Occupational Formulation: A Scoping Review of Its Development and Use

Occupational formulation offers a way to synthesise assessment information to understand a person's occupational participation and needs. Although increasingly recognised in professional guidelines, there has been limited exploration of its development and application in occupational therapy.

A scoping review was conducted following Arksey and O'Malley's framework and PRISMA-ScR guidelines. Comprehensive searches were undertaken across five databases (AMED, CINAHL, Emcare, PsycInfo and Google Scholar), a global theses repository, and multiple grey literature sources. Inclusion criteria focused on English sources describing the use by occupational therapists of formulation or conceptualisation related to occupational concepts. One hundred and two eligible sources were identified, from which data were extracted, tabulated and synthesised narratively.

The reviewed sources spanned 2002-2025, mainly originating from the United Kingdom and United States, and mental health settings. Sources included some evaluations and practice reflections but limited empirical research. Four strands of occupational formulation development were identified: formulation associated with the Model of Human Occupation, descriptions of the occupational therapy practice process, psychological formulation approaches and bespoke occupational approaches. Identified key features of occupational formulation were as follows: its grounding in occupational theory, inclusion within the practice process between assessment and goal development/therapy planning, collaborative emphasis, narrative approach, provision of a structure and being an ongoing process. Reported purposes included synthesising assessment findings, supporting reasoning, supporting shared understanding and therapy planning, enhancing communication and promoting an occupational focus. Benefits for the person, therapeutic relationship, occupational therapist and team were reported.

Occupational formulation is both a process and a written product that can strengthen occupational therapy practice by linking theory to practice, enhancing reasoning and supporting collaborative care. Definitions are proposed to support consistent use in research and practice.

Occupational formulation shows promise for enhancing occupational therapy practice. Further research should evaluate its effectiveness across diverse practice settings and populations.