Scope of Practice

C. Interventions and procedures to promote or enhance safety and performance in ADLs, IADLs, health management, rest and sleep, education, work, play, leisure, and social participation, for example,

• Occupations and activities
  • Completing morning dressing and hygiene routine using adaptive devices
  • Playing on a playground with children and adults
  • Engaging in driver rehabilitation and community mobility program
  • Managing feeding, eating, and swallowing to enable eating and feeding performance.
• Preparatory methods and tasks
  • Exercises, including tasks and methods to increase motion, strength, and endurance for occupational participation
  • Assessment, design, fabrication, application, fitting, and training in assistive technology and adaptive devices
  • Design and fabrication of splints and orthotic devices and training in the use of prosthetic devices
  • Modification of environments (e.g., home, work, school, community) and adaptation of processes, including the application of ergonomic principles
  • Application of physical agent modalities and use of a range of specific therapeutic procedures (e.g., wound care management; techniques to enhance sensory, perceptual, and cognitive processing; manual therapy techniques) to enhance performance skills
  • Assessment, recommendation, and training in techniques to enhance functional mobility, including wheelchair management
  • Explore and identify effective tools for regulating nervous system arousal levels in order to participate in therapy and/or in valued daily activities.
• Education and training
  • Training in self-care, self-management, home management, and community or work reintegration
  • Education and training of individuals, including family members, caregivers, and others.
• Advocacy
  • Efforts are directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully participate in their daily life occupations.
• Group interventions
  • Facilitate learning and skill acquisition through the dynamics of group or social interaction across the life span.
• Care coordination, case management, and transition services
• Consultative services to groups, programs, organizations, or communities.

Domain and Process

The scope of practice includes the domain and process of occupational therapy services. These two concepts are intertwined, with the domain process the delivery of occupational therapy.

The domain of occupational therapy is the everyday life activities (occupations) that people find meaningful and purposeful. Within this domain, occupational therapy services enable clients to participate in their everyday life activities in their desired roles, contexts and environments, and life situations.

Clients may be individuals or persons, groups, or populations. The occupations in which clients engage occur throughout the life span and include

• ADLs (self-care activities)
• IADLs (activities to support daily life within the home and community that often require complex interactions, e.g., household management, financial management, child care)
• Rest and sleep (activities relating to obtaining rest and sleep, including identifying the need for rest and sleep, preparing for sleep, and participating in rest and sleep)
• Education (activities to participate as a learner in a learning environment)
• Work (activities for engaging in remunerative employment or volunteer activities)
• Play (activities pursued for enjoyment and diversion)
• Leisure (nonobligatory, discretionary, and intrinsically rewarding activities)
• Social participation (the ability to exhibit behaviors and characteristics expected during interaction with others within a social system)
• Health Management (activities related to developing, managing, and maintaining health and wellness routines)

Within their domain of practice, occupational therapists and occupational therapy assistants consider the repertoire of occupations in which the client engages, the performance skills and patterns the client uses, client’s body functions and structures. Occupational therapists and occupational therapy assistants use their knowledge and skills to help clients conduct or resume daily life activities that support function and health throughout the life span. Participation in activities and occupations that are meaningful to the client involves emotional, psychosocial, cognitive, and physical aspects of performance. Participation in meaningful activities and occupations enhances health, well-being, and life satisfaction.

The domain of occupational therapy practice complements the World Health Organization’s (WHO’s) conceptualization of participation and health articulated in the Health (ICF; WHO, 2001). Occupational therapy incorporates the basic constructs of ICF, including environment, participation, activities, and body structures and functions, when providing interventions to enable full participation in occupations and maximize occupational engagement.

The process of occupational therapy refers to the delivery of services and includes evaluating, intervening, and targeting of outcomes. Occupation remains central to the occupational therapy process, which is client-centered, involving collaboration with the client throughout each aspect of service delivery. During the evaluation, the therapist develops and occupational profile; analyzes the client’s ability to carry out everyday life activities; and determines the client’s occupational needs, strengths, barriers to participation, and priorities for intervention.

Evaluation and intervention may address one or more aspects of the domain that influence occupational performance. Intervention includes planning and implementing occupational therapy services and involves activities and occupations, preparatory methods and tasks, education and training, and advocacy. The occupational therapist and occupational therapy assistant in partnership with the occupational therapist utilize occupation-based theories, frames of reference, evidence, and clinical reasoning to guide the intervention (AOTA, 2014b).

The outcome of occupational therapy intervention is directed toward “achieving health, well-being, and participation in life through engagement in occupations” (AOTA, 2014b, p. S4). Outcomes of the intervention determine future actions with the client and include occupational performance, prevention (of risk factors, disease, and disability), health and wellness, quality of life, participation, role competence, well-being, and occupational justice (AOTA, 2014b).

Sites of Intervention and Areas of Focus

Occupational therapy services are provided to persons, groups, and populations. People served come from all age groups. Practitioners work with individuals one to one, in groups, or at the population level to address occupational needs and issues, for example, in mental health; work and industry; rehabilitation, disability, and participation; productive aging; and health and wellness.

Along the continuum of service, occupational therapy services may be provided to clients throughout the life span in a variety of settings. The settings may include, but are not limited to, the following:

AOTA Scope vs. State Scope

• AOTA’s Scope of Practice does not supersede the scope of practice under which the occupational therapy practitioner is licensed and practicing.

References