otipm: a model for implementing top-down, client-centered ......updated 7 august 2017 otipm: a model...

Updated 7 August 2017

OTIPM: A model for implementing top-down,

client-centered, and occupation-based

assessment, intervention, and documentation

Developed by Professor Anne G. Fisher, ScD, OT, FAOTA

The OTIPM rescued me from an “OT-depression”! Half of my clients did not need OT, they needed

physiotherapy. After I learned the OTIPM, I made sure the OT referrals were appropriate and took

more time for the “interviewing–observing–goal-setting–process,” and I focused more on education

and compensation. Nothing totally new, but still it changed something. I gained more OT self-esteem

and joy in my work.

We changed our documentation system. And we “threw out” the old tests, and now we focus on

“performance of prioritized activities.” Even one of the most “body-function-working OT colleagues”

are enthusiastically reporting that they are reaching goals more easily and faster!

Katharina, 2015

Overview

This 3-day course is ideal for occupational therapy practitioners, educators, and researchers who want

to implement best possible occupation-based and occupation-focused services. The course content

progresses step-by-step through the phases of the occupational therapy process. Lectures, video case

examples, and extensive opportunities to practice enable the course participants to reflect on and learn

strategies they can apply to improve their practice, educational activities, and research.

While this course is based on the Occupational Therapy Intervention Process Model (OTIPM, Fisher,

2009; Fisher & Jones, in press). the emphasis is on the practical application of the OTIPM as a

professional reasoning model that helps the occupational therapist practice in a more client-centered,

top-down, occupation-based, and occupation-focused manner. The occupational therapists who take

this course find that they leave inspired to make their practice more centered on occupation.

A major premise of the OTIPM is that focusing our evaluations on the client’s quality of occupational

performance, focusing our interventions directly on enhancing or maintaining occupational performance,

and using occupation as a primary method for both evaluation and intervention all depend on a

concurrent commitment to true top–down and client-centered practice. When we embrace these

fundamental principles of occupation-based and occupation-focused services, occupational therapists

will:

• Document measureable and occupation-focused baselines, goals, and outcomes

• Use occupation-based and occupation-focused evaluation and intervention methods to enhance the

quality and effectiveness of the services they provide


• Advocate for and promote the distinct value of occupational therapy to consumers, third-party

payers, and other professionals

• Value the contributions of occupational therapy to health care and health promotion

Background

Based on her 1998 Eleanor Clarke Slagle Lectureship, Professor Fisher brings together 50 years of

experience to present a model for professional reasoning. The OTIPM is a professional reasoning model

that occupational therapists can use to ensure that they adopt an occupation-centered (OC) perspective

to guide their reasoning as they plan and implement occupation-based (OB) and occupation-focused (OF)

services (Fisher, 2013).

In the OTIPM, the occupational therapy process is depicted as occurring over three global phases,

evaluation and goal-setting, intervention, and reevaluation, and each step in the process may be OB, OF,

or both (Fisher, 2013). The steps of the occupational therapy process defined in the OTIPM are

represented schematically below (see Figure 1).


Who Should Attend?

• Occupational therapists who want to change their practice and implement services that are

occupation-based and occupation-focused.

• Occupational therapists who already practice in a manner with which they are satisfied—attending

this course will enable them to reflect on and evaluate their current practice and identify components

that they can further improve so as to become even more occupation-centered.

• Occupational therapist who want to change practice and are struggling with where to start in order

to overcome the many obstacles that limit what they can do.

Course Description

While the OTIPM is a professional reasoning model, the emphasis of this course is on the practical

application of the OTIPM in practice. A variety of individual and group activities provide the course

participants with opportunities to implement (a) nonstandardized occupation-focused and occupation-

based evaluations of quality of a person’s occupational performance, including the performance of daily

life tasks that involve social interaction, and (b) occupation-focused documentation. Video case examples

are used to reinforce learning.

