the occupational therapy practice framework:

1. Domain & Process Prepared by AOTA�s Commission on Practice Presented by Mary Jane Youngstrom MS,OTR, FAOTA

3. Why is it important? Reflects changes in knowledge Emphasizes the profession�s focus on occupation Reflects updated language. Provides links to World Health Organization�s International Classification of Functioning (ICF) language

4. The ICF A classification which provides common language to describe health and health related states

5. ICF Components Nach den Ausfuehrungen zum Kontext und Konzept des ICIDH-2 moechte ich Ihnen nun auf die Inhalte, Begriffsdefinitionen und Kodierungschema vorstellen. Der ICIDH-2 unterscheidet zwischen drei Dimensionen�Nach den Ausfuehrungen zum Kontext und Konzept des ICIDH-2 moechte ich Ihnen nun auf die Inhalte, Begriffsdefinitionen und Kodierungschema vorstellen. Der ICIDH-2 unterscheidet zwischen drei Dimensionen�

6. How does OT fit into this classification? OT considers all aspects of classification when delivering services OT strength lies in linking activities to participation within context

7. Purpose of the Framework ... A two fold purpose

8. Purpose of the Framework Describe our DOMAIN More clearly articulate OT�s unique focus on daily life activities and interventions that promote engagement in occupations to support participation in context. Outline an occupation based OT PROCESS Give practitioners a way to think about, talk about and apply occupation across the OT process� 1) Need both purposes�tells what we focus on and how we apply 2) Our hope�to position OT place in the provision of health services Provide a tool to help practitioners describe what they do (DOMAIN) and how they do it (PROCESS)�to LINK the two Both domain and process or linked to occupation. Wanted to orient and remind people of the profession�s focus and strength. Called a framework�because is a structure on which a variety of ideas, theories, and approaches could be placed 1) Need both purposes�tells what we focus on and how we apply 2) Our hope�to position OT place in the provision of health services Provide a tool to help practitioners describe what they do (DOMAIN) and how they do it (PROCESS)�to LINK the two Both domain and process or linked to occupation. Wanted to orient and remind people of the profession�s focus and strength. Called a framework�because is a structure on which a variety of ideas, theories, and approaches could be placed

9. Relationship of the domain and the process Domain outlines the area in which we provide services Process describes the structural pieces (i.e. evaluation, intervention outcomes) we use when delivering services They are interdependent The domain defines the area in which services delivery occurs. The domain serves as our foundation Defines the focus and the factors that will be addressed during the process The process is �built� on the domain Domain and process are interrelated: If therapist is unclear about the domain may shift practice to the domain of a related profession. Lack of clarity tempts therapist to adopt a �technique� practice or use techniques and approaches that are currently popular. Causes confusion about what is OT Why needed to address both�people were unclear how to apply the constructs from the UT III domain into the Process. Result�intervention became focused on the long list of perf comp. Felt needed to more clearly explicate or point out how the process needed to be grounded in an understanding of the person�s issues, needs and concerns related to engaging in occupations. Also how to use occupations in interventions�how process is focused on achieving outcomes related to engaging in occupations The domain and process are interdependent�must understand your domain to know the area in which you apply the processThe domain defines the area in which services delivery occurs. The domain serves as our foundation Defines the focus and the factors that will be addressed during the process The process is �built� on the domain Domain and process are interrelated: If therapist is unclear about the domain may shift practice to the domain of a related profession. Lack of clarity tempts therapist to adopt a �technique� practice or use techniques and approaches that are currently popular. Causes confusion about what is OT Why needed to address both�people were unclear how to apply the constructs from the UT III domain into the Process. Result�intervention became focused on the long list of perf comp. Felt needed to more clearly explicate or point out how the process needed to be grounded in an understanding of the person�s issues, needs and concerns related to engaging in occupations. Also how to use occupations in interventions�how process is focused on achieving outcomes related to engaging in occupations The domain and process are interdependent�must understand your domain to know the area in which you apply the process

10. Why is it important to be clear about our domain and process ?????

11. Domain of Occupational Therapy Figure provides an overview of our domain�all areas of the domain are important. No one is more important than another. All are features of our domain that we consider when we work with people Next�look at each aspects in more depth Will look at each section in more depth�. Figure provides an overview of our domain�all areas of the domain are important. No one is more important than another. All are features of our domain that we consider when we work with people Next�look at each aspects in more depth Will look at each section in more depth�.

