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An exploration of the role of occupation in school-based occupational therapy practice

Dissertation
Author: Jeryl DiSanti Benson
Abstract:
The purpose of this study was to explore the role of occupation in school-based occupational therapy practice. The research questions were (1) How do school-based occupational therapists describe the role of occupation during intervention? (2) Which theories of occupation do school-based occupational therapists associate with their own practice? (3) How is occupational language represented in the Individualized Educational Plans (IEPs) written by school-based occupational therapists? Participants included 16 occupational therapists currently practicing in the schools. Data were collected via an interview with the participants and the collection of Individualized Educational Plans (IEP) written by the participants. The methodology used in this study was a mixed qualitative design based on multiple case study analysis and grounded theory. The participant interviews were analyzed for themes and the IEP documents were analyzed using a priori codes based on the Framework-II (AOTA, 2008). The results indicate that occupation is a strong influence during the intervention process as well as the overall daily practice of the school-based practitioner. The data from this study indicate that school-based occupational therapists are not utilizing formal occupation-based models during daily practice. In regards to documentation, the narrative IEP reports present both occupational needs as well as performance skills baseline data when describing the child and determining needs. The long term goals equally represented both occupation focused goals and performance skill based goals. The language used to write the students' present education level reflected the language used to write the goals. This indicates that the terminology used to describe a person, whether occupation or performance focused, drives the focus of the goals. Even with the availability of the Framework II (AOTA, 2008) school-based occupational therapists are not consistently using occupational language in documentation. The results show that school-based occupational therapists are not using occupation-based models to guide practice and are only using occupational language in school-based documentation about half of the time. A discussion related to the importance of current occupational therapy practice based on theoretical models is presented. Occupational therapy practice based on theoretical models results in more effective intervention and contributes to the credibility of the profession. School-based occupational therapists have unique professional needs and will benefit from professional support to understand the contribution of theoretical models to both daily practice and the profession.

TABLE OF CONTENTS

Page Abstract .............................................................................................................................. iv Dedication .......................................................................................................................... vi Acknowledgement ............................................................................................................ vii LIST OF FIGURES ....................................................................................................... xi LIST OF TABLES ........................................................................................................ xii CHAPTER I INTRODUCTION ......................................................................................... 1 Overview ......................................................................................................................... 1 A Shift in Philosophy .................................................................................................. 2 The Impact of the Philosophical Shift on School-Based Practice and Occupation .... 6 The Return to the Root of Occupational Therapy: Occupation .................................. 8 Purpose of the Study ..................................................................................................... 11 Significance of the Study .............................................................................................. 11 Research Questions ....................................................................................................... 12 Definition of Terms ...................................................................................................... 12 CHAPTER II LITERATURE REVIEW .......................................................................... 15 Introduction ................................................................................................................... 15 Theories of Occupation ................................................................................................. 16 What is Occupation-Centered Practice? ....................................................................... 18 A Perspective of Theories of Practice ........................................................................... 20 The Effect of Occupation as a Modality ....................................................................... 23 The Use of Occupational Language .............................................................................. 27

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Conclusion .................................................................................................................... 30

CHAPTER III METHODOLOGY ................................................................................... 31 Introduction ................................................................................................................... 31 Participants .................................................................................................................... 33 Instrumentation ............................................................................................................. 34 Data Collection ............................................................................................................. 35 Data Analysis ................................................................................................................ 35 Organizing and processing the data .......................................................................... 39 Analysis ..................................................................................................................... 40 Trustworthiness ............................................................................................................. 40 Summary ....................................................................................................................... 42 CHAPTER IV ................................................................................................................... 43 RESULTS ......................................................................................................................... 43 Introduction ................................................................................................................... 43 The Participants ............................................................................................................ 43 The Interview Procedures ............................................................................................. 46 The Documentation Procedures .................................................................................... 48 Analysis of Goals ...................................................................................................... 49 Analysis of the IEPs .................................................................................................. 50 Outcomes ...................................................................................................................... 52 Research Question #1: How do school-based occupational therapists describe the role of occupation during intervention? .................................................................... 52