Course Objectives

At the conclusion of a 3-day OTIPM workshop, the participants will understand:

• The occupation-centered professional reasoning process defined in the OTIPM

• Distinctions between occupation-centered reasoning and occupation-based and occupation-focused

practice

• The various types of evaluations and interventions occupational therapists commonly use and which

ones are occupation-based or occupation-focused

• How to apply true top–down and occupation-centered reasoning in the context of implementing

occupation-based and occupation-focused services

• How to implement nonstandardized observation-based performance analyses of a person’s quality of

occupational performance

• How to write occupation-focused documentation, including observable and measureable client-

centered goals

• When and how to link other occupational therapy models of practice and evaluation methods into

the occupational therapy intervention process


Course Schedule

Day 1 — 8:30 to 10:00 Introduction to the course Developing a common language 10:00 to 10:30 Break 10:30 to 12:00 Developing a common language (continued) Introduction to the OTIPM 12:00 to 1:15 Lunch 1:15 to 3:00 Case application — Client-centered performance context 3:00 to 3:30 Break 3:30 to 4:30 Document background information, reason for referral, and self-reported level

of occupational performance Day 2 — 8:30 to 10:00 Case application — Implement performance analysis (motor and process skills) 10:00 to 10:30 Break 10:30 to 12:00 Case application — Document baseline level of performance and client-

centered goals 12:00 to 1:15 Lunch 1:15 to 3:00 Case application — Document client-centered goals (continued) 3:00 to 3:30 Break 3:30 to 4:30 Case application — Plan intervention Document intervention plan Reevaluate and document result Day 3 — 8:30 to 9:15 Introduction to a general OT program based on OTIPM 9:15 to 10:00 Case application — Implement performance analysis (social interaction skills) 10:00 to 10:30 Break 10:30 to 12:00 Case application — Document baseline level of performance and client-

centered, occupation-focused goals 12:00 to 1:15 Lunch 1:15 to 1:45 Case application — Plan intervention and evaluate results 1:45 to 3:00 Framing function from an unique occupational therapy perspective Some final thoughts Implementing changes in practice — Overcoming obstacles 3:00 to 3:30 Break 3:30 to 4:30 Implementing changes in practice — Overcoming obstacles (continued) Final reflections

Note. The schedule presented here may vary, depending on group interest and needs. Exact times for

breaks and lunch also may vary slightly, depending on the schedule of the course setting.


Selected References

Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same or

different? Scandinavian Journal of Occupational Therapy, 20, 162–173. DOI: 10.3109/11038128.2012.

754492

Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and

implementing top–down, client-centered, and occupation-based interventions. Ft. Collins, CO: Three Star

Press.

Fisher, A. G., & Griswold, L. A. (2013). Performance skills: Implementing performance analyses to

evaluate quality of occupational performance. In B. B. Schell, G. Gillen, M. Scaffa , & E. Cohn (Eds.), Willard

& Spackman’s occupational therapy (12th ed., pp. 249–264). Philadelphia: Lippincott Williams & Wilkins.

Fisher, A. G. & Jones, K. B. (2017). Occupational Therapy Intervention Process Model. In J. Hinojosa,

P. Kramer, & C. B. Royeen. Perspectives on human occupation: Theories underlying practice (2nd ed., pp.

237–286). Philadelphia: Wolters Kluwer|Lippincott Williams & Wilkins.

(Note. For additional references, go to http://www.innovativeotsolutions.com/content/otipm/references/)

Develop therapeutic rapport and work

collaboratively with client

Define and describe task actions the client

does and does not perform effectively

Select a model for education and

teaching

Reevaluate for enhanced and satisfying

occupationalperformance

Identify client’s reported and prioritized strengths

and problems of occupational performance

Observe client’s performance of prioritized

tasks and implement performance analyses

Select the compensatory

model

Plan and implement adaptive occupation to

compensate for decreased occupational skill

Select a model for enhancement of person

factors and body functions (restorative model)

Select a model for occupational skills

training(acquisitional model)

Plan and implement restorative occupation to restore or develop person factors and body functions

