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All people, regardless of abilities, should have access to, choice of, and an opportunity to participate in a full range of community activities. Individuals with intellectual disabilities (ID) have limited cognitive capacities and adaptive behaviors for participating in activities of daily living (National Institutes of Health, 2010). Individuals with ID exhibit less community participation, fewer social relationships, and lower leisure and employment participation (Verdonschot, deWitte, Reichrath, Buntinx, & Curfs, 2009). Despite these limitations, individuals with ID have the capacity to participate in a range of community activities when provided the opportunity and appropriate supports. When individuals with ID participate and live in the community, the benefits include greater community, civic, and social participation as they transition from childhood into adulthood (Verdonschot et al., 2009). Fostering community integration for individuals with ID supports the American Occupational Therapy Association's (AOTA's) commitment to inclusion and non-discrimination of all persons (AOTA, 2009).
Community integration for individuals with ID should occur across the lifespan, from infancy throughout the aging process. The community roles and activities will vary depending on the stage of the individual's life and his or her interests. For example, integrating a child or youth into the community may focus on home, school, and recreational activities; whereas integrating an adult into the community may focus on home management, employment, leisure, religious, or social activities.
A core philosophy of occupational therapy is to enable participation in society. Occupational therapists are educated and trained to understand the dynamic and changing interaction between an individual and the environment, making them essential professionals to help foster community integration.
For example, the occupational therapist works with the individual to develop a comprehensive understanding of his or her skills and abilities to perform daily activities in the home, at the workplace, at school, or in the community. Daily activities demand the integration and use of sensory, motor, cognitive, perceptual, emotional, and social skills and abilities. Occupational therapists evaluate and provide interventions for these skill areas. The occupational therapist also examines where the person will be functioning (e.g., home, school, workplace, community), and the interaction of these environments or contexts on the individual's ability to perform daily activities. The environmental factors include the physical, social, cultural, and time contexts of a person's life. Occupational therapists comprehensively analyze the interaction between the individual and the environment, and provide adaptations to promote that person's participation. Occupational therapists help individuals develop new skills, modify the activity, or modify the environment to create the best person-activity-environment match.
Role of Occupational Therapy
The role of occupational therapy in supporting community integration and participation for individuals with ID is as varied as the clients and their daily lives. Services can be provided directly or consultatively to families, members of religious organizations, leaders of community organizations, businesses owners, or public services administrators. Occupational therapy services to support community integration may include interventions to:
- Educate caregivers in best ways to communicate, organize, include, and engage clients in daily home chores and family activities by providing consistency, focusing on skills, and structuring tasks at the level of their differently abled family member.
- Provide sensitivity training to public services providers such as local police, fire, and emergency medical personnel on strategies for engaging and communicating with people of different abilities.
- Provide community education and training to various business and community members such as store owners, bus drivers, airport personnel, restaurant staff, movie theater staff, and other health care providers about sensory sensitivities and communication strategies for individuals with diverse learning needs.
- Design accessibility and educational programs at public institutions for individuals with different learning needs.
- Educate business owners, public policy makers, and community developers about universal design principles, inclusion, and access to services for individuals with ID.
- Foster, support, or develop community-based work experiences in collaboration with existing business owners and service providers in local communities.
- Design and implement special training courses for individuals with ID who live in group homes, focusing on cooking, homemaking, personal care, leisure activities, and other areas of interest.
- Design and implement pre-vocational and vocational training in collaboration with employment services and other rehabilitation service providers.
- Provide training and support for the development of inclusive youth services such as child care, community recreational programs, and extracurricular activities.
Who Can Benefit, and Where Are Services Provided?
Beneficiaries of occupational therapy intervention include individuals with ID, their friends and family members, and community members, due to improved quality of life and productive participation.
Services can be provided in virtually any setting, including family homes, residential communities, group homes, personal care homes, or assisted living environments; schools; community recreational settings; and work settings. Work settings can range from private or public businesses to sheltered vocational workshops. Community and recreational settings include the diversity of social experiences, such as going to the movies or a zoo, taking public transportation, or attending a sporting event.
Summary
Community integration programs involve a team approach that can include the client, family members and caregivers, community members, health care and educational professionals, community organization staff, and governmental agency staff, among others. Because of their emphasis on participation, occupational therapy practitioners are essential members of these teams. Not only can they help improve the lives of people with ID, but they help enrich the community by ensuring that each member is as independent as possible.
References
American Occupational Therapy Association. (2009). Occupational therapy's commitment to non-discrimination and inclusion.American Journal of Occupational Therapy, 63, 819–820. doi:10.5014/ajot.63.6.819.
National Institutes of Health. (2010, October). Fact sheet—Intellectual and developmental disabilities. Retrieved from http://report.nih.gov/NIHfactsheets/default.aspx
Verdonschot, M., deWitte, L., Reichrath, W., Buntinx, W., & Curfs, L. (2009). Community participation of people with an intellectual disability: A review of empirical findings.Journal of Intellectual Disability Research, 53(4), 303–318.
By Roger Ideishi, JD, OT/L, FAOTA; Mariana D'Amico, EdD, OTR/L, BCP, CIMI; and Tracy Jirikowic, PhD, OTR/L, for the American Occupational Therapy Association. Copyright © 2013 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@aota.org.