12. Our domain� The area of human experience in which we offer assistance to others�. We help others to engage in everyday life activities�or�. OCCUPATIONS What is a domain?�the area of human experience in which we offer assistance to others (taken from Mosey�see framework for reference) What is our domain?�OCCUPATION�we help people engage in everyday lifeWhat is a domain?�the area of human experience in which we offer assistance to others (taken from Mosey�see framework for reference) What is our domain?�OCCUPATION�we help people engage in everyday life

13. Occupation Defined as: Activities.. of everyday life, named, organized, and given value and meaning by individual and a culture. Occupation is everything people do to occupy themselves, including looking after themselves,�enjoying life,�and contributing to the social and economic fabric of their communities�(Law, Polatajko, Baptiste, & Townsend, 1997, p. 32) How we defined occupation� Note: occupations are activities with certain qualities�they are valued by the person and meaningful. They have meaning for the culture also OTs often use the terms activity and occupation interchangeably but the framework reflects current thinking that these two ideas are somewhat different (read the document and references cited)How we defined occupation� Note: occupations are activities with certain qualities�they are valued by the person and meaningful. They have meaning for the culture also OTs often use the terms activity and occupation interchangeably but the framework reflects current thinking that these two ideas are somewhat different (read the document and references cited)

14. Domain of Occupational Therapy Figure provides an overview of our domain�all areas of the domain are important. No one is more important than another. All are features of our domain that we consider when we work with people Next�look at each aspect in more depth Will look at each section in more depth�. Figure provides an overview of our domain�all areas of the domain are important. No one is more important than another. All are features of our domain that we consider when we work with people Next�look at each aspect in more depth Will look at each section in more depth�.

15. Engagement in Occupation to support Participation in Context The overarching phrase that describes the domain Why was this phrase chosen�look at each term in more depth to understand its intent and meaningWhy was this phrase chosen�look at each term in more depth to understand its intent and meaning

16. Why was this phrase chosen? Engagement�recognizes choice, personal meaning, psychological/emotional and physical aspects of performance Occupation�a vital force in regaining and promoting health Participation�an aspect of health in the ICF model. By facilitating engagement in occupations OTs link activities to participation Context�supports and mediates engagement Engagement�commitment to performance that occurs because of self-choice, motivation and meaning. Holistic understanding of performance�emotional/psychological as well as physical�subjective and objective Occupation�the core of our practice. The aspect of health that we focus on Participation-- Engaging leads to desired participation in a variety of life situations. Participation is an aspect of health (activities and participation) defined by ICF. Link our interest in and focus on helping people carry out important life occupations to an aspect of health. Makes OT contribution and role in health restoration, maintenance and promotion clearer Help therapists recognize that their interventions focus on more than task performance�interventions are ultimately directed at facilitating the person�s ability to participate in meaningful roles and routines. Context�emphasizes that performance always occurs in contextEngagement�commitment to performance that occurs because of self-choice, motivation and meaning. Holistic understanding of performance�emotional/psychological as well as physical�subjective and objective Occupation�the core of our practice. The aspect of health that we focus on Participation-- Engaging leads to desired participation in a variety of life situations. Participation is an aspect of health (activities and participation) defined by ICF. Link our interest in and focus on helping people carry out important life occupations to an aspect of health. Makes OT contribution and role in health restoration, maintenance and promotion clearer Help therapists recognize that their interventions focus on more than task performance�interventions are ultimately directed at facilitating the person�s ability to participate in meaningful roles and routines. Context�emphasizes that performance always occurs in context

17. Performance inAreas of Occupation Categories of occupation in which people engage Called performance areas in UT III Resorted and expanded from UT III To understand how clients are engaging in occupation we need a way of categorizing them We sort occupation in different areas�these areas are broad categories of human performance --they are artificial�because only the person can define an occupation and its meaning to him or her. By providing a list of categories it helps to ensure that we look at all aspects of engagement and of participation in meaningful life activities --these categories have been resorted and expanded from the UT III performance areas To understand how clients are engaging in occupation we need a way of categorizing them We sort occupation in different areas�these areas are broad categories of human performance --they are artificial�because only the person can define an occupation and its meaning to him or her. By providing a list of categories it helps to ensure that we look at all aspects of engagement and of participation in meaningful life activities --these categories have been resorted and expanded from the UT III performance areas

