The foundation of Occupational Therapy theory and practice acknowledges the inextricable relationship between the body and mind as well as the innate desire for the humans to engage in occupation learn and how this engagement contributes to learning. As the individual moves through life, there is a continuous presentation of occupational challenges which require adaption in order for the individual to experience relative mastery.
Successful adaptation involves the person, the occupational environment and the interaction between the two. Once an occupational challenge is perceived, the individual will respond to it guided by the influence of internal and external expectations for performance. An occupational response is elicited as the individual addresses the perceived challenge. The outcome is then evaluated to determine the degree of the effectiveness. Any feedback obtained during the process is integrated to allow further refinement in the drive to achieve relative mastery. This continuous process contributes to deeper learning, the development of a foundation of understanding, and provides the individual with the ability to predict outcomes.
The individual's behavior during the adaptation process is significantly influenced by intrinsic motivation, experience, and the occupational roles of the individual. When biological, psychological or environmental factors interrupt the adaptation process, purposeful activity and occupation guided by the therapist are utilized to prevent or mediate dysfunction, and elicit maximum occupational performance in the client.
The CCRI Occupational Therapy Assistant Program utilizes the Model of Occupational Adaptation (Shultz, S. & Schkade, S., 1992) in order to facilitate mastery in the students it serves. As educators, program faculty passes on the legacy of experience, knowledge of occupational therapy principles and practice. At the same time, the concept of continuous acquisition and scientific synthesis of the components of the person are explored and discussed. The concept values of client-centered practice and engagement in occupation and purposeful activity are woven into each course.
The “person”, the OTA student, enters the OTA program with a desire for mastery, to earn an Associate’s Degree in the Occupational Therapy Assistant Program. The student will draw upon sensory-perceptual skills (i.e. engaged in assessing muscle strength of a lab partner), motor and praxis skills (i.e. practicing facilitating functional activity in labs), emotional regulation (i.e. coping with the demands of completing multiple assignments), cognitive skills (i.e. developing a group protocol for an inpatient mental health group) applying tone management techniques learned in class to the client with a CVA while on Level II fieldwork), communication skills (i.e. identifying strengths and areas in need of development when reviewing the Professional Behavior assessment with faculty), and social skills (i.e. planning and end-or-semester potluck with classmates).
The student’s ability to achieve mastery within the program is influenced by components within their occupational environment. These influences may include assistance with afterschool child care from a friend (social) or neighbor, a lack awareness of how the demands of the program will require the spouse to be more involved at home (personal), and the safe use of the lab and equipment (physical). The OTA student will be required to function in the classroom, laboratory, clinical sites, large and small groups, all characterized by unique cultural influences. The interaction between the student (person) and the occupational environment will affect the process of adaptation.
The student will face many occupational challenges which foster adaptation throughout the program. Some of the challenges will be directly related to the role of a student (i.e. develop the ability to facilitate independence in dressing for a client who sustained a TBI) while others will be influenced by other roles (i.e. parent, spouse, employee). For example, a student who is also a parent will face the challenge of restructuring the allocation of time in order to continue on as the assistant soccer coach while scheduling time to meet with group members in order to complete a project in order to maintain academic standing within the program.
Student response to challenges intrinsic to the OTA program will be varied. These adaptive responses will be influenced by internal and external expectations for performance. The internal expectations and intrinsic motivation involve the student’s successful academic history, a desire to improve earning potential, fear of failure, or a desire to achieve a professional goal of becoming an OTA. External expectations may include a desire to please a parent by obtaining a college degree, the push from a spouse to obtain a job in order to contribute to the family’s financial picture, or achieving passing grades in order to fulfill the requirements of the program.
The student will respond to challenges with an occupational response. This may include decreasing work hours to allow for more study time, organizing a study group to improve retention of course material, meeting with faculty to review techniques practiced in lab, or taking 10 minutes to relax prior to entering into a lab practicum. All the while, faculty and the student are evaluating the effectiveness of the responses.
The student will receive feedback from faculty, peers, clinical supervisors, team members, clients, their families and caregivers. Once internalized, this feedback may further help the student evaluate and refine responses to challenges which will ultimately improve performance. These experiences reinforce and help the student to learn to integrate the practice of technical skills with the concepts of caring, understanding and responding to client needs. Thus, the student modifies adaptive response modes and develops new ones which are effective in achieving competency. This is the culmination of the process of occupational adaptation.
Throughout this process, the student’s continued desire for mastery is directly related to the degree of intrinsic motivation. This is a dynamic component and faculty often witness changes in the degree of motivation based on the student’s perceived view of the significance of the occupational challenge encountered. Open labs are requested more frequently when a practicum exam in in the near future, a student may be less focused upon addressing personal health issues, a student may suddenly decide to take advantage of tutoring services upon discovering they are very close to failing a course. Faculty and the college can provide the tools and an academic environment to facilitate student success, however, success is ultimately dependent upon the individual’s motivation toward achieving it.
The CCRI OTA Program has evolved over the years to reflect the changing needs of the student population, changes within OT practice settings, influences within the OT profession (i.e. OT Practice Framework III, new ACOTE Standards), as well as the needs of the community. There exist a simultaneous process of adaptation for faculty and the program. Faculty motivation to facilitate the development of kind, caring and clinically competent Occupational Therapy Assistants drive the effort to frequently evaluate outcomes the success of the program. This dynamic process is one faculty welcomes.
The ultimate outcome described by Shultz and Schkade is the “adaptive gestalt”. In this case, the student has developed plans for carrying out adaptive responses they have learned. At this stage, students begin fieldwork where they continue to meet challenges, refine adaptive responses and explore new ones in clinical practice while embracing a commitment to lifelong learning as a clinician.
Schkade, J. K. & Shultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part 1. American Journal of Occupational Therapy, 46, 829-837.
Schkade, J. K. & Shultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part 2. American Journal of Occupational Therapy, 46, 917-925.
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