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Use of the Model of Human Occupation (MOHO) to Understand the Occupational Needs of Mothers with Perinatal Mental Illness: A UK Grounded-Theory Study

Research output : Contribution to conference types › Abstract › peer-review

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• Grounded Theory Medicine & Life Sciences 100%
• Interviews Medicine & Life Sciences 56%
• Health Care Outcome Assessment Medicine & Life Sciences 55%
• Mothers Medicine & Life Sciences 53%
• Delivery of Health Care Medicine & Life Sciences 51%

Use of the Model of Human Occupation (MOHO) to Understand the Occupational Needs of Mothers with Perinatal Mental Illness : A UK Grounded-Theory Study. / Graham, Mandy.

T1 - Use of the Model of Human Occupation (MOHO) to Understand the Occupational Needs of Mothers with Perinatal Mental Illness

T2 - AOTA Annual Conference and Expo 2020

AU - Graham, Mandy

N1 - Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/8/1

Y1 - 2020/8/1

N2 - Perinatal mental healthcare is an emerging area of practice for OTs in the UK, however research to guide practice remains scarce. A qualitative grounded theory methodology elicited data from 12 OTs using semistructured interviews. The MOHO was found to enable participants to understand the complex needs of mothers with mental illness, measure outcomes, and articulate their unique and distinct role to multiple audiences.

AB - Perinatal mental healthcare is an emerging area of practice for OTs in the UK, however research to guide practice remains scarce. A qualitative grounded theory methodology elicited data from 12 OTs using semistructured interviews. The MOHO was found to enable participants to understand the complex needs of mothers with mental illness, measure outcomes, and articulate their unique and distinct role to multiple audiences.

KW - Model of human occupation (MOHO)

KW - Occupational needs

KW - Perinatal health

UR - http://www.scopus.com/inward/record.url?scp=85092292896&partnerID=8YFLogxK

U2 - 10.5014/ajot.2020.74S1-PO9512

DO - 10.5014/ajot.2020.74S1-PO9512

M3 - Abstract

AN - SCOPUS:85092292896

Y2 - 26 March 2020 through 29 March 2020

Understanding the MOHO in Occupational Therapy

Having survived several challenging years of occupational therapy grad school, we have to be honest…learning about theories, models, and frameworks in school isn’t always one of the most fun aspects of becoming an OT.

However, after practicing occupational therapy for several years now, it’s now easy to see the importance of these theories daily.

It goes without saying that OT theories, models , and frames of reference are the foundation to occupational therapy. Understanding these building blocks will allow you to grow even more as a practitioner.

Therefore, it’s only fitting that we cover one of the most important models or framework to understand as an occupational therapist – the Model of Human Occupation (MOHO) .

What is the Model of Human Occupation (MOHO)?

The Model of Human Occupation (also known as the MOHO) is a very important occupation-based framework and is woven into the fabric of occupational therapy. It utilizes a top-down holistic approach to looking at the individual, their meaningful activities or occupations, and relationship with their environment.

In four studies that started looking at the MOHO back in 1989 and that continue to research it today, the MOHO has been reported to be the most frequently used and cited occupation-based model among OT practitioners in the world ( UIC ). One study showed that more than than 80% of occupational therapists regularly use MOHO in their practice.

For a more textbook definition of the MOHO:

The MOHO explains how occupations are motivated and organized into daily life patterns and performed within a person’s environment.

In more practical and real-life terms, I like to think of the MOHO as a way to organize and understand how to use occupations into practice to improve people’s health by understanding how and why meaningful activities are motivated, patterned, and performed.

Within this definition are three very important terms that are key to understanding the MOHO – volition (motivation), habituation (habits, roles, patterns), and performance .

Furthermore, the MOHO is based on an open systems theory, which states that a human is a self-organizing system in interaction with the environment, where humans interact with their environment through occupations and receive input and output .

Input is defined as when an individual attends to information of interest or relevance within their environment and then act upon it with an output, or occupation. By interacting with the environment, a person receives feedback (input) which creates change over time.

