OTPF–4
Occupational Therapy Practice Framework:
Domain and Process Fourth Edition
The OTPF-4 is an official document of the American Occupational Therapy Association (AOTA®). Intended for occupational therapy practitioners and students, other health care professionals, educators, researchers, payers, policymakers, and consumers. The OTPF-4 presents a summary of interrelated constructs that describe occupational therapy practice.
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Within the OTPF-4, occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations (i.e., the client) for the purpose of enhancing or enabling participation.
Occupational Therapy Practitioners– refers to both occupational therapists and occupational therapy assistants.
– Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the safety and effectiveness of the occupational therapy service delivery process.
– Occupational therapy assistants deliver occupational therapy services under the supervision of and in partnership with an occupational therapist.
The clients of occupational therapy- are typically classified as persons (including those involved in care of a client), groups (collections of individuals having shared characteristics or a common or shared purpose; e.g., family members, workers, students, people with similar interests or occupational challenges), and populations. Whether the client is a person, group, or population, information about the client’s wants, needs, strengths, contexts, limitations, and occupational risks is gathered, synthesized, and framed from an occupational perspective.
The OTPF-4 is composed of 2 interrelated parts- the Domain & Process.
1. DOMAIN
This outlines the profession’s vision and the areas in which its members have an established body of knowledge and expertise. I.e.: The focus and factors addressed by the profession.
2. PROCESS
This describes the actions practitioners take when providing services that are client centered and focused on engagement in occupations. How occupational therapy puts the domain into practice- evaluation, intervention, and outcomes.
“Achieving health, well-being, and participation in life through engagement in occupation” is the overarching statement that describes the domain and process of occupational therapy in its fullest sense. This statement acknowledges the profession’s belief that active engagement in occupation promotes, facilitates, supports, and maintains health and participation.
DOMAIN
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All aspects of the occupational therapy domain: occupations, contexts, performance patterns, performance skills, and client factors have a dynamic interrelatedness, are of equal value and together interact to affect occupational identity, health, well-being, and participation in life.
| Domain | ||
| Occupations
|
• Activities of daily living (ADLs) • Instrumental activities of daily living (IADLs) • Health management • Rest and sleep • Education • Work • Play • Leisure • Social participation . Within each of these nine broad categories of occupation are many specific occupations. |
Occupations are central to a client’s (person’s, group’s, or population’s) health, identity, and sense of competence and have particular meaning and value to that client. In OT, 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. In the OTPF–4, the term occupation implies personalized and meaningful engagement in daily life events by a specific client. Activities can be used to enhance occupational engagement by supporting the development of performance skills and performance patterns. Both occupations and activities are used as interventions by practitioners. |
| Contexts | • Environmental factors • Personal factors |
Because occupational performance does not exist in a vacuum, context must always be considered.Context includes the environmental and personal factors specific to each client (person, group, population) that influence engagement and participation in occupations. Context affects clients’ access to occupations and the quality of and satisfaction with performance. Practitioners recognize that for people to truly achieve full participation, meaning, and purpose, they must not only function but also engage comfortably within their own distinct combination of contexts. |
| Performance Patterns | • Habits • Routines • Roles • Rituals |
Performance patterns are the acquired habits, routines, roles, and rituals used in the process of engaging consistently in occupations and can support or hinder occupational performance. Performance patterns help establish lifestyles and occupational balance and are shaped, in part, by context (e.g., consistency, work hours, social calendars) and cultural norms. |
| Performance Skills | • Motor skills • Process skills • Social interaction skills |
Performance skills are observable, goal-directed actions and consist of motor skills, process skills, and social interaction skills. The occupational therapist evaluates and analyzes performance skills during actual performance to understand a client’s ability to perform an activity (smaller aspect of the larger occupation) in natural contexts. |
| Client Factors | • Values, beliefs, spirituality • Body functions • Body structures |
Client factors are specific capacities, characteristics, or beliefs that are part of the person, group, or population and influence performance in occupations. Client factors are affected by the presence or absence of illness, disease, deprivation, and disability, as well as by life stages and experiences. Client factors are also affected by occupations, contexts, performance patterns, and performance skills.
