Occupational Therapy Services in Facilitating

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Work Participation and Performance

The purpose of this statement is to describe for internal and external audiences the role of occupational
therapists and occupational therapy assistants1 in facilitating the successful engagement of people, groups,
and populations in work activities and meaningful work roles. The overarching goal of occupational ther-
apy is to support people’s “health, well-being, and participation in life through engagement in occupation”
(American Occupational Therapy Association [AOTA], 2014b, p. S4). Occupations are “everyday activities
that people do as individuals, in families and with communities to occupy time and bring meaning and
purpose to life. Occupations include things that people need to, want to and are expected to do” (World
Federation of Occupational Therapists, 2017, para. 2).
Work is one of eight occupations2 categorized within the domain of occupational therapy practice (AOTA,
2014b). The Occupational Therapy Practice Framework: Domain and Process has defined the occupation of work
as “labor or exertion; to make, construct, manufacture, form, fashion, or shape objects; to organize, plan,
or evaluate services or processes of living or governing; committed occupations that are performed with
or without financial reward” (p. S20) across the lifespan. The Framework’s definition of work includes six
activities: (1) employment interests and pursuits, (2) employment seeking and acquisition, (3) job perfor-
mance, (4) retirement preparation and adjustment, (5) volunteer exploration, and (6) volunteer partici-
pation (AOTA, 2014b, pp. S20–S21). Work performance supports meaningful participation and personal
fulfillment and structure in daily life, which are essential for people’s health and well-being.
Occupational therapy services are designed to be client centered, whether the client is an individual cli-
ent or worker, a work group, an employer, or the overall workforce. Occupational therapy practitioners3
provide services to promote health and wellness, prevent injury, and maximize work performance and
participation for clients who experience challenges in attaining, maintaining, or resuming work because of
disease, disability, or injury.
When delivering work-related services, occupational therapy practitioners consider the characteristics of
the client, work tasks, environments, and contexts. Individual client or worker factors include mental func-
tions; sensory functions; neuromusculoskeletal and movement-related functions; cardiovascular, hemato-
logical, immunological, and respiratory system functions; voice and speech functions; digestive, metabolic,
and endocrine system functions; genitourinary and reproductive functions; and skin and related structure
functions, as well as values, beliefs, and spirituality (AOTA, 2014b). Work tasks and activities include
• Physical and cognitive job demands,
• Worker roles,

1Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the safety and
effectiveness of the occupational therapy service delivery process. Occupational therapy assistants deliver occupational therapy services
under the supervision of and in partnership with an occupational therapist (AOTA, 2014a).
2Occupations include “activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure,

and social participation” (AOTA, 2014b, p. S19).

3When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational

therapy assistants (AOTA, 2015).

The American Journal of Occupational Therapy 7112410040p1

• Work organization,
• Habits and routines, and
• Tools and equipment.

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Environments encompass the physical (e.g., workstation layout or temperature) and social (e.g.,
interactions with coworkers) environments, along with client demographics such as age, gender, and
educational background. Cultural, temporal, and virtual (e.g., video chat, email) contexts are also
considered.
Difficulties or potential limitations in work participation and performance may arise from dynamic inter-
actions among the person, task, and work environment and from a variety of factors within or outside the
person. For example, the client may have limited capacity to complete job tasks and activities because of
disease or disability; because the design of the tools, workplace, or work routine exposes the worker to
injury or illness risk; or because the qualities of the work environment are not suited to the needs of the
worker.
Occupational therapy practitioners provide work-related services in a variety of settings, including, but
not limited to,
• Business and industrial environments,
• Acute care and rehabilitation facilities,
• Outpatient clinics,
• Community health centers,
• Community mental health centers,
• Sheltered or supported workshops,
• Vocational programs,
• Schools and universities,
• U.S. military Vocational Rehabilitation and Employment divisions, and
• Other community-based settings.
Within these settings, occupational therapy practitioners provide services targeting
• Promotion of health and well-being of the worker and the workforce;
• Prevention of injury and illness at the workplace;
• Establishment or restoration of the worker’s ability to perform work activities;
• Modification of the work environment, adaptation of tasks, or teaching of compensatory strategies;
• Management of disability-related issues;
• Facilitation of habits and routines to support the worker role within the domain of occupation, including
activities of daily living and instrumental activities of daily living; and
• Consultation, education, advocacy, and case management.
Examples of direct and consultative services that address work participation include job task evaluation
and modification, ergonomics, injury prevention and wellness programming, accommodation under the
Americans With Disabilities Act of 1990 (ADA), accessibility, work hardening and conditioning, prework
screening, functional capacity assessment, prevocational assessment and training, volunteer work explo-
ration and engagement, and transition services (e.g., school to work, entry or reentry to the workforce).
The occupational therapy process includes evaluation; intervention planning, implementation, and review;
and outcome monitoring (AOTA, 2014b).

