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OTFramework2ndEditionCover 8/22/08 1:25 PM Page 2
FRAMEWORK:
Domain &2nd
Process
Edition
Contents INTRODUCTION
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .625
Domain of Occupational Therapy . . . . . . . . . . . . . . . . . . . .626 The Occupational Therapy Practice Framework: Domain and Process, 2nd
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .626
Supporting Health and Participation in Life Edition (Framework–II) is an official document of the American
Through Engagement in Occupation . . . . . . . . . . .628
Areas of Occupation . . . . . . . . . . . . . . . . . . . . . . . . . .630 Occupational Therapy Association (AOTA). Intended for internal and
Client Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .630
Activity Demands . . . . . . . . . . . . . . . . . . . . . . . . . . . .634
external audiences, it presents a summary of interrelated constructs that
Performance Skills . . . . . . . . . . . . . . . . . . . . . . . . . . .639
Performance Patterns . . . . . . . . . . . . . . . . . . . . . . . . .641
define and guide occupational therapy1 practice. The Framework was
Context and Environment . . . . . . . . . . . . . . . . . . . . . .642 developed to articulate occupational therapy’s contribution to promot-
Process of Occupational Therapy . . . . . . . . . . . . . . . . . . . .646
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .646 ing the health and participation of people, organizations, and popula-
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .649
Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .652 tions through engagement in occupation. It is not a taxonomy,
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .660
Historical and Future Perspectives on the Occupational theory, or model of occupational therapy and therefore must be used in
Therapy Practice Framework . . . . . . . . . . . . . . . . . . .664
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .667
conjunction with the knowledge and evidence relevant to occupation
Tables and Figures
Table 1. Areas of Occupation . . . . . . . . . . . . . . . . . . .631
and occupational therapy. The revisions included in this second edition
Table 2. Client Factors . . . . . . . . . . . . . . . . . . . . . . . .634 are intended to refine the document and include language and concepts
Table 3. Activity Demands . . . . . . . . . . . . . . . . . . . . .638
Table 4. Performance Skills . . . . . . . . . . . . . . . . . . . .640 relevant to current and emerging occupational therapy practice.
Table 5A. Performance Patterns—Person . . . . . . . . .643
Table 5B. Performnance Patterns—Organization . . . .643 Implicit within this summary are the profession’s core beliefs in the pos-
Table 5C. Performance Patterns—Population . . . . . .644
Table 6. Contexts and Environments . . . . . . . . . . . . .645 itive relationship between occupation and health and its view of people as
Table 7. Operationalizing the Occupational Therapy
Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .648
occupational beings. “All people need to be able or enabled to engage in the
Table 8. Types of Occupational Therapy
Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .653
occupations of their need and choice, to grow through what they do, and
Table 9. Occupational Therapy Intervention to experience independence or interdependence, equality, participation,
Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .657
Table 10. Types of Outcomes . . . . . . . . . . . . . . . . . . .662 security, health, and well-being” (Wilcock & Townsend, 2008, p. 198).
Table 11. Summary of Significant Framework
Revisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .665 With this aim, occupational therapy is provided to clients, the entity that
Figure 1. Occupational Therapy’s Domain . . . . . . . . .627
Figure 2. Occupational Therapy’s Process . . . . . . . . .627 receives occupational therapy services. Clients may be categorized as
Figure 3. Occupational Therapy . . . . . . . . . . . . . . . . .627
Figure 4. Aspects of Occupational Therapy’s
• Persons, including families, caregivers, teachers, employers, and
Domain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .628
Figure 5. Process of Service Delivery . . . . . . . . . . . .646
relevant others;
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .669 • Organizations, such as businesses, industries, or agencies; and
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .676
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .681 • Populations within a community, such as refugees, veterans who
Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .683
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .684 are homeless, and people with chronic health disabling condi-
Copyright © 2008, by the American Occupational Therapy tions (Moyers & Dale, 2007).
Association. When citing this document the preferred reference
is: American Occupational Therapy Association. (2008). The Framework is divided into two major sections: (1) the domain,
Occupational therapy practice framework: Domain and process
(2nd ed.). American Journal of Occupational Therapy, 62,
which outlines the profession’s purview and the areas in which its mem-
625–683.
Many of the terms that appear in bold are defined in the glossary.
1
2When the term occupational therapy practitioner is used in this document, it refers to occupational therapists and occupa-
tional therapy assistants (AOTA, 2006).
626 November/December 2008, Volume 62, Number 6
Practice Framework 2nd Edition 8/22/08 1:32 PM Page 627
CONTEXT ENVIRONMENT
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Health and
Participation in Life
Through Engagement in
Occupation
Note: Mobius in figures 1 and 3 originally designed by Mark Dow. Used with permission.
individuals; these activities meet human dence, occupational therapy practitioners consid-
needs for self-care, enjoyment, and partici- er a client as independent whether the client sole-
pation in society” (Crepeau, Cohn, & ly performs the activities, performs the activities
Schell, 2003, p. 1031). in an adapted or modified environment, makes
• “Activities that people engage in throughout use of various devices or alternative strategies, or
their daily lives to fulfill their time and give oversees activity completion by others (AOTA,
life meaning. Occupations involve mental 2002a). For example, people with a spinal cord
abilities and skills and may or may not have injury can direct a personal care assistant to assist
an observable physical dimension” (Hinojosa them with their activities of daily living (ADLs),
& Kramer, 1997, p. 865). demonstrating independence in this essential
• “[A]ctivities…of everyday life, named, orga- aspect of their lives.
nized, and given value and meaning by indi- Occupations often are shared. Those that
viduals and a culture. Occupation is everything implicitly involve two or more individuals may be
people do to occupy themselves, including termed co-occupations (Zemke & Clark, 1996).
looking after themselves…enjoying life…and Care giving is a co-occupation that involves active
contributing to the social and economic participation on the part of the caregiver and the
fabric of their communities” (Law, Polatajko, recipient of care. For example, the co-occupations
Baptiste, & Townsend, 1997, p. 32). required during mothering, such as the socially
• “A dynamic relationship among an occupa- interactive routines of eating, feeding, and com-
tional form, a person with a unique devel- forting, may involve the parent, a partner, the
opmental structure, subjective meanings child, and significant others (Olsen, 2004). The
and purpose, and the resulting occupational activities intrinsic to this social interaction are
performance” (Nelson & Jepson-Thomas, reciprocal, interactive, and nested “co-occupa-
2003, p. 90). tions” (Dunlea, 1996; Esdaile & Olson, 2004).
• “[C]hunks of daily activity that can be Clients also may perform several occupations
named in the lexicon of the culture” (Zemke simultaneously, enfolding them into one another
& Clark, 1996, p. vii). such as when a caregiver concurrently helps with
Sometimes occupational therapy practitioners homework, pays the bills, and makes dinner.
use the terms occupation and activity interchange- Consideration of co-occupation supports an inte-
ably to describe participation in daily life pursuits. grated view of the client’s engagement in relation-
Some scholars have proposed that the two terms ship to significant others within context.
are different (Christiansen & Townsend, 2004; Occupational therapy practitioners recognize
Hinojosa & Kramer, 1997; Pierce, 2001; Reed, that health is supported and maintained when
2005). In the Framework, the term occupation clients are able to engage in occupations and activi-
encompasses activity. ties that allow desired or needed participation in
Occupational engagement occurs individually home, school, workplace, and community life.
or with others. A client may be considered inde- Thus, occupational therapy practitioners are con-
pendent when the client performs or directs the cerned not only with occupations but also the com-
actions necessary to participate regardless of the plexity of factors that empower and make
amount or kind of assistance desired or required. possible clients’ engagement and participation in
In contrast with narrower definitions of indepen- positive health-promoting occupations (Wilcock &
Townsend, 2008). In 2003, Townsend applied the Individual differences in the way in which
concept of social justice to occupational therapy’s clients view their occupations reflect the com-
focus and coined the term occupational justice to plexity and multidimensionality of each occupa-
describe the profession’s concern with ethical, moral, tion. The client’s perspective of how an occupa-
and civic factors that can support or hinder health- tion is categorized varies depending on that
promoting engagement in occupations and partici- client’s needs and interests. For example, one per-
pation in home and community life. Occupational son may perceive doing laundry as work, while
justice ensures that clients are afforded the opportu- another may consider it an instrumental activity
nity for full participation in those occupations in of daily living (IADL). One population may
which they choose to engage (Christiansen & engage in a quiz game and view their participa-
Townsend, 2004, p. 278). Occupational therapy tion as play, while another population may engage
practitioners interested in occupational justice recog- in the same quiz game and view it as an educa-
nize and work to support social policies, actions, and tional occupation.
laws that allow people to engage in occupations that The way in which clients prioritize engagement
provide purpose and meaning in their lives. in areas of occupation may vary at different times.
