Mrs. B is a 54 year old woman diagnosed with schizophrenia. After being stabilized with medication and receiving treatment, she struggled with finding and maintaining employment but eventually found a job as a sales associate. Recently, she was referred to see the OT because she was beginning to feel dissatisfied with her job and wanted to explore other options. In the past, she worked 4 or 5 day shifts a week; however, currently, her employer was giving her fewer shifts per week. Her shifts were in the evening, which made it difficult for her to spend time with family. She felt stressed because her employer was expecting her to complete more tasks but did not give her adequate time to complete them. She was also having interpersonal problems with her co-workers which added to the stress. She also indicated that she wanted to expand her social network as she felt that she had few friends. The OT provided her with resources that would assist with vocational readiness. To assist with expanding her social circle, the OT provided Mrs. B with a website that connected people based on interests.
Using the above case study, this paper will discuss how the CMOP-E relates to OT practice. The focus of this paper is on the interaction between occupation and environment.
Models provide OTs with a framework to gather information about the individual and to plan interventions. The Canadian Model of Occupational Performance (CMOP) is based on a set of values and beliefs concerning occupation, person, environment, and client-centered practice (Hagedorn, 2001). A central construct of this model is that the client is involved in the process of determining needs and planning action; the therapist’s role is to enable this process and enable clients to engage in occupation (Hagedorn, 2001). The CMOP is an interactive model showing relationships between person, environment, and occupation (See Figure 1, part A) (Townsend & Polatajko, 2007, p. 23). In the CMOP, the person, represented as a triangle, has three components – cognitive, physical and affective, with spirituality at the core (Townsend & Polatajko, 2007). The model shows that occupation connects the person and the environment (Townsend & Polatajko, 2007). The key components of occupation include self-care, productivity and leisure (Townsend & Polatajko, 2007).
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A critical review of the CMOP led to the portrayal of a trans-sectional view (see Figure 1, part B) (Townsend & Polatajko, 2007, p. 23). The trans-sectional view of the CMOP can be used to show that occupation is of central interest and delimits the OT’s concern with persons and environments. The transverse view – with occupation front and centre – presents occupation as OT’s core domain of interest, showing that OTs are primarily concerned with human occupation, and the connections with the occupational person and the occupational influences of the environment; those aspects of person or environment that are not related to occupation are beyond OT’s scope (Townsend & Polatajko, 2007, p. 23 – 24). OTs need to consider the actual performance of an occupation and the level of importance it holds or the degree of satisfaction it brings to the individual, family, group or organization. OTs also need to consider the potential and possibilities for occupational engagement that is allowed by the occupation-person-environment interactions. CMOP is now CMOP-E with the added word – engagement – to extend the occupational perspective (Townsend & Polatajko, 2007, p. 24, 28).
The environment in the CMOP is the context in which an individual performs occupations and includes physical, social, cultural, and institutional elements (Cole & Tufano, 2008). The physical environment includes natural and built factors. This may include home, classroom, workplace, or natural environments (Cole & Tufano, 2008).
Social environment is composed of social groups such as family, coworkers, and community organizations (Cole & Tufano, 2008). The social environment is the source of personal relationships (Duncan, 2006).
Cultural environment may overlap with social environment and include religious, ethnic, and political factors which can affect the opportunities for, and barriers to, participation (Cole & Tufano, 2008).
The institutional environment includes the political and social systems that affect the number of opportunities present and provides rules and limits to an individual’s occupations (Cole & Tufano, 2008).
The definition of occupation is (excerpted from Enabling Occupation, CAOT, 1997):
Occupation refers to groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupation is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity). (Townsend & Polatajko, 2007, p. 17)
The area of self-care encompasses all the tasks an individual goes through in a day to take care of oneself. Personal care includes basic activities of daily living, such as bathing, dressing, or personal hygiene. Self-care also includes instrumental activities of daily living, such as budgeting, driving, or grocery shopping (Radomski & Latham, 2008).
Productivity refers to an individual’s economic contribution to society through paid and unpaid work. Some examples of productivity include paid employment, volunteer work, childcare, and homemaking (Radomski & Latham, 2008).
Leisure is activities that are completed voluntarily, intrinsically motivating and for enjoyment (Radomski & Latham, 2008). Leisure activities may include quiet activities, such as reading, or active leisure such as sports, and socialization. (Randomski & Latham, 2008).
Application in Practice
In the case study, the interaction between the occupations of productivity and leisure and the environment is evident. Mrs. B’s satisfaction in her productivity was influenced by the social environment of her job. Her strained relationship with her co-worker affected her job satisfaction and stress level. Having time constraints placed on her by her employer to complete certain tasks also increased her stress. Sparks and Cooper (1999) conducted a study to investigate the influence of seven job characteristics on mental and physical health. Results of the study showed that the quality of the social environment in the workplace is associated with stress.
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Mrs. B.’s leisure was also affected by her productivity and social environment. Mrs. B. had limited time to spend with her family when she was scheduled to work evening shifts. Working in the evenings limited her opportunities to meet new people and expand her social network. Leisure is important because it allows an individual to have a balanced life. Research has shown that a balance between work and family predicts well-being and overall quality of life. (Greenhaus, Collins, & Shaw, 2003)
The cultural environment also affected Mrs. B’s productivity. Schizophrenia or mental illnesses by their nature lack visibility; therefore, encouraging the stigmatization of individuals with a mental illness (Copeland, 2009). In addition, society expects these individuals to work. This affected Mrs. B. because the expectation placed on her from society was that she should be working.
The impact of the institutional environment on Mrs. B’s productivity is that the Government of Alberta requires individuals to meet certain conditions in order to be eligible for financial and health-related assistance programs, such as Assured Income for the Severely Handicapped (AISH) and Alberta Works. Some of the eligibility criteria for AISH are: must have a severe handicap that is permanent and substantially limits ability to earn a living, and income or income of cohabiting partner must not exceed the limits allowed under the program (Assured Income for the Severely Handicapped, AISH, n.d.). The institutional environment required Mrs. B to work because she did not qualify for AISH or Alberta Works.
Mrs. B.’s physical work environment was not addressed; however, looking at the work environment would be beneficial because it affects a person’s job satisfaction. Some elements that may affect job satisfaction include the effect of lighting, noise levels, and floor configuration and furniture layout (Vischer, 2007). Leather, Pyrgas, Beale, and Lawrence (1998) conducted a study that examined the direct and indirect effects of windows in the workplace on job satisfaction, intention to quit, and general well-being. Results from the study showed a significant direct effect for sunlight penetration on all three factors.
Self-care was also not addressed by the OT; however, it could be concluded that it did not have an effect on Mrs. B’s productivity. She was observed to have dressed appropriately and was well kept. It could be assumed that it was not an explicitly stated criterion for Mrs. B to demonstrate proper self-care before engaging in productivity with the OT. Self-care is a component that is important to address in productivity because an individual is usually interacting with others when working or volunteering. Being able to maintain proper self-care allows the individual to be socially accepted. Proper self-care also allows the individual to make a good first impression during job interviews and throughout his or her time as an employee.
The CMOP-E is a theoretical model that illustrates how occupational performance evolves from the interactions among the person, environment, and occupation. It provides OTs with a clear conceptual framework for thinking about the person throughout the occupational process. The CMOP-E with a person at its centre, demonstrates OT’s client-centered practice. The application of the CMOP-E to Mrs. B’s case study demonstrates the dynamic and interdependent relationships between all aspects of environment and occupation. Through applying this model to Mrs. B’s case study, it is evident that practice is strongly based in theory.
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