intervention
For each level of creative ability, aims of intervention are stated. These relate to the level and what the focus of therapy is. Additional, individual aims may be added by the therapist.
To meet the aims, the model provides a detailed guide to intervention in the form of ‘treatment principles’. These principles enable therapists to provide the ‘just right challenge’ to clients for growth, and in a way that is enabling.
The principles include activity requirements, handling, structuring and presenting intervention. These principles are applied to each level.
‘Activity requirements’ is a checklist of what the therapist considers in order to select an activity for intervention. The model does not prescribe specific activities for intervention. The activity must be purposeful in order to enhance its therapeutic value. Therefore, the therapist must consider the client as a person and what constitutes purposeful activity to him/her. However, the model suggests that selecting activity for intervention based only on clients’ choice of activity is insufficient – the activity that a client chooses may not be an effective choice for addressing his/her occupational performance problems and for enabling change.
The activity requirements enable therapists to engage their skills of activity analysis and grading in order to take an activity (may or may not be an activity chosen / preferred by the client), and grade it so that it is therapeutic i.e. addresses occupational performance problems, meets needs (motivation), enables experience of success and satisfaction and brings about change.
Effective selection of activity is the key task for therapists. If the activity and the way that it is graded are wrong, the application of the other principles will have limited therapeutic effect.
‘Handling principles’ is a guide to how the therapist/others need to interact with the client for therapeutic benefit– therapeutic use of self.
‘Structuring principles’ is a guide to manipulating/grading/structuring the session / time / environment.
‘Presentation principles’ incorporate the handling principles to guide on how the activity is done.
Each of these principles involves grading and is considered central to effective intervention. Within intervention, grading is constantly being applied. It is considered in decisions made through clinical reasoning in relation to the selection and use of materials, objects, people and situations. How people develop an ability to effectively relate to these involves development of concept formation and task concept. It is advisable that therapists gain training in these components. However, they are briefly explained here.
 Concept formation
“Concepts are mental representations of objects or ideas. A concept is a principle of classification that can be a guide in determining whether an entity belongs in one class rather than another. Words are used to express concepts” (Creek 2003)
Assessment and intervention consider which concepts clients have. Essentially, this is viewed on a continuum from concrete thinking to abstract thinking. The sequence of concept formation is basic, elementary, composite and abstract concepts in relation to understanding and making use of materials, objects, people and situations.
Understanding what concepts a client has means that therapists can identify what concepts need to be developed and how this can occur through careful selection and use of materials, objects, people and situations.
If a client has regressed to a low level of creative ability such as self-differentiation, it would be important to start with using activities that enable the client to handle materials directly in order to re-learn what they are, in preparation for moving onto using tools. Intervention can easily lack success because of a lack attention to this aspect of the theory.
Task concept
Task concept refers to a person’s ability to conceptualise tasks and to perform tasks. De Witt (2005) states that task concept includes:
- Understanding the influence of own effort, having a sense of engagement and that the activity is a product of own effort (Identifying with the task)
- Interest
- Understanding the process of the activity (Understanding the activity as a whole)
The nature of engagement in a task consists of: selecting a task, executing the task, completing the task, evaluating the task and task satisfaction.
To have a task concept is central to engagement with activity. A full task concept (to have all of the above) is most likely to result in effective independent occupational performance. Clients with a partial task concept (not all of the above) are likely to require the support of another person in order to live effectively.
The development of task concept is considered within intervention and activity is graded in order to assist with this development.
What activities can I use for intervention?
Du Toit’s theory enables therapists to answer this question: consider what activity is purposeful to the person and use the treatment principles to make activity therapeutic.
Identifying purposeful and therapeutic activity demands initiative on behalf of the therapist. It is important that therapists consider who the client is – what is purposeful to his/her life and culturally meaningful? What activities have meaning in the client’s life? Of those activities, which can be graded so that they are achievable, challenge the client to apply maximum effort, enable mastery and develop the client’s relational contact with materials, objects, situations and people? If therapists work through the treatment principles, it is possible to identify a large number of activities that can be used for therapeutic effect.
Below, are some examples of intervention for levels 2-5 (self-differentiation to imitative participation). These are examples only. Du Toit does not prescribe the activities – many, many activities can be used. The same activity can be used for a large number of levels – it is how you grade the activity that makes it successful for each level (see the drumming example below). Furthermore, these are examples of single activities: the model provides a guide to a complete programme of intervention including attending to personal management and use of free time. It is important to gain the literature on the model in order to use this model.
