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 

Mental health is about the way thoughts, feelings, and behaviors influence daily life, and is critical for well-being.¹ Research is needed to understand protective factors supporting resilience and to assess participation-based approaches that support mental, behavioral, and emotional health (e.g. mindfulness and trauma-informed care). 

• Approximately 25% of U.S. adults and 20% of U.S children have a diagnosable mental illness or disorder that affects thinking, mood and behaviors.² 

• Mental health conditions are a leading cause of disability in the U.S. accounting for over 13.5 disability-adjusted life years (DALYs) or years lost to illness, disability, or premature death.² 

• The current National Institute of Mental Health (NIMH) Strategic Plan for Research emphasizes the urgent need for “research that will have the greatest public health impact and continue to fuel the transformation of mental health care.” ² 

Need and Relevance to Occupational Therapy 

Mental and emotional health and well-being have been identified as 

• critical for promoting participation  

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

• an area that can be enhanced by listening to the perspectives of people with lived experience and partnering with people with lived experience in the research process 

Mental and emotional health is greatly influenced by environmental and activity factors, which can impact participation and health. Occupational therapy knowledge regarding factors that affect engagement in daily activities, particularly environment and activity factors, are needed to support mental and emotional health and well-being.  

Evidence-based and strengths-based approaches (e.g. mindfulness and trauma informed care) for supporting mental and emotional health and well-being are needed to enhance participation and quality of life. There is also a need to understand how participation serves as a protective factor and enhances resilience. 

AOTF is committed to the development of a scientific network and body of evidence to achieve effective and efficient advances in the area of mental and emotional health and wellbeing in both clinical and community settings. 

There are a few occupational therapy scientists who are building knowledge related to mental health and wellbeing.  However, 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 address mental health and wellbeing in clinical and community settings to achieve better outcomes and improve quality of life for individuals and populations. 

1. World Health Organization. Strengthening Mental Health Promotion. Geneva, World Health Organization (Fact sheet no. 220), 2001. Retrieved from http://www.who.int/mediacentre/factsheets/fs220/en/  

2. National Institute on Mental Health. Mental Health Statistics. Retrieved from http://www.nimh.nih.gov/health/statistics/index.shtml 

The prevention and management of chronic conditions is a national priority for improved quality of life and population health.¹ Programs and interventions that support positive health behaviors are needed to improve outcomes for diverse groups of people across a range of chronic conditions.  

• Chronic disease is defined by the World Health Organization (WHO) as non-communicable diseases that tend to be of long duration with a combination of causes including genetic, physiological, environmental, and behavioral.²  

• Chronic conditions are the leading cause of death and disability in the United States  impacting 7 out of 10 people.² 

• There are substantial racial and ethnic disparities in chronic diseases. Racial and ethnic minorities are 1.5 to 2 times more likely to have chronic diseases.³ 

• Centers for Medicare and Medicaid Services (CMH) identifies 21 chronic conditions that are prevalent for Medicare utilization and spending. A partial list of these include alcohol/substance abuse, asthma, Autism Spectrum Disorders, Stroke, Depression, Cancer, Heart Disease, Arthritis and Schizoprenia.4 Occupational Therapists serve people with almost all of the 21 conditions identified, although research on the long-term impact of OT is needed.  

• The recent COVID-19 pandemic has resulted in a new host of chronic conditions characterized as Long COVID. There are a number of new research initiatives to study Long COVID, as this is anticipated to become one of the next major public health crises. Although still being defined, the collective symptoms of Long COVID are referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC) by the NIH.⁵ 

• Data gathering and prevention programs at both the individual and population level are needed to track trends and progress, develop healthy environments, design health care system interventions, and connect clinical and community services.⁶ 

Need and Relevance to Occupational Therapy 

Health promotion, prevention and management of chronic conditions has been identified as: 

• a critical issue for promoting health and well-being for many conditions and populations 

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

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

Health behaviors may be defined as the “doing of everyday activities” that support wellbeing, including medication management, exercise, and healthy eating. Occupational therapy research seeks to understand the preventative and protective function of daily activities in promoting and maintaining health. Prevention and management of chronic conditions requires adoption and maintenance of daily habits and routines that promote health.  Making changes in health behaviors requires strategies that address both biomedical and sociocultural factors. Effective management of chronic conditions requires knowledge of how symptoms influence the ability to perform everyday activities and the habits, routines, and environmental supports that may be used to maintain health and quality of life.⁷   Partnerships and collaboration between providers and patients within an integrated system of care, inclusive of OT, is a key factor that needs further examination to understand the management and prevention of chronic care.  

OT research continues to advance and establish a knowledge base related to health behaviors and chronic conditions, although models of care and understanding of chronic conditions continues to evolve resulting in a continued need to advance the science to guide practice. Additionally, we need a coordinated network for occupational therapy research in this area and sufficient resources to train more occupational therapy researchers.  There are a number of models to guide interventions and supports for chronic disease management (i.e., Care Model, Improving Chronic Illness Care, Innovative Care for Chronic Conditions, Stanford Model, transitional Care model). We need to understand the impact and importance of the role of OT on the health care team within the various models of care. We believe a significant investment is needed to improve health behaviors for the prevention and management of chronic conditions in order to achieve better outcomes and improve quality of life.

1. Healthy People. Social determinants of health. Retrieved on August 11, 2022 from https://health.gov/healthypeople/priority-areas/social-determinants-health 

2. World Health Organization. Noncommunicable disease. (2021). Retrieved from  https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. 

3.  Price, J.H., Khubchandani, J., McKinney, M., Braun, R. (2013). Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States. Biomed Res Int. doi: 10.1155/2013/787616.  

4. Centers for Medicare and Medicaid Services. (2021). Chronic disease. Retrieved from[Text Wrapping Break]https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html 

5. Collins, F. (2021). NIH Launches new initiative to study “Long COVID”. Retrieved from https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid).  

6. Bauer, U.E., Briss, P.A., Goodman, R.A., Bowman, B.A. (2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 384(9937): 45-52. doi: 10.1016/S0140-6736(14)60648-6. 

7. Hand, C. L., Letts, L. J., & von Zweck, C. M. (2011). An agenda for occupational therapy's contribution to collaborative chronic disease research. Canadian Journal of Occupational Therapy, 78(3), 147-155.