Developing a socially transformative focus in Occupational Therapy: insights from South African practice

Social and political contexts are known to influence people's' opportunities to engage in occupations. Occupational therapy in the domain of community development practice addresses the social determinants of health through practice that contributes towards social transformation. Applying an autobiographical form of self-study, data was generated firstly through keeping a written reflective journal and audio recorded reflections on practice and secondly, written comments and feedback that the first author, as a clinical educator, gave students during their community development practice placements, was captured. This data was thematically analysed, yielding a theme and two categories. The theme, "Towards socially transformative practice" revealed the value of adopting a critical and collaborative approach to practicing occupational therapy. This was demonstrated as possible through the categories of being able to "See and feel the invisible" and enabled as "Equals working for change". The findings suggest that critical reflexivity together with implementation of participatory practice is a necessary requirement towards addressing the conditions of people's health and occupational well-being.

IntroductionCommunity development is a vital area of practice in occupational therapy, aligned with a recent shift in focus from individual‐level interventions to community and societal issues. Despite its growing significance, knowledge and understanding of community development in occupational therapy remain fragmented. This study aimed to provide a comprehensive map of how community development is researched, discussed, and conceptualised within the field of occupational therapy.MethodsA scoping review was conducted using 10 databases to identify relevant literature published up to September 2025. The search strategy combined the terms ‘occupational therapy’ with either ‘community development’ or ‘community‐centred practice’. Descriptive statistics and content analysis were used to examine the characteristics of the literature and to identify trends in the understanding of community development in the field of occupational therapy.Consumer and Community InvolvementThis study did not include consumer or community involvement.ResultsA total of 38 articles published between 1996 and 2025 were included, with most originating in Canada, Australia, and South Africa. Of these, 18 were empirical studies, and most employed qualitative methodologies. Findings related to community development in occupational therapy were divided into two main themes: ‘What is known about community development?’ and ‘How community development is described in relation to occupational therapy.’ConclusionThe results revealed limited contextual and methodological diversity in community development research on occupational therapy. We also identified key barriers and enablers in community development practice, offering insights to support practitioners and researchers in advancing this emerging area of occupational therapy. Future studies are required to explore community development practices in diverse geographical and cultural contexts, develop theoretical frameworks to guide occupational therapists, and apply the concept of collective occupation. Strengthening educational systems and institutional support is necessary for practitioners and students to promote and improve their engagement with community development in occupational therapy.

