640 (1)

640 November/December 2002, Volume 56, Number 6
KEY WORDS
• occupation
• occupational therapy
• participation
DISTINGUISHED SCHOLAR LECTURE
Participation in the Occupations of Everyday Life
Mary Law
Participation in the everyday occupations of life is a vital part of human devel-
opment and lived experience. Through participation, we acquire skills and
competencies, connect with others and our communities, and find purpose and
meaning in life. As members of the profession of occupational therapy, we seek to
improve health and well-being through occupation. Occupational therapy focuses
on enabling individuals and groups to participate in everyday occupations that are
meaningful to them, provide fulfillment, and engage them in everyday life with
others. Our focus is on enhancing participation.
Participation is the raison d’être of occupational therapy; it is what we are all
about; it is our unique contribution to society. Why is participation important to
us as occupational therapists? Consider our history as a profession. Participation
has always been a central focus, even though it was not articulated in the same way
as today. Adolf Meyer, one of the founders of occupational therapy, spoke of the
way in which people “learn to organize time…in terms of doing things” (Meyer,
1922, p. 1), indicating the importance of the use of time or participation across
our lives. As he said,
[A human] is an organism that maintains and balances itself in the world of reality
and actuality by being in active life and active use....It is the use that we make of our-
selves that gives the ultimate stamp to our every organ. (p. 1)
Definition of Participation
It is useful to consider the origins, or etymology, of the word participation.
Participation originates from Latin—derived from particeps meaning part-taking,
and pars + capere, meaning to take or to share in. Common English definitions
Mary Law, PhD, FCAOT, is Associate Dean
(Health Sciences) and Director, School of Rehabilitation
Science, and Co-Director CanChild Centre for Childhood
Disability Research, McMaster University, Faculty of Health
Sciences, IAHS Building, 1400 Main Street West,
Hamilton, Ontario L8S 1C7, Canada; lawm@mcmaster.ca.
Participation or involvement in everyday occupations is vital for all humans. As described by the World Health
Organization, participation has a positive influence on health and well-being. The presence of disability has
been found to lead to participation that is less diverse, is located more in the home, involves fewer social rela-
tionships, and includes less active recreation. Occupational therapy is in a unique position to contribute to the
development and fulfillment of participation for persons with and without disabilities. This article describes the
nature and outcomes of participation. Characteristics to define and measure meaningful participation are out-
lined. Information about time use will help to develop an understanding of patterns of participation across loca-
tions, gender, culture, and the life span. Factors that affect participation within the environment, family, and per-
sons are summarized. Occupational therapy research is needed to examine the complex relationship among
person, environment, and participation in occupations. In practice and education, knowledge about participa-
tion can enhance the client-centered and evidence-based nature of occupational therapy services.
Law, M. (2002). Participation in the occupations of everyday life, 2002 Distinguished Scholar Lecture. American Journal of
Occupational Therapy, 56, 640–649.
Downloaded From: http://ajot.aota.org/ on 11/14/2016 Terms of Use: http://AOTA.org/terms

The American Journal of Occupational Therapy 641
include to take part in or become involved in an activity;
the state of sharing in common with others; and the act or
state of receiving or having part of something (Simpson &
Weiner, 2002). Thus, the central concept in participation is
involvement or sharing, particularly in an activity. What is
important to note about these definitions is the focus on
both the nature and the extent of involvement, with quali-
tative and quantitative implications.
Framework of Participation
The World Health Organization (WHO) has recently fo-
cused attention on participation with the development of
the new International Classification of Functioning,
Disability and Health (ICF; WHO, 2001). The WHO
defines participation as involvement in a life situation. In
the ICF, participation is categorized into domains: learning
and applying knowledge; general task and demands; com-
munication; mobility; self-care; domestic life; interpersonal
interactions and relationships; major life areas such as work
or school; and community, social, and civic life (WHO,
2001).
The development of the ICF involved occupational
therapists from several countries and has important impli-
cations for our work. The ICF provides a common lan-
guage to describe how people live with a health condition,
and it will be used in the measurement of health outcomes.
