Abstract
Social prescribing (SP)—the use of nonmedical community activities and supports to enhance health and address social drivers of health, provided in tandem with medical interventions—is embedded in many health care systems around the globe, but its use in the United States is still emerging. Similarities between SP and occupational therapy abound. In this column, the authors take an occupational justice perspective and use the Capabilities, Opportunities, Resources and Environments framework to analyze the relationship between occupational therapy and SP. They argue that the occupational therapy profession needs to be aware of SP, understand its potential for professional role overlap or blurring, and foster the profession’s inclusion in this practice in the United States. They also discuss opportunities for occupational therapy to capitalize on this growing movement to enable a positive outcome.
In this column, the authors take an occupational justice perspective and use the Capabilities, Opportunities, Resources and Environment framework to analyze the relationship between occupational therapy and social prescribing.
Although the concept of social prescribing (SP) is not entirely new, there is growing interest in it in the United States. SP is of particular interest to occupational therapy practitioners because it appears that, like occupational therapy, it uses occupation as one mechanism of action for healing. In this column, we explore SP’s implications for occupational therapy and illuminate potential opportunities it affords and the challenges it poses to occupational therapy.
According to Social Prescribing USA (2025), SP is a model of care delivery that enables health professionals to formally prescribe nonclinical community activities—including the arts, movement, nature, and service (volunteering)—to improve patient health, and at minimal patient cost. SP is designed to address social determinants of health, including social connection. … SP is intended to broaden health professional toolkits, rather than to replace pharmacological measures. (para. 1)
Examples of SP can be seen throughout history, from Inuit shamans dating back 5,000 years who improved health by creating harmony between the person and nature (Elendu, 2024); to the use of art and music by Roman physician Asclepiades, around 100 BC (Santacroce et al., 2017); to Jane Addams of 19th-century Hull House fame, who leveraged community to improve health and well-being (Kelly & Doherty, 2017). Formalized SP dates back to the 1990s. Great Britain is credited with first use of SP by the Bromley by Bow Health Partnership (Morse et al., 2022), and it has since spread to countries around the world, including Australia, Canada, Ireland, Japan, New Zealand, Portugal, and Singapore (World Health Organization, 2022). Note that these countries, where abundant social initiatives meet with fewer sociopolitical and financial barriers than in the United States, provide universal health care (Hough et al., 2023). Despite the dearth of SP activity in the United States, there is heightened interest in exploring how the country can expand it. So great is this interest that Social Prescribing USA (https://www.socialprescribingusa.com/) was founded in 2022.
The “social” in SP is a misnomer because it denotes more than activities conducted with others. At the heart of SP is connection—whether it be to self, others, or the natural world—to enhance health and well-being. SP shares space with medical interventions but is not intended to replace them. There is no standardized process for writing and filling a social prescription, and this poses a barrier to fidelity and replication for research purposes. In general, a social prescription is initiated by a physician or other allied health professional (Royal Society for Public Health, n.d.), such as an occupational therapy practitioner. This individual identifies a need for connection that could support the medically focused outcomes the physician is hoping to achieve. The prescription is then sent to a link worker. Link workers are, in general, nonclinical professionals based in community organizations who support the fulfillment of a social prescription through knowledge of and access to community resources (Drinkwater et al., 2019). The link worker conducts an assessment of the client that is driven by the question “What matters to you?” This assessment is interview based and lasts approximately 60 min (Hotz, 2024). On the basis of the findings, the link worker identifies the specifics of the social prescription. The prescription often involves participation in a community activity, such as a pickleball club, a knitting circle, or daily nature walks. These activities are usually time bound, although the duration can vary greatly (Social Prescribing USA, 2025). In addition, the link worker will engage in behavioral activation techniques with the client, such as motivational interviewing, as needed (Oster et al., 2023). Common challenges for which social prescriptions are written include depression, anxiety, and loneliness but, in theory, they can be written in any setting and for any individual as long as the need has been identified by the referring professional. Finally, the link worker tracks progress by soliciting client feedback (Hotz, 2024). Link workers, in collaboration with clients, are responsible for determining, on the basis of the prescription, what activities provide a good fit. Hence, awareness of local opportunities is fundamental to their role, as are the financial implications of the prescription.
