Occupational Therapists work in diverse settings ranging from hospitals, schools, local community services, universities to workplaces, and are often part of a multi-disciplinary team.
OTs also assume different roles such as being a manager, practitioner, consultant, lecturer or researcher. This will determine in which settings they practice.
OT Consultants: the goal is to provide education and information only. Insurance cannot be billed for an individual client. The OT is paid privately by practices/companies that enlist this service. OT consultants can be found in a variety of settings. School systems have recently employed OT consultants to screen students and leave recommendations with classroom teachers. It is thought to be more fiscally advantageous than hiring a full time OT.
1. Acute care – Medically unstable/ injured patients requiring 24/7 care of nurses and physicians.
2. Acute Rehab – Medically unstable patients able to tolerate 3 hours of therapy per day. Physicians and nursing available 24/7.
3. Sub-Acute Rehab (SAR) – Less medically unstable but still requiring nursing and physician care. Patients have not qualified for acute rehab most likely because they cannot tolerate 3 hours of therapy per day. Patients are not safe to return home yet, and require 24/7 nursing care. Physicians on call but not on site 24/7.
4. Skilled Nursing Facility (SNF): Patients require 24/7 nursing care. Some patients are placed in a SNF for long term care. Physicians on call but not on site 24/7.
5. Home Health OT services: Patients are at home, must be “homebound” – meaning they are unable to leave home unassisted, to qualify, in most cases. They are able to leave home for medical appointments, church, AA meetings, and the salon/barber only. They do not require 24/7 nursing care and are considered medically stable to be at home.
6. Assisted Living Facilities (ALF): More help available than at home, less than available at SNF. Works like renting an apartment, the client pays a monthly rent and any extra help they need, they have to pay for. Most ALFs provide meals and entertainment on site. Clients can receive up to 45 minutes of ADL assistance per day. Therapies are usually provided through the home health setting. Though some ALFs employ their own therapy staff.
7. Outpatient OT Clinic: Clients independently arrive for scheduled treatment sessions. It is assumed they are living at home or at least in the community.
8. Work hardening: Focused heavily on outcomes and return to work. Use work conditioning programs and work simulation tasks. Is a multidisciplinary approach. FCEs are an important component to determining return to work readiness.
9. School-Based OT: Works with school aged children ages 4-21. IEPs and 504 plans are where goals and treatment plans are written.
10. Early Intervention (EI) and Pre-school OT:
EI is for children 0-3 years old, OT is performed in a “least restrictive environment” which usually is their home or day care setting. Goals and treatment plans are written using the IFSP (individualized family service plan).
Pre-school is for children 3-5 years old. Goals and treatment plans are written in an IEP.
1. Vocational Rehab: OT provides assistance, finding appropriate employment based on client’s cognitive and leisure interests. Can be for clients with cognitive delay or recent onset of physical limitations or illness preventing them from returning to former employment.
2. Pre-Vocational Training: prepares a client for placement in employment settings and addresses independent living skills with vocational skills.
** Not necessarily considered an OT practice setting but OTs are part of these programs.
3. Work tolerance screenings: suggestions are often made for weight limitation guidelines for lifting, ergonomics, and proper body mechanics. Work tolerance screens are completed on the job site and are separate from a work hardening program.
4. Transitional Employment: this can be considered as an “internship”/“apprenticeship”. It gives clients the opportunity to learn job skills and refine already learned skills. This can be part of a student’s IEP and is often mentioned in practice questions.
5. Clubhouse: Similar to a day treatment program. Clients enter of their own volition. Focus is not on diagnosis but on the client’s strengths. Usually is held in group meetings to discuss concerns and problem solve are often a platform of treatment.