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Research Question #2: Which theories of occupation do school-based occupational therapists associate with their own practice? ............................................................ 60

Research Question #3: How is occupational language represented in the IEPs written by school-based occupational therapists? ................................................................. 64 Summary ....................................................................................................................... 72 CHAPTER V .................................................................................................................... 74 DISCUSSION ................................................................................................................... 74 Review of Study ............................................................................................................ 74 Discussion of Findings .................................................................................................. 75 Implications for Practice ............................................................................................... 80 Limitations .................................................................................................................... 81 Suggestions for Future Research .................................................................................. 82 Conclusions ................................................................................................................... 83 References ......................................................................................................................... 84 APPENDIX A ................................................................................................................... 94 APPENDIX B ................................................................................................................... 99

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LIST OF FIGURES Page Figure 2.1: A Representation of the Hierarchy of Occupation-based Models in Relationship to Intervention………………………………………………………….…..21 Figure 3.1: Potential Categories of Participants………………………………...……….32

Figure 4.1: A Comparison of the Frequency of Occupational and Performance Skill Language in the IEP Text ................................................................................................. 67

Figure 4.2: Frequency of Occupational Language in the IEP Text .................................. 68 Figure 4.3: Frequency of Performance Skills Language in the IEP Text ......................... 68 Figure 4.4: Frequency of Occupational Language and Performance Skill Language in IEP Goals ................................................................................................................................. 70

Figure 4.5: A Comparison of the Categories of Occupational Language Present in IEP Goals ................................................................................................................................. 70

Figure 4.6: A Comparison of the Categories of Performance Skills Language Present in IEP Goals .......................................................................................................................... 71

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LIST OF TABLES

Page

Table 2.1: Occupational Areas and Specific Occupations as defined by the Framework-II (2008) ................................................................................................................................ 38

Table 2.2: Performance Skill Areas and Specific Skills as defined by the Framework-II (2008) ................................................................................................................................ 39

Table 4.1: Demographics of the Participants .................................................................... 45 Table 4.2: Content Analysis: Codes Grouped by Thematic Categories ........................... 47 Table 4.3: Coding of Long Term Goals Based on the Framework-II Categories ............. 49 Table 4.4: Areas of Occupation and Performance Skills based on the Framework-II (2008) ................................................................................................................................ 50

Table 4.5: Coding of IEP Narrative based on the Framework-II Categories .................... 51 Table 4.6: Number of IEPs grouped by frequency of language used…………………....62

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CHAPTER I INTRODUCTION Overview Occupation, as defined by American culture is “any activity in which a person is engaged” ( http://dictionary.reference.com/browse/occupation ). On the surface, it is a very simple concept: what we, as humans, do to fill our time. However, the concept of occupation becomes more interesting as the discussion focuses on the complexity of occupation, as a science and as a means to health and wellbeing. The profession of occupational therapy has its roots in the early 1900’s when the founding fathers of occupational therapy gathered to establish the National Society for the Promotion of Occupational Therapy (NSPOT), the organization that later became the American Occupational Therapy Association (AOTA) (Schwartz, 2003). The founders collectively believed that “meaningful engagement in occupation was the key to creating a healthy body and mind” (Schwartz, 2003, p.8) although the ways in which the profession has conceptualized occupation and its influence on health has varied over the years. When humans are engaged in the occupations of life they are able to derive meaning and purpose from doing. Therefore, the act of doing can influence a person’s health and wellbeing. Since its founding, the AOTA has defined occupation as “an individual’s active participation in self maintenance, work, leisure and play” (AOTA, 1995, p. 1015). Occupational therapy is based on the premise that daily life follows a natural pattern that provides humans with a sense of satisfaction and fulfillment (Meyer, 1922). The belief that occupations influence health and well being has been the core principle of many theoretical frameworks in occupational therapy (Dunn, 1994; Fidler,