7112410040p2 November/December 2017, Volume 71(Supplement 2)

Occupational Therapy Evaluation Related to Work Participation
The occupational therapy process begins with a referral or request for occupational therapy services. Ser-
vices may be requested to address a wide variety of issues, including the following:

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• Can the client return to work after disease or disability?
• How can the workplace be modified to support the worker in returning to work or staying at work after
disease or disability?
• What can be done to make hazardous work safer for a group of workers?
• What can be done to improve the mental and physical health and wellness of employees?
• What vocational opportunities exist for young adults with disabilities looking to enter the workforce?
The occupational therapy process can be guided by various theories, models, and frames of reference,
such the Person–Environment–Occupation–Performance Model (Baum, Christiansen, & Bass, 2015) and
the Model of Human Occupation (Kielhofner, 2009). Additional models that can be useful when address-
ing the organization or behavior change include the Transtheoretical Model and the Health Belief Model,
among many others (Rimer & Glanz, 2005).
The occupational therapy evaluation begins with an intake interview to develop an occupational pro-
file that includes the client’s occupational history, reasons for seeking services, daily activities, capacities
and needs, values and interests, priorities, and desired outcomes. The occupational therapist administers
a broad range of assessments to understand the client’s roles, routines and habits, values and interests,
current abilities and capacities, required job demands and tasks, body structures and functions, and envi-
ronmental and contextual demands (AOTA, 2014b). Evaluation of body functions may include cognitive,
emotional, sensory, motor, physiological, and communication functions and the ability to use these func-
tions to perform meaningful tasks.
Evaluation methods include record review, interview, physical measurements, performance-based test-
ing, observation, and paper-based questionnaires. For groups and organizations, participatory methods
involving stakeholders representing a variety of perspectives may also be included for a client-centered
approach. If the client is a group or population, additional information may include injury or illness trends,
demographics, and insurance costs related to worker injury or capacity. The occupational therapy evalua-
tion may also include data collection in the following areas:
• The client’s social, emotional, and communication skills; physical and cognitive abilities; potential for
improvement (if appropriate); need for adaptation; compensation; and work task change.
• The client’s vocational aptitudes and interests necessary for development of a transition plan from
school to work, from work to retirement, or for entering or reentering the workforce through paid or
volunteer work. This information is also important for clients who have never worked or who have
had difficulty maintaining meaningful employment because of serious mental illness or intellectual
disability.
• Job analysis of work and productive tasks, including work methods and behaviors, to identify the
required activity demands of the work tasks, including work routines, tools and equipment, and the
physical work environment related to ergonomic considerations and accessibility. This information may
be gathered through direct observation of the job or simulated task, client or employer interview, review
of the written job description, or use of the U.S. Department of Labor’s O*Net (https://www.onetonline.
org).
• Work site–specific roles, routines, and habits as performed by the worker or as expected by the job site or
employer. This information includes employer or workplace support for modifications that may include
assistive technologies, job adaptations, or work accommodations. Additionally, an evaluation of work
organizational culture, productivity expectations, and job requirements both internal and external to the
organization, including regulatory issues, is important (Gupta & Sabata, 2010).

