OT Models of Practice: PEO, CMOP-E, PEOP, EHP, MOHO & Kawa

Occupational therapists use models of practice to understand the whole picture: who the person is, what they need and want to do, and how their environment helps or gets in the way. This guide compares the most widely used OT models, PEO, CMOP-E, PEOP, EHP, MOHO and Kawa, and explains how they fit with frames of reference.

Models vs frames of reference

	Model of practice	Frame of reference
Scope	Broad: all clients and settings	Narrow: a specific area of function
Purpose	Organise thinking about person, occupation and environment	Guide assessment and intervention for a specific problem
Examples	PEO, CMOP-E, PEOP, EHP, MOHO, Kawa	Biomechanical, rehabilitative, sensory integration, motor learning
How they're used	Usually one model as the overall lens	One or more frames for specific problems

Person-Environment-Occupation (PEO) model

Developed by Mary Law and colleagues (1996), PEO is one of the simplest and most widely used models.

PEO: three overlapping parts

Person

Roles, skills, values, experience

Environment

Physical, social, cultural, institutional

Occupation

Activities and tasks the person does

Occupational performance is the overlap between all three. The better the fit, the better the performance. Changes over the lifespan shift the overlap.

Transactive: the three parts constantly influence each other
OTs can improve performance by working on the person (skills), the occupation (task changes) or the environment (modifications)

Example: an older adult struggles to bathe. Person: strengthening and balance. Occupation: sit to wash, long-handled sponge. Environment: grab bars and a tub bench.

Canadian Model of Occupational Performance and Engagement (CMOP-E)

Published by the Canadian Association of Occupational Therapists in 2007 (Townsend and Polatajko), CMOP-E built on the earlier CMOP (1997).

CMOP-E from the inside out

Core ↑

Spirituality

At the core of the person: meaning, will, motivation.
Person

Cognitive, affective and physical performance components.
Occupation

Self-care, productivity and leisure.
Environment

Physical, social, cultural and institutional.

Outer

Adds engagement: people may be involved in occupations in ways other than performing them
Pairs with the Canadian Occupational Performance Measure (COPM), a client-centred interview where the person rates the importance of, performance in and satisfaction with their chosen activities
CAOT has since introduced the Canadian Model of Occupational Participation (CanMOP, 2022), which puts more emphasis on participation, relationships and context

Person-Environment-Occupation-Performance (PEOP) model

Developed by Charles Christiansen and Carolyn Baum, PEOP is a client-centred model that links person factors and environment factors to occupation, performance, participation and well-being.

Person factors	Environment factors
Physiological	Social support
Psychological	Social and economic systems
Cognitive	Culture and values
Neurobehavioural	Built environment and technology
Spirituality	Natural environment

PEOP is often used in community and population health, as well as with individual clients.

Ecology of Human Performance (EHP)

Developed by Winnie Dunn, Catana Brown and Ann McGuigan (1994) at the University of Kansas, EHP highlights how context shapes what people can do.

Person: skills, abilities and experiences
Task: the behaviours needed to achieve a goal
Context: temporal (age, life stage), physical, social and cultural
Performance range: the tasks a person can do given their skills and context

EHP's five intervention approaches

Approach	What it does	Example
Establish / restore	Improve the person's skills	Strength training to carry shopping
Alter	Find a context that fits current skills	Shop at a smaller store close to home
Adapt / modify	Change the task or context	Use a trolley; online grocery orders
Prevent	Stop problems from developing	Energy conservation teaching before fatigue worsens
Create	Build supportive circumstances for everyone	A community 'easy shopping' hour

Model of Human Occupation (MOHO)

Developed by Gary Kielhofner and Janice Burke (1980), MOHO explains how occupation is motivated (volition), patterned (habituation) and performed (performance capacity) within the environment. Its strength is a large family of assessments, including the OPHI-II, MOHOST and OSA. Read our full guide to MOHO.

Kawa model

Developed by Michael Iwama (2006) with Japanese occupational therapists, the Kawa (“river”) model uses a river as a metaphor for life. Water is life flow; the riverbed and walls are the environment; rocks are life circumstances and problems; driftwood is personal assets and liabilities; and spaces are where life still flows, and where therapy can help. Read our full guide to the Kawa model.

