Disorders of the breast

 

1. Identify the incidence, risk factors, screening methods, and treatment modalities for benign breast conditions.

2. Analyze the incidence, risk factors, treatment modalities, and nursing considerations related to breast cancer.

3. Appraise reasons behind breast augmentation including the potential benefits and risks.

4. Outline preventive strategies for breast cancer through lifestyle changes and health screening.

5. Develop an educational plan to teach BSE to a group of high-risk women.

Discussion week 5 theoretical

Critique the theory of Self-Efficacy using the internal and external criticism evaluation process.

Requirements:

APA style 

In text citations

3 References within the last 5 years

Please provide 2 different responses to the original post. Also APA with 1 reference

Strategies to collect & share evidence

 

 What strategies can staff nurses use to share evidence that could impact health policy decisions?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

Apa 7th edition

 * We will be looking at local or national response protocols that were initiated during a critical incident, and you will choose your topic!

* Search reputable local and national media in the U.S. for a man-made disaster to discuss.

* Search for critical instances such as hostage situations, mass shootings, and multiple-vehicle or mass transit accidents with multiple critical injuries and disease outbreaks.

* Describe the incident and address the following:

  • Determine the incident type and explain your reasoning.
  • What resources were deployed for this incident?
  • What protocols were implemented successfully, and which were unsuccessful?
  • Discuss ways to improve the response to this type of incident in the future.

* Support your answer with evidence. Please provide a working link to your story source.

Nurs 8310 week 9: emergence and reemergence of infectious disease

  

Week 9: Emergence and Reemergence of Infectious Disease

As you have examined in this course, the scope of epidemiology has broadened over the years to include the global investigation of chronic, environmental, and genetic diseases and other health-related conditions. Yet, the practice of epidemiology has its roots in the study of infectious disease, global epidemics, and pandemics. Perhaps you recall the widely reported concerns about the H1N1 virus, SARS, or the reemergence of measles, tuberculosis, or whooping cough. The emergence and reemergence of infectious disease has long held the attention of epidemiologists, as well as the general public.

This week, you will explore the investigative process epidemiologists use to examine infectious diseases. You will also submit Assignment 4.

Learning Objectives

Students will:

· Analyze the investigative process for disease outbreaks

· Evaluate the application of health care interventions on emerging or reemerging infectious diseases

· Formulate an evaluation plan for a population health intervention

  

Learning Resources

Required Readings

Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett.

  • Chapter 12, “Epidemiology of      Infectious Diseases”

In this chapter, the authors examine the epidemiology of infectious diseases, one of the most familiar applications of epidemiology.

Centers for Disease Control and Prevention. (2011).CDC says “Take 3” actions to fight the flu. Retrieved from http://www.cdc.gov/flu/protect/preventing.html

 

This page contains the CDC’s most up-to-date recommendations regarding the prevention of seasonal flu. In addition to this page, you may wish to explore the CDC’s Seasonal Influenza home page, http://www.cdc.gov/flu/

World Health Organization. (2012).Disease outbreak news. Retrieved from http://www.who.int/csr/don/en/

 

The World Health Organization (WHO) provides information on the most recent disease outbreaks around the world. Stay up to date by visiting this site.

HealthMap. (2007). Retrieved from http://www.healthmap.org/en

Explore this interactive map that lists disease outbreaks around the world.

Centers for Disease Control and Prevention. (2011). Morbidity and mortality weekly report: Summary of notifiable diseases. Retrieved from http://www.cdc.gov/mmwr/mmwr_nd/index.html

Review the most current report on infectious diseases as reported by health care providers to state or local authorities. According to the CDC, “A disease is designated as notifiable if timely information about individual cases is considered necessary for prevention and control of the disease.” This report highlights infectious diseases reported in 2009.

Required Media

Laureate Education (Producer). (2012). Epidemiology and population health: Infectious disease: Two case studies [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this week’s program, the presenters discuss HIV and AIDS.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript VIDEO ATTACHED

Optional Resources

Ghosh, T. S., Patnaik, J. L., Alden, N. B., & Vogt, R. L. (2008). Internet-versus telephone-based local outbreak investigations. Emerging Infectious Diseases, 14(6), 975–977.

Seto, E. Y.W., Soller, J. A. & Colford, J. M. Jr. (2007). Strategies to reduce person-to-person transmission during widespread Escherichia coli O157:H7 outbreak. Emerging Infectious Diseases, 13(6), 860–866.

Open the links

https://www.who.int/home/cms-decommissioning

https://www.healthmap.org/en/

https://www.cdc.gov/mmwr/mmwr_nd/index.html

https://www.cdc.gov/flu/protect/preventing.htm

https://www.cdc.gov/flu/

  

Discussion: Investigating Pandemics and Epidemics

Some of the most notable epidemics include the bubonic plague in the 14th century, smallpox in the 18th century, and influenza in the 20th century. Reportedly, the bubonic plague caused over 137 million deaths, whereas the death toll associated with influenza was 25 million (Ernst, 2001). These are dramatic examples of the kinds of acute outbreaks that led to the practice of epidemiology.

Many epidemiologists and health care professionals are concerned about the next potential pandemic or epidemic. With the increased mobility of society, the spread of infectious diseases continues to pose a serious threat. For this Discussion, you will investigate pandemics and epidemics using epidemiological tools, and you will consider strategies for mitigating disease outbreaks.

To prepare:

· Using the Learning Resources, consider examples of emerging or reemerging infectious diseases that are occurring locally, nationally, or abroad. Then, select one example on which to focus.

· Explore the epidemiological investigative process used to identify the emerging or reemerging infectious disease or outbreak.

· Examine your selected infectious disease using the epidemiologic triangle and vector theory.

· Consider how health care interventions may reduce the emergence or reemergence of infectious diseases.

By Day 3

Post a cohesive response that addresses the following:

· Identify the emerging or reemerging infectious disease you selected.

· Discuss the investigative process used to identify the outbreak, and describe its effect using descriptive epidemiology (person, place, and time).

· Apply the epidemiologic triangle and vector theory to your selected outbreak.

· Evaluate how prior health care interventions, or lack thereof, created the conditions that allowed this infectious disease to emerge.

· Discuss how the disease outbreak might have been avoided or mitigated. Include agencies, organizations, and resources that could have supported these efforts. If appropriate, consider ongoing efforts to control the outbreak.

2 pages in APA and cite at least 4 sources of the given sources

Case study: j.t

 Purpose:Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

J.T.  is a 20 year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. J.T. has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college.

You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

  1. Generate a primary and differential diagnosis using the DSM-5 criteria.
  2. Develop a biopsychosocial plan of care for this client.
  3. Compare and contrast fear, worry, anxiety, and panic.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Unit 2 – discussion board

 Scenario attached below

Respond to the scenario below with your thoughts, ideas, and comments. Be substantive and clear, and use research to reinforce your ideas.

Now that you have gained an understanding of Red Carpet, Leroy has asked you to join in on a preliminary meeting with the VP of HR and other members of the organization to discuss change. The meeting is important because many employees are unsure of their role in the change process. In fact, the VP of HR has not settled yet on what type of change is needed or how to start the change process. Leroy has asked you to participate in the discussion to help clarify information needed about the change process.

Review the Red Carpet scenario for this course, and with your classmates, discuss the following questions that will provide insight into the change process:

  • In your opinion, what does Red Carpet need to change? Should the change be transformational, developmental, or transitional, and why?
  • What employees or employee groups should be included in the change process, and why?
  • What do you recommend Red Carpet do to begin the change process?


Scenario

This course uses the CTU Professional Learning Model™ (CTU PLM) to teach students with hands-on, industry-related, problem-solving experiences that model the professional environment and encourage achievements that lead to student and employer success. The CTU PLM is founded on the idea that students learn best by working on real-world, professional projects related to their chosen career fields. By working this way, students develop the expertise to apply conceptual knowledge to get effective results. Through professional learning, students experience the complexity of real-world problems and learn to select an appropriate approach to a problem that has more than one solution. This method of learning is called Problem-Based Learning (PBL). PBL assumes that you will master content while solving a meaningful problem in each assignment.

Throughout the course, you will work with a scenario in which some basic, background information is provided about a company. (This information could apply to any company that provides products or services of this sort in general.) You have a role in the scenario; that is, you are part of the story. The dialogue in each assignment presents the problem that must be solved. It is up to you to respond to the problem and submit a deliverable that will be graded.

Refer to the following scenario as you progress through the PBL process.

Problem-Based Learning (PBL) Scenario: Red Carpet LLC

Red Carpet LLC is a national hospitality and entertainment company with headquarters in Philadelphia, PA with national operations in the US. Historically, the company has had 3 divisions: hotels, food service, and cruise lines. However, it recently completed the acquisition of Sparkstar theaters, a movie theater company, that it is slated to become its 4th division. Red Carpet now owns 200 hotels in 48 states, 4 brands of restaurants with 1776 locations, 4 Buoy Bay branded cruise ships, and 300 Sparkstar theaters.

Its matrix organizational structure consists of a central HR, accounting, business development, sales, marketing, and research and development departments located at the headquarters in Philadelphia that serve each division. Each division is located in a different part of the US and lead by a VP that reports to the President and CEO. The company is privately owned by a consortium of investors and investor groups.

Red Carpet has 16,000 employees, 1000 of which work at its corporate headquarters. The organizational culture of the headquarters is informal and organic and there are few policies and processes that guide employee behavior. The company, as a whole, does not value HR so employees struggle with many employee relations and employment law concerns. The company outsources all of its training to one of the investor group companies, however this training is commonly not customized to the needs of Red Carpet.

As a whole, Red Carpet struggles with its business to business partners and suppliers because of its reputation for being nonnegotiable. Red Carpet would rather disrupt the quality and availability of its only products and services rather than partner for the supply chain resources that it needs. Likewise, Red Carpet does not hold many of the General Managers in its hotels, restaurants, and its cruise ships accountable for performance, opting instead for a weaker political strategy of blaming and gotcha games.

Being aware of these challenges, Red Carpet acquired Sparkstar for their strong industry reputation and financial performance in the hopes that merging the structure and culture of Sparkstar into Red Carpet would change the organization for the better. Historically, Red Carpet has been a highly successful company, however in recent years, its mismanagement has created noticeable effectives in product and service quality and its bottom line.

Divisions

Hotels: Red Carpet branded hotels are mid-price semi-luxury hotels known for high quality. Each customer is given a red velvet cupcake upon checking in. Red Carpet relies on its General Managers to micromanage the hotel. Despite its corporate parent owning a restaurant division, no Red Carpet hotels have restaurants. The Red Carpet division headquarters are in Sedona AZ. Many of the hotels are in need of refurbishment.

Food Service: Chicken Heaven is a fast-food chain with a long tradition of quality, large customer base, and 1000 locations. It is a solid overall performer for Red Carpet with high employee satisfaction. Burger Blast is another fast-food chain recently launched to cater to upscale customers who seek customized, gourmet-style burgers. It has 200 locations, however General Managers are struggling with budget and supplies causing a poor customer experience and high employee turnover. Food Park is a buffet-style restaurant with 500 locations that has been recently struggling because of high competition and poor marketing.  Delicacy is a high-end restaurant with an urban theme. It has 76 locations, is the oldest of Red Carpet’s food service operations, and provides a unique dining experience for customers. However, General Managers have a high turnover at Delicacy because of the grueling schedule. The food service division is located in Burke, ID.

Cruise Ships: Buoy Bay cruise ships offer low-cost, short-term cruises from Port Canaveral, FL only to the US Virgin Islands. Buoy Bay offers customers average quality staterooms and food from Chicken Heaven, Burger Blast, and Food Park. However, it does not offer a non-buffet formal dining option such as Delicacy. Although they are known for their over-the-top entertainment, employee turnover is very high relying primary on seasonal employees who are poorly trained. Buoy Bay has had much controversy. Just 5 years ago, the Buoy Bay cruise ship, Garland of the Sails, hit a reef, partially sank, and had to be salvaged in a 1.5 billion dollar operation. This resulted in a Federal investigation that is still pending. The Buoy Bay division is located in Lapsowanne, OR.

Movie Theaters: Sparkstar theaters were recently purchased from the Vegamega group for 2.3  billion dollars. Sparkstar is the highest rated movie theater chain the US. It has high customer and employee satisfaction, an efficient organizational structure, and solid financial results. Sparkstar’s culture is one of high HR involvement including a strong training and development department, Sparkstar Institute. Sparkstar has a customer rewards program that provides a free movie rental of the film that the customer saw in the theater which has been very popular and has increased its strong customer base. Sparkstar has its divisional headquarters in Pasadena, CA.

The Issues

With the purchase of Sparkstar theaters, Red Carpet is hoping to redefine its operations in the next 5 years. It sees opportunities to integrate its divisions, products, and services to better serve its customers and employees. Here is a summary of some of the issues that Red Carpet must address in its strategic plan:

· Internal politics and communication

· Improved HR and training

· Employee relations issues

· Federal investigations

· Product and service quality

· Marketing support

· Performance issues

· Redefining the organizational structure

· Improving its organizational culture

· Integrating products and services

· Resource and supply chain issues

Your Role 

Leroy Banks, the Director of Change management at Red Carpet is seeking an Organization Development Consultant to address Red Carpet’s need for change. You’ve just received a consulting contract from him to help prepare a plan to assist Red Carpet. You’re excited about the opportunity and are motivated to work on this project. You know that your insight will assist Red Carpet with managing organizational change.

Case study

Case Study about chapter 19 SEAN: Left Above Knee Amuptation, Stage II Sacral Decubitus Ulcer in skilled nursing pdf document.

Please see the assignment objective below and the complete chapter is below in the document is CHAPTER 19

Need to be a Word Document with APA references. Do no matter how many word or pages, all I need is the assignment objectives, procedure,Analyze various case examples, by about Chapter 19 is a client named SEAN.

See document Attach! 

2


Case Study


Lab Assignment

Name:_____________________

Date: _____________________

Course: OTA 104/105: Activity Analysis

Course objective(s):

UNIT SEVEN: Analyzing Human Motion in Daily Activity

Upon successful completion of this unit on written and practical examination, the student will:

Analyze various case examples by:

a. Identifying physical performance impairments during an occupation.

b. Selecting appropriate tests to assess the indentified physical performance deficits.

c. Determining and justifying in written form which model of practice/frame of reference would best guide the treatment of the identified impairments.

d. Implementing the selected frame of reference/model of practice in correcting, or compensating, for the identified impairments.

e. Role-playing a treatment session based on student analysis

Curriculum thread(s) addressed:

·
Occupation Centered Practice

·
Role Acquisition

Assignment Objectives:

· The student will identify and demonstrate (as applicable) role and participation in the Occupational Therapy process (referral, screening, evaluation, treatment planning, intervention, reevaluation and discharge planning)

· The student will determine and select the model of practice/frame of reference that would best guide the treatment of the identified impairments.

· The student will demonstrate proficiency in applying OT treatment techniques and practices to a case study that will be assigned to them.

· The student will create a problem list, list of strengths, long-term goals, and short-term goals.

· The student will demonstrate treatment session which will be described in an intervention note.

· After the treatment session, the student will identify opportunities to recommend to the occupational therapist the need for referring client for reevaluation, discharge planning and additional evaluation for other services and/or professional(s).

Procedure:

· The student will be assigned a case study with an array of physical dysfunctions.

· Student will complete an analysis based on a structure and guideline that requires information in regards to: Problems, strengths of the client, long-term and short-term goals for treatment.

· Student will develop two treatment sessions applying techniques, strategies and practices

· Student will demonstrate by role play, one treatment session.

· Student will write an intervention/treatment note accordingly.

Written assignment:


Poor (1)


Fair (2
)


Good (3)


Excellent (4)


Score

Determine and select model of practice/frame of reference to best guide the treatment of the identified impairments.

Unable to determine appropriate Application of model of practice/frame of reference

Additional questions arise. Difficult to follow, yet selected practice/frame of reference is present.

Application of model of practice/frame of reference requires additional clarification

Application of model of practice/frame of reference is best suited

Use of proper OTPF terminology and grammar

Use of inaccurate terminology or grammar on more than 8 occasions.

Use of inaccurate terminology or grammar on no more than 6 occasions.

Correct use; with use of inaccurate terminology or grammar on no more than 4 occasions.

Correct use; with use of inaccurate terminology or grammar on no more than 2 occasions.

Summary of primary and secondary medical diagnoses: signs, symptoms, prognosis, prevalence

Did not identify. Clarification needed

Missing 50% of data

Missing 25% of data

All relevant information provided

Developed a prioritized OT Problem list.

Explained justification of prioritization using the OTPF.

Not addressed or information not relevant.

Only two problems are OT relevant and student requires additional clarification about how practice framework is utilized to prioritize problem list.

Most problems are OT related and can be addressed by therapist. Most problems prioritized and justified with fair use of practice framework.

Problem list is accurate and prioritized considering patient specific diagnosis, needs, and wants. Utilized and explained clearly application of practice framework to problem list.

Identified all problems of the patient accurately

Did not identify problems accurately on 5-6 occasions

Did not identify problems accurately on 3-4 occasions

Identified all problems, but did not identify problems accurately on 1-2 occasions

Identified all problems accurately

Identified accurately and correctly all strengths and opportunities of the patient in the case study

Did not identify accurately and correctly all strengths and opportunities of the patient in the case study on 5-6 occasions

Did not identify accurately and correctly all strengths and opportunities of the patient in the case study on 3-4 occasions

Identified accurately and correctly mostly, but failed to identify accurately and correctly on 1-2 occasions

Identified accurately and correctly all strengths and opportunities of the patient in the case study

Completed all long term goals accurately and correctly meeting all the criteria utilizing FEAST or other documented method

Did not complete long term goals accurately and correctly meeting all criteria on 5-6 occasions

Did not complete long term goals accurately and correctly meeting all criteria on 3-4 occasions

Completed long term goals accurately and correctly meeting most criteria, but missing on 1-2 occasions

Completed all long term goals accurately and correctly meeting all the criteria

Completed all short term goals as applicable

Did not complete 5-6 short term goals

Did not complete 3-4 short term goals

Good, but missed the completion of 1-2 short term goals

Completed all short term goals as applicable

Methods/Interventions

Listed methods used to treat patient in a comprehensive list to be used as treatment plan guide. Indicate FOR (s) for treatment session.

Information provided is vague.

Methodology is not comprehensive and lacking information.

Good, but additional clarification needed.

Comprehensive list of methods that will be used in intervention. Sound, research based methodology is evident FOR (s) is indicated.

Rationale/Justification

Describes the rationale behind above methods and gives reason why this will work (justification)

Unacceptableperformance and clinical reasoning

Rationale is missing or not sound on several methods

Good, but rationale is incomplete or not sound on some methods

Sound rationale given for each method. Comprehensive.

Created and developed two treatment sessions utilizing time management skills and progression in the treatment continuum

Did not create and develop treatment sessions accurately and correctly

Creation and development treatment of sessions require additional work. Uses clinical reasoning skills for 50% of session

Good overall. Additional clarification required. Most ideas are good and uses clinical reasoning skills for 75% of session

Created and developed two treatment sessions accurately and correctly, meeting the criteria

Treatment session:

Description of main medical diagnosis, and any precautions.

Brief description of patient’s status and goals.

Too long or too short of expected length of time

Part of the treatment session is appropriate and addresses goals.

Most of treatment session is appropriate & addresses goals.

Medical and diagnoses information covered. Important precautions mentioned. Brief discussion of patient’s status and goals-

Uses and prepares equipment in the lab.

Last minute preparation with materials.

Creativity shown.

Creativity, flexibility. Demonstrates how activity can be graded.

Overview of treatments selected and why they are appropriate for this patient is indicated.

Address Q & A.

Unable to answer questions from instructor/ students related to rational or activity analysis or interventions.

Nervous, but attempts to answer questions at the end of treatment session.

Answers questions easily and somewhat accuratel
y at the end of treatment session
.

Student is able to explain and answer all questions at the end of treatment session. Shows how activities can be graded up or down. Rational is complete

Shows creativity. At the end of the treatment session, identifies opportunity to recommend to the occupational therapist the need for referring client for reevaluation, discharge planning and additional evaluation for other services and/or professional (s).

Written activity analysis for each activity.

Vague, not well elaborated, does not address value or meaning of activity. Explanation will not contribute to analysis.

Many questions arise. Data provided is acceptable, but more effort is required.

Data provided that may assist in identifying value of activity for use in treatment requires minimal additional clarification.

Well discussed, provides meaningful relevant data that may assist in identifying value of activity for use in treatment

Shows progression from adjunctive to purposeful as appropriate.

Rationale and explanation of interventions.

Unacceptable. More creativity and justification required.

Many questions arise. Rationale and explanation of interventions requires additional focus and concentration

Progression from adjunctive to purposeful requires additional thought process.

Rationale and explanation of interventions require additional work but can be followed. Some questions arise.

Progression from adjunctive to purposeful as appropriate.

Rationale and explanation of interventions is clearly identified.

Shows priority as related to discharge plans as appropriate.

Vague and not well elaborated.

Priority as related to discharge plans is not as evident. Many questions arise

Priority as related to discharge plans requires additional clarification

Priority as related to discharge plans as appropriate.

After treatment session, identification of

opportunity to

recommend to the occupational therapist the need for referring client for reevaluation and additional evaluation for other services and/or professional (s).

Unacceptable. Evidence of knowledge and understanding is not apparent

Identification of

opportunity to

recommend to the occupational therapist the need for referring client for reevaluation and additional evaluation for other services and/or professional (s) is articulated, however, many questions arise

Identification of

opportunity to

recommend to the occupational therapist the need for referring client for reevaluation and additional evaluation for other services and/or professional (s) is articulated., however, knowledge and understanding is not as apparent. Minimal clarification to increase knowledge and understanding required.

Identification of

opportunity to

recommend to the occupational therapist the need for referring client for reevaluation and additional evaluation for other services and/or professional (s) clearly articulated. Knowledge and understanding is evident.

Evidence based treatment: AJOT or other researched based articles are used to support one intervention.

Copies of article included with paper.

No evidence of article or

more than 25% of the information is not accurately transcribed.

Selection of articles are not highly relevant to case study/or is/are insufficient.

Another article is recommended

Selected article supports specified intervention, but rationale requires additional clarification

Selected article addresses specified intervention with supporting rationale provided

Treatment Note:

Completed all sections of the intervention/treatment note utilizing all the necessary criteria

Unacceptable contribution. Requires remediation in note writing.

Additional clarification is required. Moderate corrections required

Minimal corrections required, however, able to follow

Completed all sections of the intervention/treatment note

Subjective

Objective

Assessment


Plan

Comment:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Score:

Paper: Your score was _____________

Treatment session: Your score was _____________

Treatment note: Your score was _____________

The total score to accumulate is “56”. Your score was _____________ with a

percentage of _______________


ACOTE Standards for an Accredited Educational Program for the Occupational Therapy Assistant:

(B.2.11. , B.3.2., B.4.1., B.4.4., B.4.96., B.5.4.92., & B.5.84.10)



Revised 12/08/15 JM; revised 04/2029/2016 2020 JM

CASE STUDY: QUINN 1

2

CASE STUDY: QUINN

Case study: Quinn

Maria Diaz

Praxis Institute- Hialeah Campus

OTA

Activity Analysis Lab 105

Professor Alexandra Timmer

August 3, 2022

Occupational Profile

Quinn is a 77-year-old Caucasian man with a diagnosis of dementia. Quinn has a past medical history of congestive heart failure, hypertension, depression, and grout. He is married to his wife Dorothea, and she visits him on Wednesdays and Fridays. She takes him outside to the patio and reads him letters from their grandchildren. Dorothea wants Quinn to remain as mentally capable as possible, when she doesn’t have letters to read, she reads him the local newspaper instead. She also attends all his care plan meetings and frequently speaks as an advocate on his behalf.

Quinn has been a resident at the nursing home for the last 2 years in which his family has planned that Quinn remains at the nursing home indefinitely. He participates minimally in the facility’s activities, responds well to simple comments, and recognizes his wife but sometimes confuses his daughters and grandchildren. He cannot recall the names of staff members but smiles when he sees someone he recognizes. He is also dependent on all his ADLS since he has arrived at the facility and is non-ambulatory.

The nurse realized that Quinn needs more assistance with more help with his meals over the last 3 to 4 weeks and he has been referred to Occupational therapy. The facility staff feels that Quinn is more cognitively impaired than he appears. Quinn is displays short and long term memory. He is able to follow verbal commands and with some visual cues. He is unable to learn new things and information with an attention spam of approximately 5 minutes. Quinn is unable to locate, identify and locate the various utensils, however he is able to demonstrate holding a spoon and fork correctly once placed on his hands. Quinn is unable to scoop food onto the spoon, as he drops the food on his lap also. Quinn is able to drink half of his liquid because he cannot extend his neck.

Framework

In Quinn’s case study, I will use the Person-Environment Occupational Performance (PEOP). This model was chosen to guide interventions based on intrinsic and extrinsic factors that contribute to Quinn’s professional performance. PEOP guides intervention through the concept of adaptation and modification. This model explores how people, work, and the environment affect Quinn’s work performance in tasks. The focus was based on a unit of feeding task to identify cognitive or environmental factors that support his self-eating ability.

Another model that I will be using for this client will be the Allen Cognitive Level Screen (ACLS), which requires a person to do a few short stitching tasks with a string and a needle, which is used to screen for dementia (Scand J 2017). It involves following instructions, fine motor skills, and learning. Allen Cognitive Level Screen is used to determine if a person has the mental and physical ability to safely complete tasks that need to be completed daily. This is called functional cognition.in Quinn’s case, we are determining what level he is on, and what level of independence he has, such as if he can take his medications alone and where his cognitive level is.

Dementia

Dementia is also known in terms of the impairment ability to remember, think, or make decisions that interfere with everyday life activities. Some people with dementia have no control over their emotions and may change their personalities. The severity of dementia varies from the mildest stage, which is just beginning to affect a person’s function, to the most severe stage, which is completely dependent on others for basic living activities. Dementia is more common as people grow older, but most adults won’t get dementia. There are various forms of dementia, including Alzheimer’s disease. A person’s symptoms vary by type.

Dementia is caused by damage to brain cells. This damage affects the ability of brain cells to communicate with each other. Everyone loses some neurons with age, but people with dementia experience much greater loss. For example, some symptoms are Acting impulsively, Not caring about other people’s feelings, losing balance, having problems with movement, Hallucinating, or experiencing delusions or paranoia. Early detection of symptoms is important because several causes can be treated. However, in many cases, the cause of dementia is unknown and cannot be treated. Still, early diagnosis helps manage the condition and plan.

To diagnose dementia, doctors first assess whether a treatable underlying disorder may be associated with cognitive impairment. Physical tests to measure blood pressure and other vital signs, and clinical tests of blood and other fluids to check the levels of various chemicals, hormones, and vitamins to identify or rule out possible causes of symptoms. A person’s medical history and family history reviews can provide important clues about the risk of

dementia. Typical questions are whether dementia develops in the family, when and how the symptoms began, whether behavior or personality changes, and specific medications that can cause or exacerbate the symptoms.

Early stage, the person has short-term memory problems, lacks concentration, and experiences mood swings. Middle Stage, the person has orientation problems, is prone to get lost, and has problems with clothing, hygiene, food, and language. Late stage, the person cannot recognize close relatives. In addition, there is a serious language disorder and disorientation is serious. Final Stage, the person becomes completely dependent on all aspects of daily life, is indifferent and unresponsive, and has no meaningful language or memory. In addition, humans do not interact with the environment and their motor function is impaired.

OTPF

Besides feeding, Quinn has many other needs that generally require attention. Therefore, hiring as a nursing home skill can lead to other pursuits of Quinn, such as Quinn’s managers (Koch, & Iliffe, 2011). Also, one of Quinn’s best intervention sessions is to increase dietary independence by slowly teaching how to hold a spoon and improving motor coordination through exercise. Ideally, this would help him learn how to hold food from his plate without dropping it on his lap. Quinn’s wife’s role and routine greatly help Quinn’s intervention. Taking Quinn out and reading a letter to him plays an important role in improving motor coordination and cognitive ability (Spector, Orrell, & Woods, 2010). Therefore, she can be included in an intervention session designed for her husband.

Research shows that physical exercise plays an important role in helping to protect, maintain, and improve the health and well-being of people in either the pre-clinical or the clinical stages of Dementia (Buchman AS and D Bennett.). Exercises like walking, dancing, and even yoga can be very beneficial to the client. Craft projects, scrapbooking, baking, working with clay, painting, and drawing help those small muscle exercises.

Alzheimer’s disease has social implications because increased anxiety, along with memory loss and other problems, is a common symptom of dementia. People who feel anxious are less likely to be social and may even be afraid to interact with others. As a caregiver, you need to promote socialization and at the same time pay attention to the feelings of your loved ones. Make it as easy as possible for you to be with others. Personal beliefs vary from person to person. This includes religious or political beliefs and beliefs cultivated through experience and lessons of life. However, people with dementia can lose the ability to logically think about whether their beliefs are correct. These false beliefs, also known as delusions, can be very strong and anxious.

The routine is changed and sometimes even the environment is changed. This can cause anxiety and confusion. People with dementia struggle to adapt to changes in their environment because of damage to areas of the brain known as ‘multiple demand networks’, highly evolved areas of the brain that support general intelligence, say scientists at the University of Cambridge.

