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SUMMARY
Attitudes, misinformation about documentation and billing, time pressures, and persistence of habits may all play a role in creating barriers to using occupation-based intervention.
Occupational therapy clinicians in medical- based settings sometimes feel caught between providing occupation- based intervention and meeting the needs of the health care system; that is, to treat the maximum numbers of clients, obtain reimbursement for services, and provide intervention within limited settings (i.e., clinic or client's room). This article examines the various barriers to providing occupation- based intervention and presents strategies to overcoming those barriers, using the Occupational Therapy Practice Framework: Domain and Process1 (Framework) as a guide.
It is clearly the unique focus on occupation that distinguishes our profession from others. Our choice of the type of intervention and the approach we use allows us to make appropriate matches between a client's needs, wants, expectations, and intervention options. It is therefore a critical part of practice to develop an occupational profile for each of our clients before setting client-centered goals. Equally essential is the need to show how our intervention is different from that of other health professionals, which includes ensuring that we do not appear to be doing the same intervention for different reasons.2
The evidence is clear that engagement in valued occupations may be more helpful in developing independence and motor skills than other forms of intervention.3-5 So how do we overcome the barriers in medical-based settings to allow implementation of occupation-based interventions?
TYPES OF INTERVENTIONS
It is useful to begin by defining occupation- based activity. In 2002 the American Occupational Therapy Association (AOTA) replaced Uniform Terminology III (UT-III) with the Framework. The Framework aligns our practice language with the International Classification of Functioning, Disability, and Health created by the World Health Organization.6 The Framework also demonstrates a clear and unique focus on occupations.
Briefly, the Framework delineates types of occupational therapy interventions as:
* Therapeutic use of self: A clinician's planned use of his or her personality, insights, perceptions, and judgments as part of the therapy process.
* Therapeutic use of occupations or activities
* Occupation-based activity: Allows clients to engage in valued occupations in their own context (e.g., bathing or showering in their own home with adaptive equipment).
* Purposeful activity: Allows clients...