Focusing on “what matters”: the Occupation, Capability and Wellbeing Framework for Occupational Therapy

Abstract

Introduction Critical occupational therapists have challenged models from the Global North that have dominated occupational therapy and informed ableist practices focused on appraising dysfunctions, classifying deviations from bodily “norms”, and remedying individuals’ “deficits” in performing three occupations (self-care, productive, leisure). This indicated the need for a new conceptual framework; one grounded in research evidence derived from a diversity of people and contexts. Objectives To outline the imperative for, and genesis and features of an evidence-informed conceptual framework for occupational therapy, centred on occupations, capabilities and wellbeing. Methods This paper draws from the work of critical occupational therapists; outlining the conception and process of building a flexible framework by linking concepts identified through extensive review of multidisciplinary research from both the Global South and North. Results Building on evidence that occupation is a determinant of wellbeing, the Occupation, Capability and Wellbeing Framework for Occupational Therapy (OCWFOT, Hammell, 2020a) encourages a strengths-based approach to occupational therapy: assessing and building on individual, collective and community assets, abilities and resources; focusing on occupations that “matter most”; and fostering a relational view of people as interdependent and embedded within families and communities. Conclusion Focused unequivocally on the wellbeing needs and aspirations of individuals, families, groups, communities and populations that are met or unmet by current patterns of occupational engagement; on both abilities and opportunities; and on occupation as a human right, the OCWFOT is theoretically defensible, provides conceptual clarity, and has utility as an evidence-informed structure around which future research and practices may be oriented.

Being in a meaningful context. Nature and animal‐assisted activities as perceived by adults with autism

“…Participation in an occupation, such as an animal-assisted and nature-based activity, that the individual perceives meaningful, as a complement to ordinary care and social services, can be an important step in the rehabilitation process by creating favourable conditions in everyday life. This is in line with Wilcock and Hocking (2015) and Hammell (2020) who report on moving forward towards health and well-being, education or job training. Participating in animal-assisted and nature-based interventions increases self-esteem and self-confidence (Hultsjö & Jormfeldt, 2022) and probably also the perceived sense of coherence (Antonovsky, 1993) although, as far as we know, this has not been quantitatively measured.…”

“…Finding meaning through being engaged in occupations may positively contribute to social change in everyday life, and is closely related to mental health and well‐being (Hammell, 2020; Wilcock & Hocking, 2015). Animal‐assisted interventions are structured and goal‐oriented activities that integrate domestic animals in healthcare and social work (Beetz, 2017; IAHAIO, 2018), while nature‐based interventions provide activities in a horticultural and/or wild natural environment (Annerstedt & Währborg, 2011; Hansen et al, 2017).…”

Potential of virtual reality to meaningfully engage adults living with dementia in care settings: A scoping review

“…In occupational therapy literature, occupations are defined as activities which occupy a person's time (Jackman, 2014) and contribute to their overall wellbeing (Hammell, 2017;Han et al, 2016). Research has identified a positive association between engaging in meaningful occupations and overall health and wellbeing (Hammell, 2020;Hocking, 2019;Morgan-Brown et al, 2018;Neal et al, 2020;Wilcock & Townsend, 2019). Unlike participation which must be active, engagement can be passive and is characterised by 'the degree to which an individual involves him/herself' (Black et al, 2019;Jackman, 2014, p. 242), becoming deeply invested in the occupation.…”

“…Notwithstanding the theoretical understanding that person-centred care is best practice to support older adults living with dementia in RACHs (Laver et al, 2016), there has been a noticeable gap between theoretical understanding and clinical practice in RACHs (Laver, 2016). This inconsistency is evident in the limited opportunities for meaningful engagement available to residents with dementia and contributes to the issue of occupational injustice among older adults living with dementia in RACHs (Hammell, 2020;Morgan-Brown et al, 2018;Wilcock & Townsend, 2019). Research since the early 2000s reflect that residents can spend 17 or more hours in bed each day (in a study conducted by Bates-Jensen et al, 2004 across 15 RACHs) or spend most their time unoccupied and doing nothing; a reality that is worse for older adults living with dementia as they are the least likely to be engaged in care settings (Hill et al, 2010;Kolanowski & Litaker, 2006).…”