Environmental

Impact
By Dana White
 Introduction Question
How does the environment impact the delivery of
occupational therapy services for a multifaceted
population?

Population multifaceted population

Intervention delivery of occupational therapy
services
 Abstract
The environment can play a major role in providing client-centered occupational therapy
services to individuals. The course of intervention for all individuals should greatly consider
the impact environmental factors can have on an individuals treatment. By providing
therapy in a context that is similar to that of the patients natural environment, a therapist
can help to generalize and incorporate the therapeutic activities into daily routines for the
patient. An individual may experience barriers in their environment that impede their
occupational performance, so it is important for the therapist and patient to collaborate in
eliminating these barriers in an effort to achieve cohesiveness between the person,
environment, and occupations. As part of the evidence-based practice curriculum of
Chatham Universitys MOT program, the purpose of my scholarly agenda is to explore the
literature regarding the environment and its impact on the delivery of occupational therapy
services for a multifaceted population.
 Significance
The collaboration between therapists and caregivers in the
natural environment is key to providing family-centered and
quality care (Hanft & Pilkington, 2000).
Generalization of skills is more likely when there is not a
delineation of the intervention context and the natural
environment (Hanft & Pilkington, 2000).
The environment can serve as a focus of intervention and plays a
key role in supporting childrens participation (Anaby, Law,
Teplicky, & Turner, 2015).
One of the most important rehabilitation interventions is the
participation of youth in school, home, and community because it
is fundamental to both their health and development (Anaby et
al., 2015).
 Search Strategy
Search Engines: CINAHL, Medline, & Google Scholar
Search Terms:
Occupational therapy and natural environment
Occupational therapy and environment
Occupational therapy intervention in the natural environment
Inclusion Criteria:
Articles from 2000 present
Peer reviewed articles
Exclusion Criteria:
Articles older than 2000
Languages other than English
Non-peer reviewed articles
 Description of Evidence
Article 1: Therapy in Natural Environments: The Means or End Goal for
Early Intervention?
- Level V; Qualitative; Expert opinion
- Authors used their expert opinions to discuss occupational
therapy services delivered in the natural environment of children.
Article 2: Focusing on the Environment to Improve Youth Participation:
Experiences and Perspectives of Occupational Therapists
- Level V; Qualitative Phenomenological Method
- Interviews with 12 occupational therapists helped to describe their
experiences of using the PREP approach to deliver occupational
therapy services to youth.
Article 3: The Effect of Contextual Relevance on Motor Skill Transfer
- Level II; Quantitative; Randomized Controlled Trial
- The participants were selected using convenience sampling and
were randomly placed into 3 groups to investigate whether the
environment had an impact on the transfer of a complex motor skill.
Environments: The Means or End Goal for
Early Intervention?
Study objectives: To explore how working in the natural environment
can reinforce care that is family-centered, discuss the benefits for all
individuals involved when performing therapy in the natural setting
and routines, describe the process of making the decision to embed
intervention in the natural environment, and identify challenges to
providing therapy in the natural setting.

Methods: The authors focused their discussion in this article on

rehabilitation specialists with roots in the medical model in order to
acknowledge the benefits for both the children and families when
the therapist utilizes the natural environment. Specific methods to
how the information was obtained was not provided in the article.
 Article 1 continued
Outcomes:
In the authors opinion, the natural environment allows the therapist
to provide family-centered care by incorporating daily routines and
family members of the child.
Involving caregivers in the facilitation of optimal functioning in the
ordinary routines of the family increases the likelihood that the family
will independently repeat the therapeutic activities learned.
Benefits of the natural environment: enhancing family relationships
and interactions between the professional and families, increasing
opportunity for modeling and support, and understanding the abilities
of a child in an environment familiar to them.
Potential challenges: program and legislative conflicts, therapists
training and experience, and fiscal and logistical issues and staffing
shortages
 Article 2 - Focusing on the Environment
to Improve Youth Participation:
Experiences and Perspectives of
Occupational Therapists
Study Objectives: To explore the perception and experiences of
occupational therapists who implemented the PREP approach which is an
environment-based intervention for youth with physical disabilities aimed at
improving their participation in the community.

