Theoretical Foundation of Occupational Therapy
Occupational therapy education is based on a broad understanding of occupation, and the unique integration of empirical and phenomenological knowledge from the social, technological, human, biological, and life sciences. Occupational therapy contributes to and is in uenced by the development of the emerging discipline of occupational science.
Wilcock (2001) states that the debate regarding the need for a science to underpin occupational therapy began in 1917 in the USA. Yerxa first named occupational science in 1989, as a culmination of studies undertaken at the University of Southern California since the 1960’s. Occupational science is a new social science or fi eld of enquiry. It is a basic science focused on occupation. As a basic science, it focuses on the universal issues about occupation without concern for their immediate application (Yerxa et al. 1989). Occupational science is concerned with furthering the understanding of humans as occupational beings and the relationship between occupation and health, including the need for, and capacity to engage in and orchestrate, daily occupations in the environment over the life span. It incorporates the concept of «occupational justice» – consideration of the need for all people to experience meaning and well-being through what they do. Since the 1980’s the emergence of occupational science, based on the study of the form, function and meaning of occupation has strengthened the knowledge base of the profession regarding occupation and its role in the health and well being of persons and groups. This core knowledge is also being incorporated into occupational therapy education. In the TUNING Occupational Therapy Project Group there have been discussions regarding how and to what degree to include occupational science in the competences and in the Summary of the Occupational Therapy TUNING Process. The inclusion of occupational science in the TUNING process has not been raised as an issue at any point of the feedback within ENOTHE and COTEC. This might indicate that occupational science is seen as a natural foundation of occupational therapy knowledge. What is important is that this area of research on human occupation and participation is a significant source for developing and applying knowledge in occupational therapy. Occupational therapy practice is based on a unique synthesis of knowledge from occupational science together with the social and medical sciences. This unique synthesis has led to the development of various models and frames of reference, which guide and inform practice. Over time, changing ideas on where the focus of practice should be has in uenced the practice of occupational therapy. The profession has moved from a
paradigm of occupation, which emphasised the intrinsic link between mind and body, to a mechanistic paradigm, where a person was seen as a series of systems, and more recently we have witnessed the profession moving back towards its roots of occupation being central to health and the emphasis of the whole rather than the component parts. The models of practice used in occupational therapy have re ected these changes. In current practice the following selected models are utilised most frequently:
— The Model of Human Occupation. First published in 1980 by Gary Kielhofner and frequently updated. This model requires occupational therapists to have knowledge of a person’s values, sense of capacity and efficacy, his/her roles, habits, performance experience and personal environment. It is acknowledged as a model that is consistent with client-centred practice and latest versions are based on dynamic systems theory
— The Canadian Model of Occupational Performance. Based on the work of Reed and Sanderson and fi rst published in 1990 by the Canadian Association of Occupational Therapists in collaboration with the Canadian Department of National Health and Welfare. This model is a social model, which places the person in a social/environ-mental context. It takes into consideration the doing, feeling and thinking components of a person. It emphasises that occupational performance is the result of «interaction and interdependence between person, environment and occupation» (Townsend 1998, cited in Duncan 2006, p. 111)
— The Kawa (River) Model. This model has been developed in an East
Asian context during the 1990’s. It is an emerging model of practice in Europe which challenges people, including occupational therapists and their clients, to «examine and discuss their culturally situated views of what was essential to their lives, their sense of wellness and their definition and understanding of illness, health and disability (…) for the purpose of redefining occupation and realigning the purpose of occupational therapy to matters of essential importance (…)» (Lim & Iwama 2006, p. 172). This model does not claim to be universal in explaining all concepts and views of occupation, health and well being. It does seek to empower the client by «giving credence to his or her occupational life issues in the context of the client’s perspective of reality (…)» (Lim & Iwama 2006, p. 173).
In addition to the above models, occupational therapists draw on knowledge of many other models of practice or frames of reference including the medical model, bio-mechanical model and cognitive behavioural frame of reference.
Occupational therapy education therefore draws on a rich theoretical foundation, combining empirical and phenomenological knowledge in order to enable students to develop a rich understanding of the complexity of a person’s engagement in occupation and the factors affecting this process.