occupational therapy practice framework :domain & process 2nd edition
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Domain & Process 2nd Edition
Occupational Therapy practice
Framework:
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Outline
Introduction Domain of Occupational Therapy Process of Occupational Therapy Historical and Future perspectives on
the Occupational Therapy Practice Framework
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Introduction
AOTA (AJOT) Promoting the health and participation of clients
through engagement in occupation. Not a Taxonomy, Theory, Model must be used in conjunction with the
knowledge and evidence relevant to occupation and occupational therapy.
Mohsen Eslampanah
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All people need to be able or enabled to engage in the occupations of their need and choice, to grow through what they do, and to experience independence or interdependence, equality, participation, security, health, and well-being.Wilcock & Townsend, 2008, p. 198
Core beliefs
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Client
1. Persons 2. Organizations3. Populations within a community
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Persons
including families, caregivers, teachers, employers, and relevant others.
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Organization
businesses, industries, or agencies
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Populations
refugees, veterans who are homeless, and people with chronic health disabling conditions. Moyers & Dale,2007
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Performance of
Occupations
Client
Client’s Occupations
Context and environment
The domain and Process of occupational therapy direct OT practitioners to focus on …
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Occupational Therapy’s Domain
Supporting health and participation in life through engagement in occupation
EVALUATION
INTERVENTION
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Occupation = Everyday activity
Occupational Therapy’s Domain
Performance
Subjective
Emotional psychological
Objective
Physically observable
Holistic perspect
ive
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Occupational science
An interdisciplinary academic discipline in the social and behavioral sciences dedicated to the study of the
form, function, and the meaning of human occupations.
Zemke & clark, 1996
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Occupation & activity
Occupation
activity
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Co-occupations
Occupations often are shared.Example:1. Care giving => mothering
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Occupational justice
“Justice related to opportunities and resources required for occupational
participation sufficient to satisfy personal needs and full citizenship”
christiansen & Townsend,2004, p 278.
TO experience meaning and enrichment in one’s occupations TO participate in a range of occupations for health and social inclusion
TO make choices and share decision-making power in daily life TO receive equal privileges for diverse participation in occuapations
Townsend & wilcock, 2004.
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Aspects of Occupational Therapy’s Domain
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Areas of Occupation
Activities of daily living(ADL) Instrumental activities of daily living (IADL) Rest and sleep Education Work Play Leisure Social participation
Areas of Occupation
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ADLs
Care of one’s own bodyBADL or PADLFundamental to living in a social
world
Areas of Occupation
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ADLs
Bathing, showerin
g Bowel
and bladder manage
ment
Dressing
Eating
FeedingFunction
al mobility
Personal device
care
Personal hygiene
and grooming
Sexual activity
Toilet hygiene
Areas of Occupation
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IADLs
Care of others
Care of pets
Child rearing
Communication management
Community mobility
Financial managementHealth
management and
maintenance
Home establishment
and management
Meal preparati
on and cleanup
Religious observance
Safety and emergency
maintenance
shopping
Areas of Occupation
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Rest and
Sleep
rest
sleep
Sleep preparation
Sleep participation
Areas of Occupation
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Education
Formal education
participation
Informal personal
educational needs or interests
exploration
Informal personal education
participation
Areas of Occupation
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Work
Employment interests and
pursuits
Employment seeking and acquisition
Job performance
Retirement preparation
and adjustment
Volunteer exploration
Volunteer participation
Areas of Occupation
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Play
Play exploration
Play participation
leisure
Leisure exploration
Leisure participation
Areas of Occupation
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Social participation
community
familyPeer, friend
Areas of Occupation
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Client factors
Specific abilities, characteristics, or beliefs
May affect performance in areas of occupation.
Client
factors
Values, beliefs, spiritua
lty
Body functio
ns
Body structur
es
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Client factors(Values, beliefs, and spirituality)
Pers
on • Values: Principles,
standards, or qualities considered worthwhile or desirable by the client who holds them.
• Beliefs: Cognitive content held as true.
• Spirituality: The “personal quest for understanding answers to ultimate questions about life, about meaning, and the sacred”
Org
an
izati
on • Vision
statement• Code of
ethics• Value
statement• Esprit de
corps
Pop
ula
tion • Emotional
, purposive, and traditional perspectives
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Client factors (body Functions)Pe
rson • Physiological
function of body systems
• Mental functions• Sensory functions
and pain• Neuromusculoskelet
al and movement-related functions
• Cardiovascular, hematological, immunological, and respiratory system function
• Voice and speech functions
• Skin and related-structure function
Org
an
izati
on • Planning• Organizing• Coordinating• And
operationalizing the mission, products or services , and productivity
Pop
ula
tion • Economic
• Political• Social• And cultural
capital
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Client factors (body structures)Pe
rson • Anatomical
parts of the body such as organs, limbs, and their components
Org
an
izati
on • Department and departmental relationships
• Leadership and management,
• Performance measures,
• And job titles.