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1996; Keilhofner & Forsyth, 1997; Nelson, 1996; Reilly, 1962; Schkade & Schultz, 1992). A Shift in Philosophy The profession of occupational therapy was founded on the belief that engagement in occupation leads to health and wellbeing. The use of occupation as the central focus of intervention is what delineated occupational therapy from other health professions. A major premise of this study is that occupation must remain the core of occupational therapy research, education, and practice to support the growth of the profession. Although the occupational therapy profession was founded on the concept of occupation, occupational therapy practice has not always remained faithful to its roots. The use of occupation in intervention and documentation of successful occupation as an outcome was evident in the professions early years but then declined significantly as the profession moved away from an occupational model and toward a medical model for a period of over 30 years, between the 1960’s and through the 1980’s (Hinojosa, Kramer, Royeen, & Luebben, 2003). Several factors contributed to this decline: first, weak and often inconsistent definition of the concept of occupation within the profession, second, logistical limitations dictated by practice settings and third, occupational therapy education itself. The occupational therapy profession has had a long-standing difficulty with achieving consensus on its core concept--occupation. Since the professions early years, there have been multiple definitions of occupation. These definitions have emphasized various and often inconsistent aspects of the concept; for example, Hinojosa et al. (2003)

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state that a philosophical statement is a description of what “the profession values and believes to be important” (p.2). Yet, in 1979, the AOTA used purposeful activity as a synonym for occupation within the document the Philosophical Base of Occupational Therapy (AOTA, 1979). Purposeful activity is now perceived as engaging in a task that has purpose to an individual yet is void of meaning due to unnatural context while occupation is viewed as engagement in tasks which hold both meaning and purpose to an individual and are embedded in their lives. Eventually, the core meaning of occupation became lost among differences in terminology. Further complicating the issue is the fact that the terms occupation, purposeful activity, and activity are often used interchangeably (Golledge, 1998a). These inconsistencies were further reflected in occupational therapy treatment. Throughout much of the mid to late 20th century, occupational therapists used treatment methods and documented interventions that were decidedly not occupational. Royeen (2002) urged the occupational therapy profession to “reconsider and think about exactly what is meant by occupation… because, as humans, our thoughts are expressed as language. And language shapes actions and politics” (p.112). The second factor that has contributed to the decline of occupation as the primary intervention strategy is everyday practice itself. Many issues, including significant time constraints, the large number of patients who need to be treated each day, and ever increasing demands for productivity, have resulted in therapists needing to cut corners in order to respond to systems issues. Consider the treatment of a young adult male with a diagnosis of brain injury due to a traumatic event such as an automobile accident. This treatment typically occurs in an inpatient rehabilitation setting. The brain injury has caused the patient to have difficulty with daily living skills. However, the client has

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expressed a desire to return to playing basketball each week with a group of friends in his community. Having the client play basketball in a gym would be an example of using occupation in intervention. Implementing an authentically occupational intervention strategy is likely to be difficult if not impossible, as many traditional rehabilitation hospitals do not have a gymnasium that would enable the client to relearn the occupation of playing basketball. In this case the therapist would need to explore options for providing intervention in a place such as a local recreational center. However, the additional time and effort required from the therapist to organize and implement a creative, authentic intervention strategy would likely be perceived as inefficient and costly for the rehabilitation facility and as such, not be supported and authorized. As a result, the client would likely be limited to artificial and inadequate opportunities to practice a skill that has great meaning and value to him. The use or lack thereof, of occupational language to support engagement with clients can be attributed to many factors. Finances in particular, can become a very central factor in how occupational therapists choose to practice and document practice. The emphasis in the United States is on efficiency and effectiveness. Since financial priorities drive policy, the focus of service delivery is on functional goals. Reimbursement for occupational therapy in the United States occurs after the therapist has proven the intervention has made a difference (Jongbloed & Wendland, 2002). Therefore, the language used in documentation is critical to the outcome of receiving payment. This financial concern, or meeting the requirements of reimbursement, have been cited as a reason that therapists may not articulate the use of occupational theory, either verbally or via written communication (Elliot, Velde, & Wittman, 2002). A second

