The Occupational Therapy Practice Framework:

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The Occupational Therapy Practice Framework

• Domain Process
• Prepared by AOTAs
• Commission on Practice
• Presented by
• Mary Jane Youngstrom MS,OTR, FAOTA
• 
  

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What is the OT Practice Framework?

• A richer more focused description of occupational
  therapya new document
• Adopted by the RA in May 2002
• Replaces UT III

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Why is it important?

• Reflects changes in knowledge
• Emphasizes the professions focus on occupation
• Reflects updated language. Provides links to
  World Health Organizations International
  Classification of Functioning (ICF) language

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The ICF

• A classification which provides common language
  to describe health and health related states

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ICF Components
Body Functions Structures
Activities Participation
Environmental Factors
Barriers Facilitators
Functions Structures
Capacity Performance
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How does OT fit into this classification?

• OT considers all aspects of classification when
  delivering services
• OT strength lies in linking activities to
  participation within context

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Purpose of the Framework

• ... A two fold purpose

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Purpose of the Framework

• Describe our DOMAIN
• More clearly articulate OTs unique focus on
  daily life activities and interventions that
  promote engagement in occupations to support
  participation in context.
• Outline an occupation based OT PROCESS
• Give practitioners a way to think about, talk
  about and apply occupation across the OT process

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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

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Why is it important to be clear about our domain
and process

• ?????

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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
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Our domain

• The area of human experience in which we offer
  assistance to others.
• We help others to engage in everyday life
  activitiesor.
  OCCUPATIONS

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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)

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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
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Engagement in Occupation to support Participation
in Context

• The overarching phrase that describes the domain

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Why was this phrase chosen?

• Engagementrecognizes choice, personal meaning,
  psychological/emotional and physical aspects of
  performance
• Occupationa vital force in regaining and
  promoting health
• Participationan aspect of health in the ICF
  model. By facilitating engagement in occupations
  OTs link activities to participation
• Contextsupports and mediates engagement

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Performance inAreas of Occupation

• Categories of occupation in which people engage
• Called performance areas in UT III
• Resorted and expanded from UT III

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Performance in Areas of Occupation

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

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Performance SkillsNEW!

• Describes observed actionslifts, chooses, asks
• 3 kinds of skills
• Motor skills
• Process skills
• Communication /Interaction skills

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Performance Skills

• Performance skill terms differentiate skilled
  action from underlying body functionsa different
  vocabulary. Provide a language link to engaging
  in occupations.
• Effective skill performance is not ensured by
  adequate underlying body functions or structures.

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Performance PatternsNEW!

• Habits
• Routines
• Roles
• Performance patterns are recurring behaviors
  related to daily routines

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Context

• Cultural (retained)
• Physical (retained)
• Social (retained)
• Personal (resorted from UT III Temporal
  contextrefers to age, gender, educational
  socio-economic status)
• Spiritual (new)

• Temporal (resorted from UT III Temporal
  contextrefers to time of day, year, stage of
  life etc.)
• Virtual (new)

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Activity DemandsNEW!

• Objects used and their properties
• Space Demands
• Social Demands
• Sequencing and Timing

• Required actions
• Required body functions
• Required body structures

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Activity Demands

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

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Client Factorsbody 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 ICFaligned with body
  systems
• Many included in UT as performance components

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O.T. Practice Framework Process
Intervention Plan
Occupational Profile
Outcomes Engagement in Occupation to
support Participation
Intervention Review
Analysis of Occupational Performance
Intervention Implementation
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What makes this process unique to OT?

