Running head: THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

Application of EHP Model and People with Schizophrenia

Nghi Y. Tran
OT 5012: Foundations of Occupational Therapy
October 27, 2014
Dominican University of California

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

Introduction
Ecology of Human Performance (EHP) model was developed in the 1900s by
occupational therapy (OT) faculties at University of Kansas Medical Center: Winnie Dunn,
Catana Brown, and Ann McGuigan (Dunn, Brown, Mc.Guigan, 1994). The EHP model was
developed due to the rising concern that too little attention was given to the impacts environment
(i.e. context) has on occupational performance (OP) (Willard & Spackman, 2013). The model
also addresses the lack of consideration for contextual features and how that may place
limitations on a persons performance along with OTs intervention and assessment (Dunn et al.,
1994). The EHP model defines unique variables (person, context, task, and performance
outcomes) and describes the relationships among them to provide a complementary perspective
of the ecological principals (Dunn et al., 1994). The holistic nature of the EHP model is one of
the reasons why it is widely applied by health practitioners, especially those who treat
individuals with psychiatric disability. This paper demonstrates how different components that
make up the EHP model can impact schizophrenia patients health when physical, social,
temporal, and cultural factors are taken into consideration for intervention, assessment, and
research.
Theoretical Background
The EHP model was developed along with two other models: the Person-EnvironmentOccupation model (PEO) and Person-Environment-Occupation-Performance model (PEOP)
(Willard & Spackman, 2013). All three models were classified as components of the larger
ecological model (Willard & Spackman, 2013). The EHP model was built on social science
theory, occupational therapy models, and the disability movement. First of all, the environmental
psychology embedded in the social science theory explains how physical elements can influence

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

a persons behavior (Dunn et al., 1994). Secondly, the occupational therapy model contains the
general system theory that place strong emphasis on looking at a person as an integrated whole
rather than separated units (Willard & Spackman, 2013). And last but not least, the disability
movement fought against the environmental barriers or social stigma that act as barriers that
prevent a person from participating in an occupation (Willard & Spackman, 2013).
Focus of Theory and Key Components
Similar to the other ecological models, EHP focuses on the relationships between
important constructs in occupational therapy practice such as the person and context interactions.
The EHP model demonstrates the transactional relationships among the four variables: person,
context, tasks, and performance. In this paper, the term task is defined as objective sets of
behaviors necessary to accomplish a goal (Willard & Spackman, 2013, 2013). Moreover, the
range of performance outcome has a positive correlation with the level of interaction that occurs
between the person, context, and tasks.
Key Concepts
The EHP framework repeatedly highlights the relationship between the person (i.e.,
functional skills, abilities, and experiences), the tasks, and the contexts that he comes in contact
with. When the person, tasks, and contexts are taken into account, we are able to see how that
combination influences OP (Dunn et al., 1994). It is important to note that the person-taskcontext relationship is dynamic; increased interactions among these variables can result in better
OPs (Willard & Spackman, 2013, 2013). Moreover, the therapeutic approaches derived from the
EHP model are client-centered. The focus is not about finding the area of impairment and fix
them; rather, it is about evaluating the types of barrier that are preventing the person from
maximizing his performance outcomes and helping them overcome those barriers.

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

Main Assumptions
The EHP model employs the top-down approach in which the person has the ability to
choose the area of occupations he wishes to work on (Willard & Spackman, 2013). The
therapists job is to assess potential barriers and facilitate the person-context-tasks dynamic to
help the person achieve the appropriate OP. The client-centered nature of this model allows the
person to be the primary decision maker whereas the therapist is someone who advocates for the
persons right to participate in all occupations regardless of their disabilities. Moreover, the EHP
model sways away from the idea of changing the person; rather, it focuses on modifying the
context factors in ways that support the person and maximize their potential to achieve the best
OP (Willard & Spackman, 2013). The last assumption of this model emphasizes upon the
transactional and dynamic relationships between the variables that make up this model. These
variables are constantly changing through time and space; this concept requires the therapists to
maintain high degree of flexibility and avoiding generalization for each situation (Willard &
Spackman, 2013).
Application to Occupational Therapy Practice
Understanding the dynamic relationship between the person, contexts, and tasks and how
they work together to influence performance outcome, we can now put the EHP model to
practice by applying the different concepts within this model toward peoples who are
schizophrenic. Our goal is to determine how contexts influence OP and the effectiveness of
incorporating contexts into assessment, intervention, and research through these areas of studies:
Assessment