Models compared

6 OT models at a glance

Model	Developed by	Key focus	Paired assessments	Best for
PEO	Law et al. (1996)	Fit between person, environment and occupation	Any; often COPM and home assessments	Simple, any setting; environment changes
CMOP-E	CAOT (2007)	Spirituality, engagement and performance	COPM	Client-centred goal setting
PEOP	Christiansen and Baum	Person and environment factors for participation and well-being	Varied	Community and population health
EHP	Dunn, Brown and McGuigan (1994)	Context and performance range	Varied; Sensory Profile links to Dunn's work	School, community; planning interventions
MOHO	Kielhofner and Burke (1980)	Volition, habituation, performance capacity	OPHI-II, MOHOST, OSA, VQ	Mental health, return to work, chronic illness
Kawa	Iwama (2006)	Life flow and harmony; culturally responsive	The client's own river drawing	Collectivist cultures, mental health, reflection

Quick self-check

0 / 3 correct

What sits at the core of the person in CMOP-E?

Show answer

B. Spirituality is at the core of the person in CMOP-E.
Which EHP approach finds a different context that fits the person's current skills?

Show answer

B. 'Alter' means choosing a better-matched context without changing the person or the task.
Who developed the PEO model?

Show answer

A. Mary Law and colleagues published the PEO model in 1996.

Summary

Models of practice give occupational therapists a lens for understanding the whole person in context. PEO explains performance as fit, CMOP-E centres spirituality and engagement, PEOP links person and environment factors to well-being, EHP focuses on context with five intervention approaches, MOHO explains motivation and routines, and Kawa offers a culturally responsive river metaphor. Pair a model with the right frames of reference for specific problems.

References

Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L. The Person-Environment-Occupation Model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 1996;63(1):9–23.
Townsend EA, Polatajko HJ. Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation. CAOT Publications ACE; 2007.
Christiansen CH, Baum CM, Bass JD, eds. Occupational Therapy: Performance, Participation, and Well-Being. 4th ed. SLACK; 2015.
Dunn W, Brown C, McGuigan A. The ecology of human performance: a framework for considering the effect of context. American Journal of Occupational Therapy. 1994;48(7):595–607.
Iwama MK. The Kawa Model: Culturally Relevant Occupational Therapy. Churchill Livingstone; 2006.
Egan M, Restall G, eds. Promoting Occupational Participation: Collaborative Relationship-Focused Occupational Therapy. CAOT; 2022.
Law M, Baptiste S, Carswell A, McColl MA, Polatajko H, Pollock N. Canadian Occupational Performance Measure. CAOT Publications ACE.

Frequently asked questions

What are models of practice in occupational therapy?

Models of practice are broad frameworks that explain how people, their occupations and their environments interact, and guide how an OT thinks about any client. Examples include PEO, CMOP-E, PEOP, EHP, MOHO and the Kawa model.

What is the PEO model?

The Person-Environment-Occupation model, developed by Mary Law and colleagues in 1996, shows occupational performance as the overlap between the person, the environment and the occupation. The better the fit between the three, the better the performance. OTs can improve performance by changing any of the three.

What is CMOP-E?

The Canadian Model of Occupational Performance and Engagement (2007) shows the person (cognitive, affective and physical, with spirituality at the core) within their occupations (self-care, productivity and leisure) within the environment (physical, social, cultural and institutional). It pairs with the Canadian Occupational Performance Measure (COPM).

What are the five intervention approaches in EHP?

Establish or restore (improve the person's skills), alter (find a better-matched context), adapt or modify (change the task or context), prevent (stop problems developing) and create (build circumstances that support performance for everyone).

What is the difference between a model and a frame of reference?

A model is broad and applies to all clients, organising how the therapist understands occupation. A frame of reference is narrower, applies to a specific type of problem, and links theory directly to assessment and intervention.

Which OT model is best?

There isn't one best model. Choose based on the setting and client: PEO for simplicity and environment changes, CMOP-E with the COPM for client-centred goal setting, MOHO for motivation and roles, EHP or PEOP for community and population work, and Kawa for culturally responsive, client-drawn conversations.

Written by

Deepam Pawar, OT

Deepam Pawar is an occupational therapist and co-founder of Occupational Therapy OT. He focuses on clinical frameworks, assessment, and evidence-based practice.

All articles by Deepam →

This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.

Occupational Therapy Models of Practice: PEO, CMOP-E, PEOP, EHP, MOHO and Kawa