Occupational therapy’s focus on engaging in For example, a community psychiatric rehabilita-
occupations and occupational justice comple- tion organization may prioritize member voter reg-
ments the World Health Organization’s (WHO) istration during a presidential campaign and cele-
perspective of health. WHO, in its effort to bration preparations during holiday periods. The
broaden the understanding of the effects of dis- extent and nature of the engagement is as impor-
ease and disability on health, has recognized that tant as the engagement itself; for example, excessive
health can be affected by the inability to carry out work without sufficient regard to other aspects of
activities and participate in life situations caused life such as sleep or relationships places clients at
by environmental barriers, as well as by problems risk for health problems (Hakansson, Dahlin-
that exist with body structures and body func- Ivanoff, & Sonn, 2006).
tions (WHO, 2001). As members of a global
Client Factors
community, occupational therapy practitioners
advocate for the well-being of all persons, groups, Client factors are specific abilities, characteristics,
and populations with a commitment to inclusion or beliefs that reside within the client and may
and nondiscrimination (AOTA, 2004c). affect performance in areas of occupation. Because
occupational therapy practitioners view clients
holistically, they consider client factors that involve
Areas of Occupation
the values, beliefs, and spirituality; body functions;
When occupational therapy practitioners work and body structures. These underlying client fac-
with clients, they consider the many types of occu- tors are affected by the presence or absence of ill-
pations in which clients might engage. The broad ness, disease, deprivation, and disability. They
range of activities or occupations are sorted into cat- affect and are affected by performance skills, per-
egories called “areas of occupation”—activities of formance patterns, activity demands, and contex-
daily living, instrumental activities of daily liv- tual and environmental factors.
ing, rest and sleep, education, work, play, leisure, Despite their importance, the presence or
and social participation (see Table 1). absence of specific body functions and body
n REST AND SLEEP fort and safety of others such as the family • Retirement preparation and adjust-
Includes activities related to obtaining while sleeping. ment—Determining aptitudes, developing
restorative rest and sleep that supports interests and skills, and selecting appropri-
n EDUCATION
healthy active engagement in other areas of ate avocational pursuits.
occupation. • Volunteer exploration—Determining
Includes activities needed for learning and
• Rest—Quiet and effortless actions that community causes, organizations, or
participating in the environment.
interrupt physical and mental activity result- opportunities for unpaid “work” in relation-
• Formal educational participation— ship to personal skills, interests, location,
ing in a relaxed state (Nurit & Michel, 2003,
Including the categories of academic (e.g., and time available.
p. 227). Includes identifying the need to
math, reading, working on a degree),
relax; reducing involvement in taxing physi- • Volunteer participation—Performing
nonacademic (e.g., recess, lunchroom, hall-
cal, mental, or social activities; and engag- unpaid “work” activities for the benefit of
way), extracurricular (e.g., sports, band,
ing in relaxation or other endeavors that identified selected causes, organizations, or
cheerleading, dances), and vocational (pre-
restore energy, calm, and renewed interest facilities.
vocational and vocational) participation.
in engagement.
n PLAY
• Informal personal educational needs
• Sleep—A series of activities resulting in
or interests exploration (beyond for-
going to sleep, staying asleep, and ensur-
mal education)—Identifying topics and “Any spontaneous or organized activity that
ing health and safety through participation
methods for obtaining topic-related infor- provides enjoyment, entertainment, amuse-
in sleep involving engagement with the
mation or skills. ment, or diversion” (Parham & Fazio, 1997,
physical and social environments.
• Informal personal education participa- p. 252).
• Sleep preparation—(1) Engaging in
tion—Participating in classes, programs, • Play exploration—Identifying appropri-
routines that prepare the self for a comfort-
and activities that provide instruction/training ate play activities, which can include explo-
able rest, such as grooming and undress-
in identified areas of interest. ration play, practice play, pretend play,
ing, reading or listening to music to fall
games with rules, constructive play, and
asleep, saying goodnight to others, and
n WORK
symbolic play (adapted from Bergen,1988,
meditation or prayers; determining the time
pp. 64–65).
of day and length of time desired for sleep- Includes activities needed for engaging in
ing or the time needed to wake; and estab- • Play participation—Participating in play;
remunerative employment or volunteer
lishing sleep patterns that support growth maintaining a balance of play with other
activities (Mosey, 1996, p. 341).
and health (patterns are often personally areas of occupation; and obtaining, using,
• Employment interests and pursuits— and maintaining toys, equipment, and sup-
and culturally determined). Identifying and selecting work opportunities plies appropriately.
(2) Preparing the physical environment for based on assets, limitations, likes, and dis-
periods of unconsciousness, such as mak-
n LEISURE
likes relative to work (adapted from Mosey,
ing the bed or space on which to sleep; 1996, p. 342).
ensuring warmth/coolness and protection; • Employment seeking and acquisition— “A nonobligatory activity that is intrinsically
setting an alarm clock; securing the home, Identifying and recruiting for job opportuni- motivated and engaged in during discre-
such as locking doors or closing windows ties; completing, submitting, and reviewing tionary time, that is, time not committed
or curtains; and turning off electronics or appropriate application materials; preparing to obligatory occupations such as work,
lights. for interviews; participating in interviews and self-care, or sleep” (Parham & Fazio, 1997,
• Sleep participation—Taking care of per- following up afterward; discussing job bene- p. 250).
sonal need for sleep such as cessation of fits; and finalizing negotiations. • Leisure exploration—Identifying inter-
activities to ensure onset of sleep, napping, • Job performance—Job performance ests, skills, opportunities, and appropriate
dreaming, sustaining a sleep state without including work skills and patterns; time leisure activities.
disruption, and nighttime care of toileting management; relationships with co-work- • Leisure participation—Planning and
needs or hydration. Negotiating the needs ers, managers, and customers; creation, participating in appropriate leisure activities;
and requirements of others within the social production, and distribution of products maintaining a balance of leisure activities
environment. Interacting with those sharing and services; initiation, sustainment, and with other areas of occupation; and obtain-
the sleeping space such as children or part- completion of work; and compliance with ing, using, and maintaining equipment and
ners, providing nighttime care giving such work norms and procedures. supplies as appropriate.
as breastfeeding, and monitoring the com-
Note. Some of the terms used in this table are from, or adapted from, the rescinded Uniform Terminology for Occupational Therapy—Third Edition (AOTA, 1994,
pp. 1047–1054).
structures do not necessarily ensure a client’s suc- • Body functions refer to the “physiological func-
cess or difficulty with daily life occupations. tion of body systems (including psychological
Factors that influence performance such as sup- functions)” (WHO, 2001, p. 10). Examples
ports in the physical or social environment may include sensory, mental (affective, cognitive,
allow a client to manifest skills in a given area perceptual), cardiovascular, respiratory, and
even when body functions or structure are absent endocrine functions (see Table 2 for complete
or deficient. It is in the process of observing a list).
client engaging in occupations and activities that • Body structures are the “anatomical parts of the
the occupational therapy practitioner is able to body such as organs, limbs, and their compo-
determine the transaction between client factors nents” (WHO, 2001, p. 10). Body structures
and performance. and body functions are interrelated (e.g., the
Client factors are substantively different at the heart and blood vessels are body structures that
person, organization, and population levels. support cardiovascular function; see Table 2).
Following are descriptions of client factors for The categorization of body function and body
each level. structure client factors outlined in Table 2 is based
on the International Classification of Functioning,
Person
Disability, and Health proposed by the WHO
• Values, beliefs, and spirituality influence a (2001). The classification was selected because it
client’s motivation to engage in occupations and has received wide exposure and presents a language
give his or her life meaning. Values are princi- that is understood by external audiences.
ples, standards, or qualities considered worth-
Organization
while by the client who holds them. Beliefs are
cognitive content held as true (Moyers & Dale, • Values and beliefs include the vision statement,
2007, p. 28). Spirituality is “the personal quest code of ethics, value statements, and esprit de
for understanding answers to ultimate questions corps.
about life, about meaning and about relation- • Functions include planning, organizing, coordi-
ship with the sacred or transcendent, which may nating, and operationalizing the mission, prod-
(or may not) lead to or arise from the develop- ucts or services, and productivity.
ment of religious rituals and the formation of • Structures include departments and departmen-
community” (Moreira-Almeida & Koenig, tal relationships, leadership and management,
2006, p. 844). performance measures, and job titles.
The American Journal of Occupational Therapy 633
Practice Framework 2nd Edition 8/22/08 1:32 PM Page 634
n BODY FUNCTIONS: “[T]he physiological functions of body systems (including psychological functions)” (WHO, 2001, p. 10).
The “Body Functions” section of the table below is organized according to the classifications of the International Classification of
Functioning, Disability, and Health (ICF) classifications. For fuller descriptions and definitions, refer to WHO (2001).
(continued)
Voice and speech functions (Note: Occupational therapy practitioners have knowledge of
• Voice functions these body functions and understand broadly the interaction
• Fluency and rhythm that occurs between these functions to support health and par-
ticipation in life through engagement in occupation. Some ther-
• Alternative vocalization functions apists may specialize in evaluating and intervening with a spe-
Digestive, metabolic, and endocrine system function cific function, such as incontinence and pelvic floor disorders,
• Digestive system function as it is related to supporting performance and engagement in
occupations and activities targeted for intervention.)
• Metabolic system and endocrine system function
Genitourinary and reproductive functions
• Urinary functions
• Genital and reproductive functions
n BODY STRUCTURES: Body structures are “anatomical parts of the body, such as organs, limbs, and their components [that
support body function]” (WHO, 2001, p. 10). The “Body Structures” section of the table below is organized according to the ICF
classifications. For fuller descriptions and definitions, refer to WHO (2001).
Structure of the nervous system (Note: Occupational therapy practitioners have knowledge of
Eyes, ear, and related structures body structures and understand broadly the interaction that
occurs between these structures to support health and partici-
Structures involved in voice and speech
pation in life through engagement in occupation. Some thera-
Structures of the cardiovascular, immunological, and pists may specialize in evaluating and intervening with a specific
respiratory systems structure as it is related to supporting performance and engage-
Structures related to the digestive, metabolic, and ment in occupations and activities targeted for intervention.)
endocrine systems
Structure related to the genitourinary and reproductive
systems
Structures related to movement
Skin and related structures
Space demands (relates Physical environmental requirements of the activi- • Large, open space outdoors required for a
to physical context) ty (e.g., size, arrangement, surface, lighting, tem- baseball game
perature, noise, humidity, ventilation) • Bathroom door and stall width to accommodate
wheelchair
• Noise, lighting, and temperature controls for a
library
Social demands (relates Social environment and cultural contexts that may • Rules of game
to social environment and be required by the activity • Expectations of other participants in activity
cultural contexts) (e.g., sharing supplies, using language appro-
priate for the meeting)
Sequence and timing Process used to carry out the activity (e.g., specific • Steps to make tea: Gather cup and tea bag, heat
steps, sequence, timing requirements) water, pour water into cup, and so forth.
m Sequence: Heat water before placing tea bag
in water.
m Timing: Leave tea bag to steep for 2 minutes.
• Steps to conduct a meeting: Establish goals for
meeting, arrange time and location for meeting,
prepare meeting agenda, call meeting to order.
m Sequence: Have people introduce them-
selves before beginning discussion of topic.
m Timing: Allot sufficient time for discussion
of topic and determination of action items.
