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guidelines occupational therapy practice framework domain and process fourth edition contents preface preface 1 thefourtheditionoftheoccupationaltherapypracticeframework domain denitions 1 andprocess hereinafterreferredtoastheotpf 4 isanofcialdocumentof evolution of this document 2 vision for this ...

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                                                                                                                                                                                                                                                       GUIDELINES
                  Occupational Therapy Practice
                  Framework: Domain and Process
                                                                                                   Fourth Edition
                     Contents                                                                             Preface
                  Preface .....................................................................1        ThefourtheditionoftheOccupationalTherapyPracticeFramework:Domain
                        Definitions ..........................................................1          andProcess(hereinafterreferredtoastheOTPF–4),isanofficialdocumentof
                        Evolution of This Document ..............................2
                        Vision for This Work ..........................................4                the American Occupational Therapy Association (AOTA). Intended for
                  Introduction ..............................................................4          occupational therapy practitioners and students, other health care
                        Occupation and Occupational Science ...........4                                professionals,educators,researchers,payers,policymakers,andconsumers,
                        OTPF Organization .......................................4
                        Cornerstones of Occupational Therapy                                            the OTPF–4 presents a summary of interrelated constructs that describe
                               Practice ......................................................6         occupational therapy practice.
                  Domain .....................................................................6
                        Occupations .......................................................7
                        Contexts ............................................................9          Definitions
                        Performance Patterns .....................................12
                        Performance Skills ..........................................13                 WithintheOTPF–4,occupationaltherapyisdefinedasthetherapeuticuseof
                        Client Factors ..................................................15
                  Process ..................................................................17          everydaylifeoccupationswithpersons,groups,orpopulations(i.e.,theclient)
                        Overview of the Occupational Therapy                                            for the purpose of enhancing or enabling participation. Occupational therapy
                               Process ....................................................17           practitioners use their knowledge of the transactional relationship among the
                        Evaluation ........................................................21
                        Intervention ......................................................24           client, the client’s engagement in valuable occupations, and the context to
                        Outcomes ........................................................26             design occupation-based intervention plans. Occupational therapy services
                  Conclusion .............................................................28
                  Tables ....................................................................29         are provided for habilitation, rehabilitation, and promotion of health and
                  References .............................................................68            wellness for clients with disability- and non–disability-related needs. These
                        Table 1. Examples of Clients: Persons, Groups,
                            and Populations ............................................29              services include acquisition and preservation of occupational identity for
                        Table 2. Occupations ......................................30                   clients who have or are at risk for developing an illness, injury, disease,
                        Table3.ExamplesofOccupationsforPersons,
                            Groups, and Populations ..............................35                    disorder, condition, impairment, disability, activity limitation, or participation
                        Table 4. Context: Environmental Factors .......36                               restriction (AOTA, 2011; see the glossary in Appendix A for additional
                        Table 5. Context: Personal Factors ................40
                        Table 6. Performance Patterns .......................41                         definitions).
                        Table 7. Performance Skills for Persons .......43                                     When the term occupational therapy practitioners is used in this
                        Table 8. Performance Skills for Groups .........50
                        Table 9. Client Factors ....................................51                  document, it refers to both occupational therapists and occupational therapy
                        Table 10. Occupational Therapy Process for                                      assistants (AOTA, 2015b). Occupational therapists are responsible for all
                            Persons, Groups, and Populations .............55                            aspects of occupational therapy service delivery and are accountable for the
                        Table 11. Occupation and Activity
                            Demands ......................................................57            safety and effectiveness of the occupational therapy service delivery process.
                  AOTA OFFICIAL DOCUMENT                                                                                                                                                                                                                                1
                  The American Journal of Occupational Therapy, August 2020, Vol. 74, Suppl. 2                                                                                                                                                       7412410010p1
  Downloaded from http://ajot.aota.org on 09/22/2020 Terms of use: http://AOTA.org/terms
                 GUIDELINES
                      Table 12. Types of Occupational Therapy                                    Occupationaltherapyassistantsdeliveroccupationaltherapyservicesunder
                         Interventions ................................................59        the supervision of and in partnership with an occupational therapist (AOTA,
                      Table 13. Approaches to Intervention ............63
                      Table 14. Outcomes ........................................65              2020a).
