Scope of Practice

American Occupational Therapy Association

SCOPE OF PRACTICE

Statement of Purpose
The purpose of this document is to define the scope of practice in occupational therapy in order
to

1. delineate the domain of occupational therapy practice that directs the focus and actions of
services provided by occupational therapists and occupational therapy assistants;
2. delineate the dynamic process of occupational therapy evaluation and intervention services
to achieve outcomes that support the participation of clients in their everyday life activities
(occupations);
3. describe the education and certification requirements to practice as an occupational therapist
and occupational therapy assistant; and
4. 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) document Occupational Therapy Practice Framework: Domain and
Process (AOTA, 2002) and on the Philosophical Base of Occupational Therapy, which states
that “the understanding and use of occupations shall be at the central core of occupational
therapy practice, education, and research” (AOTA, 2003a, Policy 1.11). Occupational therapy is
a dynamic and evolving profession that is responsive to consumer needs and to emerging
knowledge and research.

This scope of practice document is designed to support and be used in conjunction with the
Definition of Occupational Therapy Practice for the Model Practice Act (AOTA, 2004a). While
this scope of practice document helps support state laws and regulations that govern the practice
of occupational therapy, it does not supercede those existing laws and other regulatory
requirements. Occupational therapists and occupational therapy assistants are required to abide
by statutes and regulations when providing occupational therapy services. State laws and other
regulatory requirements typically include statements about educational requirements to practice
occupational therapy, procedures to practice occupational therapy legally within the defined area
of jurisdiction, the definition and scope of occupational therapy practice, and supervision
requirements.

AOTA (1994) states that a referral is not “required for the provision of occupational therapy
services” (p. 1034); however, a referral may be indicated by some state laws and other regulatory
requirements. The AOTA 1994 document Statement of Occupational Therapy Referral states
that “occupational therapists respond to requests for services, whatever their sources. They may
accept and enter cases at their own professional discretion and based on their own level of
competency” (p. 1034). Occupational therapy assistants provide services under the supervision
of an occupational therapist. State laws and other regulatory requirements should be viewed as
minimum criteria to practice occupational therapy. Ethical guidelines that ensure safe and
effective delivery of occupational therapy services to clients always influence occupational
therapy practice (AOTA, 2000).
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Definition of Occupational Therapy

AOTA’s Definition of Occupational Therapy for the Model Practice Act defines occupational
therapy as
the therapeutic use of everyday life activities (occupations) with
individuals or groups for the purpose of participation in roles and
situations in home, school, workplace, community, and other settings.
Occupational therapy services are provided for the purpose of promoting
health and wellness and to those who have or are at risk for developing an
illness, injury, disease, disorder, condition, impairment, disability, activity
limitation, or participation restriction. Occupational therapy addresses the
physical, cognitive, psychosocial, sensory, and other aspects of
performance in a variety of contexts to support engagement in everyday
life activities that affect health, well-being, and quality of life” (AOTA,
2004a).

Scope of Practice―The Domain and Process

The scope of practice includes the domain and process of occupational therapy services. These
concepts are intertwined with the domain defining the focus of occupational therapy (see Figure
1) and the process defining the delivery of occupational therapy (see Figure 2). The domain of
occupational therapy is the everyday life activities (occupations) that people find meaningful and
purposeful. Within this domain, occupational therapy services enable clients to engage
(participate) in their everyday life activities in their desired roles, context, and life situations.
Clients may be individuals, groups, communities, or populations. The occupations in which
clients engage occur throughout the life span and include

• activities of daily living (self-care activities);

• education (activities to participate as a learner in a learning environment);
• instrumental activities of daily living (multistep activities to care for self and others, such as
household management, financial management, and childcare);
• leisure (nonobligatory, discretionary, and intrinsically rewarding activities);
• play (spontaneous and organized activities that promote pleasure, amusement, and diversion);
• social participation (activities expected of individuals or individuals interacting with others);
and
• work (employment-related and volunteer activities)

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DOMAIN OF OCCUPATIONAL THERAPY

Engagement in Occupation to Support Participation in Context or Contexts

Performance in Areas of Occupation
Activities of Daily Living (ADL)*
Instrumental Activities of Daily Living (IADL)
Education
Work
Play
Leisure
Social Participation

Performance Skills Performance Patterns

Motor Skills Habits
Process Skills Routines
Communication/Interaction Skills Roles

Context Activity Demands Client Factors

Cultural Objects Used and Their Properties Body Functions1
Physical Space Demands Body Structures2
Social Social Demands
Personal Sequencing and Timing
Spiritual Required Actions
Temporal Required Body Functions
Virtual Required Body Structures

*Also referred to as basic activities of daily living (BADL) and personal

activities of daily living (PADL).

