Recommended reading Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23

Introduction

The model was founded by Law et al (1996) in a response to an identified need of occupational therapy literature that describes the theory and clinical application of the interaction between the person, the environment and the occupation. The model is a framework that guides clinical reasoning in analysis and understanding of the interdependent interaction and therefore can form a foundation for application in practice. However, the model does not prescribe a set of assessments or provide intervention guidelines, therefore allows use of other occupational therapy assessment tools and interventions.  Person-Environment- Occupation model of occupational performance adopts a transactional, rather than an interactive approach towards the relation between the person and environment. The transactional approach emphasises the interdependence between the environment and the person.

Theoretical Basis of Model

The Person-Environment-Occupation Model of Occupational Performance

The model consists of three components, namely; the person (P), the environment (E) and the occupation (O).  The interaction of the three components results in occupational performance (P-E-O) as presented in the Figure 1. These elements are dynamic and they continue throughout the lifespan. During a lifetime of an individual or community, there are different factors and interactions that happen within the three components and the overlap can differ in size at any one time depending on these factors. This model provides a framework for a systematic interactional analysis of: P-E; P-O; E-O.

Diagrammatic Representation of PEO

Figure 1

Presentation of Components

Person

The person is a unique being who assumes multiple roles and cannot be separated from contextual influences. The person brings to the context a set of attributes, skills, knowledge and experience. Roles differ and vary in degree of importance depending on the environment and developmental stage of the person. The focus of analysis is on the behaviour of the person, such as:

• Motivation: interests, cultural relevance of activity
• Consider situations/conditions that precipitate emotional responses: failure, stress, distraction
• Degree of autonomy
• The basic assumptions of the model are that person is continually developing and is intrinsically motivated.

Environment

The environment is defined as the context within which occupational performance takes place and it is categorized into cultural, socioeconomic, institutional, physical and social. All the environmental categories are equally important to consider according to the model. The environment is considered from the unique perspective of the person, household, neighbourhood and/or community. Demands and cues about expected and appropriate behaviour are received from the environment continuously

Occupation

This is defined as self directed meaningful tasks and activities engaged in throughout a lifespan (Law et al, 1996:16). The model identifies the areas of occupation as self care, productivity and leisure. Occupations are engaged in to satisfy an intrinsic need for self-maintenance, expression, and life satisfaction and they are carried out within multiple contexts in fulfillment of developmentally appropriate roles. The temporal aspects that encompass the occupational routines of the person over time are important to consider.

When analysing occupations the focus should be on characteristics of tasks (occupation), degree of structure, duration of activity, complexity of tasks and characteristics of task demands.

Function - Dysfunction Continuum

Optimal function or occupational performance results from a good fit between the three components (P-E-O). Maximum fit relates to optimal occupational performance, whereas minimum fit relates to minimum occupational performance, hence dysfunction. Disability can be associated with a minimum or poor person-environment fit rather than the impairment itself.

Implications for OT practice

There are multiple avenues from which occupational therapists could focus or target, from the person, occupation and environment perspectives to elicit change. Implementation of these interventions has to be within context and at different levels of the environment.

The model accommodates use of a wide repertoire of well-validated instruments developed by other disciplines and occupational therapists. Change outcomes can be measured in terms of occupational performance as the focus of the model is on occupation rather than performance components.

Reference

Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23.