occupational therapy practice framework :domain & process 2nd edition

Domain & Process 2nd Edition

Occupational Therapy practice

Framework:

April 11, 2023 Mohsen Eslampanah 2


Outline

Introduction Domain of Occupational Therapy Process of Occupational Therapy Historical and Future perspectives on

the Occupational Therapy Practice Framework

April 11, 2023 4

Introduction

AOTA (AJOT) Promoting the health and participation of clients

through engagement in occupation. Not a Taxonomy, Theory, Model must be used in conjunction with the

knowledge and evidence relevant to occupation and occupational therapy.

Mohsen Eslampanah

April 11, 2023Mohsen Eslampanah5

All people need to be able or enabled to engage in the occupations of their need and choice, to grow through what they do, and to experience independence or interdependence, equality, participation, security, health, and well-being.Wilcock & Townsend, 2008, p. 198

Core beliefs


Client

1. Persons 2. Organizations3. Populations within a community


Persons

including families, caregivers, teachers, employers, and relevant others.


Organization

businesses, industries, or agencies


Populations

refugees, veterans who are homeless, and people with chronic health disabling conditions. Moyers & Dale,2007

April 11, 2023 11Mohsen Eslampanah

Performance of

Occupations

Client

Client’s Occupations

Context and environment

The domain and Process of occupational therapy direct OT practitioners to focus on …


Occupational Therapy’s Domain

Supporting health and participation in life through engagement in occupation

EVALUATION

INTERVENTION


Occupation = Everyday activity

Occupational Therapy’s Domain

Performance

Subjective

Emotional psychological

Objective

Physically observable

Holistic perspect

ive


Occupational science

An interdisciplinary academic discipline in the social and behavioral sciences dedicated to the study of the

form, function, and the meaning of human occupations.

Zemke & clark, 1996


Occupation & activity

Occupation

activity


Co-occupations

Occupations often are shared.Example:1. Care giving => mothering


Occupational justice

“Justice related to opportunities and resources required for occupational

participation sufficient to satisfy personal needs and full citizenship”

christiansen & Townsend,2004, p 278.

TO experience meaning and enrichment in one’s occupations TO participate in a range of occupations for health and social inclusion

TO make choices and share decision-making power in daily life TO receive equal privileges for diverse participation in occuapations

Townsend & wilcock, 2004.


Aspects of Occupational Therapy’s Domain


Areas of Occupation

Activities of daily living(ADL) Instrumental activities of daily living (IADL) Rest and sleep Education Work Play Leisure Social participation

Areas of Occupation


ADLs

Care of one’s own bodyBADL or PADLFundamental to living in a social

world

Areas of Occupation


ADLs

Bathing, showerin

g Bowel

and bladder manage

ment

Dressing

Eating

FeedingFunction

al mobility

Personal device

care

Personal hygiene

and grooming

Sexual activity

Toilet hygiene

Areas of Occupation


IADLs

Care of others

Care of pets

Child rearing

Communication management

Community mobility

Financial managementHealth

management and

maintenance

Home establishment

and management

Meal preparati

on and cleanup

Religious observance

Safety and emergency

maintenance

shopping

Areas of Occupation


Rest and

Sleep

rest

sleep

Sleep preparation

Sleep participation

Areas of Occupation


Education

Formal education

participation

Informal personal

educational needs or interests

exploration

Informal personal education

participation

Areas of Occupation


Work

Employment interests and

pursuits

Employment seeking and acquisition

Job performance

Retirement preparation

and adjustment

Volunteer exploration

Volunteer participation

Areas of Occupation


Play

Play exploration

Play participation

leisure

Leisure exploration

Leisure participation

Areas of Occupation


Social participation

community

familyPeer, friend

Areas of Occupation


Client factors

Specific abilities, characteristics, or beliefs

May affect performance in areas of occupation.

Client

factors

Values, beliefs, spiritua

lty

Body functio

ns

Body structur

es


Client factors(Values, beliefs, and spirituality)

Pers

on • Values: Principles,

standards, or qualities considered worthwhile or desirable by the client who holds them.

• Beliefs: Cognitive content held as true.

• Spirituality: The “personal quest for understanding answers to ultimate questions about life, about meaning, and the sacred”

Org

an

izati

on • Vision

statement• Code of

ethics• Value

statement• Esprit de

corps

Pop

ula

tion • Emotional

, purposive, and traditional perspectives


Client factors (body Functions)Pe

rson • Physiological

function of body systems

• Mental functions• Sensory functions

and pain• Neuromusculoskelet

al and movement-related functions

• Cardiovascular, hematological, immunological, and respiratory system function

• Voice and speech functions

• Skin and related-structure function

Org

an

izati

on • Planning• Organizing• Coordinating• And

operationalizing the mission, products or services , and productivity

Pop

ula

tion • Economic

• Political• Social• And cultural

capital


Client factors (body structures)Pe

rson • Anatomical

parts of the body such as organs, limbs, and their components

Org

an

izati

on • Department and departmental relationships

• Leadership and management,

• Performance measures,

• And job titles.

