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Application of the Person-Environment-Occupation Model: A practical Tool

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Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.
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KEY WORDS
Environment
Human activities and occupations
Models, occupational therapy
Occupational performance
LA REVUE CANADIENNE
DERGOTHÉRAPIE JUIN 1999
122
volume 66 • issue 3
Application of the Person-Environment-Occupation Model:
A practical tool
SUSAN STRONG PATTY RIGBY DEBRA STEWART • MARY LAW LORI LETTS BARBARA COOPER
ABSTRACT
Occupational therapy focuses on complex dynamic
relationships between people, occupations and envi-
ronments. Therapists must clearly communicate their
practices and how their practice influences out-
comes. This paper explores applications of the
Person-Environment-Occupation Model (Law et al.,
1996) in occupational therapy practice, and delin-
eates how this particular model helps therapists to
conceptualize, plan, communicate and evaluate
occupational performance interventions. Three case
studies illustrate how the model can be used by
occupational therapists to systematically approach
analysis of occupational performance issues while
considering the complexities of human functioning
and experience. The ways in which the model facili-
tates communication within and outside occupation-
al therapy are explained. The Person-Environment-
Occupation Model is offered as a tool for therapists
to use in client(s)-therapist alliances to enable
clients to successfully engage in meaningful occupa-
tions in chosen environments.
RÉSUMÉ
L’ergothérapie est axée sur les relations complexes et
dynamiques qui s’établissent entre la personne, l’occu-
pation et l’environnement. Les thérapeutes doivent
communiquer clairement leurs pratiques et la façon
dont ces dernières influent sur les résultats. Cet article
examine des façons d’appliquer le modèle personne-
environnement-occupation (Law et al., 1996) dans la
pratique de l’ergothérapie et précise comment ce mod-
èle aide les thérapeutes à conceptualiser, planifier,
communiquer et évaluer les interventions en matière de
rendement occupationnel. Trois études de cas sont
présentées afin d’illustrer comment les ergothérapeutes
peuvent se servir de ce modèle pour faire une analyse
systématique des difficultés en matière de rendement
occupationnel, tout en tenant compte des subtilités du
fonctionnement humain et de l’expérience humaine.
Les auteurs expliquent comment le modèle facilite la
communication en ergothérapie. Le modèle personne-
environnement-occupation peut être utilisé pour inciter
les clients à s’engager dans des occupations significa-
tives, dans des environnements choisis.
Susan Strong, MSc., OT(C), is
Occupational Therapist
Researcher, Rehabilitation
Services, Hamilton Psychiatric
Hospital; and Assistant Clinical
Professor and Researcher at the
Work Function Unit, School of
Rehabilitation Science, McMaster
University, Building T-16, 1280
Main Street West, Hamilton, ON
L8S 4K1
E-mail:
strongs@fhs.csu.mcmaster.ca
Patty Rigby, M.H.Sc., OT(C), is
Assistant Professor in the
Department of Occupational
Therapy, Faculty of Medicine,
University of Toronto, and
Professor Advisor/Team Leader for
Occupational Therapy, Bloorview
MacMillan Centre, Toronto, ON.
Debra Stewart, B.Sc., OT(C), is
Clinical Lecturer, School of
Rehabilitation Science, McMaster
University; and Associate Member
of the CanChild Centre for
Childhood Disability Research,
McMaster University, Hamilton,
Ontario.
Mary Law, Ph.D., OT(C), is
Associate Professor, School of
Rehabilitation Science and
Director, CanChild Centre for
Childhood Disability Research,
McMaster University, Hamilton,
Ontario.
Lori Letts, MA., OT(C), is Assistant
Professor, School of
Rehabilitation Science, McMaster
University, Hamilton, Ontario.
Barbara Cooper, Ph.D., OT(C), is
Associate Professor, School of
Rehabilitation Science, McMaster
University, Hamilton, Ontario.
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Strong et al
O
ccupational therapists are being asked by their clients,
other health care providers and funders to articulate
clearly the scope of their practice and how their practice
influences outcomes. Therapists are focusing their efforts on
complex processes among people, their occupations and roles,
and the environments in which they live, work and play. A
group of clinicians and researchers developed the Person-
Environment-Occupation Model (PEO) to serve as a framework
for examining person-environment processes and assessment
tools in the context of occupational therapy practice (Law et al,
1996). The PEO Model complements the Canadian Model of
Occupational Performance and other concepts in the Canadian
Association of Occupational Therapists (CAOT) document,
Enabling Occupation: An occupational therapy perspective
(1997). It provides therapists with a practical analytical tool to:
1) assist therapists to analyze problems in occupational per-
formance, 2) guide intervention planning and evaluation, and
3) clearly communicate occupational therapy practices.
Since the PEO Model was first proposed as a tool to
examine complex occupational performance issues, it has been
used in hospital, community, academic and research settings.