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• Environmental factors at the client level (e.g., family, friends), community level (e.g., resources, transpor-
tation), work group level, employer level, and societal level.
• Work environment, applicable policies, and management and worker perceptions when the client is a
work group, employer, or population. This information includes lost-time injury statistics, policy and

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procedure manuals, and safety procedures. Additionally, it may be necessary to conduct key informant
interviews or focus groups, possibly with workers from various groups or departments or levels of
management, to gain relevant information.
• Performance of other occupations often required for participation in work, including community mobil-
ity, health management, safety and emergency maintenance, rest and sleep, education, functional mobil-
ity, personal hygiene and grooming, and feeding.
Occupational therapists synthesize and summarize findings of the initial evaluation to respond to the refer-
ral question or problem. An initial evaluation report highlights the individual client’s occupational history
or the group’s or organization’s work environment, describes factors that interfere with and support work
participation, and provides recommendations. Services may be limited to only an evaluation; however,
interventions to address the client’s work participation needs, desired outcomes, and performance goals
are commonly recommended.

Occupational Therapy Intervention Related to Work Participation

When providing interventions, occupational therapists design an intervention plan to address areas influ-
encing work participation and performance. The intervention plan varies depending on the client’s needs,
referral question or problem, context, and time allotted for treatment or consultation. In cases in which
direct patient care is part of the contracted services, occupational therapy practitioners should consult their
state practice act regarding the need for a physician’s referral for treatment.
Occupational therapy practitioners use a variety of approaches to address factors affecting work participa-
tion. The approaches fall into the following basic categories: create, promote, establish, restore, maintain,
modify, compensate, adapt, or prevent (AOTA, 2014b).
Using the information gathered in the evaluation process, the occupational therapy practitioner collabo-
rates with the client and other team members (e.g., employers, health care providers, case managers, family
members), organizations (e.g., state workers’ compensation, insurance carriers), and agencies (e.g., educa-
tional institutions, local- and state-funded programs, vocational rehabilitation, social services departments
and programs, mental health agencies) to plan and implement intervention strategies. When developing
intervention strategies, occupational therapy practitioners consider
• The client’s age, interests, values, beliefs, culture, skills and abilities, and motivation;
• The worker role, task demands, work context, and work culture; and
• Available resources, such as natural or organizational supports in the environment and equipment to
improve ease of participation and access.
Intervention strategies are designed to identify, explore, and expand work options; enhance or develop
work-related abilities (e.g., improve physical capacities, improve health and safety performance, develop
skills and ability to participate); and obtain or retain employment or volunteer work. The following para-
graphs provide some examples of occupational therapy interventions aimed at improving work perfor-
mance and facilitating safe participation in work or volunteer activities.
Client-level or group-level interventions include the following:
• Develop individualized intervention programs using work-related activities to facilitate, increase, or
improve productive work behaviors and skills
• Identify strategies to improve social, communication, emotional regulation, and coping skills
• Identify strategies to improve foundational work behaviors and work skills

7112410040p4 November/December 2017, Volume 71(Supplement 2)

• Adapt work activities, the work environment, and work demands and promote use of assistive technol-
ogies that support the client’s access to and participation in the desired work activities
• Identify, provide, and monitor modified work or simulated work tasks to gradually increase work
demands, alter work methods, or complete work activity trials to facilitate gradual return to full work

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activity after physical illness or injury
• Develop work transition programs, job modifications, or job adaptations to facilitate successful work
performance or return to work
• Develop individualized plans for the transition of people with disabilities from school to work, from
work to retirement, or for entry or reentry to the workforce
• Develop individualized plans for people who desire to participate or would benefit from participating
in volunteer work to sustain, develop, or restore work-related skills; maintain or develop social contacts;
or otherwise remain active (e.g., recent retiree or person with disability).
Organization-level interventions include the following:
• Develop individualized, group, and organizational education and training related to health, safety, injury
prevention, proper body mechanics, postural awareness, joint protection, ergonomic considerations, symp-
tom awareness, and stress and pain management strategies applicable to work and productive activities
• Consult and collaborate with clients about adaptations of work tasks, tools, equipment, and the work
environment
• Consult with clients regarding injury management and prevention to reduce the incidence of disabili-
ty-related injury or illness, including physical and mental
• Consult with clients to accommodate people with disease, disability, or injury in the work environment
• Collaborate with other team members, employers, services, and agencies to coordinate restorative and
prevention services provided to the worker
• Provide case management services to assist clients in coordination and planning for beginning or return-
ing to work.
Table 1 provides case examples of occupational therapy interventions to assist clients with compromised
work performance in participating in meaningful work or volunteer activities.

