Occupation Centered Practice in Today’s Public Schools

As a school-based occupational therapy practitioner (OTP), I provide a related service through the child’s Individualized Education Plan (IEP). This means that occupational therapy serves as a supportive role in enabling the student’s participation in the school environment, and educationally related learning experiences. In addition to providing direct services, I collaborate with the educational team and parents, and everyone is responsible for the outcomes.

I define occupation-centered or occupation based practice (OBP) as using occupation, or meaningful tasks, as the means to achieving a goal. I utilize OBP in schools for a variety of reasons. According to the literature, best practice in pediatrics is occupation based (Estes & Pierce, 2012). OBP is individualized, students and families better understand occupations, and OBP is more family-centered (Estes & Pierce, 2012). Similar to what Estes & Pierce reported (2012), after engaging the student, I find that OBP is more motivating, enjoyable, effective, and rewarding.

With the recent shift back to occupation-based practice, I have updated how I assess students, and I now include information on the student’s occupational performance and occupational deficits (American Occupational Therapy Association [AOTA], 2014; Estes & Pierce, 2012). The goal is to determine which occupations the student (and in some cases the parent) is interested in (Molineux, 2010). OTPs in the schools uniquely establish goals that focus on occupation, and components of performance (AOTA, 2014). For example, a goal would state that the child would improve a specific performance area, as evidenced by their ability to complete a certain meaningful activity.

Once occupation based goals are identified, I achieve OBP by planning the meaningful activities, and by providing opportunities for the student to engage in a range of other purposeful occupations to improve function (Molineux, 2010; Ward, Mitchell & Price, 2007). For example, prior to the student’s arrival, I set up a variety of everyday tasks a student may engage in while at school. I allow the student to choose the activity, which makes it meaningful and motivating, then I adapt that task to address the performance areas. I consistently utilize occupation as a therapeutic agent for mealtime skills, play skills, handwriting skills and typing skills.

After reviewing the literature and becoming more informed, I have decided to include more occupational science (OS) knowledge in my practice via my clinical reasoning skills. According to Kristensen & Peterson, clinical reasoning is an essential skill set that enables OTPs to make the best professional decisions in relation to individual students (2016). Before reading Kristensen & Peterson (2016), I would have never connected OS research to clinical reasoning competency, or thought of that as OBP. Prior to my course on evidence-based practice last spring, I was solely relying on knowledge gained from professional experience to guide my clinical reasoning skills.

I have also decided to incorporate the research on co-occupation into the collaborative process that takes place in the schools (Price & Stephenson, 2009). The occupations and co-occupations of parenting are crucial in maximizing the potential of the students I work with (Price & Stephenson, 2009), and families are more likely to follow through with an occupation-based home program (Estes & Pierce, 2012). In this way OS could better inform parent education (Price & Stephenson, 2009), and again, this is considered OBP.

In conclusion, as a school-based OTP, occupation remains at the center of my practice. After reviewing the literature on occupation based practice and occupational science, its role has grown exponentially in informing my practice as an OTP. I have found that occupational science is an untapped source of knowledge that can improve my clinical reasoning skills, as well as how I implement OBP in the schools. This indicates that my professional identity has been influenced and is evolving into a more scientifically grounded and occupation based identity, thus priming me to become a better agent of change.

References

American Occupational Therapy Association [AOTA]. (2014). Occupational therapy practice framework: Domain and process, 3rd edition. American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48.

Estes, J. & Pierce, D. (2012). Pediatric therapists’ perspectives on occupation based practice. Scandinavian Journal of Occupational Therapy,19, 17–25.

Molineux, M. (2010). Occupational science and occupational therapy: Occupation at center stage, In: Introduction to Occupation: The Art and Science of Living 2nd Ed.

Ward, K., Mitchell, J., & Price, P. (2007). Occupation-based practice and its relationship to social and occupational participation in adults with spinal cord injury. OTJR: Occupation, Participation & Health, 27(4), 149–56.

Price, P., & Stephenson, S. (2009). Learning to promote occupational development through co-occupation. Journal of Occupational Science, 16(3), 140–150.

Kristensen, H. & Petersen, K. (2016). Occupational science: An important contributor to occupational therapists’ clinical reasoning. Scandinavian Journal of Occupational Therapy, 23(3), 240 -243