The increasing emphasis on participation by the WHO,
governments, and health and social systems makes it all the
more important that we understand participation, what it
means, how we measure it, and what facilitates it. Such an
understanding needs to focus across the whole spectrum of
human populations, not solely on those with disabilities.
Nature of Participation
The nature of participation is worthy of consideration and
reflection. How is it described? What are the outcomes of
participation? What characteristics define meaningful par-
ticipation? How is participation measured? What do we
know of the typical patterns of participation?
Current research from the CanChild Centre for
Childhood Disability Research has described types of par-
ticipation (Law et al., 2000). In this typology, participation
is defined as involvement in formal and informal everyday
activities. Formal activities include structured activities that
involve rules or goals and that have a formally designated
coach, leader, or instructor (e.g., music or art lessons, orga-
nized sports, youth groups). Informal activities have little or
no planning and often are initiated by the person him- or
herself (e.g., reading, hanging out with friends, playing).
Participation occurs across many locations, including envi-
ronments for work, school, play, sport, entertainment,
learning, civic life, and religious expression.
Outcomes of Participation
What is known about the outcomes of participation in
everyday occupations? Research has shown consistently that
participation in meaningful occupations, particularly work
and leisure, has an important, positive influence on health
and well-being (Freysinger, Alessio, & Mehdizadeh, 1993;
Garton & Pratt, 1991; Larson & Verma, 1999; Law,
Steinwender, & Leclair, 1998). Participation is a vital part
of the human condition and experience—it leads to life sat-
isfaction and a sense of competence and is essential for psy-
chological, emotional, and skill development.
In children, studies of high risk and resilience have
found that participation in extracurricular activities decreas-
es the incidence of behavioral and emotional difficulties
(Rutter, 1990; Stewart, Reid, & Mangham, 1997).
Competent participation in activities buffers the effect of
living with a parent who has a mental illness (Rutter, 1990).
Masten and Coatsworth (1998) found that activity partici-
pation by youth leads to decreased numbers of school
dropouts, improved engagement in school, and more effec-
tive social relationships with peers.
Currently in Canada, the National Longitudinal
Survey of Children and Youth is surveying 23,000 random-
ly selected children and youth 4 to 15 years of age every few
years (Statistics Canada, 2001). Data from this survey indi-
cate that 87% of these children and youth participated in
organized activities outside of school; few differences have
been found between genders, with the exception that boys
participate more in organized sports and girls more in arts
and music and in clubs. Youth who had participated but
stopped are three times more likely to have lower self-
esteem, have difficulty making friends, smoke, and perform
poorly in reading and math (Statistics Canada, 1999).
For adults, recreation and leisure participation is signif-
icantly related to the development of social support net-
works and to quality of life and well-being. Freysinger et al.
(1993) found that participation by older adults is positive-
ly associated with indicators of mental and physical health
as well as with life satisfaction, that participation decreases
as people get older, and that participation by men is less
than by women. Research indicates that older adults who
volunteer live longer than those who never perform com-
munity service (Menec & Chipperfield, 1997). Although
fewer studies have been done of persons with disabilities,
Viemero and Krause’s (1998) study of quality of life of per-
sons with physical disabilities found that life satisfaction
was significantly associated with occupational status,

involvement in meaningful activities, and social integration.
A recent headline in the popular literature read,
“Believe It or Not—This 91 year old Nun Can Help You
Prevent Alzheimer’s” (Lemonick & Mankato, 2001).
Although dramatized for the media, Snowdon’s (1997) lon-
gitudinal study of nuns indicates that factors such as educa-
tion and participation in activities that stimulate the brain
(e.g., puzzles, learning new skills) may be protective and
enhance participation for persons with and without disabil-
ities. Research in occupational therapy also supports the
positive effects of engagement in occupation for persons
with and without disabilities (Baum, 1995; Baum,
McGeary, Pankiewicz, Braford, & Edwards, 1996; Clark et
al., 1997, Clark et al., 2001).
Although participation is known to enhance life quali-
ty, evidence also exists that lack of participation or occupa-
tional deprivation leads to poor health and well-being. As
Whiteford (2000) stated:
Occupational deprivation is, in essence, a state in which a
person or group of people are unable to do what is neces-
sary and meaningful in their lives due to external restric-
tions. It is the state in which the opportunity to perform
those occupations that have social, cultural and personal
relevance is rendered difficult if not impossible. It is a real-
ity for numerous people living around the world today.
