Where Do You Think Occupational Therapists Work? The Answer Might Surprise You.

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Occupational therapy is an allied health profession, so you might think that occupational therapists only work in hospitals. But that would be wrong. Understanding where occupational therapists work, and what their role is, can sometimes be a little more complicated than it seems. Why? Because of the scope of practice of occupational therapy.

As defined by the World Federation of Occupational Therapists in the previous post here, occupational therapy is;

A client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life.

This definition highlights the core focus of occupational therapy beautifully. Still, there is no indication of where occupational therapists apply this unique expertise. So the goal of this post is to shed a little light on where occupational therapists work, how they identify their goals, and how they use occupation to meet those goals.

Like medicine, occupational therapy is a profession that cuts across all areas of healthcare. Some occupational therapists work across the different sub-divisions of physical health and mental health. But, other occupational therapists work in social services, the development of assistive tools and devices, community healthcare, legal consultation and even in occupational health.

So what is the thread that binds them all together? And how does the knowledge of occupation allow an occupational therapist to contribute to all of these different areas? To understand this, you need a working knowledge of how occupational therapists view the word occupation. So it’s highly suggested that you take a look at this post first, and then come back here.

Now that we are all on the same page, let’s dive a little deeper into what an occupational therapists’ role is in each of these areas. And how their unique skills make them a vital part of any healthcare team.

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Physical Health

In physical health settings, occupational therapists work across the board; from respiratory and stroke to orthopaedics and cardiology. When working in physical health, an occupational therapist focuses on the physical barriers to occupation first, e.g. shaking hands, low stamina, shortness of breath, issues with balance and core stability. They will consider the condition, the prognosis, their clients’ current stage in that journey, and which occupations are the most severely impacted by their client’s physical impairment.

Then the occupational therapist will consider the client’s environment. Is there enough space for the client to move around comfortably? Is there a chair close by that they can sit in when they get tired? Are their utensils appropriate for them to be using? Or are they too heavy, or too small to be used effectively?

Then the occupational therapist will also consider their client’s mental state. What beliefs do they have about their health? What expectations do they have, and how are those expectations going to affect their engagement in that occupation? Overall, how is their recovery going to be influenced by their mental state?

Then the occupational therapist will work with the client to determine which occupations are the most important to the client, and they will collaboratively draw up a plan to practice those occupations safely. This plan could include practice focused on each of the parts of an activity, or the overall activity itself. This process ensures that the client is working on the occupations that they feel are the most important. It also allows the therapist to assess those occupations, and their parts, in action, which gives them a deeper understanding of any barriers to engagement experienced by the client.

Could it be that the client’s mental state needs to be worked on so that they have more realistic expectations? Or will they need a perching stool while cooking so that they don’t have to stand the entire time and therefore they can utilise their energy more efficiently? Do their utensils need to be adapted or changed to make the tasks easier? Or do they have support, like family or friends, who can assist them with the more challenging parts of a task while allowing them to engage with the more accessible steps and facilitate their success that way?

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Mental health

When it comes to mental health, an occupational therapist role is more nuanced, but it is still very relevant. Here, just as with physical health, an occupational therapist will start by seeking to understand the condition that their client is experiencing. What is the prognosis, and where is their client along that path. Once these factors are understood, then the same process is applied.

The occupational therapist will work with a client to identify what occupations are the most important to them and which occupations they struggle with the most as well. For example, a client suffering from severe anxiety disorder might have trouble with shopping for the things they need. Once this is highlighted as a focus for occupational therapy intervention, the occupational therapist will work with the client to understand what it is about this occupation that they find so stressful.

Once those key triggers are identified, the occupational therapist will then work to break the task into smaller bits that the client can more easily accomplish. In this scenario, the occupational therapist could choose to utilise a desensitisation regimen, where they work with the client to increase their tolerance for completing the activity independently gradually.

It could start with helping the client with writing out a list of all the things they need to buy, and then going with the client to the store to purchase the items. The occupational therapist might take the lead role during the entire activity the first time. The purpose of this would be to engage the person in this occupation in a way that makes them feel safe. The next time this occupation is carried out, the occupational therapist might ask the client to independently create a list of the things they would like to buy, while still following the client to the store and taking a lead role with the interpersonal interactions.

The next stage might be for the client to independently make a list and meet the occupational therapist at the store, after which they would complete the rest of the task together. And that gradual exchange of power would continue, whereby the occupational therapist would give ownership of that task to the client in chunks that they can handle. Over time the goal would be for the client to be able to carry out this task independently.

Another task that can be introduced is a debriefing after each session. The occupational therapist could focus on debriefing the client in person or encouraging them to keep a journal, so they begin to understand what their emotional state was like during each of the sessions. They can then analyse what went well, what didn’t go well, and what can be improved upon together. This process actively engages the client in an occupation that they find important whilst simultaneously encouraging them to assess the beliefs or mental challenges that they are going through. And it can be instrumental in supporting the client to work through those feelings of anxiety and challenge any limiting beliefs or thoughts that are contributing to that anxiety.

This is just one of the examples of how an occupational therapist might work in a mental health setting. How an occupational therapist approaches each client, and each condition is primarily dependent on the client because occupational therapy is a client-focused profession and letting the client lead always leads to better outcomes.

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Social Services

When working in social services, an occupational therapist’s unique knowledge of the barriers and facilitators to occupation become very valuable. For example, when working with social services to adapt a clients environment, an occupational therapist will assess the client with a focus on their occupational needs. So, what is their daily routine? What challenges do they have, be that physical or mental? What support systems do they have? What is their technical capability? Etc.