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factor that may contribute to a decreased use of occupational language is the practice of utilizing the routines and terminology established by other professionals. The intent may be to establish a shared idea of the intervention and clear communication between the occupational therapist and others; therefore, the occupational therapist may use terms and language familiar to other professionals and clients (Elliot et al., 2002). By not using occupational language occupational therapists are losing the unique contribution that occupational therapy provides. Each practice arena also has its own culture. This culture sets the tone for accepted ways of treatment, for status, and the perceptions of the hierarchy of respect that each profession has within the organization. Status and respect are important to professional identity. Finlay (2001) noted that occupational therapists may choose to use “procedural and scientific routines” in an effort to gain status (p. 270). Utilizing the routines established by other professionals often results in the use of language and terminology that are more familiar to the other professionals and to the clients. For example, improving the strength and endurance of a client during the rehabilitation process is a common goal. It is expected that improved strength and endurance will enhance the client’s ability to engage in occupations such as meal preparation. Improving strength is an outcome that is easily understood and interpreted by other professionals and the client, and is important to the recovery process. When occupational therapists focus on increased strength and endurance in their documentation rather than the clients ability to successfully prepare a meal, they are using the procedures and terminology of others, and not occupational language. The language may quell some feelings of

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inferiority within the therapist however the unique contribution of occupational therapy is lost. The third factor that has contributed to the decline of occupation in practice is occupational therapy education itself. Education and practice are intertwined. During the period of time when clinical practice was moving away from occupation so was education. Occupation essentially disappeared from occupational therapy curricula as reflected by the absence of the word occupation in the Essentials and guidelines for an accredited educational program for the occupational therapist (AOTA, 1991a, 1991b). Although this would appear to be a deviation from the roots of occupational therapy, programs were actually meeting the education standards of the profession. Royeen (2002) suggested that difficulty in achieving occupation-centered education may be the lack of a clear understanding of the term “occupation” and use of terminology. A striking example of this is reflected in AOTA’s (1979) position statement that the role of the occupational therapist was to engage the client in “purposeful activity” not occupation. Guided by both the Essentials and the position statement occupational therapy educators taught students about the therapeutic use of purposeful activity and activity, not occupation (AOTA, 1991a, b; AOTA, 1979). The Impact of the Philosophical Shift on School-Based Practice and Occupation The school systems in America currently employ approximately 30% of occupational therapists licensed to practice in the United States (AOTA, 2006a). Given that school systems are the largest employers of occupational therapists, school-based practice may well have an influence on the direction of the profession. A closer look at the shifts discussed earlier in this arena of practice may provide some insight. First, a

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weak and inconsistent definition of occupation impacts occupational therapy as a whole regardless of practice setting. School-based practice was influenced by the guiding documents produced by the occupational therapy profession (Crowe & Kanny, 1990). School-based therapists, along with their rehabilitation colleagues, used purposeful activity to engage their clients, the children, in the therapeutic relationship. Second, limitations based on practice setting are different from a traditional rehabilitation setting but nonetheless present in school-based practice. Although school-based practice does not have to navigate through the reimbursement system or create a niche as part of a multidisciplinary healthcare team, constraints related to practice setting remain. For example, in the public school system, caseloads are typically very high and schedules are tight with therapists traveling between multiple locations. Time constraints are very real. Space and equipment are often in limited supply and becoming a part of the educational team is necessary, albeit time consuming, to create the most beneficial environment for the children. As demands increase, occupation may become less of a priority. Lastly, practitioners practice what they know. Use of purposeful activity as a primary means of intervention was taught and therefore used in daily practice by the now experienced practitioner (Hinojosa et al., 2003). New graduates practice what they are taught. Armed with a background in occupational theory the opportunities are greater for use of occupation, but the challenge of being supervised by a mentor without a current knowledge base ultimately may lead to a change in perspective. If therapists practice what is taught via a mentor relationship or observation of senior practitioners the change may lead to a move away from occupation without awareness of the shift. Crowe and Kanny (1990) surveyed school-based occupational therapists and found that less than 2%

