Occupational Therapy Practice Framework: Domain and ...

1 Occupational Therapy PracticeFramework: Domain and ProcessFourth EditionPrefaceThe fourth edition of theOccupational Therapy Practice framework : Domainand process (hereinafter referred to as theOTPF 4), is an official document ofthe American Occupational Therapy Association (AOTA). Intended foroccupational Therapy practitioners and students, other health careprofessionals, educators, researchers, payers, policymakers, and consumers,theOTPF 4presents a summary of interrelated constructs that describeoccupational Therapy theOTPF 4, Occupational therapyis defined as the therapeutic use ofeveryday life occupations with persons, groups, or populations ( , the client)for the purpose of enhancing or enabling participation. Occupational therapypractitioners use their knowledge of the transactional relationship among theclient, the client s engagement in valuable occupations, and the context todesign occupation-based intervention plans. Occupational Therapy servicesare provided for habilitation, rehabilitation, and promotion of health andwellness for clients with disability- and non disability-related needs.

2 Theseservices include acquisition and preservation of Occupational identity forclients who have or are at risk for developing an illness, injury, disease,disorder, condition, impairment, disability, activity limitation, or participationrestriction (AOTA, 2011; see the glossary in Appendix A for additionaldefinitions).When the termoccupational Therapy practitionersis used in thisdocument, it refers to both Occupational therapists and Occupational therapyassistants (AOTA, 2015b). Occupational therapists are responsible for allaspects of Occupational Therapy service delivery and are accountable for thesafety and effectiveness of the Occupational Therapy service delivery ..1 Definitions ..1 Evolution of This Document ..2 Vision for This Work ..4 Introduction ..4 Occupation and Occupational Science ..4 OTPFO rganization ..4 Cornerstones of Occupational TherapyPractice ..6 Domain ..6 Occupations ..7 Contexts ..9 Performance Patterns ..12 Performance Skills ..13 Client Factors.

3 15 process ..17 Overview of the Occupational TherapyProcess ..17 Evaluation ..21 Intervention ..24 Outcomes ..26 Conclusion ..28 Tables ..29 References ..68 Table 1. Examples of Clients: Persons, Groups,and Populations ..29 Table 2. Occupations ..30 Table 3. Examples of Occupations for Persons,Groups, and Populations ..35 Table 4. Context: Environmental Factors ..36 Table 5. Context: Personal Factors ..40 Table 6. Performance Patterns ..41 Table 7. Performance Skills for Persons ..43 Table 8. Performance Skills for Groups ..50 Table 9. Client Factors ..51 Table 10. Occupational Therapy process forPersons, Groups, and Populations ..55 Table 11. Occupation and ActivityDemands ..57 GUIDELINESAOTA OFFICIAL DOCUMENT1 The American Journal of Occupational Therapy ,August 2020, Vol. 74, Suppl. 27412410010p1 Downloaded from on 09/08/2020 Terms of use: Therapy assistants deliver Occupational Therapy services underthe supervision of and in partnership with an Occupational therapist (AOTA,2020a).

4 The clients of Occupational Therapy are typically classified aspersons(including those involved in care of a client),groups(collections of individualshaving shared characteristics or a common or shared purpose; , familymembers, workers, students, people with similar interests or occupationalchallenges), andpopulations(aggregates of people with common attributessuch as contexts, characteristics, or concerns, including health risks;Scaffa& Reitz, 2014). People may also consider themselves as part of acommunity,such as the Deaf community or the disability community; acommunityis acollection of populations that is changeable and diverse and includes variouspeople, groups, networks, and organizations (Scaffa, 2019; World Federationof Occupational Therapists [WFOT], 2019). It is important to consider thecommunity or communities with which a client identifies throughout theoccupational Therapy the client is a person, group, or population, information about theclient s wants, needs, strengths, contexts, limitations, and Occupational risks isgathered, synthesized, and framed froman Occupational perspective.

5 ThroughouttheOTPF 4,the termclientis used broadly to refer to persons, groups, andpopulations unless otherwise specified. In theOTPF 4, group as a client is distinctfrom group as an intervention approach. For examples of clients, seeTable 1(alltables are placed together at the end of this document). The glossary in AppendixA provides definitions of other terms used in this of This DocumentTheOccupational Therapy Practice Frameworkwas originally developed toarticulate Occupational Therapy s distinct perspective and contribution topromoting the health and participation of persons, groups, and populationsthrough engagement in occupation. Thefirst edition of theOTPF emergedfrom an examination of documents related to theOccupational Therapy ProductOutput Reporting System and Uniform Terminology for Reporting OccupationalTherapy Services(AOTA, 1979). Originally a document that responded to a federalrequirement to develop a uniform reporting system, this text gradually shifted todescribing and outlining the domains of concern of Occupational second edition ofUniform Terminology for Occupational Therapy (AOTA, 1989) was adopted by the AOTA Representative Assembly (RA) andpublished in 1989.

