Occupational therapist

Some occupational therapists treat individuals whose ability to function in a work environment has been impaired. These practitioners arrange employment, evaluate the work environment, plan work activities, and assess the client's progress. Therapists also may collaborate with the client and the employer to modify the work environment so that the work can be successfully completed.

Pediatric occupational therapists support their communities by providing services to infants, toddlers, children, youth, and their families across a variety of settings that might include schools, clinics, and homes.  They do this by implementing intervention that is driven by science and backed by evidence. A child's life is made up of “occupations.” These “occupations” and/ or daily activities include play, learning, and socializing.  The role of the pediatric occupational therapist is to support the child in any environment in which the child is not able to carry out the desired occupations. The most common areas of practice for a pediatric occupational therapist include: Neonatal Intensive Care Units (NICU), early intervention, schools, and outpatient services. Areas of emerging practice include: primary care and community-based.

Neonatal Intensive Care Units (NICU)

From the beginning of life, occupational therapists might work with infants who are medically-fragile in Neonatal Intensive Care Units (NICU) of medical centers. An occupational therapist might address areas such as feeding/nutrition, positioning, development, sensory processing and integration, and sleep.

Early Intervention

An occupational therapist may work with children in early intervention, from birth to three years old.  The role of the occupational therapist is to support the child's needs by collaborating with the caregivers/parents.  The goal of the occupational therapist in early intervention is to support the achievement of developmental milestones.  They do this by providing intervention and education in the context of play and daily living. Therapeutic intervention may include feeding/nutrition, physical development, play skill development, social/emotional development. In early intervention, a strong emphasis is placed on parent/caregiver education.  

Schools

Once a child is over the age of three and meets eligibility for special education services, the child may receive occupational therapy services through an Individualized Education Plan (IEP). In the school setting, the goal of occupational therapy is to support the implementation of the IEP.  The occupational therapist might do this by providing direct or indirect services. Direct services might include individual or group services. Indirect services might include consultation with their school team, creating modifications and/or accommodations for the classroom, and/or providing training to the school team.

Outpatient services

Occupational therapists might also work with children in an outpatient clinic.  When serving children in an outpatient clinic, services typically have to meet the criteria for medical necessity.  Occupational therapists continue to focus on “occupations”, however, the “occupations” typically are related to medically necessary occupations such as safety and health.  

Primary care

Primary care for occupational therapists is an emerging area of practice. Traditionally a primary care office included physician, physician assistant, nurse, or nurse practitioner. In this model, the physician is limited to diagnosing and medical management.   The field of occupational therapy is advocating for occupational therapists to become a part of primary care teams. In regard to children, an occupational therapist could contribute by providing early parent training, developmental screenings, tips for wellness and prevention.  

Another emerging area of practice for occupational therapy is promoting health and wellness through community-based programming.  Occupational therapist can do this by coaching and consulting in the community. It is implemented through not just the OTs but through the community stakeholders and the disabled themselves.

OTs work in CBR projects as trainers and educators to help teach community members while facilitating them and developing programs.[3]

Some examples include backpack awareness, promoting physical activity in families, creating inclusive community environments such as churches and health facilities, advocacy at government levels, conducting rallies, etc.

This refers to forced movement of communities by environmental or social factors which causes loss of occupational activities. This is caused by a number of factors including natural disaster, famine, armed conflict or developmental and economic changes. Occupational therapists work with these displaced persons in order to help rebuild roles, routines, self-efficacy, so that occupational imbalance, injustice, or deprivation does not occur. Occupational therapists work through community-based programs that are client-centered and culturally sensitive.[4]

Occupational therapy is very beneficial to the older population. Therapists help older people lead more productive, active, and independent lives through a variety of methods, including the use of adaptive equipment. Occupational therapists work with older people in many varied environments, such as in their homes in the community, in hospital, and in residential care facilities to name a few. In the home environment, occupational therapists may work with the individuals to assess for hazards and to identify environmental factors that contribute to falls. Occupational therapists are often instrumental in assessing for appropriate wheelchairs for older people who may need them. In addition, therapists with specialized training in driver rehabilitation assess an individual's ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommendations for adaptive equipment, training to prolong driving independence, and alternative transport options.

