An overview of Model, Frame of Reference and Approaches (Introduce the concept and differentiate them) Recommended book(s) for Reference: 1. Pedretti’s Practice skills for physical dysfunction edited by Heidi McHugh Pendleton ,Winifred Schultz Krohn 2. Occupational Therapy for Physical Dysfunction by Mary Vining Radomski, Catherine A Trombly 3. Occupational Therapy and Physical Dysfunction, Principles, Skills and Practice by Ann Turner, Margaret Foster, Sybil E Johnson 4. Introduction to Occupational Therapy by Hussey Subonis ,Chafea O Brien 5. Occupational Therapy and Mental Health edited by Jennifer Creek, Lesley Lougher 6. Mental Health Concepts and Techniques for the Occupational Therapy Assistant by Mary Beth Early 7. Frames of Reference in Psychosocial Occupational Therapy by Mary Ann Bruce, Barbara Borg 8. Willard & Spackman’s Occupational Therapy 9. Occupational Therapy for children by Jane Case Smith 10. Frames of Reference for Pediatric Occupational Therapy by Paula Kramer , Jim Hinojosa
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occupational therapy model frame of reference approach difference definition overview
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https://booksite.elsevier.com/samplechapters/9780702032325/9…
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occupational therapy "frame of reference" components postulates regarding change theory base Mosey Bruce Borg
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Here is a thorough overview of Models, Frames of Reference, and Approaches in Occupational Therapy - what each one is, how they are structured, and how they differ from one another.
Models, Frames of Reference, and Approaches in Occupational Therapy
1. Background: Why Theoretical Constructs Matter
Occupational therapy (OT) is a practice discipline - it requires not only knowing what to do, but why and how to do it. Theoretical constructs give practitioners a principled basis for:
- Selecting assessments
- Identifying problems
- Planning and justifying interventions
- Communicating with other professionals
Without these constructs, practice becomes purely intuitive and difficult to evaluate, teach, or replicate. As Duncan (from the Turner et al. tradition) notes, theory supports professional reasoning and ensures that practice remains evidence-based and outcome-oriented.
2. THEORY - The Foundation of All Constructs
Before defining models and frames of reference, it is important to understand theory, the bedrock beneath them.
A theory is a well-supported, systematic explanation of why something operates the way it does. It is derived from research and observation, and it proposes relationships between concepts.
- Example: The theory that there is an ongoing interaction between Person, Environment, and Occupation forms the theoretical basis of the PEO model.
- Researchers test theories to build valid and reliable models or frames of reference.
3. MODEL (Conceptual Model of Practice)
Definition
A model (also called a Conceptual Model of Practice) is a purposeful, organized representation of reality that translates theory into a structure that guides professional thinking. It is an occupation-focused theoretical construct developed specifically to explain the process and purpose of occupational therapy.
Models tell us what occupational therapists do and why - they provide the philosophical and theoretical map of the profession.
Characteristics of a Model
| Feature | Description |
|---|---|
| Origin | Developed within the OT profession |
| Focus | Occupation and the OT process; broad in scope |
| Purpose | Organizes thinking, vocabulary, and professional identity |
| Level of abstraction | High - conceptual and philosophical |
| Directs | General clinical reasoning and professional worldview |
| Clinical application | Broad - used to understand the client holistically |
What a Model Contains
Most OT models contain:
- Core concepts / constructs - the key ideas and terminology (e.g., volition, habituation, performance capacity in MOHO)
- Theoretical base - the theoretical principles underpinning the model
- View of the person - how the model understands human beings and occupation
- View of dysfunction - what constitutes occupational dysfunction
- Assessment tools - instruments derived from or congruent with the model
- Intervention principles - general guidelines (not step-by-step protocols)
Examples of OT Models
| Model | Key Focus |
|---|---|
| Model of Human Occupation (MOHO) - Kielhofner | Volition, habituation, performance capacity, environment |
| Canadian Model of Occupational Performance and Engagement (CMOP-E) | Person-environment-occupation interaction; spirituality |
| Person-Environment-Occupation (PEO) Model | Dynamic interaction between person, environment, and occupation |
| Person-Environment-Occupation-Performance (PEOP) Model | Personal abilities and contextual factors affecting performance |
| Occupational Adaptation Model | Adaptive response to occupational challenges |
| Ecology of Human Performance (EHP) | Context as central to performance |
Note: The terms "model" and "frame of reference" are sometimes used interchangeably in OT literature (e.g., the Biomechanical Model is also referred to as the Biomechanical Frame of Reference). This overlap reflects the evolving and not fully standardized terminology in the profession.
