The CRAFT Model - Dynamic Variations of a Holistic Model - Part 5

Restoring Balance To The Platform

In the preceding scenarios we reviewed the sources of imbalance, now we will discuss a central principle of Functional Therapy, supporting function.

Let's revisit the model as it is unbalanced by a deficit in abilities. No matter the ability pillar we can upset the balance of functions. Most often healthcare professionals work to restore the physical body, in fact, most of medicine is working towards addressing physical complaints, symptoms and problems. The deficits from mental, social and motivational impairments can lead to similar imbalances.

Let's return to the person with the deficit of the motivational pillar. This might have been caused by a depression or perhaps the depression is caused by the imbalance of functions; by not performing a balance of functions you can lose your motivation. Consider the lack of balanced function as a risk for other deficits.

The CRAFT Model is a snapshot of the status of an individual; consider personal history an elucidation of which caused which, in other words we get to find out if it was 'the chicken or the egg'. I wish to popularize the idea that an imbalance in functions could lead to other deficits any of the other areas. 

In order to most effectively help a person we work to restore balance to function. In this case we depict an external support, possibly a social support, to help restore balance to the platform of functions. 

"The worst place to decide whether to get up and get dressed is in bed." - Unknown  

By supporting a person doing functional things we allow them to use their mental, social, physical and motivational abilities in  functional way. In short, "the more you do, the more you can do." They also engage with their physical environment, social supports, temporal situation and consider their cultural background more deeply. The Functional Therapist and Functional Therapy Associate works to assess the limitations and then seeks to expediently restore balance. The ability to call on the whole model and more gives Functional Therapy its strength.

OTs and Functional Therapists might occasionally find themselves off the course of purely a functional or occupational approach to care; the CRAFT model seeks to help get us back to the value of doing functional things in therapy. We must consider the paths of remediation and compensation as ways to restore function along with external support and means to seek balance in function as a reasonable jump off point for a return to living.

Thank you for reading.

Yours,


Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC

P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line. 

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 4

Contextual Barriers to Function

Today we'll explore the imbalances in the model as imposed by contextual barriers. Let's review the CRAFT Model as we consider the Context Level.

The CRAFT Model is built on the Context of the individual. One premise advanced by the World Health Organization in 1980 is that environmental, or as we call them contextual, barriers can limit life roles and hold a person back from reaching their full potential. In the CRAFT Model we represent this as unbalancing the person. Let's look at the external barrier as a depiction of contextually imposed imbalance...

With or without any disability or volitional causes, external barriers can impose functional imbalances; let's consider some particular external barriers.

Cultural Barriers

The culture of a people can be hard to define but fresh eyes can often distinguish differences. For instance, in New England some basic premises are that most work days are 8 hours, that men and women work in certain careers that are somewhat gender typed, that racial prejudice is discouraged and that education is valued. In some European cultures a siesta, or afternoon period when work closes for a nap is customary, in other places it is very discouraged for women to work outside the home or even to be educated, and other stark differences in equality between different groups. Imagine the effect of a culture which prevents a little girl from learning to read, or who's family must give a dowry to have their young daughter married. These are just more dramatic examples of how the culture of a place, an institution or even a family may affect an imbalance in the roles you take on.

Temporal or Situational Barriers

The temporal (time based) or situational context is often interpreted through cultural eyes. What happens in the different times of day, times of year, times of life? What happens in a situation where people or events are involved? In the middle of the night, after 'bankers hours', in the winter, or when we're at retirement age in America. In terms of situational barriers, times of war or famine spring to mind as particular situational and temporal barriers to full human potential.

Social Barriers
When there may be many positive people and supports in a person's life imagine the debilitating impact if a harmful person as a parent, or caregiver. A person in a position of trust may betray it; a misleading statement or a lie may lead to disaster. In a group people may make unwise choices, a gang may influence a person to harm others or break the law. In light of these, more and less dramatic mistakes can be made.

Physical Barriers
When a person with a mild limitation in mobility confronts a major physical barrier it can prevent them from participating in activity. Something we now take for granted, like ramps into buildings and at curb sides, can allow a person to enter their workplace, and a lack of them can prevent someone from working, or shopping, or getting into a movie. Our culture has often worked to limit physical barriers, and OTs have often been the catalysts to find other barriers. Not all cultures have such strong advocates or such resourses that they can provide these adaptations. Consider the availability of prosthetics, wheelchairs, reading glasses and other devices to overcome physical ability barriers in the developing world. Consider the availability of clean drinking water, food and shelter as aspects of physical context and we can see part of how this area can expand.

The areas of the 4 contexts overlap in areas and are interpreted through the experience of the person in their context. In this article we only touched the surface of how we might interpret barriers in context; it is for the eyes of the OTs and Functional Therapists along with engineers, architects, governments, businesses, and individuals to find and continue to work for the betterment of personhood through removal or compensation for external barriers.

In light of all the potential limitations that may be caused by external environmental or contextual barriers we may also find where external supports help a person regain balance. That will be the focus of our next discussion as we elaborate on dynamic variations of the CRAFT Model.

Thanks for reading,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC




P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line.










 

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 3

The latest posts have depicted imbalances at the Functional level and the Ability pillar level. In this we will identify the change we have made at the Context level; you'll notice that, with a nod to Gary Kielhofner and the Model of Human Occupation, we have added the Temporal Context to the context level.

Each of the contexts influence the effectiveness of the Abilities and the choice and balance of Functions. In previous posts we have reviewed the Physical, Cutural and Social aspects of context; why does the temporal context merit inclusion at the context level? We'll see it plays a particularly important role in our lives.   

Temporal relates to factors of time. On the most rudimentary level that could include the time of day, or time of year, but let's also consider factors like time of life. For instance, we are currently preparing for the start of a new school year. That has aspects of it being August, but also of the time of our lives; it is much different for my children who will be going to school than for me who will be getting them ready in the morning and helping to get them there 'on time'. Also, it will be different at 7am than it will be at 3pm; temporal factors have influence on all other areas.

Time influences us greatly and we initially left it as part of the Abilities as in the time of a person's life (and it certainly remains there) and as a modifier for social and cultural contexts. Now though, considering that we have included it here I hope you can see how well it fits.

If you would like to learn more about the Model of Human Occupation for a thorough look at the multifactorial influences in a persons life I reccommend this link: http://books.google.com/books?id=WOYkTQNvNUgC&pg=PA5&lpg=PA5&dq=temporal+moho+model+of+human+occupation&source=bl&ots=ZL9YhsqRGG&sig=y10u4LhupUoOU1z0c8xu5WNFHTI&hl=en&ei=3ExvTL7DNYK88ga98ZHwCw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCIQ6AEwAg#v=onepage&q=temporal%20moho%20model%20of%20human%20occupation&f=false. This is Google Book's full version of the text Model of Human Occupation: Theory and Application By Gary Kielhofner. This important text is a core part of an OTs training, and I am proud to reference it here. 

When we graduated from University with our degrees in Occupational Therapy we marvelled at our new eyes for seeing the world. We were given a gift in being able to pull together the many ways that people function and we had tools to help them. It is the gift of seeing a person wholistically and in relation to the many other persons and factors around them. In some ways we are almost constantly surprised at the amazing feats we can acheive and at the relative of simplicity of its 'common sense'. OTs and Registered Functional Therapists and Associates have a very refined and deeply trained 'common sense'; and I want us to share it with the world.

Thank you for reading.

Yours,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC

P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line.