peop model occupational therapy case study

PEOP Model: Fundamentals in OT Practice

• Mandy Chamberlain MOTR/L

By our very nature and the influence of our educational background, occupational therapists have to take a wholesome approach in therapeutic intervention.   This means looking beyond the patient or client’s medical limitations and considering outside-of-the-box barriers and enablers related to occupational success.   One of the dozen theoretical models that OTs learn in school that provides a basis for such a mindset is the Person-Environment-Occupation Performance or PEOP Model .

In this post, we will give a basic overview of what the PEOP model entails, give a PEOP example so you can understand how it is applied in occupational therapy practice and then talk a little bit about the pros and cons of the model.

Overview: What is PEOP?

The first thing to understand is that the PEOP model of occupational therapy (Christiansen and Baum, 1985) and the PEO model (Law et al., 1996) are not synonymous.   Although both models have some similarities, PEOP holds to a handful of different principles.

The PEOP model highlights occupational performance as its key feature, which is made up of three interacting components (ach of their detailed characteristics which are listed in the previous image): 

• person (client),
• environment, and
• occupation (i.e. activity, role, or task)

Inevitably, environmental factors will impact a person for better or for worse which determines the occupational performance outcome.   If there is a healthy interaction between the person and their environment, then the person will experience success and improved well-being in occupational performance (Baum et al., 2015).  

Since its original development in 1985, several revisions have been made to make PEOP more client-centered.   This means that through a collaborative and supportive relationship between the client and the practitioner, the client’s needs and goals are highly vocalized and used in personal narrative form to determine the course of therapeutic care.

PEOP Model Example

Confused yet?  

Below, we have created a practical case study in which the PEOP model is applied to see how it can be applied in practice:

Diana is a 54-year old patient who was admitted for a short hospital stay following a ground-level fall.   She was attempting to transfer from her powered wheelchair to her bed at home when she slipped, resulting in a minor left shoulder fracture.   After her hospital stay, she was admitted to a skilled nursing facility for further rehabilitation.   She also has primary-progressive multiple sclerosis. Although she can stand for brief periods to perform transfers, she relies heavily on her powered wheelchair to get around at home and in the community.   Diana’s priority goal is to get her left shoulder stronger so she can still perform her own transfers safely at home.

Through a comprehensive evaluation and collaborative conversations, Diana’s OT can identify factors in all three components of Diana’s overall occupational performance:

Environment

Social support:.

Diana lives at home with her husband, who is retired and acts as her primary caregiver.   However, her husband is aging and frail and struggles with physically helping Diana get around. She has two children who live out of state and rarely visit her.

Social and economic systems:

Diana has been medically involved in the healthcare system for many years.   She has Medicare A, Medicare B, and a supplemental HMO insurance plan.

Culture and values:

Diana strongly values her own independence.   She is also a devout catholic who attends church on a regular basis.

Built environment and technology:

Diana lives in a single-level townhome and owns a wheelchair ramp, a powered wheelchair, a shower chair, a transfer board, a walker, a fall alert home system, and a toilet riser.   She also has grab bars installed throughout her home.

Natural environment:

Diana and her husband live in a city in the U.S. with easy access to flat terrain with sidewalks and other wheelchair accessible surfaces.

Physiological:

Due to MS, Diana fatigues easily and has overall low muscle tone and body strength.   The nature of her left shoulder fracture limits her range of motion and strength in upper extremity use.

Diana has experienced some mild memory deficits within the last few years.

Diana regularly attends catholic services and goes to bible study as often as possible.

Neuro-behavioral:

Due to MS, Diana has reduced sitting and standing balance as well as decreased sensation in her feet.

Psychological:

Although Diana is highly motivated to participate in therapy, she does have clinical depression.

After examining all of Diana’s unique environmental and personal factors, she, with the help of her OT, can create a tailored intervention plan to help her meet her functional transfer goals. 

Pros to PEOP

• The emphasis on a client-centered approach allows the patient or client to develop goals for themselves based on their individual wants and needs.
• The comprehensive model lists out a wide array of factors that many OTs (especially new therapists) may not otherwise consider in intervention.
• It’s a very top-down approach, which takes the focus away from the client’s medical barriers and acknowledges both limitations and enablers in the client’s overall occupational performance.

PEOP Model Limitations

• According to the authors Christiansen and Baum (2015), there is currently no assessment tool that measures outcomes based on the PEOP model.   So OTs are on their own using other tools to obtain relevant client information.
• Like a number of therapeutic models, PEOP could use additional evidence-based research to better support its principles in clinical practice.

We have also discussed a number of other occupational therapy models throughout the website including the Biopsychosocial Model here. 