4. FRAME OF REFERENCE (FOR)
Definition
A Frame of Reference (FOR) consists of theoretical or conceptual ideas - often drawn from outside the OT profession (psychology, neuroscience, biomechanics, developmental science) - that have been adapted for use in OT practice.
Mosey's classic definition:
"Integrated collections of theoretically based information, organized in such a way that they provide guidelines for problem identification and remediation as it relates to specified elements of the profession's domain of concern."
A frame of reference is the practitioner's "how-to" guide - it takes theory and turns it into specific assessment and intervention strategies for a defined area of practice.
Characteristics of a Frame of Reference
| Feature | Description |
|---|---|
| Origin | Largely from knowledge outside OT (psychology, neuroscience, biomechanics) - adapted for OT use |
| Focus | A specific area of function or dysfunction |
| Purpose | Directly links theory to practice - tells you how to assess and treat |
| Level of abstraction | Lower than a model - more concrete and operational |
| Directs | Specific evaluation tools and intervention strategies |
| Clinical application | Targeted - used for a specific problem in a specific population |
Structural Components of a Frame of Reference (Mosey's Structure)
A well-developed FOR contains the following components:
- Theoretical Base - the knowledge drawn from science, psychology, medicine, etc. that supports the FOR
- Function-Dysfunction Continua - describes what constitutes healthy function and dysfunction in the domain addressed
- Behaviors Indicative of Function and Dysfunction - specific, observable behaviors that indicate where on the continuum a client falls
- Postulates Regarding Change - "if-then" statements that specify what the therapist must do to facilitate change; these are the core clinical guidelines
- Evaluation - assessments and tools guided by the FOR
- Application to Practice - how the FOR is implemented in clinical settings
The Postulates Regarding Change are what make a FOR directly actionable. Example: "If the therapist provides graded sensory input in a safe environment, then the client's sensory processing will improve."
Examples of Frames of Reference
| Frame of Reference | Theoretical Origin | OT Application |
|---|---|---|
| Biomechanical FOR | Biomechanics, kinesiology | ROM, strength, endurance in physical dysfunction |
| Neurodevelopmental (NDT/Bobath) | Neuroscience, developmental theory | Motor control in CVA, CP |
| Sensory Integration (Ayres SI) | Neuroscience, sensory processing theory | Sensory processing disorders in children |
| Cognitive Behavioral FOR | Cognitive-behavioral psychology | Mental health, maladaptive thoughts/behaviors |
| Psychodynamic FOR | Psychoanalytic theory (Freud, object relations) | Mental health, self-awareness |
| Developmental FOR | Developmental psychology (Piaget, Erikson) | Pediatric OT, delayed development |
| Rehabilitative / Compensatory FOR | Rehabilitation science | Adapting tasks/environments for residual disability |
| Acquisitional FOR | Behavioral and learning theory | Skill acquisition, role learning |
| Model of Human Occupation (MOHO) | Systems theory | Sometimes classified as both a model AND a FOR |
5. APPROACH
Definition
An Approach is the broadest and most general of the three terms. It describes the general direction or philosophy of intervention that a therapist takes when working with a client. It is derived from, but is less detailed than, a model or FOR.
An approach answers the question: "What is the general direction of therapy?"
Types of Approaches in OT
Approaches are generally classified by the goal and direction of intervention:
| Approach | Description | Example |
|---|---|---|
| Restorative (Remedial) | Aims to restore lost function by retraining or rehabilitating underlying capacities | Strengthening a weak arm after stroke using exercise |
| Compensatory (Adaptive) | Accepts residual deficits and adapts the task, environment, or equipment | Teaching one-handed techniques; providing adaptive equipment |
| Preventive | Aims to prevent dysfunction or secondary complications before they occur | Joint protection education in rheumatoid arthritis |
| Maintenance | Preserves current level of function; prevents decline | Home program for a stable client with MS |
| Health Promotion | Enhances well-being and occupational engagement beyond baseline | Wellness programs; lifestyle redesign |
| Educational | Teaching the client and caregivers about condition management | Caregiver training in ADL assistance |
| Developmental | Follows normal developmental sequences to facilitate growth | Working with children using developmental milestones as a guide |
In Pedretti's framework, the terms Remediation and Compensation/Adaptation are the two primary approaches used in physical dysfunction OT.
