peop model occupational therapy case study

PEOP Model: Fundamentals in OT Practice

• Mandy Chamberlain MOTR/L

By our very nature and the influence of our educational background, occupational therapists have to take a wholesome approach in therapeutic intervention.   This means looking beyond the patient or client’s medical limitations and considering outside-of-the-box barriers and enablers related to occupational success.   One of the dozen theoretical models that OTs learn in school that provides a basis for such a mindset is the Person-Environment-Occupation Performance or PEOP Model .

In this post, we will give a basic overview of what the PEOP model entails, give a PEOP example so you can understand how it is applied in occupational therapy practice and then talk a little bit about the pros and cons of the model.

Overview: What is PEOP?

The first thing to understand is that the PEOP model of occupational therapy (Christiansen and Baum, 1985) and the PEO model (Law et al., 1996) are not synonymous.   Although both models have some similarities, PEOP holds to a handful of different principles.

The PEOP model highlights occupational performance as its key feature, which is made up of three interacting components (ach of their detailed characteristics which are listed in the previous image): 

• person (client),
• environment, and
• occupation (i.e. activity, role, or task)

Inevitably, environmental factors will impact a person for better or for worse which determines the occupational performance outcome.   If there is a healthy interaction between the person and their environment, then the person will experience success and improved well-being in occupational performance (Baum et al., 2015).  

Since its original development in 1985, several revisions have been made to make PEOP more client-centered.   This means that through a collaborative and supportive relationship between the client and the practitioner, the client’s needs and goals are highly vocalized and used in personal narrative form to determine the course of therapeutic care.

PEOP Model Example

Confused yet?  

Below, we have created a practical case study in which the PEOP model is applied to see how it can be applied in practice:

Diana is a 54-year old patient who was admitted for a short hospital stay following a ground-level fall.   She was attempting to transfer from her powered wheelchair to her bed at home when she slipped, resulting in a minor left shoulder fracture.   After her hospital stay, she was admitted to a skilled nursing facility for further rehabilitation.   She also has primary-progressive multiple sclerosis. Although she can stand for brief periods to perform transfers, she relies heavily on her powered wheelchair to get around at home and in the community.   Diana’s priority goal is to get her left shoulder stronger so she can still perform her own transfers safely at home.

Through a comprehensive evaluation and collaborative conversations, Diana’s OT can identify factors in all three components of Diana’s overall occupational performance:

Environment

Social support:.

Diana lives at home with her husband, who is retired and acts as her primary caregiver.   However, her husband is aging and frail and struggles with physically helping Diana get around. She has two children who live out of state and rarely visit her.

Social and economic systems:

Diana has been medically involved in the healthcare system for many years.   She has Medicare A, Medicare B, and a supplemental HMO insurance plan.

Culture and values:

Diana strongly values her own independence.   She is also a devout catholic who attends church on a regular basis.

Built environment and technology:

Diana lives in a single-level townhome and owns a wheelchair ramp, a powered wheelchair, a shower chair, a transfer board, a walker, a fall alert home system, and a toilet riser.   She also has grab bars installed throughout her home.

Natural environment:

Diana and her husband live in a city in the U.S. with easy access to flat terrain with sidewalks and other wheelchair accessible surfaces.

Physiological:

Due to MS, Diana fatigues easily and has overall low muscle tone and body strength.   The nature of her left shoulder fracture limits her range of motion and strength in upper extremity use.

Diana has experienced some mild memory deficits within the last few years.

Diana regularly attends catholic services and goes to bible study as often as possible.

Neuro-behavioral:

Due to MS, Diana has reduced sitting and standing balance as well as decreased sensation in her feet.

Psychological:

Although Diana is highly motivated to participate in therapy, she does have clinical depression.

After examining all of Diana’s unique environmental and personal factors, she, with the help of her OT, can create a tailored intervention plan to help her meet her functional transfer goals. 

Pros to PEOP

• The emphasis on a client-centered approach allows the patient or client to develop goals for themselves based on their individual wants and needs.
• The comprehensive model lists out a wide array of factors that many OTs (especially new therapists) may not otherwise consider in intervention.
• It’s a very top-down approach, which takes the focus away from the client’s medical barriers and acknowledges both limitations and enablers in the client’s overall occupational performance.