Clarify or interpret the reason(s) for client’s

problems of occupational performance

Identify resources and limitations within

client-centered performance context

Establish, finalize, or redefine client-centered and occupation-focused

goals

Evaluation and goal-setting phase Intervention phase Reevaluation phase

Establishclient-centered

performance context

Plan and implement educational programs

for groups focusedon performance of

daily life tasks

Plan and implement acquisitional occupation to reacquire or develop

occupational skill

Adapted from: Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and implementing top-down, client-centered, and occupation-based interventions. Fort Collins CO: Three Star Press. (Revised June 2013)

Updated 29 April 2016

Occupational Therapy Intervention Process Model

(OTIPM) — Note Taking Worksheet

Client-centered Performance Context: Resources and Limitations

Consider past, present, and future or each dimension

Environmental

dimension

Role

dimension

Motivational

dimension

Task

dimension

Cultural

dimension

Social

dimension

Societal

dimension

Body function

dimension

Temporal

dimension

Adaptation

dimension

Reason for

referral

Strengths and Problems of Reported Occupational Performance

Tasks performed well and/or

with satisfaction

Task performed with problems

and/or with dissatisfaction

Tasks potentially problematic




Actions (Performance Skills) Performed Effectively or Ineffectively

Motor skill Behavior (action) observed Judgment





Process skill Behavior (action) observed Judgment




ADL Motor and ADL Process Skill Specific Baseline Statements

Skills included in the cluster Specific baseline statement





Social interaction skill Behavior (action) observed Judgment




Social Interaction Skill Specific Baseline Statements

Skills included in the cluster Specific baseline statement



(OTIPM) — Documentation Worksheet

Background information

Reason for referral

Reported current level of performance

Priorities

Observed current status (global baseline)

Actions of performance (performance skills) of most concern (specific baseline)

Goals

Interpretation

Intervention plan

Potential to benefit from intervention

THIS PAGE IS INTENTIONALLY BLANK

Updated 5 March 2018

Dancza, K., Copley, J., Rodger, S., & Moran, M. (2016). The development of a theory-

informed workbook as an additional support for students on role-emerging placements.

British Journal of Occupational Therapy, 79, 235–243. https://doi.org/10.1177/

0308022615612806

Ericksen, J. B. (2009). Critical reflections on school-based occupational therapy.

Scandinavian Journal of Occupational Therapy, 17, 64–69. https://doi.org/10.3109/

11038120903160736

Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same,

same or different? Scandinavian Journal of Occupational Therapy, 20, 162‒173.

https://doi.org/10.3109/11038128.2012.754492

Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for

planning and implementing top-down, client-centered, and occupation-based interventions.

Ft. Collins, CO: Three Star Press.

Fisher, A. G. (2006). Overview of performance skills and client factors. In H. M.

Pendleton, & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for

physical dysfunction (6th ed., pp. 372–402). St. Louis MO: Mosby Elsevier.

Fisher, A. G. (1998). Uniting practice and theory in an occupational framework: 1998

Eleanor Clarke Slagle Lecture. American Journal of Occupational Therapy, 52, 509–521.

https://doi.org/10.5014/ajot.52.7.509

Fisher, A. G., Atler, K., & Potts, A. (2007). Effectiveness of occupational therapy with

frail community living older adults. Scandinavian Journal of Occupational Therapy, 14, 240–

249. https://doi.org/10.1080/11038120601182958

Fisher, A. G., Bryze, K., Hume, V, & Griswold, L. A. (2007). School AMPS: School

Version of the Assessment of Motor and Process Skills (2nd ed.). Ft. Collins, CO: Three Star

Press.

Fisher, A. G., & Griswold, L. A. (2014). Performance skills: Implementing performance

analyses to evaluate quality of occupational performance. In B. A. B. Schell, G. Gillen, & M.

E. Scaffa (eds.), Willard & Spackman’s occupational therapy (12th ed., pp. 249–264).

Philadelphia: Lippincott Williams & Wilkins.

Fisher, A. G., & Griswold, L. A. (2018). Evaluation of Social Interaction (4th ed.). Fort

Collins, CO: Three Star Press.

Fisher, A. G., & Jones, K. B. (2012). Assessment of Motor and Process Skills. Vol. 1:

Development, standardization, and administration manual (7th Rev. ed.). Fort Collins, CO:

Three Star Press.