18. Performance in Areas of Occupation Activities of Daily Living (ADL) Instrumental Activities of Daily Living (IADL) Education Work Play Leisure Social Participation* (new) Use of more universal terms (ADL, IADL) Separated education and work (was productive activity)�these are more self explanatory terms Separated Play from Leisure�again more understandable�recognizes different meanings for these terms that may related to difference in ages Added area of social participation�in community, family, with peers/friends. Defined as �activities associated with organized patterns of behavior that re characteristic and expected of an individual or an individual interacting with others within a given social system (adapted from Mosey) Use of more universal terms (ADL, IADL) Separated education and work (was productive activity)�these are more self explanatory terms Separated Play from Leisure�again more understandable�recognizes different meanings for these terms that may related to difference in ages Added area of social participation�in community, family, with peers/friends. Defined as �activities associated with organized patterns of behavior that re characteristic and expected of an individual or an individual interacting with others within a given social system (adapted from Mosey)

19. Performance Skills�NEW! Describes observed actions�lifts, chooses, asks 3 kinds of skills Motor skills Process skills Communication /Interaction skills A new term in Framework�In UT III old perf comp list actually included a mixture of perf skill, body functions, body structures and perf patterns. By sorting out perf skills hope to clarify our language and thinking OTs use these terms when describing what they see a client do when carrying out an activity or occupation as opposed to what the underlying body functions is that may be contributing to the skill performance problem Can use these terms in verbal and written communication. Inclusion of this newer language and expanded terms should help therapists more accurately and discretely describe performance�and differentiate the performance that is observed from the underlying body function that may be causing the skill deficit. Skills occur or are observed as a result of the transaction that occurs between the performer�s body functions/structures, the demands of the activity and the context in which performance occurs. Offers more precise language for understanding and describing performance. Clarify thinking about what observing Helps, hopefully, therapists to understand that body functions and skills are different�and that because a person has a body function does not directly translate into their ability to perform a skillA new term in Framework�In UT III old perf comp list actually included a mixture of perf skill, body functions, body structures and perf patterns. By sorting out perf skills hope to clarify our language and thinking OTs use these terms when describing what they see a client do when carrying out an activity or occupation as opposed to what the underlying body functions is that may be contributing to the skill performance problem Can use these terms in verbal and written communication. Inclusion of this newer language and expanded terms should help therapists more accurately and discretely describe performance�and differentiate the performance that is observed from the underlying body function that may be causing the skill deficit. Skills occur or are observed as a result of the transaction that occurs between the performer�s body functions/structures, the demands of the activity and the context in which performance occurs. Offers more precise language for understanding and describing performance. Clarify thinking about what observing Helps, hopefully, therapists to understand that body functions and skills are different�and that because a person has a body function does not directly translate into their ability to perform a skill

20. Performance Skills� Performance skill terms differentiate skilled action from underlying body functions�a different vocabulary. Provide a language link to engaging in occupations. Effective skill performance is not ensured by adequate underlying body functions or structures.

21. Performance Patterns�NEW! Habits Routines Roles Performance patterns are recurring behaviors related to daily routines Including this aspect recognizes performance patterns as a legitimate aspect of engaging in occupations that OTs address and consider Including this aspect recognizes performance patterns as a legitimate aspect of engaging in occupations that OTs address and consider