Methods: Using a post-intervention only design, 12 therapists took part in

individual semi-structured interviews consisting of five open-ended
questions. 3 interviewers independently conducted the hour-long
interviews no later than 2 to 4 weeks post-intervention. The therapists had
the opportunity to reflect on their experiences using the PREP approach to
enable participation.
 Article 2 contd
What is the PREP approach?
Pathways and Resources for Engagement and Participation.
Client-centered, strength-based approach aiming to improve youth
participation in 3-community based activities by solely modifying
aspects of the environment
Targeted for youth ages 12-18 with various functional issues
The therapist, youth, and parent collaborate to identify environmental
barriers in each of these 3 activities
Solution-based strategies to eliminate these barriers are proposed and
eliminated while building on the strength and support of the youth and
family
There is an element where the therapist coaches the family and youth
to identify and apply effective strategies to improve the youths
participation.
Protocol: (1) make goals; (2) map out a plan; (3) make it happen (4)
measure the process and outcomes; and (5) move forward
 Article 2 contd
Outcomes:
4 overarching themes emerged from the interviews: (2 informative themes & 2
reflective themes)
(1) Multi-layered composition of the environment (informative theme) - Therapists
encountered different facets of the environment to serve as barriers for
participation, including temporal, physical, and attitudinal barriers.
(2) Leveraging resources and problem-solving (informative theme) In order to
overcome barriers in the environment, therapists developed a range of solution-
based strategies with a client-centered approach to meet the familys unique
needs. Some strategies were simple solutions and others were more complex.
(3) A new take on the OT role (reflective theme) Both parents and therapists
perceived this approach as a unique method of practice and a different type of
service. Some supported this method to therapy while others felt it was not to be
considered therapy.
(4) Re-positioning the concept of participation (reflective theme): Therapists
discussed the importance of this particular age group engaging in leisure
activities. Therapists also discussed the unique benefit of moving away from the
clinical setting and providing services in the natural environment of the youth.
Article 3 - The Effect of Contextual Relevance
on Motor Skill Transfer
Study Objectives: To investigate whether practicing a complex self-care occupation in a
contextually relevant environment would enhance the transfer and learning of the skill

Methods:
56 college-aged women were randomly placed into 3 groups (a contextually relevant
group {CR}, a noncontextually relevant group {NCR}, and a control group)
Design consisted of 3 phases: skill acquisition phase, rest phase, and a transfer phase
Acquisition phase consisted of CR group learning to tie a neck tie on a mannequin and
the NR learned to tie a similar know with rope onto a wooden pole
- Consisted of participants watching a video & receiving verbal instruction &
completed 20 trials
- Participants were instructed to return in 24-hours for the remaining testing
Transfer phase consisted of the CR, NCR, and control group learning to tie a tie on
themselves
- Participants of all 3 groups performed the task for 10 trials with written and
illustrated instructions available
Participants measured by movement unit (smoothness), movement time, and the
quality of the knot
- A reflective marker was placed just proximal to their right 3rd metacarpal to
achieve measurements
Outcomes:
Article 3 Contd
Hypothesis 1: The rate of performance change during the acquisition phase would be significantly different
between the CR and NCR group in terms of movement time and movement units.
- This hypothesis was not supported; no significant difference was found between CR and NCR
group rates of performance change
- CR group demonstrated greater movement time and movement units than NCR throughout the
acquisition phase.
Hypothesis 2: A significant difference would exist among the CR, NCR, and control groups during the initial
transfer trial in terms of movement time, movement units, and quality of knot.
- This hypothesis was not supported in that there was no significant difference found among the
groups during the initial trial of the transfer phase.
Hypothesis 3: The rate of performance change during the transfer phase would be significantly different
among the CR, NCR, and control groups in terms of movement time, movement units, and quality of knot.
- This hypothesis was supported in that the rate of performance change in terms of movement time
and movement units was significantly different across the groups.
- The rate of performance change for the CR group was smaller than that of the NCR and control
groups.
 References
Anaby, D., Law, M., Teplicky, R., & Turner, L. (2015). Focusing on the environment to
improve youth participation: Experiences and perspectives of occupational
therapists. International Journal Of Environmental Research And Public Health,
12(10), 13388-13398. doi:10.3390/ijerph121013388

Ferguson, M. C., & Rice, M. S. (2001). The effect of contextual relevance on motor
skill transfer. American Journal of Occupational Therapy, 55(5), 558-565.
doi:10.5014/ajot.55.5.558

Hanft, B. E., & Pilkington, K. O. (2000). Therapy in natural environments: The means
or end goal for early intervention?. Infants and Young Children, 12(4), 1-13.