For example, the Model guided occupational therapy interven-
tions for youth with physical disabilities in schools, and later
proved useful in a qualitative study of the experiences of a
group of youth with disabilities making the transition to adult-
hood (Stewart, 1998). A participatory action research study
employed the Model to examine the environmental factors
affecting the participation of children with disabilities in their
communities (Law, 1993; Law, 1997). It was used to discover
the role of work in the recovery process in an ethnographic
study (Strong, 1998). Rehabilitation interventions have been
examined using the PEO Model, including a family-centred
approach to rehabilitation of children with cerebral palsy (Law,
et al, 1998), the use of assistive devices with older adults
(Cooper & Stewart, 1997), and the development of an affirma-
tive business for individuals with mental illness (Strong, 1995).
The effects of environmental sensitivity on occupational per-
formance have been analyzed with the Model (Peachy-Hill &
Law, 1996). In addition, the PEO Model has facilitated the
development of services locally and abroad (e.g., rehabilitation
services in Bosnia). It has been instrumental for international
fieldwork in India (McKye, Shin & Letts, 1998), and the devel-
opment of occupational therapy curriculum in Russia (Krupa &
Packer, 1997). The model has been incorporated into several
occupational therapy programmes in Ontario, and the CAOT
Certification Examination.
This paper will explore applications of the PEO Model in
occupational therapy practice, and will delineate how this partic-
ular model helps therapists to conceptualize, plan, communicate
and evaluate occupational performance interventions. Three case
scenarios drawn from a composite of actual clinical scenarios will
be used to describe how the Model could be used in practice.
Person-Environment-0ccupation Model
The PEO Model (Law et al., 1996) was developed using con-
cepts mainly from environment-behaviour theories (Baker &
Intagliata, 1982; Berlin, 1989; Kahana, 1982; Kaplan, 1982;
Lawton & Nahemow, 1973; Moos, 1980; Weisman, 1981), the-
ories of occupation (Csikszentmihalyi & Csikszentmihalyi,
1988) and client-centred practice (CAOT, 1991). Its theoretical
Figure 1
The Person-Environment-Occupation (PEO) Model (Law et al., 1996)
Reproduced from the
Canadian Journal of Occupational Therapy, 63,
p.15
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Strong et al
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basis and supporting literature was described in a previous
publication (Law et al, 1996) in greater detail. The Model is
conceptualized as the person, his/her environments and occu-
pations dynamically interacting over time. These main dimen-
sions (person, environment, occupation) are represented by
three inter-related circles or spheres transacting over the life
span as shown by a cylinder (Figure 1). The extent of congru-
ence in the person-environment-occupation (PEO) relationships
is represented by the degree of overlap between the three
spheres; the closer the spheres overlap, the greater the degree
of harmony or fit. The overlap in the centre of the spheres rep-
resents occupational performance or the dynamic experience
of a person engaged in an occupation within an environment
over time.
The quality of a persons experience, with regards to their
level of satisfaction and functioning, is the outcome of the fit
between the person-environment-occupation transaction. Both
internal or local PEO changes and external or macro changes
result in reducing or increasing the PEO fit. For example, over
time there are changes in a persons age and health as the per-
son moves through life cycles, and developmental phases.
Concomitantly, a person may experience changes in self-con-
cept, disability status and environmental constraints. Political
and economic changes, such as regulatory reforms and priva-
tization, can influence daily life experiences of individuals and
organizations. These external and internal changes require
modifications and adaptations within the PEO transaction in
order to result in a satisfying and functional outcome. Using
the model, occupational therapists can work together with
their client(s) to facilitate these adjustments towards optimal
occupational performance. The focus is on enabling occupation
by improving the PEO fit.
The PEO Model and the Canadian Model of Occupational
Performance (CAOT, 1997) are complementary and share com-
mon terminology. Both models emphasize that occupational
performance is shaped by the dynamic interdependence of
persons, occupations and environments. The person can refer
to an individual client, a group of clients or an organization.
Figure 2
The Person-Environment-Occupation Model’s Application Framework
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Strong et al
Conceptualized broadly, the environment includes cultural,
institutional, physical and social factors affecting occupational
performance. Occupations are defined as clusters of activities
and tasks in which people engage while carrying out various
roles in multiple environments. Occupations are chosen to ful-
fill a purpose and for the value and meaning which individuals
or groups attribute to them. The Canadian Model of
Occupational Performance demonstrates the occupational ther-
apy view of the person in an integrated, holistic manner,
engaged in occupations within an environmental context. The
PEO Model demonstrates the dynamic nature of this relation-
ship and how changes in any area affect occupational perfor-
mance, the outcome of the relationship. The PEO Model facili-
tates analysis of problems in occupational performance and
evaluation of the outcomes of occupational therapy interven-
tions.