22. Context Cultural (retained) Physical (retained) Social (retained) Personal (resorted from UT III Temporal context�refers to age, gender, educational & socio-economic status) Spiritual (new) Temporal (resorted from UT III Temporal context�refers to time of day, year, stage of life etc.) Virtual (new) OTs always consider how context influences performance, skills and ultimately engagement Context �interrelated conditions within and surrounding the client. Context seem as existing both external to the client and internal to the client This area was expanded and revised from UT Added: Personal (age, gender, education, socio economic) Spiritual�fundamental orientation �meaning Virtual�communication without physical contact�recognizes the increasing presence of this context in our life Revised temporal context from old UT so that meaning is different�now refers to time ie. Time of day, year, stage of lifeOTs always consider how context influences performance, skills and ultimately engagement Context �interrelated conditions within and surrounding the client. Context seem as existing both external to the client and internal to the client This area was expanded and revised from UT Added: Personal (age, gender, education, socio economic) Spiritual�fundamental orientation �meaning Virtual�communication without physical contact�recognizes the increasing presence of this context in our life Revised temporal context from old UT so that meaning is different�now refers to time ie. Time of day, year, stage of life

23. Activity Demands�NEW! Objects used and their properties Space Demands Social Demands Sequencing and Timing Required actions Required body functions Required body structures Not a new construct to OT but has been a part of our profession�s thinking and application since our early years. Supports our skill in and use of activity analysis as an important aspect of understanding and providing interventions to support performance in occupations. This is the first time we have explicated activity demands as a construct that we consider in our domain of practice.Not a new construct to OT but has been a part of our profession�s thinking and application since our early years. Supports our skill in and use of activity analysis as an important aspect of understanding and providing interventions to support performance in occupations. This is the first time we have explicated activity demands as a construct that we consider in our domain of practice.

24. Activity Demands Relate to a specific activity Different than physical context and social context Note that some of the demands listed i.e. space demand and social demands may remind one of context terms i.e. physical context, social context. Activity demands are not the same as context. The demands of an activity are small�they relate to the specific requirements or demands of a specific activity. Context is a much broader term. The demands of a specific activity occur within a larger context. For example the social demands of playing volleyball include sharing space with other team members, interacting verbally and physically with others. The social context in which volleyball might occur might be non existent if the game were being played for practice in a gym after school and no observers were present. It would be much different if the game were played in competition with team supporters for both sides present and cheering both teams on. Note that some of the demands listed i.e. space demand and social demands may remind one of context terms i.e. physical context, social context. Activity demands are not the same as context. The demands of an activity are small�they relate to the specific requirements or demands of a specific activity. Context is a much broader term. The demands of a specific activity occur within a larger context. For example the social demands of playing volleyball include sharing space with other team members, interacting verbally and physically with others. The social context in which volleyball might occur might be non existent if the game were being played for practice in a gym after school and no observers were present. It would be much different if the game were played in competition with team supporters for both sides present and cheering both teams on.

25. Client Factors�body functions & body structures Underlying physiological abilities or structures that reside in the person Includes mental (affective, cognitive, perceptual), sensory, physical and physiological abilities Used classification from ICF�aligned with body systems Many included in UT as performance components Body systems: mental functions; sensory and pain functions; neuromusculoskeletal and movement functions, cardiovascular hematological, immunological and respiratory system functions. Examples: mental body functions�emotional stability, motivation, memory, temperament, perception Sensory function: discriminating touch, Neuromsuculaoskeletal and movement functions: ROM strength eye-hand coordination. Body structures�anatomical parts of body Listing is not complete. Faculty may need to look at this area and develop lists to use in teaching that are representative and more complete for their own teaching purposes. Why chose ICF classification? Wide distribution. Understood by others. Because familiar others would get it. A broad classification that provides examples but avoids definitive lists provides more flexibility �allows updated examples to be added Differentiate body functions from perf skills�language for each. Help to clarify thinking�understanding what body function contribute to what skills.�part of clinical reasoning process.Body systems: mental functions; sensory and pain functions; neuromusculoskeletal and movement functions, cardiovascular hematological, immunological and respiratory system functions. Examples: mental body functions�emotional stability, motivation, memory, temperament, perception Sensory function: discriminating touch, Neuromsuculaoskeletal and movement functions: ROM strength eye-hand coordination. Body structures�anatomical parts of body Listing is not complete. Faculty may need to look at this area and develop lists to use in teaching that are representative and more complete for their own teaching purposes. Why chose ICF classification? Wide distribution. Understood by others. Because familiar others would get it. A broad classification that provides examples but avoids definitive lists provides more flexibility �allows updated examples to be added Differentiate body functions from perf skills�language for each. Help to clarify thinking�understanding what body function contribute to what skills.�part of clinical reasoning process.

