1. Chapter 39 The Model of Human Occupation
Kirsty Forsyth, Renée R. Taylor, Jessica M. Kramer, Susan Prior, Lynn Richie, Jaqueline Whitehead, Christine Owen, and Jane Melton

2. Learning Objectives After reading this chapter you will be able to:
Describe the personal factors addressed by the Model of Human Occupation and articulate how each concept affects occupational life.
Describe the environmental factors that are addressed by the Model of Human Occupation and articulate how each concept affects occupational life.
Identify dimensions of doing that the Model of Human Occupation uses to describe and examine a person’s engagement in occupations.

3. Learning Objectives (Continued)
Describe the steps of therapeutic reasoning in the Model of Human Occupation.
Articulate how change occurs in occupational therapy and identify client actions and therapeutic strategies that lead to change.
Describe how the Model of Human Occupation can be applied to clients with a variety of diagnoses across the life course in different practice contexts.

4. Introduction
The Model of Human Occupation (MOHO) is an occupation- focused, evidence-based, client-centered approach to OT practice
MOHO is now the most widely used occupation-based model in practice worldwide
MOHO has been developed through the efforts of an international community of scholars and practitioners
Over 400 articles and chapters present theoretical, applied, and/or research evidence

5. The Model of Human Occupation Concepts
MOHO is concerned with how people can participate in daily life occupations and achieve a state of competence and identity
MOHO conceptualizes OT as a process in which practitioners support client engagement in occupations in order to shape the clients’:
skills;
habits and routines; and
thoughts and feelings about themselves

7. MOHO Concepts Related to the Person
Volition: The process by which people are motivated toward and choose what activities they do
Includes personal causation, values, and interests
Habituation: A process whereby people organize their actions into patterns and routines
Includes habits and roles
Performance capacity: Underlying mental and physical abilities and how they are used and experienced in occupational performance

8. MOHO Concepts Related to the Environment
All occupation results from an interaction of the person with physical and social environments
The environment includes the physical, social, cultural, economic, and political features within a person’s context that influence the motivation, organization, and performance of occupation

9. Dimensions of Doing
MOHO identifies three levels at which we can examine what a person does:
Occupational participation refers to engaging in work, play, or ADLs that are part of one’s sociocultural context and are desired and/or necessary for well-being
Occupational performance is doing a task related to participation in a major life area
Skills are goal-directed actions that a person uses for occupational performance

10. Occupational Identity, Competence, and Adaptation
What people do creates their occupational identity
Occupational competence is the degree to which people are able to sustain a pattern of doing that enacts their occupational identity
Occupational adaptation entails the:
creation of an occupational identity; and
ability to enact this identity in a variety of circumstances

11. The Process of Change and Therapy
All change in OT is driven by the client’s occupational engagement
Occupational engagement refers to clients’ doing, thinking, and feeling under certain environmental conditions in the midst of therapy or as a planned consequence of therapy

12. Process of Change and Therapy (Continued)
Dimensions of occupational engagement include:
choose/decide;
commit;
explore;
identify;
negotiate;
plan;
practice;
re-examine; and
sustain
Each of these dimensions shape the change process

13. Using MOHO in Practice: The Six Steps of Therapeutic Reasoning
Generating questions about the client
Gathering information on and with the client
Using the information gathered to create an explanation of the client’s situation
Generating goals and strategies for therapy
Implementing and monitoring therapy
Determining outcomes of therapy

14. A Sample of MOHO Assessments
Assessment of Communication and Interaction Skills (ACIS)
Assessment of Occupational Functioning (AOF)
Model of Human Occupation Screening Tool (MOHOST)
Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS)
Occupational Performance History Interview-II (OPHI-II)
Occupational Self-Assessment (OSA)
Worker Role Interview (WRI)

15. Therapeutic Strategies Identified by MOHO
Validating
Identifying
Giving feedback
Advising
Negotiating
Structuring
Coaching
Encouraging
Physical support