In the period between World War World I and World War II, occupational therapy services were most valued in mental health facilities treating people with mental illness.[5] Occupational therapists found that engagement in occupation was an effective intervention for increasing self-regulation and mental well-being in people with mental illness. Occupational therapy services in mental health aim to promote positive mental health, prevent mental health problems, and help manage mental health challenges by providing client-centered care that promotes participation in meaningful occupations of everyday life.[6] Occupational therapists address the needs of clients in all phases of mental health recovery and in all settings, ranging from acute inpatient mental health settings to community mental health settings. Therapists also work with clients on a large continuum of mental health challenges, including clients with substance-use disorders, mental illness, eating disorders, or stress-related challenges. Skilled interventions with clients may include:

• Self-regulation and coping strategies (e.g. mindfulness, grounding)
• Implementation of healthy habits and routines
• Motivational interviewing
• Strategies to reduce stress
• Sensory modulation-related interventions to self-regulate
• Behavioral interventions, such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT)
• Trauma-informed care
• Skills training with accommodations or compensatory strategies
• Mental health literacy
• Lifestyle redesign, a preventative occupational therapy intervention to promote wellness

Occupational therapy (OT) practitioners help patients with terminal illnesses and conditions by assisting them with their needs related to end-of-life support. All of the areas of a patient's life including work, play and leisure are widely affected. An occupational therapist provides various treatment modalities to help such individuals to restore or maintain their deteriorating performance components by using their remaining capabilities to give them a sense of self-importance and a measure of self-confidence. The World Federation of Occupational Therapy (WFOT) recognizes the important role OT practitioners have in end-of-life care.[7] In working with patients who have severe health conditions, disabilities and terminal illnesses, the OT clinician will help these individuals engage in meaningful, everyday occupations, as well as exercise the right to well-being and the best quality of life despite the unavoidable conclusion to their lifecycle. An OT practitioner understands the transactional relationship that exists between the individual, environment, and occupation; so that life enhancing, ongoing performance in quality of life activities are promoted. The WFOT recognizes an optimistic presence for OT in end-of-life care with an ongoing need for advocacy and support.[8]

Occupational therapists often work within interdisciplinary or multidisciplinary teams (professionals such as physical therapists, nurses and physicians) to help individuals with chronic pain develop active self-management strategies. An area of specific concern to occupational therapists is the usage of a patient's time [9] but it is also common for occupational therapists to help people return to work, and to return to leisure and family activities.[10] Occupational therapists may use a variety of interventions including biofeedback, relaxation, goal setting, problem solving, planning, and can use those tools within both group and individual settings.[11] Therapists may work within a clinic setting, or in the community including the workplace, school, home and health care centers. Occupational therapists may assess occupational performance before and after intervention, as a measure of effectiveness and reduction in disability.[12]

In order for an individual or group to receive occupational therapy services they must first be referred by themselves, another health care provider, or through their support system (family, friends) to receive an occupational therapy evaluation. As part of the service delivery process, the evaluation consists of the initial occupational profile followed by an analysis of occupational performance.[13] Occupational therapy evaluations and occupational therapy assessments are important in determining an individual's skill set or deficiency. Through the occupational profile, which is a structured interview of the client, an occupational therapist can identify the client's self-perceived strengths and limitations in participating in daily occupations and help create an individualized treatment plan that addresses the occupations that are meaningful and necessary to the client. As part of the occupational profile, an occupational therapist also seeks to identify physical and social supports and barriers to participation.[13] Occupational therapists often gather additional information by communicating with the client's support system, which may include a child's parents/guardians, a student's teacher, an adult's spouse/siblings/friends, or a senior's caretaker. The analysis of occupational performance may be gathered through standardized assessments, clinical observations of the client performing a set of tasks and activities, and analysis of the physical or social environment and context in which the client performs the occupations. Occupational therapist utilize skilled observation simultaneously with evaluation of motor and process skills and the effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADLs). Occupational therapists are trained in the administration of standardized assessments across the lifespan from infancy to old age, although some standardized assessments require an occupational therapist to gain additional certifications to administer. Examples of the types of assessments or skill areas Occupational Therapy Practitioners assess include:

