Environmental Supports – documents

OFFICIAL DOCUMENTS are approved by the Representative Assembly (or the RACC) of the Association for the use of the American Occupational Therapy Association and its membership to help guide members’ practice.



Complex Environmental Modifications. Am J Occup Ther 2015;69(Supplement_3):6913410010


Complex Environmental Modification’s “CEM’s are alterations, modifications, or creation of new spaces to meet the needs of an individual, family, group or community to preserve or facilitate optimal participation in daily life.”


“Occupational therapists conduct evaluations and provide consultation, and practitioners provide intervention, training, education, and advocacy to individuals and groups, caregivers, and employers to remove environmental barriers and support occupational performance.”


“In addition, the occupational therapy practitioner may manage funding and installation of technologies and modifications as well as the training of clients in their use.”


“Outcomes: The results of the interventions, including increased performance, increased ease of use and adaptation of the environment or AT, decreased caregiver burden, and increased participation in daily life.”


Consultation on projects requiring additional knowledge and experience such as remodeling and construction of new homes, work environments, and community spaces, including plan review”


Advocacy for the needs of clients requiring modifications to home and community environments through interfacing with government agencies, payment sources, and community planners.”


“Evidence supports occupational therapy interventions to ……increase satisfaction in occupational performance and promote safe performance of caregiving (Dooley & Hinojosa, 2004). Furthermore, occupational therapy interventions directed at the caregiver reduced decline in self-care of family members (Gitlin, Corcoran, Winter, Boyce, & Hauck, 2001), thus decreasing cost of care and delaying institutionalization (Wilson, Mitchell, Kemp, Adkins, & Mann, 2009), as well as increased perceived quality of life (Szanton et al., 2011).”


“There is a demand for services to be provided to consumers not only to assist with maintaining health and wellness but also to allow for successful aging in place and community participation.”


“Occupational therapy practitioners providing CEMs must assess their own competency and ensure that they are able to safely and effectively recommend, obtain and install appropriate modifications.”


“Occupational therapy practitioners choosing to pursue CEM as an area of practice can gain advanced experience through mentoring opportunities, continuing education courses, and review of national and international professional publications on this topic.”




Occupational Therapy’s Perspective on the Use of Environments and Contexts to Facilitate Health, Well-Being, and Participation in Occupations. Am J Occup Ther 2015;69(Supplement_3):6913410050.


Using their expertise in analyzing these complex and reciprocal relationships, occupational therapy practitioners make recommendations to structure, modify, or adapt the environment and context to enhance and support performance. ”


“This assumption is consistent with current education and health care laws and policies, which stipulate that assessment and intervention by providers take place in the natural and least restrictive environments (LREs) that support the client’s successful participation.”


“Occupational therapy practitioners collaborate with clients to identify both strengths and barriers to health, well-being, and participation. As part of this process, practitioners consider a variety of environmental and contextual factors to inform the clinical reasoning process that guides client evaluation, intervention, and targeting of outcomes. Occupational therapy practitioners analyze the environment and context to understand how these elements can best support learning and performance. Solutions are then generated to reduce identified barriers or build on supports through modifications and adaptations.”


Used with written permission from AOTA through OTAustralia personal communication..