Theory Practice Resources (e.g., materials and tools
for assessment, intervention procedures
and equipment, case examples, and programs)
Basic research to test theory and applied research to test utility
of resources that
explains an aspect of practice
Use in Practice
Research
FIGURE 6.1 Components and process of a conceptual practice model.
for practical application. Feedback from practice provides information for further theory develop-ment. Basic research examines and leads to improvements in the theory, while applied re-search examines and leads to improvements in the model’s practice resources. This research provides necessary evidence for practice. The following sections examine the characteristics of conceptual practice models in more detail.
Theory
As the examples at the beginning of this chapter illustrated, practitioners often face challenging client problems or circumstances. In order to know what to do about them, it is necessary to have an understanding of them. This is the role of theory. Theories provide an explanation of some problem or circumstance as well as a rationale for what can be done to change it.
Typically, a theory names and defines vari-ous factors that are involved and identifies how they are interrelated. For instance, Chapter 11 discusses the concept of volition that helps in understanding a client who is unmotivated.
Chapter 13 presents sensory integration theory, which explains why a client may be having extreme difficulty with sensations that interferes with everyday events.
Because the theory in models is developed in response to practical problems, it also addresses the resolution of those problems.
Thus, theories also provide an explanation of how the problem or circumstance can be man-aged or changed. This means that the theory explains an aspect of how the therapy process
works. For instance, Chapter 7 overviews bio-mechanical theoretical explanations necessary for training a client to use a prosthesis in the place of an amputated arm.
In conceptual practice models, theory is designed as an explanation for application. That is, it provides therapists with an understanding of some problem or circumstance faced in prac-tice and a rationale for what can be done about it. As a result, practitioners can actively use the theory to make sense of their clients and/or ther-apy circumstances and to made decisions about what to do in therapy. For example, one theory discussed in Chapter 10 will provide explana-tions of the therapeutic relaexplana-tionship that guides how best to respond to a client’s distrust.
Stacey and a young client play in a tactile bin.
Karen explains how to use a prosthesis to a client with a recent amputation resulting from a car accident.
Andrea and a client talk about formulating achievable goals for his future.
Practice Resources
Practitioners who use models require resources to apply them. For instance, therapists must gather and analyze important information about a client or about the therapy process. This process is usually referred to as assessment.
Models provide assessments in the form of standardized materials and/or procedures for making sense of critical information. Generally, assessments operationalize one or more of the concepts in the model’s theory. As such, they allow the therapists to better comprehend or measure the phenomena explained by the con-cept. In some cases, a client’s score on an assessment can be used to make judgments or predictions that are important for practice.
Application of a model also requires thera-pists to plan goals for therapy and to plan the intervention process. Most models offer specific procedures or programs with identified goals or outcomes that are expected to result. These are important resources because they make con-crete what the theory of a model says should happen in therapy. Intervention procedures and programs are often described in articles or manuals.
Assessment and intervention procedures often involve the use of specific materials or equipment. In the case of assessment, these may include such things as performance tests, instru-ments for measuring physical abilities, and paper and pencil checklists that are completed by clients. In the case of intervention, a variety of specialized equipment may be used. This ranges from equipment that is used to compen-sate for limited capacities to equipment that is used as part of the therapy process to provide sensory experiences or exercise certain capaci-ties. The development and availability of these tools for practice are very important parts of conceptual practice models.
The application of conceptual practice models requires judgment on the part of practi-tioners. Each client represents unique circum-stances that require therapists to decide how to apply the theory, how to use available practice resources, and so on. This process of creating individualized interventions is best illustrated through case examples. Through illustrations of particular individuals, they exemplify how the therapy process unfolds and what rationale was used in each step of therapy.
Conceptual practice models are often used as a framework for planning a program of serv-ices for a particular client group. Programs are typically designed for a homogeneous group of clients who share a particular diagnosis or occu-pational problem. Programs are formalized inter-ventions in which the assessment process, the goals, and the interventions are specified and applied uniformly across clients.
Box 6.1 What Is Theory?
Theory is a formal explanation composed of concepts and postulates (Mosey, 1992a). Concepts describe and define some thing (e.g., a type of joint in the body or a kind of thought or feeling), some quality (e.g., the flexibility of a joint or the accuracy of a thought), and/or some process (e.g., moving a body part or problem-solving). Concepts provide a specific way of seeing and thinking about the phenomena to which they refer. Postulates are statements about relation-ships between concepts. They explain how the char-acteristics or processes to which concepts refer are organized. For instance, postulates might explain how the components of a joint interact to affect its extent of flexibility or how inaccuracy of thoughts can nega-tively influence problem-solving.
The key element of theory is explanation. That is, theory must give a useful account for how some-thing works. Thus, theory does more than describe or state what is assumed or important. It provides insight into the nature and workings of specific phenomena that must be dealt with in practice.
Maya tries to uncover interests in a disinterested client.
In sum, conceptual practice models are most useful to practitioners when they have well-developed resources for application. These practice resources include materials and tools for assessment, intervention procedures and equipment, case examples that illustrate appli-cation of the theory in practice, and programs for application of the model to a particular client group.
Research and Evidence Base for Models
Research is used to test a model’s theory and its practical utility. Basic research aims to test the explanations offered by a theory, whereas applied research examines the practical results of using a theory to solve problems (Mosey, 1992a, 1992b).
As research evidence mounts, the theory within models can be altered to correct or elabo-rate existing concepts and propositions. In this way, research improves the
use-fulness of a model’s theory for explaining practical problems and circumstances and what to do about them. Moreover, the existence of a body of research increases the confidence that therapists can place in the theory.
Research that supports the validity of a model’s theory and/or provides findings that a model has practical utility is important for guid-ing evidence-based practice (Holm, 2000). It provides the practitioner with evidence that supports the value of thinking about a problem in a particular way, collecting information using a particular assessment, and/or using certain interventions to achieve therapy goals.