Jul 12 / Kimberly Breeden, MS, OTR/L, Coach, Founding Partner

The Occupational Profile Brings Meaning to My OT Practice

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In my last blog, I talked about how I have found that looking for "meaningful moments" with clients helps me find fulfillment in my occupational therapy practice. As I finished that blog I started trying to identify the things that helped me to foster more meaningful engagements with the clients I work with. There are many changes I have made as I have progressed in my OT career but I think that using the occupational profile was the most influential.  
If you are not familiar with the occupational profile, the Occupational Therapy Practice Framework: Domain and Process 4th Edition states that it is part of the evaluation process. The OTPF-4 states that the occupational profile "includes information about the client's needs, problems and concerns about performance in occupations…it 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, 2020, p. 21). 
So what does that mean? I am not an expert in this area but I will share my thoughts. It means that it is important not to just consider a client's medical condition, bodily functions or what we perceive as deficits. It is important to understand what occupations are meaningful to a client and what occupations they want to participate in. It means understanding the why, when, where and how someone does the things that define them. It means learning about the life they have lived and want to live.  
When I first read about the occupational profile I thought it was merely another description for of the information typically gathered in an occupational therapy evaluation. But as I read the practice framework more I started to wonder if my initial assumption was correct. I began to consider the information that was collected in the occupational therapy evaluations I had experience with. I had worked in many different adult acute and post-acute settings and the evaluations all seemed similar with just a few differences. They all collected information regarding the client's prior level of function, current function and goals for ADLs, IADLs and sometimes work. I think that as OT practitioners we all agree this is important information, but that is not the only information that is significant to us. 
I remember in my practice as an OTA I would ask as many questions as I could to try to "get to know my clients", I felt that this helped me to find treatment interventions that the client would best respond to. I also felt that it helped me to better develop a therapeutic relationship. As a new occupational therapist, I tried to incorporate that same curiosity into my evaluations while I focused on gathering the data I needed to complete a comprehensive evaluation. It wasn't until I reviewed the AOTA Occupational Profile Template in 2017 that I fully understood what the occupational profile was and how it was different from the evaluations I worked with and completed myself. I remember that the template helped me realize that the information I was gathering to get to know my clients better was actually important data that should be part of the evaluation. I appreciated the fact that I also had a tool that helped me to understand what information should be included in the occupational profile. As I reviewed the template, I identified that some aspects of the occupational profile were already part of my evaluation. I also realized that the data I collected was specific to the occupations of ADLs, IADLs, Rest and Sleep and Health Management. Using the template helped me to incorporate into my evaluation, questions about previous and current participation, context, and client goals for all occupations, not just self care and mobility. I typically do this by telling a client "I have reviewed your medical records and understand what you have experienced from a medical perspective, but I would like to get to know you better". I then ask questions like "have you always lived in this area?" Are you currently working or retired? What kind of work do or did you do? What things did you like to do earlier in your life? What kinds of things have you enjoyed doing recently? How did you recently spend your time? What activities are important to you? Are you a member of any organizations, groups, or religious affiliation? I have found that these questions provide an abundance of information by asking questions that are relevant and make sense to a client. I am sure that other OT practitioners have developed a better strategy for gathering this information. For full disclosure, I did not implement the exact template into my practice but tried to implement the basic concepts. 
So what changed once I implemented an occupational profile into my evaluation? My plan of care became more client-centered. The client became the expert, not me. I had information that helped me to better understand what factors were impeding occupational engagement and performance, but most importantly I was focusing on the aspects of occupational performance and engagement that were meaningful to my client, not the insurance company, not me as an OT, not the standardized tests or outcomes measures. My clients expressed that they felt heard, they felt that I cared about them because I asked them what they cared about.  
This information also helped me provide education in a more individual way, I try to use terms that my clients may be more familiar with based on their occupation, hobbies and experiences. These concepts seem simple, but in reality the occupational profile gathers information regarding complex interactions and factors needed to complete the analysis of occupational performance. The recently updated AOTA Occupational Profile Template released in 2020 in my opinion better demonstrates this complexity. After reviewing the revised template, I realize that I have a lot of opportunity to improve my process for developing an occupational profile. I would love to say that I will work on it next week and have it implemented by the end of the month but the reality is that I have a lot to juggle. I realize that client care and documentation take up most of my work time. I know myself, if I wait until I have time to tackle this all at one time, I will never get to it. I have learned that things like this have to be a process for me. I will most likely implement 1 or 2 concepts at a time into my evaluation template. It will not be perfect and I will change it many times before I find a process that works for me and my clients. I have found developing a realistic process that allows room for small failures, gives me the confidence to go ahead and try something new.  
If you aren't currently utilizing an occupational profile, you may want to consider what benefits it may have for your clients and your practice.  If you are already using the occupational profile, we hope this blog gave you a few additional things to consider. 

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


Written by: Kimberly Breeden, MS, OTR, Coach, Instructor and Founding Partner
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Just for OT Coaching is here to help you!  Let Kim and Niccole share their experiences in implementing occupation-based and client-centered care.