Official documents and professional policies are approved by the AOTA Representative Assembly and undergo scheduled review and approval by the Representative Assembly Coordinating Committee (RACC). These documents are used by the Association and its membership to guide education, practice, advocacy, and policy on behalf of the profession. The documents are a valuable resource for occupational therapy practitioners and provide a solid grounding in the profession for students, consumers, and external stakeholders.Items in bold are new for 2022 and are available in this supplement to the American Journal of Occupational Therapy. Official documents are periodically reviewed, and documents may be superseded by newer versions or rescinded. A complete list of the most current documents is available at https://www.aota.org/practice/practice-essentials/aota-official-documents.Guidance documents provide comprehensive perspective and guidance on topics that shape advancement of the profession and its future direction. ▪ Guidelines for Documentation of Occupational Therapy (2018)▪ Guidelines for Occupational Therapy Services in Early Intervention and Schools (2017)▪ Guidelines for Reentry Into the Field of Occupational Therapy (2020)▪ Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2020)▪ Occupational Therapy Practice Framework: Domain and Process, 4th Edition (2020)▪ The Practice of Occupational Therapy in Feeding, Eating, and Swallowing (2017)▪ A Descriptive Review of Occupational Therapy Education (2016)▪ Scholarship in Occupational Therapy (2022)Position statements present an official stance on the provision of services, practice of occupational therapy, or role of occupational therapy. They are developed in response to a professional issue, concern, or need. ▪ COE Academic Terminal Degree (2022)▪ Assistive Technology and Occupational Performance (2016)▪ Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services (2022)▪ Cognition, Cognitive Rehabilitation, and Occupational Performance (2019)▪ Continuing Professional Development in Occupational Therapy (2016)▪ Driving and Community Mobility (2016)▪ Fieldwork Level II and Occupational Therapy Students (2018)▪ Importance of Collaborative Occupational Therapist-Occupational Therapy Assistant Intraprofessional Education in Occupational Therapy Curricula (2017)▪ Importance of Interprofessional Education for Occupational Therapy (2022)▪ Importance of Primary Care Education in Occupational Therapy Curricula (2017)▪ Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments (2022)▪ Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice (2017)▪ Occupational Therapy and Complementary Health Approaches and Integrative Health (2016)▪ Occupational Therapy Doctoral Capstone: Purpose and Value (2022)▪ Occupational Therapy Fieldwork Education: Value and Purpose (2022)▪ Occupational Therapy for Children and Youth Using Sensory Integration Theory and Methods in School-Based Practice (2015)▪ Occupational Therapy in the Promotion of Health and Well-Being (2019)▪ Occupational Therapy Scope of Practice (2021)▪ Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence (2017)▪ Occupational Therapy Services in Facilitating Work Participation and Performance (2017)▪ Occupational Therapy Services in the Promotion of Mental Health and Well-Being (2016)▪ Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion (2020)▪ Occupational Therapy’s Perspective on the Use of Environments and Contexts to Facilitate Health, Well-Being, and Participation in Occupations (2015)▪ Occupational Therapy’s Role in Case Management (2018)▪ Occupational Therapy’s Role in Medication Management (2017)▪ Occupational Therapy’s Role in the Neonatal Intensive Care Unit (2018)▪ Occupational Therapy’s Role With Chronic Conditions (2022)▪ Philosophical Base of Occupational Therapy (2017)▪ Philosophy of Occupational Therapy Education (2018)▪ Role of Occupational Therapy in End-of-Life Care (2016)▪ Role of Occupational Therapy in Pain Management (2021)▪ Physical Agents and Mechanical Modalities (2018)▪ Role of Occupational Therapy in Primary Care (2020)▪ Role of Occupational Therapy in Wound Management (2018)▪ Telehealth in Occupational Therapy (2018)▪ Value of Occupational Therapy Assistant Education to the Profession (2019)▪ Vestibular Impairment, Vestibular Rehabilitation, and Occupational Performance (2017)Professional standards describe and define minimal standards for practice, continued competence, and other professional behaviors. ▪ AOTA 2020 Code of Ethics▪ Standards for Continuing Competence (2021)▪ Standards of Practice for Occupational Therapy (2021)Societal statements are written in the form of public announcements and identify a societal issue of concern; state how the issue affects the participation of individuals, families, groups, or communities in society; and may offer action to be taken by individuals, families, groups, or communities. ▪ AOTA’s Societal Statement Denouncing Conversion “Therapy” (2022)▪ AOTA’s Societal Statement on Disaster Response and Risk Reduction (2017)▪ AOTA’s Societal Statement on Community Violence (2022)▪ AOTA’s Societal Statement on Gun Violence (2022)▪ AOTA’s Societal Statement on Health Disparities (2013)▪ AOTA’s Societal Statement on Health Literacy (2016)▪ AOTA’s Societal Statement on Livable Communities (2016)▪ AOTA’s Societal Statement on Stress, Trauma, and Posttraumatic Stress Disorder (2017)▪ AOTA’s Societal Statement on Youth Violence (2016)▪ Specialized Knowledge and Skills of Occupational Therapy Educators of the Future (2009)

Within professional and practice knowledge there are many assumptions about disability that underpin occupational therapy philosophy. The objectives of this paper are to (a) critically examine how disability has been constructed in mainstream society by introducing perspectives from contemporary disability studies theories, and (b) apply a critically reflexive lens informed by disability studies perspectives to occupational therapy practice. Drawing upon critical disability perspectives, notions of "nondisabled" versus "disabled"; metanarratives of disability; built environments and social structures; and social and attitudinal constructions of disability and identity are examined. Key issues pertaining to rehabilitation, norms, client-centred practice, language, and education within occupational therapy are discussed. This critically reflexive examination has revealed the ways in which occupational therapy and society at large are embedded in discourses that may reinforce negative connotations around disability. A renewed understanding of disability may challenge current practices.

Introduction: Occupational therapy has traditionally focused on child development but motherhood as an occupation is rarely analyzed. This study aimed to identify practices, theoretical perspectives, and concepts described or used in occupational therapy research concerning the early periods of motherhood and explore the literature to contribute to the advancement of practice. Method: A scoping review was conducted to map and synthesize multiple perspectives, provide current insights into motherhood as an occupation, and inform occupational therapists’ practice. Search across five databases and manual research in periodicals in the area were conducted up to mid-2024. Thematic analysis was used for data analysis. Findings: Eleven articles were included. The analysis revealed three themes: occupational therapy practitioner goals; occupational therapy practices; and theories and concepts supporting the relationship between motherhood, occupation and occupational therapy. The study underscores the limited number of studies available and highlights the need for clearer conceptual definitions and more explicit links between intervention strategies and underlying theoretical frameworks. Conclusion: There is a compelling need for more research to enhance our understanding of the significance of motherhood as an occupation. This understanding will serve as a foundation for refining the role of occupational therapy in supporting motherhood.

