The practice and process of occupational therapy

Using the occupational therapy process to focus your practice on occupation

This section focuses your practice of occupational therapy on occupation, occupational performance and the occupational needs of the people you work with. Your service users are seen as unique occupational beings within the context of their environments. Ill health is viewed from an occupational perspective as occupational dysfunction, disruption or deprivation. Your practice is concerned with developing, maximising and/or maintaining your service users’ occupational performance, or increasing the range of occupations in which they engage. This may involve helping your service users to change, modifying their preferred or required occupations, adapting their environments, or a combination of these.
 

The occupational therapy process

As with the previous Professional standards for occupational therapy practice (2nd ed) (COT 2007c), this version also structures the standards concerning your ‘hands-on’ practice by using the occupational therapy process. Although it is a generalisation of the stages in your interaction with your service users, it is a process that does typically occur and is common to most practitioners.

Involving your service users and their carers

Your service users and their carers should be at the centre of your practice. You should be working in partnership with them, accommodating their choices and wishes as much as possible. It is understood that this is not always possible when your service users do not have the ability or capacity to cooperate in this way. Your decisions should be guided by the best interests of your service users. Please also see the section and standards related to consent.

Your practice

Taking your service users through this process is only one part of your practice. You will need to use the knowledge and skills you have learned through training, experience and continuing professional development. You will also need to demonstrate behaviours that promote and protect the wellbeing of service users and their carers, the wider public, and the reputation of your employers and the profession. The Code of ethics and professional conduct (COT 2010a) describes a set of professional behaviours and values that the British Association of Occupational Therapists expects its members to abide by, and believes all occupational therapy personnel should follow.  (Adapted from COT 2010a, section1.1)

Auditing the quality of your practice

The quality of your practice as an occupational therapist can be audited by examining the content of your care records. If your care records are poorly kept, you cannot show the nature of your practice, nor can you justify or prove your actions.
 

4. The practice and process of occupational therapy - standards

4.1  You have clearly documented procedures for the management of referrals to the service, which may form part of a referral to a multidisciplinary team or overall organisation

Criteria
4.1.1 You have a clearly documented procedure for referral to the service
4.1.2 You have clearly documented criteria for referral to the service in line with the service specifications
4.1.3 You have a clearly documented procedure for processing the referrals and for maintaining a waiting list, including time frames and a prioritisation system
4.1.4 You have a clearly documented procedure for declining and/or transferring a referral
4.1.5 Where appropriate, informed consent is gained before your service users are referred to another service
4.1.6 You record the referral details in your service users’ records according to local policy and practice
 

4.2  Through interview, observation and/or specific assessment, you identify and evaluate your service users’ occupational performance and occupational needs, in the context of their physical, social, psychological, cultural, religious and environmental circumstances

Criteria
4.2.1 You actively involve your service users in the assessment process, including their families/carers where appropriate and necessary
4.2.2 You use assessment techniques and/or equipment that are appropriate to your service users and their circumstances
4.2.3 You use standardised and non-standardised assessment tools that are appropriate to your service users and their circumstances
4.2.4 When analysing the outcomes of your assessment(s) you take account of the background and circumstances of your service users
4.2.5 Your analysis of the assessment outcomes shows how your service users’ current circumstances or conditions affect their occupational performance
4.2.6 You identify and assess the needs of your service users’ families and carers where necessary
4.2.7 If further assessments or investigations are indicated, you are able to instigate these or refer to other services
 
More information is available from COT/BAOT Briefings 42: Quality Briefing: Assessments and outcome measures (COT 2010f).
 
 

4.3  You develop appropriate intervention plans, or recommendations, that meet the occupational performance needs of your service users, as identified by your assessment/s

Criteria
4.3.1 Your plans or recommendations are shaped by the occupational needs of your service users, as identified through your assessments
4.3.2 You aim to enable your service users to achieve their full potential in occupational performance, health and wellbeing
4.3.3 You work with your service users in the planning process, agreeing their goals and priorities for intervention
4.3.4 Your plans take account of your service users’ cultures and backgrounds
4.3.5 Your plans take account of the contexts in which your service users engage in occupation on a daily basis
4.3.6 You use research and other evidence to underpin and inform your planning or recommendations where possible
4.3.7 Your plans incorporate health promotion, where appropriate
4.3.8 You include timescales and/or review dates in your plans
4.3.9 You review and amend your plans regularly in partnership with your service users and their carers
 
