Occupational Therapy Scope of Practice

Abstract

The Occupational Therapy Scope of Practice is an updated position statement from the American Occupational Therapy Association that defines the scope of practice in occupational therapy and provides a model definition of occupational therapy to promote uniform standards and professional mobility across state occupational therapy statutes and regulations. It is intended to serve as a resource for consumers, health care providers, educators, the community, funding agencies, payers, referral sources, and policymakers.

AOTA's updated position statement defines the occupational therapy scope of practice and provides a model definition of occupational therapy.

Statement of Purpose

The purpose of this document is to

Define the scope of practice in occupational therapy by

Delineating the domain of occupational therapy practice and services provided by occupational therapists and occupational therapy assistants,

Delineating the dynamic process of occupational therapy evaluation and intervention services used to achieve outcomes that support the participation of clients ¹ in everyday life occupations, and

Describing the education and certification requirements needed to practice as an occupational therapist and occupational therapy assistant;

Provide a model definition of occupational therapy to promote uniform standards and professional mobility across state occupational therapy statutes and regulations; and

Inform consumers, health care providers, educators, the community, funding agencies, payers, referral sources, and policymakers regarding the scope of occupational therapy.

Introduction

The occupational therapy scope of practice is based on the American Occupational Therapy Association (AOTA) documents Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020c) and the Philosophical Base of Occupational Therapy (AOTA, 2017), which states that “the use of occupation to promote individual, family, community, and population health is the core of occupational therapy practice, education, research, and advocacy” (p. 1). Occupational therapy is a dynamic and evolving profession that is responsive to consumer and societal needs, to system changes, and to emerging knowledge and research.

Although this document may be a resource to use with state statutes and regulations that govern the practice of occupational therapy, it does not supersede existing laws and other regulatory requirements. Occupational therapists and occupational therapy assistants are required to abide by relevant statutes and regulations when providing occupational therapy services. State statutes and other regulatory requirements typically include statements about educational requirements to be eligible for licensure as an occupational therapy practitioner, procedures to practice occupational therapy legally within the defined area of jurisdiction, the definition and scope of occupational therapy practice, and supervision requirements for occupational therapy assistants.

It is the position of AOTA that a referral is not required for the provision of occupational therapy services; however, laws and payment policies generally affect referrals for such services. AOTA’s position is also that “an occupational therapist accepts and responds to referrals in compliance with state or federal laws, other regulatory and payer requirements, and AOTA documents” (AOTA, 2015b, Standard II.2, p. 3). State laws and other regulatory requirements should be viewed as minimum criteria to practice occupational therapy. A Code of Ethics and related standards of conduct ensure safe and effective delivery of occupational therapy services (AOTA, 2020a). Policies of payers such as public and private insurance companies also must be followed.

Occupational therapy services may be provided by two levels of practitioners: (1) the occupational therapist and (2) the occupational therapy assistant, as well as by occupational therapy students under appropriate supervision (AOTA, 2018). Occupational therapists function as autonomous practitioners, are responsible for all aspects of occupational therapy service delivery, and are accountable for the safety and effectiveness of the occupational therapy service delivery process.

The occupational therapy assistant delivers occupational therapy services only under the supervision of and in partnership with the occupational therapist (AOTA, 2020b). When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy assistants (AOTA, 2015a).

Definition of Occupational Therapy

The Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020c) defines occupational therapy as

therapeutic use of everyday life occupations with persons, groups, or populations (i.e., clients) for the purpose of enhancing or enabling participation. Occupational therapy practitioners use their knowledge of the transactional relationship among the client, their engagement in valuable occupations, and the context to design occupation-based intervention plans. Occupational therapy services are provided for habilitation, rehabilitation, and promotion of health and wellness for clients with disability- and non–disability-related needs. Services promote acquisition and preservation of occupational identity for those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. (p. 80)

Exhibit 1 contains the model definition of occupational therapy for the AOTA (2021) Model Occupational Therapy Practice Act in a format that will be used to assert the scope of practice of occupational therapy for state regulation. States are encouraged to adopt this language in their practice acts because it reflects the contemporary occupational therapy scope of practice.

Scope of Practice: Domain and Process

The scope of practice includes the domain and process of occupational therapy services. These two concepts are intertwined, with the domain (Exhibit 2) defining the focus of occupational therapy and the process (Exhibit 3) defining the delivery of occupational therapy.

The domain of occupational therapy includes the everyday life occupations that people find meaningful and purposeful; aspects of the domain are presented in Exhibit 2. Within this domain, occupational therapy services enable clients to participate in their everyday life occupations in their desired roles, contexts, and life situations.