(p. 200)
Indeed, many examples of disruption and deprivation
in occupation exist in the world today, including persons
who are unemployed, refugees, minorities, living in areas of
conflict, and living with disabilities.
Essential Characteristics of Participation
What characteristics define meaningful participation in the
occupations of everyday life? A need exists for both satisfac-
tion and individually determined balance in the daily con-
stellation of our occupations (Christiansen, Backman,
Little, & Nguyen, 1999; Jonsson, Moller, & Grimby,
1999). To achieve meaningfulness in an occupation, a bal-
ance between the challenge in the activity and the skills of
the individual is required (Moneta & Csikszentmihalyi,
1996). The goals must be clear to the participant, and feed-
back about performance must be quick and accurate.
Csikszentmihalyi and colleagues have studied how people
experience “flow” from participation in occupations and
found that flow occurs more often in structured activities
where there is more control, such as games, work, sports,
artistic activities, and ritual events (Csikszentmihalyi, 2000;
Csikszentmihalyi & LeFevre, 1989). For participation to be
meaningful, there must be a feeling of choice or control
over the activity, a supportive environment to facilitate easy
attention to the activity, a focus on the task and not on the
long-term consequences, a sense of challenge from the
activity, and a sense of mastery. This is what occupational
therapists term the “just right” challenge.
How Participation Is Measured
Because participation in occupations is complex, weaving a
pattern across time and space, capturing its essence through
measurement, is challenging. Participation in occupations
has several dimensions: the person’s preferences and inter-
ests; what he or she does, where, and with whom; and how
much enjoyment and satisfaction he or she finds. In con-
sidering person, environment, and occupation, the mea-
surement of participation occurs at the transactions
between these domains.
Currently, there is increasing interest and work in the
measurement of participation. At a general population
level, time-use surveys have been implemented in many
countries to gather specific information about how people
spend their time. The surveys typically use diary formats or
telephone-based recall. The United Nations has a Web site
listing of time-use surveys from around the world (United
Nations Statistics Division, 2002). The difficulty with time-
use surveys is that they rarely provide information about
activity preferences, meaning, and enjoyment.
Other measures are being developed and validated for
use with adults, including the Craig Handicap and
Assessment Reporting Technique (Whiteneck, Charlifue,
Gerhart, Overholser, & Richardson, 1992), the Commun-
ity Integration Questionnaire (Willer, Rosenthal, Kreutzer,
Gordon, & Rempel, 1993), the Community Integration
Measure (McColl, Davies, Carlson, Johnston, & Minnes,
2001), the Life Habits Assessment (Fougeyrollas et al.,
1998), and the National Institutes of Health Activity
Record (Gerber & Furst, 1992).
Fewer measures exist for children. One example is a
newly developed measure, the Children’s Assessment of
Participation and Enjoyment (CAPE; King et al., 2002).
The CAPE consists of cards that have drawings of children
and youth doing different activities in their time outside of
formal school and gathers data about participation frequen-
cy, enjoyment, location, and with whom participation is
done. Continued development of participation measures is
needed across all ages.
Typical Patterns of Participation
It is important for occupational therapists to develop an
understanding of patterns of participation across locations,
gender, culture, and the life span. What is known about
typical patterns of participation?
Larson and Verma (1999) reviewed how children and
adolescents around the world spend their time and noted

many differences and changes across countries. For exam-
ple, they noted that the amount of time spent in children’s
play increases as societies transition from nonliterate to lit-
erate. Participation in organized sports has risen over the
past 2 decades, with time spent in other activities such as
hobbies or art and outdoor activities declining. In teenagers,
girls participate in fewer activities than boys (Huston,
Wright, Marquis, & Green, 1999). Posner and Vandell
(1999) found developmental changes in participation, with
unstructured activities decreasing over time and social activ-
ities increasing. On average, youth spend 20% of their time
watching television. Youth in America are spending less
time with their parents (Roth & Brooks-Gunn, 2000). The
National Longitudinal Study on Adolescent Health in the
U.S. found a direct relationship between high rates of
smoking, drinking, marijuana use, and fights and not eat-
ing dinner with a parent five or more times a week (Council
of Economic Advisors, 2000).