Sources of Payment
Payment sources for work-related occupational therapy services are dependent on the type of services
provided, the beneficiary of the services, and the setting where services are provided. Payment sources
may include, but are not limited to,
• Direct reimbursement by individuals, employers, or agencies for services to individuals (including
self-pay), groups, or populations, such as job analysis and modification; development of prework
screens; individual or group ergonomic assessment of work, worker, and workplace; and group- or
population-level educational programs for health, safety, and injury prevention;
• Local, state, or federal related programs, including workers’ compensation, special education, Social
Security Disability Insurance, and Medicare or medical assistance (see the Appendix for an overview of
relevant legislation affecting rehabilitation services for workers);
• Long-term disability insurance or workers’ compensation insurance for person- or job-specific evalua-
tion and interventions to support continued participation in work or facilitate return to work; and
• Community agency resources using funds secured through federal or state monies, community or pri-
vate grants, or other philanthropic donations; such resources often include services provided to mental
health centers, sheltered workshops, supported employment programs, and programs supporting
people who are at a socioeconomic disadvantage.

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Table 1. Case Examples of Occupational Therapy Interventions for Assisting Clients With Compromised Work Performance
Description of Client Work Performance
Work-Related Musculoskeletal Disorder: Organization Level
An employer in a heavy equipment
manufacturing plant has recently noted
a decrease in productivity and an increase
in workers’ compensation claims in
the maintenance department. Further
investigation reveals a high incidence
of upper-extremity and low-back
muscle strains and sprains among the
maintenance crew.
The employer contacts an occupational
therapist for consultation to help address
the problem.
The employer’s goals are to reduce strains
and sprains, lost days of work, and costs
associated with workers’ compensation
claims. The employer also is interested
in promoting a safer workplace and
improving employee job satisfaction and
security.
Work-Related Musculoskeletal Disorder: Individual Level
Carla is a 43-yr-old woman working as a
sewing machine operator and fabric
cutter in a garment factory. For several
months, she worked 8 hr/day,
5 days/wk, plus 4 hr of overtime
2–3 days/wk.
She recently was diagnosed with de
Quervain’s tenosynovitis in her dominant
right hand and has been off work for 2 mo.
Her case manager reports that she has
experienced improvement in wrist and
hand function since undergoing treatment
but is reluctant to return to work because
of concern that she will have a relapse
and not be able to do her job.
The employer is willing to consider a
transitional return-to-work option. The
physician refers Carla to an occupational
therapist to determine her functional
abilities and potential for successful
return to work.
7112410040p6
Occupational Therapy Evaluation
• Conduct preliminary on-site inspection of
the department to identify triggers such
as makeshift changes to equipment and
signs of worker movement and positional
discomfort that could be contributing to
upper-extremity and back complaints.
• Interview employees to gain their perspective
on incidents of injury, probable causes, and
suggested remedies.
• Perform a functional job task analysis,
including identification of the physical job
demands and ergonomic considerations for
the different maintenance activities, which
include materials handling, equipment
operation, and tool use; postural
considerations; work environment; and
injury risk factors such as force, repetition,
hold time and rest time, angle/twist/body
mechanics, impact, vibration, acceleration,
and work time duration.
• Analyze data from the work site.
• Determine areas requiring intervention.
• Evaluate potential modifications to jobs,
environment, tools, or client functions.
• Conduct an evaluation to determine Carla’s
physical and functional abilities, including
upper-extremity strength and overall
endurance to perform work tasks.
• Assess the work site, and identify
environmental risk factors.
• Assess body mechanics and risk for
work-related musculoskeletal disorders
associated with
• Force and postures used with scissors
and other equipment,
• Frequency and duration of tasks such as
cutting through several layers of fabric,
and
• Static positioning of wrists and fingers
when guiding material through an
industrial sewing machine.
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Occupational Therapy Intervention
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• Collaborate with the employer to identify
and implement ergonomic changes in
specific work areas to minimize risk factors
associated with equipment, required body
positions, and the environment (Snodgrass,
2011).
• Develop an in-service education program
for the maintenance department to address
risk factor reduction strategies and body
mechanics.
• Develop a wellness program that includes
daily flexibility and stretching sessions in
addition to worker-centered lifestyle choice
classes (e.g., smoking cessation, weight
control, stress reduction; Arena et al., 2013).
• Cross-train workers to ensure adequate
staffing coverage in the event of absenteeism,
and implement job rotation to allow variation
in positions, physical exertions, and equipment
use.
• Institute an annual on-site evaluation to
monitor modifications and programs.
• Instruct Carla in incorporating proper body
mechanics and use of ergonomic scissors
when cutting layers of fabric.
• Provide employer with strategies for
instituting a job rotation program and
incorporating improved positioning and
work techniques for all employees
(Jaegers, 2015).
• Implement a work conditioning program that
includes education, flexibility and stretching,
work simulation, graded work activities, and
strengthening activities.
• Collaborate with Carla and her employer
to identify ergonomic changes and
accurate job placement for safe, productive,
functional work performance (Kaskutas &
Chapman-Day, 2012).
(Continued)
Table 1. Case Examples of Occupational Therapy Interventions for Assisting Clients With Compromised Work Performance (cont.)
Description of Client Work Performance
Mark is an 18-yr-old high school senior
diagnosed with autism spectrum disorder
resulting in mild intellectual disability.
Mark lives with his parents, who drive
him to and from school. He wants to seek
employment after graduation.
Mark received occupational therapy services
during his elementary and middle school
years. The focus of occupational therapy
was on independence in daily living skills
and the development of appropriate
social behaviors. The goal was to maximize
classroom learning and interaction with
his classmates, ultimately affording Mark
the skills to participate in his community
(AOTA, 2014b).
Mark has not worked outside the home and
has not had the opportunity to develop
work skills or work behaviors. He has
difficulty with time management, attention
span, and sustained focus on a task.
Natalie, a 27-yr-old woman with a history
of depression, is a consumer at a
community support day program. She
lives in a subsidized apartment with two
people also diagnosed with a mental
illness. In the past, Natalie has not been • Assess Natalie’s abilities in the following
able to secure a job because of mood