A major concern in community development is the application of various theories, practices, and models that are relevant to the development agenda of the selected community. Participatory theatre practice has been identified as one of such models linking theory and practice in a community development process. Students undergoing training in participatory theatre and community development are introduced to several theories and concepts whose application in the field of work may be quite different from the classroom experience. This paper explores pertinent participatory theatre theories, concepts, and ideals and how they can be effectively put to use at the communal level to achieve an expected outcome. The paper aims to present an easy practical approach to participatory theatre practice in community development.

ABSTRACTThe purpose of this study was to explore the assessments used in occupational therapy practice through identifying most commonly used assessments and the rationale for their use in different occupational therapy practice areas. The study utilized a nonprobability convenience sample of 260 occupational therapy practitioners attending the American Occupational Therapy Association's annual conference. A descriptive survey research design was used for conducting this study. The survey instrument addressed three major questions related to (a) the area of practice, (b) the specific assessments used, and (c) reasons for using the specific assessments. Descriptive statistics were utilized to analyze the results. Results indicated most of the assessments used in occupational therapy clinics target body structure and function. Assessments were used due to their convenient availability in clinics, clinical utility and standardization, client-centeredness, development by occupational therapists, being taught in school/fieldwork, and being satisfying to insurance companies. Implications for occupational therapy education, practice, and research are presented.

Increasingly, community development is recognized as an important process for occupational therapy practice. However, occupational therapists working in community development report feeling unprepared. This study aimed to identify the knowledge, skills, and experiences that occupational therapists need for practice in community development. Using the Delphi technique, the researchers developed statements from the Round 1 (n = 8) responses of occupational therapists involved in community development practice or scholarship. Rounds 2 (n = 14) and 3 (n = 12) sought to establish consensus among the occupational therapists on the areas of focus. Participants rated the importance of 64 statements grouped into 11 domains. After three rounds, researchers eliminated six statements by analyzing the median, interquartile range, and percentage of agreement. Participants reached consensus on 58 statements. Many of the competencies identified were relevant to all areas of practice, while others were specific to community development, suggesting a need for specialized education and training in this area. The results provide information that can be used to enhance the preparation of occupational therapists for practice in community development.

Purpose Play occupation has been identified as an essential part of children’s lives, and it subsequently features in paediatric occupational therapy. However, few studies address the current place of play and play occupation in occupational therapy practice. This study aims to address this gap in knowledge by exploring paediatric occupational therapists’ perspectives on the place of play and play occupation in occupational therapy practice in Ireland. Design/methodology/approach A cross-sectional online survey was conducted to gather data about the current use of play in the occupational therapy for children under 12 years. Convenience sampling and snowball recruitment techniques were used to recruit paediatric occupational therapists. Data were analysed using descriptive statistics and qualitative content analysis. Findings In total, 65 therapists responded to the survey (estimated response rate, 32%). Results are organised into four sections: demographics and practice context, play assessment practices, use of play in practice and perceived barriers to play-centred practice. Respondents reported that they valued play as a childhood occupation. However, the survey findings identified that the primary focus was on play as a means to an end. Lack of education on play (research, theory and interventions) and pressures in the workplace have been identified as barriers to play-centred practice. Research limitations/implications Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is used in occupational therapy practice. Unless clarifications are made about play occupation as being different to skills acquisition in childhood, play occupation will continue to get overlooked as an authentic concern of occupation-centred practice. Thus, play as occupation deserves further attention from educators, researchers and practitioners as a means of strengthening occupation-centred practice, in particular play-centred practice in the paediatric context. Originality/value Play has been described as an important occupation in childhood, and consequently, it features in paediatric occupational therapy. However, little is known about the current place of play in occupational therapy practice. This study addresses this gap by considering the current place of play in occupational therapy practice in Ireland.

Objective: To obtain an insight into the present situation of Occupational Therapy as a profession in India. Considering the professional experiences, documentation, and availability of Occupational therapy resources. The online survey was conducted using a single-phase, cross-sectional design. Participants: Convenience sampling, Occupational Therapy Professionals, having a minimum of 6 months working experience. Approximately 1700+ potential respondents were approached via social media and E-mails. Only 60 responses were recorded, however, out of 60, three responses did not meet the inclusion criteria, and 1 response because of deliberately misleading details was excluded, therefore leaving only 56 responses for consideration. The primary outcome measure was to report about the present scenario in occupational therapy practices in India and to understand the current occupational therapy industry across India. After analyzing responses findings were that Occupational Therapy practices in the country were skewed to domains of pediatrics. SOAP notes were chosen as leading methods of documentation, and a large number of Occupational therapy professionals felt that there is scarcity and lacunae in the availability and provision of Occupational therapy equipment and prescription aid in their regions, in India, and also on online market palaces. Conclusion: In a country like India, the skewing of most of the Occupational therapy professionals to domains of ?pediatrics? and ?rehabilitation & disability may be a major cause in restriction of growth of profession on whole. Also, introducing Occupational Therapy assistants in the Indian Context should be considered for the growth of the profession and to concord with WFOT?s QI framework.

