Practitioner Considerations

OT Dude Academy’s Free NBCOT® Exam Prep Course Process Practitioner Considerations
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1 Top-Down vs Bottom-up Approach
2 Communication
3 Family-centered practice

Top-Down vs Bottom-up Approach

  • Bottom-up approaches may view the medical condition as the problem and imply that the client is like to experience occupational dysfunction.
  • In contrast, a top-down approach views occupational in the foreground with occupational dysfunction established first, and then the causes are elaborated.1 
  • Top-down approaches are synonymous with the roots of the profession.
  • The practitioner is holistic when using a top-down approach.
  • One limitation of using bottom-up approach is that the frames of references often utilize theory from other disciplines.2 
  • Top-down promotes the client’s engagement in occupations that bring meaning.3 
  • Overall, it is important to be cognizant of both approaches and to be aware of the implications when using each one.
Bottom-upTop-down
Sensory IntegrationOccupational Science
NDTMOHO
PNFP-E-O-P
Brunnstrom Movement TherapyOccupational Adaptation
Motor RelearningActivities Health Model
Source: Weinstock-Zlotnick, G., & Hinojosa, J. (2004). Bottom-up or top-down evaluation: Is one better than the other? American Journal of Occupational Therapy, 58(5), 594-599.

Communication

  • The interactive process that focuses teams on enhancing client functional performance despite disabilities.4 

Family-centered practice

Family-centered practice involves working collaboratively with parents and other family members in occupational therapy practice.5 

  • Similar terminology: parent empowerment6 , family-focused intervention7 , family-centered service or care.8 
  • Shared decision-making results in better therapy outcomes that are more relevant and meaningful to both the child and family.9 10 
  • The traditional approach was more child-centered focused to promote changes in the child and separate from the family.11 
  • Instead of the practitioner as the expert, parents may be actively involved in the process including parent training.12 
  • Recognize the parent’s individual needs and preferences when planning interventions.13 14 
  • Parents can be a valuable resource as experts in their child’s strengths and needs.13 
  • Consider the child’s context not only in their life but within their community.15 
  • Decision-making could be collaborative and involve parents and professionals to reflect family goals and strengthen family systems.8 16 
  1. Wilding, C., & Whiteford, G. (2007). Occupation and occupational therapy: Knowledge paradigms and everyday practice. Australian Occupational Therapy Journal, 54(3), 185-193.[↩]
  2. Weinstock-Zlotnick, G., & Hinojosa, J. (2004). Bottom-up or top-down evaluation: Is one better than the other?. American Journal of Occupational Therapy, 58(5), 594-599.[↩]
  3. Brown, T., & Chien, C. W. (2010). Top-down or bottom-up occupational therapy assessment: which way do we go?.[↩]
  4. Hanft, B., & Swinth, Y. (2011). Commentary on collaboration. Journal of Occupational Therapy, Schools, & Early Intervention, 4(1), 2–7. https://doi.org/10.1080/19411243.2011.585057[↩]
  5. Hanna, K., & Rodger, S. (2002). Towards family‐centred practice in paediatric occupational therapy: A review of the literature on parent–therapist collaboration. Australian Occupational Therapy Journal, 49(1), 14-24.[↩]
  6. Dunst, C. J., Trivette, C. M. & Deal, A. G. (1988). Enabling and empowering families: Principles and guidelines for
    practice. Cambridge: Brookline Books[↩]
  7. Bailey, D. B., Simeonsson, R. J., Winton, P. J., Huntington, G. S., Comfort, M., Isbell, P., O’Donnell, K. J. & Helm, J. M. (1986). Family-focused intervention: A functional
    model for planning, implementing and evaluating individualized family services in early intervention. Journal of the Division for Early Childhood, 10, 156–171.[↩]
  8. Bailey, D. B., Buysse, V., Edmondson, R. & Smith, T. (1992b). Creating family-centered services in early intervention: Perceptions of profession[↩][↩]
  9. Bazyk, S. (1989). Changes in attitudes and beliefs regarding parent participation and home programs: An update. American Journal of Occupational Therapy, 43,
    723–728.[↩]
  10. Wallen, M. & Doyle, S. (1996). Performance indicators in paediatrics: The role of standardised assessments and goal setting. Australian Occupational Therapy Journal, 43, 172–177.[↩]
  11. Rosenbaum, P., King, S., Law, M., King, G. & Evans, J. (1998). Family-centred service: A conceptual framework and research review. Physical and Occupational Therapy in Pediatrics, 18, 1–20[↩]
  12. Bazyk, S. (1989). Changes in attitudes and beliefs regarding parent participation and home programs: An update. American Journal of Occupational Therapy, 43, 723–728.[↩]
  13. Rosenbaum, P., King, S., Law, M., King, G. & Evans, J. (1998). Family-centred service: A conceptual framework and research review. Physical and Occupational Therapy in Pediatrics, 18, 1–20.[↩][↩]
  14. Turnbull, A. P. & Turnbull, H. R. (1990). Families, professionals and exceptionality: A special partnership (2nd edn). Columbus: Merrill.[↩]
  15. Hanson, M. J. & Carta, J. J. (1995). Addressing the challenges of families with multiple risks. Exceptional Children, 62, 201–212.[↩]
  16. Gavidia-Payne, S. (1995). Contemporary perspectives in the study of families of young children with disabilities: Implications for policy and practice. Australian Journal of Early Childhood, 20, 11–18.[↩]
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