and the environments in which those activities take place. however, there have been some dissenting voices. mocellin, in particular, advocated abandoning the notion of health through occupation as he proclaimed it obsolete in the modern world. as well, he questioned the appropriateness of advocating holism when practice rarely supports it. some values formulated by the american occupational therapy association have been critiqued as being therapist-centric and do not reflect the modern reality of multicultural practice. in recent times occupational therapy practitioners have challenged themselves to think more broadly about the potential scope of the profession, and expanded it to include working with groups experiencing occupational injustice stemming from sources other than disability. examples of new and emerging practice areas would include therapists working with refugees, children experiencing obesity, and people experiencing homelessness. practice frameworks an occupational therapist works systematically with a client through a sequence of actions called the occupational therapy process. there are several versions of this process as described by numerous scholars. all practice frameworks include the components of evaluation (or assessment), intervention, and outcomes. this process provides a framework through which occupational therapists assist and contribute to promoting health and ensures structure and consistency among therapists. the occupational therapy practice framework (otpf) is the core competency of occupational therapy in the united states. the otpf is divided into two sections: domain and process. the domain includes environment, client factors, such as the individual's motivation, health status, and status of performing occupational tasks. the domain looks at the contextual picture to help the occupational therapist understand how to diagnose and treat the patient. the process is the actions taken by the therapist to implement a plan and strategy to treat the patient. the canadian model of client centered enablement (cmce) embraces occupational enablement as the core competency of occupational therapy and the canadian practice process framework (cppf) as the core process of occupational enablement in canada. the canadian practice process framework (cppf) has eight action points and three contextual element which are: set the stage, evaluate, agree on objective plan, implement plan, monitor/modify, and evaluate outcome. a central element of this process model is the focus on identifying both client and therapists strengths and resources prior to developing the outcomes and action plan. occupations according to the american occupational therapy association's (aota) occupational therapy practice framework: domain and process, 4th edition (otpf-4), an occupation is defined as any type of meaningful activity in which one engages in order to "occupy" one's time. these occupations can be goal-directed, task-oriented, purposeful, culturally relevant, role specific, individually tailored, or community-oriented, depending on one's values, beliefs, context, and environment. the following are examples of such occupations: activities of daily living (adls) the otpf-4 defines adls as daily activities that are required to take care of one's self and body, which are instrumental to one's health, well-being, and social participation. examples of adl's include: bathing, showering, toileting and toilet hygiene, dressing, swallowing/eating, feeding, functional mobility, personal hygiene and grooming, and sexual activity. instrumental activities of daily living (iadls) the otpf-4 defines iadls as daily activities that "support daily life within the home and community that often require more complex interactions than those used in adls". examples of iadls include: care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home establishment and managements, meal preparation and cleanup, medication management, religious and spiritual activities and expression, safety and emergency maintenance, shopping. rest and sleep the otpf-4 defines rest and sleep as "activities related to obtaining restorative rest and sleep to support healthy, active engagement in other occupations". examples of rest and sleep include: rest, sleep preparation, and sleep participation. education the otpf-4 defines education as the activities that are needed to support one's learning, participation, and accessibility within an educational environment. examples of education include: formal education participation, informal personal education needs or interests exploration (beyond formal education), and informal personal education participation. work employment interests and pursuits the otpf-4 cites mosey (1996, pg. 423) as how an individual selects work opportunities by their likes, dislikes, possible limitations, and assets. employment seeking and acquisition the otpf-4 defines this aspect of work as the opportunity for one to advocate for oneself along with completing, submitting, and reviewing application materials. the preparation involved for interviews, the act of participating in an interview, as well as following up after an interview. and lastly, the act of participating. job performance the otpf-4 defines this aspect of work as how an individual carries out their job. examples given are: the way in which a person carries out their job requirements i.e. work skills, work patterns, time management, interactions and relationships with coworkers/managers/customers, supervision, production, initiation, etc. retirement preparation and adjustment the otpf-4 defines this aspect of work as how an individual adjusts to their new role that includes a vocational interests and opportunities. the opportunity for individuals to develop and enhance interests and skills. volunteer exploration the otpf-4 defines this aspect of work as the opportunity for an individual to discover community causes, organizations, or opportunities in which they can participate without pay that meets their personal interests, skills, location play play exploration the otpf-4 defines this aspect of work as the opportunity for an individual to discover community causes, organizations, or opportunities in which they can participate without pay that meets their personal interests, skills, location play participation the otpf-4 defines this aspect of play as the individual's participation in the selected method of play. how an individual is able to balance play with their other occupations. this area also addresses how a person gathers the necessary components for play and uses the equipment appropriately. leisure leisure exploration the otpf-4 identifies this aspect of leisure as the individual's identification of interests, skills, opportunities, and activities that are appropriate. leisure participation the otpf-4 identifies this aspect of leisure as the individuals activity in planning, and participating in leisure activities that are appropriate. the capacity to maintain a balance between leisure and other occupation as well as using the equipment necessary appropriately. social participation community the otpf-4 defines this aspect of social participation