changes that affected her ability to
initiate and follow through.
After a recent positive response to medication
and success in volunteer work at the day
program, Natalie has identified a goal
of acquiring part-time office work and
getting an apartment of her own.
Natalie states that she lacks self-confidence
related to working and that she is afraid
she will not be able to keep up with
everyone else at a job.
Her case worker has sought the services of
an occupational therapist to assist in the
work transition process.
The American Journal of Occupational Therapy
Occupational Therapy Evaluation
Autism Spectrum Disorder
• Review Mark’s records and interview
Mark and his parents to learn about his
occupational performance related to work
and identify his perceived needs as he
moves forward (Hough & Koenig, 2014).
• Determine a work transition plan that
addresses work behaviors and communication
and social interaction skills.
• Assess the level of difficulty Mark has with
time management, especially with his
morning routine.
• Assess Mark’s prework skills, including
concentration span, attention to task, and
organizational skills; ability to follow written
and verbal directions; and ability to
communicate his ideas to others.
• Determine performance skills in the area of
community mobility and transportation use
(AOTA, 2014b).
Mental Health: Depression
• Administer an occupational profile to
determine Natalie’s occupational history,
work experiences, interests, patterns of
daily living, and meaningful occupations
(AOTA, 2014b).
areas:
• Problem-solving skills
• Independence in daily living activities
• Use of public transportation
• Medication management
• Ability to seek help and advocate for her
needs.
• Determine Natalie’s work readiness skills in
task organization and time management.
Occupational Therapy Intervention
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• Educate Mark and his family about pertinent
laws, community agencies, and resources
available to assist him in seeking
employment (Delahunt, Lowery, & Rudkoski,
2015; Hough & Koenig, 2014).
• Collaborate with a speech–language
pathologist to incorporate a peer buddy
system to strengthen Mark’s social and
communication skills.
• Instruct Mark in the use of a visual calendar
to help him stay focused and complete his
morning routines in a timely manner.
• Assist Mark in mastering the steps necessary
to ride the city bus to and from a job.
• Conduct a follow-up session after Mark
obtains employment to ensure that the
situation is working out for both Mark and
his employer.
• Collaborate with Natalie to locate and select
appropriate resources and support systems
to help her seek, obtain, and sustain
part-time employment.
• Assist Natalie with experiential exploration
of potential jobs of interest.
• Collaborate with a vocational counselor to
set up a supported employment program
(Arbesman & Logsdon, 2011).
• Work with potential employers on reasonable
accommodations to promote Natalie’s ability
to perform the essential functions of a given
job (Americans With Disabilities Act, 1990).
• Meet with a job coach and Natalie to provide
specific strategies for developing Natalie’s
work skills while building on her current
skills and strengths (Arbesman & Logsdon,
2011).
(Continued)
7112410040p7
Table 1. Case Examples of Occupational Therapy Interventions for Assisting Clients With Compromised Work Performance (cont.)
Description of Client Work Performance
John is a 45-yr-old returning veteran who
sustained a traumatic brain injury. John
has skills as a mechanic, but he is unable
to participate in work because of limited
physical endurance, difficulty
attending to tasks, and limited activity
tolerance evidenced by increasing
agitation and outbursts. John lives with
his wife in their own home. She works
part time and completes most of the
home care tasks, meal preparation, and
yard work with assistance from friends
and family.
John was referred to outpatient occupational
therapy by his physician and treatment
team with the long-term goal of
transitioning back to work as a
mechanic in the military.
A group of older adults who attend a weekly • Use a leisure activity checklist to identify
lunch-and-learn program at a local senior
center are interested in volunteering
in their community as a way to stay
physically and mentally active and to
maintain their values related to work and
community participation.
The clients have not had previous volunteer
experience and are not certain where to
begin to find a suitable venue and offer
their services.
7112410040p8
Occupational Therapy Evaluation
Traumatic Brain Injury
• Develop an occupational profile that
includes John’s roles, habits and routines,
work history and skills, and interests, as
well as his return-to-work goals.
• Assess John’s current level of daily activity
participation, executive function, physical
capacity, and triggers for outbursts and
frustration.
• Assess work tasks, including physical and
cognitive task requirements, work routines,
natural environmental supports (e.g.,
coworkers, human resources person,
supervisor), and work site resources for
part-time work and graded work tasks.
• Analyze data to compare skills with task
requirements and create an intervention
plan.
Older Adults Seeking Volunteer Activities
areas of potential interest, such as
woodworking, home repairs, work with
adolescents, and financial consultation.
• Recommend that clients do an Internet
search to identify local organizations and
programs in need of volunteers that could
benefit from their expertise, such as a Boys
Club program teaching inner-city youth to
make small furniture and decorative items, • Develop a training program within the senior
a service run by an area church to assist
elders in completing complex tax returns, and
the local chapter of Habitat for Humanity.
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• In the clinic, develop and provide work
simulation tasks and routines to develop
John’s endurance, attention, and capacity
(Martinez & Small, 2014).
• Explore strategies to reduce John’s frustration
and outbursts.
• With John and his wife, develop a graded
activity schedule for John to assume short
periods of home care tasks such as
vacuuming, lawn care, and meal
preparation.
• Meet with John and a work site
representative to identify work activities,
task requirements, and modification options.
• In consultation with the employer,
rehabilitation team, and John, develop a
part-time return-to-work plan including
work hours, specific tasks, and access to
supports while at work.
• Conduct job shadowing on site visits to
review John’s activity tolerances and work
capacity and further modify work tasks or
the environment as needed. On the basis
of John’s progress, recommend addition
of further tasks or work hours (Ntsiea, Van
Aswegen, Lord, & Olorunju, 2015).
• Establish a data bank and referral system
that matches the interests of group members
with related volunteer opportunities.
• Organize a volunteer fair for the clients to
connect with and learn about community
organizations’ volunteer needs and match
the needs with their own interests to ensure
the opportunities are personally meaningful
(Sellon, 2014).
center to prepare clients to match their skills
with the specific needs and interests of the
organizations (Sellon, 2014).
Occupational Therapy Education and Professional Responsibilities
Occupational therapy practitioners are well prepared to meet clients’ needs related to work and volunteer
participation. The educational background of entry-level occupational therapists includes skills related