Baum, C. M., Christiansen, C. H., & Bass, J. D. (2015). The Person-Environment-Occupation- Performance (PEOP) model. In C. H. Christiansen, C. M. Baum, & J. D. Bass (Eds.),  Occupational therapy: Performance, participation, and well-being  (4th ed., pp. 49-56). Thorofare, NJ: SLACK Incorporated.

Occupation Models: PEOP (Person-Environment-Occupation Performance) (2015). Lifelong Learning in OT. https://lifelonglearningwithot.wordpress.com/tag/peop-model/ . Viewed on January 30, 2020.

Post by  Meredith D. Chandler, OTR/L, Freelance Content Writer and Mandy Chamberlain MOTR/L

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What is the PEOP Model? Person-Environment-Occupation Performance

The Person-Environment-Occupation Performance (PEOP) model is an important framework used in occupational therapy to guide therapists’ assessment, intervention, and evaluation of client-centered care.

It was first developed in 1985 (and last revised in 2015) by Carolyn Baum and Charles Christiansen during the time when the biomedical model was widely used in Western medicine. The biomedical model is extremely clinician-based and it only focuses on the physical processes (like injury or disease) and doesn’t consider the person’s individual factors. The PEOP model, however, focuses heavily on the client or patient.

At its core, the PEOP model considers how environmental factors, such as social supports, built and natural environments, and cultural values, affect a client’s daily activities or important occupations. What separates the PEOP model from other occupational therapy models even more is that it groups these factors into either intrinsic or extrinsic  factors.

The PEOP utilizes a top-down, or holistic, approach in evaluating a client’s current situation, which demonstrates a more holistic approach to care. Read more about the Top Down vs Bottom Up OT Approaches in our companion article here .

Unlike the biomedical approach which just focuses on treating a symptom, the PEOP model examines all of the internal and external factors that may be affecting the client.

Intrinsic Factors in the PEOP Model

Intrinsic factors include:

• Physiological   – sleep, strength, flexibility, stress, nutrition
• Cognitive – memory, reasoning, attention
• Spiritual – what has meaning to the person
• Neurobehavioral – motor & sensory input, balance, coordination
• Psychological – personality, self-esteem, self-awareness, motivation

Extrinsic Factors in the PEOP Model

Extrinsic factors include:

• Social support – emotional support from close relationships
• Culture & values – customs, beliefs, traditions
• Social & economic systems – political or economic policies affecting health or employment
• Built environment & technology – buildings, public spaces, tools
• Natural environment – climate, terrain

The PEOP model uses a biopsychosocial approach , which takes into account the emotional, physical, and social factors that may influence a person’s occupational performance. This is the heart of occupational therapy, where practitioners consider the entire person during their interventions instead of just their deficit areas.

Integrating the PEOP Model into Practice

When using the PEOP model in occupational therapy practice, the therapist closely examines the client’s history and establishes their short and long-term goals, which highlights the client’s areas of weakness and strength.

It is important to complete a thorough history of the client during the evaluation, as even small details can have a huge impact on the course of treatment and outcomes.

Occupational therapists practicing in any setting , from pediatrics to older adults, can incorporate the PEOP model into their practice. For the most success, OT practitioners will want to continually include their client in active and collaborative goal setting and intervention planning.

Why to use the PEOP in practice:

• It offers a holistic approach
• It has a strong emphasis on occupation 
• It is client-centered
• It is easy to use for new therapists

Why not to use the PEOP in practice:

• There is currently only minimal research on validity or reliability
• It focuses more on long-term outcomes, as opposed to short-term outcomes

_______________

Occupational therapy models are the lenses in which occupational therapists look through when evaluating and treating patients or clients. The person-environment-occupation performance (PEOP) model is a top-down, holistic model which focuses on how the environment shapes a person’s occupational performance.

This can be an extremely useful model for determining what treatments to use and how to best implement them for the best long-term outcomes for your patients or clients.

Each component of the PEOP model is important to understand the impact that the environment, occupation, and performance all have on an individual.

By considering each component of the PEOP model in OT, occupational therapy practitioners can work collaboratively with patients and clients to identify barriers and facilitators to engagement in meaningful occupations, develop interventions to improve performance, and evaluate progress towards achieving goals.

____________

We’d love to know: Do you use the PEOP model in your OT practice? What are your thoughts on this model versus others? Do you have another favorite model that you use? Let us know in the comments!

Christiansen CH, Baum CM & Bass-Haugen J (2005) Occupational therapy: Performance, participation and well-being (3rd edition) Thorofare NJ: SLACK incorporated

Christiansen CH, Baum CM & Bass-Haugen J (2015) Occupational therapy: Performance, participation and well-being (4th edition) Thorofare NJ: SLACK incorporated

Duncan E & Hagedorn R (2011) Foundations for practice in occupational therapy (5th ed) Edinburgh: Elsevier Churchill Livingstone.

