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Core Beliefs

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"All people need to be able or enabled to engage in the occupations of their need and choice, to grow through what they do, and to experience independence or interdependence, equality, participation, security, health, and well-being" (Wilcock & Townsend, 2008, p. 198).

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Clients

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Persons, Organizations, Populations

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Domain

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supporting health and participation in life through engagement in occupation describes the domain in its fullest sense.

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Domain - Categories

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Areas of Occupation, Client Factors, Performance Skills, Performance Patterns, Context and Environment, Activity Demands, All are of equal value and interact

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Areas of Occupation

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Activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation

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Client Factors

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Client factors are specific abilities, characteristics, or beliefs that reside within the client and may affect performance in areas of occupation. Values, Beliefs, Spirituality, Body Structures, Body Functions

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Performance Skills

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are observable, concrete, goal-directed actions clients use to engage in daily life occupations. Motor & Praxis skills, Sensory Perceptual skills, Cognitive skills, Communication & Social skills, Emotional Regulation skills

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Performance Patterns

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Routines, Habits, Rituals, Roles When practitioners consider the client's patterns of performance, they are better able to understand the frequency and manner in which performance skills and occupations are integrated into the client's life.

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Activity Demands

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Objects Used and Their Properties, Space Demands, Social Demands, Sequencing and Timing, Required Actions, Required Body Functions, Required Body Structures

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Environment

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Physical and Social (Objects and People)

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ADLs Activities oriented toward taking care of one's own body.

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Bathing Showering, Bowel and Bladder management, Dressing, Eating, Feeding, Functional Mobility, Personal Device Care, Personal Hygiene and Grooming, Sexual Activity, Toilet Hygiene,

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IADLs Activities to support daily life within the home and community that often require more complex interactions than self-care.

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Care of others, Care of pets, Child rearing, communication management, Community mobility, Financial management, Health management and maintenance, Home establishment and management, Meal preparation and cleanup, Religious observance, Safety and emergency maintenance, Shopping,

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Rest & Sleep Includes activities related to obtaining restorative rest and sleep that supports healthy active engagement in other areas of occupation.

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Rest - relaxed state Sleep - going to sleep Sleep preparation - undressing, making bed Sleep participation - cessation of activities

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Work Includes activities needed for engaging in remunerative employment or volunteer activities

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Employment interest and pursuits, Employment seeking and acquisition, Job Performance, Retirement preparation and adjustment, Volunteer exploration, Volunteer participation

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Education Includes activities needed for learning and participating in the environment.

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Formal educational participation - math, recess Informal personal educational needs or interests exploration, Informal personal education participation

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Play Any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion

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Play exploration and Play participation

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Leisure A 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

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Exploration and Participation

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Social Participation

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Organized patterns of behavior that are characteristic and expected of an individual or a given position within a social system. Community Family Peer/Friend

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Values

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principles, standards, or qualities Client Factor

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Beliefs

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cognitive content held as true Client Factor

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Spirituality

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"the personal quest for understanding answers to ultimate questions about life, about meaning and about relationship with the sacred or transcendent, which may lead to or arise from, the development of religious rituals and the formation of community. Client Factor

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Motor & Praxis

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Motor: Actions or behaviors a client uses to move and physically interact with tasks, objects, contexts, and environments. Includes planning, sequencing (body parts), and executing new and novel movements. Praxis: Ability to carry out sequential motor acts as part of an overall plan rather than individual acts. Skilled purposeful movements

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Cognitive

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Actions or behaviors a client uses to plan and manage the performance of an activity

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Communication and Social

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Actions or behaviors a person uses to communicate and interact with others in an interactive environment

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Emotional Regulation

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Actions or behaviors a client uses to identify, manage, and express feelings while engaging in activities or interacting with others

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Sensory Perceptual

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Actions or behaviors a client uses to locate, identify, and respond to sensations and to select, interpret, associate, organize, and remember sensory events based on discriminating experiences through a variety of sensations that include visual, auditory, proprioceptive, tactile, olfactory, gustatory, and vestibular.

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Routines

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Patterns of behavior that are observable, regular, repetitive, and that provide structure for daily life. They can be satisfying, promoting, or damaging. Routines require momentary time commitment and are embedded in cultural and ecological contexts

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Habits

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"Automatic behavior that is integrated into more complex patterns that enable people to function on a day-to-day basis..." Habits can be useful, dominating or impoverished and either support or interfere with performance in areas of occupation.

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Rituals

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Symbolic actions with spiritual, cultural, or social meaning, contributing to the client's identity and reinforcing the client's values and beliefs. Rituals are highly symbolic, with a strong affective component and representative of a collection of events.

