If your brain works anything like mine, you might sometimes find yourself getting confused about what are models, which are frames of reference, and what are concepts or ideas within the field of occupational therapy. I have recently found myself questioning this while working through my Ayres Sensory Integration WISE – Module 2 Comprehensive Assessment training.
As I progressed through the course, I started wondering where Ayres Sensory Integration fits within the history of occupational therapy and how it should be classified in relation to theoretical frameworks. From my understanding, Ayres Sensory Integration is a practical frame of reference because it provides structured guidelines for assessment and intervention in sensory processing challenges (Ayres, 1972; Schaaf & Mailloux, 2015). It is not just a broad theoretical model but a systematic approach that outlines specific intervention strategies, making it more aligned with the definition of a frame of reference (Parham et al., 2011).
Of course, I did learn all of this at university, but as I have not studied formally since completing my degree in 2006, some of my theoretical knowledge is a bit rusty. I use occupational therapy models and frames of reference in my everyday practice, but revisiting them in a structured way has been a real eye-opener. It has made me realise how easily we absorb these frameworks into our clinical reasoning without necessarily revisiting their underpinning theory.
To help clarify my thoughts, I ended up going down a bit of a rabbit hole, exploring the differences between models, frames of reference, concepts, and frameworks in occupational therapy. Hopefully, this blog will help break it all down, not just for me, but for anyone else who has ever found themselves wondering the same thing.
What is Occupation?
Occupation refers to the everyday activities that individuals engage in, which bring meaning and purpose to their lives (Wilcock & Hocking, 2015). These activities include self-care, work, leisure, and social participation. Occupational therapy is grounded in the belief that engaging in meaningful occupations promotes health and well-being (Law et al., 1996). For example, a person recovering from a stroke may regain independence by participating in occupations such as cooking meals, engaging in hobbies, or returning to employment. Occupational therapists use a variety of theories and approaches to assess and support individuals in achieving their occupational goals.
Occupational therapy is shaped by various theories and ways of thinking that influence how practitioners assess, intervene, and reason professionally. However, terms like models, frames of reference, concepts, and frameworks are often used interchangeably, which can cause confusion. In this blog, these terms will be explained with references and examples to clarify their meaning in occupational therapy practice.
1. What is an Occupational Therapy Model?
A model in occupational therapy is a broad, conceptual framework that helps practitioners understand why occupation is central to health and well-being (Kielhofner, 2008). It provides a way of looking at the relationship between the person, occupation, and environment, but it does not necessarily provide specific intervention techniques.
Examples of Occupational Therapy Models:
- Model of Human Occupation (Kielhofner, 2008) – Looks at volition, habituation, and performance capacity in shaping occupational participation.
- Person-Environment-Occupation Model (Law et al., 1996) – Explains how a person’s occupational performance is influenced by the environment.
- Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2007) – Highlights the interaction between the person, their occupation, and their environment, with spirituality at the core.
- Kawa Model (Iwama, 2006) – Uses the metaphor of a river to represent life’s journey, focusing on cultural and environmental influences.
- Vona du Toit Model of Creative Ability (du Toit, 1974) – Focuses on how people develop creative ability through graded occupational engagement.
2. What is a Frame of Reference?
A Frame of Reference provides specific guidance on how occupational therapists assess and intervene with clients (Turner & Foster, 2008). It takes theory and translates it into practical ways of working, making it more applied than a model.
Examples of Occupational Therapy Frames of Reference:
- Biomechanical Frame of Reference (Trombly, 1995) – Focuses on physical function, strength, and endurance in rehabilitation.
- Cognitive-Behavioural Frame of Reference (Beck, 1976) – Uses cognitive behavioural therapy principles to address thought patterns, emotions, and behaviours.
- Sensory Integration Frame of Reference (Ayres, 1972) – Focuses on treating sensory processing difficulties.
- Psychodynamic Frame of Reference (Mosey, 1986) – Explores how unconscious thoughts and emotions influence occupational engagement.
- Reed and Sanderson’s Model of Adaptation through Occupation (Reed & Sanderson, 1992) – Although called a model, it functions as a Frame of Reference, providing structured intervention strategies for adaptation through occupation.
3. What is a Concept in Occupational Therapy?
A concept is a fundamental idea that underpins models and frames of reference (Hagedorn, 1995). Concepts help explain occupational therapy principles but are not structured enough to be considered models or frames of reference.
Examples of Occupational Therapy Concepts:
- Occupational Alienation (Wilcock, 1998) – Feeling disconnected from meaningful activities due to external factors.
- Occupational Justice (Townsend & Wilcock, 2004) – The right of all individuals to access and engage in meaningful occupations.
- Occupational Deprivation (Whiteford, 2000) – When individuals are restricted from participating in meaningful occupations due to societal or environmental barriers.
4. What is a Framework in Occupational Therapy?
A framework provides a broad guide for professional reasoning and practice, but it is often less structured than a model or frame of reference (Creek, 2010).
Examples of Occupational Therapy Frameworks:
- The Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2007) – Provides a broad guide for occupational therapy practice.
- The Occupational Therapy Practice Framework (American Occupational Therapy Association, 2020) – Defines the domain and process of occupational therapy practice.
