Tuesday, April 5, 2011

OT A to Z: D is for Domain of OT

An exciting part of the OT A to Z Challenge is that I have received a few messages and comments from people who are not OTs! Therefore, it seems important that early in this process, we take the opportunity to address what is it that OTs do. In other words, what is the Domain of OT?

Any OT student or practitioner has undoubtedly had the experience of trying to explain succinctly and clearly what we do. No, we are not "kind of like [insert other profession - nursing, PT, social work]", nor do we just work on the upper body or find people jobs. However our work can vary tremendously depending on the setting and the client population, so explaining our work can be a bit of a challenge. Interestingly, I once read that Eleanor Clark Slagle, one of the founder of OT in the US, did not particularly like the name "occupational therapy" for the profession as she felt it was unclear and would be confusing to others.

So what is the domain of OT? It the broadest sense, it is defined in the Occupational Therapy Framework: Domain and Practice (AOTA 2008) as "supporting health and participation in life through engagement in occupation" (p. 626). While we understand what those words mean, I am not sure it helps explain to others what it is we actually do!

To be a little more specific, our domain is further defined by the areas we uniquely address:
  • Activities of daily living - basic activities such as self-care, instrumental activities such as home management and driving, but also work, play leisure, education, and social participation
  • Client factors - values and beliefs of our clients, but also body structures and function
  • Performance skills - motor and praxis skills, cognitive skills, sensory processing skills, communication and social skills
  • Performance patterns - roles, habits, routines, and rituals
  • Context (our post from yesterday!) and environment - physical, social, cultural, personal, temporal, and virtual
  • Activity demands - objects used, activity requirements, sequencing, timing, body structures and functions required to complete the activity
Of course, when working with a client, these things are not addressed in a linear approach as we recognize that these functions and systems are at work simultaneously and cannot be considered independent of the others. On one hand, this is an exciting delineation as we begin to see the unique contribution of OT and how no other professions addresses these aspects of engagement in participation. However, it is still quite a litany of information to provide to someone who is learning about OT!

When explaining our domain to others, I have found that using the word occupation early in the process really makes a difference. If a client, or family, or person sitting next to me on an airplane begins to understand to what we are referring to when we say "occupation," their understanding is greatly supported. So I usually say something to this effect:

Think of all the things you need and want to do during the day - you get up, get dressed, complete your grooming, prepare your meal and feed yourself, go to work or school, interact with others, socialize with friends and family, participate in a hobby - these are all occupations. If a person has difficulty performing their daily occupations due to an injury, illness, or a developmental condition, he or she greatly benefits from occupational therapy. Occupational therapists - or OTs - address a person's ability to participate as fully as possible in their daily activities. Sometimes this is achieved through the use of activity, or sometimes the underlying cause that is limiting their participation - such as decreased strength, endurance, cognition, or sensory processing abilities - is addressed. But the goal of any OT is to support a person's occupational performance.

So how do you explain the domain of OT to those who are not familiar with our profession? What words do you consistently use in your definition?

If you are not an OT, do these explanations give you a clear picture of what it is OTs do?


  1. This blog can really help a lot of people.

    I love your site and as I browsed your blog I decided to award you the Inspiring Blog Award.
    Go to http://astorybookworld.blogspot.com/p/awards.html and pick up your award.

  2. I liked your text, it's so difficult to explain what OTs really do. In English word "occupation" is very good word to describe what we mean when we talk about OT but when I try to explain it in Finnish, it's much harder. We have only one word what we use when we translate "occupation" into Finnish (word is toiminta in Finnish) and it means different kinds of things to different people. People can understand that it means for example activity, action, functioning but very rare they think that it means those things what are occupations. When I explain what OTs do I use same kind of explanations that you describe above but usually it isn't short explanation. :)

    -Kirsi, 3rd. year OT-student, Finland

  3. Hi

    Another great post. Now I've gone back into education I tend to describe it in similar terms to you but when I was in practice I probably talked more about my day to day actvities, the client groups I saw, what I did with them etc. Like you note this is so diverse that it can result in people having a limited knowledge of what OTs do in different contexts. For example if you first meet an OT working in Hand Therapy are you then aware of their role in Mental Health.
    In the UK with the current changes to the NHS our general practitioners will have greater control of commissioning services. OTs need to focus on the bigger picture here, selling what we can do across services rather than narrowing down to client groups, conditions.
    I hope you don't mind me linking to this post on my O day.

  4. This is very informative. If someone had mentioned OT to me before I would have stared. Now I'll know what they're talking about. Thank you for that.

  5. @Deirdra and @damyantiwrites - Thank you for your kind words! The exciting thing about this project is that hopefully more people will have an increased understanding of all that OT has to offer!

    @Kirsi - You bring up a very important point!! The translation of "occupation" provides ever greater challenges in conveying what it is we do! Best wishes in your studies and welcome to OT!

    @Kirsty - You are so right about being able to speak to all it is that OTs do. Like in the UK, payment for services for OT (and many other health professions) is frequently challenged in the US, so it is important that the message about our services is as consistent and encompassing as possible. I am happy for you to link to the post!

  6. Valuable information about the great employment and job outlook for occupational therapists, and see whether or not it seems like this career may be a good fit for you. Visit good website for info.

  7. Wonderful article, thanks for putting this together! This is obviously one great post

    Work Injury Therapy & Shoulder Pain Specialist CT