Pop
ula
tion • Similar
genetics,• Sexual
orientation• And health-
related conditions
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Activity Demands
Acti
vit
y
Dem
an
ds
Object and their properties
Space demands
Social demands
Sequence and timing
Required actions and performance skills
Required body function
Required body structure
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Performance Skills
Observable, concrete, goal directed actions to engage in
daily life occupations
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Motor and praxis skills
Sensory-perceptual skills
Emotional regulation skills
Cognitive skills
Communication and social skills
Performance skills
Performance skills
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Performance patterns
HabitsSpecific, automatic behaviors
that can be useful, dominating, or impoverished
RoutinesEstablished sequences of
occupations or activities that provide a structure for daily
life.
RolesSets of behaviors expected by
society, shaped by culture, and may be further
conceptualized and defined by the client.
RitualsSymbolic actions with spiritual, cultural, or social meaning that
contribute to the client’s identity and reinforce the
client’s values and beliefs.
Performance patterns
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Context and environment
Context• Cultural: customs, beliefs, activity patterns, behavior standards, and expectation accepted by the
society
• Personal: demographic feature of the individual such as age, gender, socioeconomic status, and
educational level • Temporal: stage of life, time of day or year, duration, rhythm of activity, or
history.
• Virtual: interaction in simulated, real-time, or near time situations absent of physical contact.Environment
• Physical: natural and built nonhuman environment and objects in them. • Social: relationships, and expectations of persons, groups, and organizations
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Process of service delivery
Evaluation
• Occupational profile• Analysis of occupational performance
interventio
n
• Intervention plan• Intervention implementation• Intervention review
Outcomes
• outcomes
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Occupational Therapy’s Process
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CLINICAL REASONING ENABLES OCCUPATIONAL THERAPY PRACTITIONER TO:
1. Identify the Multiple demands, skills, and potential meanings of activity
2. Gain a deeper understanding of the interrelationships between aspects of the domain that affect performance and those that will support client-centered interventions and outcomes.
Clinical reasoning
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Who is the client ? Why in the client seeking services, and what are the
client’s current concerns relative to engaging in occupations and in daily life activities?
What area of occupation are successful, and what areas are causing problems or risks?
What context and environments support or inhibit participation and engagement in desired occupations?
What is the client’s occupational history? What are the client’s priorities and desired outcomes?
Occupational profile Questions
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Synthesizing information from the occupational profile Observing the client’s performance during activities Selecting and using specific assessments to measure performance
skills and performance patterns, Selecting assessments, to identify and measure more specifically
contexts or environments, activity demands, and client factors Interpreting the assessment data Developing and refining hypotheses about the client’s occupational
performance strengths and limitations; Creating goals Determining procedures to measure the outcomes of intervention Delineating a potential intervention approach or approaches based
on best practices and available evidence.
Analysis of occupational performance
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Planning steps:
1. Developing the plan Objective and measurable goals with a
timeframe Occupational therapy intervention
approaches Mechanisms for service delivery
2. Considering potential discharge needs and plans
3. Selecting outcome measures4. Making recommendation or referral
to others as needed.
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Create, promote (health promotion)
Establish, restore (remediation, restoration)
Maintain
Modify (compensation, adaptation)
prevent
Occupational therapy intervention
approaches
Occupational therapy
intervention approaches
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Implementation steps:
1. Determining and carry out the type of OT intervention
2. Monitoring the client’s response to interventions
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Types of occupational therapy interventions
Types of occupational
therapy interventions
Therapeutic use of
self
Therapeutic use of
occupation and
activities
Occupation-based
intervention
Purposeful activity
Preparatory
methods
Consultation
process
Education process Advocacy
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1. Re-evaluating the plan2. Modify the plan3. Determining the need for
continuation or discontinuation of OT services
Review steps
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Selecting types of outcomes and
measures
• Occupational performance
• Adaptation• Health and wellness• participation• prevention• Self-advocacy• Quality of life• Occupational justice• Role competence
Using outcomes to measure progress and
adjust goals and interventions
• Comparing progress toward goal achievement
• Assessing outcome use and results to make decisions about the future direction of intervention
Outcomes process steps:
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Reference
American Occupational Therapy Association: Occupational therapy practice
framework: domain and process, 2nd edition,
am j Occup Ther 62:625-683, 2008
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