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reported they were influenced by the “Human Occupation” frame of reference during practice; instead they cited the use of the Developmental or Neuro-developmental Treatment as frames of reference for practice (Crowe & Kanny, 1990). Regardless of the setting or the reasons, the movement away from occupation began to impact the profession. The Return to the Root of Occupational Therapy: Occupation As the profession began to lose its unique contribution to the team of healthcare providers, the movement to the return of occupation as the core of occupational therapy began. In the late 1980’s Nelson (1988) proposed a new definition and perspective on occupation. Leaders in the field published concern for the lack of and support for the resurgence of occupation as the base of the profession (Clark, 1993; Kielhofner, 1995). Scholars in occupational therapy called the profession to revisit its roots and use occupation as its core method of intervention (Dunn, 1994; Fidler,1996; Keilhofner & Forsyth, 1997; Nelson, 1996; Reilly, 1962; Schkade & Schultz, 1992). Further, they pressed the profession to better define the use of occupation within the standard education curriculum (Whiteford & Wilcock, 2001; Wood, Nielson, Humphry, Coppola, & Rourk, 2000; Yerxa, 1998). Yerxa (1998) suggested that a “curricular renaissance” (p.369) needed to occur, making occupation the foundation, or the “central organizing idea” (p. 369) of every occupational therapy education curriculum. In 1998, AOTA responded and revised the Essentials (1991a, b) creating the new Standards for an Accredited Educational Program for the Occupational Therapist (AOTA, 1998). The Standards clearly highlight the use of occupation as a core element to the basic curriculum and the difference between occupation and purposeful activity (AOTA, 1998).

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The introduction of the Standards (1998) led to the evolution of the Occupational Therapy Practice Framework: Domain and Process (Framework) in 2002 and subsequent revision, Occupational Therapy Practice Framework: Domain and Process, 2 nd edition (Framework-II) in 2008. The Framework was developed “to more clearly affirm and articulate occupational therapy’s unique focus on occupation and daily life activities and the application of an intervention process that facilitates engagement in occupation to support participation in life” (AOTA, 2002, p. 609). The purposes of the Framework are to: “(a) to describe the domain that centers and grounds the profession’s focus and actions and (b) to outline the process of occupational therapy evaluation and intervention that is dynamic and linked to the profession’s focus on and use of occupation” (AOTA, 2002, p. 609). By clearly defining the focus of the profession and providing language to support the central concept of occupational therapy, the Framework provides therapists with the means to communicate the focus of occupational therapy (AOTA, 2002). The Framework-II is a refinement of the original document including emerging practice areas (AOTA, 2008). The return of occupation as the core of the profession leads to the development and use of occupational theory defined by consistent language. Use of theory is guided by two factors: first, academic institutions that prepare practitioners to practice what they have been taught and second, research that contributes to the pool of evidence available. Whiteford and Wilcock (2001) asserted that making occupation central to occupational therapy curricula would lead to a variety of outcomes that would strengthen the profession. The outcomes include enhanced occupational therapy education, a cadre of increasingly competent clinicians who are able to articulate and treat within the identified

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framework of occupational therapy, the organization of the profession’s language and the achievement of research outcomes (Whiteford & Wilcock, 2001). In other words, education rooted in occupation-based theory leads to occupation-based practice and documentation resulting in the opportunity to create evidence in support of occupation. An understanding of theory guides the practical application of what practitioners do. Theoretical content is grounded by terminology that is clearly defined and understood, for example occupation versus purposeful activity. According to Krefting (1985), “understanding terminology is the key to comprehending any subject matter” (p. 173). Therefore, the choice and use of occupational terminology drives practice and intervention. It may be surmised that if taught theories of occupation, using consistent occupational language, the practitioner is then able to use occupation within practice. The use of occupation in the intervention process leads to greater improvements with selected skills, because infusing a sense of meaning into the intervention process engages the person emotionally and physically, thereby increasing the person’s investment in the outcome (Eakman & Nelson, 2001; Fasoli, Trombly, Tickle-Degnen, & Verfaellie, 2002; Hartman, Miller, & Nelson, 2000; Kellegrew, 1998). Based on this evidence, the use of occupation as the center of practice should be a common thread woven throughout the intervention process, from the initial evaluation to the treatment sessions to the discharge summary. Therefore, occupation should be reflected both within practice as evidenced by what practitioners do and within the documentation of the intervention process regardless of the practice setting. A decrease in knowledge related to occupational theory and a decrease in the ability to articulate the importance of occupation may lead to a decrease in the use of