Required actions and The usual skills that would be required by any • Feeling the heat of the stove
performance skills performer to carry out the activity. Sensory, per- • Gripping handlebar
ceptual, motor, praxis, emotional, cognitive, • Choosing the ceremonial clothes
communication, and social performance skills • Determining how to move limbs to control
should each be considered. The performance the car
skills demanded by an activity will be correlated • Adjusting the tone of voice
with the demands of the other activity aspects • Answering a question
(e.g., objects, space)
Required body structures “Anatomical parts of the body such as organs, • Number of hands
limbs, and their components [that support body • Number of eyes
function]” (WHO, 2001, p. 10) that are required to
perform the activity
the social demands, sequence and timing, the • Emotional regulation skills
required actions or skills needed to perform the • Cognitive skills
activity, and the required body functions and struc- • Communication and social skills.
tures used during the performance of the activity Numerous body functions and structures
(see Table 3 for definitions and examples.) underlie and enable performance (Rogers &
Activity demands are specific to each activity. Holm, 2008). Whereas body functions such as
A change in one feature of an activity may change mental (affective, cognitive, perceptual), sensory,
the extent of the demand in another feature. For neuromuscular, and movement-related body
example, an increase in the number of the steps or functions (WHO, 2001) reflect the capacities
sequence of steps in an activity increases the that reside within the body, performance skills are
demand on attention skills. the clients’ demonstrated abilities. For example,
praxis skills can be observed through client
Performance Skills actions such as imitating, sequencing, and con-
Various approaches have been used to describe structing; cognitive skills can be observed as the
and categorize performance skills. The occupation- client demonstrates organization, time manage-
al therapy literature from research and practice ment, and safety; and emotional regulation skills
offers multiple perspectives on the complexity can be observed through the behaviors the client
and types of skills used during performance. displays to express emotion appropriately.
According to Fisher (2006), performance skills Numerous body functions underlie each perfor-
are observable, concrete, goal-directed actions mance skill.
clients use to engage in daily life occupations. Multiple factors, such as the context in which
Fisher further defines these skills as small, measur- the occupation is performed, the specific demands
able units in a chain of actions that are observed as of the activity being attempted, and the client’s
a person performs meaningful tasks. They are body functions and structures, affect the client’s
learned and developed over time and are situated in ability to acquire or demonstrate performance
specific contexts and environments. Fisher catego- skills. Performance skills are closely linked and are
rized performance skills as follows: Motor Skills, used in combination with one another to allow the
Process Skills, and Communication/Interaction client to perform an occupation. A change in one
Skills. Rogers and Holm (2008) have proposed performance skill can affect other performance
that during task-specific performance skills, various skills. In practice and in some literature, perfor-
body functions and structures coalesce into unique mance skills often are labeled in various combina-
combinations and emerge to affect performance in tions such as perceptual–motor skills and
real life. social–emotional skills. Table 4 provides defini-
Given that performance skills are described tions and selected examples under each category.
and categorized in multiple ways, within the Occupational therapy practitioners observe
Occupational Therapy Practice Framework they are and analyze performance skills in order to under-
defined as the abilities clients demonstrate in the stand the transactions among underlying factors
actions they perform. The categories of a person’s that support or hinder engagement in occupa-
performance skills are interrelated and include tions and occupational performance. For exam-
• Motor and praxis skills ple, when observing a person writing a check, the
• Sensory–perceptual skills occupational therapy practitioner observes the
Sensory– Actions or behaviors a client uses to locate, identify, and • Positioning the body in the exact location for a safe jump
perceptual skills respond to sensations and to select, interpret, associate, • Hearing and locating the voice of your child in a crowd
organize, and remember sensory events based on dis- • Visually determining the correct size of a storage container
criminating experiences through a variety of sensations for leftover soup
that include visual, auditory, proprioceptive, tactile, • Locating keys by touch from many objects in a pocket or
olfactory, gustatory, and vestibular. purse (i.e., stereognosis)
• Timing the appropriate moment to cross the street safely
by determining one’s own position and speed relative to
the speed of traffic
• Discerning distinct flavors within foods or beverages
Emotional Actions or behaviors a client uses to identify, manage, • Responding to the feelings of others by acknowledgment
regulation skills and express feelings while engaging in activities or or showing support
interacting with others • Persisting in a task despite frustrations
• Controlling anger toward others and reducing aggressive acts
• Recovering from a hurt or disappointment without lashing
out at others
• Displaying the emotions that are appropriate for the situation
• Utilizing relaxation strategies to cope with stressful events
Cognitive skills Actions or behaviors a client uses to plan and manage • Judging the importance or appropriateness of clothes for
the performance of an activity the circumstance
• Selecting tools and supplies needed to clean the bathroom
• Sequencing tasks needed for a school project
• Organizing activities within the time required to meet a
deadline
• Prioritizing steps and identifying solutions to access trans-
portation
• Creating different activities with friends that are fun, novel,
and enjoyable
• Multitasking—doing more than one thing at a time, necessary
for tasks such as work, driving, and household management
motor skills of gripping and manipulating objects health promoting or damaging (Fiese et al., 2002;
and the cognitive skills of initiating and sequenc- Segal, 2004). Roles are sets of behaviors expected
ing the steps of the activity. The observed skills are by society, shaped by culture, and may be further
supported by underlying body functions related conceptualized and defined by the client. Roles
to movement and cognition and by the environ- can provide guidance in selecting occupations or
mental context of the bank. Proficient occupa- can lead to stereotyping and restricted engage-
tional performance observed in playing a game of ment patterns. Jackson (1998a, 1998b) cautioned
tennis or playing the piano requires multiple sets that describing people by their roles can be limit-
of performance skills. ing and can promote segmented rather than
Further resources informing occupational
therapy practice related to performance skills
include Fisher (2006); Bloom, Krathwohl, and “...only occupational
Masia (1984); Harrow (1972); and Chapparo and
Ranka (1997). Detailed information about the
therapy practitioners
way that skills are used in occupational therapy focus this process
practice also may be found in the literature on
specific theories such as sensory integration theo- toward the end-goal of
ry (Ayres, 1972, 2005) and motor learning and
motor control theory (Shumway-Cook &
supporting health and
Wollacott, 2007). participation in life
Performance Patterns through engagement
Performance patterns refer to habits, routines,
roles, and rituals used in the process of engaging
in occupations.”
in occupations or activities. Habits refer to specif-
ic, automatic behaviors that can be useful, domi- enfolded occupations. When considering roles
nating, or impoverished (Clark, 2000; Neistadt & within occupational therapy, occupational thera-
Crepeau, 1998), whereas routines are established py practitioners are concerned with the way
sequences of occupations or activities that provide clients construct their occupations to fulfill their
a structure for daily life. Routines also can be perceived roles and identity and reinforce their
Examples
HABITS—“Automatic behavior that is integrated into more com- – Automatically puts car keys in the same place.
plex patterns that enable people to function on a day-to-day basis” – Spontaneously looks both ways before crossing the street
(Neistadt & Crepeau, 1998, p. 869). Habits can be useful, dominat-
– Repeatedly rocks back and forth when asked to initiate a task
ing, or impoverished and either support or interfere with perfor-
mance in areas of occupation. – Repeatedly activates and deactivates the alarm system before
entering the home
– Maintains the exact distance between all hangers when hanging
clothes in a closet
ROUTINES—Patterns of behavior that are observable, regular, – Follows the morning sequence to complete toileting, bathing,
repetitive, and that provide structure for daily life. They can be sat- hygiene, and dressing
isfying, promoting, or damaging. Routines require momentary time – Follows the sequence of steps involved in meal preparation
commitment and are embedded in cultural and ecological contexts
(Fiese et al., 2002; Segal, 2004).
RITUALS—Symbolic actions with spiritual, cultural, or social – Uses the inherited antique hairbrush and brushes her hair
meaning, contributing to the client’s identity and reinforcing values with 100 strokes nightly as her mother had done
and beliefs. Rituals have a strong affective component and repre- – Prepares the holiday meals with favorite or traditional
sent a collection of events (Fiese et al., 2002; Segal, 2004). accoutrements, using designated dishware
– Kisses a sacred book before opening the pages to read
ROLES—A set of behaviors expected by society, shaped by cul- – Mother of an adolescent with developmental disabilities
ture, and may be further conceptualized and defined by the client. – Student with learning disability studying computer technology
– Corporate executive returning to work after experiencing a stroke
Note. Information for “Habits” section of this table adapted from Dunn (2000b).
Examples
ROUTINES—Patterns of behavior that are observable, regular, – Holds regularly scheduled meetings for staff, directors, execu-
repetitive, and that provide structure for daily life. They can be sat- tive boards
isfying, promoting, or damaging. Routines require momentary time – Follows documentation practices for annual reports, timecards,
commitment and are embedded in cultural and ecological contexts and strategic plans
(Fiese et al., 2002; Segal, 2004). – Turns in documentation on a scheduled basis
– Follows the chain of command
– Follows safety and security routines (e.g., signing in/out, using
pass codes)
– Maintains dress codes (e.g., casual Fridays)
– Socializes during breaks, lunch, at the water cooler
– Follows beginning or ending routines (e.g., opening/closing the
facility)
– Offers activities to meet performance expectations or standards
(Continued)
Examples
RITUALS—Symbolic actions that have meaning, contributing to – Holds holiday parties, company picnics
the organization’s identity and reinforcing values and beliefs – Conducts induction, recognition, and retirement ceremonies
(adapted from Fiese et al., 2002; Segal, 2004).
– Organizes annual retreats or conferences
– Maintains fundraising activities for organization to support local
charities
ROLES—A set of behaviors by the organization expected by soci- – Nonprofit organization provides housing for persons living with
ety, shaped by culture, and may be further conceptualized and mental illness
defined by the client. – Humanitarian organization distributes food and clothing dona-
tions to refugees
– University educates and provides service to the surrounding
community
Examples
ROUTINES—Patterns of behavior that are observable, regular, – Follows health practices, such as scheduled immunizations for
repetitive, and that provide structure for daily life. They can be sat- children and yearly health screenings for adults
isfying, promoting, or damaging. Routines require momentary time – Follows business practices, such as provision of services for
commitment and are embedded in cultural and ecological contexts the disadvantaged populations (e.g., loans to underrepresented
(Fiese et al., 2002; Segal, 2004). groups)
– Follows legislative procedures, such as those associated with
IDEA and Medicare
– Follows social customs for greeting
RITUALS—Rituals are shared social actions with traditional, – Holds cultural celebrations
emotional, purposive, and technological meaning, contributing to – Has parades or demonstrations
values and beliefs within the population.
