6. The Occupational Therapy Practice framework

The Occupational Therapy Practice
framework:
Domain & Process
The Occupational Therapy Practice
framework
• an evolution of Uniform
Terminology 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
Context
Performance patterns
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 their
properties
• 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
Intervention
Review
Outcomes
Analysis of
Occupational
Performance
Intervention
Implementation
Intervention
Plan
Engagement 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 Summary
The 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