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Roles

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Roles are sets of behaviors expected by society, shaped by culture, and may be further conceptualized and defined by the client.

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Cultural context

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includes customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the client is a member.

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Personal context

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refers to demographic features of the individual such as age, gender, socioeconomic status, and educational level that are not part of a health condition.

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Virtual context

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refers to interactions in simulated, real-time, or near-time situations absent of physical contact

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Temporal context

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includes stages of life, time of day or year, duration, rhythm of activity, or history.

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Process

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This process includes evaluation, intervention, and outcome monitoring; occurs within the purview of the domain; and involves collaboration among the occupational therapist, and the client.

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Evaluation

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Occupational Profile Analysis of occupational performance

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Intervention

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Plan, Implementation, Review

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Outcomes Supporting Health and Participation in Life Through Engagement in Occupation

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Determination of success in reaching desired targeted outcomes. Outcome assessment information is used to plan future actions with the client and to evaluate the service program (i.e., program evaluation).

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Occupational Profile

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The initial step in the evaluation process that provides an understanding of the client's occupational history and experiences, patterns of daily living, interests, values, and needs. The client's problems and concerns about performing occupations and daily life activities are identified, and the client's priorities are determined.

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Analysis of occupational performance

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The step in the evaluation process during which the client's assets, problems, or potential problems are more specifically identified. Actual performance is often observed in context to identify what supports performance and what hinders performance. Performance skills, performance patterns, context or contexts, activity demands, and client factors are all considered, but only selected aspects may be specifically assessed. Targeted outcomes are identified.

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Intervention Plan

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A plan that will guide actions taken and that is developed in collaboration with the client. It is based on selected theories, frames of reference, and evidence. Outcomes to be targeted are confirmed.

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Intervention implementation

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Ongoing actions taken to influence and support improved client performance. Interventions are directed at identified outcomes. Client's response is monitored and documented.

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Intervention review

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A review of the implementation plan and process as well as its progress toward targeted outcomes.

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Standardization

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Administered and scored in a consistent manner. Designed so that the conditons for administration, scoring procedures, and interpretaton of results are pre-determined.

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Norm-Referenced Assessments

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Used to classify an individual. A group of individuals are given the assessment before it is available to the public. Scores of those individuals given the assessment after publicaton are compared to the original norm group. A rank for the individual is determined from this type of assessment.

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Raw Score

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Sum total of the point values for all correct responses of the individual on each item of the assessment. Simply add up the correct responses and give them the point value the assessment designates. Read the assessment's manual to make sure you are giving the correct number of points.

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Standard Score

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Indicate how far above or below the average ("mean") an individual score falls. Takes variance into account, the degree to which scores typically will deviate from the average score. Can be used to compare individuals from different grades, age groups, and individuals to their own previous testng. typically a standard score of 100 is average performance.

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Percentile Ranking

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Indicates the rank of the individual compared to others within the same age on the assessment. if 100 individuals were tested 25th below average 75th above average 50th average

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Age Equivalency

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Indicates that the individual has attained the same score as an average individual of that age. Be careful when reporting age equivalencies to caregivers. Typically, the easiest score for the caregiver to understand but can be misleading or discouraging.

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Reliability

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Describes the repeatability and consistency of an assessment. You should get the same results each time you give the same assessment to an individual.

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Validity

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Describes whether the results of the assessment are an accurate reflection of the individual's actual ability.

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Criterion-Referenced Assessments

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Determines what individuals can do and what they know. Does not assess how they compare to others.

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What does a Goal have to be?

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Measurable Time-framed Occupation-based Meaningful to Client

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Goal Components

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Timeframe Performance Skill deficit Observable and Measurable Outcome Measure/Assistance Level Occupational Area

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By discharge, the patient will have increased motor coordination to promote success with dressing.

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Timeframe ✓ Performance skill deficit ✓ Occupational Area ✓ X Observable measurable X assistance level

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The patient will have increased problem-solving as demonstrated by completing a 25 piece puzzle independently, to promote success with academic skills.

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X Timeframe Performance skill deficit ✓ Occupational Area ✓ Observable measurable ✓ Assistance level ✓

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By discharge, the therapist will increase the patient's knowledge of hip precautions as demonstrated by 100% accuracy with carryover by the patient, to promote success with functional mobility and ADLs

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THE THERAPIST X Timeframe ✓ Performance skill deficit ✓ Occupational Area ✓ Observable measurable ✓ Assistance level ✓

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By discharge, the patient will have increased motor coordination as demonstrated by 90% accuracy with completion of all fine motor tasks.

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Timeframe ✓ Performance skill deficit ✓ X Occupational Area X Observable measurable Assistance level ✓

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