Key Differences: Model vs. Frame of Reference vs. Concept vs. Framework vs. Approach
| Category | Definition | Purpose | Examples |
|---|---|---|---|
| Model | Broad conceptual framework | Explains why occupation is important | Model of Human Occupation (MOHO), Person-Environment-Occupation (PEO) Model, Kawa Model |
| Frame of Reference | Practical guidelines for intervention | Explains how therapy should be delivered | Biomechanical, Cognitive-Behavioural, Sensory Integration |
| Concept | Fundamental idea or theory | Helps explain specific aspects of occupational therapy | Occupational Justice, Occupational Deprivation |
| Framework | Broad guide for professional reasoning | Provides guidelines for assessment and intervention | Canadian Model of Occupational Performance and Engagement (CMOP-E), Occupational Therapy Practice Framework (OTPF) |
| Approach | A structured way to implement therapy | Provides a method or strategy for applying models or frames of reference | Cognitive Orientation to Occupational Performance (CO-OP), Task-Oriented Approach, Strengths-Based Approach |
This comprehensive chart provides an overview of key occupational therapy models, frames of reference, frameworks, and approaches, categorised by their focus area, historical development, country of origin, and necessary training or licensing. (Please note this is not an exhaustive list.)
| Model | Year Developed | Country of Origin | Developers | Required Training/Licensing | Associated Assessments | Reference/Website | Model Type |
|---|---|---|---|---|---|---|---|
| Vona du Toit Model of Creative Ability (VdTMoCA) | 1960s | South Africa | Vona du Toit | Specialized training recommended; certification may be required in some regions | – Creative Participation Assessment | VdTMoCA Foundation | Model |
| Sensory Integration Theory (Ayres SI) | 1970s | USA | A. Jean Ayres | Certification required for administering specific SI interventions | – Sensory Integration and Praxis Tests (SIPT) | Sensory Project | Frame of Reference |
| Model of Human Occupation (MOHO) | 1980s | USA | Gary Kielhofner | Familiarity with MOHO principles; specific training may be required for certain assessments | – Assessment of Communication and Interaction Skills (ACIS) – Model of Human Occupation Screening Tool (MOHOST) – Occupational Self Assessment (OSA) | MOHO-IRM Web | Model |
| Allen’s Cognitive Disabilities Model | 1980s | USA | Claudia Allen | Training workshops recommended; no formal licensing required | – Allen Cognitive Level Screen (ACLS) | Allen Cognitive Network | Model |
| Person-Environment-Occupation-Performance (PEOP) Model | 1991 | USA | Charles Christiansen and Carolyn Baum | Understanding of PEOP principles; no specific licensing required | – No specific assessments; serves as a guide for holistic evaluation | PEOP Model Article | Model |
| Occupational Adaptation (OA) Model | 1992 | USA | Janette Schkade and Sally Schultz | Understanding of OA processes; no specific licensing required | – Occupational Adaptation Assessment | OA Model Article | Model |
| Person-Environment-Occupation (PEO) Model | 1996 | Canada | Mary Law and colleagues | Knowledge of PEO concepts; no specific licensing required | – No specific assessments; used as a framework for various evaluations | PEO Model | Model |
| Canadian Model of Occupational Performance and Engagement (CMOP-E) | 1997 | Canada | Canadian Association of Occupational Therapists | Understanding of CMOP-E framework; no specific licensing required | – Canadian Occupational Performance Measure (COPM) | CMOP-E Article | Model |
| Dunn’s Sensory Processing Framework | 1997 | USA | Winnie Dunn | Understanding of sensory processing patterns; no specific licensing required | – Sensory Profile | Dunn’s Sensory Processing Article | Framework |
| Kawa Model | 1999 | Japan | Michael Iwama and Japanese colleagues | Familiarity with the Kawa metaphor; no specific licensing required | – Kawa Model assessment involves collaborative drawing and discussion | Kawa Model | Model |
| Cognitive Orientation to Occupational Performance (CO-OP) Approach | 2001 | Canada | Helene Polatajko and Angela Mandich | Formal training recommended; certification may be required for practice | – Dynamic Performance Analysis (DPA) | CO-OP Approach | Approach |
| Transactional Model of Occupation | 2000s | USA | Townsend and Polatajko | Understanding of transactional perspectives; no specific licensing required | – No specific assessments; used as a conceptual framework | Transactional Perspective Article | Model |
Final Thoughts
Understanding the differences between models, frames of reference, concepts, and frameworks is key to applying theory to practice effectively. Models help us understand why occupation matters, while frames of reference guide how we intervene. Concepts enhance our understanding of occupational therapy principles, and frameworks provide broad guidelines for working in different settings.
By integrating these different elements, occupational therapists can provide more effective, client-centred interventions that align with the values of occupational therapy.
What are your thoughts? Do you find certain models or frames of reference more helpful in your practice? Let me know in the comments!
References
- Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
Creek, J. (2010). The core concepts of occupational therapy: A dynamic framework for practice. Jessica Kingsley Publishers.
du Toit, V. (1974). Patient volition and action in occupational therapy. Vona & Marie du Toit Foundation.
Hagedorn, R. (1995). Foundations for practice in occupational therapy. Churchill Livingstone.
Iwama, M. (2006). The Kawa model: Culturally relevant occupational therapy. Churchill Livingstone.
Kielhofner, G. (2008). Model of human occupation: Theory and application. Lippincott Williams & Wilkins.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy.
Parham, L. D., Smith Roley, S., May-Benson, T., Koomar, J., Brett-Green, B., Burke, J. P., Cohn, E. S., Mailloux, Z. & Schaaf, R. C. (2011). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention. American Journal of Occupational Therapy, 65(2), 133–142.
Schaaf, R. C. & Mailloux, Z. (2015). Clinician’s guide for implementing Ayres Sensory Integration®: Promoting participation for children with autism. Journal of Occupational Therapy, Schools, & Early Intervention, 8(3), 180-196.
Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation. CAOT Publications.
Whiteford, G. (2000). Occupational deprivation: Global challenge in the new millennium. British Journal of Occupational Therapy.