The 13 Most Common Occupational Therapy Settings
If you’re new to discovering the awesome career path of occupational therapy and are curious about all of the different occupational therapy settings you can work in, look no further.
There are so many settings to choose from, whether it’s providing occupational therapy services in a hospital, rehab facility, clinic, school, in the patient’s own home, and more.
In this article, we’ll be diving into the main OT settings that you can work in as an OT practitioner to assist patients in “living their best lives” and help improve their ability to perform their preferred activities and function as independently as possible.
So without further ado, here the top occupational therapy settings, from adults to pediatrics.
Adult Occupational Therapy Settings
If you’re interested in working with adults, there are a plethora of settings to choose from. Occupational therapists working with adults deal with the various challenges of adult life. Adults who use the services of an occupational therapist are those who are generally going through a major life change from illness or disability.
Occupational therapists work with adults who are affected by injuries, illness, surgeries, age-related diseases, disabilities, or psychological disorders. In these settings, OTs will providing clients with unique strategies and interventions to help enable them to function as independently as possible.
These are the most common of the adult-based occupational therapy settings:
In this setting, occupational therapists work with patients who have just been admitted into the hospital that present with a decline in function from their admitting diagnosis. OTs working in an acute care hospital setting provide quick, functional interventions to patients with acute and (usually) short hospital stays as well as assist the medical team with discharge planning and recommendations.
Therapists who work in acute care often work with patients who have recently suffered injuries and illnesses requiring urgent medical care. Acute care can be a high intensity setting, with high volume caseloads of very diversified patients. Acute care is a great setting for OTs who enjoy a face-paced environment with quick patient turnover and sometimes high medical complexity.
Acute Inpatient Rehab
Acute inpatient rehab, whether it is in a hospital unit or at a stand-alone rehab hospital, is an in-hospital based rehab setting that is the most “intense” form of rehab patients can get, meaning patients will get the most therapy possible here.
Patients (admitted from acute care) that are approved for a short stay of inpatient rehab will receive three hours of rehab a day, 5-6 days a week, of combined occupational therapy, physical therapy, and sometimes speech therapy (if indicated).
Patients seen in the inpatient rehab setting are generally patients that were previously independent, have a good support system, and will be able to discharge home after one to two weeks of rehab.
The types of patients seen in inpatient rehab are typically people affected by strokes, spinal cord injuries, brain injuries, multi-trauma from accidents, burns, or patients with complicated medical issues that have significantly affected their function.
The biggest focus in inpatient rehab is increasing a patient’s independence with self-care tasks including grooming, dressing, bathing, toileting, and functional transfers by providing functional interventions with ADL retraining and therapeutic activities. Caregiver education is provided throughout the process as well.
Subacute Rehab/Skilled Nursing Facilities
The next level of rehab is subacute rehab, which is a less intense form of in-house rehab where the patient stays in a skilled nursing facility (or a hospital’s subacute rehab unit) to receive 24 hour nursing care and an hour to an hour and a half (on average) of occupational therapy, physical therapy and sometimes speech therapy daily.
Many patients in acute care are admitted directly to subacute rehab after they’re medically stable if
- They aren’t safe to go home
- Cannot tolerate three hours a day of aggressive inpatient rehab
- Don’t have an approved inpatient rehab diagnosis. (A patient can have any diagnosis that affects their functioning to be approved for a subacute rehab stay, unlike inpatient rehab.)
While patients receive less daily therapy than inpatient rehab, they will typically have longer stays in subacute rehab before they are discharged home or to long-term care. OTs in subacute rehab will also address the same self-care/ADL components as inpatient rehab therapists.
In the home health setting, occupational therapists work with patients in their own homes. Home health OTs help ensure that their patients are able to put into practice the strategies and treatments they learned in the hospital or rehab setting, since many patients receive home health after their rehab stays.
Home health allows therapists to view the patients in the most functional setting (their homes) and can get an accurate feel for the actual challenges they’ll face on a daily basis when the assistance of a professional may not be immediately available.
In home health, OTs typically only see each patient 2-3 times a week for 30-60 minutes per session. Treatments include caregiver education, home modification suggestions, DME recommendations, ADL retraining, and home exercise program education.
Outpatient Hand Therapy
Hand therapy is a specialization of outpatient therapy in which the occupational therapist with advanced training on the upper extremity treats individuals that have upper extremity impairments affecting their function. Most often, these are certified hand therapists (or CHT).
In this setting, patients may be post-surgery, have arthritis, a new fracture, injury, or a neurological impairment that will benefit from the treatment of a hand therapist. Interventions may consist of manual therapy, use of modalities, therapeutic exercise and activity, splint fabrication or working on self-care tasks during treatment. If you’re interested in working in hand therapy, AOTA has a helpful fact sheet here: OT in Hand Therapy. You can also check out the article titled Day in the Life of a Hand Therapist.
Neuro Outpatient Therapy
Neuro outpatient occupational therapy is another outpatient setting with a focus on rehabbing patients with neurological impairment. In this setting, OTs will treat individuals affected by stroke, brain injury, spinal cord injury, Parkinson’s, multiple sclerosis, and other neurological impairments that contribute to a decline in function.
Common OT interventions in this setting can include fine and gross motor coordination, upper extremity strengthening, ADLs/IADLs, cognition, and vision.
In this setting, you may see patients for two weeks to over six months, so it’s a great setting to really get to know the clients and build a relationship.
