• The Occupational Therapy Practice Framework:

The Occupational Therapy Practice Framework

• Domain Process
• Prepared by AOTAs
• Commission on Practice
• Presented by
• Mary Jane Youngstrom MS,OTR, FAOTA
•
• What is the OT Practice Framework?A richer
more focused description of occupational
therapya new document
• Adopted by the RA in May 2002
• Replaces UT III
• Why is it important?Reflects changes in
knowledge
• Emphasizes the professions focus on
occupation
• Reflects updated language. Provides links to
World Health Organizations International
Classification of Functioning (ICF) language
•
The ICFA classification which provides common
language
to describe health and health related states
ICF Components
Body Functions Structures
Activities Participation
Environmental Factors
Barriers Facilitators
Functions Structures
Capacity Performance
• How does OT fit into this classification?OT
considers all aspects of classification when
delivering services
• OT strength lies in linking activities to
participation within context
• Purpose of the FrameworkDescribe our
DOMAIN
• More clearly articulate OTs unique focus on
daily life activities and interventions that
promote engagement in occupations to
support
participation in context.
• Outline an occupation based OT PROCESS
• Give practitioners a way to think about, talk
about and apply occupation across the OT
process
• Relationship of the domain and the
processDomain outlines the area in which we
provide
services
• Process describes the structural pieces (i.e.
evaluation, intervention outcomes) we use
when
delivering services
• They are interdependent
•
Domain of Occupational Therapy
Engagement in Occupation to Support
Participation in Context
Performance in Areas of Occupation
Performance Skills
Performance Patterns
Context
Activity Demands
Client Factors
• Our domainThe area of human experience in
which we offer
assistance to others.
• We help others to engage in everyday life
activitiesor.
OCCUPATIONS
• OccupationDefined as
• Activities.. of everyday life, named,
organized, and given value and meaning by
individual and a culture. Occupation is
everything people do to occupy themselves,
including looking after themselves,enjoying
life,and contributing to the social and economic
fabric of their communities(Law, Polatajko,
Baptiste, Townsend, 1997, p. 32)
•
Domain of Occupational Therapy
Engagement in Occupation to Support
Participation in Context
Performance in Areas of Occupation
Performance Skills
Performance Patterns
Context
Activity Demands
Client Factors
• Engagement in Occupation to support
Participation
in ContextThe overarching phrase that
describes the domain
•
• Why was this phrase chosen?
Engagementrecognizes choice, personal
meaning,
psychological/emotional and physical aspects of
performance
• Occupationa vital force in regaining and
promoting health
• Participationan aspect of health in the ICF
model. By facilitating engagement in occupations
OTs link activities to participation
• Contextsupports and mediates engagement
•
• Performance inAreas of OccupationCategories
of occupation in which people engage
• Called performance areas in UT III
• Resorted and expanded from UT III
•
• Performance in Areas of OccupationActivities
of Daily Living (ADL)
• Instrumental Activities of Daily Living (IADL)
• Education
• Work
• Play
• Leisure
• Social Participation (new)
•
• Performance SkillsNEW!Describes observed
actionslifts, chooses, asks
• 3 kinds of skills
• Motor skills
• Process skills
• Communication /Interaction skills
• Performance SkillsPerformance skill terms
differentiate skilled
action from underlying body functionsa
different
vocabulary. Provide a language link to
engaging
in occupations.
• Effective skill performance is not ensured by
adequate underlying body functions or
structures.
• Performance PatternsNEW!Habits
• Routines
• Roles
• Performance patterns are recurring behaviors
related to daily routines
• ContextCultural (retained)
• Physical (retained)
• Social (retained)
• Personal (resorted from UT III Temporal
contextrefers to age, gender, educational
socio-economic status)
• Spiritual (new)
• Temporal (resorted from UT III Temporal
contextrefers to time of day, year, stage of
life etc.)