Problems and Strength list

Performance issues are impairing the ability to successfully participate in feeding and social participation. Deficits are present in orientation to others, short attention span, and decreased overall functioning. Quinn ADLs: Self-feeding, Requires A to set up, and initiate movement to bring the utensil to the mouth, Stabilization of utensils, and Delayed motor coordination. Quinn has an of Positioning: Kyphosis posture. Poor positioning of extremities in w/c Skin sores.

Quinn might have some difficulties, but he also has some strengths. For Example, Quinn can perform automatic responses with prompting, maintains a regular diet, ability to feed himself finger foods, and can hold a cup independently once placed in his hand.

Methods/ Interventions

At Quinn’s stage, the patient’s caregiver can intervene and do everything for him. However, patients can still physically help with clues and prompts and should be encouraged to do so. Intervening too much as an OT, family member, or caregiver is one of our greatest frustrations as patients may not be able to continue their daily activities and lose basic self-care skills. The saying, “If you don’t use it, you lose it” really does apply in this case as said by Tepa Snow.

For this reason, most of my time is focused on working with patients in ADL retraining along with balance and functional mobility retraining. Also, explain to all nurses the benefits of working with the patient and taking care of them as much as possible. With this method, I can include increased verbal or visual cues, demonstration, physical guidance, partial physical assistance, and problem-solving to improve the outcome (Beck et al., 1997).

Long-Term Goals and Short-Term Goals

Long-term goal:

The client will engage in self-feeding compensatory strategies with mod assist to eat food off his plate using verbal and physical cues for 2 weeks.

Short-term goal:

• Client will learn the use of a built-up handle spoon/ fork with min assist in 3 days

• Client will learn the proper way to grasp the use of a universal cuff with min assist in 2 days.

• Client will independently practice eating with a plate guard in 2 days.

Long-Term Goal

The client will tolerate a 30- minute social activity in his facility at least once a day for 2 weeks.

Short-Term Goals:

• Client will eat at least one meal each day in the dining hall for increased social engagement independently in 2 days.

• Client will engage in a meal with another patient to increase socialization for 2 days.

• Client will participate with other faculty to maintain interaction for 2 days.

Long-Term Goals

The client will participate in proper upright wheelchair positioning techniques with min assistance to increase engagement in self-feeding within 2 weeks.

Short-term goals:

• Client will learn to use a pillow for proper truck support within 2 days.

• Client will participate in safety awareness when using a wheelchair with min assist in 3 days.

• Client will engage in different angles for proper positioning with min assist in 2 weeks.

Treatment Sessions

1.)
The client will engage in a 60-minute treatment session. For the first 10 minutes, I will introduce myself to Quinn, do universal precautions for both of our safety, and I will take his vital signs (blood pressure, pulse, temperature, oxygen level). For 5 minutes, I will explain to Quinn what we are doing for today and ask if he understood with a verbal cue. For 45 minutes I will show Quinn proper ways to maintain a good posture and angle such as putting pillows for trunk support, so he is not bending over. Proper position of the wheelchair. I will also do some therapeutic exercises for his upper extremities such as flexion, extension, abduction and adduction of the shoulders. So he can be warmed up and have energy through out the day.

2.) The client will participate in a 45-minute treatment session. 10 minutes, I will introduce myself to Quinn, do universal precautions for both of our safety, and I will take his vital signs (blood pressure, pulse, temperature, oxygen level). For 5 minutes I will explain to Quinn the activity for today and make sure he acknowledges it. For 30 minutes we will go to the dining hall so we can eat a prepared meal, and Quinn can learn and demonstrate the purpose of using the adaptive equipment such as a built-up handle spoon/fork, scoop dish, and plate guard. I will also do a patient education on the safety awareness of eating while seated in a wheelchair. Having Quinn eat at the dining hall will increase his socialization interaction with other patients.

Plan

The plan for Quinn is for him to benefit from our treatment plan so he will be able to eat and hold the utensil without having food dropping on him. And proper wheelchair positioning so he won’t extend his neck too much. Along with working with the patient, the family will also be provided with caregiver education. Educating your patient’s family members on your interventions to increase carryover is just as important as what you’re doing with the patient (Schaber, P., & Lieberman, D. (2010). Collaborating with the family and staff as a cohesive team makes a big difference.

Documentation

S

The client was motivated to participate in today’s activity which was evident by his facial expressions and his contribution. The client stated “I didn’t feel well last night because I was alone”

O

The client participated in a 30-minute OT session in the dining room for instruction in the use of AE for self-feeding. The client independently identified 2/2 utensils with built-up handles. The client reported satisfaction with built-up handles. The client was also instructed in the use of a plate guard and nosey cup and was independent with use after 2 attempts. The client was educated on the use of a pillow to help with trunk positioning when eating to decrease difficulty with feeding.

A

The client’s ability to learn and use AE successfully shows good potential for meeting goals. He was able to identify 2 different utensils the build-up fork and spoon, he enjoyed his meal at the dining hall with a plate guard, so his food won’t spill everywhere. The client reported that having foam around his utensils made it better for him to grasp the food better. It was reported in the objective that he has pain due to extension of his neck, and the clients use of the nosey cup has decreased pain. The client would benefit from skilled instruction in the use of weighted AE to help with tremors when performing ADL tasks.

P

The client will continue to participate for 1 week of OT sessions, by eating a prepared meal in the dining hall and outside in the garden to engage in socializing with other members so he won’t feel alone anymore, and to continue the use of AE of buildup handle spoon and fork so he can eat independently.

References

America, D. S. of. (2018, October 14).
Dementia can affect motor skills. Dementia Society. Retrieved July 18, 2022, from https://www.dementiasociety.org/post/dementia-can-affect-motor-skills

Rojo-mota G, Pedrero-pérez EJ, Huertas-hoyas E, Merritt B, Mackenzie D. Allen Cognitive Level Screen for the classification of subjects treated for addiction. Scand J Occup Ther. 2017


Schaber, P., & Lieberman, D. (2010). Occupational therapy practice guidelines for adults with Alzheimer’s disease and related disorders. Bethesda, MD: AOTA Press.

Alexandra, W., & Alexandra, W. (n.d.).
Overview of the major types of dementia.

Occupational Therapy Practice
Framework: Domain and Process

Fourth Edition

Preface

The fourth edition of theOccupational Therapy Practice Framework: Domain

and Process (hereinafter referred to as theOTPF–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.

Definitions
Within theOTPF–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 use their knowledge of the transactional relationship among the

client, the client’s engagement in valuable occupations, and the context to

design occupation-based intervention plans. Occupational therapy services

are provided for habilitation, rehabilitation, and promotion of health and

wellness for clients with disability- and non–disability-related needs. These

services include acquisition and preservation of occupational identity for

clients who have or are at risk for developing an illness, injury, disease,

disorder, condition, impairment, disability, activity limitation, or participation

restriction (AOTA, 2011; see the glossary in Appendix A for additional

definitions).

When the term occupational therapy practitioners is used in this

document, it refers to both occupational therapists and occupational therapy

assistants (AOTA, 2015b). 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.

Contents

Preface ……………………………………………………………1

Definitions ………………………………………………….1

Evolution of This Document …………………………2

Vision for This Work ……………………………………4

Introduction ……………………………………………………..4

Occupation and Occupational Science ………..4

OTPF Organization …………………………………4

Cornerstones of Occupational Therapy

Practice ………………………………………………6

Domain ……………………………………………………………6

Occupations ……………………………………………….7

Contexts ……………………………………………………9

Performance Patterns ……………………………….12

Performance Skills ……………………………………13

Client Factors …………………………………………..15

Process …………………………………………………………17

Overview of the Occupational Therapy

Process …………………………………………….17

Evaluation ………………………………………………..21

Intervention ………………………………………………24

Outcomes ………………………………………………..26

Conclusion …………………………………………………….28

Tables …………………………………………………………..29

References …………………………………………………….68

Table 1. Examples of Clients: Persons, Groups,

and Populations ……………………………………..29

Table 2. Occupations ………………………………..30

Table 3. Examples of Occupations for Persons,

Groups, and Populations …………………………35

Table 4. Context: Environmental Factors …….36

Table 5. Context: Personal Factors …………….40

Table 6. Performance Patterns …………………..41

Table 7. Performance Skills for Persons …….43

Table 8. Performance Skills for Groups ………50

Table 9. Client Factors ………………………………51

Table 10. Occupational Therapy Process for

Persons, Groups, and Populations ………….55

Table 11. Occupation and Activity

Demands ………………………………………………57

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Occupational therapy assistants deliver occupational therapy services under

the supervision of and in partnership with an occupational therapist (AOTA,

2020a).

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 (aggregates of people with common attributes

such as contexts, characteristics, or concerns, including health risks; Scaffa

& Reitz, 2014). People may also consider themselves as part of a community,

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, and framed fromanoccupational perspective. Throughout

the OTPF–4, the term client is used broadly to refer to persons, groups, and

populationsunlessotherwise specified. In theOTPF–4, “group”asa client is distinct

from “group” as an intervention approach. For examples of clients, see Table 1 (all

tables are placed together at the end of this document). The glossary in Appendix

A provides definitions of other terms used in this document.

Evolution of This Document
The Occupational Therapy Practice Framework was originally developed to

articulate occupational therapy’s distinct perspective and contribution to

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).Originally a document that responded to a federal

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) was adopted by the AOTA Representative Assembly (RA) and

published in 1989. The document focused on delineating and defining only

the occupational performance areas and occupational performance components

that are addressed in occupational therapy direct services. The third and final

edition ofUniform 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

Table 12. Types of Occupational Therapy

Interventions …………………………………………59

Table 13. Approaches to Intervention …………63

Table 14. Outcomes ………………………………….65

Exhibit 1. Aspects of the Occupational Therapy

Domain …………………………………………………..7

Exhibit 2. Operationalizing the Occupational

Therapy Process …………………………………..16

Figure 1. Occupational Therapy Domain and

Process ………………………………………………….5

Authors ……………………………………………………72

Acknowledgments …………………………………….73

Appendix A. Glossary ……………………………….74

Index ……………………………………………………….85

Copyright © 2020 by the American
Occupational Therapy Association.

Citation: American Occupational Therapy
Association. (2020). Occupational therapy
practice framework: Domain and process
(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

For permissions inquiries, visit https://www.
copyright.com.

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reflected changes in practice and provided consistent

terminology for use by the profession.

In fall 1998, the AOTA Commission on Practice (COP)

embarked on the journey that culminated in the

Occupational Therapy Practice Framework: Domain

and Process (AOTA, 2002a). At that time, AOTA also

published The Guide to Occupational Therapy Practice

(Moyers, 1999), which outlined contemporary practice

for the profession. Using this document and the feedback

received during the review process for theUT–III, the COP

proceeded to develop a document that more fully

articulated occupational therapy.

The OTPF is an ever-evolving document. As an

official AOTA document, it is reviewed on a 5-year

cycle for usefulness and the potential need for further

refinements or changes. During the review period, the COP

collects feedback from AOTA members, scholars, authors,

practitioners, AOTA volunteer leadership and staff, and

other stakeholders. The revision process ensures that the

OTPFmaintains its integrity while responding to internal and

external influences that should be reflected in emerging

concepts and advances in occupational therapy.

The OTPF was first revised and approved by the RA in

2008. Changes to the document included refinement of the

writing and the addition of emerging concepts and changes

in occupational therapy. The rationale for specific changes

can be found in Table 11 of the OTPF–2 (AOTA, 2008,

pp. 665–667).

In 2012, the process of review and revision of the

OTPF was initiated again, and several changes were

made. The rationale for specific changes can be found

on page S2 of the OTPF–3 (AOTA, 2014).

In 2018, the process to revise the OTPF began again.

After member review and feedback, several modifications

were made and are reflected in this document:

n The focus on group and population clients is

increased, and examples are provided for both.
n Cornerstones of occupational therapy practice are

identified and described as foundational to the

success of occupational therapy practitioners.
n Occupational science is more explicitly described

and defined.

n The terms occupation and activity are more clearly

defined.
n For occupations, the definition of sexual activity as an

activity of daily living is revised, health management is

added as a general occupation category, and intimate

partner is added in the social participation category

(see Table 2).
n The contexts and environments aspect of the

occupational therapy domain is changed to context on

the basis of theWorld Health Organization (WHO; 2008)

taxonomy from the International Classification of

Functioning, Disability and Health (ICF) in an effort

to adopt standard, well-accepted definitions (see

Table 4).
n For the client factors category of body functions,

gender identity is now included under “experience of

self and time,” the definition of psychosocial is

expanded to match the ICF description, and

interoception is added under sensory functions.
n For types of intervention, “preparatory methods and

tasks” has been changed to “interventions to support

occupations” (see Table 12).
n For outcomes, transitions and discontinuation are

discussed as conclusions to occupational therapy

services, and patient-reported outcomes are

addressed (see Table 14).
n Five new tables are added to expand on and clarify

concepts:
+ Table 1. Examples of Clients: Persons, Groups,

and Populations
+ Table 3. Examples of Occupations for Persons,

Groups, and Populations
+ Table 7. Performance Skills for Persons (includes

examples of effective and ineffective

performance skills)
+ Table 8. Performance Skills for Groups

(includes examples of the impact of ineffective

individual performance skills on group

collective outcome)
+ Table 10. Occupational Therapy Process for

Persons, Groups, and Populations.

n Throughout, the use of OTPF rather than Framework

acknowledges the current requirements for a unique

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identifier to maximize digital discoverability and to

promote brevity in social media communications. It

also reflects the longstanding use of the acronym in

academic teaching and clinical practice.
n Figure 1 has been revised to provide a simplified

visual depiction of the domain and process of

occupational therapy.

Vision for This Work
Although this edition of the OTPF represents the latest in

the profession’s efforts to clearly articulate the

occupational therapy domain and process, it builds on a

set of values that the profession has held since its

founding in 1917. The original vision had at its center a

profound belief in the value of therapeutic occupations as

a way to remediate illness and maintain health (Slagle,

1924). The founders emphasized the importance of

establishing a therapeutic relationship with each client

and designing a treatment plan based on knowledge

about the client’s environment, values, goals, and desires

(Meyer, 1922). They advocated for scientific practice

based on systematic observation and treatment (Dunton,

1934). Paraphrased using today’s lexicon, the founders

proposed a vision that was occupation based, client

centered, contextual, and evidence based—the vision

articulated in the OTPF–4.

Introduction

The purpose of a framework is to provide a structure or

base on which to build a system or a concept

(“Framework,” 2020). The OTPF describes the central

concepts that ground occupational therapy practice and

builds a common understanding of the basic tenets and

vision of the profession. TheOTPF–4 does not serve as a

taxonomy, theory, or model of occupational therapy. By

design, the OTPF–4 must be used to guide occupational

therapy practice in conjunction with the knowledge and

evidence relevant to occupation and occupational

therapy within the identified areas of practice and with the

appropriate clients. In addition, the OTPF–4 is intended

to be a valuable tool in the academic preparation of

students, communication with the public and

policymakers, and provision of language that can shape

and be shaped by research.

Occupation and Occupational Science
Embedded in this document is the occupational therapy

profession’s core belief in the positive relationship

between occupation and health and its view of people as

occupational beings. Occupational therapy practice

emphasizes the occupational nature of humans and the

importance of occupational identity (Unruh, 2004) to

healthful, productive, and satisfying living. As Hooper and

Wood (2019) stated,

A core philosophical assumption of the profession, therefore, is that by
virtue of our biological endowment, people of all ages and abilities
require occupation to grow and thrive; in pursuing occupation, humans
express the totality of their being, a mind–body–spirit union. Because
human existence could not otherwise be, humankind is, in essence,
occupational by nature. (p. 46)

Occupational science is important to the practice of

occupational therapy and “provides a way of thinking that

enables an understanding of occupation, the occupational

nature of humans, the relationship between occupation,

health and well-being, and the influences that shape

occupation” (WFOT, 2012b, p. 2). Many of its concepts are

emphasized throughout the OTPF–4, including

occupational justice and injustice, identity, time use,

satisfaction, engagement, and performance.

OTPF Organization
The OTPF–4 is divided into two major sections: (1) the

domain, which outlines the profession’s purview and the

areas in which its members have an established body

of knowledge and expertise, and (2) the process,

which describes the actions practitioners take when

providing services that are client centered and

focused on engagement in occupations. The

profession’s understanding of the domain and process

of occupational therapy guides practitioners as they

seek to support clients’ participation in daily living,

which results from the dynamic intersection of clients,

their desired engagements, and their contexts

(including environmental and personal factors;

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Christiansen & Baum, 1997; Christiansen et al., 2005;

Law et al., 2005).

“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. These

interrelated concepts include

n Health—“a state of complete physical, mental,

and social well-being, and not merely the

absence of disease or infirmity” (WHO, 2006,

p. 1).

n Well-being—“a general term encompassing the total

universe of human life domains, including physical,

mental, and social aspects, that make up what can be

called a ‘good life’” (WHO, 2006, p. 211).
n Participation—“involvement in a life situation” (WHO,

2008, p. 10). Participation occurs naturally when clients

are actively involved in carrying out occupations or daily

life activities they find purposeful and meaningful. More

specific outcomes of occupational therapy intervention

are multidimensional and support the end result of

participation.
n Engagement in occupation—performance of

occupations as the result of choice, motivation, and

meaning within a supportive context (including

Figure 1. Occupational Therapy Domain and Process

Achieving health,
well-being, and

participation in life
through engagement

in occupation.

PROCESS

DOMAIN
Cl

ie
nt

Fa
ct

or
s

Occupations
Contexts

Perform

ance Skills Perform
ance

Pa
tt

er
n

s

Intervention
Outcom

esEv
al

ua
tio

n

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environmental and personal factors). Engagement

includes objective and subjective aspects of clients’

experiences and involves the transactional interaction

of the mind, body, and spirit. Occupational therapy

intervention focuses on creating or facilitating

opportunities to engage in occupations that lead to

participation in desired life situations (AOTA, 2008).

Although the domain and process are described

separately, in actuality they are linked inextricably in a

transactional relationship. The aspects that constitute

the domain and those that constitute the process exist in

constant interaction with one another during the delivery of

occupational therapy services. Figure 1 represents

aspects of the domain and process and the overarching

goal of the profession as achieving health, well-being, and

participation in life through engagement in occupation.

Although the figure illustrates these two elements in

distinct spaces, in reality the domain and process interact

in complex and dynamic ways as described throughout

this document. The nature of the interactions is

impossible to capture in a static one-dimensional image.

Cornerstones of Occupational Therapy Practice
The transactional relationship between the domain and

process is facilitated by the occupational therapy

practitioner. Occupational therapy practitioners have

distinct knowledge, skills, and qualities that contribute to the

success of the occupational therapy process, described in

this document as “cornerstones.” A cornerstone can be

defined as something of great importance on which

everything else depends (“Cornerstone,” n.d.), and the

following cornerstones of occupational therapy help

distinguish it from other professions:

n Core values and beliefs rooted in occupation (Cohn,

2019; Hinojosa et al., 2017)
n Knowledge of and expertise in the therapeutic use of

occupation (Gillen, 2013; Gillen et al., 2019)
n Professional behaviors and dispositions (AOTA

2015a, 2015c)
n Therapeutic use of self (AOTA, 2015c; Taylor, 2020).

These cornerstones are not hierarchical; instead, each

concept influences the others.

Occupational therapy cornerstones provide a

fundamental foundation for practitioners from which to

view clients and their occupations and facilitate the

occupational therapy process. Practitioners develop the

cornerstones over time through education, mentorship,

and experience. In addition, the cornerstones are ever

evolving, reflecting developments in occupational therapy

practice and occupational science.

Many contributors influence each cornerstone. Like

the cornerstones, the contributors are complementary

and interact to provide a foundation for practitioners.

The contributors include, but are not limited to, the

following:

n Client-centered practice
n Clinical and professional reasoning
n Competencies for practice
n Cultural humility
n Ethics
n Evidence-informed practice
n Inter- and intraprofessional collaborations
n Leadership
n Lifelong learning
n Micro and macro systems knowledge
n Occupation-based practice
n Professionalism
n Professional advocacy
n Self-advocacy
n Self-reflection
n Theory-based practice.

Domain

Exhibit 1 identifies the aspects of the occupational

therapy domain: occupations, contexts, performance

patterns, performance skills, and client factors. All

aspects of the domain have a dynamic interrelatedness.

All aspects are of equal value and together interact to

affect occupational identity, health, well-being, and

participation in life.

Occupational therapists are skilled in evaluating all

aspects of the domain, the interrelationships among the

aspects, and the client within context. Occupational

therapy practitioners recognize the importance and

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impact of the mind–body–spirit connection on

engagement and participation in daily life. Knowledge of

the transactional relationship and the significance of

meaningful and productive occupations forms the basis for

the use of occupations as both the means and the ends

of interventions (Trombly, 1995). This knowledge sets

occupational therapy apart as a distinct and valuable

service (Hildenbrand & Lamb, 2013) for which a focus on

the whole is considered stronger than a focus on isolated

aspects of human functioning.

The discussion that follows provides a brief

explanation of each aspect of the domain. Tables included

at the end of the document provide additional

descriptions and definitions of terms.

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

occupational therapy, 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).

In the OTPF–4, the term occupation denotes

personalized and meaningful engagement in daily life

events by a specific client. Conversely, the term activity

denotes a form of action that is objective and not related

to a specific client’s engagement or context (Schell et al.,

2019) and, therefore, can be selected and designed to

enhance occupational engagement by supporting the

development of performance skills and performance

patterns. Both occupations and activities are used as

interventions by practitioners. For example, a practitioner

may use the activity of chopping vegetables during an

intervention to address fine motor skills with the ultimate

goal of improving motor skills for the occupation of

preparing a favorite meal. Participation in occupations is

considered both the means and the end in the

occupational therapy process.

Occupations occur in contexts and are influenced by

the interplay among performance patterns, performance

skills, and client factors. Occupations occur over time;

have purpose, meaning, and perceived utility to the client;

and can be observed by others (e.g., preparing a meal) or

be known only to the person involved (e.g., learning

through reading a textbook). Occupations can involve the

execution of multiple activities for completion and can

result in various outcomes.

The OTPF–4 identifies a broad range of occupations

categorized as activities of daily living (ADLs), instrumental

activities of daily living (IADLs), health management, rest

and sleep, education, work, play, leisure, and social

participation (Table 2). Within each of these nine broad

categories of occupation aremany specific occupations. For

example, the broad category of IADLs has specific

Exhibit 1. Aspects of the Occupational Therapy Domain
All aspects of the occupational therapy domain transact to support engagement, participation, and health. This exhibit does not imply
a hierarchy.

Occupations Contexts
Performance
Patterns

Performance
Skills Client Factors

Activities of daily living (ADLs)
Instrumental activities of daily

living (IADLs)
Health management
Rest and sleep
Education
Work
Play
Leisure
Social participation

Environmental
factors

Personal factors

Habits
Routines
Roles
Rituals

Motor skills
Process skills
Social interaction skills

Values, beliefs,
and spirituality

Body functions
Body structures

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occupations that include grocery shopping and money

management.

When occupational therapy practitioners work with

clients, they identify the types of occupations clients

engage in individually or with others. Differences among

clients and the occupations they engage in are complex

and multidimensional. The client’s perspective on how an

occupation is categorized varies depending on that

client’s needs, interests, and contexts. Moreover, values

attached to occupations are dependent on cultural and

sociopolitical determinants (Wilcock & Townsend, 2019).

For example, one person may perceive gardening as

leisure, whereas another person, who relies on the food

produced from that garden to feed their family or

community, may perceive it as work. Additional examples

of occupations for persons, groups, and populations can

be found in Table 3.

The ways in which clients prioritize engagement in

selected occupations may vary at different times. For

example, clients in a community psychiatric rehabilitation

setting may prioritize registering to vote during an election

season and food preparation during holidays. The unique

features of occupations are noted and analyzed by

occupational therapy practitioners, who consider all

components of the engagement and use them effectively

as both a therapeutic tool and a way to achieve the

targeted outcomes of intervention.

The extent to which a client is engaged in a particular

occupation is also important. Occupational therapy

practitioners assess the client’s ability to engage in

occupational performance, defined as the

accomplishment of the selected occupation resulting from

the dynamic transaction among the client, their contexts,

and the occupation. Occupations can contribute to a well-

balanced and fully functional lifestyle or to a lifestyle that is

out of balance and characterized by occupational

dysfunction. For example, excessive work without

sufficient regard for other aspects of life, such as sleep or

relationships, places clients at risk for health problems.

External factors, including war, natural disasters, or

extreme poverty, may hinder a client’s ability to create

balance or engage in certain occupations (AOTA, 2017b;

McElroy et al., 2012).

Because occupational performance does not exist in a

vacuum, context must always be considered. For example,

for a client who lives in food desert, lack of access to a

grocery store may limit their ability to have balance in their

performance of IADLs such as cooking and grocery

shopping or to follow medical advice from health care

professionals on health management and preparation of

nutritiousmeals. For this client, the limitation is not caused by

impaired client factors or performance skills but rather is

shaped by the context in which the client functions. This

context may include policies that resulted in the decline of

commercial properties in the area, a socioeconomic status

that does not enable the client to live in an area with access

to a grocery store, and a social environment in which lack of

access to fresh food is weighed as less important than the

social supports the community provides.

Occupational therapy practitioners recognize that

health is supported and maintained when clients are able

to engage in home, school, workplace, and community

life. Thus, practitioners are concerned not only with

occupations but also with the variety of factors that disrupt

or empower those occupations and influence clients’

engagement and participation in positive health-

promoting occupations (Wilcock & Townsend, 2019).

Although engagement in occupations is generally

considered a positive outcome of the occupational therapy

process, it is important to consider that a client’s history

might include negative, traumatic, or unhealthy

occupational participation (Robinson Johnson & Dickie,

2019). For example, a person who has experienced a

traumatic sexual encounter might negatively perceive and

react to engagement in sexual intimacy. A person with an

eating disorder might engage in eating in a maladaptive

way, deterring health management and physical health.

In addition, some occupations that are meaningful to a

client might also hinder performance in other occupations

or negatively affect health. For example, a person who

spends a disproportionate amount of time playing video

games may develop a repetitive stress injury and may

have less balance in their time spent on IADLs and other

forms of social participation. A client engaging in the

recreational use of prescription pain medications may

experience barriers to participation in previously

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important occupations such as work or spending time with

family.

Occupations have the capacity to support or promote

other occupations. For example, children engage in play

to develop the performance skills that later facilitate

engagement in leisure and work. Adults may engage in

social participation and leisure with an intimate partner

that may improve satisfaction with sexual activity. The

goal of engagement in sleep and health management

includes maintaining or improving performance of work,

leisure, social participation, and other occupations.

Occupations are often shared and done with others.

Those that implicitly involve two or more individuals are

termed co-occupations (Zemke & Clark, 1996). Co-

occupations are the most interactive of all social

occupations. Central to the concept of co-occupation is that

two or more individuals share a high level of physicality,

emotionality, and intentionality (Pickens & Pizur-Barnekow,

2009). In addition, co-occupations can be parallel (different

occupations in close proximity to others; e.g., reading while

others listen to music when relaxing at home) and shared

(same occupation but different activities; e.g., preparing

different dishes for a meal; Zemke & Clark, 1996).

Caregiving is a co-occupation that requires active

participation by both the caregiver and the recipient of

care. For the co-occupations required during parenting,

the socially interactive routines of eating, feeding, and

comforting may involve the parent, a partner, the child,

and significant others (Olson, 2004). The specific

occupations inherent in this social interaction are

reciprocal, interactive, and nested (Dunlea, 1996; Esdaile

& Olson, 2004). Consideration of co-occupations by

practitioners supports an integrated view of the client’s

engagement in the context of relationship to significant

others.

Occupational participation can be considered

independent whether it occurs individually or with others. It

is important to acknowledge that clients can be

independent in living regardless of the amount of

assistance they receive while completing occupations.

Clients may be considered independent even when they

direct others (e.g., caregivers) in performing the actions

necessary to participate, regardless of the amount or kind

of assistance required, if clients are satisfied with their

performance. In contrast to definitions of independence

that imply direct physical interaction with the environment

or objects within the environment, occupational therapy

practitioners consider clients to be independent whether

they perform the specific occupations by themselves, in an

adapted or modified environment, with the use of various

devices or alternative strategies, or while overseeing

activity completion by others (AOTA, 2002b). For

example, a person with spinal cord injury who directs a

personal care assistant to assist them with ADLs is

demonstrating independence in this essential aspect of

their life.

It is also important to acknowledge that not all clients

view success as independence. Interdependence, or

co-occupational performance, can also be an indicator

of personal success. How a client views success may

be influenced by their client factors, including their

culture.

Contexts
Context is a broad construct defined as 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 (WHO, 2008). 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.

In the literature, the terms environment and context

often are used interchangeably, but this may result in

confusion when describing aspects of situations in which

occupational engagement takes place. Understanding the

contexts in which occupations can and do occur provides

practitionerswith insights into the overarching, underlying,

and embedded influences of environmental factors and

personal factors on engagement in occupations.