– Shows national affiliations/allegiances
– Follows religious, spiritual, and cultural practices, such as
touching the mezuzah or using holy water when leaving/enter-
ing, praying to Mecca
Context and
Environment Definition Examples
Cultural Customs, beliefs, activity patterns, behavior standards, and Person: Shaking hands when being introduced
expectations accepted by the society of which the client is Organization: Employees marking the end of the work week
a member. Includes ethnicity and values as well as political with casual dress on Friday
aspects, such as laws that affect access to resources and
Population: Celebrating Independence Day
affirm personal rights. Also includes opportunities for edu-
cation, employment, and economic support.
Personal “[F]eatures of the individual that are not part of a health Person: Twenty-five-year-old unemployed man with a high
condition or health status” (WHO, 2001, p. 17). Personal school diploma
context includes age, gender, socioeconomic status, and Organization: Volunteers working in a homeless shelter
educational status. Can also include organizational lev-
Population: Teenage women who are pregnant or new mothers
els (e.g., volunteers and employees) and population lev-
els (e.g., members of society).
Temporal “Location of occupational performance in time” (Neistadt Person: A person retired from work for 10 years
& Crepeau, 1998, p. 292). The experience of time as Organization: Annual fundraising campaign
shaped by engagement in occupations. The temporal
Population: Engaging in siestas or high teas
aspects of occupation “which contribute to the patterns
of daily occupations” are “the rhythm…tempo…syn-
chronization…duration…and sequence” (Larson &
Zemke, 2004, p. 82; Zemke, 2004, p. 610). Includes
stages of life, time of day or year, duration, rhythm of
activity, or history.
Virtual Environment in which communication occurs by means Person: Text message to a friend
of airways or computers and an absence of physical Organization: Video conference, telephone conference call,
contact. Includes simulated or real-time or near-time instant message, interactive white boards among all the
existence of an environment via chat rooms, email, members
video-conferencing, radio transmissions.
Population: Virtual community of gamers
Physical Natural and built nonhuman environment and the Person: Individual’s house, apartment
objects in them: Organization: Office building, factory
• Natural environment includes geographic terrain, Population: Transportation system
sensory qualities of environment, plants and animals
• Built environment and objects includes buildings,
furniture, tools or devices.
EVALUATION
Occupational profile—The initial step in the evaluation process that provides an understanding of the client’s occupational history and experiences, patterns of daily
living, interests, values, and needs. The client’s problems and concerns about performing occupations and daily life activities are identified, and the client’s priorities
are determined.
Analysis of occupational performance—The step in the evaluation process during which the client’s assets, problems, or potential problems are more specifically
identified. Actual performance is often observed in context to identify what supports performance and what hinders performance. Performance skills, performance
patterns, context or contexts, activity demands, and client factors are all considered, but only selected aspects may be specifically assessed. Targeted outcomes are
identified.
INTERVENTION
Intervention plan—A plan that will guide actions taken and that is developed in collaboration with the client. It is based on selected theories, frames of reference,
and evidence. Outcomes to be targeted are confirmed.
Intervention implementation—Ongoing actions taken to influence and support improved client performance. Interventions are directed at identified outcomes.
Client’s response is monitored and documented.
Intervention review—A review of the implementation plan and process as well as its progress toward targeted outcomes.
Identify • Synthesize • Develop plan that • Determine types of • Reevaluate plan • Focus on outcomes
information from the includes occupational therapy relative to achieving as they relate to
• Who is the client? occupational profile.
–Objective and interventions to be targeted outcomes. supporting health
• Why is the client • Observe client’s measurable goals used and carry them • Modify plan as and participation in
seeking services? performance in with time frame, out. needed. life through
• What occupations desired occupation/ engagement in
–Occupational • Monitor client’s • Determine need for
and activities are activity. occupation.
therapy response according continuation,
successful or are • Note the intervention to ongoing discontinuation, or • Select outcome
causing problems? effectiveness of approach based assessment and referral. measures.
• What contexts and performance skills reassessment.
on theory and • Measure and use
environments and patterns and evidence, and outcomes.
support or inhibit select assessments
desired outcomes? to identify factors –Mechanisms for
(context or contexts, service delivery.
• What is the client’s
occupational activity demands, • Consider discharge
history? client factors) that needs and plan.
• What are the client’s may be influencing • Select outcome
priorities and performance skills measures.
targeted outcomes? and patterns. • Make
• Interpret recommendation or
assessment data to referral to others as
identify facilitators needed.
and barriers to
performance.
• Develop and refine
hypotheses about
client’s occupational
performance
strengths and
weaknesses.
• Collaborate with
client to create
goals that address
targeted outcomes.
• Delineate areas for
intervention based
on best practice Continue to renegotiate intervention plans and targeted outcomes.
and evidence.
Ongoing interaction among evaluation, intervention, and outcomes occurs throughout the process.
the multiple demands, skills, and potential mean- knowledge and skills in these areas influence the
ings of the activity and (2) gain a deeper under- information that is collected during the evaluation.
standing of the interrelationships between aspects Knowledge and evidence about occupational per-
of the domain that affect performance and those formance problems and diagnostic conditions are
that will support client-centered interventions used to guide information gathering and synthesis
and outcomes. of information for interpretation and intervention
planning. The occupational therapist’s skilled inter-
Evaluation pretation of assessment results relative to the whole
The evaluation process begins with an evaluation evaluation leads to a clear delineation of the
conducted by the occupational therapist and is strengths and limitations affecting the client’s occu-
focused on finding out what the client wants and pational performance. The occupational therapy
needs to do, determining what the client can do assistant contributes to the evaluation process based
and has done, and identifying those factors that act on established competencies and under the supervi-
as supports or barriers to health and participation. sion of an occupational therapist.
Evaluation often occurs both formally and infor-
Occupational Profile
mally during all interactions with the client. The
type and focus of the evaluation differs depending An occupational profile is defined as a summary of
on the practice setting. information that describes the client’s occupational
The evaluation consists of the occupational history and experiences, patterns of daily living,
profile and analysis of occupational perfor- interests, values, and needs. Because the profile is
mance. The occupational profile includes informa- designed to gain an understanding of the client’s
tion about the client and the client’s needs, prob- perspective and background, its format varies
lems, and concerns about performance in areas of depending on whether the client is a person, orga-
occupation. The analysis of occupational perfor- nization, or population. Using a client-centered
mance focuses on collecting and interpreting approach, the occupational therapy practitioner
information using assessment tools designed to gathers information to understand what is current-
observe, measure, and inquire about factors that ly important and meaningful to the client. The
support or hinder occupational performance. profile includes inquiry related to what the client
Although the ways occupational therapists collect wants and needs to do in the present or future
client information are described separately and as well as past experiences and interests that may
sequentially in the Framework, the exact manner assist in identifying strengths and limitations.
is influenced by the client needs and the practice Refinement of the information collected during
setting. Information related to the occupational the occupational profile subsequently refines the
profile is gathered throughout the occupational intervention plan and identified outcomes.
therapy process. During the process of collecting this informa-
The occupational therapist’s knowledge and tion, the client’s priorities and desired outcomes
skills, as well as theoretical principles and available that will lead to engagement in occupation for
evidence, guide his or her clinical reasoning for the improved health are identified. Clients identify
selection and application of various theories and occupations that give meaning to their lives and
frames of reference throughout the evaluation pro- select the goals and priorities important to them.
cess. Concurrently, the occupational therapist’s Valuing and respecting the client’s collaboration in
the therapeutic process helps foster client involve- sis regarding possible reasons for identified prob-
ment and more efficiently guide interventions. lems and concerns. The occupational therapy assis-
The process and timing of completing the tant contributes to this process. The information
occupational profile varies depending on the cir- from the occupational therapy profile often guides
cumstances. Occupational therapy practitioners the selection of outcome measures. If an organiza-
may gather information formally and informally tion or population is the identified client, the
in one session or over a longer period while work- strengths and needs are those that affect the collec-
ing with the client. Obtaining information tive entity rather than the individual.
through both formal interview and casual conver-
sation helps establish a therapeutic relationship Analysis of Occupational Performance
with the client. Ideally, the information obtained Occupational performance is the accomplish-
during the development of the occupational pro- ment of the selected occupation resulting from
file leads to a more client-centered approach in the dynamic transaction among the client, the
the evaluation, intervention planning, and inter- context and environment, and the activity.
vention implementation stages. Evaluation of occupational performance involves
Specifically, the information collected answers one or more of the following:
the following questions: • Synthesizing information from the occupa-
• Who is the client (person, including family, tional profile to focus on specific areas of occu-
caregivers, and significant others; popula- pation and contexts that need to be addressed;
tion; or organization)? • Observing the client’s performance during
• Why is the client seeking services, and what activities relevant to desired occupations,
are the client’s current concerns relative to noting effectiveness of the performance
engaging in occupations and in daily life skills and performance patterns;
activities? • Selecting and using specific assessments to
• What areas of occupation are successful, and measure performance skills and perfor-
what areas are causing problems or risks (see mance patterns, as appropriate;
Table 1)? • Selecting assessments, as needed, to identify
• What contexts and environments support or and measure more specifically contexts or
inhibit participation and engagement in environments, activity demands, and client
desired occupations? factors influencing performance skills and
• What is the client’s occupational history performance patterns;
(i.e., life experiences, values, interests, previ- • Interpreting the assessment data to identify
ous patterns of engagement in occupations what supports performance and what hin-
and in daily life activities, the meanings ders performance;
associated with them)? • Developing and refining hypotheses about the
• What are the client’s priorities and desired client’s occupational performance strengths
outcomes? and limitations;
Once the profile data are collected and docu- • Creating goals in collaboration with the
mented, the occupational therapist reviews the client that address the desired outcomes;
information; identifies the client’s strengths, limita- • Determining procedures to measure the out-
tions, and needs; and develops a working hypothe- comes of intervention; and
Occupation-based intervention Purpose: Client engages in client-directed occupations that match identified goals.