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to analyzing tasks and environments, evaluating client capacities and performance skills, and develop-
ing a wide variety of interventions to maximize work participation. Although additional certification is
not required to provide these services, additional training in ergonomics, functional or physical capacity
evaluations, and job and risk analysis are available for practitioners who have a desire to advance their
skills. Familiarity with legislation related to workers’ compensation laws, the ADA, transition from school
to work, and vocational rehabilitation is also important. Occupational therapy practitioners can assume
varied roles related to work including, but not limited to, independent contractor or business owner; con-
sultant; industrial rehabilitation specialist; ergonomist; health and safety specialist; therapist or consultant
employed within an institution, hospital, or facility; and vocational rehabilitation specialist.
The role of occupational therapy assistants (OTAs) in facilitating work participation and performance
is based on state practice acts that permit them to perform standardized evaluations and other duties as
allowed. OTAs should consult their state practice act to determine their abilities and limitations related to
performing tasks independently (i.e., without direct supervision). OTAs can perform portions of assess-
ments if they first establish service competency with a supervising occupational therapist. For example,
OTAs can perform ergonomic assessment of workstations after competency is demonstrated. OTAs can
perform direct patient care of an injured worker after an evaluation and treatment plan is established by an
occupational therapist. Direct patient care may include guiding and facilitating injured workers through a
work conditioning program in preparation for return to work, designing work simulation activities, and
educating injured and noninjured workers on safe material handling.