26. Three main sections outlined in the process (note color changes!!) Evaluation Intervention Outcome Understanding of and application of occupation is embedded throughout the process. Note that this process, by itself is not unique to OT.. Note: It�s important that process begins with the occupational profile�who and what the person is as an occupational being. Serves to focus our evaluation and intervention on our domain (occupation) from the very start Will talk about each box in more depth highlighting what happens and over all ideasThree main sections outlined in the process (note color changes!!) Evaluation Intervention Outcome Understanding of and application of occupation is embedded throughout the process. Note that this process, by itself is not unique to OT.. Note: It�s important that process begins with the occupational profile�who and what the person is as an occupational being. Serves to focus our evaluation and intervention on our domain (occupation) from the very start Will talk about each box in more depth highlighting what happens and over all ideas

27. What makes this process unique to OT? What is evaluated: occupational needs, problems, risks and concerns How the problem is framed: occupational performance�risks or difficulties with daily life tasks Type of intervention: use of selected therapeutic activities and occupations to facilitate engagement in occupation Outcome: directed toward facilitating engagement in occupation to support participation What makes it OT is its connection with the domain�and the integration of occupation into this process What is evaluated�look at person�s problems, needs, risks and concerns. Note phrasing�aimed at evaluating not just people with performance problems but also looking at people with potential problems�moves OT in prevention and wellness arenas How the problem is framed�its OT when we define/describe the problems/issues for which we will provide intervention in terms of occupational performance�not ROM, Sensory integration etc Type of intervention�its OT because we use therapeutic activity and occupations in our intervention to facilitate performance and engagement in occupations Outcome: its OT because it is clear throughout the process that we are working toward the outcome of helping people engage in everyday life activities that are meaningful and important to them i.e. occupations What makes process unique? The focus on occupation and the use of occupation. Occupation as ends and meansWhat makes it OT is its connection with the domain�and the integration of occupation into this process What is evaluated�look at person�s problems, needs, risks and concerns. Note phrasing�aimed at evaluating not just people with performance problems but also looking at people with potential problems�moves OT in prevention and wellness arenas How the problem is framed�its OT when we define/describe the problems/issues for which we will provide intervention in terms of occupational performance�not ROM, Sensory integration etc Type of intervention�its OT because we use therapeutic activity and occupations in our intervention to facilitate performance and engagement in occupations Outcome: its OT because it is clear throughout the process that we are working toward the outcome of helping people engage in everyday life activities that are meaningful and important to them i.e. occupations What makes process unique? The focus on occupation and the use of occupation. Occupation as ends and means

28. Key points about the process Client-centered Clients may be individuals, groups or populations Dynamic and interactive Broad & inclusive of all practice areas Context an embedded influence on the process of service delivery Grounded in occupation Clients may be individuals, groups or populations. Individuals may be persons with identified needs or individuals who are involved in supporting or caring for the person i.e. spouse, teacher, caregiver, employer parent. Understanding clients in this way broadens who OTs can serve Clients may be individuals, groups or populations. Individuals may be persons with identified needs or individuals who are involved in supporting or caring for the person i.e. spouse, teacher, caregiver, employer parent. Understanding clients in this way broadens who OTs can serve

29. The Occupational Profile��the initial step Describes client�s occupational history, patterns of living, interests, values, and needs Identify client�s priorities. What are client�s needs, wants and concerns re: engaging in occupations Frame client concerns and issues within the domain of occupational therapy Get to know the person�their background re engaging in occupation and participation, and their perspective Note: the evaluation process begins with a profile of the person�not a PROBLEM. Focuses the process within the domain (occupation) and allows therapists and client to focus on assets as well as liabilities Know what is important to them--priorities Describes their problems from occupational perspective This step firmly ground the process in a client centered approach Begin collecting data about the profile at the start of evaluation but throughout process pick up more information to add to the profileGet to know the person�their background re engaging in occupation and participation, and their perspective Note: the evaluation process begins with a profile of the person�not a PROBLEM. Focuses the process within the domain (occupation) and allows therapists and client to focus on assets as well as liabilities Know what is important to them--priorities Describes their problems from occupational perspective This step firmly ground the process in a client centered approach Begin collecting data about the profile at the start of evaluation but throughout process pick up more information to add to the profile