The key to the MOHO is understanding that all components within it are dynamic. When any part of it changes (skills, values, roles, habits, routines, environment), the entire dynamic may shift in either a healthy or unhealthy way for the individual.

How Did the MOHO Originate?

While covering the MOHO’s importance in occupational therapy, we also need to briefly discuss where this model came from. If you don’t remember from OT school, the MOHO originated from Dr. Gary Kiehlofner’s Occupational Therapy Master’s thesis in the 1970’s, and grew from there with the help of many other occupational therapy practitioners along the way. It’s goal was to articulate an approach to occupation-based interventions.

Now as a leading theory in occupational therapy, the MOHO is continually studied and supported by over 400 research articles and textbook chapters. The MOHO also has its own textbook, Kielhofner’s Model of Human Occupation: Theory and Application , currently in its 6th edition.

This textbook, regularly updated, aims to “deliver the latest in MOHO theory, research, and application to practice; [and] includes new case studies that show how MOHO can address real-life issues [to] enhance teaching and learning.” If you want to dive deeper into the MOHO model, this text is worth checking out if you haven’t already purchased it in school.

Integrating the MOHO into Occupational Therapy Practice

The MOHO allows us to dive into the why and how our patients live, work, and engage with their environment. In doing so, we can better understand what is important to them (i.e. their occupations) and integrate this into practice, which in essence is what makes us occupational therapists.

There are questions that you can ask yourself when working with a client or patient to look at the situation through a “MOHO lens”.

• Why are certain people motivated to do what they do? In other words, what are their values, interests, or occupations?
• How is occupational behavior organized or structured? What are an individual’s patterns, habits, or routines?
• How well can a person complete the task or occupation they are motivated to do?

Using MOHO Assessments

To further incorporate the MOHO in your OT practice, you start by using MOHO-related assessments during your evaluations and monitoring client progress throughout your intervention. The following are MOHO-based occupational therapy assessments that incorporate this frame of reference.

This list of MOHO-based assessments isn’t all-inclusive but it can help you get started, whether you’re working with children or adults. 

Occupational Questionnaire (OQ)

Occupational Self-Assessment (OSA)

Assessment of Motor Process Skills (AMPS)

Child Occupational Self Assessment (COSA)

Short Child Occupational Profile (SCOPE)

Pediatric Volitional Questionnaire (PVQ)

Modified Interest Checklist 

Occupational Performance History Interview-II (OPHI-II)

Worker Role Interview (WRI)

Volitional Questionnaire (VQ)

_______________

Now that we’ve gotten into the MOHO model a bit more, you can hopefully see that grasping it as a concept is not so bad!

The MOHO is a fascinating occupational therapy model that will allow you to connect with patients or clients on a deeper level by learning what motivates them and utilizing this in practice to further promote their health and well-being. It does a great job with providing us with a comprehensive, client-centered, and evidence-based framework to help us truly understand and address the complexities of human occupation.

While it is a complex and dynamic framework that can seem overwhelming at first, by understanding its layers and intricacies and using it as appropriate, you will be able to continue to grow as an occupational therapy practitioner.

This article was co-written by Josh Albarado, OTR/L and Sarah Stromsdorfer, OTR/L. It was originally published on July, 1, 2020 and last updated on January 8, 2024.

About the Model of Human Occupation (University of Illinois-Chicago), accessed on January 8, 2024.

Forsyth, K., Taylor, R., Kramer, J., Prior, S., Rickie, L., Whitehead, J.,…, Melton. J. (2014). The Model of Human Occupation. In Willard & Spackman’s Occupational Therapy (12th Ed), pp 505-524. Baltimore: Lippincott, Williams and Wilkins.

Kielhofner, G. (2002) A Model of Human Occupation: Theory and Application.(3rd Ed). Baltimore: Lippincott, Williams and Wilkins.

Model of Human Occupation: Theory and Application (University of Illinois Board of Trustees, 2020).