All of this information will then allow the occupational therapist to recommend the best equipment or adaptation to support the client’s ability to live independently. For example, an elderly client who may be at risk of falls will benefit more from having a wet room or shower than having a bath because of the heightened possibility of a fall happening within a bath, and possible difficulties with getting out of a tub that is too low to the ground. If changing the bath isn’t an option, handrails could be strategically placed along the walls with a non-slip mat to reduce the risks of falls and difficulty getting out of the bath.

An occupational therapist could also apply this reasoning to a client with neurological conditions. If a client, for example, has issues with depth perception following a neurological event, an occupational therapist could suggest that certain items, like table and sink edges, be colour-coded to assist the client with navigating their home safely. They may also indicate that the floor shouldn’t have any rugs to prevent any falls that may result from their struggle with depth perception.

In the case of recommending support based on mental health, these may be more focused on creating an adequate support system for the client. So this could include assisting them with getting in contact with local support groups, local pharmacies, getting them set up with their GP, or ensuring that they have access to the services that they need for them to be able to live independently successfully. And all of these recommendations would be supported by the best available evidence as occupational therapy is an evidence-based profession.

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Development of assistive tools and devices

When it comes to the development of assistive tools and devices, an occupational therapist’s knowledge of occupations makes them invaluable. Their experience allows them to find the pain points that are possible within any activity or task and devise solutions to those challenges. The prescription of assistive devices like splints, walking sticks, walking frames etc. are already under the umbrella of activities an occupational therapist is trained to do.

A crucial part of what makes them different is that an occupational therapist does not only look at this process from a functional point of view, they also view the process from an emotional and motivational point of view. While anyone may prescribe a splint to a child, an occupational therapist is more likely to consider if the colour of the splint will motivate the child to wear it and thus adhere to their treatment regimen more effectively. An occupational therapist will always look at the whole person and how these devices will integrate into their daily life during the process of creation and prescription.

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Community healthcare

When it comes to community health care, the role of an occupational therapist can take many forms. They may be involved in specialised teams that focus on either physical or mental health. Or they may be on a team that is dedicated to improving community engagement in an area where it is needed, for example, working in a community centre. Since their roles in physical and mental health have already been discussed, we’ll focus on the last scenario.

In this situation, an occupational therapist would focus on understanding the needs of the community as a whole and then devising strategies to meet those needs. If a high proportion of the people in the community are unemployed, an occupational therapist would understand the need for engagement in meaningful and productive work in peoples lives. So a possible recommendation may be to create a volunteer program within the community centre that allows the unemployed members of that community to engage in productive work, which could also serve to help them improve their job skills and their overall quality of life.

They may also recommend vocational training that is held at the community centre, or targeted leisure activities such as woodworking, art, gardening, etc. These opportunities will provide structure and hopefully facilitate the formation of friendships between members. In every situation, engagement in the right occupations is what brings about the change that is being worked for.

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Legal consultancy

This is an area which is very new in the realm of occupational therapy, and an occupational therapist would probably only be present in situations that require the knowledge of an appropriate health care professional. For example, consider a situation where a hearing is being conducted to decide the amount of financial support an individual needs from the state. An occupational therapist’s knowledge of the activities and occupations that this individual will need to engage in to stay healthy is an asset toward coming to a decision that is both good for the individual and sustainable for the government. They would be able to provide clear and realistic feedback, along with an evidence-based report to support their recommendation.

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Occupational Health

Occupational health is possibly the most common profession that is confused with occupational therapy. However, although occupational health and occupational therapy are not the same things, an occupational therapist’s knowledge of how to facilitate work and occupations is valuable within the occupational health setting. In this case, an occupational therapist can assess both the mental and physical barriers towards an employees engagement in their work and provide cost-effective occupation-based solutions that meet the needs of both the employee and the employer.

For example, in the case of an employee having lower back pain due to work, an occupational therapist may recommend a different type of seat and table for this employee. The occupational therapist will likely support this recommendation with the evidence highlighting the fact that that this provision will ensure that the employee is better able to fulfil their duties in the long run. While if an employee is struggling with a mental health challenge like depression, an occupational therapist is well suited to provide appropriate individual support for this employee. They will also be able to educate the colleagues and supervisors of this employee to ensure that they understand the situation and are well informed on how best to support this employee.

Overall, these are just some of the areas in which occupational therapists work and thrive based on their unique skill sets. There are some areas which weren’t covered, like learning disabilities and patient advocacy, but hopefully, this blog gave you a thorough introduction into the world of occupational therapy work.

If you enjoyed learning about this, don’t forget to give this post a clap and follow for more OT related content!

I would also like to apologise about the delay in my post for last week. The political climate in my home country of Nigeria threw a spanner in the works, but I’ll be back to posting every Monday. Thank you so much to everyone who reads these blogs and follows me. It means so much to me, and I’ll keep doing my best and hoping that’s enough.

Hope you all have a blessed week ahead! And I may or may not have a surprise post later on this week. So I guess you’ll need to stay tuned to find out.

Bye for now!

This article is for informational and educational purposes only. Do not take anything written in this post as a substitute for advice from a trained professional familiar with the specifics of your situation.

A 20-something-year-old with an endless array of interests, who also happens to be an Occupational Therapist. Welcome to my library of learning.

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The Eclectic OT

The Eclectic OT

A 20-something-year-old with an endless array of interests, who also happens to be an Occupational Therapist. Welcome to my library of learning.

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