Question
What does community-based occupational therapy look like in practice?
Answer
Community-based OT looks familiar in technique but broader in scope and setting. Practitioners assess the whole person in real-life environments and adapt interventions across homes, public spaces, and community programs. Because public environments can’t be modified at will, OTPs emphasize preparation, client training, and education of community partners. Caregiver and family training is central, ensuring strategies are reinforced in natural contexts.
Interventions span compensation and restoration. For example, a client with a leg amputation may progress from quiet outings to busier venues to rebuild confidence and balance strategies; another client post–hip replacement may work on strength, endurance, and safe movement to return to grocery shopping. Plans are often longer and more complex—escorting a client through a store involves layered problem-solving beyond what a home-based shower session demands.
Real-world case examples illustrate the range:
- Group programs like boxing classes for people with Parkinson’s integrate amplitude, voice, and participation, with OT/PT tailoring activities and following up at home as needed.
- Mobility and participation goals can be transformational—e.g., obtaining and training with a standing power wheelchair so a client can stand as a bridesmaid and later at concerts.
- Community re-entry after loss may focus on confidence with banking, car transfers, and walker management to restore independence.
- Advocacy and environmental modification occur in situ—recommending a stair lift over a ramp when appropriate, flagging unsafe railings, and leveraging funding (e.g., Medicaid home-mod dollars) for changes like converting a tub to a walk-in shower.
Populations are diverse: stroke survivors working on cars to rebuild fine motor, cognition, and identity; clients undergoing driving evaluations and training (including neurodivergent young adults pursuing licensure); and older adults maintaining community participation. The common thread is participation: meeting people where life happens and adapting, compensating, restoring, and empowering so they can engage in what matters most.
This Ask the Expert is an edited excerpt from the course, “Community-Based Occupational Therapy,” presented by Krista Covell-Pierson, OTR/L, BCB-PMD.
