1. Historical Landmarks and the Future of Occupational Therapy WOTA, October 7, 2017
Franklin Stein, PhD, OTR/L, FAOTA, Editor, Annals of International Occupational Therapy
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2. Learning Objectives discuss:
Historical Transformation of Occupational Therapy as an Independent Healthcare Profession
Current Issues in Health Care in the United States
Paradigms of Clinical Practice in Occupational Therapy
Five key issues impacting on clinical practice
World wide movement in occupational therapy
The future of occupational therapy
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3. Current Issues in Health Care
Cost Containment
Population demography changes
Increased home health services
Specialized vs. generalist roles
Evidence-based practice
High technology
Social class gap
Complementary/Alternative medicine
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4. What are the Changes Occurring in Occupational Therapy that impact Clinical Practice?
The increasing number of occupational therapists in health care.
The number of occupational therapy programs.
Reimbursement and insurance plans such as Medicare and Medicaid.
Primary settings for clinical practice.
Rising practice of home healthcare.
Application of evidence-based practice
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5. Changes in Occupational Therapy
7. Rise of complementary and alternative medicine
8. Increased use of of physical agent modalities
9. Decrease of occupational therapists in primary mental health settings.
10. Increase in standardized testing for reimbursement and efficacy.
11. Philosophical shift from humanism to corporate model.
12. Rise of international occupational therapy.
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6. Paradigms of Clinical Practice in Occupational Therapy: Early History
( )
The 3rd Phase of Medicine
Hospitals as primary environment for care
General goals of treatment
Application of arts and crafts in treatment
Education as generalist
Craft workshop
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7. Susan E. Tracy, 1910
“Perhaps the most essential element in the success of an occupation room in an institution or in the use of manual work as a therapeutic agent with the individual patient in the home or elsewhere …is the teacher”.
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8. Purposes of Reconstruction Aides in 1917 (WWI)
… to hasten the recovery of the patients … promote contentment and make the atmosphere of these hospitals such that the time spent in convalescence will pass more pleasantly because the minds and hands of the patients are properly occupied in profitable pursuits.
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9. George Barton, (1918). Occupational therapy as a Healing Profession
“It is necessary to realize first that the great fundamental upon which re-education (occupational therapy) rests is not the making of an object, but the making of a man”.
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10. Louis J. Haas, 1925 Application of Arts and Crafts
“It is because occupation can create a real work world in which man can live and engage in activities to the extent that he is conscious of the satisfaction of having done an interesting days work that occupation can help him gain control of himself again”.
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11. Emma C. Wallach, 1935, Diversional Purpose of OT
“Occupational therapy is a vital necessity in every hospital. It reduces the amount of worry and anxiety by keeping the mind and hands pleasantly occupied without it the period of convalescence would seem unduly long and tiresome”.
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12. Paradigms in Early History continued (1945-1965)
Multidisciplinary treatment teams
Observation of improvement
Treatment of individuals with chronic disabilities
Physician referral and prescription
Knowledge base came from clinical medicine and social sciences
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13. M.L. Franciscus, 1946, Definition of Occupational Therapy
“…let me give you the accepted definition of occupational therapy. It is treatment by mental or physical activity prescribed by a doctor and supervised by a therapist for the distinct purpose of hastening recovery from disease or injury”.
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14. Henrietta McNeary, 1947, Holistic Approach
“Occupational therapy can be of greatest service only when the patient is considered as a whole individual and his disabilities are minimized by helping him in the development of both physical and mental capabilities”.
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15. Adjuvant Role of Occupational Therapists (1948)
“…but occupational therapy, no doubt is important in making it easier for the patient to get a grip on the situation …after the insulin treatment …”
“… occupational therapy has important tasks as an adjunct to the new somatic treatments in psychiatry.”
Kalinowski, L. (1948) The function of the occupational therapist as an adjuvant in shock therapies and prefrontal lobotomy. AJOT:
OT’s role is adjunctive to medical treatment.