Environmental Factors

Environmental factors are aspects of the physical, social,

and attitudinal surroundings in which people live and

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conduct their lives (Table 4). Environmental factors

influence functioning and disability and have positive

aspects (facilitators) or negative aspects (barriers or

hindrances; WHO, 2008). Environmental factors include

n Natural environment and human-made changes to

the environment: Animate and inanimate elements of

the natural or physical environment and

components of that environment that have been

modified by people, as well as characteristics of

human populations within that environment.

Engagement in human occupation influences the

sustainability of the natural environment, and

changes to human behavior can have a positive

impact on the environment (Dennis et al., 2015).
n Products and technology: Natural or human-made

products or systems of products, equipment, and

technology that are gathered, created, produced, or

manufactured.
n Support and relationships: People or animals that

provide practical physical or emotional support,

nurturing, protection, assistance, and connections to

other persons in the home, workplace, or school or at

play or in other aspects of daily occupations.
n Attitudes: Observable evidence of customs,

practices, ideologies, values, norms, factual beliefs,

and religious beliefs held by people other than the

client.
n Services, systems, and policies: Benefits,

structured programs, and regulations for operations

provided by institutions in various sectors of society

designed to meet the needs of persons, groups, and

populations.

When people interact with the world around them,

environmental factors can either enable or restrict

participation in meaningful occupations and can present

barriers to or supports and resources for service delivery.

Examples of environmental barriers that restrict

participation include the following:

n For persons, doorway widths that do not allow for

wheelchair passage

n For groups, absence of healthy social opportunities

for those abstaining from alcohol use
n For populations, businesses that are not welcoming

to people who identify as LGBTQ+. (Note: In this

document, LGBTQ+ is used to represent the large

and diverse communities and individuals with

nonmajority sexual orientations and gender

identities.)

Addressing these barriers, such as by widening a doorway

to allow access, results in environmental supports that

enable participation. A client who has difficulty performing

effectively in one context may be successful when the

natural environment has human-mademodifications or if the

client uses applicable products and technology. In addition,

occupational therapy practitioners must be aware of norms

related to, for example, eating or deference to medical

professionalswhenworkingwith someone froma culture or

socioeconomic status that differs from their own.

Personal Factors

Personal factors are the unique features of a person that

are not part of a health condition or health state and that

constitute the particular background of the person’s life

and living (Table 5). Personal factors are internal

influences affecting functioning and disability and are not

considered positive or negative but rather reflect the

essence of the person—“who they are.” When clients

provide demographic information, they are typically

describing personal factors. Personal factors also

include customs, beliefs, activity patterns, behavioral

standards, and expectations accepted by the society or

cultural group of which a person is a member.

Personal factors are generally considered to be

enduring, stable attributes of the person, although some

personal factors change over time. They include, but are

not limited to, the following:

n Chronological age
n Sexual orientation (sexual preference, sexual

identity)
n Gender identity
n Race and ethnicity
n Cultural identification and attitudes

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n Social background, social status, and socioeconomic

status
n Upbringing and life experiences
n Habits and past and current behavioral patterns
n Psychological assets, temperament, unique

character traits, and coping styles
n Education
n Profession and professional identity
n Lifestyle
n Health conditions and fitness status (that may affect

the person’s occupations but are not the primary

concern of the occupational therapy encounter).

For example, siblings share personal factors of race

and age, yet for those separated at birth, environmental

differences may result in divergent personal factors in

terms of cultural identification, upbringing, and life

experiences, producing different contexts for their

individual occupational engagement.Whether separated

or raised together, as siblings move through life, they may

develop differences in sexual orientation, life experience,

habits, education, profession, and lifestyle.

Groups and populations are often formed or identified

on the basis of shared or similar personal factors that make

possible occupational therapy assessment and

intervention. Of course, individual members of a group or

population differ in other personal factors. For example, a

group of fifth graders in a community public school are

likely to share age and, perhaps, socioeconomic status.

Yet race, fitness, habits, and coping styles make each

group member unlike the others. Similarly, a population of

older adults living in an urban low-income housing

communitymay have few personal factors in commonother

than age and current socioeconomic status.

Application of Context to Occupational Justice

Interwoven throughout the concept of context is that of

occupational justice, defined as “a justice that

recognizes occupational rights to inclusive participation

in everyday occupations for all persons in society,

regardless of age, ability, gender, social class, or other

differences” (Nilsson & Townsend, 2010, p. 58).

Occupational therapy’s focus on engagement in

occupations and occupational justice complements

WHO’s (2008) perspective on health. To broaden the

understanding of the effects of disease and disability on

health,WHOemphasized that health can be affected by the

inability to carry out occupations and activities and

participate in life situations caused by contextual barriers

and by problems that exist in body structures and body

functions. The OTPF–4 identifies occupational justice as

both an aspect of contexts and an outcome of intervention.

Occupational justice involves the concern that

occupational therapy practitioners have with respect,

fairness, and impartiality and equitable opportunities

when considering the contexts of persons, groups, and

populations (AOTA, 2015a). As part of the occupational

therapy domain, practitioners consider how these

aspects can affect the implementation of occupational

therapy and the target outcome of participation.

Practitioners recognize that for individuals to truly

achieve full participation, meaning, and purpose, they

must not only function but also engage comfortably within

their own distinct combination of contexts (both

environmental factors and personal factors).

Examples of contexts that can present occupational

justice issues include the following:
n An alternative school placement for children with

mental health and behavioral disabilities that

provides academic support and counseling but

limited opportunities for participation in sports,

music programs, and organized social activities
n A residential facility for older adults that offers safety

and medical support but provides little opportunity for

engagement in the role-related occupations that were

once a source of meaning
n A community that lacks accessible and inclusive

physical environments and provides limited services

and supports, making participation difficult or even

dangerous for people who have disabilities (e.g.,

lack of screening facilities and services resulting in

higher rates of breast cancer among community

members)

n A community that lacks financial and other necessary

resources, resulting in an adverse and

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disproportionate impact of natural disasters and

severe weather events on vulnerable populations.

Occupational therapy practitioners recognize areas of

occupational injustice and work to support policies,

actions, and laws that allow people to engage in

occupations that provide purpose and meaning in their

lives. By understanding and addressing the specific

justice issues in contexts such as an individual’s home, a

group’s shared job site, or a population’s community

center, practitioners promote occupational therapy

outcomes that address empowerment and self-

advocacy.

Performance Patterns
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 (Table 6). Performance

patterns help establish lifestyles (Uyeshiro Simon &

Collins, 2017) and occupational balance (e.g., proportion

of time spent in productive, restorative, and leisure

occupations; Eklund et al., 2017; Wagman et al., 2015)

and are shaped, in part, by context (e.g., consistency,

work hours, social calendars) and cultural norms (Eklund

et al., 2017; Larson & Zemke, 2003).

Time provides an organizational structure or rhythm for

performance patterns (Larson & Zemke, 2003); for

example, an adult goes to work every morning, a child

completes homework every day after school, or an

organization hosts a fundraiser every spring. The manner

in which people think about and use time is influenced by

biological rhythms (e.g., sleep–wake cycles), family of

origin (e.g., amount of time a person is socialized to

believe should be spent in productive occupations), work

and social schedules (e.g., religious services held on the

same day each week), and cyclic cultural patterns (e.g.,

birthday celebration with cake every year, annual cultural

festival; Larson & Zemke, 2003). Other temporal factors

influencing performance patterns are timemanagement and

time use. Time management is the manner in which a

person, group, or population organizes, schedules, and

prioritizes certain activities (Uyeshiro Simon&Collins, 2017).

Time use is the manner in which a person manages their

activity levels; adapts to changes in routines; and organizes

their days, weeks, and years (Edgelow & Krupa, 2011).

Habits are specific, automatic adaptive or maladaptive

behaviors. Habits may be healthy or unhealthy (e.g.,

exercising on a daily basis vs. smoking during every

lunch break), efficient or inefficient (e.g., completing

homework after school vs. in the few minutes before the

school bus arrives), and supportive or harmful (e.g.,

setting an alarm clock before going to bed vs. not doing

so; Clark, 2000; Dunn, 2000; Matuska & Barrett, 2019).

Routines are established sequences of occupations or

activities that provide a structure for daily life; they can also

promote or damage health (Fiese, 2007; Koome et al.,

2012; Segal, 2004). Shared routines involve two or more

people and take place in a similar manner regardless of

the individuals involved (e.g., routines shared by parents

to promote the health of their children; routines shared by

coworkers to sort the mail; Primeau, 2000). Shared

routines can be nested in co-occupations. For example,

a young child’s occupation of completing oral hygiene

with the assistance of an adult is a part of the child’s daily

routine, and the adult who provides the assistance may

also view helping the young child with oral hygiene as a

part of the adult’s own daily routine.

Roles have historically been defined as sets of

behaviors expected by society and shaped by culture and

context; they may be further conceptualized and defined

by a person, group, or population (Kielhofner, 2008;

Taylor, 2017). Roles are an aspect of occupational

identity—that is, they help define who a person, group, or

population believes themselves to be on the basis of their

occupational history and desires for the future. Certain

roles are often associated with specific activities and

occupations; for example, the role of parent is associated

with feeding children (Kielhofner, 2008; Taylor, 2017).

When exploring roles, occupational therapy practitioners

consider the complexity of identity and the limitations

associated with assigning stereotypical occupations to

specific roles (e.g., on the basis of gender). Practitioners

also consider how clients construct their occupations and

establish efficient and supportive habits and routines to

achieve health outcomes, fulfill their perceived roles and

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identity, and determine whether their roles reinforce their

values and beliefs.

Rituals are symbolic actions with spiritual, cultural, or

social meaning. Rituals contribute to a client’s identity and

reinforce the client’s values and beliefs (Fiese, 2007; Segal,

2004). Some rituals (e.g., those associated with certain

holidays) are associated with different seasons or times of

the year (e.g., New Year’s Eve, Independence Day),

whereas others are associated with times of the day or days

of the week (e.g., daily prayers, weekly family dinners).

Performance patterns are influenced by all other

aspects of the occupational therapy domain and develop

over time. Occupational therapy practitioners who

consider clients’ past and present behavioral and

performance patterns are better able to understand the

frequency and manner in which performance skills and

healthy and unhealthy occupations are, or have been,

integrated into clients’ lives. Although clients may have the

ability to engage in skilled performance, if they do not

embed essential skills in a productive set of engagement

patterns, their health, well-being, and participation may be

negatively affected. For example, a person may have

skills associated with proficient health literacy but not

embed them into consistent routines (e.g., a dietitian who

consistently chooses to eat fast food rather than prepare

a healthy meal) or struggle with modifying daily

performance patterns to access health systems effectively

(e.g., a nurse who struggles to modify work hours to get a

routine mammogram).

Performance Skills
Performance skills are observable, goal-directed actions

and consist of motor skills, process skills, and social

interaction skills (Fisher & Griswold, 2019; Table 7). The

occupational therapist evaluates and analyzes

performance skills during actual performance to

understand a client’s ability to perform an activity (i.e.,

smaller aspect of the larger occupation) in natural

contexts (Fisher & Marterella, 2019). This evaluation

requires analysis of the quality of the individual actions

(performance skills) during actual performance.

Regardless of the client population, the performance skills

defined in this document are universal and provide the

foundation for understanding performance (Fisher &

Marterella, 2019).

Performance skills can be analyzed for all occupations

with clients of any age and level of ability, regardless of the

setting in which occupational therapy services are

provided (Fisher & Marterella, 2019). Motor and process

skills are seen during performance of an activity that

involves the use of tangible objects, and social

interaction skills are seen in any situation in which a

person is interacting with others:
n Motor skills refer to how effectively a person moves

self or interacts with objects, including positioning the

body, obtaining and holding objects, moving self and

objects, and sustaining performance.
n Process skills refer to how effectively a person

organizes objects, time, and space, including

sustaining performance, applying knowledge,

organizing timing, organizing space and objects, and

adapting performance.
n Social interaction skills refer to how effectively a

person uses both verbal and nonverbal skills to

communicate, including initiating and terminating,

producing, physically supporting, shaping content of,

maintaining flow of, verbally supporting, and adapting

social interaction.

For example, when a client catches a ball, the

practitioner can analyze how effectively they bend and

reach for and then grasp the ball (motor skills). When a

client cooks a meal, the practitioner can analyze how

effectively they initiate and sequence the steps to

complete the recipe in a logical order to prepare the meal

in a timely and well-organized manner (process skills). Or

when a client interacts with a friend at work, the

practitioner can analyze the manner in which the client

smiles, gestures, turns toward the friend, and responds to

questions (social interaction skills). In these examples,

many other motor skills, process skills, and social

interaction skills are also used by the client.

By analyzing the client’s performance within an

occupation at the level of performance skills, the

occupational therapist identifies effective and ineffective

use of skills (Fisher & Marterella, 2019). The result of this

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analysis indicates not only whether the person is able to

complete an activity safely and independently but also

the amount of physical effort and efficiency the client

demonstrates in activities.

After the quality of occupational performance skills has

been analyzed, the practitioner speculates about the

reasons for decreased quality of occupational

performance and determines the need to evaluate

potential underlying causes (e.g., occupational demands,

environmental factors, client factors; Fisher & Griswold,

2019). Performance skills are different from client factors

(see the “Client Factors” section that follows), which

include values, beliefs, and spirituality and body

structures and functions (e.g., memory, strength) that

reside within the person. Occupational therapy

practitioners analyze performance skills as a client

performs an activity, whereas client factors cannot be

directly viewed during the performance of occupations.

For example, the occupational therapy practitioner

cannot directly view the client factors of cognitive ability or

memory when a client is engaged in cooking but rather

notes ineffective use of performance skills when the

person hesitates to start a step or performs steps in an

illogical order. The practitioner may then infer that a

possible reason for the client’s hesitation may be

diminished memory and elect to further assess the client

factor of cognition.

Similarly, context influences the quality of a client’s

occupational performance. After analyzing the client’s

performance skills while completing an activity, the

practitioner can hypothesize how the client factors and

context might have influenced the client’s performance.

Thus, client factors and contexts converge and may

support or limit a person’s quality of occupational

performance.

Application of Performance Skills With Persons

When completing the analysis of occupational

performance (described in the “Evaluation” section later in

this document), the practitioner analyzes the client’s

challenges in performance and generates a hypothesis

about gaps between current performance and effective

performance and the need for occupational therapy

services. To plan appropriate interventions, the

practitioner considers the underlying reasons for the gaps,

which may involve performance skills, performance

patterns, and client factors. The hypothesis is generated

on the basis of what the practitioner analyzes when the

client is actually performing occupations.

Regardless of the client population, the universal

performance skills defined in this section provide the

foundations for understanding performance (Fisher &

Marterella, 2019). The following example crosses many

client populations. The practitioner observes as a client

rushes through the steps of an activity toward completion.

On the basis of what the client does, the practitioner may

interpret this rushing as resulting from a lack of impulse

control. This limitation may be seen in clients living with

anxiety, attention deficit hyperactivity disorder, dementia,

traumatic brain injury, and other clinical conditions. The

behavior of rushing may be captured in motor performance

skills of manipulates, coordinates, or calibrates; in process

performance skills of paces, initiates, continues, or

organizes; or in social interaction performance skills of

takes turn, transitions, times response, or times duration.

Understanding the client’s specific occupational challenges

enables the practitioner to determine the suitable

intervention to address impulsivity to facilitate greater

occupational performance. Clinical interventions then

address the skills required for the client’s specific

occupational demands on the basis of their alignment with

the universal performance skills (Fisher & Marterella, 2019).

Thus, the application of universal performance skills guides

practitioners in developing the intervention plan for specific

clients to address the specific concerns occurring in the

specific practice setting.

Application of Performance Skills With Groups

Analysis of performance skills is always focused on

individuals (Fisher & Marterella, 2019). Thus, when

analyzing performance skills with a group client, the

occupational therapist always focuses on one individual

at a time (Table 8). The therapist may choose to analyze

some or all members of the group engaging in relevant

group occupations over time as the group members

contribute to the collective actions of the group.

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If all members demonstrate effective performance

skills, then the group client may achieve its collective

outcomes. If one or more group members demonstrate

ineffective performance skills, the collective outcomes

may be diminished. Only in cases in which group

members demonstrate ongoing limitations in

performance skills that hinder the collective outcomes of

the group would the practitioner recommend interventions

for individual group members. Interventions would then

be directed at those members demonstrating diminished

performance skills to facilitate their contributions to the

collective group outcomes.

Application of Performance Skills With Populations

Using an occupation-based approach to population

health, occupational therapy addresses the needs of

populations by enhancing occupational performance

and participation for communities of people (see “Service

Delivery” in the “Process” section). Service delivery to

populations focuses on aggregates of people rather than

on intervention for persons or groups; thus, it is not

relevant to analyze performance skills at the person level

in service delivery to populations.

Client Factors
Client factors are specific capacities, characteristics, or

beliefs that reside within the person, group, or population

and influence performance in occupations (Table 9).

Client factors are affected by the presence or absence of

illness, disease, deprivation, and disability, as well as by

life stages and experiences. These factors can affect

performance skills (e.g., a client may have weakness in

the right arm [a client factor], affecting their ability to

manipulate a button [a motor and process skill] to button

a shirt; a child in a classroommay be nearsighted [a client

factor], affecting their ability to copy from a chalkboard [a

motor and process skill]).

In addition, client factors are affected by occupations,

contexts, performance patterns, and performance skills.

For example, a client in a controlled and calm

environment might be able to problem solve to complete an

occupation or activity, but when they are in a louder, more

chaotic environment, their ability to process and plan may

be adversely affected. It is through this interactive

relationship that occupations and interventions to support

occupations can be used to address client factors and vice

versa.

Values, beliefs, and spirituality influence clients’

motivation to engage in occupations and give their life or

existence meaning. Values are principles, standards, or

qualities considered worthwhile by the client who holds

them. A belief is “something that is accepted, considered

to be true, or held as an opinion” (“Belief,” 2020).

Spirituality is “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”

(Billock, 2005, p. 887). It is important to recognize

spirituality “as dynamic and often evolving” (Humbert,

2016, p. 12).

Body functions and body structures refer to the

“physiological function of body systems (including

psychological functions) and anatomical parts of the

body such as organs, limbs, and their components,”

respectively (WHO, 2008, p. 10). Examples of body

functions include sensory, musculoskeletal, mental

(affective, cognitive, perceptual), cardiovascular,

respiratory, and endocrine functions. Examples of body

structures include the heart and blood vessels that

support cardiovascular function. Body structures and

body functions are interrelated, and occupational therapy

practitioners consider them when seeking to promote

clients’ ability to engage in desired occupations.

Occupational therapy practitioners understand that the

presence, absence, or limitation of specific body functions

and body structures does not necessarily determine a

client’s success or difficulty with daily life occupations.

Occupational performance and client factors may benefit

from supports in the physical, social, or attitudinal

contexts that enhance or allow participation. It is through

the process of assessing clients as they engage in

occupations that practitioners are able to determine the

transaction between client factors and performance skills;

to create adaptations, modifications, and remediation; and

to select occupation-based interventions that best

promote enhanced participation.

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Exhibit 2. Operationalizing the Occupational Therapy Process
Ongoing interaction among evaluation, intervention, and outcomes occurs throughout the occupational therapy process.

Evaluation
Occupational Profile
• Identify the following:

◦ Why is the client seeking services, and what are the client’s current concerns relative to engaging in occupations and in daily
life activities?

◦ In what occupations does the client feel successful, and what barriers are affecting their success in desired occupations?
◦ What is the client’s occupational history (i.e., life experiences)?
◦ What are the client’s values and interests?
◦ What aspects of their contexts (environmental and personal factors) does the client see as supporting engagement in desired
occupations, and what aspects are inhibiting engagement?

◦ How are the client’s performance patterns supporting or limiting occupational performance and engagement?
◦ What are the client’s patterns of engagement in occupations, and how have they changed over time?
◦ What client factors does the client see as supporting engagement in desired occupations, and what aspects are inhibiting
engagement (e.g., pain, active symptoms)?

◦ What are the client’s priorities and desired targeted outcomes related to occupational performance, prevention, health and
wellness, quality of life, participation, role competence, well-being, and occupational justice?

Analysis of Occupational Performance
• The analysis of occupational performance involves one or more of the following:

◦ Synthesizing information from the occupational profile to determine specific occupations and contexts that need to be
addressed

◦ Completing an occupational or activity analysis to identify the demands of occupations and activities on the client
◦ Selecting and using specific assessments to measure the quality of the client’s performance or performance deficits while
completing occupations or activities relevant to desired occupations, noting the effectiveness of performance skills and
performance patterns

◦ Selecting and using specific assessments to measure client factors that influence performance skills and performance patterns
◦ Selecting and administering assessments to identify and measure more specifically the client’s contexts and their impact on
occupational performance.

Synthesis of Evaluation Process
• This synthesis may include the following:

◦ Determining the client’s values and priorities for occupational participation
◦ Interpreting the assessment data to identify supports and hindrances to occupational performance
◦ Developing and refining hypotheses about the client’s occupational performance strengths and deficits
◦ Considering existing support systems and contexts and their ability to support the intervention process
◦ Determining desired outcomes of the intervention
◦ Creating goals in collaboration with the client that address the desired outcomes
◦ Selecting outcome measures and determining procedures to measure progress toward the goals of intervention, which may
include repeating assessments used in the evaluation process.

Intervention

Intervention Plan
• Develop the plan, which involves selecting

◦ Objective and measurable occupation-based goals and related time frames;
◦ Occupational therapy intervention approach or approaches, such as create or promote, establish or restore, maintain, modify,
or prevent; and

◦ Methods for service delivery, including what types of intervention will be provided, who will provide the interventions, and
which service delivery approaches will be used.

• Consider potential discharge needs and plans.
• Make recommendations or referrals to other professionals as needed.

(Continued)

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Client factors can also be understood as pertaining to

group and population clients and may be used to help

define the group or population. Although client factors

may be described differently when applied to a group or

population, the underlying principles do not change

substantively. Client factors of a group or population are

explored by performing needs assessments, and

interventions might include program development and

strategic planning to help the members engage in

occupations.

Process

This section operationalizes the process undertaken by

occupational therapy practitioners when providing

services to clients. Exhibit 2 summarizes the aspects of

the occupational therapy process.

The occupational therapy process is the client-

centered delivery of occupational therapy services. The

three-part process includes (1) evaluation and (2)

intervention to achieve (3) targeted outcomes and occurs

within the purview of the occupational therapy domain

(Table 10). The process is facilitated by the distinct

perspective of occupational therapy practitioners

engaging in professional reasoning, analyzing

occupations and activities, and collaborating with clients.

The cornerstones of occupational therapy practice

underpin the process of service delivery.

Overview of the Occupational Therapy Process
Many professions use a similar process of evaluating,

intervening, and targeting outcomes. However, only

occupational therapy practitioners focus on the

therapeutic use of occupations to promote health, well-

Exhibit 2. Operationalizing the Occupational Therapy Process (cont’d)

Intervention Implementation
• Select and carry out the intervention or interventions, which may include the following:

◦ Therapeutic use of occupations and activities
◦ Interventions to support occupations
◦ Education
◦ Training
◦ Advocacy
◦ Self-advocacy
◦ Group intervention
◦ Virtual interventions.

• Monitor the client’s response through ongoing evaluation and reevaluation.

Intervention Review
• Reevaluate the plan and how it is implemented relative to achieving outcomes.
• Modify the plan as needed.
• Determine the need for continuation or discontinuation of services and for referral to other services.

Outcomes

Outcomes
• Select outcome measures early in the occupational therapy process (see the “Evaluation” section of this table) on the basis of their

properties:
◦ Valid, reliable, and appropriately sensitive to change in clients’ occupational performance
◦ Consistent with targeted outcomes
◦ Congruent with the client’s goals
◦ Able to predict future outcomes.

• Use outcome measures to measure progress and adjust goals and interventions by
◦ Comparing progress toward goal achievement with outcomes throughout the intervention process and
◦ Assessing outcome use and results to make decisions about the future direction of intervention (e.g., continue, modify,
transition, discontinue, provide follow-up, refer for other service).

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being, and participation in life. Practitioners use

professional reasoning to select occupations as primary

methods of intervention throughout the process. To help

clients achieve desired outcomes, practitioners facilitate

interactions among the clients, their contexts, and the

occupations in which they engage. This perspective is

based on the theories, knowledge, and skills generated

and used by the profession and informed by available

evidence.

Analyzing occupational performance requires an

understanding of the complex and dynamic interaction

among the demands of the occupation and the client’s

contexts, performance patterns, performance skills,

and client factors. Occupational therapy practitioners

fully consider each aspect of the domain and gauge the

influence of each on the others, individually and

collectively. By understanding how these aspects

influence one another, practitioners can better

evaluate how each aspect contributes to clients’

participation and performance-related concerns and

potentially to interventions that support occupational

performance and participation.

The occupational therapy process is fluid and

dynamic, allowing practitioners and clients to maintain

their focus on the identified outcomes while continually

reflecting on and changing the overall plan to

accommodate new developments and insights along the

way, including information gained from inter- and

intraprofessional collaborations. The process may be

influenced by the context of service delivery (e.g., setting,

payer requirements); however, the primary focus is

always on occupation.

Service Delivery Approaches

Various service delivery approaches are used when

providing skilled occupational therapy services, of

which intra- and interprofessional collaborations are a

key component. It is imperative to communicate with all

relevant providers and stakeholders to ensure a

collaborative approach to the occupational therapy

process. These providers and stakeholders can be

within the profession (e.g., occupational therapist and

occupational therapy assistant collaborating to work

with a student in a school, a group of practitioners

collaborating to develop community-based mental

health programming in their region) or outside the

profession (e.g., a team of rehabilitation and medical

professionals on an inpatient hospital unit; a group of

employees, human resources staff, and health and

safety professionals in a large organization working

with an occupational therapy practitioner on workplace

wellness initiatives).

Regardless of the service delivery approach, the

individual client may not be the exclusive focus of the

occupational therapy process. For example, the needs of

an at-risk infant may be the initial impetus for intervention,

but the concerns and priorities of the parents, extended

family, and funding agencies are also considered.

Occupational therapy practitioners understand and focus

intervention to include the issues and concerns

surrounding the complex dynamics among the client,

caregiver, family, and community. Similarly, services

addressing independent living skills for adults coping

with serious mental illness or chronic health conditions

may also address the needs and expectations of

state and local service agencies and of potential

employers.
Direct Services. Services are provided directly to

clients using a collaborative approach in settings such as

hospitals, clinics, industry, schools, homes, and

communities. Direct services include interventions

completed when in direct contact with the client through

various mechanisms such as meeting in person, leading a

group session, and interacting with clients and families

through telehealth systems (AOTA, 2018c).

Examples of person-level direct service delivery

include working with an adult on an inpatient rehabilitation

unit, working with a child in the classroom while

collaborating with the teacher to address identified goals,

and working with an adolescent in an outpatient setting.

Direct group interventions include working with a cooking

group in a skilled nursing facility, working with an

outpatient feeding group, and working with a handwriting

group in a school. Examples of population-level direct

services include implementing a large-scale healthy

lifestyle or safe driver initiative in the community and

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delivering a training program for brain injury treatment

facilities regarding safely accessing public transportation.

An occupational therapy approach to population health

focuses on aggregates or communities of people and the

many factors that influence their health and well-being:

“Occupational therapy practitioners develop and

implement occupation-based health approaches to

enhance occupational performance and participation,

[quality of life], and occupational justice for populations”

(AOTA, 2020b, p. 3).
Indirect Services. When providing services to clients

indirectly on their behalf, occupational therapy

practitioners provide consultation to entities such as

teachers, multidisciplinary teams, and community

planning agencies. For example, a practitioner may

consult with a group of elementary school teachers and

administrators about opportunities for play during

recess to promote health and well-being. A practitioner

may also provide consultation on inclusive design to a

park district or civic organization to address how the

built and natural environments can support occupa-

tional performance and engagement. In addition, a

practitioner may consult with a business regarding the

work environment, ergonomic modifications, and

compliance with the Americans With Disabilities Act of

1990 (Pub. L. 101-336).

Occupational therapy practitioners can advocate

indirectly on behalf of their clients at the person, group,

and population levels to ensure their occupational

needs are met. For example, an occupational therapy

practitioner may advocate for funding to support the

costs of training a service animal for an individual

client. A practitioner working with a group client may

advocate for meeting space in the community for a peer

support group of transgender youth. Examples of

population-level advocacy include talking with

legislators about improving transportation for older

adults, developing services for people with disabilities

to support their living and working in the community of

their choice, establishing meaningful civic engagement

opportunities for underserved youth, and assisting in

the development of policies that address inequities in

access to health care.

Additional Approaches. Occupational therapy

practitioners use additional approaches that may also be

classified as direct or indirect for persons, groups, and

populations. Examples include, but are not limited to,

case management (AOTA, 2018b), telehealth (AOTA,

2018c), episodic care (Centers for Medicare & Medicaid

Services, 2019), and family-centered care approaches

(Hanna & Rodger, 2002).

Practice Within Organizations and Systems

Organization- or systems-level practice is a valid and

important part of occupational therapy for several reasons.

