The Occupation Debate – Means vs Ends? or is Occupation Focused, Based and Centered practice enough to claim we are providing true occupational therapy?.

OTalk 23-062015 hosted by @GillyGorry

As OTs we all know that the profession of occupational therapy is diverse and OTs practice in many different settings: traditional/ non traditional, Generic and role emerging areas of practice, but sometimes there doesn’t seem to be agreement between what is and isn’t practicing occupational therapy, so tonight we’ll debate it.

Firstly I thought it useful to Define the terms:

Occupation as Ends – the outcome of intervention or goal is the ability to perform or engage in occupation, but does not necessarily mean the use of occupation was used directly as an intervention. (Gray, J.1998).

Occupation as Means – using the engagement and performance of occupations as intervention. (Gray, J. 1998).

Occupation Centered –  to put occupation at the centre and view with an occupational lens ( Fisher, A.G, 2013).

Occupation Based – the foundation or base, is fundamental to assessment and intervention and for OTs this relates to Occupation. (Fisher, A.G. 2013).

Occupation Focused – to bring something into focus and concentrate on one aspect of occupation. (Fisher, A.G. 2013).

before we chat I would like you all to take a little pre chat poll

Q1. how would you describe ‘true’ or ‘pure’ occupational therapy

Q2. Should OTs been practicing occupation as means only when providing interventions?

Q3. What would an occupation as means only OT profession look like?

Q4. Could all types of service user benefit from a means only profession? or would some miss out?

Q5. If practicing occupation as means only, would we still be holistic professionals?

Q6. Should OTs be using occupation as ends if it is, Occ focused, based and centred?

Q7. Does Generic working fit with being Occ focused, based and centred?

Q8 Does the setting dictate means or ends? does it dictate Occ focus?

Q9. How do you practice? do you see your practice as true occupational therapy?

After the chat could you please take the post chat poll

My personal opinion on this subject,  is that occupation focused, based and centered practice creates an environment where occupation can happen, whether that be by means or ends and that actually sometimes my ‘ends’ focus, might lead to another OT being able to be ‘means’ focused intervention. This view comes from working in a broad range of settings with people with Physical and Mental health issues.  for many of the people I work with, barriers such as their environment, or a severe physical disability,  would prevent them from participation in occupation as means therapies initially. However, occupation as means is often my ends, but I always keep the occupational goals of the individual at the heart of my practice. I am interested in hearing your thoughts, and views on this topic and I know from experience it usually generates a good debate. Please feel free to add your comments to the blog as well as tweeting on the night.

Gray,J. (1998). Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy, 52(5)3, 354-364.

Fisher, A.G. (2013) Occupation – Centred, Occupation – based, Occupation – focused: Same, same or different? The Scandinavian Journal of Occupational Therapy, 20: 162-173.


#OTalk 16th June 2015 – Tweets Against OT

In tonight’s #OTalk we will be trying something a little different and having some fun. 

Tweets Against OT will be our version of Cards Against Humanity – If you’ve not played before check out this website for more details. 

The rules will be simple. From the #OTalk account I will tweet out some starter lines that call for an answer, or for you to fill in the blank/s (If I run out of ideas I might need you to make some suggestions too). You respond to each starter with your funniest response that fits in a tweet (with the hashtag #otalk). At the end of the chat we’ll pick the funniest combination/s based on a popular vote – so make sure you reply to the correct starters. 

Here’s one starter that I’ll tweet at some point tonight just to give you an idea and to get your creativity flowing – If you invented an OT model it would be called…

Please remember to follow your codes of conduct but also to poke fun at our fabulous profession too. 

#OTalk – 9th June 2015 – ‘Assessment Tools: Help or Hindrance? Door-Opener or Straightjacket?’

Thank you to Nichola (@Nnikki_Duffy) for offering to host this #OTalk – I’m sure it will be very interesting! Do join us at 8pm BST on Tuesday – all welcome!


My relationship with assessment tools has been a journey, as a newly qualified practitioner I found security, confidence and like a beacon on a light house they guided my assessment structure. They provided me with an outcome measure that could demonstrate the effectiveness of interventions and provided an effective audit that demonstrated the need for more OT’s.

Interestingly COT (2013) not only promotes the use of standardised outcome measures, but warns that without incurring such data through credible/reliable sources, the evidence base to support the value of OT will fail to grow, unable to meet the challenge of producing the robust information needed to support future commissioning.

