze factors influencing the occupational performance of children and
youth. The model uses a family-centered approach to identify barriers and
strengths and guide intervention. Chapter 4 describes the Model of Human
Occupation and applies its concepts to evaluation, intervention, and
outcome. Literature is presented that supports evidence-based application of
the model.
Chapter 5 discusses the Occupational Adaptation model and describes the
person, the occupational environment, and the interaction among these to
afford occupation. It describes occupational challenges and the process of
adaptation, as well as the therapist’s role as facilitator. In Chapter 6,
Ecology of Human Performance model, the constructs of person, context,
task, and performance are discussed and the model is used to structure
interdisciplinary practice serving children and their families.
Chapter 7 synthesizes all these models, describes the clinical reasoning
process that therapists use to support occupation-based family-centered
practice and proposes the process of Occupation by Design for decision
making. This approach targets the therapeutic intervention and judges it on
appeal, contextual intactness, and accuracy. The unique contributions that
each of the models provide are discussed from this process and a
longitudinal case is used to illustrate how these models can be integrated.
All the models focus on occupation, are client/family centered, are
contextualized, and are in concert with the Practice Framework. They all
emphasize the clinical reasoning process in which therapists engage when
treating clients. Most importantly, they all reinforce occupational therapy’s
domain of concern and illustrate the profession’s unique expertise in
providing service to children and their families. This should be an essential
text for occupational therapy curricula, practitioners, and researchers.
Susan H. Knox, PhD, OTR/L, FAOTA
Director Emerita
Therapy in Action
Tarzana, California

References
American Occupational Therapy Association. (2002). Occupational therapy practice framework:
Domain and process. American Journal of Occupational Therapy, 56, 609–639.
Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine.
American Journal of Occupational Therapy, 16(1), 1–9.
Reilly, M. (1969). The educational process. American Journal of Occupational Therapy, 23(4), 299–
307.
 Introduction

Occupational therapists have a long history of working with children,

including services for individuals with deafness and blindness in the 1950s,
to the expansion of school-based practice in the 1970s, to early intervention
practice in the 1980s. Currently, there are endless opportunities for
impacting participation in childhood occupations, as well as ensuring that
family occupational needs are met in the variety of practice settings in
which we work.
The challenge continues, however, to practice in a way that family-
centered care mandates are truly being met and that the family is the central
consideration in practice. We continue to struggle with our ideals as
“experts” and may unknowingly limit ourselves, as well as the families we
interface with, by neglecting to address the whole person and the whole
family unit.
The challenge also includes a need to consistently view children through
an occupational lens, rather than limiting ourselves to a component
orientation. There is a need to see classroom participation, rather than just
pencil grip; to see peer interaction, rather than just attention span; to see
successful involvement in a physical education class, rather than just trunk
rotation; to see mother-infant interaction, rather than just a sucking pattern.
The use of a wider lens for evaluation and intervention will enable us to
better meet the occupational needs of children.
It is the particular challenges of providing authentic family-centered and
occupation-centered services that led to consideration of a text that would
address ways to view occupational therapy practice with children and
families in a different way. Traditional frames of reference offer significant
strategies for impacting specific areas of practice. They have served
occupational therapists well in that they provide methods of evaluation,
distinctions of what is function and what is dysfunction, as well as
treatment strategies to optimize functioning for specific skill areas.
However, there remains a need for integrating these aspects into a broader
schema, such as a model, for optimal provision of occupation-centered
services. Chapter 1 elaborates on these aspects and provides a distinction
between a frame of reference and a model that will enable comparative
analysis as the reader reviews the subsequent chapters.
The discipline of occupational science provides an avenue for facilitating
awareness and understanding of the significance of occupations. This
creates a bridge for then understanding children and families, their ways of
being, and how they construct their daily routines. Chapter 2 provides an
overview of how occupational science considerations can be related to
practice with children who may have developmental issues.
The text does not provide an all-inclusive approach to models for practice
with children and families. There are numerous models that one may
consider that are not mentioned in this format. The reader is encouraged to
explore alternate models and compare them to the ones in the text to assess
what is the best fit for his or her current (or future) practice and
philosophical viewpoints. The Person-Environment-Occupation model, the
Model of Human Occupation, the Occupational Adaptation model, and the
Ecology of Human Performance model are addressed in this sequence
following Chapter 2. Each chapter is written by either the model author or
recognized colleagues of the author. The culminating chapter provides an
overview and integrative approach utilizing Occupation by Design.
The numerous cases and learning activities throughout each chapter are
intended to facilitate much processing and discussion. The accompanying
Instructor’s Manual provides further learning activities that will assist the
instructor in elaborating on the chapter highlights and providing classroom
experiences that will enhance student learning.
Occupational therapists have the privilege of impacting countless
children and families. It is hoped that this information will further enhance
our ability to optimally meet the growing occupational needs of our clients
in the myriad of arenas where we work and play.
Sandra Barker Dunbar, DPA, OTR/L
Chair and Professor
Occupational Therapy Department