• Sensory processing skills
• Visual perception and visual motor skills
• Gross motor and fine motor skills
• Handwriting
• Hand dexterity
• Cognition and intelligence
• School based evaluations
• Developmental milestones
• Daily living tasks include dressing and feeding
• Pain
• Executive Functioning

Through the initial evaluation process, occupational therapists work with the client to establish an individualized treatment plan. Data is collected and recorded throughout the treatment process to be utilized to assess progress and guide ongoing client-centered intervention. This data is also frequently utilized for reimbursement of services. At the conclusion of therapy services, an occupational therapist will complete an outcome assessment which may include a re-evaluation.[13]

Assessment may also be more broad such as assessing the accessibility of public spaces for all individuals. Occupational therapists can provide recommendations for building design to allow for access for all. Occupational therapists are also skilled at completing home safety assessments and altering the environment or providing accommodations for ways to complete occupations in the home for increased safety of clients. Occupational therapists can also complete driving assessments to determine the required accommodations in the car or the ability of an individual to safely drive. Furthermore, occupational therapists can work with whole organizations to assess their workspaces to ensure that the work demands and physical set up are conducive to safe working habits to prevent workplace injuries.

• AOTA Inc. (1994). Policy 5.3.1: Definition of occupational therapy practice for state regulation. The American Journal of Occupational Therapy, 48(11), 1072-1073.
• Chapparo, C., & Ranka, J. (1997a). Occupational Performance Model (Australia): Definition of terms [Electronic Version], 58-60. Retrieved April 5, 2006 from http://www.occupationalperformance.com/index.php/au/home/definitions.
• Chapparo, C., & Ranka, J. (1997b). Using the OPM(A) to guide practice and research [Electronic Version]. Retrieved April 10, 2006 from http://www.occupationalperformance.com/index.php/au/home/practice_guide.
• Crepeau, E. B., Cohn, E. S., & Schell, B. A. B. (2003). Occupational Therapy practice today. In E. B. Crepeau, E. S. Cohn & B. A. B. Schell (Eds.), Willard & Spackman's occupational therapy (10th ed., pp. 27–30). Philadelphia: Lippincott Williams & Wilkins.
• Crossman, A. R., & Neary, D. (2000). Neuroanatomy : an illustrated colour text (2nd ed.). Edinburgh ; New York: Churchill Livingstone.
• Punwar, A. J. (2000). Defining Occupational Therapy. In A. J. Punwar & S. M. Peloquin (Eds.), Occupational therapy : Principles and practice (3rd ed., pp. 3–6). Philadelphia: Lippincott Williams & Wilkins.
• Schwartz, K. B. (2003). The history of occupational therapy. In E. B. Crepeau, E. S. Cohn & B. A. B. Schell (Eds.), Willard & Spackman's occupational therapy (10th ed., pp. 5–13). Philadelphia: Lippincott Williams & Wilkins.
• Occupational Therapists. Bureau of Labor Statistics, US Department of Labor,Occupational Outlook Handbook, 2004-05 Edition, Bulletin 2570. Superintendent of Documents, US Government Printing Office, Washington, DC, 2004.
• Strong, Unruh, Wright and Baxter (Eds.)(2002.) Pain: A textbook for therapists. Churchill Livingstone: London
• American Occupational Therapy Association (n.d.). Board and specialty certifications. Retrieved August 3, 2019, from https://www.aota.org/Education-Careers/Advance-Career/Board-Specialty-Certifications.aspx
• Bhasin, P., Blaauw, G., Lynch, M., Dunnington, C., & Swanton, J. (2010). Promote all that we do as occupational therapy practitioners to help people live life to its fullest. https://www.aota.org/~/media/Corporate/Files/AboutAOTA/Centennial/Brand/Toolbox/Discussion/Promote%20the%20Profession.pdf
• Bhasin, P., Blaauw, G., Lynch, M., Dunnington, C., & Swanton, J. (2010). Your role in promoting OT [PDF file]. https://www.aota.org/~/media/Corporate/Files/AboutAOTA/Centennial/Brand/Toolbox/Discussion/Professional%20Commitment%20Worksheet.pdf Occupational therapist. (2019). Retrieved August 3, 2019.