First, organizations serve as amechanism through which

occupational therapy practitioners provide interventions

to support participation of people who are members of or

served by the organization (e.g., falls prevention

programming in a skilled nursing facility, ergonomic

changes to an assembly line to reduce musculoskeletal

disorders). Second, organizations support occupational

therapy practice and practitioners as stakeholders in

carrying out the mission of the organization. Practitioners

have the responsibility to ensure that services provided

to organizational stakeholders (e.g., third-party payers,

employers) are of high quality and delivered in an ethical,

efficient, and efficacious manner.

Finally, organizations employ occupational therapy

practitioners in roles in which they use their knowledge of

occupation and the profession of occupational therapy

indirectly. For example, practitioners can serve in

positions such as dean, administrator, and corporate

leader (e.g., CEO, business owner). In these positions,

practitioners support and enhance the organization but

do not provide occupational therapy services in the

traditional sense. Occupational therapy practitioners can

also serve organizations in roles such as client advocate,

program coordinator, transition manager, service or care

coordinator, health and wellness coach, and community

integration specialist.

Occupational and Activity Analysis

Occupational therapy practitioners are skilled in the

analysis of occupations and activities and apply this

important skill throughout the occupational therapy

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process. Occupational analysis is performed with an

understanding of “the specific situation of the client and

therefore . . . the specific occupations the client wants or

needs to do in the actual context in which these

occupations are performed” (Schell et al., 2019, p. 322). In

contrast, activity analysis is generic and

decontextualized in its purpose and serves to develop an

understanding of typical activity demands within a given

culture. Many professions use activity analysis, whereas

occupational analysis requires the understanding of

occupation as distinct from activity and brings an

occupational therapy perspective to the analysis process

(Schell et al., 2019).

Occupational therapy practitioners analyze the

demands of an occupation or activity to understand the

performance patterns, performance skills, and client

factors that are required to perform it (Table 11).

Depending on the purpose of the analysis, the meaning

ascribed to and the contexts for performance of and

engagement in the occupation or activity are considered

either from a client-specific subjective perspective

(occupational analysis) or a general perspective within a

given culture (activity analysis).

Therapeutic Use of Self

An integral part of the occupational therapy process is

therapeutic use of self, in which occupational therapy

practitioners develop and manage their therapeutic

relationship with clients by using professional

reasoning, empathy, and a client-centered, collaborative

approach to service delivery (Taylor & Van

Puymbrouck, 2013). Occupational therapy practitioners

use professional reasoning to help clients make sense of

the information they are receiving in the intervention

process, discover meaning, and build hope (Taylor,

2019; Taylor & Van Puymbrouck, 2013). Empathy is the

emotional exchange between occupational therapy

practitioners and clients that allows more open

communication, ensuring that practitioners connect with

clients at an emotional level to assist them with their

current life situation.

Practitioners develop a collaborative relationship with

clients to understand their experiences and desires for

intervention. The collaborative approach used

throughout the process honors the contributions of

clients along with practitioners. Through the use of

interpersonal communication skills, practitioners shift

the power of the relationship to allow clients more

control in decision making and problem solving, which is

essential to effective intervention. Clients have

identified the therapeutic relationship as critical to the

outcome of occupational therapy intervention (Cole &

McLean, 2003).

Clients bring to the occupational therapy process

their knowledge about their life experiences and their

hopes and dreams for the future. They identify and

share their needs and priorities. Occupational therapy

practitioners must create an inclusive, supportive

environment to enable clients to feel safe in expressing

themselves authentically. To build an inclusive

environment, practitioners can take actions such as

pursuing education on gender-affirming care,

acknowledging systemic issues affecting

underrepresented groups, and using a lens of cultural

humility throughout the occupational therapy process

(AOTA, 2020c; Hammell, 2013).

Occupational therapy practitioners bring to the

therapeutic relationship their knowledge about how

engagement in occupation affects health, well-being,

and participation; they use this information, coupled

with theoretical perspectives and professional

reasoning, to critically evaluate, analyze, describe,

and interpret human performance. Practitioners and

clients, together with caregivers, family members,

community members, and other stakeholders (as

appropriate), identify and prioritize the focus of the

intervention plan.

Clinical and Professional Reasoning

Throughout the occupational therapy process,

practitioners are continually engaged in clinical and

professional reasoning about a client’s occupational

performance. The term professional reasoning is used

throughout this document as a broad term to encompass

reasoning that occurs in all settings (Schell, 2019).

Professional reasoning enables practitioners to

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n Identify the multiple demands, required skills, and

potential meanings of the activities and occupations

and
n Gain a deeper understanding of the interrelationships

among aspects of the domain that affect performance

and that support client-centered interventions and

outcomes.

Occupational therapy practitioners use theoretical

principles and models, knowledge about the effects of

conditions on participation, and available evidence on

the effectiveness of interventions to guide their reasoning.

Professional reasoning ensures the accurate selection

and application of client-centered evaluation methods,

interventions, and outcome measures. Practitioners also

apply their knowledge and skills to enhance clients’

participation in occupations and promote their health and

well-being regardless of the effects of disease, disability,

and occupational disruption or deprivation.

Evaluation
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. Evaluation

occurs during the initial and all subsequent interactions

with a client. The type and focus of the evaluation differ

depending on the practice setting; however, all evaluations

should assess the complex and multifaceted needs of each

client.

The evaluation consists of the occupational profile and

the analysis of occupational performance, which are

synthesized to inform the intervention plan (Hinojosa

et al., 2014). Although it is the responsibility of the

occupational therapist to initiate the evaluation process,

both occupational therapists and occupational therapy

assistants may contribute to the evaluation, following

which the occupational therapist completes the analysis

and synthesis of information for the development of the

intervention plan (AOTA, 2020a). The occupational

profile includes information about the client’s needs,

problems, and concerns about performance in

occupations. The analysis of occupational performance

focuses on collecting and interpreting information

specifically to identify supports and barriers related to

occupational performance and establish targeted

outcomes.

Although theOTPF–4 describes the components of the

evaluation process separately and sequentially, the exact

manner in which occupational therapy practitioners

collect client information is influenced by client needs,

practice settings, and frames of reference or practice

models. The evaluation process for groups and

populations mirrors that for individual clients.

In some settings, the occupational therapist first

completes a screening or consultation to determine the

appropriateness of a full occupational therapy evaluation

(Hinojosa et al., 2014). This process may include

n Review of client history (e.g., medical, health, social,

or academic records),
n Consultation with an interprofessional or referring

team, and
n Use of standardized or structured screening

instruments.

The screening or consultation process may result in

the development of a brief occupational profile and

recommendations for full occupational therapy

evaluation and intervention (Hinojosa et al., 2014).

Occupational Profile

The occupational profile is a summary of a client’s

(person’s, group’s, or population’s) occupational history

and experiences, patterns of daily living, interests,

values, needs, and relevant contexts (AOTA, 2017a).

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 andmeaningful 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

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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 givemeaning 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. Over time,

practitioners collect additional information, refine the

profile, and ensure that the additional information is

reflected in changes subsequently made to targeted

outcomes. The process of completing and refining the

occupational profile varies by setting and client and may

occur continuously throughout the occupational therapy

process.

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.

Techniques used should be appropriate and reflective of

clients’ preferred method and style of communication

(e.g., use of a communication board, translation

services). Practitioners may use AOTA’s Occupational

Profile Template as a guide to completing the

occupational profile (AOTA, 2017a). The information

obtained through the occupational profile contributes to an

individualized approach in the evaluation, intervention

planning, and intervention implementation stages.

Information is collected in the following areas:

n Why is the client seeking services, and what are the

client’s current concerns relative to engaging in

occupations and in daily life activities?

n In what occupations does the client feel successful,

and what barriers are affecting their success in

desired occupations?
n What is the client’s occupational history (i.e., life

experiences)?
n What are the client’s values and interests?
n What aspects of their contexts (environmental and

personal factors) does the client see as supporting

engagement in desired occupations, and what

aspects are inhibiting engagement?
n How are the client’s performance patterns supporting

or limiting occupational performance and

engagement?
n What are the client’s patterns of engagement in

occupations, and how have they changed over time?
n What client factors does the client see as supporting

engagement in desired occupations, andwhat aspects

are inhibiting engagement (e.g., pain, active

symptoms)?
n What are the client’s priorities and desired targeted

outcomes related to occupational performance,

prevention, health and wellness, quality of life,

participation, role competence, well-being, and

occupational justice?

After the practitioner collects profile data, the

occupational therapist views the information and develops

a working hypothesis regarding possible reasons for the

identified problems and concerns. Reasons could include

impairments in performance skills, performance patterns,

or client factors or barriers within relevant contexts. In

addition, the therapist notes the client’s strengths and

supports in all areas because these can inform the

intervention plan and affect targeted outcomes.

Analysis of Occupational Performance

Occupational performance is the accomplishment of the

selected occupation resulting from the dynamic transaction

among the client, their contexts, and the occupation. In the

analysis of occupational performance, the practitioner

identifies the client’s ability to effectively complete desired

occupations. The client’s assets and limitations or potential

problems are more specifically determined through

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assessment tools designed to analyze, measure, and inquire

about factors that support or hinder occupational

performance.

Multiple methods often are used during the evaluation

process to assess the client, contexts, occupations, and

occupational performance. Methods may include

observation and analysis of the client’s performance of

specific occupations and assessment of specific aspects

of the client or their performance. The approach to the

analysis of occupational performance is determined by

the information gathered through the occupational profile

and influenced by models of practice and frames of

reference appropriate to the client and setting. The

analysis of occupational performance involves one or

more of the following:

n Synthesizing information from the occupational

profile to determine specific occupations and

contexts that need to be addressed
n Completing an occupational or activity analysis to

identify the demands of occupations and activities on

the client
n Selecting and using specific assessments to

measure the quality of the client’s performance or

performance deficits while completing occupations or

activities relevant to desired occupations, noting the

effectiveness of performance skills and performance

patterns
n Selecting and using specific assessments to

measure client factors that influence performance

skills and performance patterns
n Selecting and administering assessments to identify
and measure more specifically the client’s contexts

and their impact on occupational performance.

Occupational performance may be measured through

standardized, formal, and structured assessment tools, and

when necessary informal approaches may also be used

(Asher, 2014). Standardized assessments are preferred,

when available, to provide objective data about various

aspects of the domain influencing engagement and

performance. The use of valid and reliable assessments

for obtaining trustworthy information can also help support

and justify the need for occupational therapy services

(Doucet & Gutman, 2013; Hinojosa & Kramer, 2014). In

addition, the use of standardized outcome performance

measures and outcome tools assists in establishing a

baseline of occupational performance to allow for objective

measurement of progress after intervention.

Synthesis of the Evaluation Process

The occupational therapist synthesizes the information

gathered through the occupational profile and analysis of

occupational performance. This process may include the

following:

n Determining the client’s values and priorities for

occupational participation
n Interpreting the assessment data to identify supports

and hindrances to occupational performance
n Developing and refining hypotheses about the

client’s occupational performance strengths and

deficits
n Considering existing support systems and contexts

and their ability to support the intervention process
n Determining desired outcomes of the intervention
n Creating goals in collaboration with the client that

address the desired outcomes
n Selecting outcome measures and determining

procedures to measure progress toward the goals of

intervention, which may include repeating

assessments used in the evaluation process.

Any outcome assessment used by occupational

therapy practitioners must be consistent with clients’

belief systems and underlying assumptions regarding

their desired occupational performance. Occupational

therapy practitioners select outcome assessments

pertinent to clients’ needs and goals, congruent with

the practitioner’s theoretical model of practice.

Assessment selection is also based on the practitioner’s

knowledge of and available evidence for the

psychometric properties of standardized measures or the

rationale and protocols for nonstandardized structured

measures. In addition, clients’ perception of success in

engaging in desired occupations is a vital part of outcome

assessment (Bandura, 1986). The occupational therapist

uses the synthesis and summary of information from the

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evaluation and established targeted outcomes to guide the

intervention process.

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

consistent with the various service delivery models.

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 well-

being; identifying and realizing aspirations; satisfying

needs; and changing or coping with contextual factors.

Types of occupational therapy interventions are

categorized as occupations and activities, interventions to

support occupations, education and training, advocacy,

group interventions, and virtual interventions (Table 12).

Approaches to intervention include create or promote,

establish or restore, maintain, modify, and prevent

(Table 13). Across all types of and approaches to

interventions, it is imperative that occupational therapy

practitioners maintain an understanding of the

Occupational Therapy Code of Ethics (AOTA, 2015a)

and the Standards of Practice for Occupational Therapy

(AOTA, 2015c).

Intervention is intended to promote health, well-being,

and participation. Health promotion is “the process of

enabling people to increase control over, and to improve,

their health” (WHO, 1986). Wilcock (2006) stated,

Following an occupation-based health promotion approach to well-being
embraces a belief that the potential range of what people can do, be, and
strive to become is the primary concern, and that health is a by-product.
A varied and full occupational lifestyle will coincidentally maintain and
improve health and well-being if it enables people to be creative and
adventurous physically, mentally, and socially. (p. 315)

Interventions vary depending on the client—person,

group, or population—and the context of service delivery.

The actual term used for clients or groups of clients

receiving occupational therapy varies among practice

settings and delivery models. For example, when

working in a hospital, the person or group might be

referred to as a patient or patients, and in a school, the

clients might be students. Early intervention requires

practitioners to work with the family system as their

clients. When practitioners provide consultation to an

organization, clients may be called consumers or

members. Terms used for others who may help or be

served indirectly include, but are not limited to,

caregiver, teacher, parent, employer, or spouse.

Intervention can also be in the form of collective

services to groups and populations. Such intervention

can occur as direct service provision or consultation.

When consulting with an organization, occupational

therapy practitioners may use strategic planning, change

agent plans, and other program development

approaches. Practitioners addressing the needs of a

population direct their interventions toward current or

potential diseases or conditions with the goal of

enhancing the health, well-being, and participation of all

members collectively. With groups and populations, the

intervention focus is often on health promotion,

prevention, and screening. Interventions may include

(but are not limited to) self-management training,

educational services, and environmental modification. For

instance, occupational therapy practitioners may provide

education on falls prevention and the impact of fear of

falling to residents in an assisted living center or training to

people facing a mental health challenge in use of the

internet to identify and coordinate community resources

that meet their needs.

Occupational therapy practitioners work with a

wide variety of populations experiencing difficulty in

accessing and engaging in healthy occupations because

of factors such as poverty, homelessness, displacement,

and discrimination. For example, practitioners can

work with organizations providing services to

refugees and asylum seekers to identify opportunities to

reestablish occupational roles and enhance well-being and

quality of life.

The intervention process is divided into three

components: (1) intervention plan, (2) intervention

implementation, and (3) intervention review. During the

intervention process, the occupational therapy practitioner

integrates information from the evaluation with theory,

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practice models, frames of reference, and research

evidence on interventions, including those that support

occupations. This information guides the practitioner’s

professional reasoning in intervention planning,

implementation, and review. Because evaluation is

ongoing, revision may occur at any point during the

intervention process.

Intervention Plan

The intervention plan, which directs the actions of

occupational therapy practitioners, describes the

occupational therapy approaches and types of

interventions selected for use in reaching clients’ targeted

outcomes. The intervention plan is developed

collaboratively with clients or their proxies and is directed

by

n Client goals, values, beliefs, and occupational needs

and
n Client health and well-being,

as well as by the practitioners’ evaluation of

n Client occupational performance needs;
n Collective influence of the contexts, occupational or

activity demands, and client factors on the client;
n Client performance skills and performance

patterns;
n Context of service delivery in which the intervention is

provided; and
n Best available evidence.

The occupational therapist designs the intervention

plan on the basis of established treatment goals,

addressing the client’s current and potential situation

related to engagement in occupations or activities. The

intervention plan should reflect the priorities of the client,

information on occupational performance gathered

through the evaluation process, and targeted outcomes

of the intervention. Intervention planning includes the

following steps:

1. Developing the plan, which involves selecting

+ Objective and measurable occupation-based goals

and related time frames;

+ Occupational therapy intervention approach or

approaches; and

+ Methods for service delivery, including what types of

interventions will be provided, who will provide the

interventions, and which service delivery

approaches will be used;

2. Considering potential discharge needs and plans; and

3. Making recommendations or referrals to other

professionals as needed.

Steps 2 and 3 are discussed in the Outcomes section.

Intervention Implementation

Intervention implementation is the process of putting

the intervention plan into action and occurs after the

initial evaluation process and development of the

intervention plan. Interventions may focus on a single

aspect of the occupational therapy domain, such as a

specific occupation, or on several aspects of the

domain, such as contexts, performance patterns, and

performance skills, as components of one or more

occupations. Intervention implementation must always

reflect the occupational therapy scope of practice;

occupational practitioners should not perform

interventions that do not use purposeful and

occupation-based approaches (Gillen et al., 2019).

Intervention implementation includes the following

steps (see Table 12):

n Select and carry out the intervention or

interventions, which may include the following:

+ Therapeutic use of occupations and activities

+ Interventions to support occupations

+ Education

+ Training

+ Advocacy

+ Self-advocacy

+ Group intervention

+ Virtual interventions.
n Monitor the client’s response through ongoing

evaluation and reevaluation.

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Given that aspects of the domain are interrelated and

influence one another in a continuous, dynamic process,

occupational therapy practitioners expect that a client’s

ability to adapt, change, and develop in one area will

affect other areas. Because of this dynamic

interrelationship, evaluation, including analysis of

occupational performance, and intervention planning

continue throughout the implementation process. In

addition, intervention implementation includes

monitoring of the client’s response to specific

interventions and progress toward goals.

Intervention Review

Intervention review is the continuous process of

reevaluating and reviewing the intervention plan, the

effectiveness of its delivery, and progress toward

outcomes. As during intervention planning, this

process includes collaboration with the client to identify

progress toward goals and outcomes. Reevaluation

and review may lead to change in the intervention plan.

Practitioners should review best practices for using process

indicators and, as appropriate, modify the intervention plan

and monitor progress using outcome performance

measures and outcome tools. Intervention review includes

the following steps:

1. Reevaluating the plan and how it is implemented

relative to achieving outcomes

2. Modifying the plan as needed

3. Determining the need for continuation or

discontinuation of occupational therapy services and

for referral to other services.

Outcomes
Outcomes emerge from the occupational therapy

process and describe the results clients can achieve

through occupational therapy intervention (Table 14).

The outcomes of occupational therapy are

multifaceted and may occur in all aspects of the domain

of concern. 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.

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 targeted in occupational therapy can be

summarized as

n Occupational performance,
n Prevention,
n Health and wellness,
n Quality of life,
n Participation,
n Role competence,
n Well-being, and
n Occupational justice.

Occupational adaptation, or the client’s effective and

efficient response to occupational and contextual

demands (Grajo, 2019), is interwoven through all of

these outcomes.

The impact of outcomes and the way they are defined

are specific to clients (persons, groups, or populations)

and to other stakeholders such as payers and regulators.

Outcomes and their documentation vary by practice

setting and are influenced by the stakeholders in each

setting (AOTA, 2018a).

The focus on outcomes is woven throughout the

process of occupational therapy. During evaluation,

occupational therapy practitioners and clients (and often

others, such as parents and caregivers) collaborate to

identify targeted outcomes related to engagement in valued

occupations or daily life activities. These outcomes are the

basis for development of the intervention plan. During

intervention implementation and review, clients and

practitioners may modify targeted outcomes to

accommodate changing needs, contexts, and

performance abilities. Ultimately, the intervention process

should result in the achievement of outcomes related to

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health, well-being, and participation in life through

engagement in occupation.

Outcome Measurement

Objective outcomes are measurable and tangible

aspects of improved performance. Outcome

measurement is sometimes derived from standardized

assessments, with results reflected in numerical data

following specific scoring instructions. These data quantify

a client’s response to intervention in a way that can be

used by all relevant stakeholders. Objective outcome

measures are selected early in the occupational therapy

process on the basis of properties showing that they are

n Valid, reliable, and appropriately sensitive to change

in the client’s occupational performance,
n Consistent with targeted outcomes,
n Congruent with the client’s goals, and
n Able to predict future outcomes.

Practitioners use objective outcome measures to

measure progress and adjust goals and interventions by

n Comparing progress toward goal achievement with

outcomes throughout the intervention process and
n Measuring and assessing results to make decisions

about the future direction of intervention (e.g.,

continue, modify, transition, discontinue, provide

follow-up, refer for other service).

In some settings, the focus is on patient-reported

outcomes (PROs), which have been defined as “any

report of the status of a patient’s health condition that

comes directly from the patient, without interpretation of

the patient’s response by a clinician or anyone else”

(National Quality Forum, n.d., para. 1). PROs can be

used as subjective measures of improved outlook,

confidence, hope, playfulness, self-efficacy, sustainability

of valued occupations, pain reduction, resilience, and

perceived well-being. An example of a PRO is parents’

greater perceived efficacy in parenting through a new

understanding of their child’s behavior (Cohn, 2001;

Cohn et al., 2000; Graham et al., 2013). Another example

is a report by an outpatient client with a hand injury of a

reduction in pain during the IADL of doing laundry. “PRO

tools measure what patients are able to do and how they

feel by asking questions. These tools enable assessment

of patient-reported health status for physical, mental, and

social well-being” (National Quality Forum, n.d., para. 1).

Outcomes can also be designed for caregivers—for

example, improved quality of life for both care recipient

and caregiver. Studies of caregivers of people with

dementia who received a home environmental

intervention found fewer declines in occupational

performance, enhanced mastery and skill, improved

sense of self-efficacy and well-being, and less need for

help with care recipients (Gitlin & Corcoran, 2005; Gitlin

et al., 2001, 2003, 2008; Graff et al., 2007; Piersol et al.,

2017).

Outcomes for groups that receive an educational

intervention may include improved social interaction,

increased self-awareness through peer support, a larger

social network, or improved employee health and

productivity. For example, education interventions for

groups of employees on safety and workplace wellness

have been shown to decrease work injuries and increase

workplace productivity and satisfaction (Snodgrass &Amini,

2017).

Outcomes for populations may address health

promotion, occupational justice and self-advocacy, health

literacy, community integration, community living, and

access to services. As with other occupational therapy

clients, outcomes for populations are focused on

occupational performance, engagement, and participation.

For example, outcomes at the population level as a result of

advocacy interventions include construction of accessible

playground facilities, improved accessibility for polling

places, and reconstruction of a school after a natural

disaster.

Transition and Discontinuation

Transition is movement from one life role or experience to

another. Transitions in services, like all life transitions,

may require preparation, new knowledge, and time to

accommodate to the new situation (Orentlicher et al.,

2015). Transition planning may be needed, for example,

when a client moves from one setting to another along

the care continuum (e.g., acute hospital to skilled nursing

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facility) or ages out of one program and into a new one

(e.g., early intervention to elementary school).

Collaboration among practitioners is necessary to ensure

safety, well-being, and optimal outcomes for clients (Joint

Commission, 2012, 2013).

Transition planning may include a referral to a provider

within occupational therapy with advanced knowledge

and skill (e.g., vestibular rehabilitation, driver evaluation,

hand therapy) or outside the profession (e.g.,

psychologist, optometrist). Transition planning for groups

and populations may be needed for a transition from one

stage to another (e.g., middle school students in a life

skills program who transition to high school) or from one

set of needs to another (e.g., older adults in a community

falls prevention program who transition to a community

exercise program).

Planning for discontinuation of occupational

therapy services begins at initial evaluation.

Discontinuation of care occurs when the client ends

services after meeting short- and long-term goals or

chooses to discontinue receiving services (consistent

with client-centered care). Safe and effective

discharge planning for a person may include

education on the use of new equipment, adaptation of

an occupation, caregiver training, environmental

modification, or determination of the appropriate

setting for transition of care. A key goal of discharge

planning for individual clients is prevention of

readmission (Rogers et al., 2017). Discontinuation of

services for groups and populations occurs when goals

are met and sustainability plans are implemented for

long-term success.

Conclusion

The OTPF–4 describes the central concepts that ground

occupational therapy practice and builds a common

understanding of the basic tenets and distinct

contribution of the profession. The occupational therapy

domain and process are linked inextricably in a

transactional relationship. An understanding of this

relationship supports and guides the complex decision

making required in the daily practice of occupational

therapy and enhances practitioners’ ability to

define the reasons for and justify the provision of

services when communicating with clients, family

members, team members, employers, payers, and

policymakers.

This edition of the OTPF provides a broader view than

previous editions of occupational therapy as related to

groups and populations and current and future

occupational needs of clients. It also presents and

describes the cornerstones of occupational therapy practice,

which are discrete and critical qualities of occupational

therapy practitioners that provide them with a foundation for

success in the occupational therapy process. The OTPF–4

highlights the distinct value of occupation and occupational

therapy in contributing to health, well-being, and participation

in life for persons, groups, and populations. This document

can be used to advocate for the importance of occupational

therapy in meeting society’s current and future needs,

ultimately advancing the profession to ensure a sustainable

future.

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Table 1. Examples of Clients: Persons, Groups, and Populations

Person Group Population

Health Management

Middle-school student with diabetes in-
terested in developing self-management
skills to test blood sugar levels

Group of students with diabetes interested
in problem solving the school setting’s
support for management of their condition

All students in the school provided with
access to food choices to meet varying
dietary needs and desires

Feeding

Family of an infant with a history of pre-
maturity and difficulty accepting nutrition
orally

Families with infants experiencing feeding
challenges advocating for the local hos-
pital’s rehabilitation services to develop
infant feeding classes

Families of infants advocating for re-
search and development of alternative
nipple and bottle designs to address
feeding challenges

Community Mobility

Person with stroke who wants to return to
driving

Stroke support group talking with elected
leaders about developing community
mobility resources

Stroke survivors advocating for increased
access to community mobility options for
all persons living with mobility limitations

Social Participation

Young adult with IDD interested in in-
creasing social participation

Young adults with IDD in a transition
program sponsoring leisure activities in
which all may participate in valued social
relationships

Young adults with IDD educating their
community about their need for inclusion
in community-based social and leisure
activities

Home Establishment and Management

Person living with SMI interested in de-
veloping skills for independent living

Support group for people living with SMI
developing resources to foster indepen-
dent living

People living with SMI in the same region
advocating for increased housing options
for independent living

Work Participation

Older worker with difficulty performing
some work tasks

Group of older workers in a factory ad-
vocating for modification of equipment to
address discomfort when operating the
same set of machines

Older workers in a national corporation
advocating for company-wide wellness
support programs

Note. IDD = intellectual and developmental disabilities; SMI = serious mental illness.

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Table 2. Occupations
Occupations are “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” (World Federation of
Occupational Therapists, 2012a, para. 2). Occupations are categorized as activities of daily living, instrumental activities of daily living,
health management, rest and sleep, education, work, play, leisure, and social participation.

Occupation Description

Activities of Daily Living (ADLs)—Activities oriented toward taking care of one’s own body and completed on a routine basis
(adapted from Rogers & Holm, 1994).

Bathing, showering Obtaining and using supplies; soaping, rinsing, and drying body
parts; maintaining bathing position; transferring to and from
bathing positions

Toileting and toilet hygiene Obtaining and using toileting supplies, managing clothing,
maintaining toileting position, transferring to and from toileting
position, cleaning body, caring for menstrual and continence
needs (including catheter, colostomy, and suppository man-
agement), maintaining intentional control of bowel movements
and urination and, if necessary, using equipment or agents
for bladder control (Uniform Data System for Medical
Rehabilitation, 1996, pp. III-20, III-24)

Dressing Selecting clothing and accessories with consideration of time of
day, weather, and desired presentation; obtaining clothing from
storage area; dressing and undressing in a sequential fashion;
fastening and adjusting clothing and shoes; applying and re-
moving personal devices, prosthetic devices, or splints

Eating and swallowing Keeping and manipulating food or fluid in the mouth, swal-
lowing it (i.e., moving it from the mouth to the stomach)

Feeding Setting up, arranging, and bringing food or fluid from the vessel
to the mouth (includes self-feeding and feeding others)

Functional mobility Moving from one position or place to another (during perfor-
mance of everyday activities), such as in-bed mobility, wheel-
chair mobility, and transfers (e.g., wheelchair, bed, car, shower,
tub, toilet, chair, floor); includes functional ambulation and
transportation of objects

Personal hygiene and grooming Obtaining and using supplies; removing body hair (e.g., using a
razor or tweezers); applying and removing cosmetics; washing,
drying, combing, styling, brushing, and trimming hair; caring
for nails (hands and feet); caring for skin, ears, eyes, and nose;
applying deodorant; cleaning mouth; brushing and flossing
teeth; removing, cleaning, and reinserting dental orthotics and
prosthetics

Sexual activity Engaging in the broad possibilities for sexual expression and
experiences with self or others (e.g., hugging, kissing, foreplay,
masturbation, oral sex, intercourse)

Instrumental Activities of Daily Living (IADLs)—Activities to support daily life within the home and community.

