The real-world impact of models and theory

Associate Professor Stephen Isbel, Editorial Board Member, Australian Occupational Therapy Journal

“Without theory, practitioners are akin to technicians. Without practice, theory has no grounding in the world. Combining the two is crucial to occupational therapy.” (Turpin and Garcia, 2021, p.213)

In this short piece, two examples are highlighted showing how theory is being successfully used to guide occupational therapy practice. In the first example Dr Robert Pereira is interviewed and describes the CORE approach (Pereira et al., 2020) and how he uses it to guide his everyday practice. Dr Pereira is an occupational therapist who works in a public mental health service part time and his own private practice part time. In the second example Katie Cole is interviewed and explains The Intentional Relationship (Taylor, 2020) in occupational therapy. Katie has successfully embedded key aspects of The Intentional Relationship with occupational therapists in a large public health service. 1. The CORE approach: Dr Robert Pereira Stephen: “What is the CORE approach?”

Robert: “The CORE approach is basically a way of doing your practice through an inclusive lens. It uses the ideas of Capabilities, Opportunities, Resources and Environment to help people engage in life and ultimately be included in society in meaningful and productive ways. It is a way of practising that is inclusive of including peoples’ goals and aspirations and importantly of their values.”

Stephen: “What are some of the key ideas that underpin the CORE approach?”

Robert: “The capabilities approach underpins some of the key assumptions of the CORE approach. The capabilities approach assumes that allows people the opportunity to engage in life by looking at their capabilities is a powerful way of creating meaningful change. Combine that with looking at how environments can influence behaviour gives us a really nice way of organising our occupational therapy practice.”

Stephen: “How do you use the CORE approach in your everyday practice?”

Robert: “The CORE approach is a way of doing practice that is all about authenticity, all about enabling people to achieve authentic occupational outcomes and I use it all the time in the mental health setting I work in.”

Stephen: “Can you give me an example of how you use the CORE approach?”

Robert: “I had a client with a mental health condition and other co-morbidities during the first COVID lockdown. He really wanted to be able to engage socially with his family and friends and continue the pre-vocational work I had been doing with him prior to the lockdown. The CORE approach helped me identify the key capabilities he brought to the table, and to frame some of the opportunities I saw he could engage in based upon those capabilities. Then we used some of the resources we had available in the form of an NDIS plan to purchase some assistive technology that allowed

him to be able to address his goals and aspirations. For him it was ultimately about social inclusion despite COVID and I did see that he was able maintain that important social inclusion aspect of his life and that was framed by the CORE approach.”

2. Katie Cole: The Intentional Relationship Stephen: “What is The Intentional Relationship and how is it relevant to your occupational therapy service?”

Katie: “The Intentional Relationship is a way to describe the components that make up a strong therapeutic relationship. It really gives you some discrete areas you can consider around yourself as a therapist, that you need to consider for your client and those activities or events that will happen in therapy and how you could respond to those. It gives you specific areas you intentionally consider and analyse in those three areas with the aim of strengthening that therapeutic relationship.”

Stephen: “How did you go about implementing The Intentional Relationship in practice?”

Katie: “Following a skills audit we identified there was a need in this area [developing therapeutic relationships with clients]. We saw there was no formal training so we developed our own workshops to deliver the training. The training focusses on the three main areas of consideration which is the client, the therapist and the interpersonal events that shape a therapeutic relationship.”

Stephen: “How did you know that the content was relevant and therapists translated that into practice?”

Katie: “We invested in the workshop to make sure it was relevant to the therapists. We made sure staff knew the common language around the model and we specifically asked about the barriers and enablers to implementing the practices described in The Intentional Relationship and we have modified the workshops as a result. We have also set up a community of practice so that the skills, knowledge and momentum we have created are continued. We have had about half of all of our clinical staff attend the training which I think shows the value that clinicians place on the training.”

Stephen: “Was there anything that surprised you about implementing this in practice?”

Katie: “I think it was interesting that many therapists said they instinctively did a lot of the practices we covered in the workshops but they didn’t have a ‘model’ in their minds as they did this. I think using The Intentional Relationship was a way of improving their practice but also validating what they were doing already.”

These examples give an insight into how two occupational therapists are applying theory in a practical way to improve their own practice, their colleagues’ practice and ultimately improve the care given to their clients. All occupational therapists are invited to reflect on the role theory can play on their everyday practice.

References Pereira, R., Whiteford, G., Hyett, N., Weekes, G., Di Tommaso, A., & Naismith, J. (2020). Capabilities, Opportunities, Resources and Environments (CORE): Using the CORE approach for inclusive, occupation-centred practice. Australian Occupational Therapy Journal, 67: 162– 171. https://doi.org/10.1111/1440-1630.12642

Taylor, R.R. (2020). The Intentional Relationship: Occupational Therapy and Use of Self. F.A. Davis Company.

Turpin, M., & Garcia, J. (2021). Occupational therapy models of practice. In Brown, T., Bourke-Taylor, H., Isbel, S., & Cordier, R. (Eds), Occupational therapy in Australia: Professional and practice issues (pp. 213-235). Routledge.