Enabling Change and Home Participation for an Individual with Intellectual Disability: A Case Study in Complex Occupational Therapy Practice

There is a need for greater visibility of occupational therapy within interdisciplinary practice and research, especially in the context of intellectual disability. This case study examines the nuanced role of occupational therapy in supporting an individual with intellectual disability and behaviours of concern during a critical transition. Drawing on data from multiple sources, the study explores occupational therapy involvement and its impact. A two-stage analysis revealed two overarching contributions: (1) the implementation of occupational therapy, and (2) the contribution and mechanisms through which occupational therapy enabled change. The findings highlight how environmental modifications, strategies to reduce participation barriers, sensory-based approaches, and interdisciplinary collaboration contributed to meaningful outcomes. Additionally, mechanisms of change were embedded in occupational therapists' practice of working competently within their scope of expertise, drawing on diverse ways of knowing, and navigating external influences. Key changes were observed for the individual through improved perceived quality of life: evidenced by reduced behaviours of concern, increased occupational participation, and a stabilised daily routine; enhanced occupational performance with greater engagement in daily activities; increased staff knowledge and confidence in supporting occupational needs; and a positive cultural shift and self-efficacy among staff, marked by increased motivation and hopefulness. This study illustrates the value of occupational therapy in enabling participation and fostering change within complex practice contexts.