For adults, there is information about average time
spent in different occupations (see Table 1). Adults increas-
ingly describe themselves as time stressed; work time is
increasing, and leisure time is decreasing. Evidence shows
that these trends are similar, if not accelerated, in the
United States (Robinson, 2002). A national study of time
use in the United States is planned to occur over the next 2
years.
For older adults, overall patterns of participation
remain similar, but time spent in specific occupations
decreases. For example, in the United States, participation
in sports events, amusement parks, playing sports, and
computers and hobbies begins to decrease after age 55.
Participation in exercise programs remains remarkably con-
stant until age 75, along with participation in charity work,
home improvement and repairs, and attendance at movies
(U.S. National Endowment for the Arts, 1997).
Research indicates that across all ages, a strong associa-
tion exists between interests and participation. A greater
number of interests usually lead to increased participation,
although this pattern is nonlinear in nature (Garton &
Pratt, 1991).
Life Span and Disability:
Effect on Participation
During their lifetime, people are exposed to different occu-
pations and develop likes and dislikes. Customs and expec-
tations from their culture influence what they learn and do
every day. Each person has unique interests and occupations
through which they find satisfaction. They live in different
environments and take on different roles as they grow up.
What they do every day, how well they do it, and how
much they enjoy the occupations of everyday life depend
on their place, age, family, communities, environmental
supports, and other issues such as disability. It is important
to examine what is known about the effect of disability on
participation across the life span.
Children
Studies of children’s activity patterns show that children
with disabilities participate in fewer active recreation activi-
ties; household tasks; and social engagements, particularly
informal social activities, than children without disabilities
(Brown & Gordon, 1987; Law et al., 1999; Sloper, Turner,
Knussen, & Cunningham, 1990). In a study of youth with
and without disability, Henry (1998) found that interests of
these two groups had many similarities; the top four inter-
ests were listening to music, hanging out with friends,
watching television, and talking on phone. However,
research also indicates that participation changes as children
with disabilities move into adolescence, with fewer activities
occurring outside the home (Brown & Gordon, 1987). A
current study of the participation of children and youth
with disabilities 6 to 15 years of age found that these chil-
dren participate in a broad range of formal and informal
activities (Law et al., 2000). Informal activities are per-
formed more often. There appear to be significant differ-
ences in informal activity intensity and enjoyment across
age groupings, with participation in informal activities
decreasing significantly as age increases.
Adults and Older Adults
Across North America, an average of 15% of adults 25 to
64 years of age report a disability that affects everyday activ-
ities (U.S. Census Bureau, 2001). This statistic rises to more
than 38% for people over 65 years of age (U.S. Census
Bureau, 2001). Adults and older adults with disabilities
experience restricted participation and social isolation and
engage in more passive activities (Blake, 1995; Dunn, 1990;
Idler & Kasl, 1997). In a study of time use of 312 men with
spinal cord injury, Pentland, Harvey, Smith, and Walker
(1999) found that most time is spent in leisure occupations,
Table 1. Time Use of Population: Canadian General Social Survey
(Statistics Canada, 1999)
Occupation Average Hours Per Day
Paid work and related activities 7.8
For working adults 11.2
Household work 3.2
Sleep 8.1
Meals and personal activities 2.4
Socializing 1.9
Watching television 2.2
Active leisure 1.0
Note. N = 10,749 persons 15 years of age and older.

followed by productivity and personal care. Men with
spinal cord injury spend 39% more time on personal care,
20% more time in leisure, and 40% less time in productiv-
ity than men without spinal cord injury.
In summary, disability has a substantial and prolonged
effect on participation across all age groups. A significant
association exists between disability severity and social iso-
lation. The presence of disability has been found to lead to
participation that is less diverse, is located more in the
home, involves fewer social relationships, and includes less
active recreation.
Factors That Influence Participation
Knowledge about factors that affect participation can help
to develop a more in-depth understanding of how partici-
pation evolves. It is important to know what environmen-
tal, family, and personal factors facilitate participation. As
well, what are the most important barriers?
