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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 53
| Issue : 2 | Page : 51-55 |
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Development of scope of practice of occupational therapy in India: An overview
Karthik Mani1, Ashwini Rao2, Murali Krishnan3, Shobana Moorthy4, Jothikumar Ramakrishnan5, Naresh Babu Karunakaran6
1 Department of Occupational Therapy, University of Texas Medical Branch at Galveston, Texas, USA
2 Department of Occupational Therapy, South Lee Autism Services, Brothers of Charity, Cork, Ireland
3 Department of Occupational Therapy, Meenakshi Academy of Higher Education and Research, Chennai, India
4 Department of Occupational Therapy, Smart Sensory Kids, Chennai, India
5 Department of Primary Care Occupational Therapy, Limerick and JK Occupational Therapy Services, Limerick, Ireland
6 Department of Occupational Therapy, Satya Special School, Puducherry, India
| Date of Submission | 29-Nov-2020 |
| Date of Decision | 15-Apr-2021 |
| Date of Acceptance | 15-Jun-2021 |
| Date of Web Publication | 23-Jul-2021 |
Correspondence Address:
Karthik Mani
1572, Harvest Vine Ct, Friendswood, TX
USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijoth.ijoth_43_20
An official scope of practice (SOP) is a critical document for any healthcare profession as it defines the profession's scope and protects its boundary from encroachment by unqualified individuals. It is a key document referred by professional regulators when regulating healthcare professions. This article outlines the development process utilized by the Indian Occupational Therapists Think Tank to develop an official SOP document for the profession of occupational therapy in India.
Keywords: Delivery of Healthcare, Occupational Therapists, Regulation, Workforce
How to cite this article:
Mani K, Rao A, Krishnan M, Moorthy S, Ramakrishnan J, Karunakaran NB. Development of scope of practice of occupational therapy in India: An overview. Indian J Occup Ther 2021;53:51-5 |
How to cite this URL:
Mani K, Rao A, Krishnan M, Moorthy S, Ramakrishnan J, Karunakaran NB. Development of scope of practice of occupational therapy in India: An overview. Indian J Occup Ther [serial online] 2021 [cited 2023 Jun 7];53:51-5. Available from: http://www.ijotonweb.org/text.asp?2021/53/2/51/322172 |
| Introduction | |  |
Scope of practice (SOP) offers a description of services that a qualified healthcare professional is deemed competent to perform and can provide.[1] Further, it provides information on (i) the profession; (ii) education, training, and registration/licensure requirements of qualified professionals; (iii) titles that qualified professional can use; and (iv) settings in which the services can be provided.
An official SOP document can be considered as an essential document for any profession as it serves as a useful reference for all stakeholders including the professionals, regulators, educators, students, and public. It also helps prevent malpractice and professional SOP boundary violations in healthcare practice.[2] Occupational therapy (OT) community in India expressed a need for an official SOP document to educate stakeholders and minimize SOP boundary violations (personnel communication, February 3, 2019). Occupational therapists (OTs) were also concerned about public safety as they witnessed trained assistants and unqualified individuals delivering OT interventions.
Indian Occupational Therapists Think Tank (IOTTT), a likeminded voluntary group with scholarly OTs who obtained their entry-level OT education in India, was founded in 2019. The IOTTT's mission is to contribute to the development of the OT profession in India by (i) exploring the issues that influence OT practice in India, (ii) developing resources to assist with the growth of the profession, and (iii) empowering the skillset of OTs in India.[3] Sensing the need for an official SOP document to support OT practice in India, the IOTTT engaged in the process of developing one. This brief article narrates the development process. The official SOP document is available as Annexure 1.
| Recruitment | | |
A six-member task force comprised 'of' highly qualified and experienced OTs was formed by the IOTTT within its membership to draft the SOP document. All members have either practiced or currently practicing OT in India. Their experience in the field of OT ranged from 10 to 25 years. Further, the members represented diverse practice settings and areas in which OTs work. The group met during IOTTT's quarterly virtual meetings and periodically as needed to discuss the development of the document. There were eight meetings in total between June 2019 and September 2020.