Care of others (including selection and supervision of caregivers) Providing care for others, arranging or supervising formal care
(by paid caregivers) or informal care (by family or friends) for
others

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Table 2. Occupations (cont’d)

Occupation Description
Care of pets and animals Providing care for pets and service animals, arranging or su-

pervising care for pets and service animals

Child rearing Providing care and supervision to support the developmental
and physiological needs of a child

Communication management Sending, receiving, and interpreting information using systems
and equipment such as writing tools, telephones (including
smartphones), keyboards, audiovisual recorders, computers or
tablets, communication boards, call lights, emergency systems,
Braille writers, telecommunication devices for deaf people,
augmentative communication systems, and personal digital
assistants

Driving and community mobility Planning and moving around in the community using public or
private transportation, such as driving, walking, bicycling, or
accessing and riding in buses, taxi cabs, ride shares, or other
transportation systems

Financial management Using fiscal resources, including financial transaction methods
(e.g., credit card, digital banking); planning and using finances
with long-term and short-term goals

Home establishment and management Obtaining and maintaining personal and household possessions
and environments (e.g., home, yard, garden, houseplants,
appliances, vehicles), including maintaining and repairing
personal possessions (e.g., clothing, household items) and
knowing how to seek help or whom to contact

Meal preparation and cleanup Planning, preparing, and serving meals and cleaning up food
and tools (e.g., utensils, pots, plates) after meals

Religious and spiritual expression Engaging in religious or spiritual activities, organizations, and
practices for self-fulfillment; finding meaning or religious or
spiritual value; establishing connection with a divine power,
such as is involved in attending a church, temple, mosque, or
synagogue; praying or chanting for a religious purpose; en-
gaging in spiritual contemplation (World Health Organization,
2008); may also include giving back to others, contributing to
society or a cause, and contributing to a greater purpose

Safety and emergency maintenance Evaluating situations in advance for potential safety risks;
recognizing sudden, unexpected hazardous situations and ini-
tiating emergency action; reducing potential threats to health
and safety, including ensuring safety when entering and exiting
the home, identifying emergency contact numbers, and
replacing items such as batteries in smoke alarms and light
bulbs

Shopping Preparing shopping lists (grocery and other); selecting, pur-
chasing, and transporting items; selecting method of payment
and completing payment transactions; managing internet
shopping and related use of electronic devices such as com-
puters, cell phones, and tablets

(Continued)

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Table 2. Occupations (cont’d)

Occupation Description

Health Management—Activities related to developing, managing, and maintaining health and wellness routines, including
self-management, with the goal of improving or maintaining health to support participation in other occupations.

Social and emotional health promotion and maintenance Identifying personal strengths and assets, managing emotions,
expressing needs effectively, seeking occupations and social
engagement to support health and wellness, developing self-
identity, making choices to improve quality of life in participation

Symptom and condition management Managing physical and mental health needs, including using
coping strategies for illness, trauma history, or societal stigma;
managing pain; managing chronic disease; recognizing
symptom changes and fluctuations; developing and using
strategies for managing and regulating emotions; planning time
and establishing behavioral patterns for restorative activities
(e.g., meditation); using community and social supports;
navigating and accessing the health care system

Communication with the health care system Expressing and receiving verbal, written, and digital commu-
nication with health care and insurance providers, including
understanding and advocating for self or others

Medication management Communicating with the physician about prescriptions, filling
prescriptions at the pharmacy, interpreting medication in-
structions, taking medications on a routine basis, refilling
prescriptions in a timely manner (American Occupational
Therapy Association, 2017c; Schwartz & Smith, 2017)

Physical activity Completing cardiovascular exercise, strength training, and
balance training to improve or maintain health and decrease risk
of health episodes, such as by incorporating walks into daily
routine

Nutrition management Implementing and adhering to nutrition and hydration recom-
mendations from the medical team, preparing meals to support
health goals, participating in health-promoting diet routines

Personal care device management Procuring, using, cleaning, and maintaining personal care de-
vices, including hearing aids, contact lenses, glasses, orthotics,
prosthetics, adaptive equipment, pessaries, glucometers, and
contraceptive and sexual devices

Rest and Sleep—Activities related to obtaining restorative rest and sleep to support healthy, active engagement in other
occupations.

Rest Identifying the need to relax and engaging in quiet and effortless
actions that interrupt physical and mental activity (Nurit &
Michal, 2003, p. 227); reducing involvement in taxing physical,
mental, or social activities, resulting in a relaxed state; engaging
in relaxation or other endeavors that restore energy and calm
and renew interest in engagement

Sleep preparation Engaging in routines that prepare the self for a comfortable rest,
such as grooming and undressing, reading or listening to
music, saying goodnight to others, and engaging in meditation
or prayers; determining the time of day and length of time

(Continued)

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Table 2. Occupations (cont’d)

Occupation Description
desired for sleeping and the time needed to wake; establishing
sleep patterns that support growth and health (patterns are often
personally and culturally determined); preparing the physical
environment for periods of sleep, such as making the bed or
space on which to sleep, ensuring warmth or coolness and
protection, setting an alarm clock, securing the home (e.g., by
locking doors or closing windows or curtains), setting up sleep-
supporting equipment (e.g., CPAP machine), and turning off
electronics and lights

Sleep participation Taking care of personal needs for sleep, such as ceasing ac-
tivities to ensure onset of sleep, napping, and dreaming; sus-
taining a sleep state without disruption; meeting nighttime
toileting and hydration needs, including negotiating the needs of
and interacting with others (e.g., children, partner) within the
social environment, such as providing nighttime caregiving
(e.g., breastfeeding) and monitoring comfort and safety of
others who are sleeping

Education—Activities needed for learning and participating in the educational environment.

Formal educational participation Participating in academic (e.g., math, reading, degree course-
work), nonacademic (e.g., recess, lunchroom, hallway),
extracurricular (e.g., sports, band, cheerleading, dances),
technological (e.g., online assignment completion, distance
learning), and vocational (including prevocational) educational
activities

Informal personal educational needs or interests exploration
(beyond formal education)

Identifying topics and methods for obtaining topic-related in-
formation or skills

Informal educational participation Participating in classes, programs, and activities that provide
instruction or training outside of a structured curriculum in
identified areas of interest

Work—Labor or exertion related to the development, production, delivery, or management of objects or services; benefits
may be financial or nonfinancial (e.g., social connectedness, contributions to society, structure and routine to daily life;
Christiansen & Townsend, 2010; Dorsey et al., 2019).

Employment interests and pursuits Identifying and selecting work opportunities consistent with
personal assets, limitations, goals, and interests (adapted from
Mosey, 1996, p. 342)

Employment seeking and acquisition Advocating for oneself; completing, submitting, and reviewing
application materials; preparing for interviews; participating in
interviews and following up afterward; discussing job benefits;
finalizing negotiations

Job performance and maintenance Creating, producing, and distributing products and services;
maintaining required work skills and patterns; managing time
use; managing relationships with coworkers, managers, and
customers; following and providing leadership and supervision;
initiating, sustaining, and completing work; complying with
work norms and procedures; seeking and responding to
feedback on performance

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Table 2. Occupations (cont’d)

Occupation Description
Retirement preparation and adjustment Determining aptitudes, developing interests and skills, selecting

vocational pursuits, securing required resources, adjusting
lifestyle in the absence of the worker role

Volunteer exploration Identifying and learning about community causes, organiza-
tions, and opportunities for unpaid work consistent with per-
sonal skills, interests, location, and time available

Volunteer participation Performing unpaid work activities for the benefit of selected
people, causes, or organizations

Play—Activities that are intrinsically motivated, internally controlled, and freely chosen and that may include suspension of
reality (e.g., fantasy; Skard & Bundy, 2008), exploration, humor, risk taking, contests, and celebrations (Eberle, 2014; Sutton-Smith,
2009). Play is a complex and multidimensional phenomenon that is shaped by sociocultural factors (Lynch et al., 2016).

Play exploration Identifying play activities, including exploration play, practice
play, pretend play, games with rules, constructive play, and
symbolic play (adapted from Bergen, 1988, pp. 64–65)

Play participation Participating in play; maintaining a balance of play with other
occupations; obtaining, using, and maintaining toys, equip-
ment, and supplies

Leisure—“Nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not
committed to obligatory occupations such as work, self-care, or sleep” (Parham & Fazio, 1997, p. 250).

Leisure exploration Identifying interests, skills, opportunities, and leisure activities

Leisure participation Planning and participating in leisure activities; maintaining a
balance of leisure activities with other occupations; obtaining,
using, and maintaining equipment and supplies

Social Participation—Activities that involve social interaction with others, including family, friends, peers, and community
members, and that support social interdependence (Bedell, 2012; Khetani & Coster, 2019; Magasi & Hammel, 2004).

Community participation Engaging in activities that result in successful interaction at the
community level (e.g., neighborhood, organization, workplace,
school, digital social network, religious or spiritual group)

Family participation Engaging in activities that result in “interaction in specific re-
quired and/or desired familial roles” (Mosey, 1996, p. 340)

Friendships Engaging in activities that support “a relationship between two
people based on mutual liking in which partners provide support
to each other in times of need” (Hall, 2017, para. 2)

Intimate partner relationships Engaging in activities to initiate and maintain a close relation-
ship, including giving and receiving affection and interacting in
desired roles; intimate partners may or may not engage in sexual
activity

Peer group participation Engaging in activities with others who have similar interests,
age, background, or social status

Note. CPAP = continuous positive airway pressure.

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Table 3. Examples of Occupations for Persons, Groups, and Populations
Persons engage in occupations, and groups engage in shared occupations; populations as a whole do not engage in shared
occupations, which happen at the person or group level. Occupational therapy practitioners provide interventions for persons, groups,
and populations.

Occupation Category Client Type Example

Activities of daily living Person Older adult completing bathing with assistance
from an adult child

Group Students eating lunch during a lunch break

Instrumental activities of daily living Person Parent using a phone app to pay a babysitter
electronically

Group Club members using public transportation to
arrive at a musical performance

Health management Person Patient scheduling an appointment with a spe-
cialist after referral by the primary care doctor

Group Parent association sharing preparation of healthy
foods to serve at a school-sponsored festival

Rest and sleep Person Person turning off lights and adjusting the room
temperature to 68° before sleep

Group Children engaging in nap time at a day care center

Education Person College student taking an African-American his-
tory class online

Group Students working on a collaborative science
project on robotics

Work Person Electrician turning off power before working on a
power line

Group Peers volunteering for a day of action at an animal
shelter

Play Person Child playing superhero dress up

Group Class playing freeze tag during recess

Leisure Person Family member knitting a sweater for a new baby

Group Friends meeting for a craft circle

Social participation Person New mother going to lunch with friends

Group Older adults gathering at a community center to
wrap holiday presents for charity distribution

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Table 4. Context: Environmental Factors
Context is the broad construct that encompasses environmental factors and personal factors. Environmental factors are aspects of the
physical, social, and attitudinal surroundings in which people live and conduct their lives.

Environmental Factor Components Examples
Natural environment and human-made
changes to the environment: Animate and
inanimate elements of the natural or
physical environment and components of
that environment that have been modified
by people, as well as characteristics of
human populations within the
environment

Physical geography • Raised flower beds in a backyard
• Local stream cleanup by Boy Scouts
during a community service day project

• Highway expansion cutting through an
established neighborhood

Population: Groups of people living in a
given environment who share the same
pattern of environmental adaptation

• Universal access playground where
children with mobility impairment can
play

• Hearing loop installed in a synagogue
for congregation members with hearing
aids

• Tree-shaded, solid-surface walking path
enjoyed by older adults in a senior living
community

Flora (plants) and fauna (animals) • Nonshedding service dog
• Family-owned herd of cattle
• Community garden

Climate: Meteorological features and
events, such as weather

• Sunny day requiring use of sunglasses
• Rain shower prompting a crew of road
workers to don rain gear

• Unusually high temperatures turning a
community ice skating pond to slush

Natural events: Regular or irregular geo-
graphic and atmospheric changes that
cause disruption in the physical
environment

• Barometric pressure causing a
headache

• Flood of a local creek damaging
neighborhood homes

• Hurricane devastating a low-lying
region

Human-caused events: Alterations or dis-
turbances in the natural environment
caused by humans that result in the dis-
ruption of day-to-day life

• High air pollution forcing a person with
lung disease to stay indoors

• Accessible dock at a local river park
demolished to make way for a new
bridge construction project

• Derailment of a train loaded with highly
combustible chemicals leading to the
emergency total evacuation of a small
town

Light: Light intensity and quality • Darkness requiring use of a reading lamp
• Office with ample natural light
• Street lamps

Time-related changes: Natural, regularly
occurring, or predictable change; rhythm
and duration of activity; time of day, week,
month, season, or year; day–night cycles;
lunar cycles

• Jet lag
• Quitting time at the end of a work shift
• Summer solstice

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Table 4. Context: Environmental Factors (cont’d)

Environmental Factor Components Examples
Sound and vibration: Heard or felt phe-
nomena that may provide useful or dis-
tracting information about the world

• Vibration of a cell phone indicating a
text message

• Bell signaling the start of the school day
• Outdoor emergency warning system on
a college campus

Air quality: Characteristics of the atmo-
sphere (outside buildings) or enclosed
areas of air (inside buildings)

• Heavy perfume use by a family member
causing an asthmatic reaction

• Smoking area outside an office building
• High incidence of respiratory diseases
near an industrial district

Products and technology: Natural or
human-made products or systems of
products, equipment, and technology that
are gathered, created, produced, or
manufactured

Food, drugs, and other products or sub-
stances for personal consumption

• Preferred snack
• Injectable hormones for a transgender
man

• Grade-school cafeteria lunch

General products and technology for
personal use in daily living (including
assistive technology and products)

• Toothbrush
• Household refrigerator
• Shower in a fitness or exercise facility

Personal indoor and outdoor mobility and
transportation equipment used by people
in activities requiring movement inside and
outside of buildings

• Four-wheeled walker
• Family car
• Elevator in a multistory apartment
building

Communication: Activities involving
sending and receiving information

• Hearing aid
• Text chain via personal cell phones
• Use of emergency response system to
warn region of impending dangerous
storms

Education: Processes and methods for
acquiring knowledge, expertise, or skill

• Textbook
• Online course
• Curriculum for workplace sexual ha-
rassment program

Employment: Paid work activities • Home office for remote work
• Assembly factory
• Internet connection for health care workers
to access electronic medical records

Cultural, recreational, and sporting
activities

• Gaming console
• Instruments for a university marching
band

• Soccer stadium

Practice of religion and spirituality • Prayer rug
• Temple
• Sunday church service television
broadcast

Indoor and outdoor human-made envi-
ronments that are planned, designed, and
constructed for public and private use

• Home bathroom with grab bars and
raised toilet seat

• Accessible playground at a city park
• Zero-grade entry to a shopping mall

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Table 4. Context: Environmental Factors (cont’d)

Environmental Factor Components Examples
Assets for economic exchange, such as
money, goods, property, and other valu-
ables that an individual owns or has rights
to use

• Pocket change
• Household budget
• Condominium association tax bill

Virtual environments occurring in simu-
lated, real-time, and near-time situations,
absent of physical contact

• Personal cell phone
• Synchronous video meeting of co-
workers in distant locations

• Open-source video gaming community

Support and relationships: People or ani-
mals that provide practical physical or
emotional support, nurturing, protection,
assistance, and relationships to other
persons in the home, workplace, or school
or at play or in other aspects of their daily
activities

Immediate and extended family • Spouses, partners, parents, siblings,
foster parents, and adoptive
grandparents

• Biological families and found or con-
structed families

Friends, acquaintances, peers, colleagues,
neighbors, and community members

• Trusted best friend
• Coworkers
• Helpful next-door neighbor
• Substance abuse recovery support
group sponsor

People in positions of authority and those
in subordinate positions

• Teacher who offers extra tutoring
• Legal guardian for a parentless minor
• Female religious reporting to a sister
superior

• New employee being oriented to the job
tasks by an assigned mentor

Personal care providers and personal as-
sistants providing support to individuals

Health care professionals and other
professionals serving a community

Domesticated animals • Therapy dog program in a senior living
community

• Horse kept to draw a buggy for an
Amish family’s transportation

Attitudes: Observable evidence of cus-
toms, practices, ideologies, values, norms,
factual beliefs, and religious beliefs held by
people other than the client

Individual attitudes of immediate and ex-
tended family, friends and acquaintances,
peers and colleagues, neighbors and
community members, people in positions
of authority and subordinate positions,
personal care providers and personal as-
sistants, strangers, and health care and
other professionals

• Shared grief over the untimely death of
a sibling

• Automatic trust from a patient who
knows one’s father

• Reliance among members of a faith
community

Societal attitudes, including discriminatory
practices

• Failure to acknowledge a young person
who wants to vote for the first time

• Racial discrimination in job hiring
processes

Social norms, practices, and ideologies
that marginalize specific populations

No time off work allowed to observe a
religion’s holy day

Services, systems, and policies: Benefits,
structured programs, and regulations for
operations, provided by institutions in

Services designed to meet the needs of
persons, groups, and populations

• Economic services, including Social
Security income and public assistance

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Table 4. Context: Environmental Factors (cont’d)

Environmental Factor Components Examples
various sectors of society, designed to
meet the needs of persons, groups, and
populations

• Health services for preventing and
treating health problems, providing
medical rehabilitation, and promoting
healthy lifestyles

Systems established by governments at
the local, regional, national, and interna-
tional levels or by other recognized
authorities

• Public utilities (e.g., water, electricity,
sanitation)

• Communications (transmission and
exchange of information)

• Transportation systems
• Political systems related to voting,
elections, and governance

Policies constituted by rules, regulations,
conventions, and standards established by
governments at the local, regional, na-
tional, and international levels or by other
recognized authorities

• Architecture, construction, open space
use, and housing policies

• Civil protection and legal services
• Labor and employment policies related
to finding suitable work, looking for
different work, or seeking promotion

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Table 5. Context: Personal Factors
Context is the broad construct that encompasses environmental factors and personal factors. Personal factors are 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.

Personal Factor Person A Person B
Age (chronological) • 48 years old • 14 years old

Sexual orientation • Attracted to men • Attracted to all genders

Gender identity • Female • Male

Race and ethnicity • Black French Caribbean • Southeast Asian Hmong

Cultural identification and cultural attitudes • Urban Black
• Feminist
• Caribbean island identification

• Traditional clan structure
• Elders who are decision makers for
community

Social background, social status, and so-
cioeconomic status

• Urban, upscale neighborhood
• Friends in the professional workforce
• Income that allows for luxury

• Family owns small home
• Father with a stable job in light
manufacturing

• Mother who is a child care provider for
neighborhood children

Upbringing and life experiences • No siblings
• Raised in household with grandmother
as caregiver

• Moved from California to Boston while an
adolescent

• Traditional
• Born in a refugee camp before parents
emigrated

• Youngest of five siblings
• Lives in a small city in the Upper
Midwest

Habits and past and current behavioral
patterns

• Coffee before anything else
• Meticulous about dress

• Organized and attentive to family
• Never misses a family meal

Individual psychological assets, including
temperament, character traits, and coping
styles, for handling responsibilities, stress,
crises, and other psychological demands
(e.g., extroversion, agreeableness, con-
scientiousness, psychic stability, open-
ness to experience, optimism, confidence)

• Anxious when not working
• Extroverted
• High level of confidence
• Readily adapts approach to and inter-
actions with those who are culturally
different

• Known for being calm
• Not outgoing but friendly to all
• Does not speak up or complain at
school during conflict

Education • Master’s degree in political science
• Law degree

• High school freshman
• Advanced skills in the sciences

Profession and professional identity • Public interest lawyer • Public high school student

Lifestyle • High-rise apartment
• Likes urban nightlife and casual dating
• Works long hours

• Engaged in clan and community
• Four older siblings who live nearby

Other health conditions and fitness • Treated for anorexia nervosa while an
adolescent

• Occasional runner

• Wears eyeglasses for astigmatism
• Sedentary at home except for assigned
chores

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Table 6. Performance Patterns
Performance patterns are the habits, routines, roles, and rituals that may be associated with different lifestyles and used in the process
of engaging in occupations or activities. These patterns are influenced by context and time use and can support or hinder occupational
performance.

Category Description Examples

Person

Habits “Specific, automatic behaviors performed repeat-
edly, relatively automatically, and with little varia-
tion” (Matuska & Barrett, 2019, p. 214). Habits can
be healthy or unhealthy, efficient or inefficient, and
supportive or harmful (Dunn, 2000).

• Automatically puts car keys in the same place
• Spontaneously looks both ways before crossing
the street

• Always turns off the stove burner before re-
moving a cooking pot

• Activates the alarm system before leaving the
home

• Always checks smartphone for emails or text
messages on waking

• Snacks when watching television

Routines Patterns of behavior that are observable, regular,
and repetitive and that provide structure for daily
life. They can be satisfying, promoting, or dam-
aging. Routines require delimited time commit-
ment and are embedded in cultural and ecological
contexts (Fiese, 2007; Segal, 2004).

• Follows a morning sequence to complete toi-
leting, bathing, hygiene, and dressing

• Follows the sequence of steps involved in meal
preparation

• Manages morning routine to drop children off at
school and arrive at work on time

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.

• Sibling in a family with three children
• Retired military personnel
• Volunteer at a local park district
• Mother of an adolescent with developmental
disabilities

• Student with a learning disability studying
computer technology

• Corporate executive returning to part-time work
after a stroke

Rituals Symbolic actions with spiritual, cultural, or social
meaning contributing to the client’s identity and
reinforcing values and beliefs. Rituals have a strong
affective component and consist of a collection of
events (Fiese, 2007; Fiese et al., 2002; Segal,
2004).

• Shares a highlight from the day during evening
meals with family

• Kisses a sacred book before opening the pages
to read

• Recites the Pledge of Allegiance before the start
of the school day

Group and Population

Routines Patterns of behavior that are observable, regular,
and repetitive and that provide structure for daily
life. They can be satisfying, promoting, or dam-
aging. Time provides an organizational structure or
rhythm for routines (Larson & Zemke, 2003).
Routines are embedded in cultural and ecological
contexts (Segal, 2004).

Group
• Workers attending weekly staff meetings
• Students turning in homework assignments as
they enter the classroom

• Exercise class attendees setting up their mats
and towels before class

Population
• Parents of young children following health
practices such as yearly checkups and sched-
uled immunizations

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Table 6. Performance Patterns (cont’d)

Category Description Examples

• Corporations following business practices such
as providing services for disadvantaged pop-
ulations (e.g., loans to underrepresented
groups)

• School districts following legislative procedures
such as those associated with the Individuals
With Disabilities Education Improvement Act of
2004 (Pub. L. 108-446) or Medicare

Roles Sets of behaviors by the group or population ex-
pected by society and shaped by culture and
context that may be further conceptualized and
defined by the group or population.

Group
• Nonprofit civic group providing housing for
people living with mental illness

• Humanitarian group distributing food and
clothing donations to refugees

• Student organization in a university educating
elementary school children about preventing
bullying

Population
• Parents providing care for children until they
become adults

• Grandparents or older community members
being consulted before decisions are made

Rituals Shared social actions with traditional, emotional,
purposive, and technological meaning contributing
to values and beliefs within the group or
population.

Group
• Employees of a company attending an annual
holiday celebration

• Members of a community agency hosting a
fundraiser every spring

Population
• Citizens of a country suspending work activities
in observance of a national holiday

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Table 7. Performance Skills for Persons
Performance skills are observable, goal-directed actions that result in a client’s quality of performing desired occupations. Skills are
supported by the context in which the performance occurs, including environmental and client factors (Fisher & Marterella, 2019).
Effective use of motor and process performance skills is demonstrated when the client carries out an activity efficiently, safely, with
ease, or without assistance. Effective use of social interaction performance skills is demonstrated when the client completes
interactions in a manner that matches the demands of the social situation. Ineffective use of performance skills is demonstrated when
the client routinely requires assistance or support to perform activities or engage in social interactions.

The examples in this table are limited to descriptions of the client’s ability to use each performance skill in an effective or ineffective
manner. A client who demonstrates ineffective use of performance skills may be able to successfully complete the entire occupation
with the use of occupational or environmental adaptations. Successful occupational performance by the client may be achieved when
such adaptions are used.

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Motor Skills—“Motor skills are the group of performance skills that represent small, observable actions related to moving
oneself or moving and interacting with tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices,
plant life) in the context of performing a personally and ecologically relevant daily life task” (Fisher & Marterella, 2019, p. 331).

Positioning the body Washing dishes at the kitchen sink

Stabilizes—Moves through task environ-
ment and interacts with task objects
without momentary propping or loss of
balance

Person moves through the kitchen without
propping or loss of balance.

Person momentarily props on the counter
to stabilize body while standing at the sink
and washing dishes.

Aligns—Interacts with task objects with-
out evidence of persistent propping or
leaning

Person washes dishes without using the
counter for support.

Person persistently leans on the counter,
resulting in ineffective performance when
washing dishes.

Positions—Positions self an effective
distance from task objects and without
evidence of awkward arm or body
positions

Person places body or wheelchair at an
effective distance for washing dishes.

Person positions body or wheelchair too
far from the sink, resulting in difficulty
reaching for dishes in the sink.

Obtaining and holding objects Acquiring a game from a cabinet in preparation for a family activity

Reaches—Effectively extends arm and,
when appropriate, bends trunk to ef-
fectively grasp or place task objects that
are out of reach

Person reaches without effort for the game
box.

Person reaches with excessive physical
effort for the game box.

Bends—Flexes or rotates trunk as ap-
propriate when sitting down or when
bending to grasp or place task objects
that are out of reach

Person bends without effort when reach-
ing for the game box.

Person demonstrates excessive stiffness
when bending to reach for the game box.

Grips—Effectively pinches or grasps task
objects such that the objects do not slip
(e.g., from between fingers, from be-
tween teeth, from between hand and
supporting surface)

Person grips the game box and game
pieces, and they do not slip from the hand.

Person grips the game box ineffectively,
and the box slips from the hand so that
game pieces spill.

Manipulates—Uses dexterous finger
movements, without evidence of fum-
bling, when manipulating task objects

Person readily manipulates the game
pieces with fingers while setting up and
playing the game.

Person fumbles the game pieces so that
some pieces fall off the game board.

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Table 7. Performance Skills for Persons (cont’d)

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Performance Skills: Motor Skills (cont’d)

Moving self and objects Completing janitorial tasks at a factory site

Coordinates—Uses two or more body
parts together to manipulate and hold
task objects without evidence of fumbling
or task objects slipping from the grasp

Person uses both hands to shuffle the
game cards without fumbling them, and
the cards do not slip from the hands.

Person uses both hands to shuffle the
cards but fumbles the deck, and the cards
slip out of the hands.

Moves—Effectively pushes or pulls task
objects along a supporting surface,
pulls to open or pushes to close doors
and drawers, or pushes on wheels to
propel a wheelchair

Person moves the broom easily, pushing
and pulling it across the floor.

Person demonstrates excessive effort to
move the broom across the floor when
sweeping.

Lifts—Effectively raises or lifts task objects
without evidence of excessive physical
effort

Person easily lifts cleaning supplies out of
the cart.

Person needs to use both hands to lift
small lightweight containers of cleaning
supplies out of the cart.

Walks—During task performance, ambu-
lates on level surfaces without shuffling
feet, becoming unstable, propping, or
using assistive devices

Person walks steadily through the factory. Person demonstrates unstable walking
while performing janitorial duties or walks
while supporting self on the cart.

Transports—Carries task objects from one
place to another while walking or
moving in a wheelchair

Person carries cleaning supplies from one
factory location to another, either by
walking or using a wheelchair, without
effort.

Person is unstable when transporting
cleaning supplies throughout the factory.

Calibrates—Uses movements of appro-
priate force, speed, or extent when
interacting with task objects (e.g., does
not crush task objects, pushes a door
with enough force to close it without a
bang)

Person uses an appropriate amount of
force to squeeze liquid soap onto a
cleaning cloth.

Person applies too little force to squeeze
soap out of the container onto the
cleaning cloth.

Flows—Uses smooth and fluid arm and
wrist movements when interacting with
task objects

Person demonstrates fluid arm and wrist
movements when wiping tables.

Person demonstrates stiff and jerky arm
and wrist movements when wiping
tables.

Sustaining performance Bathing an older parent as caregiver

Endures—Persists and completes the task
without demonstrating physical fatigue,
pausing to rest, or stopping to catch
breath

Person completes bathing of parent
without evidence of physical fatigue.

Person stops to rest, interrupting the task
of bathing the parent.

Paces—Maintains a consistent and ef-
fective rate or tempo of performance
throughout the entire task performance

Person uses an appropriate tempo when
bathing the parent.

Person sometimes rushes or delays ac-
tions when bathing the parent.

Process Skills—“Process skills are the group of performance skills that represent small, observable actions related to selecting,
interacting with, and using tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life);
carrying out individual actions and steps; and preventing problems of occupational performance from occurring or reoccurring in
the context of performing a personally and ecologically relevant daily life task” (Fisher & Marterella, 2019, pp. 336–337).

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Table 7. Performance Skills for Persons (cont’d)

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Performance Skills: Process Skills (cont’d)

Sustaining performance Writing sentences for a school assignment

Paces—Maintains a consistent and ef-
fective rate or tempo of performance
throughout the entire task performance

Person uses a consistent and even tempo
when writing sentences.

Person rushes writing sentences,
resulting in incorrectly formed letters or
misspelled words.

Attends—Does not look away from task
performance, maintaining the ongoing
task progression

Person maintains gaze on the assignment
and continues writing sentences without
pause.

Person looks toward another student and
pauses when writing sentences.

Heeds—Carries out and completes the
task originally agreed on or specified by
another person

Person completes the assignment, writing
the number of sentences required.

Person writes fewer sentences than re-
quired, not completing the assignment.