6 The document focused on delineating and defining onlythe Occupational performance areas and Occupational performance componentsthat are addressed in Occupational Therapy direct services. The third andfinaledition ofUniform Terminology for Occupational Therapy (UT III;AOTA, 1994)was adopted by the RA in 1994 and was expanded to reflect current practiceand to incorporate contextual aspects of performance (p. 1047). Each revisionTable 12. Types of Occupational TherapyInterventions ..59 Table 13. Approaches to Intervention ..63 Table 14. Outcomes ..65 Exhibit 1. Aspects of the Occupational TherapyDomain ..7 Exhibit 2. Operationalizing the OccupationalTherapy process ..16 Figure 1. Occupational Therapy Domain andProcess ..5 Authors ..72 Acknowledgments ..73 Appendix A. Glossary ..74 Index ..85 Copyright 2020 by the AmericanOccupational Therapy :American Occupational TherapyAssociation. (2020). Occupational therapypractice framework : Domain and process (4th ed.).American Journal of OccupationalTherapy, 74(Suppl.)

7 2), : 978-1-56900-488-3 For permissions inquiries, OFFICIAL DOCUMENTThe American Journal of Occupational Therapy ,August 2020, Vol. 74, Suppl. 27412410010p2 Downloaded from on 09/08/2020 Terms of use: changes in Practice and provided consistentterminology for use by the fall 1998, the AOTA Commission on Practice (COP)embarked on the journey that culminated in theOccupational Therapy Practice framework : Domainand process (AOTA, 2002a). At that time, AOTA alsopublishedThe Guide to Occupational Therapy Practice (Moyers, 1999), which outlined contemporary practicefor the profession. Using this document and the feedbackreceived during the review process for theUT III,the COPproceeded to develop a document that more fullyarticulated Occupational an ever-evolving document. As anofficial AOTA document, it is reviewed on a 5-yearcycle for usefulness and the potential need for furtherrefinements or changes. During the review period, the COPcollects feedback from AOTA members, scholars, authors,practitioners, AOTA volunteer leadership and staff, andother stakeholders.

8 The revision process ensures that theOTPF maintains its integrity whileresponding to internal andexternal influences that should be reflectedinemergingconcepts and advances in Occupational revised and approved by the RA in2008. Changes to the document included refinement of thewriting and the addition of emerging concepts and changesin Occupational Therapy . The rationale for specific changescanbefoundinTable11oftheOTPF 2(AOTA, 2008,pp. 665 667).In 2012, the process of review and revision of theOTPFwas initiated again, and several changes weremade. The rationale for specific changes can be foundon page S2 of theOTPF 3(AOTA, 2014).In 2018, the process to revise theOTPF began member review and feedback, several modificationswere made and are reflected in this document:nThe focus on group and population clients isincreased, and examples are provided for of Occupational Therapy Practice areidentified and described as foundational to thesuccess of Occupational Therapy scienceis more explicitly describedand termsoccupationandactivityare more occupations, the definition ofsexual activityas anactivity of daily living is revised,health managementisadded as a general occupation category, andintimatepartneris added in the social participation category(seeTable 2).

9 NThecontexts and environmentsaspect of theoccupational Therapy Domain is changed tocontextonthe basis of the World Health Organization (WHO; 2008)taxonomy from theInternational Classification ofFunctioning, Disability and Health (ICF)in an effortto adopt standard, well-accepted definitions (seeTable 4).nFor the client factors category of body functions,gender identityis now included under experience ofself and time, the definition ofpsychosocialisexpanded to match theICFdescription, andinteroceptionis added under sensory types of intervention, preparatory methods andtasks has been changed to interventions to supportoccupations (seeTable 12).nFor outcomes, transitions and discontinuation arediscussed as conclusions to Occupational therapyservices, and patient-reported outcomes areaddressed (seeTable 14).nFive new tables are added to expand on and clarifyconcepts:+Table 1. Examples of Clients: Persons, Groups,and Populations+Table 3. Examples of Occupations for Persons,Groups, and Populations+Table 7.

10 Performance Skills for Persons (includesexamples of effective and ineffectiveperformance skills)+Table 8. Performance Skills for Groups(includes examples of the impact of ineffectiveindividual performance skills on groupcollective outcome)+Table 10. Occupational Therapy process forPersons, Groups, and , the use ofOTPF rather thanFrameworkacknowledges the current requirements for a uniqueGUIDELINESAOTA OFFICIAL DOCUMENT3 The American Journal of Occupational Therapy ,August 2020, Vol. 74, Suppl. 27412410010p3 Downloaded from on 09/08/2020 Terms of use: to maximize digital discoverability and topromote brevity in social media communications. Italso reflects the longstanding use of the acronym inacademic teaching and clinical 1has been revised to provide a simplifiedvisual depiction of the Domain and process ofoccupational for This WorkAlthough this edition of theOTPF represents the latest inthe profession s efforts to clearly articulate theoccupational Therapy Domain and process , it builds on aset of values that the profession has held since itsfounding in 1917.