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the model of creative ability in

It is not only occupational therapists that 'categorise' clients into levels. Healthcare services have been established over a long course of history to respond to clients' needs in a manner that is categorised also. Clients on the 'higher' levels of ability (Group 3 - See 'What is the Model of Creative Ability?' page), are unlikely to require the types of services that are commonly accessed by those on the ‘lower levels (Groups 1 and 2).

Clients in Groups 1 and 2 represent clients most commonly receiving occupational therapy. Clients on the levels of tone to passive participation (Groups 1 and 2) are likely to be seen in 24 hour care residential and acute services. Clients on levels of self presentation to imitative are commonly seen in rehabilitation and community-based services. Venter and Zietsman (2005) provide a useful diagram to illustrate client levels that are likely to require more care; which levels have the fullest potential for rehabilitation and the grading in between. This diagram has been adapted (diagram 1) to illustrate feedback from clinicians regarding which levels are commonly seen in their services. The width of the upside down triangle commencing under the heading ‘rehabilitation’, indicates the amount of rehabilitation potential - for clients on the higher levels of creative ability the rehabilitation input is significant. As one moves down the levels, rehabilitation is less of a focus and the need for ‘Supervision / care’ is more significant. Conversely, the same applies if one starts with ‘Supervision / care’ at the bottom of the diagram – for the lower levels, this is the focus but as one progresses up the levels the need for supervision and care becomes less as the rehabilitation focus increases.

Diagram 1: Expected levels within services. 
Adapted from Venter and Zietsman (2005).

In fast paced services such as assessment units and acute services, knowing which levels to expect in these services means that occupational therapists are prepared with strategies for assessment and intervention. Furthermore, it enables therapists to provide intervention for all clients - not just those frequently described as ‘well enough’ to attend OT. Clients frequently viewed as too ill or not ready for OT, also receive a service in order to enable a more speedy recovery.

OTs working in long term rehabilitation settings recognise that rehabilitation wards and services are structured around levels of ability. For example, clients requiring a lot of structure and individual support (self-differentiation / self-presentation) receive a service that provides this. On-site hostel accommodation is suitable for more 'able' clients - those requiring less structure and supervision because they demonstrate a degree of self-direction and independence (passive/imitative/active participation).

Again, in these settings certain levels are expected and therefore the assessments and the intervention strategies (and activities) can be prepared. In this way, the model enables therapists to work effectively and efficiently.
The same principle applies to any service setting whether it be hostels, vocational rehab, CMHTs, EMI, forensic and so on.

For an example of therapists’ feedback on the model in context download this article which was published in OT News, April 2009.

Currently in the UK the model is being used in mental health services (acute, rehabilitation, vocational rehab, forensic, community teams, day centre, older people, adolescent); learning disabilities (assessment, rehab, forensic, community), paediatrics and head injuries. In South Africa the model is also used in other physical settings. In Japan, the model is used predominantly in forensic mental health and a variety of other mental health and physical settings.

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