References: Occupational Therapy

Intervention Process Model (OTIPM)

https://doi.org/10.1177/0308022615612806https://doi.org/10.1177/0308022615612806https://doi.org/10.3109/11038120903160736https://doi.org/10.3109/11038120903160736https://doi.org/10.3109/11038128.2012.754492https://doi.org/10.5014/ajot.52.7.509https://doi.org/10.1080/11038120601182958

Updated 5 March 2018

Fisher, A. G. & Jones, K. B. (2017). Occupational Therapy Intervention Process Model.

In J. Hinojosa, P. Kramer, & C. B. Royeen. Perspectives on human occupation: Theories

underlying practice (2nd ed., pp. 237–286). Philadelphia: Wolters Kluwer|Lippincott

Williams & Wilkins.

Fisher, A. G., & Nyman, A. (2011). OTIPM: En model för ett professionellt resonemang

som främjar bästa praxis i arbetsterapi (FOU-rapport 2007) [OTIPM: A model for

professional reasoning that promotes best practice in occupational therapy] (revised ed.).

Nacka, Sweden: Förbundet Sveriges Arbetsterapeuter.

Hällgren, M., & Kottorp, A. (2005). Effects of occupational therapy program in activities

of daily living and awareness of disability in persons with intellectual disabilities. Australian

Occupational Therapy Journal, 52, 350–359. https://doi.org/10.1111/j.1440-1630.2005.

00523.x

Kottorp, A., Hällgren, M., Bernspång, B., & Fisher, A. G. (2003). Client-centred

occupational therapy for persons with mental retardation: Implementation of an intervention

programme in activities of daily living tasks. Scandinavian Journal of Occupational Therapy,

10, 51–60. https://doi.org/10.1080/11038120310009416

Larsson-Lund, M., & Nyman, A. (2017). Participation and occupation in occupational

therapy models of practice: A discussion of possibilities and challenges. Scandinavian

Journal of Occupational Therapy, 24, 393–397. https://doi.org/10.1080/11038128.2016.

1267257

Lindström, M., Hariz, G. M., & Bernspång, B. (2012). Dealing with real-life challenges:

Outcome of a home-based occupational therapy intervention for people with severe

psychiatric disability. Occupational Therapy Journal of Research, 32, 5–13.

https://dx.doi.org/10.3928/15394492-20110819-01

Simmons, D. C., & Griswold, L. A. (2010). Using the Evaluation of Social Interaction in

a community-based program for persons with traumatic brain injury. Scandinavian Journal of

Occupational Therapy, 17, 49–56. https://doi.org/10.3109/11038120903350303

Sirkka, M., Larsson-Lund, M., & Zingmark, K. (2014). Occupational therapists'

experiences of improvement work: A journey towards sustainable evidence-based practice.

Scandinavian Journal of Occupational Therapy, 21, 90–97. https://doi.org/10.3109/

11038128.2013.872183

Zingmark, M., Fisher, A. G., Rocklöv, J., & Nilsson, I. (2014). Occupation-focused

interventions for well older people: An exploratory randomized controlled trial. Scandinavian

Journal of Occupational Therapy, 21, 447–457. https://doi.org/10.3109/11038128.2014.

927919

https://doi.org/10.1111/j.1440-1630.2005.00523.xhttps://doi.org/10.1111/j.1440-1630.2005.00523.xhttps://doi.org/10.1080/11038120310009416https://doi.org/10.1080/11038128.2016.1267257https://doi.org/10.1080/11038128.2016.1267257https://dx.doi.org/10.3928/15394492-20110819-01https://dx.doi.org/10.3928/15394492-20110819-01https://doi.org/10.3109/11038120903350303https://doi.org/10.3109/11038128.2013.872183https://doi.org/10.3109/11038128.2013.872183https://doi.org/10.3109/11038128.2014.927919https://doi.org/10.3109/11038128.2014.927919

1_3 day OTIPM workshop REVISED 0807172_English OTIPM figure handout3_Note Taking Worksheet4_Documentation Worksheet5_Blank page6_OTIPM References

otipm: a model for implementing top-down, client-centered ......updated 7 august 2017 otipm: a model...

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