The Occupational Therapy Practice Framework (OTPF) was adopted by the American Occupational Therapy Association in May 2002 and was published in the November 2002 issue of AJOT*. AOTA members are able to access this AJOT article online at aota.org.
The Occupational Therapy Practice Framework outlines the scope of OT practice and replaces other documents (e.g. Uniform Terminology) that outline OT practice in terms of domain and process. The Occupational Therapy Practice Framework provides a structure for who we are and what we do. The OTPF has two parts: domain and process. Domain describes our territory, what we cover. Process describes how we go about delivering services. The OTPF has brought the term occupation front and center. Prior to the OTPF, Uniform Terminology, in use since 1979, used terms like 'function' and 'purposeful activity' and focused more on performance skills and components than on occupation.
OTPF Domain: The focus of occupational therapy is on engagement in occupation to support participation in contexts. Occupational therapy facilitates participation in meaningful activities. In the public school, the context consists of all of the environments where children engage in activity. In understanding this engagement in occupation, the OT service provider considers the following areas:
Performance in areas of occupation including: activities of daily living (ADL), instrumental activities of daily living (IADL) (activities that involved interacting with the environment or others such as care of the student work space), education, work, play, leisure, and social participation.
Context: cultural, physical, social, personal, spiritual, temporal, and virtual
Performance patterns: habits, routines, roles
Activity demands: materials and their properties, space demands, social demands, sequencing and timing, requires actions, requires body functions and structures
Performance skills: motor, process, and communication/interaction
Client factors: body structures and functions (e.g. musculoskeletal, sensorimotor or neuromuscular status)
OTPF Process: Occupational therapists engage in evaluation, intervention, and assessment of outcomes, which focus on facilitating engagement in occupation. This is a collaborative process that occurs in the school between the student, gamiliry member, teacher, and other members of the school team.
1. Evaluations: Involve assessment of the factors that influence engagement in occupation. This includes all of the relevant areas bulleted under the domain of practice above. The focus of the evaluation is o outline the student's meaningful participation/fulfullment of expectations in student role and school context.
2. Interventions: Include planning, implementation, and review. The focus of the occupational therapy intervention is to facilitate participation in meaningful activities in order to support success in the student role. Intervention approaches include create/promote, establish/restore, maintain, modify, and prevent. The approach is selected dependent on the desired outcome. Interventions are guided by theoretical frames of reference. Type of intervention include therapeutic use of self, use of occupation and activities (includes occupational-based activity, purposeful activity, and preparatory methods), consultation, and educational processes.
Planning: The OT (or the OT in conjunction with the OTA) develops goals collaboratively with the team (student, family, educational team) relevant to the students priorities and concerns regarding engagement in occupations; determines level of service delivery (i.e. frequency, duration, location within or outside of the regular education setting; offers consultation); selects outcome measures; considers discharge needs; and makes recommendations when needed.
Implementation: Although much of the planning is done collaboratively with the team, it is the responsibility of the OT service provider to choose the best approach to address the goal(s). This includes selection of frame of reference and intervention approach(es). The OT services provider may use a variety of approaches and is responsible for monitoring the student’ responses.
Review: The therapist continually evaluates the intervention effectiveness and the student’s progress toward agreed upon outcomes. This expected result of the intervention involves engagement in occupation to support participation.
The OTPF is currently undergoing revisions and the 2nd edition will be published in the November/December 2008 issue of AJOT.
*American Occupational Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609-639.