Occupational therapy has an important and expanding role in non-traditional settings and emerging practice areas outside of the healthcare system. This has impacted types of service delivery models and expanded a focus on community-based practice and outcomes. Additionally, OT’s role in traditional medical care has evolved into new settings and functions. In response, there is a need to determine the effectiveness of both models of service delivery and the interventions.  

• Initiatives that emphasize health for all people are focusing on the social determinants of health or the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” ^{1 2} 

• OTs provide novel services in traditional medical settings (i.e., primary care; dental offices), although there is limited research identifying best models of practice.³ 

• In recent years, there is an increase in OT implemented through community health models where services are provided in non-medical and health settings. This includes cross-disciplinary work in areas such as trauma informed care, transportation, immigration, foster care, sensory-friendly environments, and the arts to identify only a few.^{4 5 6} 

• Population health programs, an emerging area of practice in OT, are often implemented through novel service delivery models and in non-traditional settings.⁷ 

• Telehealth and health information communications technologies are providing new avenues of service delivery to improve health care access and quality to meet the needs of medically underserved areas and populations. ^{8 9} 

Need and Relevance to Occupational Therapy 

Novel practice and service delivery methods has been identified as 

• a critical area to target to promote health and participation for all people 

• an area in which evidence-based measures and interventions are needed 

• an area where application of the unique expertise of occupational therapy would be highly beneficial 

The occupational therapy lens provides a comprehensive understanding of the person-environment fit to support performance of everyday activities and participation in home and community settings. This lens also bridges biomedical and sociocultural perspectives on the factors that support health and well-being at both person and population levels.¹⁰ 

Current knowledge, research training, measures and interventions in the emerging and novel practice areas are inadequate for addressing participation and health issues across the broad range of contexts.  AOTF is committed to the development of a scientific network and body of evidence to achieve effective and efficient advances in occupational therapy science in school, home, clinical, and community settings. 

Novel practice areas and approaches to service delivery have a dearth of research due to their recent emergence or expansion in occupational therapy. This provides a unique opportunity for occupational therapy scientists to establish and build the knowledge-base for the profession. There is also a need to develop a coordinated network for research in this area and train more occupational therapy researchers.  We believe a significant investment is needed to improve research in a range of emerging practice areas and novel service delivery methods in order to identify best practice and achieve better outcomes for a diverse group of consumers across a spectrum of conditions and settings. 

1. Office of Disease Prevention and Health Promotion. (2016). Social determinants of health. Retrieved from[Text Wrapping Break]http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health 

2. Centers for Medicare and Medicaid Services. (2021). CMS issues new roadmap for states to address the social determinants of health to improve outcomes, lower costs, support state valued-based care strategies. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improve-outcomes-lower-costs 

3. American Occupational Therapy Association. (2020). Role of occupational therapy in primary care. American Journal of Occupational Therapy, 74(Suppl. 3), 7413410040. https://doi.org/10.5014/ajot.2020.74S3001  

4. Jaegers, L.A., Skinner,E., Conners,B. ,Hayes,C. ,West-Bruce,S. ,Vaughn,M.G.,...Barney,K.F. (2020).Evaluation of the jail-based Occupational Therapy Transition and Integration Services program for community reentry. American Journal of Occupational Therapy,74, 7403205030.https://doi.org/10.5014/ajot.2020.035287 

5. Paul-Ward, A., & Lambdin-Pattavina, C. A. (2016). The Issue Is—New roles for occupational therapy to promote independence among youth aging out of foster care. American Journal of Occupational Therapy, 70, 7003360010.http:// dx.doi.org/10.5014/ajot.2016.017426 

6. Silverman, F., & Tyszka, A. C. (2017). Centennial Topics—Supporting participation for children with sensory processing needs and their families: Community-based action research. American Journal of Occupational Therapy, 71, 7104100010. https://doi.org/10.5014/ajot.2017.025544 

7. Braveman, B. (2016). Health Policy Perspectives—Population health and occupational therapy. American Journal of Occupational Therapy, 70, 7001090010. http://dx.doi.org/10.5014/ajot.2016.701002 

8. American Occupational Therapy Association. (2018). Telehealth in occupational therapy. American Journal of Occupational Therapy, 72(Suppl. 2), 7212410059. https://doi.org/10.5014/ajot.2018.72S219 

9. U.S. Department of Health and Human Services. (2016). Health information technologies. Retrieved from[Text Wrapping Break]http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/ 

10. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001 

Across the life course, people experience a wide range of planned and unanticipated transitions. There is a critical need for interventions to support people, families, and communities as they experience these transitions. Example transitions may include disability onset/identification/diagnosis, starting and ending educational and training programs, transitions across systems of care, retirement, aging in place, and end of life. 

• Many topics in Healthy People 2030 emphasize the unique developmental needs of different age groups (early and middle childhood, adolescent health, older adults), populations (disability and health, lesbian, gay, bisexual, and transgender health), and conditions.¹ 

• There are a variety of types of transitions that people experience throughout their lifespan. They range from developmental transitions (e.g., puberty), transition in roles and environments (e.g., school to work, retirement), transition in service settings (e.g., pediatric to adult health services) and others. Transitions can pose particular challenges during specific periods of development or populations, especially those with disabilities and chronic health conditions.² 

• There are 61 million people (26%) living in the United States with a disability including over three million children (4.3%). Across the lifespan, the highest rates of disability are within minority groups.³ 

• The transition from adolescence to adulthood can be particularly challenging for individuals with disabilities because of unique needs related to securing appropriate healthcare and education services, vocational planning, living environments, and community participation.2 

• Performance of many activities may change with aging (e.g., driving, work, physical activity). Evidence-based interventions are needed to support the health and safety of older adults. ⁴ 

• Care transitions are the end of life are common, although there is a paucity of research and understanding on best supports and practices during these critical transitions.⁵ 

Need and Relevance to Occupational Therapy 

Development and transitions have been identified as 

• a critical issue requiring attention across the lifespan to promote health and well-being. 