| Review of Model Scope of Practice Documents | | |
In the first several months of the development process, the group spent considerable amount of time reviewing model SOP documents that exist around the world.[4],[5],[6] After the review, the task force prepared an outline of the sections that need to be included in the SOP document pertaining to the Indian context of practice.
| Drafting | | |
After compiling the resources necessary for drafting the SOP, the first author prepared a rough draft of the SOP with input from other members. The draft was made available to all task force members through secure cloud-based storage solution at all times. Members reviewed, amended, and/or commented on the draft as needed throughout the development process. The first draft was completed in January 2020.
| Expert Review | | |
The first draft was shared with other members of the IOTTT for their review and comment. The members critically reviewed the document for accuracy, brevity, clarity, organization, relevance, and presentation. The draft was amended six times based on the input from IOTTT members between January and April 2020.
| Public Comments | | |
In the IOTTT's first quarterly meeting of 2020, it was decided that the updated version of the draft will be circulated for public comment for 90 days. The draft was published on the IOTTT's web blog on April 22, 2020, with July 20, 2020, as the deadline.[7] Further, IOTTT members solicited input from expert OTs in India by informing them about the SOP developing project. Comments were received through WhatsApp messages, e-mails, and the blog. All the comments (~25) were compiled and organized prior to the third quarterly meeting of the IOTTT held in the early September 2020. During the meeting, the task force critically reviewed each comment and made necessary amendments to the SOP draft. Other IOTTT members contributed to the discussion. It is important to note that the IOTTT members always had access to the draft and continued to submit their input to the task force before, during, and after the public comment phase as well as during IOTTT meetings.
| Adoption | | |
After revising the SOP draft three more times based on the public and expert input, the IOTTT officially adopted the SOP document on September 27, 2020. After adoption, the IOTTT members unanimously decided to disseminate the SOP free of cost to benefit the stakeholders and the profession. Further, they also brainstormed the ways to disseminate the SOP document so that it can easily be accessed by stakeholders when needed. In addition, the members discussed the need for stakeholder education on the availability of the SOP document after its official publication.
| Conclusion | | |
This article summarized the development process utilized by the IOTTT to develop the official SOP for the OT profession in India with the hope that professional organizations in other developing countries may utilize the process to develop an official SOP suitable to their context of practice.
Financial Support and Sponsorship
Nil.
Conflicts of Interest
There are no conflicts of interest.
| Annexure 1 | | |
Scope of Practice of Occupational Therapy in India
| Purpose | | |
The purpose of this document is to define the scope of practice (SOP) of occupational therapy (OT) in India to inform and educate all stakeholders including patients/clients who receive OT, other healthcare professionals, educators, employers, referral sources, insurance providers, and government agencies. This document outlines the required qualification and registration requirements for occupational therapists (OTs) in India, eligibility for using the title of “Occupational Therapist,” definition of OT, and scope of OT services and settings in which OTs shall practice OT.
| Qualification | | |
An individual with a baccalaureate (BOT, BOTh, BSc OT) or higher-level degree in OT (MOT, MOTh, MSc OT, and PhD [OT]) obtained from:
- A state/central government recognized educational institution (OR)
- An educational institution recognized by the central government as “Deemed University” based on the advice of University Grants Commission in India (OR)
- An All India Occupational Therapists Association (AIOTA) approved educational program (OR)
- An educational program recognized by the state/national-level regulatory body pertaining to allied health professions that may come into existence in the future (e.g. National Commission for Allied and Healthcare Professions Bill, 2020) shall be considered a “qualified occupational therapist.” Foreign-trained OTs with an equivalent or higher qualification obtained from a World Federation of Occupational Therapists (WFOT) approved educational institution shall also be deemed qualified OTs.
| Registration | | |
If the jurisdiction of practice legally requires OTs to register with a regulatory agency [Annexure I], then an OT practitioner must also register with the council (in addition to obtaining necessary qualification) to be identified as a “qualified or registered occupational therapist.” OTs in India may also seek voluntary registration offered by the Academic Council of Occupational Therapy of AIOTA.
| Title | | |
Only qualified/registered OTs shall use the title “occupational therapist” and are entitled to provide OT services either on a first contact or referral basis. Qualified OTs shall only be recruited for the positions that are titled “Occupational Therapist, Senior Occupational Therapist, Occupational Therapy in Charge, Head of Occupational Therapy, Occupational Therapy Manager, and Tutor/Lecturer/Reader/Assistant Professor/Associate Professor/Professor of Occupational Therapy.”