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occupation in current practice. Given the strong emphasis currently being placed on returning to occupation as the primary modality for occupational therapy, it is important to understand how occupational therapists are currently practicing. Therefore, this study seeks to determine the current state of school-based occupational therapy practice, the presence of occupation and occupation-based theory in school-based practice as well as the evidence of occupation in therapists’ documentation of their interventions with clients. Purpose of the Study To develop the most effective intervention plan, it is important for occupational therapists to use occupation as their primary method of intervention and for this to be clearly reflected in their documentation of service (AOTA, 2002). The extent to which this occurs is unclear. The purpose of this study is to explore the role of occupation in the practice of school-based occupational therapy. Specifically, the study will examine how occupational therapists describe their current practice and how they use occupational language in their documentation. Significance of the Study Occupational therapy practitioners believe in the power of occupation and the significance of doing (AOTA, 2008; Meyer, 1922). Although very experienced practitioners may have been schooled in the language of purposeful activity, newly educated occupational therapy practitioners have the educational background to understand and use occupation-based models of practice. This study intends to provide insight into the current trends of school-based practice. The agenda becomes an exploration into the role of occupation in the practice of school-based occupational

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therapy with the intent of providing insight into current practice trends and contributing to research literature. The role of occupation, occupation-based theory, and use of occupational language is central to the profession of occupational therapy. An understanding of current practice trends related to occupation and school-based practice will help to guide the future of school-based practice. Research Questions 1. How do school-based occupational therapists describe the role of occupation during intervention? 2. Which theories of occupation do school-based occupational therapists associate with their own practice? 3. How is occupational language represented in the Individual Educational Plan’s (IEP) written by school-based occupational therapists? Definition of Terms Individualized Educational Plan: An Individualized Education Plan (IEP) is "a document describing children's skills and stating goals for services as well as strategies for achieving those goals" (Bailey, 1994, p. 29). The IEP is a formal written document which is required for a child to receive special education and related services within an educational environment. Intervention: to involve oneself in a situation so as to alter or hinder an action or development (http://dictionary.references.com/browse/intervention). Occupational therapy intervention is the interaction between the therapist and client that results in developmental change of the client.

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Modality: A therapeutic method or agent that involves the physical treatment of a disorder (http://dictionary.references.com/browse/modality). The modality is what occupational therapists “do” within the treatment session. Occupation: “an individual’s active participation in self maintenance, work, leisure and play” (American Occupational Therapy Association, 1995, p. 1015). The AOTA (1995) also states within the definition that occupation “requires human capacities to act on the environment with intentionality in a given pursuit, as well as the unique organization of these pursuits over time and the meaning attributed to them by the doers as well as those observing them “(p. 1016). Occupational Therapist: Occupational therapy practitioners are skilled professionals whose education includes the study of human growth and development with specific emphasis on the social, emotional, and physiological effects of illness and injury (AOTA, 2004). Occupational Therapy: According to AOTA (2004) occupational therapy is skilled treatment that helps individuals achieve independence in all facets of their lives. It gives people the "skills for the job of living" necessary for independent and satisfying lives. Services typically include: Customized treatment programs to improve one's ability to perform daily activities Comprehensive home and job site evaluations with adaptation recommendations Performance skills assessments and treatment Adaptive equipment recommendations and usage training