30. Analysis of Occupational Performance More specifically identify underlying factors which support and hinder performance --observe performance --perform selected specific assessments if needed --consider context, activity demands and client factors Identify facilitators and barriers to performance Suggesting a top down approach Understood that this process occurs by using a clinical reasoning process and is guided and directed by OT theory and specific frames of reference that the therapist has selected as appropriate to this client�s problems and issues. Knowledge of evidence will also inform the therapists decisions and actions in this phase of the evaluation. Perform selected assessments. Perform only those assessment that will give you additional info you need�do not do every test! Based on additional info gathered you interpret the data In this part of evaluation you develop and refine your hypothesis about client�s strengths and weaknesses regarding occupational performance Confirm the outcome you are headed towardIdentify facilitators and barriers to performance Suggesting a top down approach Understood that this process occurs by using a clinical reasoning process and is guided and directed by OT theory and specific frames of reference that the therapist has selected as appropriate to this client�s problems and issues. Knowledge of evidence will also inform the therapists decisions and actions in this phase of the evaluation. Perform selected assessments. Perform only those assessment that will give you additional info you need�do not do every test! Based on additional info gathered you interpret the data In this part of evaluation you develop and refine your hypothesis about client�s strengths and weaknesses regarding occupational performance Confirm the outcome you are headed toward

31. Intervention Plan Develop plan in collaboration with client Base plan on: --Selected theory and/or practice framework --Evidence Select intervention approach: create/promote, establish/restore, maintain, modify, prevent Target desired outcomes Development of plan is client centered� Plan will be influenced by theory and or practice framework you use Plan should be grounded in evidence�what works best Conscious selection of interventions approach is made. Therapist needs to realize that we have many more approaches to intervention other that the �fix the person� or establish restore approach valued in the medical model. Framework outlines these (like the Guide to Practice also does). In the plan desired targeted outcomes are also stated�usually in a goal format�and these outcomes or goals are stated in occupation terms�what will the client be able to do, perform, engage in. Should be related to his/her priorities OTPF has a table which defines, describes various intervention approaches. OTs may use one or more during intervention Outcomes targeted related to end outcome of engaging in occupation Plan is client centered�work with client to develop plan and understand his needs and prioritiesDevelopment of plan is client centered� Plan will be influenced by theory and or practice framework you use Plan should be grounded in evidence�what works best Conscious selection of interventions approach is made. Therapist needs to realize that we have many more approaches to intervention other that the �fix the person� or establish restore approach valued in the medical model. Framework outlines these (like the Guide to Practice also does). In the plan desired targeted outcomes are also stated�usually in a goal format�and these outcomes or goals are stated in occupation terms�what will the client be able to do, perform, engage in. Should be related to his/her priorities OTPF has a table which defines, describes various intervention approaches. OTs may use one or more during intervention Outcomes targeted related to end outcome of engaging in occupation Plan is client centered�work with client to develop plan and understand his needs and priorities

32. Intervention Action to influence and support performance Types of interventions -Therapeutic use of self -Therapeutic use of occupations/activities Occupation-based activity, purposeful activity, preparatory methods -Consultation process -Education process During intervention actions are taken to influence and support performance�actions may be directed as one or more of the aspects of the domain that influence performance i.e. context, client factors, activity demands, perf. Skills, perf, patterns. Types of interventions outlined in Table 8. Briefly discuss what is occupation based activity, purposeful activity, and preparatory methodsDuring intervention actions are taken to influence and support performance�actions may be directed as one or more of the aspects of the domain that influence performance i.e. context, client factors, activity demands, perf. Skills, perf, patterns. Types of interventions outlined in Table 8. Briefly discuss what is occupation based activity, purposeful activity, and preparatory methods

33. Intervention Review Review plan, process and progress toward outcomes Modify plan if needed Determine future action Collaborate with client during this reviewCollaborate with client during this review

