אוגוסט 2004, כרך 13, מס' 3

 
 
לחשוב וליישם תיאוריה: מודל העיסוק האנושי – סקירת מושגים עדכניים, ניסיון קליני והמלצות
מאת: נגה זיו
מילות מפתח: חשיבה תרפויטית, השתתפות בעיסוק, ביצוע עיסוקי, נרטיב עיסוקי, זהות עיסוקית, יכולת  (competence), הסתגלות
 
תקציר:
"מודל העיסוק האנושי","The Model of Human Occupation"  (Kielhofner, 2002)נמנה על אחד המודלים המובילים בקבוצת המודלים המכונה:Conceptual Practice Model  (Kielhofner,1997; McColl et.al, 2002). ייחודו של המודל הן ביכולת היישום הטבעית של המושגים התיאורטיים והרעיוניים ברמת האבחון והטיפול, והן בקלות וביעילות הכרוכים בהטמעת המושגים בשפה הפרקטית המקצועית.
בשנים האחרונות, קיבל המודל תנופה ותאוצה בהיקף בינלאומי של שיתוף פעולה הן בתחום המחקרי והן בתחום היישומי. בגרסתו האחרונה של המודל (Kielhofner, 2002)אפשר למצוא חידושים והעמקה במושגים התיאורטיים המרכזיים והמוכרים של המודל ; סקירה ומידע על כלי אבחון וטיפול חדשים שפותחו ותוקפו במהלך השנים האחרונות, וכן דוגמאות מגוונות ליישום שלוקטו מן העולם כולו (זיו, 2002). המושגים תואמים ומשקפים את השינויים שחלו בתפיסה הרב-מקצועית של מושגי הבריאות, מוגבלות ותפקוד (WHO, 2001). וכן את השינויים בטרמינולוגיה המקצועית, שבאו לידי ביטוי במסמך ה-Occupational therapy practice framework - Domain & process, שבו הוגדר מחדש מרחב העשייה הטיפולית ותהליך הטיפול(AOTA, 2002). מושגי מודל "העיסוק האנושי" תורמים לכמה ממרכיבי המסמך (כמו מיומנויות תקשורת, דפוסי העיסוק...).
המודל במהותו מתמקד במושג העיסוק ובתור שכזה מספק גם כלים מגוונים ובעלי תוקף ומהימנות למדידת ביצוע עיסוקי, השתתפות עיסוקית, ותוצאות טיפול(outcomes), בעידן שבו מקצועות הבריאות נדרשים ליעילות טיפול ולביסוס התערבויות על ראיות מחקריות.
 
Thinking with and applying Theory: The Model of Human Occupation – Review of revised concepts, clinical experience and recommendations
 
Summary:
The Model of Human Occupation (Kielhofner, 2002) is one of the leading models in a group of models referred to as Conceptual Practice Models (Kielhofner, 1997; McColl, et al., 2002). The unique aspect of the model is the natural application of its theoretical concepts on both the assessment and the intervention levels, as well as the facility and efficiency with which the concepts are assimilated in a practical professional language.
In recent years the model has gathered momentum and acceleration in its international scope, in terms of cooperative research and application. In the model's most recent version (Kielhofner, 2002) innovations and in-depth theoretical concepts, which are central and familiar, such as a review and information on new assessment and intervention tools which were developed and validated over the course of the last few years, as well as a variety of examples for application which were collected from all over the world (Ziv, 2000). The concepts reflect the changes which have taken place in the multidisciplinary perception of concepts of health, disability and function (WHO, 2001). This is congruent with the changes in our professional terminology, seen in the document "Occupational Therapy practice framework: Domain and process", in which the intervention setting and process are redefined (AOTA, 2002). The concepts of the Model of Human Occupation contribute to several components of the document, such as communication skills and occupational habits.
The essence of the model reflects and focuses on the concept of occupation and as such, provides a rich assortment of valid and reliable tools with which to measure occupational performance, occupational participation and intervention outcomes, in an era in which health professionals are being required to account for intervention efficacy and to plan and implement intervention on evidence-based practice.
This article briefly reviews the updated concepts of the model, while emphasizing the dynamic characteristics and the interaction between all systems. The client-centered topics "thinking with theory" and "therapeutic reasoning" are discussed. The application of the model's philosophical and practical principles is briefly demonstrated, within the individual and group frameworks, with geriatric, mental health and pediatric populations. The use of specific tools, in their entirety or in part (such as OSA, OCAIRS and OPHI-II, which are work sheets for group interventions) is demonstrated, as is the way these tools enable clients to look at, to understand and to enrich their occupational lives broadly and in depth, the choice processes that they make, their habits and routines, their occupational identities, their occupational narrative, their desires, their environment (which enables or demands), their cultural and social values( which influence their ability to adapt) and their sense of ability. Members of a group have often noted that the use of "the model's terminology" enabled them, for the first time in their lives, to look at and to be aware of daily, on-going issues which appear to be banal and unimportant. They found themselves to be "enlightened" and discovered that topics that had appeared to be inconsequential actually contained the key to their health and existential problems and to their ability to change.
The uses of the model inIsrael over time are reviewed, both in the realm of research and in intervention. The combination of the model with additional intervention approaches is demonstrated, according to the client's disabilities and dysfunction of specific structures and functions, contributing to the advancement and improvement of occupational behavior, involvement and participation in occupations and significant, qualitative activities.
In light of the abovementioned, it is recommended to assimilate the use of the model inIsrael in a variety of occupational therapy intervention frameworks, with many populations and throughout the continuum, from acute to chronic, and in all stages of intervention. It is recommended to use the model's language, which empowers the accepted terminology in occupational therapy in a scientific and consistent manner. This language enables connection and immediate translation to daily concepts and in this way supplies clients too with exact, expressive and in-depth tools which contribute to a feeling of empowerment (Forsyth & Kielhofner, 2002). The use of this professional and qualitative language is of utmost importance, both in documentation and as a means for explaining, marketing and communicating the continuum that encompasses health and sickness, within the profession and outside of it, with all circles of consumers: the community of clients and the general public.