As an example, a link worker should consider carefully the implications of a prescription for a person who used to enjoy biking but is no longer doing so because of a fear of movement secondary to chronic low back pain and recent weight gain. This person’s physician may write a social prescription in addition to prescribing medications and making a referral to physiotherapy. On the basis of the assessment they have conducted, the link worker determines that this person would like to resume bike riding. They rode regularly 25 years ago but have not ridden since and no longer have access to a bike. The link worker knows of a local bike club whose riders participate for improved health, enjoyment, and socialization. The link worker secures funding (which is factored into the health care system in countries where SP is practiced) to purchase a bike and pay for the club fees.
Although there is currently no U.S.-based mechanism for credentialing link workers, some countries, such as the United Kingdom, offer clear guidance and credentialing opportunities for members of the profession. For example, the National Association of Link Workers (https://www.nalw.org.uk/) was established in 2018 in the United Kingdom to set standards that include an accreditation process. Although there is variability from country to country, there are generally no educational requirements for becoming a link worker; these workers report that the most important prerequisite is the ability to develop relationships with their clients (Spencer et al., 2022). On-the-job training is frequently offered, but this training varies widely, which adds to growing concerns about the effectiveness of link workers (Kiely et al., 2022; Mulholland et al., 2025; Spencer et al., 2022). Overall, evidence related to SP outcomes is inconsistent.
A systematic mapping review conducted by Featherstone et al. (2022) revealed that outcome measures of SP use with autistic individuals focused on the features of autism as opposed to overall health and wellness. A systematic review and meta-analysis of SP use with community-based adults managing long-term conditions found that although SP use yielded significant improvements in quality of life and disease-specific psychological outcomes related to cancer and diabetes, it did not significantly improve physical activity or general psychological well-being (O’Sullivan et al., 2024). Inconsistencies in SP research are frequently attributed to variability in approaches, differences in dosing, an unclear mechanism of action, and high attrition rates (Costa et al., 2021; Grover et al., 2023; O’Sullivan et al., 2024; Oster et al., 2023). An occupational therapy practitioner’s lens, which is based on more than 100 years of practice and research in occupation, may be useful in moving both SP and occupational therapy forward given the occupational nature of SP and the current momentum around the search for alternatives to traditional medicine.
Why Should This Matter to Occupational Therapy?
In this column, we use Pereira et al.’s (2020) Capabilities, Opportunities, Resources, and Environments (CORE) framework to argue that occupational therapy practitioners are well positioned to claim the occupation at the center of SP. The CORE framework is derived from a multidisciplinary approach to social inclusion and to supporting occupational therapy practitioners in articulating their unique contribution to health care (Pereira et al., 2020). We felt that taking this approach over the traditional strengths–weaknesses–opportunities–threats analysis enabled us to take an occupational justice perspective to advance our very specific concerns about SP; emancipate ourselves from restrictions in biomedical or psychosocial contexts; and claim our profession, because it is the shoulders on which SP stands.
According to Pereira et al. (2020), capabilities are the freedoms and abilities that enable humans to “do and be” and, for occupational therapy practitioners, to use our freedoms and abilities to enable engagement in occupation to promote health and well-being. When applying the CORE framework to occupational therapy practice, occupational therapy practitioners clearly have capabilities aligned with SP. Rose (2025) highlighted occupational therapy’s capabilities for strengths-based approaches, client-centeredness, and achieving health equity through social support and connections. Early recognition of the SP–occupational therapy overlap identified occupational therapy’s capability for addressing social injustices at the population level, especially for clients facing high unemployment and engaging in nonsanctioned occupations, such as crime or substance abuse (Thew et al., 2017). Occupational therapy practitioners have capabilities that are applicable throughout the SP process. These include expertise in holistic assessment, occupational and environmental analysis and adaptation, knowledge of community resources, skill development, measurement of outcomes, and experience addressing social drivers of health. These freedoms and abilities are not incorporated into the SP movement in the United States. As occupational therapists, we need to create opportunities for our inclusion.
Opportunities, as defined by Pereira et al. (2020), are the means to achieve, and they are afforded when choice for equitable participation in occupations is available and operationalized. In the case of SP, opportunities are what we can leverage to ensure occupational justice and equitable participation in the health care practice much like our own. Specific opportunities for occupational therapy practitioners include infusing our occupational lens into SP pathways; enhancing SP’s effectiveness through occupation analysis; and incorporating occupation-based screening and outcome measures, which has been challenging for SP (Cooper et al., 2022). Additionally, if we can find ways to include ourselves in this growing movement, occupational therapy offers a solid theoretical foundation that SP may lack, which may affect its sustainability (Johansson et al., 2021).