6. DIFFERENTIATING MODEL, FRAME OF REFERENCE, AND APPROACH
This is the most commonly tested and confused area. Here is a clear comparison:
| Dimension | Model | Frame of Reference | Approach |
|---|---|---|---|
| What it is | Conceptual map of OT practice | Theory-to-practice guide for a specific area | General direction/philosophy of intervention |
| Origin | Developed within OT | Adapted from outside OT (or OT-specific for psychosocial FORs) | Derived from models and FORs |
| Scope | Broad - covers the entire OT process | Narrow - targets a specific area of dysfunction | Broad or narrow depending on context |
| Level of abstraction | High (philosophical, conceptual) | Medium (translates theory into practice) | Low-medium (practical, directional) |
| Contains | Core constructs, theoretical base, broad intervention principles | Theory base, function-dysfunction continua, postulates regarding change, evaluation | General treatment philosophy (restore, compensate, prevent) |
| Guides | Professional identity, clinical reasoning, holistic understanding of client | Specific assessment and intervention planning | The overall direction therapy will take |
| Changes with client? | No - usually one model per case or setting | Yes - one or more FORs selected per client problem | Yes - may shift as client status changes |
| Analogy | The GPS system (big picture, where OT is going) | The route instructions (how to get there, step by step) | The mode of travel (drive, walk, fly) |
| Example | MOHO guides how you understand a client's occupational identity | Biomechanical FOR guides how you increase ROM in a shoulder | Restorative approach = focus on rebuilding the shoulder's strength |
7. HOW THEY RELATE TO EACH OTHER
The three constructs form a hierarchical and complementary relationship:
THEORY
↓
MODEL (conceptual framework - broad, occupation-focused)
↓
FRAME OF REFERENCE (theory-to-practice bridge - specific, operational)
↓
APPROACH (general direction of intervention - restorative, compensatory, etc.)
↓
SPECIFIC INTERVENTION (the actual techniques and activities used in therapy)
In practice, a therapist may:
- Use MOHO (model) to understand a client's occupational roles, motivation, and habits
- Apply a Biomechanical FOR to address the client's limited shoulder range of motion
- Take a Restorative approach early in recovery, then shift to a Compensatory approach if function does not return
- Use specific techniques (PROM, splinting, ADL training) at the intervention level
A model does not replace a FOR; they work together. The model provides the occupation-centered lens while the FOR provides the clinical-action specifics. Multiple FORs can be used simultaneously with a single model.
8. COMMON SOURCES OF CONFUSION
"Is MOHO a model or a FOR?"
- It is formally a conceptual model of practice, but because it contains detailed assessment tools and intervention strategies (e.g., OPHI-II, OSA, MOHOST), it is sometimes treated as a FOR in the literature. This is an acknowledged overlap.
"Are all FORs borrowed from outside OT?"
- Not entirely. Psychosocial FORs (as detailed in Bruce & Borg) were developed largely within OT or co-developed with mental health disciplines. The Acquisitional FOR and Occupational Adaptation FOR, for example, are OT-specific.
"Is the Biomechanical Framework a model or a FOR?"
- In Pedretti's textbook it is called the Biomechanical Frame of Reference. In some other texts, it is described as the Biomechanical Model. The terminology varies by author and textbook - the structure and function are more important than the label.
9. SUMMARY TABLE
| Construct | Key Question Answered | Example |
|---|---|---|
| Theory | Why does this happen? | Neuroplasticity theory explains motor recovery |
| Model | What is OT, who is the client, and what is our goal? | MOHO: understand volition, habituation, performance capacity |
| Frame of Reference | How do we assess and treat this specific problem? | NDT FOR: normalize tone, facilitate movement patterns |
| Approach | What is the general direction of therapy? | Restorative: aim to recover function; Compensatory: adapt to deficit |
| Intervention | What do we actually do in the session? | PROM exercises, ADL training, splint fabrication |
Key References (from your recommended list)
- Pedretti's Practice Skills for Physical Dysfunction (Pendleton & Schultz-Krohn) - Detailed coverage of physical dysfunction FORs including Biomechanical, Rehabilitative, and Motor Learning FORs
- Frames of Reference in Psychosocial OT (Bruce & Borg) - Foundational text on the structure of FORs; defines theory base, function-dysfunction continua, and postulates regarding change
- Frames of Reference for Pediatric OT (Kramer & Hinojosa) - Pediatric-specific FORs with detailed structural analysis
- Willard & Spackman's Occupational Therapy - Broad coverage of models including MOHO, CMOP-E, PEO; philosophical underpinnings of OT
- OT for Physical Dysfunction (Radomski & Trombly) - Applied FORs in physical rehabilitation settings
- Mental Health Concepts (Mary Beth Early) - FORs applied in mental health OT practice
- OT and Physical Dysfunction (Turner, Foster & Johnson) - Duncan's chapter on conceptual models vs. FORs; highly recommended for this topic
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