Conclusion
This statement describes occupational therapy evaluation and intervention services to facilitate work par-
ticipation and performance. Clients may be individuals with injury, disease, or disability; groups who work
in a particular environment or industry; or organizations or employers. Services are provided in a variety
of settings to develop, restore, and preserve work skills. Occupational therapy practitioners consider the
dynamic interaction between the person, the environment, and the occupation, along with clients’ needs
and desires, to promote health and participation in the workplace.

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Authors
Work & Industry Special Interest Section 2014–2017:
Julie Dorsey, OTD, OTR/L, CEAS
Holly Ehrenfried, OTD, OTR/L, CHT
Denise Finch, OTD, OTR/L, CHT
Lisa Jaegers, PhD, OTR/L

With contributions from

Victoria Kaskutas, BS, MHS, OTD, OTR/L, FAOTA

for

The Commission on Practice

Kathleen Kannenberg, MA, OTR/L, CCM, Chairperson

7112410040p10 November/December 2017, Volume 71(Supplement 2)

Acknowledgments
The Commission on Practice acknowledges the following authors of the 2011 version of this document
for their work on the cases: Melanie Ellexson, MBA, OTR/L, FAOTA, and Barbara Larson, MA, OTR,
FAOTA. Sincerest appreciation is extended to John Ray for his work on the Appendix.

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Adopted by the Representative Assembly Coordinating Council for the Representative Assembly, 2017

Revised by the Commission on Practice 2016

Note. This revision replaces the 2010 document Occupational Therapy Services in Facilitating Work Performance, previ-
ously published and copyrighted in 2011 by the American Occupational Therapy Association in the American Journal
of Occupational Therapy, 65(Suppl.), S55–S64. https://doi.org/10.5014/ajot.2011.65S55

Copyright © 2017 by the American Occupational Therapy Association.