                      Exhibit 1. Aspects of the Occupational Therapy                                  The clients of occupational therapy are typically classified as persons
                         Domain ...........................................................7
                      Exhibit 2. Operationalizing the Occupational                               (including those involved in care of a client), groups (collections of individuals
                         Therapy Process .........................................16             having shared characteristics or a common or shared purpose; e.g., family
                      Figure 1. Occupational Therapy Domain and
                         Process ..........................................................5     members, workers, students, people with similar interests or occupational
                      Authors ............................................................72     challenges), and populations (aggregates of people with common attributes
                      Acknowledgments ...........................................73
                      Appendix A. Glossary .....................................74               suchascontexts, characteristics, or concerns, including health risks; Scaffa
                      Index ................................................................85   &Reitz,2014).Peoplemayalsoconsiderthemselvesaspartofacommunity,
                                                                                                 such as the Deaf community or the disability community; a community is a
                                                                                                 collection of populations that is changeable and diverse and includes various
                                                                                                 people, groups, networks, and organizations (Scaffa, 2019; World Federation
                                                                                                 of Occupational Therapists [WFOT], 2019). It is important to consider the
                                                                                                 community or communities with which a client identifies throughout the
                                                                                                 occupational therapy process.
                                                                                                      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,andframedfromanoccupationalperspective.Throughout
                 Copyright © 2020 by the American                                                the OTPF–4, the term client is used broadly to refer to persons, groups, and
                 Occupational Therapy Association.                                               populationsunlessotherwisespecified.IntheOTPF–4,“group”asaclientisdistinct
                 Citation: American Occupational Therapy                                         from“group”asaninterventionapproach.Forexamplesofclients,seeTable1(all
                 Association. (2020). Occupational therapy                                       tables are placed together at the end of this document). The glossary in Appendix
                 practice framework: Domain and process                                          A provides definitions of other terms used in this document.
                 (4th ed.). American Journal of Occupational
                 Therapy, 74(Suppl. 2), 7412410010. https://doi.
                 org/10.5014/ajot.2020.74S2001
                 ISBN: 978-1-56900-488-3                                                         Evolution of This Document
                                                                                                 TheOccupational Therapy Practice Framework was originally developed to
                 For permissions inquiries, visit https://www.                                   articulate occupational therapy’s distinct perspective and contribution to
                 copyright.com.
                                                                                                 promoting the health and participation of persons, groups, and populations
                                                                                                 through engagement in occupation. The first edition of the OTPF emerged
                                                                                                 from an examination of documents related to the Occupational Therapy Product
                                                                                                 Output Reporting System and Uniform Terminology for Reporting Occupational
                                                                                                 TherapyServices(AOTA,1979).Originallyadocumentthatrespondedtoafederal
                                                                                                 requirement to develop a uniform reporting system, this text gradually shifted to
                                                                                                 describing and outlining the domains of concern of occupational therapy.
                                                                                                      The second edition of Uniform Terminology for Occupational Therapy
                                                                                                 (AOTA,1989)wasadoptedbytheAOTARepresentativeAssembly(RA)and
                                                                                                 published in 1989. The document focused on delineating and defining only
                                                                                                 theoccupationalperformanceareasandoccupationalperformancecomponents
                                                                                                 that are addressed in occupational therapy direct services. The third and final
                                                                                                 edition of Uniform Terminology for Occupational Therapy (UT–III; AOTA, 1994)
                                                                                                 was adopted by the RA in 1994 and was “expanded to reflect current practice
                                                                                                 and to incorporate contextual aspects of performance” (p. 1047). Each revision
                 2                                                                                                                                                                                                  AOTA OFFICIAL DOCUMENT
                 The American Journal of Occupational Therapy, August 2020, Vol. 74, Suppl. 2                                                                                                                                        7412410010p2
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                                                                                                                            GUIDELINES
         reflected changes in practice and provided consistent               n The terms occupation and activity are more clearly
         terminology for use by the profession.                               defined.