Applying knowledge Taking prescribed medications

Chooses—Selects necessary and appro-
priate type and number of objects for
the task, including the task objects that
one chooses or is directed to use (e.g.,
by a teacher)

Person chooses specified medicine bottles
appropriate for the specific timed dose.

Person chooses an incorrect medicine
bottle for the specific timed dose.

Uses—Applies task objects as they are
intended (e.g., using a pencil sharpener
to sharpen a pencil but not a crayon)
and in a hygienic fashion

Person uses a medicine spoon to take a
dose of liquid medicine.

Person uses a tablespoon to take a 1-
teaspoon dose of liquid medicine.

Handles—Supports or stabilizes task ob-
jects appropriately, protecting them
from being damaged, slipping, moving,
or falling

Person supports the medicine bottle,
keeping it upright without the bottle tip-
ping or falling.

Person allows the medicine bottle to tip,
and pills spill from the bottle.

Inquires—(1) Seeks needed verbal or
written information by asking questions
or reading directions or labels and (2)
does not ask for information when fully
oriented to the task and environment
and recently aware of the answer

Person reads the label on the
medicine bottle before taking the
medication.

Person asks the care provider what dose
to take having already read the dose on
the label.

Organizing timing Using an ATM to get cash to pay a babysitter

Initiates—Starts or begins the next task
action or task step without any
hesitation

Person begins each step of ATM use
without hesitation.

Person pauses before entering the PIN
into the ATM.

Continues—Performs single actions or
steps without any interruptions so that
once an action or task step is initiated,
performance continues without pauses
or delays until the action or step is
completed

Person completes each step of ATM use
without delays.

Person starts to enter the PIN, pauses,
and then continues entering the PIN.

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Table 7. Performance Skills for Persons (cont’d)

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Performance Skills: Process Skills (cont’d)

Sequences—Performs steps in an effec-
tive or logical order and with an absence
of randomness in the ordering or in-
appropriate repetition of steps

Person completes each step of ATM use in
logical order.

Person attempts to enter the PIN before
inserting the bank card into the card
reader.

Terminates—Brings to completion single
actions or single steps without inappro-
priate persistence or premature cessation

Person completes each step of ATM use in
the appropriate length of time.

Person persists in entering numbers after
completing the four-digit PIN.

Organizing space and objects Managing clerical duties for a large company

Searches/locates—Looks for and locates
task objects in a logical manner

Person readily locates needed office sup-
plies from shelves and drawers.

Person searches a shelf a second time to
locate needed clerical supplies.

Gathers—Collects related task objects into
the same work space and regathers task
objects that have spilled, fallen, or been
misplaced

Person gathers required clerical tools and
supplies in the assigned work space.

Person places required paper and pen in
different work spaces and then must
move them to the same work space.

Organizes—Logically positions or spatially
arranges task objects in an orderly fashion
within a single work space or between
multiple appropriate work spaces such that
the work space is not too spread out or too
crowded

Person organizes required clerical tools
and supplies within the work space so all
are within reach.

Person places books on top of papers,
resulting in a crowded work space.

Restores—Puts away task objects in ap-
propriate places and ensures that the
immediate work space is restored to its
original condition

Person returns clerical tools and supplies
to their original storage location.

Person puts pens and extra paper in a
different storage closet from where
originally found.

Navigates—Moves body or wheelchair
without bumping into obstacles when
moving through the task environment
or interacting with task objects

Person moves through the office space
without bumping into office furniture or
machines.

Person bumps hand into the edge of the
desk when reaching for a pen from the
pen holder.

Adapting performance Preparing a green salad for a family meal

Notices/responds—Responds appropri-
ately to (1) nonverbal task-related cues
(e.g., heat, movement), (2) the spatial
arrangement and alignment of task
objects to one another, and (3) cup-
board doors or drawers that have been
left open during task performance

Person notices the carrot rolling off the
cutting board and catches it before it rolls
onto the floor.

Person delays noticing a rolling carrot,
and it rolls off the cutting board onto the
floor.

Adjusts—Overcomes problems with on-
going task performance effectively by
(1) going to a new workspace; (2)
moving task objects out of the current
workspace; or (3) adjusting knobs, di-
als, switches, or water taps

Person readily adjusts the flow of water
from the tap when washing vegetables.

Person delays turning off the water tap
after washing the vegetables.

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Table 7. Performance Skills for Persons (cont’d)

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Performance Skills: Process Skills (cont’d)

Accommodates—Prevents ineffective
performance of all other motor and
process skills and asks for assistance
only when appropriate or needed

Person prevents problems from occurring
during the salad preparation.

Person does not prevent problems from
occurring, such as carrots rolling off the
cutting board and onto the floor.

Benefits—Prevents ineffective perfor-
mance of all other motor and process
skills from recurring or persisting

Person prevents problems from continu-
ing or reoccurring during the salad
preparation.

Person retrieves the carrot from the floor
and puts it back on the cutting board, and
the carrot rolls off the board again.

Social Interaction Skills—“Social interaction skills are the group of performance skills that represent small, observable actions
related to communicating and interacting with others in the context of engaging in a personally and ecologically relevant daily
life task performance that involves social interaction with others” (Fisher & Marterella, 2019, p. 342).

Initiating and terminating social interaction Participating in a community support group

Approaches/starts—Approaches or initi-
ates interaction with the social partner
in a manner that is socially appropriate

Person politely begins interactions with
support group members.

Person begins interactions with support
group members by yelling at them from
across the room.

Concludes/disengages—Effectively termi-
nates the conversation or social inter-
action, brings to closure the topic under
discussion, and disengages or says
goodbye

Person politely ends a conversation with a
support group member.

Person abruptly ends interaction with the
support group by walking out of the
room.

Producing social interaction Child playing in the sandbox with others to build roads for cars and trucks

Produces speech—Produces spoken,
signed, or augmentative (i.e., com-
puter-generated) messages that are
audible and clearly articulated

Person produces clear verbal, signed, or
augmentative messages to communicate
with other children playing in the sandbox.

Person mumbles when interacting with
other children playing in the sandbox, and
the other children do not understand the
message.

Gesticulates—Uses socially appropriate
gestures to communicate or support a
message

Person gestures by waving or pointing
while communicating with other children
playing in the sandbox.

Person uses aggressive gestures when
interacting with other children playing in
the sandbox.

Speaks fluently—Speaks in a fluent and
continuous manner, with an even pace
(not too fast, not too slow) and without
pauses or delays, while sending a
message

Person speaks, without pausing, stutter-
ing, or hesitating, when engaging with
other children playing in the sandbox.

Person hesitates or pauses when talking
with other children playing in the
sandbox.

Physically supporting social interaction
Older adult in a senior residence talking with other residents

during a shared mealtime

Turns toward—Actively positions or turns
body and face toward the social partner
or the person who is speaking

Person turns body and face toward other
residents while interacting during the
meal.

Person turns face away from other resi-
dents while interacting during the meal.

Looks—Makes eye contact with the social
partner

Person makes eye contact with other
residents while interacting during the
meal.

Person looks down at own plate while
interacting during the meal.

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Table 7. Performance Skills for Persons (cont’d)

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Performance Skills: Social Interaction Skills (cont’d)

Places self—Positions self at an appro-
priate distance from the social partner

Person sits an appropriate distance from
other residents at the table.

Person sits too far from other residents,
interfering with interactions.

Touches—Responds to and uses touch or
bodily contact with the social partner in
a socially appropriate manner

Person touches other residents appropri-
ately during the meal.

Person reaches out, grasps another
resident’s shirt, and abruptly pulls on it
during the meal.

Regulates—Does not demonstrate irrele-
vant, repetitive, or impulsive behaviors
during social interaction

Person avoids demonstrating irrelevant,
repetitive, or impulsive behaviors while
interacting during the meal.

Person repeatedly taps the fork on the
plate while interacting during the meal.

Shaping content of social interaction Serving ice cream to customers in an ice cream shop

Questions—Requests relevant facts and
information and asks questions that
support the intended purpose of the
social interaction

Person asks customers for their choice of
ice cream flavor.

Person asks customers for their choice of
ice cream flavor and then repeats the
question after they respond.

Replies—Keeps conversation going by
replying appropriately to suggestions,
opinions, questions, and comments

Person readily replies with relevant an-
swers to customers’ questions about ice
cream products.

Person delays in replying to customers’
questions or provides irrelevant
information.

Discloses—Reveals opinions, feelings,
and private information about self or
others in a socially appropriate manner

Person discloses no personal information
about self or others to customers.

Person reveals socially inappropriate
details about own family.

Expresses emotions—Displays affect and
emotions in a socially appropriate
manner

Person displays socially appropriate
emotions when sending messages to
customers.

Person uses a sarcastic tone of voice
when describing ice cream flavor options.

Disagrees—Expresses differences of
opinion in a socially appropriate manner

Person expresses a difference of opinion
about ice cream products in a polite way.

Person becomes argumentative when a
customer requests a flavor that is not
available.

Thanks—Uses appropriate words and
gestures to acknowledge receipt of
services, gifts, or compliments

Person thanks the customers for pur-
chasing ice cream.

Person fails to say thank you after cus-
tomers purchase ice cream.

Maintaining flow of social interaction
Sharing suggestions with others in a support group for persons experiencing

mental health challenges

Transitions—Handles transitions in the
conversation or changes the topic
without disrupting the ongoing
conversation

Person offers comments or suggestions
that relate to the topic of mental health
challenges, smoothly moving the topic in a
relevant direction.

Person abruptly changes the topic of
conversation to planning social activities
during a discussion of mental health
challenges.

Times response—Replies to social mes-
sages without delay or hesitation and
without interrupting the social partner

Person replies to another group member’s
question about community supports for
mental health challenges after briefly
considering how best to respond.

Person replies to another group mem-
ber’s question about community sup-
ports for mental health challenges before
the other person finishes asking the
question.

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Table 7. Performance Skills for Persons (cont’d)

Specific Skill Definitions

Examples

Effective Performancea Ineffective Performanceb

Performance Skills: Social Interaction Skills (cont’d)

Times duration—Speaks for a reasonable
length of time given the complexity of
the message

Person sends messages about mental
health challenges of an appropriate length.

Person sends prolonged messages con-
taining extraneous details.

Takes turns—Speaks in turn and gives the
social partner the freedom to take their turn

Person engages in back-and-forth con-
versation with others in the group.

Person does not respond to comments
from others during the group discussion.

Verbally supporting social interaction Visiting a Social Security office to obtain information relative to potential benefits

Matches language—Uses a tone of voice,
dialect, and level of language that are so-
cially appropriate and matched to the social
partner’s abilities and level of understanding

Person uses a tone of voice and vocabulary
that match those of the Social Security
agent.

Person uses a loud voice and slang when
interacting with the Social Security agent.

Clarifies—Responds to gestures or verbal
messages from the social partner sig-
naling that the social partner does not
comprehend or understand a message
and ensures that the social partner is
following the conversation

Person rephrases the initial question when
the Social Security agent requests
clarification.

Person asks an unrelated question when
the Social Security agent requests clari-
fication of the initial question.

Acknowledges and encourages—
Acknowledges receipt of messages,
encourages the social partner to con-
tinue the social interaction, and en-
courages all social partners to
participate in the interaction

Person nods to indicate understanding of
the information shared by the Social Se-
curity agent.

Person does not nod or use words to
acknowledge receipt of messages sent by
the Social Security agent.

Empathizes—Expresses a supportive at-
titude toward the social partner by
agreeing with, empathizing with, or
expressing understanding of the social
partner’s feelings and experiences

Person shows empathy when the Social
Security agent expresses frustration with
the slow computer system.

Person shows impatience when the So-
cial Security agent expresses frustration
with the slow computer system.

Adapting social interaction Deciding which restaurant to go to with a group of friends

Heeds—Uses goal-directed social inter-
actions focused on carrying out and
completing the intended purpose of the
social interaction

Person maintains focus on deciding which
restaurant to go to.

Person makes comments unrelated to
choosing a restaurant, disrupting the
group decision making.

Accommodates—Prevents ineffective or
socially inappropriate social interaction

Person avoids making ineffective re-
sponses to others about restaurant choice.

Person asks a question that is irrelevant
to choosing a restaurant.

Benefits—Prevents problems with inef-
fective or socially inappropriate social
interaction from recurring or persisting

Person avoids making reoccurring inef-
fective comments during the decision
making.

Person persists in asking questions ir-
relevant to choosing a restaurant.

Note. ATM = automated teller machine; PIN = personal identification number.
aEffective use of motor and process performance skills is demonstrated when the client carries out an activity efficiently, safely, with ease, or without assistance. Effective use of
social interaction performance skills is demonstrated when the client completes interactions in a manner that matches the demands of the social situation. bIneffective
performance skills are demonstrated when the client routinely requires assistance or support to perform activities or engage in social interaction. Ineffective use of social
interaction performance skills is demonstrated when the client engages in social interactions in a manner that does not appropriately meet the demands of the social situation.
Source. From Powerful Practice: A Model for Authentic Occupational Therapy, by A. G. Fisher and A. Marterella, 2019, Fort Collins, CO: Center for Innovative OT
Solutions. Copyright © 2019 by the Center for Innovative OT Solutions. Adapted with permission.

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Table 8. Performance Skills for Groups
To address performance skills for a group client, occupational therapy practitioners analyze the motor, process, and social interaction
skills of individual group members to identify whether ineffective performance skills may limit the group’s collective outcome.
Italicized words in the middle column are specific performance skills defined in Table 7.

Performance Skill Category
Ineffective Performance by an
Individual Group Member

Impact on Group Collective
Outcome

Group collective outcome: Religious organization committee furnishing spaces for a preschool for member families

Motor—Obtaining and holding objects • Member reaches with excessive effort
for chairs stored in closet.

• Member bends with stiffness or exces-
sive effort when reaching for the chairs.

• Member fumbles when gripping writing
materials in preparation for recording
committee decisions for planning.

• Member demonstrates limited finger
dexterity to manipulate tools for as-
sembling storage units for toys.

• Member is unable to coordinate one
hand and trunk to stabilize self while
gripping and loading toys onto shelves.

Other members may need to take re-
sponsibility for obtaining and holding
objects to accommodate the member’s
ineffective motor performance skills
during the process of furnishing pre-
school spaces.

Process—Organizing space and objects • Member repeatedly asks for help when
searching for needed furniture or lo-
cating play equipment that is organized
logically in near and distant places within
the building.

• Member does not effectively gather re-
quired play activity materials in the
designated play spaces.

• Member has difficulty organizing toys or
play equipment within the various play
spaces in a logical and orderly fashion.

• Member does not restore toys or play
equipment to storage spaces to return the
preschool space to an effective order.

• Member bumps into play furniture when
navigating spaces to set up furniture to
meet the needs of families or groups.

The group may need to accommodate the
member’s limitations in effectively orga-
nizing space and objects by adjusting the
timing of the outcome to allow greater
time to complete furnishing the preschool
spaces.

Social interaction—Producing social
interaction

• Member communicates in whispers
when producing speech to communicate
with other members about decisions for
placing play equipment.

• Member delays in gesticulating so other
members do not receive effective mes-
sages while arranging toys and play
equipment.

• Member speaks fluently but too quickly
when communicating to friends, resulting
in challenges for other members in deci-
sion making for furnishing the preschool.

The group decision-making process may
be hindered by the member’s difficulty in
producing social interactions. Limited
communication during the tasks of
placing furniture in preschool spaces may
cause confusion among group members.

Source. Performance skill categories are from Powerful Practice: A Model for Authentic Occupational Therapy, by A. G. Fisher and A. Marterella, 2019, Fort Collins,
CO: Center for Innovative OT Solutions. Copyright © 2019 by the Center for Innovative OT Solutions. Adapted with permission.

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Table 9. Client Factors
Client factors include (1) values, beliefs, and spirituality; (2) body functions; and (3) body structures. Client factors reside within the
client and influence the client’s performance in occupations.

Category Examples Relevant to Occupational Therapy Practice

Values, Beliefs, and Spirituality—Client’s (person’s, group’s, or population’s) perceptions, motivations, and related meaning
that influence or are influenced by engagement in occupations.

Values—Acquired beliefs and commitments, derived from
culture, about what is good, right, and important to do
(Kielhofner, 2008)

Person
• Honesty with self and others
• Commitment to family

Group
• Obligation to provide a service
• Fairness
• Inclusion

Population
• Freedom of speech
• Equal opportunities for all
• Tolerance toward others

Beliefs—“Something that is accepted, considered to be true, or
held as an opinion” (“Belief,” 2020).

Person
• One is powerless to influence others.
• Hard work pays off.

Group
• Teaching others how to garden decreases their reliance on
grocery stores.

•Writing letters as part of a neighborhood group can support the
creation of a community park.

Population
• Some personal rights are worth fighting for.
• A new health care policy, as yet untried, will positively affect
society.

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” (Billock, 2005, p. 887). It is important
to recognize spirituality “as dynamic and often evolving”
(Humbert, 2016, p. 12).

Person
• Personal search for purpose and meaning in life
• Guidance of actions by a sense of value beyond the acquisition
of wealth or fame

Group
• Study of religious texts together
• Attendance at a religious service

Population
• Common search for purpose and meaning in life
• Guidance of actions by values agreed on by the collective

Body Functions—“The physiological functions of body systems (including psychological functions)” (WHO, 2001, p. 10).
This section of the table is organized according to the classifications of the ICF; for fuller descriptions and definitions, refer to
WHO (2001). This list is not all inclusive.

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Table 9. Client Factors (cont’d)

Category Examples Relevant to Occupational Therapy Practice

Body Functions (cont’d)

Mental functions

Specific mental functions

Higher level cognitive Judgment, concept formation, metacognition, executive func-
tions, praxis, cognitive flexibility, insight

Attention Sustained shifting and divided attention, concentration,
distractibility

Memory Short-term, long-term, and working memory
Perception Discrimination of sensations (e.g., auditory, tactile, visual, ol-

factory, gustatory, vestibular, proprioceptive)
Thought Control and content of thought, awareness of reality vs. delu-

sions, logical and coherent thought
Mental functions of sequencing complex movement Mental functions that regulate the speed, response, quality, and

time of motor production, such as restlessness, toe tapping, or
hand wringing, in response to inner tension

Emotional Regulation and range of emotions; appropriateness of emotions,
including anger, love, tension, and anxiety; lability of emotions

Experience of self and time Awareness of one’s identity (including gender identity), body, and
position in the reality of one’s environment and of time

Global mental functions

Consciousness State of awareness and alertness, including the clarity and
continuity of the wakeful state

Orientation Orientation to person, place, time, self, and others
Psychosocial General mental functions, as they develop over the life span,

required to understand and constructively integrate the mental
functions that lead to the formation of the personal and inter-
personal skills needed to establish reciprocal social interactions,
in terms of both meaning and purpose

Temperament and personality Extroversion, introversion, agreeableness, conscientiousness,
emotional stability, openness to experience, self-control, self-
expression, confidence, motivation, impulse control, appetite

Energy Energy level, motivation, appetite, craving, impulse
Sleep Physiological process, quality of sleep

Sensory functions

Visual functions Quality of vision, visual acuity, visual stability, and visual field
functions to promote visual awareness of environment at var-
ious distances for functioning

Hearing functions Sound detection and discrimination; awareness of location and
distance of sounds

Vestibular functions Sensation related to position, balance, and secure movement
against gravity

Taste functions Association of taste qualities of bitterness, sweetness, sourness,
and saltiness

Smell functions Sensing of odors and smells

Proprioceptive functions Awareness of body position and space
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Table 9. Client Factors (cont’d)

Category Examples Relevant to Occupational Therapy Practice

Body Functions (cont’d)
Touch functions Feeling of being touched by others or touching various textures,

such as those of food; presence of numbness, paresthesia,
hyperesthesia

Interoception Internal detection of changes in one’s internal organs through
specific sensory receptors (e.g., awareness of hunger, thirst,
digestion, state of alertness)

Pain Unpleasant feeling indicating potential or actual damage to some
body structure; sensations of generalized or localized pain (e.g.,
diffuse, dull, sharp, phantom)

Sensitivity to temperature and pressure Thermal awareness (hot and cold), sense of force applied to skin
(thermoreception)

Neuromusculoskeletal and movement-related functions

Functions of joints and bones

Joint mobility Joint range of motion
Joint stability Maintenance of structural integrity of joints throughout the

body; physiological stability of joints related to structural
integrity

Muscle functions

Muscle power Strength
Muscle tone Degree of muscle tension (e.g., flaccidity, spasticity, fluctuation)
Muscle endurance Sustainability of muscle contraction

Movement functions

Motor reflexes Involuntary contraction of muscles automatically induced by
specific stimuli (e.g., stretch, asymmetrical tonic neck, sym-
metrical tonic neck)

Involuntary movement reactions Postural reactions, body adjustment reactions, supporting
reactions

Control of voluntary movement Eye–hand and eye–foot coordination, bilateral integration,
crossing of the midline, fine and gross motor control, oculo-
motor function (e.g., saccades, pursuits, accommodation,
binocularity)

Gait patterns Gait and mobility in relation to engagement in daily life activities
(e.g., walking patterns and impairments, asymmetric gait, stiff
gait)

Cardiovascular, hematological, immune, and respiratory system functions
(Note. Occupational therapy practitioners have knowledge of these body functions and understand broadly the interaction that
occurs among these functions to support health, well-being, and participation in life through engagement in occupation.)

Cardiovascular system functions Maintenance of blood pressure functions (hypertension, hy-
potension, postural hypotension), heart rate and rhythm

Hematological and immune system functions Protection against foreign substances, including infection, al-
lergic reactions

Respiratory system functions Rate, rhythm, and depth of respiration
Additional functions and sensations of the cardiovascular and
respiratory systems

Physical endurance, aerobic capacity, stamina, fatigability

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Table 9. Client Factors (cont’d)

Category Examples Relevant to Occupational Therapy Practice
Voice and speech functions; digestive, metabolic, and endocrine system functions; genitourinary and reproductive
functions (Note. Occupational therapy practitioners have knowledge of these body functions and understand broadly the
interaction that occurs among these functions to support health, well-being, and participation in life through engagement in
occupation.)

Voice and speech functions Fluency and rhythm, alternative vocalization functions

Digestive, metabolic, and endocrine system functions Digestive system functions, metabolic system, and endocrine
system functions

Genitourinary and reproductive functions Genitourinary and reproductive functions

Skin and related structure functions (Note. Occupational therapy practitioners have knowledge of these body functions and
understand broadly the interaction that occurs among these functions to support health, well-being, and participation in life through
engagement in occupation.)

Skin functions
Hair and nail functions

Protection (presence or absence of wounds, cuts, or abrasions),
repair (wound healing)

Body Structures—“Anatomical parts of the body, such as organs, limbs, and their components” that support body function
(WHO, 2001, p. 10). This section of the table is organized according to the ICF classifications; for fuller descriptions and
definitions, refer to WHO (2001).

Structure of the nervous system
Structures related to the eyes and ears
Structures involved in voice and speech
Structures of the cardiovascular, immunological, and respiratory

systems
Structures related to the digestive, metabolic, and endocrine

systems
Structures related to the genitourinary and reproductive

systems
Structures related to movement

Occupational therapy practitioners have knowledge of body
structures and understand broadly the interaction that occurs
between these structures to support health, well-being, and
participation in life through engagement in occupation.

Note. The categorization of body functions and body structures is based on the ICF (WHO, 2001). The classification was selected because it has received wide
exposure and presents a language that is understood by external audiences. ICF = International Classification of Function, Disability and Health;WHO = World Health
Organization.

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Table 10. Occupational Therapy Process for Persons, Groups, and Populations
The occupational therapy process applies to work with persons, groups, and populations. The process for groups and populations
mirrors that for persons. The process for populations includes public health approaches, and the process for groups may include both
person and population methods to address occupational performance (Scaffa & Reitz, 2014).

Process
Component

Process Step

Person Group Population
Evaluation Consultation and screening:

• Review client history
• Consult with interprofessional team
• Administer standardized screening
tools

Consultation and screening, envi-
ronmental scan:
• Identify collective need on the basis
of available data

• For each individual in the group,
+ Review history
+ Administer standardized

screening tools
+ Consult with interprofessional

team

Environmental scan, trend analysis,
preplanning:
• Collect data to inform design of
intervention program by identify-
ing information needs

• Identify health trends in targeted
population and potential positive
and negative impacts on occupa-
tional performance

Occupational profile:
• Interview client and caregiver

Occupational profile or community
profile:
• Interview persons who make up the
group

• Engage with persons in the group to
determine their interests, needs, and
priorities

Needs assessment, community
profile:
• Engage with persons within the
population to determine their in-
terests and needs and opportuni-
ties for collaboration

• Identify priorities through
+ Surveys
+ Interviews
+ Group discussions or forums

Analysis of occupational
performance:
• Assess occupational performance
• Conduct occupational and activity
analysis

• Assess contexts
• Assess performance skills and
patterns

• Assess client factors

Analysis of occupational
performance:
• Conduct occupational and activity
analysis

• Assess group context
• Assess the following for individual
group members:
+ Occupational performance
+ Performance skills and patterns
+ Client factors

• Analyze impact of individual per-
formance on the group

Needs assessment, review of sec-
ondary data:
• Evaluate existing quantitative data,
which may include
+ Public health records
+ Prevalence of disease or

disability
+ Demographic data
+ Economic data

Synthesis of evaluation process:
• Review and consolidate information
to select occupational outcomes
and determine impact of perfor-
mance patterns and client factors on
occupation

Synthesis of evaluation process:
• Review and consolidate information
to select collective occupational
outcomes

• Review and consolidate information
regarding each member’s perfor-
mance and its impact on the group
and the group’s occupational per-
formance as a whole

Data analysis and interpretation:
• Review and consolidate informa-
tion to support need for the pro-
gram and identify any missing data

Intervention Development of the intervention plan:
• Identify client goals
• Identify intervention outcomes
• Select outcome measures

Development of the intervention plan
or program:
• Identify collective group goals

Program planning:
• Identify short-term program
objectives

• Identify long-term program goals

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Table 10. Occupational Therapy Process for Persons, Groups, and Populations (cont’d)

Process
Component

Process Step

Person Group Population
• Select methods for service delivery,
including theoretical framework

• Identify intervention outcomes for
the group

• Select outcome measures
• Select methods for service delivery,
including theoretical framework

• Select outcome measures to be
used in program evaluation

• Select strategies for service deliv-
ery, including theoretical
framework

Intervention implementation:
• Carry out occupational therapy in-
tervention to address specific oc-
cupations, contexts, and
performance patterns and skills af-
fecting performance

Intervention or program
implementation:
• Carry out occupational therapy in-
tervention or program to address
the group’s specific occupations,
contexts, and performance patterns
and skills affecting group
performance

Program implementation:
• Carry out program or advocacy
action to address identified occu-
pational needs

Intervention review:
• Reevaluate and review client’s re-
sponse to intervention

• Review progress toward goals and
outcomes

• Modify plan as needed

Intervention review or program
evaluation:
• Reevaluate and review individual
members’ and the group’s response
to intervention

• Review progress toward goals and
outcomes

• Modify plan as needed
• Evaluate efficiency of program
• Evaluate achievement of determined
objectives

Program evaluation:
• Gather information on program
implementation

•Measure the impact of the program
• Evaluate efficiency of program
• Evaluate achievement of deter-
mined objectives

Outcomes Outcomes:
• Use measures to assess progress
toward outcomes

• Identify change in occupational
participation

Outcomes:
• Use measures to assess progress
toward outcomes

• Identify change in occupational
performance of individual members
and the group as a whole

Outcomes:
• Use measures to assess progress
toward long-term program goals

• Identify change in occupational
performance of targeted
population

Transition:
• Facilitate client’s move from one life
role or experience to another, such
as
+ Moving to a new level of care
+ Transitioning between providers
+ Moving into a new setting or

program

Transition:
• Facilitate group members’ move
from one life role or experience to
another, such as
+ Moving to a new level of care
+ Transitioning between providers
+ Moving into a new setting or

program

Sustainability plan:
• Develop action plan to maintain
program

• Identify sources of funding
• Build community capacity and
support relationships to continue
program

Discontinuation:
• Discontinue care after short- and
long-term goals have been achieved
or client chooses to no longer
participate

• Implement discharge plan to sup-
port performance after discontinu-
ation of services

Discontinuation:
• Discontinue care after the group’s
short- and long-term goals have
been achieved

• Implement discharge plan to sup-
port performance after discontinu-
ation of services

Dissemination plan:
• Share results with participants,
stakeholders, and community
members

• Implement sustainability plan

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Table 11. Occupation and Activity Demands
Occupation and activity demands are the components of occupations and activities that occupational therapy practitioners consider in
their professional and clinical reasoning process. Activity demands are what is typically required to carry out the activity regardless of
client and context. Occupation demands are what is required by the specific client (person, group, or population) to carry out an
occupation. Depending on the context and needs of the client, occupation and activity demands can act as barriers to or supports for
participation. Specific knowledge about activity demands assists practitioners in selecting occupations for therapeutic purposes.

