Practice Update

PEAR TREE™️ Model

A shared participation framework for practice

A quote appears at the top of the image: “The PEAR TREE Model and Framework (Smith 2025) can be introduced as an explicit guide that helps practitioners apply fidelity in neuro affirming, co production with clarity, compassion, and real world practicality.” Smith et al (2026). Below the quote is a circular diagram titled “PEAR TREE Framework & Iterative Cycle co production in support of ‘meaning making’.” The outer ring is divided into four coloured segments labelled Person, Environment, Activity, and Relational Response. Inside this ring is a continuous circular cycle with arrows moving clockwise. The stages read: Evaluation and Observation, New Sensory Opportunities, Psychoeducation and coaching, and Reflection. The arrows visually demonstrate an ongoing, dynamic process rather than a linear pathway. At the bottom of the image it reads: Smith, Crowfoot and Morton, 2025. In an Ayres Sensory Integration context, the image represents a whole system participation framework. It shows how sensory integration and processing is considered alongside environment, activity demands, and relational context. The iterative cycle reflects assessment, co produced planning, graded sensory opportunities, psychoeducation, and reflective adaptation to support meaningful participation across the lifespan.

PEAR TREE™️ is a practical framework for understanding and supporting participation. It brings together sensory integration and processing, everyday activity, environment, and relationship, so we can stop guessing and start making support fit real life. PEAR TREE links to practice informed by Ayres’ theory of sensory integration, while also remaining usable across teams, settings, and everyday contexts.

If you have ever found yourself thinking, “We have tried everything, but it still is not working”, PEAR TREE offers a different starting point. It helps us look beyond surface behaviour and asks a more useful question: what is happening in the mind, body, brain connection, in this environment, with these demands, and in these relationships, right now?

PEAR TREE™️ was created by occupational therapist Kathryn Smith, initially for work with families and then shared in teaching. It is a adaptation of the PEO and PE-OP models, to build on their wisdom, but like all innovation to extend and deepen use in line with clinical need. They are to be used by everyone: people receiving support, families, therapists, educators, health teams, and service leaders. It is simple enough to share, and deep enough to hold complexity.

Why PEAR TREE™️ is needed

Many systems still place the weight of change on the person. The plan focuses on what the person should do differently, while the environment stays the same, the activity demands stay the same, and the relational approach stays the same.

PEAR TREE™️ shifts that.

It assumes that responses make sense, even when they look confusing from the outside. It helps us see how sensory integration and processing, stress physiology, context, and human connection shape what is possible. And it keeps the focus where it belongs: participation, dignity, and a life that feels more doable.

What PEAR TREE™️ is about:

PEAR helps us understand the participation picture for each person:

TREE helps us turn understanding into lived action

Triage
What needs to change first to reduce threat and make a starting point possible?

Relational
How do we use our intentional relationship and in co-production so support is owned, usable, and respectful?

Embodied Evaluation
How do we measure progress in ways that reflect lived experience, not just paperwork?

Ethical
How do we protect rights, reduce harm, and ensure the system adapts too – in a way that is pragmatic to achieve specific, real-world outcomes?

This is a framework that keeps sensory integration inside everyday practice

PEAR TREE™️ is not a replacement for professional assessment or discipline-specific expertise. It is a shared structure that makes it easier to work together and to keep sensory integration within our professional reasoning.

PEAR TREE™️ also helps protect fidelity. It wraps around fidelity to Ayres’ Sensory INnegration®️ by supporting the important distinction between

This ensures fidelity to practice informed by Ayres’ theory of sensory integration rather than diluted into generic advice.

Co-production is not an add-on, it is the method

PEAR TREE™️ works best when it is built with the person, not applied to them.

Co-production means we create shared meaning, shared language, and shared tools together. This is where visual tools can help, because they allow the person’s lived experience to lead the plan.

These are not just resources. They become shared maps for communication, decision-making, and evaluation.

A quote appears at the top of the image: “The PEAR TREE Model and Framework (Smith 2025) can be introduced as an explicit guide that helps practitioners apply fidelity in neuro affirming, co production with clarity, compassion, and real world practicality.” Smith et al (2026). Below the quote is a circular diagram titled “PEAR TREE Framework & Iterative Cycle co production in support of ‘meaning making’.” The outer ring is divided into four coloured segments labelled Person, Environment, Activity, and Relational Response. Inside this ring is a continuous circular cycle with arrows moving clockwise. The stages read: Evaluation and Observation, New Sensory Opportunities, Psychoeducation and coaching, and Reflection. The arrows visually demonstrate an ongoing, dynamic process rather than a linear pathway. At the bottom of the image it reads: Smith, Crowfoot and Morton, 2025. In an Ayres Sensory Integration context, the image represents a whole system participation framework. It shows how sensory integration and processing is considered alongside environment, activity demands, and relational context. The iterative cycle reflects assessment, co produced planning, graded sensory opportunities, psychoeducation, and reflective adaptation to support meaningful participation across the lifespan.

PEAR TREE™️ in action:

A person is described as “refusing” or “not engaging” in going to school.

PEAR TREE™️ helps us slow down and see what is really going on.

The Person may be exhausted, overloaded, or struggling with sensory discrimination and perception differences. The Environment may be noisy, bright, unpredictable, or socially heavy and dense. The Activity may involve too many steps, too much language, or too many transitions. The Relational approach may feel rushed, conditional, or unsafe.

When we map this, the response stops looking like a “problem attitude”. It starts to look like a sensible protective response.

Then TREE guides us to a new plan: reduce sensory threat, adjust the activity demands, change how support is offered, build a shared tool, and measure what changes in the body and in participation over time.

Where to go next

If this is your first read, you do not need to understand everything today. Start with the parts that feel most relevant.

What Next:

PEAR TREE™️ is an invitation to slow down, become more precise, and work in a way that feels more human. It is a framework that honours the sensory body, protects dignity, and makes participation the outcome.

If you would like support to embed PEAR TREE in your team, explore our training and implementation resources, or begin by trying one small PEAR map with a person you support this week.

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