IS

OT Practice Framework: Domain and Process (4th ed.) Notes

Areas of Occupation

  • Definition and purpose: Occupational Therapy Practice Framework (Domain and Process), 4th ed.
  • Professional document that delineates the unique focus of occupational therapy on occupation
  • Overall concern of occupational therapy: “Achieving health, well-being, and participation in life through engagement in occupation”
  • Occupational therapy is defined as: “therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation.”
  • Occupations refer to the everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life.
  • Occupations include things people need to, want to, and are expected to do. (WFOT, 2012a, para. 2)

I. AREAS OF OCCUPATION

  • Various kinds of life activities in which people, populations, or organizations engage, including ADL, IADL, rest and sleep, education, health management, work, play, leisure, and social participation.
  • Activities of Daily Living (ADLs): Activities oriented toward taking care of your own body and completed on a routine basis
    • Bathing, showering
    • Toileting & toilet hygiene
    • Dressing
    • Eating & Swallowing
    • Feeding
    • Functional mobility
    • Personal hygiene and grooming
    • Sexual activity
  • Instrumental Activities of Daily Living (IADLs): Activities to support daily life within the home and community
    • Care of others (including selecting & supervising caregivers)
    • Care of pets & animals
    • Child rearing
    • Communication management
    • Driving & Community mobility
    • Financial management
    • Home establishment and management
    • Meal preparation and cleanup
    • Religious and spiritual expression
    • Safety and emergency maintenance
    • Shopping
  • Health Management: Activities related to developing, managing, and maintaining health and wellness routines…to support participation in other occupations
    • Social and emotional health promotion & maintenance
    • Symptom and condition management
    • Communication with the health care system
    • Medication management
    • Physical activity
    • Nutrition management
    • Personal care device management
  • Rest and Sleep: Activities related to obtaining restorative rest and sleep to support healthy active engagement in other occupations
    • Rest
    • Sleep preparation
    • Sleep participation
  • Education: Activities needed for learning and participating in the educational environment
    • Formal educational participation
    • Informal personal educational needs or interests exploration (beyond formal education)
    • Informal personal education participation
  • Work: Labor or exertion related to development, production, delivery, or management of objects or services; benefits may be financial or non-financial
    • Employment interests and pursuits
    • Employment seeking and acquisition
    • Job performance and maintenance
    • Retirement preparation and adjustment
    • Volunteer exploration
    • Volunteer participation
  • Play: Activities intrinsically motivated, internally controlled, freely chosen; may include suspension of reality, exploration, humor, risk taking, contests, celebrations
    • Play exploration
    • Play participation
  • Leisure: Non-obligatory activity that is intrinsically motivated and engaged in during discretionary time
    • Leisure exploration
    • Leisure participation
  • Social Participation: Activities that involve social interaction with others, including family, friends, peers, and community members, and that support social interdependence
    • Community participation
    • Family participation
    • Friendships
    • Intimate partner relationships
    • Peer group participation

Context

  • The broad construct that encompasses environmental factors and personal context
  • Environmental factors: aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives
  • Personal factors: the particular background of a person’s life and living, and consist of the unique features of the person that are not part of a health condition or health state

2) CONTEXT: ENVIRONMENTAL FACTORS

  • Natural environment and human-made changes to the environment
    • Physical geography
    • Population – groups of people who share the same pattern of environmental adaptation
    • Flora & fauna
    • Climate
    • Natural events
    • Human-caused events
    • Light
    • Time-related changes
  • Products & Technology
    • Food, drugs
    • Products for daily living
    • Personal mobility products and adaptive equipment for home & community
    • Communication products/technology
    • Educational products/technology
    • Employment products/technology
    • Cultural, recreational and sporting products/systems
    • Religious/spirituality items
  • Support & Relationships
    • Immediate & extended family
    • Friends, acquaintances, peers, neighbors
    • People in positions of authority or subordinates
    • Personal care providers
    • Domesticated animals
  • Attitudes
    • Individual attitudes
    • Societal attitudes
    • Social norms (that marginalize populations)
  • Services, systems and policies
    • Benefits
    • Structured programs
    • Regulations
    • Services designed to meet the needs of persons, groups, & populations