(AOTA, 2002, p. 611)

1
Body Functions (e.g., neuromuscular, sensory, visual, perceptual, cognitive, mental)
2
Body Structures (e.g., cardiovascular, digestive, integumentary systems)

Figure 1

Within this domain of practice, occupational therapists and occupational therapy assistants
consider the repertoire of occupations in which the client engages, the performance skills and
patterns the client uses, the contexts influencing engagement, the features and demands of the
activity, and the client’s body functions and structures. Occupational therapists and occupational
therapy assistants use their knowledge and skills to help clients “attain and resume daily life
activities that support function and health” throughout the lifespan (AOTA, 2002, p. 610).
Participation in activities and occupations that are meaningful to the client involves emotional,
psychosocial, cognitive, and physical aspects of performance. This participation provides a
means to enhance health, well-being, and life satisfaction.

The domain of occupational therapy practice complements the World Health Organization’s
(WHO) conceptualization of participation and health articulated in the International
Classification of Functioning, Disability and Health (ICF) (WHO, 2001). Occupational therapy
incorporates the basic constructs of ICF, including environment, participation, activities, and
body structures and functions, when addressing the complexity and richness of occupations and
occupational engagement.

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The process of occupational therapy relates to service delivery (see Figure 2) and includes
evaluating, intervening, and targeting outcomes. Occupation remains central to the occupational
therapy process. It is client-centered, involving collaboration with the client throughout each
aspect of service delivery. During the evaluation, the therapist develops an occupational profile,
analyzes the client’s ability to carry out everyday life activities, and determines the client’s
occupational needs, problems, and priorities for intervention. Evaluation and intervention may
address one or more of the domains (see Figure 1) that influence occupational performance.
Intervention includes planning and implementing occupational therapy services and involves
therapeutic use of self, activities, and occupations, as well as consultation and education. The
occupational therapist and occupational therapy assistant utilize occupation-based theories,
frames of reference, evidence, and clinical reasoning to guide the intervention (AOTA, 2002).

The outcome of occupational therapy intervention is directed toward “engagement [of the client]
in occupations that support participation in [daily life situations] (AOTA, 2002, p. 618).
Outcomes of the intervention determine future actions with the client. Outcomes include the
client’s occupational performance, role competence and adaptation, health and wellness, quality
of life and satisfaction, and prevention initiatives (AOTA, 2002, p. 619).

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COLLABORATIVE PROCESS MODEL

• Engagement in
Occupation to
Support
Participation

Outcomes

• Occupational Collaborative
Profile Process Between • Intervention Plan
Practitioner and
• Analysis of Client • Intervention
Occupational Evaluation Intervention Implementation
Performance • Intervention
Review

Figure 2: Illustration of the framework emphasizing client–practitioner interactive relationship

and interactive nature of the service delivery process (AOTA 2002, 614).

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Occupational Therapy Practice

Occupational therapists and occupational therapy assistants are experts at analyzing the
performance skills and patterns necessary for people to engage in their everyday activities in the
context in which those activities and occupations occur. The occupational therapist assumes
responsibility for the delivery of all occupational therapy services and for the safety and
effectiveness of occupational therapy services provided. The occupational therapy assistant
delivers occupational therapy services under the supervision of and in partnership with the
occupational therapist (AOTA, 2004b).

The practice of occupational therapy includes

A. Strategies selected to direct the process of interventions, such as

1. Establishment, remediation, or restoration of a skill or ability that has not yet
developed or is impaired.
2. Compensation, modification, or adaptation of activity or environment to enhance
performance.
3. Maintenance and enhancement of capabilities without which performance in
everyday life activities would decline.
4. Health promotion and wellness to enable or enhance performance in everyday life
activities.
5. Prevention of barriers to performance, including disability prevention.

B. Evaluation of factors affecting activities of daily living (ADL), instrumental activities of

daily living (IADL), education, work, play, leisure, and social participation, including
1. Client factors, including body functions (e.g., neuromuscular, sensory, visual,
perceptual, cognitive) and body structures (e.g., cardiovascular, digestive,
integumentary, genitourinary systems).
2. Habits, routines, roles, and behavior patterns.
3. Cultural, physical, environmental, social, and spiritual contexts and activity demands
that affect performance.
4. Performance skills, including motor, process, and communication/interaction skills.

C. Interventions and procedures to promote or enhance safety and performance in activities

of daily living (ADL), instrumental activities of daily living (IADL), education, work,
play, leisure, and social participation, including
1. Therapeutic use of occupations, exercises, and activities.
2. Training in self-care, self-management, home management, and community/work
reintegration.
3. Development, remediation, or compensation of physical, cognitive, neuromuscular,
sensory functions, and behavioral skills.
4. Therapeutic use of self, including one’s personality, insights, perceptions, and
judgments, as part of the therapeutic process.
5. Education and training of individuals, including family members, caregivers, and
others.
6. Care coordination, case management, and transition services.
7. Consultative services to groups, programs, organizations, or communities.
8. Modification of environments (home, work, school, or community) and adaptation of
processes, including the application of ergonomic principles.
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9. Assessment, design, fabrication, application, fitting, and training in assistive

technology, adaptive devices, and orthotic devices, and training in the use of
prosthetic devices.
10. Assessment, recommendation, and training in techniques to enhance functional
mobility, including wheelchair management.
11. Driver rehabilitation and community mobility.
12. Management of feeding, eating, and swallowing to enable eating and feeding
performance.
13. Application of physical agent modalities, and use of a range of specific therapeutic
procedures (e.g., wound care management; techniques to enhance sensory, perceptual,
and cognitive processing; manual therapy techniques) to enhance performance skills.