• an area in which evidence-based measures and interventions are needed 

• an area where application of the unique expertise of occupational therapy would be highly beneficial. 

Development and transitions require mastering the “doing of everyday activities” that support participation in daily life, health and well-being. Occupational therapy understanding of daily occupations and of the ways in which person and environment factors may serve as supports and barriers to function may guide development of better measures and interventions to support performance and participation.   

Current knowledge, research training, measures and interventions are inadequate for addressing the developmental and transition needs of individuals and populations. AOTF is committed to the development of a scientific network and body of evidence to achieve effective and efficient advances in this area across the lifespan. 

Many occupational therapy scientists are building knowledge related to development and transitions.  However, there is no coordinated network for occupational therapy research in this area, nor sufficient resources to train more occupational therapy researchers.  We believe a significant investment is needed in order to address developmental and transition needs across the lifespan in order to achieve better outcomes and improve quality of life. 

1. Office of Disease Prevention and Health Promotion. (2022). Objectives and Data. Retrieved from https://health.gov/healthypeople/objectives-and-data 

2. Centers for Disease Control and Prevention. (2021). Disability and health promotion.  Retrieved from https://www.cdc.gov/ncbddd/disabilityandhealth/people.html 

3. Centers for Disease Control and Prevention. (2020). Disability impacts all of us. Retrieved from https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html#:~:text=61%20million%20adults%20in%20the,have%20some%20type%20of%20disability. 

4. Centers for Disease Control and Prevention. (2022). Alzheimer’s Disease and Healthy Aging. Retrieved from[Text Wrapping Break]http://www.cdc.gov/aging/index.html 

5. Abraham, S. & Menec, V. (2016). Transitions between care settings at the end of life among older homecare recipients: A population-based study. Gerontology Geriatric Medicine, doi: 10.1177/2333721416684400 

Technology and environmental supports are ubiquitous across all areas of society. Technology use is a means to enhance occupational therapy interventions as well as a significant form of occupational engagement and social participation. Technology and environmental supports are a priority area across the lifespan in home, clinical, and community settings. Targeted technologies may include assistive technologies, information and communication technologies, artificial intelligence, mRehab applications, and 3D printing. Environmental supports may include universal design, home modifications, and reasonable accommodations. Systems of delivering and documenting technology need, use, and impact are also important areas of research focus within this priority. 

Technology and environmental supports is a priority area across the lifespan, in home, clinical, and community settings.  There is a substantial need of research to identify effective interventions and improved outcomes. 

• Designs for healthy communities are focusing on the characteristics of the built and natural environment that support physical activity and active living for people of all ages and abilities.¹ 

• Initiatives that emphasize health for all people are focusing on the social determinants of health or the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” ² Development and evaluation of “innovative, effective, and affordable user-centric technologies”³ is needed to increase opportunities for people with disabilities to participate in school, work, home, and community environments.⁴ 

• Telehealth and health information communications technologies are providing new avenues to improve health care access and quality and meet the needs of medically underserved areas and populations. ^{5, 6} 

• Innovative outcome measures with strong psychometric properties that document the impact of assistive technologies on key occupational therapy outcomes, including function and participation.  

• Behavioral change and motivation strategies to promote technology use and adherence.³ 

Need and Relevance to Occupational Therapy 

Technology and environmental supports has been identified as 

• a critical area to target to promote health and participation for all people 

• an area in which evidence-based measures and interventions are needed 

• an area where application of the unique expertise of occupational therapy would be highly beneficial 

The occupational therapy lens provides a comprehensive understanding of the importance of the person-technology and person-environment fit to support performance of everyday activities and participation in home and community settings. This lens also bridges biomedical and sociocultural perspectives on the factors that support health and well-being.   

Current knowledge, research training, measures and interventions in the areas of technology and environment are inadequate for addressing participation and health issues.  AOTF is committed to the development of a scientific network and body of evidence to achieve effective and efficient advances in occupational therapy science for the areas of technology and environmental supports in school, home, clinical, and community settings. 

Opportunity to Affect Progress 

While there are  many occupational therapy scientists who are building knowledge related to technology and environmental supports,  there is not a coordinated network for occupational therapy research in this area, nor sufficient resources to train more occupational therapy researchers.  We believe a significant investment is needed to improve technology and environmental supports across the lifespan in order to achieve better outcomes and improve quality of life. 

1. Centers for Disease Control and Prevention. (2016). Healthy community design. Retrieved from 

http://www.cdc.gov/nceh/publications/factsheets/ImpactoftheBuiltEnvironmentonHealth.pdf 

2. Office of Disease Prevention and Health Promotion. (2016). Social determinants of health. Retrieved from 

http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health 

3. National Institutes of Health. (2021). National Institutes of Health (NIH) Research Plan for Rehabilitation. Retrieved from https://www.nichd.nih.gov/publications/product/505 

4. Disability.gov . (2016). Assistive and accessible communities. Retrieved from 

https://www.disability.gov/resource/disability-govs-guide-assistive-technology/ 

5. Health Resources and Services Administration. (2016). Telehealth. Retrieved from 

http://www.hrsa.gov/healthit/toolbox/ruralhealthittoolbox/telehealth/ 

6. U.S. Department of Health and Human Services. (2016). Health information technologies. Retrieved from 

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/ 

7. World Health Organization/UNICEF. (2022). Global Report on Assistive Technology. Retrieved from https://www.unicef.org/reports/global-report-assistive-technology