PEOP Model Limitations

• According to the authors Christiansen and Baum (2015), there is currently no assessment tool that measures outcomes based on the PEOP model.   So OTs are on their own using other tools to obtain relevant client information.
• Like a number of therapeutic models, PEOP could use additional evidence-based research to better support its principles in clinical practice.

We have also discussed a number of other occupational therapy models throughout the website including the Biopsychosocial Model here. 

Baum, C. M., Christiansen, C. H., & Bass, J. D. (2015). The Person-Environment-Occupation- Performance (PEOP) model. In C. H. Christiansen, C. M. Baum, & J. D. Bass (Eds.),  Occupational therapy: Performance, participation, and well-being  (4th ed., pp. 49-56). Thorofare, NJ: SLACK Incorporated.

Occupation Models: PEOP (Person-Environment-Occupation Performance) (2015). Lifelong Learning in OT. https://lifelonglearningwithot.wordpress.com/tag/peop-model/ . Viewed on January 30, 2020.

Post by  Meredith D. Chandler, OTR/L, Freelance Content Writer and Mandy Chamberlain MOTR/L

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The Person-Environment-Occupation Model: Enhancing Occupational Therapy Practice

Occupational therapy is a comprehensive discipline that focuses on the intricate relationships between individuals, their occupations, and the environments they engage in. In order to effectively communicate their practices and the impact on outcomes, therapists require practical tools that can facilitate this process. This research paper delves into the applications of the Person-Environment-Occupation (PEO) Model in occupational therapy practice, highlighting its benefits in conceptualizing, planning, communicating, and evaluating interventions aimed at improving occupational performance.

How does the Person-Environment-Occupation Model help occupational therapists?

The Person-Environment-Occupation (PEO) Model, developed by Law et al. in 1996, serves as a valuable tool for occupational therapists due to its ability to address the complexities inherent in human functioning and experience. This model recognizes that individuals are influenced by various environmental factors, and that their occupations and engagement in meaningful activities greatly contribute to their overall well-being.

By utilizing the PEO Model, occupational therapists can thoroughly analyze the interactions between people, activities, and environments, allowing for a holistic understanding of clients’ needs and capabilities. Through this comprehensive assessment, therapists can tailor interventions to promote successful engagement in meaningful occupations within chosen environments, maximally benefiting their clients.

In the words of Law et al., “The PEO Model emphasizes that occupational therapy practice must be grounded in the dynamic relationships between people, their occupations, and their environments” (1996). This highlights the fundamental role that the PEO Model plays in the everyday practice of occupational therapy, empowering therapists to enhance their clients’ lives through interventions that address their unique circumstances and goals.

What are some applications of the model in occupational therapy practice?

The Person-Environment-Occupation (PEO) Model offers valuable applications for occupational therapy practice, providing therapists with a systematic approach to analyze and address occupational performance issues. Three case studies exemplify the practical use of this model, showcasing its benefits in real-life scenarios.

Case Study 1: Enhancing Independence and Safety at Home

In this case, an occupational therapist utilizes the PEO Model to assess an elderly client struggling with daily activities due to reduced mobility and the lack of supportive environmental modifications. By analyzing the client’s personal factors, such as physical abilities and cognitive function, in relation to their desire to engage in activities like cooking and personal care, the therapist gains insight into the necessary modifications to the environment. This may involve installing grab bars in the bathroom, rearranging furniture for better accessibility, and recommending assistive devices to promote safe and independent engagement in meaningful occupations at home.

Case Study 2: Promoting Social Participation in a Work Setting

This case illustrates the application of the PEO Model in a vocational context. An occupational therapist works with an individual experiencing difficulties in a workplace due to communication and social interaction challenges. Through an analysis of the social and physical aspects of the work environment, combined with an understanding of the individual’s personal factors, such as communication skills and coping mechanisms, the therapist recommends strategies to improve social interactions and overall work performance. This may involve facilitating workplace accommodations, providing communication training, and collaborating with employers to create a supportive work environment.

Case Study 3: Facilitating Recovery and Community Reintegration

Here, the PEO Model is utilized to support the rehabilitation process of an individual who has sustained a brain injury. The therapist explores the person’s cognitive, emotional, and physical abilities while considering the demands of their desired roles and environments. With this comprehensive understanding, the therapist may recommend strategies to enhance cognitive functioning, create supportive environments, and collaborate with community services to foster an individual’s successful community reintegration and resumption of meaningful occupations.

