Paradigm Shift: From the Medical Model to the Community Model

Public Health, Community Health, and Occupational Therapy

By Hui-Fen Mao 2012/9/20

1. What is paradigm? • Conceptual framework that allows for

explanation and investigation of phenomena.• “ universally recognized scientific

achievements that for a time provide model problems and solutions to a community of practitioners” (Tomas S. Kuhn, 1970, in “ The Structure of Scientific Revolutions”)

1. What is paradigm? • “ consensus-determined matrix of the most

fundamental beliefs or assumptions of a field”• “ cultural core of the discipline” and “provides

professional identity”• Two essential characteristics: 1) a sufficiently

unprecedented scientific achievement that draws a large number of constituents from competing areas of inquiry, 2) adequately open ended enough to allow for the exploration of solutions to a variety of problems.

2. What can discipline-specific paradigm determine for a profession?

• How professionals view their phenomenon of interest ？

• What puzzles, problems, or questions practitioners will seek out in their work ？

• What solution will emerge ？• What goals will be set for the direction of the

profession ？

3. Describe the positive and negative aspects of having a well-developed

paradigm• “paradigm effect”: paradigm act as filters of

perception• When utilized appropriately, it distributes or provides

information into meaningful and useful guidelines for practice

• The danger is that their potential for limiting problem solving and innovation by constraining thinking and perception

4. There are 4 stages of paradigm shifts.

5. Do you think there are paradigm shifts occurring in occupational therapy?• Paradigm Shifts in OT 1) 18th and 19th centuries: moral treatment 2) 1900~1940--Paradigm of Occupation 3) 1960s—Mechanistic Paradigm: more scientific, reductionism 4) 1980-1990s—Emerging paradigm, to understand the complexity of human behavior-- system’s perceptive

6. What are the characteristics of the emerging ( 顯現 ) paradigm in OT?

• Occupational performance results from the dynamic interaction between the person, the environmental context, and the occupations in which the person engages.

• All systems and components of systems are organized by levels and operate according to the laws of hierarchy (rather than cause-and-effect relationship)=> Dynamical systems theory: self-organizing processes

• Input (Open system)=> Throughput=> Output, the interaction of the system with it environment is refined and guided by the feedback process

7. The definition of public health• Green and Anderson, 1982• The science and art of preventing disease, prolonging

life, and promoting health and well-being through organized community effort for the sanitation （衛生設備） of the environment, the control of communicable infections, the organization of medical and nursing services for the early diagnosis and prevention of disease, the education of the individual in personal health, and the development of the social machinery to assure everyone a standard of living adequate for the maintenance or improvement of health.

8. Five phases of the “modern era” of public health

1) Miasma （毒氣、沼氣） phase (1850-1880)2) Disease control or health protection phase (1880-

1920)3) Health resources or medical phase (1920-1960)4) Social engineering phase (1960-1975)5) Health promotion phase (1975-present)

9. Health-Care Delivery for Persons with Disabilities

1) Institutionalization2) Deinstitutionalization and community develop

(1975~to late 1980)3) The era of community membership

Dysfunction is a dynamic interplay between an individual’s limitations and resources and the demands and constraints of the environment. (Systems approach: Social and environmental constraints than inherent in the physical disability)

10. The Vocational Rehabilitation (1980~)—2 models of practice

1) Clinical model of vocational rehabilitation: PWD are unemployed, need to be assessed, counseled,, and treated to make him or her more employable/ to modify or restructure the psychological and vocational skills and behaviors

2) Ecological or environmental model of vocational rehabilitation:

numerous environmental, social,, and economic forces affect the PWD/ to modify all aspects of environment (physical, social,, and political)

11. Compare and contrast the paradigm shifts in OT with those of public health and vocational rehabilitation

12. What are the basic components and/ or characteristics of a

community practice paradigm in OT?1) Broader perspectives:

Client (vs. Patient), Intervention (vs. Treatment), Funding (vs. reimbursement)

2) “Client”-centered approach to practice: promote participation, exchange information, client decision-making, and respect for choice, focus on the issues which are most important to the person or family

3) The collaborative process to enable the client to identify occupational performance problems, engage in problem solving

• * OT’s role—facilitator, educator, and mentor in the process

(* Table 2-1: Contrasting Paradigms)

12. What are the basic components and/ or characteristics of a

community practice paradigm in OT?

13. Discuss the usefulness of system theory to community practice

• How to assess the client in the community? (Box 2-1)

Public Health, Community Health, and Occupational Therapy

1. What is “Public Health”? • “The process of mobilizing local, state, national, and

international resources to ensure the conditions in which people can be health.”

• 4 strategies:1) Promoting health and preventing disease2) Improving medical care3) Promoting health-enhancing behaviors4) Controlling the environment

• * defined in terms of aims and goals, rather than grounded in a specific of knowledge=> many disciplines involved

2. Terms in Epidemiology• * Epidemiology – the study of the distribution,

frequencies, and determinants of disease, injury, and disability./ use health statistics, including measures of incidence and prevalence, to estimate disease, injury, and disability in a variety of population groups; analyze the health trends; plan and evaluate public health initiatives; and make informed health policy decisions

2. Terms in Epidemiology• Public health intervention

– To decrease “risk factors”– To increase “resiliency ( 反彈 ) factors”

• “Health Promotion”• “Prevention”• “Primary prevention”• “Secondary prevention”• “ Tertiary prevention”

3. Describe the differences between public health and medical approaches to health and disease. Discuss the implications of

these two approaches with respect to OT practice

4. What is “community health”?• *”Community”

– Noninstitutional aggregations of people linked together for common goals or other purposes

• * “Health”– the blending of a person’s physical, emotional, social,

intellectual, and spiritual resources so that he or she can master the developmental tasks necessary to enjoy a satisfying and productive life.

• * “ Community Health”— the physical, emotional, social, intellectual, and spiritual well-being of a group of people who are linked together in some way

5. What are included in “community-based approach” to enhance “

community health”?1) Educational intervention2) Social intervention (economic, political, legal, organization change)3) Environmental supports 4) The health behavior of a community: actions of any person who may influence health behaviors,, resources or services ( police maker, ill persons, professionals,, employers,…..)

6. Describe the history of the development of national health goals and objectives and

potential roles for OT practitioners within the Healthy People framework

1) “Healthy People” proposed by the Department of Health, Education and Welfare (Now the Dep. of Health and Human Services) in 1979.

* Five major health goals according to life span (infants, children, adolescents and young adults, adults, and older adults)

6. Describe the history of the development of national health goals and objectives and

potential roles for OT practitioners within the Healthy People framework

2) In 1980, “ Objectives for the Nation” 3) “ Healthy People 2000” in 1990 Focus is to improve the QOL, and people’s sense of well-being (rather than just reduction of mortality rate)

4) “ Healthy People 2010” in 2000 due to advances in preventive therapies, vaccines and pharmaceuticals, assistive technologies, and computerized systems.

5) “ Healthy People 2020”