Values, beliefs, and spirituality- influence clients’ motivation to engage in occupations and give their life or existence meaning. Body Functions and Body Structures |
PROCESS
The 3-part process includes:
1. Evaluation
2. Intervention
3. Targeted Outcome
| PROCESS | TOOLS | |
| Evaluation
Evaluation occurs during the initial and all subsequent interactions with the client.
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The evaluation process is focused on finding out what the client wants and needs to do, determining what the client can do and has done and identifying supports and barriers to health, well-being, and participation.
The evaluation consists of the occupational profile and the analysis of occupational performance |
THE OCCUPATIONAL PROFILE The occupational profile is a summary of a client’s occupational history and experiences, patterns of daily living, interests, values, needs, and relevant contexts. Developing the occupational profile provides the occupational therapy practitioner with an understanding of the client’s perspective and background. Using a client-centered approach, the occupational therapy practitioner gathers information to understand what is currently important and meaningful to the client (i.e., what the client wants and needs to do) and to identify past experiences and interests that may assist in the understanding of current issues and problems. During the process of collecting this information, the client, with the assistance of the practitioner, identifies priorities and desired targeted outcomes that will lead to the client’s engagement in occupations that support participation in daily life. Only clients can identify the occupations that give meaning to their lives and select the goals and priorities that are important to them. By valuing and respecting clients’ input, practitioners help foster their involvement and can more effectively guide interventions. Occupational therapy practitioners collect information for the occupational profile at the beginning of contact with clients to establish client-centered outcomes. Information gathering for the occupational profile may be completed in one session or over a longer period while working with the client. For clients who are unable to participate in this process, their profile may be compiled through interaction with family members or other significant people in their lives. Information for the occupational profile may also be gathered from available and relevant records. Obtaining information for the occupational profile through both formal and informal interview techniques and conversation is a way to establish a therapeutic relationship with clients and their support network. . OTHER ASSESSMENT TOOLS Multiple methods are used during the evaluation process to assess the client. Methods may include observation and analysis of the client’s performance of specific occupations. Occupational performance may be measured through standardized, and structured assessment tools, and when necessary informal approaches may also be used. Standardized assessments are preferred, when available, to provide objective data about various aspects of the domain influencing engagement and performance. |
| Intervention | The intervention process consists of services provided by occupational therapy practitioners in collaboration with clients to facilitate engagement in occupation related to health, well-being, and achievement of established goals. Practitioners use the information about clients gathered during the evaluation and theoretical principles to select and provide occupation-based interventions to assist clients in achieving physical, mental, and social wellbeing; identifying and realizing aspirations; satisfying needs; and changing or coping with contextual factors. | TYPES OF OCCUPATIONAL THERAPY INTERVENTIONS: • Occupations and activities • Interventions to support occupations • Education and training • Advocacy • Group interventions • Virtual interventions. . APPROACHES TO INTERVENTION • Create or promote • Establish or restore • Maintain • Modify • Prevent. |
| Outcomes | Results of occupational therapy services are established using outcome performance measures and outcome tools. Outcomes are directly related to the interventions provided and to the targeted occupations, performance patterns, performance skills, client factors, and contexts. Outcomes may be traced to improvement in areas of the domain, such as performance skills and client factors, but should ultimately be reflected in clients’ ability to engage in their desired occupations. | Outcomes should be measured with the same methods used at evaluation and determined through comparison of the client’s status at evaluation with the client’s status at discharge or transition. Outcomes targeted in occupational therapy can be summarized: • Occupational performance • Prevention • Health and wellness • Quality of life • Participation • Role competence • Well-being • Occupational justice |
References:
The American Journal of Occupational Therapy, August 2020, Vol. 74
https://carrieschmittotd.com/wp-content/uploads/2021/04/AOTA-Occupational-Therapy-Practice-Framwork-OTPF-4th-edition.pdf
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