How does the model facilitate communication within and outside occupational therapy?

Effective communication is crucial for occupational therapists to convey their practices, interventions, and outcomes and collaborate with clients, families, other healthcare professionals, and external stakeholders. The Person-Environment-Occupation (PEO) Model acts as a bridge, facilitating this communication in various ways.

Internally, the PEO Model allows occupational therapists to organize and structure their thoughts, assessments, and intervention plans. By employing the PEO Model, therapists can communicate their analysis of a client’s occupational performance issues comprehensively and coherently. This aids in fostering interdisciplinary collaboration, as therapists can readily share their insights, recommendations, and rationale with other healthcare professionals involved in the client’s care. Through structured communication, the PEO Model ensures that everyone involved has a holistic understanding of the client’s needs and goals, promoting a collaborative approach to intervention planning and implementation.

Externally, the PEO Model enhances communication between occupational therapists and clients, their families, and external stakeholders. By utilizing this model, therapists can visually represent the dynamic interplay between the person, environment, and occupations in a manner that is easily understood by all parties. This visual representation assists in conveying the complexity of factors influencing occupational performance and fosters shared decision-making with the client and their family. When presenting their findings and recommendations to external stakeholders, such as insurance providers or policymakers, therapists can use the PEO Model as a powerful tool to advocate for resources, support, and changes in the environment to promote the client’s engagement in meaningful occupations.

The Person-Environment-Occupation (PEO) Model serves as a practical and valuable tool for occupational therapists, enabling them to address the complex and dynamic relationships between people, occupations, and environments. By utilizing this model, therapists can systematically analyze occupational performance issues, develop tailored interventions, and foster effective communication within and outside the field of occupational therapy. The three case studies provided illustrate the wide range of applications the PEO Model offers, showcasing its ability to improve independence, social participation, and community reintegration. As occupational therapy continues to evolve and adapt to meet the needs of individuals, the PEO Model will undoubtedly remain a guiding framework for therapists seeking to enhance the lives of their clients.

Read the original research article here .

Disclaimer: While I have a passion for health, I am not a medical doctor and this is not medical advice.

Christophe Garon

October 2, 2023

Health Science , Research

occupational performance interventions , occupational therapy , person-environment-occupation model

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Application of the Person-Environment-Occupation Model: a practical tool

Affiliation.

• 1 Rehabilitation Services, Hamilton Psychiatric Hospital, ON. [email protected]
• PMID: 10462885
• DOI: 10.1177/000841749906600304

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.

Publication types

• Case Reports
• Aged, 80 and over
• Models, Psychological*
• Occupational Therapy*
• Professional-Patient Relations

Person-Environment-Occupation-Performance model (PEOP)

The Person-Environment-Occupation-Performance (PEOP) model is a system model that views the function in the systems a whole and considers the interaction among its components. Occupational performance is emphasized in the PEOP model and involves three components: (1) characteristics of the person (including physiological, psychological, motor, sensory/perceptual, cognitive, or spiritual), (2) features of the environment (including cultural, social support, social determinants, and social capital, physical and natural environments, health education and public policy, assistive technology), and (3) characteristics of the activity, task, or role. When people perform occupations, they also interact with environment. Thus, there are reciprocal consequences; that is, a person’s goals and intentions influence his/her occupational performance, and the action changes his/her environment and his/her characteristics at the same time. The interaction between the person and environmental components positively or negatively influences occupational performance. When there is a person-environment fit in supporting the valued occupation, success in occupational performance eventually leads to participation and well-being. In addition, the PEOP model is a client-centered model; that is, client must actively set goals and participate in determining a plan that promotes occupational performance. Application of the PEOP model in practice requires a collaborative relationship with the client and practitioner. Practitioner understands the issues and options presented by the client’s needs and goals by asking the appropriate questions to elicit client’s narrative. The model identifies factors in the personal performance capabilities/constraints and the environmental performance enabler/barriers that are central to the occupational performance, which in turns lead to development of a realistic and sequenced intervention plan.

Summarized by

• Model (conceptual)

Domain of occupation

• Unspecified

Application Note

Must be client-centered

Key Reference

Baum, C. M., Christiansen, C. H., & Bass, J. D. (2015). The Person-Environment-Occupation- Performance (PEOP) model. In C. H. Christiansen, C. M. Baum, & J. D. Bass (Eds.), Occupational therapy: Performance, participation, and well-being (4th ed., pp. 49-56). Thorofare, NJ: SLACK Incorporated.