Type of Demand
Activity Demands: Typically Required

to Carry Out the Activity

Occupational Demands: Required
by the Client (Person, Group,

or Population) to Carry
Out the Occupation

Relevance and importance General meaning of the activity within the
given culture

Meaning the client derives from the oc-
cupation, which may be subjective and
personally constructed; symbolic, un-
conscious, and metaphorical; and aligned
with the client’s goals, values, beliefs, and
needs and perceived utility

Person:
Knitting clothing items for personal use,
for income from sale, or as a leisure
activity

Person:
Knitting as a way to practice mindfulness
strategies for coping with anxiety

Group:
Cooking to provide nutrition, fulfill a family
role, or engage in a leisure activity

Group:
Preparation of a holiday meal with family
to connect members to each other and to
their culture and traditions

Population:
Presence of accessible restrooms in public
spaces in compliance with federal law

Population:
Creation of new accessible and all-gender
restrooms to symbolize a community’s
commitment to safety and inclusion of
members with disabilities and LGBTQ+
members

Objects used and their properties: Tools
(e.g., scissors, dishes, shoes, volleyball),
supplies (e.g., paints, milk, lipstick),
equipment (e.g., workbench, stove, bas-
ketball hoop), and resources (e.g., money,
transportation) required in the process of
carrying out the activity or occupation and
their inherent properties (e.g., heavy,
rough, sharp, colorful, loud, bitter tasting)

Person: Computer workstation that includes a computer, keyboard, mouse, desk,
and chair

Group: Financial and transportation resources for a group of friends to attend a
concert

Population: Tools, supplies, and equipment for flood relief efforts to ensure safety
of people with disabilities

Space demands: Physical environment
requirements of the occupation or activity
(e.g., size, arrangement, surface, lighting,
temperature, noise, humidity, ventilation)

Person: Desk arrangement in an elementary school classroom

Group: Accessible meeting space to run a fall prevention workshop

Population: Noise, lighting, arrangement, and temperature controls for a sensory-
friendly museum

Social demands: Elements of the social
and attitudinal environments required for
the occupation or activity

Person: Rules of engagement for a child at recess

Group: Expectations of travelers in an airport (e.g., waiting in line, following cues
from staff and others, asking questions when needed)

Population: Understanding of the social and political climate of the geographic region

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Table 11. Occupation and Activity Demands (cont’d)

Type of Demand
Activity Demands: Typically Required

to Carry Out the Activity

Occupational Demands: Required
by the Client (Person, Group,

or Population) to Carry
Out the Occupation

Sequencing and timing demands: Tem-
poral process required to carry out the
activity or occupation (e.g., specific steps,
sequence of steps, timing requirements)

Person: Preferred sequence and timing of a client’s morning routine to affirm social,
cultural, and gender identity

Group: Steps a class of students takes in preparation to start the school day

Population: Public train schedules

Required actions and performance skills:
Actions and performance skills (motor,
process, and social interaction) that are an
inherent part of the activity or occupation

Person: Body movements required to drive a car

Group and population: See “Performance Skills” section for discussion related to
groups and population

Required body functions: “Physiological
functions of body systems (including
psychological functions)” (WHO, 2001, p.
10) required to support the actions used to
perform the activity or occupation

Person: Cognitive level required for a child to play a game

Group and population: See “Client Factors” section for discussion of required body
functions related to groups and populations

Required body structures: “Anatomical
parts of the body such as organs, limbs,
and their components” that support body
functions (WHO, 2001, p. 10) and are
required to perform the activity or
occupation

Person: Presence of upper limbs to play catch

Group and population: See “Client Factors” section for discussion of required body
structures related to groups and populations

Note. WHO = World Health Organization.

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Table 12. Types of Occupational Therapy Interventions
Occupational therapy intervention types include occupations and activities, interventions to support occupations, education and
training, advocacy, group interventions, and virtual interventions. Occupational therapy interventions facilitate engagement in
occupation to enable persons, groups, and populations to achieve health, well-being, and participation in life. The examples provided
illustrate the types of interventions that clients engage in (denoted as “client”) and that occupational therapy practitioners provide
(denoted as “practitioner”) and are not intended to be all-inclusive.

Intervention Type Description Examples

Occupations and Activities—Occupations and activities selected as interventions for specific clients are designed to meet
therapeutic goals and address the underlying needs of the client’s mind, body, and spirit. To use occupations and activities
therapeutically, the practitioner considers activity demands and client factors in relation to the client’s therapeutic goals and
contexts.

Occupations Broad and specific daily life events that
are personalized and meaningful to the
client

Person
Client completes morning dressing and hy-
giene using adaptive devices.

Group
Client plays a group game of tag on the
playground to improve social participation.

Population
Practitioner creates an app to improve access
for people with autism spectrum disorder
using metropolitan paratransit systems.

Activities Components of occupations that are
objective and separate from the client’s
engagement or contexts. Activities as
interventions are selected and designed
to support the development of perfor-
mance skills and performance patterns
to enhance occupational engagement.

Person
Client selects clothing and manipulates
clothing fasteners in advance of dressing.

Group
Group members separate into two teams for a
game of tag.

Population
Client establishes parent volunteer commit-
tees at their children’s school.

Interventions to Support Occupations—Methods and tasks that prepare the client for occupational performance are used as
part of a treatment session in preparation for or concurrently with occupations and activities or provided to a client as a
home-based engagement to support daily occupational performance.

PAMs and mechanical modalities Modalities, devices, and techniques to
prepare the client for occupational
performance. Such approaches should
be part of a broader plan and not used
exclusively.

Person
Practitioner administers PAMs to decrease
pain, assist with wound healing or edema
control, or prepare muscles for movement to
enhance occupational performance.

Group
Practitioner develops a reference manual on
postmastectomy manual lymphatic drainage
techniques for implementation at an outpa-
tient facility.

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Table 12. Types of Occupational Therapy Interventions (cont’d)

Intervention Type Description Examples
Orthotics and prosthetics Construction of devices to mobilize,

immobilize, or support body structures
to enhance participation in occupations

Person
Practitioner fabricates and issues a wrist
orthosis to facilitate movement and enhance
participation in household activities.

Group
Group members participate in a basketball game
with veterans using prosthetics after amputation.

Assistive technology and environ-
mental modifications

Assessment, selection, provision, and
education and training in use of high-
and low-tech assistive technology; ap-
plication of universal design principles;
and recommendations for changes to
the environment or activity to support
the client’s ability to engage in
occupations

Person
Practitioner recommends using a visual
support (e.g., social story) to guide behavior.

Group
Practitioner uses a smart board with speaker
system during a social skills group session to
improve participants’ attention.

Population
Practitioner recommends that a large health
care organization paint exits in their facilities
to resemble bookshelves to deter patients
with dementia from eloping.

Wheeled mobility Products and technologies that facilitate
a client’s ability to maneuver through
space, including seating and position-
ing; improve mobility to enhance par-
ticipation in desired daily occupations;
and reduce risk for complications such
as skin breakdown or limb contractures

Person
Practitioner recommends, in conjunction with
the wheelchair team, a sip-and-puff switch to
allow the client to maneuver the power
wheelchair independently and interface with an
environmental control unit in the home.

Group
Group of wheelchair users in the same town
host an educational peer support event.

Self-regulation Actions the client performs to target
specific client factors or performance
skills. Intervention approaches may
address sensory processing to promote
emotional stability in preparation for
social participation or work or leisure
activities or executive functioning to
support engagement in occupation and
meaningful activities. Such approaches
involve active participation of the client
and sometimes use of materials to
simulate components of occupations.

Person
Client participates in a fabricated sensory
environment (e.g., through movement, tactile
sensations, scents) to promote alertness
before engaging in a school-based activity.

Group
Practitioner instructs a classroom teacher to
implement mindfulness techniques, visual
imagery, and rhythmic breathing after recess
to enhance students’ success in classroom
activities.

Population
Practitioner consults with businesses and
community sites to establish sensory-friendly
environments for people with sensory pro-
cessing deficits.

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Table 12. Types of Occupational Therapy Interventions (cont’d)

Intervention Type Description Examples

Education and Training

Education Imparting of knowledge and information
about occupation, health, well-being,
and participation to enable the client to
acquire helpful behaviors, habits, and
routines

Person
Practitioner provides education regarding
home and activity modifications to the spouse
or family member of a person with dementia to
support maximum independence.

Group
Practitioner participates in a team care
planning meeting to educate the family and
team members on a patient’s condition and
level of function and establish a plan of care.

Population
Practitioner educates town officials about the
value of and strategies for constructing
walking and biking paths accessible to people
who use mobility devices.

Training Facilitation of the acquisition of concrete
skills for meeting specific goals in a real-
life, applied situation. In this case, skills
refers to measurable components of
function that enable mastery. Training is
differentiated from education by its goal
of enhanced performance as opposed to
enhanced understanding, although
these goals often go hand in hand
(Collins & O’Brien, 2003).

Person
Practitioner instructs the client in the use of
coping skills such as deep breathing to ad-
dress anxiety symptoms before engaging in
social interaction.

Group
Practitioner provides an in-service on ap-
plying new reimbursement and practice
standards adopted by a facility.

Population
Practitioner develops a training program to
support practice guidelines addressing oc-
cupational deprivation and cultural compe-
tence for practitioners working with refugees.

Advocacy—Efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to
support health, well-being, and occupational participation.

Advocacy Advocacy efforts undertaken by the
practitioner

Person
Practitioner collaborates with a client to procure
reasonable accommodations at a work site.

Group
Practitioner collaborates with and educates
teachers in an elementary school about in-
clusive classroom design.

Population
Practitioner serves on the policy board of an
organization to procure supportive housing
accommodations for people with disabilities.

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Table 12. Types of Occupational Therapy Interventions (cont’d)

Intervention Type Description Examples
Self-advocacy Advocacy efforts undertaken by the

client with support by the practitioner
Person
Client requests reasonable accommodations,
such as audio textbooks, to support their
learning disability.

Group
Client participates in an employee meeting to
request and procure adjustable chairs to
improve comfort at computer workstations.

Population
Client participates on a student committee
partnering with school administration to
develop cyberbullying prevention programs
in their district.

Group Interventions—Use of distinct knowledge of the dynamics of group and social interaction and leadership techniques to
facilitate learning and skill acquisition across the lifespan. Groups are used as a method of service delivery.

Functional groups, activity groups,
task groups, social groups, and other
groups

Groups used in health care settings,
within the community, or within orga-
nizations that allow clients to explore
and develop skills for participation, in-
cluding basic social interaction skills
and tools for self-regulation, goal set-
ting, and positive choice making

Person
Client participates in a group for adults with
traumatic brain injury focused on individual
goals for reentering the community after
inpatient treatment.

Group
Group of older adults participates in volunteer
days to maintain participation in the com-
munity through shared goals.

Population
Practitioner works with middle school
teachers in a district on approaches to ad-
dress issues of self-efficacy and self-esteem
as the basis for creating resiliency in children
at risk for being bullied.

Virtual Interventions—Use of simulated, real-time, and near-time technologies for service delivery absent of physical contact,
such as telehealth or mHealth.

Telehealth (telecommunication and
information technology) and mHealth
(mobile telephone application
technology)

Use of technology such as video con-
ferencing, teleconferencing, or mobile
telephone application technology to
plan, implement, and evaluate occupa-
tional therapy intervention, education,
and consultation

Person
Practitioner performs a telehealth therapy
session with a client living in a rural area.

Group
Client participates in an initial online support
group session to establish group protocols,
procedures, and roles.

Population
Practitioner develops methods and standards
for mHealth in community occupational
therapy practice.

Note. mHealth = mobile health; PAMs = physical agent modalities.

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Table 13. Approaches to Intervention
Approaches to intervention are specific strategies selected to direct the evaluation and intervention processes on the basis of the
client’s desired outcomes, evaluation data, and research evidence. Approaches inform the selection of practice models, frames of
references, and treatment theories.

Approach Description Examples
Create, promote (health promotion) An intervention approach that does not

assume a disability is present or that any
aspect would interfere with performance.
This approach is designed to provide
enriched contextual and activity experi-
ences that will enhance performance for all
people in the natural contexts of life
(adapted from Dunn et al., 1998, p. 534).

Person
Develop a fatigue management program
for a client recently diagnosed with
multiple sclerosis

Group
Create a resource list of developmentally
appropriate toys to be distributed by staff
at a day care program

Population
Develop a falls prevention curriculum for
older adults for trainings at senior centers
and day centers

Establish, restore (remediation,
restoration)

Approach designed to change client vari-
ables to establish a skill or ability that has
not yet developed or to restore a skill or
ability that has been impaired (adapted
from Dunn et al., 1998, p. 533)

Person
Restore a client’s upper extremity
movement to enable transfer of dishes
from the dishwasher into the upper
kitchen cabinets

Collaborate with a client to help establish
morning routines needed to arrive at
school or work on time

Group
Educate staff of a group home for clients
with serious mental illness to develop a
structured schedule, chunking tasks to
decrease residents’ risk of being over-
whelmed by the many responsibilities of
daily life roles

Population
Restore access ramps to a church en-
trance after a hurricane

Maintain Approach designed to provide supports
that will allow clients to preserve the
performance capabilities that they have
regained and that continue to meet their
occupational needs. The assumption is
that without continued maintenance in-
tervention, performance would decrease
and occupational needs would not be met,
thereby affecting health, well-being, and
quality of life.

Person
Provide ongoing intervention for a client
with amyotrophic lateral sclerosis to ad-
dress participation in desired occupations
through provision of assistive technology

Group
Maintain environmental modifications at
a group home for young adults with
physical disabilities for continued safety
and engagement with housemates

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Table 13. Approaches to Intervention (cont’d)

Approach Description Examples
Population
Maintain safe and independent access for
people with low vision by increasing
hallway lighting in a community center

Modify (compensation, adaptation) Approach directed at “finding ways to
revise the current context or activity de-
mands to support performance in the
natural setting, [including] compensatory
techniques . . . [such as] enhancing some
features to provide cues or reducing other
features to reduce distractibility” (Dunn
et al., 1998, p. 533)

Person
Simplify task sequence to help a person
with cognitive impairments complete a
morning self-care routine

Group
Modify a college campus housing build-
ing to accommodate a group of students
with mobility impairments

Population
Consult with architects and builders to
design homes that will support aging in
place and use universal design principles

Prevent (disability prevention) Approach designed to address the needs
of clients with or without a disability who
are at risk for occupational performance
problems. This approach is designed to
prevent the occurrence or evolution of
barriers to performance in context. Inter-
ventions may be directed at client, context,
or activity variables (adapted from Dunn
et al., 1998, p. 534).

Person
Aid in the prevention of illicit substance
use by introducing self-initiated routine
strategies that support drug-free behavior

Group
Prevent social isolation of employees by
promoting participation in after-work
group activities

Population
Consult with a hotel chain to provide an
ergonomics educational program
designed to prevent back injuries in
housekeeping staff

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Table 14. Outcomes
Outcomes are the end result of the occupational therapy process; they describe what clients can achieve through occupational therapy
intervention. Some outcomes are measurable and are used for intervention planning and review and discharge planning. These
outcomes reflect the attainment of treatment goals that relate to engagement in occupation. Other outcomes are experienced by clients
when they have realized the effects of engagement in occupation and are able to return to desired habits, routines, roles, and rituals.

Adaptation is embedded in all categories of outcomes. The examples listed specify how the broad outcome of health and participation in
life may be operationalized.

Outcome Category Description Examples
Occupational performance Act of doing and accomplishing a selected

action (performance skill), activity, or oc-
cupation (Fisher, 2009; Fisher & Griswold,
2019; Kielhofner, 2008) that results from
the dynamic transaction among the client,
the context, and the activity. Improving or
enhancing skills and patterns in occupa-
tional performance leads to engagement in
occupations or activities (adapted in part
from Law et al., 1996, p. 16).

Person
A patient with hip precautions showers safely with
modified independence using a tub transfer
bench and a long-handled sponge.

Group
A group of older adults cooks a holiday meal
during their stay in a skilled nursing facility with
minimal assistance from staff.

Population
A community welcomes children with spina bifida
in public settings after a news story featuring
occupational therapy practitioners.

Improvement Increased occupational performance
through adaptation when a performance
limitation is present

Person
A child with autism plays interactively with a peer.
An older adult returns home from a skilled
nursing facility as desired.

Group
Back strain in nursing personnel decreases as a
result of an in-service education program on body
mechanics for job duties that require bending and
lifting.

Population
Accessible playground facilities for all children are
constructed in city parks.

Enhancement Development of performance skills and
performance patterns that augment exist-
ing performance of life occupations when a
performance limitation is not present

Person
A teenagemother experiences increased confidence
and competence in parenting as a result of struc-
tured social groups and child development classes.

Group
Membership in the local senior citizen center
increases as a result of expanded social wellness
and exercise programs.
School staff have increased ability to address and
manage school-age youth violence as a result of
conflict resolution training to address bullying.

Population
Older adults have increased opportunities to
participate in community activities through ride-
share programs.

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Table 14. Outcomes (cont’d)

Outcome Category Description Examples
Prevention Education or health promotion efforts

designed to identify, reduce, or stop the
onset and reduce the incidence of un-
healthy conditions, risk factors, diseases,
or injuries. Occupational therapy promotes
a healthy lifestyle at the individual, group,
population (societal), and government or
policy level (adapted from AOTA, 2020b).

Person
A child with orthopedic impairments is provided
with appropriate seating and a play area.

Group
A program of leisure and educational activities is
implemented at a drop-in center for adults with
serious mental illness.

Population
Access to occupational therapy services is pro-
vided in underserved areas where residents
typically receive other services.

Health and wellness Health: State of physical, mental, and social
well-being, as well as a positive concept
emphasizing social and personal resources
and physical capacities (WHO, 1986).
Health for groups and populations also
includes social responsibility of members
to the group or population as a whole.

Wellness: “Active process through which
individuals [or groups or populations]
become aware of and make choices toward
a more successful existence” (Hettler, 1984,
p. 1117). Wellness is more than a lack of
disease symptoms; it is a state of mental
and physical balance and fitness (adapted
from “Wellness,” 1997, p. 2110)

Person
A person with a mental health challenge partici-
pates in an empowerment and advocacy group to
improve services in the community.
A person with attention deficit hyperactivity dis-
order demonstrates self-management through the
ability to manage the various aspects of their life.

Group
A company-wide program for employees is
implemented to identify problems and solutions
regarding the balance among work, leisure, and
family life.

Population
The incidence of childhood obesity decreases.

Quality of life Dynamic appraisal of the client’s life sat-
isfaction (perceptions of progress toward
goals), hope (real or perceived belief that
one can move toward a goal through se-
lected pathways), self-concept (composite
of beliefs and feelings about oneself),
health and functioning (e.g., health status,
self-care capabilities), and socioeconomic
factors (e.g., vocation, education, income;
adapted from Radomski, 1995)

Person
A deaf child from a hearing family participates
fully and actively during a recreational activity.

Group
A facility experiences increased participation of
residents during outings and independent travel
as a result of independent living skills training for
care providers.

Population
A lobby is formed to support opportunities for
social networking, advocacy activities, and
sharing of scientific information for stroke sur-
vivors and their families.

(Continued)

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Table 14. Outcomes (cont’d)

Outcome Category Description Examples
Participation Engagement in desired occupations in

ways that are personally satisfying and
congruent with expectations within the
culture

Person
A person recovers the ability to perform the es-
sential duties of his or her job after a flexor tendon
laceration.

Group
A family enjoys a vacation spent traveling cross-
country in their adapted van.

Population
All children within a state have access to school
sports programs.

Role competence Ability to effectively meet the demands of
the roles in which one engages

Person
A person with cerebral palsy is able to take notes
and type papers to meet the demands of the
student role.

Group
A factory implements job rotation to allow sharing
of higher demand tasks so employees can meet
the demands of the worker role.

Population
Accessibility of polling places is improved,
enabling all people with disabilities in the
community to meet the demands of the citizen
role.

Well-being Contentment with one’s health, self-es-
teem, sense of belonging, security, and
opportunities for self-determination,
meaning, roles, and helping others
(Hammell, 2009). Well-being is “a general
term encompassing the total universe of
human life domains, including physical,
mental, and social aspects, that make up
what can be called a ‘good life’” (WHO,
2006, p. 211).

Person
A person with amyotrophic lateral sclerosis
achieves contentment with their ability to find
meaning in fulfilling the role of parent through
compensatory strategies and environmental
modifications.

Group
Members of an outpatient depression and anxiety
support group feel secure in their sense of group
belonging and ability to help other members.

Population
Residents of a town celebrate the groundbreaking
for a school being reconstructed after a natural
disaster.

(Continued)

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Outcome Category Description Examples
Occupational justice Access to and participation in the full range

of meaningful and enriching occupations
afforded to others, including opportunities
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Townsend & Wilcock, 2004)

Person
An individual with intellectual and developmental
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Group
Workers have enough break time to eat lunch with
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Group and Population
People with persistent mental illness experience
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advocacy skills, enabling them to develop an
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housing options for older adults to age in place
(population).

Note. AOTA = American Occupational Therapy Association; WHO = World Health Organization.

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Authors

Cheryl Boop, MS, OTR/L

Susan M. Cahill, PhD, OTR/L, FAOTA

Charlotte Davis, MS, OTR/L

Julie Dorsey, OTD, OTR/L, CEAS, FAOTA

Varleisha Gibbs, PhD, OTD, OTR/L

Brian Herr, MOT, OTR/L

Kimberly Kearney, COTA/L

Elizabeth “Liz” Griffin Lannigan, PhD, OTR/L, FAOTA

Lizabeth Metzger, MS, OTR/L

Julie Miller, MOT, OTR/L, SWC

Amy Owens, OTR

Krysta Rives, MBA, COTA/L, CKTP

Caitlin Synovec, OTD, OTR/L, BCMH

Wayne L. Winistorfer, MPA, OTR, FAOTA

Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA Headquarters Liaison

for

The Commission on Practice

Julie Dorsey, OTD, OTR/L, CEAS, FAOTA, Chairperson

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Acknowledgments

In addition to those named below, the COP thanks everyone who has contributed to the dialogue, feedback, and

concepts presented in the document. Sincerest appreciation is extended to AOTA Staff members Chris Davis,

Jennifer Folden, Caroline Polk, and Debbie Shelton for all their support. Further appreciation and thanks are

extended to AnneG. Fisher, ScD, OT, FAOTA; Lou AnnGriswold, PhD, OTR/L, FAOTA; and AbbeyMarterella, PhD,

OTR/L.

The COP wishes to acknowledge the authors of the third edition of this document: Deborah Ann Amini, EdD, OTR/L,

CHT, FAOTA, Chairperson, 2011–2014; Kathy Kannenberg, MA, OTR/L, CCM, Chairperson-Elect, 2013–2014;

Stefanie Bodison, OTD, OTR/L; Pei-Fen Chang, PhD, OTR/L; Donna Colaianni, PhD, OTR/L, CHT; Beth Goodrich,

OTR, ATP, PhD; Lisa Mahaffey, MS, OTR/L, FAOTA; Mashelle Painter, MEd, COTA/L; Michael Urban, MS, OTR/L,

CEAS, MBA, CWCE; Dottie Handley-More, MS, OTR/L, SIS Liaison; Kiel Cooluris, MOT, OTR/L, ASD Liaison;

Andrea McElroy, MS, OTR/L, Immediate-Past ASD Liaison; Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA

Headquarters Liaison.

The COPwishes to acknowledge the authors of the second edition of this document: Susanne Smith Roley, MS, OTR/L,

FAOTA, Chairperson, 2005–2008; Janet V. DeLany, DEd, OTR/L, FAOTA; Cynthia J. Barrows, MS, OTR/L; Susan

Brownrigg, OTR/L; DeLana Honaker, PhD, OTR/L, BCP; Deanna Iris Sava, MS, OTR/L; Vibeke Talley, OTR/L; Kristi

Voelkerding, BS, COTA/L, ATP; Deborah Ann Amini, MEd, OTR/L, CHT, FAOTA, SIS Liaison; Emily Smith, MOT, ASD

Liaison; Pamela Toto, MS, OTR/L, BCG, FAOTA, Immediate-Past SIS Liaison; Sarah King, MOT, OTR, Immediate-Past

ASD Liaison; Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA Headquarters Liaison; with contributions from

M. Carolyn Baum, PhD, OTR/L, FAOTA; Ellen S. Cohn, ScD, OTR/L, FAOTA; Penelope A. Moyers Cleveland, EdD,

OTR/L, BCMH, FAOTA; and Mary Jane Youngstrom, MS, OTR, FAOTA.

TheCOPalsowishes to acknowledge the authors of the first edition of this document: Mary Jane Youngstrom,MS,OTR,

FAOTA, Chairperson (1998–2002); Sara Jane Brayman, PhD, OTR, FAOTA, Chairperson-Elect (2001–2002); Paige

Anthony, COTA; Mary Brinson, MS, OTR/L, FAOTA; Susan Brownrigg, OTR/L; Gloria Frolek Clark, MS, OTR/L,

FAOTA; Susanne Smith Roley, MS, OTR; James Sellers, OTR/L; Nancy L. Van Slyke, EdD, OTR; Stacy M. Desmarais,

MS,OTR/L, ASD Liaison; Jane Oldham, MOTS, Immediate-Past ASCOTA Liaison; Mary Vining Radomski, MA, OTR,

FAOTA, SIS Liaison; Sarah D. Hertfelder, MEd, MOT, OTR, FAOTA, National Office Liaison.

Revised by the Commission on Practice, 2020

Adopted by the Representative Assembly May, 2020

Note. This document replaces the 2014 Occupational Therapy Practice Framework: Domain and Process (3rd ed.). Published in the American

Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://dx.doi.org/10.5014/ajot.2020.74S2001

Copyright © 2020 by the American Occupational Therapy Association.

Citation:AmericanOccupational TherapyAssociation. (2020). Occupational therapy practice framework: Domain and process (4th ed.).American

Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

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Appendix A. Glossary

A

Activities
Actions designed and selected to support the development of performance skills and performance patterns to enhance

occupational engagement.

Activities of daily living (ADLs)
Activities that are oriented toward taking care of one’s own body (adapted from Rogers & Holm, 1994) and are

completed on a daily basis. These activities are “fundamental to living in a social world; they enable basic survival and

well-being” (Christiansen & Hammecker, 2001, p. 156; see Table 2).

Activity analysis
Generic and decontextualized analysis that seeks to develop an understanding of typical activity demands within a

given culture.

Activity demands
Aspects of an activity needed to carry it out, including relevance and importance to the client, objects used and their

properties, space demands, social demands, sequencing and timing, required actions and performance skills, and

required underlying body functions and body structures (see Table 11).

Adaptation
Effective and efficient response by the client to occupational and contextual demands (Grajo, 2019).

Advocacy
Efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully

participate in their daily life occupations. Efforts undertaken by the practitioner are considered advocacy, and those

undertaken by the client are considered self-advocacy and can be promoted and supported by the practitioner (see

Table 12).

Analysis of occupational performance
The step in the evaluation process in which the client’s assets and limitations or potential problems are more specifically

determined through assessment tools designed to analyze, measure, and inquire about factors that support or hinder

occupational performance (see Exhibit 2).

Assessment
“A specific tool, instrument, or systematic interaction . . . used to understand a client’s occupational profile, client factors,

performance skills, performance patterns, and contextual and environmental factors, as well as activity demands that

influence occupational performance” (Hinojosa et al., 2014, pp. 3–4).

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B

Belief
Something that is accepted, considered to be true, or held as an opinion (“Belief,” 2020).

Body functions
“Physiological functions of body systems (including psychological functions)” (World Health Organization, 2001, p. 10;

see Table 9).

Body structures
“Anatomical parts of the body, such as organs, limbs, and their components” that support body functions (World Health

Organization, 2001, p. 10; see Table 9).

C

Client
Person (including one involved in the care of a client), group (collection of individuals having shared characteristics or

common or shared purpose, e.g., family members, workers, students, and those with similar interests or occupational

challenges), or population (aggregate of people with common attributes such as contexts, characteristics, or concerns,

including health risks; Scaffa & Reitz, 2014).

Client-centered care (client-centered practice)
Approach to service that incorporates respect for and partnership with clients as active participants in the therapy

process. This approach emphasizes clients’ knowledge and experience, strengths, capacity for choice, and overall

autonomy (Schell & Gillen, 2019, p. 1194).

Client factors
Specific capacities, characteristics, or beliefs that reside within the person and that influence performance in occu-

pations. Client factors include values, beliefs, and spirituality; body functions; and body structures (see Table 9).

Clinical reasoning
See Professional reasoning

Collaboration
“The complex interpretative acts in which the practitioners must understand the meanings of the interventions, the

meanings of illness or disability in a person and family’s life, and the feelings that accompany these experiences”

(Lawlor & Mattingly, 2019, p. 201).

Community
Collection of populations that is changeable and diverse and includes various people, groups, networks, and orga-

nizations (Scaffa, 2019; World Federation of Occupational Therapists, 2019).

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Context
Construct that constitutes the complete makeup of a person’s life as well as the common and divergent factors

that characterize groups and populations. Context includes environmental factors and personal factors (see Tables 4

and 5).

Co-occupation
Occupation that implicitly involves two or more individuals (Schell & Gillen, 2019, p. 1195) and includes aspects of

physicality, emotionality, and intentionality (Pickens & Pizur-Barnekow, 2009).

Cornerstone
Something of significance on which everything else depends.