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

To understand how context plays a role in assessment, we will look at how accurate and
efficient peoples with schizophrenia are at searching for grocery items using the context-based
Test of Grocery Shopping Skills (TOGSS) (Hamera & Brown, 2000). The goal of the study is to
identify presence of deficits (i.e., difficulty in processing subtle and environmental cues) that
make it difficult for persons with schizophrenia to achieve the desired OP outcome (Hamera &
Brown, 2000). In this part of the study, peoples with schizophrenia were given the tasks of
picking out accurate grocery items that have the lowest price and the correct size in the most
efficient manner in two trials (Hamera & Brown, 2000). For the first trial, no verbal cues are
provided for the first time, but for the second trial, peoples with schizophrenia were asked to
repeat instructions and were given verbal cues (Hamera & Brown, 2000). The study showed that
physical context such as noise and temporal context such as time constraint acted as barriers that
prevent persons with schizophrenia to complete their goals while the social context such as
interacting with research assistants helped increase their accuracy and efficiency at pick out the
correct items (Hamera & Brown, 2000).
Intervention
Now that we understood how context factors act both as barriers and promoters for
occupational outcomes, we can look at how contexts play roles in the intervention process to
influence OP of peoples with schizophrenia. In a study done by Sablier et al., a cognitive orthotic
device named Mobus was created to help people manage their Activities of Daily Living (ADLs)
better (Sablier, Stip, Jacquet, Giroux, Pigot, & Frank, 2012). Mobus is a modernized and
customizable tool that makes life more simple and enjoyable by providing a schedule manager
and allowing peoples with schizophrenia to report symptomatic experiences to their caretakers in
advance (Sablier et al., 2012); this allows caretakers to have time ahead to plan for interventions

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

during the rehabilitation process. The social interaction between the caretakers and the person
helps to establish the problem areas that people with schizophrenia face before the therapy
session (Sablier et al., 2012). This helps increase efficiency of therapy sessions when less time is
spent on deciding the appropriate occupation.

Research
In a research study done by Berglund et al., family relationship among peoples with
schizophrenia and their family members were studied to look for potential correlations
(Berglund, Vahlne, & Edman, 2002). In this study, 31 patients and their families were offered
Behavioral Family Therapy (BFT) service, whereas the remaining 28 patients and their family
were offered conventional counseling (Berglund et al., 2002). The goal was to determine whether
there are correlation between the level of family burden and the presence of the BFT service. The
result showed rating of family burden level was significantly lower for the family groups that
received BFT service compares to the other group (Berglund et al., 2002). Although we cannot
conclude that the BFT service is a direct source that decreases level of family burden, we can
speculate that the social interactions among the patient, family members, and the therapists
strongly influence the level of family burden. This information can be crucial in helping the
therapist designs interventions that best maximize the persons OP when considering both
temporal and social contexts.
Conclusion
The EHP model is one component of the ecological models. This model focuses on
intervention approaches that are client-centered and facilitate the interactions among the personcontext or environment- task or occupation to yield the most appropriate occupational outcomes.

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

The EHP model provides frameworks that encourage practitioners to look at a person in a
holistic views and how he cannot be understood without his contexts. By incorporating contexts
into intervention, assessment, and research, practitioners are able to observe how they can result
in powerful impacts that can change the lives of people with mental disabilities.

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

References
Berglund, N., Vahlne, J. O., & Edman, A. (2002). Family intervention in schizophrenia: Impact
on family burden and attitude. Social Psychiatry and Psychiatric Epidemiology, 38, 116121. Retrieved October 10, 2014, from
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[Brown, I.] (2014). Ecological Models in Occupational Therapy. In B.A.B. Schell, G. Gillen, &
M.E. Scaffa (Eds). Willard and Spackmans occupational therapy (12th ed., pp. 494-504).
Philadelphia: Lippincott Williams & Wilkins.

Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of human performance: A
framework for considering the effect of context. The American Journal of Occupational
Therapy, 48(7), 595-607. Retrieved October 5, 2014, from
http://ajot.aota.org/article.aspx?articleid=1873303

Hamera, E., & Brown, C. E. (2000). Developing a context- based performance measure for
persons with schizophrenia: The test of grocery shopping skills. American Journal of
Occupational Therapy, 54(1), 20-25. Retrieved Oct 5, 2014, from
http://ajot.aota.org/article.aspx?articleid=1868809

THE EHP MODEL AND PEOPLE WITH SCHIZOPHRENIA

Sablier, J., Stip, E., Jacquet, P., Giroux, S., Pigot, H., & Frank, N. (2012). Ecological
assessments of activities of daily living and personal experiences with Mobus, an
assistive technology for cognition: A pilot study in schizophrenia, 24, 67-77.
doi:10.1080/10400435.2012.659324