OTIPM: A model for implementing top-down,

client-centered, and occupation-based

assessment, intervention, and documentation

Developed by Professor Anne G. Fisher, ScD, OT, FAOTA

The OTIPM rescued me from an “OT-depression”! Half of my clients did not need OT, they needed
physiotherapy. After I learned the OTIPM, I made sure the OT referrals were appropriate and took
more time for the “interviewing–observing–goal-setting–process,” and I focused more on education
and compensation. Nothing totally new, but still it changed something. I gained more OT self-esteem
and joy in my work.
We changed our documentation system. And we “threw out” the old tests, and now we focus on
“performance of prioritized activities.” Even one of the most “body-function-working OT colleagues”
are enthusiastically reporting that they are reaching goals more easily and faster!
Katharina, 2015

Overview
This 3-day course is ideal for occupational therapy practitioners, educators, and researchers who want
to implement best possible occupation-based and occupation-focused services. The course content
progresses step-by-step through the phases of the occupational therapy process. Lectures, video case
examples, and extensive opportunities to practice enable the course participants to reflect on and learn
strategies they can apply to improve their practice, educational activities, and research.
While this course is based on the Occupational Therapy Intervention Process Model (OTIPM, Fisher,
2009; Fisher & Jones, in press). the emphasis is on the practical application of the OTIPM as a
professional reasoning model that helps the occupational therapist practice in a more client-centered,
top-down, occupation-based, and occupation-focused manner. The occupational therapists who take
this course find that they leave inspired to make their practice more centered on occupation.
A major premise of the OTIPM is that focusing our evaluations on the client’s quality of occupational
performance, focusing our interventions directly on enhancing or maintaining occupational performance,
and using occupation as a primary method for both evaluation and intervention all depend on a
concurrent commitment to true top–down and client-centered practice. When we embrace these
fundamental principles of occupation-based and occupation-focused services, occupational therapists
will:
• Document measureable and occupation-focused baselines, goals, and outcomes
• Use occupation-based and occupation-focused evaluation and intervention methods to enhance the
quality and effectiveness of the services they provide

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• Advocate for and promote the distinct value of occupational therapy to consumers, third-party
payers, and other professionals
• Value the contributions of occupational therapy to health care and health promotion

Background
Based on her 1998 Eleanor Clarke Slagle Lectureship, Professor Fisher brings together 50 years of
experience to present a model for professional reasoning. The OTIPM is a professional reasoning model
that occupational therapists can use to ensure that they adopt an occupation-centered (OC) perspective
to guide their reasoning as they plan and implement occupation-based (OB) and occupation-focused (OF)
services (Fisher, 2013).
In the OTIPM, the occupational therapy process is depicted as occurring over three global phases,
evaluation and goal-setting, intervention, and reevaluation, and each step in the process may be OB, OF,
or both (Fisher, 2013). The steps of the occupational therapy process defined in the OTIPM are
represented schematically below (see Figure 1).

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Who Should Attend?
• Occupational therapists who want to change their practice and implement services that are
occupation-based and occupation-focused.
• Occupational therapists who already practice in a manner with which they are satisfied—attending
this course will enable them to reflect on and evaluate their current practice and identify components
that they can further improve so as to become even more occupation-centered.
• Occupational therapist who want to change practice and are struggling with where to start in order
to overcome the many obstacles that limit what they can do.

Course Description
While the OTIPM is a professional reasoning model, the emphasis of this course is on the practical
application of the OTIPM in practice. A variety of individual and group activities provide the course
participants with opportunities to implement (a) nonstandardized occupation-focused and occupation-
based evaluations of quality of a person’s occupational performance, including the performance of daily
life tasks that involve social interaction, and (b) occupation-focused documentation. Video case examples
are used to reinforce learning.

Course Objectives
At the conclusion of a 3-day OTIPM workshop, the participants will understand:

• The occupation-centered professional reasoning process defined in the OTIPM

• Distinctions between occupation-centered reasoning and occupation-based and occupation-focused
practice
• The various types of evaluations and interventions occupational therapists commonly use and which
ones are occupation-based or occupation-focused
• How to apply true top–down and occupation-centered reasoning in the context of implementing
occupation-based and occupation-focused services
• How to implement nonstandardized observation-based performance analyses of a person’s quality of
occupational performance
• How to write occupation-focused documentation, including observable and measureable client-
centered goals
• When and how to link other occupational therapy models of practice and evaluation methods into
the occupational therapy intervention process

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Course Schedule
Day 1 — 8:30 to 10:00 Introduction to the course
Developing a common language
10:00 to 10:30 Break
10:30 to 12:00 Developing a common language (continued)
Introduction to the OTIPM
12:00 to 1:15 Lunch
1:15 to 3:00 Case application — Client-centered performance context
3:00 to 3:30 Break
3:30 to 4:30 Document background information, reason for referral, and self-reported level
of occupational performance