Examples:
• Completes morning dressing and hygiene using adaptive devices
• Purchases groceries and prepares a meal
• Utilizes the transportation system
• Applies for a job
•.Plays on playground and community recreation equipment
• Participates in a community festival
• Establishes a pattern of self-care and relaxation activities in preparation for sleep
Purposeful activity Purpose: Client engages in specifically selected activities that allow the client to develop skills that enhance
occupational engagement.
Examples:
• Practices how to select clothing and manipulate clothing fasteners
• Practices safe ways to get in and out of a bathtub
• Practices how to prepare a food list and rehearses how to use cooking appliances
• Practices how to use a map and transportation schedule
• Rehearses how to write answers on an application form
•.Practices how to get on and off playground and recreation equipment
• Role plays when to greet people and initiates conversation
• Practices how to use adaptive switches to operate home environmental control system
Preparatory methods Purpose: Practitioner selects directed methods and techniques that prepare the client for occupational
performance. Used in preparation for or concurrently with purposeful and occupation-based activities.
Examples:
• Provides sensory enrichment to promote alertness
• Administers physical agent modalities to prepare muscles for movement
• Provides instruction in visual imagery and rhythmic breathing to promote rest and relaxation
• Issues orthotics/splints to provide support and facilitate movement
• Suggests a home-based conditioning regimen using Pilates and yoga
• Provides hand-strengthening exercises using therapy putty and theraband
• Provides instruction in assertiveness to prepare for self-advocacy
(Continued)
Organization • Recommends work pattern modifications and ergonomically designed workstations for a company
• Recommends disaster evacuation strategies for a residential community related to accessibility and
reduced environmental barriers
EDUCATION PROCESS—An intervention process that involves imparting knowledge and information about occupation, health, and participation
and that does not result in the actual performance of the occupation/activity.
Organization • Teaches staff at a homeless shelter how to structure daily living, play, and leisure activities for shelter
members
Population • Instructs town officials about the value of and strategies for making walking and biking paths accessible
for all community members
ADVOCACY—Efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully participate in
their daily life occupations.
Organization • Serves on policy board of an organization to procure supportive housing accommodations for persons
with disabilities
Population • Collaborates with adults with serious mental illness to raise public awareness of the impact of this stigma
• Collaborates with and educates federal funding sources for the disabled population to include cancer
patients prior to their full remission
consumers and stakeholders. Practitioners address tional therapist and the occupational therapy assis-
features of the organization or agency such as its mis- tant in the development, implementation, and
sion, values, organizational culture and structure, review of the intervention plan.
policies and procedures, and built and natural envi-
ronments. Practitioners evaluate how each of these Intervention Plan
features either supports or inhibits the overall per- The intervention plan directs the actions of the
formance of individuals within the organization. For occupational therapist and occupational therapy
example, to enable the staff at a skilled-nursing facil- assistant. It describes the selected occupational
ity to provide better services, an occupational thera- therapy approaches and types of interventions for
py practitioner may recommend the walls in each reaching the client’s identified outcomes. The
hallway be painted a different color, enabling resi- intervention plan is developed collaboratively with
dents to more easily locate their rooms. the client and is based on the client’s goals and pri-
Interventions provided to populations are orities. Depending on whether the client is a per-
directed to all the members of the group collec- son, organization, or population, others such as
tively rather than individualized to specific people family members, significant others, board mem-
within the group. Practitioners direct their inter- bers, service providers, and community groups
ventions toward current or potential health prob- also may collaborate in the development of the
lems and disabling conditions within the popula- plan.
tion and community. Their goal is to enhance the The design of the intervention plan is directed
health of all people within the population by by the
addressing services and supports within the com- • Client’s goals, values, beliefs, and occupa-
munity that can be implemented to improve the tional needs;
population’s performance. The intervention focus • Client’s health and well-being;
often is on health promotion activities, self-man- • Client’s performance skills and performance
agement educational services, and environmental patterns;
modification. For instance, the occupational ther- • Collective influence of the context, environ-
apy practitioner may design developmentally ment, activity demands, and client factors
based day care programs run by college student on the client;
volunteers for homeless shelters catering to fami- • Context of service delivery in which the
lies in a large metropolitan area. Practitioners may intervention is provided (e.g., caregiver
work with a wide variety of populations experi- expectations, organization’s purpose, payer’s
encing difficulty in accessing and engaging in requirements, applicable regulations); and
health occupations due to conditions such as • Best available evidence.
poverty, homelessness, and discrimination. The selection and design of the intervention
The intervention process is divided into three plan and goals are directed toward addressing the
steps: (1) intervention plan, (2) intervention imple- client’s current and potential problems related to
mentation, and (3) intervention review. During the engagement in occupations or activities.
intervention process, information from the evalua- Intervention planning includes the following
tion is integrated with theory, practice models, steps:
frames of reference, and evidence. This informa- 1. Developing the plan. The occupational thera-
tion guides the clinical reasoning of the occupa- pist develops the plan with the client, and the
occupational therapy assistant contributes to 1. Determining and carrying out the type of
the plan’s development. The plan includes occupational therapy intervention or inter-
• Objective and measurable goals with a time- ventions to be used (see Table 8)
frame • Therapeutic use of self
• Occupational therapy intervention approach • Therapeutic use of occupations or activities
or approaches (see Table 9) – Occupation-based interventions
–Create or promote – Purposeful activity
–Establish or restore – Preparatory methods.
–Maintain • Consultation process
–Modify • Education process
–Prevent. • Advocacy.
• Mechanisms for service delivery 2. Monitoring the client’s response to interven-
–People providing the intervention tions based on ongoing assessment and reassess-
–Types of interventions ment of the client’s progress toward goals.
–Frequency and duration of service.
2. Considering potential discharge needs and plans Intervention Review
3. Selecting outcome measures Intervention review is the continuous process of
4. Making recommendation or referral to others as reevaluating and reviewing the intervention plan,
needed. the effectiveness of its delivery, and the progress
toward outcomes. As during intervention planning,
Intervention Implementation this process includes collaboration with the client
Intervention implementation is the process of based on his or her goals. Depending on whether
putting the plan into action. It involves the the client is a person, organization, or population,
skilled process of altering factors in the client, various stakeholders, such as family members, sig-
activity, and context and environment for the nificant others, board members, other service
purpose of effecting positive change in the providers, and community groups, also may collab-
client’s desired engagement in occupation, orate in the intervention review. Re-evaluation and
health, and participation. review may lead to change in the intervention plan.
Interventions may focus on a single aspect of The intervention review includes the follow-
the domain, such as a specific performance pat- ing steps:
tern, or several aspects of the domain, such as per- 1. Re-evaluating the plan and how it is imple-
formance patterns, performance skills, and con- mented relative to achieving outcomes
text. Given that the factors are interrelated and 2. Modifying the plan as needed
influence one another in a continuous, dynamic 3. Determining the need for continuation or dis-
process, occupational therapy practitioners expect continuation of occupational therapy services
that the client’s ability to adapt, change, and and for referral to other services.
develop in one area will affect other areas. Because The intervention review may include program
of this dynamic interrelationship, assessment and evaluations that critique the way that occupational
intervention planning continue throughout the therapy services are provided. This may include a
implementation process. Intervention implemen- review of client satisfaction and the client's percep-
tation includes the following steps: tion of the benefits of receiving occupational ther-
Establish, restore (remediation, Performance skills • Provide adjustable desk chairs to improve client
restoration)a—An intervention sitting posture
approach designed to change client • Work with senior community centers to offer
variables to establish a skill or ability driving educational programs targeted at
that has not yet developed or to improving driving skills for persons ages 65
restore a skill or ability that has been or older
impaired (adapted from Dunn et al.,
Performance patterns • Collaborate with clients to help them establish
1998, p. 533).
morning routines needed to arrive at school or
work on time
• Provide classes in fatigue management for
cancer patients and their families
• Collaborate with clients to help them establish
healthy sleep–wake patterns
• Develop walking programs at the local mall for
employees and community members
Client factors • Support daily physical education classes for
(body functions, body structures) entire population of children in a school aimed
at improving physical strength and endurance
• Collaborate with schools and businesses to
establish universal-design models in their
buildings, classrooms, and so forth
• Gradually increase time required to complete
a computer game to increase client’s attention
span
(Continued)
Modify (compensation, adapta- Performance patterns • Provide a visual schedule to help a student
tion)a—An intervention approach follow routines and transition easily between
directed at “finding ways to revise activities at home and school
the current context or activity • Simplify task sequence to help a person with
demands to support performance cognitive issues complete a morning self-care
in the natural setting, [including] routine
compensatory techniques, [such
Context or contexts or physical environments • Assist a family in determining requirements for
as]...enhancing some features to
building a ramp at home for a family member who
provide cues or reducing other
is returning home after physical rehabilitation
features to reduce distractibility”
(Dunn et al., 1998, p. 533). • Consult with builders in designing homes that
will allow families the ability to provide living
space for aging parents (e.g., bedroom and full
bath on the main floor of a multilevel dwelling)
• Modify the number of people in a room to
decrease client’s distractibility
Prevent (disability Performance skills • Prevent poor posture when sitting for prolonged
prevention)a—An intervention periods by providing a chair with proper back
approach designed to address support
clients with or without a disability Performance patterns • Aid in the prevention of illicit chemical sub-
who are at risk for occupational stance use by introducing self-initiated routine
performance problems. This strategies that support drug-free behavior
approach is designed to prevent
Context or contexts or physical environments • Prevent social isolation of employees by promot-
the occurrence or evolution of
ing participation in after-work group activities
barriers to performance in context.