• Virtual (new)
• Activity DemandsNEW!Objects used and their
properties
• Space Demands
• Social Demands
• Sequencing and Timing
• Required actions
• Required body functions
• Required body structures
•
• Activity DemandsRelate to a specific activity
• Different than physical context and social
context
O.T. Practice Framework Process
Intervention Plan
Occupational Profile
Outcomes Engagement in Occupation to
support Participation
Intervention Review
Analysis of Occupational Performance
Intervention Implementation
• What makes this process unique to OT?What is
evaluated occupational needs, problems,
risks and concerns
• How the problem is framed occupational
performancerisks or difficulties with daily life
tasks
• Type of intervention use of selected therapeutic
activities and occupations to facilitate
engagement in occupation
• Outcome directed toward facilitating engagement
in occupation to support participation
•
• Key points about the processClient-centered
• Clients may be individuals, groups or
populations
• Dynamic and interactive
• Broad inclusive of all practice areas
• Context an embedded influence on the
process of
service delivery
• Grounded in occupation
• The Occupational Profilethe initial stepDescribes
clients occupational history, patterns
of living, interests, values, and needs
• Identify clients priorities. What are clients
needs, wants and concerns re engaging in
occupations
• Frame client concerns and issues within the
domain of occupational therapy
•
• Analysis of Occupational PerformanceMore
specifically identify underlying factors
which support and hinder performance
• --observe performance
• --perform selected specific assessments
if needed
• --consider context, activity
• demands and client factors
• Intervention PlanDevelop plan in collaboration
with client
• Base plan on
• --Selected theory and/or practice
framework
• --Evidence
• Select intervention approach create/promote,
establish/restore, maintain, modify, prevent
• Target desired outcomes
•
• Intervention
• Action to influence and support performance
• Types of interventions
• -Therapeutic use of self
• -Therapeutic use of occupations/activities
• Occupation-based activity, purposeful
• activity, preparatory methods
• -Consultation process
• -Education process
• Intervention Review
• Review plan, process and progress toward
outcomes
• Modify plan if needed
• Determine future action
•
• Outcomesengagement in occupation to
support
participation
• Describes the broad outcome of the OT
intervention process
• Links the outcome to the domain
•
• Outcomesengagement in occupation to support
participationTypes of outcomes
• --Occupational performance
• --Client satisfaction
• --Role competence
• --Adaptation
• --Health and wellness
• --Prevention
• --Quality of life
•
• Integrating the domain and processapplying the
framework (in practice)Focus on the client as an
occupational
beingstart your eval with the occupational
profile. Document it
• When thinking about performance look at all
facilitators and barriers i.e. perf skills,
patterns, context, activity demands and client
factors
• Describe performance with skill language. Do not
confuse skills with client factors in either your
evaluation or intervention actions
• Integrating the domain and the process
• CASES
• Brandipediatric early interventionAge2 years, 6
months
• Reason for referraldetermine if OT services are
needed
• Medical historyhealth
• Family history--unremarkable
•
• BrandiEvaluation and impressionsImpression
• Performance skills ?
• Performance patterns ?
• Context ?
• Activity demands ?
• Client factors
• Slight speech and language delays
• Age appropriate fine and gross motor skills
• Age appropriate cognitive skills
• CONCLUSIONno therapy needed
• Assessments
• Bayley Scale of Infant Developmentscored 30-32
months
• BrandiEvaluation at 3 yr 3 moAssessments
• Classroom and playground observation
• Teacher interview
• Sensory history
• Occupational profile
• Peabody Development Motor Scales
• Impression
• --Perf patternssticks to familiar activities
• -- Context--Difficulty in multisensory
environment. Social demands often overwhelming
• --Activity demandsdifficulty with new tasks
• --Client factorssensory sensitivities, language
delays, dyspraxia, vestibular-proprioceptive
process difficulties
• Concerns regarding PARTICIPATION
• Mothers stated concerns
• I wish she could play more easily with her
sister
• Teachers stated concerns
• I wish her peers could be more accepting,
support her, and play with her more.
• Brandi—Intervention
• Approachmodify context and activity demands to
support performance at home and school.
Create/promote opportunities for play
• Contextprovide quiet calm social context. Make
physical context clutter free. Minimize
environmental changes i.e. seat assignments
• Activity demandsuse visual cues. Break down into
steps. Select activities with deep pressure and
proprioceptive properties
•
• BrandiEngagement in occupations to support
participation—OUTCOMES
• Mom states that Brandi is fine now. She plays
very well with her sister
• Teacher states that Brandi performs better in
classroom when activities match her needs.
Interacting more appropriately with peers.
•
• What did you notice?
• Integrating the domain and processapplying the
frameworkFocus on the client as an occupational
beinginclude an occupational profile in your
evaluation. Document it
• When thinking about performance issues look at
all facilitators and barriers i.e. Perf. Skills
patterns, context, activity demands and client
factors
• Differentiate between performance skills and
client body functions or capacities
• Integrating the domain and processapplying
theframework
• Observe performance
• Target goals towards outcomes that will lead
to
participation in daily life contexts
• In summaryThe Occupational Therapy Practice
Framework Domain and Process
• Affirms the professions focus on engagement
in
occupation to support participation as an
important aspect of health
• Describes and links the professions domain
and
process
• In summaryThe Occupational Therapy Practice
Framework Domain and Process
• Incorporates terms more commonly used by
other
disciplines
• Adds constructs to the domain updates terms
throughout to reflect current knowledge and
thinking
• Using the framework can help you to.Shift the
focus of your practice and clarify your
special contribution
• Add to your vocabulary new and updated
terminology and language! (i.e. performance
patterns, performance skills)
• Change what you document to make your
contribution more occupation based
• Make your practice more client centered
•