Pop

ula

tion • Similar

genetics,• Sexual

orientation• And health-

related conditions


Activity Demands

Acti

vit

y

Dem

an

ds

Object and their properties

Space demands

Social demands

Sequence and timing

Required actions and performance skills

Required body function

Required body structure


Performance Skills

Observable, concrete, goal directed actions to engage in

daily life occupations


Motor and praxis skills

Sensory-perceptual skills

Emotional regulation skills

Cognitive skills

Communication and social skills

Performance skills

Performance skills


Performance patterns

HabitsSpecific, automatic behaviors

that can be useful, dominating, or impoverished

RoutinesEstablished sequences of

occupations or activities that provide a structure for daily

life.

RolesSets of behaviors expected by

society, shaped by culture, and may be further

conceptualized and defined by the client.

RitualsSymbolic actions with spiritual, cultural, or social meaning that

contribute to the client’s identity and reinforce the

client’s values and beliefs.

Performance patterns


Context and environment

Context• Cultural: customs, beliefs, activity patterns, behavior standards, and expectation accepted by the

society

• Personal: demographic feature of the individual such as age, gender, socioeconomic status, and

educational level • Temporal: stage of life, time of day or year, duration, rhythm of activity, or

history.

• Virtual: interaction in simulated, real-time, or near time situations absent of physical contact.Environment

• Physical: natural and built nonhuman environment and objects in them. • Social: relationships, and expectations of persons, groups, and organizations


Process of service delivery

Evaluation

• Occupational profile• Analysis of occupational performance

interventio

n

• Intervention plan• Intervention implementation• Intervention review

Outcomes

• outcomes

April 11, 2023 38Mohsen Eslampanah

Occupational Therapy’s Process


CLINICAL REASONING ENABLES OCCUPATIONAL THERAPY PRACTITIONER TO:

1. Identify the Multiple demands, skills, and potential meanings of activity

2. Gain a deeper understanding of the interrelationships between aspects of the domain that affect performance and those that will support client-centered interventions and outcomes.

Clinical reasoning


Who is the client ? Why in the client seeking services, and what are the

client’s current concerns relative to engaging in occupations and in daily life activities?

What area of occupation are successful, and what areas are causing problems or risks?

What context and environments support or inhibit participation and engagement in desired occupations?

What is the client’s occupational history? What are the client’s priorities and desired outcomes?

Occupational profile Questions


Synthesizing information from the occupational profile Observing the client’s performance during activities Selecting and using specific assessments to measure performance

skills and performance patterns, Selecting assessments, to identify and measure more specifically

contexts or environments, activity demands, and client factors Interpreting the assessment data Developing and refining hypotheses about the client’s occupational

performance strengths and limitations; Creating goals Determining procedures to measure the outcomes of intervention Delineating a potential intervention approach or approaches based

on best practices and available evidence.

Analysis of occupational performance


Planning steps:

1. Developing the plan Objective and measurable goals with a

timeframe Occupational therapy intervention

approaches Mechanisms for service delivery

2. Considering potential discharge needs and plans

3. Selecting outcome measures4. Making recommendation or referral

to others as needed.


Create, promote (health promotion)

Establish, restore (remediation, restoration)

Maintain

Modify (compensation, adaptation)

prevent

Occupational therapy intervention

approaches

Occupational therapy

intervention approaches


Implementation steps:

1. Determining and carry out the type of OT intervention

2. Monitoring the client’s response to interventions


Types of occupational therapy interventions

Types of occupational

therapy interventions

Therapeutic use of

self

Therapeutic use of

occupation and

activities

Occupation-based

intervention

Purposeful activity

Preparatory

methods

Consultation

process

Education process Advocacy


1. Re-evaluating the plan2. Modify the plan3. Determining the need for

continuation or discontinuation of OT services

Review steps


Selecting types of outcomes and

measures

• Occupational performance

• Adaptation• Health and wellness• participation• prevention• Self-advocacy• Quality of life• Occupational justice• Role competence

Using outcomes to measure progress and

adjust goals and interventions

• Comparing progress toward goal achievement

• Assessing outcome use and results to make decisions about the future direction of intervention

Outcomes process steps:


Reference

American Occupational Therapy Association: Occupational therapy practice

framework: domain and process, 2nd edition,

am j Occup Ther 62:625-683, 2008

occupational therapy practice framework :domain & process 2nd edition

Health & Medicine