Occupational Therapy’s Perspective on the Use of Environments and Contexts to Support Health and Participation in Occupations

Abstract

PurposeThis paper articulates the position of the American Occupational Therapy Association (AOTA) regarding how, across all areas of practice, occupational therapy practitioners 1 select, create, and use environments and contexts to support clients' health and participation in desired occupations. IntroductionThe value and purpose of occupational therapy is to support the health and participation of clients by engaging them in their desired occupations (AOTA, 2008). Occupations are activities that "reflect cultural values, provide structure to living and meaning to individuals; these activities meet human needs for selfcare, enjoyment, and participation in society" (Crepeau, Cohn, & Schell, 2003, p. 1031. Where and how occupational therapy services are provided is based on the notion that clients' engagement in occupation is inextricably situated in environments and contexts. The environment refers to external physical and social aspects that surround clients while engaging in the occupation. Contexts are the cultural, personal, temporal, and virtual aspects of this engagement; some contexts are external to the client (e.g., virtual), some are internal to the client (e.g., personal), and some may have both external features and internalized beliefs and values (e.g., cultural) (AOTA, 2008). Occupational therapy practitioners view human performance as a transactive relationship among people, their occupations, and environments and contexts.Using their expertise in analyzing these complex and reciprocal relationships, occupational therapy practitioners make recommendations to structure, modify, or adapt the environment and context to enhance and support performance. Both environment and context influence clients' success in desired occupations and therefore are critical aspects of any occupational therapy assessment, intervention, and outcome. This assumption is consistent with current educational and health care laws and policies that stipulate that assessment and intervention by providers take place in the natural and least restrictive environments that support the client's successful participation (Americans with Disabilities Act of 1990; Individuals with Disabilities Education Improvement Act Amendments of 2004;Olmstead v. L.C. and E.W., 1999). Occupational Therapy ProcessOccupational therapy practitioners support people where life is lived. To support people to live meaningful lives in environments and contexts that best meet their needs and desires, practitioners interpret a wide range of laws, regulations, and standards as they seek to maintain the integrity and values of the profession to benefit clients. Table 1 reviews key legislation related to occupational therapy intervention and how these laws apply to practice.1 When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy assistants (AOTA, 2006). Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the s...

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