National Board for Certification in Occupational Therapy (2004). A practice analysis of entry-level occupational therapist registered and certified occupational therapy assistant practice. OTJR: Occupation, Participation, and Health, 24 (supplement 1), S1-S31.

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Thank you for writing and sharing this! I actually loved learning about OT theories in grad school and MOHO was my fave, but after years of too much practice and not enough time for studying, I’d forgotten about it. Thanks again for sharing!

MOHO was my favorite too! I’m working to get a few more frame of reference posts up in the near future as well since we can all use a little refresher every now and then 🙂

Thanks for the break down of MOHO! I’m currently learning about this in OT school and the textbook makes it difficult to understand. This really helped to understand the model.

MOHO is my favorite model ,thanks for making it precise

I’ve been using MOHO for years and this description and your application was great. In a new program at the YMCA in Australia I am looking to apply it in practice when working with vulnerable young people. I’d love to hear your thoughts/comments

I am currently learning about Moho in ot And it’s has the best assessment tool This article is very useful it has made me understand more about more Thank you

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The model of human occupation: a return to work case study

Affiliation.

• 1 Department of Occupational Therapy, University of Illinois at Chicago, USA.
• PMID: 12441438

This paper presents a case example which illustrates application of the model of human occupation along with the biomechanical model in the treatment of a patient with hand injury, which resulted in inability to work. The case illustrates application of the model of human occupation's concepts in assessing and treating the client. By combining the two models, a more holistic and effective approach to treatment was developed. Treatment resulted in a positive employment outcome.

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• Tue, 14 May Zoom The Occupational Circumstances Assessment Interview and Rating Scale 14 May 2024, 09:30 – 16:00 Zoom A days workshop looking at how to use the Occupational Circumstances Assessment Interview and Rating Scale in clinical practise. Share Buy Tickets
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Educational Resources

Want case studies, bitesize guides and learning exercises to help you develop your confidence in using the Model of Human Occupation to support your clinical reasoning?

Clinical Practice Resources

Want notes templates, goal setting, intervention planning and care plan templates to support the introduction of MOHO into your everyday practice. As well as bitesize guides, specialist interest groups for peer supervision, workbooks and videos.

Self directed study

Want access to the content in the online workshops but want to be able to work through it at your own pace?

MOHO Theory Training (online workshops)

The MoHO OT's online workshops cover a number of MOHO related subjects from, explaining MOHO theory, to using MOHO to support therapeutic reasoning, assessment, occupational formulation, goal setting, intervention planning and enabling change. While the training days look at how to use the MOHO based assessments and intervention protocols. ​

Want to know how to develop your own assessment strategy or, use MOHO to support your documentation, report writing and care planning? Then there is a workshop for you. ​

Want to know how to use the MOHOST assessment or the OCAIRS and how it may benefit your practice as an occupational therapist? Click the button to schedule a session now. ​

Want to commission The MoHO OT to deliver training within your NHS trust, or as an independent practitioner wanting to schedule a 1:1 session, then there are options available to meet your service needs.

Clinical Supervision

Through clinical education, mentoring and clinical supervision, The MOHO OT aims to support OTs to develop their knowledge of MOHO theory and how to translate this into practice. Thus, supporting the profession's passion for helping people to find meaningful occupations, through the use of occupationally focused interventions and enable OTs to support their service users gain the skills to participate in their everyday activities, and maintain their mental health and physical health.

The MOHO OT Community

The MOHO OT aims to build a peer support network for occupational therapists using the Model of Human Occupation. By making this community as easily accessible as possible, the MOHO OT hopes to provide practitioners with opportunities and the support required to develop personally and professionally.

Exploration £1 a mnth

Ideal for MOHO newcomers...

Get access to case studies and learning exercises to help you develop your confidence in using the Model of Human Occupation to support your clinical reasoning. 

Competence £10 a mnth

Ideal for those who want to integrate using MOHO into their everyday practice...

Access to notes templates, goal setting, intervention planning and care plan templates to support the introduction of MOHO into your everyday practice.