Interventions may be directed at • Reduce risk of falls by modifying the environ-
client, context, or activity variables ment and removing known hazards in the home
(adapted from Dunn et al., 1998, (e.g., throw rugs)
p. 534). Activity demands • Prevent back injury by providing instruction in
proper lifting techniques
Client factors • Prevent repetitive stress injury by suggesting
(body functions, body structures) that clients wear a wrist support splint when
typing
• Consultation with hotel chain to provide an
ergonomics educational program designed to
prevent back injuries in housekeepers
a
Parallel language used in Moyers and Dale (2007, p. 34).
apy services (adapted from Maciejewski, Kawiecki, result of choice, motivation, and meaning and
& Rockwood, 1997). Examples may include (1) a includes objective and subjective aspects of
letter of thanks from the family of a child with carrying out activities meaningful and pur-
spinal bifida (person); (2) a request for additional poseful to the individual person, organization,
occupational therapy services at a homeless shelter or population. Occupational therapy inter-
for their clients (organizations); and (3) procure- vention focuses on creating or facilitating
ment of funds to implement support groups for opportunities to engage in these occupations.
caregivers of people with Alzheimer’s disease To determine the client’s success in achieving
throughout the United States (populations). health and participation in life through engage-
ment in occupation, occupational therapy practi-
Outcomes tioners assess observable outcomes. This assess-
Supporting health and participation in life through ment takes into consideration the hypothesized
engagement in occupation is the broad, overarching relationships among various aspects of occupa-
outcome of the occupational therapy intervention tional performance. For example, a client’s
process. This outcome statement acknowledges the improved ability to embed performance skills into
profession’s belief that active engagement in occu- a routine (performance pattern) and improved
pation promotes, facilitates, and maintains health strength or range of motion (body functions)
and participation. Outcomes are defined as impor- enables engagement in managing a home (IADL).
tant dimensions of health, attributed to interven- Implicit in any outcome assessment used by
tions, and include the ability to function, health occupational therapy practitioners are the client’s
perceptions, and satisfaction with care (adapted beliefs systems and underlying assumptions regarding
from Request for Planning Ideas, 2001). Outcomes their desired occupational performance. The assess-
are the end-result of the occupational therapy pro- ment tools and the variables measured often become
cess and describe what occupational therapy inter- the operational definition for the outcome.
vention can achieve with clients. Therefore, occupational therapy practitioners select
The three interrelated concepts included in the outcome assessments pertinent to the needs and
profession’s overarching outcome are defined as desires of clients, congruent with the practitioner’s
1. Health—“[A] positive concept emphasizing theoretical model of practice, based on knowledge of
social and personal resources, as well as physi- the psychometric properties of standardized measures
cal capacities” (WHO, 1986). or the rationale and protocols of non-standardized
2. Participation—That is, “involvement in a life measures and the available evidence. In addition, the
situation” (WHO, 2001, p. 10). Participation client’s perception of success in engaging in desired
naturally occurs when clients are actively occupations is vital to any outcomes assessment. As a
involved in carrying out occupations or daily point of comparison and in collaboration with the
life activities they find purposeful and mean- client, the occupational therapist may revisit the
ingful in desired contexts. More specific out- occupational profile to assess change.
comes of occupational therapy intervention The benefits of occupational therapy are multi-
(see Table 10) are multidimensional and sup- faceted and may occur in all aspects of the domain
port the end-result of participation. of concern. Supporting health and participation in
3. Engagement in occupation—The commitment life through engagement in occupation is the broad
made to performance in occupations as the outcome of intervention. Clients’ improved perfor-
mance of occupations, perceived happiness, self- evaluation to identify the client’s initial desired out-
efficacy, and hopefulness about their life and abili- comes related to engagement in valued occupations
ties are valuable outcomes. For example, parents or daily life activities. During intervention imple-
whose children received occupational therapy val- mentation and re-evaluation, the client and thera-
ued understanding their child’s’ behaviors in new pist and, when appropriate, the occupational thera-
ways and had greater perceived efficacy about their py assistant, may modify desired outcomes to
parenting (Cohn, 2001; Cohn, Miller, & Tickle- accommodate changing needs, contexts, and per-
Degnan, 2000). Interventions designed for care- formance abilities. As further analysis of occupa-
givers who provide care for people with dementia tional performance and the development of the
improve the quality of life for both the care recipi- intervention plan occur, the occupational therapist
ent and the caregiver. Caregivers who received inter- and client may redefine the desired outcomes.
vention reported fewer declines in the occupational Implementation of the outcomes process
performance of care recipients and less need for help includes the following steps:
and enhanced mastery and skill, self-efficacy, and 1. Selecting types of outcomes and measures,
well-being for themselves (Gitlin & Corcoran, including but not limited to occupational per-
2005; Gitlin, Corcoran, Winter, Boyce, & Hauck, formance, adaptation, health and wellness,
2001; Gitlin et al., 2003). participation, prevention, self-advocacy,
Outcomes for people may include subjective quality of life, and occupational justice (see
impressions related to goals such as an improved Table 10).
outlook, confidence, hope, playfulness, self-efficacy, • Selecting outcome measures early in the
sustainability of valued occupations, resilience, or intervention process (see “Evaluation” above)
perceived well-being. Outcomes also may include • Selecting outcome measures that are valid,
measurable increments of progress in factors related reliable, and appropriately sensitive to
to occupational performance such as skin integrity, change in the client’s occupational perfor-
amount of sleep, endurance, desire, initiation, bal- mance and are consistent with the outcomes
ance, visual–motor skills, and at the participation • Selecting outcome measures or instruments
level, activity participation and community re-inte- for a particular client that are congruent
gration. Outcomes for organizations may include with client goals
increased workplace morale, productivity, reduced • Selecting outcome measures that are based
injuries, and improved worker satisfaction. on their actual or purported ability to pre-
Outcomes for populations may include health pro- dict future outcomes.
motion, social justice, and access to services. The 2. Using outcomes to measure progress and
definitions and connotations of outcomes are specif- adjust goals and interventions
ic to clients, groups, and organizations as well as to • Comparing progress toward goal achieve-
payers and regulators. Specific outcomes as well as ment to outcomes throughout the interven-
documentation of those outcomes vary by practice tion process
setting and are influenced by the particular stake- • Assessing outcome use and results to make
holders in each setting. decisions about the future direction of inter-
The focus on outcomes is interwoven through- vention (e.g., continue intervention, modify
out the process of occupational therapy. The occu- intervention, discontinue intervention, pro-
pational therapist and client collaborate during the vide follow-up, refer to other services).
Outcome Description
Occupational performance The act of doing and accomplishing a selected activity or occupation that results from the dynamic transac-
tion among the client, the context, and the activity. Improving or enabling skills and patterns in occupational
performance leads to engagement in occupations or activities (adapted in part from Law et al., 1996, p. 16).
• Improvement—Used when a performance limitation is present. These outcomes document increased
occupational performance for the person, organization, or population. Outcome examples may
include (1) the ability of a child with autism to play interactively with a peer (person); (2) the ability of
an older adult to return to the home from a skilled-nursing facility (person); (3) decreased incidence
of back strain in nursing personnel as a result of an in-service education program in body mechanics
for carrying out job duties that require bending, lifting, and so forth (organizations); and (d) construc-
tion of accessible playground facilities for all children in local city parks (populations).
• Enhancement—Used when a performance limitation is not currently present. These outcomes docu-
ment the development of performance skills and performance patterns that augment existing perfor-
mance or prevent potential problems from developing in life occupations. Outcome examples may
include (1) increased confidence and competence of teenage mothers to parent their children as a
result of structured social groups and child development classes (person); (2) increased membership
of the local senior citizen center as a result of diverse social wellness and exercise programs (organi-
zation); (3) increased ability by school staff to address and manage school-age youth violence as a
result of conflict resolution training to address ”bullying” (organizations); and (4) increased opportu-
nities for seniors to participate in community activities due to ride share programs (populations).
Adaptation A change in response approach that the client makes when encountering an occupational challenge. “This
change is implemented when the [client’s] customary response approaches are found inadequate for produc-
ing some degree of mastery over the challenge” (adapted from Schultz & Schkade, 1997, p. 474). Examples
of adaptation outcomes include (1) clients modifying their behaviors to earn privileges at an adolescent treat-
ment facility (person); (2) a company redesigning the daily schedule to allow for an even workflow and to
decrease times of high stress (organizations); and (3) a community making available accessible public trans-
portation and erecting public and “reserved” benches for older adults to socialize and rest (populations).
Health is a resource for everyday life, not the objective of living. For individuals, it is a state of physical,
Health and wellness
mental, and social well-being, as well as a positive concept emphasizing social and personal resources and
physical capacities (WHO, 1986). Health of organizations and populations includes these individual aspects
but also includes social responsibility of members to society as a whole. Wellness is ”[a]n active process
through which individuals [organizations or populations] become aware of and make choices toward a
more successful existence“ (Hettler, 1984, p. 1170). Wellness is more than a lack of disease symptoms; it
is a state of mental and physical balance and fitness (adapted from Taber’s Cyclopedic Medical Dictionary,
1997, p. 2110). Outcome examples may include (1) participation in community outings by a client with
schizophrenia in a group home (person); (2) implementation of a company-wide program to identify prob-
lems and solutions for balance among work, leisure, and family life (organizations); and (3) decreased
incidence of childhood obesity (populations).
Participation Engagement in desired occupations in ways that are personally satisfying and congruent with expectations
within the culture.
Outcome Description
Prevention “[H]ealth promotion is equally and essentially concerned with creating the conditions necessary for health
at individual, structural, social, and environmental levels through an understanding of the determinants of
health: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and
equity” (Kronenberg, Algado, & Pollard, 2005, p. 441). Occupational therapy promotes a healthy lifestyle at
the individual, group, organizational, community (societal), and governmental or policy level (adapted from
Brownson & Scaffa, 2001). Outcome examples may include (1) appropriate seating and play area for a child
with orthopedic impairments (person); (2) implementation of a program of leisure and educational activities
for a drop-in center for adults with severe mental illness (organizations); and (3) access to occupational
therapy services in underserved areas regardless cultural or ethnic backgrounds (populations).