Sexuality is a valuable activity of daily living that contributes to an individual’s quality of life. Although sexuality can be addressed in occupational therapy practice, it is often overlooked due to a lack of time, comfort, and knowledge. For sexuality content to be fully incorporated into practice, it has been suggested that education will facilitate the inclusion of sexuality topics into occupational therapy practice. The purpose of this survey study was to assess occupational therapy faculty and students’ perceived competence with addressing sexuality, to determine the methods of sexuality education, and the time spent on the topic in occupational therapy curriculums. A piloted 13-question survey was electronically mailed to program directors of accredited occupational therapy programs in the United States for them to forward to their faculty and students. The survey was available for four weeks, with a reminder sent at the two-week mark. Data was collected from Qualtrics at the end of the response window and themed by the occupational therapy doctoral student and the faculty mentor. A majority of faculty felt competent addressing sexuality (76%) and a majority of students felt neutral (34%) about discussing sexuality with their future clients. The most frequently reported amount of time being spent on sexuality topic education was one to two hours (41%). A majority of respondents felt that sexuality is an essential topic and should be incorporated into occupational therapy curriculums further.

Health professionals across all care delivery settings, including occupational therapy practitioners, are experiencing high levels of moral distress. The mental, emotional, and physical consequences of unresolved moral distress are resulting in burnout, decreased quality of care, and poor patient outcomes. Moral resilience is a teachable and learnable skill that can nullify some of the adverse consequences of moral distress. To ensure quality care outcomes and improve the well-being of individual occupational therapy practitioners and the profession, it is essential that occupational therapy practitioners be provided with the education, training, resources, and strategies needed to address moral distress, foster moral resilience, and cultivate the skills necessary to cope with ethical tensions. In this column, we call the profession to action to address the phenomenon of moral distress as it relates to occupational therapy practitioner well-being. We also discuss resources and strategies for addressing ethical tensions and building moral resilience in occupational therapy practice.

In Occupational Therapy (OT) practice, practitioners assume that the skills and strategies taught to clients during rehabilitation will transfer to performance and participation in everyday life. Despite transfer serving as a practice foundation, outcome studies conclude that this assumption of transfer is not occurring and it often results in decreased efficacy of rehabilitation. This paper investigated key aspects of transfer and found concepts in the psychology literature that can support transfer of skills and strategies in OT. Six key principles proposed from educational psychology can serve as a guide for practitioners to better train for transfer. In this paper, we discuss the six principles and apply concepts from psychology. Each principle is supported with examples of how they may be incorporated OT practice. If occupational therapists understand these principles and implement them in treatment, the efficacy of treatment may improve for many populations.

This opinion piece revisits and considers the spiritual dimensions of occupation and occupational therapy practice. It discusses the dilemmas inherent in such an exploration and suggests ways of looking at different aspects, drawing from some of the literature on this topic. Views are put forward as to whether or not spirituality is a legitimate sphere in which occupational therapists should engage and issues of ongoing debate are highlighted.

Although there is a focus in occupational science (OS) and occupational therapy (OT) research on social, policy, and physical issues that limit participation, there needs to be continued emphasis on populations and global worldviews. I propose the identification and use of the concept of social and environmental determinants of occupation (SEDO) to examine the complex issues that influence people’s experience through an intersectional lens and affect their access to participate in culturally meaningful occupations. SEDO are defined as broad (and intersecting) social and environmental factors that increase or limit an individual, community, or population’s participation in culturally meaningful occupations of their choice. Unique to SEDO and supported by OS and OT research and practice is the consideration of intersectionality, or how these global factors intersect in a multiplicative manner to influence participation. The discussion highlights health and non-health related examples of the ways intersecting SEDO identify disparities and occupational injustices that affect access to occupations for populations who experience these injustices. The need for continued research and consideration of proposed SEDO is imperative to further OS research, OT practice, and education supporting occupational justice through program and policy development and advocacy. In addition to the effect on research and practice, these considerations provide a strategy for occupational scientists and occupational therapists to monitor and evaluate the impact of policies and programs developed to address these issues and increase participation in culturally meaningful occupations for marginalized populations.