To learn more about this setting, a neuro OT shares what her day is like in A Day in the Life of an Outpatient Neuro Occupational Therapist.
When working in any setting, occupational therapists work with mental health, whether it’s in a hospital, school, or rehab facility. Getting sick or injured and facing a new disability is just one of many factors that can cause depression and anxiety, so as an OT you will be able to use your training throughout your traditional interventions in any of the other settings mentioned above.
That being said, while these jobs are rarer for OTs in the U.S., there is a subset of mental health occupational therapy. In mental health settings, OTs work directly on the patient’s mental health by promoting the active recovery model. This model enables people with mental illness to participate in their community through employment, volunteer work, social and educational programs.
Mental health occupational therapists typically work in the community setting which can include group homes, club houses, after-school programs, vocational programs, senior centers, correctional facilities, homeless shelters, and outpatient group therapy. As previously mentioned, in the US, these positions are much harder to come by than the typical rehab positions but are much more common in other places such as the UK and Australia.
To learn more about working in mental health, check out Occupational Therapy in Mental Health: An Overview of 6 Typical Settings.
While this is also a smaller niche of OT, occupational therapy in workplace ergonomics involves planning, designing and creating a work environment that enhances employee productivity and capability through maintaining and creating proper physical facilities to reduce employee injuries.
Examples of this can be seen in industrial facilities and work hardening programs. To learn more about work rehabilitation, check out AOTA’s work rehab fact sheet here.
Academic and Research Settings
After working in the field for several years, many occupational therapists transition into academia by teaching for occupational therapy programs or going into occupational therapy research at a university. Occupational therapy programs benefit greatly from OT educators that have had years of clinical experience under their belt prior to teaching or going into research.
Some OT practitioners even continue to practice in their traditional OT setting while teaching one or a few courses. With online courses becoming more prevalent, this has become easier for OTs who want to teach but also want to remain in the field. For more insight on going into academia, check out the OT Potential article What’s It Like To Be an OT Working in Academia?
Pediatric Occupational Therapy Settings
Occupational therapists that specialize in pediatrics also have the opportunity to work in a variety of settings (see our full post on pediatric occupational therapy here).
Pediatric OTs can help children diagnosed with an injury, autism spectrum disorder, ADHD, Down syndrome, cerebral palsy, and other conditions to acquire skills which they require to engage in day-to-day activities. Infants who have a risk of experiencing delayed developmental milestones can also be assisted through timely occupational therapy intervention.
Along with providing intervention, pediatric OTs also work closely with the family of the child as well as teachers and caregivers.
So what settings do pediatric occupational therapists work in?
This setting involves working in the school system with students that have been identified as having a disability that affects their education. School-based OTs work on the student’s school occupations such as social skills, attention, behavior management, communication, fine and visual motor skills, and handwriting as well as adapting the environment to ensure the most success for the student.
Interventions in this setting must be educationally relevant, meaning the treatments need to be focused on skills that affect the student’s performance in school. This area of practice is federally mandated by IDEA.
School-based OTs also have an important role in collaborating with the education team to help support the student’s success in their daily occupations. To learn more about school-based OT, check out our Day in the Life of a School-Based OT article here.
This setting involves working with children with a wide variety of disabilities, both in type and severity. Treatment takes place weekly in a special outpatient clinic that is set up to address building underlying skills in a playful manner.
Treatments may involve fine and gross motor coordination, handwriting, behavior management, equipment recommendations, and addressing developmental delays. OTs will also use occupation-based interventions to work on activities of daily living such as dressing, grooming, self-feeding and toileting.
This is also the setting where children with sensory processing differences most commonly get treatment.
NICU: This setting involves OTs with specialized education that work with newborns (often premature but not always) who have high medical needs. Most common interventions here involve feeding, positioning, and a lot of parent/caregiver education and training.
Inpatient: This setting involves working with children in the hospital, similar to the acute care setting mentioned above. Children in the inpatient setting range from newborns to young adults and may have any diagnosis from burns or cancer to an accident causing a spinal cord injury or brain injury. It is also possible to work with children with existing conditions who suddenly require increased medical care, such as a child with epilepsy who has been admitted to the PICU (Pediatric Intensive Care Unit).
Like other OT settings, treatments will address the child’s deficits that impact their activities of daily living and work to improve their independence and function.
Early Intervention OT
Early intervention (EI) involves working with children from birth to three years old to promote development and engagement with their everyday routines by “addressing areas of occupation, including activities of daily living, rest and sleep, play, education, and social participation” (AOTA, 2014). Caregiver education is also an important component of early intervention.
EI is most commonly provided in the child’s home, but may also involve community settings like childcare facilities or parks.There is a big emphasis on natural environment and developing skills that are valuable to the family, as well as helping with roles and routines. This area of practice is also federally mandated and funded by IDEA.
Whether you’re interested in occupational therapy or you are already an occupational therapy student, you can now see that there is a vast amount of occupational therapy settings for you to choose from after you graduate.
You might still be unsure of which one is right for you, but that’s okay! You will explore a variety of these in your OT school fieldwork, as well as after you graduate.
Occupational therapy is one field where you can explore a multitude of different settings to figure out which one fits for you. It might take a few experiences before you find your dream setting, but that’s the beauty of our amazing field!
What setting do you see yourself working in? What settings did we miss? Please share in the comments below!