The PEO Model can be used by occupational therapists
practicing in many different roles and settings. For example, by
considering the complexities of daily human experiences, the
PEO Model enables therapists to conceptualize where there is
a less than optimal PEO fit, and what processes are potential-
ly enabling and constraining the PEO fit. Together with clients,
therapists can plan a range of potential interventions by focus-
ing interventions on the person, environments, and/or occupa-
tions in both micro and macro contexts over time. The out-
comes of interventions directed at improving the congruence of
P-E-O transactions can be evaluated by examining changes in
occupational performance. In other words, the PEO Model
offers a way to systematically analyze what occupational ther-
apists see and do. When applying the PEO Model, therapists
consider the many complex factors influencing clients daily
occupational performance. This allows therapists to analyze
complicated situations, to plan interventions, and focus on
what is important for enabling optimal occupational perfor-
mance. In addition, interventions can expand beyond the indi-
vidual client to target occupations and environments more broad-
ly and in different ways. As a result, multiple options for change
are created.
The flexibility of the Model to interface with other per-
spectives, theories and practices facilitates communication
within and outside of the profession of occupational therapy.
For example, the ability of the Model to interface with the
Canadian Occupational Performance Process Model (CAOT,
1997) and its terminology facilitates communication within the
profession. The Model appears to be easily communicated in
other languages and cultures as shown by its use in other
countries, and other cultures. Also, the Model supports occu-
pational therapists to relate to the practices of other disciplines
who examine person-environment relations, and at the same
time, demonstrates that the uniqueness of our discipline lies in
the third sphere - occupation. By focusing the analysis of diffi-
culties on all three spheres (person, environment and occupa-
tion), a shared responsibility for the situation and its resolution
is implied between the client or clients, the environment (e.g.,
Figure 3
Assessment of person, environmental and occupational factors impacting Normans occupational performance
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family, coworkers), and occupation. Hence, collaborative plan-
ning is encouraged. Each of these ideas will be expanded upon
in this paper.
Applications of The Person-Environment-
Occupation Model
Application of the PEO Model can be readily integrated into
current practice by following the PEO Application Framework
(Figure 2). Once the client(s) has identified occupational per-
formance issues, the client(s) and therapist together look at
strengths and problems in occupational performance by
assessing the environmental conditions, analyzing occupation-
al elements (activity, task, time, sequencing etc.), and aspects
of the client’s performance components which relate to perfor-
mance of the occupation in the particular environment.
Information is synthesized within a transactional framework by
focusing on the person-occupation, occupation-environment
and person-environment relationships. With the client, a plan
is developed that identifies strategies to remove barriers and
increase supports to improve occupational performance by cre-
ating a better person-environment-occupation fit’. Plans are
evaluated by examining changes in occupational performance.
Conceptually, the PEO Application Framework works well with
the Occupational Performance Process (Fearing, Law, & Clark,
1997) which provides more specific details about the process
of conducting the assessment, planning and intervention with-
in a negotiated client-therapist alliance. Application of the PEO
Model is illustrated in the following fictitious scenarios.
Scenario 1 - Norman
A. Presenting situation
Norman is an 80 year old man who fell and fractured his hip
3 weeks ago. He was recently transferred to the rehabilitation
unit of the hospital. Norman had been living on his own in an
apartment. His only son lives in the area with his own family.
They regularly have Norman join them for Sunday dinner and
have helped him with heavy household chores. The
Rehabilitation Team have started discharge planning for
Norman and want to determine whether he is safe to return to
his apartment or whether he should be placed in a long-term
care facility. Norman has been making progress in occupation-
al therapy with his self-care, however he is unable to prepare
meals on his own. Norman insists he wishes to return home
and believes he will be able to look after his meals once he is
home. During an initial interview, Norman identified occupa-
tional performance issues that were important to him. Together
they agreed to explore how to return Norman home.
Figure 4
Analysis of Person-Environment-Occupation Transactions (Norman)
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When examining the PEO transactions (Figure 4), issues
regarding the fit between Normans interests in meal prepara-
tion and his current abilities to make his own meals will be
considered in relation to the amount and type of resources
available in his home and community environments. This
requires the involvement of Normans family in the assessment
process. The transaction of person, environment and occupa-
tion components is considered from a temporal perspective
(i.e., with regard to how they relate to one another across
time) to address concerns about Norman being able to pre-
pare meals at home. This can alleviate some anxiety as
Norman and his family realize that the amount of support he
may require immediately post-discharge may reduce as his
physical abilities improve over time.
C. Intervention
The targeted outcome for Norman is to eat nutritious, satisfying
meals in his own home upon discharge. When applying the PEO
Model, the therapist, client and family can work together to
focus on ways to remove barriers and develop supports for
improving Normans occupational performance in the area of
meal preparation. Together, they can devise a plan for
obtaining meals that considers all components of person,
environment and occupation, and thus increase the quality
of the PEO fit.
