In 1985 work began in the mountains of Colorado on what was to become the PEOP Model. At the time, there was a growing awareness that it was necessary to organize the knowledge that was being used by occupational therapists in a manner that would identify, clarify and emphasize the unique contribution of occupational therapy to the health and well-being of individuals, groups and populations. We knew that occupational therapy could provide practical and relevant interventions that enabled people to preserve or improve the quality of their lives. Yet, at that time, the most influential textbooks in the field were continuing to organize their content using a biomedical approach that resembled the diagnosis and pathology-focused approach of allopathic medicine. Influenced by writers from medicine who were calling for more health-oriented approaches (e.g. Engel 1977), as well as writers from occupational therapy who openly lamented the field's apparent divergence from ideas central to its founding (e.g. Shannon, 1977), we set about reframing the organizing structure for knowledge relevant to occupational therapy theory and practice. We intended to propose a model that would provide practitioners with an intuitive and organized way to understand the areas relevant to supporting people's ability to perform or do the activities, tasks and roles necessary for everyday living. Through creating such a framework, we aimed to facilitate thinking in ways that would guide assessment, planning and the delivery of interventions. Our goal was to have a model that would be relevant, regardless of the settings in which occupational therapists worked, the types of client they served, or the ages, life stages or diagnoses of those clients. We also felt that creating such a model would encourage a more balanced approach to care that would encourage therapists to plan intervention with a focus on the life situations of their clients. This focus, we surmised, would require that therapists consider the person-related and environment-related resources and barriers relevant to a full understanding of how to enable their clients to perform or accomplish the particular occupations necessary to live satisfying lives.

The PEOP Model is now in its third generation (Christiansen and Baum, 1991, Christiansen and Baum, 1997 and Baum and Christiansen, 2005) and continously being updated. During the years since its inception, the knowledge generated from occupational science, neuroscience, environmental science and other biological and social sciences has enabled us to refine and extend our original ideas and to provide a more solid scientific basis for the constructs we believe are central to understanding the occupational performance of humans. Throughout this process of elaboration, we have been influenced by many emerging ideas and innovations in healthcare, disability, social policy, technology, rehabilitation and public health. Although some terminology has changed, definitions have been revised, and new concepts have been added, the basic philosophical orientation of the model and its central features have remained consistent. This, we believe, indicates that we were successful in achieving a model that was not only conceptually sound, but straightforward in its ability to organize a knowledge base of information useful for practice.

Because occupational therapy is based on a cooperative approach toward care (Meyer 1922), the PEOP Model was designed to facilitate the development of a collaborative intervention plan with the client and with other professionals. Use of the term ‘client’ is meant to apply, whether the intervention is directly with a patient, a well community-dwelling child or adult, or a family, or done in consultation with a physician, a social worker, a student, an architect, an employee, an organization or an entire community. Each of these ‘clients’ would seek the knowledge and skills of the occupational therapist to address issues that influence occupational performance or the ability of people to participate fully in their lives. Occupational therapists provide a unique knowledge and skill set that bridges the world of the client and the world of healthcare and includes other important social services in communities. A core assumption is that people cannot truly be well if they cannot participate fully in their lives.

The concept of occupational performance has become the mainstay of the development of most models of occupational therapy. Occupational performance operates as a means of connecting the individual to roles and to the sociocultural environment (Reed & Sanderson 1999, p.93). We define occupational performance as the complex interactions between the person and the environments in which they carry out activities, tasks and roles that are meaningful or required of them (Baum & Christiansen 2005).

The PEOP Model is a systems model, recognizing that the interaction of the person, environment and occupational performance elements is dynamic and reciprocal, and that the client must be central to the care-planning or intervention process. Only the client (whether person, family, organization or community) is able to determine what outcomes are most important and necessary.

In the traditional medical model it is the practitioner who determines the approach to care. The PEOP Model provides a bridge from the biomedical model to a sociocultural model and provides students and clinicians with a tool to organize evidence for use in practice. That is, it recognizes impairments when they limit performance participation but also views the client in context, including a consideration of the abilities and strengths that a client can use to enable performance, as well the environmental characteristics that provide support, whether those include places, people, policies or technologies. Ultimately, the comprehensive assessment of a client, what that client needs and wants to do, and the environment clients will inhabit collectively determine the interventions aimed at enabling the client to perform valued roles, activities and tasks that are central to living, whether these pertain to management of self and others, work or community engagement. A central theme of the PEOP Model is that, ultimately, the client determines the performance goals toward which therapy is targeted.

