OT Practice Framework

Occupational Therapy Practice Framework:

Domain & Process (3rd ed)

official document of the AOTA, intended for OT practitioners and students, as well as other healthcare professionals, educators, researchers, payers, and consumers.

Presents summary of interrelated constructs that describe OT practice

Domain

Profession's purview and areas in which its members have an established body of knowledge and expertise

5 Domains

1. occupations

2. client factors

3. performance skills

4. performance patterns

5. context/environment

8 types of Occupations

1. ADLs

2. IADLs

3. Rest and Sleep

4. Education

5. Work

6. Play

7. Leisure

8. Social Participation

remember: work play leisure rest, education and social participation, ADLs IADLs

Activities of daily living (ADLS)

Activities oriented toward taking care of one's own body. ADLs also are referred to as basic activities of daily living (BADLs) and personal activities of daily living (PADLs). These activities are "fundamental to living in a social world; they enable basic survival and well-being"

List the 9 ADLs

Activities of Daily Living

1. bathing, showering

2. toileting and toilet hygiene

3. swallowing/dressing

4. eating

5. feeding

6. functional mobility- example: out of bed and walking to bathroom

7. personal device care

8. personal hygiene and grooming

9. sexual activity

IADLs

Instrumental Activities of Daily Living

-activities to support daily living within the home and community and involves more complex interactions than ADL's.

List the 12 IADLs

Instrumental Activities of Daily Living

1. Care of others

2. Care of pet

3. Child rearing

4. Communication management

5. Driving and Community Mobility

6. Financial Management

7. Health Management and Maintenance

8. Home Establishment and Management

9. Meal Preparation and Cleanup

10. Religious and Spiritual activities and expressions

11. Safety and Emergency Maintenance

12. Shopping

Rest and Sleep

supports healthy, active engagement in other occupations; sleep preparation and sleep participation

Education

activities needed for learning; formal and informal participation

Work

with or without financial reward; employment interests; seeking acquisition, job performance, retirement preparation, volunteer exploration and participation

Play

activity that provides

enjoyment, entertainment, amusement, or diversion

Leisure

"Nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations"

Social Participation

enaging in activities with others; community, family; peer, friend

client factors

things that influence the client's performance in occupation

3 Client Factors

1. Values, Beliefs, and Spirituality

2. Body functions

3. Body structures

values

acquired beliefs and commitments, derived from culture about what is right, good, important to do; honesty with self and others; commitment to family

beliefs

thoughts held as true by or about the client; hard work pays off; internal focus of control

spirituality

the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred; daily search for meaning

body functions

physiological, mental (specific, global), sensory, neuromusculoskeletal and movement related, muscle, movement, cardiovascular, hematological, immunological, respiratory, voice and speech, digestive, metabolic, endocrine, geniturinary, reproductive, skin,...

body structures

anatomical parts of the body: nervous system, eyes, ears, voice and speech, cardiovascular, immunological, respiratory, digestive, metabolic, endocrine, genitourinary, reproductive, structures related to movement and skin

performance skills

abilities the client demonstrates in the actions they perform.

3 kind of performance skills

1. Motor Skills

2. Process Skills

3. Social Interaction Skills

motor skills

actions or behaviors a client uses to interact with and move task objects and self around the environment

process skills

observed as a person selects, interacts with, and uses tools and materials; carries out individual actions and steps; modifies performance when problems are encountered

social interaction skills

observed during ongoing stream of social exchange

Performance Patterns

*Habits, routines, roles, and rituals* used in the process of engaging in occupations or activities; these patterns can *support or hinder occupational performance*.

4 kinds of performance patterns

1. habits

2. routines

3. rituals

4. roles

habits

acquired tendencies to respond and perform in certain consistent ways in familiar environments or situations

routines

patterns of behavior that are observable, regular and repetitive and provide structure for daily life

rituals

symbolic actions with spiritual, cultural, or social meaning contributing to client's identity and reinforcing values and beliefs

roles

sets of behaviors expected by society and shaped by culture and context that may be further conceptualized and defined by the client

context

Variety of interrelated conditions within and surrounding the client that

environment

external physical and social conditions that surround the client and in which the client's daily life occupations occur

6 types of contexts and environment

1. cultural

2. personal

3. physical

4. social

5. temporal

6. virtual

cultural

customs, beliefs, activity patterns, behavioral standards and expectations by society

personal

features of an individual that are not part of a health condition or health status

temporal

experience of time as shaped by engagement in occupations, rhythms, duration, sequence

virtual

communication without physical contact

physical

non-human environments; homes, animals, furniture

social

presence of, relationships with and expectations of persons or groups, or populations with whom clients have contact

Process

OT practitioners operate their expertise to provide services to clients; includes evaluation, intervention, and targeted outcomes; occurs within the purview of OT domain, and involves collaboration among the OTR, OTA, and the client

process of OT

use occupations as methods of intervention, facilitating interactions among clients, apply skills, clinical reasoning

3 steps of OT process

1. Evaluation

2. Intervention

3. Targeting of Outcomes

2 parts of evaluation

occupational profile and analysis of occupational performance

occupational profile

summary of client's occupational hx and experiences, patterns of daily living, interests, values, and needs

analysis of occupational performance

client's assets and problems or potential problems are more specifically identified through assessment tools designed to observe, measure, and inquire about factors that support or hinder occupational performance and in which targeted outcomes are identified

3 parts of intervention

1. plan

2. implementation

3. review

intervention plan

developed from evaluation, writing goals for patient based on theories, frames of reference, models and evidence, objective (the facts), outcome measures, recommendations

intervention implementation

work of goals, treat patients, monitor and watch for responses, plan into action

intervention review

ongoing evaluation, change goals, modify or discharge, done every session

OUTCOMES

1.

a. Occupational performance

b. Prevention

c. Health and wellness

d. Quality of life

e. Participation

f. Role competence

g. Well-being

h. Occupational Justice

2.

a. measure progress

b. adjust goals and interventions