However what if that guiding light fails to illuminate the person in their entirety and context? I remember having a discussion with a wonderful group of masters’ students who described the use of standardised assessments tools as trying to fit people into boxes. Lots of wonderful critical thinking going on, however on reflection I can distinctively remember in practice thinking I wish there was just another box!

However through the use of an assessment tool that was sensitive enough to illuminate a person’s capabilities at the exploratory level, family and care staff could see strength, not only loss, while providing a way of capturing the words ‘I feel like myself again’.

In context the strength of the assessment tool does not absolve the professional from there responsibility to recognise and respond to issues (Hocking, 2010), acknowledging that an assessment tool is a part of the assessment. Professionally Hocking (2010) identified that we have a profession responsibility to acknowledge our limitations, do we have the needed proficiency in administering certain assessment tools? Do we follow our assessment tool blindly, failing to review regularly against new evidence and theory?

Other questions to consider:


  • What assessment tools to you use in practice?


  • It what ways can assessment tools become opened doors?


  • It what ways can assessment tools become straightjackets?


  • What are our professional responsibilities when using assessment tools?


  • What are some of the challenges experienced when using assessment tools?


Useful Resources:


COT (2013) Position Statement: Occupational therapists’ use of standardized outcome measures.”use of outcome measures”

COT, Occupational Therapy Assessments for Older People with Dementia:”assessment tools”

Laver Fawcett, A,J. (2007) Principles of assessment and outcome measurement for occupational therapists and physiotherapists : theory, skills and application. Chichester : John Wiley.

#OTalk 2nd June – Bill Wong on his TEDx experience

In late last year, I received a message from a TEDxGrandForks planning committee member, Hana Mattern (who also was an OT student at the time) about her inquiry to nominate me to do a TEDx talk. My initial thought at the time was, “Me? I am sure there are more OTs who are more qualified than me to be on that stage, especially since I barely started my third year in OT practice. This is probably a longer term CPD goal than right now.” But then I also thought, “Opportunities like this don’t come often. I know Terry Olivas De La O (whom some of you know was my first CPD mentor in OT who passed away in early 2014) will be mad at me if I say I am not confident enough to accept the challenge.” After some debate while Hana was explaining what I would be in for more, I decided to take the risk and go for an interview with the TEDxGrandForks team that took place 2 weeks later.

I was nervous before the interview. I was afraid that I wasn’t good enough to be chosen due to my qualifications are not good enough. To my surprise, I was notified that I was invited hours later to be a speaker for TEDxGrandForks.

Upon receiving the news, I knew I had a big mission on my hands. Not only I knew I was representing occupational therapy profession, but I also knew it was my biggest stage yet for public speaking. Fortunately, Carly Rogers (the OT who did a TEDx talk before me at UCLA) is one of my great friends. So, I unashamedly ask Carly for pointers, especially what I might expect that day.

Preparing the talk was the hardest thing I have ever done. I had to write the script over 5 times to best fit the conference theme. Being a non native speaker who tends to be wordy when writing also didn’t help. Fortunately, I was able to take advantage of the 3 hours that TEDxGrandForks has provided with a speech coach. She was able to make my message a lot more concise. My next job then was to practice and make sure I included all the points I want to say and remain composed. For someone who is in the 3rd percentile in short term memory with a tendency to speak fast when feeling nervous, this was another tough challenge. To combat that, I read the script over at least 20 times with three real time rehearsals before I arrived in Grand Forks the day before.

I was fine during the practice runs because I was confident that I could make the 15 minute time limit without a problem. However, after the second stage practice was over. I began to feel nervous. I began to down cup after cup of Zen tea that I brought as I was waiting more than 3 hours for my turn. I knew there were colleagues from all over the world watching, along with 200+ people in the live audience. When I was done, I was relieved because I felt that I passed the biggest test to me professionally yet.

After the TEDx talk, I wondered, “Why aren’t there more occupational therapy students come to share their stories and showcase #otdistinctvalue in public? Why aren’t the previous two TEDx talks by occupational therapists are not as well celebrated in our profession?”


So now comes my discussion questions:


1.     What do you all think of my TEDx talk overall? (Positive and constructive comments are accepted.)

2.     How can we get more occupational therapy students and practitioners on a stage such as TEDx?

3.     How can we empower service users in our own settings to overcome their obstacles?

4.     What is your plan to promote #otdistinctvalue to the public?

5.     Any other questions you might want to raise?


Bill Wong, OTD, OTR/L

And here’s Bill’s Talk.

(My apologies to Bill for the delay in posting this)