Depending on assessment findings, examples of inter-
vention strategies for Norman may include:
Developing a weekly plan for meals with Norman and his
family
Providing family education about safety issues and com-
OCCUPATIONAL PERFORMANCE PROBLEM:
Norman wants to return home
B. Assessment
The PEO Model can be used to assess and formulate the pre-
senting problem in a client-therapist alliance. The PEO Model
guides the therapist to gather information about Norman (the
person), the tasks and activities which are important to him
(occupation) and his home (environment) as shown in Figure
3. Information would be obtained from Norman, the treatment
team, and his family using interviews, observations, chart
reviews and standardized assessment tools.
The therapist and Norman not only look at the problems
that Norman has preparing meals, but also consider the options
available for mealtime and the supports available to him. Thus,
the assessment places less emphasis on Normans performance
problems with preparing meals, and places more emphasis on
the options available to enable him to eat nutritious, satisfying
meals. The shift in emphasis allows Norman to feel less defen-
sive and consequently, to be able to be engaged in the process.
Using the PEO Model, the therapist can take the assess-
ment a step further by involving Norman and his family in the
analysis of the transactional relationships amongst the various
person, occupation and environment components across time
as illustrated in Figure 4 (i.e., person-occupation (PO), the
occupation-environment (OE), and the person-environment
(PE) processes). In Normans situation, it is important to assess
the fit between Normans current skills and abilities, his home
environment and the occupation of meal preparation.
Figure 5
Assessment of person, environmental and occupational factors impacting Karens occupational performance
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munity resources
Making referrals to community resources upon discharge
(e.g., Meals-on-wheels, home care occupational therapy
and homemaking
Recommending kitchen modifications and use of adaptive
aides to enable Norman to access his kitchen and con-
serve energy
By framing the challenge of meal preparation for Norman in
terms of the PEO fit, the therapist can clearly explain potential
intervention strategies. Norman and his family can be
explained how the therapist is trying to match Normans meal
preparation abilities, and preferences with the requirements for
obtaining daily nutritious meals, and the resources available to
him when living at home. They can be told how obstacles to
Norman obtaining satisfying nutritious meals can often be over
come by strategizing not only what things Norman could do,
but also what changes could be made to the meal making
process, and what supports for his family (e.g., community ser-
vices) could be enlisted to help. This also assists Norman and
his family in understanding the roles and functions of occupa-
tional therapy.
D. Evaluation/ Follow-up
At a discharge planning meeting the therapist and Norman can
report with confidence that he will be able to manage obtain-
ing nutritious meals in his own home, with environmental sup-
ports and a plan in place. After discharge, home care occupa-
tional therapy services can follow up to review Normans situ-
ation and consider any other issues related to his occupation-
al performance at home.
Scenario 2 - Karen
A. Presenting situation
Karen, a nine year old who has cerebral palsy, spastic diplegia
has been referred for school-based occupational therapy services.
Her parents and teachers are concerned as she has had difficul-
ty learning to print or write and is slow to complete her written
work legibly. The occupational therapist is asked to assess the
handwriting problems and provide intervention plans. During an
initial interview with Karen, she validated that completing written
work was an important issue for her and she agreed to work with
the occupational therapist to see what could be done.
OCCUPATIONAL PERFORMANCE PROBLEM:
Karen is having difficulty completing
written work at school
B. Assessment
The therapist gathers information about Karen (the person),
her school tasks and activities (occupation), and her school
and home (environments) as illustrated by Figure 5.
© CAOT PUBLICATIONS ACE
Figure 6
Analysis of Person-Environment-Occupation Transactions (Karen)
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Information can be obtained from Karen, her teacher, the
teaching assistant, her parents and the school records with for-
mal and informal assessment methods. However, the scope of
assessment is broadened to include the components in Figure
5 and extend to an analysis of the Person-Occupation (PE),
Environment-Occupation (EO), Person-Environment (PE) trans-
actions (Figure 6).
The assessment of personal factors influencing Karens
occupational performance notes her physical abilities and lim-
itations, including difficulties with motor planning and her lack
of initiative to seek help from others. Karen is observed to sit
and do nothing while her classmates are writing. She com-
ments ”I just can’t do it! I’m different than the others”.
Assessment of environmental and occupation factors reveal
that routinely, the class is expected to copy questions from the
blackboard and to fill in the answers independently. Karens
teacher sits at her desk and students are expected to approach
her with their problems.
During an analysis of PEO transactional relationships, the
occupational therapist recognizes a poor PO fit between
Karens competencies and the typical writing task requirements
in the class. Copying from the blackboard is very difficult for
Karen and she seems to have given up. Karens pace of writ-
ing is considerably slower than her peers, thus she always
feels behind and takes a great deal of work home. Upon analy-
sis of the OE relationship, it is evident that Karens teacher is
kept busy at her desk addressing the other students needs.