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Guidance to family members and caregivers Purposeful Activity: “engagement in the tasks of daily living, with the use of this term emphasizing the intentional, goal directed nature of such engagement” (AOTA, 1995, p. 1016). School-based practice: According to the AOTA (2006b) “school-based occupational therapy is available for students who are eligible for special education services. Occupational therapists complete assessments and work with other members of the school-based team to help determine what is needed for a student to receive a free appropriate public education in the least restrictive environment. They collaborate with other members of the education team to identify a student’s annual goals and determine the services, supports, modifications, and accommodations that are required for the student to achieve these goals. When the IEP team determines that occupational therapy is needed for a student in order to meet his or her annual goals, then occupational therapy should be included in the student’s IEP” (p. 2).

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CHAPTER II LITERATURE REVIEW Introduction The National Society for the Promotion of Occupational Therapy was founded as a venue for the “advancement of occupation as a therapeutic measure” (NSPOT, 1917). Essentially, the NSPOT believed in the value of occupation as a contributor to health and well being and therefore founded the first national organization to promote occupation as a means to wellness. The founding views of occupation were based on the idea that the presence or absence of occupation impacts engagement and participation in life and that the use of occupation is necessary for effective intervention. Humans are occupational beings. Humans have personal experiences and act on the environment with intentionality (Pollio, Henley & Thompson, 1997). Intentionality, as defined by Pollio et al. (1997) is “a basic structure of human existence that captures the fact that human beings are fundamentally related to the contexts in which they live” (p. 7). Humans acting with intentionality can also be stated as engaging in the occupation of life. Collins (2001) suggested that the complexity of occupation determines the opportunities and choices available while navigating life. The occupational therapy profession needs to focus on occupation and the potential of the influence of occupation on the lives of clients. Practice needs to bring occupation back to the forefront of what occupational therapy was founded on, the belief that occupation as a modality is a powerful change agent. Occupation was the original core concept of the profession and current research supports a return to the roots of the profession (Dermody, Volkens, & Heater, 1996; Eakman & Nelson, 2001; Fasoli,et al., 2002; Hanna, Russell, Barlett, Kertoy, Rosenbaum & Wynn,

Full document contains 114 pages
Abstract: The purpose of this study was to explore the role of occupation in school-based occupational therapy practice. The research questions were (1) How do school-based occupational therapists describe the role of occupation during intervention? (2) Which theories of occupation do school-based occupational therapists associate with their own practice? (3) How is occupational language represented in the Individualized Educational Plans (IEPs) written by school-based occupational therapists? Participants included 16 occupational therapists currently practicing in the schools. Data were collected via an interview with the participants and the collection of Individualized Educational Plans (IEP) written by the participants. The methodology used in this study was a mixed qualitative design based on multiple case study analysis and grounded theory. The participant interviews were analyzed for themes and the IEP documents were analyzed using a priori codes based on the Framework-II (AOTA, 2008). The results indicate that occupation is a strong influence during the intervention process as well as the overall daily practice of the school-based practitioner. The data from this study indicate that school-based occupational therapists are not utilizing formal occupation-based models during daily practice. In regards to documentation, the narrative IEP reports present both occupational needs as well as performance skills baseline data when describing the child and determining needs. The long term goals equally represented both occupation focused goals and performance skill based goals. The language used to write the students' present education level reflected the language used to write the goals. This indicates that the terminology used to describe a person, whether occupation or performance focused, drives the focus of the goals. Even with the availability of the Framework II (AOTA, 2008) school-based occupational therapists are not consistently using occupational language in documentation. The results show that school-based occupational therapists are not using occupation-based models to guide practice and are only using occupational language in school-based documentation about half of the time. A discussion related to the importance of current occupational therapy practice based on theoretical models is presented. Occupational therapy practice based on theoretical models results in more effective intervention and contributes to the credibility of the profession. School-based occupational therapists have unique professional needs and will benefit from professional support to understand the contribution of theoretical models to both daily practice and the profession.