The PEOP Model is used as a guide to creating a complete occupational profile of the client, which includes information about the client's perception of the current situation, and includes consideration of the client's roles, interests, responsibilities and/or mission and values. The assessment and planning phase of care is grounded in evidence. We believe that clients should enter into the intervention phase with a clear understanding of the outcome that should ultimately result. Intervention must be a collaborative endeavour, with effort and commitment contributed through the partnership of the practitioner and the client.

Figure 8.1 provides a graphic representation of the model. This representation is intended to convey that occupational performance is determined not only by the nature of the activity, task or role to be performed, but also by the characteristics of the person or client (depicted as intrinsic factors) and the environment (depicted as extrinsic factors). Performance and participation always occur in context, and ultimately determine well-being and quality of life. It should be noted that, for a given situation or context, the applicability or importance of given intrinsic and extrinsic factors will vary. The model presupposes that a complete assessment to plan intervention will include a consideration of each of the factors.

The PEOP Model visually represents the constructs that must come together to support both the practitioner and the client in developing a realistic and sequenced plan of care. Success in this process depends on the practitioner's skills in forming a relationship with the client, asking the right questions, and being able to access the knowledge necessary to understanding the issues and options presented by the client's occupational performance issues and goals. Using the PEOP Model involves a ‘top-down approach’, in that it first considers the individual in context, identifying the client's roles, occupations and goals. The model requires the occupational therapist to use this context to address the personal performance capabilities/constraints and the environmental performance enablers/barriers that are central to the occupational performance of the individual.

The following elements describe the steps necessary for gathering and analysing client-related information (Fig. 8.2).

The process described above fits well when the occupational therapist is working with individuals or small groups of people such as families. However, an emerging area of practice for occupational therapy addresses the occupational issues of communities and populations (Fig. 8.3). Population-based care may theoretically range from as large as all of the people in the world who fit some characteristic (e.g. people with AIDS, children who are homeless) or may reflect a small group of people or a community with issues of concern (e.g. mid-life women with family issues that affect their work for a company, or older people who have become isolated in a neighbourhood because of transport issues). Sometimes, these issues are identified within a more obvious or defined organizational structure, such as within a community group, business, or a group of people within a designated government category (e.g. people over 65 within a designated political or geographic jurisdiction). One might guess that the situational analyses conducted will look different in these different situations. Population-/community-centred situational analyses may serve as the starting point for occupational therapists who are interested in improving the health of populations or communities in general or working within specific organizations.

Consider a hypothetical situation where an occupational therapist who has worked with older people in long-term care settings for several years wants to continue to work with older people but would like to work with well elders to enable them to remain at home and improve their quality of life. How does the therapist begin? Does one already have the background and knowledge that will enable success in this new practice arena? Is one ready to begin immediately to promote these services to organizations that work with this population or in these communities? Such a possibility may occur, but is it likely?

In this situation, a population/community situational analysis may better prepare the therapist to understand the general characteristics and issues of the older population, the community in which clients live, and, most importantly, to plan interventions that will meet the needs and goals of specific organizations.

This example can be followed through a situational analysis. Although the therapist has worked with elders who have health conditions and diminished abilities in the long-term care setting, they do not have a clear understanding of well elders. So the therapist begins a population-/community-centred situational analysis by acquiring general information and conducting a broad assessment. What things should the therapist examine?

An organization situational analysis begins with an analysis of those served by the organization (Fig. 8.4). This step in the process enables the occupational therapist to approach the organization with a level of credibility that will open doors of opportunity. After developing expertise with regard to a specific population, an occupational therapist may not need to do this step in an explicit manner. Rather, the knowledge base of the professional includes this foundational information. Entry-level practitioners, however, would likely need to begin by determining an understanding of the population served by the organization as a preliminary step and prior to any discussions with a specific organization.

Three templates are provided to make explicit the activities that must come together to apply the PEOP Model effectively and appropriately. Occupational therapists have a widespread reputation for ‘doing good work’; however, because that work often employs ‘commonsense’ strategies, it is not always obvious that there is a systematic and complex thought process underlying intervention and that various sources of knowledge converge during decision-making to lead to specific recommendations. By using these templates, the practitioner is provided with appropriate language to use in reports and recommendations that will communicate the complexity of the process and the care that has gone into the resulting plan. In the end, we are confident that the templates provide a convenient means for applying the PEOP Model, so that individuals, communities and organizations can accomplish goals related to improved well-being and quality of life, despite the presence of conditions that otherwise limit or restrict occupational performance.