She rarely comes around to students’ desks while they are
completing writing tasks. The therapist also finds a poor fit
between P and E, specifically Karens abilities and the envi-
ronmental expectations and resources. All students are expect-
ed to complete written work in the same way, and no accom-
modations are made for Karens handwriting difficulties
C. Intervention
The targeted outcome in this scenario is to improve Karens
occupational performance in the area of written work, specifi-
cally to enable her to keep up with the written work demands
in her classroom. The focus of intervention is the fit between
her competencies, the written work expected in her class and
the environmental resources. This focus supports the need for
the occupational therapist to work together with Karen, her
family and school staff to improve the PEO fit.
Some examples of intervention strategies depending on
specific findings may include:
Educating school staff , with assistance from Karen and her
parents, about her disabilities and appropriate expectations
Discussing strategies with school staff to reduce the
amount of written work for Karen, such as using other
students notes to work with, receiving some assistance
to copy notes from a teaching assistant, and exploring
the use of computers at home and school
Introducing problem-solving strategies to Karen to help
her determine when to ask for assistance from a teaching
assistant or classmate
The therapist can use the PEO Model to develop a collaborative
plan with the different parties in a non-threatening manner.
Strategies focus on removing barriers to the PEO transactions
and developing supports, which enable Karen to keep up with
the written work in her classroom. Everyone can see how they
can contribute to Karens successful occupational performance.
D. Evaluation/ Follow-up
The therapist may revisit the school and meet with Karen, and
school staff to review the situation. The targeted outcome of
intervention can be evaluated in terms of whether Karen is able
to keep up with the written work in the classroom to the satis-
faction of Karen, her parents and school staff, with the recom-
mended supports and modifications in place. The PEO Model can
be used to evaluate the effectiveness of the intervention strate-
gies, by examining the extent to which they improved the quali-
ty of fit between person, environment and occupation.
The dynamic nature of the PEO relationships can be
addressed during follow-up visits by addressing how the opti-
mal fit can be sustained over time. This requires flexibility and
adjustments in the strategies implemented as changes occur
in the person, environment and/or occupation. For example, as
Karen develops her problem-solving skills and takes more
responsibility to ask for assistance when she needs it, the
teaching assistant and teacher need not check in with Karen
routinely, but can carry on with other work until she approach-
es them. Also, as the writing demands in the curriculum
change, new strategies may be needed to ensure Karen can
continue to keep up and feel successful at school. The PEO
Model can help the different parties to expect and anticipate
changes over time, and thus maintain optimal fit, or occupa-
tional performance.
Scenario 3 - Spencer
A. Presenting Situation
An occupational therapist working at an outpatient mental
health clinic is greeted by Spencer sliding into a nearby chair
saying “I can’t go back there”. Spencer insists he cannot work
any longer cleaning offices; a transitional work placement in
the community. Spencer has had schizophrenia for the last 15
years. About six weeks ago, he was placed with a temporary
employment agency to gain work experience. A phone call to
the agency staff reveals Spencer has become increasingly with-
drawn, ruminating about coworkers. A discussion ensues with
Spencer concerning how the work placement was intended to
help him achieve his vocational goals. Spencer agrees to
accompany the therapist to his work to investigate further by
talking with Spencer’s coworkers and supervisor, and by
observing Spencer working onsite.
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OCCUPATIONAL PERFORMANCE PROBLEM:
Spencer’s lack of work satisfaction
B. Assessment
Person, occupation and environment components in Figure 7
are considered with regard to how they relate to one another
across time to produce Spencer’s lack of satisfaction, and his
supervisor’s concerns about Spencer’s decline in functioning
and potentially becoming ill again (Figure 8).
An examination of the PO interaction revealed that the work
activities matched Spencer’s skills and abilities; he was generally
able to meet daily challenges with success. Although he valued
the work activities, Spencer expressed low self-efficacy regarding
his ability to do the work. Spencer was in the early stages of the
recovery process. He had not yet incorporated a sense of self as
a worker, and did not fully view himself as an active agent in his
recovery. The work was continually changing from job to job with
little routine. Spencer perceived little personal control over how
his work was performed or organized.
The OE interaction showed that although Spencer arrived
at each office with a three member team, his work was per-
formed largely in physical isolation from the rest of the team.
Team members and his supervisor expressed that Spencer’s
work was valued by the organization.
The PE interaction found the supervisor’s communication
was unclear and rules tended to be applied dogmatically to all
staff. The staff were not sure what to expect of Spencer and
appeared to treat him with ‘kid gloves’. Spencer was often not
included in social conversations. The workplaces offered
tremendous potential for work experience and training oppor-
tunities which were in keeping with Spencer’s vocational goals
and future aspirations.
Upon examining the presenting problem in this manner,
the problem was reconceptualized from what appeared initial-
ly to be Spencer becoming ill, to a complex set of transactions
constraining his satisfaction and recently his functioning on
the job. The therapist was able to rule out lack of interest, and
Spencer’s ability to function as the primary issues.
C. Intervention
Interventions focus on improving occupational performance by
removing barriers / constraints and developing supports to
improve the quality of the PEO fit. Intervention would include
targeting the relationships between Spencer, his work activi-
ties, and the work environment. The emphasis would be to
make the workplace a better place for everyone by improving
the people-work-environment fit. In this way animosity
between co-workers is avoided by Spencer not being seen as
having special concessions, the supervisor not made to feel
that he is the problem, and there is ‘buy in by all parties to
work together.