 

4.4  You provide intervention that is appropriate to your service users as individuals, based upon their identified occupational needs

Criteria
4.4.1 Your intervention uses relevant and meaningful occupations/activities based upon the occupational abilities and needs of your service users
4.4.2 Your intervention uses occupations/activities that offer the best options for achieving the agreed therapeutic goals
4.4.3 Your intervention facilitates healthy living and lifestyle choices
4.4.4 Your intervention is in accordance with national guidelines, best or evidence-based practice
4.4.5 Your intervention is shaped or structured according to established theories, frameworks and concepts of occupational therapy
4.4.6 You work in collaboration with others to provide a comprehensive programme of intervention
4.4.7 You work with your service users, and their carers, to develop their skills to manage their own occupational needs
4.4.8 Where needed, you work with your service users, and others involved, to modify the tasks they need to do, so optimising their performance
4.4.9 Where needed and possible, you modify or adapt the user’s environment to enable their occupational performance
4.4.10 Where needed, you explore possible technology and equipment with your service users to support their occupational performance
 

4.5  You evaluate the impact of, or your service users’ responses to, the intervention that you have provided

Criteria
4.5.1 You monitor and review the ongoing effectiveness of your intervention using recognised outcome measures where possible
4.5.2 You take into account the opinions of your service users and their carers when evaluating the effectiveness of occupational therapy intervention
4.5.3 You take account of the opinions of others in the care team
4.5.4 Where necessary you modify and revise your plans and intervention in partnership with your service users and their carers
4.5.5 Any decision to cease intervention is based upon your evaluation and is taken in partnership with your service users
4.5.6 Any decision to change or cease intervention is recorded in your care records, along with the underlying reasoning
4.5.7 You periodically monitor and review the quality of your practice through service user feedback and audit
 
 

4.6  You base your practice upon evidence, using research and its outcomes where appropriate

Criteria
4.6.1 You seek to access, understand and critically evaluate any research and its outcomes, along with other sources of information, that relate to your work
4.6.2 You incorporate the outcomes of available evidence and research into your practice where safe and appropriate
4.6.3 When seeking to undertake research in your practice setting, you negotiate it to be an agreed part of your role
4.6.4 When contributing to or undertaking research, or related activities such as service evaluations, you abide by local and national governance and ethical requirements
4.6.5 You always act in the best interests of your service users when undertaking any research or related activities
4.6.6 You disseminate the findings of your research or related activities through appropriate channels
 
More information is available from:
 
COT/BAOT Briefings 75: Research resources for occupational therapists (COT 2010g)
COT/BAOT Briefings 82. Applying for ethics approval for research (COT 2010h)
COT/BAOT Briefings 115. Accessing the evidence base (COT 2010i)
COT/BAOT Briefings 116. Research competence for occupational therapists (COT 2010j)
 
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These standards link with:
Code of ethics and professional conduct, section(s) 3.1; 3.3; 6.1 (COT 2010a)
Common core principles to support self care, principle(s) 4; 5; 6 (Skills for Care, Skills for Health 2008)
Doing well, doing better: Standards for health services in Wales, standard(s) 3; 5; 7; 8 (Welsh Assembly Government 2010)
Guidance about compliance: essential standards of quality and safety, outcome(s) 4; 16; 1 (CQC 2010)
National care standards – principles principle(s) 5; 6 (SCRC 2002)
Quality standards for health and social care, section(s) 5.3.1; 5.3.3; 6.3.2; 7.3 (DHSSPS 2006a)
Rehabilitation standards: hallmarks of a good provider, standard(s) 3 (UKRC 2009)
Standards of proficiency: – occupational therapists, section(s) 2 (HPC 2007)
The NHS knowledge and skills framework and the development review process, dimension(s) Health and wellbeing (DH 2004)
Research governance framework for health and social care 2nd ed (DH2005)
Research governance framework for health and social care (DHSSPS 2006)
Research governance framework for health and community care 2nd ed (SEHD 2006b)
Research governance framework for health and social care in Wales 2nd ed (WORD 2009)