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Occupational Therapy Practice Framework
Domain & Process
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The Framework was developed
in response to current practice needs—the need to more clearly affirm and articulate occupational therapy’s unique focus on occupation and daily life activities and the application of an intervention process that facilitates engagement in occupation to support participation in life.
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Purpose of the Framework
to describe the domain that centers & grounds the profession’s focus and actions to outline the process of occupational therapy evaluation and intervention that is dynamic and linked to the profession’s focus on and use of occupation.
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‘Everyday life activity’ is occupation
[A]ctivities…of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupation is everything people do to occupy themselves, including looking after themselves…enjoying life…and contributing to the social and economic fabric of their communities…. (Law, Polatajko, Baptiste, & Townsend, 1997, p. 32)
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Occupational therapist
When working with clients, occupational therapists and O.T. assistants direct their effort toward helping clients perform. Performance changes are directed to support engagement in meaningful occupations that subsequently affect health, well-being, and life satisfaction.
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Occupation vs. Activity
Occupations are generally viewed as activities having unique meaning and purpose in a person’s life. Occupations are central to a person’s identity and competence, and they influence how one spends time and makes decisions. The term activity describes a general class of human actions that is goal directed (Pierce, 2001). A person may participate in activities to achieve a goal, but these activities do not assume a place of central importance or meaning for the person.
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Engagement in Occupation~
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Engagement in occupation
Context에 참여하도록 유도. Performance의 주관적인 면+객관적인 면 OT에서는 intervention을 실시할 때 두 가지 측면을 모두 고려해야 한다. WHO Health는 신체적 구조와 기능 Activity를 수행하거나 삶에 참여하는 능력(참여)
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Participation What is participation?
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Performance in areas of occupation
Activities of Daily Living Instrumental Activities of Daily Living Education Work Play Leisure Social Paticipation
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Performance Skills Aspects of motor skill include posture, mobility, coordination, strength and effort, and energy. Aspects of process skill include energy, knowledge, temporal organization, organizing space and objects, and adaptation. Aspects of communication/interaction skills include physicality, information exchange, and relations.
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Performance Patterns Habit refer to specific, automatic behavior
whereas routines are established sequences of occupations or activities that provide a structure for daily life. Roles are “a set of behaviors that have some socially agreed upon function and for which there is an accepted code of norms” (Christiansen & Baum, 1997, p. 603).
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Context Externalphysical, social, virtual.
Internalpersonal, spiritual Ex + Incultural Time dimensions (e.g., within a temporal context, the time of day; within a personal context, one’s age) Space dimensions (e.g., within a physical context, the size of room in which activity occurs).
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Activity Demands
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Client Factors Body functions—“physiological function of body systems (including psychological functions)” Body structures—“anatomical parts of the body such as organs, limbs, and their components”
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Body Functions and Structures
Mental functions Structures of the nervous system Sensory functions and pain The eye, ear and related structures Voice and speech functions Structures involved in voice and speech Functions of the cardiovascular, haematological, immunological and respiratory systems Structures of the cardiovascular, immunological and respiratory systems Functions of the digestive, metabolic and endocrine systems Structures related to the digestive, metabolic and endocrine systems Genitourinary and reproductive functions Structures related to the genitourinary and reproductive systems Neuromusculoskeletal and movement-related functions Structures related to movement Functions of the skin and related structures Skin and related structures
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Evaluation, Intervention, and Outcome
The Process of OT Evaluation, Intervention, and Outcome
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Occupational profile 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.
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Process Who is the client (individual, caregiver, group, population)?
Why is the client seeking service, and what are the client’s current concerns relative to engaging in occupations and in daily life activities? What areas of occupation are successful, and what areas are causing problems or risks? What contexts support engagement in desired occupations, and what contexts are inhibiting engagement? What is the client’s occupational history? What are the client’s priorities and desired targeted outcomes? (table 9)
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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.
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Intervention Process 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. the client’s goals, values, and beliefs; the health and well-being of the client; the client’s performance skills and performance patterns, as they are influenced by the interaction among the context or contexts, activity demands, and client factors; the setting or circumstance in which the intervention is provided
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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.
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Outcomes Process Outcomes (Engagement in Occupation To Support Participation) Determination of success in reaching desired targeted outcomes. Outcome assessment information is used to plan future actions with the client and to evaluate the service program (i.e., program evaluation).
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Intervention Approach
Focus of Intervention Create Performance skills 아동발달 교육 프로그램 Performance pattern 스트레스 관리 시간표작성 Context 다양한 감각 놀이를 경험-환경 Activity demands 아동이 놀 수 있는 충분한 공간 Client factor 자전거 타고 학교에 가게 함
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Types of OT Intervention
Occupation-based activity 실제적인 작업에의 참여; 혼자서 옷 입기, 조립라인 개조하기 Purposeful activity 작업을 할 수 있도록 치료적으로 설계된 상항 속에서 목표지향적 활동에 참여함 Preparatory method 작업수행을 위해 환자를 준비시킴
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Occupational performance
Types of Outcomes Outcome Occupational performance Client satisfaction Role competence Adaptation Health and Wellness Prevention Quality of life
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