© CAOT PUBLICATIONS ACE
Figure 7
Assessment of person, environmental and occupational factors impacting Spencer’s occupational performance
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Examples of intervention strategies for Spencer may
include:
Clarify job expectations, arrange clearer channels of com-
munication.
Negotiate some routine.
Negotiate to have some element of control & autonomy
over work tasks.
Educate supervisor and co-workers about mental illness.
Offer on-going facilitation of problem solving to the super-
visor re: dealing with daily issues.
Counsel Spencer re: asserting himself, dealing with oth-
ers’ reactions to mental illness.
D. Evaluation/ Follow-up
The intervention could be evaluated by discussing with
Spencer changes in his perceptions of his work environment,
perhaps facilitated by using a standardized self-report measure
such as the Work Environment Scale (Moos, 1994). If the
supervisor was also requesting feedback, the Work
Environment Scale could be completed by the supervisor,
Spencer and co-workers and a comparison made of percep-
tions. The therapist would seek reports of Spencer’s satisfac-
tion (i.e., whether it was a positive experience and meeting his
vocational goals) and his supervisor’s satisfaction (i.e.,
whether Spencer’s performance was satisfactory). On-going fol-
low-up would be provided by the therapist trouble-shooting’
routine issues as they arise. These issues would be dealt with
by Spencer, his supervisor and the therapist together problem-
solving ways to improve the quality of the fit between the per-
son, environment and occupation. Explanations and group
planning may be facilitated by drawing three over lapping cir-
cles labeled workers, the work activities, and the workplace.
Discussions can be focused on strategies to improve the fit of
the circles with group members adding words or phrases to
the drawn figure.
How the PEO Model facilitates practice
The PEO Model is being used by occupational therapists in a
variety of different settings and has been found to be a prac-
tical tool to facilitate practice. A strength of the PEO Model is
that it enables therapists to consider the complexities of
human functioning and experience in the day to day realities
of clients lives and therapists’ practices. The flexibility of the
model facilitates this by allowing the therapist to consider var-
ious combinations of P-E-O components and their transactions
across time, and in different environments. The three scenar-
ios illustrate this flexibility through the different combinations
of P-E-O. By considering the transactional effects, the therapist
is also able to obtain a clearer, more comprehensive, under-
standing of complicated occupational performance situations.
For example, with Spencer, the Model helped the therapist to
reconceptualize the central problem from an issue of Spencer
becoming ill or lacking interest, to a poor Spencer-job-work
environment fit.
© CAOT PUBLICATIONS ACE
Figure 8
Analysis of Person-Environment-Occupation Transactions (Spencer)
Strong et al
LA REVUE CANADIENNE
DERGOTHÉRAPIE JUIN 1998
132
volume 66 • issue 3
There are many potential variations to the PEO elements
which can be examined. For example, person can refer to an
individual or to a group, organization, or community. The envi-
ronment can be examined for its cultural, socio-economic, insti-
tutional, physical and social aspects on both the micro (i.e.,
immediate clinical level) and macro levels (i.e., systems level).
For example, with Karen and Spencer, the therapist could also
intervene at the macro level by addressing the organizations
policies regarding working with persons with disabilities and
providing in-service training to the organization.
Another example of the flexibility of the Model is shown
by how it considers time through the PEO elements transact-
ing over the lifespan across changing situations as represent-
ed by a tube or cylinder (Figure 1). Therefore, therapists are
able to conceptualize and plan interventions which take into
account human development and change. With Karen, inter-
ventions will change as she develops and becomes more
assertive. For Spencer, the therapist considered his stage in the
recovery process. At an earlier time, the same client may have
considered himself a patient; his world solely focused on his
illness with different priorities and level of wellness. The ther-
apist and client might also have been operating in a different
context (e.g., an occupational therapist servicing an in-patient
and a multidisciplinary in-patient team).
In addition to flexibility, the Model offers a systematic
approach to the analysis of occupational performance issues.
As illustrated by the three scenarios, therapists examine prob-
lems in occupational performance by following the PEO
Application Framework (Figure 2). The result is an organized
and integrated approach. The structure is particularly useful
when attempting to see the forest for the treeswhen con-
fronted by perplexing situations. The time spent in analysis of
occupational performance issues can result in efficient use of
a therapist’s time by producing focused effective interventions
and relevant outcomes.