Environment
Researchers in social ecology have investigated environ-
ments and their effects on behavior. Using streams of
behavior recording, they discovered that environmental set-
tings such as coffee shops, recreation centers, churches, or
bowling lanes lead to persistent behaviors (e.g., level of
noise, degree of formality) that remain constant for years in
particular settings (Barker, 1978). Over our life span, we
learn these patterns of behavior and activity through social-
ization; therefore, experience in a wide variety of settings is
essential for the development of participation patterns and
interactions with others encountered in daily life routines.
What do we know about the effects of environments
on participation for persons with disabilities? Through his
analysis of classification practices used for social restraint
(e.g., persons with disability as a minority group), French
historian and philosopher Michel Foucault asserted that
power and knowledge have been used to develop a society
and health care system that marginalizes people who are dif-
ferent from the “norm” (Foucault, 1973, 1975).
Indeed, research has shown that institutional environ-
mental factors (economic, political, attitudinal) significant-
ly affect the participation of persons with disabilities (Law
et al., 1999). Issues of poverty, cost of programs, affordable
housing, lack of information and physical assistance, lack of
inclusion of persons with disabilities in planning, and staff
training and attitudes limit participation (Dunn, 1990;
Imrie & Kumar, 1998; LaPlante, Kennedy, Kaye, &
Wenger, 1996).
The social environment, in particular social attitudes
and availability of social support, are particularly important
in facilitating participation. One of the most interesting
findings is that believing that people could become involved
has important positive effects on participation and success in
life (King, Cathers, Polgar, MacKinnon, & Havens, 2000).
Social support, including a relationship with a caring adult,
promotes development and adaptation in children and
youth with disabilities (Masten & Coatsworth, 1998).
Research on resilience cites major environmental risk factors
such as poverty, a violent neighborhood, a peer group that
acts as a barrier to participation; protective factors include
school experiences, work outside home, participation in
extracurricular activities, and a good relationship with other
adults (Rutter, 1990). In a study of 2,812 community-
dwelling older adults, Idler and Kasl (1997) found a signifi-
cant association between higher levels of religious participa-
tion and social activity and social support—social support
has been shown to be a predictor of health and well-being.
Constructing the built environment to suit the needs of
the average person restricts accessibility. On a broad level,
we must consider societal production of space or the whole
organization of our cities and towns, including places of
employment, households, shopping districts, and trans-
portation networks. For example, over the past century,
changes in economic activity have led to greater spatial sep-
aration of work and home, resulting in greater travel dis-
tances and transportation difficulties for families and per-
sons with disabilities. Participation is affected by location.
For example, Garton and Pratt (1991) found that rural
schools had more sports in their school activities but less
overall participation. The separation of private and public
space, decreased political influence of the family, and acces-
sibility difficulties combine to impede the inclusion of per-
sons with disabilities. Often, institutional attitudes limit
accessibility rather than technological capability.
Family
No matter what our age, family and persons close to us have
a major impact on our participation. First, family socioeco-
nomic status has been shown to determine participation.
For example, children’s participation in sports and other
community programs is directly influenced by income, dif-
ferential availability of opportunities, values, and role mod-
els (Law et al., 2000). The presence of psychosocial support
from family members or close friends promotes participa-
tion. For example, Loomis, Javornisky, Monahan, Burke,
and Lindsay (1997) found that a supportive family envi-
ronment improves employment, mobility in the communi-
ty, and social activity for young adults with spina bifida.
Families who live with persons with disabilities experi-
ence increased demands on their daily occupational rou-
tines, leading to changes in patterns of family participation,

with more involvement of small groups within the family in
activities rather than the whole family (Crowe, 1993; Laws
& Radford, 1998; Mactavish, Schleien, & Tabourne,
1997). Participation also is influenced by family prefer-
ences. For example, children with Down syndrome whose
families prefer active recreational activities participate more
frequently in organized activities (Sloper et al., 1990).
In summary, across the age spectrum, families who
function well and provide clear expectations and positive
support to persons with disabilities help to reduce the risk
of limited participation.