Day 2 — 8:30 to 10:00 Case application — Implement performance analysis (motor and process skills)
10:00 to 10:30 Break
10:30 to 12:00 Case application — Document baseline level of performance and client-
centered goals
12:00 to 1:15 Lunch
1:15 to 3:00 Case application — Document client-centered goals (continued)
3:00 to 3:30 Break
3:30 to 4:30 Case application — Plan intervention
Document intervention plan
Reevaluate and document result

Day 3 — 8:30 to 9:15 Introduction to a general OT program based on OTIPM

9:15 to 10:00 Case application — Implement performance analysis (social interaction skills)
10:00 to 10:30 Break
10:30 to 12:00 Case application — Document baseline level of performance and client-
centered, occupation-focused goals
12:00 to 1:15 Lunch
1:15 to 1:45 Case application — Plan intervention and evaluate results
1:45 to 3:00 Framing function from an unique occupational therapy perspective
Some final thoughts
Implementing changes in practice — Overcoming obstacles
3:00 to 3:30 Break
3:30 to 4:30 Implementing changes in practice — Overcoming obstacles (continued)
Final reflections
Note. The schedule presented here may vary, depending on group interest and needs. Exact times for
breaks and lunch also may vary slightly, depending on the schedule of the course setting.

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Selected References
Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same or
different? Scandinavian Journal of Occupational Therapy, 20, 162–173. DOI: 10.3109/11038128.2012.
754492

Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and
implementing top–down, client-centered, and occupation-based interventions. Ft. Collins, CO: Three Star
Press.

Fisher, A. G., & Griswold, L. A. (2013). Performance skills: Implementing performance analyses to
evaluate quality of occupational performance. In B. B. Schell, G. Gillen, M. Scaffa , & E. Cohn (Eds.), Willard
& Spackman’s occupational therapy (12th ed., pp. 249–264). Philadelphia: Lippincott Williams & Wilkins.

Fisher, A. G. & Jones, K. B. (2017). Occupational Therapy Intervention Process Model. In J. Hinojosa,
P. Kramer, & C. B. Royeen. Perspectives on human occupation: Theories underlying practice (2nd ed., pp.
237–286). Philadelphia: Wolters Kluwer|Lippincott Williams & Wilkins.

(Note. For additional references, go to http://www.innovativeotsolutions.com/content/otipm/references/)

Updated 7 August 2017

 Evaluation and goal-setting phase Intervention phase Reevaluation phase

Identify resources and

Establish limitations within
client-centered client-centered
performance context performance context

Develop therapeutic
rapport and work
collaboratively with client

Plan and implement

Select the adaptive occupation to
Identify client’s reported compensatory compensate for decreased
and prioritized strengths model occupational skill
and problems of
occupational performance
Plan and implement
Select a model for educational programs
education and for groups focused
Observe client’s teaching on performance of
performance of prioritized daily life tasks
tasks and implement
performance analyses
Clarify or interpret the Reevaluate for
reason(s) for client’s enhanced and satisfying
problems of occupational occupational
performance performance
Define and describe
task actions the client
does and does not
perform effectively Select a model for Plan and implement
occupational skills acquisitional occupation
training to reacquire or develop
(acquisitional model) occupational skill

Establish, finalize, or
redefine client-centered Select a model for Plan and implement
and occupation-focused enhancement of person restorative occupation to
goals factors and body functions restore or develop person
(restorative model) factors and body functions

Adapted from: Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for planning and implementing
top-down, client-centered, and occupation-based interventions. Fort Collins CO: Three Star Press. (Revised June 2013)
 Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet

Client-centered Performance Context: Resources and Limitations

Consider past, present, and future or each dimension
Environmental
dimension

Role
dimension

Motivational
dimension

Task
dimension

Cultural
dimension

Social
dimension

Societal
dimension

Body function
dimension

Temporal
dimension

Adaptation
dimension

Reason for
referral

Strengths and Problems of Reported Occupational Performance

Tasks performed well and/or Task performed with problems Tasks potentially problematic
with satisfaction and/or with dissatisfaction

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 Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet

Actions (Performance Skills) Performed Effectively or Ineffectively

Motor skill Behavior (action) observed Judgment

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 Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet

Actions (Performance Skills) Performed Effectively or Ineffectively

Process skill Behavior (action) observed Judgment

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 Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet

ADL Motor and ADL Process Skill Specific Baseline Statements

Skills included in the cluster Specific baseline statement

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 Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet

Actions (Performance Skills) Performed Effectively or Ineffectively

Social interaction skill Behavior (action) observed Judgment

Updated 29 April 2016

 Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet

Social Interaction Skill Specific Baseline Statements

Skills included in the cluster Specific baseline statement

Updated 29 April 2016

 Occupational Therapy Intervention Process Model
(OTIPM) — Documentation Worksheet

Background information

Reason for referral

Reported current level of performance

Priorities

Observed current status (global baseline)

Actions of performance (performance skills) of most concern (specific baseline)

Goals

Interpretation

Intervention plan

Potential to benefit from intervention

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 References: Occupational Therapy
Intervention Process Model (OTIPM)

Dancza, K., Copley, J., Rodger, S., & Moran, M. (2016). The development of a theory-
informed workbook as an additional support for students on role-emerging placements.
British Journal of Occupational Therapy, 79, 235–243. https://doi.org/10.1177/
0308022615612806

Ericksen, J. B. (2009). Critical reflections on school-based occupational therapy.