(AOTA, 2004a)

Site of Intervention
Along the continuum of service, occupational therapy services may be provided to clients
throughout the life span in a variety of settings. The settings may include, but are not limited to,
the following:

• Institutional settings (inpatient) (e.g., acute rehabilitation, psychiatric hospital, community

and specialty focused hospitals, nursing facilities, prisons)
• Outpatient settings (e.g., hospitals, clinics, medical and therapy offices)
• Home and community settings (e.g., home care, group homes, assisted living, schools, early
intervention centers, day-care centers, industry and business, hospice, sheltered workshops,
wellness and fitness centers, community mental health facilities)
• Research facilities

Education and Certification Requirements

To practice as an occupational therapist, the individual
• must have graduated from an occupational therapy program accredited by the
Accreditation Council for Occupational Therapy Education (ACOTE®) or
predecessor organizations1, and
• must have 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 organization (AOTA, 2003b, Policy 5.3).
• must have successfully passed the national certification examination for occupational
therapists and/or met state requirements for licensure/registration.

To practice as an occupational therapy assistant, the individual

• must have graduated from an associate- or certificate-level occupational therapy
assistant program accredited by ACOTE® or predecessor organizations, and

1
Foreign educated graduates of occupational therapy programs approved by the World Federation of Occupational
therapy (WFOT) may also be eligible for certification/licensure as an occupational therapist provided additional
requirements are met.
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• must have 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 (AOTA, 2003b, Policy
5.3).
• must have successfully passed the national certification examination for occupational
therapy assistants and/or met state requirements for licensure/registration.

AOTA supports licensure of qualified occupational therapists and occupational therapy assistants
(AOTA, 2003b, Policy 5.3). State and other legislative or regulatory agencies may impose
additional requirements to practice as an occupational therapist and occupational therapy
assistants in their area of jurisdiction.

References
American Occupational Therapy Association. (1994). Statement of occupational therapy referral.
American Journal of Occupational Therapy, 48, 1034.

American Occupational Therapy Association. (2000). Occupational therapy code of ethics.

American Journal of Occupational Therapy, 54, 614–616.

American Occupational Therapy Association. (2002). Occupational therapy practice framework:

Domain and process. American Journal of Occupational Therapy, 56, 609–639.

American Occupational Therapy Association. (2003a). Policy 1.11: The philosophical base of
occupational therapy. Policy Manual (2003 ed.). Bethesda, MD: Author.

American Occupational Therapy Association. (2003b). Policy 5.3: Licensure. Policy Manual
(2003 ed.). Bethesda, MD: Author.

American Occupational Therapy Association. (2004a). Definition of occupational therapy

practice for the AOTA Model Practice Act. (Available from the State Affairs Group,
American Occupational Therapy Association, 4720 Montgomery Lane, PO Box 31220,
Bethesda, MD 20824-1220.)

American Occupational Therapy Association. (2004b). Guidelines for supervision, roles, and
responsibilities during the delivery of occupational therapy services. American Journal of
Occupational Therapy, 58 (November/December).

World Health Organization. (2001). International classification of functioning, disability and

health (ICF). Geneva, Switzerland: Author.

Additional Reading
American Occupational Therapy Association. (1993). Occupational therapy roles. American
Journal of Occupational Therapy, 47, 1087–1099.

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American Occupational Therapy Association. (1994). Statement of occupational therapy referral.

American Journal of Occupational Therapy, 48, 1034.

American Occupational Therapy Association. (1998). Guidelines to the occupational therapy

code of ethics. American Journal of Occupational Therapy, 2, 881–884.

American Occupational Therapy Association. (1999). The guide to occupational therapy

practice. American Journal of Occupational Therapy, 53, 247–322.

Moyers, P. (1999). The guide to occupational therapy practice. American Journal of

Occupational Therapy, 53(3), 247–322.

Youngstrom, M. J. (2002). Introduction to the occupational therapy practice and framework:

Domain and process. OT Practice, CE-1–CE-7.

Authors

The Commission on Practice:

Sara Jane Brayman, PhD, OTR/L, FAOTA, Chairperson
Gloria Frolek Clark, MS, OTR/L, FAOTA
Janet V. DeLany, DEd, OTR/L
Eileen R. Garza, PhD, OTR, ATP
Mary V. Radomski, MA, OTR/L, FAOTA
Ruth Ramsey, MS, OTR/L
Carol Siebert, MS, OTR/L
Kristi Voelkerding, BS, COTA/L
Patricia D. LaVesser, PhD, OTR/L, SIS Liaison
Lenna King, ASD Liaison
Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA Headquarters Liaison

for

The Commission on Practice

Sara Jane Brayman, PhD, OTR/L FAOTA, Chairperson

Adopted by the Representative Assembly 2004C23

Edited by the Commission on Practice 2005

Previously published and copyrighted in 2004 by the American Occupational Therapy

Association in the American Journal of Occupational Therapy, 58, 673–77.