Person
Among personal factors, it is common to think that a per-
son’s skills are the most important influence on participa-
tion, but other factors are equally influential. Gender is an
important factor, particularly for leisure participation
(Freysinger et al., 1993; Garton & Pratt, 1991). A person’s
preference for participation significantly affects choice and
actual participation. Similarly, sense of control and compe-
tence often determine participation and enjoyment
(Kimiecik, Horn, & Shurin, 1996; Lovell, Datillo, &
Jekubovich, 1996).
Skills and abilities, particularly interpersonal, commu-
nication, problem solving, and decision making, are impor-
tant factors in determining participation. Studies of adults
and older adults indicate that difficulties in performing
activities of daily living (ADL), decreased mobility, and
depressive symptoms are associated with less participation;
whether they are causal in nature, we do not know (Idler &
Kasl, 1997; Patrick, Kinne, Engelberg, & Pearlman, 2000).
What the effect of severity of disability and condition has
on participation is less clear, as some research, particularly
with children, indicates that environmental and family fac-
tors are more influential (Law et al., 1999). The impact of
functional abilities may be differential. For example,
Mancini, Coster, Trombly, and Herren (2000) found that
physical variables predicted limited school participation,
whereas both physical and cognitive-behavioral factors pre-
dicted full participation.
Participation is a complex issue, with many factors
influencing the occupations that a person does every day.
Examination of the literature is helpful in identifying fac-
tors that appear to have the most important relationship
and influence on participation (King et al., in press). These
include environmental factors (e.g., the physical accessibili-
ty of buildings, attitudes of community members), family
factors (e.g., parents’ own interests in recreation), and per-
sonal factors (e.g., the child’s physical function or social
competence). More knowledge is needed about the relative
influence of these factors on participation.
Implications for Occupational Therapy
Knowledge gained from research about participation is
only useful if we look at how it can positively affect occu-
pational therapy education, research, and practice. What
are the implications for what occupational therapists do
every day?
In the area of research, developing an understanding of
how factors work together to influence participation is
paramount. The use of qualitative methods and more com-
plex quantitative methods will enable researchers to disen-
tangle the complex relationship among person, environ-
ment, and participation in occupations. Without such
information, the focus of occupational therapy interven-
tions may not be targeted effectively. For example, the
largest part of therapy practice focuses on developing abili-
ties in ADL. Research on participation may indicate that
skill in ADL is much less important for participation than
program availability or knowledge and beliefs of program
staff members. This kind of information provides evidence
to support innovative approaches to occupational therapy
intervention.
A great tendency exists in research to do only what is
considered possible. What can result is research stating the
correlations of many variables to each other without exam-
ining their relative contribution to outcome. Although this
statement sounds harsh, it highlights the need to acknowl-
edge the complexity of the human experience with occupa-
tion and to develop research strategies to fit. Researchers
also have a responsibility to communicate findings in ways
that are easily understood and that can be put into everyday
practice.
For education and practice, occupational therapy, at its
best, is informed by our values, knowledge, and reasoning
about participation in everyday occupations. First, occupa-
tional therapy, at its best, is evidence-based and client-centered.
As Dunn (2000) wrote:
Best practices are a professional’s decisions and actions
based on knowledge and evidence that reflect the most cur-
rent and innovative ideas available. Best practice is a way of
thinking about problems in imaginative ways, applying
knowledge creatively to solve performance problems while
also taking responsibility for evaluating the effectiveness of
the innovations to inform future practices. (pp. 1–2)
Evidence indicates that a client-centered approach to occu-
pational therapy practice leads to greater satisfaction with
services and improved outcomes for clients and their fami-
lies (Law et al., 1998).
Occupational therapy, at its best, focuses on occupations
important to each person within his or her environment.
Through a focus on choice, therapists facilitate control for
persons receiving our services. Participation in occupations

is the experience of how everyone seeks meaning in life. It
can delight—it can defeat. Participation implies being
involved, making choices, and taking risks. Clients of occu-
pational therapy services deserve no less from therapists.
There are reliable and valid methods by which clients can
identify occupations important to them but with which
they are encountering difficulty (McColl & Pollock, 2000).