Self-differentiation - (Destructive/Incidentally constructive action)
Clients on the self-differentiation level are starting to develop a sense of themselves – human, tall/short, male/female, physical characteristics and basic abilities. In order to develop this, intervention focuses upon facilitating the client’s awareness of themselves and the impact that he/she has on the environment. Activities should present little demand on the client and can be of just 1-2 steps. Direct contact with basic materials is ideal because it facilitates discovery or rediscovery of materials and allows use and movement of the body.
An activity to facilitate destructive action could be peeling fruit with hands for a fruit salad – the destructive part is in ripping the skin/peeling or pulling a banana into pieces for the salad. No demands to use tools, but direct contact between hands and fruit in order to learn about the qualities of the material and what can be done with ones body. If you use this activity, remember that clients at this level require quick gratification and therefore it might be advisable to present one fruit at a time (which also reduces bombardment of activity), and once it is peeled and segmented, remove it otherwise you might find that the client will eat it straight away.
An activity for incidentally constructive action could be paper marbling. The OT has to put all of the effort into setting the activity up so that in one step the client places the paper onto the inked water and turns it over to see a marbled pattern on it. The result appears to have happened incidentally – but the OT planned it of course. Again, the activity allows handling of materials – contact with paper and water. The activity is flop proof to ensure success (mastery) whilst being an impressive end product that is satisfying and stimulates the client to want to do more activity.
Below, you can see that drumming can also be used for this level.
Self-differentiation (Destructive/Incidentally constructive) and Self-presentation (Explorative)
 
As previously mentioned you can identify one activity and grade it to be therapeutic across levels. At Basildon Hospital acute mental health service, this has been done with the activity of drumming/music playing.
There are two drumming intervention sessions provided for two groups of clients: Group 1 is for clients on the self-differentiation level (left image) and Group 2 is for clients on patient-directed/transitional self-differentiation and passive participation levels (right image).
Group 1
Intervention Aims (Preparation for constructive action)
Interactions with materials (drums)
Stimulate client to engage in meaningful activity
Increase awareness of self and others
Basic social skills
Immediate gratification
Sensory stimulation
Destructive activity -> Incidentally constructive
Group Activities: Open group
- Basic Drumming Skills
- Hand Position
- Centre and Edge
- Soft to Loud
- Fast to Slow
- Simple Rhythms
- minimal social demands
Group 2
Intervention Aims (Behaviour and Skill Development
Opportunity to present self
Verbal and non verbal communication skills
Explore ability to influence material and environment
Consolidation of task concept
Group Activities: Closed group
- Echo
- Drum Talking / Call Answer
- Simple rhythm in harmony
- Different sounds using instruments e.g. footsteps
- Basic skills for playing a tambourine and shakers
Passive Participation (Experimental action)
See group 2, drumming, above
On the level of passive participation, there is a full task concept and an ability to evaluate is developing. There is norm awareness in terms of behaviour, appearance and tasks. However, compliance with norms is poor: the client knows what is expected and attempts to achieve this, but finds it difficult. Tends to be a follower of others. Activities should focus on teaching/learning new skills – how to fold paper correctly, sand properly until the wood is smooth, paint neatly etc. A sample can be used to show the client what the norms/expectations are. The client can learn how to use a broader variety of tools – it is important that the activity facilitates an increase in knowledge and skills and this is a good level for developing prevocational skills. However, do not forget the importance of developing social ability. Group activities and games are also therapeutic.
Imitative (Imitative action)
On the imitative level, clients are motivated to ‘do as well as’ others or to be imitative. Task concept is comprehensive with abstract elements. Norm compliance is internalised and the client can take ownership of tasks and behaviour, with good skills for evaluation.
At this level therefore, clients respond well to having a sample to copy with a clear procedure to follow. Activities should require planning on the client’s behalf and improve work competency skills. The task now need not always be successful and the client can be encouraged to in-put his/her own ideas about how the task could be done/improved (to encourage towards transcending norms).
Tool use is good at this level and clients can use more sophisticated tools in order to produce good quality products. A cooking activity can therefore include learning how to use complicated appliances and equipment to make a complex meal so that it is as good as the picture in the recipe book.
Discussion regarding the use of activities within intervention forms is taking place within the Members' Area. |