Year Published

Primary developer.

• Carolyn Baum

Primary Developer Email

• [email protected]

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Model of Competence

This model comprises the complexity and multi-dimensionality of the relation between persons with motor disabilities and their environment. It addresses the personalized accessibility (i.e., unique needs of a person living in a specific environment that is central to this person). It defines the relationship of the person-environment interaction using six concepts, they are:

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The PEO Model and Brain Injury: How to Use OT Theory to Achieve Best Results!

Approaching care for brain injury patients is, in one word, intimidating. Figuring out how to approach consideration for all of the contextual factors that will influence recovery for this patient population is a daunting undertaking to say the least.  

We know that modifying these factors in some capacity is almost always necessary during brain injury recovery, but how do we go about approaching this when there is just so much to consider? 

An Overview of the PEO Model

If you haven’t considered the PEO model since the day you passed your boards, don’t sweat it! I want to bring it back to your consciousness & assure you that this client-centered model is a lifesaver when it comes to approaching intervention for the beloved brain injury population.

Let me start with a refresher – the PEO model posits that occupational performance is the result of interactions between the person (P), the environment (E) and the occupation itself (O) . 

The Person is complex , dynamic, intrinsically motivated and always developing. Think of your past patients — every one of them has been motivated by different words, emotions, and interested in different goals and accomplishments. 

The Person factor, especially with our brain injury population, is helpful for keeping client-centered care at the forefront of treatment while simultaneously acknowledging how quickly these personal factors can change throughout the injury-recovery continuum.  

The Environment is inclusive of social, physical and geopolitical factors–cues, demands, rules and norms are informed by the patient’s environments. Environmental considerations are paramount to ensuring our patient’s safety, providing controlled sensory enrichment, reestablishing or developing appropriate behaviors that are environment-specific and more.

The Occupation includes meaningful tasks, actions and engagements that are relevant to life maintenance, wellbeing, pleasure and productivity. Our patients’ best performance occurs when there is balance between these three factors — conversely, dysfunction is then the result of an imbalance .

Imbalance may look like a patient that is unable to safely navigate their environment due to lack of accessibility, a patient that cannot complete an occupation because it requires high level sequencing, a patient that typically enjoys crafts that now is unable to participate in crafting. The imbalance can be restored by modifying any of the three factors in order to facilitate occupational performance . Nothing too out there, right? 

Returning to our brain injury patients, the need for modifications in order to promote occupational success is nothing entirely new — there are even guidelines for doing so available for clinician reference (for free). Mild TBIs (mTBI, also known as concussions) are not excluded from this need for modifications, either! 

A PEO Example with an mTBI case:

Kailey is a 20 y/o college student who sustained an mTBI during a collegiate soccer game. She reports symptoms including some grogginess, headaches, photosensitivity & hyperacusis. Following her injury, she finds herself unable to tolerate sitting in class for prolonged periods of time due to the fluorescent lights, struggling with loud discussions and overall decreased ability to maintain focus for the duration of her classes. 

She finds it difficult to tolerate looking at handouts and exams printed on white paper, and has headaches when a professor shows a Powerpoint without turning the room lights off. At this point in her recovery, she is most concerned with being able to maintain her participation and grades in classes so she can get into OT school next year.

Analyzing Different PEO Factors 

Personal factors include Kailey’s age, involvement in collegiate soccer, status as an mTBI patient, interest in OT school and prioritization of returning to classes.  

Environmental factors include the university and classrooms Kailey goes to, the social demands of physical attendance and participation in classroom discussions, and the understanding that her getting into OT school is contingent upon good grades and participation in undergraduate coursework. Environmental factors also include the norms of utilizing white paper for handouts and exams, leaving the lights on during Powerpoint presentations, and using the standard fluorescent lights that are installed in each classroom.  

Occupational factors would include Kaileys’ new limited tolerance of the social and physical activities that are necessary for her engagement and success in education.  Being able to quickly identify these factors should give you an idea at-a-glance of where the occupational dysfunction may be occurring — her personal and environmental factors are no longer harmonious and will need to be addressed. Some standard and practical concussion treatment methods will be beneficial to Kailey here, including requesting professors to print examinations and handouts on green/yellow/blue paper to decrease the brightness and reduce her sensitivity. 