Third, the Model helps therapists to place their activities
into a framework that has a broad scope of occupational ther-
apy practice and offers multiple options for intervention. For
example, with Norman, the therapist’s scope included occupa-
tional and environmental factors and an analysis of PEO trans-
actions. Therefore the focus of the intervention expanded from
Norman making meals to multiple strategies and options for
Norman to obtain nutritious and satisfying food. A focus
beyond the individual, his/her impairments and personal com-
petencies is particularly helpful when dealing with persons
with chronic, persistent illness. With Spencer, a range of inter-
ventions were examined involving Spencer, his supervisor and
co-workers and focused on aspects of the person, the occu-
pation and different components of the environment. The
range of interventions offers the therapist the opportunity to
participate in a number of roles (e.g., provider of direct clinical
services, consultant to workplace, advocate for change or
change agent, health promotion).
The fourth benefit from using the PEO Model stems from
how the Model facilitates communication within and outside
the profession. Occupational performance problems and the
occupational therapists intentions can be explicitly described
to others using this Model. It enables therapists to explain to
themselves and others what they do uniquely. Individuals who
do not come from a medical background can understand its
rationale. Because the concepts reflect ideas in the social sci-
ences, the Model reflects the richness of occupational thera-
pys heritage. The Model is easy to understand and it does not
appear to be culturally bound. It does not require its user to
abandon his/her own perspectives; rather the Model can oper-
ate as an organizing framework for professionals to use all the
techniques or methods of intervention at their disposal for sit-
uations appropriate for a person-environment-occupation the-
oretical approach. The occupational therapist is able to use the
Occupational Performance Process (Fearing et al, 1997) togeth-
er with the PEO Model; the Occupational Performance Process
provides principles and a guiding framework for negotiating a
client-therapist alliance, while the PEO Model provides an
approach to analyzing, strategizing and communicating occu-
pational performance difficulties concerning person, environ-
ment, occupation relationships. Since the PEO Model meshes
well with other perspectives and practices, it allows team
members from different orientations or clinical training to com-
municate with a common understanding for them to work
together as a team. The Model further facilitates constructive
teamwork by reducing feelings of defensiveness by focusing
on the PEO fit issues rather than placing responsibility on any
one person or organization.
Finally, the PEO Model supports the pursuit and contin-
ued development of occupational therapy practice trends and
needs. It embodies the principles of client-centred practice and
supports the collaborative working partnership process articu-
lated in
Enabling Occupation: An Occupational Therapy
Perspective
(CAOT, 1997). The profession has been returning to
its roots through discussions on occupation and occupational
performance. The model offers a way of conceptualizing how
these constructs relate to one another theoretically and sug-
gests a structure for problem-solving intervention strategies.
The Model clearly defines the outcome of occupational perfor-
mance as the product of PEO transactions which facilitates
evaluation. This means that therapists can identify what out-
comes need to be measured.
In summary, the Person-Environment-Occupation Model
(Law et al., 1996) facilitates practice by:
Considering the complexities of human functioning and
experience
Offering a systematic approach to the analysis of occupa-
tional performance issues
Expanding the scope of practice and options for inter-
vention
© CAOT PUBLICATIONS ACE
CANADIAN JOURNAL OF
JUNE 1999 OCCUPATIONAL THERAPY
volume 66 • issue 3
133
Strong et al
Facilitating communication within and outside the profes-
sion
Supporting the pursuit and continued development of
client-centred, community based practice
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Krupa, T., & Packer, T. (1997). Canada-Russia Health and Social
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Copyright of articles published in the Canadian Journal of Occupational
Therapy (CJOT) is held by the Canadian Association of Occupational
Therapists.Permission must be obtained in writing from CAOT to photo-
copy, reprint,reproduce (in print or electronic format) any material pub-
lished in CJOT.There is a per page,per table or figure charge for commer-
cial use.When referencing this article,please us APA style, citing both the
date retrieved from our web site and the URL.For more information,
please contact:copyright@caot.ca.
... Ana yapılar arasındaki uyumun anlamlı katılımı arttıracağı, uyumsuzluğun ise katılımı veya okupasyonel performansını tehdit edeceği ileri sürülmektedir. Bu bağlamda çevre faktörü de kişinin günlük yaşamdaki görev performansını dinamik olarak etkilemektedir 18 . ...
... Bunun yanı sıra çoklu duyusal uyaranlarla zenginleştirilmiş bir çevre ile yaşlılar gözlemlendiğinde, okupasyonlara katılımda artış, davranış ve ruh hallerinde iyileşme görülmüştür 21,22 . Yani fiziksel, sosyal, kültürel ve sosyoekonomik gibi geniş bir yelpazede incelenen çevre faktörünün niteliği hem bireyin iyi olma haline hem yaşam kalitesinin sürdürülebilirliğine teşvik eder 18 . Kişi ve çevre etkileşiminde çevre faktörü, bireyin tercih ve yeteneklerini yansıtmasında rol oynar. ...