Clients may be persons, groups, or populations. The domain of occupational therapy consists of the following occupations in which clients engage throughout the life course (AOTA, 2020c, pp. 30–34, Table 2):

ADLs (activities oriented toward taking care of one’s own body and completed on a routine basis; e.g., bathing, feeding, dressing)

IADLs (activities to support daily life within the home and community that often require complex interactions; e.g., household management, financial management, child care)

Health management (activities related to developing, managing, and maintaining health and wellness routines, including self-management, with the goal of improving or maintaining health to support participation in other occupations; e.g., medication management, social and emotional health promotion and maintenance)

Rest and sleep (activities relating to obtaining restorative rest and sleep, including identifying the need for rest and sleep, preparing for sleep, and participating in rest and sleep)

Education (activities needed for learning and participating in the educational environment)

Work (activities for engaging in employment or volunteer activities with financial and nonfinancial benefits)

Play (activities that are intrinsically motivated, internally controlled, and freely chosen)

Leisure (nonobligatory and intrinsically motivated activities during discretionary time)

Social participation (activities that involve social interaction with others and support social interdependence).

Within their domain of practice, occupational therapists and occupational therapy assistants consider the repertoire of occupations in which the client engages, the contexts influencing engagement, the performance patterns and skills the client uses, the demands of the occupation, and the client’s body functions and structures. Occupational therapy practitioners use their knowledge and skills, including therapeutic use of self, to help clients conduct or resume daily life occupations that support function and health throughout the lifespan. Participation in occupations that are meaningful to the client involves emotional, psychosocial, cognitive, and physical aspects of performance. Participation in meaningful occupations enhances health, well-being, and life satisfaction.

The domain of occupational therapy practice complements the World Health Organization’s (2008) conceptualization of participation and health articulated in the International Classification of Functioning, Disability and Health (ICF). Occupational therapy incorporates the basic constructs of the ICF, including context, participation, activities, and body structures and functions, in interventions to enable full participation in occupations and maximize occupational engagement.

The process of occupational therapy refers to the delivery of services and includes evaluating, intervening, and targeting of outcomes, as detailed in Exhibit 3. Occupation remains central to the occupational therapy process, which is client centered, involving collaboration with the client throughout each aspect of service delivery. There are many service delivery approaches, including direct (e.g., providing individual services in person, leading a group session, interacting with clients and families through telehealth systems) and indirect (services on the client’s behalf; e.g., consultation to teachers, multidisciplinary teams, and community planning agencies), and services can be delivered at the person, group, or population level. This process includes the following key components:

Evaluation and intervention may address one or more aspects of the domain that influence occupational performance.

During the evaluation, the occupational therapist develops an occupational profile; analyzes the client’s ability to carry out everyday life activities; and determines the client’s occupational needs, strengths, barriers to participation, and priorities for intervention.

Intervention includes planning and implementing occupational therapy services, including education and training, advocacy, group interventions, and virtual interventions. The occupational therapist and occupational therapy assistant in partnership with the client use occupation-based theories, frames of reference, evidence, and clinical reasoning to guide the intervention (AOTA, 2020c).

The outcomes of occupational therapy intervention are directed toward “achieving health, well-being, and participation in life through engagement in occupations” (AOTA, 2020c, p. 5). Outcomes of the intervention determine future actions with the client and include occupational performance, improvement, enhancement, prevention (of risk factors, disease, and disability), health and wellness, quality of life, participation, role competence, well-being, and occupational justice (AOTA, 2020c). “Occupational adaptation, or the client’s effective and efficient response to occupational and contextual demands, is interwoven through all of these outcomes” (AOTA, 2020c, p. 26).

Sites of Intervention and Areas of Focus

Occupational therapy services are provided to clients across the life course. Practitioners work in collaboration with clients to address occupational needs and issues in areas such as mental health; work and industry; participation in education; rehabilitation, disability, and participation; productive aging; and health and wellness.

Along the continuum of service, occupational therapy services are provided to clients in a variety of settings, such as

Institutional (inpatient) settings (e.g., acute care, rehabilitation facilities, psychiatric hospitals, community and specialty-focused hospitals, nursing facilities, prisons),

Outpatient settings (e.g., hospitals, clinics, medical and therapy offices),

Home and community settings (e.g., residences, group homes, assisted living, schools, early intervention centers, day care centers, industry and business, hospice, homeless shelters, transitional living facilities, wellness and fitness centers, community mental health facilities, public and private transportation agencies, park districts, work sites), and

Research facilities.

Education and Certification Requirements

To practice as an occupational therapist, the individual trained in the United States

Has graduated from an occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE^®; 2018) or predecessor organizations;

Has successfully completed a period of supervised fieldwork experience required by the recognized educational institution where the applicant met the academic requirements of an educational program for occupational therapists that is accredited by ACOTE or predecessor organizations;

Has passed a nationally recognized entry-level examination for occupational therapists; and

Fulfills state requirements for licensure, certification, or registration.

To practice as an occupational therapy assistant, the individual trained in the United States

Has graduated from an occupational therapy assistant program accredited by ACOTE or predecessor organizations;

Has successfully completed a period of supervised fieldwork experience required by the recognized educational institution where the applicant met the academic requirements of an educational program for occupational therapy assistants that is accredited by ACOTE or predecessor organizations;

Has passed a nationally recognized entry-level examination for occupational therapy assistants; and

Fulfills state requirements for licensure, certification, or registration.

AOTA supports licensure of qualified occupational therapists and occupational therapy assistants (AOTA, 2016). State and other legislative or regulatory agencies may impose additional requirements to practice as occupational therapists and occupational therapy assistants in their area of jurisdiction.