            In fall 1998, the AOTA Commission on Practice (COP)             n For occupations, the definition of sexual activity as an
         embarked on the journey that culminated in the                       activity of daily living is revised, health management is
         Occupational Therapy Practice Framework: Domain                      addedasageneraloccupationcategory,andintimate
         and Process (AOTA, 2002a). At that time, AOTA also                   partner is added in the social participation category
         published The Guide to Occupational Therapy Practice                 (see Table 2).
         (Moyers, 1999), which outlined contemporary practice               n The contexts and environments aspect of the
         for the profession. Using this document and the feedback             occupational therapy domain is changed to context on
         receivedduringthereviewprocessfortheUT–III,theCOP                    the basis of the World Health Organization (WHO; 2008)
         proceeded to develop a document that more fully                      taxonomy from the International Classification of
         articulated occupational therapy.                                    Functioning, Disability and Health (ICF) in an effort
            The OTPF is an ever-evolving document. As an                      to adopt standard, well-accepted definitions (see
         official AOTA document, it is reviewed on a 5-year                    Table 4).
         cycle for usefulness and the potential need for further            n For the client factors category of body functions,
         refinementsorchanges.Duringthereviewperiod,theCOP                     genderidentity is now included under “experience of
         collects feedback from AOTA members, scholars, authors,              self and time,” the definition of psychosocial is
         practitioners, AOTA volunteer leadership and staff, and              expanded to match the ICF description, and
         other stakeholders. The revision process ensures that the            interoception is added under sensory functions.
         OTPFmaintainsitsintegritywhilerespondingtointernaland              n For types of intervention, “preparatory methods and
         external influences that should be reflectedinemerging                 tasks” has been changed to “interventions to support
         concepts and advances in occupational therapy.                       occupations” (see Table 12).
            The OTPF was first revised and approved by the RA in             n For outcomes, transitions and discontinuation are
         2008. Changes to the document included refinement of the              discussed as conclusions to occupational therapy
         writing and the addition of emerging concepts and changes            services, and patient-reported outcomes are
         in occupational therapy. The rationale for specific changes           addressed (see Table 14).
         canbefoundinTable11oftheOTPF–2 (AOTA, 2008,                        n Five new tables are added to expand on and clarify
         pp. 665–667).                                                        concepts:
            In 2012, the process of review and revision of the                  +Table1.Examples of Clients: Persons, Groups,
         OTPF was initiated again, and several changes were                        and Populations
         made. The rationale for specific changes can be found                   +Table 3. Examples of Occupations for Persons,
         on page S2 of the OTPF–3 (AOTA, 2014).                                    Groups, and Populations
            In 2018, the process to revise the OTPF began again.                +Table7.PerformanceSkillsforPersons(includes
         After memberreviewandfeedback,severalmodifications                         examples of effective and ineffective
         were made and are reflected in this document:                              performance skills)
                                                                                +Table 8. Performance Skills for Groups
            n The focus on group and population clients is                         (includes examples of the impact of ineffective
              increased, and examples are provided for both.                       individual performance skills on group
            n Cornerstones of occupational therapy practice are                    collective outcome)
              identified and described as foundational to the                    +Table 10. Occupational Therapy Process for
              success of occupational therapy practitioners.                       Persons, Groups, and Populations.
            n Occupational science is more explicitly described             n Throughout, the use of OTPF rather than Framework
              and defined.                                                     acknowledges the current requirements for a unique
         AOTA OFFICIAL DOCUMENT                                                                                                      3
         The American Journal of Occupational Therapy, August 2020, Vol. 74, Suppl. 2                                      7412410010p3
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         GUIDELINES
              identifier to maximize digital discoverability and to      students, communication with the public and
              promote brevity in social media communications. It        policymakers, and provision of language that can shape
              also reflects the longstanding use of the acronym in       and be shaped by research.
              academic teaching and clinical practice.