D

Domain
Profession’s purview and areas in which its members have an established body of knowledge and expertise.

E

Education
As an occupation: Activities involved in learning and participating in the educational environment (see Table 2).

As an environmental factor of context: Processes and methods for acquisition of knowledge, expertise, or skills (see

Table 4).

As an intervention: Activities that impart knowledge and information about occupation, health, well-being, and par-

ticipation, resulting in acquisition by the client of helpful behaviors, habits, and routines that may or may not require

application at the time of the intervention session (see Table 12).

Empathy
Emotional exchange between occupational therapy practitioners and clients that allows more open communication,

ensuring that practitioners connect with clients at an emotional level to assist them with their current life situation.

Engagement in occupation
Performance of occupations as the result of choice, motivation, and meaning within a supportive context.

Environmental factors
Aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives.

Evaluation
“The comprehensive process of obtaining and interpreting the data necessary to understand the person, system, or

situation. . . . Evaluation requires synthesis of all data obtained, analytic interpretation of that data, reflective

clinical reasoning, and consideration of occupational performance and contextual factors” (Hinojosa et al., 2014,

p. 3).

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G

Goal
Measurable and meaningful, occupation-based, long-term or short-term aim directly related to the client’s ability and

need to engage in desired occupations (AOTA, 2018a, p. 4).

Group
Collection of individuals having shared characteristics or a common or shared purpose (e.g., family members, workers,

students, others with similar occupational interests or occupational challenges).

Group intervention
Use of distinct knowledge and leadership techniques to facilitate learning and skill acquisition across the lifespan

through the dynamics of group and social interaction. Groups may be used as a method of service delivery (see

Table 12).

H

Habilitation
Health care services that help a person keep, learn, or improve skills and functioning for daily living (e.g., therapy for a

child who does not walk or talk at the expected age). These services may include physical and occupational therapy,

speech-language pathology, and other services for people with disabilities in a variety of inpatient and outpatient

settings (“Provision of EHB,” 2015).

Habits
“Specific, automatic behaviors performed repeatedly, relatively automatically, and with little variation” (Matuska &

Barrett, 2019, p. 214). Habits can be healthy or unhealthy, efficient or inefficient, and supportive or harmful (Dunn, 2000).

Health
“State of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (World

Health Organization, 2006, p. 1).

Health management
Occupation focused on developing, managing, and maintaining routines for health and wellness by engaging in self-

care with the goal of improving or maintaining health, including self-management, to allow for participation in other

occupations (see Table 2).

Health promotion
“Process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical,

mental, and social well-being, an individual or group must be able to identify and realize aspirations, to satisfy needs,

and to change or cope with the environment” (World Health Organization, 1986).

Hope
Real or perceived belief that one can move toward a goal through selected pathways.

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I

Independence
“Self-directed state of being characterized by an individual’s ability to participate in necessary and preferred occupations

in a satisfying manner irrespective of the amount or kind of external assistance desired or required” (AOTA, 2002a, p.

660).

Instrumental activities of daily living (IADLs)
Activities that support daily life within the home and community and that often require more complex interactions than

those used in ADLs (see Table 2).

Interdependence
“Reliance that people have on one another as a natural consequence of group living” (Christiansen & Townsend, 2010,

p. 419). “Interdependence engenders a spirit of social inclusion, mutual aid, and a moral commitment and responsibility

to recognize and support difference” (Christiansen & Townsend, 2010, p. 187).

Interests
“What one finds enjoyable or satisfying to do” (Kielhofner, 2008, p. 42).

Intervention
“Process and skilled actions taken by occupational therapy practitioners in collaboration with the client to facilitate

engagement in occupation related to health and participation. The intervention process includes the plan, imple-

mentation, and review” (AOTA, 2015c, p. 2).

Intervention approaches
Specific strategies selected to direct the process of interventions on the basis of the client’s desired outcomes,

evaluation data, and evidence (see Table 13).

Interventions to support occupations
Methods and tasks that prepare the client for occupational performance, used as part of a treatment session in

preparation for or concurrently with occupations and activities or provided to a client as a home-based engagement to

support daily occupational performance (see Table 12).

L

Leisure
“Nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time

not committed to obligatory occupations such as work, self-care, or sleep” (Parham & Fazio, 1997, p. 250; see

Table 2).

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M

Motor skills
The “group of performance skills that represent small, observable actions related to moving oneself or moving and

interacting with tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life) in the

context of performing a personally and ecologically relevant daily life task. They are commonly named in terms of type of

task being performed (e.g., [activity of daily living] motor skills, school motor skills, work motor skills)” (Fisher &

Marterella, 2019, p. 331; see Table 7).

O

Occupation
Everyday personalized activities that people do as individuals, in families, and with communities to occupy time and

bring meaning and purpose to life. Occupations can involve the execution of multiple activities for completion and can

result in various outcomes. The broad range of occupations is categorized as activities of daily living, instrumental

activities of daily living, health management, rest and sleep, education, work, play, leisure, and social participation (see

Table 2).

Occupation-based
Characteristic of the best practice method used in occupational therapy, in which the practitioner uses an evaluation

process and types of interventions that actively engage the client in occupation (Fisher & Marterella, 2019).

Occupational analysis
Analysis that is performed with an understanding of “the specific situation of the client and therefore [of] the specific

occupations the client wants or needs to do in the actual context in which these occupations are performed” (Schell

et al., 2019, p. 322).

Occupational demands
Aspects of an activity needed to carry it out, including relevance and importance to the client, objects used and their

properties, space demands, social demands, sequencing and timing, required actions and performance skills, and

required underlying body functions and body structures (see Table 10).

Occupational identity
“Composite sense of who one is and wishes to become as an occupational being generated from one’s history of

occupational participation” (Schell & Gillen, 2019, p. 1205).

Occupational justice
“A justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society,

regardless of age, ability, gender, social class, or other differences” (Nilsson & Townsend, 2010, p. 58). Occupational

justice includes access to and participation in the full range of meaningful and enriching occupations afforded to others,

including opportunities for social inclusion and the resources to participate in occupations to satisfy personal, health,

and societal needs (adapted from Townsend & Wilcock, 2004).

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Occupational performance
Accomplishment of the selected occupation resulting from the dynamic transaction among the client, their context, and

the occupation.

Occupational profile
Summary of the client’s occupational history and experiences, patterns of daily living, interests, values, needs, and

relevant contexts (see Exhibit 2).

Occupational science
“Way of thinking that enables an understanding of occupation, the occupational nature of humans, the relationship

between occupation, health and wellbeing, and the influences that shape occupation” (World Federation of

Occupational Therapists, 2012b, p. 2).

Occupational therapy
Therapeutic use of everyday life occupations with persons, groups, or populations (i.e., clients) for the purpose of

enhancing or enabling participation. Occupational therapy practitioners use their knowledge of the transactional re-

lationship among the person, their engagement in valued occupations, and the context to design occupation-based

intervention plans. Occupational therapy services are provided for habilitation, rehabilitation, and promotion of health

and wellness for clients with disability- and non-disability-related needs. Services promote acquisition and preservation

of occupational identity for those who have or are at risk for developing an illness, injury, disease, disorder, condition,

impairment, disability, activity limitation, or participation restriction (adapted from American Occupational Therapy

Association, 2011).

Organization
Entity composed of individuals with a common purpose or enterprise, such as a business, industry, or agency.

Outcome
Result clients can achieve through the occupational therapy process (see Table 14).

P

Participation
“Involvement in a life situation” (World Health Organization, 2001, p. 10).

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. These patterns are influenced by context and time and can support or hinder occupational

performance (see Table 6).

Performance skills
Observable, goal-directed actions that result in a client’s quality of performing desired occupations. Skills are supported

by the context in which the performance occurred and by underlying client factors (Fisher & Marterella, 2019).

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Person
Individual, including family member, caregiver, teacher, employee, or relevant other.

Personal factors
Unique features of the person reflecting the particular background of their life and living that are not part of a health

condition or health state. Personal factors are generally considered to be enduring, stable attributes of the person,

although some personal factors may change over time (see Table 5).

Play
Active engagement in an activity that is intrinsically motivated, internally controlled, and freely chosen and that may

include the suspension of reality (Skard & Bundy, 2008). Play includes participation in a broad range of experiences

including but not limited to exploration, humor, fantasy, risk, contest, and celebrations (Eberle, 2014; Sutton-Smith,

2009). Play is a complex and multidimensional phenomenon that is shaped by sociocultural factors (Lynch et al., 2016;

see Table 2).

Population
Aggregate of people with common attributes such as contexts, characteristics, or concerns, including health risks.

Prevention
Education or health promotion efforts designed to identify, reduce, or prevent the onset and decrease the incidence of

unhealthy conditions, risk factors, diseases, or injuries (American Occupational Therapy Association, 2020a).

Process
Series of steps occupational therapy practitioners use to operationalize their expertise in providing services to clients.

The occupational therapy process includes evaluation, intervention, and outcomes; occurs within the purview of the

occupational therapy domain; and involves collaboration among the occupational therapist, occupational therapy

assistant, and client.

Process skills
The “group of performance skills that represent small, observable actions related to selecting, interacting with, and using

tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life); carrying out

individual actions and steps; and preventing problems of occupational performance from occurring or reoccurring in the

context of performing a personally and ecologically relevant daily life task. They are commonly named in terms of type of

task being performed (e.g., [activity of daily living] process skills, school process skills, work process skills)” (Fisher &

Marterella, 2019, pp. 336–337; see Table 7).

Professional reasoning
“Process that practitioners use to plan, direct, perform, and reflect on client care” (Schell, 2019, p. 482).

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Q

Quality of life
Dynamic appraisal of life satisfaction (perception of progress toward identifying goals), self-concept (beliefs and feelings

about oneself), health and functioning (e.g., health status, self-care capabilities), and socioeconomic factors (e.g.,

vocation, education, income; adapted from Radomski, 1995).

R

Reevaluation
Reappraisal of the client’s performance and goals to determine the type and amount of change that has taken

place.

Rehabilitation
Services provided to persons experiencing deficits in key areas of physical and other types of function or limitations in

participation in daily life activities. Interventions are designed to enable the achievement and maintenance of optimal

physical, sensory, intellectual, psychological, and social functional levels. Rehabilitation services provide tools and

techniques clients need to attain desired levels of independence and self-determination.

Rituals
For persons: Sets of symbolic actions with spiritual, cultural, or social meaning contributing to the client’s identity and

reinforcing values and beliefs. Rituals have a strong affective component (Fiese, 2007; Fiese et al., 2002; Segal, 2004;

see Table 6).

For groups and populations: Shared social actions with traditional, emotional, purposive, and technological meaning

contributing to values and beliefs within the group or population (see Table 6).

Roles
For persons: Sets of behaviors expected by society and shaped by culture and context that may be further con-

ceptualized and defined by the client (see Table 6).

For groups and populations: Sets of behaviors by the group or population expected by society and shaped

by culture and context that may be further conceptualized and defined by the group or population

(see Table 6).

Routines
For persons, groups, and populations: Patterns of behavior that are observable, regular, and repetitive and

that provide structure for daily life. They can be satisfying and promoting or damaging. Routines require

momentary time commitment and are embedded in cultural and ecological contexts (Fiese et al., 2002; Segal, 2004;

see Table 6).

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S

Screening
“Process of reviewing available data, observing a client, or administering screening instruments to identify a person’s (or

a population’s) potential strengths and limitations and the need for further assessment” (Hinojosa et al., 2014, p. 3).

Self-advocacy
Advocacy for oneself, including making one’s own decisions about life, learning how to obtain information to gain an

understanding about issues of personal interest or importance, developing a network of support, knowing one’s rights

and responsibilities, reaching out to others when in need of assistance, and learning about self-determination.

Service delivery
Set of approaches and methods for providing services to or on behalf of clients.

Skilled services
To be covered as skilled therapy, services must require the skills of a qualified occupational therapy practitioner and

must be reasonable and necessary for the treatment of the patient’s condition, illness, or injury. Skilled therapy services

may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or

slow further deterioration of the patient’s condition. Practitioners should check their payer policies to ensure they meet

payer definitions and comply with payer requirements.

Social interaction skills
The “group of performance skills that represent small, observable actions related to communicating and interacting with

others in the context of engaging in a personally and ecologically relevant daily life task performance that involves social

interaction with others” (Fisher & Marterella, 2019, p. 342).

Social participation
“Interweaving of occupations to support desired engagement in community and family activities as well as those

involving peers and friends” (Schell & Gillen, 2019, p. 711) involvement in a subset of activities that incorporate social

situations with others (Bedell, 2012) and that support social interdependence (Magasi & Hammel, 2004; see Table 2).

Spirituality
“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” (Billock, 2005, p. 887). It is important to

recognize spirituality “as dynamic and often evolving” (Humbert, 2016, p. 12).

T

Time management
Manner in which a person, group, or population organizes, schedules, and prioritizes certain activities.

Transaction
Process that involves two or more individuals or elements that reciprocally and continually influence and affect one

another through the ongoing relationship (Dickie et al., 2006).

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V

Values
Acquired beliefs and commitments, derived from culture, about what is good, right, and important to do (Kielhofner,

2008).

W

Well-being
“General term encompassing the total universe of human life domains, including physical, mental, and social aspects,

that make up what can be called a ‘good life’” (World Health Organization, 2006, p. 211).

Wellness
“The individual’s perception of and responsibility for psychological and physical well-being as these contribute to overall

satisfaction with one’s life situation” (Schell & Gillen, 2019, p. 1215).

Work
Labor or exertion related to the development, production, delivery, or management of objects or services; benefits may

be financial or nonfinancial (e.g., social connectedness, contributions to society, adding structure and routine to daily

life; Christiansen & Townsend, 2010; Dorsey et al., 2019).

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Index

Note: Page numbers in italic refer to exhibits, figures, and tables.

activities

defined, 74

interventions for, 59

activities of daily living (ADLs)

overview, 30, 74

examples, 35

activity analysis, 19–20, 74

activity demands, 57–58, 74

adaptation, 74

advocacy, 61–62, 74

American Occupational Therapy

Association (AOTA)

Commission on Practice

(COP), 3

Representative Assembly

(RA), 2–3

analysis of occupational perfor-

mance, 74

animals, 31

assessment, 74

assistive technology (AT), 60

bathing, 30

beliefs

defined, 15, 75

occupational performance and,

51

body functions and body

structures

overview, 15, 75

occupational performance and,

51–54

cardiovascular system functions, 53

care of others, 30

care of pets and animals, 31

case management, 19

child rearing, 31

client factors

beliefs, 51

body functions and body

structures, 51–54

defined, 75

domain and, 15

spirituality, 51

values, 51

client-centered care (client-centered

practice), 75

clients

defined, 75

examples, 29

terminology, 2, 24

clinical reasoning, 20, 75

Commission on Practice (COP), 3

communication management, 31

communication with the health

care system, 32

community, 2, 75

community mobility, 29, 31

community participation, 34

consumers, 24

context

defined, 76

environmental factors, 36–39

personal factors, 40

co-occupations, 76

cornerstones of occupational

therapy practice, 6, 76

direct services, 18

discontinuation, 27

domain

aspects of, 5, 6

client factors, 15

defined, 76

environmental factors, 9–10

occupational justice, 11–12

occupations and, 6–9

performance patterns, 12–13

performance skills, 12–15

personal factors, 10–11

dressing, 30

driving, 31

eating and swallowing, 30

education

overview, 33, 76

examples, 35

interventions for, 61

empathy, 76

employment, 33–34. see also

work

engagement in occupation, 5–6,

76

enhancement, 65–66

environmental factors, 9–10,

36–39, 76

environmental modifications, 60

episodic care, 19

evaluation

overview, 23, 76

process, 16, 55

synthesis of, 23

family participation, 34

family-centered care approaches,

19

feeding, 29, 30

financial management, 31

friendships, 34

functional mobility, 30

goals, 77

group interventions, 62, 77

groups

defined, 2, 77

examples, 29

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performance patterns, 41–42

performance skills and, 14, 50

process, 55–56

The Guide to Occupational

Therapy Practice (Moyers), 3

habilitation, 77

habits, 12, 41, 77

health and wellness, 5, 66, 77

health management

overview, 32

defined, 77

examples, 29, 35

health promotion, 24, 77

hematological and immune

system functions, 53

home establishment and

management, 29, 31

hope, 77

immune system functions, 53

improvement, 65

independence, 78

indirect services, 18–19

instrumental activities of daily

living (IADLs)

overview, 30–31, 78

examples, 35

interdependence, 78

interests, 78

intervention

approaches to, 63–64, 78

defined, 78

for education, 61

group interventions, 62

intervention implementation, 25

intervention plan, 24–25

intervention review, 25

process, 16–17, 23–26, 55–56

supporting occupations, 78

for training, 61

types of, 59–62

virtual interventions, 62

intimate partner relationships, 34

job performance and

maintenance, 33. see also work

leisure

overview, 34, 78

examples, 35

meal preparation and cleanup, 31

medication management, 32

members, 24

mental functions, 52

motor skills, 13, 43–44, 50, 79

movement-related functions, 53

neuromusculoskeletal functions, 53

nutrition management, 32

occupational adaptation, 26

occupational analysis, 19–20, 79

occupational demands, 79

occupational identity, 79

occupational justice, 11–12,

67–68, 79

occupational performance

analysis, 16, 23

client factors, 51–54

defined, 80

outcomes, 65

occupational profile, 16, 21–22, 80

occupational science, 80

occupational therapy, 1, 4, 80

Occupational Therapy Code of

Ethics, 24

occupational therapy practice

cornerstones, 6

occupational therapy

practitioners, 1

Occupational Therapy Product

Output Reporting System and

Uniform Terminology for

Reporting Occupational

Therapy Services, 2

occupation-based practice, 79

occupations

activities of daily living (ADLs), 30, 35

defined, 79

domain and, 6–9

education, 33, 35

health management, 32, 35

instrumental activities of daily living

(IADLs), 30–31, 35

interventions for, 59

leisure, 34, 35

play, 34, 35

rest and sleep, 32–33, 35

social participation, 34, 35

work, 33–34, 35

organization, 80

organization-level practice, 19

orthotics and prosthetics, 60

outcomes

overview, 26–27, 80

descriptions and examples, 65–68

process, 17, 56

PAMs and mechanical modalities, 59

participation, 5, 67, 80

patient-reported outcomes

(PROs), 27. see also outcomes

patients, 24

peer group participation, 34

performance patterns, 12–13,

41–42, 80

performance skills

defined, 81

domain and, 12–15

motor skills, 13, 43–44, 50

process skills, 13, 44–47, 50

social interaction skills, 13, 47–49

personal care device management, 32

personal factors, 10–11, 40, 81

personal hygiene and grooming, 30

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persons

defined, 2, 81

examples, 29

performance patterns, 41

performance skills and, 14, 43–49

process, 55–56

pets and animals, 31

physical activity, 32

play

overview, 34, 81

examples, 35

populations

defined, 2, 81

examples, 29

performance patterns, 41–42

performance skills and, 15

process, 55–56

prevention, 66, 81

process

overview, 15–19

activity analysis, 19–20

aspects of, 5

case management, 19

clinical reasoning, 20

defined, 81

direct services, 18

episodic care, 19

evaluation, 16, 23

family-centered care approaches, 19

groups, 55–56

indirect services, 18–19

intervention, 16–17, 23–26

occupational analysis, 19–20

occupational performance, 16

occupational profile, 16

organization-level practice, 19

outcomes, 17

persons, 55–56

populations, 55–56

professional reasoning, 20

service delivery approaches, 18–19

systems-level practice, 19

telehealth, 19

therapeutic use of self, 20

process skills

overview, 13, 81

performance skills, 44–47, 50

professional reasoning, 20, 81

prosthetics, 60

quality of life, 66, 82

reevaluation, 82

rehabilitation, 82

religious and spiritual

expression, 31

Representative Assembly (RA), 2–3

respiratory system functions, 53

rest and sleep, 32–33, 35

retirement preparation and

adjustment, 34

revisions, 3–4

rituals, 12, 41–42, 82

role competence, 67

roles, 12, 41–42, 82

routines, 12, 41, 82

safety and emergency

maintenance, 31

screening, 83

self-advocacy, 62, 83

self-regulation, 60

sensory functions, 52–53

service delivery, 18–19, 83

sexual activity, 30

shopping, 31

showering, 30

skilled services, 83

skin and related structure functions, 54

sleep, 33. see also rest and sleep

social and emotional health

promotion and maintenance, 32

social interaction skills, 13,

47–49, 83

social participation

overview, 34, 83

examples, 29, 35

speech functions, 54

spiritual expression, 31

spirituality

defined, 15, 83

occupational performance and, 51

Standards of Practice for

Occupational Therapy, 24

students, 24

swallowing, 30

symptom and condition

management, 32

systems-level practice, 19

telehealth, 19, 62

therapeutic use of self, 20

time, time management and time

use, 12, 83

toileting and toilet hygiene, 30

training interventions, 61

transaction, 83

transition, 27

Uniform Terminology for Oc-

cupational Therapy, 2

values

defined, 15, 84

occupational performance and, 51

virtual interventions, 62

voice and speech functions, 54

volunteer exploration and

participation, 34

well-being, 5, 67, 84

wellness, 84

wheeled mobility, 60

work

overview, 33–34, 84

examples, 35

work participation, examples, 29

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  • Occupational Therapy Practice Framework: Domain and Process
    • Definitions
    • Contents
    • Evolution of This Document
    • Vision for This Work
    • Introduction
      • Occupation and Occupational Science
      • OTPF Organization
      • Cornerstones of Occupational Therapy Practice
    • Domain
      • Occupations
      • Contexts
        • Environmental Factors
        • Personal Factors
        • Application of Context to Occupational Justice
      • Performance Patterns
      • Performance Skills
        • Application of Performance Skills With Persons
        • Application of Performance Skills With Groups
        • Application of Performance Skills With Populations
      • Client Factors
    • Process
      • Overview of the Occupational Therapy Process
        • Service Delivery Approaches
        • Direct Services.
        • Indirect Services.
        • Additional Approaches.
        • Practice Within Organizations and Systems
        • Occupational and Activity Analysis
        • Therapeutic Use of Self
        • Clinical and Professional Reasoning
      • Evaluation
        • Occupational Profile
        • Analysis of Occupational Performance
        • Synthesis of the Evaluation Process
      • Intervention
        • Intervention Plan
        • Intervention Implementation
        • Intervention Review
      • Outcomes
        • Outcome Measurement
        • Transition and Discontinuation
    • Conclusion
    • References
    • References
    • Index

Outline to help guide Case-study.

Outline:

1. Introduction- this can be however you would like it to be. It can be a discussion on the

types of treatment, FOR, activities, Diagnosis…. You will be discussing in your paper.

2. Model of practice/Frame of reference- in this part of your paper you will be discussing,

not defining the MOP/FOR you will be utilizing to guide treatment and why it is

relevant to the activities/treatment you have chosen for your patient.

3. Summary of primary and secondary diagnosis- in this section you will be discussing

signs, symptoms, prognosis, and prevalence of your patients diagnosis as it relates to

your patient.

4. OT problem list- utilizing your OTPF, you will prioritize, considering patient specific

diagnosis, needs, and wants. Utilized and clearly explained application of practice

framework to problem list. For example: My patient requires max assist with upper

body dressing. This activity is considered an ADL which requires Client Factors?

Performance Skills? And so on.

5. Strengths – Identified accurately and correctly all strengths and opportunities of the

patient in the case study.

6. LTG- utilize COAST or FEAST

7. STG- same as above but it has to go with the LTG

8. Methods/Interventions listed- Comprehensive list of methods that will be used in

intervention. Sound, research-based methodology is evident FOR (s) is indicated. Sound

rationale given for each method. Comprehensive.

9. 2 Treatment sessions- utilizing time management skills and progression in the

treatment continuum. Activity Analysis of each activity discussed. Shows progression

from adjunctive to purposeful with rational. Shows priority as related to discharge

plans as appropriate. After treatment session, identification of opportunity to

recommend to the occupational therapist the need for referring client for reevaluation

and additional evaluation for other services and/or professional (s).

10. Video: Medical and diagnoses information covered. Important precautions mentioned.

Brief discussion of patient’s status and goals- Uses and prepares equipment in the lab.

Overview of treatments selected and why they are appropriate for this patient is

indicated. 20-30 minutes.

11. SOAP- based on video.

Case scenario

 

Case Scenario:

A woman is admitted to the adult inpatient behavioral health unit after experiencing flashbacks to her rape that occurred when she was a 12-year-old girl while at her babysitter’s. She was raped by the babysitter’s 15-year-old son and three of his friends. Upon admission, the client is quiet, curled on her side in the fetal position on the bed, and rejecting of others who enter her room, shrinking to the far side of the bed whenever any person opens her door. Her sister, who accompanied her to the hospital, tells you that the client has been like this since a news story appeared last week about a young girl being abducted from a mall and beaten and raped by several teenage boys. The client has not eaten, slept, or gone to work since hearing the news account. 

a.  What trauma/stress-related disorder is this client experiencing? 

b. What risk factors does she exhibit?

c.  List at least two treatment interventions that are viable options to assist the client at this time. 

Instructions

Read Thoroughly: Familiarize yourself with the case, noting key elements like symptoms, medical history, and social factors affecting the patient.

Research: Conduct scholarly research to better understand the condition presented in the case study. Use at least five peer-reviewed articles to support your analysis.

Ethical Considerations: Examine any ethical considerations associated with the case. For example, consider patient consent, confidentiality, and duty of care.

Reflection: Write a 300-word reflection on what you have learned from this assignment and how it will impact your future practice.

Due Date: The initial post and peer responses are due every Saturday at 11:30 p.m.

Academic Integrity

Plagiarism will not be tolerated. Ensure that all sources are correctly cited and that you have not copied material from other sources unless appropriately cited.

Questions?

If you encounter any issues or have questions about this assignment, please email me or post them under the ‘Class Questions’ forum.

The link between health and behavior

 Reply to this student post with a reflection of her response. Your reply must be have at least 250 words, 2 student references in APA format within the las 5 years published, and no plagiarism please,

The link between health and behavior.

Health and behavior are closely linked, and understanding this connection can help us to make healthier choices and live better lives. One crucial health paradigm is the bio psychosocial model, which suggests that health results from the interplay between biological, psychological, and social factors.

Regarding biology, our genes and physiology can play a role in our physical health and behavior. For example, certain genetic predispositions may make us more susceptible to certain diseases, while certain medications can impact our mood and behavior (Ogilvie et al., 2020). In psychology, our thoughts, feelings, and coping mechanisms can affect physical and emotional health. For example, stress and anxiety can lead to physical symptoms such as headaches and stomachaches, while positive emotions and a sense of purpose can improve our overall well-being. Regarding social factors, our relationships, environments, and culture can affect our behavior and health outcomes. For example, social support can positively impact our mental health, while living in a high-crime area can negatively affect our physical safety and well-being (Jakicic et al., 2019).

The bio psychosocial model suggests that our health is not determined by any one factor in isolation, but rather by the complex interplay between our biology, psychology, and social environment. The idea is that by taking care of our health and engaging in healthy behavior, our mental and physical state improves, leading to better behavior.

                      How this relationship impacts social determinants of health.

Social determinants are the factors that shape the conditions people live, such as income, education, and access to healthcare. These factors can have a powerful impact on our health outcomes, with individuals from disadvantaged backgrounds experiencing worse health outcomes than those from more privileged backgrounds (Hill-Briggs et al., 2021).

The above relationship can have an impact on our physical health. For example, behaviors such as smoking or poor diet lead to chronic diseases which are more prevalent among individuals from lower socio-economic backgrounds. These chronic conditions can lead to additional health problems, such as increased healthcare costs, disability, and reduced quality of life. Social determinants of health can also affect individuals’ behavior and well-being; for example, lack of access to healthy food options, lack of green spaces, and high-crime areas can lead to low physical activity and poor diet (Singu et al., 2020).

In addition, a lack of access to financial resources, education, and healthcare can lead to poor mental health, which can then affect one’s behavior. For example, stress and anxiety can make it difficult for individuals to make healthy choices and engage in healthy behaviors. Overall, addressing social determinants is vital for promoting health equity and improving health outcomes for individuals.

References 

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., … & Haire-Joshu, D. (2021). Social determinants of health and diabetes: a scientific review. Diabetes care44(1), 258–279. https://doi.org/10.2337/dci20-0053

Jakicic, J. M., Kraus, W. E., Powell, K. E., Campbell, W. W., Janz, K. F., Troiano, R. P., … & 2018 Physical Activity Guidelines Advisory Committee. (2019). Association between bout duration of physical activity and health: a systematic review. Medicine and science in sports and exercise51(6), 1213. https://journals.lww.com/acsm-msse/Fulltext/2019/06000/Association_between_Bout_Duration_of_Physical.16.aspx

Ogilvie, D., Adams, J., Bauman, A., Gregg, E. W., Panter, J., Siegel, K. R., … & White, M. (2020). Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head. J Epidemiol Community Health74(2), 203-208. http://dx.doi.org/10.1136/jech-2019-213085

Singu, S., Acharya, A., Challagundla, K., & Byrareddy, S. N. (2020). Impact of social determinants of health on the emerging COVID-19 pandemic in the United States. Frontiers in public health, p. 406. https://doi.org/10.3389/fpubh.2020.00406