Individuals who are pursuing a degree in OT shall not use the title until they fulfill all course requirements and obtain a provisional certificate from the educational institution or the official degree certificate from the awarding university.
| Definition | | |
The WFOT defines occupational therapy as “a client-centered health profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement.”[1]
The AIOTA defines occupational therapy as “a holistic evidence-based client-centered first contact and/or referral profession of modern healthcare system, based on science of occupation, with primary focus on purposeful goal-oriented activity/occupations, enhanced with the use of latest technological systems for evaluation, diagnosis, education, and treatment of the patients (clients) of any age group, whose function (s) is (are) impaired by physical, psychosocial, and cognitive impairments, development disorders, or the aging process affecting their quality of life, with the aim to prevent disability, promote health and well-being, and return to optimum occupational roles.”[2]
| Services | | |
Qualified occupational therapists shall:
- Establish an occupational profile of an individual through interviews, review of medical/nonmedical records, and clinical observation for the purpose of determining the need for further OT assessment and intervention
- Assess an individual's performance using standardized or nonstandardized assessments in the areas of activities of daily living (ADL, assessment of self-care skills, home management skills, etc.); work (prevocational skills assessment, functional capacity evaluation, etc.), education (handwriting assessment, school behavior assessment, etc.), play (play assessment), and leisure (leisure assessment)
- Assess an individual's physical, sensorimotor, cognitive, perceptual, and psychosocial skills, using standardized or nonstandardized assessments, to determine their impact on the individual's functional performance
- Assess an individual's routine, roles, and activity patterns using standardized or nonstandardized assessments
- Assess an individual's familial, cultural, religious, and/or spiritual background to determine its influence on function and activity pattern
- Assess an individual's physical, social, and virtual environment (including home, school, work and play environments), using standardized or nonstandardized assessments and site visits, to determine its impact on the individual's functional performance and recommend appropriate modifications to eliminate barriers and maximize functional participation
- Collaborate with the client, client's family, and relevant others (teacher, friend, employer, other healthcare professionals, etc.) for the purpose of data gathering and assessment, planning treatment, and/or facilitating discharge
- Collaborate with community agencies, nongovernmental organizations, employers, and relevant others to facilitate community reintegration and vocational resettlement of individuals with disabilities, to support social inclusion
- Provide direct treatment and consultative services to individuals with functional limitations, secondary to a temporary or permanent health issue (disease, disorder, injury, etc.)
- Provide direct or consultative services to individuals, groups, or organizations for the purposes of injury prevention and/or promote health and wellness of the population (for example: Ergonomics assessment and recommendations)
- Develop, remediate, or restore any skill or ability to enable function and participation
- Use adaptive aids and gadgets, assistive technology, cognitive retraining activities, compensatory activities, group therapy, functional mobility training, neuromuscular reeducation interventions, patient/caregiver education, preparatory exercises (for the purpose of enabling function), play/leisure activities, prosthetic retraining, occupations, purposeful activities, self-care activities, sensory integration interventions, sensory stimulation, sensory reeducation, social skills training, and splinting as intervention tools
- Use physical agent modalities (PAMs) as a precursor for functional training (provided the treatment provider has adequate knowledge and competence through hands-on training and education and is familiar with the device being used). The PAM cannot be used as the only treatment in any given OT treatment session
- Use self (one's personality) as a therapeutic tool (therapeutic use of self)
- Educate individuals on joint protection, energy conservation, fall prevention, lifestyle modification, skin care and integrity, and compensating for sensory loss
- Manage difficulties with feeding or swallowing food through stimulation, posture management, environmental management, and diet progression
- Prescribe assistive and adaptive devices, prefabricated splints, and durable medical equipment
- Modify or adapt devices (eating utensils, writing utensils, mouse, keyboard, etc.) to enable function
- Provide wheelchair seating and modification recommendations and wheelchair mobility training
- Design, fabricate, and apply splints and orthotics devices, except orthodontic devices
- Assess an individual's capacity to drive two-wheelers and four-wheelers and recommend modifications to the vehicles or cessation of driving
- Refer patients/clients to other services as needed and appropriate
- Discharge patients/clients from OT services
- Provide supervision and training for OT students during clinical postings and internships
- Advocate for and uphold universal design principles to ensure barrier-free and inclusive public spaces and environments.