CONTEXT: PERSONAL FACTORS

  • Age
  • Sexual orientation
  • Gender identity
  • Race and ethnicity
  • Cultural identification and attitudes
  • Social and socioeconomic background & status
  • Upbringing & life experiences
  • Habits & past behavioral patterns
  • Individual psychological tendencies (temperament, coping styles, etc)
  • Education
  • Lifestyle
  • Profession & professional identity
  • Other health conditions & fitness

II. PERFORMANCE PATTERNS

HABITS, ROUTINES, ROLES AND RITUALS THAT MAY BE ASSOCIATED WITH DIFFERENT LIFESTYLES AND USED IN THE PROCESS OF ENGAGING IN OCCUPATIONS OR ACTIVITIES

  • Habits: “Specific, automatic behaviors performed repeatedly, relatively automatically, and with little variation” (can either support or interfere with performance)
  • Routines: Patterns of behavior that are observable, regular, repetitive, and provide structure for daily life
  • Roles: Aspects of identity shaped by culture and context that may be further conceptualized and defined by the client and the activities and occupations one engages in
  • Rituals: Symbolic actions with spiritual, cultural, or social meaning contributing to the client’s identity and reinforcing values and beliefs

IV. PERFORMANCE SKILLS

OBSERVABLE, GOAL-ORIENTED ACTIONS THAT RESULT IN A CLIENT’S QUALITY OF PERFORMING DESIRED OCCUPATIONS

  • Motor Skills: Represent small, observable actions related to moving oneself or moving and interacting with tangible objects
  • Process Skills: Represent small, observable actions related to selecting, interacting with, or using tangible task objects
  • Social Interaction Skills: Represent small, observable actions related to communicating and interacting with others

V. CLIENT FACTORS

CLIENT FACTORS INCLUDE VALUES, BELIEFS, AND SPIRITUALITY, BODY FUNCTIONS, AND BODY STRUCTURES THAT RESIDE WITHIN THE CLIENT AND INFLUENCE PERFORMANCE IN OCCUPATIONS

  • Values: Acquired beliefs and commitments, derived from culture, about what is good, right and important to do
  • Beliefs: Something that is accepted, considered to be true or held as an opinion
  • Spirituality: A deep experience of meaning brought about by engaging in occupations that involve the enacting of personal values and beliefs, reflection, and intention within a supportive contextual environment
  • Body Functions: The physiological functions of body systems (including psychological functions)
    • Mental functions
    • Sensory functions
    • Neuromusculoskeletal and movement-related functions
    • Cardiovascular, hematological, immune and respiratory system functions
    • Voice and speech functions; digestive, metabolic, and endocrine system functions; genitourinary and reproduction functions
    • Skin and related structure functions
  • Body Structures: Anatomical parts of the body such as organs, limbs, and their components
    • Structures of the nervous system
    • Eyes, ears
    • Voice and speech
    • Cardiovascular, immunological and respiratory systems
    • Digestive, metabolic, and endocrine systems
    • Genitourinary and reproductive systems
    • Structures related to movement

VI. ACTIVITY DEMANDS

  • WHAT IS TYPICALLY REQUIRED TO CARRY OUT THE ACTIVITY REGARDLESS OF CLIENT OR CONTEXT
  • Objects used and their properties
    • Tools, materials, and equipment used in the process of carrying out the activity
  • Space demands
    • physical environment requirements
  • Social demands
    • social and attitudinal environments required
  • Sequencing and timing demands
    • temporal process required to carry out the activity
  • Required actions and performance skills
    • typically required skills inherent in the activity
  • Required body functions
    • physiological functions of body systems required
  • Required body structures
    • anatomical parts of the body such as organs, limbs, and their components