as successful interaction through engagement in activities with a group (i.e. neighborhood, workplace, school, religious or spiritual group). family the otpf-4 cites mosey (1996 p. 340) and defines this aspect of social participation as successful interaction within a familial role. peer, friend the otpf-4 defines this aspect of social participation as the distinctive levels of interaction and closeness which can include engagement in desired sexual activity. practice settings according to the 2015 salary and workforce survey by the american occupational therapy association, occupational therapists work in a wide-variety of practice settings including: hospitals (26.6%), schools (19.9%), long-term care facilities/skilled nursing facilities (19.2%), free-standing outpatient (10.7%), home health (6.8%), academia (6.1%), early intervention (4.6%), mental health (2.4%), community (2%), and other (15%). recently, there is a trend of ots moving towards working in the hospital setting and in the long-term care facilities/skilled nursing facilities setting, comprising 46% of the ot workforce. the canadian institute for health information (cihi) found that between 2006 and 2010 nearly half (45.6%) of occupational therapists worked in hospitals, 31.8% worked in the community, and 11.4% worked in a professional practice. areas of practice the broad spectrum of ot practice makes it difficult to categorize the areas of practice, especially considering the differing health care systems globally. in this section, the categorization from the american occupational therapy association is used. children and youth platform swing with tire used during occupational therapy with children occupational therapists work with infants, toddlers, children, youth, and their families in a variety of settings, including schools, clinics, homes, hospitals, and the community. assessment of a person's ability to engage in daily, meaningful occupations is the initial step of occupational therapy (ot) intervention and involves evaluating a young person's occupational performance in areas of feeding, playing, socializing, daily living skills, or attending school. occupational therapists take into consideration the strengths and weaknesses of a child's underlying skills which may be physical, cognitive, or emotional in nature, as well as the context and environmental demands at play. in planning treatment, occupational therapists work in collaboration with parents, caregivers, teachers, or the children and teens themselves in order to develop functional goals within a variety of occupations meaningful to the young client. early intervention is an extremely important aspect of the daily functioning of a child between the ages of birth-3 years old. this area of practice sets the tone or standard for therapy in the school setting. ot's who practice in early intervention develop a family's ability to care for their child with special needs and promote his or her function and participation in the most natural environment as possible. each child is required to have an individualized family service plan (ifsp) that focuses on the family's goals for the child. it's possible for an ot to serve as the family's service coordinator and facilitate the team process for creating an ifsp for each eligible child. objectives that an occupational therapist addresses with children and youth may take a variety of forms. for example: providing splinting and caregiver education in a hospital burn unit. facilitating handwriting development through providing intervention to develop fine motor and writing readiness skills in school-aged children. providing individualized treatment for sensory processing difficulties. teaching coping skills to a child with generalized anxiety disorder. consulting with teachers, counselors, social workers, parents/ caregivers, or any person that works with children regarding modifications, accommodations and supports in a variety of areas, such as sensory processing, motor planning, visual processing, sequencing, transitions between schools, etc. instructing caregivers in regard to mealtime intervention for children with autism who have feeding difficulties. in the united states, pediatric occupational therapists work in the school setting as a "related service" for children with an individual education plan (iep). every student who receives special education and related services in the public school system is required by law to have an iep, which is a very individualized plan designed for each specific student (u.s. department of education, 2007). related services are "developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education," and include a variety of professions such as speech–language pathology and audiology services, interpreting services, psychological services, and physical and occupational therapy. as a related service, occupational therapists work with children with varying disabilities to address those skills needed to access the special education program and support academic achievement and social participation throughout the school day (aota, n.d.-b). in doing so, occupational therapists help children fulfill their role as students and prepare them to transition to post-secondary education, career and community integration (aota, n.d.-b). occupational therapists have specific knowledge to increase participation in school routines throughout the day, including: modification of the school environment to allow physical access for children with disabilities provide assistive technology to support student success helping to plan instructional activities for implementation in the classroom support the needs of students with significant challenges such as helping to determine methods for alternate assessment of learning helping students develop the skills necessary to transition to post-high school employment, independent living or further education (aota). other settings, such as homes, hospitals, and the community are important environments where occupational therapists work with children and teens to promote their independence in meaningful, daily activities. outpatient clinics offer a growing ot intervention referred to as "sensory integration treatment". this therapy, provided by experienced and knowledgeable pediatric occupational therapists, was originally developed by a. jean ayres, an occupational therapist. sensory integration therapy is an evidence-based practice which enables children to better process and integrate sensory input from the child's body and from the environment, thus improving his or her emotional regulation, ability to learn, behavior, and functional participation in meaningful daily activities. recognition of occupational therapy programs and services for children and youth is increasing worldwide. occupational therapy for both children and adults is now recognized by the united nations as a human right which is linked to the social determinants of health. as of 2018, there are over 500,000 occupational therapists working worldwide (many of whom work with children) and 778 academic institutions providing occupational therapy instruction. health and wellness according to the