| Settings | | |
Occupational therapists shall deliver OT services in Hospitals, Primary Healthcare Centers, Nursing Homes, Rehabilitation Institutes, Schools, Special Schools, Outpatient Clinics, Gymnasium/Rehabilitation Centers associated with Non-governmental Organizations, De-addiction Centers, Old Age Homes/Hospice, Patients/Clients Residence, Day Care Centers, Vocational Rehabilitation Centers, Academic Settings, Prisons, Orphanages, Office Settings, Industries, and Community.
| Development of this Document | | |
This document is a copyrighted property of Indian Occupational Therapists Think Tank (Hereinafter referred to as Think Tank). It is drafted by a group of highly qualified and experienced occupational therapists originally graduated from India and is currently practicing/teaching/regulating OT either in India or abroad. The practice experience of the authors ranges from 10 to 25 years. In addition, several of the authors have practiced OT both in India and abroad and hence familiar with the systems and practice in India and other developed countries. In addition, several model SOP documents and documents pertaining to OT education and practice in India were reviewed during the drafting process. Further, the draft of this document was placed for review and comment among the OT professionals in India and the general public for 90 days before being officially adopted by the Think Tank on September 27, 2020.
| References | | |
- World Federation of Occupational Therapists. About Occupational Therapy; 2012. Available from https://wfot.org/about-occupational-therapy. [Last accessed on 2019 Jul 31].
- All India Occupational Therapists Association. OT Definition and Practice; 2017. Available from http://aiota.org/about_ot. [Last accessed on 2019 Jul 31].
Acknowledgments
The Think Tank SOP Development Task Force would like to render its sincere thanks to the following individuals for their review, comment, and support to the development and dissemination of the SOP.
- The current and past members of the Think Tank (Dr. Sureshkumar Kamalakannan, Mr. Manigandan Chockalingam, Ms. Sheba Swarnarajam, Ms. Saveetha Sundar, Mr. Vandhiya Devan, Ms. Charulatha Swaminathan, Ms. Geetha Samapth, Ms. Sarika Sasi, and Ms. Poornima Kamath)
- AIOTA and Academic Council of Occupational Therapy Officials (Dr. Anil K. Srivastava, Dr. Jyothika N. Bijlani, and their team of executives)
- Reviewers and Editorial Team of the Indian Journal of Occupational Therapy
- Members of the professional community and the general public who reviewed and commented on the draft SOP.
| Annexure I | | |
As of August 2020, only the following states/union territories legally regulate occupational therapists by means of a registration in India.
| References | | |
| 1. | |
| 2. | Mani K. Scope of practice boundary violation in occupational therapy: A survey of practitioners perceptions in India. Indian J Occup Ther 2021;53:15-22.  [Full text] |
| 3. | |
| 4. | American Occupational Therapy Association. Scope of practice. Am J Occup Ther 2014;68 Suppl 3:s34-40. |
| 5. | |
| 6. | Occupational Therapists Board of New Zealand. The Occupational Therapy Board of New Zealand's Use of Professional Supervision as a Condition on Scope of Practice; 2019. Available from: https://www.otboard.org.nz. [Last accessed on 2021 Apr 12]. |
| 7. | |
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