Mar 15 / Kimberly Breeden, Occupational Therapist, Coach, Continuing Education Instructor, Founding Partner

Using the OTPF 4 In Everyday OT Practice

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If you have read my previous blogs, you know that I feel it is important to promote the value of occupational therapy as often as possible. In my opinion, promoting OT is most effective when it occurs in daily practice. 
In order to do this, occupational therapy practitioners have to do more than explain to our clients, colleagues and prescribing providers what occupational therapy is and how it can be beneficial. To best promote our services we have to ensure that our clients benefit from the occupational therapy services they receive. I also feel that is important that our clients be able to distinguish OT services from those provided by other disciplines. The question I am often asked is: "How do we do this?". 
To ensure that as occupational therapists, occupational therapy assistants and students we provide the highest quality services, we must make sure that our assessments and interventions are informed and evidence-based.  
As an occupational therapist who works in home health, I have found that using the Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF 4) is the easiest way to ensure that my practice is informed and that I distinguish my services from other services provided. Unfortunately, I have not always worked to stay informed, as a matter of fact until 7 years ago I had no idea that the Uniform Terminology for Occupational Therapy had been terminated and replaced with the Occupational Therapy Practice Framework: Domain and Process in 2002. To be fully transparent, I didn’t realize it until years after the second edition was adopted. I once thought of the document as only a reference that students would use to understand occupational therapy. I now refer to it at least once a month to guide my clinical reasoning and to justify why a particular intervention such as self-management or sexuality should be addressed in my plan of care.
If you are not familiar with the OTPF 4, it is an official document of the American Occupational Therapy Association developed by the Commission on Practice and reviewed every 5 years. To quote the document, it
  "must be used to guide occupational therapy practice in conjunction with the knowledge and evidence relevant to occupation and occupational therapy within the identified areas of practice with the appropriate clients."  
It is "intended to be a valuable tool in the academic preparation of students, communication with the public and policymakers, and the provision of language that can shape and be shaped by the research".
I find it interesting that the document is meant to be used by those outside of the profession. If it is meant to be used by policymakers, that means that legislation and reimbursement policies affecting occupational therapy may be based on information included in this document. It means that our state practice acts may be influenced by this document. It means that students and new graduates may be very familiar with this document, and if I am not basing my practice on the OTPF 4, my services may be perceived as out of date or less informed. 
I find it extremely helpful in providing me with terminology that not only supports my interventions, but also clearly distinguishes my services from other disciplines. I now include a specific occupational profile in my evaluations, this not only serves to ensure that my assessment and interventions are occupation-based, but it also provides readers (co-workers, prescribing providers and insurance reviewers) a more clear idea of what occupational therapy is. I frequently refer to the aspects of the Domain to help me better clinically reason through addressing occupations, contexts, performance patterns, performance skills and client factors associated with occupational engagement. I utilize terms such as "meaningful occupations" instead of activities, because many disciplines can provide therapeutic activities, but the use of occupation is specific to OT.  
In reference to occupation, the OTPF 4 clearly defines the categories of occupations that OT would and should address: ADLs, IADLs, health management, rest and sleep, education, work, play, leisure and social participation. By clearly identifying health management and rest and sleep, I feel confident that it is within the practice of occupational therapy to address issues such as medication management, self-management of chronic conditions, management of health information, pacing and sleep hygiene.  
What I personally like the most about the document is how it articulates so clearly that "occupational therapy practitioners recognize the importance and impact of the mind-body-spirit connection on engagement and participation in daily life". There is growing research and recognition in the medical field to the benefits of holistic care, but for some reason I do not see OT practitioners leading these initiatives, even though our profession has embraced these principles for over a 100 years. I believe that the OTPF 4 supports the psychosocial interventions I provide when working within the expectations of "medical necessity". 
I am extremely grateful to all of the occupational therapists and occupational therapy assistants who have contributed to this document since it's inception, it is an invaluable tool that allows me to confidently practice and promote my profession to the fullest.  
At Aspire OT we strive to ensure that the occupational therapy continuing education courses we create are also based and influenced by the Occupational Therapy Practice Framework: Domain and Process, 4th Ed. 
If you aren't familiar with the OTPF 4, as an OT practitioner I highly recommend that you check it out. If you are familiar with it, I would challenge you to utilize it to identify areas that could be improved in your practice.  
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