Quality of life The dynamic appraisal of the client’s life satisfaction (perceptions of progress toward one’s goals), hope
(the real or perceived belief that one can move toward a goal through selected pathways), self-concept (the
composite of beliefs and feelings about oneself), health and functioning (including health status, self-care
capabilities, and socioeconomic factors, e.g., vocation, education, income; adapted from Radomski, 1995;
Zhan, 1992). Outcomes may include (1) full and active participation of a deaf child from a hearing family
during a recreational activity (person); (2) residents being able to prepare for outings and travel indepen-
dently as a result of independent-living skills training for care providers of a group (organization); and (3)
formation of a lobby to support opportunities for social networking, advocacy activities, and sharing scien-
tific information for stroke survivors and their families (population).
Role competence The ability to effectively meet the demands of roles in which the client engages.
Self-advocacy Actively promoting or supporting oneself or others (individuals, organizations, or populations); requires an
understanding of strengths and needs, identification of goals, knowledge of legal rights and responsibili-
ties, and communicating these aspects to others (adapted from Dawson, 2007). Outcomes may include (1)
a student with a learning disability requesting and receiving reasonable accommodations such as textbooks
on tape (person); (2) a grassroots employee committee requesting and procuring ergonomically designed
keyboards for their computers at work (organization); and (3) people with disabilities advocating for univer-
sal design with all public and private construction (population).
Occupational justice Access to and participation in the full range of meaningful and enriching occupations afforded to others.
Includes opportunities for social inclusion and the resources to participate in occupations to satisfy person-
al, health, and societal needs (adapted from Townsend & Wilcock, 2004). Outcomes may include (1) people
with intellectual disabilities serving on an advisory board to establish programs offered by a community
recreation center (person); (2) workers who have enough of break time to have lunch with their young chil-
dren at day care centers (organization); (3) people with persistent mental illness welcomed by community
recreation center due to anti-stigma campaign (organization); and (4) alternative adapted housing options
for older adult to “age in place” (populations).
Spirituality Move from Context Reflect the way in More commonly, individuals consider spirituality residing within the client
to Client Factor which occupational rather than as part of a context. Moreira-Almeida and Koenig (2006) dis-
therapy practition- cussed spirituality, religion, and personal beliefs as components of quality
ers view and of life. Their definitions are included in the text.
analyze meaning,
values, and beliefs
of a broad range
of clients
Performance Broaden categories Provide language Based on her work with the Assessment of Motor and Process Skills
Skills with more generic inclusive of a (AMPS), Fisher (2006) provides the most distinct categories and defini-
language broad range of tions of skill functions. An attempt is made in this revision to address
assessments and critiques of the 2002 Framework that Fisher’s categories are limited. To
interventions as broaden skill categories to more generic and inclusive language, the COP
well as commonly considered at length the differences among body functions, abilities,
used terms in the capacities, skills, levels of skills, and components of occupations. In
literature related to most articles, authors use terms related to skills interchangeably with
skills abilities and capacities, confusing the issue.
Rest and Sleep Move from ADL to Highlight the Rest and sleep are two of the four main categories of occupation dis-
Area of Occupation importance of rest cussed by Adolf Meyer (1922). Unlike any other area of occupation, all
and sleep, espe- people rest as a result of engaging in occupations and engage in sleep for
cially as they relate multiple hours per day throughout their life span. Within the occupation of
to supporting or rest and sleep are activities such as preparing the self and environment for
hindering engage- sleep, interactions with others who share the sleeping space, reading or
ment in other areas listening to music to fall asleep, napping, dreaming, nighttime care of toi-
of occupation leting needs, nighttime caregiving duties, and ensuring safety. Sleep sig-
nificantly affects all other areas of occupation. Jonsson (2007) suggested
that providing sleep prominence in the framework as an area of occupation
will promote the consideration of lifestyle choices as an important aspect
of participation and health.
Context Change to context Allow use of broader The terms context and environment are not the same but often are used
and environment language consistent interchangeably. In the general literature, environment is used more fre-
with external audi- quently. Occupational therapy theories often use environment rather than
ences and existing context. This change allows for a cross-walk between the two terms. In the
occupational therapy narrative, context is used to include environment.
theories
(Continued)
Clinical Identify the way in Highlight the Clinical reasoning was expanded in the document to emphasize its impor-
Reasoning which the practi- importance of tance throughout the occupational therapy process. Intrinsic to any interac-
tioner’s view of the the practitioner’s tion between the practitioner and the client is the critical thinking implicit
client is informed problem-solving within clinical-reasoning skills that inform and guide the intervention.
via knowledge, skills in the inter-
skills, and evidence action with the
client
Activity Analysis Include discussion Highlight the Occupational therapy practitioners have a high level of skill in identifying the
Activity Synthesis about analyzing importance of demands of an activity and then synthesizing this information by comparing
activities in and of this critical skill it with the client’s needs and abilities to identify specific occupational perfor-
themselves and in that informs mance difficulties.
relation to the intervention
client
Self-Advocacy Include self- Provide focus on When working with individuals, populations, or organizations, occupation-
advocacy as empowerment al therapy provides intervention, which promotes self-advocacy as a
an outcome as a key feature means toward improved health and participation.
in health and
participation
Evidence-based Emphasize the role Articulate the value Occupational therapy is a profession founded on basic and applied
practice of research in of a science-driven science informing practice.
informing practice profession
Activity/ Use occupation to To increase Recognizing the work of scholars in the field, the authors acknowledge the
occupation include activity in readability of differences in activity and occupation. However, this document does not
and purposeful the narrative the document engage in this debate. In the Framework, occupation is used to include
activity activity. Activity is used specific to tasks considered in isolation of the client.
Purposeful activity is used to describe a type of intervention determined by
the therapist to be “purposeful” for achieving the goals of intervention, not
in judging whether or not a client’s chosen activity is purposeful or not.
Bodison, MA, OTR/L; Sarah Burton, MS, OT/L; Kramer, PhD, OTR/L, FAOTA; Patricia LaVesser,
Denea S. Butts, OTD, OTR/L; Jane Case-Smith, PhD, OTR/L; Donna Lucente-Surber, OTR/L;
EdD, OTR, BCP, FAOTA; Florence Clark, PhD, Stephen H. Luster, MS, OTR, CHT; Zoe
OTR/L, FAOTA; Gloria Frolek Clark, MS, Mailloux, MA, OTR/L, FAOTA; Jean McKinley-
OTR/L, FAOTA; Elizabeth Crepeau, PhD, OTR, Vargas, MS, OTR/L; David Nelson, PhD,
FAOTA; Anne E. Dickerson, PhD, OTR/L, OTR/L, FAOTA; L. Diane Parham, PhD,
FAOTA; Winifred Dunn, PhD, OTR, FAOTA; OTR/L, FAOTA; Marta Pelczarski, OTR; Kathlyn
Lisa Ann Fagan, MS, OTR/L; Anne G. Fisher, L. Reed, PhD, OTR, FAOTA; Barbara Schell,
PhD, OTR, FAOTA; Naomi Gil, MSc, OT; Lou PhD, OTR/L, FAOTA; Camille Skubik-Peplaski,
Ann Griswald, PhD, OTR, FAOTA; Sharon A. MS, OTR/L, BCP; Virginia Carroll Stoffel, PhD,
Gutman, PhD, OTR/L; Jim Hinojosa, PhD, OT, OT, BCMH, FAOTA; Marjorie Vogeley, OTR/L;
FAOTA; Hans Jonsson, PhD, OT(Reg); Paula and Naomi Weintraub, PhD, OTR.
Activity analysis B
“...addresses the typical demands of an activity, the Belief
range of skills involved in its performance, and the Any cognitive content held as true by the client
various cultural meanings that might be ascribed (Moyers & Dale, 2007).
to it” (Crepeau, 2003, p. 192).
Body functions
Activity demands “The physiological functions of body systems
The aspects of an activity, which include the objects (including psychological functions)” (WHO,
and their physical properties, space, social demands, 2001, p. 10) (see Table 2).
sequencing or timing, required actions or skills, and
required underlying body functions and body struc- Body structures
tures needed to carry out the activity (see Table 3). “Anatomical parts of the body such as organs,
limbs, and their components [that support body
Adaptation
function]” (WHO, 2001, p. 10) (see Table 2).
The response approach the client makes encoun-
tering an occupational challenge. “This change is C
implemented when the individual’s customary
Client
response approaches are found inadequate for pro-
The entity that receives occupational therapy ser-
ducing some degree of mastery over the challenge”
vices. Clients may include (1) individuals and
(Schultz & Schkade, 1997, p. 474).
other persons relevant to the individual’s life,
Advocacy including family, caregivers, teachers, employers,
The “pursuit of influencing outcomes—including and others who also may help or be served indi-
public policy and resource allocation decisions rectly; (2) organizations such as business, indus-
within political, economic, and social systems and tries, or agencies; and (3) populations within a
institutions—that directly affect people’s lives” community (Moyers & Dale, 2007).
(Advocacy Institute, 2001, as cited in Goodman-
Lavey & Dunbar, 2003, p. 422).
Client-centered approach D
An orientation that honors the desires and priori- Domain
ties of clients in designing and implementing A sphere of activity, concern, or function
interventions (adapted from Dunn, 2000a, p. 4). (American Heritage Dictionary, 2006).
Client factors
Those factors residing within the client that may E
affect performance in areas of occupation. Client
Education
factors include values, beliefs, and spirituality;
Includes learning activities needed when partici-
body functions; and body structures (see Table 2).
pating in an environment (see Table 1).
Clinical reasoning
Emotional regulation skills
“Complex multi-faceted cognitive process used by
Actions or behaviors a client uses to identify, man-
practitioners to plan, direct, perform, and reflect
age, and express feelings while engaging in activi-
on intervention” (Crepeau et al., 2003, p. 1027).
ties or interacting with others.
Communication and social skills
Engagement
Actions or behaviors a person uses to communi-
The act of sharing activities.
cate and interact with others in an interactive envi-
ronment (Fisher, 2006). Environment
The external physical and social environment that
Cognitive skills
surrounds the client and in which the client’s daily
Actions or behaviors a client uses to plan and man-
life occupations occur (see Table 6).
age the performance of an activity.
