The Occupational Therapy Practice framework:

Domain & Process

The Occupational Therapy Practice framework

• an evolution of UniformTerminology III

• a broader document– Describes the profession's DOMAlN– Describes the PROCESS used to deliver services

Background—history of UT

• three editions (79, '89, '94)• Each evolved—purpose shifted• UT III reviewed in 1999 to determine need for

revision

What we found out...

• Knowledge has evolved—Practice has changed• Our language was unclear to external

audiences—and sometimes to ourselves• UT does not describe our focus on occupation

—the core of our profession• Consensus—it's time to change

Purpose of the Framework

• More clearly articulate OT's unique focus on daily life activities and interventions that promote engagement in occupations to support participation in context—

• Describe our• Give practitioners a way to think about, talk

about and apply occupation across the OT process-Outline an occupation based OT

Relationship of the domain and the process

• Domain outlines the area in which we provide services--

• Process describes the structural pieces (i.e. evaluation, intervention outcomes) we use when delivering services

• They are interdependent

Our domain...

• The area of human experience in which we offer assistance to others....

• We help others to engage in everyday life activities...or....

Occupation

• Defined as:• Activities., of everyday life, named, organized,

and given value and meaning by individual and a culture. Occupation is everything people do to occupy themselves, including looking after themselves,...enjoying life,...and contributing to the social and economic fabric of their communities...(Law, Polatajko, Baptiste, & Townsend, 1997, p. 32)

Domain of Occupational Therapy

Engagement in Occupation to Support Participation in Context

Performance in areas of occupation

Performance skills Performance patterns

Context Activity Demands Client Factors

Engagement in Occupation to Support Participation in Context

• The overarching phrase that describes the domain

Why was this phrase chosen?

• Engagement—recognizes choice, personal meaning, psychological/emotional and physical aspects of performance

• • Participation—an aspect of health in the ICF model, OTs contribution to health is in linking activities and participation through engaging in occupations

• • Context—supports and mediates engagement

Other aspects Of domain i.e. performance in areas of occupation, performance skills, performance patterns,

context, activity demands, client factors

• No one aspect more important than another• Ail aspects influence engagement in

occupations• OTs and OTAs consider all aspects during

evaluation and intervention process

Performance in Areas of Occupation

• Categories of occupation in which people engage

• Called performance areas in UTIII• Resorted and expanded from UTIII

Performance Skills—NEW

• Some Performance Components In• UT III were Performance Skills• Describes observed actions...lifts, chooses,

asks• 3 kinds of skills

-Motor skills-Process skills- Communication /Interaction skills

Performance in Areas of Occupation

• Activities of Daily Living (ADL)• Instrumental Activities of Daily Living (IADL)• Education• Work• Play• Leisure• Social Participation* (new)

Performance Patterns—NEW

• Habits• Routines• Roles• Performance patterns are recurring behaviors

related to daily routines

Performance Skills...

• Performance skill terms differentiate skilled action from underlying body functions

• Skills occur as transactions between the performer's body function/structure, the demands of the activity, and the context in which performance occurs

• Effective skill performance is not ensured by adequate underlying body functions or structures

Context

• Cultural (retained) • Physical (retained) • Social (retained)• Personal (resorted from UT III Temporal context—

refers to age, gender, educational & socio-economic status)

• Spiritual (new)• Temporal (resorted from UT HI Temporal context—

refers to time of day, year, stage of life etc.)• Virtual (new)

Activity Demands—NEW!

• Objects used and theirproperties

• Space Demands• Social Demands • Sequencing and Timing

• Required actions• Required body

functions• Required body

structures

Making OTs use of activity analysis explicit

Activity Demands

• Relate to a specific activity• Different than physical context and social

context

Client Factors—body functions & body structures

• Underlying physiological abilities or structures that reside in the person

• includes mental (affective, cognitive, perceptual), sensory, physical and physiological abilities

• Used classification from ICF— aligned with body systems

• Many included in UT as performance components

OT practice framework process

Occupational profile

Analysis of Occupational Performance

Intervention Plan

Intervention Implementation

Intervention Review

OutcomesEngagement in

occupations to support participation

What makes this process unique to OT?

• What is evaluated: occupational needs, problems, risks and concerns

• How the problem is framed: occupational performance—risks or difficulties with daily life tasks

• Type of intervention: use of selected therapeutic activities and occupations to facilitate engagement in occupation

• Outcome: directed toward facilitating engagement in occupation to support participation

Key points about the process

• Client-centered• Clients may be individuals, groups of

populations• Dynamic and interactive• Broad & inclusive of all practice areas• Context an embedded influence on the

process of service delivery• Grounded in occupation

The Occupational Profile...the initial step

• Describes client's occupational history, patterns of living, interests, values, and needs

• Identify client's priorities. What are client's needs, wants and concerns re: engaging in occupations

• Frame client concerns and issues within the domain of occupational therapy

Analysis of Occupational Performance

• More specifically identify underlying factors which support and hinder performance

-observe performance

-perform selected specific assessments if needed

-consider context, activity demands and client factors-identify client strengths & weaknesses

Intervention Plan

• Develop plan in collaboration with client• Base plan on:

--Selected theory and/or practice framework--Evidence

• Select intervention approach: create/promote, establish/restore, maintain, modify, prevent

• Target desired outcomes

Intervention

• • Action to influence and support performance• • Types of interventions• -Therapeutic use of self• -Therapeutic use of occupations/activities

Occupation-based activity, purposeful activity, preparatory methods

• -Consultation process• -Education process

Intervention Plan

• Review plan, process and progress towards outcomes

• Modify plan if needed • Determine futire action

Outcomes— Engagement in occupation to support participation

• Describes the broad outcome of the OT intervention process

• Links the outcome to the domain

Outcomes— Engagement in occupation to support participation

• Types of outcomes-Occupational performance-Client satisfaction-Role competence-Adaptation-Health and wellness —Prevention of performance problems-Quality of life

New terms.............Old terms Framework UT III

New Terms • Areas of occupation• Performance skills• Performance patterns• Context• Activity demands• Client Factors—body

functions, body structures• Outcomes

Old terms • Performance areas• Performance components• Not addressed• Performance context• Not addressed• Performance components• Not addressed

In SummaryThe Occupational Therapy Practice

Framework: Domain & Process• Affirms the profession's focus on engagement in occupation

to support participation as:• - an important aspect of health• - the broad outcome targeted by OT intervention• Describes and links the profession's domain and process• Emphasizes the profession's expertise in addressing

performance issues related to engaging in every day life occupations and activities. :

• incorporates terms more commonly used by other disciplines

• Adds constructs to the domain & updates terms throughout to reflect current knowledge and thinking

How the Framework can be used...

• Examine own practice in light of new ideas• Consider application to new settings and areas• Explain occupational therapy to others—

communicate our contribution to health• To teach about occupation centered practice