There may also be opportunities to use our capabilities to develop the evidence base of occupational therapy by seeking interdisciplinary research that has evaluated prescriptions that are nonmedical but have been stipulated by a medical professional and implemented by an occupational therapy professional. The creation of an interdisciplinary community-based team that understands and uses occupational science (OS) as it supports occupational justice and human occupation could substantially affect community health and well-being; it also could provide the field of occupational therapy an opportunity to expand community-based practice, especially mental health occupational therapy.
If all that were required for occupational therapy to be ingrained in SP is recognition of capabilities and the field’s role in SP, this would have already happened. However, resources are required to enable capabilities and operationalize opportunities for our inclusion in SP (Pereira et al., 2020). Some of the most obvious resources needed are the means and materials to educate interprofessional colleagues on occupational therapy as it relates to SP. Some occupational therapy practitioners have done just this. The Royal College of Occupational Therapists (RCOT; 2019), the professional association for occupational therapy practitioners in the United Kingdom, has been very proactive in ensuring that occupational therapy is part of the SP movement, including liaising with the National Health Service, working with the Department of Health and Social Care, and being involved in a multidisciplinary advisory group to develop an SP framework. They also have widely promoted the role of occupational therapy in SP across the United Kingdom to managers, commissioners, politicians, and professional associations of general practitioners and psychiatrists. Surely this is a resource from which we can benefit.
Finally, Pereira et al. (2020) highlighted the environment, in particular how it can be modified or adapted to maximize social inclusion. How can we modify the environment in which SP exists to ensure our inclusion in something that is a natural fit for our capabilities and expertise? We know that occupational therapy has a long history of marginalization in biomedical environments that dominate much of the U.S. health care system (Gallagher & Bagatell, 2025). However, this is shifting, and integrative medicine is becoming more prevalent, thereby enhancing ways of understanding and treating illness. We believe we can capitalize on this to embed occupation-based care more fully into this environment through the growing presence of SP. We are primed for recognizing the impact of social drivers of health and acting to foster connection and meaningful participation that promote health and well-being. Most health care points of service now question patients about social drivers, and this could be another environment to enable our access to SP. We are already using digital spaces to highlight how occupational therapy connects health care and community. It would not be difficult for occupational therapy to integrate SP into these spaces. The environment is where social inclusion happens and where our identity as occupational therapy practitioners can contribute fully to creating a just world.
What Should We Do?
This CORE analysis reveals that occupational therapy has valuable capabilities similar to SP’s; however, successfully integrating these into SP requires capitalizing on opportunities, developing and securing necessary resources, and creating inclusive environments that enable occupational therapy practitioners to use occupation to its fullest potential in supporting community health and well-being. On the basis of our review and our CORE analysis, we offer three suggestions to avoid occupational therapy’s marginalization in SP.
First, we must find the table and get a seat. In the United Kingdom, occupational therapy practitioners have clear guidelines for working in SP (RCOT, 2020). National guidance for occupational therapy practitioners in the United States could support engagement with SP in a way that improves outcomes for clients at the center of practice. Social Prescribing USA, the apparent leader of this movement in the United States, has an occupational therapy practitioner as their Healthcare Engagement & Strategy Lead. It would be valuable to understand more about this position and its impact on occupational therapy’s role in SP.
Second, it would be advantageous for those in these strategic positions to have guidance to support the work they are well positioned to do, including encouraging occupational therapy practitioners to use the SP language and write social prescriptions in the context of the work they are already doing in the community.
Third, we must invite service users to the table. Their involvement is critical to the success of any occupation-based intervention, especially those rooted in community. We must ensure that clients are cocreators, not just recipients, of care.
It is important to note that there is a gap in research that compares SP and occupational therapy processes. Filling this gap could support more integrated models. SP, as currently practiced, does not prioritize sustainable routines that support lifelong wellness. Occupational therapy can offer the OS knowledge necessary to ensure that prescribed activities do more than manage symptoms—they help clients thrive.
Conclusion
You do not prescribe medication without fully understanding what you are prescribing. Occupational therapy practitioners fully understand occupations linked to SP and what is necessary to support engagement in those occupations for the promotion of health and well-being. The real question is this: How can we capitalize on opportunities for our inclusion in the SP movement to use occupational therapy to its fullest in enabling participation in health-promoting occupations?
Footnotes
Acknowledgments
We acknowledge Social Prescribing USA for hosting the webinar on SP that brought us together for this collaboration.