Other accommodations, like permitting Kailey to Zoom into class when she is feeling fatigued or there is an expectation of a loud discussion, may also help her maintain participation while decreasing the effect of symptoms. Advocacy and education will further help account for the environmental and social norms of the educational environment that Kailey must navigate while recovering.

Patients with more severe brain injuries will show similar patterns of occupational dysfunction as well — with an increase in severity of symptoms, the need to modify the three factors will also increase. 

For our case study above, there were some simple methods for environmental modifications that helped accommodate for the personal factors interfering with occupational performance; but how does utilizing the PEO model with our more severe brain injury patients make life easier?

PEO Model With a Severe TBI Case Study:

Michael is an 63 y/o man who sustained a severe TBI post fall at his job as a mechanic. His symptoms include confusion, memory impairment, decreased strength and endurance, and fatigue. Michael was admitted to an inpatient rehab facility for rehabilitation prior to returning home.

Post injury, he has had difficulty with completing basic ADLs, and is requiring maximal visual/verbal/tactile cueing to complete tasks such as grooming, bathing, and self-care. For mobility and transfers, he requires moderate assistance for truncal control and balance.

Michael and his caregivers have set goals for him to be able to complete BADL tasks with minimal cueing, to be able to transfer himself with contact guard assist, and to return to his home with assistance from his wife. 

Personal factors in this case include Michael’s age, his status as a male living with his wife; his experience as a person with severe TBI , and his profession as a mechanic.

Environmental factors may include the facility he is in for rehabilitation – which includes his room, therapy gym, and common areas. It also can be extended to include the clinicians he interacts with on a daily basis, the new medical professionals he meets daily that have different cognitive expectations of him, and the other patients with whom he shares a room and common space with.

Environmental factors that should be taken into consideration for Michael here could include the constantly noisy and busy hallways and rooms; fluorescent lighting; flickering televisions in shared spaces, and interruptions of clinical staff for checks.

Occupational factors would include Michael’s best abilities to function at present – which require maximal verbal, visual and tactile cueing to complete BADL tasks; his strength and endurance deficits which impair his occupations such as mobility; and his cognitive and social interaction deficits.

In this specific instance, we are able to utilize an existing protocol to manage environmental factors. The Post-Traumatic Amnesia Protocol created by Moss Rehab outlines specific measures to be taken by the interdisciplinary care team to manage stimuli and continuously assess the person-environment fit for optimal engagement – supporting the person and also providing a structured frame for the health care professional.

I highly suggest you check out the entire protocol to see how the person’s environment can facilitate the occupational performance of the person, but one example is in the reference guide as to how each team member can approach the person in a supportive manner – they are instructed to introduce themselves with name and purpose; provide information; focus questions on the here and now; and keep it simple.

The staff member should: not assume that the person will remember them; not ask the individual to recall information; and not quiz them on any ‘assumed’ knowledge. This sets the social-cognitive environment up for greater success.

Compensatory approaches to care also modify the environment to support the occupational performance of the person-think of passive medical equipment such as bed rails/shower chairs; strategic placement of grooming utensils, and easy pull-on clothes as opposed to buttons and enclosures. 

Personal factors can be integrated into care such as folding therapeutic activities that speak to the person’s intrinsic personhood. In this example, using tools or parts as a way to work on strength endurance or cognition so as to speak to Michael’s background as a mechanic may be supportive to function. 

This approach to evaluation and intervention provides a solid framework that we can base occupational therapy upon, as well as helping us appreciate the nuance between these interwoven areas.

Too often, and owing to higher productivity expectations, decreased resources, or time crunches, practitioners can fall into a reactive approach to therapy. Stepping back and making space to apply our theory specific frameworks to cases is grounding for OTs. 

Occupational therapists (as we all know!) have a unique viewpoint on the way that person, environment and occupation can support or inhibit each other, and bearing this model in mind ensures we can truly practice in a client-centered way. 

About the Author

Spenser Bassett, OTD OTR/L graduated from the University of Findlay with her Doctorate in Occupational Therapy in 2022. She currently works in subacute rehab & long-term care, and is ARC Seminars’ Associate & Social Media Developer.

Spenser is passionate about promoting diversity in rehab spaces & empowering rehab professionals to succeed beyond classroom walls.

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