The goals identified by clients may be more challenging for
us as therapists: Facilitating play is more challenging than
focusing on developing fine motor skills. But the process of
a client setting goals focuses occupational therapy interven-
tion, enhances motivation, and saves time. Resilience is fos-
tered when a person has control over his or her participation
and can affect how it is shaped within his or her life (Rutter,
1993).
Occupational therapy, at its best, acknowledges the power
of engagement in occupation. If a clear message has come
from research over the past decade, it is that performance of
an activity is best learned by practicing the activity itself.
Research in motor learning (Ma & Trombly, 2001; Ma,
Trombly, & Robinson-Podolski, 1999), critical reviews of
interventions (Baker & Tickle-Degnen, 2001; Carlson,
Fanchiang, Zemke, & Clark, 1996; Law et al., 1998;
Murphy & Tickle-Degnen, 2001), studies of the effect of
activity for persons with and without disabilities (Baum,
1995; Clark et al., 1997, 2001; Everard, Lach, Fisher, &
Baum, 2000), and information about the effects of disrup-
tion in occupation (Whiteford, 2000) all confirm the pow-
erful effects of engagement in occupation. Patterns of social
restriction and isolation begin very early, whether early in
life or early after a significant disruption in occupation, sup-
porting the need for early intervention (Blake, 1995; Brown
& Gordon, 1987).
Occupational therapy, at its best, recognizes the force of the
environment as a means of intervention. For participation,
interests often precede participation, but interests may not
lead to participation because of environmental barriers.
Focusing intervention on changing environments has
potential to enhance outcomes (Law, 1991). For example,
Strong (1998) recently found that persons with severe men-
tal illnesses working in an affirmative business environment
experienced positive changes in their sense of self-efficacy
and participation. Mann, Ottenbacher, Fraas, Tomita, and
Granger (1999) found that assistive technology and envi-
ronmental modifications in the home maintain function
and reduce health care costs in frail older adults. In a ran-
domized trial examining outreach services linking adults
after traumatic brain injury to community services, Powell,
Heslin, and Greenwood (2002) found that this focus of
intervention led to significant improvements in activity and
participation.
Occupational therapy, at its best, has a broad intervention
focus. Although occupational therapists spend time focused
on specific areas of occupation, such as ADL or work, we
rarely look at occupational routine and overall use of time.
How a person focuses his or her time in order to participate
is an important focus for occupational therapy. A focus on
participation enlarges the scope of interventions to include
organizations and community agencies where factors that
hinder participation can be addressed. Emerging research
indicates that this community-based approach may be more
effective than institutionally based interventions (Clark et
al., 1997; Helewa et al., 1991; Powell et al., 2002). We will
understand that there are multiple risk and protective fac-
tors for participation; intervention can focus on cumulative
protection through decreasing risk, increasing resources,
and facilitating protective processes.
Occupational therapy, at its best, measures outcomes of
participation. A client-centered approach to occupational
therapy intervention will naturally lead us to measure out-
comes of occupational performance and participation. As
outcome measures increase in their sophistication, thera-
pists will be able to evaluate the effects of interventions on
participation, an outcome most meaningful to persons with
disabilities and their families.
Facilitating participation in everyday occupations is the
reason for occupational therapy. As Wilcock (1998) noted:
Occupational therapists are in the business of helping peo-
ple to transform their lives through enabling them to do
and to be. We are part of their process of becoming and we
should constantly bear in mind the importance of this task.
(p. 248)
Occupational therapy, at its best, focuses on occupations
important to each person within his or her environment. The
person receiving occupational therapy services leads the way
in making decisions about the focus and the nature of ther-
apy intervention. The relationship among that person, his
or her family, and the occupational therapist is a collabora-
tive partnership, the goal of which is to enhance health and
well-being through participation. L
Acknowledgments
I thank the American Occupational Therapy Association
for the honor to deliver the Distinguished Scholar Lecture,
on which this article is based, at the 2002 AOTA Annual
Conference. I thank my colleagues in the School of
Rehabilitation Science and CanChild Centre for Childhood
Disability Research at McMaster University for the won-
derful environment in which we work. I am particularly
grateful to Sue Baptiste, MHSc, FCAOT, for her thoughts
and discussion as I was writing the lecture.

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