MOHO Intervention implementation/ techniques

Practice Resources: Therapeutic Reasoning

 Generating questions about the client

 MOHO ask their client’s thoughts, feelings, roles, and habits
 Gathering information on, from, and with the client
 OT practitioner gather more details for them to answer the questions they
generate.
 OT practitioners can also use assessment tools (i.e. MOHOST, Volitional
Questionnaire, etc.)
 Using the information gathered to create an explanation of the client’s situation
 The information gathered will be used in creating a theory-based understanding
of the patient.
 The OT practitioner can identify the challenges or problems involve in the
therapy.
 Generating goals and strategies for therapy
 The theory-based understanding of clients is used to:
o Generate therapy goals
o Decide the appropriate occupational engagement
o Determine the therapeutic strategies
 Identify the ways on how to achieve the goals
 Implementing and monitoring therapy
 The monitoring process can confirm the efficiency of the practitioners’ therapy
plan.
 Determining outcomes of therapy
 Therapy outcomes are document by:
o Examine the extent to which goals have been achieved
o Re-administering structured assessments to determine whether the
client’s scores have improved

Therapeutic Strategies

 Validating
 Attending and acknowledging the client’s experience
 Identifying
 Locating and sharing factors that can facilitate occupational performance
 Giving feedback
 Sharing one’s understanding of the client’s situation
 Advising
 Provide/ recommend intervention goals
 Negotiating
 Engage in a give-and-take with the patient
 Structuring
  Establish parameter for choice and performance
 Coaching
 Consists of instructing, demonstrating, guiding, verbally, and/or physically
prompting.
 Encouraging
 Provide emotional support and reassurance
 Physical support
 Provide support for the patient to complete a task.

Example of Therapeutic Reasoning

John Doe is a first grader who struggles to keep his focus on class and when doing his
homework. According to his parents, John no longer feel motivated or happy to go to school. His
struggle in doing his homework also got worse lately that John ignored his assignments. Catherine, an
Occupational practitioner agreed to evaluate John’s situation and develop a therapy plan using the
therapeutic reasoning process.

Generating Questions

Catherine began by generating question to guide her approach to John. She asks
questions with John’s volition of doing his homework:

 Does he value school?

 What are his feelings about his ability to do his assignments?

Gathering Information

Through interviews, Catherine gathers some information about John’s performance and
behavior from his teacher and parents.

 She also observed John during class hours and met him to discuss how he
approached his homework.
 John’s parents highly value school performance and John also wants to please
his parents.
 John is having the difficulty to organize his school materials. He also admitted
that he sometimes lost his assignments that he just gave up in doing another
one.

Creating a Theory- based Explanation

 Catherine reasoned that while John have positive values about school, he has a
poor efficacy
o John believes that he will fail all his assignments because of his past
failures.
o John’s feeling of inefficacy led him to avoid his homework.
o John has poor organization system that keep his assignments in proper
place.
Therapy Goals and Strategies

 Catherine created the ff. therapy goals:

o John’s sense of efficacy for completing homework will increase
o John will consistently make choices to do homework
 Plan for John’s occupational engagement
o John would create and learn to use a system of organizing with the use
folders.
o Validate John’s feeling, collaborate with him to get the folder labeled,
and develop a plan to use it.
o Let the teacher and parents know about the folder and how John would
use it.

Monitoring and Determining Outcomes

 Catherine planned to monitor’s Drew’s reaction as they worked on the folder

and also to check in with his parents and teacher if he was able to follow
through on doing his assignments.