34. Outcomes�engagement in occupation to support participation Describes the broad outcome of the OT intervention process Links the outcome to the domain Outcomes is the last stage of the process�it is the end result of the process. However the action involved in outcome determination, measurement and achievement are woven throughout the process Note the term used to describe the broad outcome of OT intervention�Engagement in occupation to support participation. Same as term which describes our domain. Use of same or similar term serves to link the domain and the process�the area of human activity in which we provide service also describes what the outcome of our services areOutcomes is the last stage of the process�it is the end result of the process. However the action involved in outcome determination, measurement and achievement are woven throughout the process Note the term used to describe the broad outcome of OT intervention�Engagement in occupation to support participation. Same as term which describes our domain. Use of same or similar term serves to link the domain and the process�the area of human activity in which we provide service also describes what the outcome of our services are

35. Outcomes�engagement in occupation to support participation Types of outcomes --Occupational performance --Client satisfaction --Role competence --Adaptation --Health and wellness --Prevention --Quality of life Engagement in occupation to support participation is the broad dimension of health that occupational therapy targets The types of outcomes provide an idea of the many dimensions of health that can be directed to or lead to engagement in occupationEngagement in occupation to support participation is the broad dimension of health that occupational therapy targets The types of outcomes provide an idea of the many dimensions of health that can be directed to or lead to engagement in occupation

36. Integrating the domain and process�applying the framework (in practice) Focus on the client as an occupational being�start your eval with the occupational profile. Document it When thinking about performance look at all facilitators and barriers i.e. perf skills, patterns, context, activity demands and client factors Describe performance with skill language. Do not confuse skills with client factors in either your evaluation or intervention actions

37. Integrating the domain and the process CASES

38. Brandi�pediatric early intervention Age�2 years, 6 months Reason for referral�determine if OT services are needed Medical history�health Family history--unremarkable

39. Brandi�Evaluation and impressions Assessments Bayley Scale of Infant Development�scored 30-32 months Impression Performance skills ? Performance patterns ? Context ? Activity demands ? Client factors Slight speech and language delays Age appropriate fine and gross motor skills Age appropriate cognitive skills CONCLUSION�no therapy needed

40. Brandi�Evaluation at 3 yr 3 mo Assessments Classroom and playground observation Teacher interview Sensory history Occupational profile Peabody Development Motor Scales Impression --Perf patterns�sticks to familiar activities -- Context--Difficulty in multisensory environment. Social demands often overwhelming --Activity demands�difficulty with new tasks --Client factors�sensory sensitivities, language delays, dyspraxia, vestibular-proprioceptive process difficulties

41. Concerns regarding PARTICIPATION Mother�s stated concerns �I wish she could play more easily with her sister: Teacher�s stated concerns �I wish her peers could be more accepting, support her, and play with her more.�

42. Brandi--Intervention Approach�modify context and activity demands to support performance at home and school. Create/promote opportunities for play Context�provide quiet & calm social context. Make physical context clutter free. Minimize environmental changes i.e. seat assignments Activity demands�use visual cues. Break down into steps. Select activities with deep pressure and proprioceptive properties

43. Brandi�Engagement in occupations to support participation--OUTCOMES Mom states that Brandi is fine now. She plays very well with her sister Teacher states that Brandi performs better in classroom when activities match her needs. Interacting more appropriately with peers.

44. What did you notice?

45. Integrating the domain and process�applying the framework Focus on the client as an occupational being�include an occupational profile in your evaluation. Document it When thinking about performance issues look at all facilitators and barriers i.e. Perf. Skills patterns, context, activity demands and client factors Differentiate between performance skills and client body functions or capacities

46. Integrating the domain and process�applying the framework Observe performance Target goals towards outcomes that will lead to participation in daily life contexts

47. In summaryThe Occupational Therapy Practice Framework: Domain and Process Affirms the profession�s focus on engagement in occupation to support participation as an important aspect of health Describes and links the profession�s domain and process

48. In summaryThe Occupational Therapy Practice Framework: Domain and Process Incorporates terms more commonly used by other disciplines Adds constructs to the domain & updates terms throughout to reflect current knowledge and thinking

49. Using the framework can help you to�. Shift the focus of your practice and clarify your special contribution Add to your vocabulary new and updated terminology and language! (i.e. performance patterns, performance skills) Change what you document to make your contribution more occupation based Make your practice more client centered