Citation. American Occupational Therapy Association. (2017). Occupational therapy services in facilitating work
participation and performance. American Journal of Occupational Therapy, 71(Suppl. 2), 7112410040. https://doi.
org/10.5014/ajot.716S05

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Appendix
Selected Work Legislation
Legislation
Federal Employees Liability (FELA) Act, 1908
(45 U.S.C. 51 et seq.)
Vocational Rehabilitation Act Amendments
of 1943 (Pub. L. 78–113)
Vocational Rehabilitation Act Amendments
(Hill–Burton Act) of 1954 (Pub. L. 86–565)
Vocational Rehabilitation Act Amendments
of 1965 (Pub. L. 89–333)
Architectural Barriers Act of 1968
(Pub. L. 90–48)
Developmental Disabilities Services and
Facilities Construction Act of 1970
(Pub. L. 91–517)
Occupational Safety and Health Act of 1970
(Pub. L. 91–596)
Rehabilitation Act of 1973 (Pub. L. 93–112)
Rehabilitation Act Amendments of 1986
(Pub. L. 99–506)
Education of the Deaf Act (EDA) of 1986
(Pub. L. 99–371)
Omnibus Budget Reconciliation Act of 1987
(Pub. L. 100–203)
Americans With Disabilities Act (ADA) of 1990
(Pub. L. 101–336)
Ticket-to-Work and Work Incentives
Improvement Act of 1999 (Pub. L. 106–170) employment, vocational rehabilitation, and other support services from public and private
7112410040p12
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Scope
• Established the no-fault insurance system that pays benefits to employees for accidental
injuries or diseases that are work related
• Changed the original provision of the Vocational Rehabilitation Act of 1920 (Pub. L. 66–236)
to add people with physical disabilities, blindness, developmental delays, and psychiatric
disabilities to those served
• Established the Office of Vocational Rehabilitation
• Put new emphasis on activities of daily living and adaptation
• Removed the ceiling on appropriation
• Authorized greater financial support, research and demonstration grants, professional
preparation grants, state agency expansion and improvement grants, and grants to expand
rehabilitation facilities
• Increased services for several types of people with disabilities and social handicaps
• Made construction money available for rehabilitation centers and workshops
Led the way to changes in access for people with disabilities
Gave states broad responsibility for planning and implementing a comprehensive program
of services for people with developmental delays, epilepsy, cerebral palsy, and other
neurological impairments
Mandated that employers provide employment free from recognized hazards that are likely to
cause death or serious harm to workers
• Expanded services to people with more severe disabilities
• Provided for affirmative action in employment (Section 503) and nondiscrimination in
facilities (Section 504) by federal contractors and grantees
Clarified that in evaluating rehabilitation potential, one must consider recreation, employability,
and rehabilitation engineering needs
Extended the statutory authority of the National Technical Institute for the Deaf to provide
technical training and education to prepare deaf people for employment
Permitted states to offer prevocational, educational, and supported employment services to
people deinstitutionalized at any time before the waiver program
• Prevented discrimination against people with disabilities
• Guaranteed equal protection for people with disabilities in employment, public
accommodations, transportation, state and local government, and telecommunications
Increased opportunities and choices for Social Security disability beneficiaries to obtain
providers, employers, and other organizations
(Continued)
November/December 2017, Volume 71(Supplement 2)
Appendix
Selected Work Legislation (cont.)
Legislation
Americans With Disabilities Act Amendments
Act (ADAAA) of 2008 (Pub. L. 110–325)
Workforce Innovation and Opportunity Act
(WIOA) of 2014 (Pub. L. 113–128)
The American Journal of Occupational Therapy
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Scope
• Focused on the discrimination at issue instead of the person’s disability
• Made important changes to the definition of the term disability by rejecting the holdings
in several Supreme Court decisions and portions of the Equal Employment Opportunity
Commission’s ADA regulations
• Retained the ADA’s basic disability definition as an impairment that substantially limits one
or more major life activities, a record of such an impairment, or being regarded as having
such an impairment
• Aimed to better align the workforce system with education and economic development
• Provided for a stronger workforce development system with smaller and more strategic
state and local workforce boards, ensured that workers with disabilities acquire skills
for integrated employment, and established accountability measures for core programs
• Provided access to education with support for adult education and family literacy
education programs
7112410040p13