Evaluation
Context
“The process of obtaining and interpreting data
Refers to a variety of interrelated conditions with-
necessary for intervention. This includes planning
in and surrounding the client that influence per-
for and documenting the evaluation process and
formance. Contexts include cultural, personal,
results” (AOTA, 2005, p. 663).
temporal, and virtual (see Table 6).
Co-occupations G
Activities that implicitly involve at least two peo- Goals
ple (Zemke & Clark, 1996). “The result or achievement toward which effort
Cultural (context) is directed; aim; end” (Webster’s Encyclopedic
“Customs, beliefs, activity patterns, behavior stan- Unabridged Dictionary of the English Language,
dards, and expectations accepted by the society of 1994, p. 605).
which the [client] is a member. Includes ethnicity
and values as well as political aspects, such as laws H
that affect access to resources and affirm personal Habits
rights. Also includes opportunities for education, “Automatic behavior that is integrated into more
employment, and economic support” (AOTA, complex patterns that enable people to function
1994, p. 1054). on a day-to-day basis…” (Neistadt & Crepeau,
1998, p. 869). Habits can be useful, dominating,
the client to facilitate engagement in occupation meaning. Occupations involve mental abilities and
related to health and participation. The interven- skills and may or may not have an observable phys-
tion process includes the plan, implementation, ical dimension” (Hinojosa & Kramer, 1997, p. 865).
and review (see Table 7). “[A]ctivities…of everyday life, named, orga-
nized, and given value and meaning by individu-
Intervention approaches
als and a culture. Occupation is everything people
Specific strategies selected to direct the process of
do to occupy themselves, including looking after
interventions that are based on the client’s
themselves…enjoying life…and contributing to
desired outcome, evaluation date, and evidence
the social and economic fabric of their communi-
(see Table 9).
ties” (Law et al., 1997, p. 32).
“A dynamic relationship among an occupa-
L
tional form, a person with a unique developmen-
Leisure
tal structure, subjective meanings and purpose,
“A nonobligatory activity that is intrinsically moti-
and the resulting occupational performance”
vated and engaged in during discretionary time,
(Nelson & Jepson-Thomas, 2003, p. 90).
that is, time not committed to obligatory occupa-
“[C]hunks of daily activity that can be named
tions such as work, self-care, or sleep” (Parham &
in the lexicon of the culture” (Zemke & Clark,
Fazio, 1997, p. 250).
1996, p. vii).
M Occupation-based intervention
Motor and praxis skills A type of occupational therapy intervention—a
Motor client-centered intervention in which the occupa-
Actions or behaviors a client uses to move and tional therapy practitioner and client collabora-
physically interact with tasks, objects, contexts, tively select and design activities that have specific
and environments (adapted from Fisher, 2006). relevance or meaning to the client and support the
Includes planning, sequencing, and executing client’s interests, need, health, and participation in
novel movements. daily life.
Also see Praxis.
Occupational justice
“Justice related to opportunities and resources
O
required for occupational participation sufficient
Occupation to satisfy personal needs and full citizenship”
“Goal-directed pursuits that typically extend over (Christiansen & Townsend, 2004, p. 278). To
time have meaning to the performance, and experience meaning and enrichment in one’s occu-
involve multiple tasks” (Christiansen et al., 2005, pations; to participate in a range of occupations
p. 548). for health and social inclusion; to make choices
“Daily activities that reflect cultural values, and share decision-making power in daily life; and
provide structure to living, and meaning to indi- to receive equal privileges for diverse participation
viduals; these activities meet human needs for self- in occupations (Townsend & Wilcock, 2004).
care, enjoyment, and participation in society”
(Crepeau et al., 2003, p. 1031). Occupational performance
“Activities that people engage in throughout The act of doing and accomplishing a selected
their daily lives to fulfill their time and give life activity or occupation that results from the
motor activity, including following through on a ver- pation or occupations. Specifically selected activi-
bal command, visual spatial construction, ocular and ties that allow the client to develop skills that
oral–motor skills, imitation of a person or an object, enhance occupational engagement.
and sequencing actions (Ayres, 1985; Filley, 2001).
Organization of temporal sequences of actions with- Q
in the spatial context; which form meaningful occu- Quality of life
pations (Blanche & Parham, 2002). A client’s dynamic appraisal of life satisfactions (per-
Also see Motor. ceptions of progress toward identified goals), self-
concept (the composite of beliefs and feelings about
Preparatory methods
themselves), health and functioning (including
Methods and techniques that prepare the client for
health status, self-care capabilities), and socioeco-
occupational performance. Used in preparation
nomic factors (e.g., vocation, education, income)
for or concurrently with purposeful and occupa-
(adapted from Radomski, 1995; Zhan, 1992).
tion-based activities.
Prevention R
“[H]ealth promotion is equally and essentially Re-evaluation
concerned with creating the conditions necessary A reassessment of the client’s performance and goals
for health at individual, structural, social, and to determine the type and amount of change.
environmental levels through an understanding of
Rest
the determinants of health: peace, shelter, educa-
Quiet and effortless actions that interrupt physical
tion, food, income, a stable ecosystem, sustainable
and mental activity, resulting in a relaxed state
resources, social justice, and equity” (Kronenberg,
(Nurit & Michel, 2003, p. 227).
Algado, & Pollard, 2005, p. 441).
Promoting a healthy lifestyle at the individual, Ritual
group, organizational, community (societal), gov- Symbolic actions with spiritual, cultural, or social
ernmental/policy level (adapted from Brownson meaning, contributing to the client’s identity and
& Scaffa, 2001). reinforcing the client’s values and beliefs (Fiese et al.,
2002; Segal, 2004). Rituals are highly symbolic,
Process with a strong affective component and representa-
A description of the way in which occupational tive of a collection of events.
therapy practitioners operationalize their exper-
tise to provide services to clients. The process Roles
includes evaluation, intervention, and outcome Roles are sets of behaviors expected by society,
monitoring; occurs within the purview of the shaped by culture, and may be further conceptual-
domain; and involves collaboration among the ized and defined by the client.
occupational therapist, occupational therapy
Routines
assistant, and the client.
Patterns of behavior that are observable, regular,
Purposeful activity repetitive, and that provide structure for daily life.
A goal-directed behavior or activity within a ther- They can be satisfying, promoting, or damaging.
apeutically designed context that leads to an occu- Routines require momentary time commitment
and are embedded in cultural and ecological con- as widely as possible, and finally the requirement
texts (Fiese et al., 2002; Segal, 2004). that we reduce and where possible eliminate
unjustified inequalities’” (Commission on Social
Self-advocacy
Justice, 1994, p. 1).
Understanding your strengths and needs, identify-
“The promotion of social and economic
ing your personal goals, knowing your legal rights
change to increase individual, community, and
and responsibilities, and communicating these to
political awareness, resources, and opportunity for
others (Dawson, 2007).
health and well-being” (Wilcock, 2006, p. 344).
Sensory–perceptual skills Social participation
Actions or behaviors a client uses to locate, identi- “Organized patterns of behavior that are charac-
fy, and respond to sensations and to select, inter- teristic and expected of an individual in a given
pret, associate, organize, and remember sensory position within a social system” (Mosey, 1996, p.
events via sensations that include visual, auditory, 340) (see Table 1).
proprioceptive, tactile, olfactory, gustatory, and
vestibular sensations. Spirituality
“[T]he personal quest for understanding answers
Sleep to ultimate questions about life, about meaning,
“A natural periodic state of rest for the mind and and about relationship with the sacred or tran-
body, in which the eyes usually close and con- scendent, which may (or may not) lead to or arise
sciousness is completely or partially lost, so that from the development of religious rituals and the
there is a decrease in bodily movement and formation of community” (Moreira-Almeida &
responsiveness to external stimuli. During sleep Koenig, 2006, p. 844).
the brain in humans and other mammals under-
goes a characteristic cycle of brain-wave activity T
that includes intervals of dreaming” (The Free Temporal
Dictionary, 2007) (see Table 1). “Location of occupational performance in time”
A series of activities resulting in going to sleep, (Neistadt & Crepeau, 1998, p. 292). The experience
staying asleep, and ensuring health and safety of time as shaped by engagement in occupations.
through participation in sleep involving engage- The temporal aspects of occupations “which con-
ment with the physical and social environments. tribute to the patterns of daily occupations” are “the
Social environment rhythm...tempo...synchronization...duration...and
Is constructed by the presence, relationships, and sequence” (Larson & Zemke, 2004, p. 82; Zemke,
expectations of persons, organizations, and pop- 2004, p. 610). It includes stages of life, time of day,
ulations. duration, rhythm of activity, or history.
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E H
Education (area of occupation) Habits
definition and scope of activities, 632t, 670 definition and scope, 641, 643t, 670
intervention process, 654t person level, 643t
Emotional regulation skills, 639, 640t, 670 Health, 661, 662t
Engagement definition, 671
client's perspective, 630 engagement and, 629
context and environment, 642, 646 goals of occupational therapy, 625, 629, 630,
definition, 670 660
goals of occupational therapy, 625, 628, 660 Health promotion
health and, 629 definition, 652, 671
integrated view, 629 goals, 652, 674
in therapeutic process, 647 Hopes, 647, 671
Environment
I
definition, 642, 645t, 670
Identity
evaluation, 651
cultural context, 651
significance of, in occupational therapy, 646,
definition, 671
651
Independence
Evaluation, 649
definition, 629, 671
definition, 670
goals of occupational therapy, 625
goals, 647, 649
Instrumental activity of daily living, 630, 631t,
in occupational therapy process, 648t
671
re-evaluation and review, 656
Interdependence
steps, 646f, 649
definition, 671
therapist skills and knowledge for, 649
goals of occupational therapy, 625
See also Analysis of occupational performance;
Interests, 649, 671
Occupational profile
Intervention
F approaches, 657–659t, 672
Framework II clients, 652
domain, 625–626 definition, 671–672
future prospects, 664 goals, 652
historical development, 664–665 in occupational therapy process, 648t
process, 626 occupation-based, 653t, 672
purpose, 625 organization level, 652–655
revisions, 665–666t person level, 652
process, 652
G
steps, 646f, 655
Goals, 649, 670
therapist's use of self, 653t
types of, 653–654t
685
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