Access to all the bitesize guides. 

Access to monthly specialist interest groups for peer supervision.

Achievement £15 a mnth

Ideal for occupational therapists seeking to gain depth and breadth in their knowledge of MOHO knowledge, delving more into the links between theory and practice...

Everything in Exploratory and Competency

Access to videos to further learning

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Invite to a monthly specialist interest group to discuss complex cases and treatment approaches

20% discount on webinars and online courses

"Thank you for the webinar today, it was really useful and inspiring. I’m really trying to use MOHO as a framework in my practice and today has given me lots of ideas how to practically apply that."

MOHO Resources

If you are looking to purchase MOHO assessments and other products, please visit the Products section of MOHO-IRM Web.

A Guide to the Formulation of Plans and Goals in Occupational Therapy by Sue Parkinson and Rob Brooks (2021)

This practical guide for occupational therapists introduces a tried and tested method for moving from assessment to intervention, by formulating plans and measurable goals using the influential Model of Human occupation (MOHO). Designed for practicing occupational therapists and occupational students, this is an essential introduction for all those who are looking for an effective way to formulate plans and goals based on the Model of Human Occupation. Order the book online.

Recovery Through Activity by Sue Parkinson (2014)

• provides comprehensive evidence regarding the value of activity along with a wealth of resources to support implementation of an occupation focused intervention
• enables service users to recognize the long-term benefits of occupational participation by exploring the value of a range of activities
• provides occupational therapists with a valuable tool to support the use of their core skills
• helps to refocus the practice of occupational therapy in mental health on occupation - enhancing the quality of service user care in mental health

Occupation Therapy Care Packages in Mental Health

These indicative OT care packages can be used as a clinical tool to assist occupational therapy practitioners working in mental health. These care packages are intended as a template. OT care packages are not intended to be used in a prescriptive way.

Care Packages Introduction

Care Packages

A Guide to Understanding MOHO

The handout and presentation provided below can be used to explain the concept of MOHO to other professionals.

Download the presentation. Download the handout.

Employment Options (EO) Manual

Employment Options was a research and demonstration project funded by the US Department of Education: Rehabilitation Services Administration (Grant H235A980170) with the Department of Occupational Therapy at UIC in collaboration with the Howard Brown Health Center. The Employment Options Program, based upon the Model of Human Occupation (Kielhofner, 2002), supported people with AIDS in returning to work. This manual outlines the study and includes program development, program implementation, and case studies.

Download a PDF of the Employment Options Manual.

Enabling Self Determination (ESD) Manual

The Enabling Self Determination intervention was developed by the University of Illinois at Chicago and community partners as part of a controlled intervention research study funded by the National Institute on Disability and Rehabilitation Research (Grant H133G020217). This four phase intervention was developed to support individuals with HIV/AIDS to return to work and/or other productive roles and is based on the Model of Human Occupation and the Social Model of Disability. This manual outlines the study and includes information on program development and implementation.

Download a PDF of the Enabling Self Determination Manual.

MMHSCT OT brochure

The Manchester Mental Health and Social Care Trust has created an informational brochure explaining occupational therapy services for clients with mental health difficulties using MOHO concepts. You may find this brochure and the ideas presented in it useful for your own practice.

This brochure was authored by Jane Lee, John Grimshaw, and Mark McCann. MMHSCT cannot accept responsibility for any updates needed to the information contained in this brochure. If you are interested in contacting the authors to adapt this leaflet for your specific work site, please leave a message for the authors in the contact us section of their website .

To download a copy, click here . Downloading indicates you agree with the above information.

COSA Kahoot

As the COSA can be administered in a variety of formats, a Kahoot was utilized for this assessment to engage the client in a virtual quiz with pictures and music through screen share via Zoom. The client is able to click on which statements applied to them for each activity on their device (i.e., ipad). Once you click on the link, click "play" and then "host" and the COSA is ready to be administered to the client! Adapted by Jolena Lampron and Kelsey Hughes.

Click here to access COSA Kahoot.

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