            n Figure 1 has been revised to provide a simplified          Occupation and Occupational Science
              visual depiction of the domain and process of             Embedded in this document is the occupational therapy
              occupational therapy.                                     profession’s core belief in the positive relationship
                                                                        betweenoccupationandhealthanditsviewofpeopleas
         Vision for This Work                                           occupational beings. Occupational therapy practice
         Although this edition of the OTPF represents the latest in     emphasizes the occupational nature of humans and the
         the profession’s efforts to clearly articulate the             importance of occupational identity (Unruh, 2004)to
         occupational therapy domain and process, it builds on a        healthful, productive, and satisfying living. As Hooperand
         set of values that the profession has held since its           Wood (2019) stated,
         founding in 1917. The original vision had at its center a
         profoundbeliefinthevalueoftherapeuticoccupationsas             Acore philosophical assumption of the profession, therefore, is that by
                                                                        virtue of our biological endowment, people of all ages and abilities
         a way to remediate illness and maintain health (Slagle,        require occupation to grow and thrive; in pursuing occupation, humans
         1924). The founders emphasized the importance of               express the totality of their being, a mind–body–spirit union. Because
                                                                        human existence could not otherwise be, humankind is, in essence,
         establishing a therapeutic relationship with each client       occupational by nature. (p. 46)
         and designing a treatment plan based on knowledge                 Occupational science is important to the practice of
         about the client’s environment, values, goals, and desires     occupational therapy and “provides a way of thinking that
         (Meyer, 1922). They advocated for scientific practice           enablesanunderstandingofoccupation,theoccupational
         basedonsystematicobservationandtreatment(Dunton,               nature of humans, the relationship between occupation,
         1934). Paraphrased using today’s lexicon, the founders         health and well-being, and the influences that shape
         proposed a vision that was occupation based, client            occupation”(WFOT,2012b,p.2).Manyofitsconceptsare
         centered, contextual, and evidence based—the vision            emphasized throughout the OTPF–4, including
         articulated in the OTPF–4.                                     occupational justice and injustice, identity, time use,
                                                                        satisfaction, engagement, and performance.
           Introduction                                                 OTPF Organization
         The purpose of a framework is to provide a structure or        The OTPF–4 is divided into two major sections: (1) the
         base on which to build a system or a concept                   domain, which outlines the profession’s purview and the
         (“Framework,” 2020). The OTPF describes the central            areasinwhichitsmembershaveanestablishedbody
         concepts that ground occupational therapy practice and         of knowledge and expertise, and (2) the process,
         builds a common understanding of the basic tenets and          which describes the actions practitioners take when
         visionoftheprofession.TheOTPF–4doesnotserveasa                 providing services that are client centered and
         taxonomy, theory, or model of occupational therapy. By         focused on engagement in occupations. The
         design, the OTPF–4 must be used to guide occupational          profession’s understanding of the domain and process
         therapy practice in conjunction with the knowledge and         of occupational therapy guides practitioners as they
         evidence relevant to occupation and occupational               seek to support clients’ participation in daily living,
         therapy within the identified areas of practice and with the    which results from the dynamic intersection of clients,
         appropriate clients. In addition, the OTPF–4 is intended       their desired engagements, and their contexts
         to be a valuable tool in the academic preparation of           (including environmental and personal factors;
         4                                                                                                       AOTA OFFICIAL DOCUMENT
         The American Journal of Occupational Therapy, August 2020, Vol. 74, Suppl. 2                                     7412410010p4
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...Guidelines occupational therapy practice framework domain and process fourth edition contents preface thefourtheditionoftheoccupationaltherapypracticeframework denitions andprocess hereinafterreferredtoastheotpf isanofcialdocumentof evolution of this document vision for work the american association aota intended introduction practitioners students other health care occupation science professionals educators researchers payers policymakers andconsumers otpf organization cornerstones presents a summary interrelated constructs that describe occupations contexts performance patterns skills withintheotpf occupationaltherapyisdenedasthetherapeuticuseof client factors everydaylifeoccupationswithpersons groups orpopulations i e theclient overview purpose enhancing or enabling participation use their knowledge transactional relationship among evaluation intervention s engagement in valuable context to outcomes design based plans services conclusion tables are provided habilitation rehabilitati...

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