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Ergoterapi alanında model üzerinden inşa edilen bir sistem ile çizilen çerçevenin; terapi ve tedavi metotları planlanırken süreci bütünsel olarak değerlendirme noktasında katkı sağladığı bilinmektedir. Deneyime bağlı plastisitede rol oynayan çevresel zenginleştirme, bilişsel ve davranışsal kapsamlarda bireylerin bağımsızlık sürecine katkı sağlamaktadır. Çevre faktörünü farklı bağlamlarda esas alan ergoterapistler sıklıkla bireylerin yakın çevresine odaklanmaktadır. Çevrenin okupasyonlar üzerindeki önemli etkisi tam olarak anlaşılması önemlidir. Bu derlemede, çevrenin ergoterapideki rolü, kişi ve okupasyonlar ile ilişkisi, insanın dönüşümünde ve zihinsel süreçlerinde çevre faktörünün önemi genel kapsamları ile tartışılmıştır.
... The client-centred approach incorporates the person's wishes and needs, and actively involves the person with deficits in setting certain goals in their rehabilitation process [7,[9][10][11][12]. By using occupational models and assessments, such as the Person-Environment-Occupation model (PEO-model) [13] and Canadian Occupational Performance Measure (COPM) [14][15][16], therapists can involve the person with deficits in the process of setting unique and individual goals, which increases therapy motivation and consequently adherence. The extra advantage of the COPM is that it cannot only be used for goal setting but also for the assessment of self-perceived occupational performance [14][15][16]. ...
... Although conventional therapy also focusses on providing a client-centred approach, our results suggest that i-ACT can support a client-centred approach as about 88% of the persons' goals were implemented in i-ACT training compared to about 46% in control group during conventional therapy. This finding confirmed our third hypothesis as i-ACT is specifically developed to incorporate a client-centred approach by being able to record and set different kinds of activities (which are determined by the person with deficits), and provide individualised real-time feedback regarding the performance of the person with deficits [13]. These features distinguish i-ACT from other Kinect-based systems which mostly use commercially available (exer)games, which are not designed to meet rehabilitation goals such as feedback on compensation strategies, coordination patters, etc. [1,2,4,5,21,22]. ...
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Article
Occupational therapists, known for their ability to coach others through difficult changes, now find themselves in changing environments that include clients' desire for participation in service delivery, and the need for evidence of the outcome of occupational therapy intervention. This paper proposes a process model that is based on core concepts of occupation and client-centred practice, that incorporates theoretical approaches, and can be applied to all clients. The process model coaches the occupational therapist through a client-centred problem solving process. It represents a description or plan for occupational therapy assessment and intervention that leads to a collaborative approach to client-identified occupational performance issues. Examples of the application of the process to occupational therapy practice are included. This model helps to articulate core concepts and values, and provides guidance for occupational therapy practice within changing environments and expectations.
A novel transfer pole was installed in the homes of 30 community dwelling elderly women (mean age 76.8 years) and intermittently color-cued for 20/30 participants. Subjects' views of the device and their ability to transfer were monitored over a three-month period using survey, performance and self-report measures. Qualitative results indicated that seniors fully recognized and endorsed the functional utility and safety benefits of the pole. A repeated measures one-way ANOVA showed statistically significant changes across time for all groups on self-report measures as a consequence of the pole but none related to the cue, although positive trends were observed. The results corroborate basic assumptions of the Person-Environment-Occupation Model used to frame the study.
Article
Thesis (M.Sc.) -- McMaster University, 1995. Includes bibliographical references (leaves 249-261).
Article
This ethnographic study examined what makes work meaningful for persons with persistent mental illness and how this meaningfulness relates to their recovery. Twelve persons between 32 and 58 years of age who had been involved an average of 19 years with a formal mental health system participated in in-depth interviews and a focus group. Thematic analysis and case studies were understood in the context of the investigator's 15 months of participant observation of 35 persons with psychiatric disabilities working at an affirmative business. The meaning of work varied with participants perception of their illness and their self-concept. Changes in their self-efficacy and self-concept were driven by their participation in work activities to operate the affirmative business. Findings suggest that therapists could potentially facilitate these changes in clients' sense of self-efficacy and self-concept by helping them make connections with meaningful occupations and contributions to organizations in the community and to experience challenges and successes in the context of meaningful work.
Canada-Russia Health and Social Development Project
  • T Krupa
  • T Packer
Krupa, T., & Packer, T. (1997). Canada-Russia Health and Social Development Project. Resource Manual, Volume 1, Occupational Theory. Kingston, ON: Queen's University.
Changing disabling environments through participato-ry action-research: A Canadian experience Nurtured by knowledge: Learning to do partic-ipatory action-research
  • M Law
Law, M. (1997). Changing disabling environments through participato-ry action-research: A Canadian experience. In S. Smith, D. Willms, & N. A. Johnson, Nurtured by knowledge: Learning to do partic-ipatory action-research. New York, NY: Apex Press.
The transition to adulthood for youth with physical disabilities: A qualitative exploration. Unpublished master's thesis
  • D Stewart
Stewart, D., (1998). The transition to adulthood for youth with physical disabilities: A qualitative exploration. Unpublished master's thesis, McMaster University, Hamilton, Ontario, Canada.