• What is evaluated occupational needs, problems,
  risks and concerns
• How the problem is framed occupational
  performancerisks 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

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Key points about the process

• Client-centered
• Clients may be individuals, groups or populations
• Dynamic and interactive
• Broad inclusive of all practice areas
• Context an embedded influence on the process of
  service delivery
• Grounded in occupation

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The Occupational Profilethe initial step

• Describes clients occupational history, patterns
  of living, interests, values, and needs
• Identify clients priorities. What are clients
  needs, wants and concerns re engaging in
  occupations
• Frame client concerns and issues within the
  domain of occupational therapy

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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

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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

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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

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Intervention Review

• Review plan, process and progress toward outcomes
• Modify plan if needed
• Determine future action

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Outcomesengagement in occupation to support
participation

• Describes the broad outcome of the OT
  intervention process
• Links the outcome to the domain

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Outcomesengagement in occupation to support
participation

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

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Integrating the domain and processapplying the
framework (in practice)

• Focus on the client as an occupational
  beingstart your eval with the occupational
  profile. Document it
• When thinking about performance look at all
  facilitators and barriers i.e. perf skills,
  patterns, context, activity demands and client
  factors
• Describe performance with skill language. Do not
  confuse skills with client factors in either your
  evaluation or intervention actions

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Integrating the domain and the process

• CASES

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Brandipediatric early intervention

• Age2 years, 6 months
• Reason for referraldetermine if OT services are
  needed
• Medical historyhealth
• Family history--unremarkable

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BrandiEvaluation and impressions

• Impression
• Performance skills ?
• Performance patterns ?
• Context ?
• Activity demands ?
• Client factors
• Slight speech and language delays
• Age appropriate fine and gross motor skills
• Age appropriate cognitive skills
• CONCLUSIONno therapy needed

• Assessments
• Bayley Scale of Infant Developmentscored 30-32
  months

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BrandiEvaluation at 3 yr 3 mo

• Assessments
• Classroom and playground observation
• Teacher interview
• Sensory history
• Occupational profile
• Peabody Development Motor Scales

• Impression
• --Perf patternssticks to familiar activities
• -- Context--Difficulty in multisensory
  environment. Social demands often overwhelming
• --Activity demandsdifficulty with new tasks
• --Client factorssensory sensitivities, language
  delays, dyspraxia, vestibular-proprioceptive
  process difficulties

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Concerns regarding PARTICIPATION

• Mothers stated concerns
• I wish she could play more easily with her
  sister

• Teachers stated concerns
• I wish her peers could be more accepting,
  support her, and play with her more.

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Brandi--Intervention

• Approachmodify context and activity demands to
  support performance at home and school.
  Create/promote opportunities for play
• Contextprovide quiet calm social context. Make
  physical context clutter free. Minimize
  environmental changes i.e. seat assignments
• Activity demandsuse visual cues. Break down into
  steps. Select activities with deep pressure and
  proprioceptive properties

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BrandiEngagement in occupations to support
participation--OUTCOMES

• Mom states that Brandi is fine now. She plays
  very well with her sister
• Teacher states that Brandi performs better in
  classroom when activities match her needs.
  Interacting more appropriately with peers.

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• What did you notice?

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Integrating the domain and processapplying the
framework

• Focus on the client as an occupational
  beinginclude an occupational profile in your
  evaluation. Document it
• When thinking about performance issues look at
  all facilitators and barriers i.e. Perf. Skills
  patterns, context, activity demands and client
  factors
• Differentiate between performance skills and
  client body functions or capacities

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Integrating the domain and processapplying the
framework

• Observe performance
• Target goals towards outcomes that will lead to
  participation in daily life contexts

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In summaryThe Occupational Therapy Practice
Framework Domain and Process

• Affirms the professions focus on engagement in
  occupation to support participation as an
  important aspect of health
• Describes and links the professions domain and
  process

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In summaryThe Occupational Therapy Practice
Framework Domain and Process

• Incorporates terms more commonly used by other
  disciplines
• Adds constructs to the domain updates terms
  throughout to reflect current knowledge and
  thinking

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Using the framework can help you to.

• Shift the focus of your practice and clarify your
  special contribution
• Add to your vocabulary new and updated
  terminology and language! (i.e. performance
  patterns, performance skills)
• Change what you document to make your
  contribution more occupation based
• Make your practice more client centered