Lifelong learning with OT. (2015, October 23). Occupational Models: PEOP (Person-Environment- Occupation-Performance). https://lifelonglearningwithot.wordpress.com/tag/peop-model/

O’Brien, Jane Clifford & Hussey, Susan M. (2012). Introduction to Occupational Therapy, Fourth Edition . Elsevier Inc.

This post was co-written by Josh Albarado, OTR/L and Sarah Stromsdorfer, OTR/L. It was originally published on May 13, 2021 and last updated on June 15, 2024.

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Application of the Person-Environment-Occupation Model: A practical Tool

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Application of the Person-Environment-Occupation-Performance Model: A Scoping Review

Affiliations.

• 1 St. Catherine University, Saint Paul, MN, USA.
• 2 Washington University in St. Louis, MO, USA.
• PMID: 38519867
• PMCID: PMC11180417
• DOI: 10.1177/15394492241238951

The Person-Environment-Occupation-Performance (PEOP) Model is one of several occupation-based models in occupational therapy. The model describes the transactional nature of person, environment, and occupation factors that support performance (doing), participation (engagement), and well-being (health and quality of life). The purpose of this study was to explore the extent and nature of evidence on the PEOP Model. We used a scoping review to identify and analyze journal articles that used the PEOP Model as a framework for study. The PRISMA extension for scoping reviews (PRISMA-ScR) criteria were used to develop the research methods. We found 109 articles that adopted the PEOP Model as an organizing framework. The studies reviewed represent the breadth of occupational therapy practice and the transactional nature of person, environment, occupation, and performance in the PEOP Model. The PEOP Model is a useful international framework for research and practice across populations, conditions, life circumstances, settings, and areas of practice.

Keywords: PEOP Model; occupation-based models; person–environment–occupation–performance model; scoping review.

Plain language summary

The Person–Environment–Occupation–Performance (PEOP) Model: Summary of Current Research on an Occupational Therapy Lens for Everyday Living Background and Purpose: The Person–Environment–Occupation–Performance (PEOP) Model was developed to guide occupational therapy practice. The PEOP Model summarizes all the factors that support or limit our involvement in everyday living. By everyday living, we mean all the things we do to take care of ourselves, maintain our health and home, connect with friends and family, engage in meaningful activities, and support ourselves and our community through work and volunteering. The purpose of this study was to summarize the reasons why and the extent to which the PEOP Model was used in research and practice.

Method: We searched five databases to identify published articles that used the PEOP Model. Then, we analyzed our findings from peer-reviewed journals and peer-reviewed practice publications using a recommended process called a scoping review. We summarized how often the PEOP Model was used and the way in which it was used.

Findings: We found the PEOP Model was used in more than 100 published articles. The PEOP Model has been used to study everyday living for different populations, life circumstances, countries, and communities. Authors found the PEOP Model was helpful for identifying what was important to individuals and determining things that were helpful and barriers to everyday living.

Conclusion: Authors described the PEOP Model as a useful tool in their research methods and analyses. Occupational therapy professionals may find the PEOP Model helpful in current and innovative areas of practice to help people achieve their goals related to everyday living.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

PRISMA 2020 Flow Diagram Used…

PRISMA 2020 Flow Diagram Used for the Scoping Review. Note. The articles identified…

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• *Akbarfahimi M., Nabavi S. M., Kor B., Rezaie L., Paschall E. (2020). The effectiveness of occupational therapy-based sleep interventions on quality of life and fatigue in patients with multiple sclerosis: A pilot randomized clinical trial study. Neuropsychiatric Disease and Treatment, 16, 1369–1379. 10.2147/NDT.S249277 - DOI - PMC - PubMed
• *Andersson C., Mårtensson L. (2021). Women’s experiences of being in the sick leave process. Scandinavian Journal of Occupational Therapy, 28(6), 488–497. 10.1080/11038128.2020.1750692 - DOI - PubMed
• *Armstrong-Heimsoth A., Hahn-Floyd M., Williamson H. J., Lockmiller C. (2020). Toward a defined role for occupational therapy in foster care transition programming. The Open Journal of Occupational Therapy, 8(4), 1–8. 10.15453/2168-6408.1726 - DOI - PMC - PubMed
• Arnaud L. M., Gutman S. A. (2022). Supporting literacy participation for underserved children: A set of guidelines for occupational therapy practice. Journal of Occupational Therapy, Schools, & Early Intervention, 15(2), 111–130. 10.1080/19411243.2021.1934234 - DOI
• Baum C. M., Connor L. T., Morrison T., Hahn M., Dromerick A. W., Edwards D. F. (2008). Reliability, validity, and clinical utility of the executive function performance test: A measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62(4), 446–455. 10.5014/ajot.62.4.446 - DOI - PubMed

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