Scandinavian Journal of Occupational Therapy, 17, 64–69. https://doi.org/10.3109/
11038120903160736

Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same,

same or different? Scandinavian Journal of Occupational Therapy, 20, 162‒173.
https://doi.org/10.3109/11038128.2012.754492

Fisher, A. G. (2009). Occupational Therapy Intervention Process Model: A model for

planning and implementing top-down, client-centered, and occupation-based interventions.
Ft. Collins, CO: Three Star Press.

Fisher, A. G. (2006). Overview of performance skills and client factors. In H. M.

Pendleton, & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy: Practice skills for
physical dysfunction (6th ed., pp. 372–402). St. Louis MO: Mosby Elsevier.

Fisher, A. G. (1998). Uniting practice and theory in an occupational framework: 1998

Eleanor Clarke Slagle Lecture. American Journal of Occupational Therapy, 52, 509–521.
https://doi.org/10.5014/ajot.52.7.509

Fisher, A. G., Atler, K., & Potts, A. (2007). Effectiveness of occupational therapy with
frail community living older adults. Scandinavian Journal of Occupational Therapy, 14, 240–
249. https://doi.org/10.1080/11038120601182958

Fisher, A. G., Bryze, K., Hume, V, & Griswold, L. A. (2007). School AMPS: School
Version of the Assessment of Motor and Process Skills (2nd ed.). Ft. Collins, CO: Three Star
Press.

Fisher, A. G., & Griswold, L. A. (2014). Performance skills: Implementing performance

analyses to evaluate quality of occupational performance. In B. A. B. Schell, G. Gillen, & M.
E. Scaffa (eds.), Willard & Spackman’s occupational therapy (12th ed., pp. 249–264).
Philadelphia: Lippincott Williams & Wilkins.

Fisher, A. G., & Griswold, L. A. (2018). Evaluation of Social Interaction (4th ed.). Fort
Collins, CO: Three Star Press.

Fisher, A. G., & Jones, K. B. (2012). Assessment of Motor and Process Skills. Vol. 1:
Development, standardization, and administration manual (7th Rev. ed.). Fort Collins, CO:
Three Star Press.

Updated 5 March 2018

 Fisher, A. G. & Jones, K. B. (2017). Occupational Therapy Intervention Process Model.
In J. Hinojosa, P. Kramer, & C. B. Royeen. Perspectives on human occupation: Theories
underlying practice (2nd ed., pp. 237–286). Philadelphia: Wolters Kluwer|Lippincott
Williams & Wilkins.

Fisher, A. G., & Nyman, A. (2011). OTIPM: En model för ett professionellt resonemang
som främjar bästa praxis i arbetsterapi (FOU-rapport 2007) [OTIPM: A model for
professional reasoning that promotes best practice in occupational therapy] (revised ed.).
Nacka, Sweden: Förbundet Sveriges Arbetsterapeuter.

Hällgren, M., & Kottorp, A. (2005). Effects of occupational therapy program in activities
of daily living and awareness of disability in persons with intellectual disabilities. Australian
Occupational Therapy Journal, 52, 350–359. https://doi.org/10.1111/j.1440-1630.2005.
00523.x

Kottorp, A., Hällgren, M., Bernspång, B., & Fisher, A. G. (2003). Client-centred
occupational therapy for persons with mental retardation: Implementation of an intervention
programme in activities of daily living tasks. Scandinavian Journal of Occupational Therapy,
10, 51–60. https://doi.org/10.1080/11038120310009416

Larsson-Lund, M., & Nyman, A. (2017). Participation and occupation in occupational

therapy models of practice: A discussion of possibilities and challenges. Scandinavian
Journal of Occupational Therapy, 24, 393–397. https://doi.org/10.1080/11038128.2016.
1267257

Lindström, M., Hariz, G. M., & Bernspång, B. (2012). Dealing with real-life challenges:
Outcome of a home-based occupational therapy intervention for people with severe
psychiatric disability. Occupational Therapy Journal of Research, 32, 5–13.
https://dx.doi.org/10.3928/15394492-20110819-01

Simmons, D. C., & Griswold, L. A. (2010). Using the Evaluation of Social Interaction in
a community-based program for persons with traumatic brain injury. Scandinavian Journal of
Occupational Therapy, 17, 49–56. https://doi.org/10.3109/11038120903350303

Sirkka, M., Larsson-Lund, M., & Zingmark, K. (2014). Occupational therapists'

experiences of improvement work: A journey towards sustainable evidence-based practice.
Scandinavian Journal of Occupational Therapy, 21, 90–97. https://doi.org/10.3109/
11038128.2013.872183

Zingmark, M., Fisher, A. G., Rocklöv, J., & Nilsson, I. (2014). Occupation-focused
interventions for well older people: An exploratory randomized controlled trial. Scandinavian
Journal of Occupational Therapy, 21, 447–457. https://doi.org/10.3109/11038128.2014.
927919

Updated 5 March 2018