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16. Wanda Edgerton, 1954, General Goals of Occupational Therapy
Adapt activity to working position of patient
Adapt to physical needs of patient, e.g. ROM
Grade activity , e.g. simple to complex
Freedom from danger
Appeal (Patient Choice)
Stimulate Creative Expression
Suitability to budget and space
Application to work and leisure
Use of purposeful and meaningful activities
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17. Emergent Paradigms and Future Trends 1, (1965-2000)
Prevention, habilitation and rehabilitation
Community care and home health
Specificity in functional outcome
Assistive technology and physical agent modalities
Emphasis in education on clinical reasoning and problem solving
Treatment in public school, industry, home
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18. American Occupational Therapy Association, 1968
Occupational Therapy is the art and science of directing man’s response to selected activity to promote and maintain health, to prevent disability, to evaluate behavior and to treat or train patients with physical or psychological dysfunction
Introduce scientific research into OT practice
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19. AOTA, 1977
…Specific occupational therapy services include…ADL, design, fabrication and application of splints; sensorimotor activities; the use of …crafts; …adaptive equipment; prevocational evaluation and training; adaptation of physical environments …
Extension of OT to hand therapy, SI, ergonomics,
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20. Occupational Therapy Frames of Reference, 1993
Behavioral
Biomechanical
Cognitive Disability
Developmental
Neurodevelopmental
Sensory Integration
Model of Human Occupation
Rehabilitation
Psychodynamic
Spatiotemporal
Occupational Adaptation
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21. Emergent Paradigms and Future Trends 2, (2000-Present)
Complementary/Alternative Medicine Interventions
Evidence-based practice, triangulation in assessing outcome,
Ergonomics, universal design, occupational justice
Acute rehabilitation, injured worker, child with disability in public school, prevention
Independent practitioner role of occupational therapist
Entry level doctorate
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22. AOTA’s Centennial Vision, 2006
We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs.
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23. What are the Goals of Occupational Therapy Education in 2017?
Foster clinical reasoning and problem solving
Understand the humanistic core values underlining occupational therapy
Learn how to learn with an emphasis on life-long education
Learn how to use evidence-based practice
Develop scientific practitioners
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24. Educational Goals (2017)
Develop communication skills: interviewing clients, relating to families, presenting case studies to colleagues, presenting at conferences, publishing research
Apply a holistic approach in treatment considering nutrition, exercise, stress management, psycho-social, ergonomics
Incorporate complementary and alternative medicine in practice
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25. Five key issues impacting on Occupational Therapy Today and in the Future
Applying client centered approach with humanistic caring
Teaching client self-regulation
Providing equality of health Care
Emphasizing primary prevention
Designing holistic treatment programs based on EBP
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26. International Trends
World Federation of Occupational Therapy (WFOT) established in 1952, Ten countries
In 2017 there are over 80 countries represented in WFOT
In the USA there are over 150,000 practitioners
There are over 400,000 OTs in the world and growing
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27. Summary
Occupational therapy is an evolving and expanding healthcare profession requiring a graduate education, based on a humanistic philosophy of treatment, using holistic intervention methods and evidence-based practice
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28. Questions for the audience
What is your vision of the future of occupational therapy?
Should occupational therapists integrate their knowledge and services into the medical model?
What are the major issues in healthcare and what are the major roles for occupational therapists?
How can occupational therapists assist in improving the healthcare systems in developing nations?
Will Universal Healthcare benefit the patient?
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29. References
American Occupational Therapy Association (AOTA). (1972). Occupational Therapy: Its Definition and Functions. AJOT:26,
 AOTA (1977). Uniform Terminology for Occupational Therapy. AOTA Official Documents Rockville, MD.
 Barton, G.E. (1918). Reconstruction. New York: Macmillian.
 Edgerton, W.M. (1954). Activities in occupational therapy In Occupational Therapy, Willard, H. & Spackman, Principles of Occupational Therapy. pp
 Franciscus, M.L. (1946). Occupational therapy: Where? How? Why? Occupational Therapy and Rehabilitation: 4:
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30. References
Haas, L.J. (1925). Occupational Therapy for the Mentally and Nervously Ill. Milwaukee: Bruce.
 Hopkins, H. & Smith, H. (1993). Willard and Spackman’s Occupational Therapy 8th edition. Phila: Lippincott, pp
 Hospitals designated for reconstruction of disabled American soldiers and policy to be pursued outlined by Surgeon General. (1917). Official Bulletin, 2(273), 8.
McNeary, H. (1947). The scope of occupational therapy. In Occupational Therapy, Willard, H. & Spackman, Principles of Occupational Therapy. pp
 Kalinowsky, L.B. (1948). The function of occupational therapy as an adjuvant in shock therapies and prefrontal lobotomy. AJOT:2,
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31. References continued
Tracy, S.E. (1910). Invalid Occupations. Boston: Whitcomb and Barrows.
 Wallach, E.C. (1935). Evaluation of occupational therapy by patient. Occupational Therapy and Rehabilitation: 3:
 Willard, H.S. & Spackman, C.S. (1947). Principles of Occupational Therapy. Phila.:J.B. Lippincott Co.
 Willard H.S. & Spackman, C.S. (1954). Principles of Occupational Therapy 2nd ed. Phila.:J.B. Lippincott.
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