Vol. 24 • Issue 24 • Page 8
Issues in Fieldwork
The second edition of the Occupational Therapy Practice Framework: Domain & Process (OTPF) was just released in the Nov./Dec. issue of the American Journal of Occupational Therapy (AJOT). The new version reflects the assimilation and consensus following five years of collecting comments on the first edition and sending the new edition through multiple reviews by the AOTA membership spearheaded by the Commission on Practice. The Representative Assembly ratified the new Framework officially at their meeting in April.
According to the new document, "The Framework was developed to articulate occupational therapy's contribution to promoting the health and participation of people, organizations, and populations through the engagement in occupation. this second edition is intended to refine the document and include the language and the concepts relevant to current and emerging practice" (AJOT, 2008, pp. 625).
The OTPF provides a common language we can use to describe practice in terms of purpose and outcomes regardless of what therapeutic or educational model, theory or approach we use. If we use the Framework language whenever possible, we can talk between practitioners and settings with greater ease-and, more importantly, our consumers, the public and other stakeholders will come to understand the purpose of occupational therapy faster.
All fieldwork educators working with fieldwork students in the next 6-12 months are encouraged to introduce the second edition of the OTPF to each student, as most likely the students are familiar with the first edition. Encouraging fieldwork students to take on creative learning activities will assist them with learning the new document and could assist you and your staff with integrating the OTPF deeper into the fabric of your practice as well. A win-win, for sure!
Here are some ideas for fieldwork student projects to assist with integration of the OTPF during fieldwork:
Develop and present an inservice about the changes in the second edition and what implications this has for describing your practice setting.
Design an event your staff and even clients could participate in that addresses social justice issues using an occupational justice perspective.
Perform an interdisciplinary "word search" to compare the OTPF descriptions of practice with others. Or, create an interdisciplinary student activity where students compare and contrast how they describe what they do with the same clients or intervention program goals using their official language of practice. Challenge the students to define what is unique to occupational therapy.
Have an OT-OTA fieldwork student team discuss how they would approach interventions working together with patients in your setting across the areas of occupations identified in the OTPF to maximize benefits and be a cost-effective service.
Ask the student to use the OTPF's "Aspects of Occupational Therapy's Domain"-areas of occupation, client factors, performance skills, performance patterns, context and environment, and activity demands-as the categories of a major case, indentifying what is common to the diagnosis or pathology and what is an individualized consideration.
Have the student classify your current approach to initial evaluation regarding the criteria for the occupational profile and analysis of occupational performance and suggest reasonable ways to improve this process.
Develop a card file, spreadsheet or test for a marketing brochure of occupational therapy intervention approaches or outcomes-create/promote, establish/restore, maintain, modify, prevent-useful for a specialized program or specific client population.
Using the "Types of OT Interventions," ask the student to survey the practitioners in your setting regarding how they would classify their interventions as occupation based, purposeful activity or preparatory methods as well as therapeutic use of self and consultation. Invite them to report summary findings and lead a discussion with staff.
Perform an evidence-based literature review for findings that link a preparatory method used in your practice with published outcomes demonstrating the link between the methods and changes in purposeful activity and/or occupation-based intervention.
This last activity is truly the most important, as preparatory activities are used in many occupational therapy programs. OTs are responsible for ensuring that activity or occupations improve. We must either show this link in our outcomes at discharge or have evidence that supports the link for intervention-planning services. Demarcating what outcomes are assumed and which ones have evidence allows us to accurately and validly describe our intervention choices-and even choose better options.
So turn on your fieldwork students' light bulbs regarding the OTPF in your practice through innovative, structured learning activities during fieldwork!
Patricia Crist, PhD, OTR, FAOTA, is chair of the occupational therapy department at John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA. She has been a fieldwork coordinator for more than 18 years. Readers may contact Dr. Crist at email@example.com or at firstname.lastname@example.org, or write to her c/o "Issues in Fieldwork," OT ADVANCE, 2900 Horizon Drive, King of Prussia, PA 19406.